Keys to academic success for under-represented minority young investigators: recommendations from the Research in Academic Pediatrics Initiative on Diversity (RAPID) National Advisory Committee.

BackgroundAlthough Latinos, African-Americans, and American Indians/Alaska Natives comprise 34% of Americans, these under-represented minorities (URMs) account for only 7% of US medical-school faculty. Even when URMs become faculty, they face many substantial challenges to success. Little has been published, however, on keys to academic success for URM young faculty investigators.MethodsThe Research in Academic Pediatrics Initiative on Diversity (RAPID) goal is to enhance the professional advancement of URM junior faculty pursuing research careers in general academic pediatrics. One important RAPID component is the annual mentoring/career-development conference, which targets URM residents, fellows, and junior faculty, and has included 62 URM participants since its 2013 inception. A conference highlight is the panel discussion on keys to academic success for URM young investigators, conducted by the RAPID National Advisory Committee, a diverse group of leading senior researchers. The article aim was to provide a guide to academic success for URM young investigators using the 2018 RAPID Conference panel discussion. A modified Delphi technique was used to provide a systematic approach to obtaining answers to six key questions using an expert panel: the single most important key to success for URM young investigators; ensuring optimal mentorship; how to respond when patients/families say, "I don't want you to see my child because you are ____"; best strategies for maximizing funding success; how to balance serving on time-consuming committees with enough time to advance research/career objectives; and the single thing you wish someone had told you which would have substantially enhanced your success early on.Results/conclusionsThis is the first published practical guide on keys to academic success for URM young investigators. Identified keys to success included having multiple mentors, writing prolifically, being tenaciously persistent, having mentors who are invested in you, dealing with families who do not want you to care for their child because of your race/ethnicity by seeking to understand the reasons and debriefing with colleagues, seeking non-traditional funding streams, balancing committee work with having enough time to advance one's research and career by using these opportunities to generate scholarly products, and asking for all needed resources when negotiating for new jobs

The Strauss conjecture on asymptotically flat space-times

By assuming a certain localized energy estimate, we prove the existence portion of the Strauss conjecture on asymptotically flat manifolds, possibly exterior to a compact domain, when the spatial dimension is 3 or 4. In particular, this result applies to the 3 and 4-dimensional Schwarzschild and Kerr (with small angular momentum) black hole backgrounds, long range asymptotically Euclidean spaces, and small time-dependent asymptotically flat perturbations of Minkowski space-time. We also permit lower order perturbations of the wave operator. The key estimates are a class of weighted Strichartz estimates, which are used near infinity where the metrics can be viewed as small perturbations of the Minkowski metric, and the assumed localized energy estimate, which is used in the remaining compact set.Comment: Final version, to appear in SIAM Journal on Mathematical Analysis. 17 page

Evaluation of hyperspectral technology for assessing the presence and severity of peripheral artery disease

BackgroundHyperspectral imaging is a novel technology that can noninvasively measure oxyhemoglobin and deoxyhemoglobin concentrations to create an anatomic oxygenation map. It has predicted healing of diabetic foot ulcers; however, its ability to assess peripheral arterial disease (PAD) has not been studied. The aims of this study were to determine if hyperspectral imaging could accurately assess the presence or absence of PAD and accurately predict PAD severity.MethodsThis prospective study included consecutive consenting patients presenting to the vascular laboratory at the Jesse Brown VA Medical Center during a 10-week period for a lower extremity arterial study, including ankle-brachial index (ABI) and Doppler waveforms. Patients with lower extremity edema were excluded. Patients underwent hyperspectral imaging at nine angiosomes on each extremity. Additional sites were imaged when tissue loss was present. Medical records of enrolled patients were reviewed for demographic data, active medications, surgical history, and other information pertinent to PAD. Patients were separated into no-PAD and PAD groups. Differences in hyperspectral values between the groups were evaluated using the two-tailed t test. Analysis for differences in values over varying severities of PAD, as defined by triphasic, biphasic, or monophasic Doppler waveforms, was conducted using one-way analysis of variance. Hyperspectral values were correlated with the ABI using a Pearson bivariate linear correlation test.ResultsThe study enrolled 126 patients (252 limbs). After exclusion of 15 patients, 111 patients were left for analysis, including 46 (92 limbs) no-PAD patients and 65 (130 limbs) PAD patients. Groups differed in age, diabetes, coronary artery disease, congestive heart failure, tobacco use, and insulin use. Deoxyhemoglobin values for the plantar metatarsal, arch, and heel angiosomes were significantly different between patients with and without PAD (P < .005). Mean deoxyhemoglobin values for the same three angiosomes showed significant differences between patients with monophasic, biphasic, and triphasic waveforms (P < .05). In patients with PAD, there was also significant correlation between deoxyhemoglobin values and ABI for the same three angiosomes (P = .001). Oxyhemoglobin values did not predict the presence or absence of PAD, did not correlate with PAD severity, and did not correlate with the ABI.ConclusionsThese results suggest the ability of hyperspectral imaging to detect the presence of PAD. Hyperspectral measurements can also evaluate different severities of PAD

Solid Freeform Fabrication of Composite-Material Objects

Composite solid freeform fabrication (C-SFF) or composite layer manufacturing (CLM) is an automated process in which an advanced composite material (a matrix reinforced with continuous fibers) is formed into a freestanding, possibly complex, three-dimensional object. In CLM, there is no need for molds, dies, or other expensive tooling, and there is usually no need for machining to ensure that the object is formed to the desired net size and shape. CLM is a variant of extrusion-type rapid prototyping, in which a model or prototype of a solid object is built up by controlled extrusion of a polymeric or other material through an orifice that is translated to form patterned layers. The second layer is deposited on top of the first layer, the third layer is deposited on top of the second layer, and so forth, until the stack of layers reaches the desired final thickness and shape. The elements of CLM include (1) preparing a matrix resin in a form in which it will solidify subsequently, (2) mixing the fibers and matrix material to form a continuous pre-impregnated tow (also called "towpreg"), and (3) dispensing the pre-impregnated tow from a nozzle onto a base while moving the nozzle to form the dispensed material into a patterned layer of controlled thickness. When the material deposited into a given layer has solidified, the material for the next layer is deposited and patterned similarly, and so forth, until the desired overall object has been built up as a stack of patterned layers. Preferably, the deposition apparatus is controlled by a computer-aided design (CAD) system. The basic CLM concept can be adapted to the fabrication of parts from a variety of matrix materials. It is conceivable that a CLM apparatus could be placed at a remote location on Earth or in outer space where (1) spare parts are expected to be needed but (2) it would be uneconomical or impractical to store a full inventory of spare parts. A wide variety of towpregs could be prepared and stored on spools until needed. Long-shelf-life towpreg materials suitable for such use could include thermoplastic-coated carbon fibers and metal-coated SiC fibers. When a spare part was needed, the part could be fabricated by CLM under control by a CAD data file; thus, the part could be built automatically, at the scene, within hours or minutes

Eight new MSPs in NGC 6440 and NGC 6441

We report the discovery of five new millisecond pulsars in the globular cluster NGC 6440 and three new ones in NGC 6441; each cluster has one previously known pulsar. Four of the new pulsars are found in binary systems. One of the new pulsars, PSR J1748-2021B in NGC 6440, is notable for its eccentric (e = 0.57) and wide (P_b = 20.5 days) orbit. If the rate of advance of periastron is due solely to general relativity, we can estimate of the total mass of this binary system: 2.92 +/- 0.20 solar masses. This would imply an anomalously large mass for this pulsar, which could introduce important constraints in the study of the equation of state for cold neutron matter.Comment: 3 pages, 3 figures. To appear in the proceedings of "40 Years of Pulsars: Millisecond Pulsars, Magnetars, and More", August 12-17, 2007, McGill University, Montreal, Canad

Association between Insurance Status and Hospital Outcomes among Acute Kidney Failure Patients

Objectives: To investigate the relationship between insurance status and the risk of acute kidney failure (AKF) and consequential hospitalization outcomes. Methods: A cross-sectional regression analysis was conducted for inpatients ages 18-64 in South Carolina 2012–2013. One dichotomous dependent variable - diagnosed with AKF at hospital admission, and two continuous dependent variables of hospital outcomes - total charge and length of stay, were examined. The key explanatory variable was the patient’s insurance status. Other covariates included patient’s age, gender, and race as well as AKF risk factors - Type 2 diabetic mellitus (T2DM), chronic kidney disease (CKD), hypertension, and proteinuria. Results: No insurance was significantly associated with an increased risk of AKF. The odds of having AKF with concurrent CKD diagnosed among the uninsured patients (OR 10.00) is about 1.5 times as high as that among Medicaid (OR 6.40) or private insurance patients (OR 6.91). Patients without insurance coverage incurred lower charges and were discharged earlier than those with Medicaid or private insurance. However, the presence of T2DM reversed this trend. Self-pay AKF patients with T2DM were charged 6% more and stayed in hospital 25% longer than similar patients with Medicaid. Likewise, their charges and hospital stay were 9% more than patients with private insurance. Discussion: Insurance coverage could play a role in determining the risk of AKF and hospital outcomes. Insurance coverage could reduce underlying risk factors for AKF and its adverse consequences. Hospital investment to treat diabetes among the uninsured people in the catchment area might reduce uncompensated care and improve community health

Two-period linear mixed effects models to analyze clinical trials with run-in data when the primary outcome is continuous: Applications to Alzheimer\u27s disease.

Introduction: Study outcomes can be measured repeatedly based on the clinical trial protocol before randomization during what is known as the run-in period. However, it has not been established how best to incorporate run-in data into the primary analysis of the trial. Methods: We proposed two-period (run-in period and randomization period) linear mixed effects models to simultaneously model the run-in data and the postrandomization data. Results: Compared with the traditional models, the two-period linear mixed effects models can increase the power up to 15% and yield similar power for both unequal randomization and equal randomization. Discussion: Given that analysis of run-in data using the two-period linear mixed effects models allows more participants (unequal randomization) to be on the active treatment with similar power to that of the equal-randomization trials, it may reduce the dropout by assigning more participants to the active treatment and thus improve the efficiency of AD clinical trials

Measuring change in health status of older adults at the population level: The transition probability model

BACKGROUND: The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization. METHODS: We conducted a population-based retrospective cohort study of all Ontario residents aged 65+ eligible for public healthcare coverage from January 1998-December 2006. The main outcome measure was total number of utilization events. The total is computed by summing, on a per annum basis, the number of family physician visits, specialist visits, Emergency Department visits, drug claims, lab claims, X-rays, CT scans, MRI scans, and inpatient admissions. Three categories of utilization were created: low, moderate, and high. RESULTS: There is heterogeneity in health services utilization across the late lifespan. Utilization increased consistently in the 9-year study period. The probability of remaining at the high utilization category when the person was in the high category the previous year was more than 0.70 for both males and females and for all age groups. Overall healthcare utilization increases more rapidly among the high users compared to the low users. There was negligible probability for moving from high to low utilization category. Probability of death increased exponentially as age increased. Older adults in the low utilization category had the lowest probability of death. The number of male nonagenarians increased more rapidly than female nonagenarians. CONCLUSION: There are measurable and identifiable differences in the patterns of health services utilization among older adults. This data will permit clinicians and policy makers to tailor interventions appropriate to the risk class of patients