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Processing and extracting actionable information, such as fault or anomaly indicators originating from vibration telemetry, is both challenging and critical for an accurate assessment of mechanical system health and subsequent predictive maintenance. In the setting of predictive maintenance for populations of similar assets, the knowledge gained from any single asset should be leveraged to provide improved predictions across the entire population. In this paper, a novel approach to population-level health monitoring is presented adopting a transfer learning approach. The new methodology is applied to monitor multiple rotating plant assets in a power generation scenario. The focus is on the detection of statistical anomalies as a means of identifying deviations from the typical operating regime from a time series of telemetry data. This is a challenging task because the machine is observed under different operating regimes. The proposed methodology can effectively transfer information across different assets, automatically identifying segments with common statistical characteristics and using them to enrich the training of the local supervised learning models. The proposed solution leads to a substantial reduction in mean square error relative to a baseline model.
Chronic kidney disease (CKD) is a progressively worsening condition that is often overlooked in its early stages. In Brazil, factors such as population aging and rising comorbidities are expected to shift CKD prevalence toward more advanced stages, leading to greater socioeconomic and environmental impacts. The significant burden of renal replacement therapy (RRT) suggests the need to prioritize preventive and early detection strategies.
Methods
We developed a patient-level simulation model to estimate the impact of CKD in Brazil over 10 years (from 2023 to 2032) on clinical, patient, health system, environmental, productivity, and societal outcomes. Validation was conducted against Brazilian demographic data and cross-validated with the Inside CKD model. We estimated productivity losses by multiplying CKD-related workdays missed by daily costs for patients and caregivers.
Results
The number of Brazilians with CKD was projected to increase by 7.2 percent (approximately 27.7 million) over the next 10 years, mainly among patients with late-stage disease, while the number of patients undergoing dialysis was projected to increase by 170.8 percent (approximately 233,000) over the same period. CKD was projected to result in BRL198 billion (USD 38 billion) of lost income. From an environmental standpoint, freshwater consumption, fossil fuel depletion, and carbon dioxide emissions due to patients with CKD were projected to increase by 40 percent by 2032. RRT was projected to require the equivalent annual water usage of approximately 370,000 households and the annual power of approximately 11 million lightbulbs and will produce annual carbon dioxide emissions equivalent to approximately 1.5 million cars.
Conclusions
While the overall number of patients with CKD will increase by 7 percent (from 25.8 million in 2022 to 27.7 million in 2032), the distribution toward later stages of CKD will cause significant impacts in terms of the healthcare system (resource use and costs), patients and caregivers, society, and the environment.
The growing burden of chronic kidney disease (CKD) in Brazil is increasingly evident, marked by its significant contributions to mortality rates and healthcare costs. Managing CKD, especially through renal replacement therapy (RRT), demands substantial resources. To enhance healthcare decision-making, a thorough examination of the relationship between the rising prevalence of CKD and its clinical and economic impacts is crucial.
Methods
We developed a patient-level simulation model to project the natural history of CKD, defined as the IMPACT CKD. This model integrated factors such as acute kidney injury, cardiovascular events, and comorbidities, and aimed to assess CKD’s clinical, humanistic, and economic impact on the healthcare system. It forecasted the burden of CKD over the next decade (2023 to 2032). This projection is pivotal to derive the burden of CKD for health technology assessment (HTA) evaluations. Validation was conducted against Brazil’s demographic data and cross-validated with the Inside CKD model.
Results
The IMPACT CKD forecast a rapid increase of CKD population in Brazil, outpacing the growth of the general population. Specifically, there is an expected 6.9 percent increase in stages 3 to 5 CKD, leading to a higher demand for dialysis (projected 370,000 cases in 2032) and transplants (projected 115,000 cases in 2032). A significant increase in cardiovascular CKD-related events (+100.6%) and mortality (+67.8%) is expected. In 2032, it is projected 15 million CKD patients will be in stages 1 to 2, and 12.7 million in stages 3 to 5. CKD-related healthcare costs will represent 25.7 percent of Brazil’s healthcare budget, and dialysis will reach USD2.7 billion in annual costs.
Conclusions
IMPACT CKD predicts an increasing CKD prevalence and an alarming rise in stages 3 to 5 and RRT, including thousands of premature deaths, and a substantial economic burden on the Brazilian healthcare system. This data could be informative for healthcare decision-makers when choosing strategy to reduce the impact of CKD in Brazil.
The performance and confidence in fault detection and diagnostic systems can be undermined by data pipelines that feature multiple compounding sources of uncertainty. These issues further inhibit the deployment of data-based analytics in industry, where variable data quality and lack of confidence in model outputs are already barriers to their adoption. The methodology proposed in this paper supports trustworthy data pipeline design and leverages knowledge gained from one fully-observed data pipeline to a similar, under-observed case. The transfer of uncertainties provides insight into uncertainty drivers without repeating the computational or cost overhead of fully redesigning the pipeline. A SHAP-based human-readable explainable AI (XAI) framework was used to rank and explain the impact of each choice in a data pipeline, allowing the decoupling of positive and negative performance drivers to facilitate the successful selection of highly-performing pipelines. This empirical approach is demonstrated in bearing fault classification case studies using well-understood open-source data.
More than 5 million children in the United States experience food insecurity (FI), yet little guidance exists regarding screening for FI. A prediction model of FI could be useful for healthcare systems and practices working to identify and address children with FI. Our objective was to predict FI using demographic, geographic, medical, and historic unmet health-related social needs data available within most electronic health records.
Methods:
This was a retrospective longitudinal cohort study of children evaluated in an academic pediatric primary care clinic and screened at least once for FI between January 2017 and August 2021. American Community Survey Data provided additional insight into neighborhood-level information such as home ownership and poverty level. Household FI was screened using two validated questions. Various combinations of predictor variables and modeling approaches, including logistic regression, random forest, and gradient-boosted machine, were used to build and validate prediction models.
Results:
A total of 25,214 encounters from 8521 unique patients were included, with FI present in 3820 (15%) encounters. Logistic regression with a 12-month look-back using census block group neighborhood variables showed the best performance in the test set (C-statistic 0.70, positive predictive value 0.92), had superior C-statistics to both random forest (0.65, p < 0.01) and gradient boosted machine (0.68, p = 0.01), and showed the best calibration. Results were nearly unchanged when coding missing data as a category.
Conclusions:
Although our models could predict FI, further work is needed to develop a more robust prediction model for pediatric FI.
The flow of a nematic liquid crystal in a Hele-Shaw cell with an electrically controlled viscous obstruction is investigated using both a theoretical model and physical experiments. The viscous obstruction is created by temporarily electrically altering the viscosity of the nematic in a region of the cell across which an electric field is applied. The theoretical model is validated experimentally for a circular cylindrical obstruction, demonstrating user-controlled flow manipulation of an anisotropic liquid within a heterogeneous single-phase microfluidic device.
Traditionally, electricity distribution networks were designed for unidirectional power flow without the need to accommodate generation installed at the point of use. However, with the increase in Distributed Energy Resources and other Low Carbon Technologies, the role of distribution networks is changing. This shift brings challenges, including the need for intensive metering and more frequent reconfiguration to identify threats from voltage and thermal violations. Mitigating action through reconfiguration is informed by State Estimation, which is especially challenging for low voltage distribution networks where the constraints of low observability, non-linear load relationships, and highly unbalanced systems all contribute to the difficulty of producing accurate state estimates. To counter low observability, this paper proposes the application of a novel transfer learning methodology, based upon the concept of conditional online Bayesian transfer, to make forward predictions of bus pseudo-measurements. Day ahead load forecasts at a fully observed point on the network are adjusted using the intraday residuals at other points in the network to provide them with load forecasts without the need for a complete set of forecast models at all substations. These form pseudo-measurements that then inform the state estimates at future time points. This methodology is demonstrated on both a representative IEEE Test network and on an actual GB 11 kV feeder network.
Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown.
Aims
To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD.
Method
National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored.
Results
People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08–8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15–7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92–0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04–2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96–0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51–0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10–3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09–1.16, P < 0.001) were associated with worse therapy outcomes in PLWD.
Conclusions
Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
The Uniqueness of the Scottish Market: Law, Theology and Medicine
Uninterrupted runs of Scottish eighteenth-century newspapers are rare. Cheap, folio pages challenge most binders, and when finally bound in volumes, challenge most library shelves. Nevertheless, in 1776 the Caledonian Mercury urged its subscribers ‘to preserve their papers carefully, and bind them up’. This unusual advice was ‘particularly recommend[ed] … to Universities, and others who keep libraries of books’ (2 July 1776, 2). John Robertson, the publisher of the Caledonian Mercury, knew what he was doing in targeting the university market. Having purchased the Mercury four years earlier from the family of Thomas Ruddiman – publisher of Scotland's first medical periodical and Keeper of the Advocates’ Library (now the National Library of Scotland) – he was well aware that universities were the training ground for the professions, fundamentally shaping the Scottish market for news: theology, the law and medicine. These were the subjects driving the Enlightenment and enrolment at Scotland's universities, especially Edinburgh (Sher 1985: 27–31). The most complete collections of eighteenth-century Scottish newspapers now reside principally with the nation's academic and legal institutions.
The Advocates’ Library is perhaps the richest source of pre-1800 Scottish periodicals. The Signet Library, serving Edinburgh's other legal society, the Writers to the Signet, is not far behind. Advocates and solicitors were a ready market, especially for local and regional business news (Craig 1931: 81). The publisher of the Mercury understood this; after all, the relationship between Edinburgh's printers and the courts in Scotland had long been symbiotic: Scottish law required every court case to be printed in all its aspects, with copies of the proceedings circulated to the presiding justices, to the jurors and to all those involved in the prosecution and the defence (Finlay 2012: 51). Thus Petitions, Memorials and Answers – as the documents were known – account for the vast majority of all titles published in eighteenth-century Edinburgh, something the ESTC decisively demonstrates (Brown 2012: 14–18). The proceedings for the regular sittings or sessions of the High Court were bound and collected by the legal community, just as magazines were by subscribers. These Session Papers, as they came to be known, appeared in serial fashion at regular intervals and essentially comprise Scotland's first law journal.
The Uniqueness of the Scottish Market: Law, Theology and Medicine
Uninterrupted runs of Scottish eighteenth-century newspapers are rare. Cheap, folio pages challenge most binders, and when finally bound in volumes, challenge most library shelves. Nevertheless, in 1776 the Caledonian Mercury urged its subscribers ‘to preserve their papers carefully, and bind them up’. This unusual advice was ‘particularly recommend[ed] … to Universities, and others who keep libraries of books’ (2 July 1776, 2). John Robertson, the publisher of the Caledonian Mercury, knew what he was doing in targeting the university market. Having purchased the Mercury four years earlier from the family of Thomas Ruddiman – publisher of Scotland's first medical periodical and Keeper of the Advocates’ Library (now the National Library of Scotland) – he was well aware that universities were the training ground for the professions, fundamentally shaping the Scottish market for news: theology, the law and medicine. These were the subjects driving the Enlightenment and enrolment at Scotland's universities, especially Edinburgh (Sher 1985: 27–31). The most complete collections of eighteenth-century Scottish newspapers now reside principally with the nation's academic and legal institutions.
The Advocates’ Library is perhaps the richest source of pre-1800 Scottish periodicals. The Signet Library, serving Edinburgh's other legal society, the Writers to the Signet, is not far behind. Advocates and solicitors were a ready market, especially for local and regional business news (Craig 1931: 81). The publisher of the Mercury understood this; after all, the relationship between Edinburgh's printers and the courts in Scotland had long been symbiotic: Scottish law required every court case to be printed in all its aspects, with copies of the proceedings circulated to the presiding justices, to the jurors and to all those involved in the prosecution and the defence (Finlay 2012: 51). Thus Petitions, Memorials and Answers – as the documents were known – account for the vast majority of all titles published in eighteenth-century Edinburgh, something the ESTC decisively demonstrates (Brown 2012: 14–18). The proceedings for the regular sittings or sessions of the High Court were bound and collected by the legal community, just as magazines were by subscribers. These Session Papers, as they came to be known, appeared in serial fashion at regular intervals and essentially comprise Scotland's first law journal.
Depression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia.
Methods
National psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later.
Results
Improvements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (HR = 0.88, 95% CI 0.83–0.94), after adjustment for key covariates. Strongest effects were observed for vascular dementia (HR = 0.86, 95% CI 0.77–0.97) compared with Alzheimer's disease (HR = 0.91, 95% CI 0.83–1.00).
Conclusions
Reliable improvement in depression across psychological therapy was associated with reduced incidence of future dementia. Results are consistent with at least two possibilities. Firstly, psychological interventions to improve symptoms of depression may have the potential to contribute to dementia risk reduction efforts. Secondly, psychological therapies may be less effective in people with underlying dementia pathology or they may be more likely to drop out of therapy (reverse causality). Tackling the under-representation of older people in psychological therapies and optimizing therapy outcomes is an important goal for future research.
To investigate methods for in vitro assessment of anthelmintic efficacy against the chicken nematode Ascaridia galli this study firstly evaluated sample preparation methods including recovery of eggs from excreta using different flotation fluids and induced larval hatching by the deshelling–centrifugation method and the glass-bead method with or without bile. It then evaluated two in vitro assays, the in-ovo larval development assay (LDA) and larval migration inhibition assay (LMIA), for anthelmintic efficacy testing against A. galli using fresh eggs and artificially hatched larvae, respectively. Four anthelmintics, thiabendazole (TBZ), fenbendazole (FBZ), levamisole (LEV) and piperazine (PIP) were employed using an A. galli isolate of known susceptibility. The results suggested that the LDA and LMIA could successfully be used to generate concentration response curves for the tested drugs. The LDA provided EC50 values for inhibition of egg embryonation of 0.084 and 0.071 μg/ml for TBZ and FBZ, respectively. In the LMIA, the values of effective concentration (EC50) of TBZ, FBZ, LEV and PIP were 105.9, 6.32, 349.9 and 6.78 × 107 nM, respectively. For such in vitro studies, a saturated sugar solution showed high egg recovery efficiency (67.8%) and yielded eggs of the highest morphological quality (98.1%) and subsequent developmental ability (93.3%). The larval hatching assays evaluated did not differ in hatching efficiency but the deshelling–centrifugation method yielded larvae that had slightly better survival rates. For final standardization of these tests and establishment of EC50 reference values, tests using isolates of A. galli of defined resistance status need to be performed.
Clozapine is the only drug licensed for treatment-resistant schizophrenia (TRS) but the real-world clinical and cost-effectiveness of community initiation of clozapine is unclear.
Aims
The aim was to assess the feasibility and cost-effectiveness of community initiation of clozapine.
Method
This was a naturalistic study of community patients recommended for clozapine treatment.
Results
Of 158 patients recommended for clozapine treatment, 88 (56%) patients agreed to clozapine initiation and, of these, 58 (66%) were successfully established on clozapine. The success rate for community initiation was 65.4%; which was not significantly different from that for in-patient initiation (58.82%, χ2(1,88) = 0.47, P = 0.49). Following clozapine initiation, there was a significant reduction in median out-patient visits over 1 year (from 24.00 (interquartile range (IQR) = 14.00–41.00) to 13.00 visits (IQR = 5.00–24.00), P < 0.001), and 2 years (from 47.50 visits (IQR = 24.75–71.00) to 22.00 (IQR = 11.00–42.00), P < 0.001), and a 74.71% decrease in psychiatric hospital bed days (z = −2.50, P = 0.01). Service-use costs decreased (1 year: –£963/patient (P < 0.001); 2 years: –£1598.10/patient (P < 0.001). Subanalyses for community-only initiation also showed significant cost reductions (1 year: –£827.40/patient (P < 0.001); 2 year: –£1668.50/patient (P < 0.001) relative to costs prior to starting clozapine. Relative to before initiation, symptom severity was improved in patients taking clozapine at discharge (median Positive and Negative Syndrome Scale total score: initial visit: 80 (IQR = 71.00–104.00); discharge visit 50.5 (IQR = 44.75–75.00), P < 0.001) and at 2 year follow-up (Health of Nation Outcome Scales total score median initial visit: 13.00 (IQR = 9.00–15.00); 2 year follow-up: 8.00 (IQR = 3.00–13.00), P = 0.023).
Conclusions
These findings indicate that community initiation of clozapine is feasible and is associated with significant reductions in costs, service use and symptom severity.
The surgical treatment of insular gliomas requires specialized knowledge. Over the last three decades, increased momentum in surgical resection of insular gliomas shifted the focus from one of expectant management to maximal safe resection to establish a diagnosis, characterize tumor genetics, treat preoperative symptoms (i.e., seizures), and delay malignant transformation through tumor cytoreduction. A comprehensive review of the literature was performed regarding insular glioma classification/genetics, insular anatomy, surgical approaches, and patient outcomes. Modern large, published series of insular resections have reported a median 80% resection, 80% improvement in preoperative seizures, and postsurgical permanent neurologic deficits of less than 10%. Major complication avoidance includes recognition and preservation of eloquent cortex for language and respecting the lateral lenticulostriate arteries.
To identify: 1) best practice aged care principles and practices for Aboriginal and Torres Strait Islander older peoples, and 2) actions to integrate aged care services with Aboriginal community-controlled primary health care.
Background:
There is a growing number of older Aboriginal and Torres Strait Islander peoples and an unmet demand for accessible, culturally safe aged care services. The principles and features of aged care service delivery designed to meet the unique needs of Aboriginal and Torres Strait Islander peoples have not been extensively explored and must be understood to inform aged care policy and primary health care planning into the future.
Methods:
The research was governed by leaders from across the Aboriginal community-controlled primary health care sector who identified exemplar services to explore best practice in culturally aligned aged care. In-depth case studies were undertaken with two metropolitan Aboriginal community-controlled services. We conducted semi-structured interviews and yarning circles with 46 staff members to explore key principles, ways of working, enablers and challenges for aged care service provision. A framework approach to thematic analysis was undertaken with emergent findings reviewed and refined by participating services and the governance panel to incorporate national perspectives.
Findings:
A range of principles guided Aboriginal community-controlled aged care service delivery, such as supporting Aboriginal and Torres Strait Islander identity, connection with elders and communities and respect for self-determination. Strong governance, effective leadership and partnerships, Aboriginal and Torres Strait Islander workforce and culturally safe non-Indigenous workforce were among the identified enablers of aged care. Nine implementation actions guided the integration of aged care with primary health care service delivery. Funding limitations, workforce shortages, change management processes and difficulties with navigating the aged care system were among the reported challenges. These findings contribute to an evidence base regarding accessible, integrated, culturally safe aged care services tailored to the needs of Aboriginal and Torres Strait Islander peoples.
In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj).
Background:
The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally divergent approaches to management and leadership.
Methods:
Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model.
Findings:
The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities; it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas; and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety.
Conclusions:
Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.
Repeated antigen testing of 12 severe acute respiratory coronavirus virus 2 (SARS-CoV-2)–positive nursing home residents using Abbott BinaxNOW identified 9 of 9 (100%) culture-positive specimens up to 6 days after initial positive test. Antigen positivity lasted 2–24 days. Antigen positivity might last beyond the infectious period, but it was reliable in residents with evidence of early infection.
Software testing can be regarded as an art, a craft, and a science. The practical, step-by-step approach presented in this book provides a bridge between these different viewpoints. A single worked example runs throughout, with consistent use of test automation. Each testing technique is introduced in the context of this example, helping students see its strengths and weaknesses. The technique is then explained in more detail, providing a deeper understanding of underlying principles. Finally the limitations of each technique are demonstrated by inserting faults, giving learners concrete examples of when each technique succeeds or fails in finding faults. Coverage includes black-box testing, white-box testing, random testing, unit testing, object-oriented testing, and application testing. The authors also emphasise the process of applying the techniques, covering the steps of analysis, test design, test implementation, and interpretation of results. The book's web site has programming exercises and Java source code for all examples.