Spatial Health Predictors for Depressive Disorder in Manhattan: A 2020 Analysis.

Background Urban cores often present extreme disparities in the distribution of wealth and income. They also vary in health outcomes, especially regarding mental welfare. Dense urban blocks agglomerate many residents of various backgrounds, and extreme differences in income, commerce, and health may lead to variations in depressive disorder outcomes. More research is needed on public health characteristics that may affect depression in dense urban centers. Methods Data on 2020 public health characteristics for Manhattan Island was collected using the Centers for Disease Control's (CDC's) PLACES project. All Manhattan census tracts were used as the spatial observations, resulting in [Formula: see text] observations. A cross-sectional generalized linear regression (GLR) was used to fit a geographically weighted spatial regression (GWR), with tract depression rates as the endogenous variable. Data on the following eight exogenous parameters were incorporated: the percentage without health insurance, the percentage of those who binge drink, the percentage who receive an annual doctor's checkup, the percentage of those who are physically inactive, the percentage of those who experience frequent mental distress, the percentage of those who receive less than 7 hours of sleep each night, the percentage of those who report regular smoking, and the percentage of those who are obese. A Getis-Ord Gi* model was built to locate hot and cold spot clusters for depression incidence and an Anselin Local Moran's I spatial autocorrelation analysis was undertaken to determine neighborhood relationships between tracts.  Results Depression hot spot clusters at the 90%-99% confidence interval (CI) were identified in Upper Manhattan and Lower Manhattan using the Getis-Ord Gi* statistic and spatial autocorrelation. Cold spot clusters at the 90%-99% CI were in central Manhattan and the southern edge of Manhattan Island. For the GLR-GWR model, only the lack of health insurance and mental distress variables were significant at the 95% CI, with an adjusted R-2 of 0.56. Noticeable inversions were observed in the spatial distribution of the exogenous coefficients across Manhattan, with a higher lack of insurance coefficients observed in Upper Manhattan and higher frequent mental distress coefficients in Lower Manhattan. Conclusion The level of depression incidence does spatially track with predictive health and economic parameters across Manhattan Island. Additional research is encouraged on urban policies that may reduce the mental distress burden on Manhattan residents, as well as investigations of the spatial inversion observed in this study between the exogenous parameters.

Multinomial Estimations of Predictive Risk Factors for Traumatic Brain Injuries.

Introduction Traumatic brain injuries (TBIs) affect millions of patients each year, with more than 220,000 hospitalizations in 2019 and 64,000 deaths in 2020 alone. TBIs span a plethora of injuries including cerebral contusions and lacerations, axonal injuries, optic pathway disruptions, and skull fractures. Previous research has established that characteristics such as sex, mechanism of injury (MOI), and blood-thinning agents have some causal connections to a variety of cranial traumas. Methods This paper sought to analyze aggravating risk factors for various TBIs in the New York City borough of Staten Island. Data on eight predictive risk variables were collected at a level 1 trauma center from January 1, 2022, to December 31, 2022: MOI, seizure history, anticoagulant/antiplatelet therapy, alcoholism, age, biological sex, tested alcohol level, and body mass index (BMI). A multinomial logistic regression was estimated to generate risk ratios (RRs), and chi-squared tests were carried out to determine univariate associations. Results It was found that blood thinner use and sex were both significant predictors of various types of TBIs. Additionally, those not tested for alcohol, including pediatric patients, were less likely to suffer most forms of TBI, while BMI had a negligible relationship with any TBI class. The use of blood-thinning agents put patients at an increased risk of concussions (relative risk ratio [RRR]: 1.82; 95% confidence interval [CI]: 1.10-3.02) and undiagnosed intracranial injuries (RRR: 1.90; 95% CI: 1.08-3.34). Men were at higher risk of multiple cranial injuries than women (RRR: 3.62; 95% CI: 1.38-9.48), as well as physical traumas such as brain lacerations and hemorrhages (RRR: 2.81, 95% CI: 1.28-6.18). BMI was weakly correlated with undiagnosed cranial injuries (RRR: 1.04; 95% CI: 1.00-1.08) and slightly uncorrelated with physical traumas (RRR: 0.94; 95% CI: 0.88-1.00). Those not tested for alcohol were at far less risk of multiple TBIs (RRR: 0.08; 95% CI: 0.01-0.66), concussions (RRR: 0.27; 95% CI: 0.11-0.71), and physical brain traumas (RRR: 0.33; 95% CI: 0.13-0.84). No parameter exhibited any statistical significance with skull fractures. Conclusion Particular risk factors for TBIs include biological sex and blood thinner use. Injury prevention efforts should be based on the category of TBI, with a particular focus on blood thinner users becoming concussive post-trauma. Attention should also be paid to men who engage in risky behavior such as binge drinking and crime sustaining more than one brain trauma or isolated brain bleeds. Therefore, improved hospital outreach for fall precautions in nursing homes and targeted interventions for at-risk men are vital for future projects.

Urban Traumatic Moving Injuries Before and During SARS-CoV-2: A Multilinear Regression Analysis.

Background The onset of the coronavirus pandemic (COVID-19/SARS-CoV-2) saw an overall decline in traffic. Fundamental shifts in the pattern of traffic-related traumas were observed across the United States and beyond.  Objectives This study aims to predict changes in the length of stay (LOS) for patients sustaining traumatic moving injuries before and during the coronavirus pandemic.  Methods All moving injuries (bicycle accidents, pedestrians struck, motor vehicle/motorcycle accidents) before and during the first SARS-CoV-2 wave in the US were extracted from our hospital's trauma registry. The study period was from March 1st to October 31st of 2019 and 2020, respectively. Ordinary least squares (OLS) multilinear regression models were estimated with a significance level of 0.05.  Results In both periods, the Glasgow coma scores (GCS), ICU LOS, injury severity scores (ISS), and admitting service had significant impacts on hospital duration. Higher GCS scores increased the hospital LOS by 0.811 days in 2019 and 0.587 days in 2020. A higher ISS resulted in an increase in LOS by 0.207 days in 2019 and 0.124 days in 2020. The ICU admissions increased LOS by 0.82 days in 2019 and 1.25 days in 2020. Admissions to trauma services increased in duration by 2.111 days in 2019 and 1.379 days in 2020. Average LOS dropped from 3.09 to 2.50 days between both periods.  Conclusion Our trauma center saw significant changes in the admission patterns of moving injuries during COVID-19. We must therefore be better prepared to handle increased volume during public health emergencies and potential reductions in trauma utilization. Local injury prevention efforts may help reduce the burden on trauma centers during such emergencies as they did during COVID-19, allowing for greater focus on non-trauma patients.

KLTS: A Rigorous Method to Compute the Confidence Intervals for the Three-Cornered Hat and for Groslambert Covariance.

The three-cornered hat/Groslambert Covariance (GCov) methods are widely used to estimate the stability of each individual clock in a set of three, but no method gives reliable confidence intervals for large integration times. We propose a new KLTS (Karhunen-Loève Tansform using Sufficient statistics) method which uses these estimators to consider the statistics of all the measurements between the pairs of clocks in a Bayesian way. The resulting cumulative density function (CDF) yields confidence intervals for each clock Allan variance (AVAR). This CDF provides also a stability estimator that is always positive. Checked by massive Monte Carlo simulations, KLTS proves to be perfectly reliable even for one degree of freedom. An example of experimental measurement is given.

Frequency Stability Measurement of Cryogenic Sapphire Oscillators With a Multichannel Tracking DDS and the Two-Sample Covariance.

This paper shows the first measurement of three 100-MHz signals exhibiting fluctuations from 2×10-16 to parts in 10-15 for an integration time τ between 1 s and 1 day. Such stable signals are provided by three cryogenic sapphire oscillators (CSOs) operating at about 10 GHz, also delivering the 100-MHz output via a dedicated synthesizer. The measurement is made possible by a six-channel tracking direct digital synthesizer (TDDS) and the two-sample covariance tool, used to estimate the Allan variance. The use of two TDDS channels per CSO enables high rejection of the instrument background noise. The covariance outperforms the three-cornered hat (TCH) method in that the background converges to zero "out of the box," with no need of the hypothesis that the instrument channels are equally noisy, nor of more sophisticated techniques to estimate the background noise of each channel. Thanks to correlation and averaging, the instrument background (AVAR) rolls off with a slope 1/√m , the number of measurements, down to 10-18 at τ = 104 s. For consistency check, we compare the results to the traditional TCH method beating the 10-GHz outputs down to the megahertz region. Given the flexibility of the TDDS, our methods find an immediate application to the measurement of the 250-MHz output of the femtosecond combs.

Cross-Spectrum PM Noise Measurement, Thermal Energy, and Metamaterial Filters.

Virtually all commercial instruments for the measurement of the oscillator PM noise make use of the cross-spectrum method (arXiv:1004.5539 [physics.ins-det], 2010). High sensitivity is achieved by correlation and averaging on two equal channels, which measure the same input, and reject the background of the instrument. We show that a systematic error is always present if the thermal energy of the input power splitter is not accounted for. Such error can result in noise underestimation up to a few decibels in the lowest-noise quartz oscillators, and in an invalid measurement in the case of cryogenic oscillators. As another alarming fact, the presence of metamaterial components in the oscillator results in unpredictable behavior and large errors, even in well controlled experimental conditions. We observed a spread of 40 dB in the phase noise spectra of an oscillator, just replacing the output filter.

Characterization of zero-bias microwave diode power detectors at cryogenic temperature.

We present the characterization of commercial tunnel diode low-level microwave power detectors at room and cryogenic temperatures. The sensitivity as well as the output voltage noise of the tunnel diodes is measured as functions of the applied microwave power. We highlight strong variations of the diode characteristics when the applied microwave power is higher than a few microwatts. For a diode operating at 4 K, the differential gain increases from 1000 V/W to about 4500 V/W when the power passes from -30 dBm to -20 dBm. The diode white noise floor is equivalent to a Noise Equivalent Power of 0.8 pW/Hz and 8 pW/Hz at 4 K and 300 K, respectively. Its flicker noise is equivalent to a relative amplitude noise power spectral density Sα(1 Hz) = - 120 dB/Hz at 4 K. Flicker noise is 10 dB higher at room temperature.

Characterization of the Individual Short-Term Frequency Stability of Cryogenic Sapphire Oscillators at the 10(-16) Level.

We present the characterization of three cryogenic sapphire oscillators (CSOs) using the three-cornered-hat method. Easily implemented with commercial components and instruments, this method reveals itself very useful to analyze the fractional frequency stability limitations of these state-of-the-art ultrastable oscillators. The best unit presents a fractional frequency stability better than 5 ×10(-16) at 1 s and below 2 ×10(-16) for [Formula: see text].

High Stability Comparison of Atomic Fountains using two Different Cryogenic Oscillators.

We present a detailed characterization of two atomic clock interrogation systems based on two different cryogenic sapphire oscillators operated simultaneously. We use them as references for two accurate fountain clock frequency standards participating in international atomic time and operating both at the quantum projection noise frequency limit. The two fountain comparison down to a few 10􀀀16 over 28 days demonstrates the potential of a cryocooled oscillator to replace a He refilled cryogenic oscillator.

Ultralow-phase-noise oscillators based on BAW resonators.

This paper presents two 2.1-GHz low-phase noise oscillators based on BAW resonators. Both a single-ended common base structure and a differential Colpitts structure have been implemented in a 0.25-µm BiCMOS process. The detailed design methods including the realization, optimization, and test are reported. The differential Colpitts structure exhibits a phase noise 6.5 dB lower than the single-ended structure because of its good performance of power noise immunity. Comparison between the two structures is also carried out. The differential Colpitts structure shows a phase noise level of -87 dBc/Hz at 1-kHz offset frequency and a phase noise floor of -162 dBc/Hz, with an output power close to -6.5 dBm and a core consumption of 21.6 mW. Furthermore, with the proposed optimization methods, both proposed devices have achieved promising phase noise performance compared with state-of-the-art oscillators described in the literature. Finally, we briefly present the application of the proposed BAW oscillator to a micro-atomic clock.

Breast cancer and venous disease: a retrospective cohort study.

BACKGROUND: Breast cancer (BC) and chronic venous disease (CVD) are in some way related to hormonal effects, and often the clinical manifestations of CVD intersect with the clinical course of BC. This article describes the correlations between these clinical conditions. METHODS: A total of 1138 female patients with BC were retrospectively reviewed in a 5-year period to obtain clinical information about the frequency and characteristics of contemporary CVD and the relative correlations with estrogen and progesterone receptor status. RESULTS: The presence of BC was associated with concomitant CVD clinical manifestations in patients with positive estrogen receptor status, whereas no association was found in patients with negative estrogen receptor status. The presence of negative estrogen receptor status associated with positive progesterone receptor status seemed to be even protective against CVD. Patients with more severe manifestations of CVD had positive estrogen receptor status. CONCLUSIONS: BC and CVD seem to be strongly associated. Positive estrogen receptor status may predispose to a more severe clinical course of venous disease when it occurs in patients with BC.

Skin-sparing mastectomy with immediate breast and nipple reconstruction: a new technique of nipple reconstruction.

Background. Most women with breast cancer today can be managed with breast conservation; however, some women still require mastectomy for treatment of their disease. Skin-sparing mastectomy (SSM) with immediate reconstruction has emerged as a favorable option for many of these patients. The authors combined the SSM technique with the preservation of a small part of the areola with immediate nipple together with with breast reconstruction. Methods. In an 8-year-period 155 female patients (age: 20-52 years old; mean age: 37.5 years) with extensive ductal intraepithelial neoplasia (DIN) or invasive breast cancer were treated with areola skin sparing mastectomy with immediate nipple and breast reconstruction. Patients were followed up prospectively by the breast surgeon, the plastic surgeon, and the oncologist for complications and recurrence. Results. After treatment, only 2 cases (1.29%) had a local recurrence. 8 out of 155 (5.5%) patients developed early complications (infections, seroma, haematoma), and 5 out of 155 patients (3.22%) developed delayed complications (implant rotation, aestethic deterioration) in the post operative time period. The final aesthetic outcome was judged as positive in 150 out of 155 patients (96.78%). Conclusion. In our experience, immediate nipple reconstruction after skin-sparing mastectomy is a technically feasible procedure which can give excellent cosmetic results.

A high-performance frequency stability compact CPT clock based on a Cs-Ne microcell.

This paper reports on a compact table-top Cs clock based on coherent population trapping (CPT) with advanced frequency stability performance. The heart of the clock is a single buffer gas Cs-Ne microfabricated cell. Using a distributed feedback (DFB) laser resonant with the Cs D1 line, the contrast of the CPT signal is found to be maximized around 80°C, a value for which the temperature dependence of the Cs clock frequency is canceled. Advanced techniques are implemented to actively stabilize the clock operation on a zero-light-shift point. The clock frequency stability is measured to be 3.8 × 10(-11) at 1 s and well below 10(-11) until 50,000 s. These results demonstrate the possibility to develop high-performance chip-scale atomic clocks using vapor cells containing a single buffer gas.

New-generation of cryogenic sapphire microwave oscillators for space, metrology, and scientific applications.

This article reports on the characterization of cryogenic sapphire oscillators (CSOs), and on the first test of a CSO in a real field installation, where ultimate frequency stability and continuous operation are critical issues, with no survey. Thanks to low-vibration liquid-He cryocooler design, Internet monitoring, and a significant effort of engineering, these oscillators could bridge the gap from an experiment to a fully reliable machine. The cryocooler needs scheduled maintenance every 2 years, which is usual for these devices. The direct comparison of two CSOs demonstrates a frequency stability of 5 × 10(-16) for 30 s ≤ τ ≤ 300 s integration time, and 4.5 × 10(-15) at 1 day (1 × 10(-14) typical). Two prototypes are fully operational, codenamed ELISA and ULISS. ELISA has been permanently installed the new deep space antenna station of the European Space Agency in Malargüe, Argentina, in May 2012. ULISS is a transportable version of ELISA, modified to fit in a small van (8.5 m(2) footprint). Installation requires a few hours manpower and 1 day of operation to attain full stability. ULISS, intended for off-site experiments and as a technology demonstrator, and has successfully completed two long-distance travels.

Unprecedented long-term frequency stability with a microwave resonator oscillator.

This article reports on the long-term frequency stability characterization of a new type of cryogenic sapphire oscillator using an autonomous pulse-tube cryocooler as its cold source. This new design enables a relative frequency stability of better than 4.5 x 10(-15) over one day of integration. To the best of our knowledge, this represents the best long-term frequency stability ever obtained with a signal source based on a macroscopic resonator.

High-power solid-state sapphire whispering gallery mode maser.

We present new results on a cryogenic solid-state maser frequency standard, which relies on the excitation of whispering gallery (WG) modes within a doped monocrystalline sapphire resonator (alpha-Al2O3). Included substitutively within the highest purity HEMEX-grade sapphire crystal lattice are Fe2+ impurities at a concentration of parts per million, an unavoidable result of the manufacturing process. Mass conversion of Fe2+ to Fe3+ ions was achieved by thermally annealing the sapphire in air. Above-threshold maser oscillation was then excited in the resonator at zero applied DC magnetic field by pumping high-Q WG modes coincident in frequency with the electron spin resonance (ESR) energy levels of the Fe3+ spin population. A 2 stage annealing process was undertaken for a sapphire resonator with exceptionally low Fe3+ concentration, resulting in an improvement of 6 orders of magnitude in output power for this particular crystal, and exceeding the previous best implementation of our scheme in another crystal by nearly 20 dB. This represents an output signal 7 orders of magnitude more powerful than a typical commercial hydrogen maser. At this power level, we estimate a limit on the frequency stability of order 1 x 10(-17)/square root(tau) due to the Schawlow-Townes fundamental thermal noise limit.

Measurement of the fundamental thermal noise limit in a cryogenic sapphire frequency standard using bimodal maser oscillations.

We report observations of the Schawlow-Townes noise limit in a cryogenic sapphire secondary frequency standard. The effect causes a fundamental limit to the frequency stability, and was measured through the novel excitation of a bimodal maser oscillation of a Whispering Gallery doublet at 12.04 GHz. The beat frequency of 10 kHz between the oscillations enabled a sensitive probe for this measurement of fractional frequency instability of 10(-14) tau(-1/2) with only 0.5 pW of output power.

On the 1/f frequency noise in ultra-stable quartz oscillators.

The frequency flicker of an oscillator, which appears as a 1/f3 line in the phase noise spectral density, and as a floor on the Allan deviation plot, originates from two basic phenomena, namely, (1) the 1/f phase noise turned into 1/f frequency noise via the Leeson effect, and (2) the 1/f fluctuation of the resonator natural frequency. The discussion on which is the dominant effect, thus on how to improve the stability of the oscillator, has been going on for years without giving a clear answer. This article tackles the question by analyzing the phase noise spectrum of several commercial oscillators and laboratory prototypes, and demonstrates that the fluctuation of the resonator natural frequency is the dominant effect. The investigation method starts from reverse engineering the oscillator phase noise in order to show that if the Leeson effect was dominant, the resonator merit factor Q would be too low as compared to the available technology.

A cryogenic open-cavity sapphire reference oscillator with low spurious mode density.

In this paper, we describe the implementation of a microwave cryogenic sapphire oscillator (CSO) at the Laboratoire de Physique et Métrologie des Oscillateurs. In our realization we solved the problem of the spurious modes by operating the sapphire resonator in an open cavity. The CSO compared to a hydrogen maser demonstrates a frequency stability better than 3 x 10(-14) at short term. Its long-term frequency instability of the order of 3 x 10(-12)/day is limited by a random walk process. A first attempt to use this reference oscillator to characterize other signal sources is presented.

On the flicker noise of ferrite circulators for ultra-stable oscillators.

The flicker noise of the ferrite circulator is a critical element in ultra-stable microwave oscillators, in which the signal reflected from the input of the reference cavity is exploited to stabilize the frequency. This paper explains why the circulator noise must be measured in isolation mode, proposes a measurement scheme, and provides experimental results. The observed flicker spans from -162 to -170 dB[rad2]/Hz at 1 Hz off the 9.2 GHz carrier, and at +19 dBm of input power. In the same conditions, the instrument limit is below -180 dB[rad2]/Hz. Experiments also give information on the mechanical stability of the microwave assembly, which is in the range of 10(-11) m. The measurement method can be used as the phase detector of a corrected oscillator; and, in the field of solid-state physics, it can be used for the measurement of random fluctuations in magnetic materials.