Evaluation Of Yale New Haven Health System Employee Wellness Program

Objective: To assess the effectiveness of the Yale New Haven Health System (YNHHS) Employee Wellness Program. Methods: A pre- and post- study design of wellness-enrolled employees from YNHHS was conducted. Biometric screening, Health Risk Assessment, one-on-one counseling and other wellness interventions were made available to 20,630 employees across the health system. There were 8,164 individuals who participated in both 2013 and 2014. Analysis was performed on the biometric measurement data obtained at initial screening in 2013 and follow up screening in 2014. Results: Clinically and statistically significant improvements were seen after one year in biometric measures: BMI, systolic blood pressures (SBP), diastolic blood pressures (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride levels. Shifts from high-risk categories into intermediate and normal risk categories were seen for blood pressure measurements and HDL levels. Age was a significant predictor of negative changes in SBP, DBP, glucose (fasting and non-fasting), total cholesterol, LDL, and triglyceride levels. Gender significantly predicted improved change in SBP, DBP, HDL, and triglycerides levels. Marital status significantly predicted change in SBP and DBP. Race was a significant predictor of change in BMI, SBP, DBP, total cholesterol, and triglyceride levels. Job classification was a significant predictor of change in SBP, DBP, non-fasting glucose, and total cholesterol levels. Conclusion: The Yale New Haven Health System Employee Wellness program significantly improved biometric markers of health

Ruin Theory for Dynamic Spectrum Allocation in LTE-U Networks

LTE in the unlicensed band (LTE-U) is a promising solution to overcome the scarcity of the wireless spectrum. However, to reap the benefits of LTE-U, it is essential to maintain its effective coexistence with WiFi systems. Such a coexistence, hence, constitutes a major challenge for LTE-U deployment. In this paper, the problem of unlicensed spectrum sharing among WiFi and LTE-U system is studied. In particular, a fair time sharing model based on \emph{ruin theory} is proposed to share redundant spectral resources from the unlicensed band with LTE-U without jeopardizing the performance of the WiFi system. Fairness among both WiFi and LTE-U is maintained by applying the concept of the probability of ruin. In particular, the probability of ruin is used to perform efficient duty-cycle allocation in LTE-U, so as to provide fairness to the WiFi system and maintain certain WiFi performance. Simulation results show that the proposed ruin-based algorithm provides better fairness to the WiFi system as compared to equal duty-cycle sharing among WiFi and LTE-U.Comment: Accepted in IEEE Communications Letters (09-Dec 2018

Ethnicity and COVID-19 cardiovascular complications: a multi-center UK cohort

BACKGROUND: Recent reports suggest an association between ethnicity and COVID-19 mortality. In the present multi-center study, we aimed to assess the differences underlying this association, and ascertain whether ethnicity also mediates other aspects of COVID-19 like cardiovascular complications. METHODS: Data were collected from a mixed-ethnicity UK cohort of 613 patients admitted and diagnosed COVID-19 positive, across six hospitals in London during the second half of March 2020: 292 were White Caucasian ethnicity, 203 were Asian and 118 were of Afro-Caribbean ethnicity. RESULTS: Caucasian patients were older (P<0.001) and less likely to have hypertension (P=0.038), while Afro-Caribbean patients had higher prevalence of diabetes mellitus (P<0.001). Asian patients were more likely to present with venous thromboembolic disease (adj.OR=4.10, 95% CI 1.49-11.27, P=0.006). On the other hand, Afro-Caribbean had more heart failure (adj.OR=3.64, 95% CI 1.50-8.84, P=0.004) and myocardial injury (adj.OR=2.64, 95% CI 1.10-6.35, P=0.030). Importantly, our adjusted multi-variate Cox regression analysis revealed significantly higher all-cause mortality both for Asian (adj.HR=1.89, 95% CI 1.23-2.91, P=0.004) and Afro-Caribbean ethnicity (adj.HR=2.09, 95% CI 1.30-3.37, P=0.002). CONCLUSIONS: Our data show that COVID-19 may have different presentations and follow different clinical trajectories depending on the ethnicity of the affected subject. Awareness of complications more likely to arise in specific ethnicities will allow a more timely diagnosis and preventive measures for patients at risk. Due to increased mortality, individuals of Afro-Caribbean and Asian ethnicity should be considered as high-risk groups. This may have an impact on health-resource allocation and planning, definition of vulnerable groups, disease management, and the protection of healthcare workers at the frontline

High sensitivity troponin and COVID-19 outcomes

Background: Recent reports have demonstrated high troponin levels in patients affected with COVID-19. In the present study, we aimed to determine the association between admission and peak troponin levels and COVID-19 outcomes. / Methods: This was an observational multi-ethnic multi-centre study in a UK cohort of 434 patients admitted and diagnosed COVID-19 positive, across six hospitals in London, UK during the second half of March 2020. / Results: Myocardial injury, defined as positive troponin during admission was observed in 288 (66.4%) patients. Age (OR: 1.68 [1.49–1.88], p <.001), hypertension (OR: 1.81 [1.10–2.99], p =.020) and moderate chronic kidney disease (OR: 9.12 [95% CI: 4.24–19.64], p <.001) independently predicted myocardial injury. After adjustment, patients with positive peak troponin were more likely to need non-invasive and mechanical ventilation (OR: 2.40 [95% CI: 1.27–4.56], p =.007, and OR: 6.81 [95% CI: 3.40–13.62], p <.001, respectively) and urgent renal replacement therapy (OR: 4.14 [95% CI: 1.34–12.78], p =.013). With regards to events, and after adjustment, positive peak troponin levels were independently associated with acute kidney injury (OR: 6.76 [95% CI: 3.40–13.47], p <.001), venous thromboembolism (OR: 11.99 [95% CI: 3.20–44.88], p <.001), development of atrial fibrillation (OR: 10.66 [95% CI: 1.33–85.32], p =.026) and death during admission (OR: 2.40 [95% CI: 1.34–4.29], p =.003). Similar associations were observed for admission troponin. In addition, median length of stay in days was shorter for patients with negative troponin levels: 8 (5–13) negative, 14 (7–23) low-positive levels and 16 (10–23) high-positive (p <.001). / Conclusions: Admission and peak troponin appear to be predictors for cardiovascular and non-cardiovascular events and outcomes in COVID-19 patients, and their utilisation may have an impact on patient management

Живопись викторианской эпохи в Англии. История создания прерафаэлитского братства

В статье рассматривается история возникновения и развития братства Прерафаэлитов. Анализируется творчество художников: Данте Россетти, Холмана Ханта, Джона Миллеса.У статті розглядається історія виникнення та розвитку братства Прерафаелітів. Аналізується творчість митців: Данте Россетті, Холмана Ханта, Джона Міллеса.The foundation and development of the Pre-Raphaelites Brotherhood is observed in the article. The life and main works of the following artists are analyzed: Dante Gabriel Rossetti, William Holman Hunt and John Everett Millais

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Contract-based scheduling of URLLC packets in incumbent Embb traffic

Recently, the coexistence of ultra-reliable and low-latency communication (URLLC) and enhanced mobile broadband (eMBB) services on the same licensed spectrum has gained a lot of attention from both academia and industry. However, the coexistence of these services is not trivial due to the diverse multiple access protocols, contrasting frame distributions in the existing network, and the distinct quality of service requirements posed by these services. Therefore, such coexistence drives towards a challenging resource scheduling problem. To address this problem, in this paper, we first investigate the possibilities of scheduling URLLC packets in incumbent eMBB traffic. In this regard, we formulate an optimization problem for coexistence by dynamically adopting a superposition or puncturing scheme. In particular, the aim is to provide spectrum access to the URLLC users while reducing the intervention on incumbent eMBB users. Next, we apply the one-to-one matching game to find stable URLLC-eMBB pairs that can coexist on the same spectrum. Then, we apply the contract theory framework to design contracts for URLLC users to adopt the superposition scheme. Simulation results reveal that the proposed contract-based scheduling scheme achieves up to 63% of the eMBB rate for the "No URLLC" case compared to the "Puncturing" scheme.Comment: Submitted to IEEE Acces