2,104 research outputs found

    Hospital transfers of nursing home residents with advanced dementia.

    Get PDF
    To describe diagnoses and factors associated with hospital transfer in nursing home (NH) residents with advanced dementia. Prospective cohort study. Twenty-two Boston, Massachusetts-area NHs. Three hundred twenty-three NH residents with advanced dementia. Data were collected quarterly for up to 18 months. Data regarding transfers were collected with regard to hospitalization or emergency department (ED) visit, diagnosis, and duration of inpatient admission. Information on the occurrence of any acute medical event (pneumonia, febrile episode, or other acute illness) in the prior 90 days was obtained quarterly. Logistic regression conducted at the level of the acute medical event identified characteristics associated with hospital transfer. The entire cohort experienced 74 hospitalizations and 60 ED visits. Suspected infections were the most common reason for hospitalization (44, 59%), most frequently attributable to a respiratory source (30, 41%). Feeding tube-related complications accounted for 47% of ED visits. In adjusted analysis conducted on acute medical events, younger resident age, event type (pneumonia or other event vs febrile episode), chronic obstructive pulmonary disease, and the lack of a do-not-hospitalize (DNH) order (adjusted odds ratio = 5.22, 95% confidence interval = 2.31-11.79) were associated with hospital transfer. The majority of hospitalizations of NH residents with advanced dementia were due to infections and thus were potentially avoidable, because infections are often treatable in the NH. Feeding tube-related complications accounted for almost half of all ED visits, representing a common but underrecognized burden of this intervention. Advance care planning in the form of a DNH order was the only identified modifiable factor associated with avoiding hospitalization

    Inference of selection gradients using performance measures as fitness proxies

    Get PDF
    O.D.F. is supported by the Natural Sciences and Engineering Research Council of Canada and the Madame VigdĆ­s FinnbogadĆ³ttir Scholarship. M.B.M. is supported by a University Research Fellowship from the Royal Society (London).1.Ā  Selection coefficients, i.e., selection differentials and gradients, are useful for quantifying selection and for making comparisons across traits and organisms, because they appear in known equations for relating selection and genetic variation to one another and to evolutionary change. However, selection coefficients can only be estimated in organisms where traits and fitness (components) can be measured. This is probably a major contributor to taxonomic biases of selection studies. Aspects of organismal performance, i.e., quantities that are likely to be positively related to fitness components, such as body size, are sometimes used as proxies for fitness, i.e., used in place of fitness components in regression-based selection analysis. To date, little theory exists to inform empirical studies about whether such procedures may yield selection coefficients with known relationships to genetic variation and evolution. 2.Ā  We show that the conditions under which performance measures can be used as proxies for fitness are very limited. Such analyses require that the regression of fitness on the proxy is linear and goes through the origin. We illustrate how fitness proxies may be used in conjunction with information about the performance-fitness relationship, and clarify how this is different from substituting fitness proxies for fitness components in selection analyses. 3.Ā  We apply proxy-based and fitness component-based selection analysis to a system where traits, a performance measure (size; similar to proxies that are commonly used in place of fitness), and a more proximate fitness measure, are all available on the same set of individuals. We find that proxy-based selection gradients are poorly reflective of selection gradients estimated using fitness components, even when proxy-fitness relationships are quite strong and reasonably linear. 4.Ā  We discuss the implications for proxy-based selection analysis. We emphasise that measures of organismal performance, such as size, may in many cases provide useful information that can contribute to quantitative inferences about natural selection, and their use could allow quantitative inference about selection to be conducted in a wider range of taxa. However, such inferences require quantitative analysis of both trait-performance and performance-fitness relationships, rather than substitution of performance for measures of fitness or fitness components.PostprintPeer reviewe

    Emission Spectrum of Fundamental Strings: An Algebraic Approach

    Full text link
    We formulate a linear difference equation which yields averaged semi-inclusive decay rates for arbitrary, not necessarily large, values of the masses. We show that the rates for decays M \to m+\M' of typical heavy open strings are independent of the masses MM and mm, and compute the ``mass deffect''Māˆ’māˆ’Mā€²M-m-M'. For closed strings we find decay rates proportional to MmR(1āˆ’D)/2M m_{R}^{(1-D)/2}, where mRm_{R} is the reduced mass of the decy products. Our method yields exact interaction rates valid for all mass ranges and may provide a fully microscopic basis, not limited to the long string approximation, for the interactions in the Boltzmann equation approach to hot string gases.Comment: 35 pages, 3 figure

    An Ensemble Kalman-Particle Predictor-Corrector Filter for Non-Gaussian Data Assimilation

    Full text link
    An Ensemble Kalman Filter (EnKF, the predictor) is used make a large change in the state, followed by a Particle Filer (PF, the corrector) which assigns importance weights to describe non-Gaussian distribution. The weights are obtained by nonparametric density estimation. It is demonstrated on several numerical examples that the new predictor-corrector filter combines the advantages of the EnKF and the PF and that it is suitable for high dimensional states which are discretizations of solutions of partial differential equations.Comment: ICCS 2009, to appear; 9 pages; minor edit

    Parental experiences of end of life care decision-making for children with life-limiting conditions in the paediatric intensive care unit: a qualitative interview study

    Get PDF
    Objectives To provide an in-depth insight into the experience and perceptions of bereaved parents who have experienced end of life care decision-making for children with life-limiting or life-threatening conditions in the paediatric intensive care unit (PICU). Design An in-depth qualitative interview study with a sample of parents of children with life-limiting or life-threatening conditions who had died in PICU within the previous 12 months. A thematic analysis was conducted on the interview transcripts. Setting A PICU in a large National Health Service (NHS) tertiary childrenā€™s hospital in the West Midlands, UK. Participants 17 parents of 11 children who had died in the PICU. Results Five interconnected themes were identified related to end of life care decision-making:(1) parents have significant knowledge and experiences that influence the decision-making process.(2) Trusted relationships with healthcare professionals are key to supporting parents making end of life decisions.(3) Verbal and non-verbal communication with healthcare professionals impacts on the family experience.(4) Engaging with end of life care decision-making can be emotionally overwhelming, but becomes possible if parents reach a ā€˜place of acceptanceā€™.(5) Families perceive benefits to receiving end of life care for their child in a PICU. Conclusions and implications The death of a child is an intensely emotional experience for all involved. This study adds to the limited evidence base related to parental experiences of end of life care decision-making and provides findings that have international relevance, particularly related to place of care and introduction of end of life care discussions. The expertise and previous experience of parents is highly relevant and should be acknowledged. End of life care decision-making is a complex and nuanced process; the information needs and preferences of each family are individual and need to be understood by the professionals involved in their care

    Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology

    Get PDF
    Background: Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown. Materials and Methods: We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013ā€“2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict-of-interest policies were associated with the strength of the payment-prescribing association. We used modified Poisson regression to control confounding by other physician characteristics. Results: Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58ā€“2.07), CML (RR 1.22, 95% CI 1.08ā€“1.39), and lung (RR 1.69, 95% CI 1.58ā€“1.82), but not prostate (RR 0.97, 95% CI 0.93ā€“1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict-of-interest policies were not consistently associated with the direction of prescribing change. Conclusion: The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing. Implications for Practice: Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company's drug

    The visual sociogram in qualitative and mixed-methods research

    Get PDF
    The paper investigates the place of visual tools in mixed-methods research on social networks, arguing that they can not only improve the communicability of results, but also support research at the data gathering and analysis stages. Three examples from the authorsā€™ own research experience illustrate how sociograms can be integrated in multiple ways with other analytical tools, both quantitative and qualitative, positioning visualization at the intersection of varied methods and channelling substantive ideas as well as network insight in a coherent way. Visualization also facilitates the participation of a broad range of stakeholders, including among others, study participants and non-specialist researchers. It can support the capacity of qualitative and mixed-methods research to reach out to areas of the social that are difficult to circumscribe, such as hidden populations and informal organisations. On this basis, visualization appears as a unique opportunity for mixing methods in the study of social networks, emphasizing both structure and process at the same time

    Electron Spin Resonance Above Tc In Layered Manganites

    Get PDF
    We have performed electron spin resonance (ESR) and dc magnetization measurements on single crystals of La2(1-x)Sr1+2xMn2O7 up to 800 K with special emphasis on the x = 0.4 composition. The ESR linewidth shows behavior similar to that observed in the three-dimensional perovskites and above āˆ¼500 K can be described by a universal expression Ī”Hpp(T)=[C/TĻ‡(T)]Ī”Hpp (āˆž). The linewidth and the resonance field become anisotropic below āˆ¼500 K. The anisotropy in the resonance field is proportional to the magnetization M, and we concluded that it is intrinsic to the system. We show that demagnetization effects can explain only part of the anisotropy. The remainder arises from short-range uniaxial terms in the Hamiltonian that are associated with the crystal field and Dzialozhinsky-Moriya interactions. The anisotropy in the linewidth is attributed to the easy-plane ferromagnetic ordering, which also arises from the short-range anisotropy.631717441311744136Ruddlesden, S.N., Popper, P., (1958) Acta Crystallogr., 11, p. 54Moritomo, Y., Asamitsu, A., Kuwahara, H., Tokura, Y., (1996) Nature (London), 380, p. 141Causa, M.T., Tovar, M., Caneiro, A., Prado, F., Ibanez, G., Ramos, C.A., Butera, A., Oseroff, S.B., (1998) Phys. Rev. B, 58, p. 3233Causa, M.T., Alejandro, G., Tovar, M., Pagliuso, P.G., Rettori, C., Oseroff, S.B., Subramanian, M.A., (1999) J. Appl. Phys., 85, p. 5408Huber, D.L., Alejandro, G., Caneiro, A., Causa, M.T., Prado, F., Tovar, M., Oseroff, S.B., (1999) Phys. Rev. B, 60, p. 12155Oseroff, S.B., Moreno, N.O., Pagliuso, P.G., Rettori, C., Huber, D.L., Gardner, J.S., Sarrao, J.L., Alascio, B.R., (2000) J. Appl. Phys., 87, p. 5810Seehra, M.S., Ibrahim, M.M., Babu, V.S., Srinivasan, G., (1996) J. Phys.: Condens. Matter, 8, p. 11283Dominguez, M., Lofland, S.E., Bhagat, S.M., Raychaudhuri, A.K., Ju, H.L., Venkates, T., Greene, R.L., (1996) Solid State Commun., 97, p. 193Lofland, S.E., Kim, P., Dahiroc, P., Bhagat, S.M., Tyagi, S.D., Karabashev, S.G., Shultyatev, D.A., Mukovskii, Y., (1997) Phys. Lett. A, 233, p. 476Kimura, T., Tomioka, Y., Kuwahara, H., Asamitsu, A., Tamura, M., Tokura, Y., (1996) Science, 274, p. 1698Perring, T.G., Aeppli, G., Moritomo, Y., Tokura, Y., (1997) Phys. Rev. Lett., 78, p. 3197Zhou, J.-S., Goodenough, J.B., Mitchell, J.F., (1998) Phys. Rev. B, 58, p. 579Zhou, J.-S., Goodenough, J.B., (1998) Phys. Rev. Lett., 80, p. 2665Kelley, T.M., Argyriou, D.N., Robinson, R.A., Nakotte, H., Mitchell, J.F., Osbron, R., Jorgensen, J.D., (1998) Physica B, 241-243, p. 439Heffner, R.H., MacLaughlin, D.E., Nieuwenhuys, G.J., Kimura, T., Luke, G.M., Tokura, Y., Uemura, Y.J., (1998) Phys. Rev. Lett., 81, p. 1706Potter, C.D., Swiatek, M., Bader, S.D., Argyriou, D.N., Mitchell, J.F., Miller, D.J., Hinks, D.G., Jorgensen, J.D., (1998) Phys. Rev. B, 57, p. 72Chauvet, O., Goglio, G., Molinie, P., Corraze, B., Brohan, L., (1998) Phys. Rev. Lett., 81, p. 1102Hirota, K., Moritomo, Y., Fujioka, H., Kubota, M., Yoshizawa, H., Endoh, Y., (1998) J. Phys. Soc. Jpn., 67, p. 3380Li, J.Q., Matsui, Y., Kimura, T., Tokura, Y., (1998) Phys. Rev. B, 57, pp. R3205Kimura, T., Kumai, R., Tokura, Y., Li, J.Q., Matsui, Y., (1998) Phys. Rev. B, 58, p. 11081Hayashi, T., Miura, N., Tokunaga, M., Kimura, T., Tokura, Y., (1998) J. Phys.: Condens. Matter, 10, p. 11525Suryanarayanan, R., Dhalenne, G., Revcolevschi, A., Prellier, W., Renard, J.P., Dupas, C., Caliebe, W., Chatterji, T., (2000) Solid State Commun., 113, p. 267Kubota, M., Fujioka, H., Ohoyama, K., Hirota, K., Moritomo, Y., Yoshizawa, H., Endoh, Y., (1999) J. Phys. Chem. Solids, 60, p. 116Bhagat, S.M., Lofland, S.E., Mitchell, J.F., (1999) Phys. Lett. A, 259, p. 326Kittel, C., (1997) Introduction to Solid State Physics, , Wiley, New YorkOkochi, M., (1970) J. Phys. Soc. Jpn., 28, p. 897Victoria, C., Barker, R.C., Yelon, A., (1967) Phys. Rev. Lett., 19, p. 792Nagata, K., (1976) J. Phys. Soc. Jpn., 40, p. 1209Nagata, K., Yamamoto, I., Takano, H., Yokozawa, Y., (1977) J. Phys. Soc. Jpn., 43, p. 857. , and references thereinHuber, D.L., Seehra, M.S., (1976) Phys. Status Solidi B, 74, p. 145Stanger, J.-L., Andre, J.-J., Turek, P., Hosokoshi, Y., Tamura, M., Kinoshita, M., Rey, P., Veciana, J., (1997) Phys. Rev. B, 55, p. 8398Van Vleck, J.H., (1950) Phys. Rev., 78, p. 266Kittel, C., (1948) Phys. Rev., 73, p. 15

    Overcoming controllability problems in distributed testing from an input output transition system

    Get PDF
    This is the Pre-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2012 Springer VerlagThis paper concerns the testing of a system with physically distributed interfaces, called ports, at which it interacts with its environment. We place a tester at each port and the tester at port p observes events at p only. This can lead to controllability problems, where the observations made by the tester at a port p are not sufficient for it to be able to know when to send an input. It is known that there are test objectives, such as executing a particular transition, that cannot be achieved if we restrict attention to test cases that have no controllability problems. This has led to interest in schemes where the testers at the individual ports send coordination messages to one another through an external communications network in order to overcome controllability problems. However, such approaches have largely been studied in the context of testing from a deterministic finite state machine. This paper investigates the use of coordination messages to overcome controllability problems when testing from an input output transition system and gives an algorithm for introducing sufficient messages. It also proves that the problem of minimising the number of coordination messages used is NP-hard
    • ā€¦
    corecore