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Stroke is the fifth leading cause of death in the United States (1). In 2017, on average, a stroke-related death occurred every 3 minutes and 35 seconds in the United States, and stroke is a leading cause of long-term disability (1). To prevent mortality or long-term disability, strokes require rapid recognition and early medical intervention (2,3). Common stroke signs and symptoms include sudden numbness or weakness of the face, arm, or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance; and a sudden severe headache with no known cause. Recommended action at the first sign of a suspected stroke is to quickly request emergency services (i.e., calling 9-1-1) (2). Public education campaigns have emphasized recognizing stroke signs and symptoms and the importance of calling 9-1-1, and stroke knowledge increased 14.7 percentage points from 2009 to 2014 (4). However, disparities in stroke awareness have been reported (4,5). Knowledge of the five signs and symptoms of stroke and the immediate need to call emergency medical services (9-1-1), collectively referred to as "recommended stroke knowledge," was assessed among 26,076 adults aged ≥20 years as part of the 2017 National Health Interview Survey (NHIS). The prevalence of recommended stroke knowledge among U.S. adults was 67.5%. Stroke knowledge differed significantly by race and Hispanic origin (p

Objective The objective of the study was to determine whether short-term experience (i.e., 4 weeks) with a smartphone-based hearing aid application (SHAA) might positively improve attitudes toward amplification uptake and hearing impairment. Method We recruited 15 experienced hearing aid wearers who had ceased wearing their devices for > 1 year (i.e., “In-the-Drawer” group) and 15 individuals with self-reported hearing difficulties who had yet to adopt hearing aids (i.e., “First-Time” group). We obtained participant attitudes pre- and post-SHAA using 3 surveys and analyzed perceptible changes in attitude for each survey. Comparative findings were then generalized to the health belief model in the context of perceived benefits (i.e., efficacy of an action to reduce risk) and reduced perceived barriers (i.e., tangible and psychological costs that inhibit compliance and adoption). Results A short trial period with an SHAA appears to modify the psychological perception toward amplification and reduce listener perception with respect to hearing difficulties in both groups. Conclusion A short trial period with an SHAA improved the perceived benefits and reduced the perceived barriers in the average First-Time listener, who often delays adoption of traditional amplification. The same trial period was also found to improve perceived benefits and reduce perceived barriers for the average In-the-Drawer listener, but to a lesser degree than their First-Time counterparts.

Bridge deck splashing causes deterioration to a bridge&rsquo, s structure and renders the bridge unsafe for motorists and pedestrians. The traditional countermeasure for bridge deck splashing has been pier extension. Pier extensions move the pier wave and the associated splash away from the bridge deck, but retrofitting existing bridges with pier extensions is costly. This research evaluates the use of a bulbous added to the pier as an alternative to pier extension. A bulb placed on the upstream side of a bridge pier affects the splashing. The energy in the passing water is redirected from the impact by streamlining the flow. This study proposes a mathematical model for bulbous pier design, based on a model used for a mono-hull ship. Under the mono-hull model, the bulb length extends, reaching the region where viscous resistance is dominant. Unlike wave-making resistance, which is achieved through modeling, the proposed model does not require modeling to calculate pier wave reduction.

Record linkage deals with finding records that identify the same real world entity, such as an individual or a business, from a given file or set of files. Record linkage problem is also referred to as the entity resolution or record recognition problem. To locate those records identifying the same real world entity, in principle, pairwise record analyses have to be performed among all records. Analytical operations between two records vary from comparing corresponding fields to enhancing records through large knowledge bases and querying large databases. Hence, these operations are complex and take time. To reduce the number of pairwise record comparisons, blocking techniques are introduced to partition the records into blocks. After that records in each block are analyzed against one and another. One of the effective blocking methods is the closure approach, where a “related” equivalence relation is used to partition the records into equivalence classes. This paper introduces the closure problem and describes the design and implementation of a parallel and distributed closure prototype system running in an enterprise grid.

This article has been requested because Juvenile Judges are interested in the idea of Court Clinic services. They have their own ideas about their needs for such service, and how they would be served, Further, they would be interested in knowing how such a service can be established, how it must be implemented, what it is really like to have the service, and how the service should feel about the Court.

Purpose: Hawaii has the lowest rate of community water fluoridation in the nation, resulting in poor oral health for children statewide. It thus falls to healthcare providers that see children to remedy this by prescribing fluoride supplements as per American Dental Association schedules and guiding parents in their daily usage. However, knowledge of actual practice and adherence on both provider and patient sides has never been studied. Thus, the purpose …

The authors investigated the effects of hand function and aging on the ability to manipulate different hearing instrument controls. Over the past quarter century, hearing aids and hearing aid controls have become increasingly miniaturized. It is important to investigate the aging hand and hearing aid ergonomics because most hearing aid wearers are adults aged 65 years and above, who may have difficulty handling these devices.In Experiment 1, the effect of age on the ability to manipulate two different open-fit behind-the-ear style hearing aids was investigated by comparing the performance of 20 younger (18-25 years of age), 20 young-old (60-70 years of age), and 20 older adults (71-80 years of age). In Experiment 2, ability to manipulate 11 different hearing instrument controls was investigated in 28 older adults who self-reported having arthritis in their hand, wrist, or finger and 28 older adults who did not report arthritis. For both experiments, the relationship between performance on the measures of ability to manipulate the devices and performance on a battery of tests to assess hand function was investigated.In Experiment 1, age-related differences in performance were observed in all the tasks assessing hand function and in the tasks assessing ability to manipulate a hearing aid. In Experiment 2, although minimal differences were observed between the two groups, significant differences were observed depending on the type of hearing instrument control. Performance on several of the objective tests of hand function was associated with the ability to manipulate hearing instruments.The overall pattern of findings suggest that haptic (touch) sensitivity in the fingertips and manual dexterity, as well as disability, pain, and joint stiffness of the hand, all contribute to the successful operation of a hearing instrument. However, although aging is associated with declining hand function and co-occurring declines in ability to manipulate a hearing instrument, for the sample of individuals in this study, including those who self-reported having arthritis, only minimal declines were observed.

Performing modeling and visualization of task-based parallel algorithms is challenging. Libraries such as Intel Threading Building Blocks (TBB) and Microsoft's Parallel Patterns Library provide high-level algorithms that are implemented using low-level tasks. Current tools present performance at this lower level. Developers like to tune and debug at the same level as the coding abstraction, so in this paper we propose tools and a two step methodology that target this level of abstraction. In the first step, the system level metrics of utilization and overhead are collected to determine if performance is acceptable. If a problem is suspected, the second step of our methodology projects these metrics on to the algorithms contained in the application. Using these projections many common performance issues can be quickly diagnosed. We demonstrate our methodology using a prototype implementation that is integrated with the Intel Threading Building Blocks library. We show the flexibility of the approach by analyzing three applications, including a client-server benchmark that uses a parallel_for nested within a parallel pipeline.

In a recent survey of audiologists [Martin et al., J. Am. Acad. Aud. 9, 95–100 (1998)] the authors reported that only 24% of respondents used insert earphones in any capacity. Surprisingly few clinicians use insert earphones even though they have several desirable qualities relative to supra‐aural headphones. Insert earphones are reputed to eliminate ear canal collapse, reduce occlusion, and increase interaural attenuation. The purpose of this study was to determine the extent to which insert earphones might increase the speed and ease with which hearing tests are obtained. Audiometric assessments were obtained on 91 individuals in the course of their standard clinical investigations. ER‐3A insert earphones were used to assess 46 of them and the other 45 were tested using TDH‐39 supra‐aural headphones. The audiometric tests of the two groups were compared on the basis of: testing time, earphone‐related occlusion effects, necessity for masking the nontest ear, collapsed ear canals, and occluded or collapsed insert earphones. The insert earphones were found to be superior in every category. It is strongly recommended that ER‐3A insert earphones should become the earphones of choice for audiometric assessment.

(1977). Effects of Intraoral Mouth Guards on Ventilation. The Physician and Sportsmedicine: Vol. 5, No. 1, pp. 61-66.

Clinical case histories of two juvenile girl murderers are presented to explore possible causative psychodynamics and assess their congruence with a large series of boys who committed homicide.

TEN years ago a program to provide psychiatric services to courts was established in Massachusetts by the Division of Legal Medicine of the Department of Mental Health. From the small beginning of 1 pilot clinic, the system currently operates 15 clinics in courts throughout the Commonwealth. The service that has been developed is twofold, the first service being a consultative function to give opinions in matters of competency, mental-hospital commitment, dangerousness, disposition and possibility of treatment. This is an extension of the time-honored role of psychiatry in the courts and is oriented toward helping the legal system resolve the myriad . . .

RECENT reports in national news media of the adoption of children by single adults call for some speculation about the appropriateness and possible need for this practice, and of the legal and medical implications. The adoption of children by single persons, when the person is a relative, a godparent or foster parent who sought to legalize their commitment to the childrens' care, is not an uncommon occurrence. Those situations involve a pre-existing social and personal context. The issue at hand, however, refers to that of an unattached young adult acting upon a personal desire to have a child by adoption. . . .

DURING the past two years 10 boys have been referred to the court clinic in Framingham‡ for evaluation because of prolonged use of a specific cough syrup. This preparation, containing dihydrocodeinone bitartrate, was formerly sold as an "exempt narcotic," needing no prescription. This opium derivative has recently been receiving increasing attention because of its use or misuse, not only in this preparation but also as a substitute for "higher" narcotics that are more difficult to obtain. In fact, the Federal Narcotics Bureau has taken note of the danger from dihydrocodeinone and cough syrups containing it, and under new legislation has . . .

THE surgical treatment of the conditions of hermaphrodism and pseudohermaphrodism1 to correct nature's mistakes, that the sexual identity and function of such persons may be established, has long b...

THE current social climate has produced a new movement toward the reformation of abortion laws, and the considerable controversy arises once again with gathering force. Since abortion, legal or illegal, is considered to be a medical practice, it falls within the province of medicine from a technical standpoint, and the law has placed it there in terms of the restrictions and exceptions governing the practice. There is much feeling that the demands for abortion, together with the narrowness and rigidity of the law, place physicians in a hypocritical and indefensible position. Although the actual medical indications for therapeutic abortions have . . .

THE legal rights of minors as established in legislation, and court decisions involve a number of complex factors, many of which are in conflict. The new Maryland law1 gives minors full legal capac...