The effect of a visuospatial interference intervention on posttraumatic intrusions: a cross-over randomized controlled trial.

Background: Intrusive memories form a core symptom of Posttraumatic Stress Disorder (PTSD). Based on concepts of visuospatial interference and memory-updating accounts, technological innovations aim to attenuate such intrusions using visuospatial interventions.Objective: This study aims to test the effect of a visuospatial Tetris-based intervention versus a verbal condition (Wiki) and a never-targeted control (no intervention) on intrusion frequency.Method: A randomized crossover trial was conducted including N = 38 PTSD patients who had at least 3 distinct intrusive memories of trauma. After both 2 weeks (intervention 1) and 4 weeks (intervention 2), one of the three memories was randomly selected and either the visuospatial intervention (memory reminder of a traumatic memory + Tetris) or verbal condition (reading a Wikipedia article + answering questions) was performed on their first memory in randomized order. In the week 4 session, the patient conducted the other intervention condition on their second memory (crossover). The third memory was never targeted (no intervention). Daily occurrence of intrusions over 8 weeks was collected using a diary and analysed using mixed Poisson regression models.Results: Overall, there was no significant reduction in intrusion frequency from either intervention compared to each other, and to no intervention control (relative risk Tetris/Wiki: 0.947; p = .31; relative risk no intervention/Tetris: 1.060; p = .15; relative risk no intervention/Wiki: 1.004; p = .92).Conclusions: There was no effect of either intervention on intrusions when administered in a crossover design where participants received both interventions. Design shortcomings and consequences for future studies are discussed.

Visuospatial interventions, including the computer game Tetris, have been studied as a potential means to decrease intrusive memories, a core feature of Posttraumatic Stress Disorder.In this study, two interventions are tested in a crossover design with patients with intrusive memories after traumatic experiences.There was no effect of either the visuospatial intervention or the verbal condition in this design.

An improved adaptive position tracking strategy for automatic shift actuator with uncertain parameters.

Realizing precise and fast position control of the gear is a challenging issue because of its nonlinearity, parameter uncertainty and external disturbance. Therefore, this paper researches the clutch position control considering the influence because of the factor on the system performance. By virtue of the traditional adaptive control method, an improved strategy based on finite time theory is proposed to further improve the convergence rate as well as the position tracking precision. First, a model of electromechanical clutch actuator system is established by theoretical analysis. Then, an enhanced adaptive controller is designed using finite time idea by introducing power function in the virtual control. And parameter update rate is adopted in the control action. Next, the stability of the control system is proved theoretically. Finally, Matlab simulations and experimental bench test are carried out to exhibit the effectiveness of the presented method. The results show that the satisfactory performance has been achieved with accurate position tracking and fast convergence speed.

Multi-Strategy Boosted Fick's Law Algorithm for Engineering Optimization Problems and Parameter Estimation.

To address the shortcomings of the recently proposed Fick's Law Algorithm, which is prone to local convergence and poor convergence efficiency, we propose a multi-strategy improved Fick's Law Algorithm (FLAS). The method combines multiple effective strategies, including differential mutation strategy, Gaussian local mutation strategy, interweaving-based comprehensive learning strategy, and seagull update strategy. First, the differential variation strategy is added in the search phase to increase the randomness and expand the search degree of space. Second, by introducing the Gaussian local variation, the search diversity is increased, and the exploration capability and convergence efficiency are further improved. Further, a comprehensive learning strategy that simultaneously updates multiple individual parameters is introduced to improve search diversity and shorten the running time. Finally, the stability of the update is improved by adding a global search mechanism to balance the distribution of molecules on both sides during seagull updates. To test the competitiveness of the algorithms, the exploration and exploitation capability of the proposed FLAS is validated on 23 benchmark functions, and CEC2020 tests. FLAS is compared with other algorithms in seven engineering optimizations such as a reducer, three-bar truss, gear transmission system, piston rod optimization, gas transmission compressor, pressure vessel, and stepped cone pulley. The experimental results verify that FLAS can effectively optimize conventional engineering optimization problems. Finally, the engineering applicability of the FLAS algorithm is further highlighted by analyzing the results of parameter estimation for the solar PV model.

Firmware Updates over the Air via LoRa: Unicast and Broadcast Combination for Boosting Update Speed.

The capacity to update firmware is a vital component in the lifecycle of Internet of Things (IoT) devices, even those with restricted hardware resources. This paper explores the best way to wirelessly (Over The Air, OTA) update low-end IoT nodes with difficult access, combining the use of unicast and broadcast communications. The devices under consideration correspond to a recent industrial IoT project that focuses on the installation of intelligent lighting systems within ATEX (potentially explosive atmospheres) zones, connected via LoRa to a gateway. As energy consumption is not limited in this use case, the main figure of merit is the total time required for updating a project. Therefore, the objective is to deliver all the fragments of the firmware to each and all the nodes in a safe way, in the least amount of time. Three different methods, combining unicast and broadcast transmissions in different ways, are explored analytically, with the aim of obtaining the expected update time. The methods are also tested via extensive simulations, modifying different parameters such as the size of the scenario, the number of bytes of each firmware chunk, the number of nodes, and the number of initial broadcast rounds. The simulations show that the update time of a project can be significant, considering the limitations posed by regulations, in terms of the percentage of airtime consumption. However, significant time reductions can be achieved by using the proper method: in some cases, when the number of nodes is high, the update time can be reduced by two orders of magnitude if the correct method is chosen. Moreover, one of the proposed methods is implemented using actual hardware. This real implementation is used to perform firmware update experiments in a lab environment. Overall, the article illustrates the advantage of broadcast approaches in this kind of technology, in which the transmission rate is constant despite the distance between the gateway and the node. However, the advantage of these broadcast methods with respect to the unicast one could be mitigated if the nodes do not run exactly the same firmware version, since the control of the broadcast update would be more difficult and the total update time would increase.

Flexible and Energy-Efficient Synaptic Transistor with Quasi-Linear Weight Update Protocol by Inkjet Printing of Orientated Polar-Electret/High-k Oxide Composite Dielectric.

Inkjet printing artificial synapse is cost-effective but challenging in emulating synaptic dynamics with a sufficient number of effective weight states under ultralow voltage spiking operation. A synaptic transistor gated by inkjet-printed composite dielectric of polar-electret polyvinylpyrrolidone (PVP) and high-k zirconia oxide (ZrOx) is proposed and thus synthesized to solve this issue. Quasi-linear weight update with a large variation margin is obtained through the coupling effect and the facilitation of dipole orientation, which can be attributed to the orderly arranged molecule chains induced by the carefully designed microfluidic flows. Crucial features of biological synapses including long-term plasticity, spike-timing-dependence-plasticity (STDP), "Learning-Experience" behavior, and ultralow energy consumption (<10 fJ/pulse) are successfully implemented on the device. Simulation results exhibit an excellent image recognition accuracy (97.1%) after 15 training epochs, which is the highest for printed synaptic transistors. Moreover, the device sustained excellent endurance against bending tests with radius down to 8 mm. This work presents a very viable solution for constructing the futuristic flexible and low-cost neural systems.

A news update from the students and new professionals group of the International Society of Biometeorology.

An update from the new Chair and Executive Committee of the Students and New Professionals Group of the International Society of Biometeorology.

Quantification of Polystyrene Uptake by Different Cell Lines Using Fluorescence Microscopy and Label-Free Visualization of Intracellular Polystyrene Particles by Raman Microspectroscopic Imaging.

Environmental pollution caused by plastic is a present problem. Polystyrene is a widely used packaging material (e.g., Styrofoam) that can be broken down into microplastics through abrasion. Once the plastic is released into the environment, it is dispersed by wind and atmospheric dust. In this study, we investigated the uptake of polystyrene particles into human cells using A549 cells as a model of the alveolar epithelial barrier, CaCo-2 cells as a model of the intestinal epithelial barrier, and THP-1 cells as a model of immune cells to simulate a possible uptake of microplastics by inhalation, oral uptake, and interaction with the cellular immune system, respectively. The uptake of fluorescence-labeled beads by the different cell types was investigated by confocal laser scanning microscopy in a semi-quantitative, concentration-dependent manner. Additionally, we used Raman spectroscopy as a complementary method for label-free qualitative detection and the visualization of polystyrene within cells. The uptake of polystyrene beads by all investigated cell types was detected, while the uptake behavior of professional phagocytes (THP-1) differed from that of adherent epithelial cells.

Operational disruption in healthcare associated with software functionality issue due to software security patching: a case report.

Despite many benefits, the extensive deployment of Health Information Technology (HIT) systems by healthcare organizations has encountered many challenges, particularly in the field of telemetry concerning patient monitoring and its operational workflow. These challenges can add more layers of complexity when an unplanned software security patching is performed, affecting patient monitoring and causing disruption in daily clinical operations. This study is a reflection on what happened associated with software security patching and why it happened through the lens of an incident report to develop potential preventive and corrective strategies using qualitative analyses-inductive and deductive approaches. There is a need for such analyses to identify the underlying mechanism behind such issues since very limited research has been conducted on the study of software patching. The incident was classified as a "software functionality" issue, and the consequence was an "incident with a noticeable consequence but no patient harm", and the contributing factor was a software update, i.e., software security patching. This report describes how insufficient planning of software patching, lack of training for healthcare professionals, contingency planning on unplanned system disruption, and HIT system configuration can compromise healthcare quality and cause risks to patient safety. We propose 15 preventive and corrective strategies grouped under four key areas based on the system approach and social-technical aspects of the patching process. The key areas are (i) preparing, developing, and deploying patches; (ii) training the frontline operators; (iii) ensuring contingency planning; and (iv) establishing configuration and communication between systems. These strategies are expected to minimize the risk of HIT-related incidents, enhance software security patch management in healthcare organizations, and improve patient safety. However, further discussion should be continued about general HIT problems connected to software security patching.

Preponderance of generalized chain functions in reconstructed Boolean models of biological networks.

Boolean networks (BNs) have been extensively used to model gene regulatory networks (GRNs). The dynamics of BNs depend on the network architecture and regulatory logic rules (Boolean functions (BFs)) associated with nodes. Nested canalyzing functions (NCFs) have been shown to be enriched among the BFs in the large-scale studies of reconstructed Boolean models. The central question we address here is whether that enrichment is due to certain sub-types of NCFs. We build on one sub-type of NCFs, the chain functions (or chain-0 functions) proposed by Gat-Viks and Shamir. First, we propose two other sub-types of NCFs, namely, the class of chain-1 functions and generalized chain functions, the union of the chain-0 and chain-1 types. Next, we find that the fraction of NCFs that are chain-0 (also holds for chain-1) functions decreases exponentially with the number of inputs. We provide analytical treatment for this and other observations on BFs. Then, by analyzing three different datasets of reconstructed Boolean models we find that generalized chain functions are significantly enriched within the NCFs. Lastly we illustrate that upon imposing the constraints of generalized chain functions on three different GRNs we are able to obtain biologically viable Boolean models.

Aggregated parameter update schemes for monitoring binary profiles.

Profile monitoring is one of the most important topics for statistical process control. Traditional self-starting profile monitoring schemes generally use all historical observations to estimate parameters. Because of the rapid increase in the complexity of modern statistical processes, the practitioners often need to deal with massive datasets in process monitoring. However, when observations of each period are of large sample size and the computation is of high complexity, the traditional method is not economical and urgently needs a parameter update strategy. Under the framework of binary profile monitoring, this paper proposes a novel recursive update strategy based on the aggregated estimation equation (AEE) for massive datasets and designs a self-starting control chart accordingly. Numerical simulation verifies that the proposed method performs better in parameter estimation and process monitoring. In addition, we give the asymptotic property of the proposed monitoring statistic and illustrate our method's superiority by a real-data example.

Actualización del abordaje de la endometriosis / Update in endometriosis work-up and treatment

El creciente compromiso con la salud ginecológica ha puesto de manifiesto la necesidad de actualizar el abordaje de la endometriosis, por lo que se ha querido llevar a cabo una revisión exhaustiva de la literatura científica con el fin de recopilar los últimos avances relevantes en su asistencia sanitaria. En este sentido, se llevó a cabo un congreso de ginecología el 30 de septiembre y 1 de octubre que convocó a diversos expertos para revisar aspectos clínicos, farmacológicos y vanguardistas. La revisión destaca los criterios directos, indirectos y soft markers que determinan la presencia de endometriosis durante la exploración, así como las pautas adecuadas para el diagnóstico mediante pruebas de imagen. Además, analiza la importancia de realizar un diagnóstico completo y detallado en pacientes que presenten síntomas de la enfermedad. Por otra parte, resalta los avances en el tratamiento de esta enfermedad, haciendo especial énfasis en los beneficios de la N-acetil cisteína. Finalmente, estudia el papel de la cirugía, destacando sus ventajas, pero señalando que la endometriosis no debe ser siempre asociada a la operación, ya que esta puede conllevar numerosas complicaciones.(AU)

The growing commitment to gynecological health has highlighted the need to update the approach to endometriosis. Therefore, a comprehensive review of the scientific literature has been carried out to gather the latest relevant advances in its healthcare. In this regard, a gynecology congress was held on September 30 and October 1, bringing together various experts to review clinical, pharmacological, and cutting-edge aspects. The review emphasizes the direct, indirect, and soft markers that determine the presence of endometriosis during examination, as well as the appropriate guidelines for diagnosis through imaging tests. Furthermore, it discusses the importance of conducting a complete and detailed diagnosis in patients exhibiting symptoms of the disease. Additionally, it highlights advancements in the treatment of this condition, with a particular emphasis on the benefits of N-acetyl cysteine. Finally, it explores the role of surgery, emphasizing its advantages but pointing out that endometriosis should not always be associated with surgery since it can entail numerous complications.(AU)

Identity-based controlled delegated outsourcing data integrity auditing scheme.

With the continuous development of cloud computing, the application of cloud storage has become more and more popular. To ensure the integrity and availability of cloud data, scholars have proposed several cloud data auditing schemes. Still, most need help with outsourced data integrity, controlled outsourcing, and source file auditing. Therefore, we propose a controlled delegation outsourcing data integrity auditing scheme based on the identity-based encryption model. Our proposed scheme allows users to specify a dedicated agent to assist in uploading data to the cloud. These authorized proxies use recognizable identities for authentication and authorization, thus avoiding the need for cumbersome certificate management in a secure distributed computing system. While solving the above problems, our scheme adopts a bucket-based red-black tree structure to efficiently realize the dynamic updating of data, which can complete the updating of data and rebalancing of structural updates constantly and realize the high efficiency of data operations. We define the security model of the scheme in detail and prove the scheme's security under the difficult problem assumption. In the performance analysis section, the proposed scheme is analyzed experimentally in comparison with other schemes, and the results show that the proposed scheme is efficient and secure.

Updates in diagnostic tools for diagnosing nerve injury and compressions.

Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.

A Cautionary Tale: Malaligned Incentives in Total Hip and Knee Arthroplasty Payment Model Reforms Threaten Promising Innovation and Access to Care.

Over the past several years, there have been notable changes and controversies involving Medicare reimbursement for total hip (THA) and total knee arthroplasty (TKA). We have seen the development and implementation of experimental bundled payment model pilot programs goals of improving quality and decreasing overall costs of care during the last decade. Many orthopaedic surgeons have embraced these programs and have demonstrated the ability to succeed in these new models by implementing strategies, such as preservice optimization, to shift care away from inpatient or postdischarge settings and reduce postoperative complications. However, these achievements have been met with continual reductions in surgeon reimbursement rates, lower bundle payment target pricings, modest increases in hospital reimbursement rates, and inappropriate valuations of THA and TKA Common Procedural Terminology (CPT) codes. These challenges have led to an organized advocacy movement and spurred research involving the methods by which improvements have been made throughout the entire episode of arthroplasty care. Collectively, these efforts have recently led to a novel application of CPT codes recognized by payers to potentially capture presurgical optimization work. In this paper, we present an overview of contemporary payment models, summarize notable events involved in the review of THA and TKA CPT codes, review recent changes to THA and TKA reimbursement, and discuss future challenges faced by arthroplasty surgeons that threaten access to high-quality THA and TKA care.

Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2023.

The expansive scope of internal medicine can make it challenging for clinicians to stay informed about new literature that changes practice. Guideline updates and synthesis of relevant evidence can facilitate incorporation of advancements into clinical practice. The titles and abstracts from the seven general medicine journals with highest impact factors and relevance to outpatient internal medicine were reviewed by six internal medicine physicians. Coronavirus disease 19 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), Annals of Internal Medicine, JAMA Internal Medicine, and Mayo Clinic Proceedings were reviewed. Additionally, article synopsis collections and databases were evaluated: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster ACCESSSS/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, seven practice-changing articles were included.

Update on Cognitive Enhancers Among the Older Adult Population: A Clinical Review.

PURPOSE OF REVIEW: The purpose of this review is to identify key classes of medications that are used for the treatment of older adults with neurocognitive disorders. RECENT FINDINGS: Clinical factors play a critical role in the prescribing of these medication classes for the treatment of dementia. The variation in prescribing trends is determined by the presence of medical and psychiatric comorbidities commonly occurring in older adults and is based on the consideration of potential interactions between pharmacotherapies for the comorbidities and for the dementia. Six medication classes currently exist to address the neurocognitive aspect of dementia, with varying pharmacokinetic and pharmacodynamic profiles. We review these six classes in this report and provide a provision of clinical insights regarding the use of these agents. While literature exists on the safety and efficacy of individual medication options for the treatment of dementia in the older adult population, further research is needed to provide clearer guidance regarding the specific use of these agents in clinical practice.

Predicting the submission frequency of periodic safety update reports: development and application of the EURD tool.

Introduction: Periodic Safety Update Reports (PSURs) are a key pharmacovigilance tool for the continuous evaluation of the benefit-risk balance of a medicinal product in the post-authorisation phase. The PSUR submission frequency for authorised active substances and combinations of active substances across the EU is individually determined. The objective of this research was the development and application of the EURD tool, a statistical method based on readily available safety data to predict PSUR frequencies and to ensure a consistent risk-based approach. Methods: First, variables considered relevant in determining the PSUR frequency were identified from data sources available at the European Medicines Agency. A subsequent first survey with National Competent Authorities in Europe lead to a prioritisation of identified variables, while a second survey was carried out to propose the PSUR frequencies for a set of substances. Finally, a regression model was built on the information collected, applied to a larger list of substances and its results tested via a third survey with the same experts. Results: The developed EURD tool was applied to the 1,032 EURD list entries with a PSUR assessment deferred to 2025 at the time of the creation of the list in 2012. As the number of procedures would have had a significant impact on the workload for the European Medicines Regulatory Network (EMRN), in a second step the workload impact was estimated after allocating the entries according to their proposed frequency. The analysis suggests that all entries could be reviewed by 2038 by increasing the median workload by 15% (from 868 to 1,000 substances/year). Conclusion: The EURD tool is the first data-driven application for supporting decision making of PSUR frequencies based on relevant active substance safety data. While we illustrated its potential for improving the assignment of PSUR submission frequencies for active substances authorised in the EU, other institutions requiring periodic assessment of safety data and balancing of the resulting workload could benefit from it.

Systematic bias in representation of reaction time distribution.

A correct perception of one's own abilities is essential for making appropriate decisions. A well-known bias in probability perception is that rare events are overestimated. Here, we examined whether such a bias also exists for action outcomes using a simple reaction task. In Experiment 1, after completing a set of 30 trials of the simple reaction task, participants were required to judge the probability that they would be able to respond before a given reference time when performing the task next. We assessed the difference between the actual reaction times and the probability judgement and found that the represented probability distribution was more widely distributed than the actual one, suggesting that low-probability events were overestimated and high-probability events were underestimated. Experiment 2 confirmed the presence of such a bias in the representation of both one's own and another's reaction times. In addition, Experiment 3 showed the presence of such a bias regardless of the difference between the representation of another's reaction times and the mere numerical representation. Furthermore, Experiment 4 found the presence of such a bias even when the information regarding actual reaction times was visually shown before the representation. The present results reveal the existence of a highly robust bias in the representation of motor performance, which reflects the ubiquitous bias in probability perception and is difficult to eliminate.