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Accurate tremor classification is crucial for effective patient management and treatment. However, clinical diagnoses are often hindered by misdiagnoses, necessitating the development of robust technical methods. Here, we present a two-stage convolutional neural network (CNN)-based system for classifying physiological tremor, essential tremor (ET), and Parkinson’s disease (PD) tremor. Employing acceleration signals from the hands of 408 patients, our system utilizes both medically motivated signal features and (nearly) raw data (by means of spectrograms) as system inputs. Our model employs a hybrid approach of data-based and feature-based methods to leverage the strengths of both while mitigating their weaknesses. By incorporating various data augmentation techniques for model training, we achieved an overall accuracy of 88.12%. This promising approach demonstrates improved accuracy in discriminating between the three tremor types, paving the way for more precise tremor diagnosis and enhanced patient care.

Objective Patients with acute coronary syndrome (ACS) remain at high risk for recurrent ischaemic and bleeding events during follow-up. Our study aimed to quantify and compare the impact of these adverse events on quality of life (QoL).Methods Data from patients with ACS prospectively enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used for this study. The primary ischaemic and bleeding events of interest were hospital readmission for ACS and Bleeding Academic Research Consortium type 2 or 3 bleeding during 12 months follow-up. QoL was measured using the EQ-5D Visual Analogue Scale (VAS) score and the 12-item Short Form Survey version 2 derived Physical Component Summary (PCS) and Mental Health Component Summary (MCS) scores at 12 months follow-up.Results In total, 3339 patients (mean age 66.8 years, 27.9% women) were included. During follow-up, ischaemic events occurred in 202 patients (6.0%) and bleeding events in 565 patients (16.9%). After adjustment for demographic and clinical characteristics, ischaemic events remained independently associated with lower QoL regardless of metric used. Bleeding was also independently associated with lower EQ-5D VAS and PCS scores, but not with a lower MCS score. The QoL decrement associated with ischaemic events was numerically larger than the decrement associated with bleeding.Conclusions Ischaemic and bleeding events remain prevalent and are independently associated with lower QoL at 12 months follow-up in patients previously admitted for ACS. The incidence and impact of these adverse events should be considered when balancing individual ischaemic and bleeding risks.

Background Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes. Design This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n  = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans' study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features. Summary This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA. [ABSTRACT FROM AUTHOR]

Accurate tremor classification is crucial for effective patient management and treatment. However, clinical diagnoses are often hindered by misdiagnoses, necessitating the development of robust technical methods. Here, we present a two-stage convolutional neural network (CNN)-based system for classifying physiological tremor, essential tremor (ET), and Parkinson's disease (PD) tremor. Employing acceleration signals from the hands of 408 patients, our system utilizes both medically motivated signal features and (nearly) raw data (by means of spectrograms) as system inputs. Our model employs a hybrid approach of data-based and feature-based methods to leverage the strengths of both while mitigating their weaknesses. By incorporating various data augmentation techniques for model training, we achieved an overall accuracy of 88.12%. This promising approach demonstrates improved accuracy in discriminating between the three tremor types, paving the way for more precise tremor diagnosis and enhanced patient care. [ABSTRACT FROM AUTHOR]

A single innovation within a community can elicit completely opposite reactions from members who, in good faith, are all working toward the same goal. If this assumption is true--if one person's solution has the potential to be another person's problem--then how does one determine whose interests prevail? As members of National Association for College Admission Counseling (NACAC), the authors look to the Statement of Principles of Good Practice (SPGP) for guidance, but even this is problematic. The SPGP, for all the guidance and protections it affords, is, at 15 pages, an unwieldy document. Its multiple sections--each of which serves an important purpose--can be intimidating and confusing to colleagues who do not interact with it regularly. However, the individual practices are the proverbial trees within an otherwise elegant forest. The overarching themes of the SPGP rest on the association's six Core Values: (1) Professionalism; (2) Education; (3) Fairness and Equity; (4) Social Responsibility; (5) Collaboration; and (6) Trust. This article has two goals. First, the authors aim to suggest a practical and objective framework for evaluating difficult issues that is based on the Core Values. Second, the authors seek to reinforce that these clearly-defined Core Values are precisely what allow the profession to evolve in a thoughtful, deliberative manner. Three controversial issues from the profession's past and present as seen through the lens of the Core Values are discussed.

Important dimensions of emotional experiences include the level of arousal elicited and the source of that arousal, yet memory for events differing on these constructs is often compared within and across studies. One important factor for emotional memory is attachment security, which predicts how parents and children relate to each other and to the world around them. The present study investigated differences in 8- to 12-year olds' recall of emotional stimuli varied in relevance to attachment themes of separation and reunion. Moreover, memory was examined as predicted by children's attachment security, parents' attachment avoidance and anxiety, and parental elaboration during an interaction about the laboratory experience. Results revealed that recall was best for stimuli involving separation. Moreover, recall for separation stimuli was positively predicted by children's attachment security and parental avoidance, and negatively predicted by parental anxiety and elaborative interaction style. These findings highlight the importance of considering the effect of multiple dimensions of emotional events on children's memory and how contextual factors may differentially predict those memories. (Contains 2 tables and 1 figure.)

We examined adults' long-term autobiographical memory for a dramatic life event-participating as a child victim in a criminal prosecution because of alleged sexual abuse. The study is unique in several ways, including that we had extensive documentation concerning the sexual abuse allegations, the children's involvement in their legal case, and other factors known to affect long-term memory. Approximately 14 years after their legal involvement, 94 adolescents and young adults, aged 16-30 years, were interviewed about their childhood legal experiences. A subset of the victims had taken the stand in criminal court, and memory for testifying was examined. Results revealed that greater severity of the abuse, a closer relationship to the perpetrator, testifying more frequently, and greater distress were associated with more accurate memory. Findings suggest that both individual and sociocontextual factors must be considered in pursuing a scientific understanding of autobiographical memory for stressful childhood experiences. (Contains 5 tables.)

The current study was designed to investigate children's memory and suggestibility for events differing in valence (positive or negative) and veracity (true or false). A total of 82 3- and 5-year-olds were asked repeated questions about true and false events, either in a grouped order (i.e., all questions about a certain event asked consecutively) or in a nongrouped order (i.e., questions about a certain event were interspersed with questions about other events). Interviewer gender was also varied. Individual differences, including attachment style, inhibition, and behavioral adjustment, were examined as potential predictors of memory and suggestibility. Results revealed significant age, valence, and veracity effects on children's memory reports. Path analysis demonstrated that individual differences in behavioral problems and inhibitory ability predicted children's provision of inaccurate information. Implications for psychological theory and legal application are discussed. (Contains 3 figures and 2 tables.)