The Need for Culturally-Based Palliative Care Programs for African American Patients at End-of-life

Patients facing life-threatening illness often experience unnecessary and preventable suffering including extreme and prolonged pain, psychological distress, as well as unsatisfactory communication with doctors, all of which result in enormous strain on patients and caregivers (Chochinov et al., 2009; Kamal et al., 2011; Morrison & Meier, 2011). It is common for needs in the physical, psychosocial and spiritual domains to be unmet (Zhukovsky, 2000). As a result, the last few weeks and months of life, and that of their loved ones, may be additionally burdened with physical, emotional and spiritual suffering. Palliative care programs, interdisciplinary care focused on relief of pain and other symptoms in support of best possible quality of life for patients with serious illness and their families, or consultations with palliative care experts where such team programs are not available, have been shown to reduce symptoms, alleviate suffering, improve doctor-patient communication and satisfaction with care, improve family satisfaction, and enhance the efficiency and effectiveness of hospital services (Bakitas et al., 2009a; Bakitas et al., 2009b; Casarett et al., 2008; Lagman, Rivera, Walsh, LeGrand, & Davis, 2007; Morrison & Meier, 2011; O’Hara et al., 2010), as well as to be associated with hospital cost savings (Morrison et al., 2008; Morrison et al., 2011; Penrod et al., 2010). Palliative care consultations for inpatients have successfully identified unrecognized symptoms and unmet problems (Abrahm, Callahan, Rossetti, & Pierre, 1996; Bailey et al., 2005; Bascom, 1997; Kuin et al., 2004; Manfredi et al., 2000), and have been associated with lower use of ICUs (Elsayem et al., 2006; Norton et al., 2007), lower likelihood of dying in ICU (Elsayem et al., 2006), lower costs of care (Penrod et al., 2006; Smith et al., 2003), and improvement in care processes, including medication prescribing and documenting patient goals for care(Bailey et al., 2005; Higginson et al., 2002; Higginson et al., 2003)

The Impact of Family Economic Structure on Dual-Earners’ Career and Family Satisfaction

The present study builds on the explanatory power of the “doing gender” perspective to understand the effects of family economic structure on the family and career satisfaction of husbands and wives. Using data from a two-panel, couple-level survey of full-time employed middle-class families in the Northeastern United States, we find that when wives’ earnings increase relative to their husbands’, their career satisfaction significantly increases whereas their husbands’ is significantly depressed. In contrast, family economic structure has little effect on women’ and men’s level of family satisfaction, although we find a significant reduction in family satisfaction among couples who have recently shifted towards a more equal-earner economic structure. Our findings underscore the importance of considering both husbands’ and wives’ attitudes towards work and career in understanding how “gender is done” in couples, and in addressing the resulting family and work relations and dynamics. Focusing on the disjuncture between longstanding gender norms and current employment and earning patterns, we highlight the potential impact of these findings for couples, counselors, and organizations

Off-peak truck deliveries at container terminals: the 'Good Night' program in Israel

Purpose – Avoiding truck congestion and peaks in landside activity is one of the challenges to container terminal managers. The spreading of truck arrivals at terminals can be facilitated by widening the opening hours of terminals at the landside. Israel’s Ministry of Transport has instituted the “Good Night Program”, involving monetary incentives for importers and exporters who deliver containers to ports at night. Design/methodology/approach – This paper aims to quantitatively examine the market utility resulting from shifting traffic from daytime to nighttime, and analyzes customer considerations regarding nighttime transportation. Findings – The external utility found in the traffic-economics model is quite similar to the economic incentive given to customers. Therefore, a significant increase of the incentive is not feasible. Originality/value – Furthermore, it seems that an incentive method by itself is not effective enough, and does not motivate customers to act and find creative solutions to the obstacles they face. To achieve a considerable change in nighttime transport to Israeli ports, more effective methods should be examined

Dashbell: A Low-cost Smart Doorbell System for Home Use

Smart doorbells allow home owners to receive alerts when a visitor is at the door, see who the guest is, and communicate with the visitor from a smart device. They greatly improve people's life quality and contribute to the evolution of smart homes. However, the commercial smart doorbells are quite expensive, usually cost more than 190 US dollars, which is a substantial impediment on the pervasiveness of smart doorbells. To solve this problem, we introduce the Dashbell-a budget smart doorbell system for home use. It connects a WiFi-enabled device, the Amazon Dash Button, to a network and enables the home owner to answer the bell triggered by the dash button using a smartphone. The Dashbell system also enables fast fault detection and diagnosis due to its distributed framework.Comment: Accepted by IEEE PerCom 201

Predicting subsequent contralateral slipped capital femoral epiphysis: an evidence-based approach.

PurposeThe purpose of this study was to identify risk factors for developing a subsequent contralateral slipped capital femoral epiphysis (SCFE) and provide a prediction score to quantify risk of subsequent slip at the time of initial presentation.MethodsThis retrospective study included patients that presented with a unilateral SCFE between 2006 and 2017. Chart and radiographic review were performed to collect demographic, clinical and radiographic risk factors. Descriptive statistics, univariate analyses and multivariate regression analysis were used to compare risk factors between patients that did or did not develop a subsequent contralateral SCFE.ResultsThis study included 183 patients and 33 patients (18%) developed a subsequent contralateral SCFE. Younger age at time of initial presentation, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between both sides during index presentation were significant predictors of subsequent contralateral SCFE. Specifically, age ≤ 11 years, modified Oxford Score ≤ 20 and difference in epiphyseal-diaphyseal angle of ≤ 21° between both hips were predictive of a contralateral slip (Area Under the Curve = 0.78; p < 0.05). The presence of each risk factor increased the risk of subsequent contralateral SCFE and having all three risk factors increased the risk to 73%.ConclusionThere is a significant risk of subsequent contralateral SCFE in patients with unilateral SCFE, and predictive risk factors include younger age, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between the affected and unaffected hips.Level of evidenceLevel III

On Communication through a Gaussian Channel with an MMSE Disturbance Constraint

This paper considers a Gaussian channel with one transmitter and two receivers. The goal is to maximize the communication rate at the intended/primary receiver subject to a disturbance constraint at the unintended/secondary receiver. The disturbance is measured in terms of minimum mean square error (MMSE) of the interference that the transmission to the primary receiver inflicts on the secondary receiver. The paper presents a new upper bound for the problem of maximizing the mutual information subject to an MMSE constraint. The new bound holds for vector inputs of any length and recovers a previously known limiting (when the length of vector input tends to infinity) expression from the work of Bustin $\textit{et al.}$ The key technical novelty is a new upper bound on the MMSE. This bound allows one to bound the MMSE for all signal-to-noise ratio (SNR) values $\textit{below}$ a certain SNR at which the MMSE is known (which corresponds to the disturbance constraint). This bound complements the `single-crossing point property' of the MMSE that upper bounds the MMSE for all SNR values $\textit{above}$ a certain value at which the MMSE value is known. The MMSE upper bound provides a refined characterization of the phase-transition phenomenon which manifests, in the limit as the length of the vector input goes to infinity, as a discontinuity of the MMSE for the problem at hand. For vector inputs of size $n=1$, a matching lower bound, to within an additive gap of order $O \left( \log \log \frac{1}{\sf MMSE} \right)$ (where ${\sf MMSE}$ is the disturbance constraint), is shown by means of the mixed inputs technique recently introduced by Dytso $\textit{et al.}$Comment: Submitted to IEEE Transactions on Information Theor