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This paper presents the first architecture for a cloud-based, secure SCADA-as-a-Service solution. Our system, SKYDA, leverages the unique level of scalability and reliability offered by a cloud-based infrastructure while mitigating the domain-specific challenges that arise when moving SCADA from a standard utility control center to the cloud. SKYDA applies high-performance messaging and fault tolerance protocols to both the network and the SCADA Master application itself, resulting in a SCADA system that is easier to deploy and offers a lower total cost of ownership, significantly higher availability, better security and better performance than is possible today. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Substitution of a trans chloride ligand in the N-heterocycliccarbene(NHC) AuIIIcomplexes (NHC)AuCl3in the presenceof AgNTf2yields a new family of (NHC)AuCl2(NTf2) complexes. They display a moderate stability in solutionbut are stable once crystallized. These new organogold(III) complexescould be fully characterized by NMR, IR, and single crystal X-raydiffraction. They exhibit in 13C{1H} NMR anunusually upfield-shifted resonance associated with the carbene center. [ABSTRACT FROM AUTHOR]

An intramolecular diamination of acrylates is reported using sulfamates as nitro sources. This reaction proceeds under palladium(II) catalysis with copper as oxidant gives rise to anti-configured 2,3-diamino carboxylates as bicyclic sulfamate derivatives. An aminobrominated intermediate within the diamination reaction was isolated that allowed to clarify the reaction mechanism and to rationalize the observed preferential product stereochemistry. [ABSTRACT FROM AUTHOR]

Background: Super-utilizers with 4 or more admissions per year frequently receive low-quality care and disproportionately contribute to healthcare costs. Inpatient care fragmentation (admission to multiple different hospitals) in this population has not been well described.Objective: To determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes.Research Design: We analyzed inpatient data from the Health Care Utilization Project's State Inpatient and Emergency Department database from 6 states from 2013. After identifying hospital super-utilizers, we stratified by the number of different hospitals visited in a 1-year period. We determined how patient demographics, costs, and outcomes varied by degree of fragmentation. We then examined how fragmentation would influence a hospital's ability to identify super-utilizers.Subjects: Adult patients with 4 or more inpatient stays in 1 year.Measures: Patient demographics, cost, 1-year hospital reported mortality, and probability that a single hospital could correctly identify a patient as a super-utilizer.Results: Of the 167,515 hospital super-utilizers, 97,404 (58.1%) visited more than 1 hospital in a 1-year period. Fragmentation was more likely among younger, non-white, low-income, under-insured patients, in population-dense areas. Patients with fragmentation were more likely to be admitted for chronic disease management, psychiatric illness, and substance abuse. Inpatient fragmentation was associated with higher yearly costs and lower likelihood of being identified as a super-utilizer.Conclusions: Inpatient care fragmentation is common among super-utilizers, disproportionately affects vulnerable populations. It is associated with high yearly costs and a decreased probability of correctly identifying super-utilizers. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disproportionately impacted migrant farmworkers (MFWs). MFWs have experienced higher rates of infection and death than any other occupational group in the United States due to workplace exposure risks, overcrowded housing, and limited access to personal protective equipment. Barriers to accessing COVID-19 vaccines have also contributed to these disparities, especially in rural areas where the pandemic's impact has been devastating. Mobile health clinics, in partnership with community-based organizations, are an effective method for vaccine distribution to rural communities where many MFWs live and work. Between June 2021 and October 2022, the University of Minnesota's Mobile Health Initiative (MHI) organized health fairs in southern Minnesota to distribute vaccines to MFWs and their families. The success of these events can be attributed to partnering with trusted local organizations, bridging geographic barriers, ensuring language-concordant care, and offering multiple health services in one place. MHI's health fairs serve as a model for future mobile vaccination events. As the COVID-19 pandemic has ended as of this time, future pandemics may occur, and equitable vaccine access must be a priority for MFWs. Mobile health clinics are an essential tool to achieving this goal. [ABSTRACT FROM AUTHOR]

Focuses on the many cases of poor, indigenous women in Mexico forced to accept birth control despite legislation that guarantees the right to decide one's own family planning. The story of an Indian women in Chiapas, Mexico who discovered she was given an intra-uterine device against her will and her fears of reporting the incident because of her low social status; Double standard between Mexico's women's rights policy and its efforts to limit population growth; Efforts being made to stop the practice.

Background: Early identification of plasma leakage may guide treatment decisions in dengue patients. This study evaluated the value of point-of-care ultrasound (POCUS) to detect plasma leakage and predict hospitalization or referral to a higher level of care in suspected dengue patients under routine conditions at a primary care facility in Colombia. Methods: We conducted a cohort study between April 2019 and March 2020 in a primary care hospital in Cali, Colombia. We prospectively included and followed 178 patients who were at least 2 years old with fever of less than 10 days and clinician-suspected dengue. A trained general practitioner performed a standardized POCUS protocol. Images were quality-rated and overread by an expert radiologist, and her results and those of the general practitioner were compared using the Kappa index. Logistic regression was used to identify factors associated with plasma leakage at enrollment and explore its prognostic value regarding hospital admission or referral to a higher level of care. Results: Half (49.6%) POCUS images were of suitable quality to be interpreted. The proportion of plasma leakage reported by the radiologist was 85.1% (95% CI: 78.6–90.2%) and 47.2% by the study physician (Kappa = 0.25, 95% CI: 0.15–0.35). The most frequent ultrasound findings were ascites (hepatorenal 87.2%, splenorenal 64%, or pelvic 21.8%) and gallbladder wall thickening (10.5%). Plasma leakage was higher in subjects with thrombocytopenia (aOR = 4, 95% CI: 1.3–12.1) and lower in patients 30–59 years old (aOR = 0.1, 95% CI: 0.0–0.4) than in those 18 years old or younger. POCUS evidence of plasma leakage (aOR = 8.2, 95% CI: 2.2–29.9), thrombocytopenia (aOR = 6.3, 95% CI: 2.4–16.0) and pulse pressure (aOR = 1.1, 95% CI: 1.07–1.2) were associated with hospital admission or referral to a higher level of care. Conclusions: Ultrasound is useful to detect plasma leakage in primary care and, challenges remain to guarantee high-quality images and diagnostic accuracy, for which a standardized dengue POCUS protocol and training program is needed. [ABSTRACT FROM AUTHOR]

The method employs catalytic amounts of potassium bromide and sodium chlorite as oxidant and avoids any use of transition metal catalyst. [ABSTRACT FROM AUTHOR]

The title reaction selectively provides trans-substituted bicyclic sulfamates of type (II), which can be converted into derivatives like (III) and (V). [ABSTRACT FROM AUTHOR]

Sabbaticals are an important feature of academia for faculty and their institutions. Whereas sabbaticals are common in institutions of higher learning, little is known about their role and utilization in US medical schools. This perspective piece examining sabbaticals in medical school faculty was undertaken at a time that well-being of health professionals was increasingly being recognized as a workforce health priority. We surveyed associate deans at US medical schools in 2021 about faculty who had taken sabbaticals within the past 3 years, the parameters of the sabbaticals, and institutional policies and respondents' predictions of future sabbatical use. A total of 53% of respondents reported any faculty had taken sabbaticals in the past 3 years (M = 6.27; Median = 3; range = 1-60). Institutions rated enhancing research as the most important objective, while recognizing other benefits. Sabbaticals were more commonly taken by male, white, senior faculty PhDs. Details about sabbaticals, including eligibility, expectations, length, financial support, and benefits were reviewed. Most (54.8%) respondents expected no change in the number of faculty seeking sabbaticals. Nearly all anticipated the COVID-19 pandemic would not affect sabbatical policies. In contrast to other institutions of higher learning, sabbatical-taking by medical school faculty is rare. We explore factors that may contribute to this phenomenon (eg, the tripartite mission, faculty clinical responsibilities, culture of medicine, and student debt). Despite financial and other barriers, a closer look at the benefits of sabbaticals is warranted as a mechanism that may support faculty well-being, retention, and mental health. [ABSTRACT FROM AUTHOR]

Objective: Point of care ultrasound (POCUS) is a widely used clinical tool. This operator-dependent technique requires methods to establish individual benchmarks and to monitor the learning process. We present the use of the learning curve standard cumulative summation (LC-CUSUM) and CUSUM control charts to establish and monitor, respectively, the proficiency of a physician to detect pulmonary B-lines with POCUS. Materials and Methods: A training course for general practitioners was conducted to detect plasma leakage using POCUS. The trainees and an expert radiologist identified the number of pulmonary Blines in the POCUS images of 53 hospitalized patients. The interpretation of one trainee was compared to that of the expert radiologist using LCCUSUM and CUSUM considering image quality and anatomical site. Results and Discussion: We found that image quality was better in the apices than the bases of the lungs. The trainee learning curve differed by anatomical site and the results of LC-CUSUM and CUSUM differed when only high-quality (first scenario) or all images (second scenario) were included in the analysis. Conclusion: The LC-CUSUM and CUSUM control charts were useful to evaluate the learning curve in this case and to identify image quality as an important factor in the evaluation process. They warrant further study as graphical tools for realtime monitoring of POCUS training. [ABSTRACT FROM AUTHOR]

A copper(II)-mediated diamination of 1,3-butadienes is reported. The reaction employs an inorganic base, copper dibromide as a reagent, and saccharin as the nitrogen source. The diamination proceeds for a series of 1,3-butadienes under relatively mild conditions with complete selectivity in favor of the 1,4-oxidation products. [ABSTRACT FROM AUTHOR]

• 88% of healthcare workers were accepting of COVID-19 vaccines. • Healthcare workers who work with immigrant communities were more vaccine acceptant. • Healthcare workers with a vaccine concern were more likely to report patients with concerns. • Educational information was helpful for healthcare workers making a vaccine decision. • A healthcare provider vaccine recommendation was considered helpful for patients making a vaccine decision. To understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities. A dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021–4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers. 517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider's recommendation as most helpful for their patients. Healthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information. [ABSTRACT FROM AUTHOR]

Dairy farms that had participated in previous and ongoing projects with the National Farm Medicine Center (NFMC), Migrant Clinicians Network (MCN), and Upper Midwest Agricultural Safety and Health Center (UMASH) were asked to participate in a 17-question survey by phone or email to investigate biosecurity principles on Minnesota and Wisconsin dairy farms in response to COVID-19 and the effects of the pandemic on the dairy industry. Three additional farms were recruited via a press release published in agricultural newsletters. Of 76 farms contacted, 37 chose to participate in this study from June to July 2020. In response to the COVID-19 pandemic, dairies have implemented or increased biosecurity measures and COVID-19 precautions. Dairies reported adequate personal protective equipment for their workers, though face masks were not required on most dairies (n = 32, 86%). Producers were concerned about the safety of their families, maintaining a healthy workforce, and keeping their farms profitable. Access to healthcare was not perceived to be an issue for their workers. One-quarter of dairies reported COVID-19 infections on their farms. Even though the majority had an isolation protocol in place if someone on the farm were to become ill, less than half of respondents felt their farm was protected against COVID-19. Two-thirds of producers have not had to decrease production, and a majority of operations have not furloughed or terminated employees due to COVID-19. Our data suggest that dairy farms in Minnesota and Wisconsin have implemented biosecurity and safety measures in response to COVID-19. These measures can be improved. Farms would benefit from additional guidance and education on implementation of personal protective measures and disease prevention strategies to keep workers employed and safe. [ABSTRACT FROM AUTHOR]

Bovine tuberculosis is caused by Mycobacterium bovis (M. bovis), which infects both humans and cattle. In 2018, a dairy farm in Wisconsin was affected by M. bovis, including a farmworker with exposure to the affected herd. Largely eradicated by effective public health strategies in the United States, most cases are now associated with risk factors including occupational hazards, food consumption, and iatrogenic infections. M. bovis continues to cause disease worldwide affecting certain at-risk populations in the United States. Infections more often result in extrapulmonary sequelae and resistance to pyrazinamide is universal. Thus, successful treatment depends on early and correct identification of the mycobacterium species. A One Health approach to control this re-emerging disease is crucial. [ABSTRACT FROM AUTHOR]

Here we present the first reported case of a noninvasive Rhizopus fungal ball confined to the bladder of a patient with poorly controlled diabetes and right flank pain. The patient developed bilateral hydronephrosis after several hospital admissions for urinary tract infections with multiple failed courses of antibiotics. During cystoscopy to replace a ureteral stent, he was found to harbor a fungal ball in the bladder that was removed and grew Rhizopus in culture. Patient received treatment with amphotericin B and transitioned to long-term posaconazole therapy. This case highlights the importance of considering fungal agents in urinary tract infections, especially in persistent or refractory cases, and the role of the clinical microbiology laboratory in correct identification of the infectious source. [ABSTRACT FROM AUTHOR]

The article presents chemical equations related to the article "Copper-Mediated 1,4-Diamination of 1,3-Butadienes" by C. Martinez and others in the "European Journal of Organic Chemistry" in 2014.

BACKGROUND: Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates. OBJECTIVES: To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol's implementation. DESIGN: Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation. PARTICIPANTS: Patients presenting for alcohol detoxification. INTERVENTION: Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification. MAIN MEASURES: Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation. RESULTS: We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation ( p = 0.037). There was no difference in readmission rate or length of stay. CONCLUSIONS: Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions. [ABSTRACT FROM AUTHOR]

Presents several book on theology. "Freedom Evolves," by Daniel C. Dennett; "Seeing With Their Hearts: Chicago Women and the Vision of the Good City, 1871-1933," by Maureen A. Flanagan; "God Against the Gods: The History of the War Between Monotheism and Polytheism," by Jonathan Kirsch.

Background The observation that some ASD patients manifest clinical improvement in response to fever suggests that symptoms may be modulated by immune-inflammatory factors. The febrile hypothesis of ASD stems from this observation, and could be due to [1] the direct effect of temperature; [2] a resulting change in the immune inflammatory system function associated with the infection of fever; and/or [3] an increase in the functionality of a previously dysfunctional locus coeruleus-noradrenergic (LC-NA) system. Methods We completed a double blind crossover study of 15 children with ASD (5 to 17 years) using two treatment conditions, hyperthermia condition (102 °F) and control condition (98 °F) in a HydroWorx aquatic therapy pool. Five children with ASD without fever response acted as controls, completing only the hyperthermia condition, to ensure safety and feasibility. Safety measures and Social Responsiveness Scale (SRS) were collected. Ten patients with ASD and history of fever response were enrolled and received both treatment conditions. Vital signs, temperature monitoring and clinical observations were completed throughout their time in the pool. Parents completed the SRS and RBS-R. Pupillometry biomarker and buccal swabs for DNA and RNA extraction were collected pre and post pool entry. Results Five control subjects without a history of fever completed the hyperthermia condition at 102 °F, and demonstrated the safety and feasibility of the study. Ten subjects with ASD and a history of fever response were enrolled and completed the hyperthermia condition (102 °F) and control condition (98 °F) at the aquatic therapy pool. Improvement in social cognition and repetitive/restrictive behaviors were observed at the hyperthermia condition (102 °F) on parent (SRS, RBS-R) and rater (CGI-I) assessments. Pupillometry biomarker and gene expression can be correlated with clinical improvement. Side effects were minimal, and were the same as those observed in a hot tub/sauna (redness, nausea). Discussion We demonstrated improvement of socialization and repetitive and restricted behaviors at the hyperthermia condition (102 °F), and that we could reliably and safely increase children’s temperatures into the fever range (mean max temperature of 101.7 °F). This temperature increase was observed to cause significant and convergent improvement on clinician ratings (CGI-I) and parent ratings (SRS, RBS-R), both of which were kept blinded to the temperature of the pool. Interestingly, each child’s fever response history was correlated with the improvements observed at the elevated temperature. Those with a history of marked fever response had the most observable behavior changes. Behavior changes observed for each child were similar to those observed by parents during febrile episodes, including increased cooperation, communication and social reciprocity and decreased hyperactivity and inappropriate vocalizations. Although multiple rationales have been posited, this is the first study looking at the direct effect of temperature on ASD symptomatology. This study explores the direct effects of temperature on ASD symptoms and offers a window into understanding mechanisms involved in the improvement of ASD symptoms during febrile episodes. Future analyses will help to determine the genetic pathways involved in fever response, the role of the LC-NA system, and other immune-inflammatory pathways in mediating ASD symptoms. [ABSTRACT FROM AUTHOR]