CHARM: A Hierarchical Deep Learning Model for Classification of Complex Human Activities Using Motion Sensors

In this paper, we report a hierarchical deep learning model for classification of complex human activities using motion sensors. In contrast to traditional Human Activity Recognition (HAR) models used for event-based activity recognition, such as step counting, fall detection, and gesture identification, this new deep learning model, which we refer to as CHARM (Complex Human Activity Recognition Model), is aimed for recognition of high-level human activities that are composed of multiple different low-level activities in a non-deterministic sequence, such as meal preparation, house chores, and daily routines. CHARM not only quantitatively outperforms state-of-the-art supervised learning approaches for high-level activity recognition in terms of average accuracy and F1 scores, but also automatically learns to recognize low-level activities, such as manipulation gestures and locomotion modes, without any explicit labels for such activities. This opens new avenues for Human-Machine Interaction (HMI) modalities using wearable sensors, where the user can choose to associate an automated task with a high-level activity, such as controlling home automation (e.g., robotic vacuum cleaners, lights, and thermostats) or presenting contextually relevant information at the right time (e.g., reminders, status updates, and weather/news reports). In addition, the ability to learn low-level user activities when trained using only high-level activity labels may pave the way to semi-supervised learning of HAR tasks that are inherently difficult to label.Comment: 8 pages, 5 figure

Operative results and outcome of twenty-four totally laparoscopic vascular procedures for aortoiliac occlusive disease

AbstractPurpose: The study objective was to apply laparoscopic techniques to conventional bypass procedures for aortoiliac occlusive disease. Methods: From October 1995 to August 1997, we performed seven iliofemoral (IFB), five unilateral aortofemoral (UAFB), and 11 aortobifemoral (AFB) bypass procedures and one aortic endarterectomy (TEA) totally laparoscopic. A transabdominal approach with pneumoperitoneum was preferred, and only laparoscopic vascular instruments were used. Endoscopic intervention followed principles of vascular surgery. As in open surgery, we used Dacron grafts and polypropylene sutures. Results: Twenty procedures were carried out totally laparoscopic; four conversions to open surgery were necessary. Severe complications included one postoperative respiratory failure requiring ventilatory support for four days, and one iliac vein lesion with subsequent open surgery. Mean operating time was 258 ± 49 minutes for IFB, 218 ± 54 minutes for UAFB, 279 ± 69 minutes for AFB, and 290 minutes for aortic TEA. Mean blood loss was 92 ± 49 ml for IFB, 390 ± 316 ml for UAFB, 563 ± 516 ml for AFB, and 100 ml for aortic TEA. Mean postoperative stay was 7.4 days for IFB, 7.8 days for UAFB, and 10.1 days for AFB. After the aortic TEA, the patient was discharged on day 6. At control examination all grafts were patent; two patients had mild claudication because of one progressive disease and one distal suture stenosis. Conclusion: Laparoscopic vascular surgery for aortoiliac occlusive disease is feasible, safe, and effective. At the beginning, a cooperation between experienced laparoscopists and vascular surgeons is needed to overcome procedural challenge, because operating time and conversion rate decrease with growing experience. The advantages observed in the majority of our patients were minimal tissue trauma, decreased blood loss, and faster postoperative recovery when compared with patients who had open aortic surgery at our institution. Further evidence has to be gained by clinical trials to define the role of laparoscopic vascular surgery for aortoiliac occlusive disease. (J Vasc Surg 1998;28:136-42.

Does the Selection of the Procedure Impact the Return to Work in Unemployed Patients Undergoing Bariatric Surgery?

Purpose: Obesity and its comorbidities are risk factors for absenteeism and unemployment. Bariatric surgery might help to intervene in the vicious circle of unemployment, social disadvantage and increasing obesity. The most common bariatric procedures are sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). This survey analyzes the influence of the bariatric procedure on return to work. Methods: The data of a German nationwide multicenter registry StuDoQ vertical bar MBE from 2015 to 2020 are evaluated. Patients are surveyed who underwent a primary SG or RYGB while being unemployed: 782 patients are included. Primary endpoint is any form of return to work within 1 year after treatment. The surgical procedure acts as the binary main treatment variable. A multivariate binary logistic regression model was performed with age, sex, vocational training and weight loss as third variables so that odds ratios (OR) and adjusted ORs were determined. Results: Of the patients, 41.56% received a RYGB, 58.44% a SG. One year after bariatric surgery, 39.39% of the patients with SG and 33.85% with RYGB reached a return to work. The OR for return to work is 1.27 (p = 0.11) non-significant in favor of SG. The adjusted OR is 1.26 (p = 0.15), indicating that there is no significant influence of the difference between the two surgical procedures on the outcome of return to work. Conclusion: There is a positive effect regarding return to work in bariatric patients: More than a third of the previously unemployed patients were employed 1 year after surgery. Procedure-specific influences could not be determined

Cost Effectiveness of Natural Health Products: A Systematic Review of Randomized Clinical Trials

Health care spending in North America is consuming an ever-increasing share of Gross Domestic Product (GDP). A large proportion of alternative health care is consumed in the form of natural health products (NHPs). The question of whether or not NHPs may provide a cost-effective choice in the treatment of disease is important for patients, physicians and policy makers. The objective of this study was to conduct a systematic review of the literature in order to find, appraise and summarize high-quality studies that explore the cost effectiveness of NHPs as compared to conventional medicine. The following databases were searched independently in duplicate from inception to January 1, 2006: EMBASE, MEDLINE, CINAHL, BioethicsLine, Wilson General Science abstracts, EconLit, Cochrane Library, ABI/Inform and SciSearch. To be included in the review, trials had to be randomized, assessed for some measure of cost effectiveness and include the use of NHPs as defined by the Natural Health Products Directorate. Studies dealing with diseases due to malnutrition were excluded from appraisal. The pooled searches unveiled nine articles that fit the inclusion/exclusion criteria. The conditions assessed by the studies included three on postoperative complications, two on cardiovascular disease, two on gastrointestinal disorders, one on critically ill patients and one on urinary tract infections. Heterogeneity between the studies was too great to allow for meta-analysis of the results. The use of NHPs shows evidence of cost effectiveness in relation to postoperative surgery but not with respect to the other conditions assessed. In conclusion, NHPs may be of use in preventing complications associated with surgery. The cost effectiveness of some NHPs is encouraging in certain areas but needs confirmation from further research

Lipid emulsions – Guidelines on Parenteral Nutrition, Chapter 6

The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints

Sphingosine kinases regulate ER contacts with late endocytic organelles and cholesterol trafficking

Membrane contact sites (MCS), close membrane apposition between organelles, are platforms for interorganellar transfer of lipids including cholesterol, regulation of lipid homeostasis, and co-ordination of endocytic trafficking. Sphingosine kinases (SphKs), two isoenzymes that phosphorylate sphingosine to the bioactive sphingosine-1-phosphate (S1P), have been implicated in endocytic trafficking. However, the physiological functions of SphKs in regulation of membrane dynamics, lipid trafficking and MCS are not known. Here, we report that deletion of SphKs decreased S1P with concomitant increases in its precursors sphingosine and ceramide, and markedly reduced endoplasmic reticulum (ER) contacts with late endocytic organelles. Expression of enzymatically active SphK1, but not catalytically inactive, rescued the deficit of these MCS. Although free cholesterol accumulated in late endocytic organelles in SphK null cells, surprisingly however, cholesterol transport to the ER was not reduced. Importantly, deletion of SphKs promoted recruitment of the ER-resident cholesterol transfer protein Aster-B (also called GRAMD1B) to the plasma membrane (PM), consistent with higher accessible cholesterol and ceramide at the PM, to facilitate cholesterol transfer from the PM to the ER. In addition, ceramide enhanced in vitro binding of the Aster-B GRAM domain to phosphatidylserine and cholesterol liposomes. Our study revealed a previously unknown role for SphKs and sphingolipid metabolites in governing diverse MCS between the ER network and late endocytic organelles versus the PM to control the movement of cholesterol between distinct cell membranes