New York State

Importance The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness. Objective To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness. Design, Setting, and Participants Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%. Nursing home patients were excluded. Intervention A multicomponent intervention (the Primary Palliative Care for Emergency Medicine intervention) included (1) evidence-based multidisciplinary education; (2) simulation-based workshops on serious illness communication; (3) clinical decision support; and (4) audit and feedback for ED clinical staff. Main Outcome and Measures The primary outcome was hospital admission. The secondary outcomes included subsequent health care use and survival at 6 months. Results There were 98 922 initial ED visits during the study period (median age, 77 years [IQR, 71-84 years]; 50% were female; 13% were Black and 78% were White; and the median Gagne comorbidity score was 8 [IQR, 7-10]). The rate of hospital admission was 64.4% during the preintervention period vs 61.3% during the postintervention period (absolute difference, −3.1% [95% CI, −3.7% to −2.5%]; adjusted odds ratio [OR], 1.03 [95% CI, 0.93 to 1.14]). There was no difference in the secondary outcomes before vs after the intervention. The rate of admission to an intensive care unit was 7.8% during the preintervention period vs 6.7% during the postintervention period (adjusted OR, 0.98 [95% CI, 0.83 to 1.15]). The rate of at least 1 revisit to the ED was 34.2% during the preintervention period vs 32.2% during the postintervention period (adjusted OR, 1.00 [95% CI, 0.91 to 1.09]). The rate of hospice use was 17.7% during the preintervention period vs 17.2% during the postintervention period (adjusted OR, 1.04 [95% CI, 0.93 to 1.16]). The rate of home health use was 42.0% during the preintervention period vs 38.1% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of at least 1 hospital readmission was 41.0% during the preintervention period vs 36.6% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of death was 28.1% during the preintervention period vs 28.7% during the postintervention period (adjusted OR, 1.07 [95% CI, 0.98 to 1.18]). Conclusions and Relevance This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness. Trial Registration ClinicalTrials.gov Identifier: NCT03424109

Introduction Gender-based violence (GBV), including domestic violence, honor killings, and dowry deaths, represents one of the most extreme forms of violence against women. These deaths are often misclassified as accidents or suicides due to societal biases, leading to underreporting and obscuring the true impact of GBV on women’s mortality. Aims and Objectives This study aimed to evaluate the prevalence of GBV-related deaths, with a focus on cases misreported as accidents or suicides. The objective was to determine the proportion of female deaths attributable to GBV and to highlight the challenges in reporting and investigating these cases. Materials and Methods A retrospective, cross-sectional study was conducted at a medical teaching institution in Mumbai, analyzing 5 years (May 2017–April 2022) of autopsy data involving unnatural female deaths. Autopsy records, police reports, and victim/relative statements were examined to identify potential GBV cases and discrepancies in death classification. Results The study found a significant proportion of female deaths attributed to GBV, primarily within domestic settings. Many cases initially reported as accidents or suicides showed discrepancies in injury patterns and circumstances. The majority of GBV victims were young women aged 15–44 years, with burns being the most common cause of death. Conclusion The study emphasizes the need for improved investigation and classification of unnatural female deaths. Domestic violence emerged as the most common factor in these deaths, with intimate partners being primary perpetrators, with most incidents occurring within the home. It also stresses on enhanced protocols to accurately identify and address GBV-related fatalities.

Energy plays an integral role in New Yorkers’ lives. It powers the economy, moves people and goods, keeps homes and workplaces at a livable temperature, and runs critical infrastructure that keeps people healthy and safe. Reliable energy systems are easy to take for granted, but many aspects of these systems are vulnerable to weather and climate hazards. This chapter discusses how climate change is affecting and will increasingly affect New York State's energy supply, delivery, and end uses. It provides insights into current and future climate vulnerabilities as New York's energy system transitions to clean energy sources. This assessment also highlights opportunities to adapt current and future energy systems and to build resilience to climate impacts.

Clean, abundant water is essential to the health of New York State's residents, ecosystems, and economy. This critical natural resource faces numerous challenges associated with climate change, including potential impacts on the quality and quantity of source waters—both surface waters and groundwater. Climate change can also affect the infrastructure that treats and delivers safe drinking water to New Yorkers, manages wastewater to protect water quality, and protects against flooding. The Water Resources chapter examines these impacts and highlights opportunities for New Yorkers to adapt and build resilience as the state's climate changes.

This chapter is devoted to gear pairs formed by two identical circular involute gears mounted eccentrically on their shafts. The issues of kinematics and dynamics of such gear drives are considered. The method of designing EM gears is proposed, including the choice of eccentricity, dimensioning of gears and determination of module and number of teeth depending on the load, rotational speed, and strength of the material the gear rim is made of. The text is accompanied by design formulas and diagrams that make the design process relatively easy and quick. An example of design and calculations contributes to the better understanding of the proposed method.

Background: An effective health management information system plays a pivotal role in evidence-based decision-making and strengthening health service delivery in a country. The Directorate General of Health Services and the Directorate General of Family Planning of Bangladesh have adopted digital health management information system platforms named district health information system and management information system, respectively. Despite its significance, health management information system data has numerous issues, such as missing values, inaccuracies, lack of internal consistency, and the presence of outliers. This study aims to assess the data quality of reproductive health indicators in the health management information system of the Directorate General of Health Services and the Directorate General of Family Planning. Methods: The study examined two aspects of data quality: a) completeness of data, subdivided into completeness of facility reporting (report submission rate) and completeness of indicator data (presence of missing values); b) internal consistency of reported data, subdivided into presence of outliers, inter-indicator consistency, and consistency between reported data and original records (accuracy rate). The study utilised retrospective monthly data gathered from July 2021 to June 2022, covering 21 reproductive health indicators. Multi-stage cluster sampling was employed to select 112 health facilities for data collection, including 48 facilities from Directorate General of Health Services and 64 from Directorate General of Family Planning, representing various administrative levels across the country. Result: The report submission rate for Directorate General of Health Services facilities was 98%, while for the Directorate General of Family Planning facilities, it was 86%. However, 35% of data points were missing in the district health information system server of Directorate General of Health Services, whereas no missing values were observed in the management information system server of Directorate General of Family Planning. Less than 3% of outliers were detected in the server data of both directorates. Inter-indicator consistency was maintained at a high rate of 98% in health facilities under both directorates. The accuracy of reported data varied across indicators and facility types: Directorate General of Health Services facilities showed accuracy rates ranging between 75 and 92%, with an aggregated rate of 86%. Different tiers of the Directorate General of Family Planning facilities had accuracy rates ranging from 92 to 96%. Conclusion: This research emphasises the significance of rectifying missing values, ensuring consistency, and improving reporting systems, with a particular focus on lower-tier health facilities, to enhance the validity and reliability of reproductive health data in Bangladesh.

Questions surrounding engagement with generative AI are often framed in terms of trust, yet mere theorizing about trust may not yield actionable insights, given the multifaceted nature of trust. Literature on trust typically overlooks how individuals make meaning in their interactions with other entities, including AI. This paper reexamines trust with insights from Merleau-Ponty’s views on embodiment, positing trust as a style of world engagement characterized by openness—an attitude wherein individuals enact and give themselves to their lived world, prepared to reorganize their existence. This paper argues that generative AI mediates users’ existence by attuning their openness. Since users perceive generative AI not merely as a tool but as possessing human-like existence, their engagement with AI serves as a rehearsal for articulating and reorganizing their engagement with the world. Consequently, users neither trust nor distrust generative AI; rather, it mediates their trust. This perspective suggests that users’ moral stance towards generative AI involves both other-regarding ethics and information environment ethics. Drawing insights from Kant’s deontology, it proposes that respecting AI’s integrity is equivalent to preserving both our humanity and the integrity of the information environment.