Comparison of Best Management Practice Adoption Between Virginia\u27s Chesapeake Bay Basin and Southern Rivers Watersheds

Producers in two regions of Virginia (Chesapeake Bay basin and Southern Rivers region) were surveyed to compare farming practices and agricultural best management practice (BMP) adoption. Objectives were to assess farming operations and determine the extent of cost-share and non-cost-share BMP implementation and gain insight into the impact of selected socioeconomic factors on the BMP adoption. Although farming characteristics and producer attitudes toward pollution and water quality were similar, BMP implementation differed between the two regions. Differences in BMP implementation may be due to a more focused, longer-term NPS pollution control educational effort in the Bay basin

DeepAngle: Fast calculation of contact angles in tomography images using deep learning

DeepAngle is a machine learning-based method to determine the contact angles of different phases in the tomography images of porous materials. Measurement of angles in 3--D needs to be done within the surface perpendicular to the angle planes, and it could become inaccurate when dealing with the discretized space of the image voxels. A computationally intensive solution is to correlate and vectorize all surfaces using an adaptable grid, and then measure the angles within the desired planes. On the contrary, the present study provides a rapid and low-cost technique powered by deep learning to estimate the interfacial angles directly from images. DeepAngle is tested on both synthetic and realistic images against the direct measurement technique and found to improve the r-squared by 5 to 16% while lowering the computational cost 20 times. This rapid method is especially applicable for processing large tomography data and time-resolved images, which is computationally intensive. The developed code and the dataset are available at an open repository on GitHub (https://www.github.com/ArashRabbani/DeepAngle)

Homebound patients’ perspectives on technology and telemedicine: A qualitative analysis

Telemedicine holds promise in bridging the gap between homebound patients and high quality health care, but uptake of such technology remains limited. Qualitative interviews conducted with 17 homebound patients found two major barriers to telemedicine. First, participants who lack familiarity with technology are hesitant about telemedicine, as baseline use of technology in the home is limited, participants did not feel capable of learning, and the advantages of telemedicine were unclear. Second, homebound patients place a high value on in- office visits due to therapeutic benefit, face-to-face communication, and the social aspect of medical appointments

Insights into non-Fickian solute transport in carbonates

[1] We study and explain the origin of early breakthrough and long tailing plume behavior by simulating solute transport through 3‐D X‐ray images of six different carbonate rock samples, representing geological media with a high degree of pore‐scale complexity. A Stokes solver is employed to compute the flow field, and the particles are then transported along streamlines to represent advection, while the random walk method is used to model diffusion. We compute the propagators (concentration versus displacement) for a range of Peclet numbers (Pe ) and relate it to the velocity distribution obtained directly on the images. There is a very wide distribution of velocity that quantifies the impact of pore structure on transport. In samples with a relatively narrow spread of velocities, transport is characterized by a small immobile concentration peak, representing essentially stagnant portions of the pore space, and a dominant secondary peak of mobile solute moving at approximately the average flow speed. On the other hand, in carbonates with a wider velocity distribution, there is a significant immobile peak concentration and an elongated tail of moving fluid. An increase in Pe , decreasing the relative impact of diffusion, leads to the faster formation of secondary mobile peak(s). This behavior indicates highly anomalous transport. The implications for modeling field‐scale transport are discussed

The impact of porous media heterogeneity on non-Darcy flow behaviour from pore-scale simulation

The effect of pore-scale heterogeneity on non-Darcy flow behaviour is investigated by means of direct flow simulations on 3-D images of a beadpack, Bentheimer sandstone and Estaillades carbonate. The critical Reynolds number indicating the cessation of the creeping Darcy flow regime in Estaillades carbonate is two orders of magnitude smaller than in Bentheimer sandstone, and is three orders of magnitude smaller than in the beadpack. It is inferred from the examination of flow field features that the emergence of steady eddies in pore space of Estaillades at elevated fluid velocities accounts for the early transition away from the Darcy flow regime. The non-Darcy coefficient β, the onset of non-Darcy flow, and the Darcy permeability for all samples are obtained and compared to available experimental data demonstrating the predictive capability of our approach. X-ray imaging along with direct pore-scale simulation of flow provides a viable alternative to experiments and empirical correlations for predicting non-Darcy flow parameters such as the β factor, and the onset of non-Darcy flow

Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis : an international, multidisciplinary Delphi-based consensus

Background Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. Objectives Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. Methods Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. Results Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. Conclusions We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.Peer reviewe

Convex hull approach for determining rock representative elementary volume for multiple petrophysical parameters using pore-scale imaging and Lattice-Boltzmann modelling

In the last decade, the study of fluid flow in porous media has developed considerably due to the combination of X-ray Micro Computed Tomography (micro-CT) and advances in computational methods for solving complex fluid flow equations directly or indirectly on reconstructed three-dimensional pore space images. In this study, we calculate porosity and single phase permeability using micro-CT imaging and Lattice Boltzmann (LB) simulations for 8 different porous media: beadpacks (with bead sizes 50 µm and 350 µm), sandpacks (LV60 and HST95), sandstones (Berea, Clashach and Doddington) and a carbonate (Ketton). Combining the observed porosity and calculated single phase permeability, we shed new light on the existence and size of the Representative Element of Volume (REV) capturing the different scales of heterogeneity from the pore-scale imaging. Our study applies the concept of the ‘Convex Hull’ to calculate the REV by considering the two main macroscopic petrophysical parameters, porosity and single phase permeability, simultaneously. The shape of the hull can be used to identify strong correlation between the parameters or greatly differing convergence rates. To further enhance computational efficiency we note that the area of the convex hull (for well-chosen parameters such as the log of the permeability and the porosity) decays exponentially with sub-sample size so that only a few small simulations are needed to determine the system size needed to calculate the parameters to high accuracy (small convex hull area). Finally we propose using a characteristic length such as the pore size to choose an efficient absolute voxel size for the numerical rock

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN