West Palm Beach Research Articles

Returners and explorers dichotomy in the face of natural hazards

Understanding human mobility patterns amid natural hazards is crucial for enhancing urban emergency responses and rescue operations. Existing research on human mobility has delineated two primary types of individuals: returners, who exhibit a tendency to frequent a limited number of locations, and explorers, characterized by a more diverse range of movement across various places. Yet, whether this mobility dichotomy endures in the context of natural hazards remains underexplored. This study addresses this gap by examining anonymized high-resolution mobile phone location data from Lee County, Florida residents, aiming to unravel the dynamics of these distinct mobility groups throughout different phases of Hurricane Ian. The results indicate that returners and explorers maintained their distinct mobility characteristics even during the hurricane, showing increased separability. Before the hurricane, returners favored shorter trips, while explorers embarked on longer journeys, a trend that continued during the hurricane. However, the hurricane heightened people’s inclination to explore, leading to a notable increase in longer-distance travel for both groups, likely influenced by evacuation considerations. Spatially, both groups exhibited an uptick in trips towards the southern regions, away from the hurricane’s path, particularly converging on major destinations such as Miami, Fort Lauderdale, Naples, and West Palm Beach during the hurricane.

In Case You Haven't Heard…

Two giants in addiction treatment, in a field known for competition, have united. And in the process, taken both organizations to, or back to, nonprofit status. Last week the Hanley Foundation announced its acquisition of Origins Behavioral HealthCare. The Hanley Center in West Palm Beach, Florida, is now part of the same system as all Origins facilities across Texas and Florida. “In this era of commercialization of medicine, it is rare, perhaps unheard of, for an addiction treatment facility to go from nonprofit to for‐profit and back to nonprofit again,” said Chip James, board chairman of Hanley Foundation. “Our board of directors, management team, and medical and operational staff are deeply committed to the success of this big step toward eliminating addiction.” Mary Jane Hanley, co‐founder of both Hanley Center and Hanley Foundation said, “At its 40‐year milestone, nothing could make me happier than witnessing the reunification of Hanley Foundation and Hanley Center. You find great reward in helping others, especially if you walk down their path. It brings me comfort knowing that the original mission [that] Jack Hanley and I, in partnership with the community, envisioned for the organization will be fulfilled for many years to come.”

Implementation of a Pilot VIONE PharmD Telephone Clinic within an Older Adult Patient-Aligned Care Team at the West Palm Beach VA Healthcare System

Implementation of a Pilot VIONE PharmD Telephone Clinic within an Older Adult Patient-Aligned Care Team at the West Palm Beach VA Healthcare System

Prescription drug monitoring program (PDMP) utilization and outcomes within the West Palm Beach Veterans Affairs (VA) healthcare system.

Prescription drug monitoring programs (PDMPs) can identify patients at risk of controlled substance (CS) polypharmacy and accidental poisoning. A retrospective pre-/post-intervention review of a random sample of provider notes with documentation of PDMP outcomes was completed before and after the enactment of a Florida law mandating PDMP queries. West Palm Beach Veterans Affairs Health Care System, which provides inpatient and outpatient services. Reviewed a random sample of 10 percent of progress notes documenting PDMP outcomes between September and November 2017 and the same timeframe of 2018. Florida enacted a law in March 2018 requiring PDMP queries to be completed for all new and renewed CS prescriptions. The primary outcome was to compare PDMP utilization and prescribing decisions based on query results before and after the enactment of the law. The number of progress notes documenting PDMP queries increased by over 350 percent from 2017 to 2018. In 2017 and 2018, 30.6 percent (68/222) and 20.8 percent (164/790) of PDMP queries found non-Veterans Affairs (VA) CS prescriptions, respectively. Providers decided to avoid prescribing CS prescriptions in 23.5 percent (16/68) of patients with non-VA CS prescriptions found in 2017 and 11 percent (18/164) in 2018. Overlapping or unsafe combinations were identified in 10 percent (7/68) of queries with non-VA prescriptions found in 2017 and 14 percent (23/164) in 2018. Mandating PDMP queries resulted in an increase in the total number of queries, positive findings, and overlapping CS prescriptions. Outcomes of PDMP mandate impacted prescribing by discontinuation and avoidance of CS initiation in 10-15 percent of patients.

IMPROVING MEDICAL STUDENT RECOGNITION AND UNDERSTANDING OF MORAL INJURY IN MILITARY VETERANS

Abstract Developing a curriculum for medical students is essential in teaching specific skill sets to better care for patients. There are 18,000,000 living military Veterans in America with unique needs not usually included in medical school curriculum. Military personnel are trained to kill or neutralize the enemy, a doctrine that goes against the moral, religious, and societal principle of thou shalt not kill. Combat Veterans are frequently placed in circumstances where they are forced to commit or participate in acts that go against their moral beliefs leading to a dimensional problem called Moral Injury (an affliction of the soul) with accompanying psychological, behavioral, social, and symptoms such as lack of trust, spiritual distress, fatalism, regret, depression, self-loathing, and apathy, etc. and can be a significant problem encountered in older Veterans precipitated by the normative changes of aging. Discussion with more than one hundred second- and third-year medical students over a 3-year period showed that the students were unfamiliar with Moral Injury. The Geriatrics Department at the West Palm Beach VA Medical Center has created an educational module for medical students that focuses on 1) recognizing the symptoms of Mora Injury, 2) how to approach and converse with Veterans including specific questions to ask and what not to say, 3) the importance of a team approach including a chaplain, 4) interventions such as providing forgiveness and life review, and 5) being cognizant of the trust issues of older LGBTQ Veterans. The response of the medical students has been both positive and enthusiastic.

Impact of Clinical Pharmacist Practitioner-Driven High Opioid Dose Reevaluation in Veterans with Chronic Non-Cancer Pain

Veterans Health Administration implemented the Opioid Safety Initiative (OSI) in 2013 to promote safe/rational opioid prescribing. West Palm Beach VA Healthcare System (WPBVAHCS) has been an outlier for the percentage of Veterans with chronic non-cancer pain receiving ≥90 mg Morphine Equivalent Daily Dosing (MEDD) in Veterans Integrated Service Networks (VISN) 8 since the 2016 fiscal year. The purpose was to determine the utility of a Pain Clinical Pharmacist Practitioner (CPP) identifying, reviewing, and approaching Veterans utilizing high-dose opioids for dose reevaluation and the impact on OSI metric post-opioid reevaluation. Pain CPP opioid education resulted in 28% (11/39) of Veterans undergoing an average 17.7 mg MEDD opioid dose reduction. For Veterans evaluated by Pain CPP, 83% (15/18) reported no change or improvement in average pain and PEG score. Pain CPP’s implemented 48 interventions outside of opioid dose reduction, the most common related to naloxone. No documented opioid overdose events, hospitalizations for uncontrolled pain or mental health, suicide attempts or pain-related crisis interventions were reported. Pain CPP’s are equipped to provide opioid education, address risk mitigation strategies, reassess pain regimens, and refer for non-pharmacologic modalities. Utilization of Pain CPP resources helps improve OSI metrics while providing safe comprehensive medication management (CMM) for chronic pain.

Leader in substance use treatment moves into residential mental health

One of the most nationally prominent names in residential addiction treatment services is venturing into residential care for patients with a primary mental health disorder. West Palm Beach, Florida‐based Hanley Center opened an eight‐bed residential mental health program late last month.

Updating Normal Organ Weights Using a Large Current Sample Database.

Organ weights are an essential part of autopsy analysis. Deviations from normal organ weights provide important clues to disease processes. The assessment of normal organ weights depends on reliable reference tables, but most widely available reference tables are based on data that are either decades old or derived from relatively small sample sizes. To provide an updated reference table of organ weights based on contemporary sources and a large sample size. Organ weights from 4197 carefully screened autopsies performed on adults at the Palm Beach County Medical Examiner's Office in West Palm Beach, Florida, and the Mayo Clinic Hospital in Rochester, Minnesota. Height and body weight data in this study reflect the well-recognized increases in both variables, but most particularly in body weight, seen during the last decades. The study data show a strong positive association between organ weight and body weight for the heart, liver, and spleen. There is a similar but weaker association between body weight and the weight of the lungs and kidneys. Brain weight is independent of body weight but shows a strong negative association with age. Even when controlling for body weight, men's organs are heavier, except for the weight of the liver, which is comparable in men and women. These associations are in agreement with the findings of previous studies. The current study suggests that, for some of the commonly weighed organs, there has been an increase in median organ weight when compared with existing references. The tables presented here provide an updated reference that should prove useful to autopsy pathologists in the forensic and hospital settings.

Julius Heisler

Julius Heisler, 91, died Sept. 14, 2021, in West Palm Beach, Florida. “He worked for many years as an ink chemist at Borden Chemical’s Cilco Inks Division and then BASF Inmont. He taught an annual course at the National Printing Ink Research Institute’s Lehigh University summer program. After retiring and moving to Lake Worth, Florida, he and his second wife patrolled as part of the Citizens Observer Patrol, a volunteer unit of the Palm Beach Sheriff’s Office. A lifelong fisherman, he was interested in nature and ecology. He was preceded in death by his first wife, Doris Berkowitz, and his second wife, Laura Kaufman, as well as his stepdaughter, Amy Kaufman.”—Faith Heisler, daughter Most recent title: Ink chemist, BASF Inmont Education: BS, City College of New York, 1951 Survivors: Daughter, Faith; son, Phillip; stepson, Jonathan Kaufman To recognize your late loved one or colleague, submit obituary information at cenm.ag/obits.

The Effects of an mRNA Covid-19 Vaccine Booster on Immune Responses in Cancer-Bearing Veterans.

Immunocompromised cancer patients are at significant risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A method to identify those patients at highest risk is needed so that prophylactic measures may be employed. Serum antibodies to SARS-CoV-2 spike protein are important markers of protection against COVID-19 disease. We evaluated total and neutralizing antibody levels pre and post third booster vaccine and compared responses among different cancer-bearing and healthy veterans. This as a prospective, single site, comparative cohort observational trial. The setting was the West Palm Beach VA Medical Center cancer center. All veterans received a third SARS-CoV-2 mRNA booster. The main outcomes were anti-SARS-CoV-2 spike IgG and neutralizing antibodies to wild-type, and B.1.617, BA1, BA2, and BA4/5 variants were measured. Disease type and therapy, COVID-19 infection, and anti-CD20 antibody treatments were documented. The third mRNA vaccine booster increased the mean blood anti-spike IgG five-fold. The second anti-spike level was equal or greater than the first in 129/140 veterans. All the groups except the myeloma group, had post-booster antibody levels significantly higher than pre-booster with 4-fold, 12-fold, 4-fold, 6-fold and 3.5-fold increases for the control, solid tumor, CLL, B cell lymphoma and all B cell malignancy cohorts. The myeloma set showed only a non-significant 1.7-fold increase. Recently anti-CD20 antibody-treated patients were shown to have approximately 200-fold less anti-S IgG production after vaccine booster than other patients. There was a 2.5-fold enhancement of wild-type virus mean neutralizing antibodies after a third mRNA booster and mean neutralization of Delta and Omicron variants increased 2.2, 6.5, 7.7, and 6.2-fold versus pre-boost levels. B cell malignancies failed to show increased post-booster neutralization. The third SARS CoV-2 booster increased total anti-spike IgG and neutralizing antibodies for most subjects. Veterans with B cell malignancies particularly myeloma and those receiving anti-CD20 monoclonal antibodies had the weakest humoral responses. Neutralizing antibody responses to Omicron variants were less than for wild-type virus. A subset of patients without humoral immunity post-booster should be considered for prophylactic antibody or close monitoring.

Butterfly Garden Connects Community Living Center Residents, Family, and Staff During the COVID-19 Pandemic

The COVID-19 Pandemic has led to significant morbidity and mortality in older residents of long-term care facilities. In addition, the stringent restrictions on visitation of family and loved ones has further socially isolated residents leading to an increase in depression, loneliness, and spiritual distress. The Community Living Center (CLC) staff at West Palm Beach VA Medical Center wanted to address this dilemma and created a unique “Butterfly Garden” (BG) visitation space. This space is a therapeutic garden adjacent to the CLC that can be accessed by families without having to enter the facility. Participants in the BG reported feelings of peace, undisturbed reflection, and tranquility as they observed and experienced nature’s life cycle. This show of nature’s beauty promotes visual, tactile, and olfactory sensory stimulation while attracting hummingbirds, bees, butterflies, and peace to this calm garden space. The BG visitations offers residents, family, and staff opportunities to experience the health benefits of nature during their visits under strict CDC social contact guidelines. From September through December 2020 and from January through March 2021 there were 67 and 184 visits respectively as families became more involved. The feedback from residents, families, and staff indicated that the spirits of all participants were raised by the BG visits despite the difficult challenges of social distancing and limited CLC visitations. This BG concept could serve as a model for other long-term care facilities to allow socially distant family visits to loved ones in a safe nature-based environment of care with or without a pandemic.

Project Review: SwampScapes

Project Review: <i>SwampScapes</i>

Pharmacist interventions in an outpatient pain clinic at a Veterans Affairs Medical Center

AbstractPurposeClinical pharmacist practitioners (CPPs) ensure safe and evidence‐based pharmacotherapy practices. However, there is little information to date characterizing the impact of pain CPP interventions on patient outcomes within a CPP‐managed outpatient chronic and postoperative pain clinic. The primary objective of this study was to classify and quantify the number of pain CPP interventions in the outpatient pain clinic at the West Palm Beach Veteran Affairs Medical Center (WPB VAMC). The secondary objective assessed general patient outcomes associated with pain pharmacotherapy management by a CPP.SummaryA retrospective chart review of pain CPP encounters was utilized to identify interventions over a 12‐month period. A total of 805 pain management encounters with a total of 1993 interventions were recorded by pain CPPs during that time. Descriptive statistics and sample size calculations were used to summarize and evaluate results. Overall, 55% of interventions were pharmacological, 45% were nonpharmacological interventions, and 5% were referrals to other specialty providers. For the secondary objective (n = 107), patients in the pain clinic on opioid therapy experienced an average oral morphine equivalent daily dose (MEDD) reduction of 21 mg without any identified suicide or overdose events and achieved on average 45% of their SMART goals by their last visit. In patients with baseline pain, enjoyment of life, and general activity (PEG) scores (n = 69), there were 43% of patients with improved PEG scores at their last visit in which 14% (10/69) experienced a clinically meaningful improvement in PEG scores.ConclusionPain CPPs demonstrated a reduction in overall MEDDs safely while following the biopsychosocial approach to pain management by incorporating and referring for nonpharmacological interventions as well as completing opioid risk mitigation. Additional studies are needed to better characterize pain CPP impact on patient outcomes.

MobIntel: Sensing and analytics infrastructure for urban mobility intelligence

Mobility monitoring in urban environments provides valuable insights into pedestrian and vehicle movement. Understanding the causes and effects of changing mobility patterns can help city officials and businesses optimize operations and support economic development. In this paper, we introduce MobIntel, a privacy-centric alternative to visual surveillance for mobility monitoring. We present the design, implementation, and evaluation of the MobIntel sensor network, the associated cloud-based processing system, and the web-based visualization portal. We evaluate system capacity and accuracy based on real-life data collected from a deployment in downtown West Palm Beach, FL, spanning 14 months. We offer sample use cases where pedestrian activity patterns revealed by MobIntel can be helpful to the city government. Finally, we discuss several obstacles that must be overcome to transition from pedestrian counting to trajectory monitoring.

2021 Educational Opportunities to Learn More About Interventional Treatments, Research

Back to table of contents Previous article Next article Interventional PsychiatryFull Access2021 Educational Opportunities to Learn More About Interventional Treatments, ResearchRichard A. Bermudes, M.D.Richard A. BermudesSearch for more papers by this author, M.D.Published Online:27 Jul 2021https://doi.org/10.1176/appi.pn.2021.8.38The 2021 Clinical TMS Society Meeting and Pulses Course were held in West Palm Beach, Fla., in June. This was the first in-person interventional psychiatry meeting since the start of the pandemic. The majority of attendees had completed vaccination, and overall, they expressed a sense of gratitude and relief in being able to socialize and network in person while attending excellent lectures and workshops on current and evolving clinical applications of transcranial magnetic stimulation (TMS).The meeting had two two-day components: The Pulses Course and the Annual Meeting. About 100 participants attended the Pulses Course. The course consisted of a series of lectures and demonstrations on the clinical administration of TMS and offered practical recommendations for implementing TMS in a clinical practice. Lecture topics ranged from a review of TMS for treatment-resistant depression (TRD) to how to negotiate the increasing complexity of insurance coverage for TMS. Attendees also had the opportunity to participate in a virtual lecture by Prof. Anthony Barker, designer of the first TMS machine in 1985. He reviewed the history and basic scientific principles of TMS.More than 500 TMS researchers, clinicians, and thought leaders attended the Annual Meeting. The meeting featured a number of workshops and invited lecturers on a range of TMS topics. General themes included new research on clinical applications for TMS for neuropsychiatric conditions other than TRD (see box “Expanding Indications for TMS”), as well as evolving TMS applications to optimize outcomes for patients with TRD (see box “Optimizing Outcomes in Patients With Treatment-Resistant Depression”).How can TMS be more rapid and effective in severe TRD patients? With evolving applications, can we raise remission rates to the equivalent of electroconvulsive therapy and intravenous ketamine? During the Annual Meeting, Nolan Williams, M.D., presented two open-label studies of patients who had very severe TRD (that is, would qualify for deep brain stimulation) utilizing the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT TMS) protocol. These datasets showed rapid reductions in depression and suicidality within three days of treatment. Remission rates at the end of the five-day protocol were > 90%.There are a number of in-person meetings for psychiatrists who want to learn more about new developments in interventional treatments:The Clinical TMS Society will hold another Pulses Course in Nashville, Tenn., September 11 and 12.The American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP) will hold its 2021 Annual Conference (virtual/in person) in Detroit, Mich., November 4 to 6. This conference features education and research on ketamine, esketamine, and ketamine/esketamine-assisted psychotherapy.The Fourth International Brain Stimulation Meeting will be held in Charleston, S.C., December 4 to 6. This will feature reports on ECT, VNS, TMS, DBS, and tDCS. ■Expanding Indications for TMSBipolar depression: Prospective open-label data from two academic centers suggest that conventional TMS (10 hz to the L-DLPFC) may be effective in patients with treatment-resistant bipolar depression.Addiction: Multisite sham-controlled data indicate that deep TMS with a unique coil design increases the rate of smoking cessation. Future studies are planned on other substance use disorders.Adolescent depression: Studies are planned that combine psychotherapy with bilateral sequential TMS in adolescents with treatment- resistant depression.Posttraumatic stress disorder: Studies are evolving to optimize improved brain network targeting and stimulation protocols.Neuropathic pain: A consensus review by a 30-person multinational expert panel supports the finding that TMS reduces neuropathic pain.Headaches associated with traumatic brain injury (TBI): The multinational expert panel supports the finding that TMS reduces headache associated with TBI.Optimizing Outcomes in Patients With Treatment-Resistant DepressionIncreasing the dose of intermittent theta burst TMS, acceleration, and optimizing targeting:Prospective open-label data of the SAINT protocol (AJP) suggest dramatically improved remission rates after just one week of treatment.The study design for a pivotal multisite randomized, controlled study is evolving.Adding pulses and brain targets: Data comparing bilateral sequential TMS and conventional TMS show equivalent outcomes.Optimizing patient selection with potential biomarkers: Emerging biomarkers and stratification of biomarkers to predict response to TMS are evolving, but definitive trials are needed.Extending the duration of conventional TMS and developing protocols for continuation and maintenance TMS: Recent data from a literature review indicate that reintroducing TMS prior to full relapse improves patient outcomes and durability.Richard A. Bermudes, M.D., is the chief medical officer at Mindful Health Solutions in San Francisco and an assistant clinical professor of psychiatry at the University of California, San Francisco. He is also the co-editor of Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice from APA Publishing. APA members may purchase the book at a discount here. ISSUES NewArchived

Retrospective Review of Perioperative Multimodal Analgesia for Orthopedic Patients in a Veterans Affairs Setting.

To determine adherence of perioperative knee/hip arthroplasties and hip fracture repairs to the American Pain Society (APS) guideline recommendations for perioperative pain control. One secondary objective was to perform an internal quality audit on the use of enhanced recovery after surgery (ERAS) protocols; another secondary objective was to design an evidence-based, multi-modal perioperative quick-order menu (if warranted). A retrospective quality improvement (QI) review of uncomplicated knee/hip replacement and hip fracture repairs from January 2018 through March 2018. West Palm Beach Veterans Affairs Medical Center (WPB VAMC) including acute care, subacute rehabilitation, and outpatient setting. Analgesic use in the perioperative setting via electronic health record review. Forty-seven patients were retrospectively reviewed. Perioperative multi-modal analgesia was used in 85% of patients. Eighty-seven percent were discharged on multi-modal analgesia. There was a 67% response rate to the internal quality audit on ERAS protocol usage from the orthopedic team. A retrospective QI review completed approximately two years after APS guideline publication showed that compliance with these recommendations for multi-modal analgesia (consisting of the use of at least two medication classes) at the WPB VAMC in the postoperative setting for knee/hip arthroplasties and hip fracture repairs was 85%. This indicated potential for improvement in achieving a pharmacologic multimodal and ERAS intervention. The authors developed an evidence-based quick-order menu to further reinforce adherence to the APS perioperative guidelines.

Blind rehabilitation programs teach iPhone and iPad use to improve independence in Veterans with low vision or blindness

While many individuals affected by blindness or low vision utilize accessibility applications on iPhone and iPad devices, few receive professional training on application use. Determining the impact of a smartphone and tablet-based curriculum at a Blind Rehabilitation Center (BRC) on functionality and independence can help patients and physicians understand the value of these training programs. Between January 2015 and December 2019, a pre–post initiative evaluated patient functionality and independence scores before and after exposure to a technology educational curriculum at the West Palm Beach Veteran Affairs BRC. A total of 337 patients with impaired vision or complete blindness participated in a 1-month, 35-hr iPhone and iPad learning course. This course was led by technology instructors trained in working with patients with low vision or blindness. The level of function and independence was determined before and after the educational curriculum using a modified Functional Independence Measurement (FIM) Scale from 1 to 7, with 1 indicating no independent functionality and 7 indicating complete independence. After completion of the course, patients were stratified by age, gender, ethnicity, and eye-related diagnosis. All demographic groups noted an increase in FIM score, with average improvement of 3.75 points. A factorial analysis of variance (ANOVA) revealed that younger age groups displayed a statistically significant improvement in FIM score compared to older groups with an F ratio of F(3, 295) = 4.503, p = .004. Eye diagnosis did not have an impact on FIM score change. These results suggest any patient may benefit from professional training in the use of iPhone and iPad applications with younger patients showing greater rates of initial improvement. The authors recommend increased utilization of smartphone and tablet training programs at BRCs by all individuals with low vision or blindness.

401 Clinical Phenotypes of Obstructive Sleep Apnea in World Trade Center Responders

Abstract Introduction The heterogeneity of symptoms in obstructive sleep apnea (OSA) patients has been recently formalized into 3 distinct clusters: Sleepy, Disturbed Sleep, and Minimally Symptomatic. Our previous data showed that OSA is highly prevalent (&amp;gt;75%) in World Trade Center (WTC) responders, and positive airway pressure (PAP) treatment adherence is very poor (&amp;lt;20%). To better understand the heterogeneity of OSA in the WTC cohort, here we sought to examine the distribution of these distinct clinical phenotypes. Methods 643 subjects with no history of OSA or reported loud and frequent snoring before 9/11/2001 from the WTC health program clinical centers at Rutgers RWJMS, New Jersey, NYU School of Medicine, and Icahn School Medicine at Mount Sinai, New York underwent 2 nights of home sleep testing using the ARES unicorder (SleepMed, Inc., West Palm Beach, FL, USA). Epworth Sleepiness Scale (ESS), sleep onset insomnia, and sleep maintenance insomnia were assessed with questionnaires. OSA was defined as (AHI4%&amp;gt;=5 or RDI&amp;gt;=15/hr). The three clusters were defined as 1) Sleepy (ESS&amp;gt;10 and/or sleep onset/maintenance insomnia); 2) Disturbed Sleep (not sleepy (ESS&amp;lt;=10) and sleep onset/maintenance insomnia); and 3) Minimally Symptomatic (not sleepy (ESS&amp;lt;=10) and no sleep onset/maintenance insomnia). Distribution of clusters in the WTC cohort was compared to published data from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Results Among the subjects diagnosed with OSA (N 440; AHI4%=13(15); RDI =28(19); median(iqr); 81% men; age, 33–87 years; BMI, 27.4±3.7 kg/m2), the distribution of clinical phenotypes was 31.4% sleepy, 48.9% disturbed sleep, and 19.7% minimally symptomatic, and did not differ between OSA severity groups. In comparison to SAGIC and HCHS/SOL, the WTC cohort exhibited significantly increased prevalence of the disturbed sleep phenotype (WTC vs SAGIC: 48.9% vs. 19.8%, □2=54.9; p&amp;lt;0.001; WTC vs. HCHS/SOL: 48.9% vs. 38.1%, □2=26.1, p&amp;lt;0.001). Conclusion The predominant clinical phenotype of OSA in the WTC cohort is disturbed sleep (insomnia) and its prevalence is significantly greater than what has been observed in other large OSA cohorts. These findings may help explain the poor adherence to PAP treatment observed in the WTC cohort. Support (if any) NIOSH U01OH01415; AASM Foundation 233-BS-20.

Evaluation of boundary-layer and urban-canopy parameterizations for simulating wind in Miami during Hurricane Irma (2017)

AbstractThe simulated winds within the urban canopy of landfalling tropical cyclones are sensitive to the representation of the planetary-boundary and urban-canopy layers in numerical weather prediction models. In order to assess the sub-grid-scale parameterizations of these layers, mesoscale model simulations were executed and evaluated against near-surface observations as the outer wind field of Hurricane Irma (2017) interacted with the built-up region from downtown Miami northward to West Palm Beach. Four model simulations were examined, comprised of two different planetary boundary layer (PBL) parameterizations (a local closure scheme with turbulent kinetic energy prediction and a nonlocal closure scheme) and two different urban canopy models (UCMs) [a zeroth order bulk scheme and a multilayer Building Effect Parameterization (BEP) that mimics the three-dimensionality of buildings]. Overall, the simulated urban canopy winds were weakly sensitive to the PBL scheme and strongly sensitive to the UCM. The bulk simulations compared most favorably to an analyzed wind swath in the urban environment, while the BEP simulations had larger negative biases in the same region. There is uncertainty in magnitude of the urban environment biases due to the lack of many urban sheltered measurements in the wind swath analysis. Biases in the rural environment were similar among the bulk and BEP simulations. An improved comparison with the analyzed wind swath in the urban region was obtained by reducing the drag coefficient in BEP in one of the PBL schemes. The usefulness of BEP was demonstrated in its ability to predict realistic heterogeneous near-surface velocity patterns in urban regions.

Drive Through Point of Care International Normalized Ratio Testing During the COVID-19 Pandemic

In order to help combat COVID-19 and provide consistent and safe care for the veterans at the West Palm Beach Veterans Affairs Medical Center (WPVAMC), a drive through Point of Care International Normalized Ratio (POC-INR) testing site was implemented. This drive through clinic allows veterans taking warfarin to safely obtain anticoagulation management while complying with social distancing guidelines.