Optimization of inertial micropower generators for human walking motion

Published versio

Evaluating State Flex Program Population Health Activities

The Medicare Rural Hospital Flexibility (Flex) Program funds initiatives to improve the health of rural communities under Program Area 3: Population Health Improvement, in order to build the capacity of Critical Access Hospitals (CAHs) to achieve measurable improvements in the health outcomes of their communities. Th authors provide an overview of the expectations for Program Area 3; summarize State Flex Program (SFP) initiatives under this Program Area; describe promising population health strategies implemented by SFPs; and discusse outcome measurement issues for population health, including providing an example a chain of short, intermediate, and long-term outcome measures for a potential population health activity. Th authors also portray a pathway to connect Flex Program population health efforts to the U.S. Department of Health and Human Services’ Healthy Rural Hometown Initiative (HRHI), a five-year multi-program effort to address the factors driving rural disparities in heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Finally, the brief provides resources for outcome measurement in population health. A companion brief, An Inventory of State Flex Program Population Health Initiatives for Fiscal Years 2019-2023, provides a detailed description of population health initiatives proposed by the 45 SFPs. This brief is available at: https://www.flexmonitoring.org/sites/flexmonitoring.umn.edu/files/media/InventoryofSFPPopHealthActivities_0.pdf For more information, please contact John Gale at [email protected]

An analysis of galaxy cluster mis-centring using cosmological hydrodynamic simulations

The location of a galaxy cluster’s centroid is typically derived from observations of the galactic and/or gas component of the cluster, but these typically deviate from the true centre. This can produce bias when observations are combined to study average cluster properties. Using data from the BAryons and HAloes of MAssive Systems (BAHAMAS) cosmological hydrodynamic simulations, we study this bias in both two and three dimensions for 2000 clusters over the 1013–1015 M⊙ mass range. We quantify and model the offset distributions between observationally motivated centres and the ‘true’ centre of the cluster, which is taken to be the most gravitationally bound particle measured in the simulation. We fit the cumulative distribution function of offsets with an exponential distribution and a Gamma distribution fit well with most of the centroid definitions. The galaxy-based centres can be seen to be divided into a mis-centred group and a well-centred group, with the well-centred group making up about 60 per cent of all the clusters. Gas-based centres are overall less scattered than galaxy-based centres. We also find a cluster-mass dependence of the offset distribution of gas-based centres, with generally larger offsets for smaller mass clusters. We then measure cluster density profiles centred at each choice of the centres and fit them with empirical models. Stacked, mis-centred density profiles fit to the Navarro–Frenk–White dark matter profile and Komatsu–Seljak gas profile show that recovered shape and size parameters can significantly deviate from the true values. For the galaxy-based centres, this can lead to cluster masses being underestimated by up to 10 per cent⁠

Investigation of the influence of process parameters on productivity in the LPBF process for the material Inconel 718

The nickel-based alloy Inconel 718, which is used in aerospace technology, poses a great challenge to conventional machining due to its high strain hardening and toughness. Here, the laser powder bed fusion process (LPBF) offers an alternative with potential savings if sufficiently high productivity can be achieved. Based on the parameter study carried out, starting from the SLM Solutions standard parameters for the manufacturing of components, exposure parameters could be developed to realize manufacturing with 120 μm and 150 μm layer thickness, with almost the same geometric accuracy. For this purpose, the process parameters of laser power, focus diameter, hatch distance and scan speed were varied. The negative defocusing of the laser showed a positive effect on the density of the parts, realizing densities ≥ 99.94 %, with high dimensional stability and good mechanical properties. Considering the reduced manufacturing time of up to 61 %, a significant increase in productivity was achieved.Mechanical Engineerin

Provision of Mental Health Services by Critical Access Hospital-Based Rural Health Clinics

Residents of rural communities face longstanding access barriers to mental health (MH) services due to chronic shortages of specialty MH providers, long travel distances to services, increased likelihood of being uninsured or under-insured, limited choice of providers, and high rates of stigma. As a result, rural residents rely more heavily on primary care providers and local acute care hospitals to meet their MH needs than do urban residents. This reality highlights the importance of integrating primary care and MH services to improve access to needed care in rural communities. Critical Access Hospitals (CAHs) are ideally positioned to help meet rural MH needs as 60 percent manage at least one Rural Health Clinic (RHC). RHCs receive Medicare cost-based reimbursement for a defined package of services including those provided by doctoral-level clinical psychologists (CPs) and licensed clinical social workers (LCSWs). This briefing paper explores the extent to which CAH-based RHCs are employing CPs and/or LCSWs to provide MH services, describes models of MH services implemented by CAH-based RHCs, examines their successes and challenges in doing so, and provides a resource to assist CAH and RHC leaders in developing MH services. It also provides a resource for State Flex Programs to work with CAH-based RHCs in the development of MH services. FMI: John Gale, [email protected]

Engaging Critical Access Hospitals in Addressing Rural Substance Use

Substance use is a significant public health issue in rural communities. Despite this fact, substance use treatment services are limited in rural areas and residents suffer from significant barriers to care. Critical Access Hospitals (CAHs), frequently the hubs of local systems of care, can play an important role in addressing substance use disorders. To develop a coordinated response to community substance use issues, CAHs must identify and prioritize local needs, mobilize local resources and partnerships, build local capacity, and screen for substance use among their patients. These activities provide a foundation upon which CAHs and their community partners can address identified local needs by selecting and implementing initiatives to minimize the onset of substance use and related harms (prevention), treat substance use disorders, and help individuals reclaim their lives (recovery). This brief makes the case for why CAHs should address substance use, provides a framework to support CAHs in doing so, describes examples of substance use activities undertaken by CAHs to substantiate the framework, and identifies resources that can be used by State Flex Programs to support CAHs in addressing this important public and population health problem

Flexible In-Ga-Zn-O based circuits with two and three metal layers: simulation and fabrication study

The quest for high-performance flexible circuits call for scaling of the minimum feature size in Thin-Film Transistors (TFTs). Although reduced channel lengths can guarantee an improvement in the electrical properties of the devices, proper design rules also play a crucial role to minimize parasitics when designing fast circuits. In this letter, systematic Computer-Aided Design (CAD) simulations have guided the fabrication of highperformance flexible operational amplifiers (opamps) and logic circuits based on Indium-Gallium-Zinc-Oxide (IGZO) TFTs. In particular, the performance improvements due to the use of an additional third metal layer for the interconnections has been estimated for the first time. Encouraged by the simulated enhancements resulting by the decreased parasitic resistances and capacitances, both TFTs and circuits have been realized on a free-standing 50μm thick polymide foil using three metal layers. Despite the thicker layer stack, the TFTs have shown mechanical stability down to 5mm bending radii. Moreover, the opamps and the logic circuits have yielded improved electrical performance with respect to the architecture with two metal layers: gainbandwidth- product (GBWP) increased by 16:9%, for the first one, and propagation delay (tpd) decreased by 43%, for the latter one

KiDS+VIKING-450 and DES-Y1 combined:Cosmology with cosmic shear

We present a combined tomographic weak gravitational lensing analysis of the Kilo Degree Survey (KV450) and the Dark Energy Survey (DES-Y1). We homogenize the analysis of these two public cosmic shear datasets by adopting consistent priors and modeling of nonlinear scales, and determine new redshift distributions for DES-Y1 based on deep public spectroscopic surveys. Adopting these revised redshifts results in a $0.8\sigma$ reduction in the DES-inferred value for $S_8$, which decreases to a $0.5\sigma$ reduction when including a systematic redshift calibration error model from mock DES data based on the MICE2 simulation. The combined KV450 + DES-Y1 constraint on $S_8 = 0.762^{+0.025}_{-0.024}$ is in tension with the Planck 2018 constraint from the cosmic microwave background at the level of $2.5\sigma$. This result highlights the importance of developing methods to provide accurate redshift calibration for current and future weak lensing surveys.Comment: 8 pages, 4 figures, new appendix added including a simulated analysis, version accepted for publication by A&A Letters, chains can be found at https://github.com/sjoudaki/kidsde

Factors affecting the disclosure of diabetes by ethnic minority patients: a qualitative study among Surinamese in the Netherlands

<p>Abstract</p> <p>Background</p> <p>Diabetes and related complications are common among ethnic minority groups. Community-based social support interventions are considered promising for improving diabetes self-management. To access such interventions, patients need to disclose their diabetes to others. Research on the disclosure of diabetes in ethnic minority groups is limited. The aim of our study was to explore why diabetes patients from ethnic minority populations either share or do not share their condition with people in their wider social networks.</p> <p>Methods</p> <p>We conducted a qualitative study using semi-structured interviews with 32 Surinamese patients who were being treated for type 2 diabetes by general practitioners in Amsterdam, the Netherlands.</p> <p>Results</p> <p>Most patients disclosed their diabetes only to very close family members. The main factor inhibiting disclosure to people outside this group was the Surinamese cultural custom that talking about disease is taboo, as it may lead to shame, gossip, and social disgrace for the patient and their family. Nevertheless, some patients disclosed their diabetes to people outside their close family circles. Factors motivating this decision were mostly related to a need for facilities or support for diabetes self-management.</p> <p>Conclusions</p> <p>Cultural customs inhibited Surinamese patients in disclosing their diabetes to people outside their very close family circles. This may influence their readiness to participate in community-based diabetes self-management programmes that involve other groups. What these findings highlight is that public health researchers and initiatives must identify and work with factors that influence the disclosure of diabetes if they are to develop community-based diabetes self-management interventions for ethnic minority populations.</p

Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review

<p>Abstract</p> <p>Background</p> <p>In spite of advances in psychotherapy and pharmacotherapy, there are still a significant number of patients with depression and obsessive-compulsive disorder that are not aided by either intervention. Although still in the experimental stage, deep brain stimulation (DBS) offers many advantages over other physically-invasive procedures as a treatment for these psychiatric disorders. The purpose of this study is to systematically review reports on clinical trials of DBS for obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Locations for stimulation, success rates and effects of the stimulation on brain metabolism are noted when available. The first observation of the effects of DBS on OCD and TRD came in the course of using DBS to treat movement disorders. Reports of changes in OCD and depression during such studies are reviewed with particular attention to electrode locations and associated adverse events; although these reports were adventitious observations rather than planned. Subsequent studies have been guided by more precise theories of structures involved in DBS and OICD. This study suggests stimulation sites and prognostic indicators for DBS. We also briefly review tractography, a relatively new procedure that holds great promise for the further development of DBS.</p> <p>Methods</p> <p>Articles were retrieved from MEDLINE via PubMed. Relevant references in retrieved articles were followed up. We included all articles reporting on studies of patients selected for having OCD or TRD. Adequacy of the selected studies was evaluated by the Jadad scale. Evaluation criteria included: number of patients, use of recognized psychiatric rating scales, and use of brain blood flow measurements. Success rates classified as "improved" or "recovered" were recorded. Studies of DBS for movement disorders were included if they reported coincidental relief of depression or reduction in OCD. Most of the studies involved small numbers of subjects so individual studies were reviewed.</p> <p>Results</p> <p>While the number of cases was small, these were extremely treatment-resistant patients. While not everyone responded, about half the patients did show dramatic improvement. Associated adverse events were generally trivial in younger psychiatric patients but often severe in older movement disorder patients. The procedures differed from study to study, and the numbers of patients was usually too small to do meaningful statistics or make valid inferences as to who will respond to treatment.</p> <p>Conclusions</p> <p>DBS is considered a promising technique for OCD and TRD. Outstanding questions about patient selection and electrode placement can probably be resolved by (a) larger studies, (b) genetic studies and (c) imaging studies (MRI, fMRI, PET, and tractography).</p