FINANCIAL CONTROL AND VARIABLE AMORTIZATION UNDER UNCERTAINTY: AN APPLICATION TO TEXAS RICE FARMS

Agricultural Finance,

William Edwards Ladd, M.D. (1880-1967): the description of his bands.

In the early 20th century, an established surgical specialty catering to pediatric surgery did not exist, and pediatric surgical ailments were operated on by general surgeons. With his devotion to childhood diseases and his unique thinking in surgical development, William E. Ladd would become a leading figure in America by pioneering the field of pediatric surgery

Helping to Support CPC+ Initiative to Integrate Behavioral Health Within Primary Care: A Team-Based Approach to Improving Depression Management

AIM: The objective of this project is to increase the rate of documented successful treatment of depression for both new and established diagnoses of depression at Jefferson Internal Medicine Associates (JIMA) from 29% to 50% over 12 months.https://jdc.jefferson.edu/patientsafetyposters/1027/thumbnail.jp

Depression, Cognition, & Social Determinants of Health: Assessing Associations in Older African Americans with Diabetes

Social determinants of health have been widely identified as characteristics of one’s social and economic climate that affect one’s health outcomes1. (see Graphic 1) The Alzheimer’s Association indicates that rates of Alzheimer’s disease (AD) and other forms of dementia are two times higher in older African Americans than their white counterparts2. People who have diabetes are also at an increased risk. The prevalence and co-morbidity of depression among older Americans with diabetes (both with and without cognitive impairment) has been well established3. Understanding the effect that social determinants of health have on the onset and progression of dementia and depression in older African American diabetics is important as such an understanding may better inform future health policy and government spending on healthcare intervention(s).https://jdc.jefferson.edu/cwicposters/1038/thumbnail.jp

Determinants of Activity Levels in African Americans With Mild Cognitive Impairment.

Engaging in cognitive, social, and physical activities may prevent cognitive decline. In a sample of older African Americans with mild cognitive impairment (MCI; N=221), we investigated the cross-sectional relationships between activity levels and participants\u27 demographic, clinical, and neuropsychological characteristics. The average age of participants was 75.4 years (SD, 7.0); 177 (80.1%) were women. Participation in cognitive/social activities was positively associated with education, depression, literacy, mobility, instrumental activities of daily living (IADL), verbal learning, and subcomponents of executive function. A linear regression identified IADLs, education, depression, and verbal learning as independent predictors. Participation in physical activities was positively associated with sex, depression, IADLs, and subcomponents of executive function. An ordinal regression identified executive function and depression as independent correlates. These data suggest that unique characteristics are associated with cognitive/social and physical activities in older African Americans with MCI. These characteristics, coupled with low activity levels, may increase the risk of progression from MCI to dementia. Culturally relevant behavioral interventions to reduce cognitive decline in this high-risk population are needed

Long Term Neuroprotective Effects of Human Adipose-Derived Stem Cells in Neonatal Rats Post Hypoxic Ischemic Encephalopathy

Background: Hypoxemic ischemic encephalopathy (HIE) is a major cause of morbidity and mortality in the neonatal population. Recent research has shown human adipose stem cells (hASCs) to have neuroprotective effects in animal models of HIE. This study tested the hypothesis that neurodevelopmental outcomes would be improved using hASC therapy in term neonatal HIE rat model. Methods: Seven day old rats underwent left carotid artery ligation followed by 8% oxygen for 120 minutes, or carotid isolation in shams. Forty-eight hours after surgery half of the rats received hASCs and half normal saline (NS) intravenously. Rota-rod and cylinder tests were used to assess skill learning, balance, coordination, and symmetry of limb use at 2, 4 and 6 weeks of life. Results: HIE rats treated with hASCs traveled further on Rota-rod (p=0.03) when compared to HIE with NS groups. Those in the HIE-hASC group had significant improvement in the usage of the affected limb at week 6 (p=0.03) compared to those with HIE and NS. Rats receiving hASCs post HIE had less cortical atrophy compared to those with HIE and NS. Conclusions: Rats with HIE treated with hASCs showed improvement in long-term neurodevelopmental aspects and decreased cortical atrophy compared to HIE control group

#Team-based approach to sedation management in patients with SARS CoV-2 aka COVID-19 in the medical ICU

The COVID-19 pandemic has led to a proliferation of patients developing ARDS and requiring prolonged supportive care on mechanical ventilation. As a result, patients need elevated levels of sedation, often on multiple agents for a period greater than typically seen in an ICU population. As a result of this high sedation phenomenon, patients are developing higher rates of expected complications including severe constipation, neurocognitive delay, ICU myopathy, poor sedation weaning, and high pain control requirements. These complications lead to an increased rate of mortality in a population that is already very high and decreases the rate of successful extubation and discharge

Jefferson Internal Medicine Associates (JIMA) Patient Triage Initiative

HOW MIGHT WE: Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly? How might we screen patients who are coming to the office for COVID-19 symptoms and exposures

Prevalence of gastrointestinal symptoms in patients with cannabis abuse presenting to the emergency room

Introduction: Cannabis is a common recreational drug among young adults that is used to induce euphoria, promote relaxation and enhance appetite. There is a recognized correlation between cannabis abuse and cyclic episodes of nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome). However, the contribution of such symptoms to emergency room visits and hospital admissions is not known. Methods: A one-year, retrospective study was conducted on patients who presented to the emergency department and were later admitted at Abington Hospital-Jefferson Health with confirmed cannabis use (positive urine drug screen). Aim/Goal: Our primary outcome was to understand the prevalence of gastrointestinal symptoms in this patient population. We also studied other indices including other recreational drug use, the level of care, and comorbid psychological illnesses. Results: A total of 100 patients were included in the study, 60% were male, 30.3% were admitted with a primary diagnosis of gastrointestinal symptoms (e.g., nausea, vomiting and abdominal pain or cannabinoid hyperemesis), 26.3% with neurological symptoms (i.e., altered mental status, loss of consciousness (LOC) and/or seizures), 23.2% with trauma (i.e., fall or car accident), and 6.1% with cardiac issues. 34% of our patients had no past medical history. Over 50% had at least one psychiatric illness and 38.7% were taking at least one or more antipsychotic medications. Subgroup analysis of our population admitted with GI symptoms (n=30) revealed 47% males, 36% active smokers (vs 34% in total population), 33% admit to alcohol use (vs 40% in total), 10% positive for opiates (vs 18% in total), 6.7% positive for cocaine (vs 8% in total), and 16% are on prescribed narcotics (vs 20.2% total). 27 % of these patients were placed on GMF with tele or higher level of care such as MICU, SICU, or PCU (vs 51% total) and 13.3% received echocardiogram (vs 21.2% total). Interesting results were observed when stratifying patients based on age and type of controlled substance abuse. Marijuana, opiates, and benzodiazepines or barbiturates users were more prevalent in patients 27-36 yrs. of age, with 30%, 33%, and 50%, respectively. While, cocaine, hallucinogens, and amphetamines or methamphetamines users were more prevalent in those aged 26 yrs. or younger, with 37.5%, 100%, and 66%, respectively. Conclusion: GI symptoms represent an important presenting feature in patients with cannabis abuse likely more than any other presenting features. However, patients with predominant GI symptoms might require lower level of care and less cardiac workup. Additional studies are required to elucidate the significance of GI symptoms in this population of patients further

Cascading CMOS-Based Chaotic Maps for Improved Performance and Its Application in Efficient RNG Design

We present a general framework for improving the chaotic properties of CMOS-based chaotic maps by cascading multiple maps in series. Along with two novel chaotic map topologies, we present the 45 $nm$ designs for four CMOS-based discrete-time chaotic map topologies. With the help of the bifurcation plot and three established entropy measures, namely, Lyapunov exponent, Kolmogorov entropy, and correlation coefficient, we present an extensive chaotic performance analysis on eight unique map circuits (two under each topology) to show that under certain constraints, the cascading scheme can significantly elevate the chaotic performance. The improved chaotic entropy benefits many security applications and is demonstrated using a novel random number generator (RNG) design. Unlike conventional mathematical chaotic map-based digital pseudo-random number generators (PRNG), this proposed design is not completely deterministic due to the high susceptibility of the core analog circuit to inevitable noise that renders this design closer to a true random number generator (TRNG). By leveraging the improved chaotic performance of the transistor-level cascaded maps, significantly low area and power overhead are achieved in the RNG design. The cryptographic applicability of the RNG is verified as the generated random sequences pass four standard statistical tests namely, NIST, FIPS, Diehard, and TestU01