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Objectives/Goals: This proposal outlines the successful deployment of a research training initiative to support the formation of a Learning Healthcare System. Mayo Clinic Health System (MCHS) rural providers were offered the opportunity to the fundamentals of clinical research via Clinical and Translational Science Awards core curriculum, mentorship, and an online seminar series. Methods/Study Population: MCHS funded 4 key introductory research courses: 1) Manuscript Writing, 2) Grant Writing, 3) Basic Biostatistics, and 4) Essentials of Clinical and Translations Science Program. In addition to course offerings, a Research Interest Group was formed to guide novice rural researchers on topic selection and study design. This cultivated interest to create a 16-month clinical research webinar series offering CME credits. Subsequently, an internal MCHS RFA was launched seeking early-stage investigator pilot proposals focused on rural health. Results/Anticipated Results: In 2023, over 140 MCHS providers enrolled in 324 CCaTS research courses. This training led to the submission of 53 proposals to the inaugural MCHS 2023 RFA, of which 15 were awarded. Additionally, 14 MCHS extramural grants were submitted in 2023. Training efforts expanded in 2024 to include an online research seminar series covering various study topics and providing CME credit, with an approximate attendance up to 196 attendees per session. The second annual MCHS RFA resulted in 4 internal awards, with an additional 22 extramural grant submissions. These collective efforts have increased the number of MCHS first and last author publications and the number of MCHS providers with academic rank. Discussion/Significance of Impact: Leadership’s commitment of resources to educate, mentor, and engage clinicians was crucial to our success and demonstrated a strong return on investment. To maximize impact in community-based practice, continued commitment is needed in the form of protected research time, funding, and research administration support of projects of interest
Aiming at the problem of fast and consensus obstacle avoidance of multiple unmanned aerial systems in undirected network, a multi-quadrotor unmanned aerial vehicles UAVs (QUAVs) finite-time consensus obstacle avoidance algorithm is proposed. In this paper, multi-QUAVs establish communication through the leader-following method, and the formation is led by the leader to fly to the target position automatically and avoid obstacles autonomously through the improved artificial potential field method. The finite-time consensus protocol controls multi-QUAVs to form a desired formation quickly, considering the existence of communication and input delay, and rigorously proves the convergence of the proposed protocol. A trajectory segmentation strategy is added to the improved artificial potential field method to reduce trajectory loss and improve the task execution efficiency. The simulation results show that multi-QUAVs can be assembled to form the desired formation quickly, and the QUAV formation can avoid obstacles and maintain the formation unchanged while avoiding obstacles.
Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.
Methods
Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.
Results
The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).
Conclusions
Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.
In Tanzania, there are high rates of suicidal thoughts and behavior among people living with HIV (PLWH), yet few instruments exist for effective screening and referral. To address this gap, we developed and validated Swahili translations of the Columbia Suicide Severity Rating Scale (C-SSRS) Screen Version and two accompanying scales assessing self-efficacy to avoid suicidal action and reasons for living. We administered a structured survey to 80 PLWH attending two HIV clinics in Moshi, Tanzania. Factor analysis of the items revealed four subscales: suicide intensity, self-efficacy to avoid suicide, fear and social concern about suicide, and family and spirituality deterrents to suicide. The area under the receiver operating curve showed only suicide intensity, and fear and social concern met the prespecified cutoff of ≥0.7 in accurately identifying patients with a plan and intent to act on suicidal thoughts. This study provides early evidence that brief screening of intensity of suicidality in the past month, assessed by the C-SSRS Screen Version, is a strong, resource-efficient strategy for identifying suicide risk in the Tanzanian setting. Patients who report little fear of dying and low concern about social perceptions of suicide may also be at increased risk.
While the incidence of infections with the human immunodeficiency virus largely remained unchanged in Germany, an increase of other sexually transmitted infections (STIs) was observed. The aim was to analyse the effectiveness of our sexual education lecture for students in improving the awareness, knowledge and prevention of STIs. We conducted a cross-sectional survey after students had attended our extra-curricular lecture at the Department of Dermatology of the Ludwig-Maximilians-University of Munich, Germany (LMU). We compared the data with a previously performed study in which the same survey was carried out before the lecture had started. A total of 5866 questionnaires were included in the analysis. After attending the lecture significantly more students were aware of STIs (syphilis: 36.8% (before) vs. 63.5% (after); chlamydia: 30.5% vs. 49.3%; gonorrhoea: 22.4% vs. 38.2%; human papillomaviruses (HPV): 17.7% vs. 30.2%), the transmission pathways of STIs (oral: 36.6% vs. 82.6%; vaginal: 81.8% vs. 97.3%; anal: 42.8% vs. 94.0%; penile: 68.7% vs. 92.1%), knew that the HPV vaccination is directed against a virus (36.8% vs. 56.9%) and were interested in receiving a vaccination (57.7% vs. 78.8%). This study demonstrates the positive educative effects of our lecture for awareness and improved knowledge of STIs. To satisfy the need for a comprehensive sexual education, a combination of school and health facility-based programmes should be implemented as one single lecture cannot convey the entire information about STIs.
For a hypersonic-speed aircraft with a flat fuselage structure that has narrow space for a traditional wheel-type landing gear retraction, a novel type of wheel-ski landing gear is designed, which is different from traditional landing gears in force distribution and actuation methods. In order to capture the direction control performance of an aircraft with the wheel-ski landing gear, the aircraft ground taxiing nonlinear dynamic mathematical model is built based on a certain type of aircraft data. The experiment of the wheel-ski landing gear actuator and the differential brake control system is carried out to verify that the electric wheel-ski actuator model with the pressure sensor is in good agreement with the test results, indicating the model validity and the speediness of the differential brake response. Then a new fuzzy combined direction rectifying control law is designed based on the optimisation method and the fuzzy control theory. Comparing with the PD wheel-ski differential brake control, the direction rectifying efficiencies increase higher than 140% during the whole taxiing process. In addition, the combined control law can also decrease the overshoots of the yaw angle responses effectively. Finally, the stability and robustness of the designed combined direction control law are verified under various working conditions.
Effects of plasma non-uniformities and kinetic dispersiveness on the spontaneous excitation of geodesic acoustic mode (GAM) by reversed shear Alfvén eigenmode (RSAE) are investigated numerically. It is found that, due to the turning points induced by the shear Alfvén continuum structure, the nonlinear excitation of GAM is a quasiexponentially growing absolute instability. As the radial dependence of GAM frequency and pump RSAE mode structure are accounted for, the radially inward propagating GAM is preferentially excited, leading to core localized thermal plasma heating by GAM collisionless damping. Our work, thus, suggests that GAM excitation plays a crucial role in not only RSAE nonlinear saturation, but also anomalous fuel ion heating in future reactors.
Baseline data on local status of threatened species are often limited, and alternative information sources such as local ecological knowledge (LEK) have potential to provide conservation insights but require critical evaluation. We assess the usefulness of LEK to generate conservation evidence for the Hainan Peacock-pheasant Polyplectron katsumatae, a poorly known threatened island galliform. Interview surveys in rural communities across eight forested landscapes on Hainan provided a new dataset of sightings of Peacock-pheasants and other galliforms. Fewer respondents had seen Peacock-pheasants compared to other species across most landscapes, although Peacock-pheasant sightings showed significant across-landscape variation, with substantially more total and recent sightings from Yinggeling National Nature Reserve. However, validation of interview data with camera trapping data from Houmiling Provincial Nature Reserve, a landscape with few reported sightings, suggests a more optimistic possible status for Peacock-pheasants, which were detected as frequently as Red Junglefowl Gallus gallus and Silver Pheasant Lophura nycthemera during systematic camera trap placement. Hainan Peacock-pheasant sighting rates might be influenced by various factors (e.g. restricted local access to forests), with absolute abundance possibly greater than expected from limited sightings. Conversely, relative across-landscape abundance patterns from LEK are likely to be valid, as similar detection biases exist across surveyed landscapes.
Newly arriving Syrian refugees can present with specific health characteristics and medical conditions when entering the United States. Given the lack of epidemiological data available for the refugee populations, our study examined the demographic features of Syrian refugees resettled in the state of Kentucky. Specifically, we examined mental and physical health clinical data in both pre-departure health screenings and domestic Refugee Health Assessments (RHA; Kentucky Office for Refugees, n.d.) performed after resettlement.
Method:
The current study adopted a cross-sectional research design. We analyzed outcome data collected from participants from 2013 and 2015. Specifically, a comparative cross-sectional analysis was performed using clinical data from Syrian refugees who underwent an RHA as part of the resettlement process between January 2015 and August 2016. Those data were compared to data derived from refugees from other countries who resettled in Kentucky between 2013 and 2015.
Results:
Mental health screenings using the Refugee Health Screener (RHS-15; Hollifield et al., 2013) found that 19.5% (n = 34) of adult Syrian refugees reported signs and symptoms from posttraumatic stress, depressive symptoms, and/or anxiety, and nearly 40% (n = 69) reported personal experiences of imprisonment or violence, and/or having witnessed someone experiencing torture or violence. Intestinal parasites and lack of immunity to varicella were the most prevalent communicable diseases among Syrian refugees. Dental abnormalities and decreased visual acuity account for the first and second most prevalent non-communicable conditions. When comparing these results to all refugees arriving during the same years, significant differences arose in demographic variables, social history, communicable diseases, and non-communicable diseases.
Conclusion:
This study provides an initial health profile of Syrian refugees resettling in Kentucky, which reflects mental health as a major healthcare concern. Posttraumatic stress and related symptoms are severe mental health conditions among Syrian refugees above and beyond other severe physical problems.
For the safety problems caused by the limited landing space of the deck during the arresting process of the carrier-based aircraft, a dynamic model of the carrier-based aircraft’s landing and arresting is built. Based on the batch simulation method, the lateral dynamics safety envelope of the aircraft during the arresting was defined, and the dynamic response of the key points in the envelope during the arresting process was investigated. Subsequently, the influence of engine thrust and aircraft quality on the arresting safety envelope was studied based on reasonable safety evaluation indicators, and the safety status envelope of the deck arresting was given. Then, the particular Hamilton-Jacobi partial differential equation is used to obtain the lateral dynamics safety envelope of the carrier-based aircraft in the process of landing and arresting by backward inversion. Results indicate that engine thrust and landing quality have little effect on the yaw angle in the arresting safety boundary during the arresting. Additionally, with the engine thrust and landing quality increase, the maximum safe off-centre distance gradually decreases, and the safety boundary decreases accordingly. During the phase of landing glide, the engine thrust and quality have little effect on the maximum safe eccentric distance. When the engine thrust is increased by 40%, the maximum safe yaw angle is reduced from 0.3°, and the safety boundary is reduced by 4.2%. When the aircraftquality increases by 40%, the maximum safe yaw angle is reduced by 0.4°, and the safety boundary is reduced by 2.8%. The findings of this paper can provide framework for the research on theaircraft-to-carrier dynamic matching characteristics of the carrier-based system, and is of great significance to the research on improving the safety of the carrier-based aircraft landing arresting.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Clinical trials are a fundamental tool in evaluating the safety and efficacy of new drugs, medical devices, and health system interventions. Clinical trial visits generally involve eligibility assessment, enrollment, intervention administration, data collection, and follow-up, with many of these steps performed during face-to-face visits between participants and the investigative team. Social distancing, which emerged as one of the mainstay strategies for reducing the spread of SARS-CoV-2, has presented a challenge to the traditional model of clinical trial conduct, causing many research teams to halt all in-person contacts except for life-saving research. Nonetheless, clinical research has continued during the pandemic because study teams adapted quickly, turning to virtual visits and other similar methods to complete critical research activities. The purpose of this special communication is to document this rapid transition to virtual methodologies at Clinical and Translational Science Awards hubs and highlight important considerations for future development. Looking beyond the pandemic, we envision that a hybrid approach, which implements remote activities when feasible but also maintains in-person activities as necessary, will be adopted more widely for clinical trials. There will always be a need for in-person aspects of clinical research, but future study designs will need to incorporate remote capabilities.
Over recent decades, Chinese giant salamanders Andrias spp. have declined dramatically across much of their range. Overexploitation and habitat degradation have been widely cited as the cause of these declines. To investigate the relative contribution of each of these factors in driving the declines, we carried out standardized ecological and questionnaire surveys at 98 sites across the range of giant salamanders in China. We did not find any statistically significant differences between water parameters (temperature, dissolved oxygen, ammonia, nitrite, nitrate, salinity, alkalinity, hardness and flow rate) recorded at sites where giant salamanders were detected by survey teams and/or had been recently seen by local respondents, and sites where they were not detected and/or from which they had recently been extirpated. Additionally, we found direct and indirect evidence that the extraction of giant salamanders from the wild is ongoing, including within protected areas. Our results support the hypothesis that the decline of giant salamanders across China has been primarily driven by overexploitation. Data on water parameters may be informative for the establishment of conservation breeding programmes, an initiative recommended for the conservation of these species.
Although testing is widely regarded as critical to fighting the COVID-19 pandemic, what measure and level of testing best reflects successful infection control remains unresolved. Our aim was to compare the sensitivity of two testing metrics – population testing number and testing coverage – to population mortality outcomes and identify a benchmark for testing adequacy. We aggregated publicly available data through 12 April on testing and outcomes related to COVID-19 across 36 OECD (Organization for Economic Development) countries and Taiwan. Spearman correlation coefficients were calculated between the aforementioned metrics and following outcome measures: deaths per 1 million people, case fatality rate and case proportion of critical illness. Fractional polynomials were used to generate scatter plots to model the relationship between the testing metrics and outcomes. We found that testing coverage, but not population testing number, was highly correlated with population mortality (rs = −0.79, P = 5.975 × 10−9vs. rs = −0.3, P = 0.05) and case fatality rate (rs = −0.67, P = 9.067 × 10−6vs. rs = −0.21, P = 0.20). A testing coverage threshold of 15–45 signified adequate testing: below 15, testing coverage was associated with exponentially increasing population mortality; above 45, increased testing did not yield significant incremental mortality benefit. Taken together, testing coverage was better than population testing number in explaining country performance and can serve as an early and sensitive indicator of testing adequacy and disease burden.
A growing body of evidence suggests that synaptic plasticity is involved in addictive behaviour and nicotine dependence (ND). Neurotrophic factors, such as neurotrophin 3 (NT3) play a key role in modulating neuronal plasticity. Therefore, an association between nicotine, smoking and neurotrophic factors has been suggested. However, the role of NT3 in ND has not been thoroughly investigated in humans so far.
We investigated the influence of chronic (long-term smoking) and acute nicotine administration on the plasma level of NT3. We measured plasma NT3 levels at baseline and then 15 and 45 minutes after nicotine or placebo administration using an enzyme-linked-immunoabsorbent-assay (ELISA). Smokers showed higher NT3 level than non-smokers at baseline. Interestingly, 15 minutes after acute nicotine injection, plasma level of NT3 in both smokers and non-smokers decreased significantly and went back to baseline levels after 30 minutes. We found that plasma nicotine and NT3 levels were positively correlated in smokers at baseline.
There is a direct interaction of nicotine with NT3, which is different in acute and chronic exposure. Interestingly, the concentration of NT3 is correlated and up-regulated in smokers. We propose that neuroplasticity, which plays a role in addictive behaviour such as smoking or nicotine dependence (ND) might be mediated by these interactions of nicotine and NT3. We speculate that these might even play a part in the so called “self-medicating” with cigarettes that is often seen in patients with certain mental disorders.
One hundred-four depressed patients treated with amitriptyline (mean dosage: 163 mg/d; mean plasma level: 239 ng/ml) and 52 normal control subjects matched for age and sex underwent a standardized cardiovascular test battery (various autonomic cardiac parameters, which are largely independent from heart rate, namely the coefficients of variation (CV) while resting and during deep respiration, a spectral analysis of heart rate, the Valsalva ratio, and a posture index were determined). The tests included the determination of time- and frequency-derived measurements of heart rate variability (HRV), which is rather independent from heart rate. As compared to the controls the patients showed a significant plasma concentration-dependent decrease of R-R variation in the electrocardiogram (p < 0.0001), while their heart rate was significantly elevated (p < 0.0001). The markedly reduced parameters of sinus arrhythmia in amitriptyline treated patients are suggested to be mainly due to the anticholinergic effect of this drug, although it can not be excluded that the affective disorder itself might be associated with low heart rate variability. The results indicate that autonomic heart rate parameters are a valuable tool for the detection of tricyclic antidepressant (TCA) intake in unconscious patients, especially in intensive care and emergency wards.
The unsteady lift response of an airfoil in a sinusoidal gust has in the past been modelled by two different transfer functions: the first-order Sears function and the second-order Atassi function. Previous studies have shown that the Sears function holds in experiments, but recently Cordes et al. (J. Fluid Mech., vol. 811, 2017) reported experimental data that corresponded to the Atassi function rather than the Sears function. In order to clarify the observed discrepancy, the specific differences between these models are isolated analytically. To this end, data and analysis are confined to unloaded airfoils. These differences are related to physical gust parameters, and gusts with these parameters are then produced in wind-tunnel experiments using an active-grid gust generator. Measurements of the unsteady gust loads on an airfoil in the wind tunnel at Reynolds numbers ($Re_{c}$) of $2.0\times 10^{5}$ and $2.6\times 10^{5}$ and reduced frequencies between $0.09$ and $0.42$ confirm that the Sears and Atassi functions differ only in convention: the additional gust component of the Atassi problem can be scaled so that the Atassi function collapses onto the Sears function. These experiments, complemented by numerical simulations of the set-up, validate both models across a range of gust parameters. Finally, the influence of boundary-layer turbulence and the turbulent wake of the gust generator on experimental convergence with model predictions is investigated. These results serve to clarify the conditions under which the Sears and Atassi functions can be applied, and demonstrate that the Sears function can effectively model unsteady forces even when significant fluctuations in the streamwise velocity are present.
The Lung Cam expanded stratigraphic succession in Vietnam is correlated herein to the Meishan D section in China, the GSSP for the Permian–Triassic boundary. The first appearance datum of the conodont Hindeodus parvus at Meishan defines the Permian–Triassic boundary, and using published graphic correlation, the Permian–Triassic boundary level has been projected into the Lung Cam section. Using time-series analysis of magnetic susceptibility (χ) data, it is determined that H. parvus arrived at Lung Cam ∼18 kyr before the Permian–Triassic boundary. Data indicate that the Lung Cam section is expanded by ∼90 % relative to the GSSP section at Meishan. Given the expanded Lung Cam section, it is possible to resolve the timing of significant events during the Permian–Triassic transition with high precision. These events include major stepped extinctions, beginning at ∼135 kyr and ending at ∼110 kyr below the Permian–Triassic boundary, with a duration of ∼25 kyr, followed by deposition of Lung Cam ash Bed + 13, which is equivalent to Siberian Traps volcanism is graphically correlated to a precession Time-series model, placing onset of this major volcanic event at ~242 kyr before the PTB. The Meishan Beds 25 and 26, at ∼100 kyr before the Permian–Triassic boundary. In addition, the elemental geochemical, carbon and oxygen isotope stratigraphy, and magnetostratigraphy susceptibility datasets from Lung Cam allow good correlation to other Permian–Triassic boundary succession. These datasets are helpful when the conodont biostratigraphy is poorly known in sections with problems such as lithofacies variability, or is undefined, owing possibly to lithofacies exclusions, anoxia or for other reasons. The Lung Pu Permian–Triassic boundary section, ∼45 km from Lung Cam, is used to test these problems.
This study aimed to investigate endoscopic revision septoplasty with semi-penetrating straight and circular incisions in patients for whom septoplasty was unsuccessful.
Method
Patients in this study (n = 14) had a deviation of the nasal septum after septoplasty. Pre-operative and post-operative assessments were performed using a visual analogue scale and nasal endoscope. Semi-penetrating straight and circular incisions in front of the caudal septum and at the margin of the nasal septal cartilage–bone defect, respectively, were made. The mucoperichondrium and mucoperiosteum were bilaterally dissected until interlinkage with the cartilage–bone defect was achieved. Mucous membranes within the circular incision as well as the right mucoperichondrium and mucoperiosteal flaps were protected by pushing them to the right. This exposed the osteocartilaginous framework and allowed correction of the residual deviation. The patients were followed up for 30–71 months.
Results
For nasal obstruction and headaches, a significant improvement was noted in post-operative compared to pre-operative visual analogue scale scores. No patients had septal deviations, saddle nose, false hump nose or contracture of the nasal columella.
Conclusion
The technique allowed exposure of the septal osteocartilaginous framework and a broad operational vision, which enabled successful correction of various deformities of the nasal septum.