Sign Change Research Articles

The Study of the Skeletal Remains of the 16th Century Italian Commander Alessandro Farnese and His Wife, Maria D'Aviz

ABSTRACTEntheseal changes are indicators of persistent and long‐term changes induced by occupational activity and refer to marks on the skeleton where a muscle, tendon, or ligament inserts into the periosteum. Their study makes it possible to deduce further information about the person to whom the human bone remains belong. The authors present here the analysis of these markers on the bone remains of two Italian historical figures who lived in the 16th century. In 2021, the exhumation of the remains of Alessandro Farnese and Maria D'Aviz was authorized for study purposes and the skeletal remains were examined. The data collected from the examination of the mortal remains of Alessandro Farnese are compatible with historical data about his biography. As a skilled leader and assiduous sportsman, he showed signs of entheseal changes in his bone tissue attributable to physical activities. On the other hand, the case of Maria D'Aviz differs significantly from that of Alessandro Farnese in that her bone segments show no signs of entheseal changes. The analysis carried out on the remains results to be very useful in verifying the comparison with the elements present in their biography. The possibility of confirming the connection between entheseal changes and lifestyle habits is fundamental to increasing credibility in the application of these elements in the process of identifying nameless bodies in the forensic context.

A study of Poisson-type Equations with Sign Changing Parameters in Fully Asymmetric Configurations

In this paper, we consider some Poisson-type equations arising from the study of electromagnetic wave propagation in metals and metamaterials, where sign-changing coefficients in these equations lead to challenges that fall outside standard frameworks. We apply the T-isomorphism method, expanding on the approach in [1], to analyze Poisson-type equations in fully asymmetric configurations. These configurations require a new construction of isomorphism T. Finally, we obtain the well-posedness of these problems under certain parameters

The presence of unknown polio engagement confirmed by electromyography and muscle testing.

To evaluate the usefulness of electromyography at a polio clinic in identifying unperceived muscle denervation. Second, to compare people who perceived themselves as weak in 1 or both legs with those who did not. Cross-sectional study. The study included 542 persons with late effects of polio in Sweden. Mean age 58 at the first visit, 312 were female. Data used are from a clinical quality registry. At the first visit patients answered sent-out questionnaires. They underwent an electromyography test, walk test, and muscle strength assessment. Electromyography identified signs of chronic neurogenic changes in lower limb muscles (n = 260) where the patient reported no previous involvement, comprising 239 of the participants. Significant differences in values shows that the group who did not perceive themselves as weak exhibited better performance, demonstrating greater speed, strength, and reduced reliance on wheelchairs. Electromyography can identify signs of muscle denervation in association with weakness in people with late effects of polio who perceived themselves as healthy. This comparison suggests that those that do not perceive weakness may unknowingly overuse their muscles. These findings contribute to our understanding of the late effects of polio and importance of early detection and rehabilitation.

Role of divalent doping at A-sites (A=Ca2+, Sr2+, Ba2+ & Pb2+) on thermoelectric and magnetoresistive properties in La0.67(Bi0.0835Na0.0835) A0.165MnO3

The present work reports on the effect of divalent ion doping (Ca2+, Sr2+, Pb2+ & Ba2+) ions at A-site in the compound with compositional formula La0.67(Bi0.0835Na0.0835)A0.165MnO3 on structural, magnetic, magneto-transport and thermoelectric properties. X-ray diffraction reveals orthorhombic structure for calcium and barium doped with no peak splitting observed at ~ 32o whereas rhombohedral structure for strontium and lead dopants with a peak splitting in the main intensity. Doping with divalent ions at A-site in La0.67(Bi0.0835Na0.0835)A0.165MnO3 manganites has introduced Mn2+ ions, changing the ratio of Mn3+/Mn4+ in octahedral site and this has been confirmed from X-ray photospectroscopy studies. The field emission scanning electron microscope images confirm different grain sizes and morphologies for different doping elements and distinguished variation is noticed for strontium doped manganites with a grain size of 1.08µm. Room temperature ferromagnetic behavior was observed in the samples at room temperature except for calcium doped sample and magnetic behavior has been discussed on the basis of the various interactions between mixed valence manganese ions and Mn3+/Mn4+ ratio. Electrical resistivity (ρ) as a function of temperature (T) without magnetic field indicates the double peak behavior and with the application of external magnetic fields, the double peak disappears, in all the investigated samples. Highest MR% at their respective transition temperatures (TP1) has been obtained for lead doped samples when compared to barium, strontium and calcium samples. Activation energies (EP) estimated decreases initially for calcium and strontium whereas it increases for lead and barium dopants i.e. for further increases in ionic radii. The change of sign from positive to negative in Seebeck coefficient (S) was noticed with increasing ionic radii suggesting the variation in the nature of charge carriers. The electron-electron, electron-magnon, magnon-magnon scattering mechanism contributes to the temperature dependent resistivity and thermopower in the low temperature region while in the paramagnetic insulating region is governed by a small polaron hopping mechanism.

Bridging the gap between vulnerable populations and public health services through outreach initiatives

Introduction: Public health services encounter significant challenges in reaching vulnerable populations, characterized by complex social, economic, and structural barriers that impede healthcare access. The health of marginalized groups is significantly affected by gaps in equality, poverty, and access to resources and social factors. Efficient analysis of such complex relations must entail analyses of various interdisciplinary strategies that can intertwine and traverse the contrasting physiologic specialties of the healthcare field to control diverse barriers towards service provision to culturally and economically deprived populations. Materials and Methods: Comprehensive systematic review approaches were used, including several research approaches to assess existing published literature and empirical research studies. Stringent literature search criteria were employed, the sources included peer-reviewed journals, gray literature, and institution reports of interventions in health care for vulnerable populations. Appropriate bibliometric methods and qualitative synthesis approaches were applied to conduct comprehensive analyses of heterogeneous research fields. Specific methodological techniques used in the study are systematic literature review meta-analysis and comparative evaluation of clinical case studies to make an exclusive and accurate evaluation of the evidence presented. Results: Significant findings emerged regarding outreach initiative effectiveness in enhancing healthcare accessibility. The outcomes established showed that focused equitable services enhanced its use by the vulnerable people, particularly, in preventive health care, and health-related literacy and trust. Specific interventions focusing on certain at-risk groups in contexts that were characterized by interdisciplinary showed promising signs of systematic change. The statistical analysis revealed the effectiveness of the targeted outreach programs and the key role of innovation in improving the health equity indicators. Discussion: Critical interpretations of research findings emphasized complex interactions between structural vulnerabilities and healthcare access mechanisms. Detailed analysis unveiled complex issues that cannot be solved by separate departments in parallel but need an integration of solutions. The context of the intervention was also examined in detail suggesting complex interdependencies between aspects of social environment, intervention-related activities, and health outcomes. Conceptual frameworks were scrutinized to analyze the patterns that impact the healthcare of the high-risk groups. Conclusion: Strategic outreach initiatives represent pivotal mechanisms for addressing healthcare disparities. Multifaceted approaches addressing social multidimensional aspects and economic and cultural factors show great promise for the redesign of public health services. Despite these limitations, collaborative community-centered solutions define vital strategies for realizing health equity. Further research and subsequent practice of such strategies are vital for the continual improvement to close gaps in healthcare.

Toxicological Insights into Myrmecodia platytyrea Tuber Aqueous Extract: An Oral Acute and Subacute Toxicity Studies in Mice

Despite advancements in medical science, the global burden of inflammation-related diseases remains high, necessitating the exploration of novel and effective remedies that can offer relief without significant side effects. The indigenous peoples of Papua and Borneo use the decoction of Myrmecodia platytyrea tubers, the ant plant, for its medical benefits, particularly in cancer therapy, demonstrating the deep traditional knowledge of natural treatments. The Rubiaceae plant has been used in traditional medicine to alleviate inflammation and other conditions. Thus, this study aims to investigate the toxicological profile of the aqueous extract of M. platytyrea tubers (MPAE). The study conducted adhered to recognised protocols for assessing oral acute and subacute toxicity, with necessary modifications to meet the specific experimental needs. In the acute toxicity study, male and female mice received a single oral dose of MPAE at 2000 mg/kg and monitored for 14 days. In the subacute toxicity study, male and female mice received 500 mg/kg/day MPAE orally for 28 days. Physical and behavioural changes were observed. Haematological parameters and biochemical parameters were analysed, including histology of the liver and kidneys. Acute and subacute toxicity studies found no clinical signs of toxicity, mortality, or weight changes. The subacute toxicity study found no significant changes in haematological parameters or biochemical parameters for both sexes. Acute and subacute toxicity tests revealed no treatment-related necropsy, gross, or histopathological abnormalities. In conclusion, MPAE is safe to consume and supports further development of M. platytyrea for treating inflammation-related diseases, particularly cancer.

Evaluation of Photoaging and Sun Protection Behavior in Children With Xeroderma Pigmentosum, Group C: A Prospective Analysis.

Thirteen children with xeroderma pigmentosum variant C were evaluated using the Dermoscopic Photoaging Assessment Scale (DPAS), the Glogau scale, and the Sun Protection Behavior Scale (SPBS). Most patients exhibited signs of epidermal photoaging, with pigmentary and vascular changes and poor sun protection behavior (mean SPBS score: 18.92 ± 5.69). The mean DPAS score of 13.15 correlated with the Glogau scale and ocular severity score. Sun protection behavior improved significantly at 6 months after repeated reinforcement of sun protection measures (35 ± 5.68).

Giving adolescent girls and young women a foothold: Economic strengthening as a key protection strategy against HIV infection in South Africa

This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff (n = 72) and economic strengthening beneficiaries (n = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain.

Solutions to some sign change problems on functions involving sums of divisors

Solutions to some sign change problems on functions involving sums of divisors

Analyzing the speed of sound in neutron star with machine learning

Matter properties at the intermediate densities are still unknown to us. In this work, we use a neural network approach to study matter at intermediate densities to analyze the variation of the speed of sound and the measure of trace anomaly considering astrophysical constraints of mass–radius measurement of 18 neutron stars. Our numerical results show that there is a sharp rise in the speed of sound just beyond the saturation energy density. It attains a peak around 3–4 times the saturation energy density and, after that, decreases. This hints towards the appearance of new degrees of freedom and smooth transition from hadronic matter in massive stars. The trace anomaly is maximum at low density (surface of the stars) and decreases as we reach high density. It approaches zero and can even be slightly negative at the centre of massive stars. It has a negative trough beyond the maximal central densities of neutron stars. The change in sign of the trace anomaly hints towards a near-conformal matter at the centre of neutron stars, which may not necessarily be conformal quark matter.

High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy: a retrospective study

BackgroundPatients undergoing bronchoscopy, particularly those with pre-existing hypoxemia, face a significant risk of further deterioration in their oxygen saturation levels. This heightened risk necessitates the provision of supplemental oxygen therapy throughout the procedure, rendering it mandatory. High-flow nasal cannula (HFNC) has been widely employed in the management of hypoxemic acute respiratory failure (ARF) in adults. Based on this, HFNC has been used in endoscopic procedures, but there are still few studies on HFNC in fiberoptic bronchoscopy (FOB) patients. The purpose of this study was to evaluate the comparative efficacy of HFNC with nasal cannula oxygen in maintaining adequate oxygen saturation during fiberoptic bronchoscopy in patients with pre-existing hypoxemia.MethodsWe retrospectively investigated 232 patients with hypoxemia who underwent bronchoscopy between January 2018 to August 2023 who received either HFNC or nasal cannula oxygen supplementation. The control group received nasal cannula oxygen, and the observation group received HFNC. The changes of oxygen saturation, heart rate, blood pressure and adverse events during the operation were compared between the two groups.ResultsThe patients were divided into the HFNC (n = 78) and nasal cannula oxygen (n = 154) groups. During FOB, although the lowest oxygen saturation (SpO2) was similar in both groups (intraoperative minimum SpO2 was defined as the lowest value of SpO2 occurring between the start of anesthesia and the end of the operation), the occurrence of the lowest SpO2 < 90% was significantly lower in the HFNC group (3.8% vs. 17.5%, p = 0.003). No serious complications were reported in either group, however, the overall incidence of general adverse events was 7.7% and 20.1% in the HFNC and conventional oxygen therapy (COT) groups, respectively (p = 0.015). Multifactorial analysis showed that higher arterial partial pressure of oxygen versus the fraction of inspired oxygen (PaO2/FiO2; P/F) was a protective factor against desaturation events (p = 0.032, OR = 0.990, 95% CI: 0.982–0.999). In patients with baseline PaO2/FiO2 ≥ 200 mmHg, the HFNC group exhibited smoother vital sign changes from pre-procedure to the end of bronchoscopy, although there were no significant differences between the two groups regarding the rates of deoxygenation events as well as adverse events.ConclusionThe use of HFNC therapy can effectively reduce the incidence of SpO2 < 90% during bronchoscopy in patients with hypoxemia. Additionally, HFNC significantly reduces the overall incidence of adverse events compared to COT. In patients with milder hypoxemia, its advantages in maintaining operational stability during bronchoscopy should not be overlooked.

Abordagem diagnóstica e terapêutica em enteropatia inflamatória crônica felina

Chronic Inflammatory Enteropathy in cats is defined by idiopathic chronic gastrointestinal inflammation, with clinical signs of vomiting, weight loss, diarrhea and changes in appetite for more than 3 weeks. The etiopathogenesis is unknown, but it is believed to be related to the intestinal microbiome, environmental and genetic factors and the immune system. Diagnosis involves eliminating other causes with similar gastrointestinal clinical signs through laboratory, fecal, abdominal ultrasound and histopathological examinations. Histopathological examination is performed using intestinal biopsy samples and is the gold standard for diagnosis of this pathology. Differentiating between chronic inflammatory enteropathy and low-grade alimentary lymphoma is a challenge, requiring immunohistochemistry and clonality tests in some cases. Treatment is based on dietary changes, use of antibiotics and immunosuppressants. Complementary therapies such as probiotics, prebiotics, omegas, cobalamin, fecal microbiota transplantation and mesenchymal stem cells are being studied. This paper will review the etiopathogenesis, clinical signs, physical examination, diagnostic methods, treatment and prognosis of chronic inflammatory enteropathy in cats.

Thyroid peroxidase antibodies: prevalence and assessment of immunological parameter in the context of search for new predictive markers of hypothyroidism

BACKGROUND:The annual incidence of autoimmune pathologies is increasing. Studying the causes of their development and preventive measures are important. Despite the availability of analysis of antibodies to thyroid peroxidase (TPOAb), statistical data of the prevalence of AIT is incorrect. An identification of key molecular mechanisms is important for developing effective diagnostic and preventive strategies for preventing progression hypothyroidism. AIM:Assessment of the prevalence of TPOAb and the search for correlations of immunological parameters and the degree of thyroid dysfunction in AIT. MATERIALS AND METHODS:We examined 580 people over the age of 18. We measured serum levels of TSH, freeT4, TPOAb, did thyroid ultrasound, collected anamnesis. Part of them we evaluated immunological parameters: Treg; Breg; B10-lymphocytes; IFNγ, IL-17, IL-4 T lymphocytes. RESULTS:An increased level of TPOAb was detected in 143 individuals (24.7%). 73 (51.41%) of them had nodular goiter, 60 (41.96%) had hypothyroidism. We found significant differences between people with high level of TPOAb and healthy individuals in levels of TSH, ultrasound’s signs of autoimmune changes and information about having 3 or more children (p 0,001). We found significant correlation in level of TPOAb and having many children (p=0,037). We found a difference in count of Breg (in vitro incubation with additional activation) in the group of people with high levels of TPOAb and healthy donors, but without low level of IL-10 expression. We didn’t find significant differences in count of Treg, but degree of Treg’s induction was reduced when we added a specific activator. Impaired functional activity can be reason of it. CONCLUSION:Prevalence of high level of TPOAb – 24.6%. Women with 3 or more children had higher prevalence of high level of TPOAb, and significant correlation with level of TPOAb. Having many children can be risk factor of developing AIT. The study showed the expected difference in the amount of Breg in the group of people with high level of TPOAb, however, lower induction of IL-10 wasn’t observed. Further fundamental research is needed with larger target samples of individuals with AIT in the search for new prognostic markers of the development and progression of the disease.

Analysis of the Effectiveness of Surgical Treatment of Benign Epithelial Esophageal Neoplasms under Control of Magnifying Chromoendoscopy

Relevance. The article presents a study and analysis of the effectiveness of the surgical treatment technique for benign epithelial neoplasms of the esophagus under the control of magnifying chromoendoscopy. Epithelial neoplasms of the esophagus and stomach are frequent diagnostic findings during endoscopic examination of the upper gastrointestinal tract. They are detected in 2% of patients, on average, during esophagogastroduodenoscopy. Notably, tactic of their management is not adequately standardized and often encounters challenges in clinical practice. The aim of the study was to investigate the prognostic significance of individual macroscopic features that allow the morphological structure of epithelial formations to be determined during gastroscopy. Methods. The study involved clinical data and analysis of the results of prehospital surgical interventions in patients with benign epithelial neoplasms of the esophagus, who made up the main group. Patients of the control group were exposed to endoscopic investigation and diagnosed using conventional techniques. Statistical analysis of the study results was carried out in two directions, namely: endoscopic and morphological diagnostic parameters and objective data on relapses and bleeding were compared using the nonparametric Mann-Whitney test in the main and control groups; the Spearman rank correlation coefficient was applied to assess the closeness of the statistical relationship between endoscopic diagnostic parameters and morphological criteria in order to evaluate the effectiveness of magnifying chromoendoscopy in the surgical treatment of benign epithelial neoplasms of the esophagus in patients of the main group. Results. The use of magnifying video endoscopy provides beneficial perspectives for detailed assessment of the mucous membrane of the examined organs. Previously, chromo-endoscopy was used to identify the metaplasized epithelium, the boundaries of precancerous trasformations. However, this staining technique was quite time-consuming; it failed to determine microstructural changes in the lesion area and in the perifocal region with extreme accuracy. Currently,the use of magnifying narrow band imaging endoscopy allows visualizing the smallest changes in the tissue surface, assessing the architectonics of the vascular network in the study area and, most importantly, the prevalence of the pathological focus, which increases not only the level of diagnosis of precancerous changes, but also the effectiveness of endoscopic surgical treatment at the stage of primary health care. In the control group, the percentage of adverse effects was 77.7% (14 cases) based on the results of 18 polypectomies of epithelial neoplasms. If compared with conventional endoscopic examination, we noted the following advantages of the narrow-band imaging endoscopy with optical magnification in the study of benign epithelial neoplasms of the esophagus: 22 cases of endoscopically detected signs of neoplastic changes in the esophageal mucosa were registered, which were morphologically confirmed in 20 patients, this amounting to 90.9%. Conclusions. The results of the study can be useful for improving treatment approaches, developing surgical intervention protocols and making more informed clinical decisions.

Vad kan en senneolitisk urnegrav på Lurö i Vänern berätta om kontakter och levnadssätt under senneolitikum?

In the late neolitic (2300-1700 BC) there are several signs of drastic change compared to earlier parts of the neolitic. Now DNA and strontium analysis from parts of southern Sweden strongly suggests high mobility, not just from individuals, but for whole family groups. A recent excavation on the island of Lurö in lake Vänern contained the cremated bones from a human buried in the later part of the late neolitic. The bones from this person was put in a urn in the outskirts of the livingsite from the same period

Counting sign changes of partial sums of random multiplicative functions

ABSTRACT Let f be a Rademacher random multiplicative function. Let $$ M_f(u):=\sum_{n \leq u} f(n) $$ be the partial sum of f. Let $V_f(x)$ denote the number of sign changes of $M_f(u)$ up to x. We construct a family of increasing intervals $[y_k, X_k]$ that contain at least 1 sign change of $M_f(u)$ eventually, almost surely. As a consequence, we show that for any constant c &amp;gt; 2, $$ V_f(x) = \Omega ((\log \log \log x)^{1/c} ) $$ almost surely.

Finite-frequency noise, Fano factor, ΔT-noise and cross-correlations in double quantum dots

A theoretical study on electrical current fluctuations in a double quantum dot connected to electronic reservoirs is presented, with the aim of deriving the finite-frequency noise, the Fano factor and the ΔT-noise. We establish a general expression for the noise in terms of Green functions in the double quantum dot and self-energies in the reservoirs. This result is then applied to model double quantum dots in various situations. For a non-interacting double quantum dot, we highlight several interesting features in the physical properties of this system. In particular, we demonstrate the possibility of obtaining a significant reduction in zero-frequency noise and Fano factor either when the system is placed in a given operating regime, or when a temperature gradient is applied between the two reservoirs, resulting in a negative ΔT-noise being generated. In addition, in the vicinity of honeycomb vertices, a sign change is observed in the finite-frequency cross-correlator between the two reservoirs, in contrast to what is obtained for the zero-frequency cross-correlator, which remains negative throughout the(ε1,ε2)-plane,ε1,2being the level energies in each of the two dots. By using an approximate first-level numerical approach, we finally study how the finite-frequency noise in a double quantum dot evolves under the influence of Coulomb interactions.

Bone tissue condition in early dates of restoration after thermic exposure

BACKGROUND: Thermoablation is a promising method for treating bone tumors. It is important to select the optimal mode (dose/time) of high-temperature exposure to fully realize the potential of this method.AIM: to study in vivo the reaction of rabbits’ bone tissue (BT) in the dynamics of early (3-7 days) recovery after local intraoperative hyperthermic ablation in the temperature range in the bone marrow canal of 55-60℃.METHODS: The study involved 6 mongrel rabbits aged 15 weeks, weighing 3-4 kg. The animals were derived from the experiment on the 3rd and 7th days after local thermoablation of the femoral diaphysis. Histological assay of BT included overall examination (HE staining), assessment of the area of immature BT (Mallory staining), optical density and area of osteoblasts and osteocytes (Einarson staining). Statistical data processing was performed in the R programming language.RESULTS: HE staining showed no signs of pathological changes after high-temperature exposure of BT. Mallory staining revealed no negative effects of local thermoablation on the intercellular bone matrix. Morphometric analysis showed an overshoot in the area of osteoblasts by the 7th day against the background of reduced synthetic activity starting from the 3rd day of the experiment. By the 3rd day, there is also a decrease in the area and optical density of osteocytes in the diaphyses of bones subjected to thermoablation. However, by the 7th day, the area of mature bone cells doesn`t differ from the corresponding value in the contralateral limb.CONCLUSION: Local intraoperative thermoablation of rabbit femoral diaphyses at an intramedullary temperature of 55-60℃ significantly reduces the optical density of osteoblasts and osteocytes in the dynamics of early (3-7 days) recovery after extreme exposure, which suggests a violation of metabolic processes and intracellular organelles (nucleus, ribosomes) of bone cells. At the same time, signs of remodeling of the damaged area were noted, presumably through the mechanism of osteoconduction of endosteal and periosteal cells from metaphyses that were not subjected to direct hyperthermia. The results obtained may be useful in thermoablation of BT tumors with the condition of higher sensitivity of malignant cells to heating.

Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Hospital transfers from VA Community Living Centers (CLCs) are common. The objective of this study was to evaluate the effect of introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA CLCs. Cluster randomized trial involving 16 pair-matched VA CLCs. Intervention CLC nursing staff were trained in the use of INTERACT tools designed to identify early signs of a clinical change in condition and improve communication and documentation. One tool was embedded into the VA Electronic Medical Record. Intervention staff were supported by bi-weekly calls over 18 months to reinforce INTERACT tool use. The primary outcome for intent-to-treat analyses was the rate of all-cause hospitalizations per 1000 person days. Secondary outcomes, assessed through structured record reviews and algorithms, were intervention CLCs change in 1) potentially inappropriate transfer decisions and 2) potentially preventable transfers. CLC staff implementation and engagement in INTERACT were documented. Only five of the eight intervention CLCs substantially engaged in the intervention. Using a negative-binomial regression with random effects, adjusting for month, intervention, and the interaction of time and the intervention, we observed no statistically significant difference between intervention and control facilities in all-cause hospitalizations. This was confirmed with matched resident-level, as-treated, analyses among residents in the five engaged CLCs and their matched controls. Structured implicit review of intervention CLC's medical records revealed low rates of inappropriate transfer decisions both before and after the intervention. Introducing INTERACT into volunteer VA CLCs did not reduce the rates of all-cause hospitalizations. In both the pre- and post-intervention periods, all-cause hospitalization rates were relatively higher, and inappropriate transfers lower in VA CLCs than commonly observed in community NHs. Low rates of potentially inappropriate transfers and higher nurse and physician staffing in CLCs may explain why INTERACT was not implemented as fully as planned.

Variable Kerr nonlinearity and optical bistability of a four-level lambda atomic medium

Using perturbation theory we obtain expressions for the third-order nonlinear susceptibility and the Kerr nonlinear coefficient of a four-level lambda-type atomic system in the presence of Doppler broadening. The model is applied to the Rb atomic gas medium at room temperature; the investigations demonstrate the ability to enhance and control the Kerr nonlinear coefficient according to laser parameters in single-window and double-window EIT regimes. The amplitude and the sign of the Kerr nonlinear coefficient change sensitively to the driving laser parameters as well as ambient temperature. As a representative application, this Kerr nonlinear medium is applied to optical bistability (OB) and shows that the threshold intensity and the width of OB are also easily changed according to the laser parameters. In particular, in double-window EIT regime the emergence of nonlinear coefficient at different frequency domains that leads to the appearance of OB at multiple frequency domains simultaneously. This study is a good preparation for experimental observations of Kerr nonlinearity and optical bistability.