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In this work we introduce a novel meta-learning method for sleep scoring based on self-supervised learning. Our approach aims at building models for sleep scoring that can generalize across different patients and recording facilities, but do not require a further adaptation step to the target data. Towards this goal, we build our method on top of the Model Agnostic Meta-Learning (MAML) framework by incorporating a self-supervised learning (SSL) stage, and call it S2MAML. We show that S2MAML can significantly outperform MAML. The gain in performance comes from the SSL stage, which we base on a general purpose pseudo-task that limits the overfitting to the subject-specific patterns present in the training dataset. We show that S2MAML outperforms standard supervised learning and MAML on the SC, ST, ISRUC, UCD and CAP datasets. Clinical relevance- Our work tackles the generalization problem of automatic sleep scoring models. This is one of the main hurdles that limits the adoption of such models for clinical and research sleep studies.

Abstract Local adaptation can increase fitness under stable environmental conditions. However, in rapidly changing environments, compensatory mechanisms enabled through plasticity may better promote fitness. Climate change is causing devastating impacts on coral reefs globally and understanding the potential for adaptive and plastic responses is critical for reef management. We conducted a four-year, three-way reciprocal transplant of the Caribbean coral Siderastrea siderea across forereef, backreef, and nearshore populations in Belize to investigate the potential for environmental specialization versus plasticity in this species. Corals maintained high survival within forereef and backreef environments, but transplantation to nearshore environments resulted in high mortality, suggesting that nearshore environments present strong environmental selection. Only forereef-sourced corals demonstrated evidence of environmental specialization, exhibiting the highest growth in the forereef. Gene expression profiling 3.5 years post-transplantation revealed that transplanted coral hosts exhibited profiles more similar to other corals in the same reef environment, regardless of their source location, suggesting that transcriptome plasticity facilitates acclimatization to environmental change in S. siderea. In contrast, algal symbiont (Cladocopium goreaui) gene expression showcased functional variation between source locations that was maintained post-transplantation. Our findings suggest limited acclimatory capacity of some S. siderea populations under strong environmental selection and highlight the potential limits of coral physiological plasticity in reef restoration.

Abstract Objective Aloe elegans Tod. is an ecologically, environmentally, medicinally, and commercially useful aloe species in Ethiopia and Eritrea. Unfortunately, it is highly threatened due to industrial and urban expansion and traditional mining and agricultural activities. As a consequence, it is included in the IUCN List of Threatened Species since 2013. The plant is getting thinly populated in many parts of the Tigrai floristic region since it is being exploited for traditional and commercial purposes. Therefore, this study was aimed to develop a reproducible, large-scale micropropagation protocol using offshoot cuttings in Murashige and Skoog (MS) media enriched with plant growth regulators (PGRs). Results Sterilized explants cultured in full-strength MS media enriched with 0.25 mg/L benzyl amino purine (BAP) and 0.10 mg/L naphthaleneacetic acid (NAA) resulted in 100% healthy and live (i.e., initiated) explants after four weeks of initiation study. Unsupplemented initiation media (control) yielded only 14.3% initiated explants. The initiated explants were tested for their shooting response to produce microshoots by incubating in different concentrations and combinations of BAP and NAA for four weeks. Fewer days to shooting (13.0 ± 1.0 days), higher mean shoot number (5.0 ± 1.0), and higher mean shoot length (9.20 ± 2.35 cm) were observed with 1.0/0.50, 1.0/0.25, and 1.0 /0.50 mg/L BAP/NAA combinations, respectively. The rooting responses of the microshoots toward producing plantlets were also tested by incubating them in half-strength MS media enriched with different concentrations of NAA and indole-3-butyric acid (IBA) for four weeks. Fewer mean days to rooting (12.0 ± 1.0 days), higher mean root number (8.0 ± 4.0), and higher mean root length (7.53 ± 3.03 cm) were observed in MS media enriched with 0.75, 0.75, and 1.25 mg/L IBA, respectively. The responses of A. elegans plantlets to primary (in greenhouse) and secondary (in nursery shade and direct sunlight) acclimatization in coco peat, composted soil, and manured soil media were high – with survival percentages of 87.5–97.8% in three to four weeks.

Introduction and purpose: Acute mountain sickness is caused by hypoxia, of which the brain is the most sensitive. The frequency of occurrence at altitudes above 2500 m above sea level may reach up to 75% of travelers. Prevention of altitude sickness mainly concerns the travel plan and pharmacology. Our study aimed to assess the current literature on altitude sickness, and discuss the possible pathophysiology, epidemiology, and symptoms. Moreover, we underline new guidelines for the treatment, prevention, and diagnosis of altitude sickness in the context of the last guidelines and research. We conducted a PubMed literature review using keywords like "mountaineering sickness" and "altitude sickness". All article types were taken into account: clinical trial, meta-analysis, case report, case series, systematic review, randomized controlled trial, observational study, clinical study, books, and documents in the last 5 years.A brief description of the state of knowledge: In recent years, there has been a surge in the accessibility and popularity of high-altitude tourism, emphasizing the need to disseminate information about altitude sickness among travelers. This heightened accessibility has sparked a push for comprehensive research and viable solutions, aiming to address the ramifications of the increased risk associated with such endeavors. Furthermore, there's a growing call for additional research focusing on the unique medical demands posed by tourist excursions and extreme expeditions. Conclusions:It underscores the necessity for healthcare professionals equipped with specialized knowledge and expertise in both preventing and treating medical conditions arising in exceptional circumstances.

Recent years have seen rapid advances in clinical diagnosis and treatment of vestibular diseases, especially vestibular evaluation and rehabilitation technologies, greatly promoting the developments in individualization and precision of rehabilitation for peripheral and central vestibular diseases. The vestibular rehabilitation helps to correct inappropriate strategy of equilibrium and/or to accelerate a good but slow compensation phenomenon, effectively improve vestibular, visual, and proprioceptive inputs to balance coordination control ability, improve the compensatory function of central nervous system, so as to reduce or eliminate the symptoms of dizziness, vertigo, and balance instability, eventually restoring the normal vestibular status. Given this background, we reviewed the advances in mechanisms of rehabilitation, pre-rehabilitation evaluation, rehabilitation program formulation and treatment regarding vestibular diseases, offering insights into clinical implementation and research concerning vestibular rehabilitation in China.

Background and Aims: Troops deployed at high-altitude area (HAA) suffer from various high-altitude illnesses (HAIs) including high-altitude pulmonary edema (HAPE). There are various criteria to diagnose and assess the severity of HAPE, but point-of-care ultrasound (POCUS) of the lung has also been used in isolation by physicians. The aim is to assess whether POCUS of the lung improves the ability to diagnose the severity of HAPE. Methodology: A retrospective, cross-sectional descriptive study was planned for the patients treated for HAPE (n = 46) at our hospital from January 2019 to March 2020. Prehospital admission data, hospital admission data, and discharge data for the first-time inductees and reinductees were collected from the central hospital admission registry and central database of the medical department and intensive care unit. Results: The incidence of HAPE was 2.2 per 1000. First-time inductees (n = 30) were affected more when compared to reinductees (n = 16) and the maximum were at the third stage of HAA. POCUS of the lung facilitated the diagnosis of the six patients with mild HAPE with no positive radiological features. Conclusions: POCUS of the lung should be routinely used by the medical officers deployed at high altitudes. It will increase the diagnostic rate of HAPE with meticulous grading of the severity, thereby aiding in formulating the case-specific treatment protocol.

Mass bleaching and subsequent mortality of reef corals by heat stress has increased globally since the late 20th century, due to global warming. Some experimental studies have reported that corals may increase heat tolerance for short periods, but only a few such studies have monitored naturally-growing colonies. Therefore, we monitored the survival, growth, and bleaching status of Acropora corals in fixed plots by distinguishing individual colonies on a heat-sensitive reef flat in Okinawa, Japan. The level of heat stress, assessed by the modified version of degree heating week duration in July and August, when the seawater temperature was the highest, was minimally but significantly higher in 2017 than in 2016; however, the same colonies exhibited less bleaching and mortality in 2017 than in 2016. Another study conducted at the same site showed that the dominant unicellular endosymbiotic algal species did not change before and after the 2016 bleaching, indicating that shifting and switching of the Symbiodiniaceae community did not contribute to improved heat tolerance. Colonies that suffered from partial mortality in 2016 were completely bleached at higher rates in 2017 than those without partial mortality in 2016. The present results suggest that either genetic or epigenetic changes in coral hosts and/or algal symbionts, or the shifting or switching of microbes other than endosymbionts, may have improved coral holobiont heat tolerance.

Background: In emergency like condition, defence personnel are deployed to high altitude without proper acclimatization. Maladaption at high altitude leads to high altitude illness like acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) which hampers the operational capabilities. Aims and Objectives: The aim of the present study was to assess the effect of intermittent normobaric hypoxia exposure (IHE) at sea level on different physiological responses during initial days of acclimatization at 3500m and 4000m altitudes in acute induction. Materials and Methods: The IHE subjects were exposed to 12% FIO2 (equivalent altitude 14500 ft) for 4 hrs/day for 4 consecutive days at sea level and 5th day they were inducted by air to 3500m altitude. Baseline recording of different physiological parameters like cardiovascular, respiratory, oxygen saturation and AMS score were measured at sea level as well as 3500m altitude on daily basis for 6 days to assess acclimatization status. To confirm acclimatization status at 3500m, on fifth day the IHE group subjects were transported by road to 4000m and again measured different basal physiological parameters (like cardiovascular, oxygen saturation and AMS score) for four consecutive days. Results: Different physiological parameters of IHE treated group were stabilized by day 4 of air induction at 3500m altitude. Whereas, at 4000m altitude, these parameters were stabilized by day 2 of induction. Conclusion: Acclimatization schedules of four days at 3500m and two days at 4000m are essential to avoid malacclimatization/or high-altitude illness.

ObjectiveTo investigate whether an acclimatization period should be introduced into the home cage experiment for the detection of metabolic function in mice, and how to judge and set its length.MethodsData from 31 home cage experiments in 2016-2017 were collected, and each experiment was set up with a 3-day (72 hours) acclimatization period. Data such as water consumption, food intake, heat production, and body weight were recorded. The data were analyzed using 24-hour interval analysis to determine the acclimatization effect.ResultsApproximately 12% of the 356 mice drank less than 1 mL at the end of 96 hours. There were significant differences in water consumption, food intake, heat production rate, and body weight between 24-48 hours and 48-72 hours, but no significant differences were detected between 48-72 hours and 72-96 hours, except in food intake. Independent verification of the food intake of each experiment showed that there was a significant correlation between food intake adaptability and weight.ConclusionApproximately 12% of the mice were unable to learn or adapt to the new water bottle after the 72-hour acclimatization period, therefore, researchers should consider increasing the sample size of the experiment to eliminate invalid data. If food intake is not the focus of a study, the 48-hour acclimatization is sufficient to obtain reliable results.

Abstract Objective It is necessary to improve biotech platforms based on in vitro cell tissue culture to support sacha inchi (Plukenetia volubilis L.) research programs and draw on the nutritional value of the high polyunsaturated fatty acid content of its oilseed. Here, we developed a rapid and efficient method for induction and direct in vitro shoot development for this species. Results Shoots were generated from hypocotyl explants. The highest organogenic response was obtained in woody plant medium supplemented with 1 mg/L thidiazuron and 0.5 mg/L zeatin supplemented with L-glutamine, adenine hemisulfate, and L-arginine. Shoots obtained using this medium were transferred and subcultivated with different concentrations of indole-3-butyric acid and 1-naphthylacetic acid for rooting. For the first time, a histological analysis was performed supporting direct organogenic development in this species. The plantlets obtained were transferred ex vitro with a survival percentage of 80%. The genetic stability of the plants recovered was confirmed by randomly amplified polymorphic DNA analysis. All results indicate that it would be possible to stimulate direct shoot formation from hypocotyls to support the sustainable use of this species.

Acute mountain sickness (AMS) is an ilness, that occurs in non-acclimatized individuals after rapid ascent to high altitude, typically above 2,500 metres (8,000 ft). The main causes of the AMS are: reduced air pressure and lower oxygen levels at high altitudes. The early symptoms of AMS are non-specific such as: headache, anorexia, nausea, vomiting, fatigue, dizziness, and sleep disturbance, but not all need to be present at one time. It is very important to recognise the early symptoms of AMS and to start the treatment, because untreated AMS can progress to the life‐threatening: high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE). Treatment of AMS consists of stabilization of the patient conditon, descent to lower altitude, oxygen therapy and administering acetazolamide and dexamethasone. The aim of this study was to evaluate the significance of the proper acclimatization, use of the acetazolamide and dexamethasone in prevention of acute mountain sickness (AMS).Proper acclimatization, use of the acetazolamide and dexamethasone are highly effective in prevention of occurrence and reducing the symptoms of acute mountain sickness (AMS). Pharmacological prophylaxis is not necessary in low-risk situations but should be considered in addition to gradual ascent for use in moderate- to high-risk situations Acetazolamide should be strongly considered in climbers and travelers at moderate or high risk of AMS with ascent to high altitude. Dexamethasone can be used as an alternative in individuals with a history of intolerance of or allergic reaction to acetazolamide. In rare circumstances (eg, military or rescue teams that must ascend rapidly to and perform physical work at >3500 m), consideration can be given to concurrent use of acetazolamide and dexamethasone.

Hajj, annually hosted by Saudi Arabia, is considered a religious major mass gathering event that pose significant public health challenges like the transmission of infectious diseases and illnesses related to climate change. Heat stress is a key problem that faced by about two and half millions pilgrims during Hajj. It has historically experienced high morbidity and mortality due to heat illnesses. The highest incidence of mortalities attributed to heat illnesses happened in 1409 Hijri and 1412 Hijri Hajj as the recorded maximum temperatures reached 48.7°C and 47.6°C respectively. Holy Makkah area had the highest recoded incidence of these mortalities, since pilgrims stay much longer periods in Makkah compared to Arafat and Mina. This work aimed to review the prevalence of heat illness in general and heat stroke in specific among the pilgrimage during Hajj and summarize the reasons that make pilgrimage more liable to develop heat stroke. This review also describes, in brief, the process of acclimatization to heat stress and the impact of heat stress on the body besides summarizing the common clinical presentation of heat stroke.

Mentha rotundifolia (L.) Huds is an aromatic plant used for its medicinal values. This study aims to select appropriate conditions for in vitro propagation of M. rotundifolia (L.) Huds and to evaluate yield and antioxidants activity of its essential oils (EOs).

Objective: To determine the frequency of Acute Mountain Sickness (AMS) and the spectrum of clinical presentations in the troops/mountaineers who ascend to different altitudes. Study Design: Prospective case series. Place and Duration of Study: Study was conducted at Field Hospital Goma, from April to May 2012. Material and Methods: The study was carried out on 582 soldiers at 3330 meters (m), which were subsequently followed up on 4496 m and 5700 m. All participants were given Lake Louise Questionnaire to report symptoms. They were examined and any signs of AMS were registered. The frequency of AMS, spectrum of presentation and severity were noted. Results: Frequencies of development of AMS symptoms were 2.75% (3330 m), 7.4% (4496 m) and 16.7% (5700 m). The most common symptoms were headache, insomnia, fatigue, dizziness and gastrointestinal symptoms including nausea and vomiting. Conclusion: Overall, 8% people developed AMS. The severity of signs and symptoms increased with altitude.

We analyzed parameters characterizing mineral balance in a body and dental state in two groups of healthy men (n = 15 in each, aged 34.7 ± 0.6) in hot and humid marine climate conditions; one group was made of people undergoing acclimatization, the second one consisted of local population. We assessed working conditions and their category, and metrological data with determining environmental thermal load (ETL-index). Both groups worked outdoors; their labor had IIb category; they had to work overtime and under increased psy-choemotional loads; their working conditions differed as per nutrition and accommodation. When people from both groups had to work beyond their permanent location, their nutrition was represented by individual rations. Labor hardness was assessed as 3.2; labor intensity, as 3.2. Daytime temperature reached 30,0 С, relative air humidity was 77.3 ± 2.6 %, wind speed was 4.3 ± 0.3 m/sec. Microclimate was assessed as having 3.1 hazard category. Overall, working conditions were assessed as hazardous (3.3 hazard category). Electrolyte balance in a body was violated and it was proved by ower contents of K, Na, and Cl in blood serum; it was more apparent in people who were undergoing acclimatization. 70.0 % of local people had Ca contents in blood serum lower than the physiological standard. Lower Ca and increased P contents in blood serum were also detected in those undergoing acclimatization which could be evidence that Ca was washed out of a body and greater risk of dental caries occurred. As per observation dynamics we detected the following processes in people undergoing acclimatization: pH saliva and its mineralizing function shifting to acidity, salivation rate, and lower enamel resistance; they proved there was a growth in dental solid tissues demineralization. These parameters corresponded to those detected in local population. It calls for primary prevention activities aimed at fighting caries of dental solid tissues.

Abstract Introduction For many reasons, it is important for audiologists and consumers to document improvement and benefit from amplification device at various stages of uses of amplification device. Professional are also interested to see the impact of amplification device on the consumer's auditory performance at different stages i.e. immediately after fitting and over several months of use. Objective The objective of the study was to measure the hearing aid benefit following 6 months – 1-year usage, 1 year – 1.5 yeaŕs usage, and 1.5 yeaŕs – 2 years' usage. Methods A total of 45 subjects participated in the study and were divided equally in three groups: hearing aid users from 6 months to 1 year, 1 year to 1.5 year, and 1.5 year to two years. All subjects responded to the Hearing Aid Benefit Questionnaire (63 questions), which assesses six domains of listening skills. Result Results showed the mean scores obtained were higher for all domains in the aided condition, as compared with unaided condition for all groups. Results also showed a significant improvement in the overall score between first-time users with hearing aid experience of six months to one year and hearing aid users using hearing aids for a period between 1.5 and 2 years. Conclusion It is possible to conclude that measuring the hearing aid benefit with the self-assessment questionnaires will assist the clinicians in making judgments about the areas in which a patient is experiencing more difficulty in everyday listening environment and in revising the possible technologies.

Objective: The aim of our research was to identify physiological and biochemical changes induced by training at medium altitude.

Background: The deprivation of oxygen reaching the tissues (also termed as hypoxia) affects the normal functioning of the body. This results in development of many diseases like ischemia, glaucoma, MCI (Mild Cognitive Impairment), pulmonary and cerebral edema, stress and depression. There are no effective drugs that can treat such diseases. Despite such failure, alternative interventions such as mind-body techniques (MBTs) have not been adequately investigated. Methods: The first part of this review has been focused on philosophical aspects of various MBTs besides evolving an ayurgenomic perspective. The potential of MBTs as a preventive non-pharmacological intervention in the treatment of various general and hypoxic pathologies has been further described in this section. In the second part, molecular, physiological, and neuroprotective roles of MBTs in normal and hypoxic/ischemic conditions has been discussed. Results: In this respect, the importance of and in vivo studies has also been discussed. Conclusions: Although several studies have investigated the role of protective strategies in coping with the hypoxic environment, the efficacy of MBTs at the molecular level has been ignored.

Ocean temperatures have been accelerating at an alarming rate mainly due to anthropogenic fossil fuel emissions. This has led to an increase in the severity and duration of coral bleaching events. Predicted projections for the state of reefs do not take into account the rates of adaptation or acclimatization of corals as these have not as yet been fully documented. To determine any possible changes in thermal tolerances, manipulative experiments were conducted to precisely replicate the initial, pivotal research defining threshold temperatures of corals nearly five decades ago. Statistically higher calcification rates, survivorship, and lower mortality were observed in Montipora capitata, Pocillopora damicornis, and Lobactis scutaria in the present study at 31 °C compared to the original 1970 findings. First whole colony mortality was also observed to occur sooner in 1970 than in 2017 in M. capitata (3 d vs. 15 d respectively), L. scutaria (3 d vs. 17 d), and in P. damicornis (3 d vs. 13 d). Additionally, bleaching occurred sooner in 1970 compared to the 2017 experiment across species. Irradiance was an important factor during the recovery period for mortality but did not significantly alter calcification. Mortality was decreased by 17% with a 50% reduction in irradiance during the recovery period. These findings provide the first evidence of coral acclimatization or adaptation to increasing ocean temperatures for corals collected from the same location and using close replication of the experiment conducted nearly 50 years earlier. An important factor in this increased resistance to elevated temperature may be related to removal of the discharge of treated sewage into Kāne‘ohe Bay and resulting decrease in nitrification and eutrophication. However, this level of increased temperature tolerance may not be occurring rapidly enough to escape the projected increased intensity of bleaching events, as evidenced by the recent 2014 and 2015 high coral mortality in Hawai‘i (34%) and in the tropics worldwide.