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The Covid-19 pandemic has already stressed health care systems throughout the world, requiring rationing of medical equipment and care. The authors discuss the ethical values relevant to health care rationing and provide six recommendations to guide fair allocation of scarce medical resources during the pandemic.

A significant challenge in the rational design of organic thermoelectric materials is to realize simultaneously high electrical conductivity and high induced-voltage in response to a thermal gradient, which is represented by the Seebeck coefficient. Conventional wisdom posits that the polymer alone dictates thermoelectric efficiency. Herein, we show that doping — in particular, clustering of dopants within conjugated polymer films — has a profound and predictable influence on their thermoelectric properties. We correlate Seebeck coefficient and electrical conductivity of iodine-doped poly(3-hexylthiophene) and poly[2,5-bis(2-octyldodecyl)pyrrolo[3,4-c]pyrrole-1,4(2H,5H)-dione-3,6-diyl)-alt-(2,2′;5′,2′′;5′′,2′′′-quaterthiophen-5,5′′′-diyl)] films with Kelvin probe force microscopy to highlight the role of the spatial distribution of dopants in determining overall charge transport. We fit the experimental data to a phonon-assisted hopping model and found that the distribution of dopants alters the distribution of the density of states and the Kang–Snyder transport parameter. These results highlight the importance of controlling dopant distribution within conjugated polymer films for thermoelectric and other electronic applications. Designing organic thermoelectric materials with high electrical conductivity and Seebeck coefficient is challenging due to the direct relationship between these two properties. Here, the authors explore the role of dopant spatial distribution on thermoelectric performance in conjugated polymers.

Organic materials have attracted recent interest as thermoelectric (TE) converters due to their low cost and ease of fabrication. We examine the effects of disorder on the TE properties of semiconducting polymers based on the Gaussian disorder model (GDM) for site energies while employing Pauli’s master equation approach to model hopping between localized sites. Our model is in good agreement with experimental results and a useful tool to study hopping transport. We show that stronger overlap between sites can improve the electrical conductivity without adversely affecting the Seebeck coefficient. We find that positional disorder aids the formation of new conduction paths with an increased probability of carriers in high energy sites, leading to an increase in electrical conductivity while leaving the Seebeck unchanged. On the other hand, energetic disorder leads to increased energy gaps between sites, hindering transport. This adversely affects conductivity while only slightly increasing Seebeck and results in lower TE power factors. Furthermore, positional correlation primarily affects conductivity, while correlation in site energies has no effect on TE properties of polymers. Our results also show that the Lorenz number increases with Seebeck coefficient, largely deviating from the Sommerfeld value, in agreement with experiments and in contrast to band conductors. We conclude that reducing energetic disorder and positional correlation, while increasing positional disorder can lead to higher TE power factors.

Informed consent is a fundamental element of research ethics. The COVID-19 vaccine trials are high profile trials that have enrolled more than 100 000 participants. Consent documents must be succinct and understandable to ensure informed voluntary participation. To assess how well informed consent documents of the COVID-19 vaccine trials achieve the ideal of being succinct and understandable, and to create a shorter, more readable document. This quality improvement study collected and analyzed the informed consent documents used in 4 COVID-19 vaccine phase III randomized clinical trials to quantitatively assess readability and length and, based on this analysis, created a measurably more accessible informed consent document. Analysis was conducted from October 2020 to January 2021. The main outcomes were number of words (measured as word count), time-to-read (measured at reading speeds of 175-300 words per minute), language complexity (measured using Flesch-Kincaid Grade Level assessment), and readability (measured using Flesch Reading Ease Score). Secondary outcomes included clarity of how the placebo group could access the vaccine if it is proven safe and effective. The study also examined the length and readability of an improved consent document. The 4 informed consent documents were a mean (range) of 8333 (7821 to 9340) words long, with a mean (range) 35 (32.6 to 38.9) minutes to read at 240 words per minute. All documents exceeded grade 9 language complexity and scored lower than 60 in the formal reading ease metric, which constitutes difficult. Only 1 document specified that participants in the placebo group might receive vaccine. It was possible to write a document in fewer than 3000 words with a grade 7 to 8 reading level and a formal readability score that was not difficult. These findings suggest that existing COVID-19 vaccine informed consent documents were too long, difficult to read, and exceeded grade 9 in language complexity. It was possible to create a shorter, more readable informed consent document for these trials.

Energy densities of ~510 J/g (max: 698 J/g) have been achieved in azobenzene-based syndiotactic-rich poly(methacrylate) polymers. The processing solvent and polymer-solvent interactions are important to achieve morphologically optimal structures for high-energy density materials. This work shows that morphological changes of solid-state syndiotactic polymers, driven by different solvent processings play an important role in controlling the activation energy of Z - E isomerization as well as the shape of the DSC exotherm. Thus, this study shows the crucial role of processing solvents and thin film structure in achieving higher energy densities.

Importance The 2 primary efforts of Medicare to advance value-based care are Medicare Advantage (MA) and the fee-for-service–based Medicare Shared Savings Program (MSSP). It is unknown how spending differs between the 2 programs after accounting for differences in patient clinical risk. Objective To examine how spending and utilization differ between MA and MSSP beneficiaries after accounting for differences in clinical risk using data from administrative claims and electronic health records. Design, Setting, and Participants This retrospective economic evaluation used data from 15 763 propensity score–matched beneficiaries who were continuously enrolled in MA or MSSP from January 1, 2014, to December 31, 2018, with diabetes, congestive heart failure (CHF), chronic kidney disease (CKD), or hypertension. Participants received care at a large nonprofit academic health system in the southern United States that bears risk for Medicare beneficiaries through both the MA and MSSP programs. Differences in beneficiary risk were mitigated by propensity score matching using validated clinical criteria based on data from administrative claims and electronic health records. Data were analyzed from January 2019 to May 2022. Exposures Enrollment in MA or attribution to an accountable care organization in the MSSP program. Main Outcomes and Measures Per-beneficiary annual total spending and subcomponents, including inpatient hospital, outpatient hospital, skilled nursing facility, emergency department, primary care, and specialist spending. Results The sample of 15 763 participants included 12 720 (81%) MA and 3043 (19%) MSSP beneficiaries. MA beneficiaries, compared with MSSP beneficiaries, were more likely to be older (median [IQR] age, 75.0 [69.9-81.8] years vs 73.1 [68.3-79.8] years), male (5515 [43%] vs 1119 [37%]), and White (9644 [76%] vs 2046 [69%]) and less likely to live in low-income zip codes (2338 [19%] vs 750 [25%]). The mean unadjusted per-member per-year spending difference between MSSP and MA disease-specific subcohorts was $2159 in diabetes, $4074 in CHF, $2560 in CKD, and $2330 in hypertension. After matching on clinical risk and demographic factors, MSSP spending was higher for patients with diabetes (mean per-member per-year spending difference in 2015: $2454; 95% CI, $1431-$3574), CHF ($3699; 95% CI, $1235-$6523), CKD ($2478; 95% CI, $1172-$3920), and hypertension ($2258; 95% CI, $1616-2,939). Higher MSSP spending among matched beneficiaries was consistent over time. In the matched cohort in 2018, MSSP total spending ranged from 23% (CHF) to 30% (CKD) higher than MA. Adjusting for differential trends in coding intensity did not affect these results. Higher outpatient hospital spending among MSSP beneficiaries contributed most to spending differences between MSSP and MA, representing 49% to 62% of spending differences across disease cohorts. Conclusions and Relevance In this study, utilization and spending were consistently higher for MSSP than MA beneficiaries within the same health system even after adjusting for granular metrics of clinical risk. Nonclinical factors likely contribute to the large differences in MA vs MSSP spending, which may create challenges for health systems participating in MSSP relative to their participation in MA.

Health literacy is the best predictor of health status, with patient information leaflets (PILs) commonly used to improve information access. However, they can often be inconsistent. Benign colorectal disease can be challenging for patients and ensuring they are accurate and understandable is important. Available PILs in a tertiary unit were assessed. The Flesch reading ease and Flesch-Kincaid Grade level scores were used to calculate objective readability. Subjective assessment of readability, understandability, and patient opinion was assessed using a questionnaire. All PILs had objective readability scores at age 14 or older, above recommended advice. Three hundred sixty patient questionnaires were collected. The relationship between subjective readability and understandability was significant (P < .05); the easier a patient was able to read the information the more likely they were to understand it. There was no link between objective and subjective readability—a more difficult calculated reading score didn’t correspond to the patient finding it harder to read. Patients preferring paper information were significantly older than patients who preferred online information (P = .01). Patient information leaflets remain valued by patients, and PILs that patients find easier to read are then better understood; however, ease of reading is not related to objective readability scoring and there was no consensus that a shift to online information is merited.

This survey study assesses the acceptability of coronavirus disease 2019 (COVID-19) vaccine mandates among members of the US public.

Surgical training programs lack data-driven, objective feedback of resident surgeon technical performance, non-technical skill and intraoperative cognitive load (CogL). Cognitive load is the working memory resource required to perform a task. When capacity is exceeded, cognitive overload occurs, which can negatively affect fine motor and communication skills. Surgical sabermetrics is an emerging field, which focuses on advanced analytics of data derived from audiovisual recordings of operations and non-invasive physiological sensors measuring surgeon CogL. Incivility is prevalent across surgical specialties and has been shown to negatively influence morale, teamwork and performance. Little is known about the impact of CogL on trainee surgeon development, and a gap in knowledge is the impact of intraoperative trainer teaching style and behavior on trainee CogL. Simulation models provide an opportunity to instigate a sabermetrics framework to assess whether trainer behavior objectively impacts trainee CogL and surgical performance, with no risk to patient safety. In this randomized trial, vascular surgery residents will be allocated to one of two groups: supportive trainer or critical trainer. All participants will be tasked with completing a standardized, simulated vascular anastomosis using a femoral artery model, during which they will be exposed to one of these trainer behaviors. A sabermetrics framework will be utilized to collate objective data about participant technical performance, non-technical skills and CogL. Full ethical approval has been obtained for this study. Dissemination of the results will be through conferences and publications in peer reviewed journals.

Cognitive non-technical skills (NTS), encompassing situation awareness and decision-making, are critical to safe surgical practice and frequently implicated in adverse events. Data-driven approaches offer opportunities to provide objective, reproducible evaluation of cognitive NTS (e.g. through sensor use). While operative video analysis is increasingly applied to assess technical skills, its role in assessing cognitive NTS remains underexplored. This study aims to evaluate the feasibility, validity and educational utility of operative video analysis for assessing surgical trainees’ cognitive NTS. This will be a single-center, longitudinal observational cohort study at a tertiary teaching hospital in Scotland. Eligible trainees performing laparoscopic appendicectomy and cholecystectomy will undergo video capture of both the operative field and the operating room. NTS will be rated using the Non-Technical Skills for Surgeons (NOTSS) framework. Video annotations will generate metrics reflecting cognitive processes, which will be correlated with NOTSS scores. Individualized feedback reports containing video-derived metrics will be provided to trainees. Acceptability and perceived educational utility of these reports will be evaluated through trainee and trainer surveys. Statistical analysis will include inter-rater reliability, correlation and receiver operating characteristic analyses. Formal ethical approval for this study has been granted. Results will be disseminated through conferences and peer-reviewed publication.