We present a quasi-incompressible Navier–Stokes–Cahn–Hilliard (q-NSCH) diffuse interface model for two-phase fluid flows with variable physical properties that maintains thermodynamic consistency. Then, we couple the diffuse domain method with this two-phase fluid model – yielding a new q-NSCH-DD model – to simulate the two-phase flows with moving contact lines in complex geometries. The original complex domain is extended to a larger regular domain, usually a cuboid, and the complex domain boundary is replaced by an interfacial region with finite thickness. A phase-field function is introduced to approximate the characteristic function of the original domain of interest. The original fluid model, q-NSCH, is reformulated on the larger domain with additional source terms that approximate the boundary conditions on the solid surface. We show that the q-NSCH-DD system converges to the q-NSCH system asymptotically as the thickness of the diffuse domain interface introduced by the phase-field function shrinks to zero ($\epsilon \rightarrow 0$) with $\mathcal {O}(\epsilon )$. Our analytic results are confirmed numerically by measuring the errors in both $L^{2}$ and $L^{\infty }$ norms. In addition, we show that the q-NSCH-DD system not only allows the contact line to move on curved boundaries, but also makes the fluid–fluid interface intersect the solid object at an angle that is consistent with the prescribed contact angle.

Cysticercosis caused by the metacestode larval stage of Taenia hydatigena formerly referred to as Cysticercus tenuicollis is a disease of veterinary importance that constitutes a significant threat to livestock production worldwide, especially in endemic regions due to condemnation of visceral organs and mortality rate of infected young animals. While the genetic diversity among parasites is found to be potentially useful in many areas of research including molecular diagnostics, epidemiology and control, that of T. hydatigena across the globe remains poorly understood. In this study, analysis of the mitochondrial DNA (mtDNA) of adult worms and larval stages of T. hydatigena isolated from dogs, sheep and a wild boar in China showed that the population structure consists of two major haplogroups with very high nucleotide substitutions involving synonymous and non-synonymous changes. Compared with other cestodes such as Echinococcus spp., the genetic variation observed between the haplogroups is sufficient for the assignment of major haplotype or genotype division as both groups showed a total of 166 point-mutation differences between the 12 mitochondrial protein-coding gene sequences. Preliminary analysis of a nuclear protein-coding gene (pepck) did not reveal any peculiar changes between both groups which suggests that these variants may only differ in their mitochondrial makeup.

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.

Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)

Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).

Background: In an effort to reduce inappropriate testing of hospital-onset Clostridioides difficile infection (HO-CDI), we sequentially implemented 2 strategies: an electronic health record-based clinical decision support tool that alerted ordering physicians about potentially inappropriate testing without a hard stop (intervention period 1), replaced by mandatory infectious diseases attending physician approval for any HO-CDI test order (intervention period 2). We analyzed appropriate HO-CDI testing rates of both intervention periods. Methods: We performed a retrospective study of patients 18 years or older who had an HO-CDI test (performed after hospital day 3) during 3 different periods: baseline (no intervention, September 2014–February 2015), intervention 1 (clinical decision support tool only, April 2015–September 2015), and intervention 2 (ID approval only, December 2017–September 2018). From each of the 3 periods, we randomly selected 150 patients who received HO-CDI testing (450 patients total). We restricted the study to the general medicine, bone marrow transplant, medical intensive care, and neurosurgical intensive care units. We assessed each HO-CDI test for appropriateness (see Table 1 for criteria), and we compared rates of appropriateness using the χ2 test or Kruskall-Wallis test, where appropriate. Results: In our cohort of 450 patients, the median age was 61 years, and the median hospital length of stay was 20 days. The median hospital day that HO-CDI testing was performed differed among the 3 groups: 12 days at baseline, 10 days during intervention 1, and 8.5 days during intervention 2 (P < .001). Appropriateness of HO-CDI testing increased from the baseline with both interventions, but mandatory ID approval was associated with the highest rate of testing appropriateness (Fig. 1). Reasons for inappropriate ordering did not differ among the periods, with <3 documented stools being the most common criterion for inappropriateness. During intervention 2, among the 33 inappropriate tests, 8 (24%) occurred where no approval from an ID attending was recorded. HO-CDI test positivity rates during the 3 time periods were 12%, 11%, and 21%, respectively (P = .03). Conclusions: We found that both the clinical decision support tool and mandatory ID attending physician approval interventions improved appropriateness of HO-CDI testing. Mandatory ID attending physician approval leading to the highest appropriateness rate. Even with mandatory ID attending physician approval, some tests continued to be ordered inappropriately per retrospective chart review; we suspect that this is partly explained by underdocumentation of criteria such as stool frequency. In healthcare settings where appropriateness of HO-CDI testing is not optimal, mandatory ID attending physician approval may provide an option beyond clinical decision-support tools.

Funding: None

Disclosures: None

There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.

The photothermal experiments on the incident light angle dependence are carried out using simulated solar light on thin films of both iron oxides (Fe3O4 and Fe3O4@Cu2-xS) and porphyrin compounds (chlorophyll and chlorophyllin). Fe3O4 and Fe3O4@Cu2-xS are synthesized using various solution methods that produce mono-dispersed nanoparticles on the order of 10 nm. Chlorophyll is extracted from fresh spinach and chlorophyllin sodium copper is a commercial product. These photothermal (PT) materials are dispersed in polymethyl methacrylate (PMMA) solutions and deposited on glass substrates via spin coating that result in clear and transparent thin films. The iron-oxide based thin films show distinctive absorption spectra; Fe3O4 exhibits a strong peak near UV and gradually decreases into the visible and NIR regions; the absorption of Fe3O4@Cu2-xS is similar in the UV region but shows a broad absorption in the NIR region. Both chlorophyll and chlorophyllin are characterized with absorption peaks near UV and NIR showing a “U”-shaped spectrum, ideally required for efficient solar harvest and high transparency in energy-efficient single-pane window applications. Upon coating of the transparent PT films on the window inner surfaces, solar irradiation induces the photothermal effect, consequently raising the film temperature. In this fashion, the thermal loss through the window can be significantly lowered by reducing the temperature difference between the window inner surface and the room interior, based on a new concept of so-called optical thermal insulation (OTI) without any intervention medium, such as air/argon, as required in the glazing technologies. Single-panes are therefore possible to replace double- or triple panes. As OTI is inevitably affected by seasonal and daily sunlight changes, an incident light angle dependence of the photothermal effect is crucial in both thin film and window designs. It is found that the heating curves reach their maxima at small angles of incidence while the photothermal effect is considerably reduced at large angles. This angle dependence is well explained by light reflection by the thin film surface, however, deviated from what is predicted by the Fresnel's law, attributable to non-ideal surfaces of the substrates. The angle dependence data provide an important reference for OTI that window exposure to the sun is greater at winter solstice while that is considerably reduced in the summer. This conclusion indicates much enhanced solar harvesting and heat conversion via optically insulated windows in the winter season, resulting in much lower U-factors.

We investigated human understanding of different network visualizations in a large-scale online experiment. Three types of network visualizations were examined: node-link and two different sorting variants of matrix representations on a representative social network of either 20 or 50 nodes. Understanding of the network was quantified using task time and accuracy metrics on questions that were derived from an established task taxonomy. The sample size in our experiment was more than an order of magnitude larger (N = 600) than in previous research, leading to high statistical power and thus more precise estimation of detailed effects. Specifically, high statistical power allowed us to consider modern interaction capabilities as part of the evaluated visualizations, and to evaluate overall learning rates as well as ambient (implicit) learning. Findings indicate that participant understanding was best for the node-link visualization, with higher accuracy and faster task times than the two matrix visualizations. Analysis of participant learning indicated a large initial difference in task time between the node-link and matrix visualizations, with matrix performance steadily approaching that of the node-link visualization over the course of the experiment. This research is reproducible as the web-based module and results have been made available at: https://osf.io/qct84/.

Although federal regulation of vehicle fuel economy is often seen as environmental policy, over 70% of the estimated benefits of the 2017–2025 federal standards are savings in consumer expenditures on gasoline. Rational-choice economists question the counting of these benefits since studies show that the fuel efficiency of a car is reflected in its price at sale and resale. We contribute to this debate by exploring why most consumers in the United States do not purchase a proven fuel-saving innovation: the hybrid-electric vehicle (HEV). A database of 110 vehicle pairs is assembled where a consumer can choose a hybrid or gasoline version of virtually the same vehicle. Few choose the HEV. A total cost of ownership model is used to estimate payback periods for the price premiums associated with the HEV choice. In a majority of cases, a rational-choice explanation is sufficient to understand consumer disinterest in the HEV. However, in a significant minority of cases, a rational-choice explanation is not readily apparent, even when non-pecuniary attributes (e.g., performance and cargo space) are considered. Future research should examine, from a behavioral economics perspective, why consumers do not choose HEVs when pricing and payback periods appear to be favorable.

Strong strain-mediated magnetoelectric (ME) coupling in magnetic/ferroelectric heterostructures has great potential for different high-frequency multiferroic devices. In this article, we present the most recent progress in integrated multiferroic devices. Integrated magnetic tunable inductors with a wide operation frequency range, integrated nonreciprocal bandpass filters with dual magnetic and electric-field tunability based on magnetostatics surface waves, and novel radio-frequency nanomechanical ME resonators with pico-Tesla sensitivity for direct current magnetic fields are presented. Finally, a new antenna miniaturization mechanism, acoustically actuated nanomechanical ME antennas, which can successfully miniaturize the size by 1–2 orders, is introduced. With the advantages of high magnetic field sensitivity, highest antenna gain among all nanoscale antennas at similar frequency, integrated capability with complementary metal oxide semiconductor technology, and ground-plane immunity from metallic surfaces and the human body, ME antennas have a bright future for biomedical applications, wearable antennas, and the Internet of Things due to their unique and particular properties.