HES-SO Fribourg

AIM: To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. DESIGN: Systematic review and indirect-comparisons meta-analysis. DATA SOURCES: Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. STUDY APPRAISAL AND SYNTHESIS: Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. RESULTS: We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of -0.77 (95% Credible Interval (CrI) -1.22 to -0.31), while massage (-0.78; -1.55 to -0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, -0.72; -1.34 to -0.09), combined aerobic and resistance training (-0.67; -1.01 to -0.34), resistance training (-0.53; -1.02 to -0.03), aerobic (-0.53; -0.80 to -0.26) and yoga (-0.51; -1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (-0.68; -0.93 to -0.43). Combined aerobic and resistance training (-0.50; -0.66 to -0.34), combined CBT (-0.45; -0.70 to -0.21), Tai-Chi (-0.45; -0.84 to -0.06), CBT (-0.42; -0.58 to -0.25), resistance training (-0.35; -0.62 to -0.08) and aerobic (-0.33; -0.51 to -0.16) showed all small-to-moderate SMDs. CONCLUSIONS: Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.

proposed a new neural network architecture named Transformer. That modern architecture quickly revolutionized the natural language processing world. Models like GPT and BERT relying on this Transformer architecture have fully outperformed the previous state-of-theart networks. It surpassed the earlier approaches by such a wide margin that all the recent cutting edge models seem to rely on these Transformer-based architectures. In this paper, we provide an overview and explanations of the latest models. We cover the auto-regressive models such as GPT, GPT-2 and XLNET, as well as the auto-encoder architecture such as BERT and a lot of post-BERT models like RoBERTa, ALBERT, ERNIE 1.0/2.0.

Intelligent assistive technologies (IATs) have the potential of offering innovative solutions to mitigate the global burden of dementia and provide new tools for dementia care. While technological opportunities multiply rapidly, clinical applications are rare as the technological potential of IATs remains inadequately translated into dementia care. In this article, the authors present the results of a systematic review and the resulting comprehensive technology index of IATs with application in dementia care. Computer science, engineering, and medical databases were extensively searched and the retrieved items were systematically reviewed. For each IAT, the authors examined their technological type, application, target population, model of development, and evidence of clinical validation. The findings reveal that the IAT spectrum is expanding rapidly in volume and variety over time, and encompasses intelligent systems supporting various assistive tasks and clinical uses. At the same time, the results confirm the persistence of structural limitations to successful adoption including partial lack of clinical validation and insufficient focus on patients' needs. This index is designed to orient clinicians and relevant stakeholders involved in the implementation and management of dementia care across the current capabilities, applications, and limitations of IATs and to facilitate the translation of medical engineering research into clinical practice. In addition, a discussion of the major methodological challenges and policy implications for the successful and ethically responsible implementation of IAT into dementia care is provided.

Buildings consume a significant amount of energy, estimated at about one-third of total primary energy resources. Building energy efficiency has turned out to be a major issue in limiting the increasing energy demands of the sector. Literature shows that building user behavior can increase the efficiency of the energy used in the building and different strategies have been tested to address and support this issue. These strategies often combine the quantification of energy savings and qualitative interpretation of occupant behavior in order to foster energy efficiency. Strategies that influence building occupant behaviors include eco-feedback, social interaction, and gamification. This review paper presents a study conducted on the state of the art related to the impact of building user behavior on energy efficiency, in order to provide the research community with a better understanding and up-to-date knowledge of energy, comfort-related practices, and potential research opportunities. Achieving and maintaining energy-efficient behavior without decreasing the comfort of building occupants still represents a challenge, despite emerging technologies and strategies as well as general research progress made over the last decade. Conclusions highlight eco-feedback as an effective way to influence behavior, and gamification as a new opportunity to trigger behavioral change. The impact of user behavior is difficult to quantify for methodological reasons. Factors influencing human behavior are numerous and varied. Multi-disciplinary approaches are needed to provide new insights into the inner dynamic nature of occupant’s energy behavior.

To create life-like movements, living muscle actuator technologies have borrowed inspiration from biomimetic concepts in developing bioinspired robots. Here, the development of a bioinspired soft robotics system, with integrated self-actuating cardiac muscles on a hierarchically structured scaffold with flexible gold microelectrodes is reported. Inspired by the movement of living organisms, a batoid-fish-shaped substrate is designed and reported, which is composed of two micropatterned hydrogel layers. The first layer is a poly(ethylene glycol) hydrogel substrate, which provides a mechanically stable structure for the robot, followed by a layer of gelatin methacryloyl embedded with carbon nanotubes, which serves as a cell culture substrate, to create the actuation component for the soft body robot. In addition, flexible Au microelectrodes are embedded into the biomimetic scaffold, which not only enhance the mechanical integrity of the device, but also increase its electrical conductivity. After culturing and maturation of cardiomyocytes on the biomimetic scaffold, they show excellent myofiber organization and provide self-actuating motions aligned with the direction of the contractile force of the cells. The Au microelectrodes placed below the cell layer further provide localized electrical stimulation and control of the beating behavior of the bioinspired soft robot.

OBJECTIVE: Psychological distress remains a major challenge in cancer care. The complexity of psychological symptoms in cancer patients requires multifaceted symptom management tailored to individual patient characteristics and active patient involvement. We assessed the relationship between resilience, psychological distress and physical activity in cancer patients to elucidate potential moderators of the identified relationships. METHOD: A cross-sectional observational study to assess the prevalence of symptoms and supportive care needs of oncology patients undergoing chemotherapy, radiotherapy or chemo-radiation therapy in a tertiary oncology service. Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10), social support was evaluated using the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) and both psychological distress and activity level were measured using corresponding subscales of the Rotterdam Symptom Checklist (RSCL). Socio-demographic and medical data were extracted from patient medical records. Correlation analyses were performed and structural equation modeling was employed to assess the associations between resilience, psychological distress and activity level as well as selected socio-demographic variables. RESULTS: Data from 343 patients were included in the analysis. Our revised model demonstrated an acceptable fit to the data (χ2(163) = 313.76, p = .000, comparative fit index (CFI) = .942, Tucker-Lewis index (TLI) = .923, root mean square error of approximation (RMSEA) = .053, 90% CI [.044.062]). Resilience was negatively associated with psychological distress (β = -.59), and positively associated with activity level (β = .20). The relationship between resilience and psychological distress was moderated by age (β = -0.33) but not social support (β = .10, p = .12). CONCLUSION: Cancer patients with higher resilience, particularly older patients, experience lower psychological distress. Patients with higher resilience are physically more active. Evaluating levels of resilience in cancer patients then tailoring targeted interventions to facilitate resilience may help improve the effectiveness of psychological symptom management interventions.

PROBLEM IDENTIFICATION: In cancer care, empirical research and theory development on resilience has primarily been the domain of pediatric settings. This article aims to (a) describe current scientific perspectives on the concept of resilience, (b) summarize quantitative research on resilience in adult cancer care, and (c) identify implications for cancer nursing. LITERATURE SEARCH: An integrative literature review using PubMed, CINAHL®, and PsycINFO databases was performed and full-text, peer-reviewed articles published since 2003 were included. DATA EVALUATION: To summarize quantitative research, 252 articles were retrieved yielding 29 eligible studies, of which 11 articles were evaluated and synthesized. Appropriate articles were reviewed and data were extracted and tabulated for synthesis. SYNTHESIS: Resilience is a dynamic process of facing adversity related to a cancer experience. It may be facilitated through nursing interventions after people affected by cancer have been confronted with the significant adversity posed by diagnosis, treatment, (long-term) symptoms, and distress. CONCLUSIONS: Resilience in adult cancer care is an under-researched area. Studies confirm the association with improved health outcomes (e.g., psychological well-being, mental and physical health). IMPLICATIONS FOR RESEARCH: Resilience is an important issue for adult cancer care. Researchers must carefully define a conceptual framework for developing nursing interventions aimed at furthering resilience in adult cancer care.

Several developing countries seek to build knowledge-based economies by attempting to expand scientific research capabilities. Characterizing the state and direction of progress in this arena is challenging but important. Here, we employ three metrics: a classical metric of productivity (publications per person), an adapted metric which we denote as Revealed Scientific Advantage (developed from work used to compare publications in scientific fields among countries) to characterize disciplinary specialty, and a new metric, scientific indigeneity (defined as the ratio of publications with domestic corresponding authors) to characterize the locus of scientific activity that also serves as a partial proxy for local absorptive capacity. These metrics-using population and publications data that are available for most countries-allow the characterization of some key features of national scientific enterprise. The trends in productivity and indigeneity when compared across other countries and regions can serve as indicators of strength or fragility in the national research ecosystems, and the trends in specialty can allow regional policy makers to assess the extent to which the areas of focus of research align (or not align) with regional priorities. We apply the metrics to study the Middle East and North Africa (MENA)-a region where science and technology capacity will play a key role in national economic diversification. We analyze 9.8 million publication records between 1981-2013 in 17 countries of MENA from Morocco to Iraq and compare it to selected countries throughout the world. The results show that international collaborators increasingly drove the scientific activity in MENA. The median indigeneity reached 52% in 2013 (indicating that almost half of the corresponding authors were located in foreign countries). Additionally, the regional disciplinary focus in chemical and petroleum engineering is waning with modest growth in the life sciences. We find repeated patterns of stagnation and contraction of scientific activity for several MENA countries contributing to a widening productivity gap on an international comparative yardstick. The results prompt questions about the strength of the developing scientific enterprise and highlight the need for consistent long-term policy for effectively addressing regional challenges with domestic research.

In this paper, we present an unsupervised feature learning method for page segmentation of historical handwritten documents available as color images. We consider page segmentation as a pixel labeling problem, i.e., each pixel is classified as either periphery, background, text block, or decoration. Traditional methods in this area rely on carefully hand-crafted features or large amounts of prior knowledge. In contrast, we apply convolutional autoencoders to learn features directly from pixel intensity values. Then, using these features to train an SVM, we achieve high quality segmentation without any assumption of specific topologies and shapes. Experiments on three public datasets demonstrate the effectiveness and superiority of the proposed approach.

AIM: To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward. DESIGN: A single-centre observational descriptive study. METHOD: Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre-registered list of 42 activities classified into 13 dimensions. RESULTS: A total of 507.5 work hours were observed. Less than one third of registered nurses' work time was spent with patients. They allocated the most time to the dimensions of 'communication and care coordination' and 'care planning', whereas 'optimizing the quality and safety of care', 'integrating and supervising staff' and 'client education' were allocated the least time. CONCLUSION: This study provided a reliable description of nurses' time use at work. It highlighted suboptimal use of the full scope of nursing practice. IMPACT: Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses' skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses' knowledge.

BACKGROUND: The concept of a 'specialist nurse' has existed for many years and related education programmes are proliferating. However, while literature clearly outlines the roles and practice of registered nurses and advanced practice nurses, those of specialist nurses remain unclear and nursing specializations across Europe need clarifying. AIM: This pilot study aimed to explore the competencies, education requirements and regulation of specialist nurses in Europe. DESIGN: A descriptive cross-sectional survey. METHODS: An online questionnaire named 'Specialist nurse and specialization in Europe' was sent to 550 members of the European Federation of Nurse Educators and ten members of the European Specialist Nurses Organizations. Snowball sampling was then used to build a convenience sample of nurse educators, clinical nurses and specialist nurses, national nursing association members, and chief nursing officers from all European countries. Besides quantitative aspects, responses to open-ended questions were analysed using a qualitative content analysis process. RESULTS: A total of 77 experts from 29 European countries responded to the questionnaire. Findings highlighted variations in titles, levels and length of education, certification, regulation and scope of practice for specialized nurses in Europe. Analysis of the promoted competencies revealed dominant clinical and technical aspects of the role with a high level of knowledge. CONCLUSIONS: The study emphasized the need to improve standards for education, certification and regulation for specialist nurses. Interpretation of the role and competencies is diverse with a weak presence of health policy that would enhance and develop the specialities. IMPLICATIONS FOR NURSING AND HEALTH POLICY: To address the current lack of provisions for automatic recognition of specialist nurses, common training frameworks corresponding to the relevant level of the European Qualifications Framework should promote lifelong learning and mobility, and enhance levels of health care and patient safety.

Ethics by Design concerns the methods, algorithms and tools needed to endow autonomous agents with the capability to reason about the ethical aspects of their decisions, and the methods, tools and formalisms to guarantee that an agent's behavior remains within given moral bounds. In this context some questions arise: How and to what extent can agents understand the social reality in which they operate, and the other intelligences (AI, animals and humans) with which they co-exist? What are the ethical concerns in the emerging new forms of society, and how do we ensure the human dimension is upheld in interactions and decisions by autonomous agents?. But overall, the central question is: "Can we, and should we, build ethically-aware agents?" This paper presents initial conclusions from the thematic day of the same name held at PRIMA2017, on October 2017.

Tsunamis, landslide-generated waves, and dam failures are rare, but highly destructive phenomena, associated with extreme loading on infrastructure. Recent events showed that specific measures must be taken to guarantee safety of both people and the built environment. This experimental study investigates the forces and moments exerted on free-standing buildings that are induced by both surges and bores. The hydrodynamic impact was characterized by high splash, subsequently followed by a quasi-steady flow around the structure. For dry bed surges, the time history of the horizontal force was proportional to the momentum flux per unit width. For wet bed bores, an attenuation of the peak force due to the presence of an aerated front was observed and the introduction of a reduction coefficient was necessary to achieve a realistic force estimation. Additional force analysis in terms of peak time, wave height at maximum force and impulse also pointed out some key differences between forces exerted by dry bed surges and wet bed bores. The occurrence of the maximum tilting moment on the building coincided with the maximum horizontal force and an evaluation of the cantilever arm was possible. These findings provide engineers with practical information for the design of safer coastal structures.

Launched in November 2022, ChatGPT is an unprecedented publicly available and simple web interface that can “write” human-like texts. This artificial intelligence chatbot can be used in a variety of settings, including in the field of nutrition and dietetics. This article describes ChatGPT and discusses the possible opportunities and risks of using ChatGPT in the practice of credentialed nutrition and dietetics practitioners working in public health, clinical settings, academia, and other settings.

A new methodology is proposed to couple a meteorological model with a building energy use model. The aim of such a coupling is to improve the boundary conditions of both models with no significant increase in computational time. In the present case, the Canopy Interface Model (CIM) is coupled with CitySim. CitySim provides the geometrical characteristics to CIM, which then calculates a high resolution profile of the meteorological variables. These are in turn used by CitySim to calculate the energy flows in an urban district. We have conducted a series of experiments on the EPFL campus in Lausanne, Switzerland, to show the effectiveness of the coupling strategy. First, measured data from the campus for the year 2015 are used to force CIM and to evaluate its aptitude to reproduce high resolution vertical profiles. Second, we compare the use of local climatic data and data from a meteorological station located outside the urban area, in an evaluation of energy use. In both experiments, we demonstrate the importance of using in building energy software, meteorological variables that account for the urban microclimate. Furthermore, we also show that some building and urban forms are more sensitive to the local environment.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Importance: Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations. Objective: To compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP. Design, Setting, and Participants: This prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial recruited participants with nonspecific subacute or chronic LBP from a tertiary care center in France starting February 17, 2014, with follow-up completed on October 23, 2017. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 22, 2018, to December 5, 2018. Interventions: Six sessions (1 every 2 weeks) of standard OMT or sham OMT delivered by nonphysician, nonphysiotherapist osteopathic practitioners. Main Outcomes and Measures: The primary end point was mean reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index (score range, 0-100). Secondary outcomes were mean reduction in LBP-specific activity limitations; mean changes in pain and health-related quality of life; number and duration of sick leaves, as well as number of LBP episodes at 12 months; and consumption of analgesics and nonsteroidal anti-inflammatory drugs at 3 and 12 months. Adverse events were self-reported at 3, 6, and 12 months. Results: Overall, 200 participants were randomly allocated to standard OMT and 200 to sham OMT, with 197 analyzed in each group; the median (range) age at inclusion was 49.8 (40.7-55.8) years, 235 of 394 (59.6%) participants were women, and 359 of 393 (91.3%) were currently working. The mean (SD) duration of the current LBP episode was 7.5 (14.2) months. Overall, 164 (83.2%) patients in the standard OMT group and 159 (80.7%) patients in the sham OMT group had the primary outcome data available at 3 months. The mean (SD) Quebec Back Pain Disability Index scores for the standard OMT group were 31.5 (14.1) at baseline and 25.3 (15.3) at 3 months, and in the sham OMT group were 27.2 (14.8) at baseline and 26.1 (15.1) at 3 months. The mean reduction in LBP-specific activity limitations at 3 months was -4.7 (95% CI, -6.6 to -2.8) and -1.3 (95% CI, -3.3 to 0.6) for the standard OMT and sham OMT groups, respectively (mean difference, -3.4; 95% CI, -6.0 to -0.7; P = .01). At 12 months, the mean difference in mean reduction in LBP-specific activity limitations was -4.3 (95% CI, -7.6 to -1.0; P = .01), and at 3 and 12 months, the mean difference in mean reduction in pain was -1.0 (95% CI, -5.5 to 3.5; P = .66) and -2.0 (95% CI, -7.2 to 3.3; P = .47), respectively. There were no statistically significant differences in other secondary outcomes. Four and 8 serious adverse events were self-reported in the standard OMT and sham OMT groups, respectively, though none was considered related to OMT. Conclusions and Relevance: In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable. Trial Registration: ClinicalTrials.gov Identifier: NCT02034864.

In this paper, we present the design process of a smart bracelet that aims at enhancing the life of elderly people. The bracelet acts as a personal assistant during the user's everyday life, monitoring the health status and alerting him or her about abnormal conditions, reminding medications and facilitating the everyday life in many outdoor and indoor activities.

The co-simulation of both urban and building-level models leverages the advantages of both platforms. It better accounts for the localized effects of surrounding buildings, geography and climate conditions while maintaining high-fidelity building systems representation. This paper describes the co-simulation process of the building and urban-scale models of two university campuses in Switzerland using EnergyPlus and CitySim. In the first case study, on-site measured performance data is compared to the co-simulation results. The second case study examines the results of the two engines. The results show that coupling of EnergyPlus with CitySim resulted in a −15.5% and −7.5% impact on cooling consumption and a +6.5% and +4.8% impact on heating use as compared to solo simulations.The co-simulation process was able to better model realistic conditions for heating, but not cooling in one case study. It was able to substantially reduce the discrepancies in prediction between the engines in the other study.

OBJECTIVE: Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care. SETTING: We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland. PARTICIPANTS: In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women. MAIN OUTCOME MEASURES: The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months. RESULTS: The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs 14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women (16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52-4.09). After adjustment for the patients' age and cardiovascular disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30-3.78). CONCLUSION: Although the same proportion of women and men present with a chest pain of cardiovascular origin in ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure equity between men and women in medical care.