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High performance computing has entered the Exascale Age. Capable of performing over 1018 floating point operations per second, exascale computers, such as El Capitan, the National Nuclear Security Administration's first, have the potential to revolutionize the detailed in-depth study of highly complex science and engineering systems. However, in addition to these kind of whole machine "hero" simulations, exascale systems could also enable new paradigms in digital design by making petascale hero runs routine. Currently, untenable problems in complex system design, optimization, model exploration, and scientific discovery could all become possible. Motivated by the challenge of uncovering the next generation of robust high-yield inertial confinement fusion (ICF) designs, project ICECap (Inertial Confinement on El Capitan) attempts to integrate multiple advances in machine learning (ML), scientific workflows, high performance computing, GPU-acceleration, and numerical optimization to prototype such a future. Built on a general framework, ICECap is exploring how these technologies could broadly accelerate scientific discovery on El Capitan. In addition to our requirements, system-level design, and challenges, we describe some of the key technologies in ICECap, including ML replacements for multiphysics packages, tools for human-machine teaming, and algorithms for multifidelity design optimization under uncertainty. As a test of our prototype pre-El Capitan system, we advance the state-of-the art for ICF hohlraum design by demonstrating the optimization of a 17-parameter National Ignition Facility experiment and show that our ML-assisted workflow makes design choices that are consistent with physics intuition, but in an automated, efficient, and mathematically rigorous fashion. [ABSTRACT FROM AUTHOR]

Background: Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences.Results: A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000.Conclusions: RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology. [ABSTRACT FROM AUTHOR]

Background and objective: The diagnosis of rare diseases (RDs) is often challenging due to their rarity, variability and the high number of individual RDs, resulting in a delay in diagnosis with adverse effects for patients and healthcare systems. The development of computer assisted diagnostic decision support systems could help to improve these problems by supporting differential diagnosis and by prompting physicians to initiate the right diagnostic tests. Towards this end, we developed, trained and tested a machine learning model implemented as part of the software called Pain2D to classify four rare diseases (EDS, GBS, FSHD and PROMM), as well as a control group of unspecific chronic pain, from pen-and-paper pain drawings filled in by patients. Methods: Pain drawings (PDs) were collected from patients suffering from one of the four RDs, or from unspecific chronic pain. The latter PDs were used as an outgroup in order to test how Pain2D handles more common pain causes. A total of 262 (59 EDS, 29 GBS, 35 FSHD, 89 PROMM, 50 unspecific chronic pain) PDs were collected and used to generate disease specific pain profiles. PDs were then classified by Pain2D in a leave-one-out-cross-validation approach. Results: Pain2D was able to classify the four rare diseases with an accuracy of 61–77% with its binary classifier. EDS, GBS and FSHD were classified correctly by the Pain2D k-disease classifier with sensitivities between 63 and 86% and specificities between 81 and 89%. For PROMM, the k-disease classifier achieved a sensitivity of 51% and specificity of 90%. Conclusions: Pain2D is a scalable, open-source tool that could potentially be trained for all diseases presenting with pain. [ABSTRACT FROM AUTHOR]

Background: Rare diseases (RDs) in rheumatology as a group have a high prevalence, but randomized controlled trials are hampered by their heterogeneity and low individual prevalence. To survey the current evidence of pharmacotherapies for rare rheumatic diseases, we conducted a systematic review and meta-analysis. Randomized controlled trials (RCTs) of RDs in rheumatology for different pharmaco-interventions were included into this meta-analysis if there were two or more trials investigating the same RD and using the same assessment tools or outcome parameters. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PUBMED were searched up to April 2nd 2020. The overall objective of this study was to identify RCTs of RDs in rheumatology, evaluate the overall quality of these studies, outline the evidence of pharmacotherapy, and summarize recommended therapeutic regimens.Results: We screened 187 publications, and 50 RCTs met our inclusion criteria. In total, we analyzed data of 13 different RDs. We identified several sources of potential bias, such as a lack of description of blinding methods and allocation concealment, as well as small size of the study population. Meta-analysis was possible for 26 studies covering six RDs: Hunter disease, Behçet's disease, giant cell arteritis, ANCA-associated vasculitis, reactive arthritis, and systemic sclerosis. The pharmacotherapies tested in these studies consisted of immunosuppressants, such as corticosteroids, methotrexate and azathioprine, or biologicals. We found solid evidence for idursulfase as a treatment for Hunter syndrome. In Behçet's disease, apremilast and IF-α showed promising results with regard to total and partial remission, and Tocilizumab with regard to relapse-free remission in giant cell arteritis. Rituximab, cyclophosphamide, and azathioprine were equally effective in ANCA-associated vasculitis, while mepolizumab improved the efficacy of glucocorticoids. The combination of rifampicin and azithromycin showed promising results in reactive arthritis, while there was no convincing evidence for the efficacy of pharmacotherapy in systemic sclerosis.Conclusion: For some diseases such as systemic sclerosis, ANCA-associated vasculitis, or Behcet's disease, higher quality trials were available. These RCTs showed satisfactory efficacies for immunosuppressants or biological drugs, except for systemic sclerosis. More high quality RCTs are urgently warranted for a wide spectrum of RDs in rheumatology. [ABSTRACT FROM AUTHOR]

The global pandemic, COVID-19, affected all areas of education and healthcare for RDNs, including dietetic internship rotations and learning experiences to prepare entry-level practitioners. The objective of this study was to investigate how COVID-19 impacted dietetic internship experiences and rotations, and how learning experiences were adapted to support an ever-changing learning environment. Data was collected in spring 2021 through a Qualtrics survey to collect quantitative and qualitative data. This survey was sent to Internship Directors and the Academy of Nutrition and Dietetics Nutrition and Dietetics Educators and Preceptors DPG listserv. Faculty and preceptors were asked to send this survey to students who completed all or part of their internship during the 2020-2021 academic year; nationally 187 responses were collected. Phenomenological data was gathered regarding confidence levels relating to accomplishment of internship competencies, benefits and challenges to completing internships, and how COVID-19 impacted career preparedness. Thematic analysis identified emerging themes in qualitative data, while descriptive statistical analysis was used for quantitative data. Findings identified that 96% of respondents had to complete some internship rotations virtually or through alternative experiences, with case studies being the most common alternative experience. Quantitative data showed confidence levels of 87% using the Nutrition Care Process for assessment/intervention, 74% for planning and implementing nutrition education lessons, and 45% for incorporating procurement, production, and distribution in foodservice management. Students identified flexibility, less required supervised practice hours, and learning how to adapt as benefits to completing their internship during the pandemic, with lack of hands-on experience, decreased ability to make personal relationships with patients/preceptors, and uncertainty of the future as challenges. Understanding how alternative experiences influence student learning is important for educators to prepare successful entry-level practitioners. Interns want employers to know they are more adaptable, flexible, and resilient because of their internship experience; however, they may require a little more on-the-job training than interns whose experiences were not significantly impacted by COVID-19. None [ABSTRACT FROM AUTHOR]

The objective of Marshall's Nutrition for Health, Healing and Recovery program is to increase participants' abilities to identify nutrient dense foods and improve their confidence in shopping for and preparing healthy snacks and meals. The opioid crisis has had a devastating impact on individuals and families nationwide. Poor health, nutrient deficiencies, and malnutrition are often noted as consequences of addiction, as is a preference for sugary foods with minimal nutritional value. It is documented that nutrition education during recovery can improve outcomes and help prevent relapse; however, few treatment centers offer this as a service. Marshall University's Nutrition Education Program partnered with local substance use recovery facilities to offer food and nutrition education to participants. The program included six classes focused on nutrient dense foods for recovery, emotional and mindful eating, food safety, and meal planning with budget considerations. Four to six recipes corresponding to lessons were prepared by groups of participants followed by tasting and discussions. Kitchen supplies were provided at the end of each class to build participant's meal preparation resources. Participants were asked to complete a 14-question pre/post survey to assess eating habits and confidence regarding several aspects of nutritional wellbeing. Responses were analyzed to identify improvements after implementation of nutrition education. Upon program conclusion, participants reported drinking more water than soda and increasing daily servings of fruits and vegetables. Questions addressing perceived confidence revealed increased levels in the following areas: using mindfulness in food choice (38% to 61%); substituting healthier foods for those high in fat and sugar (27% to 54%); planning nutritious meals (42% to 58%); finding healthy foods at the grocery store (44% to 69%); and preparing a healthy recipe (38% to 69%). Participating in an education program focused on food and nutrition during substance use disorder treatment improved consumption of nutrient dense foods and confidence in planning for and preparing healthy meals and snacks. Pallottine Foundation of Huntington [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the success of implementing nutrition education through culinary medicine (CM) with medical students (MS) and dietetic interns (DI). A critical step in the prevention and treatment of chronic illness is providing nutrition education for physicians, yet nutrition education receives little focus in medical school. A congressional resolution was passed in 2022 encouraging the inclusion of nutrition education in medical curricula. This program evaluated the use of a food-first model in CM for MS and evaluated the phenomenological perspective of DIs. First-/Fourth-year MS students; dietetic interns. Marshall Dietetics meets step one nutrition education policy recommendations through a unique CM program. First-year medical students focused on nutrition concepts and food resource management; cooking reinforced baseline knowledge. An intensive fourth-year elective, including online modules and cooking experience, is offered. Dietetic interns lead both programs under RDN and cardiology faculty. A mixed-methods evaluation was used. Pre-/post-assessments of first-year MS (n=69/40) determined knowledge of nutrition, food resource management skills, and where students source nutrition information. Fourth-year MS (n=37) were assessed with course evaluation. DI (n=19) were evaluated with a qualitative phenomenological narrative. Findings showed MS learned from the experience. Only 18% of first-year MS (n=69) had prior nutrition education; 73% of students identified significant knowledge on the post-evaluation. Fourth-year evaluation showed 70% of MS rated the quality of the CM rotation as extremely high, expressing collaboration with RDNs/DIs enhanced their learning. Qualitative analysis revealed MS intend to make personal dietary changes, based on increased knowledge. Dietetic interns reported gaining leadership skills, improved cultural competency, and recognized the relational importance between dietitians and physicians. CM is a feasible way to incorporate nutrition education into medical curricula. MS students gained nutrition knowledge and food resource management skills from the experience. Both MS and DIs recognize the importance of the interprofessional team, while DIs gained important leadership skills. Marshall University Department of Dietetics, Joan C Edwards School of Medicine [ABSTRACT FROM AUTHOR]

Background: The diagnosis of rare diseases poses a particular challenge to clinicians. This study analyzes whether patients' pain drawings (PDs) help in the differentiation of two pain-associated rare diseases, Ehlers-Danlos Syndrome (EDS) and Guillain-Barré Syndrome (GBS).Method: The study was designed as a prospective, observational, single-center study. The sample comprised 60 patients with EDS (3 male, 52 female, 5 without gender information; 39.2 ± 11.4 years) and 32 patients with GBS (10 male, 20 female, 2 without gender information; 50.5 ± 13.7 years). Patients marked areas afflicted by pain on a sketch of a human body with anterior, posterior, and lateral views. PDs were electronically scanned and processed. Each PD was classified based on the Ružička similarity to the EDS and the GBS averaged image (pain profile) in a leave-one-out cross validation approach. A receiver operating characteristic (ROC) curve was plotted.Results: 60-80% of EDS patients marked the vertebral column with the neck and the tailbone and the knee joints as pain areas, 40-50% the shoulder-region, the elbows and the thumb saddle joint. 60-70% of GBS patients marked the dorsal and plantar side of the feet as pain areas, 40-50% the palmar side of the fingertips, the dorsal side of the left palm and the tailbone. 86% of the EDS patients and 96% of the GBS patients were correctly identified by computing the Ružička similarity. The ROC curve yielded an excellent area under the curve value of 0.95.Conclusion: PDs are a useful and economic tool to differentiate between GBS and EDS. Further studies should investigate its usefulness in the diagnosis of other pain-associated rare diseases. This study was registered in the German Clinical Trials Register, No. DRKS00014777 (Deutsches Register klinischer Studien, DRKS), on 01.06.2018. [ABSTRACT FROM AUTHOR]