Food Groups of Dietary Fiber by Elderly Participants in a Congregate Meal Program

Food, Nutrition and Institution Administratio

Spatio-Temporal Modeling Of Anatomic Motion For Radiation Therapy

In radiation therapy, it is imperative to deliver high doses of radiation to the tumor while reducing radiation to the healthy tissue. Respiratory motion is the most significant source of errors during treatment. Therefore, it is essential to accurately model respiratory motion for precise and effective radiation delivery. Many approaches exist to account for respiratory motion, such as controlled breath hold and respiratory gating, and they have been relatively successful. They still present many drawbacks. Thus, research has been expanded to tumor tracking. The overall goal of 4D-CT is to predict tumor motion in real time, and this work attempts to move in that direction. The following work addresses both the temporal and the spatial aspects of four-dimensional CT reconstruction. The aims of the paper are to (1) estimate the temporal parameters of 4D models for anatomy deformation using a novel neural network approach and (2) to use intelligently chosen non-uniform, non-separable splines to improve the spatial resolution of the deformation models in image registration

4-D Modeling of Displacement Vector Fields for Improved Radiation Therapy

In radiation therapy, it is imperative to deliver high doses of radiation to the tumor while reducing radiation to the healthy tissue. Respiratory motion is the most significant source of errors during treatment. Therefore, it is essential to accurately model respiratory motion for precise and effective radiation delivery. Many approaches exist to account for respiratory motion, such as controlled breath hold and respiratory gating, and they have been relatively successful. They still present many drawbacks. Thus, research has been expanded to tumor tracking. This paper presents a spatio-temporal model for four dimensional CT reconstruction. The method begins with a set of initial CT projections and a simultaneously acquired breathing trace. Two methods are explored to model the spatial components: principal component analysis and a pseudoinverse matrix method. An iterative approach is used to match the simulated projections to the actual projections. The simulated projections and the initial projections are evaluated using Normalized Root Mean Square Error (NRMSE). The proposed method shows simulated projections and actual projections match, and as such the model is able to accurately predict the deformation

The HIV-associated tuberculosis epidemic--when will we act?

Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in affected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensified tuberculosis case finding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be effective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past

Rural Implications of Geographic Rating of Health Insurance Premiums

This brief examines how and to what extent states allow health plans to vary premiums by geographic rating area and, using insurance data from selected states, assesses the direction and magnitude of variations in rural and urban geographic rating factors. The authors conclude with a discussion of strategies that federal and state policymakers might use to help ensure that premium variations based on geography are justified. KEY POINTS: There is no clear pattern of geographic rating factors favoring rural or urban areas. This lack of a clear pattern suggests that health plans may use geographic rating for business purposes other than adjusting for underlying cost/price differences. Geographic rating could reduce insurance risk pooling and be used as a proxy for experience rating. To limit the effect of market segmentation resulting from geographic rating, rate bands could be imposed on area rating factors

COVID-19 infection outcome in African American Renal Transplant recipients: Detroit Medical Center

Background: Transplant recipients are more vulnerable to infections including COVID-19, given their comorbidities and chronic immunosuppression. Most preliminary care series report rapid clinical progression and higher mortality compared to the general population. Methods: Retrospective study at Harper University Hospital - Detroit Medical Center. Twenty-five renal transplant recipients (RTR) presenting consecutively with COVID-19 symptoms and positive NP swab PCR for SARS-CoV2 between 03/01/2020 - 05/01/2020 were included. Data on demographics, clinical presentation, laboratory findings, management and outcomes were collected. Results: Patients had a median age of 56, all African American and deceased donor transplant recipients. Most had hypertension (96%), about half (52%) had diabetes, 64% had pulmonary disease including obstructive sleep apnea, COPD and pulmonary hypertension. Most common presenting symptom was dyspnea (64%), followed by fever and cough (56%) and diarrhea (56%). Half of patients had multifocal opacities on initial chest x-ray (52%). Immunosuppression with tacrolimus and low dose prednisone was continued, while mycophenolate mofetil was held on admission. Following institution guidelines, hydroxychloroquine was given to 32% who met criteria for risk of severe disease, while 48% received both hydroxychloroquine and steroids. Prophylactic anticoagulation was given to 80% of patients, while therapeutic coagulation to 8%. Oxygen supplementation given to 60% of patients and one patient required intubation. Three patients (12%) were admitted to intensive care, of which one expired. Treatment with mycophenolate was reintroduced based on resolution of symptoms and laboratory parameters. Conclusion: COVID-19 infected RTR in this cohort had lower mortality of 4% (n=1) compared to State-wide mortality of 10%. Clinical presentation was similar to non-immunocompromised hosts, but diarrhea was common. Despite multiple co-morbidities and chronic immunosuppression, our patient cohort had favorable outcome and lower mortality compared to other series. Exact reasons for this optimal outcome are unclear

Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.

OBJECTIVE: To investigate the impact of antiretroviral therapy (ART) on long-term population-level tuberculosis disease (TB) incidence in sub-Saharan Africa. METHODS: We used a mathematical model to consider the effect of different assumptions about life expectancy and TB risk during long-term ART under alternative scenarios for trends in population HIV incidence and ART coverage. RESULTS: All the scenarios we explored predicted that the widespread introduction of ART would initially reduce population-level TB incidence. However, many modelled scenarios projected a rebound in population-level TB incidence after around 20 years. This rebound was predicted to exceed the TB incidence present before ART scale-up if decreases in HIV incidence during the same period were not sufficiently rapid or if the protective effect of ART on TB was not sustained. Nevertheless, most scenarios predicted a reduction in the cumulative TB incidence when accompanied by a relative decline in HIV incidence of more than 10% each year. CONCLUSIONS: Despite short-term benefits of ART scale-up on population TB incidence in sub-Saharan Africa, longer-term projections raise the possibility of a rebound in TB incidence. This highlights the importance of sustaining good adherence and immunologic response to ART and, crucially, the need for effective HIV preventive interventions, including early widespread implementation of ART

Measured in-situ mass absorption spectra for nine forms of highly-absorbing carbonaceous aerosol

Mass absorption coefficient spectra were measured between λ = 500 nm and 840 nm for nine forms of highly-absorbing carbonaceous aerosol: five samples generated from gas-, liquid- and solid-fueled flames; spark-discharge fullerene soot; graphene and reduced graphene oxide (rGO) crumpled nanosheets; and fullerene (C_(60)) assemblies. Aerosol absorption spectra were measured for size- and mass-selected particles and found to be dependent on fuel type and formative conditions. Flame-generated particles had morphologies consistent with freshly emitted black carbon (BC) with mass absorption coefficients (MAC) ranging between 3.8 m^2 g^(−1) and 8.6 m^2 g^(−1) at λ = 550 nm. Absorption Ångström exponents (AAE) – i.e. MAC spectral dependence – ranged between 1.0 and 1.3 for flame-generated particles and up to 7.5 for C_(60). The dependence of MAC and AAE on mobility diameter and particle morphology was also investigated. Lastly, the current data were compared to all previously published MAC measurements of highly-absorbing carbonaceous aerosol

Six-Month Mortality among HIV-Infected Adults Presenting for Antiretroviral Therapy with Unexplained Weight Loss, Chronic Fever or Chronic Diarrhea in Malawi.

In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART). We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy