Multiparametric Investigation of Dynamics in Fetal Heart Rate Signals

In the field of electronic fetal health monitoring, computerized analysis of fetal heart rate (FHR) signals has emerged as a valid decision-support tool in the assessment of fetal wellbeing. Despite the availability of several approaches to analyze the variability of FHR signals (namely the FHRV), there are still shadows hindering a comprehensive understanding of how linear and nonlinear dynamics are involved in the control of the fetal heart rhythm. In this study, we propose a straightforward processing and modeling route for a deeper understanding of the relationships between the characteristics of the FHR signal. A multiparametric modeling and investigation of the factors influencing the FHR accelerations, chosen as major indicator of fetal wellbeing, is carried out by means of linear and nonlinear techniques, blockwise dimension reduction, and artificial neural networks. The obtained results show that linear features are more influential compared to nonlinear ones in the modeling of HRV in healthy fetuses. In addition, the results suggest that the investigation of nonlinear dynamics and the use of predictive tools in the field of FHRV should be undertaken carefully and limited to defined pregnancy periods and FHR mean values to provide interpretable and reliable information to clinicians and researchers

Interpreting in a Recreational Paediatrics Setting: Displaying (Inter)cultural Competence with Children

The focus of this article is interpreting for children and adolescents in the healthcare setting of Barretstown Camp, a therapeutic and recreational facility for children and adolescents suffering from chronic or serious illness that uses volunteer interpreters. The data collected will be discussed to highlight autonomous discourse moves made by interpreters that reveal their cultural competence and make communication with children more effective and affective. Interpreting for children poses a number of challenges for interpreters and the other professionals involved in the interaction. Any interpreter-mediated conversation poses a number of general challenges (such as bridging the gap between two different cultural worlds) and also more specific challenges related to both the setting (legal, medical, educational, etc.) and the beneficiaries of the interpreting (children, adults, doctors, lawyers, etc.). While interpreting for adults has been investigated quite extensively, interpreting for children is almost unchartered territory. In the first part of this paper, there is a short overview of the literature in this area, including a discussion of issues that may arise when interpreting for children. The first of these issues concerns whether it is the task of the interpreter or the other professionals to adapt the language spoken to the needs of the child, with the literature offering a number of different approaches, depending on the setting. The second issue concerns the role boundaries of interpreters when mediating a conversation involving a child. Another very important issue discussed is the difficulty in listening to the voice of children involved in interpreter-mediated encounters. In the second part of the paper, the focus is on the concept of subjective culture and its relevance in interpreter-mediated doctor-patient encounters. There are studies supporting the idea that not only individuals belonging to ethnic minority groups experience discrimination, but also ethnic majority individuals belonging to micro-cultural groups. This is something that should be taken into consideration by interpreters when working, for instance, with children and adolescents suffering from chronic illnesses as they, in fact, belong to one of these majority subgroups and may be subject to discriminatory behaviour. More generally, it is argued that the paediatric setting entails a subjective layer of culture that interpreters need to be aware of. Next, the different roles interpreters can fulfil in this field are discussed by presenting some of the classifications elaborated by authors who have investigated this topic. The implications of each individual role on the interaction and its participants are then discussed. In addition to identifying the different responsibilities each role entails for the interpreter, the perception that other professionals and users have of the interpreter’s role are also highlighted. In the final part of the paper, the focus is on an aspect that deserves particular attention on the part of interpreters when working with children: the use of child-friendly language by making references to the world of children. This aspect is discussed using examples taken from the data collected at Barretstown. The data are briefly described to provide the context for the analysis. Examples of references to the world of children produced by both professionals working at the camp and interpreters with autonomous additions in their renditions are discussed together with the pragmatic implications of these autonomous discourse moves

The best interest of the child in interpreter-mediated interviews – Researching children’s point of view

Children’s rights enshrined in the UN Convention on the Rights of the Child (CRC) can be substantiated only if children can understand them and can communicate their point of view effectively. Whenever children do not speak the same language of the country where they live, and no action is taken to guarantee their right to communicate in their mother tongue, their rights are at risk. Yet, interpreting is still generally considered as a service activity for adults also in research and interpreter education, and the perception of interpreting by children and adolescents is understudied so far. This paper contributes to filling this gap by giving voice to a group of 18 Italian children and adolescents aged between 6 and 17 who communicated via an interpreter for the first time and expressed their preferences and concerns. The aim was to collect information about their perception of some aspects of an interpreter-mediated interview, in particular how they felt during the interview, what was their perception of role and rapport building and their preferred seating arrangements. We hope with this study to inspire further research in thisarea and also, possibly, specialised training for interpreters who work with children

Disease modifying treatments and symptomatic drugs for cognitive impairment in multiple sclerosis: where do we stand?

Abstract Cognitive dysfunction is frequent in multiple sclerosis patients and has important and negative consequences for daily activities and quality of life of subjects. Disease modifying treatments for multiple sclerosis reduce the incidence of relapses and may prevent disease progression, but the influence on cognitive impairment is unclear, due to several limitations of the available studies. Moreover, symptomatic drugs for the improvement of already established cognitive deficits have been tested in small pilot studies, providing conflicting or mainly negative results. Currently, specific pharmacological therapies for the management of cognitive deficits in MS have not yet been developed. We will provide an updated overview of available evidence of pharmacological approaches for ameliorating cognitive deficits, based either on disease modifying treatments or symptomatic drugs

Exploiting Linearity in Sharing Analysis of Object-oriented Programs

AbstractWe propose a new sharing analysis of object-oriented programs based on abstract interpretation. Two variables share when they are bound to data structures which overlap. We show that sharing analysis can greatly benefit from linearity analysis. We propose a combined domain including aliasing, linearity and sharing information. We use a graph-based representation of aliasing information which naturally encodes sharing and linearity information, and define all the necessary operators for the analysis of a Java-like language

Cultural mediators in Italy: a new breed of linguists

While most countries have developed accredited, certified interpreting services to facilitate communication between migrant populations and public service providers, in Italy service providers turned to the associations created to assist the migrant populations. Rather than just interpreting, the people sent by the associations also wished to act on the migrants\u2019 behalf as cultural mediators. The guidelines put forward for the professional profile and training of this figure include an unrealistic array of tasks, including interpreting, for which no specific training is provided. The need to involve universities in the training of cultural mediators is most apparent as regards their role as interpreters. Universities have been monitoring this new breed of linguists through research work. This study of mediated healthcare encounters shows how cultural mediators tend to assume conversational dominance and/or proxy roles, with interaction often becoming dyadic, to the exclusion of the patient

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Cardiovascular abnormalities and impaired exercise performance in adolescents with congenital adrenal hyperplasia

Context: Patients with classic Congenital Adrenal Hyperplasia (CAH) are treated with lifelong glucocorticoids (GCS). Cardiovascular (CV) and metabolic effects of such therapy in adolescents have never been quantified. Objective: To investigate left ventricular (LV) morphology, function and exercise performance in adolescents with CAH. Design and Setting: cross-sectional and controlled study conducted at a tertiary referral centre. Patients: Twenty patients with classic CAH (10 females) aged 13.6±2.5 years and 20 healthy controls comparable for sex and pubertal status were enrolled in the study and compared to a group of 18 patients without CAH receiving a similar dose of GCS for Juvenile Idiopathic Arthritis (JIA). Main Outcomes Measures: Echocardiographic assessment and symptom-limited exercise testing were performed. Anthropometric, hormonal and biochemical parameters were also measured. Results: Compared to healthy controls, patients with CAH exhibited an increased BMI (p<0.001), waist-to-height ratio (p<0.001), percentage of body fat (p<0.001) as well as higher insulin concentrations and HOMA index even after adjustment for BMI (p=0.03 and p=0.05, respectively). Moreover, CAH patients exhibited an impaired exercise capacity as shown by reduced peak workload (99±27 vs 126±27 W, p<0.01) and higher systolic blood pressure response at peak (156±18 vs 132±11 mmHg, p<0.01; Δ=45±24 vs 22±10 mmHg, p=0.05) with respect to healthy controls. CAH males displayed mild LV diastolic dysfunction as documented by significant prolongation of both isovolumic relaxation time (IRT) (118±18 vs 98±11ms, p<0.05) and mitral deceleration time (MDT) (138±25 vs 111±15 ms, p<0.01). No significant differences in CV function were found between CAH and JIA patients. Conclusion: Adolescents with CAH exhibit impaired exercise performance and enhanced systolic blood pressure response during exercise. In our population, such abnormalities appear related to GCS therapy rather than CAH per se. CAH males, but no females, present mild LV diastolic dysfunction that correlates with testosterone concentrations suggesting a sex hormone related difference

A Comprehensive Review of Techniques for Processing and Analyzing Fetal Heart Rate Signals

The availability of standardized guidelines regarding the use of electronic fetal monitoring (EFM) in clinical practice has not effectively helped to solve the main drawbacks of fetal heart rate (FHR) surveillance methodology, which still presents inter- and intra-observer variability as well as uncertainty in the classification of unreassuring or risky FHR recordings. Given the clinical relevance of the interpretation of FHR traces as well as the role of FHR as a marker of fetal wellbeing autonomous nervous system development, many different approaches for computerized processing and analysis of FHR patterns have been proposed in the literature. The objective of this review is to describe the techniques, methodologies, and algorithms proposed in this field so far, reporting their main achievements and discussing the value they brought to the scientific and clinical community. The review explores the following two main approaches to the processing and analysis of FHR signals: traditional (or linear) methodologies, namely, time and frequency domain analysis, and less conventional (or nonlinear) techniques. In this scenario, the emerging role and the opportunities offered by Artificial Intelligence tools, representing the future direction of EFM, are also discussed with a specific focus on the use of Artificial Neural Networks, whose application to the analysis of accelerations in FHR signals is also examined in a case study conducted by the authors