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The spread of electronic health records systems (EHRs) poses challenges for both patient and provider care experience. Limited research suggests that scribes offer potential benefits to productivity and clinician satisfaction in emergency health and specialty settings. We conducted this evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR 2011–2014. The scribe programme trained and managed scribes for 51 providers (25% participation) from 5 of 12 San Francisco Health Network primary care clinics. We evaluated the programme using four measures. Providers reported spending less time out of clinic completing notes after sessions with scribes versus sessions without scribes (14.0 min vs 30.2 min, p<0.01). The rate of incomplete EHR notes at 72 hours was not significantly different for clinics using and not using scribes (16.9% vs 16.7%, p=0.4). Mean visit length using EHR-recorded provider cycle time was shorter for sessions with scribes (24.0 min), compared with sessions without scribes (26.4 min, p<0.01). Patients at clinics using scribes were as likely to recommend their provider (74.5%), compared with patients at clinics not using scribes (74.3%). Limitations of our evaluation include selection bias and possible confounding by clinic- and provider-level factors. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.

Single-molecule Förster resonance energy transfer (smFRET) is increasingly being used to determine distances, structures, and dynamics of biomolecules in vitro and in vivo. However, generalized protocols and FRET standards to ensure the reproducibility and accuracy of measurements of FRET efficiencies are currently lacking. Here we report the results of a comparative blind study in which 20 labs determined the FRET efficiencies (E) of several dye-labeled DNA duplexes. Using a unified, straightforward method, we obtained FRET efficiencies with s.d. between ±0.02 and ±0.05. We suggest experimental and computational procedures for converting FRET efficiencies into accurate distances, and discuss potential uncertainties in the experiment and the modeling. Our quantitative assessment of the reproducibility of intensity-based smFRET measurements and a unified correction procedure represents an important step toward the validation of distance networks, with the ultimate aim of achieving reliable structural models of biomolecular systems by smFRET-based hybrid methods.

Single-molecule FRET (smFRET) is a versatile technique to study the dynamics and function of biomolecules since it makes nanoscale movements detectable as fluorescence signals. The powerful ability to infer quantitative kinetic information from smFRET data is, however, complicated by experimental limitations. Diverse analysis tools have been developed to overcome these hurdles but a systematic comparison is lacking. Here, we report the results of a blind benchmark study assessing eleven analysis tools used to infer kinetic rate constants from smFRET trajectories. We test them against simulated and experimental data containing the most prominent difficulties encountered in analyzing smFRET experiments: different noise levels, varied model complexity, non-equilibrium dynamics, and kinetic heterogeneity. Our results highlight the current strengths and limitations in inferring kinetic information from smFRET trajectories. In addition, we formulate concrete recommendations and identify key targets for future developments, aimed to advance our understanding of biomolecular dynamics through quantitative experiment-derived models. The ability to infer quantitative kinetic information from single-molecule FRET (smFRET) data can be challenging. Here the authors perform a blind benchmark study assessing different analysis tools used to infer kinetic rate constants from smFRET trajectories, testing on simulated and experimental data.

An updated analysis of observed stratospheric temperature variability and trends is presented on the basis of satellite, radiosonde, and lidar observations. Satellite data include measurements from the series of NOAA operational instruments, including the Microwave Sounding Unit covering 1979–2007 and the Stratospheric Sounding Unit (SSU) covering 1979–2005. Radiosonde results are compared for six different data sets, incorporating a variety of homogeneity adjustments to account for changes in instrumentation and observational practices. Temperature changes in the lower stratosphere show cooling of ∼0.5 K/decade over much of the globe for 1979–2007, with some differences in detail among the different radiosonde and satellite data sets. Substantially larger cooling trends are observed in the Antarctic lower stratosphere during spring and summer, in association with development of the Antarctic ozone hole. Trends in the lower stratosphere derived from radiosonde data are also analyzed for a longer record (back to 1958); trends for the presatellite era (1958–1978) have a large range among the different homogenized data sets, implying large trend uncertainties. Trends in the middle and upper stratosphere have been derived from updated SSU data, taking into account changes in the SSU weighting functions due to observed atmospheric CO2 increases. The results show mean cooling of 0.5–1.5 K/decade during 1979–2005, with the greatest cooling in the upper stratosphere near 40–50 km. Temperature anomalies throughout the stratosphere were relatively constant during the decade 1995–2005. Long records of lidar temperature measurements at a few locations show reasonable agreement with SSU trends, although sampling uncertainties are large in the localized lidar measurements. Updated estimates of the solar cycle influence on stratospheric temperatures show a statistically significant signal in the tropics (∼30°N–S), with an amplitude (solar maximum minus solar minimum) of ∼0.5 K (lower stratosphere) to ∼1.0 K (upper stratosphere).

This article examines the flight dynamics and trajectory analysis of a parachute–payload system deployed from a C-17 aircraft. The aircraft is modeled with an open cargo door, extended flaps, and four turbo-fan engines operating at an altitude of 2000 feet Above Ground Level (AGL) and an airspeed of 150 knots. The payloads consist of simplified CONEX containers measuring either 192 inches or 240 inches in length, 9 feet in width, and 5.3 feet in height, with their mass and moments of inertia specified. At positive deck angles, gravitational forces cause these payloads to begin a gradual descent from the rear of the aircraft. For aircraft at zero deck angle, a ring-slot parachute with approximately 20% geometric porosity is utilized to extract the payload from the aircraft. This study specifically employs the CREATE-AV Kestrel simulation software to model the chute-payload system. The extraction and suspension lines are represented using Kestrel’s Catenary capability, with the extraction line connected to the floating confluence points of the CONEX container and the chute. The chute and payload will experience coupled motion, allowing for an in-depth analysis of the flight dynamics and trajectory of both elements. The trajectory data obtained will be compared to that of a payload (without chute and cables) exiting the aircraft at positive deck angles. An adaptive mesh refinement technique is applied to accurately capture the engine exhaust flow and the wake generated by the C-17, chute, and payloads. Friction and ejector forces are estimated to align the exit velocity and timing with those recorded during flight testing. The results indicate that the simulation of extracted payloads aligns with expected trends observed in flight tests. Notably, higher deck angles result in longer distances from the ramp, leading to increased exit velocities and reduced payload rotation rates. All payloads exhibit clockwise rotation upon leaving the ramp. The parachute extraction method yields significantly higher exit velocities and shorter exit times, while the payload-chute acceleration correlates with the predicted drag of the chute as demonstrated in prior studies.

This study uses the CREATETM-AV/Kestrel simulation software to model a towed jumper scenario using standard aircraft settings to quantify paratrooper stability and risk of contact during static line airborne operations. The focus areas of this study include a review of the technical build-up, which includes aircraft, paratrooper and static line modeling, plus preliminary functional checkouts executed to verify simulation performance. This research and simulation development effort is driven by the need to meet the analysis demands required to support the US Army Personnel Airdrop with static line length studies and the North Atlantic Treaty Organization (NATO) Joint Airdrop Capability Syndicate (JACS) with airdrop interoperability assessments. Each project requires the use of various aircraft types, static line lengths and exit procedures. To help meet this need and establish a baseline proof of concept (POC) simulation, simulation setups were developed for a towed jumper from both the C-130J and C-17 using a 20-ft static line to support US Army Personnel Airdrop efforts. Concurrently, the JACS is requesting analysis to support interoperability testing to help qualify the T-11 parachute from an Airbus A400M Atlas aircraft, operated by NATO nations. Due to the lack of an available A400M geometry, the C-17 was used to demonstrate the POC, and plans to substitute the geometry are in order when it becomes available. The results of a nominal Computational Fluid Dynamics (CFD) simulation run using a C-17 and C-130J will be reviewed with a sample of the output to help characterize performance differences for the aircraft settings selected. The US Army Combat Capabilities Development Command Soldier Center (DEVCOM-SC) Aerial Delivery Division (ADD) has partnered with the US Air Force Academy (USAFA) High Performance Computing Research Center (HPCRC) to enable Modeling and Simulation (M&S) capabilities that support the Warfighter and NATO airdrop interoperability efforts.

Anorexia Nervosa (AN) is a severe and often enduring disorder characterized by restriction of food intake, low body weight, fear of weight gain, and distorted body image. Investigations on cognition performance in AN patients have yielded conflicting results. Using an established and sensitive computerized cognitive test battery, we aimed to assess core aspects of cognitive function, including attention span, information processing, reasoning, working and episodic memory, in AN patients and controls. Patients were recruited from the Danish Prospective Longitudinal all-comer inclusion study in Eating Disorders (PROLED). Included were 26 individuals with AN and 36 healthy volunteers (HV). All were tested with CogTrack (an online cognitive assessment system) at baseline, and AN patients were tested again at a follow-up time point after weight increase (n = 13). At baseline, AN patients showed faster reaction times in the attention tasks, as well as increased accuracy in grammatical reasoning compared to HV. There were no differences in cognitive function between AN patients and HV in the other cognitive domains measured (sustained attention, working and episodic memory, speed of retrieval, and speed of grammatical reasoning). No differences were visible in the AN sample between baseline and follow-up. Performance did not correlate with any clinical variables in the AN sample. These findings supplement results from other studies suggesting increased concentration and reasoning accuracy in patients suffering from AN, who showed increased performance in cognitive tasks despite their illness.