A user evaluation of speech/phrase recognition software in critically ill patients: a DECIDE-AI feasibility study.

OBJECTIVES: Evaluating effectiveness of speech/phrase recognition software in critically ill patients with speech impairments. DESIGN: Prospective study. SETTING: Tertiary hospital critical care unit in the northwest of England. PARTICIPANTS: 14 patients with tracheostomies, 3 female and 11 male. MAIN OUTCOME MEASURES: Evaluation of dynamic time warping (DTW) and deep neural networks (DNN) methods in a speech/phrase recognition application. Using speech/phrase recognition app for voice impaired (SRAVI), patients attempted mouthing various supported phrases with recordings evaluated by both DNN and DTW processing methods. Then, a trio of potential recognition phrases was displayed on the screen, ranked from first to third in order of likelihood. RESULTS: A total of 616 patient recordings were taken with 516 phrase identifiable recordings. The overall results revealed a total recognition accuracy across all three ranks of 86% using the DNN method. The rank 1 recognition accuracy of the DNN method was 75%. The DTW method had a total recognition accuracy of 74%, with a rank 1 accuracy of 48%. CONCLUSION: This feasibility evaluation of a novel speech/phrase recognition app using SRAVI demonstrated a good correlation between spoken phrases and app recognition. This suggests that speech/phrase recognition technology could be a therapeutic option to bridge the gap in communication in critically ill patients. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC: Communication can be attempted using visual charts, eye gaze boards, alphabet boards, speech/phrase reading, gestures and speaking valves in critically ill patients with speech impairments. WHAT THIS STUDY ADDS: Deep neural networks and dynamic time warping methods can be used to analyse lip movements and identify intended phrases. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE AND POLICY: Our study shows that speech/phrase recognition software has a role to play in bridging the communication gap in speech impairment.

Oxygen-participated electrochemistry of new lithium-rich layered oxides Li3MRuO5 (M = Mn, Fe).

We describe the synthesis, crystal structure and lithium deinsertion-insertion electrochemistry of two new lithium-rich layered oxides, Li3MRuO5 (M = Mn, Fe), related to rock salt based Li2MnO3 and LiCoO2. The Li3MnRuO5 oxide adopts a structure related to Li2MnO3 (C2/m) where Li and (Li0.2Mn0.4Ru0.4) layers alternate along the c-axis, while the Li3FeRuO5 oxide adopts a near-perfect LiCoO2 (R3[combining macron]m) structure where Li and (Li0.2Fe0.4Ru0.4) layers are stacked alternately. Magnetic measurements indicate for Li3MnRuO5 the presence of Mn(3+) and low spin configuration for Ru(4+) where the itinerant electrons occupy a π*-band. The onset of a net maximum in the χ vs. T plot at 9.5 K and the negative value of the Weiss constant (θ) of -31.4 K indicate the presence of antiferromagnetic superexchange interactions according to different pathways. Lithium electrochemistry shows a similar behaviour for both oxides and related to the typical behaviour of Li-rich layered oxides where participation of oxide ions in the electrochemical processes is usually found. A long first charge process with capacities of 240 mA h g(-1) (2.3 Li per f.u.) and 144 mA h g(-1) (1.38 Li per f.u.) is observed for Li3MnRuO5 and Li3FeRuO5, respectively. An initial sloping region (OCV to ca. 4.1 V) is followed by a long plateau (ca. 4.3 V). Further discharge-charge cycling points to partial reversibility (ca. 160 mA h g(-1) and 45 mA h g(-1) for Mn and Fe, respectively). Nevertheless, just after a few cycles, cell failure is observed. X-ray photoelectron spectroscopy (XPS) characterisation of both pristine and electrochemically oxidized Li3MRuO5 reveals that in the Li3MnRuO5 oxide, Mn(3+) and Ru(4+) are partially oxidized to Mn(4+) and Ru(5+) in the sloping region at low voltage, while in the long plateau, O(2-) is also oxidized. Oxygen release likely occurs which may be the cause for failure of cells upon cycling. Interestingly, some other Li-rich layered oxides have been reported to cycle acceptably even with the participation of the O(2-) ligand in the reversible redox processes. In the Li3FeRuO5 oxide, the oxidation process appears to affect only Ru (4+ to 5+ in the sloping region) and O(2-) (plateau) while Fe seems to retain its 3+ state.

The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients.

Sleep deprivation is common among intensive care patients and may be associated with delirium. We investigated whether the implementation of a bundle of non-pharmacological interventions, consisting of environmental noise and light reduction designed to reduce disturbing patients during the night, was associated with improved sleep and a reduced incidence of delirium. The study was divided into two parts, before and after changing our practice. One hundred and sixty-seven and 171 patients were screened for delirium pre- and post-intervention, respectively. Compliance with the interventions was > 90%. The bundle of interventions led to an increased mean (SD) sleep efficiency index (60.8 (3.5) before vs 75.9 (2.2) after, p = 0.031); reduced mean sound (68.8 (4.2) dB before vs 61.8 (9.1) dB after, p = 0.002) and light levels (594 (88.2) lux before vs 301 (53.5) lux after, p = 0.003); and reduced number of awakenings caused by care activities overnight (11.0 (1.1) before vs 9.0 (1.2) after, p = 0.003). In addition, the introduction of the care bundle led to a reduced incidence of delirium (55/167 (33%) before vs 24/171 (14%) after, p < 0.001), and less time spent in delirium (3.4 (1.4) days before vs 1.2 (0.9) days after, p = 0.021). Increases in sleep efficiency index were associated with a lower odds ratio of developing delirium (OR 0.90, 95% CI 0.84-0.97). The introduction of an environmental noise and light reduction programme as a bundle of non-pharmacological interventions in the intensive care unit was effective in reducing sleep deprivation and delirium, and we propose a similar programme should be implemented more widely.

Selection of efficient degradation features for rolling element bearing prognosis using Gaussian Process Regression method.

Rolling Element Bearings are one of the most ubiquitous machine elements used in various machineries in the manufacturing industry. Prognosis and estimation of residual life of rolling element bearing are very important for efficient implementation of health monitoring and condition-based maintenance. In this paper, a rolling element bearing fault or degradation trend prediction is modeled using Gaussian Process Regression (GPR) method. Various vibration features based on signal complexity, namely Shannon entropy, permutation entropy, and approximate entropy are estimated to obtain the bearing degradation trend. When fault or degradation occurs in rolling element bearing, there is a subtle change in the dynamics of the system and subsequently, there are changes in the features extracted from the vibration signal. In this paper, a comparative analysis of various kernel functions of the GPR model is carried out using accuracy-based metrics. In addition, the combination of goodness of metric (monotonicity (Mon), robustness (Rob), and prognosability (Pro)), namely hybrid metric, is proposed to select the efficient bearing degradation trend of features. Further, the GPR at ARD exponential kernel has been employed to make the prognosis of degradation trend in bearings with a 95% confidence interval (CI). The proposed methodology is validated through a mathematical model of the simulated vibration signal. Finally, from the simulated and experimental data, it is demonstrated that the entropy features have better performance than the statistical features.

Proximate ferromagnetic state in the Kitaev model material α-RuCl3.

α-RuCl3 is a major candidate for the realization of the Kitaev quantum spin liquid, but its zigzag antiferromagnetic order at low temperatures indicates deviations from the Kitaev model. We have quantified the spin Hamiltonian of α-RuCl3 by a resonant inelastic x-ray scattering study at the Ru L3 absorption edge. In the paramagnetic state, the quasi-elastic intensity of magnetic excitations has a broad maximum around the zone center without any local maxima at the zigzag magnetic Bragg wavevectors. This finding implies that the zigzag order is fragile and readily destabilized by competing ferromagnetic correlations. The classical ground state of the experimentally determined Hamiltonian is actually ferromagnetic. The zigzag state is stabilized by quantum fluctuations, leaving ferromagnetism - along with the Kitaev spin liquid - as energetically proximate metastable states. The three closely competing states and their collective excitations hold the key to the theoretical understanding of the unusual properties of α-RuCl3 in magnetic fields.

Synthesis of thermally stable mesoporous cerium oxide with nanocrystalline frameworks using mesoporous silica templates.

Highly ordered mesoporous cerium oxides, composed of nanocrystalline pore walls and exhibiting high thermal stability even at 973 K, were synthesized using mesoporous silica templates with hexagonal p6mm and cubic Ia3d symmetries.

Color removal in groundwater through the enhanced softening process.

The source of water for Miami-Dade County, Florida is groundwater derived from the Biscayne aquifer. The raw water is rich in natural organic material producing correspondingly high color levels. Currently, breakpoint chlorination is used at the water treatment plant to control the color problem. However, this results in the formation of disinfection by-products. Proposed alternatives to reduce color and avoid by-product formation include the addition of coagulants such as ferric chloride and organic polymers, and the operation of the existing lime softening process at a higher pH. This study uses jar tests to evaluate the relative effectiveness of the proposed alternatives. Results indicate that significant color reduction is achieved using the existing lime softening process with activated silica coagulant by increasing the softening pH to 11 or more. Elevated pH also produced a > 30% reduction in total organic carbon. In the presence of higher raw water color (> or = 80 units), the addition of ferric chloride as coagulant at dosages of 80 mg/L is recommended.

Water purification systems: a comparative analysis based on the occurrence of disinfection by-products.

Trihalomethanes (THMs) are halogenated hydrocarbons, and are by-products of the chlorination of drinking water. Most THMs are formed in drinking water when chlorine reacts with naturally occurring organic substances such as decomposing plant and animal materials. Risks for certain types of cancer are now being correlated with the presence of disinfection by-products (DBPs). The present research uses gas chromatography to analyze the presence and levels of THMs in drinking water samples from a variety of sources. These include (1) municipal drinking water from two south Florida counties; (2) two brands of bottled water; (3) untreated residential well water; and (4) municipal tap water passed through additional water purification systems. The results are summarized in a tabular format, and the compliance of each water with existing US EPA-mandated standards is examined. General conclusions from this study are that all the waters tested complied with federal regulations regarding THM levels, properly functioning home filtration units may be quite effective in further reducing DBP concentrations and, as expected, non-chlorinated waters such as bottled water and residential well water contain lower THM levels.

Information Management System for Site Remediation Efforts.

/ Environmental regulatory agencies are responsible for protecting human health and the environment in their constituencies. Their responsibilities include the identification, evaluation, and cleanup of contaminated sites. Leaking underground storage tanks (USTs) constitute a major source of subsurface and groundwater contamination. A significant portion of a regulatory body's efforts may be directed toward the management of UST-contaminated sites. In order to manage remedial sites effectively, vast quantities of information must be maintained, including analytical dataon chemical contaminants, remedial design features, and performance details. Currently, most regulatory agencies maintain such information manually. This makes it difficult to manage the data effectively. Some agencies have introduced automated record-keeping systems. However, the ad hoc approach in these endeavors makes it difficult to efficiently analyze, disseminate, and utilize the data. This paper identifies the information requirements for UST-contaminated site management at the Waste Cleanup Section of the Department of Environmental Resources Management in Dade County, Florida. It presents a viable design for an information management system to meet these requirements. The proposed solution is based on a back-end relational database management system with relevant tools for sophisticated data analysis and data mining. The database is designed with all tables in the third normal form to ensure data integrity, flexible access, and efficient query processing. In addition to all standard reports required by the agency, the system provides answers to ad hoc queries that are typically difficult to answer under the existing system. The database also serves as a repository of information for a decision support system to aid engineering design and risk analysis. The system may be integrated with a geographic information system for effective presentation and dissemination of spatial data.

An educational and audit tool to reduce prescribing error in intensive care.

AIM: To reduce prescribing errors in an intensive care unit by providing prescriber education in tutorials, ward-based teaching and feedback in 3-monthly cycles with each new group of trainee medical staff. METHODS: Prescribing audits were conducted three times in each 3-month cycle, once pretraining, once post-training and a final audit after 6 weeks. The audit information was fed back to prescribers with their correct prescribing rates, rates for individual error types and total error rates together with anonymised information about other prescribers' error rates. RESULTS: The percentage of prescriptions with errors decreased over each 3-month cycle (pretraining 25%, 19%, (one missing data point), post-training 23%, 6%, 11%, final audit 7%, 3%, 5% (p<0.0005)). The total number of prescriptions and error rates varied widely between trainees (data collection one; cycle two: range of prescriptions written: 1-61, median 18; error rate: 0-100%; median: 15%). CONCLUSION: Prescriber education and feedback reduce manual prescribing errors in intensive care.

Experimental realization of an exact solution to the Vlasov equations for an expanding plasma.

We study the expansion of ultracold neutral plasmas in the regime in which inelastic collisions are negligible. The plasma expands due to the thermal pressure of the electrons, and for an initial spherically symmetric Gaussian density profile, the expansion is self-similar. Measurements of the plasma size and ion kinetic energy using fluorescence imaging and spectroscopy show that the expansion follows an analytic solution of the Vlasov equations for an adiabatically expanding plasma.

Electron-temperature evolution in expanding ultracold neutral plasmas.

We have used the free expansion of ultracold neutral plasmas as a time-resolved probe of electron temperature. A combination of experimental measurements of the ion expansion velocity and numerical simulations characterize the crossover from an elastic-collision regime at low initial Gamma(e), which is dominated by adiabatic cooling of the electrons, to the regime of high Gamma(e) in which inelastic processes drastically heat the electrons. We identify the time scales and relative contributions of various processes, and we experimentally show the importance of radiative decay and disorder-induced electron heating for the first time in ultracold neutral plasmas.

Effects of surfactant addition on the biomineralization and microbial toxicity of phenanthrene.

Surfactants are known to increase the apparent aqueous solubility of polycyclic aromatic hydrocarbons and may thereby enhance their bioavailability. In this study the effects of four surfactants on the mineralization of phenanthrene by Pseudomonas aeruginosa in liquid culture and in soil-water suspensions was studied in batch reactors over a 15-week study period. In the absence of surfactant, liquid cultures mineralized approximately 50% of the phenanthrene added within seven weeks following a one-week lag period and an initial mineralization rate of 0.04 mg/d. Mineralization in soil-water suspensions proceeded without any measurable lag period. The initial mineralization rate was lower (0.006 mg/d), but mineralization continued to >70% over the fifteen week period. In general, the addition of very low concentrations of surfactant (<0.001%) to liquid cultures did not impact mineralization significantly. At higher surfactant concentrations (>CMC) all surfactants were seen to be inhibitory. In soil-water systems, the rate of phenanthrene mineralization was decreased even at surfactant doses that did not produce significant solubilization. In summary, none of the surfactants enhanced the mineralization of phenanthrene by P. aeruginosa in liquid culture or in soil-water suspensions. In order to rank surfactant toxicity, microbial toxicity tests were performed measuring the light output of bioluminescent bacteria as affected by the presence of surfactants. Additional toxicity testing indicated that the presence of solubilized phenanthrene increased the toxicity of the surfactant by a 100-fold suggesting that the toxicity of solubilized substrate needs also to be considered in the application of surfactant-amended remediation.

Effects of nonionic surfactants on the solubilization and mineralization of phenanthrene in soil-water systems.

The solubilization and mineralization of (14)C-phenanthrene in soil-water systems was examined with several commercially available surface-active agents, viz., an alkyl ethoxylate C(12)E(4); two alkylphenol ethoxylate surfactants: C(8)PE(9.5) and C(9)PE(10.5); two sorbitan ethoxylate surfactants: the sorbitan monolaurate (Tween 20) and the sorbitan monooleate (Tween 80); two pairs of nonionic ethoxylate surfactant mixtures: C(12)E(4)/C(12)E(23) at a 1:1 ratio, and C(12-15)E(3)/C(12-15)E(9) at a 1:3 ratio; and two surfactants possessing relatively high critical micelle concentration (CMC) values and low aggregation numbers: CHAPS and octyglucoside. Surface tension experiments were performed to evaluate surfactant sorption onto soil and the surfactant doses required to attain the CMC in the soil-water systems. Surfactant solubilization of (14)C-phenanthrene commenced with the onset of micellization. The addition of surface-active agents was observed not to be beneficial to the microbial mineralization of phenanthrene in the soil-water systems and, for supra-CMC surfactant doses, phenanthrene mineralization was completely inhibited for all the surfactants tested. A comparison of solubilization, surface tension, and mineralization data confirms that the inhibitory effect on microbial degradation of phenanthrene is related to the CMC of the surfactant in the presence of soil. Additional tests demonstrated the recovery of mineralization upon dilution of surfactant concentration to sub-CMC levels, and a relatively high exit rate for phenanthrene from micelles. These tests suggest that the inhibitory effect is probably related to a reversible physiological surfactant micelle-bacteria interaction, possibly through partial complexing or release of membrane material with disrupting membrane lamellar structure. This study indicates that nonionic surfactant solubilization of sorbed hydrophobic organic compounds from soil may not be beneficial for the concomitant enhancement of soil bioremediation. Additional work is needed to address physicochemical processes for bioavailability enhancement, and effects of solubilizing agents on microorganisms for remediation and treatment of hydrophobic organic compounds and nonaqueous phase liquids.

Biodegradation of 4-nitrophenol by indigenous microbial populations in Everglades soils.

The Everglades in South Florida are a unique ecological system. As a result of the widespread use of pesticides and herbicides in agricultural areas upstream from these wetlands, there is a serious potential for pollution problems in the Everglades. The purpose of this study was to evaluate the ability of indigenous microbial populations to degrade xenobiotic organic compounds introduced by agricultural and other activities. Such biodegradation may facilitate the remediation of contaminated soils and water in the Everglades. The model compound selected in this study is 4-nitrophenol, a chemical commonly used in the manufacture of pesticides. The mineralization of 4-nitrophenol at various concentrations was studied in soils collected from the Everglades. At concentrations of 10 and 100 microg/g soil, considerable mineralization occurred within a week. At a higher concentration, i.e., 10 mg/g soil, however, no mineralization of 4-nitrophenol occurred over a 4-month period; such a high concentration apparently produced an inhibitory effect. The rate and extent of 4-nitrophenol mineralization was enhanced on inoculation with previously isolated nitrophenol-degrading microorganisms. The maximum mineralization extent measured, however, was less than 30% suggesting conversion to biomass and/or unidentified intermediate products. These results indicate the potential for natural mechanisms to mitigate the adverse effects of xenobiotic pollutants in a complex system such as the Everglades.

Mutations in the p53 gene are not limited to classic 'hot spots' and are not predictive of p53 protein expression in high-grade non-Hodgkin's lymphoma.

We have investigated the relationship between the p53 genotype and phenotype in a series of 22 high-grade non-Hodgkin's lymphomas (NHLs) in which we sequenced the p53 gene open reading frame (exons 2-11). Immunostaining for p53 was already available for these cases. Mutations were found in 10/22 cases (45%) and 3/10 were in exons 4 or 10 outside the classic 'hot spot' regions (exons 5-8). Comparison with immunostaining indicated that, besides cases with the 'expected' patterns (in which gene mutation and protein detection were either both present or both absent) there were also cases in which p53 protein was detected in the absence of any mutation and those with a mutant gene in which the protein was undetectable. These data show that: (1) in high-grade NHLs mutations frequently occur outside the classic hot spot regions and (2) staining for p53 is not predictive of the status of the gene, i.e. whether or not a mutation is present. Therefore in order to document p53 involvement in lymphoid tumours it is necessary both to sequence at least the whole translated open reading frame of the gene and to show evidence of protein expression by immunostaining.

Using absorption imaging to study ion dynamics in an ultracold neutral plasma.

We report optical absorption imaging of ultracold neutral strontium plasmas. The ion absorption spectrum determined from the images is Doppler broadened and thus provides a quantitative measure of the ion kinetic energy. For the particular plasma conditions studied, ions heat rapidly as they equilibrate during the first 250 ns after plasma formation. Equilibration leaves ions on the border between the weakly coupled gaseous and strongly coupled liquid states. On a longer time scale of microseconds, pressure exerted by the trapped electron gas accelerates the ions radially.

Electron screening and kinetic-energy oscillations in a strongly coupled plasma.

We study equilibration of strongly coupled ions in an ultracold neutral plasma produced by photoionizing laser-cooled and trapped atoms. By varying the electron temperature, we show that electron screening modifies the equilibrium ion temperature. Even with few electrons in a Debye sphere, the screening is well described by a model using a Yukawa ion-ion potential. We also observe damped oscillations of the ion kinetic energy that are a unique feature of equilibration of a strongly coupled plasma.