890 research outputs found
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
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
Toroidal automorphic forms, Waldspurger periods and double Dirichlet series
The space of toroidal automorphic forms was introduced by Zagier in the
1970s: a GL_2-automorphic form is toroidal if it has vanishing constant Fourier
coefficients along all embedded non-split tori. The interest in this space
stems (amongst others) from the fact that an Eisenstein series of weight s is
toroidal for a given torus precisely if s is a non-trivial zero of the zeta
function of the quadratic field corresponding to the torus.
In this paper, we study the structure of the space of toroidal automorphic
forms for an arbitrary number field F. We prove that it decomposes into a space
spanned by all derivatives up to order n-1 of an Eisenstein series of weight s
and class group character omega precisely if s is a zero of order n of the
L-series corresponding to omega at s, and a space consisting of exactly those
cusp forms the central value of whose L-series is zero.
The proofs are based on an identity of Hecke for toroidal integrals of
Eisenstein series and a result of Waldspurger about toroidal integrals of cusp
forms combined with non-vanishing results for twists of L-series proven by the
method of double Dirichlet series.Comment: 14 page
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Involvement of Bruton's tyrosine kinase in FcepsilonRI-dependent mast cell degranulation and cytokine production.
We investigated the role of Bruton's tyrosine kinase (Btk) in FcepsilonRI-dependent activation of mouse mast cells, using xid and btk null mutant mice. Unlike B cell development, mast cell development is apparently normal in these btk mutant mice. However, mast cells derived from these mice exhibited significant abnormalities in FcepsilonRI-dependent function. xid mice primed with anti-dinitrophenyl monoclonal IgE antibody exhibited mildly diminished early-phase and severely blunted late-phase anaphylactic reactions in response to antigen challenge in vivo. Consistent with this finding, cultured mast cells derived from the bone marrow cells of xid or btk null mice exhibited mild impairments in degranulation, and more profound defects in the production of several cytokines, upon FcepsilonRI cross-linking. Moreover, the transcriptional activities of these cytokine genes were severely reduced in FcepsilonRI-stimulated btk mutant mast cells. The specificity of these effects of btk mutations was confirmed by the improvement in the ability of btk mutant mast cells to degranulate and to secrete cytokines after the retroviral transfer of wild-type btk cDNA, but not of vector or kinase-dead btk cDNA. Retroviral transfer of Emt (= Itk/Tsk), Btk's closest relative, also partially improved the ability of btk mutant mast cells to secrete mediators. Taken together, these results demonstrate an important role for Btk in the full expression of FcepsilonRI signal transduction in mast cells
Counting and effective rigidity in algebra and geometry
The purpose of this article is to produce effective versions of some rigidity
results in algebra and geometry. On the geometric side, we focus on the
spectrum of primitive geodesic lengths (resp., complex lengths) for arithmetic
hyperbolic 2-manifolds (resp., 3-manifolds). By work of Reid, this spectrum
determines the commensurability class of the 2-manifold (resp., 3-manifold). We
establish effective versions of these rigidity results by ensuring that, for
two incommensurable arithmetic manifolds of bounded volume, the length sets
(resp., the complex length sets) must disagree for a length that can be
explicitly bounded as a function of volume. We also prove an effective version
of a similar rigidity result established by the second author with Reid on a
surface analog of the length spectrum for hyperbolic 3-manifolds. These
effective results have corresponding algebraic analogs involving maximal
subfields and quaternion subalgebras of quaternion algebras. To prove these
effective rigidity results, we establish results on the asymptotic behavior of
certain algebraic and geometric counting functions which are of independent
interest.Comment: v.2, 39 pages. To appear in Invent. Mat
From Quantum Systems to L-Functions: Pair Correlation Statistics and Beyond
The discovery of connections between the distribution of energy levels of
heavy nuclei and spacings between prime numbers has been one of the most
surprising and fruitful observations in the twentieth century. The connection
between the two areas was first observed through Montgomery's work on the pair
correlation of zeros of the Riemann zeta function. As its generalizations and
consequences have motivated much of the following work, and to this day remains
one of the most important outstanding conjectures in the field, it occupies a
central role in our discussion below. We describe some of the many techniques
and results from the past sixty years, especially the important roles played by
numerical and experimental investigations, that led to the discovery of the
connections and progress towards understanding the behaviors. In our survey of
these two areas, we describe the common mathematics that explains the
remarkable universality. We conclude with some thoughts on what might lie ahead
in the pair correlation of zeros of the zeta function, and other similar
quantities.Comment: Version 1.1, 50 pages, 6 figures. To appear in "Open Problems in
Mathematics", Editors John Nash and Michael Th. Rassias. arXiv admin note:
text overlap with arXiv:0909.491
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