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Background: The implementation and clinical impact of machine learning-based early warning systems for patient deterioration in hospitals have not been well described. We sought to describe the implementation and evaluation of a multifaceted, real-time, machine learning-based early warning system for patient deterioration used in the general internal medicine (GIM) unit of an academic medical centre. Methods: In this nonrandomized, controlled study, we evaluated the association between the implementation of a machine learning-based early warning system and clinical outcomes. We used propensity score-based overlap weighting to compare patients in the GIM unit during the intervention period (Nov. 1, 2020, to June 1, 2022) to those admitted during the pre-intervention period (Nov. 1, 2016, to June 1, 2020). In a difference-indifferences analysis, we compared patients in the GIM unit with those in the cardiology, respirology, and nephrology units who did not receive the intervention. We retrospectively calculated system predictions for each patient in the control cohorts, although alerts were sent to clinicians only during the intervention period for patients in GIM. The primary outcome was non-palliative in-hospital death. Results: The study included 13 649 patient admissions in GIM and 8470 patient admissions in subspecialty units. Non-palliative deaths were significantly lower in the intervention period than the pre-intervention period among patients in GIM (1.6% v. 2.1%; adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.55-1.00) but not in the subspecialty cohorts (1.9% v. 2.1%; adjusted RR 0.89, 95% CI 0.63-1.28). Among high-risk patients in GIM for whom the system triggered at least 1 alert, the proportion of non-palliative deaths was 7.1% in the intervention period, compared with 10.3% in the pre-intervention period (adjusted RR 0.69, 95% CI 0.46-1.02), with no meaningful difference in subspecialty cohorts (10.4% v. 10.6%; adjusted RR 0.98, 95% CI 0.60-1.59). In the difference-indifferences analysis, the adjusted relative risk reduction for non-palliative death in GIM was 0.79 (95% CI 0.50-1.24). Interpretation: Implementing a machine learning-based early warning system in the GIM unit was associated with lower risk of non-palliative death than in the pre-intervention period. Machine learning-based early warning systems are promising technologies for improving clinical outcomes., Predicting, preventing, and rapidly responding to patient deterioration in hospital is a major goal for improving patient safety. Unrecognized clinical deterioration is the leading cause of unplanned transfers to intensive [...]

Previous research has revealed higher career adaptivity leads to higher career adaptability from between-person perspective. However, the construction of career adaptability is dynamic rather than static, so how career adaptivity influences episode-level career adaptability from a within-person perspective is critical but unknown. Drawing on career construction theory, we examined how future orientation, considered part of career adaptivity, influences weekly career adaptability. One wave of between-person data (N = 97) and four waves of within-person data (repeated measures) were collected from undergraduates in a Chinese university. The results found that future orientation positively predicted weekly career adaptability, and weekly future work self-mediated the relationship between them. Loneliness negatively moderated the relationship between future orientation and weekly future work self and further negatively moderated the indirect effect of weekly future work self between future orientation and weekly career adaptability. The theoretical and practical implications are discussed. KEYWORDS career adaptability, career construction theory, future orientation, loneliness, INTRODUCTION In the current era of volatility, uncertainty, complexity, and ambiguity, it becomes imperative for individuals to adopt forward-thinking approaches and make proactive career preparations (Bennett & Lemoine, 2014). Those [...]

Benzoic acid-the simplest aromatic carboxylic acid-is widely used in various industries and applications, including in chemical, food and pharmaceutical manufacturing, among others. Due to its numerous uses, the production of [...]

Purpose: To examine the effect of walking interventions on sleep quality of persons with dementia (PWD) and their caregivers (dyads), and how different companions affect results. Method: Forty-five dyads were divided into three groups: a control group and two experimental groups (one with a care attendant, one with a family caregiver). The two experimental groups engaged in 120 minutes of walking per week for 24 weeks. Results: A significant improvement in sleep quality was observed among PWD in the family caregiver group (Wald χ[sup.2] = 4.55, p = 0.033), whereas there was no improvement in the care attendant group. A slight improvement in sleep quality of family caregivers was also found. Conclusion: Findings suggest the importance of creating individualized walking activity plans for dyads, incorporating trust and rapport-building strategies to improve sleep quality. [Journal of Gerontological Nursing, 50(8), 46–56.], Persons with dementia (PWD) and their family caregivers encounter various health challenges. Previous studies have shown that older adults with Alzheimer's disease exhibit various behavioral and psychological symptoms of dementia [...]

Younger generations are leading the push to normalize advanced skin care practices for men. At the same time, social media is delivering more male-focused education. To tap into the category's [...]

In China, as consumers' demand for skin care has become increasingly sophisticated and science-based, home-use beauty devices have gradually become an important step in the skin care routine. Euromonitor International [...]

Objective. Hypoxic-ischemic brain injury in infants often leads to hemiplegic motor dysfunction. The mechanism of their motor dysfunction has been attributed to deficiencies of the transcription factor sex-determining region (SRY) box 2 (Sox2) or the non-receptor-type tyrosine kinase Fyn (involved in neuronal signal transduction), which causes a defect in myelin formation. Constraint-induced movement therapy (CIMT) following cerebral hypoxia-ischemia may stimulate myelin growth by regulating Sox2/Fyn, Ras homolog protein family A (RhoA), and rho-associated kinase 2 (ROCK2) expression levels. This study investigated how Sox2/Fyn regulates myelin remodeling following CIMT to improve motor function in rats with hemiplegic cerebral palsy (HCP). Methods. To investigate the mechanism of Sox2 involvement in myelin growth and neural function in rats with HCR Lentivirus (Lenti)-Sox2 adeno-associated virus and negative control-Lenti-Sox2 (LS) adeno-associated virus were injected into the lateral ventricle. The rats were divided into a control group and an HCP group with different interventions (CIMT, LS, or negative control-LS [NS] treatment), yielding the HCR HCP plus CIMT (HCP + CIMT), HCP + LS, HCP +LS + CIMT, HCP + NS, and HCP + NS + CIMT groups. Front-limb suspension and RotaRod tests, Golgi-Cox staining, transmission electron microscopy, immunofluorescence staining, western blotting, and quantitative polymerase chain reaction experiments were used to analyze the motor function, dendrite/axon area, myelin ultrastructure, and levels of expression of oligodendrocytes and Sox2/Fyn/RhoA/ROCK2 in the motor cortex. Results. The rats in the HCP + LS + CIMT group had better values for motor function, dendrite/axon area, myelin ultrastructure, oligodendrocytes, and Sox2/Fyn/RhoA/ROCK2 expression in the motor cortexthan rats in the HCP and HCP + NS groups. The improvement of motor function and myelin remodeling, the expression of oligodendrocytes, and the expression of Sox2/Fyn/RhoA/ROCK2 in the HCP + LS group were similar to those in the HCP + CIMT group. Conclusion. CIMT might overcome RhoA/ROCK2 signaling by upregulating the transcription of Sox2 to Fyn in the brain to induce the maturation and differentiation of oligodendrocytes, thereby promoting myelin remodeling and improving motor function in rats with HCP. Impact. The pathway mediated by Sox2/Fyn could be a promising therapeutic target for HCP. Keywords: Cerebral Palsy, Constraint-Induced Movement Therapy, Fyn, Motor Dysfunction, Myelin Remodeling, Sox2, Introduction Children with hemiplegic cerebral palsy (HCP) have severe impairment of movement and/or sensation on 1 side of the body, especially in the upper extremities; this impairment may lead to [...]

Background: Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. Methods: We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993-2017) and infant deaths (1993-2018), linked to parental immigration data (1960-2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. Results: Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01-1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10-1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90-0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00-1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. Interpretation: Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities., Nearly 1 in 4 (23%) people in Canada are immigrants and this number is projected to reach 1 in 3 within 20 years. (1) Immigrant populations are not homogeneous, and [...]

Purpose: The purpose of this study was to determine whether the government export assistance moderate the relationship between strategic capabilities (i.e. innovation, market-linking, marketing, technology, and management capabilities) and export performance Manufacturing SMEs in Malaysia. Design/methodology/approach: This study used a quantitative approach. Data was obtained via online questionnaires and physical distribution to respondents. Hypothesis testing was analyzed using Partial Least Square (PLS) technique. Findings: Results showed that the moderator strengthens the relationship between strategic capabilities and export performance if the SMEs use financing assistance provided by the government. Research limitations/implications: The limitation of this study is the small number of sample sizes. Practical implications: This study is to test whether the relationship between strategic capabilities and export performance is strengthened with the usage of government export assistance (moderator). Originality/value: The findings of this study will provide insights to SMEs exporters and policymakers in designing development programs to promote manufacturing products of SMEs in international business. This study is originally focusing on Malaysian manufacturing SMEs usage of government assistance program (financial), thus future research can take a step further by studying types of financial assistance used by manufacturing SMEs to gain deeper understanding of the value creation of government export assistance programs to improve their strategic capabilities and increase export performance. Keywords: SMEs, Government Export Assistance, Strategic Capabilities, Export Performance, Introduction Local SMEs have received remarkable support from the government to enable them to enter international markets. The government agencies play an important role in assisting firm promotions and increase [...]

Objective: To test whether the impacts of Medicaid's Home and Community-Based Services (HCBS) expenditures have been equitable. Data Sources and Study Setting: This is a secondary data analysis. We linked annual data on state-level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006-2016). Study Design: We evaluated the association between state-level HCBS expenditure quartiles and the risk of experiencing challenges in basic or instrumental activities of daily living (I/ADLs) without assistance (unmet needs for care). We fitted generalized estimating equations (GEE) with a Poisson distribution, log link function, and an unstructured covariance matrix. We controlled demographics, time, and place-based fixed effects and estimated models stratified by race and ethnicity, gender, and urbanicity. We tested the robustness of results with negative controls. Data Collection/Extraction Methods: Our analytic sample included HRS Medicaid beneficiaries, aged 55+, who had difficulty with [greater than or equal to]1 I/ADL (n = 2607 unique respondents contributing 4719 person-wave observations). Principal Findings: Among adults with IADL difficulty, higher quartiles of HCBS expenditure (vs. the lowest quartile) were associated with a lower overall prevalence of unmet needs for care (e.g., Prevalence Ratio [PR], Q4 vs. Q1: 0.91, 95% CI: 0.84-0.98). This protective association was concentrated among non-Hispanic white respondents (Q4 vs. Ql: 0.82, 95% CI: 0.73-0.93); estimates were imprecise for Hispanic individuals and largely null for non-Hispanic Black participants. We found no evidence of heterogeneity by gender or urbanicity. Negative control robustness checks indicated that higher quartiles of HCBS expenditure were not associated with (1) the risk of reporting I/ADL difficulty among 55+ Medicaid beneficiaries, and (2) the risk of unmet care needs among non-Medicaid beneficiaries. Conclusion: The returns to higher state-level HCBS expenditures under Medicaid for older adults with I/ADL disability do not appear to have been equitable by race and ethnicity. KEYWORDS aging/elderly/geriatrics, long term care, Medicaid, social determinants of health, 1 | INTRODUCTION It is estimated that more than 12 million older adults need some form of long-term care and this number is expected to reach 27 million by 2050. [...]

Optical coherence tomography (OCT) is an essential imaging test in the diagnosis and management of ocular pathology. It provides us clinicians with quantitative and qualitative information to help detect structural [...]

As a journalist in authoritarian China, I learned the value of community. As a parliamentary candidate in the UK, I am determined to preserve it I am embarking on a [...]

Technology innovation in sensing, computing, and robotics has significantly bolstered the transportation sector over the past decades, from intelligent construction to nondestructive evaluation (NDE). Technology is a primary driving force [...]

Traditionally, either fasteners or adhesives have been used to join metal parts to carbon fiber-reinforced thermoplastic (CFRTP). However, both methods have limitations. To use fasteners, holes must be drilled in [...]

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Scholars' opinions diverge on the relationship between a firm's negative attainment discrepancy and its international expansion. To reconcile the dispute, we draw upon the behavioral theory of the firm and develop an empirical framework that integrates the perspectives of problemistic search, experiential learning, and vicarious learning. We contend that a firm's search behavior is jointly influenced by its performance feedback and accumulated (both direct and indirect) experience. Specifically, the international experience of the focal firm or its peers plays an important role in triggering the firm's internationalization process by shaping the direction of problemistic search: a firm is more likely to pursue international expansion as a solution for performance shortfalls if it (or its peers) possesses more general experience or successful experience in foreign markets. Analysis on longitudinal data (2011-2019) from publicly listed Chinese firms supports our hypotheses. This study makes theoretical contribution on firm internationalization literature and the behavioral theory of the firm, and provides a practical insight into firms' strategic decision-making process. Keywords Behavioral theory of the firm * Problemistic search * Experiential learning * Vicarious learning * Performance feedback * Firm internationalization, 1 Introduction Why do firms engage in internationalization? This question has been a significant topic, spanning diverse literature in strategic management and international business (IB) studies, and leads to rich [...]

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Long hours on the assembly line can easily lead to fatigue. Tired workers are less efficient and more prone to errors. These problems can be avoided if assemblers are able [...]

Byline: Yang Jian Jaguar Land Rover plans to revive the Freelander SUV as an electric vehicle that will be produced in China through a joint venture with Chery Holdings. The [...]