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To compare the characteristics of two commercially available compression systems, a dual-compression bandage system (DCS) and a traditional two-layer bandage (TLB), using a laboratory bench test.The compression systems were evaluated in a computer-controlled tensile test to generate force-deflection curves for each sample. The compressive work and the theoretical pressure applied to the limb by the respective compression bandages were calculated at the maximum stretch and a stretch instructed by the manufacturers. The manufacturer of the DCS provides reference points on how much the bandage should be stretched to provide the desired pressure, and the TLB stretch was calculated from the product's datasheet.The combined results of layers 1 and 2 for the DCS showed greater load and work than the TLB at both the maximum and recommended stretch. The recommended stretch for DCS and TLB was less than 50% of the deflection up to the breaking point.The high work provided by the two layers of the DCS suggests a wider range of performance than the TLB when applied to the lower limb, especially after the limb volume is initially reduced by compression. Moreover, using the tensile test and the guide of the reference points on layers 1 and 2 from DCS, the calculated pressure achieved the expected values stated by the manufacturer. Human studies should be conducted to determine whether the reference points provided by DCS are beneficial for obtaining repeatable values.

BACKGROUND Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, especially in the home setting. Technology can support home-based cancer symptom management but must consider the experience of both patients and family caregivers, as well as the broader environmental context. OBJECTIVE To test feasibility and acceptability of a smart health sensing system, Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), designed to monitor, and ultimately support management of, cancer pain in the home setting. METHODS Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center in the Southeastern U.S. BESI-C was deployed in dyad homes for approximately two weeks each. Data were collected via: 1) environmental sensors that measure ambient noise, humidity, barometric pressure, light, and temperature; 2) Bluetooth beacons to help localize dyad position; and 3) smart watches worn by both patients and caregivers equipped with heartrate monitors, accelerometers, and a custom application to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partner’s perspective. Sensor data streams were integrated to describe and explore the context for cancer pain events. Feasibility was assessed technically (by scoring each deployment regarding fidelity of data capture across system components) and procedurally (e.g., deployment process, participant recruitment). Acceptability was assessed by post-deployment surveys and structured interviews with participants. RESULTS 5 deployments (n=10 participants; 5 dyads of patients and primary family caregivers) were completed, and a total of 283 unique pain events were recorded. Using our ‘BESI-C Performance Scoring Instrument’, the overall feasibility technical score for deployments was 86.4/100. Procedural feasibility challenges included: rural location of dyads; smart watch battery life and EMA reliability; and length of time required for deployment installation. Post-deployment acceptability Likert surveys (1, strongly disagree; 5, strongly agree), found dyads disagreed that BESI-C was a burden (1.7/5) or compromised their privacy (1.9/5) and agreed the system collected helpful information to better manage cancer pain (4.6/5). Participants also expressed interest in seeing their own individual data (4.4/5) and strongly agreed it is important that data collected by BESI-C are shared with their respective partner (4.8/5) and healthcare provider (4.8/5). Qualitative feedback from participants suggests BESI-C positively improved communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients and their caregivers will mark pain events in real time using a smart watch. CONCLUSIONS It is feasible to deploy BESI-C, and dyads find the system acceptable. Leveraging human-centered design and the collection of heterogenous environmental, physiological, and behavioral data, BESI-C offers an innovative approach to monitor cancer pain, mitigate escalation of pain and distress, and improve symptom management self-efficacy. Future work will: (shorter-term) 1) test BESI-C in a larger, more diverse sample; 2) continue to streamline system architecture; 3) deploy a no-contact, self-installation system in response to the COVID-19 pandemic and to enhance scalability; 4) explore how to best share data visualizations of collected data with key stakeholders; and 5) (longer-term) inform design of and deliver just-in-time personalized pain management interventions to patients and caregivers. CLINICALTRIAL n/a INTERNATIONAL REGISTERED REPORT RR2-10.2196/16178

Alzheimer’s disease and related diseases (ADRD) disproportionately affect persons of African American ethnicity, yet persons who identify as Black/African American are consistently and markedly underrepresented in Alzheimer’s research. Prior research suggests that a complex array of factors, from mistrust in medical research to non-inclusive recruitment approaches, have led to the disparity. With the growing rates of ADRD among racial/ethnic groups in the US, it is imperative that research scientists develop interventions and clinical research that are culturally informed and meaningful to the lives of diverse caregivers. The goal of our research is to demonstrate the importance of community engagement and culturally informed interventions, and to offer best practices to advance the science of caregiver recruitment, which may ultimately improve overall representation across racial/ethnic caregiver groups. Research findings will highlight the variety of recruitment strategies used to build trust and more sustainable relationships with diverse communities often underrepresented in research.

A network intrusion can be any unauthorized activity on a network and network intrusion detection is a significant topic in cybersecurity. Data analytics is conducted on the database ‘spambase’ as ...

BACKGROUND Inadequately managed pain is a serious problem for patients with cancer and those who care for them. Smart health systems can help with remote symptom monitoring and management, but they must be designed with meaningful end-user input. OBJECTIVE This study aims to understand the experience of managing cancer pain at home from the perspective of both patients and family caregivers to inform design of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system. METHODS This was a descriptive pilot study using a multimethod approach. Dyads of patients with cancer and difficult pain and their primary family caregivers were recruited from an outpatient oncology clinic. The participant interviews consisted of (1) open-ended questions to explore the overall experience of cancer pain at home, (2) ranking of variables on a Likert-type scale (0, no impact; 5, most impact) that may influence cancer pain at home, and (3) feedback regarding BESI-C system prototypes. Qualitative data were analyzed using a descriptive approach to identity patterns and key themes. Quantitative data were analyzed using SPSS; basic descriptive statistics and independent sample t tests were run. RESULTS Our sample (n=22; 10 patient-caregiver dyads and 2 patients) uniformly described the experience of managing cancer pain at home as stressful and difficult. Key themes included (1) unpredictability of pain episodes; (2) impact of pain on daily life, especially the negative impact on sleep, activity, and social interactions; and (3) concerns regarding medications. Overall, taking pain medication was rated as the category with the highest impact on a patient’s pain (=4.79), followed by the categories of wellness (=3.60; sleep quality and quantity, physical activity, mood and oral intake) and interaction (=2.69; busyness of home, social or interpersonal interactions, physical closeness or proximity to others, and emotional closeness and connection to others). The category related to environmental factors (temperature, humidity, noise, and light) was rated with the lowest overall impact (=2.51). Patients and family caregivers expressed receptivity to the concept of BESI-C and reported a preference for using a wearable sensor (smart watch) to capture data related to the abrupt onset of difficult cancer pain. CONCLUSIONS Smart health systems to support cancer pain management should (1) account for the experience of both the patient and the caregiver, (2) prioritize passive monitoring of physiological and environmental variables to reduce burden, and (3) include functionality that can monitor and track medication intake and efficacy; wellness variables, such as sleep quality and quantity, physical activity, mood, and oral intake; and levels of social interaction and engagement. Systems must consider privacy and data sharing concerns and incorporate feasible strategies to capture and characterize rapid-onset symptoms.

Idelalisib is a highly selective oral inhibitor of PI3Kδ indicated for the treatment of patients with relapsed chronic lymphocytic leukemia in combination with rituximab. Despite additive clinical effects, previous studies have paradoxically demonstrated that targeted therapies potentially negatively affect anti-CD20 mAb effector mechanisms. To address these potential effects, we investigated the impact of PI3Kδ inhibition by idelalisib on the effector mechanisms of rituximab and obinutuzumab. At clinically relevant concentrations, idelalisib minimally influenced rituximab- and obinutuzumab-mediated Ab-dependent cellular cytotoxicity and phagocytosis on human lymphoma cell lines, while maintaining the superiority of obinutuzumab-mediated Ab-dependent cellular cytotoxicity. Consistent with this, idelalisib did not influence obinutuzumab-mediated B cell depletion in whole-blood B cell–depletion assays. Further, idelalisib significantly enhanced obinutuzumab-mediated direct cell death of chronic lymphocytic leukemia cells. In murine systems, in vivo inhibition of PI3Kδ minimally interfered with maximal rituximab- or obinutuzumab-mediated depletion of leukemic targets. In addition, the duration of rituximab- and obinutuzumab-mediated depletion of leukemia cells was extended by combination with PI3Kδ inhibition. Collectively, these data demonstrate that PI3Kδ inhibition does not significantly affect the effector mechanisms induced by rituximab or obinutuzumab and provides an effective in vivo therapeutic combination. Therefore, combinations of obinutuzumab and idelalisib are currently being assessed in clinical studies.

BACKGROUND An estimated 60%-90% of patients with cancer experience moderate to severe pain. Poorly managed cancer pain negatively affects the quality of life for both patients and their family caregivers and can be a particularly challenging symptom to manage at home. Mobile and wireless technology (“Smart Health”) has significant potential to support patients with cancer and their family caregivers and empower them to safely and effectively manage cancer pain. OBJECTIVE This study will deploy a package of sensing technologies, known as Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), and evaluate its feasibility and acceptability among patients with cancer-family caregiver dyads. Our primary aims are to explore the ability of BESI-C to reliably measure and describe variables relevant to cancer pain in the home setting and to better understand the dyadic effect of pain between patients and family caregivers. A secondary objective is to explore how to best share collected data among key stakeholders (patients, caregivers, and health care providers). METHODS This descriptive two-year pilot study will include dyads of patients with advanced cancer and their primary family caregivers recruited from an academic medical center outpatient palliative care clinic. Physiological (eg, heart rate, activity) and room-level environmental variables (ambient temperature, humidity, barometric pressure, light, and noise) will be continuously monitored and collected. Behavioral and experiential variables will be actively collected when the caregiver or patient interacts with the custom BESI-C app on their respective smart watch to mark and describe pain events and answer brief, daily ecological momentary assessment surveys. Preliminary analysis will explore the ability of the sensing modalities to infer and detect pain events. Feasibility will be assessed by logistic barriers related to in-home deployment, technical failures related to data capture and fidelity, smart watch wearability issues, and patient recruitment and attrition rates. Acceptability will be measured by dyad perceptions and receptivity to BESI-C through a brief, structured interview and surveys conducted at deployment completion. We will also review summaries of dyad data with participants and health care providers to seek their input regarding data display and content. RESULTS Recruitment began in July 2019 and is in progress. We anticipate the preliminary results to be available by summer 2021. CONCLUSIONS BESI-C has significant potential to monitor and predict pain while concurrently enhancing communication, self-efficacy, safety, and quality of life for patients and family caregivers coping with serious illness such as cancer. This exploratory research offers a novel approach to deliver personalized symptom management strategies, improve patient and caregiver outcomes, and reduce disparities in access to pain management and palliative care services. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16178

The objective of this study was to evaluate the impact of Swine Awake® (SA; NutriQuest, Mason City, IA) on commercial nursery pigs from a single-source positive for Porcine Reproductive and Respiratory Virus (PRRSV). This study included 16 nursery rooms located on 3 farms. Rooms were alternately assigned between Control and SA treatment for a total of 8 rooms per treatment, with both treatments equally represented at each farm. Control and SA treatment rooms averaged 1,144 and 1,125 pigs placed for 47.4 and 48.3 days on trial, respectively. Swine Awake was administered via water for 21 d post-placement. Serum samples were collected from 30 pigs in each room at placement before MLV PRRSV vaccination and pooled in groups of 5 within room. Pooled serum samples along with oral fluid samples pulled the last days of trial were sent for PRRSV quantification by PCR. Performance data were analyzed using the MIXED procedure of SAS. Farm, start BW, and days on trial were used as covariates in the model when significant (P < 0.05). Twenty-seven of 96 pooled serum samples and 29 of 30 oral fluid samples tested positive for PRRSV with CT values ranging from 26.2 to < 37, suggesting pigs were viremic at placement with virus present throughout the study. End BW, ADG, and G/F did not significantly differ between treatments (P > 0.10); however, a numerical improvement of 0.27 kg for end BW and a 1.9% improvement in G/F were observed for pigs given SA compared with Control. Reduced percentage of dead or euthanized pigs was observed for pigs given SA compared with Control (4.1 vs. 5.9%, P = 0.06). Overall, nursery growth performance in pigs coming from a PRRSV positive flow was not different between treatments, but total mortality was decreased by 31% in barns where SA was administered.

Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections.We conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations. Patients who were undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator were randomly assigned, in a 1:1 ratio, to receive the envelope or not. Standard-of-care strategies to prevent infection were used in all patients. The primary end point was infection resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death, within 12 months after the CIED implantation procedure. The secondary end point for safety was procedure-related or system-related complications within 12 months.A total of 6983 patients underwent randomization: 3495 to the envelope group and 3488 to the control group. The primary end point occurred in 25 patients in the envelope group and 42 patients in the control group (12-month Kaplan-Meier estimated event rate, 0.7% and 1.2%, respectively; hazard ratio, 0.60; 95% confidence interval [CI], 0.36 to 0.98; P = 0.04). The safety end point occurred in 201 patients in the envelope group and 236 patients in the control group (12-month Kaplan-Meier estimated event rate, 6.0% and 6.9%, respectively; hazard ratio, 0.87; 95% CI, 0.72 to 1.06; P0.001 for noninferiority). The mean (±SD) duration of follow-up was 20.7±8.5 months. Major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group (hazard ratio, 0.63; 95% CI, 0.40 to 0.98).Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. (Funded by Medtronic; WRAP-IT ClinicalTrials.gov number, NCT02277990.).

Today, Big Data analytics is used in multiple areas. We introduce the characteristics of big data, visualization tools of big data, chief prospects of utilizing big data in healthcare, advantages of Big Data analytics in healthcare, and progresses of healthcare Big Data technology in this paper. Blockchain and privacy have also gained momentum in the healthcare sector, so privacy issues and blockchain-based cybersecurity are also examined closely. Healthcare is rapidly changing, and technology will have to change with the needs expressed by providers. With the push towards personalized medicine, Big Data should see much success in healthcare, however, there are many challenges of healthcare Big Data and cybersecurity that also need to be discussed.

Big Data analytics for intrusion detection is an important topic in cybersecurity. Network flows and system events generate big data, which often leads to challenges in intrusion detection with high efficiency and good accuracy. This paper focuses on the ‘Variety’ and ‘Veracity’ of big data characteristics in network traffic and attacks. Datasets with various data types are analyzed; data duplicates removal and missing values detection are performed. A clustering analysis based on k-means are also conducted.

Background Testing for Clostridioides difficile infection has been the subject of recent debate. Guidelines from the Infectious Diseases Society of America now support the addition of a stool toxin test to a positive nucleic acid amplification test (NAAT) as part of a multi-step testing algorithm. In November 2017, the University of Kentucky HealthCare system added stool toxin testing to any specimen positive for C. difficile by NAAT. This change was accompanied by face to face education with provider groups and clinical decision support in the form of interpretive verbiage added to the results that are reported into the electronic record. The objective of this study was to assess whether this diagnostic stewardship intervention made an impact on C. difficile treatment Methods We performed a retrospective review of adult patients admitted to UK HealthCare from November 1, 2017 through October 31, 2018 who tested positive by NAAT but negative by stool toxin test to determine whether or not they were treated. We also assessed treatment by service line to see whether there were treatment differences among these groups. A cost analysis was also performed. Results A total of 300 adult inpatients were positive for C. difficile by NAAT during the study period with 71% (213 patients) having a negative stool toxin test. Of those, 58% (123) were never started on C. difficile therapy and an additional 14% (30) had their therapy stopped after 48 hours. Only 28% (60) of these patients received a full course of therapy. Hospital medicine had the highest rate of non-treatment at 82%. Conversely, our solid-organ and bone marrow transplant services had the lowest rate of non-treatment at 31%. Overall, this approach was associated with an estimated 1470 oral vancomycin days avoided (5,880 doses) and a cost savings of $6,278. Conclusion The addition of stool toxin testing to NAAT combined with education and clinical decision support lead to a dramatic reduction of treatment for NAAT positive but toxin-negative patients. This form of diagnostic stewardship had a significant impact on therapy decisions and can be a powerful antimicrobial stewardship approach to decrease unnecessary treatment of C. difficile colonization. Disclosures All authors: No reported disclosures.

Device repositioning during Micra leadless pacemaker implantation may be required to achieve optimal pacing thresholds.The purpose of this study was to describe the natural history of acute elevated Micra vs traditional transvenous lead thresholds.Micra study VVI patients with threshold data (at 0.24 ms) at implant (n = 711) were compared with Capture study patients with de novo transvenous leads at 0.4 ms (n = 538). In both cohorts, high thresholds were defined as1.0 V and very high as1.5 V. Change in pacing threshold (0-6 months) with high (1.0 to ≤1.5 V) or very high (1.5 V) thresholds were compared using the Wilcoxon signed-rank test.Of the 711 Micra patients, 83 (11.7%) had an implant threshold of1.0 V at 0.24 ms. Of the 538 Capture patients, 50 (9.3%) had an implant threshold of1.0 V at 0.40 ms. There were no significant differences in patient characteristics between those with and without an implant threshold of1.0 V, with the exception of left ventricular ejection fraction in the Capture cohort (high vs low thresholds, 53% vs 58%; P = .011). Patients with an implant threshold of1.0 V decreased significantly (P.001) in both cohorts. Micra patients with high and very high thresholds decreased significantly (P.01) by 1 month, with 87% and 85% having 6-month thresholds lower than the implant value. However, when the capture threshold at implant was2 V, only 18.2% had a threshold of ≤1 V at 6 months and 45.5% had a capture threshold of2 V.Pacing thresholds in most Micra patients with elevated thresholds decrease after implant. Micra device repositioning may not be necessary if the pacing threshold is ≤2 V.

This paper addresses the relationship between temperature or relative humidity and the number of patients seen and how often the treating physician deemed it necessary to transport the patient to the hospital. A retrospective review was performed on 251 patients seen at the Dayton airshow during the 2‐day period of 21‐22 July 2001. The air show has an attendance of approximately 50,000 people spread out through this 3‐day event. The first aid tents that provide the medical care at the air show are staffed by either senior emergency medicine residents or emergency medicine attendings. Results showed that the relationship between the number of patients transported and the temperature reveals a pattern of more patients being transported as the temperature increases.

Recruiting rural African Americans for research presents special problems because of cultural differences, the view of researchers as cultural “outsiders”, and transportation problems. This paper reports successful strategies in recruiting rural African American adults with type 2 diabetes for research studies. The researchers tested recruitment strategies commonly used in research, such as flyers, advertisements in local newspapers and radio stations. The researchers also encouraged referrals from medical professionals. When recruitment goals were not met, the researchers modified strategies. Twenty-two rural African American participants were recruited and randomly assigned to culturally-tailored Group or Individual Diabetes Self Management Education (DSME). The latter included storytelling and an interactive learning approach. The key recruitment strategies involved spending time in the community, visits to churches, and flyers to key leaders in the Black community. Enrolling rural African Americans required cultural competence, careful planning, and time in the community. Recruiting for clinical research is challenging and more difficult when targeting minority members in rural settings. Research in diabetes care is needed with rural African Americans because of high rates of diabetes, and limited health care access for this population. Effective recruitment and retention strategies are needed to test interventions to reduce health disparities.

Background Targeting new antigens in chronic lymphocytic leukemia (CLL) and lymphoma may increase flexibility in the clinic and help circumvent resistance. The tetraspanin CD37 domain mediates transduction of survival and apoptotic signals (Lapalombella et al.,Cancer Cell, 2014), and has been clinically validated by recent trials of otlertuzumab (TRU-016) in CLL and Non-Hodgkin Lymphoma . Ligation of CD37 by this reagent simultaneously induced pro-apoptotic signaling and inhibited pro-survival signaling of phosphoinositide 3-kinase δ (PI3Kδ), which introduces a unique opportunity to use combination strategies employing activation of CD37 and inhibition of PI3Kδ. A new agent BI 836826 is an Fc-engineered anti-CD37 IgG1 that displays improved effector activities as well as crosslinker-independent direct cytotoxicity. We have evaluated the efficacy of BI 836826 combined with the PI3Kδ-selective inhibitor idelalisib in diffuse large B-cell lymphoma (DLBCL) cell lines and primary human CLL B-cells in the University and then by industry to validate the synergistic finding initially reported. Methods Cell viability assays usedCellTiterGlo to measure inhibition of antibody, isotype control, idelalisib or a combination of antibody and compound over 72h in culture. The cell viability of vehicle is measured at the time of dosing (T0) and after seventy-two hours (T72). A GI reading of 0% represents no growth inhibition, GI 100% represents complete growth inhibition, and a GI 200% represents complete death of all cells in the culture well. Annexin V-FITC and propidium iodide measure by flow cytometry was used to assess enhanced killing of primary CLL cells, with incubation of BI 836826 (0.1 µg/mL) and/or idelalisib (1 µM) at 37°C for 24 hours. Trastuzumab included as a non-specific IgG1 control. Data was reported as percentage of viable cells (Annexin V negative, PI negative) normalized to untreated control. Results DLBCL cell lines were variably sensitive to single agent BI 836826. In most of the cell lines tested, the cell viability was inhibited by 40%-50% with BI 836826 in the concentration range of 1-1000 ng/mL (Figure 1A). A synergistic effect was noted in several DLBCL cell lines when BI 836826 was combined with idelalisib. When the maximal effect of BI 836826 was greater than isotype control (GI% > 12, dotted line) and the effect of idelalisib showed a GI50 < 1uM, 3/5 cell lines showed synergy in combination (red dot, Figure 1B). A shift in the EC50of idelalisib can be seen with the addition of increasing amounts of BI 836826 (Figure 1C). In primary CLL B-cell cultures, 1 µM idelalisib displayed weak single agent activity following 24-hour incubation. The cytotoxicity of BI 836826 at 0.1 µg/mL was more variable, although treatment of samples from most CLL patients resulted in 20-50% B-cell death. The combination of these 2 agents resulted in enhanced cytotoxic activity (Figure 2A), and this effect was not attenuated by the presence of del(17)(p13.1), as there was no significant difference in cytotoxicity against these cells compared to those with lower risk cytogenetics (Figure 2B,C). Additionally, the combination was beneficial in CLL B-cells isolated from patients who were refractory to ibrutinib (Figure 2D). Conclusions This collaborative industry and academic endeavor with cross validation of initial mechanistic studies of synergy between CD37 and idelalisib demonstrates that addition of idelalisib to BI 836826 augments cytotoxicity against DLBCL cell lines and primary human CLL B-cells in an additive-to-synergistic manner. In addition, it maintains efficacy against CLL B-cells with del(17)(p13.1) and those from ibrutinib-refractory patients. Further exploration of this therapeutic strategy in clinical trials is strongly warranted. Disclosures Jones: AbbVie: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics, LLC, an AbbVie Company: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Awan:Innate Pharma: Research Funding; Pharmacyclics: Consultancy; Novartis Oncology: Consultancy. Grosmaire:Gilead: Employment. Jones:Gilead: Employment. DiPaolo:Gilead: Employment. Tannheimer:Gilead Sciences: Employment. Heider:4Boehringer Ingelheim RCV: Employment.

Evaporation rates and total energy loads from an unoccupied, heated, outdoor pool in Fort Collins, Colorado were investigated. Pool and air temperatures, humidity, thermal radiation, wind speed, and water loss due to evaporation were measured over 21 test periods ranging from 1.1 to 16.2 hours during August and September, 1992. Data were analyzed and compared to commonly used evaporation rate equations, most notably that used in the ASHRAE Applications Handbook. Measured evaporation was 72% of the ASHRAE calculated value with near-zero wind velocity, and 82% of the ASHRAE value at 2.2 m/s wind velocity. A modified version of the ASHRAE equation was developed. Two overnight tests showed energy loss of 56% by evaporation, 26% by radiation, and 18% by convection. A correlation between radiation loss and temperatures was also found for the range of test conditions.

Vehicle-induced ruts can cause severe adverse effects on soil and vegetation and reduce a vehicle's mobility potential. Vehicle turning factors including turning radius, velocity, and dynamic weight effects were integrated into the Vehicle Terrain Interaction (VTI) terrain mechanics model to predict rut formation during vehicle turning operations on yielding soils. In the modified VTI model, the resultant force on a single tire is a dynamic variable correlated with the vehicle's dynamic weight, velocity, and turning radius. Field tests using an eight-wheeled light armored vehicle (LAV) were conducted, and the results were analyzed and implemented in a modified VTI sinkage model for turning. The LAV was operated at varying velocities during spiral-pattern turn testing to obtain continuously decreasing radii rutting results. The results of the LAV field tests were analyzed with predictions from the modified VTI, and the conclusion shows that the modified model can be used to predict the influence of turning on soil rutting. Rut depths for both vehicle tracks were predicted for turning operations. Results show a tremendous improvement in prediction of rut depth using the modified VTI model, which includes the effect of turning.

Physical modeling has proven to be a successful method of synthesizing highly expressive sounds. However, providing deep methods of real time musical control remains a major challenge. In this paper we describe our work towards an instrument for percussion synthesis, in which a waveguide mesh is both excited and damped by a 2D matrix of forces from a sensor. By emulating a drum skin both as controller and sound generator, our instrument has reproduced some of the expressive qualities of hand drumming. Details of our implementation are discussed, as well as qualitative results and experience gleaned from live performances.

"How many colours are there in a field of grass to the crawling baby unaware of 'green'? How many rainbows can light create for the untutored eye? Imagine a world alive with incomprehensible objects, and shimmering with an endless variety of movement and innumerable gradations of colour. Imagine a world before the 'beginning was the word.'"-Stan Brakhage1. Before the Beginning2. Procession [1x2x3x4x5x6]3. The Garden

Background: The current recommended starting dose of sotalol is 80 mg orally twice per day, followed by a judicious increase in dosage every 3 days under continuous telemetry monitoring. We hypothesized that sotalol administered at a higher starting dose (120 or 160 mg twice daily) would allow a more rapid attainment of therapeutic response with an acceptable safety and comparable efficacy profile. Methods: Two hundred nine inpatients with various atrial and ventricular dysrhythmias were begun on either a standard starting dose (80 mg b.i.d.) or an accelerated dose (120 or 160 mg b.i.d.) of sotalol. In-hospital occurrences of drug-related adverse effects (proarrhythmic and others), drug efficacy, and length of hospitalization were retrospectively compared between the two groups. Results: Ten patients (9.3%) in the 80 mg b.i.d. starting dose group experienced a cardiac adverse effect of sotalol as compared to 15 patients (14.9%) in the accelerated dose group (P = 0.286). The mean amount of corrected QT (QTc) prolongation over baseline was not significantly different between the two groups at hospital discharge (22.5 ms vs 21.6 ms, P = 0.898). There was a trend toward more noncardiac side effects of sotalol in the accelerated dose group: 2 (1.9%) versus 7(6.9%), P = 0.092. The average length of hospital stay was similar in the two groups (6.8 days vs 7.4 days, P = 0.558). Conclusion: Initiating sotalol at 120–160 mg orally twice per day marginally increases the risk of cardiac and non-cardiac side effects compared to the standard starting regimen of 80 mg b.i.d. Such an accelerated dosing regimen neither shortened hospitalization nor had any effect on treatment efficacy in this retrospective analysis.

Clostridium difficile is widely known as a cause of disease in humans, and has emerged as an important problem in neonatal swine. No commercial product is available for immunoprophylaxis of C. difficile-associated disease, but success in preventing experimental infections in hamsters by use of nontoxigenic strains to competitively exclude toxigenic strains led us to try this method in neonatal pigs. Spores were administered orally to newborn pigs or were sprayed onto perineum and teats of dams. Significantly more piglets were weaned among litters receiving spores orally, and average weaning weights were significantly higher for both treatment groups than for controls. Toxins A and B were detected in 44.8% of litters and 16.5% of piglets born to sprayed sows and 58.3% of litters and 15.4% of piglets in the control group. However, toxins were detected in only 13.8% of litters and 3.4% of piglets given spores orally. These data support a contention that precolonization by a nontoxigenic strain can ameliorate the pre-weaning growth retardation associated with C. difficile infection in piglets.

The objective of this research was to make the decision making process of complex agents less predictable and more realistic, by incorporating emotional factors that affect humans. To this end, researchers adopted an approach that promotes the emergence of behavior as a result of complex interactions between factors affecting emotions, integrated in a connectionist style model, and factors affecting decision making, represented in a symbolic model. This report explains the model subcomponents, integration, and testing, which includes a description of the behaviors we used in the development of prototype, the design of experiments, a representative set of behavior patterns that emerged as a result of exercising the model over the design space, and recommendations for future work. Results of prototype suggest an effective means of increasing the variability of computer generated forces (CGF) behavior in manner consistent with modern day emotional theories.

We demonstrate the use of an Nd:YAG laser to optically pump an HBr gas laser, a concept combining the advanctages of solid-state and gas-laser technologies. A Q-switched Nd:YAG laser, tuned to 1.34 μm and frequency-stabilized, excites the v=3, J=5 state of HBr in a third-overtone transition. A diode laser locked to the HBr transition provides the seed signal for the Nd:YAG laser. Higher efficiencies than previously obtained for similar systems are expected in this concept because of the possibility of cascade lasing, which we have observed in our experiments and predicted in our simulations. Pump pulses of approximately 400-ns duration and 20-mJ energy are directed along the axis of a 1-m containing 15-torr HBr. In the currently unoptimized configuration, approximately 6 laser lines at about 4 μm are observed. The observed laser spectrum suggests collisional pumping for some lines and that intracavity atmospheric CO2 is a factor. We have developed and used a kinetic model, which shows good agreement with the experimental results. There is evidence of pure rotatioal lasing. Amplifiers are being added to increase the pump energy to 1 J.

Due to a narrow window of high atmospheric transmission near 4 microns, there is a great deal of interest for a scalable laser energy source in this spectral region. We propose a concept that combines the advantages of solid-state and gas laser technology. A Nd:YAG laser is tuned to 1.3391 microns by inserting an intracavity etalon and raising the operating temperature of the laser rod to 85 degree(s)C. This allows us to excite the v (0 →3), J (4 → 5) vibrational-rotational transition of HBr. To stabilize the frequency, a diode laser locked to this HBr transition seeds the Nd:YAG laser. Once excited, HBr can potentially lase in three subsequent steps to the ground state, emitting three photons in the 4-micron region. We present theoretical and experimental results demonstrating the operational principle of this laser system.

The purpose of this analysis was to identify vehicle parameters and terrain features that impede mobility, to forecast mobility over different mission areas of interest, and to identify vehicle parameter modifications that will improve LVSR mobility performance.

We present spectra of depleted uranium metal from laser plasmas generated by nanosecond Nd:YAG (1064 nm) and femtosecond Ti:sapphire (800 nm) laser pulses. The latter pulses produce short-lived and relatively cool plasmas in comparison to the longer pulses, and the spectra of neutral uranium atoms appear immediately after excitation. Evidence for nonequilibrium excitation with femtosecond pulses is found in the dependence of spectral line intensities on the pulse chirp.

A fully automated rain exclusion canopy system has been designed and constructed to study the impact of simulated acid rain on the growth and yield of agricultural crops. The system consists of three, mobile greenhouse shelters which exclude ambient rainfall and apply simulated acid rain (SAR) treatments to crops established in field plots. All aspects of the field system are controlled by a microcomputer and data acquisition system. In addition, elevated ambient levels of gaseous pollutants (e.g. O3, SO2, NOx) are reduced in field plots via an air exclusion system consisting of large blowers, potassium permanganate-treated alumina filters and perforated polyethylene tubes. Gaseous pollutants can be injected into the treatment plots via the blowers.

Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimal hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in the late graft occlusion. Forth-two canine PTFE iliofemoral grafts (all with end-to-side distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimal hyperplasia occurred exclusively at the heel and the toe of the graft and the floor of the host artery. The distal anastomotic intimal hyperplasia was 80-130 cells thick. Light microscopy and transmission electron microscopy revealed a similar architecture of interlamination of cellular elements and extracellular matrix in the hyperplastic cells. Transmission electron microscopy further defined a gradual cell transformation and orientation from the graft to the lumen. The cells near the graft were characterized by a gradual reduction of rough endoplasmic reticulum with a concomitant acquisition of myofilaments, transforming ovoid mesenchymoid cells to slender myofibroblasts. The orientation of cells in distal anastomotic intimal hyperplasia was embodied by random cell distribution at the periphery to a well-organized interlamination of myofibroblasts and extracellular matrix near the lumen. Distal anastomotic intimal hyperplasia is a biologic entity with active cellular and subcellular events. Its biogenesis appears to be influenced by the hemodynamics of blood flow at the distal anastomosis.

We have isolated and characterized complete cDNAs for two isoforms (HSPDE4D4 and HSPDE4A5) encoded by the human PDE4D gene, one of four genes that encode cAMP-specific rolipram-inhibited 3ʹ,5ʹ-cyclic nucleotide phosphodiesterases (type IV PDEs; PDE4 family). The HSPDE4D4 and HSPDE4D5 cDNAs encode proteins of 810 and 746 amino acids respectively. A comparison of the nucleotide sequences of these two cDNAs with those encoding the three other human PDE4D proteins (HSPDE4D1, HSPDE4D2 and HSPDE4D3) demonstrates that each corresponding mRNA transcript has a unique region of sequence at or near its 5ʹ-end, consistent with alternative mRNA splicing. Transient expression of the five cDNAs in monkey COS-7 cells produced proteins of apparent molecular mass under denaturing conditions of 68, 68, 95, 119 and 105 kDa for isoforms HSPDE4D1-5 respectively. Immunoblotting of human cell lines and rat brain demonstrated the presence of species that co-migrated with the proteins produced in COS-7 cells. COS-cell-expressed and native HSPDE4D1 and HSPDE4D2 were found to exist only in the cytosol, whereas HSPDE4D3, HSPDE4D4 and HSPDE4D5 were found in both cytosolic and particulate fractions. The IC50 values for the selective PDE4 inhibitor rolipram for the cytosolic forms of the five enzymes were similar (0.05-0.14 μM), whereas they were 2-7-fold higher for the particulate forms of HSPDE4D3 and HSPDE4D5 (0.32 and 0.59 μM respectively), than for the corresponding cytosolic forms. Our data indicate that the N-terminal regions of the HSPDE4D3, HSPDE4D4 and HSPDE4D5 proteins, which are derived from alternatively spliced regions of their mRNAs, are important in determining their subcellular localization, activity and differential sensitivity to inhibitors.