Using Surveillance With Near-Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019.

In 2019, Connecticut launched an opioid overdose-monitoring program to provide rapid intervention and limit opioid overdose-related harms. The Connecticut Statewide Opioid Response Directive (SWORD)-a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups-required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients' status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD's near-real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

Real-time ultrasound-guided external intracerebral hemorrhage drain placement.

We report a new minimally invasive technique utilizing interventional ultrasound for precise external intracerebral hemorrhage drain (EICHD) placement in pigs.

Virtual reality as a clinical tool in mental health research and practice
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Virtual reality (VR) is a potentially powerful technology for enhancing assessment in mental health. At any time or place, individuals can be transported into immersive and interactive virtual worlds that are fully controlled by the researcher or clinician. This capability is central to recent interest in how VR might be harnessed in both treatment and assessment of mental health conditions. The current review provides a summary of the advantages of using VR for assessment in mental health, focusing on increasing ecological validity of highly controlled environments, enhancing personalization and engagement, and capturing real-time, automated data in real-world contexts. Considerations for the implementation of VR in research and clinical settings are discussed, including current issues with cost and access, developing evidence base, technical challenges, and ethical implications. The opportunities and challenges of VR are important to understand as researchers and clinicians look to harness this technology to improve mental health outcomes.
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La realidad virtual (RV) es una tecnología potencialmente poderosa para mejorar la evaluación en salud mental. En cualquier momento o lugar, las personas pueden ser transportadas y quedar inmersos en mundos virtuales interactivos que están totalmente controlados por el investigador o el clínico. Esta capacidad es parte fundamental del interés reciente por la manera en cómo se podría aprovechar la RV tanto en el tratamiento como en la evaluación de las condiciones de salud mental. Esta revisión proporciona un resumen de las ventajas del empleo de la RV para la evaluación en salud mental, enfocándose en el aumento de la validez ecológica de entornos altamente controlados, en mejorar la personalización y el compromiso, y capturar datos automatizados en tiempo real en contextos del mundo real. Se discuten las consideraciones para la implementación de la realidad virtual en investigación y en situaciones clínicas, incluidos los problemas actuales de costo y acceso, el desarrollo en base a la evidencia, los desafíos técnicos y las implicancias éticas. Es importante comprender las oportunidades y los desafíos de la realidad virtual, ya que los investigadores y los médicos buscan aprovechar esta tecnología para mejorar los resultados de salud mental.

L'évaluation de la santé mentale pourrait bénéficier de la puissance de la technologie de la réalité virtuelle (RV). Les sujets peuvent être transportés en immersion à tout moment ou en tout lieu dans des mondes virtuels interactifs totalement contrôlés par le chercheur ou le médecin. C'est ce qui motive l'intérêt récent sur la façon d'exploiter la RV à la fois dans le traitement et l'évaluation des maladies mentales. Notre présentation résume les avantages de la RV dans ce cadre ; elle est centrée sur la validité écologique renforcée des environnements très contrôlés, sur une meilleure personnalisation et participation du sujet, et sur la saisie de données automatisées en temps et contextes réels. Nous analysons les conditions de l'introduction de la RV en recherche et en clinique, y compris les enjeux actuels de coût et d'accès, le développement d'une base de données, les défis techniques et les questions éthiques. Chercheurs et médecins souhaitent expérimenter la réalité virtuelle pour améliorer les résultats dans le contexte de la santé mentale, il est donc important d'en comprendre les opportunités et les difficultés.

Modelling and Control of Mechatronics Lines Served by Complex Autonomous Systems.

The aim of this paper is to reverse an assembly line, to be able to perform disassembly, using two complex autonomous systems (CASs). The disassembly is functioning only in case of quality default identified in the final product. The CASs are wheeled mobile robots (WMRs) equipped with robotic manipulators (RMs), working in parallel or collaboratively. The reversible assembly/disassembly mechatronics line (A/DML) assisted by CASs has a specific typology and is modelled by specialized hybrid instruments belonging to the Petri nets class, precisely synchronized hybrid Petri nets (SHPN). The need of this type of models is justified by the necessity of collaboration between the A/DML and CASs, both having characteristics and physical constraints that should be considered and to make all systems compatible. Firstly, the paper proposes the planning and scheduling of tasks necessary in modelling stage as well as in real time control. Secondly, two different approaches are proposed, related to CASs collaboration: a parallel approach with two CASs have simultaneous actions: one is equipped with robotic manipulator, used for manipulation, and the other is used for transporting. This approach is correlated with industrial A/D manufacturing lines where have to transport and handle weights in a wide range of variation. The other is a collaborative approach, A/DML is served by two CASs used for manipulation and transporting, both having simultaneous movements, following their own trajectories. One will assist the disassembly in even, while the other in odd workstations. The added value of this second approach consists in the optimization of a complete disassembly cycle. Thirdly, it is proposed in the paper the real time control of mechatronics line served by CASs working in parallel, based on the SHPN model. The novelty of the control procedure consists in the use of the synchronization signals, in absence of the visual servoing systems, for a precise positioning of the CASs serving the reversible mechatronics line.

A review on blockchain applications in the agri-food sector.

BACKGROUND: Food security can benefit from the technology's transparency, relatively low transaction costs and instantaneous applications. A blockchain is a distributed database of records in the form of encrypted blocks, or a public ledger of all transactions or digital events that have been executed and shared among participating parties and can be verified at any time in the future. Generally, the robust and decentralized functionality of the blockchain is used for global financial systems, but it can easily be expanded to contracts and operations such as tracking of the global supply chain. In the precision agriculture context, Information and Communications Technology can be further implemented with a blockchain infrastructure to enable new farm systems and e-agriculture schemes. RESULTS: The purpose of this review is to show a panorama of the scientific studies (enriched by a terms mapping analysis) on the use of blockchain in the agri-food sector, from both an entirely computational and an applicative point of view. As evidenced by the network analysis, the reviewed studies mainly focused on software aspects (e.g. the architecture and smart contracts). However, some aspects regarding the different blockchain knots (computers always connected to the blockchain network) having the role to store and distribute an updated copy of each block in a food supply-chain, result of crucial importance. CONCLUSION: These technologies appear very promising and rich of great potential showing a good flexibility for applications in several sectors but still immature and hard to apply due to their complexity. © 2019 Society of Chemical Industry.

Real-time contextual feedback for close-loop control of navigation.

OBJECTIVE: Close-loop control of brain and behavior will benefit from real-time detection of behavioral events to enable low-latency communication with peripheral devices. In animal experiments, this is typically achieved by using sparsely distributed (embedded) sensors that detect animal presence in select regions of interest. High-speed cameras provide high-density sampling across large arenas, capturing the richness of animal behavior, however, the image processing bottleneck prohibits real-time feedback in the context of rapidly evolving behaviors. APPROACH: Here we developed an open-source software, named PolyTouch, to track animal behavior in large arenas and provide rapid close-loop feedback in ~5.7 ms, ie. average latency from the detection of an event to analog stimulus delivery, e.g. auditory tone, TTL pulse, when tracking a single body. This stand-alone software is written in JAVA. The included wrapper for MATLAB provides experimental flexibility for data acquisition, analysis and visualization. MAIN RESULTS: As a proof-of-principle application we deployed the PolyTouch for place awareness training. A user-defined portion of the arena was used as a virtual target; visit (or approach) to the target triggered auditory feedback. We show that mice develop awareness to virtual spaces, tend to stay shorter and move faster when they reside in the virtual target zone if their visits are coupled to relatively high stimulus intensity (⩾49 dB). Thus, close-loop presentation of perceived aversive feedback is sufficient to condition mice to avoid virtual targets within the span of a single session (~20 min). SIGNIFICANCE: Neuromodulation techniques now allow control of neural activity in a cell-type specific manner in spiking resolution. Using animal behavior to drive closed-loop control of neural activity would help to address the neural basis of behavioral state and environmental context-dependent information processing in the brain.

Echo state networks are universal.

This paper shows that echo state networks are universal uniform approximants in the context of discrete-time fading memory filters with uniformly bounded inputs defined on negative infinite times. This result guarantees that any fading memory input/output system in discrete time can be realized as a simple finite-dimensional neural network-type state-space model with a static linear readout map. This approximation is valid for infinite time intervals. The proof of this statement is based on fundamental results, also presented in this work, about the topological nature of the fading memory property and about reservoir computing systems generated by continuous reservoir maps.

An improved robust heteroscedastic probabilistic neural network based trust prediction approach for cloud service selection.

Trustworthiness is a comprehensive quality metric which is used to assess the quality of the services in service-oriented environments. However, trust prediction of cloud services based on the multi-faceted Quality of Service (QoS) attributes is a challenging task due to the complicated and non-linear relationships between the QoS values and the corresponding trust result. Recent research works reveal the significance of Artificial Neural Network (ANN) and its variants in providing a reasonable degree of success in trust prediction problems. However, the challenges with respect to weight assignment, training time and kernel functions make ANN and its variants under continuous advancements. Hence, this work presents a novel multi-level Hypergraph Coarsening based Robust Heteroscedastic Probabilistic Neural Network (HC-RHRPNN) to predict trustworthiness of cloud services to build high-quality service applications. HC-RHRPNN employs hypergraph coarsening to identify the informative samples, which were then used to train HRPNN to improve its prediction accuracy and minimize the runtime. The performance of HC-RHRPNN was evaluated using Quality of Web Service (QWS) dataset, a public QoS dataset in terms of classifier accuracy, precision, recall, and F-Score.

Implementing a digital real-time Hydrocephalus and Shunt Registry to evaluate contemporary pattern of care and surgical outcome in pediatric hydrocephalus.

OBJECTIVE: Treatment monitoring and outcome evaluation in pediatric hydrocephalus require gapless documentation regarding surgical and clinical follow-up data beginning from day 1 of treatment in order to apply high quality of care. Endoscopic procedures, shunt insertion and revision surgeries, and individual modifications of valve hardware or pressure settings during follow-up as well as established outcome measurements are highly relevant for complete illustration of the patient's hydrocephalus histories. A digital tool to capture, organize, and analyze comprehensive treatment-related data was estimated long overdue, consequentially developed, and implemented in daily pediatric neurosurgical routine. METHODS: We established a self-contained, network-capable database application to supply and back up clinical information of complete surgical treatment history with implant status and follow up for all institutional pediatric hydrocephalus patients from 1995 to date. The application content has been prospectively complemented since 2012 during daily pediatric neurosurgical routine. Beside surgical data, neurological outcome and quality of life assessment were integrated according to validated scales to be recordable 2, 3, and 5 years after initial surgical intervention for prospective administration. The application is in continuous and problem-free use since implementation offering homogeneous and structured real-time information of surgical and corresponding neurological hydrocephalus-related data. By using an automatized data extraction tool, an exemplary surgical outcome evaluation reviewing institutional ventriculo-peritoneal shunt (VPS) treatment in infants over a period of more than 20 years was performed. To validate applicability, the Registry was successfully implemented in an external institution under identical conditions continuously serving for the same purpose until today. RESULTS: Upon completion of the developing process, the application was successfully implemented into routine clinical workflow of our institution. In total, 579 pediatric hydrocephalus patients entered into the Registry with collectively 1874 corresponding hydrocephalus-related surgeries (9% neuro-endoscopic procedures, 18% temporary CSF-diversions, 73% shunt surgeries) so far. For exemplary surgical outcome analysis, the total volume of complex data sets could easily be reduced stepwise in regard to requested inclusion criteria. The selection process generated conclusive data of 256 institutional pediatric VPS patients providing a median follow-up of 8.5 years. Surgical outcome was evaluated in regard to hydrocephalus etiology, applied valve design, valve augmentation, cause of initial malfunction, time to initial shunt revision, and number of total revisions. CONCLUSION: The pediatric hydrocephalus registry application delivers easy access to contemporary and up-to-date clinical information during daily clinical routine and proves comprehensive value for various scientific purposes. Institutional hydrocephalus etiologies, treatment modalities, and surgical outcome could be reviewed for a selected pediatric patient collective during an interval of more than 20 years and confirmed initial shunt treatment within the first year of age, communicating hydrocephalus and a history of prematurity as significant variables for unfavorable shunt survival and long-term revision rate. At our institution, the Registry emerged to an essential and sustainable tool to capture, organize, and analyze patterns of care in pediatric hydrocephalus patients of all etiologies and treatment modalities. Because of its adaptable and reliable predicate, a prospective multi-center utilization is currently in preparation.

Validation of a Real-Time Minute-to-Minute Urine Output Monitor and the Feasibility of Its Clinical Use for Patients Undergoing Cardiac Surgery.

Acute kidney injury after cardiac surgery is associated with increased morbidity and mortality. Methods for measuring urine output in real time may better ensure renal perfusion perioperatively in contrast to the current standard of care where urine output is visually estimated after empiric epochs of time. In this study, we describe an accurate method for monitoring urine output continuously during cardiopulmonary bypass. This may provide a means for setting patient-specific targets for blood pressure and cardiopulmonary bypass flow as a potential strategy to reduce the risk for acute kidney injury.

Current applications of big data in obstetric anesthesiology.

PURPOSE OF REVIEW: The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. RECENT FINDINGS: Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients. Also, large national databases have been used to better understand trends in anesthesia-related adverse events during cesarean delivery as well as outline potential racial/ethnic disparities in obstetric anesthesia care. Finally, real-time analysis of patient data across a number of disparate health information systems through the use of sophisticated clinical decision support and surveillance systems is one promising application of big data technology on the labor and delivery unit. SUMMARY: 'Big data' research has important implications for obstetric anesthesia care and warrants continued study. Real-time electronic surveillance is a potentially useful application of big data technology on the labor and delivery unit.

Real-time object tracking based on scale-invariant features employing bio-inspired hardware.

We developed a vision sensor system that performs a scale-invariant feature transform (SIFT) in real time. To apply the SIFT algorithm efficiently, we focus on a two-fold process performed by the visual system: whole-image parallel filtering and frequency-band parallel processing. The vision sensor system comprises an active pixel sensor, a metal-oxide semiconductor (MOS)-based resistive network, a field-programmable gate array (FPGA), and a digital computer. We employed the MOS-based resistive network for instantaneous spatial filtering and a configurable filter size. The FPGA is used to pipeline process the frequency-band signals. The proposed system was evaluated by tracking the feature points detected on an object in a video.

Electronic Health Records: Then, Now, and in the Future.

OBJECTIVES: Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved. METHODS: Literature search based on "Electronic Health Record", "Medical Record", and "Medical Chart" using Medline, Google, Wikipedia Medical, and Cochrane Libraries resulted in an initial review of 2,356 abstracts and other information in papers and books. Additional papers and books were identified through the review of references cited in the initial review. RESULTS: By 1992, hardware had become more affordable, powerful, and compact and the use of personal computers, local area networks, and the Internet provided faster and easier access to medical information. EHRs were initially developed and used at academic medical facilities but since most have been replaced by large vendor EHRs. While EHR use has increased and clinicians are being prepared to practice in an EHR-mediated world, technical issues have been overshadowed by procedural, professional, social, political, and especially ethical issues as well as the need for compliance with standards and information security. There have been enormous advancements that have taken place, but many of the early expectations for EHRs have not been realized and current EHRs still do not meet the needs of today's rapidly changing healthcare environment. CONCLUSION: The current use of EHRs initiated by new technology would have been hard to foresee. Current and new EHR technology will help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system.

Universal automated high frequency oscillation detector for real-time, long term EEG.

OBJECTIVE: Interictal high frequency oscillations (HFOs) in intracranial EEG are a potential biomarker of epilepsy, but current automated HFO detectors require human review to remove artifacts. Our objective is to automatically redact false HFO detections, facilitating clinical use of interictal HFOs. METHODS: Intracranial EEG data from 23 patients were processed with automated detectors of HFOs and artifacts. HFOs not concurrent with artifacts were labeled quality HFOs (qHFOs). Methods were validated by human review on a subset of 2000 events. The correlation of qHFO rates with the seizure onset zone (SOZ) was assessed via (1) a retrospective asymmetry measure and (2) a novel quasi-prospective algorithm to identify SOZ. RESULTS: Human review estimated that less than 12% of qHFOs are artifacts, whereas 78.5% of redacted HFOs are artifacts. The qHFO rate was more correlated with SOZ (p=0.020, Wilcoxon signed rank test) and resected volume (p=0.0037) than baseline detections. Using qHFOs, our algorithm was able to determine SOZ in 60% of the ILAE Class I patients, with all algorithmically-determined SOZs fully within the resected volumes. CONCLUSIONS: The algorithm reduced false-positive HFO detections, improving the precision of the HFO-biomarker. SIGNIFICANCE: These methods provide a feasible strategy for HFO detection in real-time, continuous EEG with minimal human monitoring of data quality.

Ocio entre pares en la era digital: percepción del ocio conectado juvenil / Leisure between the digital age pair: perception youth connected leisure

Las herramientas de comunicación online han modificado sustancialmente las prácticas de ocio juvenil en los últimos años. Mediante la incorporación de dispositivos digitales portátiles, muchas actividades de ocio tradicionales se han visto transformadas, mientras que la conexión a Internet se convertía, en sí misma, en un espacio de ocio. No abundan los estudios de corte cualitativo que se ocupen de las percepciones de los jóvenes en torno a estas nuevas formas de ocio. Este estudio quiere explorarlas a través de las técnicas del grupo de discusión y la entrevista en profundidad, aplicadas a una muestra de un total de 88 estudiantes de primero y segundo de Bachillerato de Bizkaia. Los resultados confirman la presencia cotidiana del ocio digital en la vida de estos jóvenes, pero presentan ciertas dudas respecto de su valoración, mostrando incluso su asociación con expresiones de connotación negativa

Online communication tools have substantially modified leisure practices among young people in the last years. Many traditional leisure activities have been transformed by the effect of digital mobile devices, while Internet connectivity became a leisure space in itself. Qualitative studies dealing with how young people perceive these new forms of leisure are scarce. The present study intends to explore these perceptions by means of focus groups and in-depth interviews, which were administered to 88 students of first and second grade of Bachillerato in the province of Bizkaia. Results confirm the everyday presence of digital leisure in the lives of young people, but also present some doubts regarding their appreciation of it, showing even how it is associated with terms with a negative connotation

La salud digital como motor de cambio hacia nuevos modelos asistenciales y de relación entre los pacientes y los profesionales de la salud. La disrupción de los procesos asistenciales / No disponible

Nos encontramos al final de una época de asimetría en el dominio de la información de salud, donde la mayor parte de esta se halla bajo custodia del sistema sanitario. Cada vez más, el ciudadano reclama un papel central dentro del nuevo paradigma, que le posibilite ejercer adecuadamente el derecho de acceso a sus datos de salud y disponer de tecnologías fiables y seguras que contribuyan al manejo de su condición y la promoción de estilos de vida saludables. Hasta ahora, el plan estratégico TIC Salud se desarrollaba de forma independiente al Plan de Salud del Departament de Salut de la Generalitat de Catalunya, que marca la estrategia de las políticas de salud en el territorio catalán. Sin embargo, el nuevo Plan de Salud (2016- 2020) contempla desde su diseño inicial la incorporación de una nueva línea estratégica TIC (tecnologías de la información y la comunicación) denominada “Salud Digital”. Introducir las TIC en el Plan de Salud va a permitir que estas tecnologías sean integradas en todos los procesos asistenciales estratégicos, actuando como motor de cambio hacia nuevos modelos asistenciales y de relación entre los ciudadanos y los profesionales de la salud. La Salud Digital lleva consigo disrupción, por la convergencia de distintas tecnologías y su impacto positivo sobre la salud y los procesos asistenciales, por el acceso de todos los ciudadanos a la información sobre su salud y por la generación de nuevas oportunidades para la promoción de la salud y el paradigma salutogénico, que empodera al ciudadano en el desarrollo de su salud, bienestar y calidad de vida (AU)

We find ourselves at the end of an era of asymmetry in the domain of health information where the majority of this data is in the hands of the healthcare system. Increasingly, the public are calling for a more central role in the new paradigm that enables them to duly exercise their right of access to their health data while availing of more reliable and safer technologies which contribute to the management of their condition and promote healthy lifestyles. So far, the TIC Salud strategic plan has been developed independently from the Generalitat de Catalunya Health Department's Healthcare Plan, which sets out health policy strategy in Catalonia. However, from its initial design stage the new Healthcare Plan (2016- 2020) envisages incorporating a new strategic Information and communications technology (ICT) line called “Digital Health”. Incorporating ICT into the Health Plan will allow these technologies to become integral part of all strategic healthcare processes, acting as a driving force for a shift towards a new healthcare models and an innovative relationship between the public and healthcare professionals. The Digital Health implies a disruption in itself, by way of the convergence of several technologies and their positive impact on health and healthcare procedures, by way of the public's access to information concerning their health, and by creating new opportunities for promoting health and the salutogenic paradigm which empowers people to develop their health, welfare and quality of life (AU)