New, Optimized Skin Calorimeter Version for Measuring Thermal Responses of Localized Skin Areas during Physical Activity.

We present an optimized version of the skin calorimeter for measuring localized skin thermal responses during physical activity. Enhancements include a new holding system, more sensitive thermopiles, and an upgraded spiked heat sink for improved efficiency. In addition, we used a new, improved calorimetric model that takes into account all the variables that influence the measurement process. Resolution in power measurement is 1 mW. Performance tests under air currents and movement disturbances showed that the device maintains high accuracy; the deviation produced by these significant disturbances is less than 5%. Human subject tests, both at rest and during exercise, confirmed its ability to accurately measure localized skin heat flux, heat capacity, and thermal resistance (less than 5% uncertainty). These findings highlight the calorimeter's potential for applications in sports medicine and physiological studies.

Validation of a Skin Calorimeter to Determine the Heat Capacity and the Thermal Resistance of the Skin.

In vivo determination of the skin's thermal properties is of growing interest. Several types of sensors are being designed and tested. In this field, we have developed a skin calorimeter for the determination of the heat flow, the heat capacity and the thermal resistance of the skin. The calorimeter calibration consists of the determination of the parameters of the model we have chosen to represent the behavior of the device. This model considers the heat capacity and the thermal resistance of the skin, which depend on the case (body zone, subject, physical state, etc.) and also have a strong time dependence. Therefore, this work includes a validation study with reference materials. Finally, it is concluded that the heat capacity determined is a function of the thermal penetration depth of the measurement characteristics. In the case of high thermal conductivity materials in which the thermal penetration is nearly total, the heat capacity obtained coincides with that of the reference material sample.

Multi-Agent Team Learning in Virtualized Open Radio Access Networks (O-RAN).

Starting from the concept of the Cloud Radio Access Network (C-RAN), continuing with the virtual Radio Access Network (vRAN) and most recently with the Open RAN (O-RAN) initiative, Radio Access Network (RAN) architectures have significantly evolved in the past decade. In the last few years, the wireless industry has witnessed a strong trend towards disaggregated, virtualized and open RANs, with numerous tests and deployments worldwide. One unique aspect that motivates this paper is the availability of new opportunities that arise from using machine learning, more specifically multi-agent team learning (MATL), to optimize the RAN in a closed-loop where the complexity of disaggregation and virtualization makes well-known Self-Organized Networking (SON) solutions inadequate. In our view, Multi-Agent Systems (MASs) with MATL can play an essential role in the orchestration of O-RAN controllers, i.e., near-real-time and non-real-time RAN Intelligent Controllers (RIC). In this article, we first provide an overview of the landscape in RAN disaggregation, virtualization and O-RAN, then we present the state-of-the-art research in multi-agent systems and team learning as well as their application to O-RAN. We present a case study for team learning where agents are two distinct xApps: power allocation and radio resource allocation. We demonstrate how team learning can enhance network performance when team learning is used instead of individual learning agents. Finally, we identify challenges and open issues to provide a roadmap for researchers in the area of MATL based O-RAN optimization.

The Influence of Sleep Quality on Patient Safety Learning of Nursing Students.

ABSTRACT: We investigated the influence of nursing students' sleep quality on their patient safety (PS) competence (i.e., knowledge of the dimensions of PS). The investigation surveyed 242 nursing students in a Saudi university. The majority of the surveyed students were characterized as having poor sleep quality. Notably, more male students experienced poor sleep quality than female students. The students reported the highest confidence in "culture of safety" and "managing safety risk"; they exhibited the poorest confidence in "working in teams." Increased length of sleep latency decreased sleep efficiency, and increased daytime sleepiness-related dysfunction was associated with reduced PS competence.

Towards a Measure for Characterizing the Informational Content of Audio Signals and the Relation between Complexity and Auditory Encoding.

The accurate description of a complex process should take into account not only the interacting elements involved but also the scale of the description. Therefore, there can not be a single measure for describing the associated complexity of a process nor a single metric applicable in all scenarios. This article introduces a framework based on multiscale entropy to characterize the complexity associated with the most identifiable characteristic of songs: the melody. We are particularly interested in measuring the complexity of popular songs and identifying levels of complexity that statistically explain the listeners' preferences. We analyze the relationship between complexity and popularity using a database of popular songs and their relative position in a preferences ranking. There is a tendency toward a positive association between complexity and acceptance (success) of a song that is, however, not significant after adjusting for multiple testing.

A Method to Determine Human Skin Heat Capacity Using a Non-Invasive Calorimetric Sensor.

A calorimetric sensor has been designed to measure the heat flow dissipated by a 2 x 2 cm2 skin surface. In this work, a non-invasive method is proposed to determine the heat capacity and thermal conductance of the area of skin where the measurement is made. The method consists of programming a linear variation of the temperature of the sensor thermostat during its application to the skin. The sensor is modelled as a two-inputs and two-outputs system. The inputs are 1) the power dissipated by the skin and transmitted by conduction to the sensor, and 2) the power dissipated in the sensor thermostat to maintain the programmed temperature. The outputs are 1) the calorimetric signal and 2) the thermostat temperature. The proposed method consists of a sensor modelling that allows the heat capacity of the element where dissipation takes place (the skin) to be identified, and the transfer functions (TF) that link the inputs and outputs are constructed from its value. These TFs allow the determination of the heat flow dissipated by the surface of the human body as a function of the temperature of the sensor thermostat. Furthermore, as this variation in heat flow is linear, we define and determine an equivalent thermal resistance of the skin in the measured area. The method is validated with a simulation and with experimental measurements on the surface of the human body.

Measurement of human body surface heat flux using a calorimetric sensor.

We have developed a calorimetric sensor that can perform local measurements of the heat flux transmitted by conduction between a human body and thermostat located inside the sensor. The sensor has a detection area of 2 × 2 cm2 and, in its current configuration, facilitates measurement with a resolution of 10 mW. In this paper, measurements of two healthy male subjects of different ages (24 and 60 years) are presented. We study the variation in the power dissipated by the human body surface as a function of time for a thermostat temperature of 28 °C. We also study the same power with thermostat temperatures varying from 24° to 36°C. Measurements are performed on three different surface areas of the human body: the sternum, abdomen, and hand. The ambient room temperature during all measurements was in the range of 22-24 °C, and the subjects were seated and resting. The results show that the heat flux in the trunk is much more stable than that in the hand and that the heat flux in the sternum is greater than that in other areas. Additionally, this flux is higher in the younger subject (42 mW/cm2) than in the older subject (35 mW/cm2). We also defined a thermal parameter that represents the thermal resistance between the sensor thermostat and the skin. The mean value of this parameter varies between 51 and 71 K/W depending on the subject and measurement area.

Mathematical Model for Localised and Surface Heat Flux of the Human Body Obtained from Measurements Performed with a Calorimetry Minisensor.

The accuracy of the direct and local measurements of the heat power dissipated by the surface of the human body, using a calorimetry minisensor, is directly related to the calibration rigor of the sensor and the correct interpretation of the experimental results. For this, it is necessary to know the characteristics of the body's local heat dissipation. When the sensor is placed on the surface of the human body, the body reacts until a steady state is reached. We propose a mathematical model that represents the rate of heat flow at a given location on the surface of a human body by the sum of a series of exponentials: W(t) = A0 + ∑Aiexp(-t/τi). In this way, transient and steady states of heat dissipation can be interpreted. This hypothesis has been tested by simulating the operation of the sensor. At the steady state, the power detected in the measurement area (4 cm²) varies depending on the sensor's thermostat temperature, as well as the physical state of the subject. For instance, for a thermostat temperature of 24 °C, this power can vary between 100-250 mW in a healthy adult. In the transient state, two exponentials are sufficient to represent this dissipation, with 3 and 70 s being the mean values of its time constants.

Calorimetry Minisensor for the Localised Measurement of Surface Heat Dissipated from the Human Body.

We have developed a calorimetry sensor that can perform a local measurement of the surface heat dissipated from the human body. The operating principle is based on the law of conductive heat transfer: heat dissipated by the human body passes across a thermopile located between the individual and a thermostat. Body heat power is calculated from the signals measured by the thermopile and the amount of power dissipated across the thermostat in order to maintain a constant temperature. The first prototype we built had a detection area measuring 6 × 6 cm², while the second prototype, which is described herein, had a 2 × 2 cm² detection area. This new design offers three advantages over the initial one: (1) greater resolution and three times greater thermal sensitivity; (2) a twice as fast response; and (3) it can take measurements from smaller areas of the body. The sensor has a 5 mW resolution, but the uncertainty is greater, up to 15 mW, due to the measurement and calculation procedure. The order of magnitude of measurements made in healthy subjects ranged from 60 to 300 mW at a thermostat temperature of 28 °C and an ambient room temperature of 21 °C. The values measured by the sensor depend on the ambient temperature and the thermostat's temperature, while the power dissipated depends on the individual's metabolism and any physical and/or emotional activity.

Textbook outcome in distal pancreatectomy: A multicenter study.

BACKGROUND: Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula. METHODS: Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien-Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C). RESULTS: Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes. CONCLUSION: The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome-distal pancreatectomy because it is the most frequent complication of this procedure.

Veterinary Spinal Manipulative Therapy or Animal Chiropractic in Veterinary Rehabilitation.

Veterinary rehabilitation is a multimodal diagnostic and treatment approach that is recommended and provided to patients daily. One therapeutic modality that may be beneficial (diagnostically and therapeutically) is veterinary spinal manipulative therapy or animal chiropractic (AC). AC is a receptor-based health-care modality being provided more frequently in veterinary practices. All clinicians should strive to understand the mode of action, indications, contraindications, how it affects the patient from the neuro-anatomical and biomechanical point of view, and most importantly, when not to provide the requested modality, as further diagnostics may be indicated.

Metastasis of Renal Cell Carcinoma to Pancreatic Bile Duct.

Secondary pancreatic neoplasms account for less than 5% of all pancreatic malignancies, with renal cell carcinoma (RCC) being one of the most common primary tumors. Here, we present the case of a patient with obstructive jaundice secondary to an isolated metastatic RCC, to the intrapancreatic portion of the common bile duct, ampulla of Vater, and pancreatic parenchyma. Patient had a history of a left radical nephrectomy due to a primary RCC 10 years prior to presentation, and eventually underwent a pylorus-sparing pancreaticoduodenectomy (PD) with minor morbidity. While metastases of RCC to the pancreatic body and tail have been reported, isolated metastasis to the pancreatic bile duct comprises an even rarer subgroup.

Perioperative hyperoxia and myocardial injury after surgery: a randomized controlled trial.

BACKGROUND: The World Health Organization recommends hyperoxia (80% fraction of inspired oxygen, FiO2) during and for 2-6 hours following surgery to reduce surgical site infection (SSI). However, some studies suggest increased cardiovascular complications with such a high perioperative FiO2. The goal of our study was to compare the appearance of cardiovascular complications in elective adult colorectal surgery comparing the use of FiO2>0.8 versus conventional therapy (FiO2<0.4). METHODS: We performed a randomized controlled trial in intubated patients undergoing elective major colorectal surgery. Patients were randomly assigned to receive perioperative FiO2>0.8 or FiO2<0.4. The primary outcome, expressed as Odds Ratio (OR) ±95% Confidence Interval (95%CI), was the incidence of MINS (myocardial injury after noncardiac surgery evaluated for the first 4 postoperative days). Secondary outcomes included MACCE (major adverse cardiovascular and cerebral events) up to 30 postoperative days, SSI, other postoperative complications (according to Clavien-Dindo classification) and length of stay. RESULTS: We included in the final analyses 403 patients. Comparing the FiO2>0.8 and FiO2<0.4 groups, there was no difference in the appearance of MINS (6.0% vs. 10.4%; OR 0.55; 95% CI: 0.26-1.14; P=0.945). There were no differences between the groups for important secondary outcomes including MACCE to 30 days, SSI, postoperative complications or length of stay. CONCLUSIONS: Perioperative hyperoxia therapy (FiO2>0.8) with the aim of decreasing SSI did not increase cardiovascular complications after elective colorectal surgery in a general population.

Longitudinal alterations in brain morphometry mediated the effects of bullying victimization on cognitive development in preadolescents.

Bullying victimization is associated with a doubled risk of attempting suicide in adulthood. Two longitudinal brain morphometry studies identified the fusiform gyrus and putamen as vulnerable to bullying. No study identified how neural alterations may mediate the effect of bullying on cognition. We assessed participants with caregiver-reported bullying (N = 323) and matched non-bullied controls (N = 322) from the Adolescent Brain Cognitive Development Study dataset to identify changes in brain morphometry associated with ongoing bullying victimization over two years and determine whether such alterations mediated the effect of bullying on cognition. Bullied children (38.7% girls, 47.7% racial minorities, 9.88 ± 0.62 years at baseline) had poorer cognitive performance (P < 0.05), larger right hippocampus (P = 0.036), left entorhinal cortex, left superior parietal cortex, and right fusiform gyrus volumes (all P < 0.05), as well as larger surface areas in multiple other frontal, parietal, and occipital cortices. Thinner cortices were also found in the left hemisphere, particularly in the left temporal lobe, and right frontal region (all P < 0.05). Importantly, larger surface area in the fusiform cortices partially suppressed (12-16%), and thinner precentral cortices partially mitigated, (7%) the effect of bullying on cognition (P < 0.05). These findings highlight the negative impact of prolonged bullying victimization on brain morphometry and cognition.

Prenatal tobacco exposure on brain morphometry partially mediated poor cognitive performance in preadolescent children.

Objectives: To evaluate whether prenatal tobacco exposure (PTE) is related to poorer cognitive performance, abnormal brain morphometry, and whether poor cognitive performance is mediated by PTE-related structural brain differences. Methods: The Adolescent Brain Cognitive Development study dataset was used to compare structural MRI data and neurocognitive (NIH Toolbox®) scores in 9-to-10-year-old children with (n=620) and without PTE (n=10,989). We also evaluated whether PTE effects on brain morphometry mediated PTE effects on neurocognitive scores. Group effects were evaluated using Linear Mixed Models, covaried for socio-demographics and prenatal exposures to alcohol and/or marijuana, and corrected for multiple comparisons using the false-discovery rate (FDR). Results: Compared to unexposed children, those with PTE had poorer performance (all p-values <0.05) on executive function, working memory, episodic memory, reading decoding, crystallized intelligence, fluid intelligence and overall cognition. Exposed children also had thinner parahippocampal gyri, smaller surface areas in the posterior-cingulate and pericalcarine cortices; the lingual and inferior parietal gyri, and smaller thalamic volumes (all p-values <0.001). Furthermore, among children with PTE, girls had smaller surface areas in the superior-frontal (interaction-FDR-p=0.01), precuneus (interaction-FDR-p=0.03) and postcentral gyri (interaction-FDR-p=0.02), while boys had smaller putamen volumes (interaction-FDR-p=0.02). Smaller surface areas across regions of the frontal and parietal lobes, and lower thalamic volumes, partially mediated the associations between PTE and poorer neurocognitive scores (p-values <0.001). Conclusions: Our findings suggest PTE may lead to poorer cognitive performance and abnormal brain morphometry, with sex-specific effects in some brain regions, in pre-adolescent children. The poor cognition in children with PTE may result from the smaller areas and subcortical brain volumes.

Assessing the impact of privacy-preserving record linkage on record overlap and patient demographic and clinical characteristics in PCORnet®, the National Patient-Centered Clinical Research Network.

OBJECTIVE: This article describes the implementation of a privacy-preserving record linkage (PPRL) solution across PCORnet®, the National Patient-Centered Clinical Research Network. MATERIAL AND METHODS: Using a PPRL solution from Datavant, we quantified the degree of patient overlap across the network and report a de-duplicated analysis of the demographic and clinical characteristics of the PCORnet population. RESULTS: There were ∼170M patient records across the responding Network Partners, with ∼138M (81%) of those corresponding to a unique patient. 82.1% of patients were found in a single partner and 14.7% were in 2. The percentage overlap between Partners ranged between 0% and 80% with a median of 0%. Linking patients' electronic health records with claims increased disease prevalence in every clinical characteristic, ranging between 63% and 173%. DISCUSSION: The overlap between Partners was variable and depended on timeframe. However, patient data linkage changed the prevalence profile of the PCORnet patient population. CONCLUSIONS: This project was one of the largest linkage efforts of its kind and demonstrates the potential value of record linkage. Linkage between Partners may be most useful in cases where there is geographic proximity between Partners, an expectation that potential linkage Partners will be able to fill gaps in data, or a longer study timeframe.

Antioxidant 1 copper chaperone gene expression and copper levels in dog osteosarcoma patients.

Twenty-four dogs with OS underwent limb amputation. Serum, OS tumour, and normal bone were harvested at time of surgery. RNA was extracted and gene expression was performed using quantitative polymerase chain reaction (qPCR). Tissue and blood copper concentrations were also determined with spectrophotometry. Compared to bone, tumour samples had significantly higher expressions of antioxidant 1 copper chaperone (ATOX1, p = .0003). OS tumour copper levels were significantly higher than that of serum (p < .010) and bone (p = .038). Similar to our previous observations in mouse and human OS, dog OS demonstrates overexpression of genes that regulate copper metabolism (ATOX1), and subsequent copper levels. Dogs with OS may provide a robust comparative oncology platform for the further study of these factors, as well as potential pharmacologic interventions.

Hot-water phytosanitary treatment against Ceratitis capitata (Diptera: Tephritidae) in 'Ataulfo' mangoes.

We determined the thermal death rate constants and mortality curves for the eggs and different instars of Ceratitis capitata (Mediterranean fruit fly) (Wiedemann) submerged in isolation in water at 44, 46, and 48 degrees C and submerged within fruits of Mangifera indica (mango) (L.) in water at 43.1, 44.1, 45.1, and 46.1 degrees C. The first instar was the most tolerant to this treatment, with estimated times for achieving 99.9968% mortality of 103.28, 92.73, and 92.49 min at temperatures of 43.1, 44.1, and 45.1 degrees C, respectively. The results of the study indicate that 'Ataulfo' mangoes weighing < 329 +/- 2.11 g and at risk immature Mediterranean fruit fly infestation should be immersed for 95 min at 46.1-47 degrees C to ensure that the fruit pulp remains at this temperature for 10 min. An efficacy test was conducted that involved treating 730 mangoes, with an average weight of 326 +/- 2.11 g (mean +/- SE) and infested with 84 +/- 1.15 first instars. In this test, none of the 61,720 larvae treated survived. The confirmatory test was performed using commercial equipment in which 1,112 infested mango fruit weighing an average of 329 +/- 2.11 g were treated. Each fruit was previously infested with an average of 59 +/- 0.61 first instars (= 65,825 total larvae) of which none survived. The data collected on mango quality indicate that hot water immersion for 95 min at 46.1-47 degrees C can produce a more uniform fruit-color and positively modify the pH (producing more palatable fruits), but can also produce a loss of firmness and weight (5%). Taking all factors into consideration, we conclude that this treatment is sufficient to meet quarantine restrictions against C. capitata while maintaining market quality at least for 15 d.

Peer victimization (bullying) on mental health, behavioral problems, cognition, and academic performance in preadolescent children in the ABCD Study.

Objective: Peer victimization is a substantial early life stressor linked to psychiatric symptoms and poor academic performance. However, the sex-specific cognitive or behavioral outcomes of bullying have not been well-described in preadolescent children. Methods: Using the baseline dataset of the Adolescent Brain Cognitive Development (ABCD) Study 2.0.1 data repository (N = 11,875), we evaluated associations between parent-reported bullying victimization, suicidality (suicidal ideation, intent, and/or behavior), and non-suicidal self-injury (NSSI), as well as internalizing and externalizing behavioral problems, cognition, and academic performance. Results: Of the 11,015 9-10-year-old children included in the analyses (5,263 girls), 15.3% experienced bullying victimization, as reported by the primary caregiver. Of these, boys were more likely to be bullied than girls (odds ratio [OR], 1.2 [95% CI, 1.1-1.3]; p = 0.004). Children who were bullied were more likely to display NSSI or passive suicidality (OR, 2.4 [95% CI, 2.0-2.9]; p < 0.001) and active suicidality (OR, 3.4 [95% CI, 2.7-4.2]; p < 0.001). Bullied children also had lower cognitive scores, greater behavioral problems, and poorer grades (p < 0.001). Across all participants, boys had poorer grades and greater behavioral problems than girls; however, bullied boys had greater behavioral problems than girls in several areas (p < 0.001). Compared to their non-bullied peers, bullied children with greater non-suicidal self-injury or suicidality also had greater behavioral problems and poorer grades (p < 0.001). Conclusion: These findings highlight the sex-specific effects of bullying, and the negative associations of bullying victimization with cognitive performance, behavioral problems, and academic performance. Future longitudinal studies will identify the natural history and neural correlates of these deficits during adolescence.

Establishing a framework for privacy-preserving record linkage among electronic health record and administrative claims databases within PCORnet®, the National Patient-Centered Clinical Research Network.

OBJECTIVE: The aim of this study was to determine whether a secure, privacy-preserving record linkage (PPRL) methodology can be implemented in a scalable manner for use in a large national clinical research network. RESULTS: We established the governance and technical capacity to support the use of PPRL across the National Patient-Centered Clinical Research Network (PCORnet®). As a pilot, four sites used the Datavant software to transform patient personally identifiable information (PII) into de-identified tokens. We queried the sites for patients with a clinical encounter in 2018 or 2019 and matched their tokens to determine whether overlap existed. We described patient overlap among the sites and generated a "deduplicated" table of patient demographic characteristics. Overlapping patients were found in 3 of the 6 site-pairs. Following deduplication, the total patient count was 3,108,515 (0.11% reduction), with the largest reduction in count for patients with an "Other/Missing" value for Sex; from 198 to 163 (17.6% reduction). The PPRL solution successfully links patients across data sources using distributed queries without directly accessing patient PII. The overlap queries and analysis performed in this pilot is being replicated across the full network to provide additional insight into patient linkages among a distributed research network.