Detection of Medication Taking Using a Wrist-Worn Commercially Available Wearable Device.

PURPOSE: Medication nonadherence is a persistent and costly problem across health care. Measures of medication adherence are ineffective. Methods such as self-report, prescription claims data, or smart pill bottles have been used to monitor medication adherence, but these are subject to recall bias, lack real-time feedback, and are often expensive. METHODS: We proposed a method for monitoring medication adherence using a commercially available wearable device. Passively collected motion data were analyzed on the basis of the Movelet algorithm, a dictionary learning framework that builds person-specific chapters of movements from short frames of elemental activities within the movements. We adapted and extended the Movelet method to construct a within-patient prediction model that identifies medication-taking behaviors. RESULTS: Using 15 activity features recorded from wrist-worn wearable devices of 10 patients with breast cancer on endocrine therapy, we demonstrated that medication-taking behavior can be predicted in a controlled clinical environment with a median accuracy of 85%. CONCLUSION: These results in a patient-specific population are exemplar of the potential to measure real-time medication adherence using a wrist-worn commercially available wearable device.

Imbalanced class distribution and performance evaluation metrics: A systematic review of prediction accuracy for determining model performance in healthcare systems.

Focus on predictive algorithm and its performance evaluation is extensively covered in most research studies to determine best or appropriate predictive model with Optimum prediction solution indicated by prediction accuracy score, precision, recall, f1score etc. Prediction accuracy score from performance evaluation has been used extensively as the main determining metric for performance recommendation. It is one of the most widely used metric for identifying optimal prediction solution irrespective of dataset class distribution context or nature of dataset and output class distribution between the minority and majority variables. The key research question however is the impact of class inequality on prediction accuracy score in such datasets with output class distribution imbalance as compared to balanced accuracy score in the determination of model performance in healthcare and other real-world application systems. Answering this question requires an appraisal of current state of knowledge in both prediction accuracy score and balanced accuracy score use in real-world applications where there is unequal class distribution. Review of related works that highlight the use of imbalanced class distribution datasets with evaluation metrics will assist in contextualizing this systematic review.

Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa.

BACKGROUND: Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans. OBJECTIVE: To evaluate the association of SHSE with stroke among indigenous Africans. METHODS: We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05. RESULTS: Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes. CONCLUSION: Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.

The globalizability of temporal discounting.

Economic inequality is associated with preferences for smaller, immediate gains over larger, delayed ones. Such temporal discounting may feed into rising global inequality, yet it is unclear whether it is a function of choice preferences or norms, or rather the absence of sufficient resources for immediate needs. It is also not clear whether these reflect true differences in choice patterns between income groups. We tested temporal discounting and five intertemporal choice anomalies using local currencies and value standards in 61 countries (N = 13,629). Across a diverse sample, we found consistent, robust rates of choice anomalies. Lower-income groups were not significantly different, but economic inequality and broader financial circumstances were clearly correlated with population choice patterns.

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

BACKGROUND AND PURPOSE: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. METHODS: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. RESULTS: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). CONCLUSIONS: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Emergency traffic adaptive MAC protocol for wireless body area networks based on prioritization.

This paper proposes an emergency Traffic Adaptive MAC (eTA-MAC) protocol for WBANs based on Prioritization. The main advantage of the protocol is to provide traffic ranking through a Traffic Class Prioritization-based slotted-Carrier Sense Multiple Access/Collision Avoidance (TCP-CSMA/CA) scheme. The emergency traffic is handled through Emergency Traffic Class Provisioning-based slotted-CSMA/CA (ETCP-CSMA/CA) scheme. The emergency-based traffic adaptivity is provided through Emergency-based Traffic Adaptive slotted-CSMA/CA (ETA-CSMA/CA) scheme. The TCP-CSMA/CA scheme assigns a distinct, minimized and prioritized backoff period range to each traffic class in every backoff during channel access in Contention Access Period (CAP). The ETCP-CSMA/CA scheme delivers the sporadic emergency traffic that occurs at a single or multiple BMSN(s) instantaneously, with minimum delay and packet loss. It does this while being aware of normal traffic in the CAP. Then, the ETA-CSMA/CA scheme creates a balance between throughput and energy in the sporadic emergency situation with energy preservation of normal traffic BMSNs. The proposed protocol is evaluated using NS-2 simulator. The results indicate that the proposed protocol is better than the existing Medium Access Control (MAC) protocols by 86% decrease in packet delivery delay, 61% increase in throughput, and a 76% decrease in energy consumption.

Traffic Class Prioritization-Based Slotted-CSMA/CA for IEEE 802.15.4 MAC in Intra-WBANs.

This paper proposes an improved Traffic Class Prioritization based Carrier Sense Multiple Access/Collision Avoidance (TCP-CSMA/CA) scheme for prioritized channel access to heterogenous-natured Bio-Medical Sensor Nodes (BMSNs) for IEEE 802.15.4 Medium Access Control (MAC) in intra-Wireless Body Area Networks (WBANs). The main advantage of the scheme is to provide prioritized channel access to heterogeneous-natured BMSNs of different traffic classes with reduced packet delivery delay, packet loss, and energy consumption, and improved throughput and packet delivery ratio (PDR). The prioritized channel access is achieved by assigning a distinct, minimized and prioritized backoff period range to each traffic class in every backoff during contention. In TCP-CSMA/CA, the BMSNs are distributed among four traffic classes based on the existing patient's data classification. The Backoff Exponent (BE) starts from 1 to remove the repetition of the backoff period range in the third, fourth, and fifth backoffs. Five moderately designed backoff period ranges are proposed to assign a distinct, minimized, and prioritized backoff period range to each traffic class in every backoff during contention. A comprehensive verification using NS-2 was carried out to determine the performance of the TCP-CSMA/CA in terms of packet delivery delay, throughput, PDR, packet loss ratio (PLR) and energy consumption. The results prove that the proposed TCP-CSMA/CA scheme performs better than the IEEE 802.15.4 based PLA-MAC, eMC-MAC, and PG-MAC as it achieves a 47% decrease in the packet delivery delay and a 63% increase in the PDR.

Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke.

BACKGROUND: Annotation and Image Markup on ClearCanvas Enriched Stroke-phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. METHODS: One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen's kappa statistics. RESULTS: For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. CONCLUSION: The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.

Secure Scientific Applications Scheduling Technique for Cloud Computing Environment Using Global League Championship Algorithm.

Cloud computing system is a huge cluster of interconnected servers residing in a datacenter and dynamically provisioned to clients on-demand via a front-end interface. Scientific applications scheduling in the cloud computing environment is identified as NP-hard problem due to the dynamic nature of heterogeneous resources. Recently, a number of metaheuristics optimization schemes have been applied to address the challenges of applications scheduling in the cloud system, without much emphasis on the issue of secure global scheduling. In this paper, scientific applications scheduling techniques using the Global League Championship Algorithm (GBLCA) optimization technique is first presented for global task scheduling in the cloud environment. The experiment is carried out using CloudSim simulator. The experimental results show that, the proposed GBLCA technique produced remarkable performance improvement rate on the makespan that ranges between 14.44% to 46.41%. It also shows significant reduction in the time taken to securely schedule applications as parametrically measured in terms of the response time. In view of the experimental results, the proposed technique provides better-quality scheduling solution that is suitable for scientific applications task execution in the Cloud Computing environment than the MinMin, MaxMin, Genetic Algorithm (GA) and Ant Colony Optimization (ACO) scheduling techniques.

Development of a method to estimate mouth-level benzo[a]pyrene intake by filter analysis.

BACKGROUND: Benzo[a]pyrene (BaP) is one of the most potent carcinogens generated in cigarette smoke. During smoking, cigarette filters trap a significant portion of mainstream smoke benzo[a]pyrene. This trapped portion is proportional to what exits the end of the filter and is drawn into the mouth of smokers. METHODS: We developed a new method to estimate mouth-level BaP intake using filter analysis. In this analysis, cigarettes are smoked by a smoking machine using a variety of conditions to yield a range of mainstream smoke deliveries, which approximate a range of human puffing characteristics. Mainstream smoke BaP collected on Cambridge filter pads and the corresponding 1-cm mouth-end cigarette filter butts is extracted, purified by solid-phase extraction, and quantified by high-performance liquid chromatography coupled with a fluorescence detector. On the basis of the amount of BaP retained in cigarette butts and the amount collected on pads, we can relate them using a linear regression model. RESULTS: Using this model and subsequently analyzing cigarette filters collected from smokers, we are able to estimate their mouth-level intakes, which smokers received when they consumed cigarettes. We made a series of measurements using research cigarettes and select commercial cigarettes having a wide range of machine smoke "tar" and nicotine deliveries. CONCLUSIONS: In all cases, results indicate a linear relation of BaP between cigarette filter butts and Cambridge filter pads, with R(2) ranging from 0.93 to 0.98. IMPACT: This technique provides a noninvasive means to examine intake on a per cigarette basis to examine both exposure and behavioral aspects of smoking.

Divergence between strength indicators in packaging and cigarette engineering: a case study of Marlboro varieties in Australia and the USA.

OBJECTIVES: To investigate how the tobacco industry is adapting to regulatory action in accordance with provisions of the Framework Convention on Tobacco Control that targets misleading packaging and labelling. To relate the packaging and labelling of new cigarette varieties to their construction and performance. METHODS: The principal design features and tar, nicotine and carbon monoxide yields of the Marlboro 'brand family' in Australia were measured and compared with those of the US equivalents. RESULTS: Marlboro Red and Blue/Medium, could not be differentiated in preliminary tests in Australia, but were different in the USA. However, yield testing showed Marlboro Blue/Medium did not have lower tar and nicotine yields in either country, indeed being higher in Australia. CONCLUSIONS: Colour can be used to market cigarettes as 'milder', independently of ISO yields and 'Light'/'Mild' descriptors. Banning of 'Light' and 'Mild' brand descriptors may be inadequate to end belief in less harmful cigarettes so long as the tobacco industry remains free to engineer 'mildness' and to use colours, other descriptors and design features to characterise varieties it wants to market as 'milder'.

Estimating smokers' mouth-level exposure to select mainstream smoke constituents from discarded cigarette filter butts.

INTRODUCTION: Standardized machine smoking measurements are poor predictors of exposure. We have refined a method using the solanesol deposited in discarded cigarette butts as a marker for estimating deliveries of mainstream smoke constituents. Developing a fast and accurate method for measuring solanesol in cigarette filters to assess tobacco smoke intake could provide a way to assess how people smoke under natural conditions. We have developed and validated a new, lower-cost, high-throughput method to measure the solanesol content in discarded cigarette filter butts and correlated these measurements with mainstream smoke deliveries of nicotine and tobacco-specific nitrosamines (TSNAs). METHODS: Cigarettes were machine smoked under a variety of conditions to cover a wide range of nicotine deliveries and solanesol levels in the spent cigarette filter. Following machine smoking, a 1-cm portion of filter material, measured from the mouth end, was removed from the cigarette butts for analysis. Although an isotopically labeled solanesol analog is currently not commercially available, we achieved excellent quantitative results using a structurally similar compound, geranylgeraniol, as an internal standard (IS). After spiking with IS and solvent extracted, solanesol extracts were then analyzed using liquid chromatography coupled with a single-quadrupole mass analyzer. Analysis was carried out using manual preparation as well as a high-throughput 48-well format using automated liquid handlers. RESULTS: Recoveries of solanesol from cigarette butts exceeded 95% with excellent precision and exhibited excellent linearity for both preparation methods. In addition, we show that the mouth-level exposure for both nicotine and TSNAs may be estimated by their relation to the solanesol retained in the cigarette filter. DISCUSSION: We believe that this method provides excellent versatility and throughput for the estimation of mouth-level exposure to a wide range of toxins in cigarette smoke under naturalistic conditions. In addition, this method allows a far more accurate measure of exposure both from a single cigarette as well as from daily smoking.

Respiratory responses to repeated prolonged exposure to 0.12 ppm ozone.

Repeated exposure to high concentrations of ozone results first in augmentation (typically on the second day) and then attenuation of pulmonary response in humans. To determine the effects of repeated prolonged low-concentration ozone exposure, we exposed 17 healthy nonsmoking male subjects to 0.12 ppm ozone for 6.6 h on 5 consecutive days. Subjects were also exposed once to filtered air. Volunteers exercised at a ventilation of approximately 39 L/min for 50 min of each hour during the exposure. Spirometry, plethysmography, and symptom responses were obtained before, during, and after each exposure. Nasal lavage and aerosol bolus dispersion were obtained before and after exposure. Spirometry decreased and symptoms increased on the first day. Responses were less on the second day compared with those on the first day, and they were absent compared with control values on the subsequent 3 days of ozone exposure. Percent change in FEV1 after ozone exposure compared with that after air exposure averaged -12.79, -8.73, -2.54, -0.6, +0.18% for Days 1 to 5 of ozone exposure, respectively. FEV1 responses ranged from a zero to 34% decrease on Days 1 and 2. After each exposure, we determined the ratio of SRaw after inhaling a fixed dose of methacholine to SRaw after inhaling saline aerosol, as an index of airway responsiveness. Airway responsiveness was significantly increased after each ozone exposure. The mean ratios were 2.22, 3.67, 4.55, 3.99, 3.24, and 3.74 for filtered air and ozone Days 1 to 5, respectively. Symptoms of cough and pain on deep inspiration increased significantly on ozone Day 1 only.(ABSTRACT TRUNCATED AT 250 WORDS)

Decline in intravenous drug use among treatment-seeking opiate users.

Opiate users seeking treatment during similar time periods in 1986 (n = 60) and 1988 (n = 82) did not differ significantly with regard to demographic factors, length of addiction, use of cocaine, history of alcohol problems, or indices of depression. In 1988, however, users reported significantly lower rates of current intravenous drug use than was reported in 1986: 39% in 1988, compared to 14% in 1986, reported not currently using IV (chi 2(1, N = 142) = 11.302, p < .001). For the combined periods, current IV users (n = 102) did not differ significantly from those who were not currently using IV (n = 40) with regard to demographic factors, size of habit, history of alcohol problems, or indices of depression. Current IV users had used opiates longer (mean 11.3 years versus 8.4 years; t(1, 65) = 2.20, p < .03), and there was a trend for cocaine use to be associated with current IV administration. For the smaller subset of those who survived waiting lists of between 1 to 4 months from the time of intake to program admission and physical examination (n = 81), 35% (6/17) of those who were not IV drug users at the time of clinic intake reported resuming or initiating IV drug use by the time of program admission. The validity of self-reports of not using IV at the time of program admission was assessed by comparison of self-report with findings of track marks on physical examination: inconsistencies were detected in 11% (1/9) of those whose self-reports indicated no current IV use.

Respiratory response of humans exposed to low levels of ozone for 6.6 hours.

Recent evidence suggests that prolonged exposures of exercising men to 0.08 ppm ozone (O3) result in significant decrements in lung function, induction of respiratory symptoms, and increases in nonspecific airway reactivity. The purpose of this study was to confirm or refute these findings by exposing 38 healthy young men to 0.08 ppm O3 for 6.6 h. During exposure, subjects performed exercise for a total of 5 h, which required a minute ventilation of 40 l/min. Significant O3-induced decrements were observed for forced vital capacity (FVC, -0.25 l), forced expiratory volume in 1 s (FEV1.0, -0.35 l), and mean expiratory flow rate between 25% and 75% of FVC (FEF25-75, -0.57 l/s), and significant increases were observed in airway reactivity (35%), specific airway resistance (0.77 cm H2O/s), and respiratory symptoms. These results essentially confirm previous findings. A large range in individual responses was noted (e.g., percentage change in FEV1.0; 4% increase to 38% decrease). Responses also appeared to be nonlinear in time under these experimental conditions.

Ozone concentration and pulmonary response relationships for 6.6-hour exposures with five hours of moderate exercise to 0.08, 0.10, and 0.12 ppm.

The magnitudes of pulmonary responses we previously observed (1) following 6.6-h exposures to 0.12 ppm ozone (O3) suggested that responses would also occur with similar exposures at lower O3 concentrations. The objective of this study was to determine the extent of pulmonary function decrements, respiratory discomfort, and increased airway reactivity to methacholine induced by exposure to O3 below 0.12 ppm. Separate 6.6-h chamber exposures to 0.00, 0.08, 0.10, and 0.12 ppm O3 included six 50-min periods of moderate exercise (VE approximately equal to 39 L/min, HR approximately equal to 115 bpm, and VO2 approximately equal to 1.5 L/min). Each exercise period was followed by 10 min of rest. A 35-min lunch break was included midway through the exposure. Although not intended as an exact simulation, the overall duration, intensity, and metabolic requirements of the exercise performed were representative of a day of moderate to heavy work or play. Preexposure FEV1 averaged 4.39 L, and essentially no change (+0.03 L) occurred with exposure to 0.00 ppm O3. Significant decreases (p less than 0.01) of -0.31, -0.30, and -0.54 L were observed with exposures to 0.08, 0.10, and 0.12 ppm, respectively. The provocative dose of methacholine required to increase airway resistance by 100% (PD100) was 58 cumulative inhalation units (CIU) following exposure to 0.00 ppm and was significantly reduced (p less than 0.01) to 37 CIU at 0.08, 31 CIU at 0.10, and 26 CIU at 0.12 ppm O3; reductions in PD100 are considered indicative of increases in nonspecific airway responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

The respiratory responses of subjects with allergic rhinitis to ozone exposure and their relationship to nonspecific airway reactivity.

Ozone exposure in man produces changes in respiratory function and symptoms. There is a large degree of unexplained intersubject variability in the magnitude of these responses. There is concern that individuals with chronic respiratory diseases may also be more responsive to ozone than normal individuals. The purpose of this study was to describe the responses of subjects with allergic rhinitis to ozone exposure and to compare these responses to those previously observed in normal individuals. A further purpose was to measure the association of baseline nonspecific airway reactivity with changes in lung function and respiratory symptoms following ozone exposure. A group of 26 nonasthmatic subjects with allergic rhinitis performed a bronchial inhalation challenge with histamine and subsequently underwent two hour exposures to both clean air and to 0.18 part per million ozone with alternating periods of rest and heavy exercise. The airway reactivity of this group of subjects was no greater than that of a comparable group of subjects without allergic rhinitis. The respiratory responses of these subjects to ozone exposure were similar to those previously reported for subjects without allergic rhinitis with the exception that the allergic rhinitis subjects appeared to have a modestly increased bronchoconstrictor response compared to normals. Furthermore, we observed no significant relationships between nonspecific airway reactivity and response to ozone as measured by changes in lung function or the induction of symptoms.

Reproducibility of individual responses to ozone exposure.

Because large intersubject differences in the magnitudes of response to a single ozone (O3) exposure have been observed, we undertook to determine if this variability were due to differences in intrinsic responsiveness to O3 or to other factors. Thirty-two subjects were exposed to 1 of 5 O3 concentrations (0.12, 0.18, 0.24, 0.30, or 0.40 ppm), and each underwent one or more repeat exposures separated by from 3 wk to 14 months. Magnitudes of change for pulmonary function variables, respiratory rate and tidal volume, and for reported symptoms were compared for the repeated exposures. Changes induced in forced expiratory spirometric measurements were highly reproducible for as long as 10 months and for all tested O3 concentrations of 0.18 ppm or greater. This high degree of reproducibility indicates that the magnitude of response to a single exposure is a precise estimate of that subject's intrinsic O3 responsiveness. We conclude that the previously observed intersubject variability in magnitude of O3-induced effects is the result of large differences in intrinsic responsiveness to O3.