Using mental tasks transitions detection to improve spontaneous mental activity classification

This paper presents an algorithm based on canonical variates transformation (CVT) and distance based discriminant analysis (DBDA) combined with a mental tasks transitions detector (MTTD) to classify spontaneous mental activities in order to operate a brain-computer interface working under an asynchronous protocol. The algorithm won the BCI Competition III--Data Set V: Multiclass Problem, Continuous EEG--achieving an averaged classification accuracy over three subjects of 68.65% (79.60, 70.31 and 56.02%, respectively) in a three-class problem.     

Rethinking transitions of care: An interprofessional transfer triage protocol in post-acute care

Readmissions to hospitals from post-acute care (PAC) units within long-term care settings have been rapidly increasing over the past decade, and are drivers of increased healthcare costs. With an average of $11,000 per admission, there is a need for strategies to reduce 30-day preventable hospital readmission rates. In 2018, incentives and penalties will be instituted for long-term care facilities failing to meet all-cause, all-condition hospital readmission rate performance measures. An interprofessional team (IPT) developed and implemented a Transfer Triage Protocol used in conjunction with the INTERACT programme to enhance clinical decision-making and assess the potential to reduce the facility’s 30-day preventable hospital readmission rates by 10% within 6 weeks of implementation. Results from quantitative analysis demonstrated an overall 35.2% reduction in the 30-day preventable hospital readmission rate. Qualitative analysis revealed the need for additional staff education, improved screening and communication upon admission and prior to hospital transfer, and the need for more IPT on-site availability. This pilot study demonstrates the benefits and implications for practice of an IPT to improve the quality of care within PAC and decrease 30-day preventable hospital readmissions.     

Mesoscale networks and corresponding transitions from self-assembly of block copolymers

A series of cubic network phases was obtained from the self-assembly of a single-composition lamellae (L)-forming block copolymer (BCP) polystyrene-block-polydimethylsiloxane (PS-b-PDMS) through solution casting using a PS-selective solvent. An unusual network phase in diblock copolymers, double-primitive phase (DP) with space group of Im3¯m, can be observed. With the reduction of solvent evaporation rate for solution casting, a double-diamond phase (DD) with space group of Pn3¯m can be formed. By taking advantage of thermal annealing, order–order transitions from the DP and DD phases to a double-gyroid phase (DG) with space group of Ia3¯d can be identified. The order–order transitions from DP (hexapod network) to DD (tetrapod network), and finally to DG (trigonal planar network) are attributed to the reduction of the degree of packing frustration within the junction (node), different from the predicted Bonnet transformation from DD to DG, and finally to DP based on enthalpic consideration only. This discovery suggests a new methodology to acquire various network phases from a simple diblock system by kinetically controlling self-assembling process.

From constituted molecules to polymers, finally ordered hierarchical superstructures, self-assembled solids cover a vast area of nanostructures where the characters of building blocks direct the progress of self-assembly (1, 2). In nature, fascinating periodic network structures and morphologies from different species are appealing in nanoscience and nanotechnology due to their superior properties, especially for photonic crystal structures (3–7). For gyroid, trigonal planar network with chirality demonstrates its potential as chiropitc metamaterial (8–10). Beyond the splendid colors, networks either in macroscale or mesoscale mechanically strengthen their skeletons and protect those fragile but vital organs from impact (11, 12). Inspired by nature, biomimicking materials with mesoscale network may exceed the limitation of the intrinsic properties (13). The topology of networks could further improve their adaptability, allowing extreme deformation for energy dissipation (14). Moreover, network materials from hybridization of self-assembled block copolymers (BCPs) have been exploited to the design of mesoscale quantum metamaterials (15, 16). With the desire to acquire network textures for biomimicking nanomaterials, BCPs with immiscible constituted segments covalently joined together give the accessibility to the formation of nanonetwork morphologies via balancing enthalpic penalty from the repulsive interaction of constituted blocks and entropic penalty from the stretching of polymer chains (17–21). By taking advantage of precise synthesis procedures, it is feasible to obtain the aimed network phases from the self-assembly of BCPs such as Fddd (O⁷⁰) (22–24), gyroid (Q²¹⁴, Q²³⁰) (20, 21, 25–27), and diamond (Q²²⁴, Q²²⁷) (28–31) experimentally and theoretically. On the basis of theoretical prediction, the junction points (nodes) in the network phases could be coordinated with three, four, or six neighbors in three-dimensional space, resulting in the enhancement of packing frustration (31). Topologically, all these phases match the coordination number to neighbors (n = 3, 4, 6), showing no special case of quasicrystal. Accordingly, an order–order transition from double-diamond phase (DD, tetrapod) to double-gyroid phase (DG, trigonal planar network) has been observed (29). Yet, there is no DP phase being found in simple diblock systems except for liquid crystals (32, 33) or organic–inorganic nanocomposites from the mixtures of BCP with inorganic precursors (34, 35). Searching the rare occurrence of network phases and the corresponding phase transitions among phases will be essential to the demands for application by considering the deliberate structuring effects on aimed properties but the approaches remain challenging (8, 36–40). For instance, viewing the narrow window for network morphologies in diblock copolymer phase diagram, it demands harsh requirements for syntheses (2, 41). Recently, by taking advantage of using selective solvent for solution casting, it is feasible to acquire DG phase and even inverted DG phase from the self-assembly of lamellae (L)-forming polystyrene-block-polydimethylsiloxane (PS-b-PDMS) (42). Apart from that, a triclinic DG phase was recently discovered from the PS-b-PDMS which is commonly believed nonexisting in the conventional phase diagram (43). As a result, the phase diagram of BCPs with high interaction parameter is worthy of study for searching the metastable phases with unique network textures (44). Herein, we aim to acquire network phases from a simple diblock system by kinetically controlling the transformation mechanisms of self-assembly. As exemplified by using the PS-b-PDMS for solution casting, with the use of a PS-selective solvent (chloroform), a DP phase and a DD phase could be formed through controlled self-assembly, giving unique network phases simply from solution casting. Moreover, a DG phase can be also acquired from phase transformation. Consequently, a series of network phases with hexapod, tetrapod, and trigonal planar building units could be successfully obtained by using a single-composition L-forming PS-b-PDMS for self-assembly. The corresponding order–order transitions among these network phases examined by temperature-resolved in situ small-angle X-ray scattering (SAXS) combining with electron tomography results provide insights of network phase formation and the corresponding phase transformation mechanisms in the self-assembly of BCPs.     

Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

Objectives

To examine the effect of an emergency department (ED )‐based transitional care nurse (TCN ) on hospital use.

Design

Prospective observational cohort.

Setting

Three U.S. (NY , IL , NJ ) ED s from January 1, 2013, to June 30, 2015.

Participants

Individuals aged 65 and older in the ED (N = 57,287).

Intervention

The intervention was first TCN contact. Controls never saw a TCN during the study period.

Measurements

We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30‐day admission (any admission on Days 0–30) and 72‐hour ED revisits.

Results

A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: ?9.9% risk of inpatient admission, 95% confidence interval (CI ) = ?12.3% to ?7.5%; site 2: ?16.5%, 95% CI = ?18.7% to ?14.2%; site 3: ?4.7%, 95% CI = ?7.5% to ?2.0%). Participants with TCN contact had greater risk of a 72‐hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7–2.3%; site 2: 1.4%, 95% CI = 0.7–2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: ?7.8%, 95% CI = ?10.3% to ?5.3%; site 2: ?13.8%, 95% CI = ?16.1% to ?11.6%).

Conclusion

Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.

     

Wetting Transitions in Polymer Nanograss Generated by Nanoimprinting

To study the transitions between wetting regimes on highly rough surfaces, the authors have fabricated a set of polymer nanograss surfaces with virtually identical geometry, but different surface chemistry by double replication. A common silicon master of the “black silicon” type, obtained by cryogenic SF₆/O₂ plasma etching, is used for all replications. Additionally, the same process is used to generate nanograss‐carrying, transferrable foils, and the authors show how to increase sample size by multiple lithography steps side by side on one support. This process proves generally applicable to soluble thermoplastics. Thus, by choosing polymers with different surface energy, all three possible wetting regimes on highly rough surfaces are realized—superwetting, superhydrophobicity, and the intermediate, sticky Wenzel regime. The locations of and the phenomena close to the transitions between these three wetting regimes are studied, based on dynamic contact angle measurements.

     

Catalogue of abrupt shifts in Intergovernmental Panel on Climate Change climate models

Abrupt transitions of regional climate in response to the gradual rise in atmospheric greenhouse gas concentrations are notoriously difficult to foresee. However, such events could be particularly challenging in view of the capacity required for society and ecosystems to adapt to them. We present, to our knowledge, the first systematic screening of the massive climate model ensemble informing the recent Intergovernmental Panel on Climate Change report, and reveal evidence of 37 forced regional abrupt changes in the ocean, sea ice, snow cover, permafrost, and terrestrial biosphere that arise after a certain global temperature increase. Eighteen out of 37 events occur for global warming levels of less than 2°, a threshold sometimes presented as a safe limit. Although most models predict one or more such events, any specific occurrence typically appears in only a few models. We find no compelling evidence for a general relation between the overall number of abrupt shifts and the level of global warming. However, we do note that abrupt changes in ocean circulation occur more often for moderate warming (less than 2°), whereas over land they occur more often for warming larger than 2°. Using a basic proportion test, however, we find that the number of abrupt shifts identified in Representative Concentration Pathway (RCP) 8.5 scenarios is significantly larger than in other scenarios of lower radiative forcing. This suggests the potential for a gradual trend of destabilization of the climate with respect to such shifts, due to increasing global mean temperature change.The gradual rise in greenhouse gas concentrations is projected to drive a mostly smooth increase in global temperature (1). However, the Earth system is suspected to have a range of “tipping elements” with the characteristic that their gradual change will be punctuated by critical transitions on regional scales (2, 3). That is, for relatively small changes in atmospheric concentrations of greenhouse gases, parts of the Earth system exhibit major changes. The recent fifth Assessment Report (AR5) of the Intergovernmental Panel on Climate Change (IPCC) presents a catalog of possible abrupt or irreversible changes (table 12.4 in ref. 4). This catalog builds on a previous literature review (2) of components believed to have the potential for an acceleration of change as fossil fuel burning changes atmospheric composition and thus radiative forcing.The expert elicitation (2) motivated discussion of a multitude of environmental threats to the planet in which it was critically argued that atmospheric carbon dioxide concentration should not cross 350 ppm (5), trying to determine what constitutes safe levels of global warming. This threshold was suggested in ref. 5 to minimize the risk due to massive sea ice change, sea level rise, or major changes to terrestrial ecosystems and crops. An alternative purely temperature-based threshold is that from the Copenhagen accord, setting an upper limit of 2° (6). However, major uncertainty exists in knowledge of climate sensitivity (7), which makes it difficult to relate this warming level to a precise CO₂ concentration. However, despite this and the growing interest in the societal effects of such transitions, there has been no systematic study of the potential for abrupt shifts in state-of-the-art Earth System Models.To explore what may be deduced from the current generation of climate models in this context, we analyze the simulations produced by Coupled Model Intercomparison Project 5 (CMIP5) (8) that were used to inform the IPCC. CMIP5 provides a compilation of coordinated climate model experiments. Each of 37 analyzed models includes representations of the oceans, atmosphere, land surface, and cryosphere. The climate models have been forced with future changes in atmospheric gas concentrations, depicted in four Representative Concentration Pathways (RCPs) (9), starting in year 2006. Of these, we analyze RCP2.6, RCP4.5, and RCP8.5 to explore a range of changes in radiative forcing, reaching levels of 2.6 W⋅m⁻², 4.5 W⋅m⁻², and 8.5 W⋅m⁻², respectively, by year 2100 (including all available simulations that go beyond 2100). We also analyze historical simulations, capturing changes from preindustrial conditions in year 1850 to the present, and preindustrial control simulations.To assess future risks of abrupt, potentially irreversible, changes in important climate phenomena, we first need to define what we mean by “abrupt.” This term clearly refers to time scale and is usually defined as when changes observed are faster than the time scale of the external forcing. Here we choose a methodology consisting of three stages. Firstly, we systematically screen the CMIP5 multimodel ensemble of simulations for evidence of abrupt changes using search criteria (Methods) to make a first filtering of regions of potentially relevant abrupt events from this dataset (stage 1). These criteria are motivated by the definition of the assessment report, AR5 (4): “A large-scale change in the climate system that takes place over a few decades or less, persists (or is anticipated to persist) for at least a few decades, and causes substantial disruptions in human and natural systems.” Other definitions have emphasized the timescales of the change, e.g., 30 y (10), and rapidity in comparison with the forcing (11), which also meet our search criteria. Global maps of quantities with potential to change abruptly are expressed as (i) the mean difference between end and beginning of a simulation, (ii) the SD of the detrended time series, and (iii) the maximum absolute change within 10 y. These maps are made for all scenario runs and compared with values for the preindustrial control runs. When at least two indicators suggest locations of major change, we construct time series for area averages of at least 0.5 × 10⁶ km² (roughly 10 by 10 degrees) and visually inspect these for abrupt shifts standing out from the internal variability (stage 2). Subsequently, we check whether the selected cases can indeed be considered examples of abrupt change applying formal classification criteria (Methods) such as the criterion that the change should be larger than 4 times the SD of the preindustrial simulation, in combination with additional statistical tests (stage 3).We find a broad range of transitions passing our classification criteria (Fig. 1, SI Appendix, Table S1), which can be grouped into four categories (Fig. 2). They include abrupt shifts in sea ice and ocean circulation patterns as well as abrupt shifts in vegetation and the terrestrial cryosphere. Fig. 2 shows a selected example for each category. All other time series are displayed in Fig. 3. Information on the regions where the shifts occur and the results of the statistical tests used for classification are displayed in SI Appendix, Tables S2 and S3, respectively. A list of the climate models and their acronyms is provided in SI Appendix, Table S1.Open in a separate windowFig. 1.Geographical location of the abrupt climate change occurrences. All 30 model cases listed in

Resident learning across the full range of core competencies through a transitions of care curriculum

ABSTRACT

The authors developed a Transitions of Care (TOC) curriculum to teach and measure learner competence in performing TOC tasks for older adults. Internal medicine interns at an academic residency program received the curriculum, which consisted of experiential learning, self-study, and small group discussion. Interns completed retrospective pre/post surveys rating their confidence in performing five TOC tasks, qualitative open-ended survey questions, and a self-reflection essay. A subset of interns also completed follow-up assessments. For all five TOC tasks, the interns’ confidence improved following completion of the TOC curriculum. Self-confidence persisted for up to 3 months later for some but not all tasks. According to the qualitative responses, the TOC curriculum provided interns with learning experiences and skills integral to performing safe care transitions. The TOC curriculum and a mixed-method assessment approach effectively teaches and measures learner competency in TOC across all six Accreditation Council for Graduate Medical Education competency domains.     

上皮-间质转化在肿瘤多药耐药性发生中的作用

化学治疗是肿瘤综合治疗的重要方法之一,而多药耐药一直是导致肿瘤化学治疗失败的主要原因。上皮-间质转化(EMT)是正常发育、伤口愈合的基础,同时也在肿瘤发生、侵袭及转移过程中发挥着重要作用,近年来越来越多的研究证实EMT也参与了肿瘤多药耐药的发生。该文主要就EMT的概念、发生机制及其在肿瘤多药耐药过程中机制的研究进展进行综述。     

Subtypes of potentially inappropriate medications in older Chinese-Americans during care transitions: Cross sectional retrospective study

Background

The number of Chinese Americans is growing and nearly 20% of older Chinese-American home care patients have at least one potentially inappropriate medications (PIMs) prescribed at hospital discharge. Further examination of PIMs during care transition is warranted, especially among older Chinese-Americans.

Objectives

To describe, during care transitions from hospital to home care: (i) the subtypes of PIMs, (ii) the difference of PIM prevalence prescribed at hospital discharge as compared to home care admission, (iii) the relationship between subtypes of PIMs, and (iv) issues affecting medication reconciliation among older Chinese-Americans.

Methods

This cross-sectional, retrospective study was conducted in a large urban home care agency from June 2010 to July 2011. From data collected by in-home survey and chart abstraction, PIMs were identified using 2002 diagnosis-independent Beers criteria. The difference of PIM prevalence at hospital discharge and at home care admission was analyzed by Wilcoxon Signed Ranks test. The relationship between subtypes of PIMs was evaluated using Phi coefficient.

Participants

82 older (age 65 years and above) Chinese-American home care patients following recent hospital discharge.

Results

3.38% (22) and another 3.72% (28) of prescribed medications were identified as PIMs at hospital discharge and home care admission, respectively. There was no statistically significant difference in PIM prevalence identified at hospital discharge and at homecare admission (z = −1.732, p = .083). PIMs included: long-term use of stimulant laxatives and high-dosages of ferrous sulfate, and a significant relationship between these two PIMS (r = .224, p = .04). More than 80% (n = 65) of study participants reported low education levels and limited English proficiency.

Conclusions

Subtypes of PIMs were ordered during the post-hospital transfers, indicating the necessity to review the appropriateness of medications during this transition. Guidelines such as Beer's criteria regarding appropriateness of medications should be incorporated in medication reconciliation before adding new medications to treat the older adult's health problems. The medication management process needs to be both culturally sensitive and adapted to literacy level; validating the patients’ full understanding of their medications is paramount.