Nutrition and Isolation in a Rural US Population over 80 Years Old: A Descriptive Analysis of a Vulnerable Population.

Factors allowing rural, community-dwelling 80+ year-olds to thrive remain unexplored. Isolation can impact this vulnerable population. In this study, patients were prospectively surveyed for age, gender, cohabitation (self, spouse, family) and location (suburban, rural, and isolated). Mini-nutritional assessment short form (MNA-SF) and BMI were obtained. A p < 0.05 represented statistical significance. Patients (n = 167) were mostly female (120; 71.9%) with an average overweight BMI (26.5) and low-normal MNA-SF scores (11.8). Most live alone (49.7%), followed by spousal (31.7%) and family (18.6%) cohabitation. Over 80% are rural (71) or rural-isolated (67), and of these, 83% had normal nutrition. Self-habitation correlated with lower MNA-SF scores (p = 0.02). Normal BMIs correlated with family cohabitation (OR = 0.90 [CI: 0.82-0.99]) and nourished MNA-SF scores with spousal cohabitation (OR = 1.69; CI: 1.15-2.47) rather than living alone. Self-habitation increases vulnerability to obesity and malnutrition. Interventions should aim to maintain independence while improving the effects of habitation on nutrition.

Nanoscale morphology and thermal properties of low insertion loss fiber Bragg gratings produced using the phase mask technique and a single femtosecond laser pulse.

Fiber Bragg gratings with a very low insertion loss are inscribed using the phase mask technique and a single infrared (800 nm) femtosecond laser pulse. The morphology of the resultant light-induced structural changes in the Ge-doped silica fiber (SMF-28) is analyzed using scanning electron microscopy. The electron microscopy images reveal that each Bragg grating period incorporates an elongated micropore embedded in a region of homogeneous material modification. The Bragg wavelength drift and reflectivity of fiber Bragg gratings produced with single pulses having the same energy but different duration (80 fs and 350 fs) are monitored for 1000 hours in the course of isothermal annealing at 1000°C. The annealing data demonstrate that both the isothermal Bragg wavelength drift and the decrease in the reflectivity of the fiber Bragg gratings under test are statistically slower for the 350 fs inscription pulses.

Delayed hemorrhage following deep brain stimulation device placement in a patient with Parkinson's disease and lupus anticoagulant syndrome: illustrative case.

BACKGROUND: Treatment options for Parkinson's disease (PD) include both medical and surgical approaches. Deep brain stimulation (DBS) is a surgical procedure that aims to improve motor symptomatology. OBSERVATIONS: A 66-year-old White male with a 9-year history of PD presented to the neurosurgery clinic for DBS consideration. On the morning of scheduled surgery, preoperative laboratory test results revealed a prolonged prothrombin time of 50 seconds. Surgery was postponed, and further work-up revealed that the patient had a positive test result for lupus anticoagulant (LA). DBS implantation was performed 2 months later. The first stage of surgery was uneventful. The patient returned 1 week later for the second stage. Postoperatively, the patient exhibited a diminished level of consciousness. Computed tomography revealed left frontal intraparenchymal hemorrhage with surrounding edema, trace subarachnoid hemorrhage, intraventricular hemorrhage, and midline shift. LESSONS: The authors suspect that the hemorrhage occurred secondary to venous infarct, because LA is associated with a paradoxically increased risk of thrombosis. Although there is no documented association between LA and acute or delayed hemorrhage, this case demonstrates a possible relationship in a patient following DBS placement. More research is needed to confirm an association with coexisting LA with PD and an increased hemorrhage risk in neurosurgical interventions.

Ultrafast Laser Processing of Optical Fibers for Sensing Applications.

A review of recent progress in the use of infrared femtosecond lasers to fabricate optical fiber sensors that incorporate fiber Bragg gratings (FBG) and random fiber gratings (RFG) is presented. The important advancements in femtosecond laser writing based on the phase mask technique now allow through-the-coating (TTC) fabrication of Bragg gratings in ultra-thin fiber filaments, tilted fiber Bragg gratings, and 1000 °C-resistant fiber Bragg gratings with very strong cladding modes. As an example, through-the-coating femtosecond laser writing is used to manufacture distributed fiber Bragg grating sensor arrays for oil pipeline leak detection. The plane-by-plane femtosecond laser writing technique used for the inscription of random fiber gratings is also reviewed and novel applications of the resultant devices in distributed temperature sensing, fiber lasers and fiber laser sensors are discussed.

Fiber Bragg Grating Wavelength Drift in Long-Term High Temperature Annealing.

High-temperature-resistant fiber Bragg gratings (FBGs) are the main competitors to thermocouples as sensors in applications for high temperature environments defined as being in the 600-1200 °C temperature range. Due to their small size, capacity to be multiplexed into high density distributed sensor arrays and survivability in extreme ambient temperatures, they could provide the essential sensing support that is needed in high temperature processes. While capable of providing reliable sensing information in the short term, their long-term functionality is affected by the drift of the characteristic Bragg wavelength or resonance that is used to derive the temperature. A number of physical processes have been proposed as the cause of the high temperature wavelength drift but there is yet no credible description of this process. In this paper we review the literature related to the long-term wavelength drift of FBGs at high temperature and provide our recent results of more than 4000 h of high temperature testing in the 900-1000 °C range. We identify the major components of the high temperature wavelength drift and we propose mechanisms that could be causing them.

Ensuring contact: calling rural Appalachian older adults during the COVID-19 epidemic.

INTRODUCTION: Older adults, especially those aged 85 years or older, remain at significantly higher risk for COVID-19. This group, along with those with pre-existing heart and lung disease and diabetes, have accounted for 80% of hospitalizations and an even higher percentage of COVID-19 related deaths in the USA. West Virginia, the only state in the USA located completely within Appalachia, has a higher percentage of elderly than all but two states in the nation. Rural seniors are hesitant to use hospital emergency departments and attend routine care visits for fear of exposure to the virus. Restricted cell phone and internet service may limit effective technological outreach to more isolated rural older adults. More information is needed to develop effective, safe, and acceptable approaches to care for rural, isolated older adults. METHODS: Telephone interviews were conducted with 124 community-dwelling residents in four counties in rural Appalachia between 1 and 22 April 2020. Participants were aged 75 years or older. Descriptive statistics were calculated and Fisher's Exact Test was used to examine for associations among variables. RESULTS: Participants consisted of 86 (69.4%) women and 38 (30.6%) men with an average age of 82.5 years. Telephone contact was the preferred method of contact among all but four participants (96.8%). Seventeen calls (13.7%) resulted in some form of intervention, including arranging for emergent home repairs, treatment of severe hypertension, scheduling urgent laboratory testing, arranging for terminal care, treating acute conditions, and providing durable medical equipment. The 17 participants requiring intervention were significantly more likely to be aged 85 years or older (p=0.004), and report two or more chronic conditions (p<0.001). Those describing themselves as 'lonely' were significantly more likely to live alone (p=0.009) and describe themselves as 'anxious' or 'depressed' (p<0.001). CONCLUSION: A telephone call appears to be the most effective means of communication with patients in these rural Appalachian counties. Patients aged 85 years or older and those living alone should be given highest priority for regular outreach by healthcare providers. In this population, systematically calling rural elderly patients during the COVID-19 epidemic and its aftermath represents an effective strategy for providers who care for elderly rural patients.

Extreme Environment Sensing Using Femtosecond Laser-Inscribed Fiber Bragg Gratings.

The femtosecond laser-induced fiber Bragg grating is an effective sensor technology that can be deployed in harsh environments. Depending on the optical fiber chosen and the inscription parameters that are used, devices suitable for high temperature, pressure, ionizing radiation and strain sensor applications are possible. Such devices are appropriate for aerospace or energy production applications where there is a need for components, instrumentation and controls that can function in harsh environments. This paper will present a review of some of the more recent developments in this field.

Virtual intubation training at a remote military site.

To provide medical support to the far forward battlefield, training in advanced medical technologies is essential for military healthcare providers. To meet this challenge, the use of modern video communication technologies and novel medical devices can be implemented. This study demonstrates the combined use of modern video conferencing technology and video laryngoscopy equipment in the virtual laryngoscopy training of deployed military medical personnel.

The use of virtual training to support insertion of advanced technology at remote military locations.

Effective training in advanced medical technologies is essential for military healthcare providers to support the far forward battlefield. The use of modern video communication technologies and novel medical devices can be utilized for meeting this challenge. This study demonstrates the combined use of video conferencing equipment and videolaryngoscopy in the virtual training of a novice in videolaryngoscopy, nasal intubation and airway foreign body removal.

Direct evidence of tilted Bragg grating azimuthal radiation mode coupling mechanisms.

A number of useful fiber optic devices depend on being able to predict and manipulate the radiation field emitted by tilted fiber Bragg gratings. Previously we demonstrated analytically the manner in which this radiation field is directionally dependent on the phase matching characteristics of a grating's three-dimensional structure as well as the polarization dependent dipole response of the medium itself. In this paper, for the first time, experimental measurements of the out-tapped field are presented which clearly illustrate and confirm the existence of the predicted trends associated with each of these physical mechanisms. Using an infrared camera and commercially available beam profiling software, these findings were gathered from a number of tilted fiber Bragg gratings written with an ultraviolet excimer laser at a variety of blaze angles.

Multiple-beam interference patterns in optical fiber generated with ultrafast pulses and a phase mask.

We compare the cladding patterns present in grating structures fabricated with an ultrafast laser and a phase mask with a cw beam interference model. We find that the observed patterns agree well with the model results for picosecond pulses; however, for femtosecond pulses, we show that the full bandwidth and the pulsed nature of the sources must be considered because the pattern can be affected by group-velocity walk-off. An interesting consequence of order walk-off is the possibility of pure two-beam interference generation with a phase mask in the femtosecond pulse regime.

Some symmetry-induced isotope effects in the kinetics of recombination reactions.

Symmetry-induced isotope effects in recombination and collision-induced dissociation reactions are discussed. Progress on understanding the anomalous isotope effects in ozone is reviewed. Then, calculations are performed for the simpler reaction xNe+yNe+H<-->xNeyNe+H, where x and y label either identical or different isotopes. The atomic masses in the model are chosen so that symmetry is the only difference between the systems. Starting from a single potential energy surface, the properties of the bound, quasibound, and continuum states of the neon dimer are calculated. Then, the vibration rotation infinite order sudden approximation is used to calculate cross sections for all possible inelastic and dissociative processes. A rate constant matrix that exactly satisfies detailed balance is constructed. It allows recombination to occur both via direct three-body collisions and via tunneling into the quasibound states of the energy transfer mechanism. The eigenvalue rate coefficients are determined. Significant isotope effects are clearly found, and their behavior depends on the pressure, temperature, and mechanism of the reaction. Both spin statistics and symmetry breaking produce isotope effects. Under most conditions the breaking of symmetry enhances the rates, but a wide spectrum of effects is observed; they range from isotope effects with a normal mass dependence to huge, mass-independent isotope effects to cancellation and even to reversal of the isotope effects. This is the first calculation of symmetry-induced isotope effects in recombination rates from first principles. The relevance of the present effects to ozone recombination is discussed.

Fiber bragg gratings made with a phase mask and 800-nm femtosecond radiation.

High-quality retroreflecting fiber Bragg gratings were written in standard Ge-doped telecom fiber (Corning SMF-28) after a few minutes exposure with pulsed 800-nm, 120-fs laser radiation by use of a deep-etch silica zero-order nulled phase mask optimized for 800 nm. Induced index modulations of 1.9 x 10(-3) were achieved with peak power intensities of 1.2 x 10(13) W/cm2 without any fiber sensitization. The fiber gratings are stable and did not erase after 2 weeks at 300 degrees C. The primary mechanism of induced index change results from a structural modification to the fiber core.

Falls in rural elders: an empirical study of risk factors.

BACKGROUND: Our objective was to analyze and determine several risk factors of falls in the rural elderly population. Our study examined several variables believed to be positively correlated with the likelihood of an elderly person sustaining a fall. METHODS: Analysis was performed on a prospective study of 308 community-dwelling rural elders during a span of 6 years. Factors such as prescription medication, eyesight, age, sex, recent hospitalizations, and personal health ratings were analyzed through a series of advanced empirical techniques. RESULTS: Of the five significant variables found in our analysis, four were different types of prescription drugs. The biometric results suggest the probability of falling increases by as much as 4% for each year of age. Prescription painkillers increase the probability of falling by 20% to 85%. Arthritis medication decreases the probability of falling by 20% to 60%. CONCLUSION: Although our results are necessary to the body of falls research, further study is required for precise determination of those medications found to be statistically significant in our analysis.