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The assist-as-needed (AAN) controller is effective in robot-assisted rehabilitation. However, variations of the engagement of subjects with fixed controller often lead to unsatisfying results. Therefore, adaptive AAN that adjusts control parameters based on individualized engagement is essential to enhance the training effect further. Nevertheless, current approaches mainly focus on the within-trial real-time engagement estimation, and the presence of measurement noise may cause improper evaluation of engagement. In addition, most studies on human-in-loop optimization strategies modulate the controller by greedy strategies, which are prone to fall into local optima. These shortcomings in previous studies could significantly limit the efficacy of AAN. This paper proposes an adaptive AAN to promote engagement by providing subjects with a subject-adaptive assistance level based on trial-wise engagement estimation and performance. Firstly, the engagement is estimated from energy information, which assesses the work done by the subject during a full trial to reduce the influence of measurement outliers. Secondly, the AAN controller is adapted by Bayesian optimization (BO) to maximize the subject’s performance according to historical trial-wise performance. The BO algorithm is good at dealing with noisy signals within limited steps. Experiments with ten healthy subjects resulted in a decrease of 34.59$\%$ in their average trajectory error, accompanied by a reduction of 9.71$\%$ in their energy consumption, thus verifying the superiority of the proposed method to prior work. These results suggest that the proposed method could potentially improve the effect of upper limb rehabilitation.
The state has historically played favourites—by incentivizing conventional families and clamping down on alternative families like ascetic maths, it ensured that the heteronormative family flourished. I trace the socio-legal histories of families and establish a constitutional imperative for “family equality” located in the rights to religious freedom, privacy, and equal treatment, and propose that it (not marriage equality) drives the queer movement. “Family” must be reimagined beyond marriage in light of the public ethic of care to encompass a vast range of non-normative families like hijra communes. I consider the Canadian Law Commission’s proposals for recognizing “families” and argue that a similar framework is an unrecognized constitutional mandate in India that, once recognized, would render a wealth of laws interacting with family life unconstitutional. The shared socioconstitutional contexts across jurisdictions and the growing convergence of human rights standards could well mean that this will impact legal systems around the world.
Iodine is a vital trace element in the human body and is associated with several important coronary artery disease (CAD) risk factors. We aimed to explore the correlation between urinary iodine concentration (UIC) and CAD. Data from 15 793 US adults in the National Health and Nutrition Examination Survey (2003–2018) were analysed. We conducted multivariable logistic regression models and fitted smoothing curves to study the correlation between UIC and CAD. Furthermore, we performed subgroup analysis to investigate possible effect modifiers between them. We found a J-shaped association between UIC and CAD, with an inflection point at Lg UIC = 2·65 μg/l. This result indicated a neutral association (OR 0·89; 95 % CI 0·68, 1·16) between UIC and CAD as Lg UIC < 2·65 μg/l, but the per natural Lg [UIC] increment was OR 2·29; 95 % CI 1·53, 3·43 as Lg UIC ≥ 2·65 μg/l. An interaction between diabetes and UIC might exist. The increase in UIC results in an increase in CAD prevalence (OR 1·84, 95 % CI 1·32, 2·58) in diabetes but results in little to no difference in non-diabetes (OR 0·98, 95 % CI 0·77, 1·25). The J-shaped correlation between UIC and CAD and the interaction between diabetes and UIC should be confirmed in a prospective study with a series of UIC measurements. If excessive iodine precedes CAD, then this new finding could guide clinical practice and prevent iodine deficiency from being overcorrected.
What effects do contentious elections have on partisan appraisals of democracy? We consider the case of the November 2020 US election, a highly polarized partisan contest but also an objectively free and fair election by credible accounting. We conducted a panel study embedded within two nationally representative surveys before and after the election. Results indicate a familiar but underexamined partisan gap, in which satisfaction with democracy decreases among Republicans and increases among Democrats relative to nonpartisans. We find that the gap is fully mediated by partisan shifts in satisfaction with elections and the news media that cover them. Our results underscore how eroding institutional confidence can undermine democratic legitimacy in hitherto consolidated democracies. To overcome partisan divisions following contentious elections, we highlight the need to bolster confidence in democratic institutions to reduce partisan fears and uncertainties—both rational and irrational—that electoral losses may trigger.
Coronary artery aneurysms have been considered the most serious complication of Kawasaki disease. However, some coronary artery aneurysms do regress. Therefore, the ability to predict the expected time of coronary artery aneurysm regression is critical. Herein, we have created a nomogram prediction system to determine the early regression (<1 month) among patients with small to medium coronary artery aneurysms.
Methods:
Seventy-six Kawasaki disease patients identified with coronary artery aneurysms during the acute or subacute phase were included. All the patients who met inclusion criteria demonstrated regression of coronary artery aneurysms within the first-year post Kawasaki disease diagnosis. The clinical and laboratory parameters were compared between the groups of coronary artery aneurysms regression duration within and beyond 1 month. Multivariate logistic regression analysis was used to identify the independent parameters for early regression based on the results from the univariable analysis. Then nomogram prediction systems were established with associated receiver operating characteristic curves.
Results:
Among the 76 included patients, 40 cases recovered within 1 month. Haemoglobin, globulin, activated partial thromboplastin time, the number of lesions, location of the aneurysm, and coronary artery aneurysm size were identified as independent factors for early regression of coronary artery aneurysms in Kawasaki disease patients. The predictive nomogram models revealed a high efficacy in predicting early regression of coronary artery aneurysms.
Conclusion:
The size of coronary artery aneurysms, the number of lesions, and the location of aneurysms presented better predictive value for predicting coronary artery aneurysms regression. The nomogram system created from the identified risk factors successfully predicted early coronary artery aneurysm regression.
The coronavirus disease 2019 (COVID-19) pandemic had important consequences on the health system. Emergency Medical Services (EMS) were a key element in the response and were forced to modify their daily procedures. The main objective of this study was to find out if there were differences in response times and in the profile of patients treated by the Advanced Life Support (ALS) units of Servicio de Asistencia Médica Urgente (SAMU)-Asturias, the EMS of the Principality of Asturias, between the pre-pandemic period and the pandemic period.
Methodology:
This was a descriptive, cross-sectional, observational, and retrospective study that included all patients treated by SAMU-Asturias ALS from January 1, 2019 through December 31, 2020.
Results:
The pandemic has had an impact on daily activity of SAMU-Asturias, with a 9.2% decrease in daily ALS services during the pandemic, longer prehospital times during the pandemic period (mean = 54’35”; SD = 0’48”; P = 0.00) mainly due to an increase in scene time (mean = 28’01”; SD = 12’57”; P = 0.00), and a slight increase in the average age of patients during the pandemic in relation to the pre-pandemic period. No differences were found between the types of incidents for ALS or between the resolution of the patients.
Conclusions:
The COVID-19 pandemic mainly affects prehospital times in an emergency service, with no differences being observed in types of incidents; in EMS future pandemic planning, this should be taken into consideration.
Piccinini’s usability constraint states that physical processes must have “physically constructible manifestation[s]” to be included in epistemically useful models of physical computation. But to determine what physical processes can be implemented in physical systems (as parts of computations), we must already know what physical processes can be implemented in physical systems (as parts of processes for constructing computing systems). We need additional assumptions about what qualifies as a building process. Piccinini implicitly assumes a classical computational understanding of executable processes, but this is an assumption imposed on physical theories and may artificially limit our picture of epistemically useful physical computation.
We evaluated the epidemiology of carbapenemase-producing bacteria (CPB) in Switzerland by comparing risk factors between patients colonized with CPB and patients colonized with extended-spectrum β-lactamase–producing Enterobacterales (ESBL-PE).
Methods:
This retrospective cohort study was conducted at the University Hospital Basel in Switzerland. Hospitalized patients with CPB in any sample between January 2008 and July 2019 were included. The ESBL-PE group consisted of hospitalized patients with detection of ESBL-PE from any sample between January 2016 and December 2018. Comparisons of risk factors for acquisition of CPB and ESBL-PE were performed by logistic regression.
Results:
Inclusion criteria were met for 50 patients in the CPB group and 572 in the ESBL-PE group. In the CPB group, 62% had a travel history and 60% had been hospitalized abroad. When comparing the CPB group to the ESBL-PE group, hospitalization abroad (odds ratio [OR], 25.33; 95% confidence interval [CI], 11.07–57.98) and prior antibiotic therapy (OR, 4.76; 95% CI, 2.15–10.55) remained independently associated with CPB colonization. Hospitalization abroad (P < .001) and prior antibiotic therapy (P < .001) predicted CPB in the comparison of CPB with ESBL Escherichia coli, whereas hospitalization abroad was associated with CPB in comparison to ESBL Klebsiella pneumoniae.
Conclusions:
Although CPB still seem to be mainly imported from areas of higher endemicity, local acquisition of CPB is emerging, especially in patients with close and/or frequent contact with healthcare services. This trend resembles the epidemiology of ESBL K. pneumoniae, supporting mainly healthcare-associated transmission. Frequent evaluation of CPB epidemiology is required to improve detection of patients at risk of CPB carriage.
In 2011, the Internal Revenue Service reversed a previous regulation that excluded lactation supplies, including breast pumps, from medical care tax benefits. This policy change was met with joy by some working mothers. Often torn between family needs and workplace duties, these lactating employees struggled with trying to be a “good worker” and a “good mother.” They saw the new tax law as validation of their efforts to express milk at work and legitimation for the accommodations they required. They felt that even an area of law as technical and complex as tax law could recognize their commitment to combining breastfeeding and employment. However, the women recognized that the law only facilitated greater ability to lactate but not more time with their babies, which they greatly wanted. Indeed, this article asks if breast pumps and supplies would even be an issue for many women if the United States provided women with the more extensive maternity leave that workers in other developed countries receive.
To compare characteristics and outcomes associated with central-line–associated bloodstream infections (CLABSIs) and electronic health record–determined hospital-onset bacteremia and fungemia (HOB) cases in hospitalized US adults.
Methods:
We conducted a retrospective observational study of patients in 41 acute-care hospitals. CLABSI cases were defined as those reported to the National Healthcare Safety Network (NHSN). HOB was defined as a positive blood culture with an eligible bloodstream organism collected during the hospital-onset period (ie, on or after day 4). We evaluated patient characteristics, other positive cultures (urine, respiratory, or skin and soft-tissue), and microorganisms in a cross-sectional analysis cohort. We explored adjusted patient outcomes [length of stay (LOS), hospital cost, and mortality] in a 1:5 case-matched cohort.
Results:
The cross-sectional analysis included 403 patients with NHSN-reportable CLABSIs and 1,574 with non-CLABSI HOB. A positive non-bloodstream culture with the same microorganism as in the bloodstream was reported in 9.2% of CLABSI patients and 32.0% of non-CLABSI HOB patients, most commonly urine or respiratory cultures. Coagulase-negative staphylococci and Enterobacteriaceae were the most common microorganisms in CLABSI and non-CLABSI HOB cases, respectively. In case-matched analyses, CLABSIs and non-CLABSI HOB, separately or combined, were associated with significantly longer LOS [difference, 12.1–17.4 days depending on intensive care unit (ICU) status], higher costs (by $25,207–$55,001 per admission), and a >3.5-fold increased risk of mortality in patients with an ICU encounter.
Conclusions:
CLABSI and non-CLABSI HOB cases are associated with significant increases in morbidity, mortality, and cost. Our data may help inform prevention and management of bloodstream infections.
Orthomodular logic is a weakening of quantum logic in the sense of Birkhoff and von Neumann. Orthomodular logic is shown to be a nonlinear noncommutative logic. Sequents are given a physically motivated semantics that is consistent with exactly one semantics for propositional formulas that use negation, conjunction, and implication. In particular, implication must be interpreted as the Sasaki arrow, which satisfies the deduction theorem in this logic. As an application, this deductive system is extended to two systems of predicate logic: the first is sound for Takeuti’s quantum set theory, and the second is sound for a variant of Weaver’s quantum logic.
This article proposes a simple but powerful framework to measure political sophistication based on open-ended survey responses. Discursive sophistication uses automated text analysis methods to capture the complexity of individual attitude expression. I validate the approach by comparing it to conventional political knowledge metrics using different batteries of open-ended items across five surveys spanning four languages (total $ N\approx 35,000 $). The new measure casts doubt on the oft-cited gender gap in political knowledge: women might know fewer facts about institutions and elites, but they do not differ substantively in the sophistication of their expressed political attitudes.
This paper is devoted to the study of generalized tilting theory of functor categories in different levels. First, we extend Miyashita’s proof (Math Z 193:113–146,1986) of the generalized Brenner–Butler theorem to arbitrary functor categories $\mathop{\textrm{Mod}}\nolimits\!(\mathcal{C})$ with $\mathcal{C}$ an annuli variety. Second, a hereditary and complete cotorsion pair generated by a generalized tilting subcategory $\mathcal{T}$ of $\mathop{\textrm{Mod}}\nolimits \!(\mathcal{C})$ is constructed. Some applications of these two results include the equivalence of Grothendieck groups $K_0(\mathcal{C})$ and $K_0(\mathcal{T})$, the existences of a new abelian model structure on the category of complexes $\mathop{\textrm{C}}\nolimits \!(\!\mathop{\textrm{Mod}}\nolimits\!(\mathcal{C}))$, and a t-structure on the derived category $\mathop{\textrm{D}}\nolimits \!(\!\mathop{\textrm{Mod}}\nolimits \!(\mathcal{C}))$.
Gender quotas are increasingly being adopted by autocrats in part to legitimize their rule. Yet, even in autocracies, these quotas increase women’s political representation. It thus stands to reason that public support for gender quotas in autocracies might be shaped by this trade-off between advancing women’s rights and granting the regime legitimacy. All else equal, regime opponents should be less supportive of gender quotas in autocracies, wary of legitimizing the regime. We uncover evidence of this proposition in an analysis of region-wide Arab Barometer surveys and a survey experiment in Algeria. We also find that evaluations of this trade-off are conditioned by other demographics, with women, gender egalitarians, and Islamists remaining more consistent in their support for/opposition to gender quotas regardless of regime gains. Overall, our findings suggest that gender quotas in autocracies are viewed through a political lens, creating a potential backlash toward women’s empowerment.
For many years, the existence of ancient human settlements in the Amazon was deemed impossible, particularly those as old as 12,000 BP as found in Pedra Pintada Cave in Monte Alegre, in the state of Pará, by Anna Roosevelt and colleagues in the 1990s and by Edithe Pereira's team in 2014. In this article, we present the results of the technological analyses of the bifacial tools found in the cave, focusing on raw materials, techniques, shaping and retouching methods, and technical procedures. The analyses indicate careful knapping, with no mistakes, in hundreds of flakes in the shaping and retouching phases, as well as fragmented tools with flaws. Whenever possible, we compare the results to the data published by Roosevelt and colleagues in 1996 from the same site.