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OBJECTIVES/SPECIFIC AIMS: The objective of this project is to determine whether HRV, collected peri-operatively, is predictive of cognitive decline among older adults who undergo elective surgery/anesthesia. METHODS/STUDY POPULATION: This project is a part of the ongoing INTUIT/PRIME study, which is collecting pre- and post-operative cognitive testing, fMRI imaging, CSF samples, and EEG recordings from 200 older adults (age ≥ 60) undergoing elective non-cardiac/non-neurologic surgery scheduled to last > 2 hours at Duke University Medical Center and Duke Regional Hospital. This project utilizes data from the first 60 INTUIT participants who contributed continuous heart rate data before and during surgery. Participants undergo cognitive testing prior to surgery (baseline) and at 6 weeks after surgery. Our primary dependent variable is the change in the composite score from baseline to 6-weeks. Delirium is assessed in the hospital with the twice daily 3D-CAM tool, so we will report the proportion of individuals with 6-week cognitive decline who exhibited delirium in the days following surgery. Participants’ echocardiogram (ECG) recordings are extracted pre- and intraoperatively from B650/B850 patient monitors with VSCapture software. HRV is defined as the variability between successive R-spikes or inter-beat-intervals on ECG. RESULTS/ANTICIPATED RESULTS: We anticipate that lower intraoperative HRV is associated with worse cognitive decline at 6 weeks after surgery. As secondary objectives, we will determine whether pre-operative HRV or change in HRV (from pre-operative to intra-operative measures) are predictive of cognitive decline after surgery. We expect that in-hospital delirium will be detected in a higher proportion of those with 6-week cognitive decline, compared to those with stable or improved cognition at 6 weeks. DISCUSSION/SIGNIFICANCE OF IMPACT: HRV may address the present need for pre- and intra-operative cognitive risk stratification in the elderly. Physiological indices like HRV have the potential to dramatically change our understanding of CI in older adults undergoing surgery, as they offer an accessible, cost-effective, and non-invasive means whereby clinicians, particularly those unfamiliar with the nuances of geriatric and CI/dementia-related care, can monitor patients and refer those at high-risk of CI after surgery for early intervention.
To many observers across the political spectrum, American democracy appears under threat. What does the Trump presidency portend for American politics? How much confidence should we have in the capacity of American institutions to withstand this threat? We argue that understanding what is uniquely threatening to democracy requires looking beyond the particulars of Trump and his presidency. Instead, it demands a historical and comparative perspective on American politics. Drawing on insights from the fields of comparative politics and American political development, we argue that Trump’s election represents the intersection of three streams in American politics: polarized two-party presidentialism; a polity fundamentally divided over membership and status in the political community, in ways structured by race and economic inequality; and the erosion of democratic norms. The current political circumstance threatens the American democratic order because of the interactive effects of institutions, identity, and norm-breaking.
Angiostrongylus cantonensis (rat lungworm), a parasitic nematode, is expanding its distribution. Human infection, known as angiostrongyliasis, may manifest as eosinophilic meningitis, an emerging infectious disease. The range and incidence of this disease are expanding throughout the tropics and subtropics. Recently, the Hawaiian Islands have experienced an increase in reported cases. This study addresses factors affecting the parasite's distribution and projects its potential future distribution, using Hawaii as a model for its global expansion. Specimens of 37 snail species from the Hawaiian Islands were screened for the parasite using PCR. It was present on five of the six largest islands. The data were used to generate habitat suitability models for A. cantonensis, based on temperature and precipitation, to predict its potential further spread within the archipelago. The best current climate model predicted suitable habitat on all islands, with greater suitability in regions with higher precipitation and temperatures. Projections under climate change (to 2100) indicated increased suitability in regions with estimated increased precipitation and temperatures, suitable habitat occurring increasingly at higher elevations. Analogously, climate change could facilitate the spread of A. cantonensis from its current tropical/subtropical range into more temperate regions of the world, as is beginning to be seen in the continental USA.
The plea by Murillo, Shrank, and Luna (MSL) for a more “grounded” political economy approach to the study of Latin America is much welcome, and it merits a serious debate among scholars of the region. To help advance that debate, this essay raises several issues regarding the substance and methods of the political economy they advocate.
The study of party system institutionalization in Latin America is complicated by the fact that political development in the region has been indelibly marked by period-specific stages and challenges of capitalist development. These periods are associated with distinct patterns of social mobilization, class conflict and political incorporation or exclusion of labour and popular constituencies. These patterns heavily condition the programmatic structuring of partisan competition and its impact on party system institutionalization. Important theoretical insights can be derived from the study of intra-regional variation in period-specific challenges and effects, but this requires careful attention to the factors that differentiate cases.
NASA's Program for Arctic Regional Climate Assessment (PARCA) includes measurements of ice velocity and ice thickness along the 2000 m elevation contour line in the western part of the ice sheet. Here we use these measurements together with published estimates of snow-accumulation rates to infer die mass balance, or rate of thickening/thinning, of the ice-sheet catchment area inland from the velocity traverse. Within the accuracy to which we know snow-accumulation rates, the entire area is in balance, but localized regions inland from Upernavik Isstrom and Jakobshavn Isbra both appear to be thickening by about 10 cm a-1.
Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.
To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.
Interrupted time-series design.
SETTING AND PARTICIPANTS
Nonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.
We did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).
The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.
A political earthquake struck Venezuela when Hugo Chávez was elected president in December 1998. Chávez, a former lieutenant colonel in the Venezuelan army, launched his political career in 1992 by leading a bloody military revolt against a democratic regime that had long been considered among the most stable in Latin America. The coup attempt failed, landing Chávez in prison, but it catapulted the former paratrooper instructor into the public imagination as a symbol of rebellion against the political establishment and its mismanagement of the country’s oil wealth. Following a presidential pardon, Chávez founded a new political movement and launched a populist campaign for the presidency in frontal opposition to traditional parties and the free-market reforms they had supported for most of the past decade. Although Venezuela boasted one of the strongest and most highly institutionalized party systems in Latin America (Coppedge 1994; Mainwaring and Scully 1995: 17), the two dominant parties ultimately withdrew their own presidential candidates and threw their support to a less threatening independent figure in a desperate gambit to defeat Chávez’s “outsider” campaign. Nevertheless, Chávez won a landslide victory that not only signaled the eclipse of traditional parties, but a collapse of the collusive, patronage-ridden political order they had anchored since the founding of the democratic regime forty years before. Within a year, Chávez had bypassed congress and convoked a series of popular referendums to elect a constituent assembly, rewrite and ratify a new constitution, and refound regime institutions. For Venezuela, a new political era had dawned.
Several years later, neighboring Brazil also elected a new leftist president, former union leader Luiz Inácio “Lula” da Silva of the Workers’ Party (PT). Like Chávez, Lula had a track record of opposition to the “neoliberal” market reforms that swept across Latin America in the waning decades of the 20th century, although he had moderated his stance considerably by the time he captured the presidency in 2002 (on his fourth bid for the office). Unlike Chávez, Lula represented a party that had become a pillar of Brazil’s political establishment, despite its origins in a militant labor movement that spearheaded popular protests against Brazil’s military dictatorship in the late 1970s (Keck 1992; Hunter 2010).