Artificial Intelligence - Modularity with Behavior Trees

Artificial intelligence (AI) is a growing field of interest in computer science and is becoming increasingly important. There are numerous applications of AI with one of the most common ones being in video games. AI in video games often requires complex behavior for non-player characters (agents) within the game (e.g., enemies). One challenge for video game developers is to provide robust agent behavior while reducing duplication of code. Agent behavior often consists of a choice between independent actions ( should I run or shoot? ), but good design principles dictate that the code for those actions should not be duplicated in each agent. As more behaviors and actions are introduced, more code for common actions are repeated in each one, thus ballooning the code. One AI technique to combat this problem is behavior trees. Behavior trees allow behaviors to be composed from independent actions, while reducing the repetition of code. Modularity is also another benefit of behavior trees as behaviors can be created through different combinations of independent actions. The purpose of this project is to explore the concept of behavior trees and determine its effectiveness to the repetition issue. A simple space-shooter type game is used to show the application of behavior trees and how effective it is when used to create different types of behaviors for the AI. The result demonstrates that behavior trees can be used to not only create different types of complex behaviors for the AI, but also reduce the repetition of code through reusability and modularity

Objectively measured physical activity of Vietnamese adults with type 2 diabetes: Opportunities to intervene

Objectives: To objectively determine and compare the physical activity (PA) levels of adults newly diagnosed with type 2 diabetes (T2D) and adults without T2D in Vietnam using an accelerometer. Methods: A total of 120 participants with newly diagnosed T2D and 120 adults without T2D were recruited from a large hospital in Hanoi, the capital city of Vietnam. All participants wore an ActiGraph GT3X accelerometer for at least 5 days, including 1 weekend day. Freedson cut-off points were used to estimate different intensities of PA. In addition, comparisons between groups were made with respect to achieving the World Health Organization (WHO) and International Diabetes Federation (IDF) recommended PA guidelines. Results: Men with T2D had significantly lower levels of PA than men without T2D. The respective multivariable-adjusted mean values of daily step count, daily light-intensity, moderate-intensity, and moderate-to-vigorous-intensity PA were approximately 14%, 19%, and 22% lower in the men with T2D than in their non-T2D counterparts. However, women with T2D accumulated a greater number of steps per day than women without T2D. Only 59.2% of the adults with T2D met the minimum recommended level of PA (WHO and IDF), compared to 74.2% of adults without T2D (p<0.05). After adjusting for potential confounders, participants with T2D experienced 50.0% significantly lower odds of achieving PA recommendations. Conclusions: Vietnamese men with T2D were less physically active than those without T2D, and adults with T2D were less likely to meet PA guidelines. The results suggest a need for integrating PA into the self-management of this chronic condition

Protocol for developing a core outcome set for male infertility research:an international consensus development study

Abstract STUDY QUESTION We aim to develop, disseminate and implement a minimum data set, known as a core outcome set, for future male infertility research. WHAT IS KNOWN ALREADY Research into male infertility can be challenging to design, conduct and report. Evidence from randomized trials can be difficult to interpret and of limited ability to inform clinical practice for numerous reasons. These may include complex issues, such as variation in outcome measures and outcome reporting bias, as well as failure to consider the perspectives of men and their partners with lived experience of fertility problems. Previously, the Core Outcome Measure for Infertility Trials (COMMIT) initiative, an international consortium of researchers, healthcare professionals and people with fertility problems, has developed a core outcome set for general infertility research. Now, a bespoke core outcome set for male infertility is required to address the unique challenges pertinent to male infertility research. STUDY DESIGN, SIZE, DURATION Stakeholders, including healthcare professionals, allied healthcare professionals, scientists, researchers and people with fertility problems, will be invited to participate. Formal consensus science methods will be used, including the modified Delphi method, modified Nominal Group Technique and the National Institutes of Health’s consensus development conference. PARTICIPANTS/MATERIALS, SETTING, METHODS An international steering group, including the relevant stakeholders outlined above, has been established to guide the development of this core outcome set. Possible core outcomes will be identified by undertaking a systematic review of randomized controlled trials evaluating potential treatments for male factor infertility. These outcomes will be entered into a modified Delphi method. Repeated reflection and re-scoring should promote convergence towards consensus outcomes, which will be prioritized during a consensus development meeting to identify a final core outcome set. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. STUDY FUNDING/COMPETING INTEREST(S) This work has been supported by the Urology Foundation small project award, 2021. C.L.R.B. is the recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. S.B. received royalties from Cambridge University Press, Speaker honoraria for Obstetrical and Gynaecological Society of Singapore, Merk SMART Masterclass and Merk FERRING Forum, paid to the University of Aberdeen. Payment for leadership roles within NHS Grampian, previously paid to self, now paid to University of Aberdeen. An Honorarium is received as Editor in Chief of Human Reproduction Open. M.L.E. is an advisor to the companies Hannah and Ro. B.W.M. received an investigator grant from the NHMRC, No: GNT1176437 is a paid consultant for ObsEva and has received research funding from Ferring and Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Aytu Bioscience also funded MiOXYS systems and sensors. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with Human Reproduction Open. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586. TRIAL REGISTRATION DATE N/A. DATE OF FIRST PATIENT’S ENROLMENT N/A

Developing a core outcome set for future infertility research : An international consensus development study

STUDY QUESTION: Can a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed? SUMMARY ANSWER: A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility. WHAT IS KNOWN ALREADY: Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. STUDY DESIGN, SIZE, DURATION: A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE: The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS: Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S): This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Quantifying the Relationships Among Selective Motor Control, Brain Imaging, Biomechanics and Physical Therapy in Children with Spastic Bilateral Cerebral Palsy

Cerebral palsy (CP) is a motor disorder caused by an injury to the developing fetal or infantbrain. While the corticospinal tract (CST) is related to selective motor control (SMC) function, an underlying deficit in spastic CP, little is known about CST microstructural impairment, its relationship with motor function measures and neuroplasticity in response to a physical therapy intervention focused on intensive practice of lower extremity (LE) SMC exercises. The aim of this dissertation was to study the effect of Camp Leg Power, a novel LE SMC intervention in spastic CP, on measures of white matter (WM) motor tract microstructure and motor function measures.Children with unilateral or bilateral spastic CP born premature were recruited for CampLeg Power. Diffusion-weighted imaging scans were collected for participants with bilateral CP and periventricular leukomalacia (PVL). Children with typical development (TD) were recruited as brain imaging controls. The Selective Control Assessment of the Lower Extremity (SCALE) and the gross motor function measure were collected for all participants with CP. Motor function measures analyzed included the 10-meter walk/run test, 6-minute walk test, stride length during gait and isokinetic knee joint torque.Twenty-three children with spastic CP were enrolled (3 unilateral, 20 bilateral; mean age� SD: 10.1 � 2.8 years; age range: 5.6-16.6 years). Diffusion-weighted imaging scans were evaluated for a subset of 12 participants with spastic bilateral CP and PVL and 12 children with TD (mean age � SD: 10.3 � 1.5 years; age range: 7.5-12.8 years). The CP group exhibited lower anisotropy, damaged myelination, decreased axonal integrity and greater overall diffusivity throughout the whole brain including WM motor tracts relative to TD. The CP group improved their motor function following Camp Leg Power coinciding with improved myelination of brain motor regions suggesting neuroplasticity in response to intervention. SCALE is a strong clinical correlate of brain motor impairment, baseline motor function and post-intervention motor outcomes.This work contributes to the overall understanding of neuroimaging, clinical correlates ofimpaired WM and biomechanics measures, neuroplasticity and motor function changes in response to a novel LE SMC intervention in spastic CP

Quantifying the Relationships Among Selective Motor Control, Brain Imaging, Biomechanics and Physical Therapy in Children with Spastic Bilateral Cerebral Palsy

Cerebral palsy (CP) is a motor disorder caused by an injury to the developing fetal or infantbrain. While the corticospinal tract (CST) is related to selective motor control (SMC) function, an underlying deficit in spastic CP, little is known about CST microstructural impairment, its relationship with motor function measures and neuroplasticity in response to a physical therapy intervention focused on intensive practice of lower extremity (LE) SMC exercises. The aim of this dissertation was to study the effect of Camp Leg Power, a novel LE SMC intervention in spastic CP, on measures of white matter (WM) motor tract microstructure and motor function measures.Children with unilateral or bilateral spastic CP born premature were recruited for CampLeg Power. Diffusion-weighted imaging scans were collected for participants with bilateral CP and periventricular leukomalacia (PVL). Children with typical development (TD) were recruited as brain imaging controls. The Selective Control Assessment of the Lower Extremity (SCALE) and the gross motor function measure were collected for all participants with CP. Motor function measures analyzed included the 10-meter walk/run test, 6-minute walk test, stride length during gait and isokinetic knee joint torque.Twenty-three children with spastic CP were enrolled (3 unilateral, 20 bilateral; mean age� SD: 10.1 � 2.8 years; age range: 5.6-16.6 years). Diffusion-weighted imaging scans were evaluated for a subset of 12 participants with spastic bilateral CP and PVL and 12 children with TD (mean age � SD: 10.3 � 1.5 years; age range: 7.5-12.8 years). The CP group exhibited lower anisotropy, damaged myelination, decreased axonal integrity and greater overall diffusivity throughout the whole brain including WM motor tracts relative to TD. The CP group improved their motor function following Camp Leg Power coinciding with improved myelination of brain motor regions suggesting neuroplasticity in response to intervention. SCALE is a strong clinical correlate of brain motor impairment, baseline motor function and post-intervention motor outcomes.This work contributes to the overall understanding of neuroimaging, clinical correlates ofimpaired WM and biomechanics measures, neuroplasticity and motor function changes in response to a novel LE SMC intervention in spastic CP