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IMPORTANCE: The evidence that maintaining a healthy body weight in conjunction with healthier eating patterns, exercise training, and reduced stress can improve clinical outcomes in patients with atherosclerotic cardiovascular disease is substantial. However, little is known about the magnitude and temporal effects of a comprehensive lifestyle treatment on coronary artery anatomy, myocardial inflammation, and fibrosis in people affected by coronary heart disease. OBJECTIVE: To conduct a randomised clinical trial to determine the impact of a 12-month intense lifestyle intervention delivered via an mHealth platform (in the form of a mobile App) versus standard clinical care on low attenuation plaque volume and structure, stress myocardial perfusion, and diastolic function. DESIGN: A single centre, parallel-group, randomised controlled trial. The co-primary endpoints are: 1-Low Attenuation Plaque (LAP) volume (mm3) using coronary computed tomography angiography (CCTA) at 12 months, and 2-Adenosine stress myocardial blood flow (stress MBF, mL/min/g) using cardiovascular magnetic resonance imaging (MRI) at 12 months. Other key measurements include liver steatosis by MRI, subclinical abnormalities detected by advanced electrocardiography, arterial stiffness, endothelial function, genomic, metabolomic, and gut microbiome-related adaptations to these structural changes. An intention-to-treat principle will be used for all analyses. SETTING: Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and Royal Prince Alfred Hospital (RPAH) Departments of Cardiology and Radiology. All clinical investigations will be undertaken within the Charles Perkins Centre-RPAH clinic. PARTICIPANTS: Individuals (n = 150) with stable coronary heart disease who have low attenuation plaque based on a CCTA within the past 3 months, will be randomised to a lifestyle intervention program comprising a 5:2 pesco-vegetarian diet, exercise training, and mindfulness-based stress reduction (n = 75) or usual care (n = 75). DISCUSSION: This trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention targeting multiple metabolic pathways, delivered via a customized mHealth App on smart devices, on coronary macro- and microcirculation, heart physiology, and cardiometabolic risk. It will provide a new framework for allowing clinicians and individuals to optimise metabolic health for the prevention and management of atherosclerotic cardiovascular diseases that is epidemic in modern society.

UNSTRUCTURED Background Achieving the physical activity recommendations of at least 150 to 300 minutes a week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity aerobic exercise, is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long-term. Objectives The Messages Improving Resting hearT Health (MIRTH) study aims to determine whether or not: (1) sending daily motivational messages via a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart diseases randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training. Design A single center, micro-randomized trial (MRT). Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (months 4-6) and at the end (10-12) of the LIVEPLUS trial (ACTRN12620001151921). Wrist-worn devices (Fitbit Inspire 2) Bluetooth paired with smartphones will be used to passively collect data for proximal (i.e., physical activity duration, steps walked, heart rate within 180 minutes of receiving messages) and distal (i.e., change values for resting heart rate and total steps walked within and across both Phases 1 and 2 of the trial) outcomes. Setting Participants will be recruited from a large academic Cardiology office practice (Central Sydney Cardiology) and Royal Prince Alfred Hospital (RPAH) Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre-RPAH clinic. Participants Individuals (n = 58) with stable coronary heart disease who have low attenuation plaque based on a CCTA within the past 3 months and have been randomized to an intensive lifestyle intervention program. Discussion This MIRTH micro-randomization trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention targeting multiple metabolic pathways, delivered via a customized mHealth App on smart devices, on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions. Trial Registration ACTRN12622000731796; pre-results Universal Trial Number (UTN) U1111-1269-8610

Medical comorbidities occur in more persons with HIV than without HIV. We used a nationally representative 10% sample of 2016 Pharmaceutical Benefits Scheme (PBS) dispensing data to compare the proportions of antiretroviral therapy (ART)-purchasing and non-ART-purchasing patients who also purchased prescriptions for medical comorbidities. Each patient who purchased ART was compared with two gender- and age group-matched patients who did not purchase ART in the same year. We calculated the proportions of patients who also purchased coprescriptions used for hypertension, dyslipidemia, diabetes, cancer, low bone mineral density, and mental health, defined using PBS medication coding categories, and the resulting odds ratios. A total of 1,973 ART-purchasing patients in our sample were matched to 3,946 non-ART-purchasing patients. Compared with non-ART-purchasing patients, a greater proportion of ART-purchasing patients also purchased medications for dyslipidemia (19.8% vs. 16.6%

Objective. The purpose of the study was to compare suicidal ideation among medical and pharmacy students and characterize related symptoms. Methods. The authors conducted a cross-sectional, retrospective study to compare suicidal ideation among medical and pharmacy students at a single public university during 2009 to 2020. Respondents’ voluntary and anonymous responses to the Interactive Screening Program (ISP) Stress and Depression Questionnaire are reported. Results. The authors analyzed responses from 619 medical and 214 pharmacy students collected over 11 academic years. There was no significant difference between medical and pharmacy students who endorsed suicidal ideation (13.5% vs 17.3%, respectively). The Patient Health Questionnaire-9 (PHQ-9) scores were significantly different between medical and pharmacy students, with more pharmacy students reporting moderate to severe depression (24.3% for medical vs 35.1% for pharmacy). Compared to medical students, more pharmacy students also endorsed anhedonia, a reduced capacity for pleasure (13.4% vs 24.3%, respectively), sleep problems (29.6% vs 42.6%, respectively), and fatigue (46% vs 64.4%, respectively). Pharmacy students also reported more intense affective states such as “feeling your life is too stressful” and “feeling intensely anxious or having anxiety attacks.” Relationships and physical/mental health/substance abuse were common themes that emerged from the qualitative data. Conclusion. While there was no significant difference in suicidal ideation between pharmacy and medical students, the prevalence is alarming compared to the general population. More pharmacy students endorsed symptoms of depression and intense affective states that could impair functioning. Future studies may focus on mitigation strategies for suicidal ideation among health professions students.

The scramble number of a graph is an invariant recently developed to aid in the study of divisorial gonality. In this paper we prove that scramble number is NP-hard to compute, also providing a proof that computing gonality is NP-hard even for simple graphs, as well as for metric graphs. We also provide general lower bounds for the scramble number of a Cartesian product of graphs, and apply these to compute gonality for many new families of product graphs., 20 pages, 6 figures

UNSTRUCTURED During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients’ feelings of “copresence”—a sense of connection with another interactant via digital technology—with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients’ anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient’s need to reach out to their health care provider during a time when health care resources are being stretched.

The 4 ⁢ N {4N} -carpets are a class of infinitely ramified self-similar fractals with a large group of symmetries. For a 4 ⁢ N {4N} -carpet F, let { F n } n ≥ 0 {\{F_{n}\}_{n\geq 0}} be the natural decreasing sequence of compact pre-fractal approximations with ⋂ n F n = F {\bigcap_{n}F_{n}=F} . On each F n {F_{n}} , let ℰ ⁢ ( u , v ) = ∫ F N ∇ ⁡ u ⋅ ∇ ⁡ v ⁢ d ⁢ x {\mathcal{E}(u,v)=\int_{F_{N}}\nabla u\cdot\nabla v\,dx} be the classical Dirichlet form and u n {u_{n}} be the unique harmonic function on F n {F_{n}} satisfying a mixed boundary value problem corresponding to assigning a constant potential between two specific subsets of the boundary. Using a method introduced by [M. T. Barlow and R. F. Bass, On the resistance of the Sierpiński carpet, Proc. Roy. Soc. Lond. Ser. A 431 (1990), no. 1882, 345–360], we prove a resistance estimate of the following form: there is ρ = ρ ⁢ ( N ) > 1 {\rho=\rho(N)>1} such that ℰ ⁢ ( u n , u n ) ⁢ ρ n {\mathcal{E}(u_{n},u_{n})\rho^{n}} is bounded above and below by constants independent of n. Such estimates have implications for the existence and scaling properties of Brownian motion on F.

Objectives: As HIV-positive people age, diagnosis and management of comorbidities associated with ageing are of increasing concern. In this study, we aimed to compare the self-reported prevalences of heart disease, stroke, thrombosis and diabetes in older Australian HIV-positive and HIV-negative gay and bisexual men (GBM). Methods: We analysed data from the Australian Positive & Peers Longevity Evaluation Study (APPLES), a study of a prospectively recruited cross-sectional sample of 228 (51.1%) HIV-positive and 218 (48.9%) HIV-negative GBM, aged >= 55 years. Regression methods were used to assess the association of HIV status with self-reported comorbidities. Results: Of 446 patients, 389 [200 (51.4%) HIV-positive] reported their disease history. The reported prevalence of comorbidities was higher in the HIV-positive group than in the HIV-negative group: heart disease, 19.5 versus 12.2%; stroke, 7.5 versus 4.2%; thrombosis, 10.5 versus 4.2%; and diabetes, 15.0 versus 9.0%, respectively. In adjusted analyses, HIV-positive GBM had significantly increased odds of reporting heart disease [adjusted odds ratio (aOR) 1.99; P = 0.03] and thrombosis (aOR 2.87; P = 0.01). In our analysis, HIV status was not significantly associated with either age at diagnosis of heart disease (median 53 years for HIV-positive GBM versus 55 years for HIV-negative GBM; P = 0.64) or 5-year cardiovascular disease (CVD) risk estimated using the Framingham risk score. Conclusions: HIV-positive GBM more commonly reported heart disease and thrombosis compared with their HIV-negative peers. These results further highlight the need to understand the impact of HIV on age-related comorbidities in GBM, to guide optimal screening and treatment strategies to reduce the risk of these comorbidities among the HIV-positive population.

Objectives Cohort studies are often used as a national surveillance tool to monitor trends in HIV treatment and morbidity outcomes. However, there are limited studies validating the accuracy of using cohorts as a representation of the overall HIV-positive population. We compared data from a large Australian HIV-positive cohort study (Australian HIV Observational Database [AHOD]) and a 10% longitudinal sample from Australia's subsidized prescription medication scheme (Pharmaceutical Benefits Scheme [PBS]) to assess the use of cohorts for providing representative data for surveillance and monitoring purposes. Study Design and Setting Basic demographics and treatment information from July 1, 2013, to March 31, 2016, were divided into half-yearly periods to compare HIV trends between AHOD (n = 2,488) and PBS (n = 18,409) patients. Results In both data sets, most patients were men, aged above 50 years, and primarily resided in New South Wales. Both data sets revealed a significant shift toward the increased use of integrase strand transfer inhibitors and a gradual decline in the use of protease inhibitors and nonnucleoside reverse-transcriptase inhibitors among the treated population in Australia. Similarly, a substantial increase in the use of once daily, single-tablet, fixed-dose combination regimens was also observed. Conclusion Our results show that observational cohort studies can serve as useful surrogate surveillance tools for monitoring patient characteristics and HIV treatment trends.

Objective To investigate the relationship between emotion sharing and technically troubled dialysis (TTD) in a remote patient monitoring (RPM) setting. Materials and Methods A custom software system was developed for home hemodialysis patients to use in an RPM setting, with focus on emoticon sharing and sentiment analysis of patients’ text data. We analyzed the outcome of emoticon and sentiment against TTD. Logistic regression was used to assess the relationship between patients’ emotions (emoticon and sentiment) and TTD. Results Usage data were collected from January 1, 2015 to June 1, 2018 from 156 patients that actively used the app system, with a total of 31 159 dialysis sessions recorded. Overall, 122 patients (78%) made use of the emoticon feature while 146 patients (94%) wrote at least 1 or more session notes for sentiment analysis. In total, 4087 (13%) sessions were classified as TTD. In the multivariate model, when compared to sessions with self-reported very happy emoticons, those with sad emoticons showed significantly higher associations to TTD (aOR 4.97; 95% CI 4.13–5.99; P = < .001). Similarly, negative sentiments also revealed significant associations to TTD (aOR 1.56; 95% CI 1.22–2; P = .003) when compared to positive sentiments. Discussion The distribution of emoticons varied greatly when compared to sentiment analysis outcomes due to the differences in the design features. The emoticon feature was generally easier to understand and quicker to input while the sentiment analysis required patients to manually input their personal thoughts. Conclusion Patients on home hemodialysis actively expressed their emotions during RPM. Negative emotions were found to have significant associations with TTD. The use of emoticons and sentimental analysis may be used as a predictive indicator for prolonged TTD.

The use of computational fluid dynamics (CFD) to model and predict surgical outcomes in the nasal cavity is becoming increasingly popular. Despite a number of well-known nasal segmentation methods being available, there is currently a lack of an automated, CFD targeted segmentation framework to reliably compute accurate patient-specific nasal models. This paper demonstrates the potential of a robust nasal cavity segmentation framework to automatically segment and produce nasal models for CFD. The framework was evaluated on a clinical dataset of 30 head Computer Tomography (CT) scans, and the outputs of the segmented nasal models were further compared with ground truth models in CFD simulations on pressure drop and particle deposition efficiency. The developed framework achieved a segmentation accuracy of 90.9 DSC, and an average distance error of 0.3 mm. Preliminary CFD simulations revealed similar outcomes between using ground truth and segmented models. Additional analysis still needs to be conducted to verify the accuracy of using segmented models for CFD purposes.

During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients’ feelings of “copresence”—a sense of connection with another interactant via digital technology—with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients’ anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient’s need to reach out to their health care provider during a time when health care resources are being stretched.

Background Treatment guidelines for antiretroviral therapy (ART) have evolved to emphasize newer regimens that address ageing-related comorbidities. Using national Australian dispensing data we compare ART regimens with Australian HIV treatment guidelines in the context of treated comorbidities. Methods The study population included all individuals in a 10% sample of national data from the Australian Pharmaceutical Benefits Scheme (PBS) who purchased a prescription of ART during 2016. We defined each patient’s most recently dispensed ART regimen and characterized them to evaluate regimen complexity and adherence to national HIV treatment guidelines. We then analyzed ART regimens in the context of other co-prescriptions purchased for defined comorbidities. Results The 1995 patients in our sample purchased 212 different ART regimens during 2016; 1524 (76.4%) purchased one of the top ten most common regimens of which 62.3% were integrase strand transfer inhibitor-based. Among the 1786 (90%) patients that purchased the most common regimens, 83.7% purchased a regimen recommended by the guidelines for initial antiretroviral therapy and 11.4% purchased antiretrovirals that are not recommended for initial therapy

Optical vortices are waves carrying orbital angular momentum and exhibit helical phase fronts. Helical phase front leads to discontinuous azimuthal phase jumps and the number of phase discontinuities (abrupt phase jumps from −π to π) within a 2π range is referred to as the topological charge of an optical vortex. Optical vortices have been applied in trapping and spinning of microparticles, and recently in free-space data transmission. Generation of optical beams carrying orbital angular momentum has received increasing attentions recently, both in the far-field and in the near-field. Near-field vortices are typically generated through the excitation of surface plasmons (SP). However, the intensity patterns of the SP vortices generated thus far, just like the free-space vortex beams, are all azimuthally symmetrical (annular) since mathematically they conform to the Bessel function.

In Australia, almost half of HIV-positive people are now aged over 50 and are predominately gay and bisexual men (GBM). Compared to the general HIV-negative population, GBM engage more in behaviours that may increase the risk of age-related comorbidities, including smoking, high alcohol consumption and recreational drug use. The objective of APPLES was to compare comorbidities and risk factors in HIV-positive older GBM with an appropriate control group of HIV-negative GBM. We undertook a prospectively recruited cross-sectional sample of HIV-positive and HIV-negative GBM ≥ 55 years. Detailed data collection included clinic data, a health and lifestyle survey, and blood sample collection. We report key demographic, laboratory markers and self-reported comorbidities by HIV status. For selected comorbidities we also adjust HIV status a priori for age, smoking and body mass index. Over 16 months 228 HIV-positive and 218 HIV-negative men were recruited. Median age was 63 years (IQR: 59–67). Although more HIV-positive men reported having ever smoked, smoking status was not statistically different between HIV positive and HIV negative men (p = 0.081). Greater alcohol use was reported by HIV-negative men (p = 0.002), and recreational drug use reported more often by HIV-positive men (p

TeraDiode is manufacturing multi-kW-class ultra-high brightness fiber-coupled direct diode lasers for industrial applications. Our TeraBlade industrial platform achieves world-record brightness levels for direct diode lasers. The laser output has a Beam Parameter Product (BPP) of 4 mm-mrad. This 4-kW fiber-coupled direct diode laser has a comparable BPP to industrial fiber and solid state lasers used for cutting and welding processes.

The U.S. cotton classification system has been undergoing significant changes, moving from human classing to the use of precise instruments. Along with this trend, the current research is an effort to develop a new computer vision system to measure detailed trash and color attributes of raw cotton. The system primarily consists of a color ccd camera, xenon flash light, and customized software. In this paper, we introduce a new trash and spot identification method, multidimension thresholding, and the methods for characterizing size, spatial density, shape, and color of trash and spots present in cotton samples. We report on the trash and color measurements of twelve cotton samples, including statistical data and distribution curves, and we compare the results from this system with those from other instruments such as the Spinlab and Motion Control hvi machines and the Minolta Chroma Meter CR-210. Finally, we investigate the influence of trash and spots on cotton color values.

Direct diode lasers have some of the most attractive features of any laser. They are very efficient, compact, wavelength versatile, low cost, and highly reliable. However, the full utilization of direct diode lasers has yet to be realized. This is mainly due their poor output beam quality. Because of this, direct diode lasers are typically used to pump other lasers such as bulk solid-state (rod and thin disk) and fiber lasers. In other words these other lasers are primarily used as brightness converters. Thus, currently industrial lasers for high brightness applications such as cutting and welding are dominated by CO2, fiber, and bulk solid-state lasers.

TeraDiode has built kW-class direct diode lasers with the same output power and beam quality as existing industrial lasers. Our kW-class direct diode laser has cut gauge-thickness metal with comparable quality as existing industrial lasers.

As the size of quartz resonator continues to shrink, beveling of the plano-plano quartz crystal is needed to reduce mounting loss and to sustain energy trapping so to have low motional resistance for oscillation. The beveling process though is time consuming and difficult to control for small size and low frequency quartz crystals. In recent years, studies on stepped electrode (a.k.a bi-mesa electrode) began to appear. It's believed that stepped electrode on plano-plano crystal would do part of the job in energy trapping like beveled crystals. In this paper, we report our own study of stepped electrode with the following configurations- single layer electrode on plano-plano crystal, stepped electrode on plano-plano crystal, single layer electrode on beveled crystal, and stepped electrode on beveled crystal. The vehicle for this study was a 15 MHz 3.2mmx2.5mm crystal. Preliminary results show that stepped electrode can provide to some degree of energy trapping as bevel crystals.

Pavement macrotexture plays a critical role in highway users' safety. It is also closely related to tire-pavement interaction noise. In recent years, continuous effort has been made toward three-dimensional macrotexture measurement in the field to accommodate pavement management. This study presents a newly developed macrotexture measuring system with 3D laser scanning technology. The underlying system demonstrates a series of desirable properties including: (1) 3D surface feature, (2) high speed data collection, (3) large sampling capacity, (4) high resolution and accuracy, and (5) ease of operation. Based on data collected on a real-world asphalt pavement by the system, it is demonstrated that the existing pavement macrotexture evaluation indexes are extended from 2D to 3D. By comparison, it is shown that the 3D indexes are able to characterize pavement macrotexture in a more comprehensive and realistic manner. The correlation among the 3D indexes is also evaluated, which provides pavement researchers and engineers more flexibility in selecting relevant indexes in macrotexture property evaluation.