Exploration of the methods and rules of syndrome/pattern differentiation and treatment of headache from the acupuncture-moxibustion prescriptions of ancient literature based on the data mining technology

The study aims to identifying and exploring the methods and rules of the syndrome/pattern differentiation and treatment of headache through collating acupuncture-moxibustion prescriptions recorded earliest in ancient literature. Using Excel2016 software, the structural data table was prepared with "name of disease", "location of disease", "etiology and pathogenesis", "complicated symptoms", "sites for acupuncture and moxibustion" and "techniques of acupuncture and moxibustion" included. The normative approach was conduced on "name of disease", "etiology and pathogenesis", "complicated symptoms" and "nomenclature of acupoint". Using conventional literature statistical method, combined with Apriori algorithm of association rule, the implicit multi-dimensional correlation rules were explored among various elements of syndrome/pattern differentiation of headache and corresponding therapeutic methods. Based on the findings of the study, the regularity was distinct regarding the treatment at "distal acupoints along the affected meridian and the local acupoints at the affected area" after identifying the location of headache; the strong association was presented between "etiology and pathogenesis" and "acupoint selection", and between "etiology and pathogenesis" and "therapeutic methods", including 9 and 12 rules, respectively. Guanyuan (CV 4) selected in treatment of headache was associated with kidney deficiency, the combination of Zhongwan (CV 12) and Zusanli (ST 36) was with phlegm, Fengfu (GV 16), Fengchi (GB 20), Xinghui (GV 22) and Baihui (GV 20) was with wind, and Hegu (LI 4) was with cold. Moxibustion was dominant in treatment if headache was caused by pathogenic cold or related to deficiency syndrome; acupuncture was used specially for the case caused by phlegm, or interaction of wind and phlegm or wind and heat. For heat syndrome, either acupuncture or moxibustion was applicable, in general, acupuncture was more commonly used in comparison with moxibustion for headache. There were 6 association rules regarding the acupoint selection and the techniques of acupuncture and moxibustion. Moxibustion was generally applied to Xinghui (GV 22), Shangxing (GV 23) and Baihui (GV 20) ; and acupuncture was to Fengfu (GV 16), Hegu (LI 4) and Zusanli (ST 36). There were few association rules between the complicated symptoms and acupoint selection. Among nearly 100 complications, there were only 3 feature associations. Zhongwan (CV 12) was selected for the case with poor appetite, Chengjiang (CV 24) was with neck stiffness, and Fengchic (GB 20) combined with Fenglong (ST 40) or Jiexi (ST 41) was used if vertigo was present. In the ancient time, regarding the treatment of headache, acupuncture and moxibustion are delivered based on the three aspects, i.e. the location of illness, the etiology and pathogenesis, and the complicated symptoms. For acupoint selection, in line with the courses of affected meridians, the adjacent and distal acupoints are combined according to the location of headache. The acupoint prescription is composed in terms of the etiology and pathogenesis. The techniques of acupuncture and moxibustion are optimized in consideration of the sites where acupuncture and moxibustion are operated.

Identification of Whole-Blood DNA Methylation Signatures and Rules Associated with COVID-19 Severity

BACKGROUND

Different severities of coronavirus disease 2019 (COVID-19) cause different levels of respiratory symptoms and systemic inflammation. DNA methylation, a heritable epigenetic process, also shows differential changes in different severities of COVID-19. DNA methylation is involved in regulating the activity of various immune cells and influences immune pathways associated with viral infections. It may also be involved in regulating the expression of genes associated with the progression of COVID-19.

METHODS

In this study, a sophisticated machine-learning workflow was designed to analyze whole-blood DNA methylation data from COVID-19 patients with different severities versus healthy controls. We aimed to understand the role of DNA methylation in the development of COVID-19. The sample set contained 101 negative controls, 360 mildly infected individuals, and 113 severely infected individuals. Each sample involved 768,067 methylation sites. Three feature-ranking algorithms (least absolute shrinkage and selection operator (LASSO), light gradient-boosting machine (LightGBM), and Monte Carlo feature selection (MCFS)) were used to rank and filter out sites highly correlated with COVID-19. Based on the obtained ranking results, a high-performance classification model was constructed by combining the feature incremental approach with four classification algorithms (decision tree (DT), k-nearest neighbor (kNN), random forest (RF), and support vector machine (SVM)).

RESULTS

Some essential methylation sites and decision rules were obtained.

CONCLUSIONS

The genes (IGSF6, CD38, and TLR2) of some essential methylation sites were confirmed to play important roles in the immune system.

Rules and exceptions: A Tolerance Principle account of the possessive suffix in Northern East Cree

Debate around inflectional morphology in language acquisition has contrasted various rule- versus analogy-based approaches. This paper tests the rule-based Tolerance Principle (TP) against a new type of pattern in the acquisition of the possessive suffix -im in Northern East Cree. When possessed, each noun type either requires or disallows the suffix, which has a complex distribution throughout the lexicon. Using naturalistic video data from one adult and two children - Ani (2;01-4;03) and Daisy (3;08-5;10) - this paper presents two studies. Study 1 applies the TP to the input to extrapolate two possible sets of nested rules for -im and make predictions for child speech. Study 2 tests these predictions and finds that each child's production of possessives over time is largely consistent with the predictions of the TP. This paper finds the TP can account for the acquisition of the possessive suffix and discusses implications for language science and Cree language communities.

Rules for Interventional Radiology

During the hands-on teaching of Interventional Radiology (IR) to Residents and Fellows, certain learning tips or guiding statements are often repeated. Over the past two decades, these tips have evolved into the "Rules for Interventional Radiology." Relying on humour and the technical and foundational principles of our subspeciality, it is hoped that these Rules for IR provide helpful guidance to learners and practising Interventionalists in their daily work.

Conceptualising informal institutions: Drawing on the case of guanxi

Institutions regulate social life through formal rules and sanctions. These are distinguished from another source of social regulation, the informal incentives and constraints inherent in cultural currents and customary practices. Informal practices may be based not simply on cultural forces, though, but expectations regularised by informal rules and sanctions, which may operate as informal institutions. One approach holds that informal institutions arise out of formal institutional voids. Another holds that informal institutions operate in response to situations in which formal institutions frustrate the interests of individuals and groups who engage informal institutions to augment, compromise, or subvert formal institutions. After developing the concept of informal institution, the article goes on to indicate how an informal relationship pervasive in modern China, guanxi, may be understood as an informal institution. It is shown that by drawing on the case of guanxi the scope of the concept informal institution can be extended and also that our understanding of guanxi is enriched when the concept of informal institution is applied to its analysis.

Identifying MicroRNA Markers That Predict COVID-19 Severity Using Machine Learning Methods

Individuals with the SARS-CoV-2 infection may experience a wide range of symptoms, from being asymptomatic to having a mild fever and cough to a severe respiratory impairment that results in death. MicroRNA (miRNA), which plays a role in the antiviral effects of SARS-CoV-2 infection, has the potential to be used as a novel marker to distinguish between patients who have various COVID-19 clinical severities. In the current study, the existing blood expression profiles reported in two previous studies were combined for deep analyses. The final profiles contained 1444 miRNAs in 375 patients from six categories, which were as follows: 30 patients with mild COVID-19 symptoms, 81 patients with moderate COVID-19 symptoms, 30 non-COVID-19 patients with mild symptoms, 137 patients with severe COVID-19 symptoms, 31 non-COVID-19 patients with severe symptoms, and 66 healthy controls. An efficient computational framework containing four feature selection methods (LASSO, LightGBM, MCFS, and mRMR) and four classification algorithms (DT, KNN, RF, and SVM) was designed to screen clinical miRNA markers, and a high-precision RF model with a 0.780 weighted F1 was constructed. Some miRNAs, including miR-24-3p, whose differential expression was discovered in patients with acute lung injury complications brought on by severe COVID-19, and miR-148a-3p, differentially expressed against SARS-CoV-2 structural proteins, were identified, thereby suggesting the effectiveness and accuracy of our framework. Meanwhile, we extracted classification rules based on the DT model for the quantitative representation of the role of miRNA expression in differentiating COVID-19 patients with different severities. The search for novel biomarkers that could predict the severity of the disease could aid in the clinical diagnosis of COVID-19 and in exploring the specific mechanisms of the complications caused by SARS-CoV-2 infection. Moreover, new therapeutic targets for the disease may be found.

Applying Different Strategies of Task Constraint Manipulation in Small-Sided and Conditioned Games: How Do They Impact Physical and Tactical Demands?

This study aimed to investigate how different strategies of task constraint manipulation impact physical and tactical demands in small-sided and conditioned games (SSCG). Ten recreational U-17 soccer players participated in this study (16.89 ± 0.11 years). We used different strategies of task manipulation to design two 4 vs. 4 SSCG: Structural SSCG and Functional SSCG. In Structural SSCG, pitch format and goal sizes were manipulated, while in Functional SSCG, players were allowed to kick the ball twice and at least 5 passes to shoot at the opponent’s goal. Players participated in four Structural and Functional SSCG, of five minutes duration with a two-minute interval in between. Players’ physical performance and tactical behavior were assessed using the WIMU PROTM inertial device. Structural SSCG stimulated players to cover more distance in sprinting (p = 0.003) and high-speed running (p < 0.001). Regarding tactical behavior, Structural SSCG stimulated players to explore game space better (p < 0.001). Moreover, Functional SSCG stimulated players to be closer to the ball, decreasing the effective playing space (p = 0.008). We conclude that these strategies of task constraint manipulation impact physical and tactical demands of the game.

Factors associated and knowledge on road traffic accidents, rules among private university students in Chengalpattu district, Tamil Nadu, India - A cross-sectional study

BACKGROUND

Road traffic accidents (RTAs) are an emerging public health issue of global concern causing 1.35 million deaths per year. They are the leading cause of death among 5-29 years who contribute to the future and current productive population of the country. The outcome of mortality and permanent disability are public health concerns. We determined the factors associated with RTAs among medical undergraduates and assessed their knowledge of road traffic rules.

MATERIALS AND METHODS

This study had 500 medical undergraduates from a tertiary hospital located in Chengalpattu district, Tamil Nadu. Data were collected using questions from "Road safety question bank" issued by Ministry of Road Transport and Highways, Government of India, sent as Google forms to students. Descriptive statistics were used and multivariate analysis was performed to identify risk factors associated with RTAs.

RESULTS

The mean age of the students was 21.4 (standard deviation = 1.7) years. About 30.4% of students suffered from RTAs in the past 2 years. Practice of drunken driving and mobile phone usage showed significant association with RTA occurrence (P < 0.001). Multiple logistic regression revealed that students crossing speed limits and jumping signals had 3.19 and 2.04 times more risk of sustaining RTAs. Seventy-five percent of students had good knowledge on road traffic rules.

CONCLUSION

Nearly half the subjects have suffered RTA in the past 2 years. Students who over speed, jumped signals and used mobile phones while driving sustained more RTAs. Overall, road traffic rules knowledge was satisfactory. Students need education on risky driving behaviors and aftermath of crashes.

The "Empty-Goal" Rule Change from the Perspective of International-Level Team Handball Goalkeepers

The 2016 "empty-goal" rule change in team handball allowed for swift goalkeeper-player substitutions, which opened the door to a variety of tactical solutions that could not be implemented prior to the change. This change is one of many rule changes that have taken place in ball games in general and in handball in particular that were aimed to improve the competition and make gameplay more interesting. Previous literature shows that more often than not, such rule changes have led to unforeseen and undesired effects on players' and teams' behavior and performance. The aim of the current study was to consider the empty-goal rule from the goalkeeper's perspective, as their offense-defense game routine was drastically transformed following the introduction of this new rule. Results of a survey among 95 professional goalkeepers, 80 of whom participated in international matches, revealed that the keepers' level of confidence in empty-goal situations is moderate to high, that empty goal is rarely practiced more than once a week, and that less experienced goalkeepers are more positive regarding this rule change. Additionally, we found that the amount of empty-goal practice is positively related to the approval of the empty-goal rule among goalkeepers.

Effect of Rapid Weight Loss on Hydration Status and Performance in Elite Judo Athletes

Background: This study aimed to investigate the effect of 5% rapid weight loss on hydration status and judo performance in highly trained judo athletes. Methods: Eighteen male judo athletes participated in the study and were divided into two groups: control and rapid weight loss (RWL). RWL athletes were given 48 h to cut 5% of their body mass while the control group followed their routines. Athletes performed three measurements, including hydration, body mass and three consecutive special judo fitness tests (SJFTs). At the 1st and 6th minutes following each SJFT and 1st, 6th and 15th minutes following the last SJFT, blood lactate and heart rate (HR) was monitored. Results: The effect of RWL on variables was tested with split-plot ANOVA. RWL significantly affected urine specific gravity with a higher value following weight loss compared to baseline and recovery (F2-32 = 13.2, p < 0.001). In addition, athletes’ SJFT total throw numbers differed among measurements (F2-32 = 7.70, p < 0.001). Athletes presented worse SJFT index after weight loss (F2-32 = 8.05, p = 0.01; F1-16 = 6.43, p = 0.02, respectively). HR changed significantly among measurements days and times (F28-448 = 143.10, p < 0.001). Conclusion: RWL induced dehydration and impaired heart rate recovery in highly trained judo athletes, and they could not rehydrate between competition simulated weigh-in and 15 h of recovery.

Four levers of reciprocity across human societies: concepts, analysis and predictions

This paper surveys five human societal types - mobile foragers, horticulturalists, pre-state agriculturalists, state-based agriculturalists and liberal democracies - from the perspective of three core social problems faced by interacting individuals: coordination problems, social dilemmas and contest problems. We characterise the occurrence of these problems in the different societal types and enquire into the main force keeping societies together given the prevalence of these. To address this, we consider the social problems in light of the theory of repeated games, and delineate the role of intertemporal incentives in sustaining cooperative behaviour through the reciprocity principle. We analyse the population, economic and political structural features of the five societal types, and show that intertemporal incentives have been adapted to the changes in scope and scale of the core social problems as societies have grown in size. In all societies, reciprocity mechanisms appear to solve the social problems by enabling lifetime direct benefits to individuals for cooperation. Our analysis leads us to predict that as societies increase in complexity, they need more of the following four features to enable the scalability and adaptability of the reciprocity principle: nested grouping, decentralised enforcement and local information, centralised enforcement and coercive power, and formal rules.

A practical strategy for incorporating the convolution algorithm in Leksell GammaPlan for routine treatment planning†

Purpose

This study aims to establish criteria for convolution dose calculations and an efficient procedure to include the heterogeneity effects in GammaKnife radiosurgery (GKRS) treatment plans.

Methods and materials

We analyzed 114 GKRS cases of various disease types, tumor locations, sizes, the number of fractions, and prescription doses. There was a total of 205 tumors. CT scans were performed in addition to routine MRI scans for all treatments. All treatment plans were created using the TMR10 algorithm (TMR10). We repeated the dose calculations for this study with the convolution algorithm (Conv). We calculated the ratios between Conv and TMR10 of the treatment volume (TxtVol), the volume covered by half of the prescription dose (TxtVol2), the minimum, maximum, and mean doses in the tumor (minDose, maxDose, and meanDose), and the volume of tumor covered by the prescription isodose (covVol). We then categorized those quantities for locations of tumors represented by the shortest distance of the skull surface from the tumor center (distC) and the tumor edge (distE). [Table: see text].

Results

All six ratios increased with increasing distC and distE. For example, the median minDose ratio increased from 0.885 to 0.933 as distE increased. There was a statistically significant difference in the minDose ratio between tumors of distE < 2 cm and distE ≥ 2 cm. On the other hand, the median maxDose ratio was about 0.933 [0.928-0.939], being almost independent of distE. This suggested a 6.1% overestimation of the delivered dose with TMR10.

Conclusion

The heterogeneity effects must be considered for the volume dose calculations by applying the convolution algorithm when the distance of the skull surface from the closest point of the tumor is less than 2 cm to achieve less than 3% accuracy.

Building a global taxonomy of wildlife offenses

Most countries have many pieces of legislation that govern biodiversity, including a range of criminal, administrative, and civil law provisions that state how wildlife must be legally used, managed, and protected. However, related debates in conservation, such as about enforcement, often overlook the details within national legislation that define which specific acts are illegal, the conditions under which laws apply, and how they are sanctioned. Based on a review of 90 wildlife laws in 8 high-biodiversity countries with different legal systems, we developed a taxonomy that describes all types of wildlife offenses in those countries. The 511 offenses are organized into a hierarchical taxonomy that scholars and practitioners can use to help conduct legal analyses. This is significant amidst competing calls to strengthen, deregulate, and reform wildlife legislation, particularly in response to fears over zoonotic threats and large-scale biodiversity loss. It can be used to provide more nuance legal analyses and facilitate like-for-like comparisons across countries, informing processes to redraft conservation laws, review deregulation efforts, close loopholes, and harmonize legislation across jurisdictions. We applied the taxonomy in a comparison of sanctions in 8 countries for hunting a protected species. We found not only huge ranges in fines (US$0 to $200,000) and imprisonment terms (1.5 years to life imprisonment), but also fundamentally different approaches to designing sanctions for wildlife offenses. The taxonomy also illustrates how future legal taxonomies can be developed for other environmental issues (e.g., invasive species, protected areas).

Productivity and the acquisition of gender

Children's differing learning trajectories cross-linguistically have been at the forefront of gender acquisition research, often with conflicting results and conclusions. As a result, the source of children's different learning behaviors in gender acquisition has been unclear. I argue that children's gender acquisition is driven by the search for productive patterns. First, I provide corpus studies where the predictions of a learning model (Yang, 2016) are formulated. Second, I report the results of an elicited production task on Icelandic-speaking children (N = 26, ages 2;6-6;3 years) and adults (N = 18) that puts these predictions to test. The results suggest that Icelandic-speaking children and adults draw a categorical distinction between productive and unproductive suffixes in Icelandic gender assignment. I discuss the implications of these findings for morphological learning beyond gender acquisition.

Targeting Rule Implementation Decreases Concussions in High School Football: A National Concussion Surveillance Study

Background:

Concussions occur at higher rates in high school football as compared with all other high school sports. In 2014, the National Federation of State High School Associations implemented rules defining illegal contact against a defenseless player above the shoulders to reduce concussions in football players in the United States. To the best of our knowledge, rates of emergency department (ED)—diagnosed concussions of high school football players before and after the 2014 rule implementation have not been compared.

Hypothesis:

It was hypothesized that (1) there would be lower rates of helmet-to-helmet and helmet-to-body-part concussions after rule implementation and (2) alternative mechanisms of concussion would not differ, as these would be less influenced by rule implementation.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data from the National Electronic Injury Surveillance System (NEISS) were analyzed for high school football players 14 to 18 years old sustaining a concussion from January 1, 2009, to December 31, 2019. Data were collected on mechanism of injury, setting, and loss of consciousness. Raw data were used to calculate national estimates based on the assigned statistical sample weight of each hospital by the NEISS.

Results:

A total of 4983 (national estimate = 154,221) high school football concussions were diagnosed in US EDs; 58.8% of concussions occurred during competition and 41.2% during practice. Between 2009 and 2013 the rate of concussions diagnosed in EDs rose 10.7% as compared with a 6.2% decrease between 2015 and 2019 (P = .04). Between 2009 and 2013, the rate of helmet-to-helmet concussions rose 17.6% as compared with a 5.6% decrease between 2015 and 2019 (P = .03). There were no significant changes between other mechanisms of concussion before and after the 2014 rule implementation.

Conclusion:

We identified a decreased trend in overall and helmet-to-helmet high school football concussions diagnosed in the ED after implementation of the targeting rule. This study adds to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related concussions.

Leg Movements during Sleep in Children Treated with Serotonergic Antidepressants

STUDY OBJECTIVES

To evaluate leg movements during sleep (LMS) in children taking serotonergic antidepressants, compared to those of children with restless legs syndrome (RLS) and controls, and to assess the time structure of intermovement intervals (IMI).

METHODS

Twenty-three children (12 girls, mean age 14.1 years) on antidepressants and with a total LMS index ≥15/hour, 21 drug-naïve RLS children (11 girls, mean age 13.6 years) also with total LMS index ≥15/hour, and 35 control children (17 girls, mean age 14.3 years) were recruited. LMS were scored and a series of parameters was calculated, along with the analysis of their time structure.

RESULTS

Children taking antidepressants showed higher total and periodic LMS (PLMS) indexes than both controls and RLS children, as well as higher short-interval and isolated LMS indexes than controls. LMS periodicity was highest in children on antidepressants. In children taking antidepressants, a well-defined PLMS IMI peak corresponding to ~10-60 s, with a maximum at ~20 s was present, which was much less evident in RLS patients and absent in controls. A progressive decrease of PLMS during the night and more frequent arousals were found in children on antidepressants and with RLS.

CONCLUSIONS

Children taking serotonergic antidepressants show higher periodicity LMS than children with RLS or controls and have a higher number of PLMS through the night. Antidepressant-associated PLMS in children seem to have features similar to PLMS of adults with RLS. Whether this is a marker of an increased risk to develop RLS later in life needs to be determined.

Smart-Contract Aware Ethereum and Client-Fog-Cloud Healthcare System

The Internet of Medical Things (IoMT) is increasingly being used for healthcare purposes. IoMT enables many sensors to collect patient data from various locations and send it to a distributed hospital for further study. IoMT provides patients with a variety of paid programmes to help them keep track of their health problems. However, the current system services are expensive, and offloaded data in the healthcare network are insecure. The research develops a new, cost-effective and stable IoMT framework based on a blockchain-enabled fog cloud. The study aims to reduce the cost of healthcare application services as they are processing in the system. The study devises an IoMT system based on different algorithm techniques, such as Blockchain-Enable Smart-Contract Cost-Efficient Scheduling Algorithm Framework (BECSAF) schemes. Smart-Contract Blockchain schemes ensure data consistency and validation with symmetric cryptography. However, due to the different workflow tasks scheduled on other nodes, the heterogeneous, earliest finish, time-based scheduling deals with execution under their deadlines. Simulation results show that the proposed algorithm schemes outperform all existing baseline approaches in terms of the implementation of applications.

Approach to Identifying Causative Pathogens of Community-Acquired Pneumonia in Children Using Culture, Molecular, and Serology Tests

Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a challenge despite advances in diagnostic methods. Currently available guidelines generally recommend empiric antimicrobial therapy when the specific etiology is unknown. However, shifts in epidemiology, emergence of new pathogens, and increasing antimicrobial resistance underscore the importance of identifying causative pathogen(s). Although viral CAP among children is increasingly recognized, distinguishing viral from bacterial etiologies remains difficult. Obtaining high quality samples from infected lung tissue is typically the limiting factor. Additionally, interpretation of results from routinely collected specimens (blood, sputum, and nasopharyngeal swabs) is complicated by bacterial colonization and prolonged shedding of incidental respiratory viruses. Using current literature on assessment of CAP causes in children, we developed an approach for identifying the most likely causative pathogen(s) using blood and sputum culture, polymerase chain reaction (PCR), and paired serology. Our proposed rules do not rely on carriage prevalence data from controls. We herein share our perspective in order to help clinicians and researchers classify and manage childhood pneumonia.

Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment

OBJECTIVE

A new diagnosis of pediatric cancer may disrupt family functioning. The current study aimed to describe changes in family rules and routines during the first year of pediatric cancer treatment, and to explore associations with demographics, illness factors, and caregiver distress.

METHODS

This exploratory mixed-methods, cross-sectional study examined 44 primary caregivers of youth in treatment for a new cancer diagnosis in 2019 and 2020, before the onset of the COVID-19 pandemic. Caregivers completed validated questionnaires assessing demographic and child illness characteristics, psychosocial distress, and cancer-related stressors, and participated in a semi-structured interview about family rules and routines.

RESULTS

Caregivers reported changes in bedtime, mealtime, and school routines, relaxed behavioral expectations and rules around screen time, and new rules and routines around treatment, medications, and infection control. Caregivers with elevated levels of psychosocial distress reported more changed routines than caregivers with low levels of psychosocial distress. Caregivers who endorsed more cancer-related stressors reported more new rules and routines than those who reported fewer cancer-related stressors. Demographic and illness factors were not significantly associated with the number of changed, new, or stable family rules and routines.

CONCLUSIONS

Families may relax rules and routines during the first several months of diagnosis, and this may be related to side effects of treatment and limited caregiver capacity. The long-term impact of changes in family rules and routines during cancer treatment warrants further study given that accommodating parenting strategies have been associated with adverse short- and long-term child health and behavior outcomes.

Scoring of large muscle group movements during sleep: An International Restless Legs Syndrome Study Group (IRLSSG) position statement

There is a gap in the manuals for scoring sleep-related movements because of the absence of rules for scoring large movements. A taskforce of the International Restless Legs Syndrome Study Group elaborated rules that define the detection and quantification of movements involving large muscle groups. Consensus on each of the criteria in this paper was reached by testing the presence of consensus on a first proposal; if no consensus was achieved, the concerns were considered and used to modify the proposal. This process was iterated until consensus was reached. A preliminary analysis of the duration of movements involving large muscle groups was also carried out on data from two previous studies, which, however, used a visual analysis of video-polysomnographic recordings obtained from children or adults. Technical specifications and scoring rules were designed for the detection and quantification of large muscle group movements during sleep with a duration between 3 and 45 s in adults or 3 and 30 s in children, characterized by an increase in electromyographic activity and/or the occurrence of movement artifact in any combination of at least two recommended channels and not meeting the criteria for any other type of movement. Large muscle group movements are often accompanied by sleep stage changes, arousals, awakenings, and heart rate rises. The absence of clear and detailed rules defining them has likely impeded the development of studies that might disclose their clinical relevance; these new rules fill this gap.

Do children use logic to spell logician? Implicit versus explicit teaching of morphological spelling rules

BACKGROUND

Intervention studies have reported the advantage of teaching children about morphemes for spelling, but direct comparisons between explicit and implicit teaching have been examined systematically in relation to only a few morphological rules.

AIMS

This study compared explicit versus implicit teaching of the functional rule for the conservation of stem morphemes in derived words in English (e.g., logic is conserved in the derivative logician in spite of changes in pronunciation).

SAMPLE

Participants (n = 90; 7- to 9-year-olds) were drawn from three schools with a diverse intake.

METHODS

The design included a pre-test and two post-intervention tests. Participants were randomly assigned to one of three groups: an explicit group, taught about stems and their conservation in derived words; an implicit group, exposed to the same stems and derivatives without explicit teaching; and an unseen control group. At pre- and post-test, the children's spelling of stems in derivatives was assessed. The interventions involved practice games in which the children spelled derived words after seeing the base forms; the explicit group discussed the connection between the spellings, whereas the implicit group did not.

RESULTS

Analyses of variance revealed that explicit teaching led to more significant spelling improvements than implicit or no teaching, and this effect held at both post-tests.

CONCLUSIONS

It was concluded that explicit teaching of the stem conservation rule in derived forms combined with appropriate practice games shows a sustained effect on spelling. The evidence supports explicit teaching of this morphological rule in classroom practice.

Call to Action: Recommendations to Improve the Methodological Reporting of Games-Based Drills in Basketball Research

PURPOSE

Games-based drills are the predominant form of training adopted during basketball practice. As such, researchers have begun to quantify the physical, physiological, and perceptual demands of different games-based drill formats. However, study methodology has not been systematically reported across studies, limiting the ability to form conclusions from existing research. The authors developed this call to action to draw attention to the current standard of methodological reporting in basketball games-based drill research and establish a systematic reporting standard the authors hope will be utilized in future research. The Basketball Games-Based Drill Methodical Reporting Checklist (BGBDMRC) was developed to encourage the systematic reporting of games-based drill methodology. The authors used the BGBDMRC to evaluate the current methodological reporting standard of studies included in their review published in the International Journal of Sports Physiology and Performance, "A Systematic Review of the External and Internal Workloads Experienced During Games-Based Drills in Basketball Players" (2020), which highlighted this issue. Of the 17 studies included in their review, only 38% (±18%) of applicable checklist items were addressed across included studies, which is problematic as checklist items are essential for study replication.

CONCLUSIONS

The current standard of methodological reporting in basketball games-based drill research is insufficient to allow for replication of examined drills in future research or the application of research outcomes to practice. The authors implore researchers to adopt the BGBDMRC to improve the quality and reproducibility of games-based drill research and increase the translation of research findings to practice.

Monetary Policy Cooperation/Coordination and Global Financial Crises in Historical Perspective

The Covid 19 pandemic spawned a global liquidity crisis in March 2020. The global liquidity crisis was alleviated by the Federal Reserve and other advanced country central banks cooperating by extending the swap lines they developed in the Global Financial Crisis 2007–2008. Central bank cooperation in 2020 evolved from a two-century history across several monetary regimes that is surveyed in this paper. I find that in monetary regimes which are rules-based cooperation was most successful. International currency swaps developed to manage exchange rates during the Bretton Woods era have evolved into the leading tool to manage international liquidity crises. The swap network can be viewed as a step in the direction of a global financial safety net.

Security and Privacy when Applying FAIR Principles to Genomic Information

Making data Findable, Accessible, Interoperable and Reusable (FAIR) is a good approach when data needs to be shared. However, security and privacy are still critical aspects. In the FAIRification process, there is a need both for de-identification of data and for license attribution. The paper analyses some of the issues related to this process when the objective is sharing genomic information. The main results are the identification of the already existing standards that could be used for this purpose and how to combine them. Nevertheless, the area is quickly evolving and more specific standards could be specified.

Identifying Robust Microbiota Signatures and Interpretable Rules to Distinguish Cancer Subtypes

Cancer can be generally defined as a cluster of systematic diseases triggered by abnormal cell proliferation and growth. With the development of biological sciences and biotechnologies, the etiology of cancer is partially revealed, including some of the most substantial pathogenic factors [either endogenous (genetics) or exogenous (environmental)]. However, some remaining factors that contribute to the tumorigenesis but have not been analyzed and discussed in detail remain. For instance, some typical correlations between microorganisms and tumorigenesis have been reported already, but previous studies are just sporadic studies on single microorganism–cancer subtype pairs and do not explain and validate the specific contribution of microbiome on tumorigenesis. On the basis of the systematic microbiome analyses of blood and cancer-associated tissues in cancer patients/controls in public domain, we performed interpretable analyses. We identified several core regulatory microorganisms that contribute to the classification of multiple tumor subtypes and established quantitative predictive models for interpretable prediction by using multiple machine learning methods. We also compared the optimal features (microorganisms) and rules identified from microbiome profiles processed using the Kraken and the SHOGUN. Collectively, our study identified new microbiome signatures and their interpretable classification rules for cancer discrimination and carried out reliable methodological comparison for robust cancer microbiome analyses, thereby promoting the development of tumor etiology at the microbiome level.

Is It High Time to Increase Elite Soccer Substitutions Permanently?

Rules determine how team sport matches occur. Match-induced fatigue is specific to each sport, and may be associated with injury incidence. For example, the injury rate in soccer is distinctly higher during matches than in training sessions. Understanding the differences between team sports rules might be useful for enhancing rules (e.g., safer sport). Therefore, this study aimed to evaluate the impact of the rule-induced physical demands between soccer, futsal, basketball, and handball, focusing on substitution rules. Data from the elite team sports' rules (e.g., absolute and relative court dimensions; the number of players, substitutions allowed, total game time, time-outs) were collected, including the changes due to the coronavirus disease (COVID-19) pandemic in soccer substitutions, and comparisons were performed. The data showed that soccer has higher rule-induced physical demands: e.g., substantially lower substitution rate, higher dimensions in absolute (eight to fifteen times), and relative (four to eight times) values. Simulations also showed that soccer has extremely large differences, even considering COVID-19 substitution changes (from three to up to five). We conclude that elite soccer has remarkably higher overall rule-induced physical demands than elite futsal, basketball and handball, and increasing soccer substitutions permanently (e.g., unlimited) might mitigate overall soccer demands.

The Effects of Obligatory and Preferential Frames on Delay Discounting

Human decision making is partly determined by the verbal stimuli involved in a choice. Verbal stimuli that may be particularly relevant to human decision making are the words should and like, whereby should is presumably associated with what one ought to choose, and like is presumably associated with what one prefers to choose. The current study examined the potential effects of should and like on decisions in a monetary delay-discounting task. Eighty-three participants were recruited from Amazon's Mechanical Turk and were randomly assigned to a sequence of 2 conditions-should and like-in a repeated-measures experimental design. Based on condition assignment, the questions "Which should you choose?" and "Which would you like to choose?" appeared above each monetary option and its respective delay. Overall, participants demonstrated significantly lower levels of discounting in the should condition when compared to the like condition. However, this effect was much less consistent for participants exposed to the should condition prior to the like condition. The results of the current investigation indicate that the use of the words should and like constitutes separate classes of verbal stimuli that we refer to as obligatory and preferential frames. The effect of obligatory and preferential frames on delay discounting may be relevant to the prediction and control of decision making in social contexts.

Actigraphy in sleep research with infants and young children: Current practices and future benefits of standardized reporting

Actigraphy is a cost‐efficient method to estimate sleep–wake patterns over long periods in natural settings. However, the lack of methodological standards in actigraphy research complicates the generalization of outcomes. A rapidly growing methodological diversity is visible in the field, which increasingly necessitates the detailed reporting of methodology. We address this problem and evaluate the current state of the art and recent methodological developments in actigraphy reporting with a special focus on infants and young children. Through a systematic literature search on PubMed (keywords: sleep, actigraphy, child *, preschool, children, infant), we identified 126 recent articles (published since 2012), which were classified and evaluated for reporting of actigraphy. Results show that all studies report on the number of days/nights the actigraph was worn. Reporting was good with respect to device model, placement and sleep diary, whereas reporting was worse for epoch length, algorithm, artefact identification, data loss and definition of variables. In the studies with infants only (n = 58), the majority of articles (62.1%) reported a recording of actigraphy that was continuous across 24 hr. Of these, 23 articles (63.9%) analysed the continuous 24‐hr data and merely a fifth used actigraphy to quantify daytime sleep. In comparison with an evaluation in 2012, we observed small improvements in reporting of actigraphy methodology. We propose stricter adherence to standards in reporting methodology in order to streamline actigraphy research with infants and young children, to improve comparability and to facilitate big data ventures in the sleep community.

Law and order of modern ophthalmology: Teleophthalmology, smartphones legal and ethics

In recent years, new technologies used in the field of ophthalmology have been emerging and developing rapidly. Two major aspects of these advancements are teleophthalmology and smartphones, which have enabled practitioners to achieve optimal outcomes in record time with minimal costs. Several rules and regulations have been applied to these technologies in order to frame them under the appropriate medico-legal ethics, and specialized committees have been dedicated to maintaining their efficacy and avoiding shortcomings. In addition multiple studies and case reports conducted worldwide have assessed them according to specific diseases or global concerns. This review article constitutes an up-to date account of almost all of the applications and medico-legal perspectives of technologies used in ophthalmology in order to summarize and better visualize their advantages and disadvantages.

Improving the Named Entity Recognition of Chinese Electronic Medical Records by Combining Domain Dictionary and Rules

Electronic medical records are an integral part of medical texts. Entity recognition of electronic medical records has triggered many studies that propose many entity extraction methods. In this paper, an entity extraction model is proposed to extract entities from Chinese Electronic Medical Records (CEMR). In the input layer of the model, we use word embedding and dictionary features embedding as input vectors, where word embedding consists of a character representation and a word representation. Then, the input vectors are fed to the bidirectional long short-term memory to capture contextual features. Finally, a conditional random field is employed to capture dependencies between neighboring tags. We performed experiments on body classification task, and the F1 values reached 90.65%. We also performed experiments on anatomic region recognition task, and the F1 values reached 93.89%. On both tasks, our model had higher performance than state-of-the-art models, such as Bi-LSTM-CRF, Bi-LSTM-Attention, and Vote. Through experiments, our model has a good effect when dealing with small frequency entities and unknown entities; with a small training dataset, our method showed 2–4% improvement on F1 value compared to the basic Bi-LSTM-CRF models. Additionally, on anatomic region recognition task, besides using our proposed entity extraction model, 12 rules we designed and domain dictionary were adopted. Then, in this task, the weighted F1 value of the three specific entities extraction reached 84.36%.

Neural Correlates of Strategy Switching in the Macaque Orbital Prefrontal Cortex

We can adapt flexibly to environment changes and search for the most appropriate rule to a context. The orbital prefrontal cortex (PFo) has been associated with decision making, rule generation and maintenance, and more generally has been considered important for behavioral flexibility. To better understand the neural mechanisms underlying the flexible behavior, we studied the ability to generate a switching signal in monkey PFo when a strategy is changed. In the strategy task, we used a visual cue to instruct two male rhesus monkeys either to repeat their most recent choice (i.e., stay strategy) or to change it (i.e., shift strategy). To identify the strategy switching-related signal, we compared nonswitch and switch trials, which cued the same or a different strategy from the previous trial, respectively. We found that the switching-related signal emerged during the cue presentation and it was combined with the strategy signal in a subpopulation of cells. Moreover, the error analysis showed that the activity of the switch-related cells reflected whether the monkeys erroneously switched or not the strategy, rather than what was required for that trial. The function of the switching signal could be to prompt the use of different strategies when older strategies are no longer appropriate, conferring the ability to adapt flexibly to environmental changes. In our task, the switching signal might contribute to the implementation of the strategy cued, overcoming potential interference effects from the strategy previously cued. Our results support the idea that ascribes to PFo an important role for behavioral flexibility.SIGNIFICANCE STATEMENT We can flexibly adapt our behavior to a changing environment. One of the prefrontal areas traditionally associated with the ability to adapt to new contingencies is the orbital prefrontal cortex (PFo). We analyzed the switching related activity using a strategy task in which two rhesus monkeys were instructed by a visual cue either to repeat or change their most recent choice, respectively using a stay or a shift strategy. We found that PFo neurons were modulated by the strategy switching signal, pointing to the importance of PFo in behavioral flexibility by generating control over the switching of strategies.

The influence of offside rule and pitch sizes on the youth soccer players' small-sided games external loads

The aim was to analyse the influence of the offside rule and pitch sizes on the external loads encountered by young soccer players during small-sided games (SSGs). Twenty-four U12 soccer players belonged to the same Spanish Performance Soccer Academy participated in the study. Each player participated in six different SSGs attending to the offside rule (i.e., offside not applicable [NOS] and with offside [WOS]) and the pitch sizes (i.e., individual interaction space [IIS] of 25, 50 and 75 m² per player). The obtained data included measures of external loads by global positioning systems. Players covered higher total distance and greater distances at jogging (8-12.9 km·h^-1), cruising (13.0-16.0 km·h^-1) and sprinting (>16.0 km·h^-1) in NOS₇₅ and WOS₇₅ SSGs (p < 0.01; d = 0.65-6.60). Besides, in the NOS₇₅ SSG, the total distance and the distance at cruising were higher in respect to WOS₇₅ (p < 0.01; d = 0.63-0.82). In addition, players performed lower sprints (p < 0.01; d = 1.17-1.71) and achieved lower V_max (p > 0.05; d = 1.10-1.88) during NOS₂₅ and WOS₂₅ SSGs. These findings could provide relevant information for coaches in order to apply different pitch sizes and the inclusion/absence of the offside rule throughout the microcycle.

Awareness and Opinions of Research Professionals on India's New Drug and Clinical Trials Regulations: Protocol for a Cross-Sectional Web-Based Survey Study

Background

Although several studies have been conducted and several articles have been published on India's new clinical trial regulations, very few have examined the views of investigators and ethics board members regarding modifications to the previous regulations. Overall, they have neglected to find out the opinions of other relevant professionals, such as research assistants, coordinators, associates, and managers. To our knowledge, no study has yet investigated the awareness and opinions of Indian research professionals on the new 2019 regulations.

Objective

This study aims to describe the awareness and opinions of Indian research professionals on the new drug and clinical trial regulations.

Methods

In this cross-sectional, Web-based study, we will conduct an open survey for various Indian research professionals. These professionals will be selected randomly using multiple sources. The survey questionnaires, which have already been validated, were developed using the form function in Google docs. A Web link was generated for participants to take the survey. Descriptive statistics will be shown as means and standard deviations for constant variables, whereas certain variables will instead be shown as numbers and percentages.

Results

The survey was opened in July 2019. Enrollment has already started and will be completed in three months. The results calculations are expected to begin in October 2019.

Conclusions

The results of the survey are expected to represent the views of research professionals on the new regulations that will support the development of clinical research and the pharmaceutical industry in India. These regulations are expected to help advance clinical trials, help with the approval of new drugs, and enhance ethical norms in the country.

International Registered Report Identifier (IRRID)

PRR1-10.2196/14744

Effect of the Modification of the Number of Players, the Size of the Goal, and the Size of the Field in Competition on the Play Actions in U-12 Male Football

A player’s sports development involves a long process. The modification of rules for youth players seeks to adapt the sport to the child and his/her development. The manipulation of rules affects the technical and tactical skills demonstrated by players and, therefore, their development. The objective of this study was to analyse the effect of a reduction in the number of players (from 8 per team to 5 per team), the size of the goal (from 6 × 2 m to 3 × 2 m) and the playing space (from 58 × 38 m to 38 × 20 m), on the technical and tactical actions in youth football players. A quasi-experimental A-B-A design was implemented to assess the effect of the rule changes. The players (n = 40) played three tournaments using two competition formats (official rules, modified rules, and official rules). The results show that the use of the modified rules generated a greater number and variability in the technical–tactical actions, a greater number of actions with teammates in the pass line, a greater continuity in the game, a greater number of attack and defence actions in areas close to the goal, and favours team play. The experimental format fits the players’ individual progression better (U-12) as well as the players’ and teams’ collective development, and it will allow players to evolve from the individual development of previous stages.

Radium-223 for the treatment of bone metastases in castration-resistant prostate cancer: when and why

Radium-223 dichloride (²²³Ra) is the first, recently approved, α-particle-emitting radiopharmaceutical for the treatment of patients with bone metastases in castration-resistant prostate cancer (CRPC) and no evidence of visceral metastases. We explored MEDLINE, relevant congresses, and websites for data on ²²³Ra and prostate cancer therapies, focusing on therapeutic strategies and timing, bone metastases, and diagnostic assessment. ²²³Ra represents the only bone-targeting agent that has significantly extended patients' overall survival while reducing pain and symptomatic skeletal events. Unlike other radiopharmaceuticals, such as strontium-89 and samarium-153 EDTMP, ²²³Ra (11.4-days half-life) has shown a high biological efficiency mainly due to its short penetration range. These features potentially allow reduced bone marrow toxicity and limit undue exposure. ²²³Ra has been validated under the product name Xofigo^® by the US Food and Drug Administration and the European Medicines Agency. Patient selection, management, and treatment sequencing is recommended to be discussed in the context of a multidisciplinary environment, including oncology, urology, nuclear medicine, and radiation therapy physicians. No consensus has been achieved regarding the optimal timing and its administration as single agent or in combination with zoledronic acid or chemotherapy, so far. This review aims to provide a rationale for the use of ²²³Ra in treating metastases from CRPC, highlighting the crucial role of a multidisciplinary approach, the disputed inclusion and exclusion criteria on the basis of agencies regulations, and the value of diagnostics for therapy assessment.

How to make rules and regulations for the states in accordance with the Mental Healthcare Act 2017

Mental Healthcare Act (MHCA) 2017 was gazetted on April 7, 2017. It repeals the Mental Health Act, 1987, and it can be implemented only after the state rules are formed. The central government has already published three sets of rules. This article was written with an objective to review how to make rules and regulations for the state as per MHCA, 2017. All sections of MHCA 2017 and the mental health rules previously made by different states according to the Mental Health Act 1987 were reviewed. Google and PubMed searches were done to review the implementation of their respective mental health acts by different countries and states in the past. Go through Central/State Mental Health Rules, 2018, framed by the central government. Try to adapt it for the state. A meeting on MHCA 2017 should be conducted, including all stakeholders who will give their suggestions about changes to be made. Frame an initial draft and discuss it with the stakeholders and finalize the draft. Discuss the draft in state mental health authority meetings and submit the draft to the government. The Department of Legislation and Parliamentary Affairs can be consulted. The draft should be sent to the central government's Ministry of Health and Family Welfare for approval. According to MHCA 2017, state rules can be formed in relation to the aspects mentioned under Sections 121 and 123. The state government should make notification of the rules and then implement them.

Selective Role of the Putamen in Serial Reversal Learning in the Marmoset

Fronto-striatal circuitry involving the orbitofrontal cortex has been identified as mediating successful reversal of stimulus-outcome contingencies. The region of the striatum that most contributes to reversal learning remains unclear, with studies in primates implicating both caudate nucleus and putamen. We trained four marmosets on a touchscreen-based serial reversal task and implanted each with cannulae targeting both putamen and caudate bilaterally. This allowed reversible inactivation of the two areas within the same monkeys, but across separate sessions, to directly investigate their respective contributions to reversal performance. Behavioral sensitivity to the GABAA agonist muscimol varied across subjects and between brain regions, so each marmoset received a range of doses. Intermediate doses of intra-putamen muscimol selectively impaired reversal performance, leaving the baseline discrimination phase unchanged. There was no effect of low doses and high doses were generally disruptive. By contrast, low doses of intra-caudate muscimol improved reversal performance, while high doses impaired both reversal and baseline discrimination performance. These data provide evidence for a specific role of the putamen in serial reversal learning, which may reflect the more habitual nature of repeated reversals using the same stimulus pair.

Rule Emission: A Possible Variable for Improved Therapeutic Practice

It has been suggested that achieving greater effectiveness in psychotherapeutic treatment requires analyzing what therapists actually do and say, how they do this and when it is done. Based on this approach, in this study we focused on the rules emitted by therapists, since providing rules is thought to be of fundamental importance in promoting effective and efficient clinical change. Specifically, we sought to determine whether the experience level of therapists and the brevity of therapy would be related to patterns of therapist rule emission as categorized by the Category System of Rules emitted by the Therapist (SISC-RULES-T) (Vargas-de la Cruz & Pardo-Cebrián, 2014). Greater therapist experience and shorter therapy duration were found to be reliably predictive of more rule emissions across most rule categories (Z values between: Z = -3.68 and Z = -2.05; p values: p < .05 and p < .001). These variables were also predictive of more emissions of rules that specified all three operant contingency elements (situation, behavior, and consequence) rather than fewer elements (Z = -2.59, p < .05; Z = -2.26, p < .05). In the expert therapists and therapist with shorter cases, there was a nonsignificant tendency for the emission of general and conceptual rules to increase over sessions whereas emissions of concrete and particular rules tended to decrease; the explicitness of the three contingency elements also tended to decrease as treatment progressed. These findings may help to identify verbal characteristics of therapists that could lead to improved therapeutic practice.

Exploring fair decision-making rules in nursing: A qualitative study

BACKGROUND

The decision-making process should be done according to a set of rules and principles so as to be fairly understood.

OBJECTIVES

The aim of this study was to identify the basic principles and rules used by nurses to understand justice in nurse managers' decision-making processes based on a procedural justice model. Research design and participants: This research was a qualitative study based on directed content analysis, which was performed on a group of 15 nurses working in different hospitals in Tehran, Iran. An in-depth semi-structured interview was used as the method of data collection for this study. Ethical consideration: This research has been approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. The respondents were informed about the aim of the study, about voluntary participation, anonymity and confidentiality.

FINDINGS

The results of this study showed that in order to understand procedural justice, nurses use several rules, including: duties organization, managerial support, consistency, bias-suppression, accuracy, correctability, representativeness, and ethicality.

CONCLUSION

Nursing leaders must consider the importance of justice rules as one of many strategies to ensure the nurses' perception of fairness in decision-making processes.

Movement Notation Revisited: Syntax of the Common Morphokinetic Alphabet (CMA) System

Advances in the study of non-verbal behavior and communication have generated a need for movement transcription systems capable of incorporating continuous developments in visual and computer technology. Our research team has been working on the construction of a common morphokinetic alphabet (CMA) for the systematic observation of daily life activities. The project, which was launched several years ago, was designed to create a system for describing and analyzing body motion expression, physical activity, and physical appearance. In this paper, we describe an idiosyncratic application of Noam Chomsky’s phrase marker grammar to the morphokinetic phrase, the objective being to establish the grammatical rules and basic order of the symbol string according to a relational tree formed by the breakdown of the syntactic components identified as structuring the visual description of movement. Criteria for using the CMA as a coding system and a free transcription system are proposed.

Automatic Generation of Figural Analogies With the IMak Package

Automatic Item Generation (AIG) techniques are offering innovative ways to produce test items as they overcome many disadvantages involving standard item writing, such as time-consuming work and resource-intensive demands. Although this field is relatively new, it is progressing at a high speed, and several contributions have been accomplished. Nevertheless, a scarce amount of AIG software evidencing favorable psychometric properties of the generated items has been made accessible to the broad scientific community. This research had two goals: first, to present an empirical study of items produced with the aid of the Item Maker (IMak) package available online and, second, to present IMak itself for the automatic generation of figural analogies. We were particularly interested in assessing whether automatically created figural analogy rules could predict item psychometric difficulty. A total of 23 items were generated and administered to 307 participants, 49.51% from Germany. The mean age was 28.61 (SD = 10.19) and 57.65% of the participants were female. Results reveal adequate psychometric properties including convergent validity, that most of the manipulated rules contribute to item difficulty, and that rule-based difficulty prediction is possible to some extent. In other words, psychometric quality of the generated items is supported, which reveals the utility of the IMak package in assessment settings. Finally, the package is presented and its functions for figural analogy item generation are further described.

To follow a rule? On frontline clinicians' understandings and embodiments of hospital-acquired infection prevention and control rules

This article reports on a study of clinicians' responses to footage of their enactments of infection prevention and control. The study's approach was to elicit clinicians' reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians' learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians' appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians' 'practical wisdom' is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules.

Inside general practice ethics: guidelines 'and' 'of' or 'for' good clinical practice

The RCGP conference, like other annual healthcare conferences offers a protected space for reflection on ethical aspects of practice. This paper presents a summary and discussion of a fringe session led by the RCGP Committee On Medical Ethics at the 2017 RCGP annual conference in Liverpool. Well thought-out rules offer a potential solution to the burden of responsibility for making every single decision from first principles. But guidelines can be difficult to follow, too numerous to know, may conflict with each-other and may not be appropriate in all circumstances. Delegates at this meeting discussed barriers to good guideline development and implementation, perceptions of medicolegal risk in non-adherence, aspects of benefit, harm and justice in guideline use and ethical guidelines. Delegates found it easier in the meeting to critique clinical rather than ethical guidelines. There was broad agreement that understanding how to practice in relation to guidelines represented a learning need in general practice education.

An Advanced IoT-based System for Intelligent Energy Management in Buildings

The energy sector is closely interconnected with the building sector and integrated Information and Communication Technologies (ICT) solutions for effective energy management supporting decision-making at building, district and city level are key fundamental elements for making a city Smart. The available systems are designed and intended exclusively for a predefined number of cases and systems without allowing for expansion and interoperability with other applications that is partially due to the lack of semantics. This paper presents an advanced Internet of Things (IoT) based system for intelligent energy management in buildings. A semantic framework is introduced aiming at the unified and standardised modelling of the entities that constitute the building environment. Suitable rules are formed, aiming at the intelligent energy management and the general modus operandi of Smart Building. In this context, an IoT-based system was implemented, which enhances the interactivity of the buildings’ energy management systems. The results from its pilot application are presented and discussed. The proposed system extends existing approaches and integrates cross-domain data, such as the building’s data (e.g., energy management systems), energy production, energy prices, weather data and end-users’ behaviour, in order to produce daily and weekly action plans for the energy end-users with actionable personalised information.

A Knowledge-Base for a Personalized Infectious Disease Risk Prediction System

We present a knowledge-base to represent collated infectious disease risk (IDR) knowledge. The knowledge is about personal and contextual risk of contracting an infectious disease obtained from declarative sources (e.g. Atlas of Human Infectious Diseases). Automated prediction requires encoding this knowledge in a form that can produce risk probabilities (e.g. Bayesian Network - BN). The knowledge-base presented in this paper feeds an algorithm that can auto-generate the BN. The knowledge from 234 infectious diseases was compiled. From this compilation, we designed an ontology and five rule types for modelling IDR knowledge in general. The evaluation aims to assess whether the knowledge-base structure, and its application to three disease-country contexts, meets the needs of personalized IDR prediction system. From the evaluation results, the knowledge-base conforms to the system's purpose: personalization of infectious disease risk.

Neuromodulation of Prefrontal Cortex in Non-Human Primates by Dopaminergic Receptors during Rule-Guided Flexible Behavior and Cognitive Control

The prefrontal cortex (PFC) is indispensable for several higher-order cognitive and executive capacities of primates, including representation of salient stimuli in working memory (WM), maintenance of cognitive task set, inhibition of inappropriate responses and rule-guided flexible behavior. PFC networks are subject to robust neuromodulation from ascending catecholaminergic systems. Disruption of these systems in PFC has been implicated in cognitive deficits associated with several neuropsychiatric disorders. Over the past four decades, a considerable body of work has examined the influence of dopamine on macaque PFC activity representing spatial WM. There has also been burgeoning interest in neuromodulation of PFC circuits involved in other cognitive functions of PFC, including representation of rules to guide flexible behavior. Here, we review recent neuropharmacological investigations conducted in our laboratory and others of the role of PFC dopamine receptors in regulating rule-guided behavior in non-human primates. Employing iontophoresis, we examined the effects of local manipulation of dopaminergic subtypes on neuronal activity during performance of rule-guided pro- and antisaccades, an experimental paradigm sensitive to PFC integrity, wherein deficits in performance are reliably observed in many neuropsychiatric disorders. We found dissociable effects of dopamine receptors on neuronal activity for rule representation and oculomotor responses and discuss these findings in the context of prior studies that have examined the role of dopamine in spatial delayed response tasks, attention, target selection, abstract rules, visuomotor learning and reward. The findings we describe here highlight the common features, as well as heterogeneity and context dependence of dopaminergic neuromodulation in regulating the efficacy of cognitive functions of PFC in health and disease.

IQC Laboratory management strategy for medical biology

Medical biology laboratories rely especially on internal quality control (IQC) to monitor the performance of equipment and ensure results reliability. Strategies for these controls vary considerably from one laboratory to another. Some laboratories use Westgard's rules to detect drifts and are faced with a large number of false rejections caused by frequent runs of control samples and strategies that activate all rejection rules, regardless of the analyte considered. To minimize these rejections, some laboratories have combined several theories, sometimes despite the relevance of the resulting strategy. In this article, we want to explain the foundations of the main IQC theories and set out a strategy to optimize the detection of problems while minimizing false IQC rejections. We will also address some frequently asked questions from laboratories as part of ISO 15189 accreditation.

Treatment of Elopement Without Blocking With a Child With Autism

Elopement is a dangerous behavior common in children with autism spectrum disorder (ASD). Relative to other forms of problematic behavior, elopement has received little attention in both assessment and treatment. The current study entailed a functional analysis of elopement of one child with ASD, results of which suggested a partially automatic function. We then evaluated a differential reinforcement procedure, along with a rule, which successfully decreased elopement without the use of blocking. A changing-criterion design embedded within a withdrawal design was used to gradually increase the criterion for maintaining a close proximity to a therapist prior to being allowed to run.