Hospital transfers of nursing home residents with advanced dementia.

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

Achieving Health Equity in Embedded Pragmatic Trials for People Living with Dementia and Their Family Caregivers

Embedded pragmatic clinical trials (ePCTs) advance research on Alzheimer's disease/Alzheimer's disease and related dementias (AD/ADRD) in real-world contexts; however, health equity issues have not yet been fully considered, assessed, or integrated into ePCT designs. Health disparity populations may not be well represented in ePCTs without special efforts to identify and successfully recruit sites of care that serve larger numbers of these populations. The National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory's Health Equity Team will contribute to the overall mission of the collaboratory by developing and implementing strategies to address health equity in the conduct of ePCTs and ensure the collaboratory is a national resource for all Americans with dementia. As a first step toward meeting these goals, this article reviews what is currently known about the inclusion of health disparities populations of people living with dementia (PLWD) and their caregivers in ePCTs, highlights unique challenges related to health equity in the conduct of ePCTs, and suggests priority areas in the design and implementation of ePCTs to increase the awareness and avoidance of pitfalls that may perpetuate and magnify healthcare disparities

Nucleotide Frequencies in Human Genome and Fibonacci Numbers

This work presents a mathematical model that establishes an interesting connection between nucleotide frequencies in human single-stranded DNA and the famous Fibonacci's numbers. The model relies on two assumptions. First, Chargaff's second parity rule should be valid, and, second, the nucleotide frequencies should approach limit values when the number of bases is sufficiently large. Under these two hypotheses, it is possible to predict the human nucleotide frequencies with accuracy. It is noteworthy, that the predicted values are solutions of an optimization problem, which is commonplace in many nature's phenomena.Comment: 12 pages, 2 figure

Parity Nonconservation in Neutron Resonances in 133Cs

Spatial parity nonconservation (PNC) has been studied in the compound-nuclear states of 134Cs by measuring the helicity dependence of the neutron total cross section. Transmission measurements on a thick 133Cs target were performed by the time-of-flight method at the Manuel Lujan Neutron Scattering Center with a longitudinally polarized neutron beam in the energy range from 5 to 400 eV. A total of 28 new p-wave resonances were found, their neutron widths determined, and the PNC longitudinal asymmetries of the resonance cross sections measured. The value obtained for the root-mean-square PNC element M=(0.06-0.02+0.25) meV in 133Cs is the smallest among all targets studied. This value corresponds to a weak spreading width Γw=(0.006-0.003+0.154)×10-7 eV

Cassini nightside observations of the oscillatory motion of Saturn's northern auroral oval

In recent years we have benefitted greatly from the first in-orbit multi-wavelength images of Saturn's polar atmosphere from the Cassini spacecraft. Specifically, images obtained from the Cassini UltraViolet Imaging Spectrograph (UVIS) provide an excellent view of the planet's auroral emissions, which in turn give an account of the large-scale magnetosphere-ionosphere coupling and dynamics within the system. However, obtaining near-simultaneous views of the auroral regions with in situ measurements of magnetic field and plasma populations at high latitudes is more difficult to routinely achieve. Here we present an unusual case, during Revolution 99 in January 2009, where UVIS observes the entire northern UV auroral oval during a 2 h interval while Cassini traverses the magnetic flux tubes connecting to the auroral regions near 21 LT, sampling the related magnetic field, particle, and radio and plasma wave signatures. The motion of the auroral oval evident from the UVIS images requires a careful interpretation of the associated latitudinally “oscillating” magnetic field and auroral field-aligned current signatures, whereas previous interpretations have assumed a static current system. Concurrent observations of the auroral hiss (typically generated in regions of downward directed field-aligned current) support this revised interpretation of an oscillating current system. The nature of the motion of the auroral oval evident in the UVIS image sequence, and the simultaneous measured motion of the field-aligned currents (and related plasma boundary) in this interval, is shown to be related to the northern hemisphere magnetosphere oscillation phase. This is in agreement with previous observations of the auroral oval oscillatory motion

A cross sectional survey of sociodemographic characteristics, primary care health needs and living conditions of asylum-seekers living in a Greek reception centre

Background In 2019, a migrant camp on the Greek island of Samos designed for 650 people was home to a growing population of over 5500. We aimed to quantitatively describe living conditions and health needs in the camp. Methods A questionnaire was designed with reference to international humanitarian standards, following a consultative process with the asylum-seeker population. Domains assessed included demographics, living conditions, safety/vulnerability, and health. The questionnaire was piloted and then conducted in June 2019 on a sample of asylum seekers. Results Five hundred participants, predominantly from Afghanistan and the Democratic Republic of Congo (DRC). Of these, 79.4% lived in tents. Respondents cared for a total of 570 children; 20.6% of women were pregnant, 35.4% had experienced violence, 83% psychological distress, 71% skin disease, 66% diarrhoea and vomiting, and 64% respiratory disease. Accommodation, sanitation, and nutrition fell below internationally recognised standards, and poor access to water was significantly associated (p < 0.001) with respiratory disease, diarrhoea and vomiting, skin disease ,and psychological distress. Conclusions Living conditions in the Samos camp fall below basic humanitarian standards and are associated with poor health status. Further research is imperative to analyse and monitor the diverse, varying needs of asylum-seekers and inform policies to improve conditions

Cassini multi-instrument assessment of Saturn's polar cap boundary

We present the first systematic investigation of the polar cap boundary in Saturn's high-latitude magnetosphere through a multi-instrument assessment of various Cassini in situ data sets gathered between 2006 and 2009. We identify 48 polar cap crossings where the polar cap boundary can be clearly observed in the step in upper cutoff of auroral hiss emissions from the plasma wave data, a sudden increase in electron density, an anisotropy of energetic electrons along the magnetic field, and an increase in incidence of higher-energy electrons from the low-energy electron spectrometer measurements as we move equatorward from the pole. We determine the average level of coincidence of the polar cap boundary identified in the various in situ data sets to be 0.34° ± 0.05° colatitude. The average location of the boundary in the southern (northern) hemisphere is found to be at 15.6° (13.3°) colatitude. In both hemispheres we identify a consistent equatorward offset between the poleward edge of the auroral upward directed field-aligned current region of ~1.5–1.8° colatitude to the corresponding polar cap boundary. We identify atypical observations in the boundary region, including observations of approximately hourly periodicities in the auroral hiss emissions close to the pole. We suggest that the position of the southern polar cap boundary is somewhat ordered by the southern planetary period oscillation phase but that it cannot account for the boundary's full latitudinal variability. We find no clear evidence of any ordering of the northern polar cap boundary location with the northern planetary period magnetic field oscillation phase

Digital Simulation for Automobile Maneuvers

A new all-digital simulation of automobile handling allows severe maneuvers involving braking or accel eration and cornering. A novel feature is the in corporation of closed-loop control based on a mathematical model of the human driver. The program is modular and well-documented. The model includes provisions for nonlinear tire and suspension forces and moments; it also allows the user to switch off the nonlinearities and to include an antilock brake system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68886/2/10.1177_003754978103700304.pd

Ecologically relevant measures of tolerance to potentially lethal temperatures

The acute thermal tolerance of ectotherms has been measured in a variety of ways; these include assays where organisms are shifted abruptly to stressful temperatures and assays where organisms experience temperatures that are ramped more slowly to stressful levels. Ramping assays are thought to be more relevant to natural conditions where sudden abrupt shifts are unlikely to occur often, but it has been argued that thermal limits established under ramping conditions are underestimates of true thermal limits because stresses due to starvation and/or desiccation can arise under ramping. These confounding effects might also impact the variance and heritability of thermal tolerance. We argue here that ramping assays are useful in capturing aspects of ecological relevance even though there is potential for confounding effects of other stresses that can also influence thermal limits in nature. Moreover, we show that the levels of desiccation and starvation experienced by ectotherms in ramping assays will often be minor unless the assays involve small animals and last for many hours. Empirical data illustrate that the combined effects of food and humidity on thermal limits under ramping and sudden shifts to stressful conditions are unpredictable; in Drosophila melanogaster the presence of food decreased rather than increased thermal limits, whereas in Ceratitis capitata they had little impact. The literature provides examples where thermal limits are increased under ramping presumably because of the potential for physiological changes leading to acclimation. It is unclear whether heritabilities and population differentiation will necessarily be lower under ramping because of confounding effects. Although it is important to clearly define experimental methods, particularly when undertaking comparative assessments, and to understand potential confounding effects, thermotolerance assays based on ramping remain an important tool for understanding and predicting species responses to environmental change. An important area for further development is to identify the impact of rates of temperature change under field and laboratory conditions