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As the understanding of health care worker lived experience during coronavirus disease 2019 (COVID-19) grows, the experiences of those utilizing emergency health care services (EHS) during the pandemic are yet to be fully appreciated.
The objective of this research was to explore lived experience of EHS utilization in Victoria, Australia during the COVID-19 pandemic from March 2020 through March 2021.
An explorative qualitative design underpinned by a phenomenological approach was applied. Data were collected through semi-structured, in-depth interviews, which were transcribed verbatim and analyzed using Colaizzi’s approach.
Qualitative data were collected from 67 participants aged from 32 to 78-years-of-age (average age of 52). Just over one-half of the research participants were male (54%) and three-quarters lived in metropolitan regions (75%). Four key themes emerged from data analysis: (1) Concerns regarding exposure and infection delayed EHS utilization among participants with chronic health conditions; (2) Participants with acute health conditions expressed concern regarding the impact of COVID-19 on their care, but continued to access services as required; (3) Participants caring for people with sensory and developmental disabilities identified unique communication needs during interactions with EHS during the COVID-19 pandemic; communicating with emergency health care workers wearing personal protective equipment (PPE) was identified as a key challenge, with face masks reported as especially problematic for people who are deaf or hard-of-hearing; and (4) Children and older people also experienced communication challenges associated with PPE, and the need for connection with emergency health care workers was important for positive lived experience during interactions with EHS throughout the pandemic.
This research provides an important insight into the lived experience of EHS utilization during the COVID-19 pandemic, a perspective currently lacking in the published peer-reviewed literature.
During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime.
Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis.
The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care.
Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime.
Clinical trials are a fundamental tool in evaluating the safety and efficacy of new drugs, medical devices, and health system interventions. Clinical trial visits generally involve eligibility assessment, enrollment, intervention administration, data collection, and follow-up, with many of these steps performed during face-to-face visits between participants and the investigative team. Social distancing, which emerged as one of the mainstay strategies for reducing the spread of SARS-CoV-2, has presented a challenge to the traditional model of clinical trial conduct, causing many research teams to halt all in-person contacts except for life-saving research. Nonetheless, clinical research has continued during the pandemic because study teams adapted quickly, turning to virtual visits and other similar methods to complete critical research activities. The purpose of this special communication is to document this rapid transition to virtual methodologies at Clinical and Translational Science Awards hubs and highlight important considerations for future development. Looking beyond the pandemic, we envision that a hybrid approach, which implements remote activities when feasible but also maintains in-person activities as necessary, will be adopted more widely for clinical trials. There will always be a need for in-person aspects of clinical research, but future study designs will need to incorporate remote capabilities.
Despite widespread use of radio-echo sounding (RES) in glaciology and broad distribution of processed radar products, the glaciological community has no standard software for processing impulse RES data. Dependable, fast and collection-system/platform-independent processing flows could facilitate comparison between datasets and allow full utilization of large impulse RES data archives and new data. Here, we present ImpDAR, an open-source, cross-platform, impulse radar processor and interpreter, written primarily in Python. The utility of this software lies in its collection of established tools into a single, open-source framework. ImpDAR aims to provide a versatile standard that is accessible to radar-processing novices and useful to specialists. It can read data from common commercial ground-penetrating radars (GPRs) and some custom-built RES systems. It performs all the standard processing steps, including bandpass and horizontal filtering, time correction for antenna spacing, geolocation and migration. After processing data, ImpDAR's interpreter includes several plotting functions, digitization of reflecting horizons, calculation of reflector strength and export of interpreted layers. We demonstrate these capabilities on two datasets: deep (~3000 m depth) data collected with a custom (3 MHz) system in northeast Greenland and shallow (<100 m depth, 500 MHz) data collected with a commercial GPR on South Cascade Glacier in Washington.
Major depressive disorder and neuroticism (Neu) share a large genetic basis. We sought to determine whether this shared basis could be decomposed to identify genetic factors that are specific to depression.
We analysed summary statistics from genome-wide association studies (GWAS) of depression (from the Psychiatric Genomics Consortium, 23andMe and UK Biobank) and compared them with GWAS of Neu (from UK Biobank). First, we used a pairwise GWAS analysis to classify variants as associated with only depression, with only Neu or with both. Second, we estimated partial genetic correlations to test whether the depression's genetic link with other phenotypes was explained by shared overlap with Neu.
We found evidence that most genomic regions (25/37) associated with depression are likely to be shared with Neu. The overlapping common genetic variance of depression and Neu was genetically correlated primarily with psychiatric disorders. We found that the genetic contributions to depression, that were not shared with Neu, were positively correlated with metabolic phenotypes and cardiovascular disease, and negatively correlated with the personality trait conscientiousness. After removing shared genetic overlap with Neu, depression still had a specific association with schizophrenia, bipolar disorder, coronary artery disease and age of first birth. Independent of depression, Neu had specific genetic correlates in ulcerative colitis, pubertal growth, anorexia and education.
Our findings demonstrate that, while genetic risk factors for depression are largely shared with Neu, there are also non-Neu-related features of depression that may be useful for further patient or phenotypic stratification.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
OBJECTIVES/SPECIFIC AIMS: The central goal of this proposal is to characterize the mechanisms that mediate success or failure of immature intestinal barrier in necrotizing enterocilitis. METHODS/STUDY POPULATION: To do this, I will utilize stem cell derived human intestinal organoids (HIOs), an innovative model of the immature intestine, and a cohort of bacterial isolates collected from premature infants who developed NEC to interrogate the cause-effect relationship of these strains on maintenance of the intestinal barrier. I hypothesize that the epithelial response to bacterial colonization is strain-dependent and results in differences in inflammatory signaling that shape epithelial barrier function in the immature intestine. RESULTS/ANTICIPATED RESULTS: Preliminary data shows that colonization of HIOs with different bacteria leads to species-specific changes in barrier function, and some species selectively damage the epithelial barrier while others enhance epithelial barrier function. I have identified key inflammatory signals that serve as central drivers of intestinal barrier function. DISCUSSION/SIGNIFICANCE OF IMPACT: Characterization of this process is expected to substantially advance scientific understanding of early events in NEC pathogenesis and lead to new opportunities for targeted therapeutic intervention to accelerate barrier maturation or prevent hyperinflammatory reactivity in the neonatal intestine. The research proposed in this application represents an entirely novel approach to studying host-microbial interactions in the immature. Conceptually, this novel translational approach will help to define the pivotal role of colonizing bacteria in initiating epithelial inflammation in NEC patients.
Brette contends that the neural coding metaphor is an invalid basis for theories of what the brain does. Here, we argue that it is an insufficient guide for building an artificial intelligence that learns to accomplish short- and long-term goals in a complex, changing environment.
Intelligence and educational attainment are strongly genetically correlated. This relationship can be exploited by Multi-Trait Analysis of GWAS (MTAG) to add power to Genome-wide Association Studies (GWAS) of intelligence. MTAG allows the user to meta-analyze GWASs of different phenotypes, based on their genetic correlations, to identify association's specific to the trait of choice. An MTAG analysis using GWAS data sets on intelligence and education was conducted by Lam et al. (2017). Lam et al. (2017) reported 70 loci that they described as ‘trait specific’ to intelligence. This article examines whether the analysis conducted by Lam et al. (2017) has resulted in genetic information about a phenotype that is more similar to education than intelligence.
We analyze Sun-as-a-star observations spanning over solar cycles 22 – 24 from the ground-based network BiSON and solar cycles 23 – 24 collected by the space-based VIRGO and GOLF instruments on board the SoHO satellite. Using simultaneous observations from all three instruments, our analysis suggests that the structural and magnetic changes responsible for modifying the frequencies remained comparable between cycle 23 and cycle 24 but differ from cycle 22. Thus we infer that the magnetic layer of the Sun has become thinner since the beginning of cycle 23 and continues during the current cycle.
We introduce the notion of exact tilting objects, which are partial tilting objects $T$ inducing an equivalence between the abelian category generated by $T$ and the category of modules over the endomorphism algebra of $T$. Given a chain of sufficiently negative rational curves on a rational surface, we construct an exceptional sequence whose universal extension is an exact tilting object. For a chain of $(-2)$-curves, we obtain an equivalence with modules over a well-known algebra.
Cardiac rhabdomyomas are the most common tumours in children and are typically seen in association with the tuberous sclerosis complex. Although benign and often associated with spontaneous regression, in rare circumstances surgical resection is indicated to relieve obstruction or other mass-related effects. Recent clinical trials have demonstrated the benefits of mammalian target of rapamycin inhibitors for the treatment of other tumour sub-types associated with tuberous sclerosis. Here we report rapid regression of several massive cardiac rhadomyomas in two neonates with the use of the mammalian target of rapamycin inhibitor sirolimus.
We examine the role of status quo bias in the ballot wording of social issues that affect the rights of minority groups. We test the salience of this framing bias by conducting an experiment that randomly assigns different ballot wordings for five policies across survey respondents. We find that status quo bias changes the percent of individuals who vote for the ballot measure by 5–8 percentage points with the least informed individuals being the most affected by status quo bias.
A complete text-to-speech system has been created by the authors, based on a tube resonance model of the vocal tract and a development of Carré’s “Distinctive Region Model”, which is in turn based on the formant-sensitivity findings of Fant and Pauli (1974), to control the tube. In order to achieve this goal, significant long-term linguistic research has been involved, including rhythm and intonation studies, as well as the development of low-level articulatory data and rules to drive the model, together with the necessary tools, parsers, dictionaries and so on. The tools and the current system are available under a General Public License, and are described here, with further references in the paper, including samples of the speech produced, and figures illustrating the system description.
This volume of the Haskins Society Journal brings together a rich and interdisciplinary collection of articles. Topics range from the politics and military organization of northern worlds of the Anglo-Normans and Angevins in the twelfth and thirteenth centuries, to the economic activity of women in Catalonia and political unrest in thirteenth-century Tripoli. Martin Millett's chapter on thesignificance of rural life in Roman Britain for the early Middle Ages continues the Journal's commitment to archaeological approaches to medieval history, while contributions on �lfric's complex use of sources in his homilies, Byrhtferth of Ramsey's reinterpretation of the Alfredian past, and the little known History of Alfred of Beverly engage with crucial questions of sources andhistoriographical production within Anglo-Saxon and Anglo-Norman England. Pieces on the political meaning of the Empress Helena and Constantine I for Angevin political ambitions and the role of relicssuch as the Holy Lance in strategies of political legitimation in Anglo-Saxon England and Ottonian Germany in the tenth century complete the volume.
Contributors: David Bachrach, Mark Blincoe, Katherine Cross, Sarah Ifft Decker, Joyce Hill, Katherine Hodges-Kluck, Jesse Izzo, Martin Millett, John Patrick Slevin, Oliver Stoutner, Laura Wangerin.