Impact of Race on Decision Making for Nursing Home Residents With Advanced Dementia: Can We Disrupt and Transform?

Despite 20 years of research and numerous experts and associations advocating a palliative approach to care for nursing home (NH) residents with advanced dementia, research consistently demonstrate striking and persistent racial differences in the use of burdensome interventions such as feeding tubes and hospital transfer. Most notable is that Black NH residents experience more burdensome interventions at the end of life. The reasons for these differences are poorly understood. The purpose of this study was to examine NH staff members’ perceptions of advance care planning with proxies of Black and White residents. We conducted thematic analysis of semi-structured interviews with 158 NH staff members gathered as part of the ADVANCE study. This is a large qualitative study in 13 NHs in 4 regions of the country aimed at explaining regional and racial factors influencing feeding tube and hospital transfer rates. We found that NH staff, regardless of region of the country, held several assumptions about Black proxies including: being attached or not wanting to let go; not wanting to talk about death, believing everything must be done; not wanting to play God; having large conflicted families, not trusting; putting on attitude, and tending not to use NHs. We found that these assumptions led some NH staff to feel that rather than engaging in shared decision making, they were engaged in a battle with proxies leading them to pick and choose their battles and at times even giving up trying. Whether these assumptions can be disrupted and transformed will be discussed.

An efficient machine learning approach to nephrology through iris recognition

Iridology is a technique in science used to analyze color, patterns, and various other properties of the iris to assess an individual's general health. Few regions in the iris are connected by nerves coming from different organs of body, this shows some special unique qualities which is advantageous along with which assist in psychological condition, particular organ conditions and construction of the body. The structural and designed patterns present on specific part of iris represent the level of intensity of disorder caused by the organs. This method of approach can be employed as reasonable and logical guidelines for the detection and identification of disorders. Therefore, after scanning the image of iris advance study of disorder can be carried out for detecting the condition of organ. Initially by the service of an adaptive histogram, the image of eye should be separated from part of the image captured. Next the images of iris are classified and recognized using machine learning algorithm Support Vector machine or Support Vector Networks. The features are extracted from images of iris using white Gaussian filters which are then used as a feature descriptor. These descriptors count the occurrences of gradient orientation and magnitude in localized portions of an image. Then convert the image of iris to a gray scaled image, final image is standardized. Next is to convert it into rectangular shape and then assembling the HMM images of eyes related to the kidney. The final level is to diagnose the edge of image of iris HMM. By analysing end results, condition of the organ can be diagnosed and results can be obtained from the iris recognition system.

ADVANCE research 20 years later

Observational and interventional studies have shown that intensive blood pressure control may benefit in patients with diabetes. The Action in Diabetes and Vascular Disease: Preterax and Diarnicron MR Controlled Evaluation (ADVANCE) international randomized, controlled, clinical trial was launched in 2001. According to the results of the study, the risk of major micro- and macrovascular events (primary endpoint) significantly decreased by 9%, while the risks of cardiovascular death and death from any cause decreased by 18% and 14%, respectively. There was a decrease in the risks of microvascular complications – any renal event, the appearance or worsening of nephropathy and the appearance of microalbuminuria by 21%, 18% and 21%, respectively. The results of the antihypertensive part of the ADVANCE study supplemented the expanding evidence base and served as the basis for changing clinical guidelines for the management of patients with hypertension and diabetes. According to the updated joint guidelines of the European Society of Cardiology / European Association for the Study of Diabetes (ESC/EASD), the target systolic / diastolic blood pressure levels should be 130/80 mmHg, with some exceptions, and the fixed combination of the RAAS blocker with a diuretic or calcium antagonist is suggested as first-line therapy.The observational ADVANCE-ON study, which enrolled 8494 patients out of 11 140 patients randomized to the ADVANCE study, found a memory effect, or ‘inheritance’, in which intensive blood pressure control during the study had a beneficial effect on various outcomes after its termination. These findings highlight the importance of achieving and maintaining optimal blood pressure control to reduce the risk of micro- and macrovascular complications.

A Laissez-Faire Strategy Marked by Blinkers to Fulfill Established Pandemic Goals—The Case of Sweden

Objectives: To examine (i.e., contextualize and visualize) the consequences of a laissez-faire strategy characterized by blinkers to fulfill established pandemic goals. The aim is to shed light on the implementation of pandemic measures based on post hoc (after-the-fact) reactions and actions instead of pre hoc ones (in advance). Study Design: This study is based on weekly updates of pandemic variables (i.e., cases, tests, percentage of positive tests, hospitalizations, Intensive Care Unit (ICU) admissions, deceased, and 7- and 14-day incidence) in Sweden from the start of the pandemic in March 2020 until March 2021. Method: This study reports the empirical findings based on Swedish pandemic variables during 52 consecutive weeks, related to the pandemic, all of which has been divided into three time periods to separate the 1st and 2nd waves of the pandemic, and considers them all together as one time period. Results: The findings illustrate the implementation of pandemic measures and the subsequent consequences of a laissez-faire strategy characterized by blinkers. People become diseased and then deceased. This reveals strong associations between the assessed pandemic variables and its subsequent consequences on morbidity and mortality, based on post hoc reactions and actions. Conclusions: The implementation of a pandemic strategy should react and act pre hoc, and to take the safe with the unsafe. Governments and public health agencies should take into account the inevitable associations between pandemic variables. Intertwined pre hoc measures of prevention, enforcement, and monitoring should be implemented in society to avoid the implementation of a laissez-faire strategy based on post hoc reactions and actions.

Cardiac responses in paediatric Pompe disease in the ADVANCE patient cohort

Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score. Trial registry: ClinicalTrials.gov Identifier: NCT01526785 https://clinicaltrials.gov/ct2/show/NCT01526785. Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.

An Efficient Machine Learning Approach to Nephrology Through Iris Recognition

Iridology is a technique in science used to analyze color, patterns, and various other properties of the iris to assess an individual's general health. Few regions in the iris are connected by nerves coming from different organs of body, this shows some special unique qualities which is advantageous along with which assist in psychological condition, particular organ conditions and construction of the body. The structural and designed patterns present on specific part of iris represent the level of intensity of disorder caused by the organs. This method of approach can be employed as reasonable and logical guidelines for the detection and identification of disorders. Therefore, after scanning the image of iris advance study of disorder can be carried out for detecting the condition of organ. Initially by the service of an adaptive histogram, the image of eye should be separated from part of the image captured. Next the images of iris are classified and recognized using machine learning algorithm Support Vector machine or Support Vector Networks. The features are extracted from images of iris using white Gaussian filters which are then used as a feature descriptor. These descriptors count the occurrences of gradient orientation and magnitude in localized portions of an image. Then convert the image of iris to a gray scaled image, final image is standardized. Next is to convert it into rectangular shape and then assembling the HMM images of eyes related to the kidney. The final level is to diagnose the edge of image of iris HMM. By analysing end results, condition of the organ can be diagnosed and results can be obtained from the iris recognition system.

Population groups and banks: a comparative study on the survival analysis of Indian commercial banks

Purpose Banks in India have started opening their branches in different areas to make sure that their customers get a high-touch experience and they see them as a premier brand. This could be ensured only if the banks show a stable physical presence in the market as well as provide the recent high-tech services to their customers as per the population group. The purpose of this study is to examine the survival rates of the commercial banks in India across the four population groups along with the differences that exist in their survival rates in all the population groups. Design/methodology/approach The analysis is based on the quarterly data of the number of functioning offices of the commercial banks in India as per the four population groups from March 2006 to December 2019. The survival is estimated using the Kaplan–Meier estimator. Findings From the analysis, it is revealed that survival of the banks changes as per the population group. In addition to this, it is found that the survival time of each category of the bank varies in each population group. Research limitations/implications This study focuses only on the commercial banks of India; a similar research could be done for other categories of Indian banks. Also, the results would have been different if the variables such as the size of the bank, bank risk, etc. are included and studied. Moreover, this study is done using the Kaplan–Meier estimator, i.e. time-to-event. Further, an advance study could be done after considering the financial parameters of banks using the Cox’s regression model, which explores the relationship between various predictors and the time-to-event. Social implications Due to the changes in the preferences of societies, the banks should also adopt different strategies to ensure that their products are understood and accepted by their customers. This will eventually increase the survival rate of the banks. Originality/value The work made in this study is completely new.