Polarization Maintaining, Very-Large-Mode Area, Er Fiber Amplifier for High Energy Pulses at 1572.3 nm

We demonstrate the first polarization maintaining, very-large-mode-area Er-doped fiber amplifier with ~1000 square micron effective area. The amplifier is core pumped by a Raman fiber laser and is used to generate single frequency one microsecond pulses with pulse energy of 368 microJoules, M2 of 1.1, and polarization extinction greater than 20 dB. The amplifier operates at 1572.3 nm, a wavelength useful for trace atmospheric CO2 detection

Fiber-Based Laser Transmitter at 1.57 Micrometers for Remote Sensing of Atmospheric Carbon Dioxide from Satellites

Over the past 20 years, NASA Goddard has successfully developed space-based lidar for remote sensing studies of the Earth and planets. The lidar in all missions to date have used diode pumped Nd:YAG laser transmitters. Recently we have been concentrating work on developing integrated path differential absorption (IPDA) lidar to measure greenhouse gases, with the goal of measurements from space. Due to the absorption spectrum of CO2 a fiber-based master oscillator power amplifier (MOPA) laser with a tunable seed source is an attractive laser choice. Fiber-based lasers offer a number of potential advantages for space, but since they are relatively new, challenges exist in developing them. In order to reduce risks for new missions using fiber-based lasers, we developed a 30- month plan to mature the technology of a candidate laser transmitter for space-based CO2 measurements to TRL-6. This work is also intended to reduce development time and costs and increase confidence in future mission success

Risk Factors for Hyperosmolar Hyperglycemic State in Pediatric Type 2 Diabetes.

BACKGROUND: There is a paucity of data on the risk factors for the hyperosmolar hyperglycemic state (HHS) compared with diabetic ketoacidosis (DKA) in pediatric type 2 diabetes (T2D). METHODS: We used the national Kids Inpatient Database to identify pediatric admissions for DKA and HHS among those with T2D in the years 2006, 2009, 2012, and 2019. Admissions were identified using ICD codes. Those aged <9yo were excluded. We used descriptive statistics to summarize baseline characteristics and Chi-squared test and logistic regression to evaluate factors associated with admission for HHS compared with DKA in unadjusted and adjusted models. RESULTS: We found 8,961 admissions for hyperglycemic emergencies in youth with T2D, of which 6% were due to HHS and 94% were for DKA. These admissions occurred mostly in youth 17-20 years old (64%) who were non-White (Black 31%, Hispanic 20%), with public insurance (49%) and from the lowest income quartile (42%). In adjusted models, there were increased odds for HHS compared to DKA in males (OR 1.77, 95% CI 1.42-2.21) and those of Black race compared to those of White race (OR 1.81, 95% CI 1.34-2.44). Admissions for HHS had 11.3-fold higher odds for major or extreme severity of illness and 5.0-fold higher odds for mortality. CONCLUSION: While DKA represents the most admissions for hyperglycemic emergencies among pediatric T2D, those admitted for HHS had higher severity of illness and mortality. Male gender and Black race were associated with HHS admission compared to DKA. Additional studies are needed to understand the drivers of these risk factors

Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial.

BACKGROUND: The COVID- 19 pandemic prompted rapid development of scarce resource allocation policies (SRAP) in case demand for critical health services eclipsed capacity. We sought to test whether a brief, educational video could improve alignment of participant values and preferences with the tenets of the University of California Healths SRAP in a post hoc analysis of a randomized controlled trial (RCT) conducted during the pandemic. METHODS: An RCT of an educational video intervention embedded in a longitudinal web-based survey conducted from May to December 2020, analyzed in August 2024. The explainer video intervention was approximately 6 min long and provided an overview of the mechanics and ethical principles underpinning the UC Health SRAP, subtitled in six languages. California residents were randomized to view the intervention or not, stratified by age, sex, education, racial identity, and self-reported health care worker status. Non-California residents were assigned to the control group. 1,971 adult participants were enrolled at baseline, and 939 completed follow-up. 770 participants with matched baseline and follow-up responses were analyzed. Self-reported survey assessments of values regarding components of SRAP were scored as the percentage of agreement with the UC Health SRAP as written. Participants responded to items at baseline and follow-up (approximately 10 weeks after baseline), with randomization occurring between administrations. RESULTS: After the intervention, overall agreement improved by a substantial margin of 5.2% (from 3.8% to 6.6%, P <.001) for the intervention group compared to the control group. Significant changes in agreement with SRAP logistics and health factors were also observed in the intervention group relative to the control, while no significant changes were noted for social factors. Differential intervention effects were observed for certain demographic subgroups. CONCLUSIONS: A brief educational video effectively explains the complex ethical principles and mechanisms of the SRAP, as well as how to improve the alignment of participant values with the foundational principles of UC Health SRAP. This directly informs practice by providing a framework for educating individuals about the use of these policies during future situations that require crisis standards of care, which can, in turn, enhance agreement and buy-in from affected parties. TRIAL REGISTRATION: ClinicalTrials.gov registration NCT04373135 (registered 4 May 2020)

Preterm Labor and Hypertensive Disorders in Adolescent Pregnancies With Diabetes Between 2006 and 2019.

OBJECTIVE: We sought to evaluate the risk of preterm labor and hypertensive disorders in adolescent pregnancies with and without diabetes. METHODS: We evaluated 1,843,139 adolescents (≤20 years old) with labor and delivery admissions in the national Kids Inpatient Database (KID) in years 2006, 2009, 2012, 2016, and 2019. International classification of disease codes was used to identify diabetes and medical factors affecting pregnancy. Weighted logistic regression was used to evaluate the association between diabetes and complications. RESULTS: Among admissions, 0.2% had type 1 diabetes (T1D), 0.2% had type 2 diabetes (T2D), and 0.7% had gestational diabetes (GDM); 10.1% of admissions were complicated by hypertensive disorders and 5.8% by preterm labor. Compared to adolescents without diabetes, those with diabetes had a higher prevalence of hypertensive disorders (T1D: 35.4%, T2D: 37.8%, GDM: 24.9%, None: 9.9%; p <0:001) and preterm labor (T1D: 21.5%, T2D: 16.8%, GDM: 6.8%, none: 5.7%; p <0:001). In adjusted models, odds of hypertensive disorders were higher in later study years (2019 vs. 2006 OR 1.85, 95% CI 1.77-1.94), among those with T1D (OR 4.32, 95% CI 3.94-4.74), with T2D (OR 4.18, 95% CI 3.79-4.61), and with GDM (OR 1.99, 95% CI 1.89-2.10). Adjusted odds of preterm labor were higher among those with T1D (OR 4.53, 95% CI 4.09-5.02), with T2D (OR 3.35, 95% CI 2.96-3.78), and with GDM (OR 1.18, 95% CI 1.08-1.28); disparities were seen by race/ethnicity, insurance, and income. CONCLUSIONS: Diabetes, which is increasing among adolescents, is a significant risk factor for preterm labor and hypertensive disorders. Though the absolute number of adolescent pregnancies is decreasing, rates of hypertensive disorders have increased. Appropriate interventions are needed to ensure healthy outcomes for adolescents who are pregnant

Tobacco consumption behavior change during the COVID-19 pandemic is associated with perceived COVID threat

RationaleTobacco use is a risk factor for COVID-19 adverse outcomes. Despite health implications, data conflict regarding COVID-19 and tobacco consumption. We present results from a survey of health behaviors during the pandemic to identify how COVID-19 influenced tobacco behaviors.MethodsA nationally administered, internet-based survey was deployed between May-September 2020. Of respondents, we analyzed participants who reported current smoking and/or vaping. Our primary outcome of interest was change in tobacco or vape use using measures from the Behavioral Risk Factor Surveillance System, as well as whether participants reported that these changes were related to COVID-19. Our principal exposures were previously psychometrically evaluated measures of anxiety, depression, and novel perceived COVID-19 threat scale with additional adjustment for age. We employed multinomial logistic regression to determine associations between these factors and tobacco consumption.ResultsWe identified 500 respondents who reported ever smoking in their lifetime, 150 of which reported currently smoking at the time of the survey. Of 220 participants who reported any use of vapes, 110 reported currently vaping. Increased perceived threat of COVID-19 was associated with both increased (aRRincrease 1.75, 95% CI [1.07-2.86], P = 0.03) and decreased (aRRdecrease 1.72 [1.04-2.85], P = 0.03) tobacco consumption relative to no change. There were no significant relationships found between perceived threat of COVID-19 and vaping behavior.ConclusionsAs perceived COVID-19 threat increased, people were more likely to increase or decrease their smoking as opposed to continue at the same amount of use, even after controlling for anxiety and depression, both of which are known to affect smoking in either direction. Further study into motivators of changing tobacco consumption behaviors, and how barriers to care from safer-at-home policies and changes in care delivery moderate change in tobacco use will aid planning tobacco reduction interventions during the ongoing and future respiratory viral pandemics.Trial registrationThis manuscript is derived from baseline survey data obtained in the "Understanding Community Considerations, Opinions, Values, Impacts, and Decisions in COVID-19" study.Clinicaltrialsgov registration NCT04373135, registered 04/30/2020

Does the Perception That Stress Affects Health Matter? The Association with Health and Mortality

OBJECTIVE: This study sought to examine the relationship among the amount of stress, the perception that stress affects health, and health and mortality outcomes in a nationally-representative sample of U.S. adults. METHODS: Data from the 1998 National Health Interview Survey were linked to prospective National Death Index mortality data through 2006. Separate logistic regression models were used to examine the factors associated with current health status and psychological distress. Cox proportional hazard models were used to determine the impact of perceiving that stress affects health on all-cause mortality. Each model specifically examined the interaction between the amount of stress and the perception that stress affects health, controlling for sociodemographic, health behavior, and access to healthcare factors. RESULTS: 33.7% of nearly 186 million (n=28,753) U.S. adults perceived that stress affected their health a lot or to some extent. Both higher levels of reported stress and the perception that stress affects health were independently associated with an increased likelihood of worse health and mental health outcomes. The amount of stress and the perception that stress affects health interacted such that those who reported a lot of stress and that stress impacted their health a lot had a 43% increased risk of premature death (HR = 1.43, 95% CI [1.20, 1.71]). CONCLUSIONS: High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health and reported a large amount of stress had an increased risk of premature death