Search

BACKGROUND: Initiation and up-titration of guideline-directed medical therapies (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal, in part due to concerns regarding tolerability and adverse events (AE). OBJECTIVES: To compare rates of adverse events in patients randomized to GDMT medication vs placebo in a meta-analysis of landmark cardiovascular outcomes trials. METHODS: We assessed rates of reported AE in 17 landmark HFrEF clinical trials across each class of GDMT in the placebo and intervention arms. The overall rates of AE for each drug class, the absolute difference in frequency in AEs between the placebo and intervention arms, and the odds of each AE according based on randomization strata were calculated. RESULTS: AE were reported commonly in trials across each class of GDMT, with 75-85% of participants reporting at least one AE. There was no significant difference in the frequency of AE between the intervention and placebo arms, except for angiotensin converting enzyme (ACE) inhibitors (87.0% [85.0-88.8%] vs 82.0% [79.8-84.0%], absolute difference +5% with intervention, P

The bioaccessibility and bioavailability of food-derived bioactive compounds are important issues when assessing their in vivo physiological health-promoting effects. Food components such as proteins and peptides are exposed to different proteases and peptidases during gastrointestinal digestion and absorption. Different in vitro approaches have therefore been developed to evaluate the bioaccessibility and stability of bioactive peptides. The static simulated gastrointestinal digestion model (SGD) was widely reported to assess the bioaccessibility of bioactive peptides. On the other hand, although the dynamic SGD model may better simulate human digestion, it has rarely been explored in bioaccessibility studies of food bioactive peptides due to its high cost and lack of standardization. For bioavailability studies, the Caco-2 cell monolayer model has been used extensively for the assessment of food bioactive peptides. In fact, very few reports using alternative methods for determining transepithelial transport of bioactive peptides have been employed. In this sense, ex vivo tissue-based models such as the Ussing chamber and the everted sac gut have been used. Current evidence supports the fact that using SGD with cell-based models for evaluating the bioaccessibility, absorption, and bioavailability of food-derived bioactive peptides, is the most commonly used approach. Nevertheless, SGD with ex vivo tissue-based models such as the everted sac, remains to be further explored because it seems to be the model that better mimics the physiological process - it is also fast and inexpensive, and several compounds may be tested simultaneously. In the present review, we discuss information available on the different in vitro approaches for the determination of bioaccessibility and bioavailability of food-derived bioactive peptides with special emphasis on ex vivo tissue-based models such as the everted sac and the Ussing chamber models. © 2022 Society of Chemical Industry.

Early circulatory shock following traumatic brain injury (TBI) is a multifactorial process; however, the impact of brain injury biomarkers on the risk of shock has not been evaluated. We examined the association between neuronal injury biomarker levels and the development of circulatory shock following moderate-severe TBI.In this retrospective cohort study, we examined adults with moderate-severe TBI (Glasgow Coma Scale score13) enrolled in the TRACK-TBI study, an 18-center prospective TBI cohort study. The exposures were day-1 levels of neuronal injury biomarkers (glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1 [UCH-L1], S100 calcium-binding protein B [S100B], neuron-specific enolase), and of an inflammatory biomarker (high-sensitivity C-reactive protein). The primary outcome was the development of circulatory shock, defined as cardiovascular Sequential Organ Failure Assessment Score ≥2 within 72 hours of admission. Association between day-1 biomarker levels and the development of circulatory shock was assessed with regression analysis.The study included 392 subjects, with a mean age of 40 years; 314 (80%) were male and 165 (42%) developed circulatory shock. Median (interquartile range) day-1 levels of UCH-L1 (994.8 [518.7 to 1988.2] pg/mL vs. 548.1 [280.2 to 1151.9] pg/mL; P0.0001) and S100B (0.47 μg/mL [0.25 to 0.88] vs. 0.27 [0.16 to 0.46] μg/mL; P0.0001) were elevated in those who developed early circulatory shock compared with those who did not. In multivariable regression, there were associations between levels of both UCH-L1 (odds ratio, 1.63 [95% confidence interval, 1.25-2.12]; P0.0005) and S100B (odds ratio, 1.73 [95% confidence interval 1.27-2.36]; P0.0005) with the development of circulatory shock.Neuronal injury biomarkers may provide the improved mechanistic understanding and possibly early identification of patients at risk for early circulatory shock following moderate-severe TBI.

Este documento presenta el resultado de un proyecto de residencia profesional realizado para la empresa Autobuses México Puebla Estrella Roja S.A. de C.V. la cual tiene como giro el transporte de pasajeros provenientes de la ciudad de Puebla con destino a la CDMX (Ciudad de México) y viceversa. Al ser una empresa dedicada al transporte de pasajeros, tiene presente el constante riesgo de siniestros carreteros debido al estado físico del camino, la carga vehicular y eventos naturales durante el tránsito. La empresa cuenta con el Centro de control y Monitoreo (C.C.M.) que se encarga de controlar el flujo de información de los sucesos en las carreteras, reporta a las autoridades y a los encargados de otras áreas sobre los siniestros suscitados. Sin embargo, en ocasiones se han presentado errores u omisiones por parte de los monitoristas generando pérdida de tiempo para dar respuesta y apoyar a los operadores ante una situación de emergencia. Con base a lo anterior, se tuvo la necesidad de generar un sistema de monitoreo de información que tuviera mayor certeza y exactitud sobre los siniestros teniendo como aliados principales las redes sociales.

IntroductionWe assessed benefits and harms of sacubitril/valsartan (S/V) compared to angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in patients with heart failure (HF).Material and methodsWe systematically searched for randomised controlled trials (RCTs) evaluating S/V vs ACEI or ARB in acute or chronic HF in August 2021. Primary outcomes were HF hospitalisations, and cardiovascular (CV) mortality; secondary outcomes included all-cause mortality, biomarkers, and renal function.ResultsWe selected 11 RCTs (n=18766) with 2-48 months follow-up. Five RCTs had ACEIs as control, five RCTs had ARBs as control, and one RCT had both ACEI and ARB as control. Compared to ACEI or ARB, S/V reduced HF hospitalisations by 20% (HR 0.80, 95%CI 0.68-0.94; 3 RCTs; I2=65%; high CoE), CV mortality by 14% (HR 0.86, 95%CI 0.73 to 1.01; 2 RCTs; I2=57%; high CoE) and all-cause mortality by 11% (HR 0.89, 95%CI 0.78-1.00; 3 RCTs; I2=36%; high CoE). S/V reduced NTproBNP (SMD -0.34, 95%CI -0.52 to -0.16; 3 RCTs; I2=62%), hs-TNT (Ratio of differences 0.84, 95%CI 0.79-0.88; 2 RCTs; I2=0%), and decline in renal function by 33% (HR 0.67, 95%CI 0.39-1.14; 2RCTs; I2=78%; high CoE). S/V increased hypotension (RR 1.69, 95%CI 1.33-2.15; 9 RCTs; I2=65%; high CoE). Hyperkalaemia and angioedema events were similar. Effects were in the same direction when stratified by type of control (ACEI vs. ARB).ConclusionsSacubitril/valsartan had better clinical, intermediate, and renal outcomes in HF in comparison to ACEI or ARB. There was no difference in angioedema and hyperkalemia events, but more hypotension events.

This article analyzes the managerial experiences of the directors of the primary schools of Puebla (Mexico) developed in the exercise of their function during the pandemic caused by the SARS-Cov-2 virus (Covid-19). In the theoretical references, three ways of exercising the managerial function were recognized: pedagogical, managerial and mixed. The research had an epistemic positioning of a phenomenological-hermeneutical nature, with a qualitative approach and a case study design. The instrument consisted of semi-structured interviews applied by Google Meet in the period from March to April of the year 2021. The findings suggest that they exercised their function attached to the form of mixed direction with managerial emphasis. They strengthened leadership, communication, teamwork and problem-solving skills. In addition, they developed discursive lines with an ontological emphasis, according to which the human being, complex and subjective, constitutes the reason for being that animates all forms of social existence; pro-health focused on physical and emotional health care; ethical that guided the forms of labor exercise based on the analysis of the relevance of the normative-institutional framework; and technology that promoted the strengthening of digital skills for the proper development of their functions. They also implemented permanent and temporary hermeneutic devices that helped them understand and interpret the new educational reality. The permanent ones were ontological, ethical-professional, linguistic, epistemological, ideological, identity, pedagogical-didactic and technical. The transients were of the resilient and residual type. It is concluded that they carried out their functions recognizing their human. En este artículo se analizaron las experiencias directivas que las personas directoras de las escuelas primarias de Puebla, México, desarrollaron en el ejercicio de su función durante la pandemia ocasionada por el virus SARS-Cov-2 (COVID-19). En los referentes teóricos se reconocieron tres formas de ejercer la función directiva: pedagógica, gerencial y mixta. La investigación tuvo un posicionamiento epistémico de corte fenomenológico-hermenéutico con enfoque cualitativo y diseño de estudio de caso. El instrumento consistió en una entrevista semiestructurada aplicada por Google Meet en el periodo de marzo a abril del año 2021. Los hallazgos sugieren que las personas directoras ejercieron su función apegadas a la forma de dirección mixta con énfasis gerencial. Potenciaron habilidades de liderazgo, comunicación, trabajo en equipo y resolución de problemas. Además, desarrollaron líneas discursivas con énfasis ontológico, conforme al cual el ser humano, complejo y subjetivo constituye la razón de ser que anima toda forma de existencia social; pro-salud enfocado al cuidado de la salud física y emocional; ético que orientó las formas de ejercicio laboral con base en el análisis de la pertinencia del marco normativo-institucional; y tecnológico que promovió el fortalecimiento de las habilidades digitales para el adecuado desarrollo de sus funciones. También, implementaron dispositivos hermenéuticos, permanentes y transitorios para comprender e interpretar la nueva realidad educativa. Los dispositivos permanentes fueron de tipo ontológico, ético-profesional, lingüístico, epistemológico, ideológico, identitario, pedagógico-didáctico y técnico. Los dispositivos transitorios fueron de tipo resiliente y residual. Finalmente, los resultados indican que las directoras y directores reconocieron su condición humana, así como su salud física y emocional como los máximos baluartes dentro de la emergencia sanitaria. En este artículo se analizaron las experiencias directivas que las personas directoras de las escuelas primarias de Puebla, México, desarrollaron en el ejercicio de su función durante la pandemia ocasionada por el virus SARS-Cov-2 (COVID-19). En los referentes teóricos se reconocieron tres formas de ejercer la función directiva: pedagógica, gerencial y mixta. La investigación tuvo un posicionamiento epistémico de corte fenomenológico-hermenéutico con enfoque cualitativo y diseño de estudio de caso. El instrumento consistió en una entrevista semiestructurada aplicada por Google Meet en el periodo de marzo a abril del año 2021. Los hallazgos sugieren que las personas directoras ejercieron su función apegadas a la forma de dirección mixta con énfasis gerencial. Potenciaron habilidades de liderazgo, comunicación, trabajo en equipo y resolución de problemas. Además, desarrollaron líneas discursivas con énfasis ontológico, conforme al cual el ser humano, complejo y subjetivo constituye la razón de ser que anima toda forma de existencia social; pro-salud enfocado al cuidado de la salud física y emocional; ético que orientó las formas de ejercicio laboral con base en el análisis de la pertinencia del marco normativo-institucional; y tecnológico que promovió el fortalecimiento de las habilidades digitales para el adecuado desarrollo de sus funciones. También, implementaron dispositivos hermenéuticos, permanentes y transitorios para comprender e interpretar la nueva realidad educativa. Los dispositivos permanentes fueron de tipo ontológico, ético-profesional, lingüístico, epistemológico, ideológico, identitario, pedagógico-didáctico y técnico. Los dispositivos transitorios fueron de tipo resiliente y residual. Finalmente, los resultados indican que las directoras y directores reconocieron su condición humana, así como su salud física y emocional como los máximos baluartes dentro de la emergencia sanitaria.

Background We examined multi-dimensional clinical and laboratory data in participants with normoglycemia, prediabetes, and diabetes to identify characteristics of prediabetes and predictors of progression from prediabetes to diabetes or reversion to no diabetes. Methods The Project Baseline Health Study (PBHS) is a multi-site prospective cohort study of 2502 adults that conducted deep clinical phenotyping through imaging, laboratory tests, clinical assessments, medical history, personal devices, and surveys. Participants were classified by diabetes status (diabetes [DM], prediabetes [preDM], or no diabetes [noDM]) at each visit based on glucose, HbA1c, medications, and self-report. Principal component analysis (PCA) was performed to create factors that were compared across groups cross-sectionally using linear models. Logistic regression was used to identify factors associated with progression from preDM to DM and for reversion from preDM to noDM. Results At enrollment, 1605 participants had noDM; 544 had preDM; and 352 had DM. Over 4 years of follow-up, 52 participants with preDM developed DM and 153 participants reverted to noDM. PCA identified 33 factors composed of clusters of clinical variables; these were tested along with eight individual variables identified a priori as being of interest. Six PCA factors and six a priori variables significantly differed between noDM and both preDM and DM after false discovery rate adjustment for multiple comparisons (q a priori variables: ASCVD risk, coronary artery calcium, and triglycerides (q –21 for all). Four factors were significantly different between preDM and noDM, but concordant or similar between DM and preDM: red blood cell indices (q = 8 × 10-10), lung function (q = 2 × 10-6), risks of chronic diseases (q = 7 × 10-4), and cardiac function (q = 0.001), along with a priori variables of diastolic function (q = 1 × 10-10), sleep efficiency (q = 9 × 10-6) and sleep time (q = 6 × 10-5). Two factors were associated with progression from prediabetes to DM: anthropometry and physical function (OR [95% CI]: 0.6 [0.5, 0.9], q = 0.04), and heart failure and c-reactive protein (OR [95% CI]: 1.4 [1.1, 1.7], q = 0.02). The anthropometry and physical function factor was also associated with reversion from prediabetes to noDM: (OR [95% CI]: 1.9 [1.4, 2.7], q = 0.02) along with a factor of white blood cell indices (OR [95% CI]: 0.6 [0.4, 0.8], q = 0.02), and the a priori variables ASCVD risk score (OR [95% CI]: 0.7 [0.6, 0.9] for each 0.1 increase in ASCVD score, q = 0.02) and triglycerides (OR [95% CI]: 0.9 [0.8, 1.0] for each 25 mg/dl increase, q = 0.05). Conclusions PBHS participants with preDM demonstrated pathophysiologic changes in cardiac, pulmonary, and hematology measures and declines in physical function and sleep measures that precede DM; some changes predicted an increased risk of progression to DM. A factor with measures of anthropometry and physical function was the most important factor associated with progression to DM and reversion to noDM. Future studies may determine whether these changes elucidate pathways of progression to DM and related complications and whether they can be used to identify individuals at higher risk of progression to DM for targeted preventive interventions. Trial registration ClinicalTrials.gov NCT03154346

Data analysis subjects are an important part of the computer science degree. In these subjects, seminars and practical sessions where students can practice with different data mining algorithms and techniques are a paramount part. This usually involves the installation and deployment of a common development environment for all the students including libraries, databases, datasets and so forth. Due to the heterogeneity of these environments and the characteristics of the undergraduates, such a configuration and deployment might be an important task in the seminars schedule. Consequently, the present work puts forward an open-source tool for the automatic deployment of data-mining environments based on Docker containers. By means of this tool, the teacher can specify the parameters of the environment to deploy. This results in a set of virtual images comprising the whole practice environment that can be easily distributed among students. This way, we meaningfully optimize the aforementioned deployment step and we also guarantee that all students work with the same practice environment. Finally, we have evaluated the performance of the tool and the level of satisfaction of the students with the generated environments showing quite promising results.

The Northwestern University Freight Rail Infrastructure & Energy Network Decarbonization (NUFRIEND) framework is a comprehensive industry-oriented tool for simulating the deployment of new energy technologies including biofuels, e-fuels, battery-electric, and hydrogen locomotives. By classifying fuel types into two categories based on deployment requirements, the associated optimal charging/fueling facility location and sizing problem are solved with a five-step framework. Life-cycle analysis (LCA) and techno-economic analysis (TEA) are used to estimate carbon reduction, capital investments, cost of carbon reduction, and operational impacts, enabling sensitivity analysis with operational and technological parameters. The framework is illustrated on lower-carbon drop-in fuels as well as battery-electric technology deployments for the US Eastern and Western Class I railroad networks. Drop-in fuel deployments are modeled as admixtures with diesel in existing locomotives, while battery-electric deployments are shown for varying technology penetration levels and locomotive ranges. When mixed in a 50% ratio with diesel, results show biodiesel’s capacity to reduce emissions at 36% with a cost of $ 0.13 per kilogram of CO2 reduced, while e-fuels offer a potential reduction of 50% of emissions at a cost of $ 0.22 per kilogram of CO2 reduced. Battery-electric results for 50% deployment over all ton-miles highlight the value of future innovations in battery energy densities as scenarios assuming 800-mi range locomotives show an estimated emissions reduction of 46% with a cost of $ 0.06 per kilogram of CO2 reduced, compared with 16% emissions reduction at a cost of $ 0.11 per kilogram of CO2 reduced for 400-mi range locomotives. The NUFRIEND framework provides a systematic method for comparing different alternative energy technologies and identifying potential challenges and benefits in their future deployments.

BACKGROUND: Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear. METHODS: In the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n ​= ​560). We also classified LVDD using the American Society of Echocardiography recommendations. RESULTS: The mean age of the participants was 51 ​± ​17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e', E/e', and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e' and E/e', the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e' and E/e' included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds. CONCLUSION: In the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function. GOV IDENTIFIER: NCT03154346. ispartof: JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY vol:16 issue:6 pages:498-508 ispartof: location:United States status: accepted

Rationale: Cardiovascular disease remains the leading cause of death in women. To address its determinants including persisting cardiovascular risk factors amplified by sex and race inequities, novel personalized approaches are needed grounded in the engagement of participants in research and prevention. Objective: To report on a participant-centric and personalized dynamic registry designed to address persistent gaps in understanding and managing cardiovascular disease in women. Methods and Results: The American Heart Association and Verily launched the Research Goes Red registry (RGR) in 2019, as an online research platform available to consenting individuals over the age of 18 years in the United States. RGR aims to bring participants and researchers together to expand knowledge by collecting data and providing an open-source longitudinal dynamic registry for conducting research studies. As of July 2021, 15 350 individuals have engaged with RGR. Mean age of participants was 48.0 48.0±0.2 years with a majority identifying as female and either non-Hispanic White (75.7%) or Black (10.5%). In addition to 6 targeted health surveys, RGR has deployed 2 American Heart Association-sponsored prospective clinical studies based on participants’ areas of interest. The first study focuses on perimenopausal weight gain, developed in response to a health concerns survey. The second study is designed to test the use of social media campaigns to increase awareness and participation in cardiovascular disease research among underrepresented millennial women. Conclusions: RGR is a novel online participant-centric platform that has successfully engaged women and provided critical data on women’s heart health to guide research. Priorities for the growth of RGR are centered on increasing reach and diversity of participants, and engaging researchers to work within their communities to leverage the platform to address knowledge gaps and improve women’s health.

IntroductionThe impact of low-density lipoprotein cholesterol (LDL-C) on the risk of different types of strokes is unclear. Therefore, we systematically evaluated the impact of LDL-C levels (cohort studies) and lipid lowering drugs (LLAs, randomized controlled trials) on the different types of stroke.Material and methodsPubMed, SCOPUS, Web of Science and Google Scholar were searched up to 1st December 2019.ResultsParticipants at highest category of LDL-C had a lower risk for of hemorrhagic stroke (RR: 0.91, 95%CI 0.85-0.98, I2:0%) compared with the lowest category of LDL-C. Subjects with the highest category of LDL-C had a higher risk of ischemic stroke (RR: 1.11, 95%CI 1.07-1.14, I2:0%) compared to the lowest LDL-C category. LLAs decreased the risk of all types of strokes for those who achieved LDL-CConclusionsOur study sheds light on the debatable association between low LDL-C and different type of strokes. This information can help determine the optimal LDL-C range for stroke prevention, and help plan future LLAs studies.

Extracranial multisystem organ failure is a common sequela of severe traumatic brain injury (TBI). Risk factors for developing circulatory shock and long-term functional outcomes of this patient subset are poorly understood.To identify emergency department predictors of circulatory shock after moderate-severe TBI and examine long-term functional outcomes in patients with moderate-severe TBI who developed circulatory shock.We conducted a retrospective cohort study using the Transforming Clinical Research and Knowledge in TBI database for adult patients with moderate-severe TBI, defined as a Glasgow Coma Scale (GCS) score of13 and stratified by the development of circulatory shock within 72 hours of hospital admission (Sequential Organ Failure Assessment score ≥2). Demographic and clinical data were assessed with descriptive statistics. A forward selection regression model examined risk factors for the development of circulatory shock. Functional outcomes were examined using multivariable regression models.Of our moderate-severe TBI population (n = 407), 168 (41.2%) developed circulatory shock. Our predictive model suggested that race, computed tomography Rotterdam scores3, GCS in the emergency department, and development of hypotension in the emergency department were associated with developing circulatory shock. Those who developed shock had less favorable 6-month functional outcomes measured by the 6-month GCS-Extended (odds ratio 0.36, P = .002) and 6-month Disability Rating Scale score (Diff. in means 3.86, P = .002) and a longer length of hospital stay (Diff. in means 11.0 days, P.001).We report potential risk factors for circulatory shock after moderate-severe TBI. Our study suggests that developing circulatory shock after moderate-severe TBI is associated with poor long-term functional outcomes.

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults with an extremely poor prognosis. There is a dire need to develop effective therapeutics to overcome the intrinsic and acquired resistance of GBM to current therapies. The process of developing novel anti-neoplastic drugs from bench to bedside can incur significant time and cost implications. Drug repurposing may help overcome that obstacle. A wide range of drugs that are already approved for clinical use for the treatment of other diseases have been found to target GBM-associated signaling pathways and are being repurposed for the treatment of GBM. While many of these drugs are undergoing pre-clinical testing, others are in the clinical trial phase. Since GBM stem cells (GSCs) have been found to be a main source of tumor recurrence after surgery, recent studies have also investigated whether repurposed drugs that target these pathways can be used to counteract tumor recurrence. While several repurposed drugs have shown significant efficacy against GBM cell lines, the blood–brain barrier (BBB) can limit the ability of many of these drugs to reach intratumoral therapeutic concentrations. Localized intracranial delivery may help to achieve therapeutic drug concentration at the site of tumor resection while simultaneously minimizing toxicity and side effects. These strategies can be considered while repurposing drugs for GBM.

Higher education must prepare future mental health providers to work with individuals who have been exposed to trauma. This is vital to the success of students’ practice, many of whom would benefit from trauma reduction strategies in their own lives. The purpose of this systematic review is to summarize the knowledge base on teaching methods that may reduce the potential that trauma content in the classroom could cause: (a) re-traumatization; (b) vicarious traumatization; or (c) secondary traumatic stress (collectively “adverse consequences”) in higher education students. This systematic review was conducted following PRISMA-P guidelines. A total of 27 peer-reviewed articles met the inclusion criteria, which included studies that focused on teaching methods that were used to teach trauma content for students in higher education, peer-reviewed articles, and articles published in English before February 12, 2020. Studies were identified based on key words and the full-text articles were reviewed by two authors who discussed discrepancies until consensus was obtained. Researchers recommend using a variety of teaching approaches, from teaching about self-care to journaling. However, the major findings showed that few studies analyzed the effectiveness of these methods, and that therefore, the effectiveness of various methods to address the adverse consequences of teaching trauma content is unknown. Further research is needed, including cross-sectional and longitudinal studies in this area.

In this paper, we propose Long-Short Term Memory (LSTM)-based mosquito’s genus classification, in which the time-frequency features are extracted from the wingbeat sound of mosquitos of three genera, Aedes, Anopheles and Culex. The extracted features are fed into the proposed LSTM-based classifier. We evaluated three time-frequency features, which are: Mel Spectrogram, Log-Mel spectrogram, and Mel-frequency Cepstral Coefficients (MFCC). The proposed scheme is composed by two LSTM layers and one Fully Connected layer connected to a SoftMax activation function. The classification accuracies using the three features are 92.97(±0.2)%, 96.71(±0.2)% and 96.65(±0.2)%, respectively. The Area Under Curve (AUC) of the Receiver Operating Characteristics (ROC) for each feature are also obtained, which are 0.9944, 0.9986 and 0.9987, respectively. The proposed classifier requires approximately 62,000 trainable parameters. This number is much smaller than that required for the state-of-arts CNNs, such as AlexNet and Vgg16. This compact configuration of the proposed scheme takes advantage of the mobile and IoT implementation, because the number of trainable parameters is directly proportional to the amount of memory and CPU required.

The aim of this study was to describe the utilization patterns of brain tissue oxygen (PbtOWe conducted a retrospective cohort study of patients from United States trauma centers participating in the American College of Surgeons National Trauma Databank between 2008 and 2016. We examined patients with severe TBI (defined by admission Glasgow Coma Scale score ≤ 8) over the age of 18 years who survived more than 24 h from admission and required intracranial pressure (ICP) monitoring. The primary exposure was PbtOA total of 35,501 patients underwent placement of an ICP monitor. There were 1,346 (3.8%) patients who also underwent PbtOPbtO

The purpose of this work is to study the feasibility of estimating the first and second ventilatory thresholds (VT1 and VT2, respectively) by using electrocardiogram (ECG)-derived respiratory rate during exercise testing. The ECGs of 25 healthy volunteers during cycle ergometer exercise test with increasing workload were analyzed. Time-varying respiratory rate was estimated from an ECG-derived respiration signal obtained from QRS slopes' range method. VT1 and VT2 were estimated as the points of maximum change in respiratory rate slope using polynomial spline smoothing. Reference VT1 and VT2 were determined from the ventilatory equivalents of O2 and CO2. Estimation errors (in watts) of -13.96 (54.84) W for VT1 and -8.06 (39.63) Wfor VT2 (median (interquartile range)) were obtained, suggesting that ventilatory thresholds can be estimated from solely the ECG signal.

Business ecosystems are increasingly gaining relevance in research and practice. Because ecosystems progressively change, enterprises are required to analyse their ecosystem, in order to identify and respond to such changes. For gaining a comprehensive picture of the ecosystem, various enterprise stakeholders need to be involved in the analysis process. We use an Action Design Research approach to implement a collaborative process for modelling and visualizing business ecosystems in two case studies. We look at the challenges of the collaborative process and study how a model-driven approach addresses these challenges. We validate and discuss the modelling process along six steps; definition of the business ecosystem focus, model instantiation, data collection, provision of tailored visualizations, model adaption, and using visualizations ‘to tell a story’. In a cross-case analysis, we draw conclusions with respect to process implementation and the role of visualizations.

Business ecosystems are increasingly gaining relevance in research and practice. Because ecosystems progressively change, enterprises are required to analyse their ecosystem, in order to identify and respond to such changes. For gaining a comprehensive picture of the ecosystem, various enterprise stakeholders need to be involved in the analysis process. We use an Action Design Research approach to implement a collaborative process for modelling and visualizing business ecosystems in two case studies. We look at the challenges of the collaborative process and study how a model-driven approach addresses these challenges. We validate and discuss the modelling process along six steps; definition of the business ecosystem focus, model instantiation, data collection, provision of tailored visualizations, model adaption, and using visualizations ‘to tell a story’. In a cross-case analysis, we draw conclusions with respect to process implementation and the role of visualizations.

Thirteen lanthanide sulfonatoterephthalates, [Ln(TPSO 3 )(H 2 O) 2 ] n (TPSO 3 = sulfonatoterephthalate, C 8 H 3 O 7 S 3− ), with Ln = Ce − Lu, except Pm , as well as [Y(TPSO 3 )(H 2 O) 2 ] n were obtained via hydrothermal syntheses. All materials are isotypic and crystallize in the triclinic crystal system with space group P 1 ¯ . They assemble as two-dimensional (2D) layers that are further tied into three-dimensional (3D) networks via hydrogen bonding. The compounds possess LnO 9 coordination polyhedra, which further assemble as Ln 2 O 16 clusters via edge sharing of two oxygen atoms being supplied by two sulfonato-groups. TPSO 3 -spacers interlink the coordination polyhedra along the b -axis, while carboxylate groups connect adjacent Ln 3+ -ions in the c -direction. The resulting 2D-layers are tied together along the a -axis via hydrogen bonds between coordinated water molecules and two oxygen atoms of the sulfonato-substituents. When plotted versus the ionic radii, the cell parameters, especially the cell volume, show a linear decline between Ce and Tm. We further characterized these materials utilizing elemental analyses, powder X-ray diffraction, and FT-IR spectroscopy.

On May 16 and 17, 2017, the Transforming Anthropology staff had the pleasure of visiting the “Sacred Arts of the Black Atlantic” collection, which features the living art and ritual objects of Dr. J. Lorand Matory, the Lawrence Richardson Professor of Cultural Anthropology at Duke University, and also to celebrate the eleventh year of his seminal book, Black Atlantic Religion (Princeton University Press, 2005). During the tour and discussion with Professor Matory, Transforming Anthropology's team was able to explore this extensive showcasing of African and African-inspired religious artifacts, as well as to delve more deeply into his philosophy of “distributed self.” This two-day tour and discussion ended with an hour-long interview with Professor Matory about both his collection and his scholarship on African inspired religions. As part of TA's special forum on race and religion, we highlight an extended excerpt of the interview, conducted by two of the journal's editorial interns, Khytie Brown (KB) and Adrian Hernandez-Acosta (AHA). The interview centers on how Professor Matory models his philosophy of “live dialogue,” and the role of objects in mediating relationships among people, spirits, and their gods. To listen to the interview, check out the Transforming Anthropology podcast (https://soundcloud.com/transformanthro).

In this conceptual article, we highlight group modeling and crowd-based modeling as an approach for collectively constructing business ecosystem models. Based on case study examples, we showcase how engaging in the collective activity of crowd-based modeling supports the creation of value propositions in business ecosystems. Such collective activity creates shared, IS-embedded resources on the network level that align the diverse set of ecosystem stakeholders such as firms, public actors, citizens, and other types of organizations. Based on extant research, we describe the roles involved in building ecosystem models that inform and reconfigure shared infrastructures and platforms.

Secret sharing (SS) schemes based on cellular automata (CA) are considered as secure encrypting algorithms, where several secret data can be shared among some persons. Recently the SS schemes can be applied to solve real-world problems, such as security in cloud computing. The principal obstacle of use of the SS scheme is its considerably high computational cost; especially if a large amount of secret data must be encrypted and shared. In this work, we propose a parallel CA-based SS scheme suitable for any kinds of digital data in the graphic processing unit using compute unified device architecture technology. The uses of global memory and shared memory are analyzed from computational effectiveness and security points of view. The experimental results show the proposed parallel implementation provides a speedup rate more than 18-fold compared with its sequential implementation. Also we show the increase of the security level of the parallel implementation with respect to the sequential implementation.

The aim of this study was to use a multicenter, observational outpatient registry of patients with heart failure with reduced ejection fraction (HFrEF) to describe the association between changes in patients' medications with changes in health status.Alleviating symptoms and improving function and quality of life for patients with HFrEF are primary treatment goals and potential indicators of quality. Whether titrating medications in routine clinical care improves patients' health status is unknown.The association of any change in HFrEF medications with 3-month change in health status, as measured using the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale, was determined in unadjusted and multivariate-adjusted (25 clinical characteristics, baseline health status) models using hierarchical linear regression.Among 3,313 outpatients with HFrEF from 140 centers, 21.9% had medication changes. Three months later, 23.7% and 46.4% had clinically meaningfully worse (≥5-point decrease) and improved (≥5-point increase) Kansas City Cardiomyopathy Questionnaire Overall Summary Scale scores. The 3-month median change in Kansas City Cardiomyopathy Questionnaire Overall Summary Scale score for patients whose HFrEF medications were changed was significantly larger (7.3 points; interquartile range: -3.1 to 20.8 points) than in patients whose medications were not changed (3.1 points; interquartile range: -4.7 to 12.5 points) (adjusted difference 3.0 points; 95% confidence interval: 1.4 to 4.6 points; p 0.001). Among patients whose medications were adjusted, 26% had very large clinical improvement (≥20 points) compared with 14% whose regimens were not changed.In routine care of patients with HFrEF, changes in HFrEF medications were associated with significant improvements in patients' health status, suggesting that health status-based performance measures can quantify the benefits of titrating medicines in patients with HFrEF.