Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care.DiscussionIf this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings.Trial registrationClinicalTrials.gov Identifier NCT01763203

Deployment of assisted living technology solution platform using smart body sensors for elderly people health monitoring.

Many of the Ambient Assisted Living Technologies (AALT) available in the market to the end-users with long term health condition have no common inter-operational protocol. Each product has its own communication protocols, different interfaces and interoperation which limits their solution reliability, flexibility and efficiency. This paper presents assisted living platform solution for elderly people with long term health condition based on wireless sensors networking technology. The system includes multi feedback sensor arrangements for monitoring, such as: blood pressure, heart rate and body temperature. Each sensor has been integrated with the necessary near real time embedded and wireless protocols that allow data collection, transfer and interoperate in ad-hoc bases. The data will be communicated wirelessly to central data base system and shared though cloud network. The collected data will be processed and relevant intelligent algorithms will be deployed to ensure certain actions taken place when health condition warnings arise. These warnings to be communicated to relevant carer, General Practitioner (GP) and health authority to take the necessary action and steps to handle such end user health condition warnings. The proposed solution system will provide the flexibility to analyse most of the health conditions based on near real time monitoring technology. It will enable the population of elderly with long term health condition to manage their daily life activities within multiple environments i.e. from their comfort home, care centres and hospitals. The data and information will be treated with high confidentiality to ensure end-users integrity and dignity have been maintained.N/

Hardware Implementation of Deep Network Accelerators Towards Healthcare and Biomedical Applications

With the advent of dedicated Deep Learning (DL) accelerators and neuromorphic processors, new opportunities are emerging for applying deep and Spiking Neural Network (SNN) algorithms to healthcare and biomedical applications at the edge. This can facilitate the advancement of the medical Internet of Things (IoT) systems and Point of Care (PoC) devices. In this paper, we provide a tutorial describing how various technologies ranging from emerging memristive devices, to established Field Programmable Gate Arrays (FPGAs), and mature Complementary Metal Oxide Semiconductor (CMOS) technology can be used to develop efficient DL accelerators to solve a wide variety of diagnostic, pattern recognition, and signal processing problems in healthcare. Furthermore, we explore how spiking neuromorphic processors can complement their DL counterparts for processing biomedical signals. After providing the required background, we unify the sparsely distributed research on neural network and neuromorphic hardware implementations as applied to the healthcare domain. In addition, we benchmark various hardware platforms by performing a biomedical electromyography (EMG) signal processing task and drawing comparisons among them in terms of inference delay and energy. Finally, we provide our analysis of the field and share a perspective on the advantages, disadvantages, challenges, and opportunities that different accelerators and neuromorphic processors introduce to healthcare and biomedical domains. This paper can serve a large audience, ranging from nanoelectronics researchers, to biomedical and healthcare practitioners in grasping the fundamental interplay between hardware, algorithms, and clinical adoption of these tools, as we shed light on the future of deep networks and spiking neuromorphic processing systems as proponents for driving biomedical circuits and systems forward.Comment: Submitted to IEEE Transactions on Biomedical Circuits and Systems (21 pages, 10 figures, 5 tables

Semantic definition of a subset of the structured query language (SQL)

Journal ArticleSQL is a relational database definition and manipulation language. Portions of the manipulation language are readily described in terms of relational algebra. The semantics of a subset of the SQL select statement is described. The select statement allows the user to query the database. The select statement is shown to be equivalent to a series of relational and set operations. The semantics are described in terms of abstract data types for relation schemes, tuples, and relations. Certain forms of the union or intersection of two select statements are shown to have equivalent single select statement forms

Shared versus distributed memory multiprocessors

The question of whether multiprocessors should have shared or distributed memory has attracted a great deal of attention. Some researchers argue strongly for building distributed memory machines, while others argue just as strongly for programming shared memory multiprocessors. A great deal of research is underway on both types of parallel systems. Special emphasis is placed on systems with a very large number of processors for computation intensive tasks and considers research and implementation trends. It appears that the two types of systems will likely converge to a common form for large scale multiprocessors

Investigation into the wafer-scale integration of fine-grain parallel processing computer systems

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis investigates the potential of wafer-scale integration (WSI) for the implementation of low-cost fine-grain parallel processing computer systems. As WSI is a relatively new subject, there was little work on which to base investigations. Indeed, most WSI architectures existed only as untried and sometimes vague proposals. Accordingly, the research strategy approached this problem by identifying a representative WSI structure and architecture on which to base investigations. An analysis of architectural proposals identified associative memory to be general purpose parallel processing component used in a wide range of WSI architectures. Furthermore, this analysis provided a set of WSI-level design requirements to evaluate the sustainability of different architectures as research vehicles. The WSI-ASP (WASP) device, which has a large associative memory as its main component is shown to meet these requirements and hence was chosen as the research vehicle. Consequently, this thesis addresses WSI potential through an in-depth investigation into the feasibility of implementing a large associative memory for the WASP device that meets the demanding technological constraints of WSI. Overall, the thesis concludes that WSI offers significant potential for the implementation of low-cost fine-grain parallel processing computer systems. However, due to the dual constraints of thermal management and the area required for the power distribution network, power density is a major design constraint in WSI. Indeed, it is shown that WSI power densities need to be an order of magnitude lower than VLSI power densities. The thesis demonstrates that for associative memories at least, VLSI designs are unsuited to implementation in WSI. Rather, it is shown that WSI circuits must be closely matched to the operational environment to assure suitable power densities. These circuits are significantly larger than their VLSI equivalents. Nonetheless, the thesis demonstrates that by concentrating on the most power intensive circuits, it is possible to achieve acceptable power densities with only a modest increase in area overheads.SER