Enhancing biofeedback-driven self-guided virtual reality exposure therapy through arousal detection from multimodal data using machine learning.

Virtual reality exposure therapy (VRET) is a novel intervention technique that allows individuals to experience anxiety-evoking stimuli in a safe environment, recognise specific triggers and gradually increase their exposure to perceived threats. Public-speaking anxiety (PSA) is a prevalent form of social anxiety, characterised by stressful arousal and anxiety generated when presenting to an audience. In self-guided VRET, participants can gradually increase their tolerance to exposure and reduce anxiety-induced arousal and PSA over time. However, creating such a VR environment and determining physiological indices of anxiety-induced arousal or distress is an open challenge. Environment modelling, character creation and animation, psychological state determination and the use of machine learning (ML) models for anxiety or stress detection are equally important, and multi-disciplinary expertise is required. In this work, we have explored a series of ML models with publicly available data sets (using electroencephalogram and heart rate variability) to predict arousal states. If we can detect anxiety-induced arousal, we can trigger calming activities to allow individuals to cope with and overcome distress. Here, we discuss the means of effective selection of ML models and parameters in arousal detection. We propose a pipeline to overcome the model selection problem with different parameter settings in the context of virtual reality exposure therapy. This pipeline can be extended to other domains of interest where arousal detection is crucial. Finally, we have implemented a biofeedback framework for VRET where we successfully provided feedback as a form of heart rate and brain laterality index from our acquired multimodal data for psychological intervention to overcome anxiety.

Acute presentation of a partially obstructing laryngeal tumour: adjuvant agents to gaseous induction of anaesthesia.

We present the case of a 53-year-old man who attended our emergency department with stridor. He had recently undergone investigation for possible glottic cancer. We discuss the airway management of such a case. We believe this to be the first description of propofol target controlled infusion and clonidine to supplement a sevoflurane gas induction, in order to obtund response to intubation while maintaining spontaneous ventilation. We also consider how airway interventions may impact prognosis and need to be considered.

Transient heat stress compromises the resistance of wheat (Poales: Poaceae) seedlings to Hessian fly (Diptera: Cecidomyiidae) infestation.

Heat stress exerts a profound impact on the resistance of plants to parasites. In this research, we investigated the impact of an acute transient heat stress on the resistance of the wheat line 'Molly,' which contains the R gene H13, to an avirulent Hessian fly (Mayetiola destructor (Say)) population. We found that a significant portion of Molly seedlings stressed at 40 degrees C for 6 h during or after the initial Hessian fly larval attack became susceptible to otherwise avirulent insects, whereas unstressed control plants remained 100% resistant. Specifically, 77.8, 73.3, 83.3, and 46.7% of plants heat stressed at 0, 6,12, and 24 h, respectively, after the initial larval attack became susceptible. Biochemical analysis revealed that heat stress caused a transient decrease in 12-oxo-phytodienoic acid, but an increase in salicylic acid accumulation in Molly plants. The change in phytohormones after heat stress and Hessian fly infestation was not observed in 'Newton,' a near-isogenic but Hessian fly susceptible wheat line. Instead, heat stress caused a relatively prolonged reduction in palmitoleic acid. The role of phytohormones in heat-induced loss of wheat resistance was discussed.

Forest to reclaimed mine land use change leads to altered ecosystem structure and function.

The United States' use of coal results in many environmental alterations. In the Appalachian coal belt region, one widespread alteration is conversion of forest to reclaimed mineland. The goal of this study was to quantify the changes to ecosystem structure and function associated with a conversion from forest to reclaimed mine grassland by comparing a small watershed containing a 15-year-old reclaimed mine with a forested, reference watershed in western Maryland. Major differences were apparent between the two watersheds in terms of biogeochemistry. Total C, N, and P pools were all substantially lower at the mined site, mainly due to the removal of woody biomass but also, in the case of P, to reductions in soil pools. Mineral soil C, N, and P pools were 96%, 79%, and 69% of native soils, respectively. Although annual runoff from the watersheds was similar, the mined watershed exhibited taller, narrower storm peaks as a result of a higher soil bulk density and decreased infiltration rates. Stream export of N was much lower in the mined watershed due to lower net nitrification rates and nitrate concentrations in soil. However, stream export of sediment and P and summer stream temperature were much higher. Stream leaf decomposition was reduced and macroinvertebrate community structure was altered as a result of these changes to the stream environment. This land use change leads to substantial, long-term changes in ecosystem capital and function.

Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme.

PROBLEM: The hospital based musculoskeletal service in northwest Wales was unable to cope with the demand for referrals from general practitioners. Waiting times were long, duplicate referrals to other departments were common, and general practitioners were reluctant to refer patients with common problems because of the perceived lack of service. Many referrals were made to the inappropriate specialty, especially orthopaedics. At least part of this problem was due to a lack of coordination between the four hospital departments providing musculoskeletal services and the emphasis on district general hospital based rather than community provision. DESIGN: Review over 18 months of impact of the targeted early access to musculoskeletal services (TEAMS) programme on accessibility to musculoskeletal services. SETTING: Northwest Wales. KEY MEASURES FOR IMPROVEMENT: Number of patients referred and seen with musculoskeletal problems, waiting times, number of duplicate referrals, and surgery conversion rates in orthopaedic clinics. STRATEGIES FOR CHANGE: Establishing with central clinical triage a common pathway for all musculoskeletal referrals so that patients attend the appropriate department. A back pain pathway led by extended scope physiotherapists was developed, and general practitioners with special interests and extended scope physiotherapists were trained to provide services for patients with uncomplicated musculoskeletal problems in the community. EFFECTS OF CHANGE: Over 18 months the number of referrals more than doubled. Despite this, waiting times for musculoskeletal services fell; this was noticeable for rheumatology and pain management. Duplicate referrals were abolished. Surgery conversion rates did not, however, change. Questionnaires from the clinics showed a high level of patient satisfaction. LESSONS LEARNT: Integration of hospital services that traditionally have worked in isolation can result in greatly improved access to musculoskeletal services. Community based multidisciplinary clinics run by specially trained general practitioners with special interests and extended scope physiotherapists are an effective way of managing patients with uncomplicated musculoskeletal problems and have been well received by patients and general practitioners. The huge unmet burden of need was reflected by the great increase in musculoskeletal referrals. Other approaches are needed to meet this, including better education of general practitioners and methods for identifying and modifying psychosocial risk factors for chronic pain at an early stage.

A collaborative effort between nurse leaders to address the hospital nursing shortage.

The current nursing shortage is not a routine swinging of the supply pendulum. Indeed, this shortage is determined to be quantitatively and qualitatively different from those of the past (Kimball & O'Neil, 2002). In Cincinnati, Ohio, nurse leaders decided that the uniqueness of this shortage necessitated new strategies. Hospital nurse executives proposed the creation of a community leadership group, and other Cincinnati nurse leaders enthusiastically embraced the idea. A collaborative effort was initiated in the spring of 2000 between a representative group of hospital chief nursing officers, school of nursing deans and faculty, staff nurses, hospital nurse recruiters, and professional nursing organizations to address concerns related to the nursing shortage. This article describes the process and outcomes of this collaborative effort with a focus on the retention of hospital nurses.

High-throughput fingerprinting of bacterial artificial chromosomes using the snapshot labeling kit and sizing of restriction fragments by capillary electrophoresis.

We have developed an automated, high-throughput fingerprinting technique for large genomic DNA fragments suitable for the construction of physical maps of large genomes. In the technique described here, BAC DNA is isolated in a 96-well plate format and simultaneously digested with four 6-bp-recognizing restriction endonucleases that generate 3' recessed ends and one 4-bp-recognizing restriction endonuclease that generates a blunt end. Each of the four recessed 3' ends is labeled with a different fluorescent dye, and restriction fragments are sized on a capillary DNA analyzer. The resulting fingerprints are edited with a fingerprint-editing computer program and contigs are assembled with the FPC computer program. The technique was evaluated by repeated fingerprinting of several BACs included as controls in plates during routine fingerprinting of a BAC library and by reconstruction of contigs of rice BAC clones with known positions on rice chromosome 10.

Women's reflections on divorce-- 10 years later.

Ten years after divorce 95 women who participated in an earlier study of divorce were asked to reflect on their lives since their divorce. They were mailed a questionnaire to describe demographic data, self-esteem, control, life assessment, and their lives since divorce. Fewer than half remarried and of those who did, 10 divorced a second time. Slightly more women partnered than married. Their overall assessment of their lives was reported positively. However, 25% felt the same or worse than they had 10 years earlier. Income was the only demographic variable correlated with self-esteem, control, and life assessment. Women used a variety of self-care actions to improve their lives and only six women went to professional therapy. Their lives and some of the actions taken are described.