Miracle-dz/UniFAR-FTUs huggingface dataset:
Hybrid Convolutional Networks for End-to-End Event Detection in Concurrent PPG and PCG Signals Affected by Motion Artifacts

The accurate detection of physiologically-related events in photopletismographic (PPG) and phonocardiographic (PCG) signals, recorded by wearable sensors, is mandatory to perform the estimation of relevant cardiovascular parameters like the heart rate and the blood pressure. However, the measurement performed in uncontrolled conditions without clinical supervision leaves the detection quality particularly susceptible to noise and motion artifacts. This work proposes a new fully-automatic computational framework, based on convolutional networks, to identify and localize fiducial points in time as the foot, maximum slope and peak in PPG signal and the S1 sound in the PCG signal, both acquired by a custom chest sensor, described recently in the literature by our group. The event detection problem was reframed as a single hybrid regression-classification problem entailing a custom neural architecture to process sequentially the PPG and PCG signals. Tests were performed analysing four different acquisition conditions (rest, cycling, rest recovery and walking). Cross-validation results for the three PPG fiducial points showed identification accuracy greater than 93 % and localization error (RMSE) less than 10 ms. As expected, cycling and walking conditions provided worse results than rest and recovery, however reaching an accuracy greater than 90 % and a localization error less than 15 ms. Likewise, the identification and localization error for S1 sound were greater than 90 % and less than 25 ms. Overall, this study showcased the ability of the proposed technique to detect events with high accuracy not only for steady acquisitions but also during subject movements. We also showed that the proposed network outperformed traditional Shannon-energy-envelope method in the detection of S1 sound, reaching detection performance comparable to state of the art algorithms. Therefore, we argue that coupling chest sensors and deep learning processing techniques may disclose wearable devices to unobtrusively acquire health information, being less affected by noise and motion artifacts.
No elephant in the room: The incremental validity of implicit self-esteem measures.

Correlational research aiming to validate measures and the construct of implicit self-esteem (ISE) has produced heterogeneous results in the past. We argue that this might be caused by two underappreciated obstacles: the situational malleability and construct irrelevant variance in conventional ISE measures. To minimize these problems, we applied process and latent state-trait modeling to Implicit Association Test and Name Letter Task data collected on four occasions across six weeks in a preregistered online study (initial N = 360, final N = 302). We investigated the relation of supposed trait ISE parameters with trait explicit self-esteem (ESE) and criteria. Results indicated no latent trait correlation among the different supposed indicators of ISE, small latent trait correlations of indicators of ISE and ESE, and little incremental validity of the supposed ISE measures in predicting potential criterion measures over and above ESE. These findings align with previous critical evaluations regarding the supposed measures of ISE and the conceptual validity of ISE as an association. Implications for future research on ISE are discussed.
Work Setting Effects on Speech-Language Pathology Practice: Implications for Identification of Children With Specific Language Impairment.

PURPOSE Most research on language acquisition and impairments is neutral to work setting; however, work settings (e.g., schools, health care) are expected to differ in alignment with overlaid workplace models (e.g., education, medical). These differences may affect clinical service provision for individuals with specific language impairment (SLI). This article evaluates potential effects of work setting on top-down advocacy initiatives and clinical service provision for children with symptoms of SLI. METHOD Speech-language pathologists serving pediatric populations in health care-based (n = 140) and school-based (n = 423) work settings completed a three-part survey: (a) participant demographics, (b) report of case/workload and practice patterns, and (c) clinical vignettes and eligibility belief. Data analysis included descriptives and chi-square tests. RESULTS The work setting groups reported differences in eligibility terminology, eligibility criteria, and practice patterns from the point of referral through discharge. The reported differences aligned with overlaid workplace models. As compared to the school-based group, health care-based participants reported fewer eligibility restrictions in the workplace, agreed more often with a belief in less restrictive eligibility criteria, and reported more sensitive clinical decisions when operating under neutral workplace circumstances. Despite these findings, health care-based participants reported a smaller proportion of individuals with language impairment only on their caseload. DISCUSSION Work setting variations influence the underidentification of individuals with SLI for speech-language pathology services. Differences in responses by workplace indicate the need for unique and targeted advocacy efforts. Shifting diagnostic terminology and criteria will be insufficient in closing the gap unless advocacy efforts also address speech-language pathologists' workplace realities.
Understanding the factors affecting employees’ perceived benefits of healthcare information technology

Abstract Healthcare information technology (HIT) is becoming a critical component of healthcare delivery and promises dramatic improvements in efficiencies and quality. However, the ability to attain the benefits from HIT is still being understood. This research examines the relationship of HIT benefits with perceived barriers, training, skill, and level of use. Data were gathered from a survey of employees at King Abdul-Aziz Medical City in Riyadh, Saudi Arabia. Variables representing HIT benefits and barriers were constructed through principal component analysis, which were combined with individual and organizational characteristics and analyzed through multivariate regression. Our findings suggest that HIT benefits are related to the type and understanding of barriers and the level of training, use, and skills. Hospital managers should understand that utilizing these factors may assist in achieving the promises of HIT.
Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design

Unplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse‐led models of care focusing on improving in‐house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse‐led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals.
Competitive intelligence: A precursor to a learning health system

Unlike other developed countries, the US healthcare system is largely privatized and highly competitive. This dynamic stifles effective information sharing, while the need for prompt and accurate evidence-based decision making has become crucial. Crises, like the COVID-19 pandemic, elevate the importance of quality decision making and exacerbate issues associated with the lack of a cohesive system to share information. Competitive intelligence (CI) is a discipline that encourages gathering, analyzing, and sharing information throughout a firm in order to develop and sustain competitive advantage. CI could be considered a precursor in establishing a learning organization (LO). Although CI research has focused on its process and value, little is found in the literature on how to integrate CI into an organization; this is particularly true in healthcare. A conceptual model is proposed to build and integrate a CI function and culture within a healthcare organization to encourage effective information sharing and knowledge development. In turn, this can provide a mechanism to create a learning health system (LHS). Although the model was developed specifically for US healthcare, it offers application to healthcare in other countries as well as most any industry.
Prospects and limitations of paramagnetic chemical exchange saturation transfer agents serving as biological reporters in vivo

The concept of using paramagnetic metal ion complexes as chemical exchange saturation transfer agents (paraCEST) for molecular imaging of various biological processes first appeared in the literature about 20 years ago. The first paraCEST agent was based on a highly shifted, inner‐sphere, slowly exchanging water molecule that could be activated at a frequency far away from bulk water, a substantial advantage for selective activation of the agent alone. Many other paraCEST agent designs followed that were based on activation of exchanging ‐NH or ‐OH proton on the chelate itself. Both types of paraCEST designs are attractive for molecular imaging because the rates of water molecule or ligand proton exchange can be designed to be sensitive to a biological or physiological property such as pH, enzyme activity, or redox. Hence, the intensity or frequency of the resulting CEST signal provides a direct readout of that property. Many molecular designs have appeared in the literature over the past 20 years, mostly reported as proof‐of‐concept designs but, unfortunately, only a few reports have explored the limitations of paraCEST agents for imaging a biological process in vivo. As a community, we now know that the sensitivity of paraCEST agents is lower than one might anticipate based upon simple chemical exchange principles and, in general, it appears the sensitivity of paraCEST agents is even lower in vivo than in vitro. In this short review, we address some of the factors that contribute to the limited sensitivity of paraCEST agents in vivo, offer some thoughts on approaches that could lead to dramatically improved paraCEST sensitivity, and challenge the scientific community to perform more in vivo experiments designed to test these ideas.
A tool kit for primary HVAC system energy calculation. Part 1: Boiler model

This is the first in a series of papers presenting the fundamentals of a new simulation tool kit developed by ASHRAE TC 4.7. The modeling approach used in this tool kit is oriented toward simple solutions with a minimum number of parameters and is accurate enough for annual energy calculations of whole building systems. The boiler model is developed and documented on the basis of the following elements: an information flow diagram in which a selection of input output variables and parameters is proposed, two conceptual schemas in which the main physical assumptions are stated, and a set of equations derived from the conceptual schemas. After the modeling of the combustion chamber and the heat exchangers, the paper describes the simulation of a boiler submitted to a certain heat demand. Three types of combustion control systems are considered: on-off, low-high/low-off, and modulating. For the first two control systems, it is assumed that the cyclic operation can be represented by a simple linear combination of two steady-state regimes (``quasi-static`` model). Particular attention is paid to parameter identification: the tool kit must allow the user to ``translate`` the (sometimes incomplete) information found in catalogs into fundamental characteristics of the component being considered.more » Boiler parameters consist of a set of heat transfer coefficients (two or three, according to the burner control mode). Special identification procedures are provided to the user in order to identify these heat transfer coefficients on the basis of the available experimental tests and/or default values. The proposed model is well validated on the basis of available experimental results. « less
How Caregivers Cope and Adapt When a Family Member Is Diagnosed With a Hematologic Malignancy: Informing Supportive Care Needs

Background Informal family caregivers (FCs) of adults with various diseases including hematologic malignancy (HM) experience low quality of life and psychological well-being. Although HMs are life-threatening cancers associated with high mortality, numerous symptoms, and lengthy hospitalizations and are therefore likely to be challenging for FCs to cope with, there is scant research exploring FC experiences. Objective The aim of this study was to describe the coping and adaptation of FCs of patients during diagnosis and treatment of HM. Methods This study used a qualitative descriptive design to analyze semi-structured interview responses from FCs (N = 28) within 3 months of the patients’ HM diagnosis. A content analysis was conducted to generate common themes. Results Family caregivers endorsed adaptive and maladaptive coping. Adaptive strategies included taking one day at a time, spirituality, engaging in pastimes, and utilizing emotional and instrumental family and community support. Maladaptive coping included wishful thinking, harmful habits, avoidance, and lacking or being unable to accept family and community support. Conclusions Findings highlight the complexities of caregiver burden as they support their loved ones with HM. Implications for Practice Family caregivers would benefit from receiving an interdisciplinary family-centered approach as their HM person is initiating treatment. Nurses should consider assessing the FCs’ psychosocial needs to help facilitate appropriate services, such as palliative care consultations, social work referrals, support groups, and/or counseling.
Educational system orientation tor requirements of real estate business environment. Accents and limits in intercultural communication

The main drivers of globalization are the multinational corporations. In this context, the higher education system must adapt its curricula to the requirements of global real estate business environment and multinational corporations in order to enable graduates to acquire desired skills. This paper highlights the importance of acquiring trans-cultural and trans-disciplinary skills by bringing forefront the complex issue of intercultural communication. Transversal skills tend to become increasingly important, so in a global real estate business environment acquiring communication skills and overcoming barriers to intercultural communication are key aspects in acquiring important positions in real estate multinational corporations.
Atomic structure of the Leishmania spp. Hsp100 N‐domain

Hsp100 is an ATP‐dependent unfoldase that promotes protein disaggregation or facilitates the unfolding of aggregation‐prone polypeptides marked for degradation. Recently, new Hsp100 functions are emerging. In Plasmodium, an Hsp100 drives malaria protein export, presenting a novel drug target. Whether Hsp100 has a similar function in other protists is unknown. We present the 1.06 Å resolution crystal structure of the Hsp100 N‐domain from Leishmania spp. , the causative agent of leishmaniasis in humans. Our structure reveals a network of methionines and aromatic amino acids that define the putative substrate‐binding site and likely evolved to protect Hsp100 from oxidative damage in host immune cells.
Prevalence and Risk Factors of Advanced Liver Fibrosis in a Population‐Based Study in Germany

The prevalence of liver disease, and especially of advanced liver fibrosis, in the German population is poorly defined. The aim of the study was to explore liver enzymes and surrogate scores of hepatic steatosis and advanced hepatic fibrosis in a population‐based cohort study in Germany. In the cross‐sectional population‐based Gutenberg Health study, data of 14,950 participants enrolled between 2007 and 2012 were captured and analyzed. The distribution of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma‐glutamyltransferase (GGT), fatty liver index (FLI), and Fibrosis‐4 (FIB‐4) score, as well as the underlying risk factors, were assessed by regression models. Elevated liver enzymes in this population‐based sample were seen in 19.9% for ALT, 12.8% for AST, and 14% for GGT. Risk factors for liver disease included alcohol use and the presence of the metabolic syndrome, which were both risk factors associated with increased liver enzymes. The FLI suggested that 37.5% of the population exhibited hepatic steatosis and 1.1% of patients exhibited a FIB‐4 above the upper cutoff, while 19.2% were in the intermediate range. Interestingly, advanced fibrosis was significantly more frequent in men compared with women (FIB‐4: 1.5% vs. 0.6% [P < 0.0001]; NFS: 3.6% vs. 1.9% [P < 0.0001]). In addition, age was a relevant risk factor for exhibiting a noninvasive surrogate score suggestive of advanced fibrosis in the current study population. Conclusion: Elevated liver enzymes were seen in almost a fifth of the German population. At the population‐based level, the prevalence of advanced fibrosis was estimated at 1% in Germany.
Prone Position and COVID-19: Mechanisms and Effects*

Prone positioning was first applied in critically ill patients by Piehl and Brown (1) in 1976 who reported a marked oxygenation improvement in five patients with acute respiratory failure. This observation remained essentially a curiosity until the first CT scan of acute respiratory distress syndrome (ARDS) patients showed that parenchymal densities were disproportionately distributed in the dorsal lung regions. This finding provided the anatomical hypothesis for the improvement in gas exchange and led to an increase in the clinical use of prone position (2). The assumption was that the normally ventilated lung located in the “ventral” regions (i.e., the anatomical concept of “baby lung”) would be better perfused if placed in a gravitationally dependent position, improving the overall ventilation/perfusion (V/Q) ratio, and hence gas exchange. However, further studies of CT scans taken with patients in the prone position disproved the mechanistic hypothesis that change in perfusion determined its effects on oxygenation (3). On the contrary, it became apparent that the main effect following prone position was the redistribution of lung densities from the dorsal to the ventral lung regions. This discovery led to the formulation of the “sponge” model of the lung in which the rapid resolution and formation of atelectasis in different regions of the heavily edematous ARDS lung are primarily due to changes of superimposed hydrostatic pressure which follow the change in gravitational axis (4). The improvement of oxygenation, consistently found both clinically and experimentally, prompted the parallel implementation of clinical trials. Over the ensuing years, diverse studies of prone positioning led on one hand to better understanding of the mechanisms that improve oxygenation; on the other hand, observational and clinical trials that progressively refined the indications for its use in ARDS. Significant survival benefits were demonstrated when prone position was applied for 12–16 consecutive hours in the more severe forms of respiratory failure (Pao2/Fio2 < 150 mm Hg) (5), whereas its application does not provide convincing survival advantage in patients with milder disease (6). Therefore, what we understood regarding “typical” ARDS might be summarized as follows: prone positioning in ARDS, a condition characterized by extensive inflammatory edema, leads to decreased frontal chest wall compliance, to partial clearing of dorsal atelectasis, and to the development of new ventral atelectasis. In most patients, the balance favors clearing of dorsal atelectasis, thus increasing the net amount of well-aerated tissue. Regarding perfusion, evidence from both experimental models and clinical studies indicated little change with the shift from supine to prone position (7, 8). As we learned in other landmark trials, however, better oxygen exchange does not satisfactorily explain the survival advantage attributable to prone Luciano Gattinoni, MD, FRCP1
A contemporary assessment of resuscitative endovascular balloon occlusion of the aorta

A s with its original description in 1954, the modern development of resuscitative endovascular balloon occlusion of the aorta (REBOA) emerged from the crucible of war. Early in the Afghanistan and Iraq Wars, data from the military's Joint Trauma System and registry showed that 25% of wounded service members died from potentially survivable injuries, 90% of those from uncontrolled bleeding before reaching surgical care. Although the military had established themost comprehensive casualty care system in history, it was not working for service members with noncompressible torso hemorrhage and shock who required rapid intervention to support blood pressure and bleeding control before the operating room. Despite advances in blood component-based resuscitation, the otherwise surgery-centric paradigm of “get the patient into the operating room as soon as possible” needed reappraisal and new approaches.
Sensitivity of Vowel-Evoked Envelope Following Responses to Spectra and Level of Preceding Phoneme Context

Objective: Vowel-evoked envelope following responses (EFRs) could be a useful noninvasive tool for evaluating neural activity phase-locked to the fundamental frequency of voice (f0). Vowel-evoked EFRs are often elicited by vowels in consonant-vowel syllables or words. Considering neural activity is susceptible to temporal masking, EFR characteristics elicited by the same vowel may vary with the features of the preceding phoneme. To this end, the objective of the present study was to evaluate the influence of the spectral and level characteristics of the preceding phoneme context on vowel-evoked EFRs. Design: EFRs were elicited by a male-spoken /i/ (stimulus; duration = 350 msec), modified to elicit two EFRs, one from the region of the first formant (F1) and one from the second and higher formants (F2+). The stimulus, presented at 65 dB SPL, was preceded by one of the four contexts: /∫/, /m/, /i/ or a silent gap of duration equal to that of the stimulus. The level of the context phonemes was either 50 or 80 dB SPL, 15 dB lower and higher than the level of the stimulus /i/. In a control condition, EFRs to the stimulus /i/ were elicited in isolation without any preceding phoneme contexts. The stimulus and the contexts were presented monaurally to a randomly chosen test ear in 21 young adults with normal hearing. EFRs were recorded using single-channel electroencephalogram between the vertex and the nape. Results: A repeated measures analysis of variance indicated a significant three-way interaction between context type (/∫/, /i/, /m/, silent gap), level (50, 80 dB SPL), and EFR-eliciting formant (F1, F2+). Post hoc analyses indicated no influence of the preceding phoneme context on F1-elicited EFRs. Relative to a silent gap as the preceding context, F2+-elicited EFRs were attenuated by /∫/ and /m/ presented at 50 and 80 dB SPL, as well as by /i/ presented at 80 dB SPL. The average attenuation ranged from 14.9 to 27.9 nV. When the context phonemes were presented at matched levels of 50 or 80 dB SPL, F2+-elicited EFRs were most often attenuated when preceded by /∫/. At 80 dB SPL, relative to the silent preceding gap, the average attenuation was 15.7 nV, and at 50 dB SPL, relative to the preceding context phoneme /i/, the average attenuation was 17.2 nV. Conclusion: EFRs elicited by the second and higher formants of /i/ are sensitive to the spectral and level characteristics of the preceding phoneme context. Such sensitivity, measured as an attenuation in the present study, may influence the comparison of EFRs elicited by the same vowel in different consonant-vowel syllables or words. However, the degree of attenuation with realistic context levels exceeded the minimum measurable change only 12% of the time. Although the impact of the preceding context is statistically significant, it is likely to be clinically insignificant a majority of the time.