790 research outputs found
Association Between Public Reporting of Outcomes With Procedural Management and Mortality for Patients With Acute Myocardial Infarction
AbstractBackgroundPublic reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention (PCI) for critically ill patients.ObjectivesThis study evaluated the association between public reporting with procedural management and outcomes among patients with acute myocardial infarction (AMI).MethodsUsing the Nationwide Inpatient Sample, we identified all patients with a primary diagnosis of AMI in states with public reporting (Massachusetts and New York) and regionally comparable states without public reporting (Connecticut, Maine, Maryland, New Hampshire, Rhode Island, and Vermont) between 2005 and 2011. Procedural management and in-hospital outcomes were stratified by public reporting.ResultsAmong 84,121 patients hospitalized with AMI, 57,629 (69%) underwent treatment in a public reporting state. After multivariate adjustment, percutaneous revascularization was performed less often in public reporting states than in nonreporting states (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.67 to 0.96), especially among older patients (OR: 0.75, 95% CI: 0.62 to 0.91), those with Medicare insurance (OR: 0.75, 95% CI: 0.62 to 0.91), and those presenting with ST-segment elevation myocardial infarction (OR: 0.63, 95% CI: 0.56 to 0.71) or concomitant cardiac arrest or cardiogenic shock (OR: 0.58, 95% CI: 0.47 to 0.70). Overall, patients with AMI in public reporting states had higher adjusted in-hospital mortality rates (OR: 1.21, 95% CI: 1.06 to 1.37) than those in nonreporting states. This was observed predominantly in patients who did not receive percutaneous revascularization in public reporting states (adjusted OR: 1.30, 95% CI: 1.13 to 1.50), whereas those undergoing the procedure had lower mortality (OR: 0.71, 95% CI: 0.62 to 0.83).ConclusionsPublic reporting is associated with reduced percutaneous revascularization and increased in-hospital mortality among patients with AMI, particularly among patients not selected for PCI
‘Minimal symptom expression’ in patients with acetylcholine receptor antibody-positive refractory generalized myasthenia gravis treated with eculizumab
Background The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension.
Methods Attainment of 'minimal symptom expression' was evaluated using patient-reported outcome measures of gMG symptoms [MG activities of daily living scale (MG-ADL), 15-item MG quality of life questionnaire (MG-QOL15)] at the completion of REGAIN and during the open-label extension. 'Minimal symptom expression' was defined as MG-ADL total score of 0-1 or MG-QOL15 total score of 0-3.
Results At REGAIN week 26, more eculizumab-treated patients achieved 'minimal symptom expression' versus placebo [MG-ADL: 21.4% vs 1.7%; difference 19.8%; 95% confidence interval (CI) 8.5, 31.0; p = 0.0007; MG-QOL15: 16.1% vs 1.7%; difference 14.4%; 95% CI 4.3, 24.6; p = 0.0069]. During the open-label extension, the proportion of patients in the placebo/eculizumab group who achieved 'minimal symptom expression' increased after initiating eculizumab treatment and was sustained through 130 weeks of open-label eculizumab (MG-ADL: 1.7 to 27.8%; MG-QOL15: 1.7 to 19.4%). At extension study week 130, similar proportions of patients in the eculizumab/eculizumab and placebo/eculizumab groups achieved 'minimal symptom expression' (MG-ADL: 22.9% and 27.8%, respectively, p = 0.7861; MG-QOL15: 14.3% and 19.4%, respectively, p = 0.7531). The long-term tolerability of eculizumab was consistent with previous reports.
Conclusions Patients with AChR+ refractory gMG who receive eculizumab can achieve sustained 'minimal symptom expression' based on patient-reported outcomes. 'Minimal symptom expression' may be a useful tool in measuring therapy effectiveness in gMG
Analysis of Elliptically Polarized Maximally Entangled States for Bell Inequality Tests
When elliptically polarized maximally entangled states are considered, i.e.,
states having a non random phase factor between the two bipartite polarization
components, the standard settings used for optimal violation of Bell
inequalities are no longer adapted. One way to retrieve the maximal amount of
violation is to compensate for this phase while keeping the standard Bell
inequality analysis settings. We propose in this paper a general theoretical
approach that allows determining and adjusting the phase of elliptically
polarized maximally entangled states in order to optimize the violation of Bell
inequalities. The formalism is also applied to several suggested experimental
phase compensation schemes. In order to emphasize the simplicity and relevance
of our approach, we also describe an experimental implementation using a
standard Soleil-Babinet phase compensator. This device is employed to correct
the phase that appears in the maximally entangled state generated from a
type-II nonlinear photon-pair source after the photons are created and
distributed over fiber channels.Comment: 8 page
Coherence properties of a single dipole emitter in diamond
On-demand, high repetition rate sources of indistinguishable, polarised
single photons are the key component for future photonic quantum technologies.
Colour centres in diamond offer a promising solution, and the narrow line-width
of the recently identified nickel-based NE8 centre makes it particularly
appealing for realising the transform-limited sources necessary for quantum
interference. Here we report the characterisation of dipole orientation and
coherence properties of a single NE8 colour centre in a diamond nanocrystal at
room-temperature. We observe a single photon coherence time of 0.21 ps and an
emission lifetime of 1.5 ns. Combined with an emission wavelength that is
ideally suited for applications in existing quantum optical systems, these
results show that the NE8 is a far more promising source than the more commonly
studied nitrogen-vacancy centre and point the way to the realisation of a
practical diamond colour centre-based single photon source.Comment: 10 pages, 4 colour figure
An appraisal of carbon footprint of milk from commercial grass-based dairy farms in Ireland according to a certified life cycle assessment methodology
Stroke Ready: a multi-level program that combines implementation science and community-based participatory research approaches to increase acute stroke treatment: protocol for a stepped wedge trial
Abstract
Background
Post-stroke disability is common, costly, and projected to increase. Acute stroke treatments can substantially reduce post-stroke disability, but few patients take advantage of these cost-effective treatments. Practical, cost-efficient, and sustainable interventions to address underutilized acute stroke treatments are currently lacking. In this context, we present the Stroke Ready project, a stepped wedge design, multi-level intervention that combines implementation science and community-based participatory research approaches to increase acute stroke treatments in the predominately African American community of Flint, Michigan, USA.
Methods
Guided by the Tailored Implementation of Chronic Disease (TICD) framework, we begin with optimization of acute stroke care in emergency departments, with particular attention given to our safety-net hospital partners. Then, we move to a community-wide, multi-faceted, stroke preparedness intervention, with workshops led by peer educators, over 2 years. Measures of engagement of the safety-net hospital and the feasibility and sustainability of the implementation strategy as well as community intervention reach, dose delivered, and satisfaction will be collected. The primary outcome is acute stroke treatment rates, which includes both intravenous tissue plasminogen activator, and endovascular treatment. The co-secondary outcomes are intravenous tissue plasminogen activator treatment rates and the proportion of stroke patients who arrive by ambulance.
Discussion
If successful, Stroke Ready will increase acute stroke treatment rates through emergency department and community level interventions. The stepped wedge design and process evaluation will provide insight into how Stroke Ready works and where it might work best. By exploring the relative effectiveness of the emergency department optimization and the community intervention, we will inform hospitals and communities as they determine how best to use their resources to optimize acute stroke care.
Trial registration
ClinicalTrials.gov
Trial Identifier
NCT03645590
.https://deepblue.lib.umich.edu/bitstream/2027.42/148211/1/13012_2019_Article_869.pd
Disorder-Induced Critical Phenomena in Hysteresis: Numerical Scaling in Three and Higher Dimensions
We present numerical simulations of avalanches and critical phenomena
associated with hysteresis loops, modeled using the zero-temperature
random-field Ising model. We study the transition between smooth hysteresis
loops and loops with a sharp jump in the magnetization, as the disorder in our
model is decreased. In a large region near the critical point, we find scaling
and critical phenomena, which are well described by the results of an epsilon
expansion about six dimensions. We present the results of simulations in 3, 4,
and 5 dimensions, with systems with up to a billion spins (1000^3).Comment: Condensed and updated version of cond-mat/9609072,``Disorder-Induced
Critical Phenomena in Hysteresis: A Numerical Scaling Analysis'
Cavity Induced Interfacing of Atoms and Light
This chapter introduces cavity-based light-matter quantum interfaces, with a
single atom or ion in strong coupling to a high-finesse optical cavity. We
discuss the deterministic generation of indistinguishable single photons from
these systems; the atom-photon entanglement intractably linked to this process;
and the information encoding using spatio-temporal modes within these photons.
Furthermore, we show how to establish a time-reversal of the aforementioned
emission process to use a coupled atom-cavity system as a quantum memory. Along
the line, we also discuss the performance and characterisation of cavity
photons in elementary linear-optics arrangements with single beam splitters for
quantum-homodyne measurements.Comment: to appear as a book chapter in a compilation "Engineering the
Atom-Photon Interaction" published by Springer in 2015, edited by A.
Predojevic and M. W. Mitchel
Estimating the NIH Efficient Frontier
Background:
The National Institutes of Health (NIH) is among the world’s largest investors in biomedical research, with a mandate to: “…lengthen life, and reduce the burdens of illness and disability.” Its funding decisions have been criticized as insufficiently focused on disease burden. We hypothesize that modern portfolio theory can create a closer link between basic research and outcome, and offer insight into basic-science related improvements in public health. We propose portfolio theory as a systematic framework for making biomedical funding allocation decisions–one that is directly tied to the risk/reward trade-off of burden-of-disease outcomes.
Methods and Findings:
Using data from 1965 to 2007, we provide estimates of the NIH “efficient frontier”, the set of funding allocations across 7 groups of disease-oriented NIH institutes that yield the greatest expected return on investment for a given level of risk, where return on investment is measured by subsequent impact on U.S. years of life lost (YLL). The results suggest that NIH may be actively managing its research risk, given that the volatility of its current allocation is 17% less than that of an equal-allocation portfolio with similar expected returns. The estimated efficient frontier suggests that further improvements in expected return (89% to 119% vs. current) or reduction in risk (22% to 35% vs. current) are available holding risk or expected return, respectively, constant, and that 28% to 89% greater decrease in average years-of-life-lost per unit risk may be achievable. However, these results also reflect the imprecision of YLL as a measure of disease burden, the noisy statistical link between basic research and YLL, and other known limitations of portfolio theory itself.
Conclusions:
Our analysis is intended to serve as a proof-of-concept and starting point for applying quantitative methods to allocating biomedical research funding that are objective, systematic, transparent, repeatable, and expressly designed to reduce the burden of disease. By approaching funding decisions in a more analytical fashion, it may be possible to improve their ultimate outcomes while reducing unintended consequences
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