The Evolution of Elderly Telehealth and Health Informatics

Many elderly individuals experience memory loss and often dementia as they age. This causes problems for the elderly due to diminished skills and increase in medical problems and natural decline. The Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Such programs are cost-effective. Long-term care insurance companies are likely to cover these services. Home care and nursing home corporations are following the VHA’s lead. We have recently witnessed significant advances in technology. Internet and mobile applications have opened a new world, providing information and opportunities for individuals to learn more information about illness and at a much faster rate. Smart home technology has evolved. Elderly patients often encounter difficulties using these technologies. Despite the advances in telehealth and telemedicine and the evolution of the technology, many individuals cannot afford the treatment or the technology. These same individuals and families are part of the digital divide, and they have not embraced the new technology. Federal programs have been developed and implemented to help this portion of the population

Elevating zero dimensional global scaling predictions to self-consistent theory-based simulations

We have developed an innovative workflow, STEP-0D, within the OMFIT integrated modelling framework. Through systematic validation against the International Tokamak Physics Activity (ITPA) global H-mode confinement database, we demonstrated that STEP-0D, on average, predicts the energy confinement time with a mean relative error (MRE) of less than 19%. Moreover, this workflow showed promising potential in predicting plasmas for proposed fusion reactors such as ARC, EU-DEMO, and CFETR, indicating moderate H-factors between 0.9 and 1.2. STEP-0D allows theory-based prediction of tokamak scenarios, beginning with zero-dimensional (0D) quantities. The workflow initiates with the PRO-create module, generating physically consistent plasma profiles and equilibrium using the same 0D quantities as the IPB98(y,2) confinement scaling. This sets the starting point for the STEP (Stability, Transport, Equilibrium, and Pedestal) module, which further iterates between theory-based physics models of equilibrium, core transport, and pedestal to yield a self-consistent solution. Given these attributes, STEP-0D not only improves the accuracy of predicting plasma performance but also provides a path towards a novel fusion power plant (FPP) design workflow. When integrated with engineering and costing models within an optimization, this new approach could eliminate the iterative reconciliation between plasma models of varying fidelity. This potential for a more efficient design process underpins STEP-0D's significant contribution to future fusion power plant development.Comment: 12 pages, 13 figures, accepted by Physics of Plasmas 202

Season of Prescribed Fire Determines Grassland Restoration Outcomes After Fire Exclusion and Overgrazing

Fire exclusion and mismanaged grazing are globally important drivers of environmental change in mesic C4 grasslands and savannas. Although interest is growing in prescribed fire for grassland restoration, we have little long-term experimental evidence of the influence of burn season on the recovery of herbaceous plant communities, encroachment by trees and shrubs, and invasion by exotic grasses. We conducted a prescribed fire experiment (seven burns between 2001 and 2019) in historically fire-excluded and overgrazed grasslands of central Texas. Sites were assigned to one of four experimental treatments: summer burns (warm season, lightning season), fall burns (early cool season), winter burns (late cool season), or unburned (fire exclusion). To assess restoration outcomes of the experiment, in 2019, we identified old-growth grasslands to serve as reference sites. Herbaceous-layer plant communities in all experimental sites were compositionally and functionally distinct from old-growth grasslands, with little recovery of perennial C4 grasses and long-lived forbs. Unburned sites were characterized by several species of tree, shrub, and vine; summer sites were characterized by certain C3 grasses and forbs; and fall and winter sites were intermediate in composition to the unburned and summer sites. Despite compositional differences, all treatments had comparable plot-level plant species richness (range 89–95 species/1000 m2). At the local-scale, summer sites (23 species/m2) and old-growth grasslands (20 species/m2) supported greater richness than unburned sites (15 species/m2), but did not differ significantly from fall or winter sites. Among fire treatments, summer and winter burns most consistently produced the vegetation structure of old-growth grasslands (e.g., mean woody canopy cover of 9%). But whereas winter burns promoted the invasive grass Bothriochloa ischaemum by maintaining areas with low canopy cover, summer burns simultaneously limited woody encroachment and controlled B. ischaemum invasion. Our results support a growing body of literature that shows that prescribed fire alone, without the introduction of plant propagules, cannot necessarily restore old-growth grassland community composition. Nonetheless, this long-term experiment demonstrates that prescribed burns implemented in the summer can benefit restoration by preventing woody encroachment while also controlling an invasive grass. We suggest that fire season deserves greater attention in grassland restoration planning and ecological research

Wave-formed sediment ripples: Transient analysis of ripple spectral development

A new method has been developed that models the changes a wave-formed rippled sediment bed undergoes as it is actively evolving between two given equilibrium states due to a change in surface wave conditions. The transient analysis of rippled beds has received very little attention within the literature. Dynamic changes within ripple parameters have implications for the estimation of flow dissipation and sediment transport by changing the bottom roughness height. The method uses the spectral density function of the rippled bed and is based on a series of ripple growth and ripple transition experimental tests. The ripple evolution model was developed from the well-known Logistic Growth Law. Fitting the general solution of the logistic nonlinear differential equation to the experimental data enabled the evolution rate of the bed to be determined for each experimental test. It was concluded that there was no difference between the evolution rate determined from the ripple growth tests and the ripple transition tests. This indicated that the two types of growth are special cases of the same evolution processes, which is adequately modeled by the logistic growth equation. A functional dependence was established between the ripple evolution rate and the Shields parameter. This allows the evolution rate to be estimated from flow and sediment properties. The estimation of the rate at which rippled sediment beds evolve under a variable sea state has the potential to lead to significant improvements to the way ripple transition and hence bottom roughness is approximated in coastal wave models.Joseph P. Davis, David J. Walker, Murray Townsend, Ian R. Youn

Implementation of a Shared Data Repository and Common Data Dictionary for Fetal Alcohol Spectrum Disorders Research

Many previous attempts by fetal alcohol spectrum disorders researchers to compare data across multiple prospective and retrospective human studies have failed due to both structural differences in the collected data as well as difficulty in coming to agreement on the precise meaning of the terminology used to describe the collected data. Although some groups of researchers have an established track record of successfully integrating data, attempts to integrate data more broadly amongst different groups of researchers have generally faltered. Lack of tools to help researchers share and integrate data has also hampered data analysis. This situation has delayed improving diagnosis, intervention, and treatment before and after birth. We worked with various researchers and research programs in the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CI-FASD) to develop a set of common data dictionaries to describe the data to be collected, including definitions of terms and specification of allowable values. The resulting data dictionaries were the basis for creating a central data repository (CI-FASD Central Repository) and software tools to input and query data. Data entry restrictions ensure that only data which conform to the data dictionaries reach the CI-FASD Central Repository. The result is an effective system for centralized and unified management of the data collected and analyzed by the initiative, including a secure, long-term data repository. CI-FASD researchers are able to integrate and analyze data of different types, collected using multiple methods, and collected from multiple populations, and data are retained for future reuse in a secure, robust repository

A preliminary study of genetic factors that influence susceptibility to bovine tuberculosis in the British cattle herd

Associations between specific host genes and susceptibility to Mycobacterial infections such as tuberculosis have been reported in several species. Bovine tuberculosis (bTB) impacts greatly the UK cattle industry, yet genetic predispositions have yet to be identified. We therefore used a candidate gene approach to study 384 cattle of which 160 had reacted positively to an antigenic skin test (‘reactors’). Our approach was unusual in that it used microsatellite markers, embraced high breed diversity and focused particularly on detecting genes showing heterozygote advantage, a mode of action often overlooked in SNP-based studies. A panel of neutral markers was used to control for population substructure and using a general linear model-based approach we were also able to control for age. We found that substructure was surprisingly weak and identified two genomic regions that were strongly associated with reactor status, identified by markers INRA111 and BMS2753. In general the strength of association detected tended to vary depending on whether age was included in the model. At INRA111 a single genotype appears strongly protective with an overall odds ratio of 2.2, the effect being consistent across nine diverse breeds. Our results suggest that breeding strategies could be devised that would appreciably increase genetic resistance of cattle to bTB (strictly, reduce the frequency of incidence of reactors) with implications for the current debate concerning badger-culling

Establishing a marine monitoring programme to assess antibiotic resistance: a case study from the Gulf Cooperation Council (GCC) region

The World Health Organization considers antimicrobial resistance as one of the most pressing global issues which poses a fundamental threat to human health, development, and security. Due to demographic and environmental factors, the marine environment of the Gulf Cooperation Council (GCC) region may be particularly susceptible to the threat of antimicrobial resistance. However, there is currently little information on the presence of AMR in the GCC marine environment to inform the design of appropriate targeted surveillance activities. The objective of this study was to develop, implement and conduct a rapid regional baseline monitoring survey of the presence of AMR in the GCC marine environment, through the analysis of seawater collected from high-risk areas across four GCC states: (Bahrain, Oman, Kuwait, and the United Arab Emirates). 560 Escherichia coli strains were analysed as part of this monitoring programme between December 2018 and May 2019. Multi-drug resistance (resistance to three or more structural classes of antimicrobials) was observed in 32.5% of tested isolates. High levels of reduced susceptibility to ampicillin (29.6%), nalidixic acid (27.9%), tetracycline (27.5%), sulfamethoxazole (22.5%) and trimethoprim (22.5%) were observed. Reduced susceptibility to the high priority critically important antimicrobials: azithromycin (9.3%), ceftazidime (12.7%), cefotaxime (12.7%), ciprofloxacin (44.6%), gentamicin (2.7%) and tigecycline (0.5%), was also noted. A subset of 173 isolates was whole genome sequenced, and high carriage rates of qnrS1 (60/173) and bla CTX-M-15 (45/173) were observed, correlating with reduced susceptibility to the fluoroquinolones and third generation cephalosporins, respectively. This study is important because of the resistance patterns observed, the demonstrated utility in applying genomic-based approaches to routine microbiological monitoring, and the overall establishment of a transnational AMR surveillance framework focussed on coastal and marine environments