Allergic Rhinitis.

Allergic rhinitis is a common ailment in primary and acute care settings. Diagnosis is clinical, by means of history and physical examination. Referral to an allergist is considered when symptoms are difficult to manage and/or confirmation by means of further testing is desired. Management of allergic rhinitis should not be considered trivial, as multiple secondary effects can present as the course progresses. Several treatment modalities exist but should begin with glucocorticoid nasal sprays and systemic second- or third-generation antihistamines.

Introducing lifestyle medicine into family medicine: Theory and applications.

"Lifestyle medicine (LM) is an evidence-based therapeutic intervention delivered by clinicians trained and certified in this specialty to prevent, treat, and often reverse chronic disease". Eighty percent of the conditions primary care physicians routinely encounter in their offices, e.g., diabetes mellitus, hypertension, COPD, cardiovascular disease, have root causes in poor lifestyle choices, e.g., smoking, insufficient sleep, being sedentary, eating highly processed foods. Lifestyle is the foundation of most chronic disease management guidelines aimed at reducing morbidity and mortality. Studies have shown that changes in lifestyle can be achieved and the changes link almost directly to reduction in risk for chronic illness. Primary care physicians are ideally positioned to incorporate LM into their practices. It is important to recognize and find solutions to the many barriers to implementing LM from the patient, physician, and system level. There is an urgent need to increase opportunities for practicing physicians to increase their knowledge and skills related to LM and include this in medical school and residency curricula. Many resources exist that can provide the necessary training to seasoned physicians and students/residents to become competent in practicing LM and address barriers to implementing LM. LM has the potential to revolutionize clinical practice by placing a greater emphasis on disease prevention and the role of healthy lifestyle behaviors in disease management and remission.

Quality Improvement Capacity in a Department of Family Medicine: A Mixed-Methods Study.

Background and Objectives: Quality improvement capacity is defined as ongoing commitment to sustained quality improvement (QI) and requires knowledge of QI methods and commitment to QI activities from practice leadership and staff. The aim of this project was to identify the major facilitators and barriers to developing quality improvement capacity in a teaching practice of a department of family medicine. Methods: We conducted an exploratory, sequential, mixed-methods study, inviting key informants to participate in qualitative interviews and then conducting a survey of faculty, resident physicians, and staff at a community residency teaching practice affiliated with an academic medical center in the Midwest United States. Results: Among 12 qualitative key informant interviewees, facilitators of QI capacity included a strong motivation to provide high-quality care and a desire to leverage team-based care in QI interventions. Barriers included competing clinical and educational priorities, lack of faculty expertise in quality and scholarship, and lack of infrastructure to turn QI into scholarship. The survey response rate was 75% (48 of 64 total team members). The most common motivation for participation in QI work was "making a difference" (41, 85%), while the biggest barriers were prioritization of patient care (25, 53%), and teaching (19, 40%). Conclusion: This mixed-methods study identified key barriers and facilitators to QI capacity, of which addressing competing priorities, improving QI training, and creating infrastructure for scholarship may improve QI capacity.

Resilience basins of complex systems: An application to prosumer impacts on power grids.

Comparable to the traditional notion of stability in system dynamics, resilience is typically measured in a way that assesses the quality of a system's response, for example, the speed of its recovery. We present a broadly applicable complementary measurement framework that quantifies resilience similarly to basin stability by estimating a resilience basin, which reflects the extent of adverse influences that the system can recover from in a sufficient manner. In contrast to basin stability, the adverse influences considered here are not necessarily displacements in state space, but arbitrarily complex impacts to the system, quantified by adequate parameters. As a proof of concept, we present two applications: (i) the well-studied single-node power system as an easy-to-follow example and (ii) a stochastic model of a low-voltage DC power grid undergoing an unregulated energy transition consisting in the random appearance of prosumers. These act as decentral suppliers of photovoltaic power and alter the flow patterns while the grid topology remains unchanged. The resilience measurement framework is applied to evaluate the effect and efficiency of two response options: (i) upgrading the capacity of existing power lines and (ii) installing batteries in the prosumer households. The framework demonstrates that line upgrades can provide potentially unlimited resilience against energy decentralization, while household batteries are inherently limited (achieving ≤70% of the resilience of line upgrades). Further, the framework aids in optimizing budget efficiency by pointing toward threshold budget values as well as budget-dependent ideal strategies for the allocation of line upgrades and for the battery charging algorithm.

Allergic Rhinitis.

Allergic rhinitis is a common ailment in primary and acute care settings. Diagnosis is clinical, by means of history and physical examination. Referral to an allergist is considered when symptoms are difficult to manage and/or confirmation by means of further testing is desired. Management of allergic rhinitis should not be considered trivial, as multiple secondary effects can present as the course progresses. Several treatment modalities exist but should begin with glucocorticoid nasal sprays and systemic second- or third-generation antihistamines.

A multiplex, multi-timescale model approach for economic and frequency control in power grids.

Power systems are subject to fundamental changes due to the increasing infeed of decentralized renewable energy sources and storage. The decentralized nature of the new actors in the system requires new concepts for structuring the power grid and achieving a wide range of control tasks ranging from seconds to days. Here, we introduce a multiplex dynamical network model covering all control timescales. Crucially, we combine a decentralized, self-organized low-level control and a smart grid layer of devices that can aggregate information from remote sources. The safety-critical task of frequency control is performed by the former and the economic objective of demand matching dispatch by the latter. Having both aspects present in the same model allows us to study the interaction between the layers. Remarkably, we find that adding communication in the form of aggregation does not improve the performance in the cases considered. Instead, the self-organized state of the system already contains the information required to learn the demand structure in the entire grid. The model introduced here is highly flexible and can accommodate a wide range of scenarios relevant to future power grids. We expect that it is especially useful in the context of low-energy microgrids with distributed generation.

Network-induced multistability through lossy coupling and exotic solitary states.

The stability of synchronised networked systems is a multi-faceted challenge for many natural and technological fields, from cardiac and neuronal tissue pacemakers to power grids. For these, the ongoing transition to distributed renewable energy sources leads to a proliferation of dynamical actors. The desynchronisation of a few or even one of those would likely result in a substantial blackout. Thus the dynamical stability of the synchronous state has become a leading topic in power grid research. Here we uncover that, when taking into account physical losses in the network, the back-reaction of the network induces new exotic solitary states in the individual actors and the stability characteristics of the synchronous state are dramatically altered. These effects will have to be explicitly taken into account in the design of future power grids. We expect the results presented here to transfer to other systems of coupled heterogeneous Newtonian oscillators.

Bounding the first exit from the basin: Independence times and finite-time basin stability.

We study the stability of deterministic systems, given sequences of large, jump-like perturbations. Our main result is the derivation of a lower bound for the probability of the system to remain in the basin, given that perturbations are rare enough. This bound is efficient to evaluate numerically. To quantify rare enough, we define the notion of the independence time of such a system. This is the time after which a perturbed state has probably returned close to the attractor, meaning that subsequent perturbations can be considered separately. The effect of jump-like perturbations that occur at least the independence time apart is thus well described by a fixed probability to exit the basin at each jump, allowing us to obtain the bound. To determine the independence time, we introduce the concept of finite-time basin stability, which corresponds to the probability that a perturbed trajectory returns to an attractor within a given time. The independence time can then be determined as the time scale at which the finite-time basin stability reaches its asymptotic value. Besides that, finite-time basin stability is a novel probabilistic stability measure on its own, with potential broad applications in complex systems.

Survivability of Deterministic Dynamical Systems.

The notion of a part of phase space containing desired (or allowed) states of a dynamical system is important in a wide range of complex systems research. It has been called the safe operating space, the viability kernel or the sunny region. In this paper we define the notion of survivability: Given a random initial condition, what is the likelihood that the transient behaviour of a deterministic system does not leave a region of desirable states. We demonstrate the utility of this novel stability measure by considering models from climate science, neuronal networks and power grids. We also show that a semi-analytic lower bound for the survivability of linear systems allows a numerically very efficient survivability analysis in realistic models of power grids. Our numerical and semi-analytic work underlines that the type of stability measured by survivability is not captured by common asymptotic stability measures.

Tweaking synchronization by connectivity modifications.

Natural and man-made networks often possess locally treelike substructures. Taking such tree networks as our starting point, we show how the addition of links changes the synchronization properties of the network. We focus on two different methods of link addition. The first method adds single links that create cycles of a well-defined length. Following a topological approach, we introduce cycles of varying length and analyze how this feature, as well as the position in the network, alters the synchronous behavior. We show that in particular short cycles can lead to a maximum change of the Laplacian's eigenvalue spectrum, dictating the synchronization properties of such networks. The second method connects a certain proportion of the initially unconnected nodes. We simulate dynamical systems on these network topologies, with the nodes' local dynamics being either discrete or continuous. Here our main result is that a certain number of additional links, with the relative position in the network being crucial, can be beneficial to ensure stable synchronization.

Earnings and the elusive dividends of health

The paper presents a methodology for estimating the impact of health on earnings that addresses problems of measurement error and endogeneity, then summarizes the main findings of related studies undertaken as part of a larger project. These studies show that health status does have a significant, although modest, impact on earnings in four Latin American countries.This paper looks at the relationship between health and income. After discussing the general context of health improvements in Latin America during the last few decades, the study elaborates on the interrelationships between the physical and social determinants of health, the complexities that arise in attributing earnings differentials to variations in health status, and the difficulties of accurately measuring health status.Furthermore, environmental conditions (such as housing and sanitation) appear to have significant impacts on health status, compared to health services and public health facilities, which show little influence. The universally strong relationship between education and earnings is only modestly reduced by the inclusion of health status despite a general expectation that estimated returns to education were, in part, capturing the frequently unmeasured effects of health.

Walking for Fitness: Slow but Sure.

A walking program may be the best option for out-of-shape adults just starting a fitness program. It's safe, convenient, and it definitely exerts a training effect.

Walking for Rehabilitation: The First Step.

Walking can be a positive approach for patients in rehabilitation programs. They can condition themselves, lose weight, and relieve stress without risking musculoskeletal problems.

Flexibility: Day of the Static Stretch.

Even with all the attention now given to stretching exercises, many experts say our athletes are too tight. Physicians can help by telling their patients both the why and how of flexibility exercises.