Conceptualizing Care Continua: Lessons from Hiv, Hepatitis C virus, Tuberculosis and implications for the Development of Improved Care and Prevention Continua

Background: To examine the application of continuum models to tuberculosis, HIV, and other conditions; to theorize the concept of continua; and to learn lessons that could inform the development of improved care and prevention continua as public health metrics. Methods: An analytic review of literature drawn from several fields of health care. Results: The continuum construct is now part of public health evaluation systems for HIV, and is increasingly used in public health and the medical literature. Issues with the comparability and optimal design of care continuum models have been raised, and their methodologic and theoretic underpinnings and scope of focus have been underaddressed. Review of relevant publications suggests that a key limitation of current models is their lack of measures reflecting incidence and mortality. Issues relating to continua data being longitudinal or cross-sectional, definition of numerators and denominators for each step, data sources, measures of timeliness of step completion, theoretic models to facilitate inferences of causes of care continuum gaps, how measures of prevention efforts, reinfection/relapses, and interactions of continua for co-occurring comorbidities should be reflected, and how analyses of differences in retention over time, across geographic regions, and in response to interventions should be conducted are critical to the development of sound care and prevention continuum models. Conclusion: Lessons learned from the application of continuum models to HIV and other conditions suggest that the application of well-formulated constructs of care and prevention continua, that depict, in well defined, standardized steps, incidence and mortality, along with degrees of and time to screening, engagement in care and prevention, treatment and treatment outcomes, including relapse or reinfection, may be vital tools in evaluating intervention and program outcomes, and in improving population health and population health metrics for a wide range conditions

BaBar B Decay Results

Data from the first run of the BaBar detector at the PEP II accelerator are presented. Measurements of many rare B decay modes are now possible using the large data sets currently being collected by BaBar. An overview of analysis techniques and results on data collected in 2000 are described.Comment: 16 pages, 35 figures. Submission to Lepton-Photon 2001 Rome conference proceeding

Improving the Stainless Steel System at Process Technology International Using 5S, Process Improvement, and Inventory Control

Process Technology International (PTI) is a small manufacturing company producing industrial equipment used in the processing of steel. The purpose of this project is to reduce costs and improve inefficiencies within the stainless steel system. After meeting with industry sponsors and determining their most pertinent issues, we decided to search for inefficiencies in three places: inventory controls, manual processes, and physical workspace arrangement. To measure how the current inefficiencies were affecting costs, the team performed EOQ analysis on the inventory controls and time study evaluations on the processes. By collecting demand data, holding cost, ordering cost and price break cost data from the steel providers, EOQ analysis was able to be performed. The team then began taking time studies of the relevant processes, identifying and timing movements that were considered ‘non- value-added’ meaning they added no value to the process. With the non-value-added steps identified, a cost was assigned to each based on the time that it took, and the labor cost of the worker performing the process. The team performed pareto analysis to identify the costliest steps and performed a descriptive and qualitative analysis to determine which non-value-added movements could be eliminated by either process improvement, workspace improvement, or a combination of the two. The team identified four alternatives with the potential to reduce costs and inefficiencies: Solution 1. EOQ Implementation Implement an economic order quantity and reorder points for stainless steel inventory controls. These give the purchasing department specific inventory levels at which they will order specific quantities that optimize stainless steel ordering, holding, and unit costs. Solution 2. Standard Operating Procedure Implementation Create and implement standard operating procedures (SOPs) for the welding processes. Each SOP will specifically instruct the operator to layout necessary tools such that later excess movement is avoided. Solution 3. Workspace Improvement Build and utilize a new stainless steel storage rack, two dedicated carts, and specialized tool storage at the two welding stations. Use the new organized rack, tool holders, and carts to cut down on wasted time spent searching for materials, searching for tools, and manually transporting items across warehouse. Solution 4. 5S Total Quality System Implementation Completely overhaul facility with a 5S quality system that implements all of the other suggestions and additionally adds demarcation and color-coded labeling to the various storage areas throughout facility. 5S system eliminates non-value-added movements from processes and improves efficiency throughout entire system. Using cost-benefit analysis, the team found that each solution provided potential cost savings. TOPSIS analysis was performed using five variables: cost of implementation, annual cost savings, time to implement, employee acceptance, and ease of implementation. The TOPSIS analysis revealed that the workspace improvement suggestions (solution 3) provided the closest-to-ideal solution to the stainless steel system inefficiencies

Repeatable Dynamic Rollover Roof Test Fixture”,

ABSTRACT Experimental rollover tests have been criticized for their poor emulation of actual rollovers and for their lack of repeatability. We have designed and built a test fixture that overcomes both of these criticisms. The fixture holds a passenger compartment, weighted to match the inertia characteristics of a complete vehicle, or a complete vehicle at the appropriate pitch and yaw. The compartment is then rotated about its principal (longitudinal) axis through an arc that mimics the rolling motion of an entire vehicle. At the appropriate roll angle and falling velocity, the roof strikes a moving patch of concrete. The compartment is controlled throughout the sequence and is suspended after the impact, so that a sequence of impacts can be individually studied in separate tests. Initial tests have shown that we can achieve repeatable impacts. Test variables include pitch, yaw, roll rate and vehicle center of gravity motion (both lateral and vertical velocity). This test device addresses the various shortcomings of previous rollover tests, fixtures and the various static and drop tests of vehicles conducted to determine rollover performance

CCL2 Overexpression in the Brain Promotes Glial Activation and Accelerates Tau Pathology in a Mouse Model of Tauopathy

Innate immune activation is a major contributor to Alzheimer’s Disease (AD) pathophysiology, although the mechanisms involved are poorly understood. Chemokine C-C motif ligand (CCL) 2 is produced by neurons and glial cells and is upregulated in the AD brain. Transgene expression of CCL2 in mouse models of amyloidosis produces microglia-induced amyloid β oligomerization, a strong indication of the role of these activation pathways in the amyloidogenic processes of AD. We have previously shown that CCL2 polarizes microglia in wild type mice. However, how CCL2 signaling contributes to tau pathogenesis remains unknown. To address this question, CCL2 was delivered via recombinant adeno-associated virus serotype 9 into both cortex and hippocampus of a mouse model with tau pathology (rTg4510). We report that CCL2 overexpression aggravated tau pathology in rTg4510 as shown by the increase in Gallyas stained neurofibrillary tangles as well as phosphorylated tau-positive inclusions. In addition, biochemical analysis showed a reduction in the levels of detergent-soluble tau species followed by increase in the insoluble fraction, indicating a shift toward larger tau aggregates. Indeed, increased levels of high molecular weight species of phosphorylated tau were found in the mice injected with CCL2. We also report that worsening of tau pathology following CCL2 overexpression was accompanied by a distinct inflammatory response. We report an increase in leukocyte common antigen (CD45) and Cluster of differentiation 68 (CD68) expression in the brain of rTg4510 mice without altering the expression levels of a cell-surface protein Transmembrane Protein 119 (Tmem119) and ionized calcium-binding adaptor molecule 1 (Iba-1) in resident microglia. Furthermore, the analysis of cytokines in brain extract showed a significant increase in interleukin (IL)-6 and CCL3, while CCL5 levels were decreased in CCL2 mice. No changes were observed in IL-1α, IL-1β, TNF-α. IL-4, Vascular endothelial growth factor-VEGF, IL-13 and CCL11. Taken together our data report for the first time that overexpression of CCL2 promotes the increase of pathogenic tau species and is associated with glial neuroinflammatory changes that are deleterious. We propose that these events may contribute to the pathogenesis of Alzheimer’s disease and other tauopathies

Mitochondrial diversity analysis of Glossina palpalis gambiensis from Mali and Senegal

West African riverine tsetse populations of Glossina palpalis gambiensis Vanderplank (Diptera: Glossinidae) were investigated for gene flow, inferred from mitochondrial diversity in samples of 69 flies from Senegal and 303 flies from three river drainages in Mali. Four polymorphic mitochondrial loci were scored. Mean haplotype diversities were 0.30 in Mali and 0.18 over both Mali and Senegal. These diversities estimate the probabilities that two randomly chosen tsetse have different haplotypes. Substantial rates of gene flow were detected among flies sampled along tributaries belonging to the river basins of the Senegal, Niger, and Bani in Mali. There was virtually no gene flow between tsetse in Senegal and Mali. No seasonal effects on gene flow were detected. The implications of these preliminary findings for the implementation of area-wide integrated pest management (AW-IPM) programmes against riverine tsetse in West Africa are discussed

Racial disparities in the SOFA score among patients hospitalized with COVID-19

BACKGROUND: Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION: Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS: Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as \u3c6 or ≥6. RESULTS: Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION: Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients

Response of the solar atmosphere to magnetic field evolution in a coronal hole region

Methods. We study an equatorial CH observed simultaneously by HINODE and STEREO on July 27, 2007. The HINODE/SP maps are adopted to derive the physical parameters of the photosphere and to research the magnetic field evolution and distribution. The G band and Ca II H images with high tempo-spatial resolution from HINODE/BFI and the multi-wavelength data from STEREO/EUVI are utilized to study the corresponding atmospheric response of different overlying layers. Results. We explore an emerging dipole locating at the CH boundary. Mini-scale arch filaments (AFs) accompanying the emerging dipole were observed with the Ca II H line. During the separation of the dipolar footpoints, three AFs appeared and expanded in turn. The first AF divided into two segments in its late stage, while the second and third AFs erupted in their late stages. The lifetimes of these three AFs are 4, 6, 10 minutes, and the two intervals between the three divisions or eruptions are 18 and 12 minutes, respectively. We display an example of mixed-polarity flux emergence of IN fields within the CH and present the corresponding chromospheric response. With the increase of the integrated magnetic flux, the brightness of the Ca II H images exhibits an increasing trend. We also study magnetic flux cancellations of NT fields locating at the CH boundary and present the obvious chromospheric and coronal response. We notice that the brighter regions seen in the 171 A images are relevant to the interacting magnetic elements. By examining the magnetic NT and IN elements and the response of different atmospheric layers, we obtain good positive linear correlations between the NT magnetic flux densities and the brightness of both G band (correlation coefficient 0.85) and Ca II H (correlation coefficient 0.58).Comment: 9 pages, 9 figures. A&A, in pres