An Experiential Learning Opportunity in Norway: Computation for Bioengineering and Mechanical Engineering Students.

The global learning initiative at Northeastern University is focused on fostering intercultural communication skills. The Dialogue of Civilization (DOC) program serves as a mechanism to achieve such a goal by offering faculty-led international experiences. In this paper, we have presented a detailed account of a DOC program that took place in Norway. The primary objective of the program was to teach mechanical engineering and bio-engineering students computational skills while stimulating critical thinking about the cultural and social aspects of technology and engineering in Norway. The program focused on two courses: a technical course and a special topics course. The technical course introduced students to finite element analysis, with practical applications and site visits in Norway to enhance experiential learning. In the special topics course, the interplay between modern technologies, like green energy, state policies, and the rights and traditions of the indigenous Sámi people was explored. The course highlighted both the progressive social policies in Norway and the historical discrimination against the Sámi. Student feedback was positive and experiential learning components such as guest lectures and site visits were particularly appreciated. Additional surveys showed that students' self-confidence was higher following the DOC program. In addition, female-identifying students had higher confidence in their future success after completion of this program as compared to their male-identifying counterparts. Our paper is expected to serve as a resource for educators seeking to integrate technical education with intercultural experiences and discussions on social and cultural impacts in engineering.

Short Physical Performance Battery and Mediation of the Effect of Mild Cognitive Impairment on Falls by Community-Dwelling Older Adults.

OBJECTIVE: The authors examined the association among cognitive function, falling, and physical performance among community-dwelling older adults (ages ≥65 years). METHODS: Eight waves of the National Health and Aging Trends Study (NHATS; 2011-2018) were assessed, with 1,225 respondents who participated in all waves. The outcomes were self-reported number of falls and NHATS Short Physical Performance Battery (SPPB) score. The Clock Drawing Test measured participants' executive function, and immediate and delayed word recall tests assessed memory. RESULTS: The analyses indicated no direct correlation between executive function and fall risk when controlled for contributing factors. However, executive function and memory significantly predicted the risk for poor physical performance, defined by the NHATS SPPB score. The interaction between pain medication and memory worsened poor physical performance among participants with mild and severe memory impairment, as well as among those with mild to moderate impairment in executive function. CONCLUSIONS: Screening older adults living in the community for executive function, memory impairment, and physical performance can predict the risk for falls and the subsequent consequences of falling.

Elder Care in Iran: A Case with a Unique Demographic Profile.

Iran will encounter rapid population aging, resulting from increased life expectancy and fluctuating fertility rates during its eight-year war with Iraq (1980-1988). The need for long-term care in Iran is expected to increase dramatically. The purpose of this paper is to examine Iran's health care system and informal care upon discussing its demographic profile. Scant attention of policymakers on the country's demographic transformation has resulted in limited resources for quality elder care as well as budget constraints for relevant research. In this demographic and political context, the costs of formal care, the shortage of health workforce and infrastructures (i.e., long-term care facilities), and the continuation of traditional cultural values are the most significant reasons for heavy reliance on informal elder care. In addition to inadequate systemic support, the prevalence of domestic violence, abuse, and infantalization are largely attributable to insufficient knowledge among informal elder carers.

Automatic gender detection of dream reports: A promising approach.

A computer program was developed in an attempt to differentiate the dreams of males from females. Hypothesized gender predictors were based on previous literature concerning both dream content and written language features. Dream reports from home-collected dream diaries of 100 male (144 dreams) and 100 female (144 dreams) adolescent Anglophones were matched for equal length. They were first scored with the Hall and Van de Castle (HVDC) scales and quantified using DreamSAT. Two male and two female undergraduate students were asked to read all dreams and predict the dreamer's gender. They averaged a pairwise percent correct gender prediction of 75.8% (κ=0.516), while the Automatic Analysis showed that the computer program's accuracy was 74.5% (κ=0.492), both of which were higher than chance of 50% (κ=0.00). The prediction levels were maintained when dreams containing obvious gender identifiers were eliminated and integration of HVDC scales did not improve prediction.

Balance performance and grip strength as predictors of cognitive function among community-dwelling older adults in the USA.

Objectives: To investigate how balance and grip strength predicts the probability of cognitive function impairment (i.e., executive function: mild and mild-to-moderate impairment, and delayed recall) over eight years in community-dwelling older adults in the US, controlling for sex and race/ethnicity. Methods: The National Health and Aging Trends Study dataset (2011 - 2018) was employed. Dependent variables included the Clock Drawing Test (Executive Function) and Delayed Word Recall Test. Longitudinal ordered logistic regression examined the association between cognitive function and predictors (i.e., balance and grip strength) over eight waves (n=9800, 1,225 per wave). Results: Those who could complete side-by-side standing and semi-tandem tasks were 33% and 38% less likely to have mild or mild-to-moderate executive function impairment, respectively, relative to those who could not complete these tests. One score decrease in grip strength increased the executive function impairment risk by 13% (Odds Ratio: 0.87, CI: 0.79-0.95). Those who completed the side-by-side tasks were 35% (Odds Ratio: 0.65, CI: 0.44-0.95) less likely to experience delayed recall impairments than those who could not complete this test. With one score decrease in grip strength, the risk of delayed recall impairment was increased by 11% (OR: 0.89, CI: 0.80-1.00). Conclusions: A combination of these two simple tests (i.e., semi-tandem stance and grip strength) can screen for cognitive impairment among community-dwelling older adults to identify people with mild and mild-to-moderate cognitive impairment in clinical settings.

Influence of Care Network Characteristics on Physician Visit Experiences for Black, White, and Hispanic Older Adults With Dementia.

OBJECTIVES: Most older adults with dementia are assisted by multiple caregivers, but the relationship of care network structure with health care access and quality is underexamined. We sought to test the associations of care network characteristics with the physician visit experience for older adults with dementia across diverse racial/ethnic groups. METHODS: We used data on Medicare beneficiaries (aged 65+) with dementia from the National Health and Aging Trends Study (2015-2019) to fit logistic regression models to test associations between physician visit outcomes and (a) size of the potential care network and (b) proportion of potential care network members (PCNMs) currently helping with daily functioning tasks. We also tested for modifications by race/ethnicity. RESULTS: Hispanic respondents had the largest potential care networks (M = 6.89, standard deviation [SD] = 3.58) and the smallest proportion of PCNMs providing help with daily functioning (M = 29.89%, SD = 22.29). In models adjusted for demographics and dementia classification, both network size and proportional involvement of PCNMs were positively associated with the presence of a PCNM and assistance during the visit. Associations remained significant at 4-year follow-up for the presence of PCNM at the visit and were robust to further adjustments for insurance type, income, and health factors. Associations were not modified by race/ethnicity. DISCUSSION: Larger networks and a higher proportion of PCNMs providing assistance predicted caregiver presence and assistance at the physician visit but not access to care. Findings suggest that strengthening care networks early in the disease may support improved health care outcomes for persons with dementia across diverse populations.

Before and After the Flint Water Crisis: Changes in the Consumption of Sugary Beverages in Residents Affected by Lead Contamination.

The present study examines the changes in the type and frequency of beverage consumption of Genesee County, Michigan residents before and after the Flint water crisis (FWC). Employing Speak to Your Health! Community Survey data of adults (N=1,825) and random-effects longitudinal ordered logistic regression, we examined between the frequency of daily soda, juice, and other sweetened drinks (OSD) intake in two subpopulations: respondents residing in ZIP codes affected and not affected by lead contamination. After the FWC, African Americans were more likely to consume all three beverage types compared with Whites. It should be noted that the context of the FWC made this a time when mistrust in local government messaging might have been a factor. Within the affected area, African Americans' likelihood of soda, fruit juice, and OSD consumption increased significantly by 156%, 146%, and 924%, respectively.

Minimizing the COVID-19 spread in hospitals through optimization of ventilation systems.

The rapid spread of SARS-CoV-2 virus has overwhelmed hospitals with patients in need of intensive care, which is often limited in capacity and is generally reserved for patients with critical conditions. This has led to higher chances of infection being spread to non-COVID-19 patients and healthcare workers and an overall increased probability of cross contamination. The effects of design parameters on the performance of ventilation systems to control the spread of airborne particles in intensive care units are studied numerically. Four different cases are considered, and the spread of particles is studied. Two new criteria for the ventilation system-viz., dimensionless timescale and extraction timescale-are introduced and their performances are compared. Furthermore, an optimization process is performed to understand the effects of design variables (inlet width, velocity, and temperature) on the thermal comfort conditions (predicted mean vote, percentage of people dissatisfied, and air change effectiveness) according to suggested standard values and the relations for calculating these parameters based on the design variables are proposed. Desirability functions that are comprised of all three thermal condition parameters are used to determine the range of variables that result in thermally comfortable conditions and a maximum desirability of 0.865 is obtained. The results show that a poorly designed ventilation system acts like a perfectly stirred reactor-which enormously increases the possibilities of contamination-and that when air is injected from the ceiling and extracted from behind the patient beds, the infection spread is least probable since the particles exit the room orders of magnitude faster.

Utility of Handheld Ultrasound Performed by Cardiology Fellows in Patients Presenting with Suspected ST-Elevation Myocardial Infarction.

Background: In academic hospitals, cardiology fellows may be the first point of contact for patients presenting with suspected ST-elevation myocardial infarction (STEMI) or acute coronary syndrome (ACS). In this study, we sought to determine the role of handheld ultrasound (HHU) in patients with suspected acute myocardial injury (AMI) when used by fellows in training, its association with the year of training in cardiology fellowship, and its influence on clinical care. Methods: This prospective study's sample population comprised patients who presented to the Loma Linda University Medical Center Emergency Department with suspected acute STEMI. On-call cardiology fellows performed bedside cardiac HHU at the time of AMI activation. All patients subsequently underwent standard transthoracic echocardiography (TTE). The impact of the detection of wall motion abnormalities (WMAs) on HHU in regard to clinical decision-making, including whether the patient would undergo urgent invasive angiography, was also evaluated. Results: Eighty-two patients (mean age: 65 years, 70% male) were included. The use of HHU by cardiology fellows resulted in a concordance correlation coefficient of 0.71 (95% confidence interval: 0.58-0.81) between HHU and TTE for left ventricular ejection fraction (LVEF), and a concordance correlation coefficient of 0.76 (0.65-0.84) for wall motion score index. Patients with WMA on HHU were more likely to undergo invasive angiogram during hospitalization (96% vs. 75%, P < 0.01). The time interval between the performance of HHU to initiation of cardiac catheterization (time-to-cath) was shorter in patients with abnormal versus normal HHU examinations (58 ± 32 min vs. 218 ± 388 min, P = 0.06). Finally, among patients who underwent angiography, those with WMA were more likely to undergo angiography within 90 min of presentation (96% vs. 66%, P < 0.001). Conclusion: HHU can be reliably used by cardiology fellows in training for measurement of LVEF and assessment of wall motion abnormalities, with good correlation to findings obtained via standard TTE. HHU-identified WMA at first contact was associated with higher rates of angiography as well as sooner angiography compared to patients without WMA.

Word associations contribute to machine learning in automatic scoring of degree of emotional tones in dream reports.

Scientific study of dreams requires the most objective methods to reliably analyze dream content. In this context, artificial intelligence should prove useful for an automatic and non subjective scoring technique. Past research has utilized word search and emotional affiliation methods, to model and automatically match human judges' scoring of dream report's negative emotional tone. The current study added word associations to improve the model's accuracy. Word associations were established using words' frequency of co-occurrence with their defining words as found in a dictionary and an encyclopedia. It was hypothesized that this addition would facilitate the machine learning model and improve its predictability beyond those of previous models. With a sample of 458 dreams, this model demonstrated an improvement in accuracy from 59% to 63% (kappa=.485) on the negative emotional tone scale, and for the first time reached an accuracy of 77% (kappa=.520) on the positive scale.

Surprising up-regulation of P-selectin glycoprotein ligand-1 (PSGL-1) in endotoxin-induced uveitis.

P-selectin glycoprotein ligand-1 (PSGL-1) is constitutively expressed on leukocytes and was thought to be down-regulated with cell activation. However, this work shows the surprising finding of functional PSGL-1 up-regulation during acute inflammation. PSGL-1 function was studied in our autoperfusion assay, in which blood from a mouse carotid flows through a microchamber coated with a fixed density of P-selectin. Under the inflammatory conditions--uveitis induced by systemic lipopolysaccharide injection--we recorded significantly reduced leukocyte rolling velocity, which suggests PSGL-1 up-regulation; however, flow cytometry showed reduced PSGL-1. When bound leukocytes were released from the vasculature by PSGL-1 blockade, a large peripheral blood leukocyte (PBL) population showed elevated PSGL-1, which could account for the reduced PSGL-1 in the remaining unbound population. In the eye, systemic blockade of PSGL-1 with a monoclonal antibody or recombinant soluble PSGL-1 drastically reduced the severe manifestations of uveitis. Furthermore, PSGL-1 blockade was significantly more effective in reducing retinal leukostasis than was P-selectin blockade. Our results provide surprising evidence for functional PSGL-1 up-regulation in PBLs during acute inflammation. The temporal overlap between PSGL-1 and P-selectin up-regulation reveals an as yet unrecognized collaboration between this receptor-ligand pair, increasing efficiency of the first steps of the leukocyte recruitment cascade.

Quality of life in the Iranian Blind War Survivors in 2007: a cross-sectional study.

BACKGROUND: Quality of Life measurements are necessary tools for effectively evaluating health services. In the population of patients afflicted with war-related blindness in Iran, such measurements have yet to be documented and utilized. "The design and implementation of this study involved the determination of a baseline score for QOL in a population of Iranian blinded in the Iraq-Iran war in order to facilitate the design of interventions intended to improve the population's QOL." METHODS: This was a cross-sectional study of a representative population of 250 war victims blind in both eyes at a 14-day recreational conference. RESULTS: Participants had a mean age of 43.20(SD8.34) and their composition was 96.5% male and 3.5% female with a mean SF-36 QOL score of 59.20(SD22.80). An increasing level of education among the participants correlated with a higher QOL score (p = 0.006). The QOL also has a significant correlation to number of injuries (p < 0.0001). High systolic and diastolic blood pressure, hearing loss, and tinnitus had negative individual correlations to QOL (p = 0.016, 0.016, 0.005, p < 0.0001). The male sexual disorders of erectile dysfunction and premature ejaculation both had significant correlations to QOL (p = 0.026, p < 0.0001). Hypercholesterolemia showed significant correlation to QOL (p = 0.021). CONCLUSIONS: As blind war survivors' age, they will present with a greater set of burdens despite their relatively better QOL in the physical component scale when compared with lower limb amputees. Risk factors of cardiovascular attack such as high blood pressure and hypercholesterolemia were present and need future interventions. KEYWORDS: Quality of life, blindness, SF36, health.

Impact of the interaction between mild and mild-to-moderate cognitive impairment with chronic health problems on hospital admission among community-dwelling older adults.

AIM: This study aims to examine the effect of concurrent mild and mild-to-moderate cognitive impairment with chronic diseases on hospital admission (HA) among community-dwelling older adults. METHOD: The National Health and Aging Trends Study (2011-2018), with 1225 respondents (each wave), were used. The number of HAs within 1 year was the outcome. Clock drawing test, delayed word recall test, self-reported chronic diseases and their interactions were the independent variables. RESULTS: The effect of cognitive impairment on the frequency of HAs varies for executive function and memory impairment. Executive function impairment concurrent with the history of heart attack or diabetes mellitus (DM) can increase the risk of HAs. Memory impairment concurrent with hypertension, DM or stroke can increase the chance of HAs. CONCLUSION: Screening to identify mild and mild-to-moderate cognitive impairment at the time of admission can help to reduce the risk of rehospitalization, particularly for patients with DM, hypertension, stroke and heart attack. Geriatr Gerontol Int 2020; 20: 1213-1220.

Race/Ethnic Differences in Social Resources as Cognitive Risk and Protective Factors.

Overall social network size, often the sum of common lifetime relationships, including children, family, and friends, has been linked to cognitive impairment and Alzheimer's Disease. However, little research has examined the association between network size composition and cognitive function in middle-aged and older adults in the context of race/ethnicity. We investigated the associations between the number of close children, family, and friends independently with executive function (EF) and memory across a subsample of non-Hispanic Black, Hispanic, and non-Hispanic White participants who completed the Health and Retirement Study Harmonized Cognitive Assessment Protocol (N = 2,395). We found that network size composition was more closely linked to EF than memory and that these associations varied by race/ethnicity. Specifically, the strongest associations existed between EF and quadratic estimates of the number of close children of non-Hispanic Black participants, and number of close family members for Hispanic participants. Among Black participants, a curvilinear relationship indicated that two close children were associated with greater EF, while a smaller or larger number of close children were associated with lower EF. On the other hand, among Hispanic participants, higher EF was associated with fewer (0-1) and greater (4-5+) numbers of family member contacts. Overall, these results indicate that examining children, family, and friends independently may be more useful than the common practice of aggregation of overall network size, especially in the context of race/ethnicity.

Online engagement and cognitive function among older adults.

AIM: Social engagement is known to serve an important role in cognitive health, but there has been limited information on the role of online engagement. The present study aimed to identify the benefits of different online activities for the cognitive function of older adults. METHODS: Data came from the National Health and Aging Trend Study, Round I-V (2011-2015), with >8000 respondents from Medicare beneficiaries. Cognitive function was measured by the Clock Drawing Test and immediate 10-word recall. The respondents were also asked if they carried out any of the online activities listed. RESULTS: Some online activities, such as email, texting and seeking medical information, can reduce the risk of cognitive decline. Whereas contacting a medical provider using online can increase the risk of cognitive decline. CONCLUSIONS: Given the findings, the development of new technologies for online social engagement needs to be one of the priorities for researchers and policymakers in the field of aging and dementia. Geriatr Gerontol Int 2019; 19: 918-923.

The Level of Cognitive Impairment and Likelihood of Frequent Hospital Admissions.

Objective: This study aims to examine the relationship between different levels of cognitive impairment (CI) and the frequency of hospital admission (HA). Method: Data from the National Health and Aging Trend Study, Round 1 (2011), with 8,245 respondents from Medicare beneficiaries were used. The data account for the number of hospital admissions for one year before the data collection. Clock Drawing Test and delayed word recall were employed to measure CI. Results: The severity of CI is one of the factors significantly associated with HA. Controlling for the level of function, the likelihood of HA increased among respondents with moderate, mild-to-moderate, and mild CI. Counterintuitively, HA was reduced when CI is severe. Discussion: People with CI are at more risk of frequent HA and the severity of impairment can increase this risk subsequently. Screening for CI at admission can open up the possibility of interventions, hence reducing complications during and after hospitalization.

Safety and efficacy of overlapping sirolimus-eluting versus paclitaxel-eluting stents.

BACKGROUND: The short-term and long-term safety and efficacy of paclitaxel versus sirolimus-overlapping drug-eluting stents (DES) is unknown. We sought to examine the clinical consequences of overlapping sirolimus versus paclitaxel DES. METHODS: We reviewed catheterization reports from April 2003 to May 2005 for all patients who underwent percutaneous coronary revascularization with DES. All patients were followed-up for at least 1 year. Patients were included if they received only 2 single-type overlapping stent (eg, sirolimus-sirolimus) during the index procedure. The end points included early (inhospital and 30-day) and late composite of all-cause mortality, stent thrombosis, myocardial infarction, and target lesion revascularization. RESULTS: A total of 282 individuals met our study criteria. Of these, 188 had sirolimus and 94 had paclitaxel-overlapping DES. There were 78 events for a median follow-up of 24 months for the composite end point. No statistically significant differences between overlapping sirolimus and paclitaxel DES were seen for inhospital, 30-day (16% vs 23%, respectively; P = .13), and long-term (25% vs 33%, respectively; P = .16) composite end points. In addition, in Kaplan-Meier and Cox proportional hazard analysis, no significant differences for the composite end point were noted. CONCLUSIONS: In this analysis, there were no significant differences in safety or efficacy between the 2 types of overlapping DES. Trends toward more events with overlapping paclitaxel stents should be evaluated in an adequately powered randomized controlled trial.

Intratidal Overdistention and Derecruitment in the Injured Lung: A Simulation Study.

GOAL: Ventilated patients with the acute respiratory distress syndrome (ARDS) are predisposed to cyclic parenchymal overdistention and derecruitment, which may worsen existing injury. We hypothesized that intratidal variations in global mechanics, as assessed at the airway opening, would reflect such distributed processes. METHODS: We developed a computational lung model for determining local instantaneous pressure distributions and mechanical impedances continuously during a breath. Based on these distributions and previous literature, we simulated the within-breath variability of airway segment dimensions, parenchymal viscoelasticity, and acinar recruitment in an injured canine lung for tidal volumes( VT ) of 10, 15, and 20 mL·kg-1 and positive end-expiratory pressures (PEEP) of 5, 10, and 15 cm H2O. Acini were allowed to transition between recruited and derecruited states when exposed to stochastically determined critical opening and closing pressures, respectively. RESULTS: For conditions of low VT and low PEEP, we observed small intratidal variations in global resistance and elastance, with a small number of cyclically recruited acini. However, with higher VT and PEEP, larger variations in resistance and elastance were observed, and the majority of acini remained open throughout the breath. Changes in intratidal resistance, elastance, and impedance followed well-defined parabolic trajectories with tracheal pressure, achieving minima near 12 to 16 cm H2O. CONCLUSION: Intratidal variations in lung mechanics may allow for optimization of ventilator settings in patients with ARDS, by balancing lung recruitment against parenchymal overdistention. SIGNIFICANCE: Titration of airway pressures based on variations in intratidal mechanics may mitigate processes associated with injurious ventilation.

Emergency room (ER) referrals and health insurance in the United States.

This article aims to determine how various health insurance policies affect the rate of emergency room (ER) referrals in the United States. The secondary data, gathered in National Health Measurement Study (NHMS) in 2008 and 2010, was used. The authors identify the relationships between health insurance and ER referrals by using zero-inflated binomial and zero-inflated Poisson regression. About 17% (2008) and 20% (2010) of the respondents had one or more ER referrals in the 2 years; those who were under coverage of governmental health insurance are more likely to refer ER than uninsured group. The differences in ER referrals that ended with hospital admission across different insurance policies are not significant. Health insurance is a remarkable factor in ER referrals; the coverage of health insurance plans can affect consuming the services provided in ER. Governmental insurance plans can increase ER referrals.