Mitigation for University Health Systems and Transfer Trauma: Hurricane Sandy as a Case Study

In the aftermaths of Hurricanes Katrina, Rita, Irene, and Sandy, as well as other natural and technological disasters (wildfires, tornadoes, tsunamis, earthquakes, and terrorist attacks), University health systems have led the way in both continuing to care for inpatients, as well as working to triage those affected by both forecasted and “surprise” events. As a result, medical manpower is stretched thin, and those working in predominately research units within University health systems experience a shift in responsibilities away from credential specific (simply MD or RN) to being “jacks of all trades,” and taking on responsibilities of orderlies, lab techs, emergency technicians, life-flight paramedics, and ICU doctors and nurses. In such a scenario, the most critical patients in the ICU are those who require the most supervision, and who fall prey to the greatest consequences when University health systems (e.g., New York University Health System, Tulane University Hospital, and Louisiana State University Health System) lose power and must move patients to other facilities that can take over responsibilities for providing critical care. This presentation draws upon data from Hurricane Sandy and her impact on New York University’s Health System (which lost power during the storm), and examines the impact of the transfer trauma experienced by patients who must be moved away from a top research hospital to a secondary facility. Given that the greatest ramification of transfer trauma is mortality, I will discuss this risk with regard to the Changes in Health, End-Stage Disease and Symptoms and Signs (CHESS) measures. Further, I will provide recommendations for greater disaster preparedness and mitigation for University Health Systems, so that critical care patients will experience greater health outcomes by being able to remain at these Hospitals without compromised care

Nest -Building Behavior In House Mice (Mus Musculus), A Potential Model Of Obsessive -Compulsive Disorder In Humans

Thesis (Ph.D.) University of Alaska Fairbanks, 2007OCD (obsessive-compulsive disorder) is a chronic and debilitating psychiatric condition characterized by intrusive and persistent thoughts (obsessions) and repetitive behaviors (compulsions) that become ritualistic in an attempt to escape the obsessions. Currently there is a paucity of animal models with robust and spontaneous (non-drug or non-behaviorally induced) compulsive-like behaviors. This study is aimed at validating a novel robust and spontaneous genetic mouse model of OCD. The compulsive-like nest-building behavior in mice selected for high levels of nest-building behavior (BIG) has good face validity, with a behavioral phenotype that resembles hoarding behavior characteristic of OCD. In addition, male and female BIG mice displayed compulsivelike digging behavior relative to mice selected for low levels of nest-building behavior (SMALL), as assessed by the marble-burying test. Both chronic oral fluoxetine and clomipramine treatment reduced compulsive-like nest-building behavior in male BIG mice. Furthermore, chronic oral fluoxetine administration decreased nest-building behavior of BIG mice in a dose-dependent manner, while desipramine, an antidepressant not effective for treating OCD, did not significantly alter this behavior. The administration of fluoxetine did not cause a decrease in general locomotor behavior. These findings suggest that the nest-building phenotype has predictive validity. In addition, chronic oral fluoxetine treatment reduced compulsive-like digging behavior in male and female BIG mice as compared to SMALL mice. Gender effects were also found in treatment response. Clomipramine did not reduce nest-building in female BIG mice in a dose-dependent manner, which is consistent with previous studies. These data are in contrast to previous studies using BIG male mice which had a significant decrease in nest-building behavior with oral clomipramine. These results are consistent with studies on humans, which have found gender differences in the treatment effects of antidepressants. Additional construct validity is implicated by the results of targeted serotonergic lesions of the raphe nuclei in male BIG mice, which reduced repetitive nest-building behavior. More research is necessary to confirm the appropriateness of this model for human OCD; however, this model is promising based on the data that support good face, predictive and construct validity

Building Resilience to Treat Trauma and Improve Social Participation with Youth in Foster Care

Childhood trauma is classified by adverse childhood experiences (ACEs) that caused the trauma. An ACE is a traumatic event that an individual has observed from birth to 18 years old (Atchison & Suarez, 2021). ACEs include but are not limited to physical, sexual, or emotional abuse, and neglect. ACEs also include household dysfunctions such as domestic violence, divorce, incarceration of family, substance abuse, food scarcity, poverty, and the COVID-19 pandemic. Building resilience promotes healthy coping skills, the ability to trust and engage with support systems, and the prevention of retraumatization (Bethell et al., 2017). Trauma and resiliency are invertedly related, as resilience increases, the impacts of trauma decrease. Youth in foster care who engage in resiliency programs will build resiliency programs will build resiliency together to increase outcomes, create support systems, and improve social participation. Purpose: An occupational therapy group program for youth can work to build resiliency in a client-centered manner to prevent retraumatization and increase occupational performance.https://soar.usa.edu/otdcapstonesfall2023/1014/thumbnail.jp

Cervical Cancer Prevention Screening: A Quality Improvement Project to Reduce Variation and Increase Timeliness in Managing and Reporting Abnormal Papanicolaou Smear Results

Cervical cancer is the fifth most common cancer in United States with more than 12,000 women diagnosed each year and more than 4,000 preventable deaths with minorities disproportionally represented. Cervical cancer prevention strategies rarely focus on the management of abnormal screening results. The purpose of this quality improvement project was to standardize the management program for abnormal cervical cancer screening results within an integrated health delivery system serving a large minority community. The Plan-Do-Study-Act model guided a comprehensive program evaluation with process improvement, including the creation of an electronic quality data reporting tool to formalize the work process and a quality control and assurance program with exception reports. The evaluation was completed with data to measure the timeliness of abnormal results outreach and continued clinical management. The data were evaluated over time with run charts. Also, an analysis of the data was done through pre- and post-test comparisons with 2-sample t tests to evaluate abnormal cervical cancer screening management before and after the revisions. Although the project did not show a statistically significant difference in the timeliness of outreach and follow-up of abnormal cervical cancer screening results due to the limited data set, the run charts trended positively for timeliness and consistent data reporting with no missed screening reports. Effective cervical cancer screening includes the accurate and timely management of abnormal results to reduce disparities in cervical cancer deaths. This project contributes to positive social change by responding to the Healthy People 2020 goal to reduce the incidence of cervical cancer deaths through a formal process to insure timely intervention for abnormal results in a largely minority community

Global Superdiffusion of Weak Chaos

A class of kicked rotors is introduced, exhibiting accelerator-mode islands (AIs) and {\em global} superdiffusion for {\em arbitrarily weak} chaos. The corresponding standard maps are shown to be exactly related to generalized web maps taken modulo an ``oblique cylinder''. Then, in a case that the web-map orbit structure is periodic in the phase plane, the AIs are essentially {\em normal} web islands folded back into the cylinder. As a consequence, chaotic orbits sticking around the AI boundary are accelerated {\em only} when they traverse tiny {\em ``acceleration spots''}. This leads to chaotic flights having a quasiregular {\em steplike} structure. The global weak-chaos superdiffusion is thus basically different in nature from the strong-chaos one in the usual standard and web maps.Comment: REVTEX, 4 Figures: fig1.jpg, fig2.ps, fig3.ps, fig4.p

Integrating Smart Ceiling Fans and Communicating Thermostats to Provide Energy-Efficient Comfort

The project goal was to identify and test the integration of smart ceiling fans and communicating thermostats. These highly efficient ceiling fans use as much power as an LED light bulb and have onboard temperature and occupancy sensors for automatic operationbased on space conditions. The Center for the Environment (CBE) at UC Berkeley led the research team including TRC, Association for Energy Affordability (AEA), and Big Ass Fans (BAF). The research team conducted laboratory tests, installed99 ceiling fans and 12 thermostats in four affordable multifamily housing sites in California’s Central Valley, interviewed stakeholders to develop a case study, developed an online design tool and design guide, outlined codes and standards outreach, and published several papers.The project team raised indoor cooling temperature setpoints and used ceiling fans as the first stage of cooling; this sequencing of ceiling fans and air conditioningreducesenergy consumption, especially during peak periods, while providing thermal comfort.The field demonstration resulted in 39% measured compressor energy savings during the April–October cooling seasoncompared to baseline conditions, normalized for floor area. Weather-normalized energy use varied from a 36% increase to 71% savings, withmedian savings of 15%.This variability reflects the diversity in buildings, mechanical systems, prior operation settings, space types, andoccupants’ schedules,preferences, and motivations. All commercial spaces with regular occupancy schedules (and twoof the irregularly-occupied commercial spaces and one of the homes) showed energy savings on an absolute basis before normalizing for warmer intervention temperatures,and 10 of 13 sites showed energy savings on a weather-normalized basis. The ceiling fans provided cooling for one site for months during hot weather when the coolingequipment failed.Occupants reported high satisfaction with the ceiling fans and improved thermal comfort. This technology can apply to new and retrofit residential and commercial buildings

Antiresonance and Localization in Quantum Dynamics

The phenomenon of quantum antiresonance (QAR), i.e., exactly periodic recurrences in quantum dynamics, is studied in a large class of nonintegrable systems, the modulated kicked rotors (MKRs). It is shown that asymptotic exponential localization generally occurs for $\eta$ (a scaled $\hbar$) in the infinitesimal vicinity of QAR points $\eta_0$. The localization length $\xi_0$ is determined from the analytical properties of the kicking potential. This ``QAR-localization" is associated in some cases with an integrable limit of the corresponding classical systems. The MKR dynamical problem is mapped into pseudorandom tight-binding models, exhibiting dynamical localization (DL). By considering exactly-solvable cases, numerical evidence is given that QAR-localization is an excellent approximation to DL sufficiently close to QAR. The transition from QAR-localization to DL in a semiclassical regime, as $\eta$ is varied, is studied. It is shown that this transition takes place via a gradual reduction of the influence of the analyticity of the potential on the analyticity of the eigenstates, as the level of chaos is increased.Comment: To appear in Physical Review E. 51 pre-print pages + 9 postscript figure

Implementing a State‐Adopted High School Health Curriculum: A Case Study

BACKGROUNDThe Michigan Model for Health™ (MMH) is the official health curriculum for the State of Michigan and prevailing policy and practice has encouraged its adoption. Delivering evidence‐based programs such as MMH with fidelity is essential to program effectiveness. Yet, most schools do meet state‐designated fidelity requirements for implementation (delivering 80% or more of the curriculum).METHODSWe collected online survey (N = 20) and in‐person interview (N = 5) data investigating fidelity and factors related to implementation of the MMH curriculum from high school health teachers across high schools in one socioeconomically challenged Michigan county and key stakeholders.RESULTSWe found that 68% of teachers did not meet state‐identified standards of fidelity for curriculum delivery. Our results indicate that factors related to the context and implementation processes (eg, trainings) may be associated with fidelity. Teachers reported barriers to program delivery, including challenges with adapting the curriculum to suit their context, competing priorities, and meeting students’ needs on key issues such as substance use and mental health issues.CONCLUSIONSMultiple factors influence the fidelity of health curriculum delivery in schools serving low‐income students. Investigating these factors guided by implementation science frameworks can inform use of implementation strategies to support and enhance curriculum delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155483/1/josh12892_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155483/2/josh12892.pd

EXCEDE Technology Development III: First Vacuum Tests

This paper is the third in the series on the technology development for the EXCEDE (EXoplanetary Circumstellar Environments and Disk Explorer) mission concept, which in 2011 was selected by NASA's Explorer program for technology development (Category III). EXCEDE is a 0.7m space telescope concept designed to achieve raw contrasts of 1e6 at an inner working angle of 1.2 l/D and 1e7 at 2 l/D and beyond. This will allow it to directly detect and spatially resolve low surface brightness circumstellar debris disks as well as image giant planets as close as in the habitable zones of their host stars. In addition to doing fundamental science on debris disks, EXCEDE will also serve as a technological and scientific precursor for any future exo-Earth imaging mission. EXCEDE uses a Starlight Suppression System (SSS) based on the PIAA coronagraph, enabling aggressive performance. We report on our continuing progress of developing the SSS for EXCEDE, and in particular (a) the reconfiguration of our system into a more flight-like layout, with an upstream deformable mirror and an inverse PIAA system, as well as a LOWFS, and (b) testing this system in a vacuum chamber, including IWA, contrast, and stability performance. The results achieved so far are 2.9e-7 contrast between 1.2-2.0 l/D and 9.7e-8 contrast between 2.0-6.0 l/D in monochromatic light; as well as 1.4e-6 between 2.0-6.0 l/D in a 10% band, all with a PIAA coronagraph operating at an inner working angle of 1.2 l/D. This constitutes better contrast than EXCEDE requirements (in those regions) in monochromatic light, and progress towards requirements in broadband light. Even though this technology development is primarily targeted towards EXCEDE, it is also germane to any exoplanet direct imaging space-based telescopes because of the many challenges common to different coronagraph architectures and mission requirements.Comment: 12 pages, 12 figures, to be published in proceedings of SPIE Astronomical Telescopes + Instrumentation (2014

Universal diffusion near the golden chaos border

We study local diffusion rate $D$ in Chirikov standard map near the critical golden curve. Numerical simulations confirm the predicted exponent $\alpha=5$ for the power law decay of $D$ as approaching the golden curve via principal resonances with period $q_n$ ($D \sim 1/q^{\alpha}_n$). The universal self-similar structure of diffusion between principal resonances is demonstrated and it is shown that resonances of other type play also an important role.Comment: 4 pages Latex, revtex, 3 uuencoded postscript figure