A Formally Verified Floating-Point Implementation of the Compact Position Reporting Algorithm

The Automatic Dependent Surveillance-Broadcast (ADS-B) system allows aircraft to communicate their current state, including position and velocity information, to other aircraft in their vicinity and to ground stations. The Compact Position Reporting (CPR) algorithm is the ADS-B module responsible for the encoding and decoding of aircraft positions. CPR is highly sensitive to computer arithmetic since it heavily relies on functions that are intrinsically unstable such as floor and modulo. In this paper, a formally-verified double-precision floating-point implementation of the CPR algorithm is presented. The verification proceeds in three steps. First, an alternative version of CPR, which reduces the floating-point rounding error is proposed. Then, the Prototype Verification System (PVS) is used to formally prove that the ideal real-number counterpart of the improved algorithm is mathematically equivalent to the standard CPR definition. Finally, the static analyzer Frama-C is used to verify that the double-precision implementation of the improved algorithm is correct with respect to its operational requirement. The alternative algorithm is currently being considered for inclusion in the revised version of the ADS-B standards document as the reference implementation of the CPR algorithm

Cutlines: UM Graduates

Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care. Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB. Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide OB care, through fliers at emergency departments/urgent cares or posters in clinic waiting rooms; 2) keeping at least one same-day visit for OB patients; 3) distributing standard OB note templates to residents/faculty; and 4) placing patient educational handouts at each clinic. Patients, residents and faculty were reassessed at 9 months postintervention. Surveys were analyzed with Fisher’s exact tests. Results: Respondents to the preintervention survey included 83 patients, 26 residents and 19 faculty; 61 patients, 23 residents and 21 faculty responded to the postintervention survey. On both pre- and post-surveys, patients knew that their providers delivered babies (59% vs 57%, respectively; P = 0.86). However, only 22% and 33% of patients, respectively, had a doctor at our clinics deliver their baby or partner’s baby (P = 0.25). Even so, 95% and 100% of patients, respectively, would recommend their friends or family to our family practice clinics if they became pregnant (P = 0.14). On the pre-survey, 38% of residents felt clinic OB numbers were adequate versus 70% following intervention (P \u3c 0.05). On both pre- and post-surveys, residents planned on incorporating obstetric or prenatal care into their future practice (42% vs 52%, respectively; P = 0.57). On both pre- and post-surveys, faculty felt comfortable with OB skills and knowledge (53% vs 62%, respectively; P = 0.75). Lifestyle was the most common reason faculty gave for why they stopped doing deliveries (37% vs 33%, respectively). Conclusion: Implementation of changes to our OB workflow resulted in non-statistically significant improvements in viewpoints toward OB. Resident feelings of OB number adequacy significantly improved following intervention. Further study in multiple clinics could confirm the effectiveness and reasons for success of our interventions

Blood lead screening rates in children aged 12-35 months within a Milwaukee family medicine residency clinic

Background: There is no safe level of lead in the body. Elevated blood lead levels primarily affect the development of the central nervous system. Blood lead levels are highest between the ages of 18 and 36 months secondary to an increase in mobility and hand-tomouth behavior. Children in the city of Milwaukee are recommended to be screened for lead levels at 12, 18, and 24 months, followed by annual screening through the age of 5. Yet, Milwaukee continues to have a greater proportion of children who test positive for elevated lead levels compared to the national average. Purpose: To review the rate of lead screening in children aged 12–35 months at Aurora Sinai Medical Center’s Family Care Center (FCC) clinic and to identify risk factors. Methods: Data were retrospectively collected from Aurora Health Care’s electronic health records and the Wisconsin Lead Registry on children 12 to 35 months old who attended FCC for well-child exams from October 1, 2018, to September 30, 2019. The screening results were sorted into the age groups of 12–17, 18–23, and 24–-35 months, giving us a snapshot of screening rates. Basic descriptive statistics were computed, and Fisher’s exact test was used for categorical analysis. Results: A total of 383 patients were included for analysis. In all, there was an equal percentage of females and males; 72% were Black, followed by 10% White, and 10% Hispanic. Appropriate lead level screening rates of children by age were as follows: 45% for 12–17 months, 26% for 18–23 months, and 35% for 24–35 months. Overall, 62% of 12–35-month-old children at FCC had at least one blood lead test. There was no statistically significant difference in screening based on race as defined by Black vs non-Black (P=0.56). However, there was a statistically significant difference between insurance carriers, with Medicaid patients being screened more than those with other types of insurance (P=0.016). Conclusion: Lead screening rates at FCC were comparable to statewide screening. The higher screening rate for Medicaid patients may likely be due to having additional access to WIC services and recommended point-of-care lead testing. Implementation of point-ofcare lead testing at FCC may improve overall future screening rates

Is Patient Age Associated with increased control of HTN and DM in Primary Care?

Project Aim: To determine if patient age is associated increased control of HTN and DM - two other common chronic diseases in F

A Reduction from Unbounded Linear Mixed Arithmetic Problems into Bounded Problems

We present a combination of the Mixed-Echelon-Hermite transformation and the Double-Bounded Reduction for systems of linear mixed arithmetic that preserve satisfiability and can be computed in polynomial time. Together, the two transformations turn any system of linear mixed constraints into a bounded system, i.e., a system for which termination can be achieved easily. Existing approaches for linear mixed arithmetic, e.g., branch-and-bound and cuts from proofs, only explore a finite search space after application of our two transformations. Instead of generating a priori bounds for the variables, e.g., as suggested by Papadimitriou, unbounded variables are eliminated through the two transformations. The transformations orient themselves on the structure of an input system instead of computing a priori (over-)approximations out of the available constants. Experiments provide further evidence to the efficiency of the transformations in practice. We also present a polynomial method for converting certificates of (un)satisfiability from the transformed to the original system

Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment

Background: Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition. Methods: Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives. Results: A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce. Conclusions: There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD

Sustaining Family Physicians in Urban Underserved Settings

OBJECTIVE: Our objective was to identify factors that sustain family physicians practicing in Milwaukee\u27s underserved urban areas. METHODS: Family physicians with clinical careers in Milwaukee\u27s urban, underserved communities were identified and invited to participate in a 45-60 minute interview using a literature-based semi-structured protocol. Each interview was transcribed and de-identified prior to independent analysis using a grounded theory qualitative approach by two authors to yield sustaining themes. The project was determined not human subjects research per Aurora Health Care IRB. RESULTS: Sixteen family physicians were identified; six of 11 who met inclusion criteria agreed to interview. Four general domains central to sustaining family physicians working with underserved populations were identified: (1) cognitive traits and qualities (trouble shooting, resilience, flexibility), (2) core values (medicine as mechanism to address social justice), (3) skills (self-care, communication, clinical management), and (4) support systems (supportive family/employer, job flexibility, leadership opportunities, staff function as team). The formation of these personal attributes and skills was partly shaped by experiences (from childhood to medical training to work experience) and by personal drivers that varied by individual. Common was that the challenges of providing care in urbanunderserved settings was seen as rewarding in and of itself and aligned with these physicians\u27 values and skills. CONCLUSIONS: Family physicians working with underserved populations described possessing a combination of values, cognitive qualities, skill sets, and support systems. While family physicians face complex challenges in quality care goals in urban underservedsettings, training in the personal and professional skill sets identified by participants may improve physician retention in such communities

Sustaining Family Physicians in Urban Underserved Settings

OBJECTIVE: Our objective was to identify factors that sustain family physicians practicing in Milwaukee\u27s underserved urban areas. METHODS: Family physicians with clinical careers in Milwaukee\u27s urban, underserved communities were identified and invited to participate in a 45-60 minute interview using a literature-based semi-structured protocol. Each interview was transcribed and de-identified prior to independent analysis using a grounded theory qualitative approach by two authors to yield sustaining themes. The project was determined not human subjects research per Aurora Health Care IRB. RESULTS: Sixteen family physicians were identified; six of 11 who met inclusion criteria agreed to interview. Four general domains central to sustaining family physicians working with underserved populations were identified: (1) cognitive traits and qualities (trouble shooting, resilience, flexibility), (2) core values (medicine as mechanism to address social justice), (3) skills (self-care, communication, clinical management), and (4) support systems (supportive family/employer, job flexibility, leadership opportunities, staff function as team). The formation of these personal attributes and skills was partly shaped by experiences (from childhood to medical training to work experience) and by personal drivers that varied by individual. Common was that the challenges of providing care in urbanunderserved settings was seen as rewarding in and of itself and aligned with these physicians\u27 values and skills. CONCLUSIONS: Family physicians working with underserved populations described possessing a combination of values, cognitive qualities, skill sets, and support systems. While family physicians face complex challenges in quality care goals in urban underservedsettings, training in the personal and professional skill sets identified by participants may improve physician retention in such communities