Embedded Ribbons of Graphene Allotropes: An Extended Defect Perspective

Four fundamental dimer manipulations can be used to produce a variety of localized and extended defect structures in graphene. Two-dimensional templates result in graphene allotropes, here viewed as extended defects, which can exhibit either metallic or semiconducting electrical character. \emph{Embedded allotropic ribbons}--i.e. thin swaths of the new allotropes--can also be created within graphene. We examine these ribbons and find that they maintain the electrical character of their parent allotrope even when only a few atoms in width. Such extended defects may facilitate the construction of monolithic electronic circuitry.Comment: 24 pages, 21 figure

Assessing Variability in End-of-Life Intensity of Care After Out-of-Hospital Cardiac Arrest

Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans per year.1 Many factors affect the outcomes and overall OHCA survival in a community; some of these include an individual’s characteristics such as age, co-morbid conditions, availability of an AED on scene, time to CPR, and the characteristics of the hospital they are treated at.1,2 Directly following resuscitation from cardiac arrest, the individual is at risk of developing numerous problems caused by sequelae of ischemic injury sustained during the arrest. The national average rate of survival to discharge is only 10%.2,3 Many of these factors are modifiable and provide an opportunity to improve outcomes. In our project, we focus on lifesustaining procedures administered by hospitals upon receiving and admitting individuals experiencing OHCA. We used previously validated measures as defined by Barnato et al as “life sustaining end of life (EOL) measures”:4 • Intubation and mechanical ventilation • Tracheostomy • Gastrostomy tube insertion • Hemodialysis • Enteral/parenteral nutrition • CPRhttps://jdc.jefferson.edu/cwicposters/1035/thumbnail.jp

Validation of an ICD code for accurately identifying emergency department patients who suffer an out-of-hospital cardiac arrest.

AIM: International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA. METHODS: Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return of spontaneous circulation (ROSC) were collected. Separately, the EMR was searched for patients who received ICD-9 code 427.5. The kappa coefficient (κ) was calculated, as was the sensitivity and specificity of the code for identifying OHCA. RESULTS: The keyword search identified 1717 patients, of which 385 suffered OHCA and 333 were assigned the code 427.5. The agreement between ICD-9 code and cardiac arrest was excellent (κ = 0.895). The ICD-9 code 427.5 was both specific (99.4%) and sensitive (86.5%). Of the 52 cardiac arrests that were not identified by ICD-9 code, 33% had ROSC before arrival to the ED. When searching independently on ICD-9 code, 347 patients with ICD-9 code 427.5 were found, of which 320 were true arrests. This yielded a positive predictive value of 92% for ICD-9 code 427.5 in predicting OHCA. CONCLUSIONS: ICD-9 code 427.5 is sensitive and specific for identifying ED patients who suffer OHCA with a positive predictive value of 92%

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy\u27s landfall to utilization before the disaster in 2012. RESULTS: In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS: We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks

Mixed methods in land change research: towards integration

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89580/1/j.1475-5661.2011.00482.x.pd

Expression profiling and QTL analysis: a powerful complementary strategy in drug abuse research

Alcoholism is a complex disease exhibiting a multifactorial mode of transmission. To simplify the genetic and phenotypic complexity of the alcoholic phenotype, alcohol-preferring (P) and -non-preferring (NP) rats were developed on the basis of alcohol preference and consumption as an animal model of alcoholism. Total gene expression analysis (TOGA) and quantitative trait loci (QTL) analysis were applied to selectively bred, inbred P and NP rats as complementary studies to identify genetic factors that contribute to alcohol preference and consumption. TOGA analysis was utilized to screen for differential expression in several brain regions involved in the mesocorticolimbic dopamine (DA) system. Genes exhibiting differences in expression were then screened for an association to the alcohol preference phenotype, the quantitative trait of a previously identified QTL. By evaluating differences in gene expression for linkage to a quantitative trait, this combined approach was implemented to identify alpha-synuclein, a candidate gene for alcohol preference

Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.

BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom durationmodel, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration \u3e270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration \u3c6 \u3eh. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification

Constant Size Molecular Descriptors For Use With Machine Learning

A set of molecular descriptors whose length is independent of molecular size is developed for machine learning models that target thermodynamic and electronic properties of molecules. These features are evaluated by monitoring performance of kernel ridge regression models on well-studied data sets of small organic molecules. The features include connectivity counts, which require only the bonding pattern of the molecule, and encoded distances, which summarize distances between both bonded and non-bonded atoms and so require the full molecular geometry. In addition to having constant size, these features summarize information regarding the local environment of atoms and bonds, such that models can take advantage of similarities resulting from the presence of similar chemical fragments across molecules. Combining these two types of features leads to models whose performance is comparable to or better than the current state of the art. The features introduced here have the advantage of leading to models that may be trained on smaller molecules and then used successfully on larger molecules.Comment: 18 pages, 5 figure

The characteristics of billows generated by internal solitary waves

The spatial and temporal development of shear-induced overturning billows associated with breaking internal solitary waves is studied by means of a combined laboratory and numerical investigation. The waves are generated in the laboratory by a lock exchange mechanism and they are simulated numerically via a contour-advective semi-Lagrangian method. The properties of individual billows (maximum height attained, time of collapse, growth rate, speed, wavelength, Thorpe scale) are determined in each case, and the billow interaction processes are studied and classified. For broad flat waves, similar characteristics are seen to those in parallel shear flow, but, for waves not at the conjugate flow limit, billow characteristics are affected by the spatially varying wave-induced shear flow. Wave steepness and wave amplitude are shown to have a crucial influence on determining the type of interaction that occurs between billows and whether billow overturning can be arrested. Examples are given in which billows (i) evolve independently of one another, (ii) pair with one another, (iii) engulf/entrain one another and (iv) fail to completely overturn. It is shown that the vertical extent a billow can attain (and the associated Thorpe scale of the billow) is dependent on wave amplitude but that its value saturates once a given amplitude is reached. It is interesting to note that this amplitude is less than the conjugate flow limit amplitude. The number of billows that form on a wave is shown to be dependent on wavelength; shorter waves support fewer but larger billows than their long-wave counterparts for a given stratification.PostprintPeer reviewe