Role of interactions in nonequilibrium transformations.

For arbitrary nonequilibrium transformations in complex systems, we show that the distance between the current state and a target state can be decomposed into two terms: one corresponding to an independent estimate of the distance, and another corresponding to interactions, quantified using the relative mutual information between the variables. This decomposition is a special case of a more general decomposition involving successive orders of correlation or interactions among the degrees of freedom of the system. To illustrate its practical significance, we study the thermal relaxation of two interacting, optically trapped colloidal particles, where increasing pairwise interaction strength is shown to prolong the longevity of the time-dependent nonequilibrium state. Additionally, we study a system with both pairwise and triplet interactions, where our approach identifies their distinct contributions to the transformation. In more general setups where it is possible to control the strength of different orders of interactions, our findings provide a way to disentangle their effects and identify interactions that facilitate the transformation.

At-home hemoglobin A1c testing during COVID-19 improved glycemic control.

OBJECTIVES: COVID-19 has exacerbated barriers to routine testing for chronic disease management. This study investigates whether a home hemoglobin A1c (HbA1c) test kit intervention increases frequency of HbA1c testing and leads to changes in HbA1c 6 months post testing and whether self-reinforcement education improves maintenance of HbA1c testing. STUDY DESIGN: Retrospective analysis of a randomized, controlled quality improvement intervention among members with type 2 diabetes (T2D) in a large commercial health plan. METHODS: Participants were 41,214 commercial fully insured members with T2D without an HbA1c test in the past 6 months or with only 1 HbA1c test in the last 12 months. Members were randomly assigned to either a control group or an at-home HbA1c testing intervention group consisting of either an opt-in test or a direct-to-member opt-out HbA1c test kit shipment. A third cohort of members was assigned to a self-reinforcement group to encourage continued testing twice per year. Main outcomes were HbA1c testing rates and HbA1c levels (in %). RESULTS: A total of 11.1% (508 of 4590) at-home HbA1c kits were completed. At-home HbA1c test kits increased testing rates by 4.9% compared with controls (P < .001). Members with an HbA1c level of at least 7% who requested and completed at-home HbA1c testing had a 0.38% reduction in HbA1c in the 6 months post intervention when controlling for baseline HbA1c (P < .001). Members who received self-reinforcement messaging had a 0.37% HbA1c reduction post intervention (P = .015). CONCLUSIONS: This novel, at-home approach to test HbA1c is an effective intervention to increase testing rates and facilitate HbA1c reduction over time in patients with T2D.

Adaptive nonequilibrium design of actin-based metamaterials: Fundamental and practical limits of control.

The adaptive and surprising emergent properties of biological materials self-assembled in far-from-equilibrium environments serve as an inspiration for efforts to design nanomaterials. In particular, controlling the conditions of self-assembly can modulate material properties, but there is no systematic understanding of either how to parameterize external control or how controllable a given material can be. Here, we demonstrate that branched actin networks can be encoded with metamaterial properties by dynamically controlling the applied force under which they grow and that the protocols can be selected using multi-task reinforcement learning. These actin networks have tunable responses over a large dynamic range depending on the chosen external protocol, providing a pathway to encoding "memory" within these structures. Interestingly, we obtain a bound that relates the dissipation rate and the rate of "encoding" that gives insight into the constraints on control-both physical and information theoretical. Taken together, these results emphasize the utility and necessity of nonequilibrium control for designing self-assembled nanostructures.

Can we predict urethral length of boys? - An observational study.

INTRODUCTION: An additional knowledge about normal anatomy of urethra in boys can improve clinical outcome of any urological interventions. This will also reduce catheter related complications like intra vesical knotting and urethral injuries. At present there is no systematic data available which has studied the urethral length of boys. We have done this study to analyse the length of urethra in boys. AIM: The aim of the study is to measure the urethral length in Indian children from the age of 1 year till 15 years and plot a nomogram. Furthermore to analyse the influence of anthropometry on urethral length and derived a formula to predict the urethral length in boys. STUDY DESIGN: This is a single institution prospective observational study. After obtaining clearance from the institutional review board, a total of 180 children from the age of 1-15 were recruited for the study. The urethral length was measured during Foley's catheter removal. Other data like age, weight, and height of the patient are collected and the obtained values were analysed with SPSS software. The acquired figures were further used to derive formulae to predict urethral length. RESULTS: A nomogram of urethral length based on age was plotted. With collected figures, five separate formulae were derived to calculate the urethral length based on the age, height and weight. Furthermore for day-to-day use we have deduced a formulas to calculate urethral length which are simplified forms of original formulae. DISCUSSION: The length of urethra of a new-born male is 5 cm, which attains 8 cm by three years of age and to 17 cm by adulthood. There were attempts to measure the urethral length in adults using cystoscopy, Foley's catheter and different imaging techniques like Magnetic Resonance Imaging and dynamic retrograde urethrography. Simplified formulae which has been derived from this study for clinical use is Urethral length = 8.7 + Age (in year) × 0.55 CONCLUSION: Our results will complement the current anatomical understanding of the urethra. This evades some rare complications of catheterisation and facilitate reconstructive procedures.

Intensive care management of a complex Medicaid population: a randomized evaluation.

OBJECTIVES: Care management programs are employed by providers and payers to support high-risk patients and affect cost and utilization, with varied implementation. This study sought to evaluate the impact of an intensive care management program on utilization and cost among those with highest cost (top 5%) and highest utilization in a Medicaid accountable care organization (ACO) population. STUDY DESIGN: Randomized controlled quality improvement trial of intensive care management, provided by a nonprofit care management vendor, for Medicaid ACO patients at 2 academic centers. METHODS: Patients were identified using claims, chart review, and primary care validation, then randomly assigned 2:1 to intervention and control groups. Among 131 patients included in intent-to-treat analysis, 87 and 44 were randomly assigned to the intervention and control groups, respectively. Patients in the intervention group were eligible to receive intensive care management in the community/home setting and, in some cases, home-based primary care. Patients in the control group received standard of care, including practice-based care management. Prespecified primary outcome measures included total medical expense (TME), emergency department (ED) visits, and inpatient utilization. RESULTS: Relative to controls, patients randomly assigned to receive intensive care management had a $1933 smaller increase per member per month in TME (P = .04) and directionally consistent but nonsignificant reductions in ED visits (17% fewer; P = .40) and inpatient admissions (34% fewer; P = .29) in the 12 months post randomization compared with the 12 months prerandomization. CONCLUSIONS: Our study results support that targeted, intensive care management can favorably affect TME in a health system-based high-cost, high-risk Medicaid population. Further research is needed to evaluate the impact on additional clinical outcomes.

Accidental Stainless Crown Ingestion During Dental Treatment in a Pediatric Patient.

Accidental ingestion of foreign bodies is very frequent in children. Ingestion of dislodged restorations, dental appliances, crowns, and teeth in dental operatory is frequently reported. Early diagnosis of foreign bodies ingestion in a dental operatory and awareness of its signs and symptoms are very crucial. A five-year-old boy accidentally ingested a stainless steel crown during the trial fit at the dental operatory. Crown retrieval was attempted but without success, and thus, the patient was further observed for possible signs and symptoms. Due to possible serious complications, ingestion of foreign bodies during dental procedures must be appropriately prevented and managed if it occurs.

Optimizing vaccine distribution via mobile clinics: a case study on COVID-19 vaccine distribution to long-term care facilities.

BACKGROUND: People living in clustered communities with health comorbidities are highly vulnerable to COVID-19 infection. Rapid vaccination of vulnerable populations is critical to reducing fatalities and mitigating strain on healthcare systems. We present a case study on COVID-19 vaccine distribution via mobile vans to residents/staff of 47,907 long-term care facilities (LTCFs) across the United States that relied on algorithms to optimize vaccine distribution. METHODS: We developed a modeling framework for vaccine distribution to high-risk populations in a supply-constrained environment. Our framework decomposed this challenge as two separate problems: an assignment problem where we optimally mapped each LTCF to select CVS stores responsible for distributing vaccines; and a scheduling problem where we developed an algorithm to assign available resources efficiently. RESULTS: We assigned 1,214 retail stores as depots for vaccine distribution to LTCFs throughout the United States. Forty-one percent of matched depot-LTCF pairs were within 5 miles of a depot, 74% were within 20 miles, and only 8% mapped to depots farther than 50 miles away. Our two-step approach ensured that the first LTCF vaccination dose was distributed within 9 days after the program start date in 76% of states, and greater than 90% of doses were administered in the minimum amount of time. CONCLUSIONS: We demonstrate that algorithmic approaches are instrumental in maximizing vaccine distribution efficiency. Our learning and framework may be of use to other organizations, including communities where mobile clinics can be established to efficiently distribute vaccines and other healthcare resources in a variety of scenarios.

Photonic Crystal Fiber-Based Reconfigurable Biosensor Using Phase Change Material.

A reconfigurable biosensor with different spectral sensitivities could provide new opportunities to increase the label-free selectivity and sensitivity for biomolecules. Here, we propose and numerically demonstrate a phase change chalcogenide material (Ge2 Sb2 Te5)-based photonic crystal fiber (PCF) sensor for tunable and enhanced refractive index sensing at near infrared (NIR) wavelengths. In order to achieve this, we integrate a thin hybrid sensing layer of Au/Ge2 Sb2 Te5 with D-shaped PCF. By switching the structural phase of Ge2 Sb2 Te5 from amorphous to crystalline, we realize tunable and enhanced refractive index sensing with a large figure of merit (FOM) for the sensing range from 1.35 to 1.40, which covers most known analytes such as proteins, cancer cells, glucose and viruses or DNA/RNA. The obtained average bulk refractive index sensitivity is 17,600 nm/RIU and 8,000 nm/RIU for crystalline and amorphous phase, respectively. The observed large tunable differential response of the proposed sensor offers a promising opportunity to design an assay for the selective detection of higher and lower molecular weight biomolecules through future artificial intelligence-based sensing.

Enhancing employer coverage of smoking cessation treatment: A randomized trial of the Partners in Helping You Quit (PiHQ) program.

The workplace is a key channel for delivering tobacco cessation treatment to a population. Employers can provide workplace-based programs and/or financial incentives such as health insurance benefits that cover the cost of treatment accessed outside the workplace. Little is known about the effect of combining these strategies. We tested the benefit of adding a workplace cessation program, Partners in Helping You Quit (PiHQ), to comprehensive health insurance coverage of smoking cessation medications by Partners HealthCare, a large Boston-based healthcare delivery system. PiHQ offers biweekly telephone-based behavioral support, additional automated calls, and medication care coordination for 3 months then monthly telephone monitoring for 9 months. In a pragmatic randomized trial, employees who smoked were informed about the insurance benefit, then randomly assigned (2:1) to PiHQ or to active referral to a free 3-month phone-based community program, Massachusetts Quitline (QL). Outcomes were assessed at 3, 6, and 12 months. During 2015-2018, 106 smokers (n = 73 PiHQ, n = 33 QL) enrolled (64% female; 75% white, 21% black; mean age 46 years, mean cigarettes/day = 13). More PiHQ than QL participants made a quit attempt by 3 months (82 vs. 61%, p < .02) and achieved the primary outcome, verified past 7-day cigarette abstinence at 6 months (31 vs. 12%, odds ratio 3.34, 95% CI, 1.05-10.60). Among participants using behavioral support, PiHQ participants completed more scheduled calls and rated counseling helpfulness higher than did QL participants. These results suggest that employers can enhance the impact of providing comprehensive health insurance coverage of smoking cessation medication by adding a phone-based worksite cessation program.

Prevalence and Characteristics of Three-rooted Mandibular Molars in Saudi Population: A Retrospective Radiographic Analysis.

AIMS: To study the prevalence of three-rooted mandibular permanent first molars (PFM) among Saudi population in Al Zulfi. MATERIALS AND METHODS: Subjects were selected from the patients' records, College of Dentistry, Majmaah University, Al Zulfi, Kingdom of Saudi Arabia. Healthy patients with the presence of both mandibular PFM, orthopantomogram (OPG) and/or intraoral periapical (IOPA) radiographs were included in the study. All patients included were evaluated by a single examiner using OPG and IOPA radiographs. The occurrence of three roots, status of the tooth and associated anomalies were considered for analysis. Descriptive statistics performed using IBM SPSS (Version 21.0) at a 95% confidence interval (p < 0.05) while the Chi-square test and Fisher test were used for the incidence, and comparison of occurrence of the third root in PFM in the mandibular arch. RESULTS: A sample of 433 subjects was selected randomly based on our inclusion criteria. Only 24 (5.5%) subjects had evidence of three-rooted mandibular PFM with the mean age of 27.67 years. The frequency of bilateral and unilateral three-rooted mandibular PFM was 2.3% (10) and 3.2% (14), respectively. Overall 41.6% of subjects were witnessed with the bilateral occurrence and unilateral occurrence was 58.4% [(57% (8) were on the right and 42% (6) were left side] (p < 0.05). However, no significant relationship was observed between the left and right occurrence of three-rooted mandibular PFM (p < 0.05). Thirty-four (7.8%) PFM were presented with three roots and among them, 70% (24) received treatment. Dilacerations (12.5%), taurodontism (37%) and hypodontia (4%) were associated with three-rooted PFM in the mandibular arch. Kappa statistics showed excellent intra-examiner reliability (κ = 0.9). CONCLUSION: The prevalence of three-rooted PFM was 5.5% in the present study and unilateral occurrence is very common. Over 70% of these PFM received dental treatment in Saudi Arabia population. Always, IOPA radiographs are required to confirm the evidence of three-rooted mandibular PFM where three-dimensional imaging is not available. CLINICAL SIGNIFICANCE: An Eagle's eye of an endodontist on three-rooted PFM is of utmost importance in the treatment protocol when the tooth is planned for root canal therapy.

Inferring Entropy Production from Short Experiments.

We provide a strategy for the exact inference of the average as well as the fluctuations of the entropy production in nonequilibrium systems in the steady state, from the measurements of arbitrary current fluctuations. Our results are built upon the finite-time generalization of the thermodynamic uncertainty relation, and require only very short time series data from experiments. We illustrate our results with exact and numerical solutions for two colloidal heat engines.

Efficacy of Licorice Lollipops in Reducing Dental Caries in a Paediatric Population: A Systematic Review.

PURPOSE: To assess the efficacy of licorice lollipops in reducing dental caries in children. MATERIALS AND METHODS: A literature search was confined to the English language using MeSH terms congruent with PICO format in 'PubMed', 'Cochrane Library' and 'Ovid', covering the period from April 1967 to December 2017. Searches in Google Scholar, grey literature and hand search of cross-references were performed to find additional data. Suitable studies were selected based on the predefined inclusion and exclusion criteria. Quality analysis and risk of bias of the selected studies were performed using the Cochrane Collaboration's tool for risk of bias. RESULTS: Overall 519 articles were retrieved, 516 (electronic databases) and 3 (Google scholar). 516 publications were excluded due to non-availability of abstracts, or because they were unrelated studies, narrative reviews, and systematic reviews as well as letters to editors. Only three studies were included for final analysis. Quality analysis of these three studies showed that only one was of high quality, whereas the other two were rated as low. CONCLUSION: Licorice lollipops showed a promising effect in reducing caries by decreasing Streptococcus mutans counts in the saliva. Further research using randomised controlled clinical trial (RCT) designs with large sample size are recommended.

Pediatric intraosseous schwannoma in maxillary sinus: A case report with review of literature.

Neurilemmoma has been defined as a benign, encapsulated neoplasm that arises in the nerve fiber. It originates from the proliferation of Schwann cells in the perineurium causing displacement and compression of the adjacent nerve. This neoplasm is composed primarily of Schwann cells in a poorly collagenized stroma. It can occur in any age group. Neurilemmoma occurs all over the body including the head and neck region. In the head and neck region, 25%-40% of schwannoma cases have been reported. Occurrences of intraoral schwannomas are rare with reported prevalence being 1%. In the present article, we report a case of a 19-month-old baby complaining of pain and swelling. On clinical, radiological and histopathological features it was diagnosed as pediatric intraosseous schwannoma of the maxillary sinus.

Retention and effectiveness of pit and fissure sealants placed with or without bonding agent in young permanent teeth: A randomized clinical trial with a year follow-up.

BACKGROUND AND AIMS: The aim of this study is to evaluate the clinical efficacy of pit and fissure sealants (PFS) placed on young permanent teeth with or without the application of the bonding agent. METHODS: A.total of 100 permanent first molars from 25 children between 6-9 years of age were included and randomly allocated into 2 groups. In group A, the teeth received sealant with the bonding agent, and in group B, without a bonding agent. All the sealed teeth were evaluated for retention of the sealant at regular intervals of 3, 6, and 12 months. The difference in the retention rate with and without bonding was analyzed using Chi-square test. RESULTS: After 12 months, the clinically acceptable retention rates for PFS placed with and without bonding agent were 80% and 72%, respectively. No statistically significant difference was observed in relation to marginal integrity, marginal discoloration, and anatomic form among the PFS placed with and without bonding agent (Ps > 0.05). CONCLUSIONS: Sealant application with bonding agent showed an increased retention rate than without the use of a bonding agent. However, an additional step of bonding may be excluded in children, as it did not show any statistically significant difference in clinical retention rate compared to PFS application without bonding.

First-line management of metastatic non-small cell lung cancer: An Indian perspective.

Lung cancer has been the most common cancer in the world for several decades. The non-small cell lung cancer (NSCLC) constitutes approximately about 80% of the total cases of lung cancer. Therapeutic interventions in NSCLC have shifted to the target-based approach from histology-based approach, and this has completely changed the face of the management of NSCLC. Developing countries, such as India, have very limited data compiled about the prevalence and treatment practices of lung cancer, despite a large burden of the disease. However, in recent times, there has been a lot of data generated in this regard. This article is an attempt to collate and shine light on the available data for the first-line treatment of NSCLC in India keeping in mind the current standards of care in this area.

Efficiency Fluctuations in Microscopic Machines.

Nanoscale machines are strongly influenced by thermal fluctuations, contrary to their macroscopic counterparts. As a consequence, even the efficiency of such microscopic machines becomes a fluctuating random variable. Using geometric properties and the fluctuation theorem for the total entropy production, a "universal theory of efficiency fluctuations" at long times, for machines with a finite state space, was developed by Verley et al. [Nat. Commun. 5, 4721 (2014)NCAOBW2041-172310.1038/ncomms5721; Phys. Rev. E 90, 052145 (2014)PRESCM1539-375510.1103/PhysRevE.90.052145]. We extend this theory to machines with an arbitrary state space. Thereby, we work out more detailed prerequisites for the "universal features" and explain under which circumstances deviations can occur. We also illustrate our findings with exact results for two nontrivial models of colloidal engines.

Developmental Disturbance of a Maxillary Permanent Lateral Incisor Following Trauma at the Age of 16 Months: A 6-Year Follow-Up.

A 3 year and 8 months old Chinese boy was referred for a consultation regarding his missing maxillary anterior teeth. He had a history of trauma to his primary maxillary anterior teeth due to a fall at the age of 16 months. Clinical examination of the patient indicated multiple carious lesions and inadequate oral hygiene. Radiographic examination revealed intrusion of the primary left lateral incisor, with evidence of damage to the permanent tooth germ. Subsequently, the patient was followed-up for almost six years during which his permanent maxillary left lateral incisor erupted exhibiting an unusual morphology. Clinically enamel hypoplasia and radiographically dens invaginatus were evident in affected tooth.

Development of an electronic health record-based chronic kidney disease registry to promote population health management.

BACKGROUND: Electronic health record (EHR) based chronic kidney disease (CKD) registries are central to population health strategies to improve CKD care. In 2015, Partners Healthcare System (PHS), encompassing multiple academic and community hospitals and outpatient care facilities in Massachusetts, developed an EHR-based CKD registry to identify opportunities for quality improvement, defined as improvement on both process measures and outcomes measures associated with clinical care. METHODS: Patients are included in the registry based on the following criteria: 1) two estimated glomerular filtration rate (eGFR) results < 60 ml/min/1.73m2 separated by 90 days, including the most recent eGFR being < 60 ml/min/1.73m2; or 2) the most recent two urine protein values > 300 mg protein/g creatinine on either urine total protein/creatinine ratio or urine albumin/creatinine ratio; or 3) an EHR problem list diagnosis of end stage renal disease (ESRD). The registry categorizes patients by CKD stage and includes rates of annual testing for eGFR and proteinuria, blood pressure control, use of angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), nephrotoxic medication use, hepatitis B virus (HBV) immunization, vascular access placement, transplant status, CKD progression risk; number of outpatient nephrology visits, and hospitalizations. RESULTS: The CKD registry includes 60,503 patients and has revealed several opportunities for care improvement including 1) annual proteinuria testing performed for 17% (stage 3) and 31% (stage 4) of patients; 2) ACE-I/ARB used in 41% (stage 3) and 46% (stage 4) of patients; 3) nephrotoxic medications used among 23% of stage 4 patients; and 4) 89% of stage 4 patients lack HBV immunity. For advanced CKD patients there are opportunities to improve vascular access placement, transplant referrals and outpatient nephrology contact. CONCLUSIONS: A CKD registry can identify modifiable care gaps across the spectrum of CKD care and enable population health strategy implementation. No linkage to Social Security Death Master File or US Renal Data System (USRDS) databases limits our ability to track mortality and progression to ESRD.