Who’s in Charge, Anyway – A Proposal for Community-Based Legal Services (with Raymond H. Brescia and Robin Golden)

For over one hundred years, some of our country\u27s most dedicatedlawyers have struggled to provide legal services to poor people.The road has not been an easy one. Richard Nixon vetoed alegal services bill over the issue of presidential appointments, thensigned the Legal Services Corporation Act just before resigning.Nixon\u27s Vice-President, Spiro Agnew, was a vocal opponent of federally-funded legal services. Ronald Reagan submitted eight consecutivebudgets seeking to eliminate all federal funding for theLegal Services Corporation ( LSC ). Simultaneously, he appointeda hostile LSC board of directors. Bill Clinton\u27s election,however, brought new hope to advocates. Hillary Clinton is a formerpresident of the LSC Board. The early Clinton budgets includedan increase in LSC funding, but they were countereddramatically by the severe cuts and restrictions imposed by the1994 Republican-controlled Congress

VIALACTEA knowledge base homogenizing access to Milky Way data

The VIALACTEA project has a work package dedicated to "Tools and Infrastructure" and, inside it, a task for the "Database and Virtual Observatory Infrastructure". This task aims at providing an infrastructure to store all the resources needed by the, more purposely, scientific work packages of the project itself. This infrastructure includes a combination of: storage facilities, relational databases and web services on top of them, and has taken, as a whole, the name of VIALACTEA Knowledge Base (VLKB). This contribution illustrates the current status of this VLKB. It details the set of data resources put together; describes the database that allows data discovery through VO inspired metadata maintenance; illustrates the discovery, cutout and access services built on top of the former two for the users to exploit the data content

Comparison of Evaluations for Heart Transplant Before Durable Left Ventricular Assist Device and Subsequent Receipt of Transplant at Transplant vs Nontransplant Centers

IMPORTANCE: In 2020, the Centers for Medicare & Medicaid Services revised its national coverage determination, removing the requirement to obtain review from a Medicare-approved heart transplant center to implant a durable left ventricular assist device (LVAD) for bridge-to-transplant (BTT) intent at an LVAD-only center. The association between center-level transplant availability and access to heart transplant, the gold-standard therapy for advanced heart failure (HF), is unknown. OBJECTIVE: To investigate the association of center transplant availability with LVAD implant strategies and subsequent heart transplant following LVAD implant before the Centers for Medicare & Medicaid Services policy change. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of the Society of Thoracic Surgeons Intermacs multicenter US registry database was conducted from April 1, 2012, to June 30, 2020. The population included patients with HF receiving a primary durable LVAD. EXPOSURES: LVAD center transplant availability (LVAD/transplant vs LVAD only). MAIN OUTCOMES AND MEASURES: The primary outcomes were implant strategy as BTT and subsequent transplant by 2 years. Covariates that might affect listing strategy and outcomes were included (eg, patient demographic characteristics, comorbidities) in multivariable models. Parameters for BTT listing were estimated using logistic regression with center-level random effects and for receipt of a transplant using a Cox proportional hazards regression model with death as a competing event. RESULTS: The sample included 22 221 LVAD recipients with a median age of 59.0 (IQR, 50.0-67.0) years, of whom 17 420 (78.4%) were male and 3156 (14.2%) received implants at LVAD-only centers. Receiving an LVAD at an LVAD/transplant center was associated with a 79% increased adjusted odds of BTT LVAD designation (odds ratio, 1.79; 95% CI, 1.35-2.38; P \u3c .001). The 2-year transplant rate following LVAD implant was 25.6% at LVAD/transplant centers and 11.9% at LVAD-only centers. There was an associated 33% increased rate of transplant at LVAD/transplant centers compared with LVAD-only centers (adjusted hazard ratio, 1.33; 95% CI, 1.17-1.51) with a similar hazard for death at 2 years (adjusted hazard ratio, 0.99; 95% CI, 0.90-1.08). CONCLUSIONS AND RELEVANCE: Receiving an LVAD at an LVAD-transplant center was associated with increased odds of BTT intent at implant and subsequent transplant receipt for patients at 2 years. The findings of this study suggest that Centers for Medicare & Medicaid Services policy change may have the unintended consequence of further increasing inequities in access to transplant among patients at LVAD-only centers

Optical Switching in VO2 films by below-gap excitation

We study the photo-induced insulator-metal transition in VO2, correlating threshold and dynamic evolution with excitation wavelength. In high-quality single crystal samples, we find that switching can only be induced with photon energies above the 670-meV gap. This contrasts with the case of polycrystalline films, where formation of the metallic state can also be triggered with photon energies as low as 180 meV, well below the bandgap. Perfection of this process may be conducive to novel schemes for optical switches, limiters and detectors, operating at room temperature in the mid-IR

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme