Retrospective Review of Fluoroscopic Swallowing Studies and Outcomes at an Academic Health Center

Introduction: Aspiration is often associated with underlying medical conditions and can cause pneumonia or death. Aspiration risk can be assessed via video fluoroscopic swallowing study (VFSS) or barium swallow (BaSw). We aimed to assess the diagnoses and clinical course of patients who were evaluated for potential aspiration through VFSS or BaSw to determine if there is a degree of aspiration that increases the risk of developing pneumonia and/or death. Methods: We conducted a retrospective chart review of 374 patients in TJUH who were evaluated via VFSS or BaSw from January 1 to June 30, 2017. We recorded the degree and contents of aspiration, the underlying diagnoses, and evidence of subsequent pneumonia. We then collected data for any future admissions concerning for pneumonia. Results: Of the 374 patients, 165 had swallowing studies positive for laryngeal penetration or aspiration. Of the 165 patients, 78 patients (47.2%) had evidence of clinical and radiological pneumonia, and 18 of those 78 patients (23.1%) died. We found that 61 of 165 exhibited laryngeal penetration. Of those 61, 23 patients (37.7%) showed clinical and radiological signs of pneumonia, and 7 of the 23 (30.4%) died of aspiration pneumonia. Discussion: The incidence of pneumonia was considerable in persons with an abnormal swallow and the mortality rate was substantial. Minimally abnormal swallows with laryngeal penetration, but no true aspiration, still had serious consequences. While the incidence of pneumonia was lower (37.7%), there was a substanitial mortality rate (30.4%)

Engine inlet distortion in a 9.2 percent scale vectored thrust STOVL model in ground effect

Advanced Short Takeoff/Vertical Landing (STOVL) aircraft which can operate from remote locations, damaged runways, and small air capable ships are being pursued for deployment around the turn of the century. To achieve this goal, NASA Lewis Research Center, McDonnell Douglas Aircraft, and DARPA defined a cooperative program for testing in the NASA Lewis 9- by 15-foot low speed wind tunnel (LSWT) to establish a database for hot gas ingestion, one of the technologies critical to STOVL. Results are presented which show the engine inlet distortions (both temperature and pressure) in a 9.2 percent scale vectored thrust STOVL model in ground effects. Results are shown for the forward nozzle splay angles of 0 degrees, -6 degrees, and 18 degrees. The model support system had 4 degrees of freedom, heated high pressure air for nozzle flow, and a suction system exhaust for inlet flow. The headwind (freestream) velocity was varied from 8 to 23 knots

Survival and recovery modeling of acute kidney injury in critically ill adults

Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I–III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (p-value \u3c 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1–22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14–39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention

Hot gas ingestion characteristics and flow visualization of a vectored thrust STOVL concept

A 9.2 percent scale short takeoff and vertical landing (STOVL) hot gas ingestion model was designed and built by McDonnell Douglas Corporation (MCAIR) and tested in the NASA Lewis Research Center 9- by 15-Foot Low Speed Wind Tunnel (LSWT). Hot gas ingestion, the entrainment of heated engine exhaust into the inlet flow field, is a key development issue for advanced short takeoff and vertical landing aircraft. The Phase 1 test program, conducted by NASA Lewis and McDonnell Douglas Corporation, evaluated the hot ingestion phenomena and control techniques and Phase 2 test program which was conducted by NASA Lewis are both reported. The Phase 2 program was conducted at exhaust nozzles temperatures up to 1460 R and utilized a sheet laser system for flow visualization of the model flow field in and out of ground effects. Hot gas ingestion levels were measured for the several forward nozzle splay configurations and with flow control/lift improvement devices which reduced the hot gas ingestion. The model support system had four degrees of freedom, heated high pressure air for nozzle flow, and a suction system exhaust for inlet flow. The headwind (freestream) velocity for Phase 1 was varied from 8 to 90 kn, with primary data taken in the 8 to 23 kn headwind velocity range. Phase 2 headwind velocity varied from 10 to 23 kn. Results of both Phase 1 and 2 are presented. A description of the model, facility, a new model support system, and a sheet laser illumination system are also provided. Results are presented over a range of main landing gear height (model height) above the ground plane at a 10 kn headwind velocity. The results contain the compressor face pressure and temperature distortions, total pressure recovery, compressor face temperature rise, and the environmental effects of the hot gas. The environmental effects include the ground plane temperature and pressure distributions, model airframe heating, and the location of the ground flow separation. Results from the sheet laser flow visualization test are also shown

Hot gas ingestion testing of an advanced STOVL concept in the NASA Lewis 9- by 15-foot low speed wind tunnel with flow visualization

Advanced Short Takeoff/Vertical Landing (STOVL) aircraft capable of operating from remote sites, damaged runways, and small air capable ships are being pursued for deployment around the turn of the century. To achieve this goal, it is important that the technologies critical to this unique class of aircraft be developed. Recognizing this need, NASA Lewis Research Center, McDonnell Douglas Aircraft, and DARPA defined a cooperative program for testing in the NASA Lewis 9- by 15-Foot Low Speed Wind Tunnel (LSWT) to establish a database for hot gas ingestion, one of the technologies critical to STOVL. Results from a test program are presented along with a discussion of the facility modifications allowing this type of testing at model scale. These modifications to the tunnel include a novel ground plane, an elaborate model support which included 4 degrees of freedom, heated high pressure air for nozzle flow, a suction system exhaust for inlet flow, and tunnel sidewall modifications. Several flow visualization techniques were employed including water mist in the nozzle flows and tufts on the ground plane. Headwind (free-stream) velocity was varied from 8 to 23 knots

Spin tunnelling in mesoscopic systems

We study spin tunnelling in molecular magnets as an instance of a mesoscopic phenomenon, with special emphasis on the molecule Fe8. We show that the tunnel splitting between various pairs of Zeeman levels in this molecule oscillates as a function of applied magnetic field, vanishing completely at special points in the space of magnetic fields, known as diabolical points. This phenomena is explained in terms of two approaches, one based on spin-coherent-state path integrals, and the other on a generalization of the phase integral (or WKB) method to difference equations. Explicit formulas for the diabolical points are obtained for a model Hamiltonian.Comment: 13 pages, 5 figures, uses Pramana style files; conference proceedings articl

ReservoirPy: an Efficient and User-Friendly Library to Design Echo State Networks

International audienceWe present a simple user-friendly library called ReservoirPy based on Python scientific modules. It provides a flexible interface to implement efficient Reservoir Computing (RC) architectures with a particular focus on Echo State Networks (ESN). Advanced features of ReservoirPy allow to improve up to 87.9% of computation time efficiency on a simple laptop compared to basic Python implementation. Overall, we provide tutorials for hyperparameters tuning, offline and online training, fast spectral initialization, parallel and sparse matrix computation on various tasks (MackeyGlass and audio recognition tasks). In particular, we provide graphical tools to easily explore hyperparameters using random search with the help of the hyperopt library

Seedling root architecture and its relationship with seed yield across diverse environments in \u3ci\u3ePhaseolus vulgaris\u3c/i\u3e

Seedling root phenotypes may have important impacts on fitness and are more easily measured than mature root phenotypes. We phenotyped the roots of 577 genotypes of common bean (Phaseolus vulgaris), representing the bulk of the genetic diversity for recent cultivars and landraces in this species. Root architectural phenotypes of seedlings germinated for nine days were compared to root architectural phenotypes in the field as well as seed yield across 51 environments with an array of abiotic stresses including drought, nutrient deficiency, and heat, as well as non-stress conditions. We observed repeatability ranging from 0.52–0.57 for measures of root phenotypes in seedlings, significant variation in root phene states between gene pools and races, relationships between seedling and field phenotypes, and varying correlations between seedling root phenes and seed yield under a variety of environmental conditions. Seed yield was significantly related to seedling basal root number in 22% of environments, seedling adventitious root abundance in 35% of environments, and seedling taproot length in 12% of environments. Cluster analysis grouped genotypes by their aggregated seedling root phenotype, and variation in seed yield among these clusters under non-stress, drought, and low fertility conditions was observed. These results highlight the existence and influence of integrated root phenotypes for adaptation to edaphic stress, and suggest root phenes have value as breeding targets under real-world conditions