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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Impact of ventilation frequency and parenchymal stiffness on flow and pressure distribution in a canine lung model.

To determine the impact of ventilation frequency, lung volume, and parenchymal stiffness on ventilation distribution, we developed an anatomically-based computational model of the canine lung. Each lobe of the model consists of an asymmetric branching airway network subtended by terminal, viscoelastic acinar units. The model allows for empiric dependencies of airway segment dimensions and parenchymal stiffness on transpulmonary pressure. We simulated the effects of lung volume and parenchymal recoil on global lung impedance and ventilation distribution from 0.1 to 100 Hz, with mean transpulmonary pressures from 5 to 25 cm H2O. With increasing lung volume, the distribution of acinar flows narrowed and became more synchronous for frequencies below resonance. At higher frequencies, large variations in acinar flow were observed. Maximum acinar flow occurred at first antiresonance frequency, where lung impedance achieved a local maximum. The distribution of acinar pressures became very heterogeneous and amplified relative to tracheal pressure at the resonant frequency. These data demonstrate the important interaction between frequency and lung tissue stiffness on the distribution of acinar flows and pressures. These simulations provide useful information for the optimization of frequency, lung volume, and mean airway pressure during conventional ventilation or high frequency oscillation (HFOV). Moreover our model indicates that an optimal HFOV bandwidth exists between the resonant and antiresonant frequencies, for which interregional gas mixing is maximized.

Effects of atorvastatin on the hypertension-induced oxidative stress in the rat brain.

BACKGROUND: It is well known that the development of brain oxidative stress is one of the most serious complications of arterial hypertension that evokes brain tissue damage. The aim of this study was to examine the effects of atorvastatin treatment (20 mg/kg/day), as an antioxidant, to prevent the brain tissue oxidative stress in the hypertensive (HTN) rats. METHODS: Experiments were performed in four groups of rats (n = 5 each group): sham, sham-treated, HTN and HTN treated. Rats were made HTN by aortic constriction above the renal arteries. After 30 days, rats were slaughtered under deep anesthesia to remove brain hemispheres. After tissue homogenization, enzyme activities of superoxide dismutase (SOD) and catalase (CAT), as well as glutathione (GSH) content and malondialdehyde (MDA) level were determined by biochemical methods. RESULTS: In HTN rats, arterial blood pressure was increased about 40% and brain enzyme activities of SOD and CAT were significantly decreased compared with sham group. Induction of hypertension significantly decreased GSH content and increased MDA level of brain tissue. Treatment with atorvastatin enhanced the activity of SOD and prevented from GSH decrement during hypertension. CONCLUSION: Based on the findings of this study, treatment with atorvastatin might have saved the brain tissue of HTN rats from hypertension-induced oxidative stress.

Activities of daily living independence in Iranian blind war survivors: a cross sectional study, 2008.

AIM: Assessment of activities of daily living (ADL) can be helpful for designing individualized rehabilitation programs for disabled individuals. Measuring and comparing the basic ADL (BADL) and instrumental ADL (IADL) independence between middle aged and senior Iranian blind war survivors (IBWS) was the aim of this study. METHODS: This cross-sectional study assessed BADL and IADL of 312 blind war survivors, using the Barthel Index and the Lawton-Bordy scale. Data collection was carried out in a recreational event for the blind war survivors in Mashhad, Iran, 2008. RESULTS: The majority of the participants were male (99%), and more than 80% had multiple injuries. None of them were independent in all BADL and IADL. Older groups were more dependent in IADL such as telephone use, drug management, financial management, and BADL such as walking on uneven surfaces, bed/chair transfer and using stairs. The functional status and activities' level differences between those aged younger than 50 years and those aged older than 50 years were significant (P<0.05). DISCUSSION: In the present study, all the IBWS were dependent in at least one ADL. Multiple physical injuries could be one of the main reasons for the dependency in this group. IBWS aged older than 50 years were considerably more dependent in their BADL and IADL than the younger group. It appears that starting the fifth decade of age in IBWS might cause some considerable decrease in their function. Training and individualized rehabilitation programs are warranted.

Simulating ventilation distribution in heterogenous lung injury using a binary tree data structure.

To determine the impact of mechanical heterogeneity on the distribution of regional flows and pressures in the injured lung, we developed an anatomic model of the canine lung comprised of an asymmetric branching airway network, which can be stored as binary tree data structure. The entire tree can be traversed using a recursive flow divider algorithm, allowing for efficient computation of acinar flow and pressure distributions in a mechanically heterogeneous lung. These distributions were found to be highly dependent on ventilation frequency and the heterogeneity of tissue elastances, reflecting the preferential distribution of ventilation to areas of lower regional impedance.