Weakly Enforced Boundary Conditions for the NURBS-Based Finite Cell Method

In this paper, we present a variationally consistent formulation for the weak enforcement of essential boundary conditions as an extension to the finite cell method, a fictitious domain method of higher order. The absence of boundary fitted elements in fictitious domain or immersed boundary methods significantly restricts a strong enforcement of essential boundary conditions to models where the boundary of the solution domain coincides with the embedding analysis domain. Penalty methods and Lagrange multiplier methods are adequate means to overcome this limitation but often suffer from various drawbacks with severe consequences for a stable and accurate solution of the governing system of equations. In this contribution, we follow the idea of NITSCHE [29] who developed a stable scheme for the solution of the Laplace problem taking weak boundary conditions into account. An extension to problems from linear elasticity shows an appropriate behavior with regard to numerical stability, accuracy and an adequate convergence behavior. NURBS are chosen as a high-order approximation basis to benefit from their smoothness and flexibility in the process of uniform model refinement

Acoustic observations of vertical and horizontal swimming velocities of a diel migrator

A strong sound scattering layer which underwent diel vertical migration was observed over 176 days using a bottom-mounted 600 kHz ADCP at a depth of approximately 285 m on the upper continental slope. Average observed descent times of the scatterers were within 12 minutes of sunrise and average ascent times were within 13 minutes of sunset. Average ascent speeds progressively increased away from the bed and approached 6 cm/s. Average descent speeds similarly reached a maximum of ∼6 cm/s. Horizontal velocities of the scatterers during vertical migration were found to be smaller than ambient velocities (by up to 3 cm/s), and it is inferred that the migrators were swimming horizontally against the flow. Horizontal velocities of the scatterers during time intervals when the layer was near the seafloor were found to be southwest (up to 3 cm/s), and onshelf (up to 1.7 cm/s) relative to the flow above the layer. Swimming velocities were independent of alongshelf flow direction, counter to the hypothesis that the scatterers sought to maintain their position by swimming against the flow

Ambient Air Pollution, Social Inequalities and Asthma Exacerbation in Greater Strasbourg (France) Metropolitan Area: the PAISA Study

International audienceThe socio-economic status (SES) of populations has an influence on the incidence or mortality rates of numerous health outcomes, among which respiratory diseases (Prescott et al., 2003; Ellison-Loschmann et al., 2007). Considering asthma, the possible contribution of SES to overall prevalence –regardless of asthma severity-, remains controversial in industrialized countries. Several studies indicate that allergic asthma is more prevalent in more well-off populations whereas the non-allergic forms of asthma are more common in the deprived ones (Cesaroni et al., 2003; Blanc et al., 2006). On the other hand, severe asthma whatever its etiology appears to be more frequent in the latter populations, as compared to the more affluent (Basagana et al., 2004). Risk factors for exacerbations (e.g., passive smoking (Wright Subramanian, 2007), psychosocial stress (Gold & Wright, 2005), cockroach allergens (Kitch et al., 2000), and suboptimal compliance with anti-inflammatory medication (Gottlieb et al., 1995)) are generally more common among people with asthma and low SES than their better-off counterparts. These observations support the hypothesis that some factors more present in deprived populations contribute to asthma exacerbation (Mielck et al., 1996)

The association of health literacy with adherence in older 2 adults, and its role in interventions: a systematic meta-review

Background: Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this older age group with low health literacy was also explored. Methods: Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results: Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions: Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions

Safety, Clinical Outcome, and Fracture Rate of Femoropopliteal Stenting Using a 4F Compatible Delivery System.

OBJECTIVE: To determine the safety, clinical outcome, and fracture rate of femoropopliteal interventions using 4F stents. METHODS: Between January 2010 and December 2011, 112 symptomatic patients were treated by stent implantation. Ten patients were lost to follow up; therefore, 102 patients (62 men; mean age 66.4 +/- 10.1 years) were retrospectively analyzed. The indication for femoropopliteal revascularization was severe claudication (Rutherford-Becker score = 3) in 63 (62%) patients and chronic critical limb ischemia (Rutherford-Becker score = 4-6) in 39 (38%). Follow up included palpation of peripheral pulses and measurement of ankle brachial index. In patients with suspected in-stent restenosis duplex ultrasonography was performed. In 2013, patients were asked to return for a fluoroscopic examination of the stents. RESULTS: 114 lesions (Trans-Atlantic InterSociety Consensus-C and D, n = 45) were treated with 119 stents (Astron Pulsar, n = 42; Pulsar-18, n = 77). Lesions were long (>/=100 mm) in 49 cases and heavily calcified in 35. Stents were long (>/=120 mm) in 46 cases. Ten stents were partially overlapped. The technical and clinical success rates were 100%. Two puncture related complications were noted, neither of which required surgical repair. Eleven patients died (myocardial infarction, n = 4; stroke, n = 2; cancer, n = 5) and nine patients underwent major amputation (above knee, n = 4). The primary patency rate was 83% at 6 months and 80% at 12 months. The primary assisted patency rate was 97% at 6 months and 94% at 12 months. The secondary patency rate was 86% at 6 months and 85% at 12 months. The prevalence of fractures was 26% (type III and IV, 10%) after an average follow up of 25 months. CONCLUSION: Femoropopliteal stenting using a 4F compatible delivery system can be accomplished with a low complication rate, acceptable fracture rate, and with similar 12 month patency and revascularization rates as their 6F counterparts

Robust Poisson Surface Reconstruction

Abstract. We propose a method to reconstruct surfaces from oriented point clouds with non-uniform sampling and noise by formulating the problem as a convex minimization that reconstructs the indicator func-tion of the surface’s interior. Compared to previous models, our recon-struction is robust to noise and outliers because it substitutes the least-squares fidelity term by a robust Huber penalty; this allows to recover sharp corners and avoids the shrinking bias of least squares. We choose an implicit parametrization to reconstruct surfaces of unknown topology and close large gaps in the point cloud. For an efficient representation, we approximate the implicit function by a hierarchy of locally supported basis elements adapted to the geometry of the surface. Unlike ad-hoc bases over an octree, our hierarchical B-splines from isogeometric analysis locally adapt the mesh and degree of the splines during reconstruction. The hi-erarchical structure of the basis speeds-up the minimization and efficiently represents clustered data. We also advocate for convex optimization, in-stead isogeometric finite-element techniques, to efficiently solve the min-imization and allow for non-differentiable functionals. Experiments show state-of-the-art performance within a more flexible framework.

Hablamos Juntos (Together We Speak): Interpreters, Provider Communication, and Satisfaction with Care

The Hablamos Juntos—Together We Speak (HJ)—national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. To investigate how access to interpreters for adult Spanish-speaking Latinos is associated with ratings of doctor/office staff communication and satisfaction with care. Cross-sectional cohort study. A total of 1,590 Spanish-speaking Latino adults from eight sites across the United States who participated in the outpatient HJ evaluation. We analyzed two multi-item measures of doctor communication (4 items) and office staff helpfulness (2 items), and one global item of satisfaction with care by interpreter use. We performed regression analyses to control for patient sociodemographic characteristics, survey year, and clustering at the site of care. Ninety-five percent of participants were born outside the US, 81% were females, and survey response rates ranged from 45% to 85% across sites. In this cohort of Spanish-speaking patients, those who needed and always used interpreters reported better experiences with care than their counterparts who needed but had interpreters unavailable. Patients who always used an interpreter had better adjusted ratings of doctor communication [effect size (ES = 0.51)], office staff helpfulness (ES = 0.37), and satisfaction with care (ES = 0.37) than patients who needed but did not always use an interpreter. Patients who needed and always used interpreters also reported better experiences with care in all three domains measured [doctor communication (ES = 0.30), office staff helpfulness (ES = 0.21), and satisfaction with care (ES = 0.23)] than patients who did not need interpreters. Among adult Spanish-speaking Latinos, interpreter use is independently associated with higher satisfaction with doctor communication, office staff helpfulness, and ambulatory care. Increased attention to the need for effective interpreter services is warranted in areas with rapidly growing Spanish-speaking populations

Extensive genetic diversity, unique population structure and evidence of genetic exchange in the sexually transmitted parasite <i>Trichomonas vaginalis</i>

Background Trichomonas vaginalis is the causative agent of human trichomoniasis, the most common non-viral sexually transmitted infection world-wide. Despite its prevalence, little is known about the genetic diversity and population structure of this haploid parasite due to the lack of appropriate tools. The development of a panel of microsatellite makers and SNPs from mining the parasite's genome sequence has paved the way to a global analysis of the genetic structure of the pathogen and association with clinical phenotypes. Methodology/Principal Findings Here we utilize a panel of T. vaginalis-specific genetic markers to genotype 235 isolates from Mexico, Chile, India, Australia, Papua New Guinea, Italy, Africa and the United States, including 19 clinical isolates recently collected from 270 women attending New York City sexually transmitted disease clinics. Using population genetic analysis, we show that T. vaginalis is a genetically diverse parasite with a unique population structure consisting of two types present in equal proportions world-wide. Parasites belonging to the two types (type 1 and type 2) differ significantly in the rate at which they harbor the T. vaginalis virus, a dsRNA virus implicated in parasite pathogenesis, and in their sensitivity to the widely-used drug, metronidazole. We also uncover evidence of genetic exchange, indicating a sexual life-cycle of the parasite despite an absence of morphologically-distinct sexual stages. Conclusions/Significance Our study represents the first robust and comprehensive evaluation of global T. vaginalis genetic diversity and population structure. Our identification of a unique two-type structure, and the clinically relevant phenotypes associated with them, provides a new dimension for understanding T. vaginalis pathogenesis. In addition, our demonstration of the possibility of genetic exchange in the parasite has important implications for genetic research and control of the disease

A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial [ISRCTN11535170]

BACKGROUND: Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care. METHODS: We performed a 12-month randomized controlled trial. From November 2001 to April 2003, we enrolled participants aged 30–80, who had heart failure and took furosemide. Intervention patients received education on self-care emphasizing daily weight measurement, diuretic dose self-adjustment, and symptom recognition and response. Picture-based educational materials, a digital scale, and scheduled telephone follow-up were provided to reinforce adherence. Control patients received a generic heart failure brochure and usual care. Primary outcomes were combined hospitalization or death, and heart failure-related quality of life. RESULTS: 123 patients (64 control, 59 intervention) participated; 41% had inadequate literacy. Patients in the intervention group had a lower rate of hospitalization or death (crude incidence rate ratio (IRR) = 0.69; CI 0.4, 1.2; adjusted IRR = 0.53; CI 0.32, 0.89). This difference was larger for patients with low literacy (IRR = 0.39; CI 0.16, 0.91) than for higher literacy (IRR = 0.56; CI 0.3, 1.04), but the interaction was not statistically significant. At 12 months, more patients in the intervention group reported monitoring weights daily (79% vs. 29%, p < 0.0001). After adjusting for baseline demographic and treatment differences, we found no difference in heart failure-related quality of life at 12 months (difference = -2; CI -5, +9). CONCLUSION: A primary care-based heart failure self-management program designed for patients with low literacy reduces the risk of hospitalizations or death