Cool Companions to White Dwarfs from the 2MASS Second Incremental Data Release

We present near-infrared magnitudes for all white dwarfs (selected from the catalog of McCook & Sion) contained in the 2 Micron All Sky Survey Second Incremental Data Release(2MASS 2IDR). We show that the near-IR color-color diagram is an effective means of identifying candidate binary stars containing a WD and a low mass main sequence star. The loci of single WDs and WD + red dwarf binaries occupy distinct regions of the near-IR color-color diagram. We recovered all known unresolved WD + red dwarf binaries located in the 2IDR sky coverage, and also identified as many new candidate binaries (47 new candidates out of 95 total). Using observational near-IR data for WDs and M-L dwarfs, we have compared a sample of simulated WD + red dwarf binaries with our 2MASS data. The colors of the simulated binaries are dominated by the low mass companion through the late-M to early-L spectral types. As the spectral type of the companion becomes progressively later, however, the colors of unresolved binaries become progressively bluer. Binaries containing the lowest mass companions will be difficult to distinguish from single WDs solely on the basis of their near-IR colors.Comment: 18 pages, including 2 figures, accepted for publication in Ap

Code Status Discussions Between Attending Hospitalist Physicians and Medical Patients at Hospital Admission

BackgroundBioethicists and professional associations give specific recommendations for discussing cardiopulmonary resuscitation (CPR).ObjectiveTo determine whether attending hospitalist physicians' discussions meet these recommendations.DesignCross-sectional observational study on the medical services at two hospitals within a university system between August 2008 and March 2009.ParticipantsAttending hospitalist physicians and patients who were able to communicate verbally about their medical care.Main measuresWe identified code status discussions in audio-recorded admission encounters via physician survey and review of encounter transcripts. A quantitative content analysis was performed to determine whether discussions included elements recommended by bioethicists and professional associations. Two coders independently coded all discussions; Cohen's kappa was 0.64-1 for all reported elements.Key resultsAudio-recordings of 80 patients' admission encounters with 27 physicians were obtained. Eleven physicians discussed code status in 19 encounters. Discussions were more frequent in seriously ill patients (OR 4, 95% CI 1.2-14.6), yet 66% of seriously ill patients had no discussion. The median length of the code status discussions was 1 min (range 0.2-8.2). Prognosis was discussed with code status in only one of the encounters. Discussions of patients' preferences focused on the use of life-sustaining interventions as opposed to larger life goals. Descriptions of CPR as an intervention used medical jargon, and the indication for CPR was framed in general, as opposed to patient-specific scenarios. No physician quantitatively estimated the outcome of or provided a recommendation about the use of CPR.ConclusionsCode status was not discussed with many seriously ill patients. Discussions were brief, and did not include elements that bioethicists and professional associations recommend to promote patient autonomy. Local and national guidelines, research, and clinical practice changes are needed to clarify and systematize with whom and how CPR is discussed at hospital admission

Assessment of management capacity to improve the value of health-care systems: a survey

Background: Strong management is important for high-value health-care systems if returns on global health investments are to be delivered and the Sustainable Development Goals met by 2030. Managers are responsible for care delivery systems and strategies, making sure that health services benefit the population they intend to serve. Most managers in resource-limited settings work at the district level and below, with little training in non-clinical skills. They are often health care providers who have been promoted into management roles. Here, we aimed to understand the most challenging aspects of the health-care management role in resource-constrained settings and to identify gaps in managers' skills and knowledge in order to better design programmes and tools to support managers in their delivery of care. Methods: We sent a web-based branching survey to frontline global health managers via Devex between October, 2014, and January, 2015. The survey used multiple-choice and Likert-scale questions about skills within five categories of management in global health: finance; human resources; facility/supply chain or inventory management; clinical, field, or laboratory team management; and relationships with community and partners. Before the survey, we did a literature review, held a virtual discussion with experts, and piloted the survey to refine areas of management and enable targeted training. The pilot survey was also completed by mid-career professionals attending the Global Health Delivery Intensive at the Harvard T H Chan School of Public Health in July, 2013. Findings: We included data from from 350 survey respondents in 44 low-income countries, the virtual discussion panel with 131 experts from five continents, and responses from 33 Global Health Delivery Intensive attendees from 11 countries. Our findings indicated that health-care managers are short on time, are required to multitask without an understanding of priorities, and that they lack management skills, motivation, and information. We refined our intensive global health delivery course to meet what were identified as the most pressing challenges, and we offer an online community of practice to facilitate peer-to-peer learning and expert guidance to these areas. In 2016, 52 professionals from 24 countries participated in the eighth annual Global Health Delivery Summer Intensive. More than 90% of respondents (n=49) said they planned to incorporate their learning to make changes to their professional approach or practice. Interpretation: Universities can play an important role in convening managers and helping them to facilitate knowledge dissemination and translation. Future investments are needed to ensure global health professionals can access continuous professional development opportunities. Funding: The Abundance Foundation

Evolutionary contributions to the study of human fertility.

Demography, lacking an overarching theoretical framework of its own, has drawn on theories in many other social sciences to inform its analyses. The aim of this paper is to bring to the demographic community's attention research in the evolutionary sciences on fertility, and to demonstrate that evolutionary theory can be another useful tool in the demographer's toolkit. I first dispel some myths which impede the incorporation of evolutionary theory into demography: I make it clear that evolutionary explanations do not assume that all human behaviour is hardwired and functions to maximize genetic fitness; that they are able to explain variation in human behaviour; and that they are not necessarily alternatives to social science explanations. I then describe the diversity of work on fertility by evolutionary researchers, particularly human evolutionary ecologists and cultural evolutionists, and illustrate the usefulness of the evolutionary approach with examples of its application to age at first birth and the fertility transition

Thirty-Eight-Negative Kinase 1 Is a Mediator of Acute Kidney Injury in Experimental and Clinical Traumatic Hemorrhagic Shock

Trauma represents a major socioeconomic burden worldwide. After a severe injury, hemorrhagic shock (HS) as a frequent concomitant aspect is a central driver of systemic inflammation and organ damage. The kidney is often strongly affected by traumatic-HS, and acute kidney injury (AKI) poses the patient at great risk for adverse outcome. Recently, thirty-eight-negative kinase 1 (TNK1) was proposed to play a detrimental role in organ damage after trauma/HS. Therefore, we aimed to assess the role of TNK1 in HS-induced kidney injury in a murine and apost hocanalysis of a non-human primate model of HS comparable to the clinical situation. Mice and non-human primates underwent resuscitated HS at 30 mmHg for 60 min. 5 h after the induction of shock, animals were assessed for systemic inflammation and TNK1 expression in the kidney.In vitro, murine distal convoluted tubule cells were stimulated with inflammatory mediators to gain mechanistic insights into the role of TNK1 in kidney dysfunction. In a translational approach, we investigated blood drawn from either healthy volunteers or severely injured patients at different time points after trauma (from arrival at the emergency room and at fixed time intervals until 10 days post injury; identifier: NCT02682550,). A pronounced inflammatory response, as seen by increased IL-6 plasma levels as well as early signs of AKI, were observed in mice, non-human primates, and humans after trauma/HS. TNK1 was found in the plasma early after trauma-HS in trauma patients. Renal TNK1 expression was significantly increased in mice and non-human primates after HS, and these effects with concomitant induction of apoptosis were blocked by therapeutic inhibition of complement C3 activation in non-human primates. Mechanistically,in vitrodata suggested that IL-6 rather than C3 cleavage products induced upregulation of TNK1 and impaired barrier function in renal epithelial cells. In conclusion, these data indicate that C3 inhibitionin vivomay inhibit an excessive inflammatory response and mediator release, thereby indirectly neutralizing TNK1 as a potent driver of organ damage. In future studies, we will address the therapeutic potential of direct TNK1 inhibition in the context of severe tissue trauma with different degrees of additional HS