Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail.

Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes

Language barriers to health care access among Medicare beneficiaries

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings suggest the federal government should take steps to reduce language barriers in Medicare

Language barriers to health care access among Medicare beneficiaries

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings suggest the federal government should take steps to reduce language barriers in Medicare

Applying Formal Verification Methods to Pure Rule-Based Programs

Reliability, defined as the guarantee that a program satisfies its specifications, is an important aspect of many applications for which rule-based expert systems are suited. Verification refer to the process used to determine the reliability of the rule-based program. Because past approaches to verification are informal, guarantees of reliability cannot fully be made without severely restricting the system. On the other hand, by constructing formal specifications for a program and showing the program satisfies those specifications, guarantees of reliability can be made. This paper presents an assertional approach to the verification of rule-based programs. The proof logical needed for verification is adopted from one already in use by researchers in concurrent programming. The approach involves using a language called Swarm, and requires one to express program specifications as assertions over the Swarm representation of the program. Among models the employ rule-based notation, Swarm is the first to have an axiomatic proof logic

Forward positioning and consolidation of strategic inventories

The forward positioning of strategic inventory in the supply chain has an impact on transportation times and is important for sensitive demand profiles. Consolidation of stocks creates pooling effects and minimizes costs. This study analyzes a current military case where forward consolidation of equipment is considered using optimization, and payback periods are calculated for the cost of consolidating inventory at one of six locations. Results indicate that forward positioning and consolidation reduces time and cost, and also creates savings in reverse logistics flows. The study has implications for geographically diverse supply chains such as humanitarian aid and emergency response operations

System for Centering a Turbofan in a Nacelle During Tests

A feedback position-control system has been developed for maintaining the concentricity of a turbofan with respect to a nacelle during acoustic and flow tests in a wind tunnel. The system is needed for the following reasons: Thermal and thrust loads can displace the fan relative to the nacelle; In the particular test apparatus (see Figure 1), denoted as a rotor-only nacelle (RAN), the struts, vanes, and other stator components of a turbofan engine that ordinarily maintain the required concentricity in the face of thermal and thrust loads are not present; and The struts and stator components are not present because it is necessary to provide a flow path that is acoustically clean in the sense that the measured noise can be attributed to the fan alone. The system is depicted schematically in Figure 2. The nacelle is supported by two struts attached to a two-axis traverse table located outside the wind-tunnel wall. Two servomotors acting through 100:1 gearboxes drive the table along the Y and Z axes, which are perpendicular to the axis of rotation. The Y and Z components of the deviation from concentricity are measured by four laser displacement sensors mounted on the nacelle and aimed at reflective targets on the center body, which is part of the fan assembly. The outputs of the laser displacement sensors are digitized and processed through a personal computer programmed with control software. The control output of the computer commands the servomotors to move the table as needed to restore concentricity. Numerous software and hardware travel limits and alarms are provided to maximize safety. A highly ablative rub strip in the nacelle minimizes the probability of damage in the event that a deviation from concentricity exceeds the radial clearance [<0.004 in. (<0.1 mm)] between the inner surface of the nacelle and the tips of the fan blades. To be able to prevent an excursion in excess of the tip clearance, the system must be accurate enough to control X and Y displacements to within 0.001 in. (.0.025 mm). One characteristic essential to such accuracy is sufficient rigidity in the mechanical components of the system to prevent excitation of vibrations in the strut/ nacelle subsystem. The need for such a high degree of accuracy prompted a comprehensive analysis of sources of measurement and control errors, followed by rigorous design efforts to minimize these errors. As a result, the design of the system incorporates numerous improvements in hardware, software, and operational procedures

Continuous Cognitive Dynamics of the Evaluation of Trustworthiness in Williams Syndrome

The decision to approach or avoid an unfamiliar person is based in part on one’s evaluation of facial expressions. Individuals with Williams syndrome (WS) are characterized in part by an excessive desire to approach people, but they display deficits in identifying facial emotional expressions. Likert-scale ratings are generally used to examine approachability ratings in WS, but these measures only capture an individual’s final approach/avoid decision. The present study expands on previous research by utilizing mouse-tracking methodology to visually display the nature of approachability decisions via the motor movement of a computer mouse. We recorded mouse movement trajectories while participants chose to approach or avoid computer-generated faces that varied in terms of trustworthiness. We recruited 30 individuals with WS and 30 chronological age-matched controls (mean age = 20 years). Each participant performed 80 trials (20 trials each of four face types: mildly and extremely trustworthy; mildly and extremely untrustworthy). We found that individuals with WS were significantly more likely than controls to choose to approach untrustworthy faces. In addition, WS participants considered approaching untrustworthy faces significantly more than controls, as evidenced by their larger maximum deviation, before eventually choosing to avoid the face. Both the WS and control participants were able to discriminate between mild and extreme degrees of trustworthiness and were more likely to make correct approachability decisions as they grew older. These findings increase our understanding of the cognitive processing that underlies approachability decisions in individuals with WS