Spiral Foundation

The energy consumption analysis and optimization of data centers have been an increasingly popular topic over the past few years. It is widely recognized that several effective metrics exist to capture the efficiency of hardware and/or software hosted in these infrastructures. Unfortunately, choosing the corresponding metrics for specific infrastructure and assessing its efficiency over time is still considered an open problem. For this purpose, energy efficiency metrics, such as the Power Usage Effectiveness (PUE), assess the efficiency of the computing equipment of the infrastructure. However, this metric stops at the power supply of hosted servers and fails to offer a finer granularity to bring a deeper insight into the Power Usage Effectiveness of hardware and software running in cloud infrastructure.Therefore, we propose to leverage complementary PUE metrics, coined xPUE, to compute the energy efficiency of the computing continuum from hardware components, up to the running software layers. Our contribution aims to deliver realtime energy efficiency metrics from different perspectives for cloud infrastructure, hence helping cloud ecosystems-from cloud providers to their customers-to experiment and optimize the energy usage of cloud infrastructures at large.

Digital therapeutics (DTx) are a promising way to provide safe, effective, accessible, sustainable, scalable, and equitable approaches to advance individual and population health. However, developing and deploying DTx is inherently complex in that DTx includes multiple interacting components, such as tools to support activities like medication adherence, health behavior goal-setting or self-monitoring, and algorithms that adapt the provision of these according to individual needs that may change over time. While myriad frameworks exist for different phases of DTx development, no single framework exists to guide evidence production for DTx across its full life cycle, from initial DTx development to long-term use. To fill this gap, we propose the DTx real-world evidence (RWE) framework as a pragmatic, iterative, milestone-driven approach for developing DTx. The DTx RWE framework is derived from the 4-phase development model used for behavioral interventions, but it includes key adaptations that are specific to the unique characteristics of DTx. To ensure the highest level of fidelity to the needs of users, the framework also incorporates real-world data (RWD) across the entire life cycle of DTx development and use. The DTx RWE framework is intended for any group interested in developing and deploying DTx in real-world contexts, including those in industry, health care, public health, and academia. Moreover, entities that fund research that supports the development of DTx and agencies that regulate DTx might find the DTx RWE framework useful as they endeavor to improve how DTxcan advance individual and population health.

Mujer de 33 años de edad, agricultora y sin antecedentes médicos de importancia que ingresó al Servicio de Emergencia por cefalea, fiebre, parálisis facial periférica bilateral, parestesias, dolor muscular y ataxia con posterior desarrollo de paresia ascendente en los miembros inferiores. Inicialmente, fue manejada en UCI, recibió inmunoglobulina G, antibióticos y ventilación mecánica. El estudio electrofisiológico reveló una polirradiculopatía axonal y aguda; y,la prueba ELISA Ig M para Lesptospira spp. fue positiva. Salió de alta después de 54 días de hospitalización, muy recuperada.

Abstract This chapter on the TSM brain in action brings us to the safe enactment of the TSM trauma triangle with simultaneous protagonists. We have already shared a prescriptive role drama and a defenses drama in this section. Now, we move into the depth of the TSM trauma work. This chapter presents a brief description of the overall view of TSM trauma dramas. After Scene 1 of the prescriptive roles, we are ready for direct trauma work. Follow the journey around the TSM trauma triangle that starts with the wounded child, adds appropriate authority, and only then moves to the perpetrator role. Learn the three-part role reversal with the victim and perpetrator roles so that the group brain is not overwhelmed and pushed out of the window of tolerance, which is needed to consciously change these roles into post-traumatic growth. The composite example that is shared represents Kate's work in China from 2004 to the present. This chapter follows the format of the previous chapters in this section: setting, sociometric protagonist choice, prescriptive role scene, and in this case, safe enactment of victim and perpetrator roles. Complete with the director’s soliloquy, this chapter presents the inside workings of a TSM team with four assistant leaders, eight trained auxiliary egos, and Kate as the director and team leader, all of whom work with one interpreter. It shows the use of the TSM group brain and simultaneous protagonists in a group of 100 participants, that is representative of Kate's work in China.KeywordsTraumaTrauma-informed careExperiential therapy with traumaTSM psychodramaClassical psychodramaThe trauma survivor’s internal role atomTSIRATSMWindow of tolerancePrescriptive rolesTSM trauma triangleVictimPerpetratorAbandoning authorityCross-cultural applicationsLarge groups

Transcranial Magnetic Stimulation (TMS) can be used to map cortical motor topography by spatially sampling the sensorimotor cortex while recording Motor Evoked Potentials (MEP) with surface electromyography (EMG). Traditional sampling strategies are time-consuming and inefficient, as they ignore the fact that responsive sites are typically sparse and highly spatially correlated. An alternative approach, commonly employed when TMS mapping is used for presurgical planning, is to leverage the expertise of the coil operator to use MEPs elicited by previous stimuli as feedback to decide which loci to stimulate next. In this paper, we propose to automatically infer optimal future stimulus loci using active learning Gaussian Process-based sampling in place of user expertise. We first compare the user-guided (USRG) method to the traditional grid selection method and randomized sampling to verify that the USRG approach has superior performance. We then compare several novel active Gaussian Process (GP) strategies with the USRG approach. Experimental results using real data show that, as expected, the USRG method is superior to the grid and random approach in both time efficiency and MEP map accuracy. We also found that an active warped GP entropy and a GP random-based strategy performed equally as well as, or even better than, the USRG method. These methods were completely automatic, and succeeded in efficiently sampling the regions in which the MEP response variations are largely confined. This work provides the foundation for highly efficient, fully automatized TMS mapping, especially when considered in the context of advances in robotic coil operation.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Issues of feasibility, acceptability, satisfaction, safety, and fidelity were examined in a single case program review as an initial step to assessment of the clinical utility of the SAFE PLACE program, a unique multi-disciplinary intervention program for children with complex trauma and sensory processing disorder. The feasibility of conducting a pilot intervention study was also examined. A mixed methods, single-case, program review was conducted. The intervention was the 12-week SAFE PLACE program with pre and post-intervention baseline periods. Random intervention sessions were assessed for fidelity. Post-program interviews and questionnaires were utilized to obtain qualitative and quantitative information on feasibility, acceptability, satisfaction, and safety. The SAFE PLACE fidelity measure demonstrated the intervention was safe and implemented with fidelity to the intervention model. The intervention was acceptable to the family with an average rating of 4.3 (between acceptable and perfectly acceptable) on a five-point scale. The family was very satisfied with the intervention and its outcomes with a rating of 4.75 (between satisfied and very satisfied). Numerous positive qualitative comments about participation in the program and outcomes of the intervention were spontaneously provided by the family. Staff satisfaction rating was 4.3. Scheduling, staffing and financial reimbursement feasibility challenges were identified. Preliminary outcomes of the intervention suggested positive results and provided guidance for selection of future clinical and research outcome measures. The SAFE PLACE intervention was found to be a safe, acceptable intervention with high caregiver satisfaction that could be delivered with fidelity. The program was deemed feasible for future research studies but scheduling, staffing and financial reimbursement challenges may inhibit implementation in routine clinical practice.

Sensory integration, now trademarked as Ayres Sensory Integration® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The theory and practice of ASI continues to evolve as greater understanding of the neurobiology of human behavior emerges. In this paper we examine core constructs of ASI identified in the seminal work of Dr. Jean Ayres, and present current neuroscience research that underlies the main patterns of sensory integration function and dysfunction. We consider how current research verifies and clarifies Ayres’ propositions by describing functions of the vestibular, proprioceptive, and tactile sensory systems, and exploring their relationships to ocular, postural, bilateral integration, praxis, and sensory modulation. We close by proposing neuroplasticity as the mechanisms underlying change as a result of ASI intervention.