AIDS and New England Hospitals

The Centers for Disease Control projects that nine thousand persons with AIDS will be alive in New England in 1991, representing a sevenfold increase from 1986. Our analysis indicates that more than 2 percent of medical/surgical beds in New England will be used for AIDS care by 1991, representing 766 fully occupied hospital beds. The direct cost of providing hospital care to New England\u27s AIDS patients is projected to be $195.2 million in 1991, reflecting 3 percent of all hospital inpatient costs in the region. AIDS treatment is very unevenly distributed among hospitals in New England. Just twenty hospitals (8 percent of short-term general hospitals in the region) provided over 60 percent of the care required by all AIDS patients in New England in 1986. If this trend continues, nearly 5 percent of all the beds available in these twenty institutions will be required for AIDS care by 1991. Alternatives to inpatient care are an important means of limiting the demands the AIDS epidemic places on inpatient care facilities. A number of outpatient AIDS clinics have been established in New England hospitals, including clinics at Yale-New Haven Hospital and Rhode Island Hospital. However, skilled nursing facilities in New England, as in other parts of the country, are not prepared to care for AIDS patients. Similarly, the development of in-home services for AIDS patients is just beginning in New England. Hospital planning for New England should begin addressing the need to expand alternative care services. Hospitals may begin by developing an integrated system of inpatient care with outpatient clinics and by designing units or multidisciplinary teams to care for AIDS patients. But even the best case management and discharge planning efforts cannot succeed if there is no place outside the hospital for AIDS patients to go. Each state needs to look closely at its capacity to provide long-term care, hospice care, and home care in order to fill gaps where they exist

Statistical coarse-graining as an approach to multiscale problems in magnetism

Multiscale phenomena which include several processes occuring simultaneously at different length scales and exchanging energy with each other, are widespread in magnetism. These phenomena often govern the magnetization reversal dynamics, and their correct modeling is important. In the present paper, we propose an approach to multiscale modeling of magnets, applying the ideas of coarse graining. We have analyzed the choice of the weighting function used in coarse graining, and propose an optimal form for this function. Simple tests provide evidence that this approach may be useful for modeling of realistic magnetic systems.Comment: 5 RevTeX pages, 2 figure

The Implementation of Measuring What Matters in Research and Practice: Series Commentary

The joint American Academy of Hospice and Palliative Medicine (AAHPM) and Hospice and Palliative Nurses Association (HPNA) “Measuring What Matters” (MWM) initiative selected and recommended ten quality indicators for hospice and palliative care practice (1) (Table 1). These quality indicators were chosen after a systematic process, relying on the existing evidence base. The intent was identification of a core set of clinically relevant, cross-cutting performance measures for use by palliative care and hospice programs to drive quality improvement efforts

Tactics: Practical and Imagined

Since December 2017, a group of us (including Kim Solga, Sylvan Baker, Diana Damian Martin, Rebecca Hayes Laughton, and Katherine Low) have been convening working sessions at various schools and conferences that address the questions and problems animating this issue of RiDE. In this final article, a handful of our respondents from ASTR 2018 in San Diego ruminate upon, list, and re-member tactics they have used, or dreamed of using, to make it through the neoliberal academic day-to-day. Their thoughts are accompanied here by a handful of photos that document the documentation we produced at our first symposium

Residential mobility and childhood leukemia.

AimsStudies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility.MethodsWe analyzed data from a population-based case-control study of childhood leukemia using cases who were born in California and diagnosed between 1988 and 2008 and birth certificate controls. We used stratified logistic regression, case-only analysis, and propensity-score adjustments to assess predictors of residential mobility between birth and diagnosis, and account for potential confounding due to residential mobility.ResultsChildren who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status. Odds ratios for leukemia among non-movers living <50 meters (m) from a 200+ kilovolt line (OR: 1.62; 95% CI: 0.72-3.65) and for calculated fields ≥ 0.4 microTesla (OR: 1.71; 95% CI: 0.65-4.52) were slightly higher than previously reported overall results. Adjustments for propensity scores based on all variables predictive of mobility, including dwelling type, increased odds ratios for leukemia to 2.61 (95% CI: 1.76-3.86) for living < 50 m from a 200 + kilovolt line and to 1.98 (1.11-3.52) for calculated fields. Individual or propensity-score adjustments for all variables, except dwelling type, did not materially change the estimates of power line exposures on childhood leukemia.ConclusionThe residential mobility of childhood leukemia cases varied by several sociodemographic characteristics, but not by the distance to the nearest power line or calculated magnetic fields. Mobility appears to be an unlikely explanation for the associations observed between power lines exposure and childhood leukemia

Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias

Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of networkâ level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153062/1/alzjjalz201904002.pd

Advancing the Science of Self‐Management in Adults With Long‐Term Left Ventricular Assist Devices

This study tested the applicability of the individual and family self‐management theory (IFSMT) to self‐management (SM) in patients with left ventricular assist devices (LVADs). From an existing data set, we extracted the following variables that correspond to IFSMT’s conceptual dimensions: anxiety, depression, and cognition (context dimension); self‐efficacy (SM process dimension); adherence and quality of life (QOL; outcome dimensions). Descriptive statistics and partial least squares path modeling procedures were used for data analyses. A total of 100 patients (mean age 52 ± 13.4 years) with continuous flow LVAD designs comprised the present study. Most patients were White (78%), married (69%), college‐educated (72%), and on disability (53%). Their mean anxiety and depression scores were slightly above normal, while their cognitive function scores were slightly lower than normal. LVAD care self‐efficacy, adherence, and QOL were within normal ranges. Factor loadings ranged from 0.50 to 1.0, and there were significant forward path relationships among the context, process, and outcome dimensions (β ranges from 0.02 to 0.60, all P values < 0.05). In conclusion, the IFSMT provides a good fit for SM in LVAD. Further research is needed to clarify how best to improve LVAD SM practice and treatment outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146581/1/aor13113_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146581/2/aor13113.pd

Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study

Aims: The aim of this study was to explore and understand the perceptions and experiences of women with fibromyalgia syndrome regarding their sexuality. Background: Fibromyalgia syndrome is a chronic pathology, which compromises a woman’s physical, mental and emotional health. Although concerns related to sexuality are commonly reported, research has tended to focus on the physical symptoms. Design: An interpretive qualitative research methodology using Gadamer’s philosophical hermeneutics was carried out. Methods: This qualitative study explores the sexuality of women with fibromyalgia syndrome. A focus group and semi-structured interviews were conducted with 13 women with fibromyalgia syndrome. Data were collected between April - June 2014. Participants were recruited until findings reached saturation. Findings: Three themes define the perception of sexuality for these women: (i) Physical impact: don’t touch, don’t look; (ii) Sexuality and identity: fighting against their loss; (iii) Impact on the relationship: sexuality as a way of connecting the couple. Conclusion: Despite limitations, sexuality is important for the identity and quality of life of women with fibromyalgia syndrome. Together with the physical symptomology, guilt, fear and a lack of understanding compromise the coping process. Women need the support of their partner, their socio-family environment and health professionals. Nurses can aid the successful adjustment to sexual problems related to fibromyalgia syndrome

On the Quantum Computational Complexity of the Ising Spin Glass Partition Function and of Knot Invariants

It is shown that the canonical problem of classical statistical thermodynamics, the computation of the partition function, is in the case of +/-J Ising spin glasses a particular instance of certain simple sums known as quadratically signed weight enumerators (QWGTs). On the other hand it is known that quantum computing is polynomially equivalent to classical probabilistic computing with an oracle for estimating QWGTs. This suggests a connection between the partition function estimation problem for spin glasses and quantum computation. This connection extends to knots and graph theory via the equivalence of the Kauffman polynomial and the partition function for the Potts model.Comment: 8 pages, incl. 2 figures. v2: Substantially rewritte

A preliminary study of genetic factors that influence susceptibility to bovine tuberculosis in the British cattle herd

Associations between specific host genes and susceptibility to Mycobacterial infections such as tuberculosis have been reported in several species. Bovine tuberculosis (bTB) impacts greatly the UK cattle industry, yet genetic predispositions have yet to be identified. We therefore used a candidate gene approach to study 384 cattle of which 160 had reacted positively to an antigenic skin test (‘reactors’). Our approach was unusual in that it used microsatellite markers, embraced high breed diversity and focused particularly on detecting genes showing heterozygote advantage, a mode of action often overlooked in SNP-based studies. A panel of neutral markers was used to control for population substructure and using a general linear model-based approach we were also able to control for age. We found that substructure was surprisingly weak and identified two genomic regions that were strongly associated with reactor status, identified by markers INRA111 and BMS2753. In general the strength of association detected tended to vary depending on whether age was included in the model. At INRA111 a single genotype appears strongly protective with an overall odds ratio of 2.2, the effect being consistent across nine diverse breeds. Our results suggest that breeding strategies could be devised that would appreciably increase genetic resistance of cattle to bTB (strictly, reduce the frequency of incidence of reactors) with implications for the current debate concerning badger-culling