scholarly journals A common model for the breathlessness experience

2020 ◽  
Author(s):  
Sarah Louise Finnegan ◽  
Kyle T S Pattinson ◽  
Josefin Sundh ◽  
Magnus Skold ◽  
Christer Janson ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Body Burden ◽  
Disease Diagnosis ◽  
Adverse Outcomes ◽  
Data Driven ◽  
Measurement Tool ◽  
Treatment Target ◽  
Model Stability ◽  
Underlying Mechanisms ◽  
The Stability

Introduction: Chronic breathlessness occurs across many different diseases, independently of severity. Yet, despite being strongly linked to adverse outcomes, chronic breathlessness is generally not considered a stand-alone treatment target. Here we move focus from identifying the "best" measurement tool and use data-driven techniques to identify and confirm the stability of underlying features (factors) driving breathlessness across different cardiorespiratory diseases. Such frameworks could provide an opportunity to address the underlying mechanisms of breathlessness and over-come issues with co-morbidities, particularly when medical therapies have been optimised. Methods: Longitudinal study of questionnaire data on 182 participants with main diagnoses of asthma (21.4%), COPD (24.7%), heart failure (19.2%), idiopathic pulmonary fibrosis (18.7%), other interstitial lung disease (5.5%), and "other diagnoses" (8.8%) were entered into an exploratory factor analysis (EFA). Participants were stratified based on their EFA factor scores, allowing us to examine whether the breathlessness experience differed across disease diagnosis. We then examined model stability after six months and established through an iterative process the most compact, and therefore least burdensome assessment tool. Results: From the 25 input measures, 16 measures were retained for model validation. The resulting model contained four factors to which we assigned the following descriptive labels: 1) body burden, 2) affect/mood, 3) breathing burden and 4) anger/frustration. Stratifying patients by their scores across the four factors revealed two groups corresponding to high and low burden. These were not found to be predictive of primary disease diagnosis and did remain stable after six months. Conclusions: We have identified four stable and disease-independent factors that seem to underlie the experience of breathlessness. We suggest that interventions may target factors within this framework to answer the question of whether they are also driving the experience itself.

scholarly journals A common model for the breathlessness experience across cardiorespiratory disease

2021 ◽  
pp. 00818-2020
Author(s):  
Sarah L. Finnegan ◽  
Kyle T.S. Pattinson ◽  
Josefin Sundh ◽  
Magnus Sköld ◽  
Christer Janson ◽  
...  
Keyword(s):  
Body Burden ◽  
Disease Diagnosis ◽  
Adverse Outcomes ◽  
Data Driven ◽  
Compact Set ◽  
Factor Scores ◽  
Model Stability ◽  
Patient Groups ◽  
The Stability

IntroductionChronic breathlessness occurs across many different conditions, often independently of disease severity. Yet, despite being strongly linked to adverse outcomes, the consideration of chronic breathlessness as a stand-alone therapeutic target remains limited. Here we use data-driven techniques to identify and confirm the stability of underlying features (factors) driving breathlessness across different cardiorespiratory diseases.MethodsStudy of questionnaire data on 182 participants with main diagnoses of asthma (21.4%), COPD (24.7%), heart failure (19.2%), idiopathic pulmonary fibrosis (18.7%), other interstitial lung disease (5.5%), and “other diagnoses” (8.8%) were entered into an exploratory factor analysis (EFA). Participants were stratified based on their EFA factor scores. We then examined model stability using six-month follow-up data and established the most compact set of measures describing the breathlessness experience.ResultsIn this dataset, we have identified four stable factors that underlie the experience of breathlessness. These factors were assigned the following descriptive labels: 1) body burden, 2) affect/mood, 3) breathing burden and 4) anger/frustration. Stratifying patients by their scores across the four factors revealed two groups corresponding to high and low burden. These two groups were not related to the primary disease diagnosis and remained stable after six months.DiscussionIn this work we identified and confirmed the stability of underlying features of breathlessness. Previous work in this domain has been largely limited to single-diagnosis patient groups without subsequent re-testing of model stability. This work provides further evidence supporting disease independent approaches to assess breathlessness.

scholarly journals Data-Driven Stability Assessment of Multilayer Long Short-Term Memory Networks

2021 ◽  
Vol 11 (4) ◽  
pp. 1829
Author(s):  
Davide Grande ◽  
Catherine A. Harris ◽  
Giles Thomas ◽  
Enrico Anderlini
Keyword(s):  
Neural Network ◽  
Network Architecture ◽  
Short Term Memory ◽  
Moving Average ◽  
Machine Learning Algorithms ◽  
Physical Models ◽  
Data Driven ◽  
The Stability ◽  
And Control ◽  
Nonlinear Autoregressive

Recurrent Neural Networks (RNNs) are increasingly being used for model identification, forecasting and control. When identifying physical models with unknown mathematical knowledge of the system, Nonlinear AutoRegressive models with eXogenous inputs (NARX) or Nonlinear AutoRegressive Moving-Average models with eXogenous inputs (NARMAX) methods are typically used. In the context of data-driven control, machine learning algorithms are proven to have comparable performances to advanced control techniques, but lack the properties of the traditional stability theory. This paper illustrates a method to prove a posteriori the stability of a generic neural network, showing its application to the state-of-the-art RNN architecture. The presented method relies on identifying the poles associated with the network designed starting from the input/output data. Providing a framework to guarantee the stability of any neural network architecture combined with the generalisability properties and applicability to different fields can significantly broaden their use in dynamic systems modelling and control.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

Development of the Caregiver Confidence using Music Scale

2021 ◽  
Vol 13 (4) ◽  
Author(s):  
David Kim ◽  
Brandon Ruan ◽  
Lee Bartel ◽  
Bev Foster ◽  
Chelsea Mackinnon
Keyword(s):  
Cluster Analysis ◽  
Convergent Validity ◽  
Assessment Tool ◽  
Hierarchical Cluster ◽  
Current Data ◽  
Face Validity ◽  
Measurement Tool ◽  
Healthcare Settings ◽  
Care Training ◽  
Readiness To Adopt

Music serves as an important tool to improve the health and wellness of individuals in healthcare settings. In times of high caregiver burnout, therapeutic outlets such as music for care receivers and providers are becoming increasingly important. This paper presents the first iteration of the Caregiver Confidence using Music Scale (CCuMS), an assessment tool designed to evaluate caregivers’ readiness to adopt music care. Music care is defined as the informed and intentional use of music by anyone to improve the quality of care. The CCuMS was derived from a hierarchical cluster analysis of the Music Care Training program’s Level 1 post-evaluation survey (Post-MCTL1). Thematic interpretation of the statistical outputs from the cluster analysis was completed, resulting in the first iteration of the CCuMS. Initial validation methods that were feasible with current data were conducted. Specifically, face validity, content validity and convergent validity were calculated using Pearson correlations. The CCuMS shows promise as a measurement tool for use in healthcare settings due to the moderate correlation between the Post-MCTL1 and the CCuMS scale (r=0.524), and the strong correlation between the music care training thematic questionnaire and the CCuMS (r=0.970).

scholarly journals Nonlinear Blade Stability for a Scaled Autogyro Rotor at High Advance Ratios

2020 ◽  
Vol 65 (1) ◽  
pp. 1-19
Author(s):  
Djamel Rezgui ◽  
Mark H. Lowenberg
Keyword(s):  
High Speed ◽  
Flow Speed ◽  
Numerical Continuation ◽  
Control Input ◽  
Nonlinear Phenomenon ◽  
Scaled Model ◽  
Underlying Mechanisms ◽  
Slowed Rotor ◽  
The Stability ◽  
Blade Pitch Angle

Despite current research advances in aircraft dynamics and increased interest in the slowed rotor concept for high-speed compound helicopters, the stability of autogyro rotors remains partially understood, particularly at lightly loaded conditions and high advance ratios. In autorotation, the periodic behavior of a rotor blade is a complex nonlinear phenomenon, further complicated by the fact that the rotor speed is not held constant. The aim of the analysis presented in this article is to investigate the underlying mechanisms that can lead to rotation-flap blade instability at high advance ratios for a teetering autorotating rotor. The stability analysis was conducted via wind tunnel tests of a scaled autogyro model combined with numerical continuation and bifurcation analysis. The investigation assessed the effect of varying the flow speed, blade pitch angle, and rotor shaft tilt relative to the flow on the rotor performance and blade stability. The results revealed that rotor instability in autorotation is associated with the existence of fold bifurcations, which bound the control-input and design parameter space within which the rotor can autorotate. This instability occurs at a lightly loaded condition and at advance ratios close to 1 for the scaled model. Finally, it was also revealed that the rotor inability to autorotate was driven by blade stall.

scholarly journals METHOD OF FORENSIC ASSESSMENT OF RISK FACTORS OF TREATMENT FAILURE OUTCOMES AS AN ELEMENT OF QUALITY MANAGEMENT OF MEDICAL CARE

2020 ◽  
Vol 73 (5) ◽  
pp. 1041-1047
Author(s):  
Vyacheslav K. Sokol ◽  
Vira A. Kolesnichenko ◽  
Kostyantin M. Sokol ◽  
Vladyslav A. Smiianov
Keyword(s):  
Forensic Assessment ◽  
Adverse Outcomes ◽  
Expert Assessment ◽  
Delayed Fracture ◽  
Fracture Consolidation ◽  
Secondary Displacement ◽  
Bone Fragments ◽  
Diaphyseal Fractures ◽  
Post Traumatic ◽  
The Stability

The aim: The aim of this research was to study causes of the development of adverse outcomes in isolated femоral diaphyseal fractures. Materials and methods: A retrospective analysis of the protocols of clinical and radiological examination of 21 patients was performed. Based on the initial expert assessment, these patients have not been established the severity of injuries due to the development of complications in the postoperative period. Conclusions: Patient-dependent, implant-dependent, and surgery-dependent causes that caused a violation of the stability of osteosynthesis (95.2%) were identified. This led to a secondary displacement of bone fragments (71.4%), delayed fracture consolidation (61.9%), the formation of pseudarthrosis (38.1%), the development of post-traumatic osteomyelitis (14,3), migration of screws from the osseous plate (47.6%), and the development of post-traumatic contracture of the knee joint (81.0%).

scholarly journals The collapse of genetic incompatibilities in a hybridizing population

2021 ◽  
Author(s):  
Tianzhu Xiong ◽  
James L MALLET
Keyword(s):  
Gene Regulation ◽  
Reproductive Isolation ◽  
Genetic Drift ◽  
Recombination Rate ◽  
Time Scale ◽  
Genetic Incompatibility ◽  
Genetic Process ◽  
Underlying Mechanisms ◽  
The Stability

Genetic incompatibility has long been considered to be a hallmark of speciation due to its role in reproductive isolation. Previous analyses of the stability of epistatic incompatibility show that it is subject to collapse upon hybridization. In the present work, we derive explicitly the distribution of the lifespan of two-locus incompatibilities, and show that genetic drift, along with recombination, is critical in determining the time scale of collapse. The first class of incompatibilities, where derived alleles separated in parental populations act antagonistically in hybrids, survive longer in smaller populations when incompatible alleles are (co)dominant and tightly linked, but collapse more quickly when they are recessive. The second class of incompatibilities, where fitness is reduced by disrupting co-evolved elements in gene regulation systems, collapse on a time scale proportional to the exponential of effective recombination rate. Overall, our result suggests that the effects of genetic drift and recombination on incompatibility's lifespan depend strongly on the underlying mechanisms of incompatibilities. As the time scale of collapse is usually shorter than the time scale of establishing a new incompatibility, the observed level of genetic incompatibilities in a particular hybridizing population may be shaped more by the collapse than by their initial accumulation. Therefore, a joint theory of accumulation-erosion of incompatibilities is in need to fully understand the genetic process under speciation with hybridization.

scholarly journals Validity and reliability of Korean version Competency Assessment Tool-Mental Health

2020 ◽  
Vol 7 (2) ◽  
pp. 143-152
Author(s):  
Hyun Mee Cho ◽  
Jeong Won Han ◽  
Eun Joung Choi ◽  
Hyo Eun Jeong ◽  
Bo Ram Hong ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Internal Consistency ◽  
Assessment Tool ◽  
Reliability And Validity ◽  
Basic Data ◽  
Measurement Tool ◽  
Competency Assessment ◽  
Validity And Reliability

AbstractObjectiveTo establish basic data for identifying the level of mental health care competency of general nurses through verification of the reliability and validity of Competency Assessment Tool-Mental Health in the development of a measurement tool for mental health care competency in Korea.MethodsThis study was conducted on nurses working at general wards, excluding those working at the Department of Psychiatry, in five hospitals with 200 beds or more located in Korea. Content, construct, concurrent validity, and internal consistency of the measurement were confirmed.ResultsAs a result of the construct validity, the section on importance of skills and knowledge for mental health care had 21 items, whereas the section on benefits of additional education had 22 items. The internal consistency of measurement was confirmed as follows: Cronbach's α = 0.96 for the section on importance and 0.96 for the section on benefits section.ConclusionsThis study verified the high validity and reliability of the tool in assessing the mental health care competency of nurses, and it is believed to be significant as basic data for enhancing such competency.

Development and psychometric testing of Indonesian clinical assessment tool (In-Cat) for student nurses

2021 ◽  
Vol 18 (1-2) ◽  
Author(s):  
Justina Purwarini
Keyword(s):  
Nursing Students ◽  
Clinical Assessment ◽  
Assessment Tool ◽  
Real Life ◽  
Student Nurses ◽  
Psychometric Testing ◽  
Measurement Tool ◽  
Mixed Method Research ◽  
Teachers And Students ◽  
Competency Based

In clinical nursing, students apply knowledge gained from classroom experience to real life situations. This educational model is experiential in nature, where patient learning experiences are selected based on the successful learning process. Hence, the competencies anticipated at a certain level are achieved in accordance with the objectives of knowledge. Purpose: This study was, therefore, aimed at developing a valid clinical assessment tool to guide the education system, and evaluate nursing students’ performance during practice in Indonesia. Methods: This research employed an exploratory sequential mixed method research design. Result: The transcripts generated from Focus Group Discussions and in-depth interviews showed three major areas of competence to be achieved while undergoing clinical practice. These ought to be combined with learning outcomes on the Competency-Based Curriculum in Indonesia, and subsequently reprocessed, to establish the final results, comprising 37 items. The study shows IN-CAT as acceptable (Scale-CVI= 0.9), indicating the agreement is adequate (Cohen’s kappa= 0.795), and satisfactory (The Cronbach’s alpha= 0.949). Conclusion: The results initially specify the scale as a reliable and valid measurement tool, with the potential for use in the assessment and evaluation of clinical competence amongst nursing students. Based on the feedback from teachers and students, The assessment tool demonstrates clarified learning objectives, improved focus, and enhanced the evaluation objectivity.

scholarly journals Early identification of severe community-acquired pneumonia: a retrospective observational study

2019 ◽  
Vol 6 (1) ◽  
pp. e000438 ◽  
Author(s):  
Frances S Grudzinska ◽  
Kerrie Aldridge ◽  
Sian Hughes ◽  
Peter Nightingale ◽  
Dhruv Parekh ◽  
...  
Keyword(s):  
Early Warning ◽  
Assessment Tool ◽  
Characteristic Curve ◽  
Community Acquired Pneumonia ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Early Warning Score ◽  
News Medium ◽  
Increased Risk ◽  
Early Warning Scores

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of sepsis worldwide. Prompt identification of those at high risk of adverse outcomes improves survival by enabling early escalation of care. There are multiple severity assessment tools recommended for risk stratification; however, there is no consensus as to which tool should be used for those with CAP. We sought to assess whether pneumonia-specific, generic sepsis or early warning scores were most accurate at predicting adverse outcomes.MethodsWe performed a retrospective analysis of all cases of CAP admitted to a large, adult tertiary hospital in the UK between October 2014 and January 2016. All cases of CAP were eligible for inclusion and were reviewed by a senior respiratory physician to confirm the diagnosis. The association between the CURB65, Lac-CURB-65, quick Sequential (Sepsis-related) Organ Failure Assessment tool (qSOFA) score and National Early Warning Score (NEWS) at the time of admission and outcome measures including intensive care admission, length of hospital stay, in-hospital, 30-day, 90-day and 365-day all-cause mortality was assessed.Results1545 cases were included with 30-day mortality of 19%. Increasing score was significantly associated with increased risk of poor outcomes for all four tools. Overall accuracy assessed by receiver operating characteristic curve analysis was significantly greater for the CURB65 and Lac-CURB-65 scores than qSOFA. At admission, a CURB65 ≥2, Lac-CURB-65 ≥moderate, qSOFA ≥2 and NEWS ≥medium identified 85.0%, 96.4%, 40.3% and 79.0% of those who died within 30 days, respectively. A Lac-CURB-65 ≥moderate had the highest negative predictive value: 95.6%.ConclusionAll four scoring systems can stratify according to increasing risk in CAP; however, when a confident diagnosis of pneumonia can be made, these data support the use of pneumonia-specific tools rather than generic sepsis or early warning scores.

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