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Understanding the clinical risk factors for COVID-19 disease severity and outcomes requires a combination of data from electronic health records and patient reports. To facilitate the collection of patient-reported data, as well as accelerate and standardize the collection of data about host factors, we have constructed a COVID-19 survey. This survey is freely available to the scientific community to send electronically for patients to complete online. This patient survey is designed to be comprehensive, yet not overly burdensome, to gather data useful for a range of clinical investigations, and to accommodate a wide variety of implementation settings including at a COVID-19 testing site, at home during infection or after recovery, and/or for individuals while they are hospitalized. A widely adopted standardized survey that can be implemented online with minimal resources can serve as a critical tool for combining and comparing data across studies to improve our understanding of COVID-19 disease.
Introduction: Community Paramedics (CPs) require access to timely blood analysis in the field to guide treatment and transport decisions. Point of care testing (POCT), as opposed to traditional laboratory analysis, may offer a solution, but limited research exists on CP POCT. The objective of this study is to compare the validity of two POCT devices (Abbott i-STAT® and Alere epoc®) and their use by CPs in the community. Methods: In a CP programme responding to 6,000 annual patient care events, a split sample validation of POCT against traditional laboratory analysis for seven analytes (sodium, potassium, chloride, creatinine, hemoglobin, hematocrit, and glucose) was conducted on a consecutive sample of patients. The difference of proportion of discrepant results between POCT and laboratory was compared using a two sample proportion test. Usability was analysed by survey of CP experience, an expert heuristic evaluation of devices, a review of device-logged errors, coded observations of POCT use during quality control testing, and a linear mixed effects model of Systems Usability Scale (SUS) adjusted for CP clinical and POCT experience. Results: Of 1,649 CP calls for service screened for enrollment, 174 had a blood draw, with 108 patient care encounters (62.1%) enrolled from 73 participants. Participants had a mean age of 58.7 years (SD16.3); 49% were female. In 4 of 646 (0.6%) individual comparisons, POCT reported a critical value that the laboratory did not; with no statistically significant difference in the number of discrepant critical values reported with epoc® compared to i-STAT®. There were no instances of the laboratory reporting a critical value when POCT did not. In 88 of 1,046 (8.4%) individual comparisons, the a priori defined acceptable difference between POCT and the laboratory was exceeded; occurring more often in epoc® (10.7%;95%CI:8.1%,13.3%) compared to i-STAT® (6.1%;95%CI:4.1%,8.2%)(p=0.007). Eighteen of 19 CP surveys were returned, with 11/18 (61.1%) preferring i-STAT® over epoc®. The i-STAT® had a higher mean SUS score (higher usability) compared to the epoc® (84.0/100 vs. 59.6/100; p=0.011). Fewer field blood analysis device-logged errors occurred in i-STAT® (7.8%;95%CI:2.9%,12.7%) compared to epoc® (15.5%;95%CI:9.3%,21.7%) although not statistically significant (p=0.063). Conclusion: CP programs can expect valid results from POCT. Usability assessment suggests a preference for i-STAT.
Introduction: Gastroenteritis accounts for 1.7 million emergency department visits by children annually in the United States. We conducted a double-blind trial to determine whether twice daily probiotic administration for 5 days, improves outcomes. Methods: 886 children aged 348 months with gastroenteritis were enrolled in six Canadian pediatric emergency departments. Participants were randomly assigned to twice daily Lactobacillus rhamnosus R0011 and Lactobacillus helveticus R0052, 4.0 x 109 CFU, in a 95:5 ratio or placebo. Primary outcome was development of moderate-severe disease within 14 days of randomization defined by a Modified Vesikari Scale score 9. Secondary outcomes included duration of diarrhea and vomiting, subsequent physician visits and adverse events. Results: Moderate-severe disease occurred in 108 (26.1%) participants administered probiotics and 102 (24.7%) participants allocated to placebo (OR 1.06; 95%CI: 0.77, 1.46; P=0.72). After adjustment for site, age, and frequency of vomiting and diarrhea, treatment assignment did not predict moderate-severe disease (OR, 1.11, 95%CI, 0.80 to 1.56; P=0.53). In the probiotic versus placebo groups, there were no differences in the median duration of diarrhea [52.5 (18.3, 95.8) vs. 55.5 (20.2, 102.3) hours; P=0.31], vomiting [17.7 (0, 58.6) vs. 18.7 (0, 51.6) hours; P=0.18], physician visits (30.2% vs. 26.6%; OR 1.19; 95% CI0.87. 1.62; P=0.27), or adverse events (32.9% vs. 36.8%; OR 0.83; 95%CI 0.62. 1.11; P=0.21). Conclusion: In children presenting to an emergency department with gastroenteritis, twice daily administration of 4.0 x 109 CFU of a Lactobacillus rhamnosus/helveticus probiotic does not prevent development of moderate-severe disease or improvements in other outcomes measured.
In an attempt to distill what we know about the effects of workplace mindfulness-based training, Hyland, Lee, and Mills (2015) cast a wide net with regard to the array of studies included in their review. For example, they include studies that investigate the benefits associated with workplace mindfulness training (e.g., Wolever et al., 2012) as well as training conducted for patients within primary care settings (e.g., Allen, Bromley, Kuyken, & Sonnenberg, 2009). In addition, their review includes studies based on self-reports of individual differences in mindfulness traits/skills (e.g., Hafenbrack, Kinias, & Barsade, 2014). Reviewing a broad cross-section of research is helpful to illustrate the wide-ranging nature of mindfulness research but also has the potential to obfuscate what we know about mindfulness as it pertains to workers and workplaces.
Depression and diabetes commonly co-occur; however, the strength of the physiological effects of diabetes as mediating factors towards depression is uncertain.
We analyzed extensive clinical, epidemiological and laboratory data from n = 2081 Mexican Americans aged 35–64 years, recruited from the community as part of the Cameron County Hispanic Cohort (CCHC) divided into three groups: Diagnosed (self-reported) diabetes (DD, n = 335), Undiagnosed diabetes (UD, n = 227) and No diabetes (ND, n = 1519). UD participants denied being diagnosed with diabetes, but on testing met the 2010 American Diabetes Association and World Health Organization definitions of diabetes. Depression was measured using the Center for Epidemiological Studies – Depression (CES-D) scale. Weighted data were analyzed using dimensional and categorical outcomes using univariate and multivariate models.
The DD group had significantly higher CES-D scores than both the ND and UD (p ⩽ 0.001) groups, whereas the ND and UD groups did not significantly differ from each other. The DD subjects were more likely to meet the CES-D cut-off score for depression compared to both the ND and UD groups (p = 0.001), respectively. The UD group was also less likely to meet the cut-off score for depression than the ND group (p = 0.003). Our main findings remained significant in models that controlled for socio-demographic and clinical confounders.
Meeting clinical criteria for diabetes was not sufficient for increased depressive symptoms. Our findings suggest that the ‘knowing that one is ill’ is associated with depressive symptoms in diabetic subjects.
In this note, we revisit the work of Carson and Crespinto examine the effect of different redistricting plans on competitiveness in U.S. House elections. Similar to the previous results, our probit estimates on an expanded dataset that includes redistricting cycles from 1972 to 2012 reveal that commission and court-drawn districts experience more competition on average than those drawn by legislatures. These results provide additional support for the hypothesis that one way to increase the competitiveness of congressional elections is to allow extra-legislative bodies to draw congressional district boundaries.
We carried out an extensive photometric and spectroscopic investigation of the SPB binary, HD 25558 (see Fig. 1 for the time and geographic distribution of the observations). The ~2000 spectra obtained at 13 observatories during 5 observing seasons, the ground-based multi-colour light curves and the photometric data from the MOST satellite revealed that this object is a double-lined spectroscopic binary with a very long orbital period of about 9 years. We determined the physical parameters of the components, and have found that both lie within the SPB instability strip. Accordingly, both components show line-profile variations consistent with stellar pulsations. Altogether, 11 independent frequencies and one harmonic frequency were identified in the data. The observational data do not allow the inference of a reliable orbital solution, thus, disentangling cannot be performed on the spectra. Since the lines of the two components are never completely separated, the analysis is very complicated. Nevertheless, pixel-by-pixel variability analysis of the cross-correlated line profiles was successful, and we were able to attribute all the frequencies to the primary or secondary component. Spectroscopic and photometric mode-identification was also performed for several of these frequencies of both binary components. The spectroscopic mode-identification results suggest that the inclination and rotation of the two components are rather different. While the primary is a slow rotator with ~6 d rotation period, seen at ~60° inclination, the secondary rotates fast with ~1.2 d rotation period, and is seen at ~20° inclination. Our spectropolarimetric measurements revealed that the secondary component has a magnetic field with at least a few hundred Gauss strength, while no magnetic field was detected in the primary.
The detailed analysis and results of this study will be published elsewhere.
The objective of this study is to learn if participants with Parkinson disease (PD), when compared to normal controls, are impaired in making simultaneous but independent right and left hand movements. Participants were tested with Luria's Alternating Hand Postures (AHP) test and modified AHP tests. Twelve PD participants without dementia and twelve matched controls were assessed for their ability to perform the parallel AHP test (both hands remaining in the same coronal plane) and with modifications of this test into swimming (alternative arm extension with finger extension and arm flexion with finger flexion) and reverse swimming (alternative arm extension—finger flexion and arm flexion—finger extension) movements. The participants with PD were significantly impaired when performing the parallel and the reverse swimming movements AHP tests, but not impaired on the swimming movements AHP test. Swimming movements may be phylogenetically and ontogenetically more primitive and not as heavily dependent on frontal-basal ganglia networks; thus performance of swimming movements during the parallel AHP test may decrease this test's sensitivity. (JINS, 2011, 17, 702–708)
Collaboration is used by the US National Security Council as a means to integrate inter-federal government agencies during planning and execution of common goals towards unified, national security. The concept of collaboration has benefits in the healthcare system by building trust, sharing resources, and reducing costs. The current terrorist threats have made collaborative medical training between military and civilian agencies crucial.
This review summarizes the long and rich history of collaboration between civilians and the military in various countries and provides support for the continuation and improvement of collaborative efforts. Through collaboration, advances in the treatment of injuries have been realized, deaths have been reduced, and significant strides in the betterment of the Emergency Medical System have been achieved. This review promotes collaborative medical training between military and civilian medical professionals and provides recommendations for the future based on medical collaboration.
An outbreak of legionellosis associated with a hotel in Sydney, Australia, and the subsequent epidemiological and environmental investigations are described. Four cases of Legionnaires' disease were notified to the Public Health Unit. A cross-sectional study of 184 people who attended a seminar at the hotel was carried out. Serological and questionnaire data were obtained for 152 (83%) of these. Twenty-eight (18%) respondents reported symptoms compatible with legionellosis. Thirty-three subjects (22%) had indirect fluorescent antibody (IFA) titres to Legionella pneumophila serogroup 1 (Lp-1) of 128 or higher. The only site which those with symptoms of legionellosis and IFA titre ≥128 were more likely to have visited than controls was the hotel car park (adjusted odds ratio [OR] 14·7, 95% confidence interval [CI]: 1·8–123·1). Those with symptoms compatible with legionellosis, but whose IFA titres were < 128 were also more likely to have visited the hotel car park (adjusted OR 4·4, 95% CI: 1·5–12·9). Seroprevalence of Lp-1 antibodies was higher in those who attended the seminar than in a population sample of similar age. Findings suggested that the 4 cases represented a small fraction of all those infected, and highlighted difficulties in defining illness caused by Lp-1 and in interpreting serology.
The optical and structural properties of amorphous sputtered films of Ge2Sb2Te5 depend strongly on the preparation conditions. Films grown at higher growth rates exhibit greater local strains as indicated by the slope of the optical absorption in the exponential “band-tail” region, but these films also incorporate smaller densities of oxygen impurities. At slower growth rates the band-tail slopes are sharper (smaller local strains) but there is greater oxygen incorporation. We will discuss several experiments that suggest that the local strain relief in the films grown at slower growth rates is due to a greater ability of the atoms to rearrange on the growing surface and not to increased oxygen incorporation. Small angle x-ray scattering experiments show that the films exhibit small elliptical “voids” with long axes perpendicular to the growing surface. The approximate dimensions of these voids are 3 × 20 nm. These films can be switched optically with little change in surface topography as measured by atomic force microscopy. Electron spin resonance measurements indicate that paramagnetic defects exist in some films but are either absent or below the detection limit (~ 1018 cm-3) in most films. The implications of these results for the switching mechanisms will be discussed.
We used X-ray diffraction (XRD), Raman scattering and photoluminescence (PL) spectroscopy to characterize structural and electronic properties of nc-Si:H films made with different hydrogen dilution ratios and hydrogen dilution profiling with continuously reduced hydrogen dilution during the deposition. The XRD results show that the crystalline volume fraction (fc) is in the range of 60-70% with grain size of 22-26 nm for the nc-Si:H films studied. Comparing the sample made using hydrogen dilution profiling to that with constant hydrogen dilution, the hydrogen dilution profiling promotes the (220) preferential orientation due to a very high hydrogen dilution in the initial growth. The Raman results show that the fc is in the range of 60-90%, depending on the sample and excitation wavelength. For the samples with constant hydrogen dilution, the fc measured by Raman increases along the growth direction. The hydrogen dilution profiling reverses this trend, which affirms that the hydrogen profiling controls the nanocrystalline structure evolution along the growth direction. The PL results show only one peak around 0.8-0.9 eV for the samples made with constant hydrogen dilution, but an additional peak at 1.4 eV appears in the sample made with the hydrogen dilution profiling.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Despite the large body of research concerned with the near wake of a circular cylinder, the far wake, which extends beyond about 100 diameters downstream, is relatively unexplored, especially at low Reynolds numbers. We have recently shown that the structure of the far wake is exquisitely sensitive to free-stream noise, and is precisely dependent on the frequency and scale of the near wake; indeed it is shown that the presence of extremely low-amplitude peaks in the free-stream spectrum, over a remarkably wide range of frequencies, are sufficient to trigger an “oblique wave resonance” in the far wake.
We show, in the upper photograph of Fig. 1, a nonlinear interaction between oblique shedding waves generated from upstream (to the left) and 2–D waves amplified downstream from free-stream disturbances (in the central region). We use the “smoke-wire” technique (placed 50 diameters down-stream), and the wake is viewed in planview, with flow to the right. This two-wave interaction triggers a third wave, namely an “oblique resonance wave” at a large oblique angle, to grow through nonlinear effects (in the right half of the photograph), in preference to the original two waves. If smoke is introduced 100 diameters downstream, in the lower photograph (under slightly different conditions), then all that is seen is a set of such large-angle oblique resonance waves.
This work is supported by the Office of Naval Research.
Visualization of different transition mechanisms
The sequence of photos in Figs. 1(a)-1(d) illustrates the different types of boundary-layer transitions that occur as a function of Tollmien-Schlichting (T-S) wave amplitude and fetch.
These photographs show the vortex structures that result from the interaction of vortices that are shed from a 2D bluff body and those shed from a slot jet. The slot jet (3 mm x 150 mm) is located in the center of the rectangular face of the bluff body (15 mm x 240 mm). The photographs are positioned so that the velocity of the slot jet increases from left to right. In the first three photographs starting from the left, the velocity of the jet is smaller than the velocity of the flow around the bluff-body. In the fourth picture, the shear layer velocities of the jet and bluff body are nearly equal and a wavy structure is observed. At higher velocities, as noted by the 5th and 6th photographs, the vortex structures from the jet dominate the flow field. This is noted by the change in the direction of rotation of the vortices.
The flow is visualized by the Reactive Mie Scattering (RMS) technique in which Mie scattering is observed from micron size TiO2 particles that are formed by the spontaneous reaction of TiCl4 vapor in the slot jet air with the water in the annulus air. The technique has been shown to be more effective than smoke because it highlights the streamlines where molecular mixing is taking place. The photographs were taken in the 15ns firing of a YAG laser used to form the light sheet.
For an averaged air jet velocity of 18.5 cm/s, the alternating vortex structures shed from the 2D bluff body are evident after about 5 bluff-body widths downstream. As the jet velocity increases, the wake from the bluff body is significantly modified.
Hydrogenated microcrystalline silicon (m c-Si:H) solar cells with different thicknesses were deposited on specular stainless steel substrates and on textured Ag/ZnO back reflectors using RF and modified very high frequency glow discharge at various deposition rates. Raman spectra and X-ray diffraction patterns exhibit a significant increase of microcrystalline volume fraction and in grain size with film thickness. Atomic force microscopy reveals an increase in the size of microstructural features and the surface roughness with increasing thickness. Based on these results, we believe that the increase of the microcrystalline phase with thickness is the main reason for the deterioration of cell performance with the thickness of the intrinsic layer. To overcome this problem, we have developed a procedure of varying the hydrogen dilution ratio during deposition. Using this method, we have been successful in controlling the microstructure evolution and achieved an initial active-area efficiency of 8.4% for a c-Si:H single-junction solar cell, and 13.6% for an a-Si:H/a-SiGe:H/m c-Si:H triple-junction solar cell.