Combined DFT and Molecular Mechanics Modeling of the Adsorption of Semiconducting Molecules on an Ionic Substrate: PTCDA and CuPc on NaCl.

Experimental results suggest that molecular geometry and energies can be influenced by the presence of thin film substrates as well as surrounding molecules. It is imperative that computational models take this influence into account. The accurate computational modeling of these molecules is an efficient way of carrying out chemistry calculations and reinforcing experimental findings. In our study, density functional theory (DFT) and molecular mechanics (MM) are used to model the configurations of the organic semiconducting materials, 3,4,9,10-perylene tetracarboxylic dianhydride, C24H8O6 (PTCDA), and copper(II) phthalocyanine, C32H16CuN8 (CuPc), as adsorbed on single- and double-layer NaCl substrates of various dimensions and charge settings. After a geometry and charge optimization of the molecules using DFT, the molecular geometries are optimized under different environments using computational calculations with specific force-field settings in HyperChem Professional 8.0(TM) software using MM. Energies and geometries of the molecules are then recorded, and our data are compared to experimental results of similar systems. We find that, with the appropriate choice of substrate properties, the calculated molecular configurations directly reflect those found experimentally. Our results support the idea that this method of simulation can produce reliable models in the field of physical chemistry.

Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series.

BACKGROUND: Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia. OBJECTIVE: The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior. METHODS: A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy. RESULTS: Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants' self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools. CONCLUSIONS: Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come.

Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care.

BACKGROUND: Mobile and wearable technology presents exciting opportunities for monitoring behavior using widely available sensor data. This could support clinical research and practice aimed at improving quality of life among the growing number of people with dementia. However, it requires suitable tools for measuring behavior in a natural real-life setting that can be easily implemented by others. OBJECTIVE: The objectives of this study were to develop and test a set of algorithms for measuring mobility and activity and to describe a technical setup for collecting the sensor data that these algorithms require using off-the-shelf devices. METHODS: A mobility measurement module was developed to extract travel trajectories and home location from raw GPS (global positioning system) data and to use this information to calculate a set of spatial, temporal, and count-based mobility metrics. Activity measurement comprises activity bout extraction from recognized activity data and daily step counts. Location, activity, and step count data were collected using smartwatches and mobile phones, relying on open-source resources as far as possible for accessing data from device sensors. The behavioral monitoring solution was evaluated among 5 healthy subjects who simultaneously logged their movements for 1 week. RESULTS: The evaluation showed that the behavioral monitoring solution successfully measures travel trajectories and mobility metrics from location data and extracts multimodal activity bouts during travel between locations. While step count could be used to indicate overall daily activity level, a concern was raised regarding device validity for step count measurement, which was substantially higher from the smartwatches than the mobile phones. CONCLUSIONS: This study contributes to clinical research and practice by providing a comprehensive behavioral monitoring solution for use in a real-life setting that can be replicated for a range of applications where knowledge about individual mobility and activity is relevant.

Pervasive assistive technology for people with dementia: a UCD case.

Smart mobile and wearable technology offers exciting opportunities to support people with dementia (PwD). Its ubiquity and popularity could even benefit user adoption - a great challenge for assistive technology (AT) for PwD that calls for user-centred design (UCD) methods. This study describes a user-centred approach to developing and testing AT based on off-the-shelf pervasive technologies. A prototype is created by combining a smartphone, smartwatch and various applications to offer six support features. This is tested among five end-users (PwD) and their caregivers. Controlled usability testing was followed by field testing in a real-world context. Data is gathered from video recordings, interaction logs, system usability scale questionnaires, logbooks, application usage logs and interviews structured on the unified theory of acceptance and use of technology model. The data is analysed to evaluate usability, usefulness and user acceptance. Results show some promise for user adoption, but highlight challenges to be overcome, emphasising personalisation and familiarity as key considerations. The complete findings regarding usability issues, usefulness of support features and four identified adoption profiles are used to provide a set of recommendations for practitioners and further research. These contribute toward UCD practices for improved smart, pervasive AT for dementia.

Accounting for center in the Early External Cephalic Version trials: an empirical comparison of statistical methods to adjust for center in a multicenter trial with binary outcomes.

BACKGROUND: Clustering of outcomes at centers involved in multicenter trials is a type of center effect. The Consolidated Standards of Reporting Trials Statement recommends that multicenter randomized controlled trials (RCTs) should account for center effects in their analysis, however most do not. The Early External Cephalic Version (EECV) trials published in 2003 and 2011 stratified by center at randomization, but did not account for center in the analyses, and due to the nature of the intervention and number of centers, may have been prone to center effects. Using data from the EECV trials, we undertook an empirical study to compare various statistical approaches to account for center effect while estimating the impact of external cephalic version timing (early or delayed) on the outcomes of cesarean section, preterm birth, and non-cephalic presentation at the time of birth. METHODS: The data from the EECV pilot trial and the EECV2 trial were merged into one dataset. Fisher's exact method was used to test the overall effect of external cephalic version timing unadjusted for center effects. Seven statistical models that accounted for center effects were applied to the data. The models included: i) the Mantel-Haenszel test, ii) logistic regression with fixed center effect and fixed treatment effect, iii) center-size weighted and iv) un-weighted logistic regression with fixed center effect and fixed treatment-by-center interaction, iv) logistic regression with random center effect and fixed treatment effect, v) logistic regression with random center effect and random treatment-by-center interaction, and vi) generalized estimating equations. RESULTS: For each of the three outcomes of interest approaches to account for center effect did not alter the overall findings of the trial. The results were similar for the majority of the methods used to adjust for center, illustrating the robustness of the findings. CONCLUSIONS: Despite literature that suggests center effect can change the estimate of effect in multicenter trials, this empirical study does not show a difference in the outcomes of the EECV trials when accounting for center effect. TRIAL REGISTRATION: The EECV2 trial was registered on 30 July 30 2005 with Current Controlled Trials: ISRCTN 56498577.

Protocol: systematic review and meta-analyses of birth outcomes for women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital.

BACKGROUND: There has been a renewed interest in the place of birth, including intended home birth, for low risk women. In the absence of adequately-sized randomised controlled trials, a recent Cochrane review recommended that a systematic review and meta-analysis, including observational studies, be undertaken to inform this topic. The objective of this review is to determine if women intending at the onset of labour to give birth at home are more or less likely to experience a foetal or neonatal loss compared to a cohort of women who are comparable to the home birth cohort on the absence of risk factors but who intend to give birth in a hospital setting. METHODS: We will search using Embase, MEDLINE, CINAHL, AMED and the Cochrane Library to find studies published since 1990 that compare foetal, neonatal and maternal outcomes for women who intended at the onset of labour to give birth at home to a comparison cohort of low risk women who intended at the onset of labour to give birth in hospital. We will obtain pooled estimates of effect using Review Manager. Because of the likelihood of differences in outcomes in settings where home birth is integrated into the health care system, we will stratify our results according to jurisdictions that have a health care system that integrates home birth and those where home birth is provided outside the usual health care system. Since parity is known to be associated with birth outcomes, only studies that take parity into account will be included in the meta-analyses. We will provide results by parity to the extent possible. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with PROSPERO at http://www.crd.york.ac.uk/Prospero/ (Registration number: CRD42013004046).

Consequences of meconium stained amniotic fluid: what does the evidence tell us?

BACKGROUND: Meconium stained amniotic fluid (MSAF) is common and associated with meconium aspiration syndrome (MAS). Other consequences of meconium passage before birth are less well understood. METHODS: We reviewed the literature for original papers reporting on outcomes associated with MSAF. FINDINGS: Among preterm infants MSAF is more prevalent than previously believed and is associated with higher neonatal morbidity. Intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS. No compelling evidence supported an association between MSAF and increased neurological impairment, including early seizure activity.

Comparative study of T-amplitude features for fitness monitoring using the ePatch® ECG recorder.

This study investigates ECG features, focusing on T-wave amplitude, from a wearable ECG device as a potential method for fitness monitoring in exercise rehabilitation. An automatic T-peak detection algorithm is presented that uses local baseline detection to overcome baseline drift without the need for preprocessing, and offers adequate performance on data recorded in noisy environments. The algorithm is applied to 24 hour data recordings from two subject groups with different physical activity histories. Results indicate that, while mean heart rate (HR) differs most significantly between the groups, T-amplitude features could be useful depending on the disparities in fitness level, and require further investigation on an individual basis.

Models of organization of maternity care by midwives in Canada: a descriptive review.

Most provinces in Canada now offer regulated midwifery, but the way services are delivered across the country varies. The Canadian Midwifery Regulators Consortium has identified a need to examine the different ways in which care is being organized; this is to determine what elements are essential to maintain and where flexibility is desirable, in order to promote growth of the profession and maximize the contribution of midwifery to the provision of services. In April 2012 a planning meeting (funded by Canadian Institutes of Health Research) brought together midwifery leaders, researchers, regulators, and lead clinicians of several maternity service programs across Canada. The various approaches to organizing care were discussed and three of the programs presented were selected for this descriptive review because of their unique approaches and ability to respond to the needs of communities and of care providers within those communities who strive to deliver sustainable maternity care. The programs include an interprofessional group-care approach in British Columbia, an expanded scope of practice in an underserved community in the Northwest Territories, and an interprofessional collaboration of primary maternity caregivers in Nova Scotia. Each is discussed in terms of the population served, the program itself, and the fit of that microsystem within the larger health care system. The organization of maternity care must address the needs of communities and providers alike to make the greatest contribution. Through collaborative and creative organizational approaches, midwives have an opportunity to contribute in a meaningful way and increase their impact on the provision of services.

Antiretroviral treatment interruption leads to progression of liver fibrosis in HIV-hepatitis C virus co-infection.

OBJECTIVE: Despite potential negative consequences, HIV/hepatitis C virus (HCV) co-infected patients may discontinue antiretroviral treatment (ART) for several reasons. We examined the impact of ART interruption on liver fibrosis progression in co-infected adults, using the aspartate aminotransferase-to-platelet ratio index (APRI) as a surrogate marker of liver fibrosis. METHOD: Data were analyzed from a multisite prospective cohort of 541 HIV-HCV co-infected adults. ART interruption was included as a time-updated variable and defined as the cessation of all antiretrovirals for at least 14 days. The primary endpoint was the development of an APRI score at least 1.5. Time-dependent Cox proportional hazards regression and inverse probability-of-treatment weighting (IPTW) in a marginal structural model were used to evaluate the association of baseline and time-varying covariates with developing significant fibrosis. RESULTS: Patients were followed for a median of 1.02 years; 10% (n = 53) interrupted ART and 10% (n = 53) developed significant fibrosis. After accounting for potential confounders, including CD4 T-cell count, HIV viral load, baseline APRI score, age and gender, the hazard ratio for ART interruption was 2.52 (95% confidence interval 1.20-5.28). Use of IPTW resulted in a similar effect estimate, suggesting that mediation by time-varying confounders was negligible. CONCLUSION: ART interruption was associated with an increased risk of fibrosis progression in HIV-HCV co-infection that was only partially accounted for by HIV viral load and CD4 T-cell counts. Our findings suggest that liver disease progression observed in ART-treated co-infected patients is partly due to the consequences of treatment interruptions.