Search

Background Elderly patients with diabetes mellitus (DM) are faced with potential changes in their lower extremities, such as peripheral neuropathy and peripheral arterial disease, making them vulnerable to falls. We hypothesized that evaluations by podiatrists would lower the events of falls. Methods A retrospective chart review of a cohort of patients with DM, 65 years or older, was performed, who visited our primary care office between January 1, 2019 and June 30, 2019. Patients were divided into those who had podiatrist evaluations (PODEVAL), and those who did not (no PODEVAL). Events of falls and comorbid medical conditions were compared between the two groups. We also compared the associations of risk factors between the patients who had falls and those who did not. Results Among 197 patients (PODEVAL = 92; no PODEVAL = 105), the mean ages of the two groups were comparable (76.9 years for PODEVAL, 75.5 years for no PODEVAL; P = 0.151). There was no significant difference in the events of falls in a 6-month follow-up period between PODEVAL and no PODEVAL groups (35.9% vs. 32.4%; P = 0.606). We found significantly higher frequencies of association of several disorders of the lower extremities in PODEVAL group compared to no PODEVAL group, such as bunions and calluses (48.9% vs. 27.6%; P = 0.002), peripheral arterial disease (50.0% vs. 26.7%; P < 0.001), and peripheral neuropathy (75.0% vs. 47.6%; P < 0.001). Patients with falls had higher frequencies of associations of some comorbidities compared to the patients without reported falls, such as coronary artery disease, peripheral arterial disease, dementia, congestive heart failure, carotid stenosis, and syncope. Conclusions Among elderly patients with DM, there is no significant difference in the events of falls between the groups of patients who had podiatrist evaluations and who did not.

Objective: OTC Medicine Safety, a free, easily accessible, in-classroom educational program available through Young Minds Inspired (https://ymiclassroom.com/lesson-plans/otcmedsafety), was developed to improve adolescents’ knowledge of safe use of medicines. In a proof-of-concept study, students increased knowledge about safe, appropriate use of over-the-counter (OTC) medicines. In this study, we assessed whether the OTC Medicine Safety program effectively increased students’ knowledge and if students retained this knowledge over time. Methods: We measured student knowledge before implementation (baseline, Quiz 1) immediately after implementation (Quiz 2), and 10 weeks after baseline (Quiz 3) in 3 test schools. We measured knowledge at similar intervals in 3 control schools (no program implementation). Results: Baseline knowledge was low (average 39.3% of 36 questions answered correctly). Among intervention schools, scores significantly improved immediately (average correct 62.9%) after implementation and were retained at 10 weeks (59.8%) (p < .001). Change in score from baseline among intervention schools immediately after the lesson implementation was significantly higher than corresponding changes from baseline among control schools (intervention: +23.0 vs control: -3.2) and at 10 weeks (intervention: +19.9 vs control: -2.9), p < .001. Conclusion: The OTC Medicine Safety Program effectively improved students’ knowledge of safe medicine-taking practices and students retained this knowledge at 10 weeks.

Dysphagia, or a disorder of swallowing, is very common and is reported in 1 out of 25 adults with approximately 1 million new cases per year in the United States alone. This also disproportionately impacts elderly patients, with a prevalence of 17%. Patients with dysphagia may have severe clinical complications such as starvation, dehydration, and airway obstruction- which may further increase mortality. Hence, timely and accurate diagnosis of dysphagia is hence crucial in management considerations. The gold standard for evaluating and diagnosing dysphagia is a modified barium swallow study (MBSS). The study is typically performed as a collaborative effort between a speech language pathologist (SLP) and a radiologist, who bring their individual skill sets to the table. Current MBSS reporting involves separately dictated and interpreted reports from the SLP and radiologist. In this paper, we elucidate our experience in a multi-institutional healthcare system wherein we have devised a single, integrated report for MBSS, which involves collaborative effort between SLP and the radiologist. We weight the advantages and disadvantages of unified reporting, the challenges of implementing it in a large healthcare system, and note how it can help improve efficiency and deliver unified patient care. We hope that this would be a template for other institutions as well as improve standardization of reporting techniques.

The Affordable Care Act mandated data collection standards to identify people with disabilities in federal surveys to better understand and address health disparities within this population. Most federal surveys use six questions from the American Community Survey (ACS-6) to identify people with disabilities, whereas many international surveys use the six-item Washington Group Short Set (WG-SS). The National Survey on Health and Disability (NSHD), which focuses on working-age adults ages 18-64, uses both question sets and contains other disability questions. We compared ACS-6 and WG-SS responses with self-reported disability types. The ACS-6 and WG-SS failed to identify 20 percent and 43 percent, respectively, of respondents who reported disabilities in response to other NSHD questions (a broader WG-SS version missed 4.4 percent of respondents). The ACS-6 and the WG-SS performed especially poorly in capturing respondents with psychiatric disabilities or chronic health conditions. Researchers and policy makers must augment or strengthen federal disability questions to improve the accuracy of disability prevalence counts, understanding of health disparities, and planning of appropriate services for a diverse and growing population.

MFIX-Exa is a computational fluid dynamics–discrete element model (CFD-DEM) code designed to run efficiently on current and next-generation supercomputing architectures. MFIX-Exa combines the CFD-DEM expertise embodied in the MFIX code—which was developed at NETL and is used widely in academia and industry—with the modern software framework, AMReX, developed at LBNL. The fundamental physics models follow those of the original MFIX, but the combination of new algorithmic approaches and a new software infrastructure will enable MFIX-Exa to leverage future exascale machines to optimize the modeling and design of multiphase chemical reactors.

Objectives To reduce childhood mortality from severe malaria by implementing the World Health Organization's standardized malarial treatment protocol. Design Observational study comparing the mortality rate from malaria before and after the intervention. Setting Inpatient pediatric ward in a district referral hospital of Sierra Leone. Participants A total of 1298 pediatric patients (ages 0-13 years, male and female) received the intervention, representing 100% of the pediatric patients admitted with severe malaria during the dates of implementation (there were no exclusion criteria). Interventions We implemented the World Health Organization's standardized malarial protocol on September 30, 2015. Based on monthly run reports of mortality and root cause analysis, we adapted the malaria protocol by adding sublingual glucose as a treatment to target hypoglycemia complications in March 2016. Main Outcome Measures The primary outcome was a change in monthly percent mortality from severe malaria, and the secondary outcome was the percent of mortality attributed to hypoglycemia. Results The monthly average percent mortality from severe malaria dropped from 9% to 3.6% after the intervention, which was borderline statistically significant (p 0.06, CI 95% 1.5 to 5.6). The secondary outcome, percent of malarial deaths attributable to hypoglycemia via chart reviews, dropped from 83% to 44% across the study period. There was an increase in the average number of admissions for severe malaria from 71 to 153 children per month in the second half of the year (range from 49-212 per month). Conclusion Implementing the WHO malaria treatment protocol with bedside tracking of protocol steps reduced malaria mortality and improved our ward's efficiency without adding any human or medical resources.

Monarch butterfly (Danaus plexippus L.) declines in eastern North America have prompted milkweed host plant restoration efforts in non-agricultural grasslands. However, grasslands harbor predator communities that exert high predation pressure on monarch eggs and larvae. While diurnal monarch predators are relatively well known, no studies have investigated the contribution of nocturnal monarch predators. We used video cameras to monitor sentinel monarch eggs and fourth instars on milkweed in southern Michigan to identify predators and determine if nocturnally-active species impose significant predation pressure. We observed ten arthropod taxa consuming monarch eggs and larvae, with 74% of egg predation events occurring nocturnally. Taxa observed attacking monarch eggs included European earwigs (Forficula auricularia L.), tree crickets (Oecanthus sp.), lacewing larvae (Neuroptera), plant bugs (Miridae), small milkweed bugs (Lygaeus kalmii Stal), ants (Formicidae), spiders (Araneae: Salticidae and other spp.), harvestmen (Opiliones), and velvet mites (Trombidiformes: Trombidiidae). Larvae were attacked by ground beetles (Calleida sp.), jumping spiders (Araneae: Salticidae), and spined soldier bugs (Podisus maculiventris Say). Our findings provide important information about monarch predator–prey interactions that could be used to develop strategies to conserve monarchs through reducing predation on early life stages.

Janos Kornai developed soft budget constraint logic to explain the socialist world’s dysfunctional economies. We extend his logic to explain dysfunctional land reform in the developing world. International development organizations such as the World Bank provide support for land privatization to developing-country governments, softening their budget constraints. Softer budget constraints encourage developing-country governments to pursue land privatization even when its social value is negative. Kenya’s land reform program illustrates the soft budget constraint syndrome.

Description, This study finds that no-excuse absentee voting policies did not meaningfully increase turnout in the 2020 U.S. election., The 2020 U.S. election saw a record turnout, saw a huge increase in absentee voting, and brought unified national Democratic control—yet these facts alone do not imply that vote-by-mail increased turnout or benefited Democrats. Using new microdata on millions of individual voters and aggregated turnout data across all 50 states, this paper offers a causal analysis of the impact of absentee vote-by-mail during the COVID-19 (coronavirus disease 2019) pandemic. Focusing on natural experiments in Texas and Indiana, we find that 65-year-olds voted at nearly the same rate as 64-year-olds, despite the fact that only 65-year-olds could vote absentee without an excuse. Being just old enough to vote no-excuse absentee did not substantially increase Democratic turnout relative to Republican turnout. Voter interest appeared to be more important in driving turnout across vote modes, neutralizing the electoral impact of Democrats voting by mail at higher rates during the historic pandemic.

Dielectric barrier discharge (DBD) offers an attractive alternative to conventional wet chemical approaches for surface modification of polymer materials while inducing adhesive or wettability properties in small diameter tubes. A DBD plasma apparatus was developed in this work to induce modification to the inner surface of microbore tubing with the capability for continuous treatment. This study investigates the effects of deposited plasma power and treatment time on surface roughness and wettability induced by the DBD system. The developed system successfully demonstrates the ability to generate a broad range of surface roughness, size and density of induced surface features, and contact angles. Additional evidence of mechanical adhesion of poly(lactic-coglycolic acid) to the induced surface features is also observed.

Physical review letters 127(11), 114801 (2021). doi:10.1103/PhysRevLett.127.114801, We propose a scheme to explore regimes of strong-field quantum electrodynamics (SF QED) otherwise unattainable with the currently available laser technology. The scheme relies on relativistic plasma mirrors curved by radiation pressure to boost the intensity of petawatt-class laser pulses by Doppler effect and focus them to extreme field intensities. We show that very clear SF QED signatures could be observed by placing a secondary target where the boosted beam is focused., Published by APS, College Park, Md.

Conserving threatened organisms requires knowledge of the factors impacting their populations. The Eastern monarch butterfly (Danaus plexippus L.) has declined by as much as 80% in the past two decades and conservation biologists are actively seeking to understand and reverse this decline. While it is well known that most monarchs die as eggs and young larvae, few studies have focused on identifying what arthropod taxa contribute to these losses. The aim of our study was to identify previously undocumented predators of immature monarchs in their summer breeding range in the United States. Using no-choice feeding assays augmented with field observations, we evaluated 75 arthropod taxa commonly found on the primary host plant for their propensity to consume immature monarchs. Here we report 36 previously unreported monarch predators, including representatives from 4 new orders (Orthoptera, Dermaptera, Lepidoptera and Opiliones) and 11 taxa (Acrididae, Gryllidae, Tettigoniidae, Forficulidae, Anthocoridae, Geocoridae, Lygaeidae, Miridae, Nabidae, Erebidae and Opilliones). Surprisingly, several putative herbivores were found to readily consume immature monarchs, both in a targeted fashion or incidentally as a result of herbivory. This work expands our understanding of the monarch predator community and highlights the importance of unrecognized predation on insects of conservation concern.

Background: Protocols for HIV care are widely accepted by all international organizations and are proven to reduce mortality and complications from living with HIV. Unfortunately, executing best practice recommendations in Sierra Leone is difficult due to shortages in staff, training, and medications. Methods: From June 2016 to August 2016, we implemented both an HIV guideline-based clinical evaluation protocol and a patient-centered workflow for TB screening and CD4 testing in the HIV clinic at Koidu Government Hospital (KGH) in rural Sierra Leone. The primary outcome of interest was how often this service center resulted in a clinically significant change in the patients’ HIV regimen. Reasons for changing regimen included diagnosis of co-infection with tuberculosis (TB), diagnosis of clinical or presumed immunologic treatment failure of antiretroviral (ART) medications and, need for adherence to weight-based dosing in pediatric patients. Findings: A total of 188 patients with HIV were seen in the clinic; 49 (26%) of these patients had a clinically significant change in their HIV regimen. The most common reason for regimen change was TB co-infection diagnosis in 38 (20%) patients. The other reasons for HIV regimen changes included: eight children whose ART was adjusted to meet appropriate levels for weight-based guidelines, five patients diagnosed with presumed immunologic treatment failure (some also co-infected with tuberculosis), and two patients with a serious side effect to ART. Interpretation: A comprehensive, patient-centric HIV clinic can result in high rates of case detection for tuberculosis and recognition of immunological ART failure. Keywords: HIV, Immunological failure, Co-infection, Quality, Tuberculosis, Africa

Little is known about how home entrances are related to community participation for people with mobility impairments.This investigation explored how the need to navigate steps at the entrance of a home affects the community participation levels of people with mobility impairments.This survey study used pre-measure data collected from three different samples. Participants were adults living independently in the community aged 18-94 years old who self-reported having a mobility impairment. Measures included the Brief Community Engagement Questionnaire to examine potential differential effects on the number of non-discretionary trips people make into the community (e.g., getting groceries, medications) versus the number of discretionary activities (e.g., socializing outside the home) people reported over seven days.People with mobility impairments were less likely to report a stepped entrance than people without MI, but when the entrance they use the most had steps they reported significantly higher exertion to use the entrance. The presence of steps had no effect on non-discretionary trips (p = .74), but was associated with 49% (p .01) fewer discretionary activities reported by people with mobility impairment relative to those without MI.Steps at the home entrance of people with mobility impairment may be an important mediating factor in their level of participation. When researchers and practitioners evaluate interventions that aim to increase community participation of people with mobility impairment, they should control for the presence of steps at their home entrance.

Physics of plasmas 28(2), 023105 (2021). doi:10.1063/5.0028512, The fully electromagnetic particle-in-cell code WarpX is being developed by a team of the U.S. DOE Exascale Computing Project (with additional non-U.S. collaborators on part of the code) to enable the modeling of chains of tens to hundreds of plasma accelerator stages on exascale supercomputers, for future collider designs. The code is combining the latest algorithmic advances (e.g., Lorentz boosted frame and pseudo-spectral Maxwell solvers) with mesh refinement and runs on the latest computer processing unit and graphical processing unit (GPU) architectures. In this paper, we summarize the strategy that was adopted to port WarpX to GPUs, report on the weak parallel scaling of the pseudo-spectral electromagnetic solver, and then present solutions for decreasing the time spent in data exchanges from guard regions between subdomains. In Sec. IV, we demonstrate the simulations of a chain of three consecutive multi-GeV laser-driven plasma accelerator stages., Published by American Institute of Physics, [S.l.]

Parallel computing 108, 102833 (2021). doi:10.1016/j.parco.2021.102833, WarpX is a general purpose electromagnetic particle-in-cell code that was originally designed to run on many-core CPU architectures. We describe the strategy followed to allow WarpX to use the GPU-accelerated nodes on OLCF's Summit supercomputer, a strategy we believe will extend to the upcoming machines Frontier and Aurora. We summarize the challenges encountered, lessons learned, and give current performance results on a series of relevant benchmark problems., Published by North-Holland, Elsevier Science, Amsterdam [u.a.]

Neutrinos drive core-collapse supernovae, launch outflows from neutron star merger accretion disks, and set the ratio of protons to neutrons in ejecta from both systems that generate heavy elements in the universe. Neutrinos of different flavors interact with matter differently, and much recent work has suggested that fast flavor instabilities are likely ubiquitous in both systems, but the final flavor content after the instability saturates has not been well understood. In this work we present particle-in-cell calculations which follow the evolution of all flavors of neutrinos and antineutrinos through saturation and kinematic decoherence. We conduct one-dimensional three-flavor simulations of neutrino quantum kinetics to demonstrate the outcome of this instability in a few example cases. We demonstrate the growth of both axially symmetric and asymmetric modes whose wavelength and growth rate match predictions from linear stability analysis. Finally, we vary the number density, flux magnitude, and flux direction of the neutrinos and antineutrinos and demonstrate that these factors modify both the growth rate and post-saturation neutrino flavor abundances. Weak electron lepton number (ELN) crossings in these simulations produce both slow growth of the instability and little difference between the flavor abundances in the initial and final states. In all of these calculations the same number of neutrinos and antineutrinos change flavor, making the least abundant between them the limiting factor for post-saturation flavor change. Many more simulations and multi-dimensional simulations are needed to fully probe the parameter space of the initial conditions., 15 pages, 10 figures, plus references and appendices. Accepted to PRD

Block-structured adaptive mesh refinement (AMR) provides the basis for the temporal and spatial discretization strategy for a number of ECP applications in the areas of accelerator design, additive manufacturing, astrophysics, combustion, cosmology, multiphase flow, and wind plant modelling. AMReX is a software framework that provides a unified infrastructure with the functionality needed for these and other AMR applications to be able to effectively and efficiently utilize machines from laptops to exascale architectures. AMR reduces the computational cost and memory footprint compared to a uniform mesh while preserving accurate descriptions of different physical processes in complex multi-physics algorithms. AMReX supports algorithms that solve systems of partial differential equations (PDEs) in simple or complex geometries, and those that use particles and/or particle-mesh operations to represent component physical processes. In this paper, we will discuss the core elements of the AMReX framework such as data containers and iterators as well as several specialized operations to meet the needs of the application projects. In addition we will highlight the strategy that the AMReX team is pursuing to achieve highly performant code across a range of accelerator-based architectures for a variety of different applications., 16 pages, 9 figures, submitted to IJHPCA

Background It is important for people with disabilities to be vaccinated against COVID-19 because, as a group, they are at increased risk of severe outcomes. While there are multiple vaccines available to prevent COVID-19, a considerable proportion of Americans report some hesitancy to becoming vaccinated, including people with disabilities. Objective We conducted a study to explore what factors may contribute to COVID-19 vaccination hesitancy among Americans with disabilities. Methods We used Amazon's Mechanical Turk to survey 439 people with disabilities (ages 18+) about their concerns of the COVID-19 disease, vaccines, and hesitancy toward vaccination to learn more about factors that influence vaccination hesitancy. Concerns about vaccines were analyzed as a composite variable representing different dimensions such as: side effects, too new, developed too quickly, influenced by politics, and effectiveness. Results Results from a logistic regression indicate that concern about vaccines was the most significant predictor of hesitancy, even after considering demographic, economic, and geographic factors. Concerns about getting COVID-19, getting tested for COVID-19, trust in experts, education, and being a Democrat were negatively associated with hesitancy. Conclusions These findings indicate that some groups of individuals may be more vaccination hesitant because they are more concerned about vaccine safety than COVID-19 infection. Public health messaging that focuses on the risks of vaccines relative to the risks of COVID-19 might be one strategy to reduce hesitancy and increase vaccination uptake. Messaging should also be tailored to specific disabilities (i.e. physical, mental, sensory), written in plain language, and disseminated in accessible formats.

Numerical solutions to the Vlasov-Poisson system of equations have important applications to both plasma physics and cosmology. In this paper, we present a new Particle-in-Cell (PIC) method for solving this system that is 4th-order accurate in both space and time. Our method is a high-order extension of one presented previously [B. Wang, G. Miller, and P. Colella, SIAM J. Sci. Comput., 33 (2011), pp. 3509--3537]. It treats all of the stages of the standard PIC update - charge deposition, force interpolation, the field solve, and the particle push - with 4th-order accuracy, and includes a 6th-order accurate phase-space remapping step for controlling particle noise. We demonstrate the convergence of our method on a series of one- and two- dimensional electrostatic plasma test problems, comparing its accuracy to that of a 2nd-order method. As expected, the 4th-order method can achieve comparable accuracy to the 2nd-order method with many fewer resolution elements., Comment: 18 pages, 10 figures, submitted to SISC