Impact of the COVID-19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension: The Pulmonary Hypertension Association Registry

To better understand the impact of the COVID-19 pandemic on the care of patients with pulmonary hypertension, we conducted a retrospective cohort study evaluating health insurance status, healthcare access, disease severity, and patient reported outcomes in this population. Using the Pulmonary Hypertension Association Registry (PHAR), we defined and extracted a longitudinal cohort of pulmonary arterial hypertension (PAH) patients from the PHAR\u27s inception in 2015 until March 2022. We used generalized estimating equations to model the impact of the COVID-19 pandemic on patient outcomes, adjusting for demographic confounders. We assessed whether insurance status modified these effects via covariate interactions. PAH patients were more likely to be on publicly-sponsored insurance during the COVID-19 pandemic compared with prior, and did not experience statistically significant delays in access to medications, increased emergency room visits or nights in the hospital, or worsening of mental health metrics. Patients on publicly-sponsored insurance had higher healthcare utilization and worse objective measures of disease severity compared with privately insured individuals irrespective of the COVID-19 pandemic. The relatively small impact of the COVID-19 pandemic on pulmonary hypertension-related outcomes was unexpected but may be due to pre-established access to high quality care at pulmonary hypertension comprehensive care centers. Irrespective of the COVID-19 pandemic, patients who were on publicly-sponsored insurance seemed to do worse, consistent with prior studies highlighting outcomes in this population. We speculate that previously established care relationships may lessen the impact of an acute event, such as a pandemic, on patients with chronic illness

Advancing NZ hospital seismic readiness: creating a post-earthquake functionality dashboard

Continued functionality of critical infrastructure systems, such as hospitals, shortly after an earthquake is expected. However, experience indicates that there may be some disruption due to damage, outages, or access that vary in size and duration. While damage to structural components can have significant life safety and economic implications, damage to non-structural components or failures of the interconnected and interdependent supporting infrastructure systems can also have a substantial impact on the operability. A functionality dashboard to rapidly identify drops in functional performance is needed. The dashboard must be based on real and possible disruptions, including data from previous disruptive events. The dashboard utilises a functionality database and risk analysis tools to holistically predict a level of post-disaster functionality. Creating a functionality database from past earthquake events provides the necessary information to create a representative event tree of hospital performance. Drops in functionality are governed by fault trees that are created based on the data gathered in the functionality database. These tools provide the engine for a hospital functionality dashboard for estimating hospital functionality to scenario events. Use of the dashboard will help determine critical links between hospital components impacting functionality and provide needed information for improving facility design. It will also be useful for testing the implementation of emergency procedures linking the physical environment with human and organisation requirements

Quantifying functionality of buildings to natural hazards

Continued functionality of critical infrastructure systems shortly after an earthquake is expected. However, experience has shown that this is often not the case. Building with limited or no structural damage may still experience significant non-structural damage or be impacted by surrounding and interconnected infrastructural failures that can a sustained and substantial impact on the operability of the building. A method to rapidly identify how damage, outages, or blockages are linked to drops in functional performance measures for the people and organisations is being developed for hospitals and will be further expanded to other building occupancies and infrastructure including commercial buildings, critical facilities, and housing. Immediate understanding of damage and the subsequent effects of the damage can provide instant feedback on the level of operational functionality. This poster show how this is currently being implemented for hospitals and how this work can be extended to other buildings. Functionality is determined through the use of risk analysis tools that help to quantitatively define probabilities of building and organisational functionality. The project aims to take a holistic view of a building’s performance, considering the physical and spatial factors of damage, use and needs of the structure, and interconnected interdependencies

Prospectus, January 31, 2007

https://spark.parkland.edu/prospectus_2007/1002/thumbnail.jp

Prospectus, 14, 2007

https://spark.parkland.edu/prospectus_2007/1004/thumbnail.jp

Prospectus, January 17, 2007

https://spark.parkland.edu/prospectus_2007/1000/thumbnail.jp

Prospectus, November 8, 2006

https://spark.parkland.edu/prospectus_2006/1027/thumbnail.jp

Prospectus, December 6, 2006

https://spark.parkland.edu/prospectus_2006/1029/thumbnail.jp

The Formation of Fragments at Corotation in Isothermal Protoplanetary Disks

Numerical hydrodynamics simulations have established that disks which are evolved under the condition of local isothermality will fragment into small dense clumps due to gravitational instabilities when the Toomre stability parameter $Q$ is sufficiently low. Because fragmentation through disk instability has been suggested as a gas giant planet formation mechanism, it is important to understand the physics underlying this process as thoroughly as possible. In this paper, we offer analytic arguments for why, at low $Q$, fragments are most likely to form first at the corotation radii of growing spiral modes, and we support these arguments with results from 3D hydrodynamics simulations.Comment: 21 pages, 1 figur