Explaining and Visualizing Embeddings of One-Dimensional Convolutional Models in Human Activity Recognition Tasks.

Human Activity Recognition (HAR) is a complex problem in deep learning, and One-Dimensional Convolutional Neural Networks (1D CNNs) have emerged as a popular approach for addressing it. These networks efficiently learn features from data that can be utilized to classify human activities with high performance. However, understanding and explaining the features learned by these networks remains a challenge. This paper presents a novel eXplainable Artificial Intelligence (XAI) method for generating visual explanations of features learned by one-dimensional CNNs in its training process, utilizing t-Distributed Stochastic Neighbor Embedding (t-SNE). By applying this method, we provide insights into the decision-making process through visualizing the information obtained from the model's deepest layer before classification. Our results demonstrate that the learned features from one dataset can be applied to differentiate human activities in other datasets. Our trained networks achieved high performance on two public databases, with 0.98 accuracy on the SHO dataset and 0.93 accuracy on the HAPT dataset. The visualization method proposed in this work offers a powerful means to detect bias issues or explain incorrect predictions. This work introduces a new type of XAI application, enhancing the reliability and practicality of CNN models in real-world scenarios.

Explaining One-Dimensional Convolutional Models in Human Activity Recognition and Biometric Identification Tasks.

Due to wearables' popularity, human activity recognition (HAR) plays a significant role in people's routines. Many deep learning (DL) approaches have studied HAR to classify human activities. Previous studies employ two HAR validation approaches: subject-dependent (SD) and subject-independent (SI). Using accelerometer data, this paper shows how to generate visual explanations about the trained models' decision making on both HAR and biometric user identification (BUI) tasks and the correlation between them. We adapted gradient-weighted class activation mapping (grad-CAM) to one-dimensional convolutional neural networks (CNN) architectures to produce visual explanations of HAR and BUI models. Our proposed networks achieved 0.978 and 0.755 accuracy, employing both SD and SI. The proposed BUI network achieved 0.937 average accuracy. We demonstrate that HAR's high performance with SD comes not only from physical activity learning but also from learning an individual's signature, as in BUI models. Our experiments show that CNN focuses on larger signal sections in BUI, while HAR focuses on smaller signal segments. We also use the grad-CAM technique to identify database bias problems, such as signal discontinuities. Combining explainable techniques with deep learning can help models design, avoid results overestimation, find bias problems, and improve generalization capability.

Evaluating the performance of convolutional neural networks with direct acyclic graph architectures in automatic segmentation of breast lesion in US images.

BACKGROUND: Outlining lesion contours in Ultra Sound (US) breast images is an important step in breast cancer diagnosis. Malignant lesions infiltrate the surrounding tissue, generating irregular contours, with spiculation and angulated margins, whereas benign lesions produce contours with a smooth outline and elliptical shape. In breast imaging, the majority of the existing publications in the literature focus on using Convolutional Neural Networks (CNNs) for segmentation and classification of lesions in mammographic images. In this study our main objective is to assess the ability of CNNs in detecting contour irregularities in breast lesions in US images. METHODS: In this study we compare the performance of two CNNs with Direct Acyclic Graph (DAG) architecture and one CNN with a series architecture for breast lesion segmentation in US images. DAG and series architectures are both feedforward networks. The difference is that a DAG architecture could have more than one path between the first layer and end layer, whereas a series architecture has only one path from the beginning layer to the end layer. The CNN architectures were evaluated with two datasets. RESULTS: With the more complex DAG architecture, the following mean values were obtained for the metrics used to evaluate the segmented contours: global accuracy: 0.956; IOU: 0.876; F measure: 68.77%; Dice coefficient: 0.892. CONCLUSION: The CNN DAG architecture shows the best metric values used for quantitatively evaluating the segmented contours compared with the gold-standard contours. The segmented contours obtained with this architecture also have more details and irregularities, like the gold-standard contours.

Personally Identifiable Information in State Laws: Use, Release, and Collaboration at Health Departments.

Despite benefits to sharing data among public health programs, confidentiality laws are often presumed to obstruct collaboration or data sharing. We present an overview of the use and release of confidential, personally identifiable information as consistent with public health interests and identify opportunities to align data-sharing procedures with use and release provisions in state laws to improve program outcomes. In August 2013, Centers for Disease Control and Prevention staff and legal researchers from the National Nurse-Led Care Consortium conducted a review of state laws regulating state and local health departments in 50 states and the District of Columbia. Nearly all states and the District of Columbia employ provisions for the general use and release of personally identifiable information without patient consent; disease-specific use or release provisions vary by state. Absence of law regarding use and release provisions was noted. Health departments should assess existing state laws to determine whether the use or release of personally identifiable information is permitted. Absence of direction should not prevent data sharing but prompt an analysis of existing provisions in confidentiality laws.

Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-July 7, 2016.

Zika virus is a flavivirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes, and infection can be asymptomatic or result in an acute febrile illness with rash (1). Zika virus infection during pregnancy is a cause of microcephaly and other severe birth defects (2). Infection has also been associated with Guillain-Barré syndrome (GBS) (3) and severe thrombocytopenia (4,5). In December 2015, the Puerto Rico Department of Health (PRDH) reported the first locally acquired case of Zika virus infection. This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico (6,7). A confirmed case of Zika virus infection is defined as a positive result for Zika virus testing by reverse transcription-polymerase chain reaction (RT-PCR) for Zika virus in a blood or urine specimen. A presumptive case is defined as a positive result by Zika virus immunoglobulin M (IgM) enzyme-linked immunosorbent assay (MAC-ELISA)* and a negative result by dengue virus IgM ELISA, or a positive test result by Zika IgM MAC-ELISA in a pregnant woman. An unspecified flavivirus case is defined as positive or equivocal results for both Zika and dengue virus by IgM ELISA. During November 1, 2015-July 7, 2016, a total of 23,487 persons were evaluated by PRDH and CDC Dengue Branch for Zika virus infection, including asymptomatic pregnant women and persons with signs or symptoms consistent with Zika virus disease or suspected GBS; 5,582 (24%) confirmed and presumptive Zika virus cases were identified. Persons with Zika virus infection were residents of 77 (99%) of Puerto Rico's 78 municipalities. During 2016, the percentage of positive Zika virus infection cases among symptomatic males and nonpregnant females who were tested increased from 14% in February to 64% in June. Among 9,343 pregnant women tested, 672 had confirmed or presumptive Zika virus infection, including 441 (66%) symptomatic women and 231 (34%) asymptomatic women. One patient died after developing severe thrombocytopenia (4). Evidence of Zika virus infection or recent unspecified flavivirus infection was detected in 21 patients with confirmed GBS. The widespread outbreak and accelerating increase in the number of cases in Puerto Rico warrants intensified vector control and personal protective behaviors to prevent new infections, particularly among pregnant women.

Enhancing HIV/AIDS, viral hepatitis, sexually transmitted disease, and tuberculosis prevention in the United States through program collaboration and service integration: the case for broader implementation.

HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis in the United States remain major public health concerns. The current disease-specific prevention approach oftentimes has led to narrow success and missed opportunities for increasing program capacity, leveraging resources, addressing social and structural determinants, and accelerating health impact-suggesting a need for greater innovation to prevent related diseases. The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's Program Collaboration and Service Integration (PCSI) strategic priority aims to strengthen collaborative engagement across these disease areas and to integrate services at the client level. In this review, we articulate the 5 principles of PCSI-appropriateness, effectiveness, flexibility, accountability, and acceptability. Drawing upon these principles and published literature, we discuss the case for change that underlies PCSI, summarize advances in the field since 2007, and articulate key next steps. Although formal evaluation is needed to fully assess the health impact of PCSI, available evidence suggests that this approach is a promising tool to advance prevention goals.

Iatrogenic cortical aneurysm post-craniotomy.

Taking into account the number of craniotomies performed every day around the world, iatrogenic aneurysm post-craniotomy is extremely rare with only anecdotal cases reported in literature. We report an iatrogenic aneurysm affecting a cortical vessel which probably developed during dural closure of a conventional craniotomy. The aneurysm was discovered 6 months after surgery on a routine control angiography. The patient was successfully treated by trapping the parent vessel and excising the aneurysm. Histopathological findings were compatible with a true type of traumatic aneurysm. The possibility of this rare condition occurring highlights the risk of arterial injury during craniotomy.

Program collaboration and service integration activities among HIV programs in 59 U.S. health departments.

OBJECTIVES: We identified the level and type of program collaboration and service integration (PCSI) among HIV prevention programs in 59 CDC-funded health department jurisdictions. METHODS: Annual progress reports (APRs) completed by all 59 health departments funded by CDC for HIV prevention activities were reviewed for collaborative and integrated activities reported by HIV programs for calendar year 2009. We identified associations between PCSI activities and funding, AIDS diagnosis rate, and organizational integration. RESULTS: HIV programs collaborated with other health department programs through data-related activities, provider training, and providing funding for sexually transmitted disease (STD) activities in 24 (41%), 31 (53%), and 16 (27%) jurisdictions, respectively. Of the 59 jurisdictions, 57 (97%) reported integrated HIV and STD testing at the same venue, 39 (66%) reported integrated HIV and tuberculosis testing, and 26 (44%) reported integrated HIV and viral hepatitis testing. Forty-five (76%) jurisdictions reported providing integrated education/outreach activities for HIV and at least one other disease. Twenty-six (44%) jurisdictions reported integrated partner services among HIV and STD programs. Overall, the level of PCSI activities was not associated with HIV funding, AIDS diagnoses, or organizational integration. CONCLUSIONS: HIV programs in health departments collaborate primarily with STD programs. Key PCSI activities include integrated testing, integrated education/outreach, and training. Future assessments are needed to evaluate PCSI activities and to identify the level of collaboration and integration among prevention programs.

Necessidades em saúde de puérperas dependentes químicas na perspectiva dos profissionais de enfermagem / Health needs of puerperal women with chemical dependence according to nursing professionals / Necesidades de salud de puérperas dependientes químicas, de acuerdo con los profesionales de enfermería

Objetivo: Analisar as representações de familiares de pacientes em cuidados paliativos. Métodos: Trata-se de uma pesquisa de abordagem qualitativa de cunho descritivo, a qual visou conhecer as representações de familiares de pacientes em cuidados paliativos, sendo que esta pesquisa baseou-se na Teoria das Representações Sociais criada por Serge Moscovici. Resultados: A figura da morte é caracterizada como um estágio final fisiológico, ou seja, um processo tecnicamente ordenado e natural da natureza; de forma geral, é a única certeza que possuímos na vida. A morte pode ser vista como um mistério incompreensível, como um absurdo inaceitável ou como um tabu ou uma representação social de um universo próprio e pessoal. Conclusão: Aprofundando o resultado, registramos que, apesar de este paciente não possuir mais possibilidade de cura mediante as terapêuticas convencionais, ele necessita de cuidados especiais ou cuidados paliativos

Objective: This study aims to describe the health needs of puerperal women with chemical dependence according to the nursing professionals' perceptions. Methods: It is an exploratory research with a qualitative approach, which was carried out in the rooming-in environment of a Public Maternity Unit from the Southern Region of Brazil. Ten nursing professionals participated in this study, being seven auxiliary nurses and three nurse practitioners. Data were collected through a semi-structured interview and analyzed by the categorical thematic analysis and synthesized according to the Health Needs proposed by Cecilio and Matsumoto. Results: The following need

Objetivo: Caracterizar las necesidades de salud de las madres con dependencia química, en la percepción de los profesionales de enfermería. Métodos: Investigación cualitativa, exploratoria llevadas a cabo en el alojamiento conjunto en una maternidad pública en el sur de Brasil. Un total de diez profesionales de enfermería, asistentes de siete y tres enfermeras. Los datos fueron recolectados a través de entrevistas semiestructuradas, se analizan mediante análisis de categorías temáticas y sintetizado de acuerdo con los requisitos de salud propuestas por Cecilio y Matsumoto. Resultados: A partir del análisis del discurso surgieron las siguientes necesidades: la higiene, la alimentación sana, la adhesión a la atención médica, vigilancia profesional, calificación atención, orientación de salud, el cuidado Integridad, la escucha activa, la humanización de la atención, el apoyo familiar y el enlace con el niño. Conclusiones: Comprender las necesidades de estas madres permite el diseño de intervenciones en materia de salud que buscan promover su autonomía y empoderamiento para el cuidado de su salud, proporcionando un práctico, dirigido a la rehabilitación y la promoción de la salud

Cetuximab concomitant with gemcitabine and radiotherapy in advanced squamous cell carcinomas of upper aerodigestive tract: a pilot study.

PURPOSE: To explore the response and toxicity of advanced non-metastatic squamous cell carcinomas of upper aerodigestive tract (SCC-UADT) to a combination of cetuximab concomitant with gemcitabine and radiotherapy. METHODS: We managed patients with concomitant treatment of cetuximab (400 mg/m(2) as uploading dose, then 250 mg/m(2), IV) concomitant with gemcitabine (50 mg/m(2)) weekly for seven courses, and radiotherapy in classical fractionation until completion of 70 Gy. Primary endpoints were complete response (CR) to treatment and toxicity. We evaluated patients for toxicity on a weekly basis; evaluation of response included physical examination, endoscopy, computed tomography (CT) scan and biopsy when indicated, and was performed 6 weeks after completion of radiotherapy. Additional evaluations were done every 3 months to document disease status. Between November 2004 and November 2005, 20 patients were included. RESULTS: CR was 82.4%, overall response was 100%. Neck disease reached CR in 61.5% and partial in 38.5% of patients. The main toxicities were nausea, lymphopenia, neutropenia and mucositis. Grade 3 and 4 side effects were presented in 70.6% of patients, but mucositis, and lymphopenia without clinical repercussions, occurred in 88.2% of patients. Gastrostomy was required in 11.8% of patients to maintain nutrition. Radioepithelitis developed in 76.5%, but only three of these (23.1%) were grade III. Median overall survival was 53 months (range 6-55 months) and median progression-free survival has not yet been reached at the time of evaluation. CONCLUSIONS: Although toxicity is important, this approach has interesting activity and deserves further investigation.

Perfil das mulheres portadoras de sífilis gestacional em Santa Catarina no ano de 2012 / Profile of the women with syphilis gestational in the state of Santa Catarina in 2012

Determinar o perfil das mulheres portadoras de Sífilis Gestacional em Santa Catarina no ano de 2012. Trata-se de estudo de delineamento ecológico caracterizado por abordagem quantitativa a partir de pesquisa junto à base de dado SINAN ­ Sistema Nacional de Agravos e Notificações - dos casos notificados por sífilis gestacional no Estado de Santa Catarina, por nove macrorregiões de saúde, determinadas pela Secretaria de Estado de Saúde de Santa Catarina. Ao todo, 328 casos de sífilis gestacional foram notificados no ano de 2012. Observou-se o diagnóstico de sífilis secundária em 42% das gestantes. No que se refere à triagem pré-natal (VDRL), verificou-se que 95% das sorologias positivas foram identificadas logo no primeiro teste, contudo após a realização do teste confirmatório constatou-se um valor de 51% positivos. A conduta terapêutica preferencialmente usada foi Penicilina G Benzatina 7.200.000UI (43%) para as gestantes e apenas 37% dos parceiros foram submetidos ao tratamento. A taxa de incidência de sífilis em Santa Catarina foi de 5,14 casos por 100.000. Constatouse de maneira indireta um aumento na incidência dos casos de sífilis gestacional com um perfil de acometimento mais relacionado a mulheres jovens acima de 20 anos em idade fértil, brancas e de baixa escolaridade.

The aim of this study is to determine the profile of the women with gestational syphilis in Santa Catarina in 2012. This is an ecological study characterized by quantitative approach from the SINAN survey database ­ (National System of Diseases and Notifications) ­ from the reported cases by gestational syphilis in the state of Santa Catarina, in nine health macro-regions, determined by the State health Department of Santa Catarina. Altogether, 328 cases of gestational syphilis were reported in 2012. Secondary syphilis diagnoses were observed in 42% of the pregnant women. About prenatal selection (VDRL), it was found that 95% of the positive serology were quickly identified in the first test, however after confirmatory test was performed, it showed a value of 51% positive cases. The therapeutic approach used was preferably Penicillin G Benzathine 7.200.000UI (43%) for pregnant women and only 37% of the partners underwent treatment. The syphilis incidence rate in Santa Catarina was 5.14 cases per 100,000. It was indirectly found an increase in the incidence of gestational syphilis with involvement profile more related to young women over 20 years old within childbearing age, white and low education.

Diagnóstico nutricional e crescimento de lactentes filhos de mães que fizeram o uso de cocaína e/ou crack durante o período gestacional / Nutricional diagnosis and growth of infants born to mothers who used cocaine and/or crack during pregnancy

Introdução: o uso de cocaína e/ou crack durante o período gestacional implica em alterações orgânicas e variabilidade nos dados antropométricos da criança. Ainda são escassos estudos sobre a relação entre o uso de cocaína e/ou crack durante a gestação e o crescimento infantil. Objetivos: sintetizar estudos sobre crescimento pôndero- estatural e descrever o diagnóstico nutricional de lactentes (crianças de 0 a 1 ano), filhos de mulheres que usaram cocaína e/ou crack durante o período gestacional. Método: foram realizados revisão integrativa e estudo epidemiológico observacional descritivo de abordagem quantitativa, apresentados em dois artigos. A revisão buscou estudos com medidas de peso, estatura e/ou perímetro cefálico, até o primeiro ano de vida, nas bases Scopus, Cinahl, Embase, Web of Science e PsycNET e nos portais Pubmed e BVS, que respondessem à pergunta: Como ocorre o crescimento pôndero-estatural de lactentes cujas mães fizeram uso de cocaína e/ou crack durante o período gestacional?. O estudo de campo usou dados de prontuários, do período de 2013 a 2017, em um ambulatório de seguimento neonatal e infantil em Curitiba (PR), sendo variáveis dependentes peso, comprimento e perímetro cefálico, e variáveis independentes dados do pré-natal, do parto, do nascimento e do período pós-natal. A análise dos dados utilizou os programas Antrho®, para crianças a termo, e Intergrowth-21®, para prematuros, construindo os diagnósticos nutricionais de peso para idade, comprimento para idade, perímetro cefálico para idade e peso por comprimento. O projeto teve aprovação dos Comitês de Ética em Pesquisa (CAEE 99594818.7.0000. 5392 e CAEE 99594818.7.3001.0096). Resultados: o estudo de revisão incluiu 7 estudos, publicados entre 1992 e 2011, nos EUA. Os lactentes expostos apresentaram valores menores nas medidas de crescimento, quando comparados aos de grupo controle. As diferenças foram mais expressivas ao nascimento, tendendo à aproximação com o passar dos meses. No estudo de campo, a amostra foi composta por 94 crianças, com dados do nascimento, decrescendo nas mensurações seguintes, havendo apenas 17 com dados no final do primeiro ano. Eram filhas de mulheres brancas (48,9%), com baixa escolaridade (34,0% fundamental incompleto; 11,7% fundamental completo; 15,9% ensino médio incompleto); maioria com uso de crack (68,0%) e cocaína (39,4%). O número médio de consultas de pré-natal foi de 5,6, idade gestacional média de 37,65 semanas, peso de 2.724 g, comprimento de 46,74 cm e perímetro cefálico de 32,84 cm. Quanto ao diagnóstico nutricional, no grupo avaliado pelo Intergrowth-21®, uma parcela dos lactentes apresentou perímetro cefálico elevado nas primeiras medições, com aumento na última medida e demais parâmetros com diagnósticos adequados no nascimento e fim do primeiro ano. No grupo avaliado pelo Anthro®, a maior parte da amostra apresentou valores adequados de perímetro cefálico, comprimento e peso conforme a idade, no nascimento e na última medida. O total de perdas de seguimento nos dois grupos foi de 34 lactentes. Conclusão: segundo a literatura, o uso de cocaína/crack durante o período gestacional proporciona desfechos de crescimento pôndero-estatural diferentes, quando comparado a não expostos, ocorrendo catch-up entre o sexto e o décimo segundo meses de vida. No estudo epidemiológico, houve grande número de perdas de seguimento, demandando estudos mais robustos para a compreensão do fenômeno.

Introduction: The use of cocaine and / or crack during the gestational period implies organic alterations and variability in the anthropometric data of the child. There are still few studies on the relationship between cocaine use and/or crack during pregnancy and child growth. Objectives: To synthesize studies on weight and height growth and to describe the nutritional diagnosis of infants (children 0 to 1 year old), children of women who used cocaine and/or crack during the gestational period. Method: an integrative review and descriptive observational epidemiological study of quantitative approach were performed, presented in two articles. The review sought studies with measures of weight, height and / or head circumference, up to the first year of life, in the Scopus, Cinahl, Embase, Web of Science and PsycNET databases, and in the Pubmed and BVS portals, which answered the question: How is there weight and height growth in infants whose mothers used cocaine and / or crack during pregnancy? . The field study used data from medical records, from 2013 to 2017, in a neonatal and child follow-up outpatient clinic in Curitiba (PR), with dependent variables weight, length and head circumference, and independent variables data from prenatal care. childbirth, birth and the postnatal period. Data analysis used Antrho® for term infants and Intergrowth-21® programs for preterm infants, building the nutritional diagnoses of weight for age, length for age, head circumference for age and weight for length. The project was approved by the Research Ethics Committees (CAEE 99594818.7.0000. 5392 and CAEE 99594818.7.3001.0096). Results: The review study included 7 studies, published between 1992 and 2011, in the USA. The exposed infants had lower values in the growth measures when compared to the control group. The differences were more expressive at birth, tending to approach over the months. In the field study, the sample consisted of 94 children with birth data, decreasing in the following measurements, with only 17 with data at the end of the first year. They were daughters of white women (48.9%), with low education (34.0% incomplete elementary school; 11.7% complete elementary school; 15.9% incomplete high school); most with crack (68.0%) and cocaine (39.4%). The average number of prenatal visits was 5.6, average gestational age 37.65 weeks, weight 2,724 g, length 46.74 cm and head circumference 32.84 cm. Regarding nutritional diagnosis, in the group assessed by Intergrowth-21®, a portion of infants had a high head circumference at the first measurements, with an increase in the last measurement and other parameters with adequate diagnoses at birth and at the end of the first year. In the group evaluated by Anthro®, most of the sample had adequate values of head circumference, length and weight according to age, birth and last measurement. Total follow-up losses in both groups were 34 infants. Conclusion: According to the literature, the use of cocaine/crack during gestational period provides different height and height when compared to not exposed, with catch-up occurring between the sixth and twelfth months of life. In the epidemiological study, there was a large number of follow-up losses, requiring more robust studies to understand the phenomenon.