Electronic Health Record-Based Surveillance for Community Transmitted COVID-19 in the Emergency Department

Introduction: SARS-CoV-2, a novel coronavirus, manifests as a respiratory syndrome (COVID-19) and is the cause of an ongoing pandemic. The response to COVID-19 in the United States has been hampered by an overall lack of diagnostic testing capacity. To address uncertainty about ongoing levels of SARS-CoV-2 community transmission early in the pandemic, we aimed to develop a surveillance tool using readily available emergency department (ED) operations data extracted from the electronic health record (EHR). This involved optimizing the identification of acute respiratory infection (ARI)-related encounters and then comparing metrics for these encounters before and after the confirmation of SARS-CoV-2 community transmission.Methods: We performed an observational study using operational EHR data from two Midwest EDs with a combined annual census of over 80,000. Data were collected three weeks before and after the first confirmed case of local SARS-CoV-2 community transmission. To optimize capture of ARI cases, we compared various metrics including chief complaint, discharge diagnoses, and ARI-related orders. Operational metrics for ARI cases, including volume, pathogen identification, and illness severity, were compared between the pre- and post-community transmission timeframes using chi-square tests of independence.Results: Compared to our combined definition of ARI, chief complaint, discharge diagnoses, and isolation orders individually identified less than half of the cases. Respiratory pathogen testing was the top performing individual ARI definition but still only identified 72.2% of cases. From the pre to post periods, we observed significant increases in ED volumes due to ARI and ARI cases without identified pathogen.Conclusion: Certain methods for identifying ARI cases in the ED may be inadequate and multiple criteria should be used to optimize capture. In the absence of widely available SARS-CoV-2 testing, operational metrics for ARI-related encounters, especially the proportion of cases involving negative pathogen testing, are useful indicators for active surveillance of potential COVID-19 related ED visits

State Implementation of the AIDS Drug Assistance Programs

Acquired immunodeficiency syndrome (AIDS) drug assistance programs (ADAPs) provide access to medications for people who lack other health coverage. In this article, the authors present the results of a 1997 survey identifying how 48 States implemented ADAPs, focusing on the number of beneficiaries, medical and financial eligibility criteria, the administration of waiting lists, and the coverage of drugs including protease inhibitors. Increased funding for ADAPs is necessary to maintain this important part of the public sector safety net for human immunodeficiency virus (HIV) care

THE UBERCRYPT FRAMEWORK: A NEW APPROACH IN CRYPTOSYSTEMS

This article describes a novel and unique cryptosystem making use of a small set of private security parameters and public initialization values to produce a pseudorandom byte stream with large period. The byte stream can be used as a one-time stream cipher for securing communication between parties and for data archival. The cryptosystem makes use of geometry and number theory to generate a set of large prime integers and then from the primes a column-periodic matrix of bytes from which further calculation produces a pseudorandom, long period byte stream. The cryptosystem is extensible in that additional private user-supplied security parameters can supplement the private geometric security parameters while adding strength in the process. The article discusses the design and operation of the system and lists many potential questions of interest to the community of mathematical and cryptological researchers. Foremost among these questions are determining the most appropriate method for assessing the cryptographic strength of the algorithm and determining any weaknesses in the security of the algorithm

Historical-institutionalist perspectives on the development of the EU budget system

The EU budget has only recently started to feature in theories of European integration. Studies typically adopt a historical-institutionalist framework, exploring notions such as path dependency. They have, however, generally been rather aggregated, or coarse-grained, in their approach. The EU budget has thus been treated as a single entity rather than a series of inter-linked institutions. This paper seeks to address these lacunae by adopting a fine-grained approach. This enables us to emphasize the connections that exist between EU budgetary institutions, in both time and space. We show that the initial set of budgetary institutions was unable, over time, to achieve consistently their treaty-based objectives. In response, rather than reform these institutions at potentially high political cost, additional institutions were layered on top of the extant structures. We thus demonstrate how some EU budgetary institutions have remained unchanged, whilst others have been added or changed over time

Role of Stone-Wales Defects on the Interfacial Interactions Among Graphene, Carbon Nanotubes, and Nylon 6: A First-Principles Study

We investigate computationally the role of Stone-Wales (SW) defects on the interfacial interactions among graphene, carbon nanotubes (CNTs), and Nylon 6 using density functional theory (DFT) and the empirical force-field. Our first-principles DFT calculations were performed using the Quantum ESPRESSO electronic structure code with the highly accurate van der Waals functional (vdW-DF2). Both pristine and SW-defected carbon nanomaterials were investigated. The computed results show that the presence of SW defects on CNTs weakens the CNT-graphene interactions. Our result that CNT-graphene interaction is much stronger than CNT-CNT interaction indicates that graphene would be able to promote the dispersion of CNTs in the polymer matrix. Our results demonstrate that carbon nanomaterials form stable complexes with Nylon 6 and that the van der Waals interactions, as revealed by the electronic charge density difference maps, play a key stabilizing role on the interfacial interactions among graphene, CNTs, and Nylon 6. Using the density of states calculations, we observed that the bandgaps of graphene and CNTs were not significantly modified due to their interactions with Nylon 6. The Young’s moduli of complexes were found to be the averages of the moduli of their individual constituents. Published by AIP Publishing. https://doi.org/10.1063/1.503208

Expanding a Supercomputer Facility Using Modular Data Center Technology

With the expansion of high-end computing resources needed to support NASA's increasing demands for physics-based simulations, the facility housing Pleiades-the agency's largest supercomputer-recently reached its power and cooling capacity. In response, the NASA Advanced Supercomputing Division at Ames Research Center undertook a prototype project that resulted in a new facility based on modular data center technology. The facility, a ~1000 square-foot module on a concrete pad with room for 16-18 compute racks, was completed in fall 2016 and an SGI computer system, named Electra, was deployed there in early 2017. Cooling is performed via an evaporative system built into the module, and preliminary experience shows a Power Usage Effectiveness (PUE) of ~1.03. Electra achieved over a petaflop on the LINPACK benchmark, sufficient to rank number 96 on the November 2016 TOP500 list. The system consists of 1,152 InfiniBand-connected Intel Xeon Broadwell-based nodes. Its users access their files on a facility wide file system shared by all compute assets via Mellanox MetroX InfiniBand extenders, which connect the Electra fabric to Lustre routers InfiniBand fabric over fiber-optic links about 300 meters long. The prototype has exceeded expectations and is serving as a blueprint for future expansions.

The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures.

In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests