Machine-learning prediction of thermal expansion coefficient for perovskite oxides with experimental validation.

Perovskite oxides have been of high-interest and relatively well studied over the last 20 years due to their various applications, specifically for solid oxide fuel cells (SOFCs) and solid oxide electrolysis cells (SOECs). One of the key properties for a perovskite to perform well as a component in SOFCs, SOECs, and other high-temperature applications is its thermal expansion coefficient (TEC). The use of machine learning (ML) to predict material properties has greatly increased over the years and has proven to be a very useful tool for materials screening. The process of synthesizing and testing perovskite oxides is laborious and costly, and the use of physics-based models is often highly computationally expensive. Due to the amount of elements able to be accommodated in the ABO3 structure and the ability for crystallographic mixing in both the A and B-sites, there are a massive amount of possible ABO3 perovskites. In this paper, a ML model for the prediction of the TECs of AA'BB'O3 perovskites is produced and applied to millions of potential compositions resulting in reliable TEC predictions for 150 451 of the compositions.

Predicting knee osteoarthritis severity: comparative modeling based on patient's data and plain X-ray images.

Knee osteoarthritis (KOA) is a disease that impairs knee function and causes pain. A radiologist reviews knee X-ray images and grades the severity level of the impairments according to the Kellgren and Lawrence grading scheme; a five-point ordinal scale (0-4). In this study, we used Elastic Net (EN) and Random Forests (RF) to build predictive models using patient assessment data (i.e. signs and symptoms of both knees and medication use) and a convolution neural network (CNN) trained using X-ray images only. Linear mixed effect models (LMM) were used to model the within subject correlation between the two knees. The root mean squared error for the CNN, EN, and RF models was 0.77, 0.97 and 0.94 respectively. The LMM shows similar overall prediction accuracy as the EN regression but correctly accounted for the hierarchical structure of the data resulting in more reliable inference. Useful explanatory variables were identified that could be used for patient monitoring before X-ray imaging. Our analyses suggest that the models trained for predicting the KOA severity levels achieve comparable results when modeling X-ray images and patient data. The subjectivity in the KL grade is still a primary concern.

Few-shot hypercolumn-based mitochondria segmentation in cardiac and outer hair cells in focused ion beam-scanning electron microscopy (FIB-SEM) data.

We present a novel AI-based approach to the few-shot automated segmentation of mitochondria in large-scale electron microscopy images. Our framework leverages convolutional features from a pre-trained deep multilayer convolutional neural network, such as VGG-16. We then train a binary gradient boosting classifier on the resulting high-dimensional feature hypercolumns. We extract VGG-16 features from the first four convolutional blocks and apply bilinear upsampling to resize the obtained maps to the input image size. This procedure yields a 2688-dimensional feature hypercolumn for each pixel in a 224 × 224 input image. We then apply L 1-regularized logistic regression for supervised active feature selection to reduce dependencies among the features, to reduce overfitting, as well as to speed-up gradient boosting-based training. During inference we block process 1728 × 2022 large microscopy images. Our experiments show that in such a formulation of transfer learning our processing pipeline is able to achieve high-accuracy results on very challenging datasets containing a large number of irregularly shaped mitochondria in cardiac and outer hair cells. Our proposed few-shot training approach gives competitive performance with the state-of-the-art using far less training data.

Muscle activation and sound during voluntary single coughs and cough peals in healthy volunteers: Insights into cough intensity.

Very few studies have addressed how coughing varies in intensity. We assessed the influence of cough effort and operating volume on the mechanics of coughing using respiratory muscle surface electromyography (EMG), oesophageal/gastric pressures and cough sounds recorded from 15 healthy subjects [8 female, median age 30 (IQR 30-50)years] performing 120 voluntary coughs from controlled operating volume/effort and three cough peals. For single coughs, low operating volumes and high efforts were associated with the highest EMG activity (p < 0.001); the resultant pressures increased with effort but volume had little influence. In contrast, cough sounds increased with both volume and effort. During cough peals, EMG fell initially, increasing towards the end of peals, pressures remained stable and sound parameters fell steadily to the end of the peal. In conclusion, effort and operating volume have important influences on cough mechanics but modulate muscle activation, pressure and cough sound amplitude and energy differently. Consequently, these cough sound parameters poorly represent voluntary cough mechanics and have limited potential as a surrogate intensity measure.

Real-time field sports scene classification using colour and frequency space decompositions.

This paper presents a novel approach to recognize a scene presented in an image with specific application to scene classification in field sports video. We propose different variants of the algorithm ranging from bags of visual words to the simplified real-time implementation, that takes only the most important areas of similar colour into account. All the variants feature similar accuracy which is comparable to very well-known image indexing techniques like SIFT or HoGs. For the comparison purposes, we also developed a specific database which is now available online. The algorithm is suitable in scene recognition task thanks to changes in speed and robustness to the image resolution, thus, making it a good candidate in real-time video indexing systems. The procedure features high simplicity thanks to the fact that it is based on the very well-known Fourier transform.

Institutional decision making: empowering of health system and economic transformation.

Organized medicine (OM) is an institution built to defend the American health care system of the 20th century. The institutional structures that it employed, however, operated mechanically and independently of its practitioner base, which drew from physician and nonphysician health professions. This article suggests that OM's institutional structures were founded and defended by a "logic of confidence," which initially served as a buffer against external socioeconomic pressures. The institutional structures of OM came to be treated systemically as rules (e.g.,"Trust me, I'm a doctor" and "The doctor knows best"), biasing and guiding organizational decision making and activities. Such rules were inculcated through professional education and clinical practice and were promulgated to the public by OM's practitioner and consumer base. OM so effectively promoted its rules that they were installed as powerful myths in the American psyche. So powerful were these myths that even OM was prevented from updating its identity to match its changing socioeconomic context. Instead, OM compartmentalized and sequestered its operational components from the public and from one another, effectively decoupling its identity from its activities and its context. In this manner, OM maintained an outmoded status quo when confronted by changing socioeconomic circumstances. The author explains how OM's failure to adapt has impelled the strongest representatives of all health professions to resist top-down decoupling in favor of bottom-up identity maturation, applying a new "logic of appropriateness." The logic of appropriateness is offered as a framework to guard against biased decision making and to ensure that institutional and individual identity, context, and decision making are coordinated and relevant. A new, public health-led, American health system is described in which the family physician and family nurse practitioner co-lead primary care practice and in which professional psychology has a vital role at every level.

The variance needed to accurately describe jump height from vertical ground reaction force data.

In functional principal component analysis (fPCA) a threshold is chosen to define the number of retained principal components, which corresponds to the amount of preserved information. A variety of thresholds have been used in previous studies and the chosen threshold is often not evaluated. The aim of this study is to identify the optimal threshold that preserves the information needed to describe a jump height accurately utilizing vertical ground reaction force (vGRF) curves. To find an optimal threshold, a neural network was used to predict jump height from vGRF curve measures generated using different fPCA thresholds. The findings indicate that a threshold from 99% to 99.9% (6-11 principal components) is optimal for describing jump height, as these thresholds generated significantly lower jump height prediction errors than other thresholds.

The prescribing clinical health psychologist: a hybrid skill set in the new era of integrated healthcare.

The prescribing clinical health psychologist brings together in one individual a combination of skills to create a hybrid profession that can add value to any healthcare organization. This article addresses the high demand for mental health services and the inequitable distribution of mental health practitioners across the nation. The close link between physical and mental health and evidence that individuals in psychological distress often enter the mental health system via primary care medical clinics is offered as background to a discussion of the author's work as a commissioned officer of the U.S. Public Health Service assigned to the Chaparral Medical Center of La Clinica de Familia, Inc. near the U.S.-Mexico border. The prescribing clinical health psychologist in primary care medical settings is described as a valuable asset to the future of professional psychology.

Chronic cough: relationship between microaspiration, gastroesophageal reflux, and cough frequency.

BACKGROUND: Microaspiration is often considered a potential cause of cough. The aim of this study was to investigate the relationship between microaspiration, the degree and type of gastroesophageal reflux, and the frequency of coughing in patients with chronic cough. METHODS: One hundred patients with chronic cough (mean [± SD] age, 55.8 years [± 11.0 years]; 65 women) and 32 healthy volunteers (median age, 43.5 years [interquartile range (IQR), 30-50.8 years]; 16 women) were recruited. Patients with chronic cough performed 24-h objective cough frequency with simultaneous esophageal impedance/pH monitoring and measurement of pepsin concentrations in sputum and BAL. Twelve healthy volunteers underwent bronchoscopy/BAL, and 20 underwent impedance/pH monitoring. RESULTS: Patients with chronic cough had significantly more reflux episodes than healthy volunteers (median, 63.5 reflux episodes [IQR, 52.5-80.0] vs 59.0 [IQR, 41.8-66.0]; P = .03), although the absolute difference was small, and there was no difference in numbers of events extending into the proximal esophagus (median, 17.2% [IQR, 8.0%-26.0%] vs 20.3% [IQR, 5.1%-32.1%]; P = .36). BAL pepsin levels were also similar in chronic cough to control subjects (median, 18.2 ng/mL [range, 0-56.4 ng/mL] vs 9.25 ng/mL [range, 0-46.9 ng/mL]; P = .27). Sputum but not BAL pepsin weakly correlated with the number of proximally occurring reflux events (r = 0.33, P = .045) but was inversely related to cough frequency (r = −0.52, P = .04). Sputum pepsin was, therefore, best predicted by combining the opposing influences of cough and proximal reflux (r = 0.50, P = .004). CONCLUSIONS: Proximal gastroesophageal reflux and microaspiration into the airways have limited roles in provoking chronic cough. Indeed, coughing appears to be protective, reducing pepsin concentration in the larger airways of patients with chronic cough.

Chest wall dynamics during voluntary and induced cough in healthy volunteers.

Coughing both protects the airways from foreign material and clears excessive secretions in respiratory diseases, and therefore requires high expiratory flows. We hypothesised that the volume inspired prior to coughing (operating volume) would significantly influence the mechanical changes during coughing and thus cough flow. Sixteen healthy volunteers (6 female, mean age 31 ± 10 years) performed six single voluntary coughs from four different operating volumes (10%, 30%, 60% and 90% of vital capacity) followed by three peals of voluntary and citric acid-induced coughs. During coughing we simultaneously measured (i) chest and upper abdominal wall motion using opto-electronic plethysmography (OEP), (ii) intra-thoracic and intra-abdominal pressures with a balloon catheter in each compartment and (iii) flow at the mouth. Operating volume was the most important determinant of the peak flow achieved and volume expelled during coughing, but had little influence on the pressures generated. The duration of single coughs increased with operating volume, whereas coughs were much shorter and varied little during peals. Voluntary cough peals were also associated with significant blood shift away from the trunk. In conclusion, this study has shown that operating volume is the most important determinant of cough peak flow and volume expelled in healthy individuals. During peals of coughs, similar mechanical effects were achieved more rapidly, suggesting a modification of the motor pattern with improved efficiency. Future studies investigating cough mechanics in health and disease should control for the influence of operating volume.

A novel approach to studying the relationship between subjective and objective measures of cough.

BACKGROUND: Currently, no data are available on the relationship between changes in objective and subjective measures of cough, the magnitude of change in cough frequency perceived by patients as clinically meaningful, or the sample sizes required to show significant changes in cough therapeutic trials. Because patients anecdotally report reductions in cough severity while undergoing esophageal testing, we aimed to address these issues by assessing objective and subjective measures of cough with and without an esophageal catheter. METHODS: Twenty-four-hour cough monitoring was performed on two occasions, with and without esophageal impedance/pH monitoring in 62 patients with chronic cough (mean age 56.8 years [SD±10.8]; 43 women; median cough duration 3.3 years [interquartile range (IQR), 2.0-10.0]). Cough was assessed objectively measuring coughs per hour and subjectively using a numerical cough score and a visual analog scale (VAS), scored separately for day and night, and then averaged to represent each 24-h period. RESULTS: Objective cough frequency was reduced by a median of 33.3% (IQR, -68.8% to -13.0%; P<.001) with the catheter. The averaged day and night cough scores and VAS scores also significantly decreased, but changes in these did not correlate with decreases in cough frequency. Sample-size calculations suggested that crossover designs using objective cough frequency may be preferable in therapeutic trials. CONCLUSIONS: These observations provide useful information on the reduction in objective cough frequency scored as an improvement by patients with chronic cough and offer guidance for the design and powering of future therapeutic trials. TRIAL REGISTRY: ISRCTN; No.: ISRCTN62337037; URL: http://www.controlled-trials.com.

Acoustic cough-reflux associations in chronic cough: potential triggers and mechanisms.

BACKGROUND & AIMS: Central sensitization is thought to play a role in chronic cough and might explain the temporal association between cough and gastroesophageal reflux (GOR) in patients in whom non-GOR causes have been excluded. Using our novel simultaneous acoustic cough recording and impedance/pH monitoring technique, we aimed to explore this further by assessing such temporal associations and their relationship to the acidity, duration, and proximal extent of reflux and the presence of erosive disease and cough reflex sensitivity in unselected patients (ie, including non-GOR causes) with chronic cough. METHODS: Twenty-four hour ambulatory acoustic cough monitoring with simultaneous impedance/pH recording was carried out in 71 unselected patients with chronic cough, aged 51-64 years (47 female). In addition, all patients underwent cough reflex sensitivity testing to citric acid, and 66 patients underwent gastroscopy. Temporal associations between cough and reflux were expressed using the symptom association probability. RESULTS: Seventy percent of patients exhibited temporal associations, with 48% having a positive symptom association probability (SAP(R-C)) for cough preceded by reflux (mainly distal), 56% a positive symptom association probability (SAP(C-R (2 min))) for reflux preceded by cough, and 32% both. Moreover, SAP(R-C) positive patients had a more sensitive cough reflex (P = .03) but similar esophageal reflux exposure and erosive disease, together with similar prevalence of extraesophageal causes of cough compared with SAP(R-C) negative patients. Reflux immediately following cough was rare. CONCLUSIONS: Cough temporally associates with reflux irrespective of proposed diagnoses, may be self-perpetuating in some patients, and is likely to be driven by central processes.

A comparison of objective and subjective measures of cough in asthma.

BACKGROUND: Cough is widely recognized as a key symptom in the diagnosis and the monitoring of asthma, but little is known about how best to assess cough in asthma. OBJECTIVE: To determine how objective cough rates correlate with subjective measures of cough in asthma. METHODS: We studied 56 subjects, median age 42.0 years (range, 28.5-71), 34 (60.7%) female, with asthma. Subjects performed cough reflex sensitivity testing (concentration of citric acid causing 2 and 5 coughs [C2 and C5]), 24-hour fully ambulatory cough recordings, subjectively scored the severity of their cough (visual analog scales and 0-5 score) and completed a cough-related quality of life questionnaire (Leicester Cough Questionnaire). Ambulatory cough recordings were manually counted and reported in cough seconds per hour (cs/h). RESULTS: The median time spent coughing was 2.6 cs/h (range, 0.0-14.2), with subjects spending more time coughing by day (median, 3.9 cs/h [0.0-18.5]) than by night (median, 0.3 cs/h [0.0-8.7]; P < .001). A weak inverse relationship was seen between day cough rates and log(10)C2 (r = -0.39; P = .03) but not log(10)C5 (r = -0.08; P = .65). Objective time spent coughing was also weak-moderately associated with subjective cough scores and visual analog scales, and most strongly correlated with cough-related quality of life (r = -0.54; P < .001). CONCLUSION: Subjective measures of cough and cough reflex sensitivity are poor surrogates for objective cough frequency in asthma. When designing studies to assess interventions for cough in asthma, we advocate a combination of both objective measures of cough and cough-related quality of life.

Chronic cough: how do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring?

BACKGROUND: Cough reflex sensitivity, subjective estimates of cough frequency and cough-related quality of life have been used to assess cough and monitor treatment responses. The relationships between these measures and objective cough monitoring remain unclear and the usefulness of subjective assessments remains questionable. SUBJECTS: 62 patients with chronic cough (39 women) were studied. Mean age of patients was 54.9 (SD 12.2) years, with a median duration of cough of 5.5 (range 1-30) years. METHODS: Cough reflex sensitivity testing (C5; citric acid) was performed in all patients before fully ambulatory day-time and night-time cough recordings. Patients scored the frequency and severity of their cough (Visual Analogue Scales (VAS) and 0-5 score) for each recording period and completed a cough-related quality-of-life questionnaire, Leicester Cough Questionnaire (LCQ). Ambulatory cough recordings were manually counted and reported in terms of cough seconds per hour (cs/h). Cough rates were log(10) transformed for analysis. RESULTS: The median time spent coughing was 11.36 (range 1.06-46) cs/h with median day rates of 15.59 (range 2-74.8) cs/h and median night rates of 2.94 (range 0-26.67) cs/h. An inverse relationship was seen between day cough rates and log(10) C5 (r = -0.452, p< or =0.001). Subjective cough scores and visual analogue scales were only moderately associated with objective time spent coughing, with night-time being scores more strongly associated than day-time scores. The strongest correlation with objective cough frequency was cough-related quality of life (LCQ), (r = -0.622, p< or =0.001), mediated through the psychological domain. CONCLUSIONS: Subjective measures of cough and cough reflex sensitivity are only moderately related to objective time spent coughing, and hence cannot be used as surrogate markers for objective cough-frequency measurements. Cough-related quality of life (LCQ) is most strongly related to objectively counted cough, and may be a useful adjunct to objective measures in the assessment of cough.

The USNS Mercy and the changing landscape of humanitarian and disaster response.

Operation Unified Assistance was the United States' historic response to the tsunami that struck Southeast Asia on December 26, 2004. The USNS Mercy participated in Operation Unified Assistance from January to March 2005. Stationed off the coast of Sumatra, Indonesia, the Mercy's crew consisted of uniformed members of the U.S. Navy and U.S. Public Health Service and civilian members of Project HOPE. The Mercy's participation in Operation Unified Assistance provided a platform and context to study disaster-related psychological processes. Observations of crew members aboard the Mercy suggested similar psychological processes for disaster victims and responders. Responder risk and protective factors; disaster responders as potential psychological casualties; responder selection, preparation, and intervention strategies; and the hospital ship as a research platform are discussed. Such issues are generally relevant to the interaction between civilian volunteers and professional disaster responders.

Operation Unified Assistance population-based programs of the U.S. Public Health Service and international team.

The United States Public Health Service and several international relief agencies collaborated to create a series of programs for educational, governmental, and other behavioral health personnel in Aceh Province, Indonesia, following the tsunami of December 2004. This article provides a detailed account of the methodologies and approaches used to create the collaborations, as well as how they continue to be used by the people of Aceh through to this writing. Now known as the "Mercy Model," the approach represents a valuable set of programmatic approaches for rapidly developing and delivering large-scale behavioral health interventions in highly chaotic relief environments. It also details the potential benefits of using small teams on the ground, backed by much larger virtual teams to develop programming in real time across nations and continents, and do so in very short time frames.