Residual blood specimens collected at health facilities may be a source of samples for serosurveys of adults, a population often neglected in community-based serosurveys. Anonymized residual blood specimens were collected from individuals 15 – 49 years of age attending two sub-district hospitals in Palghar District, Maharashtra, from November 2018 to March 2019. Specimens also were collected from women 15 – 49 years of age enrolled in a cross-sectional, community-based serosurvey representative at the district level that was conducted 2 – 7 months after the residual specimen collection. Specimens were tested for IgG antibodies to measles and rubella viruses. Measles and rubella seroprevalence estimates using facility-based specimens were 99% and 92%, respectively, with men having significantly lower rubella seropositivity than women. Age-specific measles and rubella seroprevalence estimates were similar between the two specimen sources. Although measles seropositivity was slightly higher among adults attending the facilities, both facility and community measles seroprevalence estimates were 95% or higher. The similarity in measles and rubella seroprevalence estimates between the community-based and facility serosurveys highlights the potential value of residual specimens to approximate community seroprevalence.

Residual blood specimens provide a sample repository that could be analyzed to estimate and track changes in seroprevalence with fewer resources than household-based surveys. We conducted parallel facility and community-based cross-sectional serological surveys in two districts in India, Kanpur Nagar District, Uttar Pradesh, and Palghar District, Maharashtra, before and after a measles-rubella supplemental immunization activity (MR-SIA) from 2018 to 2019. Anonymized residual specimens from children 9 months to younger than 15 years of age were collected from public and private diagnostic laboratories and public hospitals and tested for IgG antibodies to measles and rubella viruses. Significant increases in seroprevalence were observed following the MR SIA using the facility-based specimens. Younger children whose specimens were tested at a public facility in Kanpur Nagar District had significantly lower rubella seroprevalence prior to the SIA compared to those attending a private hospital, but this difference was not observed following the SIA. Similar increases in rubella seroprevalence were observed in facility-based and community-based serosurveys following the MR SIA, but trends in measles seroprevalence were inconsistent between the two specimen sources. Despite challenges with representativeness and limited metadata, residual specimens can be useful in estimating seroprevalence and assessing trends through facility-based sentinel surveillance.

Our systematic review and meta-analysis of 40 studies (n = 3,905,559) identified gastric acid suppressants, recent hospitalization, antibiotic exposure, and certain comorbidities as independent predictors of healthcare-associated Clostridioides difficile infection (HA-CDI) among adult inpatients. Targeted antibiotic stewardship and judicious use of gastric acid suppressants can reduce the incidence of HA-CDI.

Precise and efficient performance in remote robotic teleoperation relies on intuitive interaction. This requires both accurate control actions and complete perception (vision, haptic, and other sensory feedback) of the remote environment. Especially in immersive remote teleoperation, the complete perception of remote environments in 3D allows operators to gain improved situational awareness. Color and Depth (RGB-D) cameras capture remote environments as dense 3D point clouds for real-time visualization. However, providing enough situational awareness needs fast, high-quality data transmission from acquisition to virtual reality rendering. Unfortunately, dense point-cloud data can suffer from network delays and limits, impacting the teleoperator’s situational awareness. Understanding how the human eye works can help mitigate these challenges. This paper introduces a solution by implementing foveation, mimicking the human eye’s focus by smartly sampling and rendering dense point clouds for an intuitive remote teleoperation interface. This provides high resolution in the user’s central field, which gradually reduces toward the edges. However, this systematic visualization approach in the peripheral vision may benefit or risk losing information and burdening the user’s cognitive load. This work investigates these advantages and drawbacks through an experimental study and describes the overall system, with its software, hardware, and communication framework. This will show significant enhancements in both latency and throughput, surpassing 60% and 40% improvements in both aspects when compared with state-of-the-art research works. A user study reveals that the framework has minimal impact on the user’s visual quality of experience while helping to reduce the error rate significantly. Further, a 50% reduction in task execution time highlights the benefits of the proposed framework in immersive remote telerobotics applications.

The present study investigates streamwise ($\overline {u^2}$) energy-transfer mechanisms in the inner and outer regions of turbulent boundary layers (TBLs). Particular focus is placed on the $\overline {u^2}$ production, its inter-component and wall-normal transport as well as dissipation, all of which become statistically significant in the outer region with increasing friction Reynolds number ($Re_{\tau }$). These properties are analysed using published data sets of zero, weak and moderately strong adverse-pressure-gradient (APG) TBLs across a decade of $Re_{\tau }$, revealing similarity in energy-transfer pathways for all these TBLs. It is found that both the inner and outer peaks of $\overline {u^2}$ are always associated with local maxima in the $\overline {u^2}$ production and its inter-component transport, and the regions below/above each of these peaks are always dominated by wall-ward/away-from-wall transport of $\overline {u^2}$, thereby classifying the $\overline {u^2}$ profiles into four distinct regimes. This classification reveals existence of phenomenologically similar energy-transfer mechanisms in the ‘inner’ and ‘outer’ regions of moderately strong APG TBLs, which meet at an intermediate location coinciding with the minimum in $\overline {u^2}$ profiles. Conditional averaging suggests existence of similar phenomena even in low $Re_{\tau }$ canonical and/or weak APG TBLs, albeit with the outer-region mechanisms weaker than those in the inner region. This explains the absence of their $\overline {u^2}$ outer peak and the dominance of $\overline {u^2}$ wall-normal transport away from the wall, which potentially originates from the inner region. Given that the wall-ward/away-from-wall transport of $\overline {u^2}$ is governed by the $Q_4$(sweeps)/$Q_2$(ejections) quadrants of the Reynolds shear stress, it is argued that the emergence of the $\overline {u^2}$ outer peak corresponds with the statistical dominance of $Q_4$ events in the outer region. Besides unravelling the dynamical significance of $Q_2$ and $Q_4$ events in the outer region of TBLs, the present analysis also proposes new phenomenological arguments for testing on canonical wall-turbulence data at very high $Re_{\tau }$.

We calculate the mean throughput, number of collisions, successes, and idle slots for random tree algorithms with successive interference cancellation. Except for the case of the throughput for the binary tree, all the results are new. We furthermore disprove the claim that only the binary tree maximizes throughput. Our method works with many observables and can be used as a blueprint for further analysis.

In the 1980s, heart transplantation was the first successful treatment for infants born with hypoplastic left heart syndrome. Infants who have required heart transplantation benefit from immunologic “advantages,” including long-term survival free from cardiac allograft vasculopathy. Currently ∼ 90% of children undergoing a heart transplant are reaching their first-year anniversary and the clinical practices of paediatric heart transplantation have dramatically improved. These successes are largely attributed to research sponsored by the Pediatric Heart Transplant Study Group, the International Society of Heart and Lung Transplantation and, more recently, the Non-profits Enduring Hearts and Additional Ventures. Despite these successes, the field is challenged to increase progress to achieve long-term survival into adulthood. The wait-list mortality, especially among infants, is unacceptably high often leading to palliative measures that can increase post-transplant mortality. Cardiac allograft vasculopathy remains a major cause for progressive graft loss of function and sudden death. The relative tolerance seen in immature recipients has not been translated to modifying older recipients’ post-transplant outcomes. The modifiable cause(s) for the increased risks of transplantation in children of different ethnicities and races require definition. Addressing these challenges faces the reality that for-profit research favours funding adult recipients, with ∼ 10-fold greater numbers, and their more modest longevity goals. Advocacy for funding “incentives” such as the Orphan Drug rules in the United States and upholding principles of equity and inclusion are critical to addressing the challenges of paediatric heart transplant recipients worldwide.

The present study tests the efficacy of the well-known viscous drag reduction strategy of imposing spanwise wall oscillations to reduce pressure drag contributions in transitional and fully rough turbulent wall flow. This is achieved by conducting a series of direct numerical simulations of a turbulent flow over two-dimensional (spanwise-aligned) semi-cylindrical rods, placed periodically along the streamwise direction with varying streamwise spacing. Surface oscillations, imposed at fixed viscous-scaled actuation parameters optimum for smooth wall drag reduction, are found to yield substantial drag reduction ($\gtrsim$25 %) for all the rough wall cases, maintained at matched roughness Reynolds numbers. While the total drag reduction is due to a drop in both viscous and pressure drag in the case of transitionally rough flow (i.e. with large inter-rod spacing), it is associated solely with pressure drag reduction for the fully rough cases (i.e. with small inter-rod spacing), with the latter being reported for the first time. The study finds that pressure drag reduction in all cases is caused by the attenuation of the vortex shedding activity in the roughness wake, in response to wall oscillation frequencies that are of the same order as the vortex shedding frequencies. Contrary to speculations in the literature, this study confirms that the mechanism behind pressure drag reduction, achieved via imposition of spanwise oscillations, is independent of the viscous drag reduction. This mechanism is responsible for weakening of the Reynolds stresses and increase in base pressure in the roughness wake, explaining the pressure drag reduction observed by past studies, across varying roughness heights and geometries.

We investigate the role of inter-scale interactions in the high-Reynolds-number skin-friction drag reduction strategy reported by Marusic et al. (Nat. Commun., vol. 12, 2021). The strategy involves imposing relatively low-frequency streamwise travelling waves of spanwise velocity at the wall to actuate the drag generating outer scales. This approach has proven to be more energy efficient than the conventional method of directly targeting the drag producing inner scales, which typically requires actuation at higher frequencies. Notably, it is observed that actuating the outer scales at low frequencies leads to a substantial attenuation of the major drag producing inner scales, suggesting that the actuations affect the nonlinear inner–outer coupling inherently existing in wall-bounded flows. In the present study, we find that increased drag reduction, through imposition of spanwise wall oscillations, is always associated with an increased coupling between the inner and outer scales. This enhanced coupling emerges through manipulation of the phase relationships between these triadically linked scales, with the actuation forcing the entire range of energy-containing scales, from the inner (viscous) to the outer (inertial) scales, to be more in phase. We also find that a similar enhancement of this nonlinear coupling, via manipulation of the inter-scale phase relationships, occurs with increasing Reynolds number for canonical turbulent boundary layers. This indicates improved efficacy of the energy-efficient drag reduction strategy at very high Reynolds numbers, where the energised outer scales are known to more strongly superimpose and modulate the inner scales. Leveraging the inter-scale interactions, therefore, offers a plausible mechanism for achieving energy-efficient drag reduction at high Reynolds numbers.

We present experimental evidence that the superstructures in turbulent boundary layers comprise smaller, geometrically self-similar coherent motions. The evidence comes from identifying and analysing instantaneous superstructures from large-scale particle image velocimetry datasets acquired at high Reynolds numbers, capable of capturing streamwise elongated motions extending up to 12 times the boundary layer thickness. Given the challenge in identifying the constituent motions of the superstructures based on streamwise velocity signatures, a new approach is adopted that analyses the wall-normal velocity fluctuations within these very long motions, which reveals the constituent motions unambiguously. The conditional streamwise energy spectra of the Reynolds shear stress and the wall-normal fluctuations, corresponding exclusively to the superstructure region, are found to exhibit the well-known distance-from-the-wall scaling in the intermediate-scale range. It suggests that geometrically self-similar motions are the constituent motions of these very-large-scale structures. Investigation of the spatial organization of the wall-normal momentum-carrying eddies, within the superstructures, also lends empirical support to the concatenation hypothesis for the formation of these structures. The association between the superstructures and self-similar motions is reaffirmed on comparing the vertical coherence of the Reynolds-shear-stress-carrying motions, by computing conditionally averaged two-point correlations, which are found to match with the mean correlations. The mean vertical coherence of these motions, investigated for the log region across three decades of Reynolds numbers, exhibits a unique distance-from-the-wall scaling invariant with Reynolds number. The findings support modelling of these dynamically significant motions via data-driven coherent structure-based models.

OBJECTIVES/GOALS: The goal of this proposal is to develop a technology that combines calcium imaging via confocal microscopy, and force measurement via monolayer stress microscopy to perform simultaneous quantitative measurements of agonist-induced Ca2+ and mechanical signals in HASMCs. METHODS/STUDY POPULATION: The methods by which second messenger signals and changes in mechanical forces determine specific physiological responses are complex. Recent studies point to the importance of temporal and spatial encoding in determining signal specificity. Hence, approaches that probe both chemical and mechanical signals are needed. We combine hyperspectral imaging for second messenger signal measurements, monolayer stress microscopy for mechanical force measurements, and S8 analysis software for quantifying localized signals. Imaging was performed using an excitation-scanning hyperspectral microscope. Hyperspectral images were unmixed to identify signals from fluorescent labels and microparticles. Images were analyzed to quantify localized force dynamics through monolayer stress microscopy. RESULTS/ANTICIPATED RESULTS: Results indicate that localized and transient cellular signals can be quantified and mapped within cell populations. Importantly, these results establish a method for simultaneous interrogation of cellular signals and mechanical forces that may play synergistic roles in regulating downstream cellular physiology in confluent monolayers. DISCUSSION/SIGNIFICANCE: We will measure the distribution of chemical and mechanical signals within cells, providing insight into the dynamics of cell signaling. Studies will have implication in the understanding of infections, drug delivery in which non-uniform distributions of drugs are a certainty, and in understanding coordinated responses in cellular systems.

Root cause analysis (RCA), imported from high-reliability industries into health two decades ago, is the mandated methodology to investigate adverse events in most health systems. In this analysis, we argue that the validity of RCA in health and in psychiatry must be established, given the impact of these investigations on mental health policy and practice.