Maxim Integrated (United States)

This study aimed to report changes in utilization and payment trends of low-back pain (LBP) interventions and the impact of nonsurgeon interventionalists on these changes. Medicare Part B national summary data files were used to gather annual utilization and Centers for Medicare and Medicaid Services (CMS) payment data for LBP interventions from 2000 to 2021. Healthcare Common Procedure Coding System (HCPCS) codes were grouped as decompression, spinal fusion, sacroiliac (SI) joint fusion, epidural steroid injections (ESIs), physical therapy (PT), and chiropractic manipulation (Chiro). The total allowed services and payments were collected for each HCPCS group. CMS provider-level files, available from 2013 to 2021, were used to collect neurosurgeon, orthopedic surgeon, and nonsurgeon interventionalist (interventional radiology and pain management) data for each surgical HCPCS code group (decompression, spinal fusion, and SI joint fusion). The United States Consumer Price Index was used to adjust for inflation. From 2000 to 2021, there were 339,720,725 Medicare-approved interventions and payments of approximately $21 billion for LBP (percentage of cumulative payments: 41.8% Chiro, 16.5% ESI, 14.4% spinal fusion, 14.3% PT, 10.2% decompression, and 0.4% SI joint fusion). In a subgroup analysis, spinal fusions for Medicare patients were performed by orthopedic surgeons (59.2%), neurosurgeons (40.6%), and nonsurgeon interventionalists (< 1%) from 2013 to 2021. From 2013 to 2021, neurosurgeon and orthopedic surgeon fusion utilization each grew by < 3% and associated Medicare payments to each specialty declined by 1% each year. During the same period, nonsurgeon interventionalist utilization grew 26% each year and associated Medicare payments to nonsurgeon interventionalists for spine fusions grew 62% each year. In a subgroup analysis, SI joint fusions for Medicare patients were performed by orthopedic surgeons (50.7%), neurosurgeons (24.8%), and nonsurgeon interventionalists (24.5%) from 2018 to 2021. Neurosurgeon utilization of SI joint fusion declined by 1% each year and associated Medicare payments to this group grew 2% each year. Orthopedic surgeon utilization of SI joint fusion declined 1% and associated Medicare payments to this group grew 4% each year. Nonsurgeon interventionalist use of SI joint fusions grew 415% and payments grew 435% each year. The substantial growth in Medicare payments for surgical LBP interventions is disproportionally driven by nonsurgeon interventionalists. The exponential growth of nonsurgeon interventionalists performing spinal fusion surgeries, particularly SI joint fusions, largely accounts for the significant increase in Medicare expenditures.

We report on an updated field trial of a novel method for measuring global horizontal irradiance (GHI), direct normal irradiance (DNI), diffuse horizontal irradiance (DHI), and reflected horizontal irradiance (RHI) using an array of reference cells with no moving parts. The technique, similar to previously explored methods using multi-pyranometer array concepts, uses multiple reference cells facing different directions together with an analysis model that fits the data from the sensors to determine GHI, DNI, DHI, and RHI. In previous work we reported on a first test of this approach at a single site. In this work we report further progress with this method, including an updated configuration of the reference cell array that offers improved sensitivity, an updated analysis that does not require site-specific training, and early field test results from prototypes installed at two different locations with different latitude.

Polymerase chain reaction (PCR) remains the gold standard in disease diagnostics due to its extreme sensitivity and specificity. However, PCR tests are expensive and complex, require skilled personnel and specialized equipment to conduct the tests, and have long turnaround times. On the other hand, lateral flow immunoassay-based antigen tests are rapid, relatively inexpensive, and can be performed by untrained personnel at the point of care or even in the home. However, rapid antigen tests are less sensitive than PCR since they lack the inherent target amplification of PCR. It has been argued that rapid antigen tests are better indicators of infection in public health decision-making processes to test, trace, and isolate infected people to curtail further transmission. Hence, there is a critical need to increase the sensitivity of rapid antigen tests and create innovative solutions to achieve that goal. Herein, we report the development of a low-cost diagnostic platform, enabling rapid detection of SARS-CoV-2 under field or at-home conditions. This platform (Halo™) is a small, highly accurate, consumer-friendly diagnostic reader paired with fluorescently labeled lateral flow assays and custom software for collection and reporting of results. The focus of this study is to compare the analytical performance of HaloTM against comparable tests that use either colloidal gold nanoparticles or fluorescence-based reporters in simulated nasal matrix and not in clinical samples. Live virus data has demonstrated limit of detection performance of 1.9 TCID50/test in simulated nasal matrix for the delta variant, suggesting that single-assay detection of asymptomatic SARS-CoV-2 infections may be feasible. Performance of the system against all tested SARS CoV-2 virus variants showed comparable sensitivities indicating mutations in SARS-CoV-2 variants do not negatively impact the assay.

This article examines a fundamental lot-sizing problem which arises in the context of a make-to-order remanufacturing environment. The problem setting is characterized by a stochastic used-item return process along with a stochastic remanufactured-item demand process faced by a remanufacturer. We explicitly take into account for all relevant costs, including the fixed costs (associated with remanufacturing of used-items and dispatching of remanufactured-item orders in batches) and inventory-related cost (associated with used-item inventory holding costs and remanufactured-item order waiting costs). We propose five batching policies inspired by shipment consolidation practice (three periodic policies and two threshold policies). For the purpose of computing policy parameters, we develop analytical models that are aimed at minimizing the long-run average expected total cost of the remanufacturer. Since the underlying cost expressions are not analytically tractable, we propose easily computable approximations that lead to closed-form expressions for obtaining policy parameters. A careful numerical investigation demonstrates that the resulting policy parameters are highly effective approximations. Then, we extend the policies by considering disposal options when needed. For this extension, an effective parameter-based approximation approach is developed for computational purposes, and additional numerical experiments demonstrate the effectiveness of the proposed approach.

Abstract The Microcontrollers/microelectronics have been used in variety of engineering applications on complex and efficient operations. One of the challenges in applying existing microelectronic technologies to these engineering systems lies in the need of modular portability, scalability, customizability, and compatibility. This paper focuses on addressing such challenges by designing a portable sensing platform that integrates a Lidar with USB interface and TI ARM M4 microcontroller. This developed sensing system will serve as an effective teaching platform to create new or enhance existing microelectronic courses that allow students to gain hands-on experiences in mobile embedded system designs. Moreover, the customizability and portability of the embedded sensing platform can also be used for the unmanned aerial vehicles in the GPS-denied environments. Highlights of the presentation will address the following: • Hardware and software interface design of TI ARM M4 microcontrollers with short range USB based Lidars • Demonstrations of the use of the developed embedded sensing platform for the object identification and obstacle avoidance applications • Recommendations of potential research applications and the curriculum development of the developed sensing platform Topic Areas: 1. Capstone Projects in ET 2. Curriculum Developments 3. Embedded System Designs in ET 4. Applied Engineering Projects in ET

Abstract Massive open online courses (MOOCs) provide anyone with an Internet connection easy access to a wealth of learning and computer training opportunities. Optics and photonics devices are frequently used in numerous academic fields and industries. Therefore, a MOOC approach to optics education would be beneficial to many students, researchers, and professionals all over the world, as this would empower personal and professional development with global reach. As part of online education, students can learn professional computer modeling tools and use them for completing course assignments. In this paper, several optical design packages are reviewed and evaluated for their applicability to MOOC optics education in terms of availability, functionality, and wealth of training resources. An example of an optics MOOC case‐study is also presented.

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A spread-spectrum clock generator is proposed based on an in-band phase modulation. In a charge-pump phase-locked loop configuration, the input phase modulation signal is applied to the proposed charge-based discrete-time loop filter. The phase difference between the input phase modulation signal and the output clock feedback phase is sampled and applied to the control voltage of an oscillator. The loop gain of the clock generator pushes the output clock phase to accurately trace the input phase modulation signal. This article achieves 3.2% spread-spectrum modulation range and 26.51-dB spread-spectrum attenuation at 352-MHz output frequency using a 2-MHz reference frequency. The in-band modulation improves a design sensitivity, and a 298-ppm modulation range error is measured with over 140% K <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">VCO</sub> perturbations. This spread-spectrum clock generator is implemented in a 0.18-μm CMOS, and achieves 951-fs <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">rms</sub> period jitter while consuming 9.98 mW from a 1.8-V power supply.

This paper presents a current generator with trimmed temperature coefficient (TC) to achieve stability over a large temperature range. The proposed circuit is based on the V <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">T</sub> -multiplier combined with a metal resistor for temperature compensation and utilizes digital resistor trimming for TC and output current calibration. The circuit has been designed at the transistor level and extensively simulated in a 180-nm BiCMOS process. Simulation results show less than 1% corner and mismatch variation of the nominal 10-μA output current and a remarkably low 11.3-ppm/°C residual temperature coefficient over the range from -40 to 135 °C.