722 research outputs found
Some Implications of Endogenous Stabilization Policy
macroeconomics, stabilization policy
Comments and Discussion [Crowding Out or Crowding In? Economic Consequences of Financing Government Deficits]
macroeconomics, deficits, federal deficit, tax reduction, inflation, deflation
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Emergency Medicine Palliative Care Access (EMPallA): Protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness
Introduction Emergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement. Methods and analysis This is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. We will enrol 1350 patients aged 50+ years and 675 of their caregivers across nine EDs. Eligible patients: (1) have advanced cancer (metastatic solid tumour) or end-stage organ failure (New York Heart Association class III or IV heart failure, end-stage renal disease with glomerular filtration rate /min/m2, or global initiative for chronic obstructive lung disease stage III, IV or oxygen-dependent chronic obstructive pulmonary disease); (2) speak English; (3) are scheduled for ED discharge or observation status; (4) reside locally; (5) have a working telephone and (6) are insured. Patients will be excluded if they: (1) have dementia; (2) have received hospice care or two or more palliative care visits in the last 6 months or (3) reside in a long-term care facility. We will use patient-level block randomisation, stratified by ED site and disease. Effectiveness will be compared by measuring the impact of each intervention on the specified outcomes. The primary outcome will measure change in patient quality of life. Ethics and dissemination Institutional Review Board approval was obtained at all study sites. Trial results will be submitted for publication in a peer-reviewed journal
Quantum Pufferfish Privacy: A Flexible Privacy Framework for Quantum Systems
We propose a versatile privacy framework for quantum systems, termed quantum
pufferfish privacy (QPP). Inspired by classical pufferfish privacy, our
formulation generalizes and addresses limitations of quantum differential
privacy by offering flexibility in specifying private information, feasible
measurements, and domain knowledge. We show that QPP can be equivalently
formulated in terms of the Datta-Leditzky information spectrum divergence, thus
providing the first operational interpretation thereof. We reformulate this
divergence as a semi-definite program and derive several properties of it,
which are then used to prove convexity, composability, and post-processing of
QPP mechanisms. Parameters that guarantee QPP of the depolarization mechanism
are also derived. We analyze the privacy-utility tradeoff of general QPP
mechanisms and, again, study the depolarization mechanism as an explicit
instance. The QPP framework is then applied to privacy auditing for identifying
privacy violations via a hypothesis testing pipeline that leverages quantum
algorithms. Connections to quantum fairness and other quantum divergences are
also explored and several variants of QPP are examined.Comment: 31 pages, 10 figure
Emergency Medicine Palliative Care Access (EMPallA): Preliminary Data from a Multi-Center Randomized Controlled Trial
Introduction: Emergency department (ED)-initiated palliative care has been shown to improve patient-centered outcomes in older adults with serious illnesses, but the optimal modality for providing such interventions is unknown. The EMPallA trial compares nurse-led, telephonic case management with specialty, outpatient palliative care on: 1) patient quality of life (QOL); 2) healthcare utilization; 3) loneliness and symptom burden; and 4) caregiver strain, QOL, and bereavement.
Objective: Summarize preliminary demographic and QOL data for the EMPallA cohort.
Methods: A pragmatic, parallel, two-arm randomized controlled trial is enrolling 1350 ED patients across 9 EDs over 3 years to compare the effectiveness of palliative care models. Eligible patients have end-stage heart failure, renal disease, chronic obstructive pulmonary disease (COPD), or cancer. Baseline data is collected at bedside using surveys. Functional Assessment of Cancer Therapy - General (FACT-G) QOL scores are rescaled into T-scores based on general US and cancer patient samples, standardized with mean 50 and standard deviation 10.
Results: 138 patients enrolled from April 16 to October 16, 2018. Average age was 69 years; 55% were female, and 55% were white. Advanced cancer was most prevalent (48%), followed by heart failure (24%), COPD (23%), and end-stage renal disease (15%). Average FACT-G T-scores were 41 (general population) and 40 (cancer patients), which are below population means of 50 by more than 5, a clinically-meaningful difference.
Discussion: This gender-balanced, racially-diverse cohort stands to benefit in QOL from palliative care. When trial enrollment and follow-up are complete, the impact of interventions can be assessed
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