1,657 research outputs found

    The role of nursing in multimorbidity care

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    Background Multimorbidity (the co-occurrence of two or more chronic conditions in the same person) affects around one in three persons, and it is strongly associated with a range of negative outcomes including worsening physical function, increased health care use, and premature death. Due to the way healthcare is provided to people with multimorbidity, treatment can become burdensome, fragmented and inefficient. In people with palliative conditions, multimorbidity is increasingly common. Better models of care are needed. Methods A mixed-methods programme of research designed to inform the development of a nurse-led intervention for people with multimorbidity and palliative conditions. A mixed-methods systematic review explored nurse-led interventions for multimorbidity and their effects on outcomes. A cross-sectional study of 63,328 emergency department attenders explored the association between multimorbidity, complex multimorbidity (≥3 conditions affecting ≥3 body systems), and disease-burden on healthcare use and inpatient mortality. A focussed ethnographic study of people with multimorbidity and life-limiting conditions and their carers (n=12) explored the concept of treatment burden. Findings Nurse-led interventions for people with multimorbidity generally focus on care coordination (i.e., case management or transitional care); patients view them positively, but they do not reliably reduce health care use or costs. Multimorbidity and complex multimorbidity were significantly associated with admission from the emergency department and reattendance within 30 and 90 days. The association was greater in those with more conditions. There was no association with inpatient mortality. People with multimorbidity and palliative conditions experienced treatment burden in a manner consistent with existing theoretical models. This thesis also noted the effect of uncertainty on the balance between capacity and workload and proposes a model of how these concepts relate to one another. Discussion This thesis addresses a gap in what is known about the role of nurses in providing care to the growing number of people with multimorbidity. A theory-based nurse-led intervention is proposed which prioritises managing treatment burden and uncertainty. Conclusions Nursing in an age of multimorbidity necessitates a perspective shift which conceptualises chronic conditions as multiple overlapping phenomena situated within an individual. The role of the nurse should be to help patients navigate the complexity of living with multiple chronic conditions

    LIPIcs, Volume 251, ITCS 2023, Complete Volume

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    LIPIcs, Volume 251, ITCS 2023, Complete Volum

    On the Utility of Representation Learning Algorithms for Myoelectric Interfacing

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    Electrical activity produced by muscles during voluntary movement is a reflection of the firing patterns of relevant motor neurons and, by extension, the latent motor intent driving the movement. Once transduced via electromyography (EMG) and converted into digital form, this activity can be processed to provide an estimate of the original motor intent and is as such a feasible basis for non-invasive efferent neural interfacing. EMG-based motor intent decoding has so far received the most attention in the field of upper-limb prosthetics, where alternative means of interfacing are scarce and the utility of better control apparent. Whereas myoelectric prostheses have been available since the 1960s, available EMG control interfaces still lag behind the mechanical capabilities of the artificial limbs they are intended to steer—a gap at least partially due to limitations in current methods for translating EMG into appropriate motion commands. As the relationship between EMG signals and concurrent effector kinematics is highly non-linear and apparently stochastic, finding ways to accurately extract and combine relevant information from across electrode sites is still an active area of inquiry.This dissertation comprises an introduction and eight papers that explore issues afflicting the status quo of myoelectric decoding and possible solutions, all related through their use of learning algorithms and deep Artificial Neural Network (ANN) models. Paper I presents a Convolutional Neural Network (CNN) for multi-label movement decoding of high-density surface EMG (HD-sEMG) signals. Inspired by the successful use of CNNs in Paper I and the work of others, Paper II presents a method for automatic design of CNN architectures for use in myocontrol. Paper III introduces an ANN architecture with an appertaining training framework from which simultaneous and proportional control emerges. Paper Iv introduce a dataset of HD-sEMG signals for use with learning algorithms. Paper v applies a Recurrent Neural Network (RNN) model to decode finger forces from intramuscular EMG. Paper vI introduces a Transformer model for myoelectric interfacing that do not need additional training data to function with previously unseen users. Paper vII compares the performance of a Long Short-Term Memory (LSTM) network to that of classical pattern recognition algorithms. Lastly, paper vIII describes a framework for synthesizing EMG from multi-articulate gestures intended to reduce training burden

    20th SC@RUG 2023 proceedings 2022-2023

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    20th SC@RUG 2023 proceedings 2022-2023

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    Resilient and Scalable Forwarding for Software-Defined Networks with P4-Programmable Switches

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    Traditional networking devices support only fixed features and limited configurability. Network softwarization leverages programmable software and hardware platforms to remove those limitations. In this context the concept of programmable data planes allows directly to program the packet processing pipeline of networking devices and create custom control plane algorithms. This flexibility enables the design of novel networking mechanisms where the status quo struggles to meet high demands of next-generation networks like 5G, Internet of Things, cloud computing, and industry 4.0. P4 is the most popular technology to implement programmable data planes. However, programmable data planes, and in particular, the P4 technology, emerged only recently. Thus, P4 support for some well-established networking concepts is still lacking and several issues remain unsolved due to the different characteristics of programmable data planes in comparison to traditional networking. The research of this thesis focuses on two open issues of programmable data planes. First, it develops resilient and efficient forwarding mechanisms for the P4 data plane as there are no satisfying state of the art best practices yet. Second, it enables BIER in high-performance P4 data planes. BIER is a novel, scalable, and efficient transport mechanism for IP multicast traffic which has only very limited support of high-performance forwarding platforms yet. The main results of this thesis are published as 8 peer-reviewed and one post-publication peer-reviewed publication. The results cover the development of suitable resilience mechanisms for P4 data planes, the development and implementation of resilient BIER forwarding in P4, and the extensive evaluations of all developed and implemented mechanisms. Furthermore, the results contain a comprehensive P4 literature study. Two more peer-reviewed papers contain additional content that is not directly related to the main results. They implement congestion avoidance mechanisms in P4 and develop a scheduling concept to find cost-optimized load schedules based on day-ahead forecasts

    Moving away from the Monoplot: conventional narrative structure in the screenplay and the unconventional alternatives

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    Through a combination of creative and critical practice, this project seeks to explore the conventionalisation effect that popular screenwriting handbooks have had on screenwriting practice, the unconventional structural models that are available to the screenwriter once they move away from the conventional model, and the meanings which conventional and unconventional structural approaches create. By examining the most influential screenwriting handbooks, and tracing the historical development of screenwriting conventions, a model for quantifying and understanding conventional narrative structure will be proposed: Conventional Monoplot. An exploration of the cinematic canon, box office statistics and Academy Awards success will attempt to show that the conventionalisation of structural practice within the screenplay has led to an increased homogeneity of form and meaning in mainstream cinema and a concurrent reduction in narrative sophistication and critical esteem. By applying the Conventional Monoplot model in their practice, this project will argue that the screenwriter can quantify and understand divergence from conventional structural practice by negative correlation to the model, and through such practice the homogeneity of film form might be challenged. Through an examination of a wide body of film texts a taxonomy of alternative structural models will be proposed, and the meanings which these models create will be explored. The creative element, a feature screenplay, will demonstrate practical application of one of these models, and a critical reflection will explore the meanings created by use of this unconventional structural model, locating a methodology for unconventional practice in the screenplay. The project will propose that the influence of screenwriting handbooks has led to homogeneity and conventionalisation in the culture of the screenplay, and that by consciously focusing on unconventional structural practices the screenwriter can access a greater diversity of meaning at the structural level

    Darknet traffic classification and adversarial attacks using machine learning

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    The anonymous nature of darknets is commonly exploited for illegal activities. Previous research has employed machine learning and deep learning techniques to automate the detection of darknet traffic in an attempt to block these criminal activities. This research aims to improve darknet traffic detection by assessing a wide variety of machine learning and deep learning techniques for the classification of such traffic and for classification of the underlying application types. We find that a Random Forest model outperforms other state-of-the-art machine learning techniques used in prior work with the CIC-Darknet2020 dataset. To evaluate the robustness of our Random Forest classifier, we obfuscate select application type classes to simulate realistic adversarial attack scenarios. We demonstrate that our best-performing classifier can be degraded by such attacks, and we consider ways to effectively deal with such adversarial attacks

    Behavior quantification as the missing link between fields: Tools for digital psychiatry and their role in the future of neurobiology

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    The great behavioral heterogeneity observed between individuals with the same psychiatric disorder and even within one individual over time complicates both clinical practice and biomedical research. However, modern technologies are an exciting opportunity to improve behavioral characterization. Existing psychiatry methods that are qualitative or unscalable, such as patient surveys or clinical interviews, can now be collected at a greater capacity and analyzed to produce new quantitative measures. Furthermore, recent capabilities for continuous collection of passive sensor streams, such as phone GPS or smartwatch accelerometer, open avenues of novel questioning that were previously entirely unrealistic. Their temporally dense nature enables a cohesive study of real-time neural and behavioral signals. To develop comprehensive neurobiological models of psychiatric disease, it will be critical to first develop strong methods for behavioral quantification. There is huge potential in what can theoretically be captured by current technologies, but this in itself presents a large computational challenge -- one that will necessitate new data processing tools, new machine learning techniques, and ultimately a shift in how interdisciplinary work is conducted. In my thesis, I detail research projects that take different perspectives on digital psychiatry, subsequently tying ideas together with a concluding discussion on the future of the field. I also provide software infrastructure where relevant, with extensive documentation. Major contributions include scientific arguments and proof of concept results for daily free-form audio journals as an underappreciated psychiatry research datatype, as well as novel stability theorems and pilot empirical success for a proposed multi-area recurrent neural network architecture.Comment: PhD thesis cop

    Security and Privacy for Modern Wireless Communication Systems

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    The aim of this reprint focuses on the latest protocol research, software/hardware development and implementation, and system architecture design in addressing emerging security and privacy issues for modern wireless communication networks. Relevant topics include, but are not limited to, the following: deep-learning-based security and privacy design; covert communications; information-theoretical foundations for advanced security and privacy techniques; lightweight cryptography for power constrained networks; physical layer key generation; prototypes and testbeds for security and privacy solutions; encryption and decryption algorithm for low-latency constrained networks; security protocols for modern wireless communication networks; network intrusion detection; physical layer design with security consideration; anonymity in data transmission; vulnerabilities in security and privacy in modern wireless communication networks; challenges of security and privacy in node–edge–cloud computation; security and privacy design for low-power wide-area IoT networks; security and privacy design for vehicle networks; security and privacy design for underwater communications networks
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