An auditory brain-computer interface to detect changes in sound pressure level for automatic volume control.

Volume control is necessary to adjust sound levels for a comfortable audio or video listening experience. This study aims to develop an automatic volume control system based on a brain-computer interface (BCI). We thus focused on a BCI using an auditory oddball paradigm, and conducted two types of experiments. In the first experiment, the participant was asked to pay attention to a target sound where the sound level was high (70 dB) compared with the other sounds (60 dB). The brain activity measured by electroencephalogram showed large positive activity (P300) for the target sound, and classification of the target and nontarget sounds achieved an accuracy of 0.90. The second experiment adopted a two-target paradigm where a low sound level (50 dB) was introduced as the second target sound. P300 was also observed in the second experiment, and a value of 0.76 was obtained for the binary classification of the target and nontarget sounds. Further, we found that better accuracy was observed in large sound levels compared to small ones. These results suggest the possibility of using BCI for automatic volume control; however, it is necessary to improve its accuracy for application in daily life.

PD-L1-negative Non-small-cell Lung Cancer Treated with Nivolumab Plus Ipilimumab during Maintenance Hemodialysis Results in Rapid Initial Progression Followed by a Long-lasting Response.

Nivolumab plus ipilimumab is one of the first-line treatments for advanced non-small-cell lung cancer (NSCLC), but the safety and efficacy in patients on hemodialysis (HD) is unclear. We herein report a patient with NSCLC on HD in whom nivolumab and ipilimumab were initiated. We observed general deterioration and enlarged lesions, followed by a long-term response. The patient developed secondary hypoadrenocorticism, an immune-related adverse event that was easily controlled. Nivolumab plus ipilimumab can be used safely for patients with NSCLC on HD. Long-term effectiveness can be observed after initial progression, so we should carefully assess the response.

Association of functional and cognitive impairment severity with discharge to long-term care facilities in older patients admitted to a general acute care hospital from home.

BACKGROUND: The early recognition of hospitalized patients at risk of being discharged to long-term care facilities (LTCFs) may help to identify those who require transitional care programs and interventions that support discharge to home. We examined the association of functional and cognitive impairment severity with discharge to LTCFs among older hospitalized patients. METHODS: In this retrospective cohort study, we used an administrative claims database linked with geriatric assessment data from a general acute care hospital in Japan. We analyzed patients aged ≥65 years discharged between July 2016 and December 2018. The severity of functional and cognitive impairments was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) scale. Based on their DASC-8 scores, patients were designated as Category I (no impairment), Category Ⅱ (mild impairment), or Category III (moderate/severe impairment). We conducted logistic regression analyses to examine the association between the severity of impairments and discharge to LTCFs after adjusting for patient-level factors. RESULTS: We analyzed 9,060 patients (mean age: 79.4 years). Among the 112 patients (1.2%) discharged to LTCFs, 62.3%, 18.6%, and 19.2% fell under Category I, Category Ⅱ, and Category III, respectively. Category II was not significantly associated with discharge to LTCFs. However, Category III had a significantly higher odds of discharge to LTCFs than Category I (Adjusted odds ratio: 2.812, 95% confidence interval: 1.452-5.449). CONCLUSION: Patients identified as Category III by the DASC-8 on admission may benefit from enhanced transitional care and interventions that promote discharge to home.

All-Cause Readmission or Potentially Avoidable Readmission: Which Is More Predictable Using Frailty, Comorbidities, and ADL?

Background and Objectives: Readmission-related health care reforms have shifted their focus from all-cause readmissions (ACR) to potentially avoidable readmissions (PAR). However, little is known about the utility of analytic tools from administrative data in predicting PAR. This study determined whether 30-day ACR or 30-day PAR is more predictable using tools that assess frailty, comorbidities, and activities of daily living (ADL) from administrative data. Research Design and Methods: This retrospective cohort study was conducted at a large general acute care hospital in Tokyo, Japan. We analyzed patients aged ≥70 years who had been admitted to and discharged from the subject hospital between July 2016 and February 2021. Using administrative data, we assessed each patient's Hospital Frailty Risk Score, Charlson Comorbidity Index, and Barthel Index on admission. To determine the influence of each tool on readmission predictions, we constructed logistic regression models with different combinations of independent variables for predicting unplanned ACR and PAR within 30 days of discharge. Results: Among 16 313 study patients, 4.1% experienced 30-day ACR and 1.8% experienced 30-day PAR. The full model (including sex, age, annual household income, frailty, comorbidities, and ADL as independent variables) for 30-day PAR showed better discrimination (C-statistic: 0.79, 95% confidence interval: 0.77-0.82) than the full model for 30-day ACR (0.73, 0.71-0.75). The other prediction models for 30-day PAR also had consistently better discrimination than their corresponding models for 30-day ACR. Discussion and Implications: PAR is more predictable than ACR when using tools that assess frailty, comorbidities, and ADL from administrative data. Our PAR prediction model may contribute to the accurate identification of at-risk patients in clinical settings who would benefit from transitional care interventions.

Characteristics associated with hospitalization within 30 days of geriatric intermediate care facility admission.

AIM: To identify facility-level characteristics associated with hospitalization within 30 days after admission to a geriatric intermediate care facility (GICF) (30-day hospitalization) in Japan. METHODS: This retrospective cohort study used nationwide long-term care insurance claims data and a national survey of long-term geriatric care facilities. The study population was residents admitted to GICFs between October 2016 and February 2018. The outcome variable was 30-day hospitalization. The independent variables were facility-level characteristics such as level of healthcare professionals. RESULTS: The final sample for analysis comprised 282 991 residents of mean age ± SD, 85.8 ± 7.2 years, of whom 12 814 (4.5%) experienced 30-day hospitalization. In a multivariable logistic generalized estimating equation model adjusted for facility- and resident-level characteristics, and clustering GICFs, the odds of 30-day hospitalization were 0.906 times lower (95% confidence interval [CI] 0.857-0.958) among residents in a GICF with dental hygienist than in those in a facility without. Furthermore, the risk of 30-day hospitalization was lower among residents who had been admitted to a GICF with higher staffing levels of pharmacists (adjusted odds ratio [aOR] 0.941, 95% CI 0.899-0.985), registered nurses (aOR 0.931, 95% CI 0.880-0.986), care workers (aOR 0.920, 95% CI 0.879-0.964) and speech-language pathologists (aOR 0.926, 95% CI 0.874-0.982) than in those who had been admitted to a GICF with fewer of these healthcare professionals. CONCLUSIONS: Transitional care including dental hygienist or higher staffing levels of pharmacists, registered nurses, care workers and speech-language pathologists may be a more effective way to prevent 30-day hospitalization. Geriatr Gerontol Int 2021; 21: 1010-1017.

Physical Activity and Sedentary Behavior Assessment: A Laboratory-Based Evaluation of Agreement between Commonly Used ActiGraph and Omron Accelerometers.

Different models of accelerometer have the potential to provide a different estimate of the same physical activity or sedentary behavior. Our study compared the outputs of the Active Style Pro (ASP) and ActiGraph (AG) devices in assessing predicted metabolic equivalents (METs) for specific activities under laboratory conditions. Thirty healthy young adults wore two hip accelerometers (ASP and AG), simultaneously while performing twenty-two activities (eight sedentary, eight household, and six ambulatory activities) in a controlled laboratory setting. For the AG, predicted METs for each activity was calculated using four equations based on vertical-axis and vector magnitude data. Separate paired t-tests and Bland-Altman analysis examined the difference and agreement in METs between AG using four commonly used equations and ASP measurements for each activity. AG devices using different equations calculated significantly different outcomes for most activities compared with ASP devices. The smallest differences in predicted METs estimates between ASP and AG were observed for ambulatory activities. Ambulatory activities demonstrated the best agreement between ASP and AG regardless of which AG equation was used. Our findings can be used to assist researchers in their selection of accelerometer and output estimation equations for measuring physical activity and sedentary behavior in adults.

Assessing Physical Activity and Sedentary Behavior under Free-Living Conditions: Comparison of Active Style Pro HJA-350IT and ActiGraphTM GT3X.

Various accelerometers have been used in research measuring physical activity (PA) and sedentary behavior (SB). This study compared two triaxial accelerometers-Active style Pro (ASP) and ActiGraph (AG)-in measuring PA and SB during work and nonwork days in free-living conditions. A total of 50 working participants simultaneously wore these two accelerometers on one work day and one nonwork day. The difference and agreement between the ASP and AG were analyzed using paired t-tests, Bland-Altman plots, and intraclass coefficients, respectively. Correction factors were provided by linear regression analysis. The agreement in intraclass coefficients was high among all PA intensities between ASP and AG. SB in the AG vertical axis was approximately 103 min greater than ASP. Regarding moderate-to-vigorous-intensity PA (MVPA), ASP had the greatest amount, followed by AG. There were significant differences in all variables among these devices across all day classifications, except for SB between ASP and AG vector magnitude. The correction factors decreased the differences of SB and MVPA. PA time differed significantly between ASP and AG. However, SB and MVPA differences between these two devices can be decreased using correction factors, which are useful methods for public health researchers.

Comparison of Older and Newer Generation Active Style Pro Accelerometers in Physical Activity and Sedentary Behavior Surveillance under a Free-Living Environment.

Background. Comparability of accelerometers in epidemiological studies is important for public health researchers. This study aimed to compare physical activity (light, LPA; moderate, MPA; and moderate-to-vigorous, MVPA) and sedentary behavior (SB) data collected using two Omron triaxial accelerometer generations (Active style Pro, ASP) among a sample of Japanese workers in a free-living environment. Methods. Thirty active and sedentary workers (24-62 years) wore two types of ASP accelerometers, the HJA-350IT (350IT) and the HJA-750C (750C), simultaneously for seven consecutive days to represent a typical week. The accelerometers estimated daily average step counts and time spent per day in LPA, MPA, and MVPA. If a participant had data for ≥4 days (>10 h/day) it was considered valid. The difference and agreement between the two ASPs were analyzed using a paired t-test, intra-class correlation coefficients (ICC), and a Bland-Altman analysis in total and for each type of worker. Results. Among all workers, the 750C measured significantly (p < 0.05) less SB, MPA, MVPA, and more LPA compared with the 350IT. The agreements in ICC were high (ICC ≥ 0.94). Conclusions. Compared with the 350IT, the newer generation 750C ASP accelerometer may not provide equivalent estimates of activity time, regardless of the type of physical activity.

Improving the Performance of an Auditory Brain-Computer Interface Using Virtual Sound Sources by Shortening Stimulus Onset Asynchrony.

Recently, a brain-computer interface (BCI) using virtual sound sources has been proposed for estimating user intention via electroencephalogram (EEG) in an oddball task. However, its performance is still insufficient for practical use. In this study, we examine the impact that shortening the stimulus onset asynchrony (SOA) has on this auditory BCI. While very short SOA might improve its performance, sound perception and task performance become difficult, and event-related potentials (ERPs) may not be induced if the SOA is too short. Therefore, we carried out behavioral and EEG experiments to determine the optimal SOA. In the experiments, participants were instructed to direct attention to one of six virtual sounds (target direction). We used eight different SOA conditions: 200, 300, 400, 500, 600, 700, 800, and 1,100 ms. In the behavioral experiment, we recorded participant behavioral responses to target direction and evaluated recognition performance of the stimuli. In all SOA conditions, recognition accuracy was over 85%, indicating that participants could recognize the target stimuli correctly. Next, using a silent counting task in the EEG experiment, we found significant differences between target and non-target sound directions in all but the 200-ms SOA condition. When we calculated an identification accuracy using Fisher discriminant analysis (FDA), the SOA could be shortened by 400 ms without decreasing the identification accuracies. Thus, improvements in performance (evaluated by BCI utility) could be achieved. On average, higher BCI utilities were obtained in the 400 and 500-ms SOA conditions. Thus, auditory BCI performance can be optimized for both behavioral and neurophysiological responses by shortening the SOA.

Validity and Reliability of Japanese-Language Self-reported Measures for Assessing Adults Domain-Specific Sedentary Time.

BACKGROUND: Good quality measures of Japanese adults' sedentary behaviors are needed to accurately assess correlates of specific sedentary behaviors. The present study assessed criterion validity of total sedentary behavior and test-retest reliability of six domain-specific sedentary behaviors. METHODS: We administered a questionnaire, based on previous studies, that measured domain-specific sedentary behaviors. To examine validity, agreement between self-reported time spent in sedentary behaviors from the questionnaire and objectively-measured sedentary time using accelerometers was compared among 392 adults (aged 40-64 years) in two Japanese cities. For reliability, a 2-week interval test-retest was administered to a convenience sample of 34 participants. RESULTS: The correlation between total self-reported and objectively measured sedentary time was significant (all P < 0.001) and fair-to-good for workdays (ρ = 0.57) and whole week (ρ = 0.49), but was low for non-workdays (ρ = 0.23). The difference between the two measures was significant for whole week (z = -2.25, P = 0.03) and non-workdays (z = -5.50, P < 0.001), but was not significant for workdays (z = -0.60, P = 0.55). There was a significant positive association between the difference in the two measures and the average of these two measures (workdays: r = 0.53; non-workdays: r = 0.45; and whole week: r = 0.54, all P < 0.001). There was fair-to-good test-retest reliability of total sedentary time for each domain (workdays: interclass correlation coefficient [ICC] = 0.77, non-workdays: ICC = 0.53, and whole week: ICC = 0.7; all P < 0.01). CONCLUSIONS: The scale of domain-specific sedentary behaviors is reliable for estimating where and for what purpose Japanese adults spend their sedentary time, and total sedentary time is valid for workdays and the whole week.

Comparability of activity monitors used in Asian and Western-country studies for assessing free-living sedentary behaviour.

This study aims to compare the outputs of the waist-worn Active style Pro HJA-350IT (ASP; used in studies with Asian populations), the waist-worn ActiGragh™GT3X+ using the normal filter (GT3X+) and the thigh-worn activPAL3 (AP) in assessing adults' sedentary behaviour (total sedentary time, number of breaks) under free-living conditions. Fifty healthy workers wore the three monitors simultaneously during their waking hours on two days, including a work day and a non-work day. Valid data were at least 10 hours of wearing time, and the differences between monitors on the sedentary outputs using the AP as criterion measurement were analyzed by ANOVA. The number of participants who had complete valid data for work day and non-work day was 47 and 44, respectively. Total sedentary time and breaks estimated by the AP were respectively 466.5 ± 146.8 min and 64.3 ± 24.9 times on the work day and 497.7 ± 138.3 min and 44.6 ± 15.4 times on the non-work day. In total sedentary time, the ASP estimated 29.7 min (95%CI = 7.9 to 51.5) significantly shorter than the AP on the work day but showed no significant difference against the AP on the non-work day. The GT3X+ estimated 80.1 min (54.6 to 105.6) and 52.3 (26.4 to 78.2) significantly longer than the AP on the work day and the non-work day, respectively. For the number of breaks from sedentary time, on both days, the ASP and the GT3X+ estimated significantly more than the AP: 14.1 to 15.8 times (6.3 to 22.5) for the ASP and 27.7 to 28.8 times (21.8 to 34.8) for the GT3X+. Compared to the AP as the criterion, the ASP can underestimate total sedentary time and the GT3X+ can overestimate it, and more so at the lower levels of sedentary time. For breaks from sedentary time, compared to the AP, both the GT3X+ the ASP can overestimate.

Estimating the intended sound direction of the user: toward an auditory brain-computer interface using out-of-head sound localization.

The auditory Brain-Computer Interface (BCI) using electroencephalograms (EEG) is a subject of intensive study. As a cue, auditory BCIs can deal with many of the characteristics of stimuli such as tone, pitch, and voices. Spatial information on auditory stimuli also provides useful information for a BCI. However, in a portable system, virtual auditory stimuli have to be presented spatially through earphones or headphones, instead of loudspeakers. We investigated the possibility of an auditory BCI using the out-of-head sound localization technique, which enables us to present virtual auditory stimuli to users from any direction, through earphones. The feasibility of a BCI using this technique was evaluated in an EEG oddball experiment and offline analysis. A virtual auditory stimulus was presented to the subject from one of six directions. Using a support vector machine, we were able to classify whether the subject attended the direction of a presented stimulus from EEG signals. The mean accuracy across subjects was 70.0% in the single-trial classification. When we used trial-averaged EEG signals as inputs to the classifier, the mean accuracy across seven subjects reached 89.5% (for 10-trial averaging). Further analysis showed that the P300 event-related potential responses from 200 to 500 ms in central and posterior regions of the brain contributed to the classification. In comparison with the results obtained from a loudspeaker experiment, we confirmed that stimulus presentation by out-of-head sound localization achieved similar event-related potential responses and classification performances. These results suggest that out-of-head sound localization enables us to provide a high-performance and loudspeaker-less portable BCI system.

Estimation of direction of attention using EEG and out-of-head sound localization.

Brain-Machine Interfaces (BMIs) are being researched controlling external devices such as robots and computers by measuring the cranial nerve activity of the operator. The brain activities evoked by visual stimuli have been studied intensively. However, few studies have considered a BMI that uses the brain activities evoked by auditory stimuli. This study investigated whether a person's direction of attention can be estimated using an event-related potential (ERP) generated by selective attention to an auditory stimulus. An auditory stimulus and an out-of-head sound localization system that can create an audio image outside the head that is presented through an earphone were used instead of a loudspeaker system. This system was experimentally evaluated by presenting the subject auditory cues from one of six directions while the subject directed his attention in one direction. An EEG response similar to an ERP was observed. The direction of attention was estimated using support vector machine with an accuracy of 89.2[%] on average for the three subjects. This suggests that a BMI system based on the estimated direction of attention can be developed by using out-of-head sound localization.