Perry Point VA Medical Center

Emerging IoT applications are transitioning from battery-powered to grid-powered nodes. DRP, a contention-based data dissemination protocol, was developed for these applications. Traditional contention-based protocols resolve collisions through control packet exchanges, significantly reducing goodput. DRP mitigates this issue by employing a distributed delay timer mechanism that assigns transmission-start delays based on the average link quality between a sender and its children, prioritizing highly connected nodes for early transmission. However, our in-field experiments reveal that DRP is unable to accommodate real-world link quality fluctuations, leading to overlapping transmissions from multiple senders. This overlap triggers CSMA's random back-off delays, ultimately degrading the goodput performance. To address these shortcomings, we first conduct a theoretical analysis that characterizes the design requirements induced by real-world link quality fluctuations and DRP's passive acknowledgments. Guided by this analysis, we design EDRP, which integrates two novel components: (i) Link-Quality Aware CSMA (LQ-CSMA) and (ii) a Machine Learning-based Block Size Selection (ML-BSS) algorithm for rateless codes. LQ-CSMA dynamically restricts the back-off delay range based on real-time link quality estimates, ensuring that nodes with stronger connectivity experience shorter delays. ML-BSS algorithm predicts future link quality conditions and optimally adjusts the block size for rateless coding, reducing overhead and enhancing goodput. In-field evaluations of EDRP demonstrate an average goodput improvement of 39.43\% than the competing protocols.

Biomarker-guided therapy could improve management of inpatients with coronavirus disease 2019 (COVID-19). Although some results indicate that antibody tests are prognostic, little is known about patient management using point-of-care (POC) antibody tests. COVID-19 inpatients were recruited to evaluate 2 POC tests: LumiraDx and RightSign. Ease of use data were collected. Blood was also collected for centralized testing using an established antibody assay (GenScript cPass). A nested case-control study assessed if POC tests conducted on stored specimens were predictive of time to sustained recovery, mortality, and a composite safety outcome. While both POC tests exhibited moderate agreement with the GenScript assay (both agreeing with 89% of antibody determinations), they were significantly different from the GenScript assay. Treating the GenScript assay as the gold standard, the LumiraDx assay had 99.5% sensitivity and 58.1% specificity whereas the RightSign assay had 89.5% sensitivity and 84.0% specificity. The LumiraDx assay frequently gave indeterminant results. Both tests were significantly associated with clinical outcomes. Although both POC tests deviated moderately from the GenScript assay, they predicted outcomes of interest. The RightSign test was easier to use and was more likely to detect those lacking antibody compared to the LumiraDx test treating GenScript as the gold standard. NCT05227404.

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Aim: This Department of Veterans Affairs’ (VA) research project evaluated the impact of postoperative atrial fibrillation (POAF) upon 10-year outcomes for coronary artery bypass grafting (CABG) patients. Methods: Veterans enrolled in the “Randomized On-/Off-pump Bypass” (ROOBY) trial with new-onset POAF post-CABG were compared to those without POAF with respect to 10-year atrial fibrillation (AF) and mortality rates. Multivariable logistic regression examined whether AF was independently associated with 10-year survival after holding other preoperative risk factors constant. Results: Of the 2203 ROOBY veterans enrolled at 18 VA medical centers from 2002 to 2008, 100 patients with preoperative AF (n = 93) or unknown post-CABG POAF status (n = 7) were excluded. The POAF rate was 26.2% (n = 551/2103). The POAF patients were older and had more co-morbidities than the non-POAF patients (n = 1552). The AF rate among 10-year ROOBY POAF survivors was 18.9% (n = 64/338) compared to 5.8% (n = 61/1048) for non-POAF patients; P < 0.001. Compared to non-POAF patients’ 10-year survival of 70%, the ROOBY POAF veterans’ 10-year survival rate was 63%. Baseline risks inversely associated with 10-year survival included age, chronic obstructive pulmonary disease, serum creatinine > 1.5, peripheral vascular disease, and smoking. Holding these factors constant, POAF was not independently associated with 10-year survival. Conclusion: Post-CABG, ROOBY POAF veterans had higher rates of 10-year AF, which was negatively associated with 10-year survival; however, this association was not significant. Given that POAF may adversely impact 10-year AF rates, additional investigation appears warranted to improve future POAF patients’ care.

Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5 years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR > 1, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.

In physician practices and pharmacies, staff members work to process prescription renewals so that patients receive a steady supply of medications. These functions are essential to ensure patients have continuous access to medications and remain adherent to prescribed therapies. Despite the incorporation of e-prescribing software programs to ease management of these processes, barriers to effective management of the prescription renewal process exist. Mismanagement of pharmacy adherence programs can ultimately lead to patients receiving inappropriate medications and excessive use of staff resources. The objective of this article is to examine the prescription renewal process in both the primary care setting and the pharmacy and report challenges associated with the process. A literature review was conducted to find studies that describe pharmacists’ and physicians’ handlings of prescription renewals, use of e-prescribing software, and benefits and barriers to using these technologies. Although studies report e-prescribing software improves efficiency in the prescription renewal process, there is a need to reduce technological problems that create challenges in use. It is recommended that staff within physician practices and pharmacies standardize prescription renewal processes and educate patients about the prescription renewal process.

Affecting nearly 5.4 million Americans and 35.6 million individuals worldwide, dementia is one of the greatest health crises of our time. Though pharmacological interventions are a mainstay of treatment, their efficacy remains limited. More attention has been given to non-pharmacological interventions as a primary form of intervention. Offering persons with dementia a voice in selection of stimulation activities is shown to reduce behavioral issues and decrease medication use. One approach, Cognitive Stimulation Therapy (CST), is reported to improve processing and recall for individuals with dementia but few studies incorporate additional social, psychological, or familial measures of improvement within CST interventions. Ninety-four community-based CST participants (M=78.55 years, SD=10.01) underwent CST with 21 continuing onto maintenance CST. Pre-/post intervention measures of cognition, depression, quality of life, and mobility were taken. Using a paired samples t test, there is a statistically significant difference of SLUMS score after CST (t93=6.123, p<.001). On average, post-scores were 2.4 points higher. A statistically significant post-test difference of Cornell Scale for Depression in Dementia exists (t94=-6.743, p<.001) as well as Quality of life (t94=5.931, p<.001). Results remained significant when comparing results at 12-month mark to baseline. There was no statistically significant difference in caregiver quality of life, caregiver depression, or mobility. CST proves to be an effective form of treatment among older adults with mild to moderate dementia. Implications for integration into practice and education will be highlighted.