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The Wabanaki Two-Spirit Alliance (W2SA), a regional Two-Spirit organization, administered an online survey in May of 2020 to identify priorities and concerns of Two-Spirit (2S) individuals and Indigenous 2SLGBTQQIA+ people in Atlantic Canada during the novel coronavirus (COVID-19) pandemic. The respondents (n=149) shared health concerns including deterioration(s) of mental health (56.32%) and described mental health supports (68.42%), health supports for Two-Spirit individuals (57.89%), healing gatherings (46.05%) and trans-specific supports (44.74%) as critical interventions in fostering Two-Spirit health. The Alliance’s immediate response was to develop community-led responses to address urgent concerns. Our key promising practice has been hosting Two-Spirit gatherings as community-based health/cultural supports; the gatherings also serve as an opportunity for the Alliance to consult the Two-Spirit community about priorities and concerns. During the COVID-19 pandemic, the Alliance explored ways to keep the Two-Spirit community safe while maintaining critical social support(s) and gaining invaluable knowledge from the Two-Spirit community. We designed a survey that provided critical feedback resulting in the Alliance shifting priorities towards developing ways to bring Two-Spirit people together safely by virtual means, seeking sustainable resources to address emerging health concerns, and increasing capacity development of the Alliance.

Introduction: Cardiac Arrest (CA) is a serious, yet not infrequent complication in the cardiacvascular intensive care unit (CVICU). A recent quality improvement project, Cardiac Arrest Prevention (CAP), showed a decrease in CA by applying a bundle to pre-identified patients at higher risk. Despite this success, CA still occurs among “low” risk patients. Automated risk analytics can offer patient-specific tools to identify risk periods in real time. Hypothesis: Methods: Time series data including vitals and laboratory values were collected (6/2019 - 8/2020). These data were fed into a risk analytics algorithm [Etiometry Inc., Boston, MA] which uses a model of patient physiology to compute risk indices for various physiologic variables. Risk indices examined in this study include IDO2 (likelihood of SvO2 < 40%), HLA (likelihood of lactate > 4 mmol/L), and IVCO2 (likelihood of PaCO2 > 50 mmHg). Various criteria using these risk indices were retrospectively evaluated for categorizing risk status. Once criteria were met a 12-hour “watcher period” was established after a 1-hour assumed response period (figure 1A). CAP status was assigned on a daily basis. Results: 665 encounters for 484 patients were included. 128 (19.2%) neonatal ( Conclusions: A TTS based on risk indices could provide a patient/pathophysiologic status specific tool to increase our ability to identify patients at risk of CA when used in conjunction with CAP criteria. Further validation of these data in other cohorts and prospective application of the tool is warranted.

Advances in space resource utilization have the potential to revolutionize humanity’s place in the solar system by drastically reducing the economic barriers to space travel and by creating entirely new markets beyond those of Earth. One rapidly advancing technology with high space resource utilization potential is additive manufacturing. Additive manufacturing is already prevalent in the aerospace industry and is an enabling technology of significant potential for weight savings, cost reduction, tool repair, and just-in-time manufacturing. In the last few years, institutions such as ASTM International and NASA have released standards for additive manufacturing, but research done in the field of additive manufacturing with space resources is still in its infancy. Among the technologies under investigation, powder bed fusion technologies for melting regolith show particular promise due to their efficiency and freedom from binder material. Though powder bed-based approaches are likely unsuitable for microgravity situations, these technologies show significant potential for applications on the moon and Mars. As strict material and process control is difficult with space resource utilization focused technology, the lessons learned by terrestrial manufacturing experts are still being adapted for use in the burgeoning field. Proposed is a framework for adapting existing standards for use with space resources by identifying specific risks and fundamental factors for part quality, determining part criticality, and documenting material, process controls, environmental conditions, and other influencing factors. Stricter documentation and risk identification may greatly improve the quality of work and advancement of adoption of additive manufacturing for space resources related missions, decreasing mission costs and accelerating the pace of extraplanetary colonization.

Objective Hospital engagement in electronic health information exchange (HIE) has increased over recent years. We aimed to 1) determine the change in adoption of 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and 2) to assess if growth in each approach corresponded to increased ability to access and integrate patient information from outside providers. Methods Panel analysis of all nonfederal, acute care hospitals in the United States using hospital- and year-fixed effects. The sample consisted of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016. Results Adoption of each approach increased by 9–15 percentage points over the study period. The average number of HIE approaches used by each hospital increased from 1.0 to 1.4. Adoption of each approach was associated with increased likelihood that providers routinely had necessary outside information of 4.2–12.7 percentage points and 4.5–13.3 percentage points increase in information integration. Secure messaging was associated with the largest increase in both. Adoption of 1 approach increased the likelihood of having outside information by 10.3 percentage points, while adopting a second approach further increased the likelihood by 9.5 percentage points. Trends in number of approaches and integration were similar. Discussion/Conclusion No single HIE tool provided high levels of usable, integrated health information. Instead, hospitals benefited from adopting multiple tools. Policy initiatives that reduce the complexity of enabling high value HIE could result in broader adoption of HIE and use of information to inform care.

BACKGROUND Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients’ use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. OBJECTIVE This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. METHODS We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods—preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)—controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers’ use of EMRs explained disparities. RESULTS From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (PPP=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers’ use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models. CONCLUSIONS Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients’ use of messaging.

Background Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients’ use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. Objective This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. Methods We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods—preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)—controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers’ use of EMRs explained disparities. Results From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P Conclusions Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients’ use of messaging.

It has been suggested that the oldest stellar populations in the Milky Way Galaxy are tightly bound and confined to the central regions of the Galaxy. This is one of the reasons why a handful of globular clusters located in the bulge region are thought to be remnants of the primeval formation stages of the Milky Way. The globular cluster, ESO 456-SC38 (Djorgovski~2) is one such cluster; it has a blue horizontal branch, is projected very close to the center of the Galaxy, and has an orbit confining it to the bulge/bar region. The first alpha abundances of seven stars in this heavily reddened cluster are presented using APOGEE DR16. A significant spread in the abundances of N, C, Na, and Al indicates the presence of multiple stellar populations in this cluster. Using Gaia DR2 proper motions and radial velocities from BRAVA-RR, we confirm RR Lyrae stars belong to this globular cluster., accepted to The Astronomical Journal

The goal of this paper is to introduce a next generation patient monitoring technology that relies on objective and continuous data analytics to alleviate the data overload in the critical care unit. The technology provides the foundation for increasing the consistency and efficacy of data use in clinical practice and improving outcomes. This paper presents results for applying the approach to the hemodynamic monitoring of infants immediately following cardiac surgery and demonstrates its efficacy of estimating the probability of inadequate systemic oxygen delivery, which is an essential risk attribute in the management of critically ill patients.

Patients in the ICU generate more data than any other clinical environment. Data overload leads to preventable mortality and increased costs. Clinical decision support systems that assist clinicians with interpreting the vast amount of acquired physiologic signals have the potential to save lives and reduce cost. This paper presents a novel methodology which employs physiologic models to translate patient data into actionable risks that are relevant for informed treatment decisions. At the core of the reported technology is a particle-based inference scheme implemented using a Dynamic Bayesian Network that estimates the probabilities of specific pathologies and their causes. The methodology is demonstrated through a pilot study on a post-operative congenital single ventricle population.

Review of 'Exile Cultures, Misplaced Identities' by Paul Allatson and Jo McCormack.