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During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift-to some degree-from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by "crisis standards of care," but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.

Objectives: Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients., Methods: Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups., Results: We evaluated 1551 patients, 82years and 56% women. Using HR strata of <70 and ≥70bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and <120mmHg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR<70bpm and SBP≥140mmHg (n=176; low-risk), HR<70 and SBP<140+HR≥70 and SBP<120 (n=1089; moderate-risk) and HR≥70 and SBP<120 (n=286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors., Conclusions: The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Surface characteristics of a cross slope can impact the ease with which a manual wheelchair (MWC) user propels across a surface. The purpose of this research was two-fold. Phase I of this research surveyed MWC users to identify cross slope scenarios that they reported to be more difficult to traverse compared to other common driving obstacles. Our survey results showed that, overall, cross slopes were harder to propel across than narrow and manual doors, and cross-slopes in inclement weather conditions were equal or more difficult than gravel and rough-surfaces. Cross slopes with severe angles and those with compound angles (slope with cross-slope) were the most difficult to traverse. Phase II focused on identifying the responses (e.g., avoid, explore alternative, experience a sense of insecurity, no effect) people had when viewing pictures of various cross-slopes scenarios (e.g., narrow space, compound angles, extreme weather) that wheelchair users encounter. These results showed that people reported that they would avoid or feel insecure on some cross-sloped surfaces, like the weather, that are not within our control, others, like compound angle and curb-cuts on slopes, that can be addressed in the construction of pathways or sidewalks.