Beyond spatial scalability limitations with a massively parallel method for linear oscillatory problems

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this record.This paper presents, discusses and analyses a massively parallel-in-time solver for linear oscillatory PDEs, which is a key numerical component for evolving weather, ocean, climate and seismic models. The time parallelization in this solver allows us to significantly exceed the computing resources used by parallelization-in-space methods and results in a correspondingly significantly reduced wall-clock time. One of the major difficulties of achieving Exascale performance for weather prediction is that the strong scaling limit – the parallel performance for a fixed problem size with an increasing number of processors – saturates. A main avenue to circumvent this problem is to introduce new numerical techniques that take advantage of time parallelism. In this paper we use a time-parallel approximation that retains the frequency information of oscillatory problems. This approximation is based on (a) reformulating the original problem into a large set of independent terms and (b) solving each of these terms independently of each other which can now be accomplished on a large number of HPC resources. Our results are conducted on up to 3586 cores for problem sizes with the parallelization-in-space scalability limited already on a single node. We gain significant reductions in the time-to-solution of 118.3 for spectral methods and 1503.0 for finite-difference methods with the parallelizationin-time approach. A developed and calibrated performance model gives the scalability limitations a-priory for this new approach and allows us to extrapolate the performance method towards large-scale system. This work has the potential to contribute as a basic building block of parallelization-in-time approaches, with possible major implications in applied areas modelling oscillatory dominated problems.The authors gratefully acknowledge the Gauss Centre for Supercomputing e.V. (www.gauss-centre.eu) for funding this project by providing computing time on the GCS Supercomputer SuperMUC at Leibniz Supercomputing Centre (LRZ, www.lrz. de). We also acknowledge use of Hartree Centre resources in this work on which the early evaluation of the parallelization concepts were done

Determination of Serum Nucleotidase with Cytidine Monophosphate as Substrate. Part II: Improvement of the procedure

Peer Reviewe

Using structured and unstructured data to identify patients’ need for services that address the social determinants of health

Introduction Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. Methods A cross-sectional study described patients in need of SDH services offered by a safety-net hospital’s federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. Results More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. Discussion The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data

Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia

Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study from One FQHC System

Objective: Given the increasing difficulty healthcare providers face in addressing patients’ complex social circumstances and underlying health needs, organizations are considering team-based approaches including case conferences. We sought to document various perspectives on the facilitators and challenges of conducting case conferences in primary care settings. Study Design: Qualitative study using semi-structured telephone interviews Methods: We conducted 22 qualitative interviews with members of case conferencing teams, including physicians, nurses, and social workers from a Federally Qualified Health Clinic, as well as local county public health nurses. Interviews were recorded, transcribed, and reviewed using thematic coding to identify key themes/subthemes. Results: Participants reported perceived benefits to patients, providers, and healthcare organizations including better care, increased inter-professional communication, and shared knowledge. Perceived challenges related to underlying organizational processes and priorities. Perceived facilitators for successful case conferences included generating and maintaining a list of patients to discuss during case conference sessions and team members being prepared to actively participate in addressing tasks and patient needs during each session. Participants offered recommendations for further improving case conferences for patients, providers, and organizations. Conclusions: Case conferences may be a feasible approach to understanding patient’s complex social needs. Participants reported that case conferences may help mitigate the effects of these social issues and that they foster better inter-professional communication and care planning in primary care. The case conference model requires administrative support and organizational resources to be successful. Future research should explore how case conferences fit into a larger population health organizational strategy so that they are resourced commensurately

Specimen dimensions influence the measurement of material properties in tendon fascicles

Stress, strain and modulus are regularly used to characterize material properties of tissue samples. However, when comparing results from different studies it is evident the reported material properties, particularly failure strains, vary hugely. The aim of our study was to characterize how and why specimen length and cross-sectional area (CSA) appear to influence failure stress, strain and modulus in fascicles from two functionally different tendons. Fascicles were dissected from five rat tails and five bovine foot extensors, their diameters determined by a laser micrometer, and loaded to failure at a range of grip-to-grip lengths. Strain to failure significantly decreased with increasing in specimen length in both rat and bovine fascicles, while modulus increased. Specimen length did not influence failure stress in rat tail fascicles, although in bovine fascicles it was significantly lower in the longer 40 mm specimens compared to 5 and 10 mm specimens. The variations in failure strain and modulus with sample length could be predominantly explained by end-effects. However, it was also evident that strain fields along the sample length were highly variable and notably larger towards the ends of the sample than the mid-section even at distances in excess of 5 mm from the gripping points. Failure strain, stress and modulus correlated significantly with CSA at certain specimen lengths. Our findings have implications for the mechanical testing of tendon tissue: while it is not always possible to control for fascicle length and/or CSA, these parameters have to be taken into account when comparing samples of different dimensions