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PloS One 2024Fractional order algorithms demonstrate superior efficacy in signal processing while retaining the same level of implementation simplicity as traditional algorithms. The...
Fractional order algorithms demonstrate superior efficacy in signal processing while retaining the same level of implementation simplicity as traditional algorithms. The self-adjusting dual-stage fractional order least mean square algorithm, denoted as LFLMS, is developed to expedite convergence, improve precision, and incurring only a slight increase in computational complexity. The initial segment employs the least mean square (LMS), succeeded by the fractional LMS (FLMS) approach in the subsequent stage. The latter multiplies the LMS output, with a replica of the steering vector (Ŕ) of the intended signal. Mathematical convergence analysis and the mathematical derivation of the proposed approach are provided. Its weight adjustment integrates the conventional integer ordered gradient with a fractional-ordered. Its effectiveness is gauged through the minimization of mean square error (MSE), and thorough comparisons with alternative methods are conducted across various parameters in simulations. Simulation results underscore the superior performance of LFLMS. Notably, the convergence rate of LFLMS surpasses that of LMS by 59%, accompanied by a 49% improvement in MSE relative to LMS. So it is concluded that the LFLMS approach is a suitable choice for next generation wireless networks, including Internet of Things, 6G, radars and satellite communication.
Topics: Algorithms; Signal Processing, Computer-Assisted; Least-Squares Analysis; Computer Simulation; Models, Theoretical
PubMed: 38905213
DOI: 10.1371/journal.pone.0304018 -
JAMA Network Open Jun 2024Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments.
OBJECTIVE
To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators.
DESIGN, SETTING, AND PARTICIPANTS
This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments.
INTERVENTION
The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing.
MAIN OUTCOME AND MEASURES
The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction.
RESULTS
A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling.
TRIAL REGISTRATION
bfarm.de Identifier: DRKS00024840.
Topics: Humans; Male; Gambling; Female; Middle Aged; Adult; Internet-Based Intervention; Cognitive Behavioral Therapy; Treatment Outcome; Germany; Motivational Interviewing; Aged; Young Adult; Internet
PubMed: 38904962
DOI: 10.1001/jamanetworkopen.2024.17282 -
BMJ Open Jun 2024Career self-management is believed to be a critical behaviour in the new career era. However, the underlying mechanisms that stimulate nurses' career self-management are...
OBJECTIVES
Career self-management is believed to be a critical behaviour in the new career era. However, the underlying mechanisms that stimulate nurses' career self-management are unclear. The aim of this study was to examine the mediating effect of self-efficacy and the moderating effect of proactive personality on the relationship between perceived organisational support and career self-management among nurses.
DESIGN
This was a cross-sectional survey.
SETTING AND PARTICIPANTS
A total of 1866 nurses from 15 hospitals across 15 cities in China were recruited for this study.
PRIMARY AND SECONDARY OUTCOME MEASURES
The Perceived Organizational Support Scale, General Self-efficacy Scale, Proactive Personality Scale and Individual Career Management Questionnaire were used. Data were analysed using moderated mediation regressions with Hayes' PROCESS macro in SPSS version 26.0.
RESULTS
General self-efficacy mediated the relationship between perceived organisational support and career self-management. Proactive personality moderated the direct (B=0.043, p<0.001, 95% CI 0.026 to 0.060) and indirect relationship (B=0.098, p<0.001, 95% CI 0.074 to 0.123) between perceived organisational support and career self-management. Further, the positive effects of perceived organisational support on general self-efficacy and career self-management were stronger for nurses with a high level of proactive personality. The model explained 47.2% of the variance in career self-management.
CONCLUSION
The findings highlight the crucial benefits of self-efficacy and important conditional effects of perceived organisational support on nurses' career self-management.
Topics: Humans; Self Efficacy; Female; Cross-Sectional Studies; Male; Adult; China; Personality; Surveys and Questionnaires; Self-Management; Mediation Analysis; Organizational Culture; Middle Aged; Nursing Staff, Hospital; Job Satisfaction; Nurses; Attitude of Health Personnel; Social Support
PubMed: 38904141
DOI: 10.1136/bmjopen-2023-081334 -
Clinical Kidney Journal Jun 2024Acute kidney injury (AKI) is associated with increased morbidity/mortality. With artificial intelligence (AI), more dynamic models for mortality prediction in AKI...
BACKGROUND
Acute kidney injury (AKI) is associated with increased morbidity/mortality. With artificial intelligence (AI), more dynamic models for mortality prediction in AKI patients have been developed using machine learning (ML) algorithms. The performance of various ML models was reviewed in terms of their ability to predict in-hospital mortality for AKI patients.
METHODS
A literature search was conducted through PubMed, Embase and Web of Science databases. Included studies contained variables regarding the efficacy of the AI model [the AUC, accuracy, sensitivity, specificity, negative predictive value and positive predictive value]. Only original studies that consisted of cross-sectional studies, prospective and retrospective studies were included, while reviews and self-reported outcomes were excluded. There was no restriction on time and geographic location.
RESULTS
Eight studies with 37 032 AKI patients were included, with a mean age of 65.3 years. The in-hospital mortality was 18.0% in the derivation and 15.8% in the validation cohorts. The pooled [95% confidence interval (CI)] AUC was observed to be highest for the broad learning system (BLS) model [0.852 (0.820-0.883)] and elastic net final (ENF) model [0.852 (0.813-0.891)], and lowest for proposed clinical model (PCM) [0.765 (0.716-0.814)]. The pooled (95% CI) AUC of BLS and ENF did not differ significantly from other models except PCM [Delong's test = .022]. PCM exhibited the highest negative predictive value, which supports this model's use as a possible rule-out tool.
CONCLUSION
Our results show that BLS and ENF models are equally effective as other ML models in predicting in-hospital mortality, with variability across all models. Additional studies are needed.
PubMed: 38903953
DOI: 10.1093/ckj/sfae150 -
Frontiers in Medicine 2024Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB...
INTRODUCTION
Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, "REACHing Equity."
METHODS
To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one's own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys.
RESULTS
Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum.
CONCLUSIONS
Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.
PubMed: 38903809
DOI: 10.3389/fmed.2024.1316475 -
Health Science Reports Jun 2024Further exploration is needed to recognize symptom clusters and categorize subgroups with distinct cluster patterns and associated risks, focusing on symptoms that are...
BACKGROUND AND AIMS
Further exploration is needed to recognize symptom clusters and categorize subgroups with distinct cluster patterns and associated risks, focusing on symptoms that are highly self-reported by patients with breast cancer undergoing chemotherapy. This study aimed to identify subgroups and risk factors for self-reported high symptom cluster burden among patients with breast cancer undergoing chemotherapy.
METHODS
A total of 647 participants who met the inclusion criteria were included in the study, with data collected on demographics, disease information, self-reported symptoms, and psychosocial factors. Latent class analysis was utilized to identify the subgroup, while logistic regression was used to pinpoint predictive risk factors.
RESULTS
Latent class analysis revealed three subgroups: the "high burden of all symptoms group" ( = 107, 16.54%), the "high burden of psychological symptoms group" ( = 103, 15.92%), and the "low burden of all symptoms group" ( = 437, 67.54%). Patients in the high burden of all symptom group and high burden of psychological symptom group exhibited significantly worse function outcomes ( < 0.001). Predictive risk factors for the "high burden of all symptom group" included older age, lower self-efficacy, worse body image, and a higher financial burden. Similarly, patients with high burden of psychological symptom were more likely to have low self-efficacy, poor body image, and a high financial burden.
CONCLUSION
The study demonstrated the importance of giving more attention to patients with breast cancer who are at risk of developing into membership of high symptom cluster burden group.
PubMed: 38903658
DOI: 10.1002/hsr2.2188 -
Frontiers in Psychology 2024The increasingly digital and multicultural 21st-century society requires future teachers to be prepared for the changes and challenges they may encounter. Not only...
UNLABELLED
The increasingly digital and multicultural 21st-century society requires future teachers to be prepared for the changes and challenges they may encounter. Not only language and digital competences, but critical-thinking and problem-solving skills are needed. Moreover, well developed socio-affective abilities, empathy among them, are also key when dealing with others. This is even more relevant when teachers are to work with a non-mainstream population, such as adult migrants with low literacy levels, and to design student-centered curricula or activities. Empathy is a multifaceted process involving, among others, perception, intellection, affect and other sensory aspects of the lived experience. It has been argued that the first-person perspective-taking involved in empathic engagement must necessarily involve rational computation and cognitively mediated processing. Training future teachers in the Pedagogy of Multiliteracies is a means to integrate multimodal digital instruction and aggregate cognitive as well as socio-emotional features to the education of future language teachers.
METHOD
A mixed-method pre-post study was conducted with 48 trainee teachers who participated in stand-alone digital multiliteracy interventions, in which they were encouraged to envisage themselves as future teachers of low-literate migrants. Policy documents such as the reference guide on Literacy and Second Language Learning for the Linguistic Integration of Adult Migrants, journal articles, audiovisual resources as well as examples of existing educational materials aimed at the target audience, were made available to them on an online platform. In two separate studies, trainees were encouraged to collaboratively produce two different multimodal outputs. The Revised Scale of Ethnocultural Empathy was administered before and after the intervention, subjecting the data obtained to quantitative analysis. Qualitative data was also collected to gain a better understanding of the affective and cognitive processes experienced by the participants.
RESULTS
Simple statistical analysis coupled with the comparison of means was used to respond to the research questions. Statistical hypothesis testing, including correlations and non-parametric statistics were used to analyze the relationship between each of the factors within the RSEE and the participants, considering the different interventions applied. Non-parametric tests (U-Mann Whitney) were used to compare the differences between the levels of ethnocultural empathy of the participants in the two studies. Significant differences were found in Factor 3 (Empathy) and Factor 5 (Anxiety) between the groups and their post-intervention results, with a value of 0.053 and 0.038, respectively. The effect size r was calculated, obtaining a size effect of 0.625 for Factor 3 (Empathy) and 0.674 for Factor 5 (Anxiety). These results indicate that the significant differences and the size effect between both groups are large. U-Mann Whitney non-parametric analysis also revealed gender differences in Factor 3 (Empathy), showing females higher levels than males. Effect size r analysis showed a large size effect of 0.708 for Factor 3 (Empathy). The findings pertaining to gender-related differences in empathy levels confirm the conclusions drawn by previous studies. When contrasting study 1 and 2, statistical differences were also shown after the intervention for the 'Anxiety and Lack of Multicultural Self-efficacy' factor. The qualitative data analysis was carried out with Atlas.ti v.8, in order to isolate and categorize the broader themes and the most significant explanatory quotes extracted from the participants' records and interviews. The results reveal the learning strategies that each group of learners applied to successfully complete the task at hand, as well as the participants' deployment of their critical thinking skills and the awakening of a sense of awareness of their own professional competence development process.
CONCLUSION
This study set out to compare how effective two digital multiliteracy interventions were in developing future language teachers' ethnocultural empathy and cognitive abilities when appraising the educational needs of low-literacy migrants. Despite the small sample size, the study certainly adds to our understanding of the impact of multimodal tasks involving critical thinking skills on trainees' cognitive and affective abilities. Besides, it expands the growing body of research that points to the desirability of embedding digitally-based content creation tasks in training curricula for future language teachers.
PubMed: 38903477
DOI: 10.3389/fpsyg.2024.1398457 -
Indian Journal of Anaesthesia Jun 2024Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT....
BACKGROUND AND AIM
Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective α-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT.
METHODS
This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's -test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test.
RESULTS
There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C ( < 0.001). MBP and HR changes were comparable ( > 0.05).
CONCLUSION
A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy.
PubMed: 38903251
DOI: 10.4103/ija.ija_1159_23 -
Frontiers in Bioengineering and... 2024To investigate the impact of diaphragmatic breathing combined with limb training on lower limb lymphedema following surgery for gynecological cancer.
OBJECTIVE
To investigate the impact of diaphragmatic breathing combined with limb training on lower limb lymphedema following surgery for gynecological cancer.
METHODS
From January 2022 to May 2022, 60 patients with lower limb lymphedema post-gynecologic cancer surgery were chosen. They were split into a control group ( = 30) and a treatment group ( = 30). The control group underwent complex decongestive therapy (CDT) for managing lower limb lymphedema after gynecologic cancer surgery, while the treatment group received diaphragmatic breathing combined with limb coordination training alongside CDT. Both groups completed a 4-week treatment regimen. The lower limb lymphedema symptoms were evaluated using the genital, lower limb, buttock, and abdomen (GCLQ) scores; bilateral lower limb circumference measurements; and anxiety and depression scores.
RESULTS
Compared to sole CDT administration, individuals undergoing diaphragmatic breathing coupled with limb coordination training experienced notable reductions in scores for the self-perceived symptom assessment questionnaire (GCLQ), bilateral lower limb circumference, as well as anxiety and depression scores.
CONCLUSION
The incorporation of diaphragmatic breathing combined withalongside limb coordination training can accelerate and augment the efficacy of treating lower limb lymphedema post-gynecologic cancer surgery.
PubMed: 38903184
DOI: 10.3389/fbioe.2024.1392824 -
Clinical and Experimental Pediatrics Jun 2024The exclusive breastfeeding (EBF) rate in Indonesia is lower than expected. Among the key factors affecting breastfeeding practices, paternal support has been suggested.
BACKGROUND
The exclusive breastfeeding (EBF) rate in Indonesia is lower than expected. Among the key factors affecting breastfeeding practices, paternal support has been suggested.
PURPOSE
To explore the role of paternal support in EBF failure among 3-month-old infants.
METHODS
This sequential mixed-methods study, part of an ongoing cohort study in West Java in early 2022, included 225 infants. The parents of 3-month-old infants were interviewed. Paternal support was assessed using a 15-point validated questionnaire for a total score of 15-60 points. Multivariate binary regression was used to determine adjusted odds ratios (aORs). The qualitative exploration was based on in-depth interviews (IDIs) and forum group discussions (FGDs) following the quantitative survey.
RESULTS
Of the 225 infants, 52.2% were no longer EBF. High paternal support (greater than the mean score) of breastfeeding was determined in 52.9% of cases (mean± standard deviation, 38.7±6.7 for the overall population vs. 37.5±6.3 and 40.2±6.8 for infants who were and were not EBF at 3 months of age, respectively). Low paternal support was associated with an increased EBF failure rate (aOR, 2.84; 95% confidence interval [CI], 1.46-5.54). Other variables that remained as predictors in the final model were a low birth rate (aOR, 7.35; 95% CI, 1.73-31.20), negative maternal attitude (aOR, 3.31; 95% CI, 1.63-6.75), lower self-efficacy (aOR, 4.82; 95% CI, 2.43-9.57), and lower maternal education level (aOR, 2.87; 95% CI, 1.03- 8.03). The IDIs and FGD observed the importance of the father's support of the mother and EBF. The qualitative exploration revealed a lack of knowledge about EBF as a parental support barrier.
CONCLUSION
Paternal support is important for EBF. Paternal involvement in EBF planning encouraged themother to continue. Plans that include fathers in breastfeeding education may help increase paternal support.
PubMed: 38902920
DOI: 10.3345/cep.2023.01375