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Introduction: This study investigated the differences between males and females in autonomic functions and cognitive performance during cold-air exposure and cold-water partial-immersion compared to a room temperature-air environment. Although several studies have investigated the effects of cold-air or cold-water exposures on autonomic function and cognitive performance, biological sex differences are often under-researched. Methods: Twenty-two males and nineteen females participated in the current study. Subjects completed a battery of cognitive tasks based upon those used within the Defense Automated Neurobehavioral Assessment (DANA), consisting of five subtasks that assess simple and procedural reaction time, spatial manipulation, attention, and immediate memory. In total, subjects took the battery within a 15-minute period across 30-minute intervals throughout the duration of environmental exposure. Across three separate days, subjects were exposed to three different environmental conditions: room temperature air (23°C), cold air (10°C), and cold water (15°C; in which subjects were immersed up to their necks). Room temperature and cold-air conditions consisted of five sessions (about 2.5 h), and the cold-water condition consisted of three sessions (about 1.5 h). During each experimental condition, physiological data were collected to assess autonomic function, including electrodermal activity (EDA) data and heart rate variability (HRV) derived from electrocardiogram signals. Results: Females showed slower reaction time in spatial manipulation tasks, immediate memory, and attention during cold-air exposures compared to room temperature air, whereas the performance of males were similar or better during cold-air exposures compared to room temperature air. Cold-water immersion affected the immediate memory performance of males. Both males and females exhibited smaller EDA amplitudes during cold-air and cold-water conditions compared to room temperature air. For HRV, only male subjects exhibited significantly greater values in low-frequency and very-low-frequency components during cold air exposure compared to the normal condition. Discussion: Sex introduces important differences in cognitive performance and autonomic functions during exposure to cold-air and cold-water. Therefore, sex should be considered when assessing the autonomic nervous system in cold environments and when establishing optimal thermal clothing for performance in operational environments. Our findings can assist with determination of operational clothing, temperature in operating environment, and personnel deployment to operational sites, particularly in settings involving both males and females. [ABSTRACT FROM AUTHOR]

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BackgroundAtrial fibrillation (AF) is the most common arrhythmia during critical illness, representing a sepsis-defining cardiac dysfunction associated with adverse outcomes. Large burdens of premature beats and noisy signal during sepsis may pose unique challenges to automated AF detection. ObjectiveThe objective of this study is to develop and validate an automated algorithm to accurately identify AF within electronic health care data among critically ill patients with sepsis. MethodsThis is a retrospective cohort study of patients hospitalized with sepsis identified from Medical Information Mart for Intensive Care (MIMIC III) electronic health data with linked electrocardiographic (ECG) telemetry waveforms. Within 3 separate cohorts of 50 patients, we iteratively developed and validated an automated algorithm that identifies ECG signals, removes noise, and identifies irregular rhythm and premature beats in order to identify AF. We compared the automated algorithm to current methods of AF identification in large databases, including ICD-9 (International Classification of Diseases, 9th edition) codes and hourly nurse annotation of heart rhythm. Methods of AF identification were tested against gold-standard manual ECG review. ResultsAF detection algorithms that did not differentiate AF from premature atrial and ventricular beats performed modestly, with 76% (95% CI 61%-87%) accuracy. Performance improved (P=.02) with the addition of premature beat detection (validation set accuracy: 94% [95% CI 83%-99%]). Median time between automated and manual detection of AF onset was 30 minutes (25th-75th percentile 0-208 minutes). The accuracy of ICD-9 codes (68%; P=.002 vs automated algorithm) and nurse charting (80%; P=.02 vs algorithm) was lower than that of the automated algorithm. ConclusionsAn automated algorithm using telemetry ECG data can feasibly and accurately detect AF among critically ill patients with sepsis, and represents an improvement in AF detection within large databases.

Background: In a typical multiechelon supply chain, the supplier makes semifinished items, from which the manufacturer produces finished products to eventually get sold at retailers. However, the majority of existing supply chain models consider the remanufacturing of defective products by solely one organization, despite the fact that both the supplier and manufacturer can produce defective products. This study considers the remanufacturing of defective products with fresh materials and additional expenses by both the supplier and manufacturer. Contrary to well-established articles that hold major partners to be accountable for reducing carbon emissions under a carbon cap-and-trade policy, the proposed model presumes an initial green technological investment by each chain partner. Methods: This study represents a varying market with fuzzy cost components that are then defuzzified with λ -integral method. This study determines the critical values of three discrete and four other continuous decision variables that globally maximize the profitability of the proposed model. Results: Slower production with a longer cycle boosts profitability in a developing market. To increase profit, a case study on the oil and natural gas business suggested to reduce the production of defective items and cutting emission through green investments. Conclusions: Managers can sustainably boost profit via careful production, modern machinery, and slightly longer cycles. [ABSTRACT FROM AUTHOR]