Miracle-dz/UniFAR-FTUs huggingface dataset:
Association of Hearing Loss and Loneliness in Older Adults

Objective: The objective of this study is to determine factors associated with loneliness in older adults presenting for hearing loss treatment. Method: A cross-sectional analysis was conducted of 145 participants (aged 50-94) who presented for hearing aids or cochlear implants and were enrolled in the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study from 2011 to 2013. Social, communicative, physical, and mental health functioning were assessed using self-administered questionnaires, and loneliness using the University of California, Los Angeles (UCLA) Loneliness Scale. Results: Younger age and greater hearing loss were significantly associated with greater loneliness. Metrics of depressive symptoms and hearing-related quality of life, communication difficulties, and emotional well-being, mental health, and 36-Item Medical Outcomes Study Short-Form (SF-36) scores were moderately or highly correlated with loneliness. Discussion: Younger age and greater hearing loss are independently associated with higher levels of loneliness in older adults presenting to clinic for hearing loss treatment. Further studies needed to determine whether hearing treatment can reduce loneliness in older adults.
Understanding the Subjective Experience of Medication Adherence for Older Urban African Americans With Type 2 Diabetes and a History of Illicit Drug Addiction

Objective: African Americans experience high rates of type 2 diabetes mellitus (T2D). Self-management strategies, such as medication adherence, are key to mitigating negative T2D outcomes. This article addresses a gap in the literature by examining the intersections of drug abuse histories and medication adherence among urban, older African Americans with T2D. Method: In-depth interview data were collected as part of a larger ethnographic study examining the subjective experience of T2D among urban older adults. Two representative focal cases were selected and thematic analysis performed to illustrate how former illicit drug addicts perceive prescription medication usage. Results: Narratives reveal that participants are displeased about having to take prescription drugs and are making lifestyle changes to reduce medication usage and maintain sobriety. Discussion: Previous drug abuse not only complicates medication adherence but is also a significant part of how older African Americans who are former drug users frame their understanding of T2D more broadly.
Hijacking Bitcoin: Routing Attacks on Cryptocurrencies

As the most successful cryptocurrency to date, Bitcoin constitutes a target of choice for attackers. While many attack vectors have already been uncovered, one important vector has been left out though: attacking the currency via the Internet routing infrastructure itself. Indeed, by manipulating routing advertisements (BGP hijacks) or by naturally intercepting traffic, Autonomous Systems (ASes) can intercept and manipulate a large fraction of Bitcoin traffic.This paper presents the first taxonomy of routing attacks and their impact on Bitcoin, considering both small-scale attacks, targeting individual nodes, and large-scale attacks, targeting the network as a whole. While challenging, we show that two key properties make routing attacks practical: (i) the efficiency of routing manipulation; and (ii) the significant centralization of Bitcoin in terms of mining and routing. Specifically, we find that any network attacker can hijack few (<100) BGP prefixes to isolate ∼50% of the mining power—even when considering that mining pools are heavily multi-homed. We also show that on-path network attackers can considerably slow down block propagation by interfering with few key Bitcoin messages.We demonstrate the feasibility of each attack against the deployed Bitcoin software. We also quantify their effectiveness on the current Bitcoin topology using data collected from a Bitcoin supernode combined with BGP routing data. The potential damage to Bitcoin is worrying. By isolating parts of the network or delaying block propagation, attackers can cause a significant amount of mining power to be wasted, leading to revenue losses and enabling a wide range of exploits such as double spending. To prevent such effects in practice, we provide both short and long-term countermeasures, some of which can be deployed immediately.
On the Economics of Offline Password Cracking

We develop an economic model of an offline password cracker which allows us to make quantitative predictions about the fraction of accounts that a rational password attacker would crack in the event of an authentication server breach. We apply our economic model to analyze recent massive password breaches at Yahoo! , Dropbox, LastPass and AshleyMadison. All four organizations were using key-stretching to protect user passwords. In fact, LastPass' use of PBKDF2-SHA256 with 10^5 hash iterations exceeds 2017 NIST minimum recommendation by an order of magnitude. Nevertheless, our analysis paints a bleak picture: the adopted key-stretching levels provide insufficient protection for user passwords. In particular, we present strong evidence that most user passwords follow a Zipf's law distribution, and characterize the behavior of a rational attacker when user passwords are selected from a Zipf's law distribution. We show that there is a finite threshold which depends on the Zipf's law parameters that characterizes the behavior of a rational attacker — if the value of a cracked password (normalized by the cost of computing the password hash function) exceeds this threshold then the adversary's optimal strategy is always to continue attacking until each user password has been cracked. In all cases (Yahoo! , Dropbox, LastPass and AshleyMadison) we find that the value of a cracked password almost certainly exceeds this threshold meaning that a rational attacker would crack all passwords that are selected from the Zipf's law distribution (i.e., most user passwords). This prediction holds even if we incorporate an aggressive model of diminishing returns for the attacker (e.g., the total value of 500 million cracked passwords is less than 100 times the total value of 5 million passwords). On a positive note our analysis demonstrates that memory hard functions (MHFs) such as SCRYPT or Argon2i can significantly reduce the damage of an offline attack. In particular, we find that because MHFs substantially increase guessing costs a rational attacker will give up well before he cracks most user passwords and this prediction holds even if the attacker does not encounter diminishing returns for additional cracked passwords. Based on our analysis we advocate that password hashing standards should be updated to require the use of memory hard functions for password hashing and disallow the use of non-memory hard functions such as BCRYPT or PBKDF2.
Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions

Objective: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Method: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Results: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that “physicians know best. ” Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients’ priorities. Clinician–patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Discussion: Stakeholders’ recommendations suggest health care redesigns that incorporate patients’ health priorities into care decisions and realign relationships across patients and clinicians.
AI2: Safety and Robustness Certification of Neural Networks with Abstract Interpretation

We present AI2, the first sound and scalable analyzer for deep neural networks. Based on overapproximation, AI2 can automatically prove safety properties (e.g., robustness) of realistic neural networks (e.g., convolutional neural networks). The key insight behind AI2 is to phrase reasoning about safety and robustness of neural networks in terms of classic abstract interpretation, enabling us to leverage decades of advances in that area. Concretely, we introduce abstract transformers that capture the behavior of fully connected and convolutional neural network layers with rectified linear unit activations (ReLU), as well as max pooling layers. This allows us to handle real-world neural networks, which are often built out of those types of layers. We present a complete implementation of AI2 together with an extensive evaluation on 20 neural networks. Our results demonstrate that: (i) AI2 is precise enough to prove useful specifications (e.g., robustness), (ii) AI2 can be used to certify the effectiveness of state-of-the-art defenses for neural networks, (iii) AI2 is significantly faster than existing analyzers based on symbolic analysis, which often take hours to verify simple fully connected networks, and (iv) AI2 can handle deep convolutional networks, which are beyond the reach of existing methods.
Adverse Childhood Circumstances and Functional Status Throughout Adult Life

Objective:We studied the association of childhood adversity with adult functional status. Method: With data from the Panel Study of Income Dynamics and the 2014 Childhood Retrospective Circumstances Study (1992-2013; N = 6,705; 62,885 person-years), we estimated functional status transition probabilities associated with childhood adversity, with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, and education. Microsimulation then estimated functional status outcomes throughout adulthood for African American, Hispanic, and non-Hispanic White women and men. Results: Adversity was significantly associated with functional status. Of White women without adversities, 2.3% had difficulty doing activities of daily living at age 30, compared with 8.2% with high adversity; comparable results were 3.7% and 8.7% for African Americans, 0.9% and 11.5% for Hispanics (all p < .01). Patterns were similar at other ages, for men, and when adjusted for midlife health conditions and health behavior. Discussion: Childhood adversity may substantially increase functional impairment throughout adult life.
Older Adults With a Combination of Vision and Hearing Impairment Experience Higher Rates of Cognitive Impairment, Functional Dependence, and Worse Outcomes Across a Set of Quality Indicators

Objectives: Hearing and vision impairment were examined across several health-related outcomes and across a set of quality indicators (QIs) in home care clients with both vision and hearing loss (or dual sensory impairment [DSI]). Method: Data collected using the Resident Assessment Instrument for Home Care (RAI-HC) were analyzed in a sample of older home care clients. The QIs represent the proportion of clients experiencing negative outcomes (e.g., falls, social isolation). Results: The average age of clients was 82.8 years (SD = 7.9), 20.5% had DSI and 8.5% had a diagnosis of Alzheimer’s disease (AD). Clients with DSI were more likely to have a diagnosis of dementia (not AD), have functional impairments, report loneliness, and have higher rates across 20 of the 22 QIs, including communication difficulty and cognitive decline. Clients with highly impaired hearing, and any visual impairment, had the highest QI rates. Discussion: Individuals with DSI experience higher rates of adverse events across many health-related outcomes and QIs. Understanding the unique contribution of hearing and vision in this group can promote optimal quality of care.
The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment

Objective: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. Method: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index (n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death. Results: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different “paths” down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity. Discussion: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.
My Parent—Not Myself

We studied 100 adult child caregivers providing care to dependent parents and found that although the vast majority supported family care for older persons in general and their own parent in particular, 46% did not want family care for themselves if they became dependent. For many the contrast between their general statements supporting care of parents and eschewing it for themselves was quite sharp. Caregiver variables significantly associated with not wanting family care for self included age, conflict with relatives over caring, caregiving burden, number of caregiving tasks performed, poorer mental health, and number of years has provided care. Caregivers not wanting family care for self were also more likely to consider placing their parent in a nursing home. Our data reveal contrasting themes in caregiving that may affect caregiver well-being and burden, and that may have implications for the future care of dependent older persons.
Assessing Response to Therapy

Assessing the response of ventilator-associated pneumonia (VAP) to antibi otic therapy is crucial to management. It is a naive assumption by clinicians, whether they use invasive quantitative cultures or clinical diagnosis, that an accurate diagnosis and antibiotic prescription based on sensitivity testing universally leads to cure of pneu monia. Failure of antibiotic therapy for VAP may be as common as 30 to 40% of initial courses. Failure is more common with certain organisms, mainly nonfermenting, gram-negative bacilli, and is more likely in the most severely ill patients. Systemic manifesta tions of VAP should resolve in the first 1 to 2 days. Of the systemic manifestations, persis tence of fever and a persistent respiratory alkalosis are the most sensitive indicators of uncontrolled local infection. Persistent leukocytosis may be a delayed marker of inade quate response to antibiotics but is not helpful in the first few days of therapy. Improved oxygenation and a decrease in minute ventilation suggest local control of infection while chest radiographs and purulent secretions are insensitive. While tracheal aspirate cul tures are generally not helpful in assessing response to therapy, serial quantitative cul tures may reliably detect antibiotic failure, even before it is clinically apparent. Assessing the response of ventilator-associated pneumonia (VAP) to antibiotic therapy is crucial to the management of critically ill patients with this condition. Many clinicians assume that if appropri ate antibiotics are chosen, the clinical symptoms of pneumonia will abate and the infection will be cured. While this assumption may be valid in a ma jority of patients with pneumonia, in patients with severe hospital-acquired pneumonia, especially VAP, this relationship is less clear. Both autopsy and clinical studies have demonstrated failure of antibi otic therapy despite either broad-spectrum empiric coverage or specific culture-targeted therapy. 1-3
Electroclinical Features of the Psychomotor Seizure

Despite the advent of efficient new drugs and the monitoring of blood levels, the idea that surgery can help patients with refractory epilepsy is one that persists. Currently, the hope is that operations other than block resection anterior to Labbe's vein will be of help to patients with psychomotor seizures. These operations may be either restricted in scope (eg, amygdalohippocampectomy) or more venture-some (eg, removal of the opercular cortex). The author of this new book, building on the work of Talairach and Bancaud, reports his experience with 51 patients at the Kantonspital in Zurich. An attempt was made via depth EEG recordings to localize the source of patients' seizures and to guide surgeons to the site of excision. Wieser believes that there are five clinical appearances of psychomotor seizures with five different sites of origin: temporobasal-limbic, temporal pole, frontobasal-cingulate, opercular, and posterior neocortical-temporal. The author recognizes some of the
Leadership and transformational change in healthcare organisations: A qualitative analysis of the North East Transformation System

The research project ‘An Evaluation of Transformational Change in NHS North East’ examines the progress and success of National Health Service (NHS) organisations in north east England in implementing and embedding the North East Transformation System (NETS), a region-wide programme to improve healthcare quality and safety, and to reduce waste, using a combination of Vision, Compact, and Lean-based Method. This paper concentrates on findings concerning the role of leadership in enabling tranformational change, based on semi-structured interviews with a mix of senior NHS managers and quality improvement staff in 14 study sites. Most interviewees felt that implementing the NETS requires committed, stable leadership, attention to team-building across disciplines and leadership development at many levels. We conclude that without senior leader commitment to continuous improvement over a long time scale and serious efforts to distribute leadership tasks to all levels, healthcare organisations are less likely to achieve positive changes in managerial-clinical relations, sustainable improvements to organisational culture and, ultimately, the region-wide step change in quality, safety and efficiency that the NETS was designed to deliver.
The balance of care approach to health and social care planning: Lessons from a systematic literature review

The strategic allocation of resources is one the most difficult tasks facing health and social care decision makers, with multiple organisations delivering complex services to heterogeneous populations. The enduring appeal of the balance of care approach, a systematic framework for exploring the potential costs and consequences of changing the mix of community and institutional services in a defined geographical area, is thus unsurprising. However, no attempt has previously been made to synthesise or appraise the methodological approaches employed and lessons to inform future applications may go unheard. This paper seeks to address those concerns by reporting the findings of a systematic literature review that identified 33 examples of the model's use spanning 40 years. The majority of studies were undertaken in the UK and explored the services needed by frail older people. There is, however, nothing in the model to restrict it to this context. The paper also details the different ways key elements of the model (information about clients, resources, the appraisal of settings, costs and outcomes) have been operationalised, and considers their strengths and weaknesses. Whilst several studies identified a potential to reduce costs via the use of less institutional care, not all applications predicted cost savings.
Chimiorésistance de P. falciparum en milieu urbain à Yaoundé, Cameroun. Part 2: Evaluation de l'efficacité de l'amodiaquine et de l'association sulfadoxine‐pyriméthamine pour le traitement de l'accès palustre simple àPlasmodium falciparumà Yaoundé, Cameroun

Résumé L'extension de la chloroquino‐résistance ou sa stabilisation à un niveau élevé nécessite une modification des stratégies thérapeutiques avec éventuellement le remplacement de la chloroquine. Nous avons évalué l'efficacité de l'amodiaquine comparée à celle de l'association sulfadoxine‐pyriméthamine à Yaoundé. Parmi les 140 adultes et enfants de plus de 5 ans inclus, 59 dans le groupe amodiaquine et 58 dans le groupe sulfadoxine‐pyriméthamine, ont été suivis à 14 jours. L'efficacité de l'amodiaquine a été de 100% alors de 12,1% (3,7%– 20,5%) d'échec thérapeutiques précoces ont été dénombrés dans le groupe sulfadoxine‐pyriméthamine. Les effets secondaires dans les deux groupes ont été mineurs et spontanément résolutifs. Cette étude a été complétée par des tests in vitro au monodéséthylamodiaquine (le métabolite actif de l'amodiaquine) et à la pyriméthamine, et par des dosages plasmatiques du monodéséthylamodiaquine, de la sulfadoxine et de la pyriméthamine. Les résultats du test in vitroà la pyriméthamine ne sont pas concordants avec les résultats de l'étude clinique. Les dosages plasmatiques ont confirmé les variations inter‐individuelles. Contrairement à la chloroquine, les concentrations moyennes ne varient pas en fonction de l'âge. Il n'existe pas de différence significative entre les concentrations de sulfadoxine et de pyriméthamine chez les malades ayant présenté un succès ou un échec thérapeutique. L'amodiaquine présente plusieurs avantages par rapport à l'association sulfadoxine‐pyriméthamine et peut être considéré comme un médicament efficace en zone de chloroquino‐résistance modérée.
A comparison and verification of computational methods to determine the permeability of vertebral trabecular bone

Fluid flow in the intertrabecular spaces of vertebral bone has been implicated in a number of physiological phenomena. Despite the potential clinical significance of the flow of various fluids through the intertrabecular cavities, the intrinsic permeability of trabecular bone is not fully characterized or understood. Furthermore, very little is known about the interdependence of permeability and morphological parameters. The main purpose of this study is to characterize computational methods to determine intrinsic bone permeability from three-dimensional computed tomography (CT) image stacks that were, depending on the underlying algorithm of each model, acquired at a spatial resolution ranging from the order of 500 μm (macroscale) up to 10 μm (microscale). A Finite Element formulation of the steady-state Stokes flow and an in house developed pore network modeling approach compute permeability on the microscopic length scale. To approximate the geometry of the trabecular bone network, a cellular model is used to map morphological information into intrinsic permeability by means of a log-linear regression equation. If the image resolution is too low for the quantification of the trabecular bone architecture, permeability is directly derived by fitting a simplified version of the log-linear regression equation to the CT Hounsfield values. Depending on the resolution of the raw image data and the chosen model, permeability value correlations are 0.31 ≤ R2 ≤ 0.90 compared to the Finite Element method, that is referred to as the baseline for any comparisons in this study. Furthermore, we found no significant dependence of the intrinsic permeability on the trabecular thickness parameter.