Teleneurology service provided via tablet technology: 3-year outcomes and physician satisfaction

© James Cook University. Introduction: This study aimed to demonstrate that teleneurology consultations conducted via tablet technology are an efficient and cost-effective means of managing acute neurologic emergencies at community-based hospitals and that utilizing such technology yields high community physician satisfaction. Method: During a 39-month period, Vanderbilt University Medical Center in Tennessee USA, provided teleneurology services to 10 community-based hospitals that lacked adequate neurology coverage. Hospitalists at one community-based hospital were not comfortable treating any patient with a neurologic symptom, resulting in 100% of those patients being transferred. This facility now retains more than 60% of neurology patients. For less than US$1200, these hospitals were able to meet the only capital expenditure required to launch this service: the purchase of handheld tablet computers. Real-time teleneurology consultations were conducted via tablet using two-way video conferencing, radiologic image sharing, and medical record documentation. Community physicians were regularly surveyed to assess satisfaction. Results: From February 2014 to May 2017, 3626 teleneurology consultations were conducted. Community physicians, in partnership with neurologists, successfully managed 87% of patients at the community-based hospital. Only 13% of patients required transfer to another facility for a higher level of care. The most common diagnoses included stroke (34%), seizure (11%), and headache/migraine (6%). The average time for the neurologist to answer a request for consultation page and connect with the community physician was 10.6 minutes. Ninety-one percent of community physicians were satisfied or somewhat satisfied with the overall service. Conclusion: In the assessment of neurology patients, tablets are a more cost-effective alternative to traditional telehealth technologies. The devices promote efficiency in consultations through ease of use and low transfer rates, and survey results indicate community physician satisfaction

Single particle tracking in systems showing anomalous diffusion: the role of weak ergodicity breaking

Anomalous diffusion has been widely observed by single particle tracking microscopy in complex systems such as biological cells. The resulting time series are usually evaluated in terms of time averages. Often anomalous diffusion is connected with non-ergodic behaviour. In such cases the time averages remain random variables and hence irreproducible. Here we present a detailed analysis of the time averaged mean squared displacement for systems governed by anomalous diffusion, considering both unconfined and restricted (corralled) motion. We discuss the behaviour of the time averaged mean squared displacement for two prominent stochastic processes, namely, continuous time random walks and fractional Brownian motion. We also study the distribution of the time averaged mean squared displacement around its ensemble mean, and show that this distribution preserves typical process characteristic even for short time series. Recently, velocity correlation functions were suggested to distinguish between these processes. We here present analytucal expressions for the velocity correlation functions. Knowledge of the results presented here are expected to be relevant for the correct interpretation of single particle trajectory data in complex systems.Comment: 15 pages, 15 figures; References adde

Nature of the current-induced insulator-to-metal transition in Ca2_2RuO4_4 as revealed by transport-ARPES

The Mott insulator Ca$_2$RuO$_4$ exhibits a rare insulator-to-metal transition (IMT) induced by DC current. While structural changes associated with this transition have been tracked by neutron diffraction, Raman scattering, and x-ray spectroscopy, work on elucidating the response of the electronic degrees of freedom is still in progress. Here we unveil the current-induced modifications of the electronic states of Ca$_2$RuO$_4$ by employing angle-resolved photoemission spectroscopy (ARPES) in conjunction with four-probe transport. Two main effects emerge: a clear reduction of the Mott gap and a modification in the dispersion of the Ru-bands. The changes in dispersion occur exclusively along the $XM$ high-symmetry direction, parallel to the $b$-axis where the greatest in-plane lattice change occurs. These experimental observations are reflected in dynamical mean-field theory (DMFT) calculations simulated exclusively from the current-induced lattice constants, indicating a current driven structural transition as the primary mechanism of the IMT. Furthermore, we demonstrate this phase is distinct from the high-temperature zero-current metallic phase. Our results provide insight into the elusive nature of the current-induced IMT of Ca$_2$RuO$_4$ and advance the challenging, yet powerful, technique of transport-ARPES.Comment: 8 pages, 4 figure

The Early Ultraviolet Light-Curves of Type II Supernovae and the Radii of Their Progenitor Stars

We present a sample of 34 normal SNe II detected with the Zwicky Transient Facility, with multi-band UV light-curves starting at $t \leq 4$ days after explosion, as well as X-ray detections and upper limits. We characterize the early UV-optical colors and provide prescriptions for empirical host-extinction corrections. We show that the $t > 2\,$days UV-optical colors and the blackbody evolution of the sample are consistent with the predictions of spherical phase shock-cooling (SC), independently of the presence of `flash ionization" features. We present a framework for fitting SC models which can reproduce the parameters of a set of multi-group simulations without a significant bias up to 20% in radius and velocity. Observations of about half of the SNe II in the sample are well-fit by models with breakout radii $<10^{14}\,$cm. The other half are typically more luminous, with observations from day 1 onward that are better fit by a model with a large $>10^{14}\,$cm breakout radius. However, these fits predict an early rise during the first day that is too slow. We suggest these large-breakout events are explosions of stars with an inflated envelope or a confined CSM with a steep density profile, at which breakout occurs. Using the X-ray data, we derive constraints on the extended ($\sim10^{15}$ cm) CSM density independent of spectral modeling, and find most SNe II progenitors lose $<10^{-4} M_{\odot}\, \rm yr^{-1}$ a few years before explosion. This provides independent evidence the CSM around many SNe II progenitors is confined. We show that the overall observed breakout radius distribution is skewed to higher radii due to a luminosity bias. We argue that the $66^{+11}_{-22}\%$ of red supergiants (RSG) explode as SNe II with breakout radii consistent with the observed distribution of field RSG, with a tail extending to large radii, likely due to the presence of CSM.Comment: Submitted to ApJ. Comments are welcome at [email protected] or [email protected]

Pueblo Pathways Project

While in Santa Fe, our group worked with the Pueblo Pathways Project. We established deliverables, such as a website, social media pages, multiple programs, and a foundation to apply for non-profit status. Additionally, we conducted interviews with minority businesses, performed research to understand non-profit processes and how to start organizations. We hope to use what we have learned through working with P3 to create an extensive report for grass root minority organizations to help streamline their businesses’ start-up process

Applications of Green Infrastructure as a Response to Detroit's Vacant Land Crisis

https://digitalcommons.wpi.edu/gps-posters/1761/thumbnail.jp

Morbidity of Returning Travelers Seen in Community Urgent Care Centers throughout Israel

Information regarding post-travel morbidity is usually reported via dedicated post-travel clinics and mainly relates to travelers returning from low–middle-income countries (LMIC), however, the spectrum of morbidity seen within the community setting is scarcely reported. This prospective observational study among visitors to 17 community Urgent Care Centers (UCC) was designed to evaluate the reasons for post-travel community clinic visits and to compare travelers returning from LMIC to high-income countries (HIC). All visitors within one-month post-travel to all destinations were included. A total of 1580 post-travel visits were analyzed during 25 months. Travelers to LMICs were younger (mean 36.8 years old vs. 41.4 in the HIC group) and stayed longer periods abroad (30.1 ± 41.2 vs. 10.0 ± 10.6 in the HIC group) but more of them had pre-travel vaccines (35.5% vs. 6.6%). Travel-related morbidity was significantly more common in the LMIC group 58.3% (253/434) vs. 34.1% (391/1146) in the HIC group, (p p < 0.001). Other common morbidities in the LMIC cohort were respiratory (23.3%), cutaneous (15.8%), and injuries (9.9%). In the HIC group, the common morbidities were respiratory (37.3%), and diarrhea composed only 6.6% of the complaints. Our study group represents a less biased sample of travelers to LMIC as well as HIC, therefore, data from the UCC setting and at the specialized travel clinics complete each other in understanding the true extent of morbidity in travelers