Multiple Issues Research Articles

APA Board Looks to Future of Psychiatry, Importance of Measurement-Based Care

APA Board Looks to Future of Psychiatry, Importance of Measurement-Based Care

The environmental impact of the Dutch health-care sector beyond climate change: an input–output analysis

Studies suggest that the Dutch health-care sector is responsible for 4-8% of the national carbon footprint, but the environmental footprint of this sector beyond climate change is not well understood. Therefore, we aimed to estimate the environmental footprint of the Dutch health-care sector for a range of environmental impact categories. In this input-output analysis, we used Exiobase (version 3), which contains data on global trade flows and their associated environmental impact, in combination with health-care expenditure data from Statistics Netherlands. We covered the impact categories: climate change, blue water consumption, abiotic material extraction, land use, and total waste generation. The calculated sectoral footprint was the sum of all impacts associated with the operational phase (direct impact) and impacts occurring in the value chain of purchased goods and services (indirect impact) given an expenditure vector. The expenditure vector was the sum of three elements of health-care expenditure: health-care services; pharmaceuticals and chemical products; and medical appliances. We calculated the impact share of health care on the total Dutch consumption footprint. We evaluated the contribution to the impact categories from the categories that composed the expenditure vector. We did a hotspot analysis in which the indirect impact was split according to where (sector, geography, or both) the impact physically occurred. These top-down results were complemented with bottom-up data on emissions from pressurised metered-dose inhalers, anaesthetic gases, and private travel. The health-care sector's share of the national footprint was highest for material extraction (13·0%), followed by blue water consumption (7·5%), climate change (7·3%), land use (7·2%), and waste generation (4·2%). Pharmaceuticals and other chemical products were the biggest contributors to all impacts. The sectors contributing to climate change were more evenly distributed than the sectors contributing to the other impact categories. The mining sector mostly contributed to material extraction and the agricultural sector contributed largely to blue water consumption and land use. The mining sector and the agricultural sector were the main contributors to waste generation. Climate change occurred mainly in the Netherlands, whereas the other impacts mainly occurred abroad. The Dutch health-care sector contributes to a broad set of environmental impact categories beyond climate change. Our results will help stakeholders involved in the health-care sector to pinpoint topics that need to be prioritised and to prevent trade-offs by addressing multiple environmental issues simultaneously. Dutch Ministry of Health, Welfare and Sport.

PP134 Health Technology Assessment Life Cycle Approach In Asthma Care

IntroductionWithin Dutch health care, Zorginstituut Nederland regularly selects topics for reassessment of diagnostic and therapeutic interventions. Until now, about 15 topics have been investigated, such as hip/knee arthrosis, stable angina, low back pain, urinary incontinence, palliative care, retinopathy and asthma.MethodsFor each topic, stakeholders were asked to report what could be improved. Also a working group was created to analyze: what do guidelines recommend, what does actual care look like seen from administrative data, is there a gap between guidelines and delivered care, what can be improved? A report with recommendations was written with a calculation of the impact. Agreements were made on implementation. This report focused on findings relating to asthma.ResultsWe identified the multiple issues in the management of asthma: (i) Only 11 percent of patients had their diagnosis confirmed (with spirometry and reversibility or visit to pulmonologist). (ii) 60,000 patients had intensive short acting broncho-adrenegic agents (SABA) without inhaled corticosteroids (ICS) representing overuse of SABA. (iii) 200,000 patients use inhalers that can be empty, without the patient knowing this, as there is no indicator showing the number of actuation/puffs left, which leads to under treatment. (iv) 60.000 patients have aerosol and powder inhalers together, each requiring a different technique, leading to mistakes. (v) 67 percent of asthma adults get a chest x-ray on referral to hospital, which is a high proportion. (vi) 49 percent of patients use inhalers with propellant, which is needlessly high, given their undesirable impact on climate change. This causes 36 million kg co2 equivalent, the same as 36000 extra gasoline cars. (vii) Only 37 percent of patients receive yearly monitoring. We calculated that EUR 14 million annually can be saved as a result of better diagnosis leading to less overdiagnosis and overtreatment and less spacers.ConclusionsDespite that ‘HTA (Health Technology Assessment) at the doorstep’ has been applied for asthma interventions, we noticed considerable room for improvement. We consider this method important for real HTA life cycle approach.

Softwarized Resource Management and Allocation With Autonomous Awareness for 6G-Enabled Cooperative Intelligent Transportation Systems

Cooperative intelligent transport system (C-ITS) is one emerging application scenario in 6G. Within the content of 6G, softwarization is the dominant attribute of networks. 6G networks are required to have the intelligence and autonomy attributes, too. With softwarization and autonomy, not only the network capable of flexibly managing softwarized resources can be achieved, but also the network can learn and adapt itself with respect to the dynamic networking environment. However, multiple issues stand in the way of developing 6G networks, requiring to be addressed. In this paper, the softwarized resource management and allocation with autonomy and intelligence awareness in 6G networks for C-ITS application is researched. Firstly, key enabling technologies and problem model of 6G-enabled C-ITS are described. Then, an architecture design enabling to achieve the intelligent and softwarized resource management and allocation per service request, abbreviated as ReMaAl-AutoNet, is proposed. The proposed architecture design, based on reinforcement learning (RL), can realize the intelligent resource management and allocation by undergoing the training. Afterwards, simulations are illustrated to validate the proposed ReMaAl-AutoNet architecture. For instance, the successful ratio of ReMaAl-AutoNet has an advantage of over ten percentages than the direct counterpart without training.

Appropriate Medical Staffing Improves Patient Safety, Training and Doctor Wellbeing.

Background Cross-covering of medical and surgical specialities out-of-hours is a problem in many hospitals, leaving trainee doctors responsible out-of-hours for patients they have never met, in specialities where they do not normally work. This has implications for patient safety and doctor wellbeing. In our Trust, a historical decision resulted in trainee doctors in Trauma & Orthopaedics and Ear Nose and Throat Surgery being reallocated out-of-hours to cross-cover medical inpatients. This left one doctor cross-covering all surgical specialities, including General Surgery, Urology, Vascular, Ear, Nose and Throat surgery (ENT), Trauma & Orthopaedics (T&O) and Spinal Surgery. As the out-of-hours workload increased over time, this impacted negatively on patient safety and doctor wellbeing to a point where it became unsustainable. Methods Evidence of safety concerns relating to surgical night shifts was gathered from Exception Reporting data and anecdotally from the Postgraduate Doctor Forum. Once the scale of this problem was accepted by the hospital board, following the successful presentation of two Business Cases, 17 additional doctors were recruited. This recruitment reduced the cross-covering of specialities out-of-hours and enable adequate staffing throughout all departments. Qualitative evidence was gathered by surveying affected doctors before and after the change in order to assess its impact on doctor wellbeing, training and perceived patient safety. Quantitative analysis of Exception Reports and Immediate Safety Concerns was also performed. Results The survey results following the change were overwhelmingly positive, demonstrating a significant improvement in workload, rest breaks and quality of care for patients. Foundation doctors reported higher levels of confidence and enhanced training due to more consistent supervision. Job satisfaction improved, with 81% of surgical senior house officers reporting they would recommend their job, compared with 42% previously. Trends in out-of-hours Exception Reporting and patient safety concerns were analysed to show a moderate improvement following the intervention. Conclusion With the ever-increasing volume and complexity of patients presenting to global healthcare systems, it is key that staffing levels are safe and adequate in order to maintain patient safety and doctor wellbeing. This project has demonstrated how historic short-term fixes such as redeploying trainee doctors out of their home speciality and implementing cross-cover of multiple specialities can have detrimental long-term effects. Our preliminary data revealed multiple issues related to patient safety, junior doctor workload and lack of training opportunities. By using this data, and enlisting the help of multiple valued senior stakeholders, an acceptable Business Plan was approved by the Trust with a view to reversing these issues. The recruitment of additional Trust Grade doctors to create a third tier of the surgical out-of-hours cover has been instrumental in improving conditions within our Trust and has shown that adequate workforce planning is achievable when supported by robust evidence. This project could be used as a guide for other units seeking to make similar improvements.

The problem analysis and optimization strategy research of the advertising strategy of the Bilibili platform

In contemporary society, the Bilibili platform has gained popularity incrementally in the world. Undoubtedly, the advertisement strategies indirectly have such a conducive effort to assist Bilibili in achieving great success. However, there are still some problems in the advertising strategy, which need to optimize the advertising communication strategy. The literature research and analysis method can be properly harnessed to find out the problem of the strategies about the advertisement propagation and address them by supporting many optimization strategies. Unfortunately, there have been multiple issues with the content of the advertisements on the Bilibili platform, such as piracy of the animation, inappropriate content, false propaganda, and fierce competition. The strict supervision of the government might solve that problem, and the supervision can include inventing the monitoring application, universal education, and related regulations or law. Meanwhile, the platform should be capable of investigating the irregular contents of the advertisement. And the consumer should be aware of judging the latent, risky advertisements. To establish a harmonious website environment, many advertisers should consciously comply with the regulation related to advertisement dissemination. By taking the case of the Bilibili platform, the other similar type of industries can acquire constructive experience from this paper, learning how to address the current issue about advertisement strategies.

Assessment of Rainwater Harvesting Facilities Tank Size Based on a Daily Water Balance Model: The Case of Korea

Factors affecting rainwater resource management for the present and future include population growth, urbanization, and climate change. Rainwater harvesting (RWH) allows multiple urban water-related issues to be mitigated. In this study, a spreadsheet-based daily water balance model was developed to analyze the existing laws and regulations regarding the storage tank size of RWH facilities. Six buildings at different locations were selected for this study. Two are office buildings, two are school buildings, and two are sports buildings. The term “RWH facility evaluation criteria” is collectively used for rainwater supply satisfaction rate, rainwater guarantee rate, and rainwater utilization rate. A green roof can hold the rainwater for some time, reducing the peak flow and runoff volume. The results provide evidence that, among the selected studied buildings, buildings having a combination of a green roof and RWH facility score the highest in terms of RWH facility evaluation criteria, even though the actual tank size is much smaller than the standard tank size. This is the case with the Yesan County Office, in which a green roof connected to a small (66 m3) rainwater storage tank is installed. As a green roof can decrease the runoff volume, the rainwater can be managed efficiently with less pumping energy and only a small storage tank.

Interpreting Umbilical Cord Blood Gases: Section 9: Deciphering Multiple Issues

Interpreting Umbilical Cord Blood Gases: Section 9: Deciphering Multiple Issues

TABS: Transforming automatically BPMN models into blockchain smart contracts

Research on blockchains addresses multiple issues, with one being the automated creation of smart contracts. Developing smart contract methods is more difficult than mainstream software development as the underlying blockchain infrastructure poses additional complexity. We report on a new approach to developing smart contracts with the objective of automating the process to increase developer efficiency and reduce the risk of errors introduced by software developers. To support industry adoption, we use Business Process Model and Notation (BPMN) modeling to describe an application while targeting applications in the trade vertical. We describe a system that transforms a BPMN model into a multi-modal model that combines Discrete Event (DE) modeling for concurrency with Hierarchical State Machines (HSMs) to represent application functionality. Then, further transformations are used to transform the DE-HSM model into methods in smart contracts. The system lets the modeler decide which of the independent patterns should be transformed into methods of a separate smart contract that is deployed on a sidechain for the purpose of (i) reducing processing costs and/or (ii) providing privacy so that other participants in the smart contract do not have visibility into the processing of the pattern. We also briefly describe a proof-of-concept tool we built to demonstrate the feasibility of our approach.

Aggregation of Correlated Judgments on Multiple Interconnected Issues

Aggregation of Correlated Judgments on Multiple Interconnected Issues

L’IMPATTO PSICOLOGICO DELLA PUBBLICITÀ SUI BAMBINI

This paper aims at providing a psychological analysis of some of the most recent videos produced in Italia and aimed at children (kid marketing) on youtube and social media, apps or on the channels of the Italian national television, RAI. We cannot talk of exhaustiveness, for the multiple issues that might be considered: image, text, message, characters, prosody and their huge impact on the target audience. We have chosen videos that advertise food products, sweets, toys, kids clothing, holidays, services.

Antioxidant Properties of Hemp Proteins: From Functional Food to Phytotherapy and Beyond.

As one of the oldest plants cultivated by humans, hemp used to be banned in the United States but returned as a legal crop in 2018. Since then, the United States has become the leading hemp producer in the world. Currently, hemp attracts increasing attention from consumers and scientists as hemp products provide a wide spectrum of potential functions. Particularly, bioactive peptides derived from hemp proteins have been proven to be strong antioxidants, which is an extremely hot research topic in recent years. However, some controversial disputes and unknown issues are still underway to be explored and verified in the aspects of technique, methodology, characteristic, mechanism, application, caution, etc. Therefore, this review focusing on the antioxidant properties of hemp proteins is necessary to discuss the multiple critical issues, including in vitro structure-modifying techniques and antioxidant assays, structure-activity relationships of antioxidant peptides, pre-clinical studies on hemp proteins and pathogenesis-related molecular mechanisms, usage and potential hazard, and novel advanced techniques involving bioinformatics methodology (QSAR, PPI, GO, KEGG), proteomic analysis, and genomics analysis, etc. Taken together, the antioxidant potential of hemp proteins may provide both functional food benefits and phytotherapy efficacy to human health.

Pklr Variants Associated with Acute Pain in Sickle Cell Disease Influence ATP Concentrations in Red Blood Cells

Background: We previously demonstrated association of PKLR intron 2 variants with hospitalization rate for acute pain in people with sickle cell disease (SCD) and utilized allele-specific expression analysis to show that these variants influence PKLR activity (Wang et al, 2022). Pyruvate kinase (gene PKLR, protein PKR) is a rate-limiting enzyme in glycolysis. Reduced PKR activity leads to an increase in intracellular 2,3-diphosphoglycerate (2,3-DPG), and a concomitant decrease of adenosine triphosphate (ATP), factors that promote sickle hemoglobin (HbS) polymerization and red blood cell (RBC) sickling. On this basis, we explored how the "high risk" PKLR intron 2 variants affect levels of PKR protein expression, 2,3-DPG, ATP, oxygen dissociation (p50) and sickling kinetics (t50). Methods: We studied a total of 416 subjects which included 125 HbSS, 89 HbAS, and 202 ethnic-matched healthy controls (HbAA) enrolled under protocol NCT03685721 approved by the NHLBI Institutional Review Board. DNA was genome scanned using Ilumina's Infinium "MEGA" chip (1.7m markers). The results were quality controlled followed by genotype imputation based on the 1000 Genomes Project phase 3 data using the Michigan Imputation Server. Whole blood levels of ATP and 2,3-DPG were measured using LC-MS/MS with LLOQ at 50.0 μg/mL and converted to intracellular concentrations by dividing by the hematocrit (as a fraction). PKR was detected by antibody-based capture and detection using an electrochemiluminescence immunoassay (Meso Scale Discovery, Rockville, MD, USA) and the signal normalized to a control sample. A Hemox Analyzer [TCS, Scientific Corp, New Hope, PA] was used to obtain p50 values (defined as the partial pressure of oxygen at which Hb is 50% saturated with oxygen). t50 is single parameter measure of sickling kinetics (Dunkelberger et al, 2018). Single variant analyses (under additive genetic model adjusted for age and sex) were conducted in each of the Hb sub-populations for associations between the 7 PKLR variants (intron 4 - rs2071053, and intron 2 -rs8177970, rs116244351, rs114455416, rs12741350, rs3020781, and rs8177964) and the 5 parameters (PKR, 2,3-DPG, ATP, p50 and t50). False-discovery rate (FDR) adjusted p-values were calculated to account for the multiple testing issue. Results: Table 1A shows levels of the 5 parameters (ATP/HCT, 2,3-DPG/HCT, PKR, p50 and t50) in the 3 Hb genotypic groups (HbAA, HbAS and HbSS). Because patients with SCD have variable anemia, ATP and 2,3-DPG were normalized against HCT. The observed trending higher ATP / HCT and significantly elevated 2,3-DPG /HCT in HbSS compared to HbAS and to HbAA are consistent with previous reports (Poillon et al, 1990). HbSS subjects also had higher PKR protein expression, as well as right-shifted p50 values, compared to HbAS and HbAA (Table 1A), which suggest HbSS RBCs have lower specific activity of PKR. A one-way ANOVA showed that the differences in these mean values were highly significant (Table 1A). All 7 PKLR variants were associated with ATP levels in the HbAS group, of which 4 (rs8177970, rs116244351, rs114455416 and rs8177964) in intron 2 remained statistically significant after multiple testing adjustment (Table 1B). We also identified association between 3 variants (intron 2 - rs12741350, rs3020781, intron 4 - rs071053) and 2,3-DPG levels in the HbSS, as well as t50 in the HbAS group. Conclusion: ATP is essential for maintaining RBC membrane integrity and shape; reduced ATP dehydrates RBCs and promotes sickling. In a previous report, a PKLR intron 2 'high-risk" haplotype was implicated in acute sickle pain by affecting PKLR expression (Wang et al, 2022). In this follow-up study, we show that the same intron 2 "high-risk" haplotype negatively affects ATP levels when accounting for PKR expression, thus providing a biological basis for PKLR as a genetic modifier of SCD pain presentation. 3 of the 7 variants are also associated with elevated 2,3-DPG levels in HbSS as well as t50 (a single parameter that depends primarily on sickling kinetics) in HbAS. The variant associations are observed more clearly in HbAS but not in HbSS, possibly because of the much more homogeneous cell population in HbAS. We conclude that PKLR intron variants may directly contribute to the severity and frequency of acute pain episodes in SCD, thus additional studies with larger sample sizes are warranted. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract PR008: Overcoming PDAC T cell therapy barriers with CD47-targeted costimulatory fusion proteins

Abstract T cell therapy is a promising immunotherapy treatment option that uses genetically modified immune cells (T cells) to eliminate tumors. This approach uses the patients’ own immune cells to generate a “living drug” and can avoid the toxic side effects of other common therapies, such as radiation or chemotherapies. However, the pancreatic ductal adenocarcinoma (PDAC) tumor microenvironment (TME) can establish several obstacles to protect the tumor from T cells, including delivery of inhibitory and death signals that shut down T cells, usurping metabolic nutrients, and recruiting and/or converting immune cells to inhibitory phenotypes that block the T cell response. CD47 is upregulated in PDAC tumors, and patients with CD47hi tumors exhibit worse survival. CD47 serves as a “don’t eat me” signal by binding to the SIRPα receptor on macrophages to block phagocytosis. CD47 expression also inhibits T cell-mediated tumor rejection by blocking cross-presentation of tumor antigens by SIRPα+ dendritic cells. Reagents that interfere with SIRPα-CD47 signaling, such as monoclonal antibodies, are currently in clinical trials and have been shown to synergize with chemotherapy in PDA models, but native CD47 expression can produce erythrocyte and platelet depletion. Costimulatory signals delivered by surface-bound receptors can initiate gene expression programs that address multiple issues in the PDAC TME by mechanisms such as lowering the threshold of activation, altering metabolic programming, and reducing exhaustion. We develop engineering strategies to deliver costimulatory signals to engineered T cells. Immunomodulatory fusion proteins (IFPs) combine the ectodomain of an inhibitory T cell receptor with an intracellular costimulatory signaling domain and we have shown in proof-of-concept studies that this effectively “replaces a brake with an accelerator” in CD8 T cells. We have found that generating IFPs is not as simple as indiscriminately fusing any two proteins together and we have developed critical design concepts that inform the selection of the fusion site, ectodomain and costimulatory signaling domain pairing, and immunological synapse localization to enhance signaling. To develop a CD47-targeted IFP, we combined the SIRPa ectodomain with the CD28 signaling endodomain and tested this technology with our mesothelin-targeted TCR-T cell platform. In in vitrostudies, SIRPa-CD28 T cells exhibited enhanced proliferation, accumulation, and tumor cytotoxicity. SIRPa IFP-T cells exhibited increased intratumoral accumulation and therapeutic efficacy in the KrasLSL-G12D/+; Trp53LSL-R172H/+;p48Cre/+ (KPC) model, without toxicity or erythrocyte depletion. Here we describe how a thoughtfully engineered fusion protein can “armor” T cells against multiple obstacles and significantly improve therapeutic efficacy against PDAC. Citation Format: Shannon Oda, Leah Schmidt, Ashley Thelen, Cody Jenkins, Edison Chiu, Aitong Ruan, Philip Greenberg. Overcoming PDAC T cell therapy barriers with CD47-targeted costimulatory fusion proteins [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr PR008.

Overcoming Barriers to T Cell Therapy Against AML with Dual Costimulatory Receptors

Acute myeloid leukemia (AML) is a rapidly progressing and highly fatal disease, with only 27% of patients surviving 5 years after diagnosis. Adoptive cell therapy (ACT) provides the opportunity to genetically modify T cells to generate a "living drug" that can recognize and destroy tumor, and subsequently generate a memory population to protect against future recurrence. ACT is particularly attractive as a potential AML therapy, as T cells naturally home to the sites of disease, and ACT has proven effective and is now an FDA-approved therapy for other hematological malignancies. However, several obstacles in the AML bone marrow (AML-BM) can impede T cell therapeutic efficacy, including T cell exhaustion, limited metabolic substrates, and lack of costimulation. Additionally, engineering strategies to improve ACT have mainly been T cell-intrinsic, with little or no support of endogenous anticancer immunity. Costimulatory signals transmitted through cell surface receptors can initiate gene expression programs that address multiple issues in the AML-BM by mechanisms such as lowering the threshold of activation, metabolic reprogramming, and reducing exhaustion. In particular, tumor necrosis family receptor (TNFR) members have been targeted in the clinic with drug-based approaches, with the aim of activating antigen presenting cells (APCs), such as dendritic cells (DCs), macrophages, and B cells, both to boost their own antitumor functions and enhance costimulatory signals leading to enhanced antitumor activity of T and NK cells. Dual costimulatory receptors as a new cell engineering platform. We innovate synthetic transmembrane fusion proteins (FPs) that combine a receptor ectodomain with a costimulatory signaling endodomain. We have shown that engineered fusion proteins, such as immunomodulatory fusion proteins (IFPs) that utilize an inhibitory decoy ectodomain, can empower T cells to overcome several hurdles faced in the tumor microenvironment and significantly improve therapeutic efficacy in cancer models. Here we report our next generation of FP, called Dual Costimulatory Receptors (DCRs), that pair a costimulatory ligand ectodomain with a costimulatory endodomain. This approach addresses two critical objectives: to enable engineered T cells to attack cancer more powerfully and durably AND to support the activation of endogenous immune cells in the AML-BM. To build on insights from agonist antibody research, we developed DCRs with TNFR ectodomains and created a flexible platform with a variety of pre-selected costimulatory endodomains. We hypothesized that this approach would result in greater efficacy over traditional T cell engineering strategies that aim only to enhance cell-intrinsic function and tested this using murine and human models of AML. Primary human DCR-engineered T cells exhibited high surface expression of the DCR ectodomain, and increased DCR-T cell activation and ability to lyse tumor in in vitro studies. DCR-T cells co-cultured with immature DCs induced maturation similar to positive control conditions (LPS-maturation), demonstrating cell-extrinsic DCR activity. To determine if promising DCR candidates could enhance in vivo ACT efficacy, AML-bearing B6 mice were treated with1e6 engineered T cells after a single dose of cyclophosphamide (Cy) conditioning therapy, modeling human ACT protocols. Whereas the native full-length costimulatory ligand only modestly improved survival (P=ns), several DCR candidates showed significantly improved therapeutic efficacy (P<0.01-0.05). Here we describe a first-of-kind engineering strategy for the treatment of AML to expand our basic understanding of how different cell-intrinsic and -extrinsic costimulatory signals might achieve enhanced antitumor function and provide a dataset to support clinical translation for AML patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

3D-SiamMask: Vision-Based Multi-Rotor Aerial-Vehicle Tracking for a Moving Object

This paper aims to develop a multi-rotor-based visual tracker for a specified moving object. Visual object-tracking algorithms for multi-rotors are challenging due to multiple issues such as occlusion, quick camera motion, and out-of-view scenarios. Hence, algorithmic changes are required for dealing with images or video sequences obtained by multi-rotors. Therefore, we propose two approaches: a generic object tracker and a class-specific tracker. Both tracking settings require the object bounding box to be selected in the first frame. As part of the later steps, the object tracker uses the updated template set and the calibrated RGBD sensor data as inputs to track the target object using a Siamese network and a machine-learning model for depth estimation. The class-specific tracker is quite similar to the generic object tracker but has an additional auxiliary object classifier. The experimental study and validation were carried out in a robot simulation environment. The simulation environment was designed to serve multiple case scenarios using Gazebo. According to the experiment results, the class-specific object tracker performed better than the generic object tracker in terms of stability and accuracy. Experiments show that the proposed generic tracker achieves promising results on three challenging datasets. Our tracker runs at approximately 36 fps on GPU.

Prioritising enhancements across allied health telehealth services in a metropolitan hospital: Using a concept mapping approach

Introduction A prior study examining perceptions of Allied Health Professions (AHP) telehealth services at a metropolitan hospital highlighted multiple issues impacting service uptake, operationalisation, and delivery. Concept mapping methodology was utilised to address these issues and prioritise actionable telehealth service improvements. Methods Representatives (n = 22) from seven AHP departments and consumers generated statements addressing the question: ‘What do we need to do to enhance and sustain telehealth services?’ Statements were synthesised and then clinicians and managers sorted them into similar groups and assigned each statement a ranking of perceived (a) importance and (b) changeability. Multivariate and multidimensional scaling was undertaken to develop a final prioritised set of goals for change. Results Ninety-six unique statements were generated as actionable goals for change. Statements were grouped into 13 clusters relating to improvements in staff support, infrastructure, consumer support and organisational processes. All clusters were rated >50% for importance (range 3.3–2.4 out of 4) and changeability (range 2.6–2.1 out of 4). Twenty-six statements were ranked highest for importance and changeability. Key prioritised areas were staff training, consumer advocacy and engagement, telehealth operations and workflow. Conclusion Concept mapping was an effective process for generating a prioritised list of actions to enhance AHP telehealth services.

A Genetic Hyper-Heuristic for an Order Scheduling Problem with Two Scenario-Dependent Parameters in a Parallel-Machine Environment

Studies on the customer order scheduling problem have been attracting increasing attention. Most current approaches consider that either component processing times for customer orders on each machine are constant or all customer orders are available at the outset of production planning. However, these assumptions do not hold in real-world applications. Uncertainty may be caused by multiple issues including a machine breakdown, the working environment changing, and workers’ instability. On the basis of these factors, we introduced a parallel-machine customer order scheduling problem with two scenario-dependent component processing times, due dates, and ready times. The objective was to identify an appropriate and robust schedule for minimizing the maximum of the sum of weighted numbers of tardy orders among the considered scenarios. To solve this difficult problem, we derived a few dominant properties and a lower bound for determining an optimal solution. Subsequently, we considered three variants of Moore’s algorithm, a genetic algorithm, and a genetic-algorithm-based hyper-heuristic that incorporated the proposed seven low-level heuristics to solve this problem. Finally, the performances of all proposed algorithms were evaluated.

The Correlation Between Otitis Media With Effusion and Adenoid Hypertrophy Among Pediatric ‎Patients: A Systematic Review‎.

Otitis media with effusion (OME) affects approximately 80% of children due to the middle ear being flooded with fluids, though with no microbial infection manifestations. Multiple issues can drive recurring pediatric OME, such as environment-based issues, previous medical issues, inherited vulnerability from family, contact time at childcare institutes, passive smoking, and more than three siblings together with atopy or allergic rhinitis. If OME is not promptly addressed, this could eventually result in hearing impairment or loss, with consequent negative repercussions on the child's communicative and behavioral patterns. OME diagnosis within the clinic is possible, with hearing capacity being assessed pre- and post-therapy. Adenoid hypertrophy (AH) represents a typical causative factor for middle-ear conditions, stemming from mechanical or anatomical issues. Consequently, adenoid size is paramount when determining tympanometry types and ear fluids. This systematic review investigated PubMed, Medline, Cochrane Library, and Science Direct databases in order to retrieve knowledge related to this issue, adopting inclusion and exclusion criteria and maintaining review quality through the employment of the Assessment of Multiple Systematic Reviews (AMSTAR), the Newcastle-Ottawa tool, and the Axis scale. This systematic review analyzed a previous review article, six observation-based investigations, andthree cross-sectional investigations. Previous randomized controlled trials (RCTs) were not found within previous literature, suggesting such scarcity in this research niche and thus warranting future RCT investigations based on this compelling research niche.

Dynamic Task Pricing in Mobile Crowdsensing: An Age-of-Information-Based Queueing Game Scheme

The ubiquitous mobile portable devices have accelerated the rise of mobile crowdsensing (MCS), a distributed perception paradigm. In MCS, multiple requesters issue their sensing tasks on a server platform, and then the platform distributes the tasks to multiple workers. In this process, requesters typically specify the tasks and requirements; meanwhile, the needed task pricing to workers is also specified, which is used to offsetting worker’s efforts by completing the tasks. However, for different application scenarios, the task requirements, the time periods, and the resource consumptions for completing the tasks are varied, which results in a challenge to raise an appropriate task pricing to diverse workers. Therefore, we study the dynamic task pricing problem in the MCS network system with diverse factors (e.g., multiple requester queueing competitions, dynamic task requirements, and distinct waiting time costs). To solve the problem, we resort to the theory of Age of Information (AoI). Specifically, we leverage the AoI timeliness metric in modeling the requester’s waiting time costs, and then we use queueing game theory to build the dynamic task pricing model. The model analysis has shown the existence of the optimal pricing strategies under the first-come–first-served (FCFS) queueing rule and the last-come–first-served with preemptive in waiting (LCFSW) queueing rule. Finally, numerical simulations are conducted to validate the existence of the optimal task pricing.