Predicting future medical needs and mortality risk in geriatric long-term care patients : Development and validation of the Nascher score and revised Nascher score.

BACKGROUND: Choosing the right intensity of medical care is a huge challenge particularly in long-term geriatric care. The Nascher score was developed to assess future medical care needs. The aim of this study was to determine whether the Nascher score and a revised version can predict future medical needs. METHODS: In this retrospective cohort study, 396 residents in long-term care hospitals, who were admitted over a period of two years and followed up to two and a half yeare, were analysed. Outcome parameters were: (1) number of medication changes, (2) number of ward doctor documentations and (3) number of acute illnesses treated with antibiotics, and mortality risk. Based on the first results, an alternative scoring of the Nascher score with 12 instead of 26 items was developed, called the revised Nascher score. RESULTS: The Nascher score significantly correlated with the number of medication changes, the number of ward doctor documentations, and the number of acute ilnesses treated with antibiotics with Spearman correlation coefficients of 0.30, 0.26, and 0.15, respectively. The revised Nascher score showed a higher correlation with correlation coefficients of 0.36, 0.26, and 0.21, respectively. Residents with a Nascher score in the highest quartile had a significantly higher mortality risk than residents in the lowest quartile (hazard ratio, HR 2.97, 95% confidence interval, CI 1.80-4.34). The corresponding values for the revised Nascher score were HR 3.03, 95% CI 2.03-4.54 in the highest and HR 1.80, 95% CI 1.24-2.60 in the middle quartiles. CONCLUSION: The Nascher score and even more so the revised Nascher score are well suited to predicting the various parameters of future medical needs and mortality risk.

Context effects in cognitive effort evaluation.

When given a choice, people will avoid cognitively effortful courses of action because the experience of effort is evaluated as aversive and costly. At the same time, a body of work spanning psychology, economics, and neuroscience suggests that goods, actions, and experiences are often evaluated in the context in which they are encountered, rather in absolute terms. To probe the extent to which the evaluation of cognitive effort is also context-dependent, we had participants learn associations between unique stimuli and subjective demand levels across low-demand and high-demand contexts. We probed demand preferences and subjective evaluation using a forced-choice paradigm as well by examining effort ratings, taken both on-line (during learning) and off-line (after choice). When choosing between two stimuli objectively identical in terms of demand, participants showed a clear preference for the stimulus learned in the low- versus high-demand context and rated this stimulus as more subjectively effortful than the low-demand context in on-line but not off-line ratings, suggesting an assimilation effect. Finally, we observed that the extent to which individual participants who exhibited stronger assimilation effects in off-line demand ratings were more likely to manifest an assimilation effect in demand preferences. Broadly, our findings suggest that effort evaluations occur in a context-dependent manner and are specifically assimilated to the broader context in which they occur.

The burdens and benefits of managing and engaging: a diary study approach to person-centred risk assessment of top executives and works council members.

The present diary study investigates the impact of daily effort-reward imbalance (ERI), subjective stress and the cortisol awakening response (CAR) as an objective measure on work engagement of top managers and high-level works council members (N = 45) on three consecutive working days. In the scope of psychosocial risk assessment, we argue that focusing on ERI as a generalized work characteristic might be more suitable for work re-design of higher leadership positions because of their highly dynamic and unpredictable psychosocial work characteristics, while at the same time having more access to job resources. The analyses reveal that both baseline and daily ERI, as well as subjective stress, influence work engagement. Our results suggest that interventions to reduce daily levels of ERI may improve the work environment of top managers and works councils by promoting work engagement and related positive health outcomes in the scope of person-centred risk assessment.

Influences of noise reduction on speech intelligibility, listening effort, and sound quality among adults with severe to profound hearing loss.

Introduction: Noise reduction (NR) algorithms have been integrated into modern digital hearing aids to reduce noise annoyance and enhance speech intelligibility. This study aimed to evaluate the influences of a novel hearing aid NR algorithm on individuals with severe-to-profound hearing loss. Methods: Twenty-five participants with severe-to-profound bilateral sensorineural hearing loss underwent three tests (speech intelligibility, listening effort, and subjective sound quality in noise) to investigate the influences of NR. All three tests were performed under three NR strength levels (Off, Moderate, and Strong) for both speech in noise program (SpiN) and speech in loud noise program (SpiLN), comprising six different hearing aid conditions. Results: NR activation significantly reduced listening effort. Subjective sound quality assessments also exhibited benefits of activated NR in terms of noise suppression, listening comfort, satisfaction, and speech clarity. Discussion: Individuals with severe-to-profound hearing loss still experienced advantages from NR technology in both listening effort measure and subjective sound quality assessments. Importantly, these benefits did not adversely affect speech intelligibility.

Teacher support and its impact on ESL student engagement in blended learning: The mediating effects of L2 grit and intended effort.

BACKGROUND: In the shifting paradigm of English as a Foreign Language (EFL) instruction, blended learning has become increasingly prevalent, necessitating understanding factors that drive student engagement. The research delves into the intricate interaction between teacher support and student engagement, postulating that L2 grit and intended effort function as mediators within this dynamic. METHODS: We employed a cross-sectional design involving a sample of 712 EFL students engaged in blended learning courses. Through quantitative analysis, we measured the constructs of teacher support, L2 grit, intended effort, and student engagement with validated scales. Structural Equation Modeling (SEM) was applied to investigate the relationships between these variables and to test the hypothesized mediation effects. RESULTS: The results demonstrated that teacher support correlated with higher levels of student engagement. L2 grit and intended effort were identified as significant mediators in this relationship. L2 grit acted as a bridge between teacher support and student engagement, reflecting the essential role of perseverance and passion for long-term language learning objectives. Intended effort further mediated this relationship, indicating that supportive teacher behaviors foster greater student effort, enhancing overall engagement. The study also revealed a chain mediation effect, suggesting that teacher support sequentially enhances L2 grit, which in turn increases intended effort, cumulatively leading to improved student engagement. CONCLUSION: The findings offer evidence of the central role of teacher support in bolstering student engagement through the development of L2 grit and the enhancement of intended effort. This paper underlines the necessity of a supportive learning environment in blended EFL settings and presents a novel sequential mediation framework that can guide educators, curriculum designers, and policymakers in creating more effective learning experiences.

Correlation analysis of occupational stress and metabolic syndrome among employees of a power grid enterprise in China.

BACKGROUND: Being in a state of high occupational stress may disrupt the metabolic balance of the body, thus increasing the risk of metabolic diseases. However, the evidence about the relationship between occupational stress and metabolic syndrome was limited. OBJECTIVES: To explore the association between occupational stress and metabolic syndrome (MetS) in employees of a power grid enterprise. METHODS: A total of 1091 employees were recruited from a power grid enterprise in China. Excluding those who failed to complete the questionnaire and those who had incomplete health check-ups, 945 subjects were included in the study. Assessment of occupational stress was used by job demand-control (JDC) and effort-reward imbalance (ERI) questionnaires, respectively. The information on body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were collected. The levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood glucose (FBG) in the fasting venous blood samples were measured. Logistic regression analysis and multiple linear regression methods were used to analyze the correlation between JDC and ERI models of occupational stress, metabolic syndrome, and its components, respectively. RESULTS: The prevalence of MetS was 8.4% and 9.9% in JDC and ERI model high occupational stress employees, respectively. ERI model occupational stress and smoking are significantly associated with the risk of MetS. ERI ratio was significantly associated with lower HDL-C levels. Gender, age, marital status, smoking, high-temperature and high-altitude work were significantly associated with metabolic component levels. CONCLUSION: Our study revealed a high detection rate of occupational stress in both JDC and ERI models among employees of a power grid enterprise. ERI model occupational stress, demanding more attention, was associated with the risk of MetS as well as its components such as HDL-C.

Transcranial direct current stimulation enhances effort maintenance in ADHD.

BACKGROUND: Youth with attention-deficit/hyperactivity disorder (ADHD) exhibit increased effort aversion, likely due to deficits in anticipatory dopamine firing. Previous research has shown that transcranial direct current stimulation (tDCS) targeting the right prefrontal cortex can enhance activity in dopaminergic meso-striatal regions. However, the extent to which this specific tDCS configuration effectively modulates effort behavior in anticipation of rewards in ADHD remains uncertain. HYPOTHESIS: We expected an increase of effort maintenance and invigoration during and following our tDCS set-up compared to sham in subjects with ADHD. METHODS: Twenty-four children and adolescents with ADHD (mean age: 11.6 years; 95 % CI [10.7, 12.4]) received 2 mA and sham tDCS for 20 min each. The anode was positioned over the ventromedial prefrontal cortex (PFC), while the cathode was placed over the right dorsolateral PFC, generating an electrical field with maximal strength in the right PFC. During and after the tDCS sessions, participants performed a button-pressing task aimed at earning delayed monetary rewards. Primary outcomes were effort maintenance (frequency of button presses) and invigoration (slopes of button presses), measuring motor task performance. RESULTS: We observed a significant increase in effort maintenance both during (b = 2.66; p < 0.001) and after tDCS (b = 2.04; p= .007) compared to sham. No significant difference was found for invigoration during stimulation, while after bonferroni correction (p = 0.025) a non-significant decrease was found after tDCS compared to sham (b = -5.18; p = 0.041). CONCLUSION: tDCS targeting the ventromedial PFC (anodal) and right dorsolateral PFC (cathodal) increases effort maintenance in children and adolescents with ADHD.

Effortful retrieval of semantic memories induces forgetting of related negative and neutral episodic memories.

Retrieval-induced forgetting (RIF) experiments show that the act of retrieving some recently encoded items from a given conceptual category leads to greater forgetting of competing items from that same category. However, RIF studies using emotional stimuli have produced mixed results, perhaps due to the reinstatement of arousal or negative affect during retrieval practice. To induce forgetting of negative episodic memories more indirectly, we examined if retrieving neutral semantic memories leads to RIF of related negative memories. In two experiments, participants studied eight categorized lists comprised of an equal number of negative and neutral words (Experiment 1) or neutral words preceded by neutral or negative images (Experiment 2). To avoid re-exposing individuals to negative material during retrieval practice, participants then performed a semantic memory retrieval task in which they generated (i.e., completed word-stems for) new neutral words from half of the studied categories. We found that semantic retrieval, or word generation, induced forgetting of recently studied words irrespective of their emotional valence or original emotional context. Additionally, across both experiments, less successful word generation was associated with stronger RIF effects. In Experiment 2, the magnitude of RIF was also correlated with higher subjective ratings of retrieval effort during word generation. Together, these results suggest that even when retrieving neutral semantic memories, effortful retrieval may enhance inhibitory processes that lead to forgetting of both neutral and negative episodic memories.

The Impact of Hearing Aids on Listening Effort and Listening-Related Fatigue - Investigations in a Virtual Realistic Listening Environment.

Participation in complex listening situations such as group conversations in noisy environments sets high demands on the auditory system and on cognitive processing. Reports of hearing-impaired people indicate that strenuous listening situations occurring throughout the day lead to feelings of fatigue at the end of the day. The aim of the present study was to develop a suitable test sequence to evoke and measure listening effort (LE) and listening-related fatigue (LRF), and, to evaluate the influence of hearing aid use on both dimensions in mild to moderately hearing-impaired participants. The chosen approach aims to reconstruct a representative acoustic day (Time Compressed Acoustic Day [TCAD]) by means of an eight-part hearing-test sequence with a total duration of approximately 2½ h. For this purpose, the hearing test sequence combined four different listening tasks with five different acoustic scenarios and was presented to the 20 test subjects using virtual acoustics in an open field measurement in aided and unaided conditions. Besides subjective ratings of LE and LRF, behavioral measures (response accuracy, reaction times), and an attention test (d2-R) were performed prior to and after the TCAD. Furthermore, stress hormones were evaluated by taking salivary samples. Subjective ratings of LRF increased throughout the test sequence. This effect was observed to be higher when testing unaided. In three of the eight listening tests, the aided condition led to significantly faster reaction times/response accuracies than in the unaided condition. In the d2-R test, an interaction in processing speed between time (pre- vs. post-TCAD) and provision (unaided vs. aided) was found suggesting an influence of hearing aid provision on LRF. A comparison of the averaged subjective ratings at the beginning and end of the TCAD shows a significant increase in LRF for both conditions. At the end of the TCAD, subjective fatigue was significantly lower when wearing hearing aids. The analysis of stress hormones did not reveal significant effects.

El trabajo de fuerza muscular en la atención a adultos mayores con sarcopenia

El proceso de envejecimiento está marcado por el sedentarismo y la escasa actividad física, lo que se asocia a la disminución rápida y continua de las capacidades funcionales, la dependencia y la fragilidad. El objetivo del trabajo se orienta a valorar, mediante el test de repeticiones máximas con pesos no extremos, el efecto de la aplicación de ejercicios con pesas para la atención de la sarcopenia. Se aplicaron métodos de los niveles teóricos y empíricos como el analítico, sintético, inductivo, deductivo, revisión documental, análisis documental, observación, encuesta y entrevista. Se aplicó, como instrumento de trabajo, una batería de ejercicios físicos de resistencia a la fuerza, y aeróbicos que permitieron utilizar el método de medición en siete adultos mayores con sarcopenia, atendidos en el Centro de Actividad Física y Salud de la Universidad de las Ciencias de la Cultura Física y Deportes ¨ Manuel Fajardo. Se evaluó el trabajo de fuerza muscular mediante el test mencionado, lo que permitió identificar el peso real de la carga física con la que deben entrenar y, sobre esa base, se elaboró la batería de ejercicios con pesas. En los resultados preliminares registrados, mediante la aplicación del test, se constató que la integración del trabajo con pesas y el aeróbico influyen de manera favorable en la ganancia de fuerza en el adulto mayor.

O processo de envelhecimento é marcado por um estilo de vida sedentário e pouca atividade física, o que está associado ao declínio rápido e contínuo das capacidades funcionais, à dependência e à fragilidade. O objetivo do trabalho visa avaliar, por meio do teste de repetições máximas com pesos não extremos, o efeito da aplicação de exercícios com carga no tratamento da sarcopenia. Foram aplicados métodos dos níveis teórico e empírico como analítico, sintético, indutivo, dedutivo, revisão documental, análise documental, observação, levantamento e entrevista. Como instrumento de trabalho foi aplicada uma bateria de exercícios físicos resistidos de força e aeróbios que permitiu a utilização do método de mensuração em sete idosos com sarcopenia atendidos no Centro de Atividade Física e Saúde da Universidade de Ciências da Cultura Física e. Desporto ¨ Manuel Fajardo. O trabalho de força muscular foi avaliado por meio do referido teste, que possibilitou identificar o real peso da carga física com a qual devem treinar e, com base nisso, foi desenvolvida a bateria de exercícios com pesos. Nos resultados preliminares registrados, por meio da aplicação do teste, foi confirmado que a integração do trabalho com pesos e do trabalho aeróbio influencia favoravelmente o ganho de força em idosos.

The aging process is marked by a sedentary lifestyle and little physical activity, which is associated with the rapid and continuous decline in functional capacities, dependency and fragility. The objective of the work is aimed at assessing, through the test of maximum repetitions with non-extreme weights, the effect of the application of exercises with weights for the care of sarcopenia. Methods from the theoretical and empirical levels such as synthetic analytical, inductive-deductive, documentary review, documentary analysis, observation, survey and interview were applied. As a working instrument, a set of strength endurance and aerobic physical exercises was applied that allowed the measurement method to be used in seven older adults with sarcopenia, treated at the Center for Physical Activity and Health of the University of Sciences. of Physical Culture and Sports ¨Manuel Fajardo¨. The muscular strength work was evaluated using the aforementioned test, which made it possible to identify the real weight of the physical load with which they must train and, on that basis, the set of exercises with weights was developed. In the preliminary results recorded, through the application of the test, it was confirmed that the integration of weight work and aerobic work favorably influences strength gain in the older adults.

Predicting human effort needed to correct auto-segmentations.

Medical image auto-segmentation techniques are basic and critical for numerous image-based analysis applications that play an important role in developing advanced and personalized medicine. Compared with manual segmentations, auto-segmentations are expected to contribute to a more efficient clinical routine and workflow by requiring fewer human interventions or revisions to auto-segmentations. However, current auto-segmentation methods are usually developed with the help of some popular segmentation metrics that do not directly consider human correction behavior. Dice Coefficient (DC) focuses on the truly-segmented areas, while Hausdorff Distance (HD) only measures the maximal distance between the auto-segmentation boundary with the ground truth boundary. Boundary length-based metrics such as surface DC (surDC) and Added Path Length (APL) try to distinguish truly-predicted boundary pixels and wrong ones. It is uncertain if these metrics can reliably indicate the required manual mending effort for application in segmentation research. Therefore, in this paper, the potential use of the above four metrics, as well as a novel metric called Mendability Index (MI), to predict the human correction effort is studied with linear and support vector regression models. 265 3D computed tomography (CT) samples for 3 objects of interest from 3 institutions with corresponding auto-segmentations and ground truth segmentations are utilized to train and test the prediction models. The five-fold cross-validation experiments demonstrate that meaningful human effort prediction can be achieved using segmentation metrics with varying prediction errors for different objects. The improved variant of MI, called MIhd, generally shows the best prediction performance, suggesting its potential to indicate reliably the clinical value of auto-segmentations.

The impact of subclinical psychotic symptoms on delay and effort discounting: Insights from behavioral, computational, and electrophysiological methods.

BACKGROUND: The ability to value rewards is crucial for adaptive behavior and is influenced by the time and effort required to obtain them. Impairments in these computations have been observed in patients with schizophrenia and may be present in individuals with subclinical psychotic symptoms (PS). METHODS: In this study, we employed delay and effort-discounting tasks with food rewards in thirty-nine participants divided into high and low levels of PS. We investigated the underlying mechanisms of effort-discounting through computational modelling of dopamine prefrontal and subcortical circuits and the electrophysiological biomarker of both delay and effort-discounting alterations through resting-state frontal alpha asymmetry (FAA). RESULTS: Results revealed greater delay discounting in the High PS group compared to the Low PS group but no differences in the effort discounting task. However, in this task, the same levels of estimated dopamine release were associated with a lower willingness to exert effort for high-calorie food rewards in High PS participants compared to Low PS participants. Although there were no significant differences in FAA between the High PS and Low PS groups, FAA was significantly associated with the severity of participants' negative symptoms. CONCLUSIONS: Our study suggests that the dysfunction in temporal and effort cost computations, seen in patients with schizophrenia, may be present in individuals with subclinical PS. These findings provide valuable insight into the early vulnerability markers (behavioral, computational, and electrophysiological) for psychosis, which may aid in the development of preventive interventions. These findings are preliminary and warrant further investigation.

Breathing Monitoring in Soccer: Part I-Validity of Commercial Wearable Sensors.

Growing evidence suggests that respiratory frequency (fR) is a valid marker of effort during high-intensity exercise, including sports of an intermittent nature, like soccer. However, very few attempts have been made so far to monitor fR in soccer with unobtrusive devices. This study assessed the validity of three strain-based commercial wearable devices measuring fR during soccer-specific movements. On two separate visits to the soccer pitch, 15 players performed a 30 min validation protocol wearing either a ComfTech® (CT) vest or a BioharnessTM (BH) 3.0 strap and a Tyme WearTM (TW) vest. fR was extracted from the respiratory waveform of the three commercial devices with custom-made algorithms and compared with that recorded with a reference face mask. The fR time course of the commercial devices generally resembled that of the reference system. The mean absolute percentage error was, on average, 7.03% for CT, 8.65% for TW, and 14.60% for BH for the breath-by-breath comparison and 1.85% for CT, 3.27% for TW, and 7.30% for BH when comparison with the reference system was made in 30 s windows. Despite the challenging measurement scenario, our findings show that some of the currently available wearable sensors are indeed suitable to unobtrusively measure fR in soccer.

Measles and Rubella Elimination in the Western Pacific Region in 2013-2022: Lessons Learned from Progress and Achievements Made during Regional and Global Measles Resurgences.

Measles is the most contagious communicable disease, causing an estimated 5.5 million cases and more than 30,000 deaths in the Western Pacific Region (WPR) during 2000. Rubella infection in a pregnant woman can be devastating for the foetus, resulting in congenital rubella syndrome (CRS) in 90% of rubella infections in early pregnancy. It was estimated that approximately 9000 CRS cases occurred in the WPR in 2010. World Health Organization (WHO) Member States in the WPR decided in 2003 to eliminate measles and in 2014 to eliminate rubella from the region. While the WPR successfully attained historically low measles incidence in 2012, it experienced a region-wide measles resurgence in 2013-2016. During the regional resurgence, WHO and Member States accumulated greater knowledge on the epidemiology of measles and rubella in the WPR and strategies to maintain gains. The implementation of the resulting new regional strategy and plan of action from 2018 has proven that measles and rubella elimination is achievable and sustainable under the pressure of multiple importations of measles virus during the world-wide measles resurgences in 2018-2019. This article discusses this progress and achievements towards achieving the global eradication of measles and rubella.

Hip Exoskeleton for Cycling Assistance.

Cycling stands as one of the most widely embraced leisure activities and serves purposes such as exercise, rehabilitation, and commuting. This study aimed to assess the feasibility of assisting three unimpaired participants (age: 34.0 ± 7.9 years, height: 1.86 ± 0.02 m, weight: 75.7 ± 12.7 kg) using the GuroX hip exoskeleton, originally designed for walking assistance, during cycling against a resistance of 1 W/kg. The performance evaluation employed a sweep protocol that manipulated the timing of the exoskeleton's peak extension and flexion torque in addition to human-in-the-loop optimization to enhance these timings based on metabolic cost. Our findings indicate that with a peak assistance torque of approximately 10.3 Nm for extension and flexion, the GuroX substantially reduced the net metabolic cost of cycling by 31.4 ± 8.1% and 26.4 ± 14.1% compared to transparent and without exoskeleton conditions, respectively. This demonstrates the significant potential of a hip exoskeleton developed for walking assistance to profoundly benefit cycling. Additionally, customizing the assistance strategy proves beneficial in maximizing assistance. While we attribute the average motor power to be a major contributor to the reduced cycling effort, participant feedback suggests that user comfort and synchronization between the user and exoskeleton may have played integral roles. Further research should validate our initial findings by employing a larger participant pool in real-world conditions. Incorporating a more diverse set of parameters for the human-in-the-loop optimization could enhance individualized assistance strategies.

Hungry pigeons prefer sooner rare food over later likely food or faster information.

Introduction: Making decisions and investing effort to obtain rewards may depend on various factors, such as the delay to reward, the probability of its occurrence, and the information that can be collected about it. As predicted by various theories, pigeons and other animals indeed mind these factors when deciding. Methods: We now implemented a task in which pigeons were allowed to choose among three options and to peck at the chosen key to improve the conditions of reward delivery. Pecking more at a first color reduced the 12-s delay before food was delivered with a 33.3% chance, pecking more at a second color increased the initial 33.3% chance of food delivery but did not reduce the 12-s delay, and pecking more at a third color reduced the delay before information was provided whether the trial will be rewarded with a 33.3% chance after 12 s. Results: Pigeons' preference (delay vs. probability, delay vs. information, and probability vs. information), as well as their pecking effort for the chosen option, were analyzed. Our results indicate that hungry pigeons preferred to peck for delay reduction but did not work more for that option than for probability increase, which was the most profitable alternative and did not induce more pecking effort. In this task, information was the least preferred and induced the lowest level of effort. Refed pigeons showed no preference for any option but did not drastically reduce the average amounts of effort invested. Discussion: These results are discussed in the context of species-specific ecological conditions that could constrain current foraging theories.

Measuring cognitive effort using tabular transformer-based language models of electronic health record-based audit log action sequences.

OBJECTIVES: To develop and validate a novel measure, action entropy, for assessing the cognitive effort associated with electronic health record (EHR)-based work activities. MATERIALS AND METHODS: EHR-based audit logs of attending physicians and advanced practice providers (APPs) from four surgical intensive care units in 2019 were included. Neural language models (LMs) were trained and validated separately for attendings' and APPs' action sequences. Action entropy was calculated as the cross-entropy associated with the predicted probability of the next action, based on prior actions. To validate the measure, a matched pairs study was conducted to assess the difference in action entropy during known high cognitive effort scenarios, namely, attention switching between patients and to or from the EHR inbox. RESULTS: Sixty-five clinicians performing 5 904 429 EHR-based audit log actions on 8956 unique patients were included. All attention switching scenarios were associated with a higher action entropy compared to non-switching scenarios (P < .001), except for the from-inbox switching scenario among APPs. The highest difference among attendings was for the from-inbox attention switching: Action entropy was 1.288 (95% CI, 1.256-1.320) standard deviations (SDs) higher for switching compared to non-switching scenarios. For APPs, the highest difference was for the to-inbox switching, where action entropy was 2.354 (95% CI, 2.311-2.397) SDs higher for switching compared to non-switching scenarios. DISCUSSION: We developed a LM-based metric, action entropy, for assessing cognitive burden associated with EHR-based actions. The metric showed discriminant validity and statistical significance when evaluated against known situations of high cognitive effort (ie, attention switching). With additional validation, this metric can potentially be used as a screening tool for assessing behavioral action phenotypes that are associated with higher cognitive burden. CONCLUSION: An LM-based action entropy metric-relying on sequences of EHR actions-offers opportunities for assessing cognitive effort in EHR-based workflows.

Survival costs of reproduction are independent of energy costs in a seabird, the pelagic cormorant.

Life-history theory predicts that investment in reproduction should decrease survival (the 'cost of reproduction'). It is often assumed that energy allocation drives such trade-offs, with limited energy available for both reproduction and survival. However, the underlying mechanisms remain poorly understood, maybe because survival costs of reproduction are only apparent when resources are limited. Here, we took advantage of a natural experiment created by fluctuating environmental conditions to compare energy expenditure of a seabird, the pelagic cormorant (Phalacrocorax pelagicus), between contrasting population-scale scenarios of survival costs of reproduction. We used multi-state capture-recapture modelling across 16 years to identify which breeding seasons induced high survival costs (survival ratebreeders < survival ratenon/failed breeders) and we concomitantly estimated energy expenditure of chick-rearing males using time-energy budget models across 4 years. Daily energy expenditure (DEE) of chick-rearing pelagic cormorants varied significantly among years. However, survival costs of reproduction were observed in only 1 year, and contrary to our expectations, variation in DEE was not associated with population-level survival costs. Similarly, at the individual level, DEE in 1 year did not predict the probability of being observed again at the colony in following years (apparent survival). Finally, DEE was independent of brood size and brood age, but older individuals tended to expend less energy than younger ones. Given the lack of an apparent energetic 'cost of reproduction', lower DEE in older birds could be due to improved efficiency rather than avoidance of costs in old birds. Although future studies should account for potential sex-specific energetic constraints by including data on female energy expenditure, we conclude that a direct link between the rate of energy expenditure during breeding and subsequent survival is unlikely in this system.

Global expansion of marine protected areas and the redistribution of fishing effort.

The expansion of marine protected areas (MPAs) is a core focus of global conservation efforts, with the "30x30" initiative to protect 30% of the ocean by 2030 serving as a prominent example of this trend. We consider a series of proposed MPA network expansions of various sizes, and we forecast the impact this increase in protection would have on global patterns of fishing effort. We do so by building a predictive machine learning model trained on a global dataset of satellite-based fishing vessel monitoring data, current MPA locations, and spatiotemporal environmental, geographic, political, and economic features. We then use this model to predict future fishing effort under various MPA expansion scenarios compared to a business-as-usual counterfactual scenario that includes no new MPAs. The difference between these scenarios represents the predicted change in fishing effort associated with MPA expansion. We find that regardless of the MPA network objectives or size, fishing effort would decrease inside the MPAs, though by much less than 100%. Moreover, we find that the reduction in fishing effort inside MPAs does not simply redistribute outside-rather, fishing effort outside MPAs would also decline. The overall magnitude of the predicted decrease in global fishing effort principally depends on where networks are placed in relation to existing fishing effort. MPA expansion will lead to a global redistribution of fishing effort that should be accounted for in network design, implementation, and impact evaluation.

Predicting the effort required to manually mend auto-segmentations.

Auto-segmentation is one of the critical and foundational steps for medical image analysis. The quality of auto-segmentation techniques influences the efficiency of precision radiology and radiation oncology since high- quality auto-segmentations usually require limited manual correction. Segmentation metrics are necessary and important to evaluate auto-segmentation results and guide the development of auto-segmentation techniques. Currently widely applied segmentation metrics usually compare the auto-segmentation with the ground truth in terms of the overlapping area (e.g., Dice Coefficient (DC)) or the distance between boundaries (e.g., Hausdorff Distance (HD)). However, these metrics may not well indicate the manual mending effort required when observing the auto-segmentation results in clinical practice. In this article, we study different segmentation metrics to explore the appropriate way of evaluating auto-segmentations with clinical demands. The mending time for correcting auto-segmentations by experts is recorded to indicate the required mending effort. Five well-defined metrics, the overlapping area-based metric DC, the segmentation boundary distance-based metric HD, the segmentation boundary length-based metrics surface DC (surDC) and added path length (APL), and a newly proposed hybrid metric Mendability Index (MI) are discussed in the correlation analysis experiment and regression experiment. In addition to these explicitly defined metrics, we also preliminarily explore the feasibility of using deep learning models to predict the mending effort, which takes segmentation masks and the original images as the input. Experiments are conducted using datasets of 7 objects from three different institutions, which contain the original computed tomography (CT) images, the ground truth segmentations, the auto-segmentations, the corrected segmentations, and the recorded mending time. According to the correlation analysis and regression experiments for the five well-defined metrics, the variety of MI shows the best performance to indicate the mending effort for sparse objects, while the variety of HD works best when assessing the mending effort for non-sparse objects. Moreover, the deep learning models could well predict efforts required to mend auto-segmentations, even without the need of ground truth segmentations, demonstrating the potential of a novel and easy way to evaluate and boost auto-segmentation techniques.