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Abstract The Internet of Things (IoT) involves the gathering of all those devices that connect to the Internet with the purpose of collecting and sharing data. The application of IoT in the different sectors, including health, industry has also picked up the threads to augment over the past few years. The IoT and, by integrity, the IIoT, are found to be highly susceptible to different types of threats and attacks owing to the networks nature that in turn leads to even poor outcomes (i.e., increasing error rate). Hence, it is critical to design attack detection systems that can provide the security of IIoT networks. To overcome this research work of IIoT attack detection in large amount of evolutions is failed to determine the certain attacks resulting in a minimum detection performance, reinforcement learning-based attack detection method called sliding principal component and dynamic reward reinforcement learning (SPC–DRRL) for detecting various IIoT network attacks is introduced. In the first stage of this research methodology, preprocessing of raw TON_IoT dataset is performed by employing min–max normalization scaling function to obtain normalized values with same scale. Next, with the processed sample data as output, to extract data from multi-sources (i.e., different service profiles from the dataset), a robust log likelihood sliding principal component-based feature extraction algorithm is applied with an arbitrary size sliding window to extract computationally-efficient features. Finally, dynamic reward reinforcement learning-based IIoT attack detection model is presented to control the error rate involved in the design. Here, with the design of dynamic reward function and introducing incident repository that not only generates the reward function in an arbitrary fashion but also stores the action results in the incident repository for the next training, therefore reducing the attack detection error rate. Moreover, an IIoT attack detection system based on SPC–DRRL is constructed. Finally, we verify the algorithm on the ToN_IoT dataset of University of New South Wales Australia. The experimental results show that the IIoT attack detection time and overhead along with the error rate are reduced considerably with higher accuracy than that of traditional reinforcement learning methods.

Abstract Objective To observe the effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke. Patients & methods This prospective pre-post study was conducted in a tertiary teaching research hospital with 29 adult stroke patients, with age up to 65 years. Patients fulfilling the inclusion criteria were divided in 2 groups based on the duration of stroke (≤ 6 months-sub-acute & > 6 months-chronic stroke) and provided overground gait training with MARS robot for 12 sessions (1 h/session) over a period of 2–3 weeks. Primary outcome measures were; 10-Meter walk test-10MWT, 6-min’ walk test-6MWT and Timed up & Go-TUG tests. Secondary outcome measures were Functional Ambulation Category-FAC, Modified Rankin Scale-MRS and Scandinavian Stroke Scale-SSS. Results No adverse events were reported. Twenty-five patients who were able to perform 10-MWT at the beginning of study were included in the final analysis with 12 in sub-acute and 13 in chronic stroke group. All primary and secondary outcome measures showed significant improvement in gait parameters at the end of the training (p

Abstract Background To describe patterns of recent health service utilisation, and consequent out-of-pocket expenses among older people in countries with low and middle incomes, and to assess the equity with which services are accessed and delivered. Methods 17,944 people aged 65 years and over were assessed in one-phase population-based cross-sectional surveys in geographically-defined catchment areas in nine countries - urban and rural sites in China, India, Mexico and Peru, urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and a rural site in Nigeria. The main outcome was use of community health care services in the past 3 months. Independent associations were estimated with indicators of need (dementia, depression, physical impairments), predisposing factors (age, sex, and education), and enabling factors (household assets, pension receipt and health insurance) using Poisson regression to generate prevalence ratios and fixed effects meta-analysis to combine them. Results The proportion using healthcare services varied from 6% to 82% among sites. Number of physical impairments (pooled prevalence ratio 1.37, 95% CI 1.26-1.49) and ICD-10 depressive episode (pooled PR 1.21, 95% CI 1.07-1.38) were associated with service use, but dementia was inversely associated (pooled PR 0.93, 95% CI 0.90-0.97). Other correlates were female sex, higher education, more household assets, receiving a pension, and health insurance. Standardisation for age, sex, physical impairments, depression and dementia did not explain variation in service use. There was a strong borderline significant ecological correlation between the proportion of consultations requiring out-of-pocket costs and the prevalence of health service use (r = -0.50, p = 0.09). Conclusions While there was little evidence of ageism, inequity was apparent in the independent enabling effects of education and health insurance cover, the latter particularly in sites where out-of-pocket expenses were common, and private health insurance an important component of healthcare financing. Variation in service use among sites was most plausibly accounted for by stark differences in the extent of out-of-pocket expenses, and the ability of older people and their families to afford them. Health systems that finance medical services through out-of-pocket payments risk excluding the poorest older people, those without a secure regular income, and the uninsured.

Abstract Background The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We investigated the prevalence and correlates of dependence among older people from middle income countries. Methods A one-phase cross-sectional survey was carried out at 11 sites in seven countries (urban sites in Cuba, Venezuela, and Dominican Republic, urban and rural sites in Peru, Mexico, China and India). All those aged 65 years and over living in geographically defined catchment areas were eligible. In all, 15,022 interviews were completed with an informant interview for each participant. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, dementia, physical impairments and self-reported diagnoses. Dependence was interviewer-rated based on a key informant's responses to a set of open-ended questions on the participant's needs for care. We estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analysed, and population attributable prevalence fractions (PAPF) calculated. Results The prevalence of dependence increased with age at all sites, with a tendency for the prevalence to be lower in men than in women. Age-standardised prevalence was lower in all sites than in the USA. Other than in rural China, dementia made the largest independent contribution to dependence, with a median PAPF of 34% (range 23%-59%). Other substantial contributors were limb impairment (9%, 1%-46%), stroke (8%, 2%-17%), and depression (8%, 1%-27%). Conclusion The demographic and health transitions will lead to large and rapid increases in the numbers of dependent older people particularly in middle income countries (MIC). The prevention and control of chronic neurological and neuropsychiatric diseases and the development of long-term care policies and plans should be urgent priorities.

Abstract Background Eighty percent of deaths occur in low and middle income countries (LMIC), where chronic diseases are the leading cause. Most of these deaths are of older people, but there is little information on the extent, pattern and predictors of their mortality. We studied these among people aged 65 years and over living in urban catchment areas in Chennai, south India. Methods In a prospective population cohort study, 1005 participants were followed-up after three years. Baseline assessment included sociodemographic and socioeconomic characteristics, health behaviours, physical, mental and cognitive disorders, disability and subjective global health. Results At follow-up, 257 (25.6%) were not traced. Baseline characteristics were similar to the 748 whose vital status was ascertained; 154 (20.6%) had died. The mortality rate was 92.5/1000 per annum for men and 51.0/1000 per annum for women. Adjusting for age and sex, mortality was associated with older age, male sex, having no friends, physical inactivity, smaller arm circumference, dementia, depression, poor self-rated health and disability. A parsimonious model included, in order of aetiologic force, male sex, smaller arm circumference, age, disability, and dementia. The total population attributable risk fraction was 0.90. Conclusion A balanced approach to prevention of chronic disease deaths requires some attention to proximal risk factors in older people. Smoking and obesity seem much less relevant than in younger people. Undernutrition is preventable. While dementia makes the largest contribution to disability and dependency, comorbidity is the rule, and more attention should be given to the chronic care needs of those affected, and their carers.

The focus of the study is the exploration of the possible efficacy and environmental advantages of nanofluids, including hybrid nanoparticles, concerning the effectiveness of the Vapor Compression Refrigeration System (VCRS). This necessitates a thorough assessment of the stability qualities, synthesis techniques, thermal conductivity, viscosity, and heat transfer efficiency of nanofluids. This research also aims to explore different Nano‐Refrigerant combinations that influence the Coefficient of Performance (COP). According to some research findings, the use of copper nanoparticles improved COP by 8.1%, while the use of alumina nanoparticles raised COP values as high as 6.71%. Moreover, studies have demonstrated that various hybrid nanoparticles like silver‐graphene oxide also greatly improve outcomes concerning amounts used, raising the system's overall performance capabilities. Finally, it can be said that there is a wide range of applications for these fluids because they can function cost‐effectively and environmentally friendly while significantly reducing energy consumption, acting as refrigerants or secondary fluid systems, and having a positive impact on performance when used in deployed VCRS configurations. [ABSTRACT FROM AUTHOR]

Abstract Background Kerala is known as the diabetes mellitus (DM) and hypertension (HTN) capital of the world, thus compelling health professionals to model strategies, addressing their social, behavioural, and cognitive risk factors and eliminating various barriers to management. This paper describes the protocol of our study that aims to examine the effectiveness and sustainability of an integrated care model for the management of chronic conditions and their risk factors through a family-based intervention. The proposed care model targets to modify systems and processes that predispose to chronic conditions by enhancing social cohesion and social networks, preventing lifestyle risks, developing iterative cognitive interventions, and engaging the family into customised treatment adherence strategies navigated by community health social workers (CHSWs). Methods A cluster randomised controlled trial (RCT) in selected participants will be conducted involving additional assessments prior to the baseline assessment. The assessment will identify and categorise patients into four risk groups, namely behavioural, social, cognitive, and multiple, based on dominant risks identified. Eligible participants will be randomly allocated (at a ratio of 1:1) into the intervention or control arm. The intervention arm will receive social, behavioural, and cognitive or multiple interventions corresponding to the identified risk groups, whereas the control arm will receive general intervention. Both the groups will be followed up at 6 months and 12 months post baseline to measure outcomes. The primary outcome will be the control of HTN and DM, and secondary outcomes include decreased depression and anxiety and improved functioning, social cohesion, and social network linkages. The sustainability and scalability of this intervention will be assessed through cost effectiveness, acceptability, and user friendliness of the integrated approach by performing a qualitative evaluation. Discussion This RCT will inform the potential paradigm shift from a medical model of chronic condition management to a multidimensional, multisystem, and multidisciplinary convergence model navigated by CHSWs. Such a model is not currently considered in the management of chronic conditions in Kerala. Trial registration Trial has been prospectively registered on Clinical Trial Registry of India- CTRI/2020/12/029474 on 1st December 2020.

Job strain results from a combination of high workload and few decision-making opportunities in the workplace. There is inconsistent evidence regarding the association between job strain and hypertension, and methodological shortcomings preclude firm conclusions. Thus, a meta-analysis of observational studies on hypertension among occupational groups was conducted to determine whether job strain was associated with hypertension. In January 2012, we carried out a comprehensive, topic-specific electronic literature search of the Ovid MEDLINE, EMBASE and PsychoINFO databases complemented by individual help from non-communicable disease experts. Experimental/interventional studies and studies on personality disorders were excluded. Nine of 894 identified studies met the eligibility criteria and were included in the meta-analysis. The pooled OR of the nine studies was 1.29 (95% CI 1.14 to 1.47; p

Background: The burden of disability on individuals and society is enormous in India, and informal care systems try to reduce this burden. This study investigated the association between neighbourhood cohesion and disability in a community-based population in Kerala, India. To the best of our knowledge, no previous studies have examined this association in India. Methods: A cross-sectional household survey was conducted with 997 participants aged 30 years and above, in Kerala. Neighbourhood cohesion was assessed by three scales: trust, community participation, and perceived safety. Functional ability was measured by WHODAS 2.0. Explanatory covariates included chronic disease conditions, age, gender, education, income, and mental health conditions. Results: Of 997 participants (37% male; mean age, 53.9 [range, 30–90] years), the majority were married or cohabiting. Univariate analysis showed functional ability to be positively associated with most demographic and health characteristics. However, after adjustment, only social cohesion, age, income, education, chronic diseases and mental health conditions remained significant. Mediation analysis showed the effect of personal and health characteristics on functional ability as mediated by social cohesion. Conclusion: Social cohesion is an important moderator of functional ability. Interventions targeting the creation of stronger ties among neighbours and a sense of belonging should be scaled-up and evaluated in future research.

Introducción. Son escasos los estudios sobre prevalencia de la fragilidad realizados en países de bajos y medianos ingresos. Objetivo: estimar la prevalencia y asociaciones de riesgo del síndrome de fragilidad en áreas urbanas y rurales de América Latina, India y China. Método. Estudio de corte transversal, puerta a puerta, de base poblacional, fue realizado en ocho áreas urbanas y cuatro áreas rurales de ocho países: Cuba, República Dominicana, Puerto Rico, Venezuela, Perú, México, China y la India. Los indicadores de fragilidad evaluados fueron velocidad de la marcha, agotamiento, pérdida de peso y baja actividad física. El fenotipo de fragilidad se definió por la presencia de dos o más indicadores. Resultados. Fueron visitadas 17 031 personas de 65 años y más. La prevalencia global de fragilidad fue del 15,2 % (IC 95 % 14,6-15,7 %). Controlando el efecto de la edad, el sexo y la educación, la fragilidad se asoció con la edad avanzada, el sexo femenino, bajo nivel socioeconómico, enfermedad física limitante, ictus, depresión, demencia, discapacidad y dependencia, así como a elevados costos en salud. La prevalencia de fragilidad y sus diversos indicadores varía según las diferentes áreas estudiadas en América Latina, India y China. La cultura y otros factores contextuales influyen de manera significativa en la evaluación de la fragilidad incluso utilizando los cuestionarios y las mediciones físicas habituales.