Automatic Behavior Assessment from Uncontrolled Everyday Audio Recordings by Deep Learning.

The manual categorization of behavior from sensory observation data to facilitate further analyses is a very expensive process. To overcome the inherent subjectivity of this process, typically, multiple domain experts are involved, resulting in increased efforts for the labeling. In this work, we investigate whether social behavior and environments can automatically be coded based on uncontrolled everyday audio recordings by applying deep learning. Recordings of daily living were obtained from healthy young and older adults at randomly selected times during the day by using a wearable device, resulting in a dataset of uncontrolled everyday audio recordings. For classification, a transfer learning approach based on a publicly available pretrained neural network and subsequent fine-tuning was implemented. The results suggest that certain aspects of social behavior and environments can be automatically classified. The ambient noise of uncontrolled audio recordings, however, poses a hard challenge for automatic behavior assessment, in particular, when coupled with data sparsity.

Necessity of technicians for computerized neuropsychological assessment devices in multiple sclerosis.

OBJECTIVE: Determine the influence of technician supervision on computer-administered cognitive tests in multiple sclerosis (MS). METHODS: Eighty MS patients underwent assessment using the CogState Brief Battery (CSBB) and the Cleveland Clinic Cognitive Battery (C3B). Each was administered twice, once with a technician guiding assessment, and once with technician-absent. Twenty-eight healthy controls were also evaluated. RESULTS: The influence of technician guidance was not statistically significant for group means on either test. For CSBB, administration problems were more common in the technician-absent condition. CONCLUSION: In this MS sample, reliable and valid test results were obtained from computer-assisted cognitive testing without technician guidance.

Processing speed test: Validation of a self-administered, iPad®-based tool for screening cognitive dysfunction in a clinic setting.

BACKGROUND: Cognitive dysfunction is common in multiple sclerosis (MS) patients and has important consequences for daily activities, yet, unlike motor function, is not routinely assessed in the clinic setting. We developed the Processing Speed Test (PST), a self-administered iPad®-based tool to measure MS-related deficits in processing speed. OBJECTIVE: To determine whether the PST is valid for screening cognitive dysfunction by comparing it to the paper-and-pencil Symbol Digit Modalities Test (SDMT). METHODS: We assessed PST test-retest reliability, sensitivity of PST and SDMT in discriminating MS patients from healthy controls (HC), convergent validity between PST and SDMT, correlations between T2 lesion load and PST and SDMT, and PST performance with and without technician present during administration. RESULTS: PST had excellent test-retest reliability, was highly correlated with SDMT, was slightly more sensitive than SDMT in discriminating MS from HC groups, and correlated better with cerebral T2 lesion load than did SDMT. Finally, PST performance was no different with or without a technician in the testing environment. CONCLUSION: PST has advantages over SDMT because of its efficient administration, scoring, and potential for medical record or research database integration. PST is a practical tool for routine screening of processing speed deficits in the MS clinic.

Experimental iron amendment suppresses toxic cyanobacteria in a hypereutrophic lake.

The effects of reducing nutrient inputs to lakes and reservoirs are often delayed by hysteresis resulting from internal phosphorus (P) loading from sediments. Consequently, controlling harmful algal blooms (HABs) in many eutrophic ecosystems requires additional management to improve water quality. We manipulated iron (Fe) concentrations in a hypereutrophic lake to determine if Fe amendment would suppress HABs by inhibiting P release from sediments. Our experiment consisted of 15 in situ mesocosms, 12 of which each received a different dose of Fe (ranging from 2 to 225 g/m2 ); the remaining three were unmanipulated to serve as controls. Iron amendment decreased P accumulation in porewaters and the flux of P from sediments, which significantly lowered P concentrations in the water column. Iron exerted significant dose-dependent negative effects on the biomass of phytoplankton and periphyton, and reduced the dominance of cyanobacteria. Even at the lowest doses, Fe appeared to reduce the toxicity of cyanobacterial blooms, as measured by concentrations of hepatotoxic microcystins. Overall, our findings highlight the potential for Fe treatment as an effective strategy for minimizing HABs in eutrophic lakes and reservoirs. More broadly, our study reinforces the importance of Fe in regulating the trophic state of freshwaters, and the sensitivity of certain ecosystems to changes in Fe supply. Finally, we hypothesize that decreases in natural Fe supplies to lakes associated with anthropogenic activities may worsen outbreaks of toxic cyanobacteria.

Reducing Phosphorus to Curb Lake Eutrophication is a Success.

As human populations increase and land-use intensifies, toxic and unsightly nuisance blooms of algae are becoming larger and more frequent in freshwater lakes. In most cases, the blooms are predominantly blue-green algae (Cyanobacteria), which are favored by low ratios of nitrogen to phosphorus. In the past half century, aquatic scientists have devoted much effort to understanding the causes of such blooms and how they can be prevented or reduced. Here we review the evidence, finding that numerous long-term studies of lake ecosystems in Europe and North America show that controlling algal blooms and other symptoms of eutrophication depends on reducing inputs of a single nutrient: phosphorus. In contrast, small-scale experiments of short duration, where nutrients are added rather than removed, often give spurious and confusing results that bear little relevance to solving the problem of cyanobacteria blooms in lakes.

Temporal variation in the deposition of polycyclic aromatic compounds in snow in the Athabasca Oil Sands area of Alberta.

Atmospheric deposition of polycyclic aromatic compounds (PACs) via and onto snow, and their releasing during spring snowmelt has been a concern in the Athabasca Oil Sands Region of Alberta. This study was designed to evaluate the concentrations, loadings, and distribution of PACs in springtime snowpack and how they have changed since the first study in 2008. Snowpack samples were collected in late winters 2011-2014 at varying distances from the main developments. PAC concentration and deposition declined exponentially with distance, with pyrenes, chrysenes, and dibenzothiophenes dominating the distribution within the first 50 km. The distribution of PACs was different between sites located close to upgraders and others located close to mining facilities. Overall, PAC loadings were correlated with priority pollutant elements and water chemistry parameters, while wind direction and speed were not strong contributors to the variability observed. Total PAC mass deposition during winter months and within the first 50 km was initially estimated by integrating the exponential decay function fitted through the data using a limited number of sites from 2011 to 2014: 1236 kg (2011), 1800 kg (2012), 814 kg (2013), and 1367 (2014). Total loadings were estimated to have a twofold increase between 2008 and 2014, although the increase observed was not constant. Finally, kriging interpolation is presented as an alternative and more robust approach to estimate PAC mass deposition in the area. After a more intensive sampling campaign in 2014, the PAC mass deposition was estimated to be 1968 kg.

Oil sands mining and reclamation cause massive loss of peatland and stored carbon.

We quantified the wholesale transformation of the boreal landscape by open-pit oil sands mining in Alberta, Canada to evaluate its effect on carbon storage and sequestration. Contrary to claims made in the media, peatland destroyed by open-pit mining will not be restored. Current plans dictate its replacement with upland forest and tailings storage lakes, amounting to the destruction of over 29,500 ha of peatland habitat. Landscape changes caused by currently approved mines will release between 11.4 and 47.3 million metric tons of stored carbon and will reduce carbon sequestration potential by 5,734-7,241 metric tons C/y. These losses have not previously been quantified, and should be included with the already high estimates of carbon emissions from oil sands mining and bitumen upgrading. A fair evaluation of the costs and benefits of oil sands mining requires a rigorous assessment of impacts on natural capital and ecosystem services.

Depression and Differential Oral Health Status Among U.S. Adults With and Without Prior Active Duty Service in the U.S. Military, National Health and Nutrition Examination Survey 2011-2018.

INTRODUCTION: Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. MATERIALS AND METHODS: Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health-related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. RESULTS: Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression. CONCLUSIONS: This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.

Assessing the Use of Radiographs Alone to Determine Air Force Dental Readiness Classification.

INTRODUCTION: The Air Force Dental Service is responsible for ensuring that airmen are dentally ready to support military operations worldwide by delivering top-tier dental care. As the military healthcare landscape undergoes significant changes, the Air Force Dental Service has explored innovative approaches to dental care delivery. One consideration involves the potential use of radiographs as the primary tool for assessing service members' dental conditions, specifically focusing on identifying nondeployable conditions and periodontal health. MATERIALS AND METHODS: Providers who previously participated as examiners in the 2018 Air Force Recruit Oral Health Study were recruited to re-evaluate randomly selected de-identified records, this time making assessments exclusively based on radiographs. Their evaluations included Dental Readiness Classification (DRC) determinations, total caries counts, and Periodontal Screening and Recording (PSR) index scores, providers also rated their confidence in these conclusions using a 5-point Likert scale. The study then computed sensitivity and specificity to assess the diagnostic performance of providers using radiographs only compared to the original study results that use the gold standard of radiographs with a clinical examination. RESULTS: Providers exceled at ruling out most DRC 3 conditions, with specificities surpassing 70%. Positively identifying those with DRC 3, particularly radiographically identifying periodontal conditions posed challenges with computed sensitivity rates as low as 8%. Discrepancies in PSR scores also accentuated limitations in relying solely on radiographs, where provider's radiographically determined PSR scores that matched less than one third of the time. In general, providers had low to very low confidence in their assessments. CONCLUSIONS: The study strongly cautions against relying solely on radiographs for determining the dental health of U.S. Air Force personnel. While providers effectively ruled out the absence of certain conditions, the challenge of positively identifying DRC 3 conditions poses significant risks to oral health if such a workflow was utilized. Particularly, the high probability of false negatives would be detrimental to the operational readiness of military personnel. Therefore, results support the continued use of radiographic and clinical examinations for comprehensive dental exams.

Oil sands development contributes elements toxic at low concentrations to the Athabasca River and its tributaries.

We show that the oil sands industry releases the 13 elements considered priority pollutants (PPE) under the US Environmental Protection Agency's Clean Water Act, via air and water, to the Athabasca River and its watershed. In the 2008 snowpack, all PPE except selenium were greater near oil sands developments than at more remote sites. Bitumen upgraders and local oil sands development were sources of airborne emissions. Concentrations of mercury, nickel, and thallium in winter and all 13 PPE in summer were greater in tributaries with watersheds more disturbed by development than in less disturbed watersheds. In the Athabasca River during summer, concentrations of all PPE were greater near developed areas than upstream of development. At sites downstream of development and within the Athabasca Delta, concentrations of all PPE except beryllium and selenium remained greater than upstream of development. Concentrations of some PPE at one location in Lake Athabasca near Fort Chipewyan were also greater than concentration in the Athabasca River upstream of development. Canada's or Alberta's guidelines for the protection of aquatic life were exceeded for seven PPE-cadmium, copper, lead, mercury, nickel, silver, and zinc-in melted snow and/or water collected near or downstream of development.

Oral health risk factors and overall dental treatment needs for incoming air force recruits.

OBJECTIVE: To determine if relationships exist between the total dental treatment needs of incoming Air Force recruits and non-clincal demographic and oral-health related factors. METHODS: Data from the 2018 Air Force Recruit Oral Health Study (ROHS) was used, an anonymized sample of 1330 AF recruits that included a comprehensive oral exam and survey collecting demographic and oral health behavior information. The primary outcome variable was the total number of dental treatment needs for recruits, and independent predictor variables included select socio-demographic factors and wellness behaviors. Along with descriptive statistics, a multivariable negative binomial regression analysis was performed to assess the relationship between variables with a normalized weight making the final results representative of all incoming recruits. RESULTS: The final adjusted analysis showed that an incoming recruit's self-rated oral health, dental coverage prior to enlistment, need for a dental visit within the last 12 months, sugar intake, and tobacco use increased their risk for dental treatment needs. CONCLUSION: This is the first study to assess the relationship between specific risk indicators and increased dental treatment needs while adjusting other related covariates. Factors associated with dental treatment needs were identified that provide Air Force leaders with actionable information to directly improve recruit oral health and military readiness by identifying new airmen at the highest risk for excessive dental care needs while at basic military training.

Patient Satisfaction in Military Dental Clinics-Findings From the Department of Defense Dental Patient Satisfaction Survey.

INTRODUCTION: An objective of the Military Health System is to deliver an improved health care experience. Patient satisfaction affects the patient experience, health outcomes, and treatment compliance. The purpose of this study is to identify indicators of high and low patient satisfaction within a military dental setting. MATERIALS AND METHODS: De-identified data from 248,342 responses to the DoD Dental Patient Satisfaction Survey conducted from October 2014 to March 2016 were used. The overall satisfaction and other related outcomes were analyzed by age, sex, beneficiary status, current rank, current Service, type of dental treatment, clinic location, and clinic size. Unpaired t-tests and logistic regression modeling were used to ascertain relationships between various aspects of patient satisfaction and variables of interest. RESULTS: Overall, 96% of patients attending military dental clinics were satisfied, whereas 72% of patients were satisfied with the number of days waited for an appointment. Air Force patients were the most satisfied compared to their Army, Navy, and Marine Corps counterparts. Patients treated in small dental clinics (less than 5 dentists) were 74% more satisfied than patients treated at large dental clinics (more than 12 dentists). Patients seeking routine dental treatment were significantly more satisfied with the number of days waiting for an appointment (odds ratio = 8.03; 95% CI: 7.64-8.43) compared to patients waiting for an emergency dental appointment. CONCLUSIONS: There were important differences in patient satisfaction by military Service and clinic size, suggesting that improvement in satisfaction may need to be Service specific. These differences warrant further research that could inform policy changes directed at improving service members' dental care and readiness.

The Parkinson's disease waiting room of the future: measurements, not magazines.

Utilizing technology to precisely quantify Parkinson's disease motor symptoms has evolved over the past 50 years from single point in time assessments using traditional biomechanical approaches to continuous monitoring of performance with wearables. Despite advances in the precision, usability, availability and affordability of technology, the "gold standard" for assessing Parkinson's motor symptoms continues to be a subjective clinical assessment as none of these technologies have been fully integrated into routine clinical care of Parkinson's disease patients. To facilitate the integration of technology into routine clinical care, the Develop with Clinical Intent (DCI) model was created. The DCI model takes a unique approach to the development and integration of technology into clinical practice by focusing on the clinical problem to be solved by technology rather than focusing on the technology and then contemplating how it could be integrated into clinical care. The DCI model was successfully used to develop the Parkinson's disease Waiting Room of the Future (WROTF) within the Center for Neurological Restoration at the Cleveland Clinic. Within the WROTF, Parkinson's disease patients complete the self-directed PD-Optimize application on an iPad. The PD-Optimize platform contains cognitive and motor assessments to quantify PD symptoms that are difficult and time-consuming to evaluate clinically. PD-Optimize is completed by the patient prior to their medical appointment and the results are immediately integrated into the electronic health record for discussion with the movement disorder neurologist. Insights from the clinical use of PD-Optimize has spurred the development of a virtual reality technology to evaluate instrumental activities of daily living in PD patients. This new technology will undergo rigorous assessment and validation as dictated by the DCI model. The DCI model is intended to serve as a health enablement roadmap to formalize and accelerate the process of bringing the advantages of cutting-edge technology to those who could benefit the most: the patient.

Cleveland Clinic Cognitive Battery (C3B): Normative, Reliability, and Validation Studies of a Self-Administered Computerized Tool for Screening Cognitive Dysfunction in Primary Care.

BACKGROUND: The self-administered iPad-based Cleveland Clinic Cognitive Battery (C3B) was designed specifically for the efficient screening of cognitive functioning of older adults in a primary care setting. OBJECTIVE: 1) Generate regression-based norms from healthy participants to enable demographic corrections to facilitate clinical interpretation; 2) estimate test-retest reliability and practice effects; 3) examine ability to discriminate mild cognitive impairment (MCI) from healthy aging; 4) d etermine validity of screening in a distracting clinical environment; and 5) determine completion rates and patient satisfaction in a primary care setting. METHODS: Study 1 (S1) recruited a stratified sample of 428 healthy adults, ages 18-89, to generate regression-based equations. S2 assessed 2-week test-retest reliability and practice effects in 30 healthy elders. S3 recruited 30 MCI patients and 30 demographically-matched healthy controls. In S4, 30 healthy elders self-administered the C3B in a distracting environment and in a quiet private room in counterbalanced order. In a demonstration project, 470 consecutive primary care patients were administered the C3B as part of routine clinical care (S5). RESULTS: C3B performance was primarily influenced by age, education, and race (S1), had acceptably high test-retest reliability and minimal practice effects (S2), discriminated MCI from healthy controls (S3), was not negatively impacted by a distracting clinical environment (S4), had high completion rates (>92%) and positive ratings from primary care patients (S5). CONCLUSION: The C3B is a computerized cognitive screening tool that is reliable, validated, self-administered, and is conducive to integration into a busy primary care clinical workflow for detecting MCI, early Alzheimer's disease, and other related dementias.

The dilemma of controlling cultural eutrophication of lakes.

The management of eutrophication has been impeded by reliance on short-term experimental additions of nutrients to bottles and mesocosms. These measures of proximate nutrient limitation fail to account for the gradual changes in biogeochemical nutrient cycles and nutrient fluxes from sediments, and succession of communities that are important components of whole-ecosystem responses. Erroneous assumptions about ecosystem processes and lack of accounting for hysteresis during lake recovery have further confused management of eutrophication. I conclude that long-term, whole-ecosystem experiments and case histories of lake recovery provide the only reliable evidence for policies to reduce eutrophication. The only method that has had proven success in reducing the eutrophication of lakes is reducing input of phosphorus. There are no case histories or long-term ecosystem-scale experiments to support recent claims that to reduce eutrophication of lakes, nitrogen must be controlled instead of or in addition to phosphorus. Before expensive policies to reduce nitrogen input are implemented, they require ecosystem-scale verification. The recent claim that the 'phosphorus paradigm' for recovering lakes from eutrophication has been 'eroded' has no basis. Instead, the case for phosphorus control has been strengthened by numerous case histories and large-scale experiments spanning several decades.

Oil sands development contributes polycyclic aromatic compounds to the Athabasca River and its tributaries.

For over a decade, the contribution of oil sands mining and processing to the pollution of the Athabasca River has been controversial. We show that the oil sands development is a greater source of contamination than previously realized. In 2008, within 50 km of oil sands upgrading facilities, the loading to the snowpack of airborne particulates was 11,400 T over 4 months and included 391 kg of polycyclic aromatic compounds (PAC), equivalent to 600 T of bitumen, while 168 kg of dissolved PAC was also deposited. Dissolved PAC concentrations in tributaries to the Athabasca increased from 0.009 microg/L upstream of oil sands development to 0.023 microg/L in winter and to 0.202 microg/L in summer downstream. In the Athabasca, dissolved PAC concentrations were mostly <0.025 microg/L in winter and 0.030 microg/L in summer, except near oil sands upgrading facilities and tailings ponds in winter (0.031-0.083 microg/L) and downstream of new development in summer (0.063-0.135 microg/L). In the Athabasca and its tributaries, development within the past 2 years was related to elevated dissolved PAC concentrations that were likely toxic to fish embryos. In melted snow, dissolved PAC concentrations were up to 4.8 microg/L, thus, spring snowmelt and washout during rain events are important unknowns. These results indicate that major changes are needed to the way that environmental impacts of oil sands development are monitored and managed.

The role of software in science: a knowledge graph-based analysis of software mentions in PubMed Central.

Science across all disciplines has become increasingly data-driven, leading to additional needs with respect to software for collecting, processing and analysing data. Thus, transparency about software used as part of the scientific process is crucial to understand provenance of individual research data and insights, is a prerequisite for reproducibility and can enable macro-analysis of the evolution of scientific methods over time. However, missing rigor in software citation practices renders the automated detection and disambiguation of software mentions a challenging problem. In this work, we provide a large-scale analysis of software usage and citation practices facilitated through an unprecedented knowledge graph of software mentions and affiliated metadata generated through supervised information extraction models trained on a unique gold standard corpus and applied to more than 3 million scientific articles. Our information extraction approach distinguishes different types of software and mentions, disambiguates mentions and outperforms the state-of-the-art significantly, leading to the most comprehensive corpus of 11.8 M software mentions that are described through a knowledge graph consisting of more than 300 M triples. Our analysis provides insights into the evolution of software usage and citation patterns across various fields, ranks of journals, and impact of publications. Whereas, to the best of our knowledge, this is the most comprehensive analysis of software use and citation at the time, all data and models are shared publicly to facilitate further research into scientific use and citation of software.

Community-based high-intensity cycling improves disease symptoms in individuals with Parkinson's disease: A six-month pragmatic observational study.

Participation in supervised, laboratory-based aerobic exercise protocols holds promise in slowing the progression of Parkinson's disease (PD). Gaps remain regarding exercise adherence and effectiveness of laboratory protocols translated to community-based programs. The aim of the project was to monitor exercise behaviour and evaluate its effect on disease progression over a 6 month period in people with PD participating in a community-based Pedalling for Parkinson's (PFP) cycling program. A pragmatic, observational study design was utilised to monitor exercise behaviour at five community sites. The Movement Disorders Society-Unified Parkinson's disease Rating Scale Motor III (MDS-UPDRS-III) and other motor and non-motor outcomes were gathered at enrollment and following 6 months of exercise. Attendance, heart rate, and cadence data were collected for each exercise session. On average, people with PD (N = 41) attended nearly 65% of the offered PFP classes. Average percent of age-estimated maximum heart rate was 69.3 ± 11.9%; average cadence was 74.9 ± 9.0 rpms. The MDS-UPDRS III significantly decreased over the 6-month exercise period (37.2 ± 11.7 to 33.8 ± 11.7, p = 0.001) and immediate recall significantly improved (42.3 ± 12.4 to 47.1 ± 12.7, p = 0.02). Other motor and non-motor metrics did not exhibit significant improvement. Participants who attended ~74% or more of available PFP classes experienced the greatest improvement in MDS-UPDRS III scores; of those who attended less than 74% of classes, cycling greater than or equal to 76 rpms lead to  improvement. Attendance and exercise intensity data indicated that a laboratory-based exercise protocol can be successfully translated to a community setting. Consistent attendance and pedalling at a relatively high cadence may be key variables to PD symptom mitigation. Improvement in clinical ratings coupled with lack of motor and non-motor symptom progression over 6 months provides rationale for further investigation of the real-world, disease-modifying potential of aerobic exercise for people with PD.