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Background and ObjectivesThe aim of this study was to identify predictors of a resective surgery and subsequent seizure freedom following intracranial EEG (ICEEG) for seizure-onset localization.MethodsThis is a retrospective chart review of 178 consecutive patients with medically refractory epilepsy who underwent ICEEG monitoring from 2002 to 2015. Univariable and multivariable regression analysis identified independent predictors of resection vs other options. Stepwise Akaike information criteria with the aid of clinical consideration were used to select the best multivariable model for predicting resection and outcome. Discrete time survival analysis was used to analyze the factors predicting seizure-free outcome. Cumulative probability of seizure freedom was analyzed using Kaplan-Meier curves and compared between resection and nonresection groups. Additional univariate analysis was performed on 8 select clinical scenarios commonly encountered during epilepsy surgical evaluations.ResultsMultivariable analysis identified the presence of a lesional MRI, presurgical hypothesis suggesting temporal lobe onset, and a nondominant hemisphere implant as independent predictors of resection (p < 0.0001, area under the receiver operating characteristic curve 0.80, 95% CI 0.73–0.87). Focal ICEEG onset and undergoing a resective surgery predicted absolute seizure freedom at the 5-year follow-up. Patients who underwent resective surgery were more likely to be seizure-free at 5 years compared with continued medical treatment or neuromodulation (60% vs 7%; p < 0.0001, hazard ratio 0.16, 95% CI 0.09–0.28). Even patients thought to have unfavorable predictors (nonlesional MRI or extratemporal lobe hypothesis or dominant hemisphere implant) had ≥50% chance of seizure freedom at 5 years if they underwent resection.DiscussionUnfavorable predictors, including having nonlesional extratemporal epilepsy, should not deter a thorough presurgical evaluation, including with invasive recordings in many cases. Resective surgery without functional impairment offers the best chance for sustained seizure freedom and should always be considered first.Classification of EvidenceThis study provides Class II evidence that the presence of a lesional MRI, presurgical hypothesis suggesting temporal lobe onset, and a nondominant hemisphere implant are independent predictors of resection. Focal ICEEG onset and undergoing resection are independent predictors of 5-year seizure freedom.

Background Despite a national decrease in emergency department visits in the United States during the first 10 months of the pandemic, preliminary Consumer Product Safety Commission data indicate increased firework-related injuries. We hypothesized an increase in firework-related injuries during 2020 compared to years prior related to a corresponding increase in consumer firework sales. Methods The National Electronic Injury Surveillance System (NEISS) was queried from 2018 to 2020 for cases with product codes 1313 (firework injury) and narratives containing “fireworks”. Population-based national estimates were calculated using US Census data, then compared across the three years of study inclusion. Patient demographic and available injury information was also tracked and compared across the three years. Firework sales data obtained from the American Pyrotechnics Association were determined for the same time period to examine trends in consumption. Results There were 935 firework-related injuries reported to the NEISS from 2018 to 2020, 47% of which occurred during 2020. National estimates for monthly injuries per million were 1.6 times greater in 2020 compared to 2019 (p p = 0.38). The same results were found when the month of July was excluded. Firework consumption in 2020 was 1.5 times greater than 2019 or 2018, with a 55% increase in consumer fireworks and 22% decrease in professional fireworks sales. Conclusions Firework-related injures saw a substantial increase in 2020 compared to the two years prior, corroborated by a proportional increase in consumer firework sales. Increased incidence of firework-related injuries was detected even with the exclusion of the month of July, suggesting that the COVID-19 pandemic may have impacted firework epidemiology more broadly than US Independence Day celebrations.

Bentonite pellets or their mixtures with powdered bentonite are potential buffer/backfill materials for the deep geological disposal of high-level radioactive waste (HLW) and are used to backfill the joints between neighbouring bentonite blocks or the construction gaps between bentonite blocks in the buffer layer and surrounding rock. Knowledge of the thermal properties of buffer/backfill materials is essential for the thermal evaluation and design of HLW repositories. The thermal properties were measured on a mixture of GMZ07 bentonite pellets and powdered bentonite with 70% pellet content over a wide range of water contents, dry densities, and temperatures. The test results revealed that the thermal conductivity of the specimen compacted with pure bentonite powder was higher than that of the mixture. This was due to the different pore-size distributions that influenced the conductive heat transfer in the specimens. The difference in thermal conductivity between the two types of specimens made by different methods decreased with increasing dry density, which was mainly attributed to the preparation of bentonite pellets using a compaction–crushing method. In addition, the destruction of bentonite pellets increased gradually with increasing dry density. The thermal conductivity, thermal diffusivity, and volumetric heat capacity of the mixture increased with increasing temperature. For a given dry density, the size of the inter-aggregate pores and aggregates of the mixture was larger than that of compacted pure GMZ07 bentonite, resulting in a decrease in the extent or quality of connections between neighbouring aggregates and a reduction in the thermal conductivity.

ObjectiveTo describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.DesignCross sectional survey and retrospective cohort study.Setting140 US medical schools accredited by the Association of American Medical Colleges.Participants30 651 graduating medical students in 2016 and 2017.Main outcome measuresSelf-reported sex, race or ethnicity, and sexual orientation groups were considered, based on the unique combinations of historically marginalized identities held by students. Multivariable linear regression was used to determine the association between unique identity groups and burnout along two dimensions (exhaustion and disengagement) as measured by the Oldenburg Burnout Inventory for Medical Students while accounting for mistreatment and discrimination.ResultsStudents with three marginalized identities (female; non-white; lesbian, gay, or bisexual (LGB)) had the largest proportion reporting recurrent experiences of multiple types of mistreatment (88/299, PConclusionIn this study population of US medical students, those with multiple marginalized identities reported more mistreatment and discrimination during medical school, which appeared to be associated with burnout.

ImportancePrevious studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.ObjectiveTo examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.Design, Setting, and ParticipantsThis retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)–accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.Main Outcomes and MeasuresThe primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.ResultsThe study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: −1.27 [0.38]; P P P Conclusions and RelevanceIn this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.

A direct observation strategy (Standardized Observation Analogue Procedure, SOAP) was used in a large-scale randomized trial of parent training versus parent education in young children with autism spectrum disorder (ASD) and disruptive behavior. The 16-minute SOAP, modified from an earlier version of this same measure, included parentchild interaction to assess child behavior in a clinical laboratory setting. Despite study entry criteria for all child participants requiring moderate levels of disruptive behavior in this project, 126 of 168 children with complete SOAP data at baseline showed no disruptive behavior on this measure. Although the primary purpose of the study was to determine whether the SOAP could detect differences between the two conditions (i.e.,parent training (PT) and parent education (PE)), baseline observation data was not consistent with parent ratings at baseline or subsequent follow up visits, leaving little room to demonstrate improvement with this observation measure. This and the challenging, time-consuming and resource intensive effort involved in using such a measure in a large randomized scale trial, raises fundamental questions about the validity of the SOAP as an outcome measure in such a study. Further consideration related to the feasibility and practicality of using direct observation as a primary measure in larger scale efforts overall are also discussed.

The temperature dependence of the relationship between thermal conductivity and saturation of lateritic clays is more complex than that of other soils. This paper reports sample-scale measurements of thermal conductivity of two lateritic clays with aggregates and dual-porosity at different saturations and temperatures. Test results indicate that the thermal conductivity increases with increasing temperature. The effects of the latent heat transfer (LHT) of vapor on the thermal conductivity were more pronounced at intermediate saturations and temperatures above 60 °C. The thermal conductivity resulting from the LHT of vapor has obvious peak value with saturation, and its peak value and corresponding saturation are related to the clay content. The difference in the thermal conductivity from the LHT of vapor between two clays at a given temperature is due to the effect of the microstructure. The mercury intrusion porosimetry (MIP) tests were also performed to observe the pore-size distribution (PSD) of two lateritic clays, which can explain the difference in the temperature effect on thermal conductivity. The inter-particle contact heat transfer (IPCHT) model provides good agreement with test data at temperatures ranging from 5 to 90 °C for two lateritic clays. The soil-water retention curves play an important role in predicting the thermal conductivity by the IPCHT model, which can be further improved by better consideration of the microstructure and phase configuration.

Thermal conductivity of compacted bentonite is one of the parameters affecting the behaviour of high-level radioactive waste (HLW) repositories, where the bentonite will be used as a buffer. Because the heat released from the HLW will be diffused across the buffer, understanding the thermal properties of buffer materials is necessary to accurately assess the thermal performance of the HLW repository. In this study, the thermal conductivity of compacted Gaomiaozi (GMZ07) and Wyoming (MX80) bentonites was measured and investigated under different testing conditions: temperature, water content and dry density. The obtained results showed that the thermal conductivity of compacted bentonites increased with increasing temperature. The thermal conductivity increased noticeably with temperature above 60 °C, while the change in thermal conductivity with temperature was small at temperature ranging from 5 to 60 °C. The temperature effect on thermal conductivity decreased with increasing dry density, and for a dry specimen, the thermal conductivity was negligibly changed with temperature.

The thermal conductivity of compacted bentonite is one of the most crucial parameters for the safe operation of high-level radioactive waste (HLW) repositories where bentonite can act as a feasible buffer. In this study, the potential effects of aging on the thermal conductivity of Gaomiaozi (GMZ07) and Wyoming (MX80) bentonites were investigated experimentally. The bentonite specimens were prepared under different conditions, such as varying water content and dry density, through the static compaction method in a special mould. The water content of the compacted bentonite specimens was kept constant during curing periods of 0, 5, 15, 30, 60, and 100 d under constant volume conditions, and the thermal conductivity of the two bentonites was then measured using the thermal probe method. The test results showed that the thermal conductivity decreased with increasing aging time for both of the compacted bentonites, with a trend that decreased significantly at the early aging periods and then tended to be constant when the aging time exceeded 60 d. The effects of aging are more pronounced for specimens with higher dry densities and water contents. Mercury intrusion porosimetry (MIP) test results confirmed that the reduction in thermal conductivity with aging time could be attributed to smectite hydration within the bentonites during the aging process. With this hydration, part of the soil water moves into the interlayer spaces of smectite crystals, resulting in a decrease in the pore water outside the bentonite particles, which decreases the thermal conductivity of the bentonites.

Background The ‘Sankofa’ pediatric HIV disclosure study (2013–2017) was an intervention that aimed to address the low prevalence of disclosure of HIV status in Ghana. Methods We conducted a cross-sectional study at the intervention site in Kumasi, Ghana, in 2019, (2 years after study closure) and administered the 21-item Beck Depression Inventory (BDI) and the 10-item Child Depression Inventory (CDI) to caregiver-child dyads who received the intervention. Results We enrolled 65% (N = 157) of the original dyads in the present study. Between Sankofa enrollment baseline and the present study, both children and caregivers had significant (p r = 0.019, p = 0.019). No statistically significant associations between disclosure status and either CDI score or BDI score were found. Conclusions Our findings did not support caregivers’ fears that disclosure leads to depression. Trial registration ClinicalTrials.gov Identifier: NCT01701635 (date of registration Oct 5, 2012).

Aiming at the research problem of multi-machine cooperative passive sensor and radar joint detection, according to the characteristics of the airborne passive sensor, the ability to perform target detection together with the radar is quantified. Mathematical planning of task time allocation for radar minimum working time and radar power control method. The feasibility and effectiveness of this method are demonstrated by computer simulation.

The conventional Kalman filter (KF) which uses the current measurement to estimate the current state is a posterior estimation. KF is identified as the optimal estimation in linear models with Gaussian noise. However, the performance of KF with incomplete information may be degraded or diverged. In order to improve the performance of KF, an Amended KF (AKF) is proposed by using more posterior measurements. The principle, derivation and recursive process of AKF are presented. The differences among Kalman smoother, adaptive fading method and AKF are analyzed. The simulation results of target tracking with different covariance of motion model indicate the high precision and robustness of AKF.

In this paper, coupled governing equations were proposed to simulate three-dimensional heat conduction and moisture transport in the nuclear waste repository. Because there will be a large temperature gradient near inner and outer boundaries of the bentonite buffer layer, and the heat driven moisture transport is introduced in the governing equation of moisture transport. By applying the Fourier and Laplace transforms, the governing equations were converted to the Bessel equations, and the Laplace-domain solutions to temperature and moisture distributions were derived through the inverse Fourier transform. The reliability of the proposed solutions was verified through comparative analysis with the line heat source model. These analytical solutions were applied to obtain the evolutions of temperature field and moisture distribution near the waste canister. Finally, a sensitivity study was performed to analyze the effects of relevant parameters on the heat driven moisture transport.

Soil thermal properties are essential for investigating the thermal performance of many kinds of underground thermal engineering structure. To investigate the influences of microstructure alteration on soil thermal properties, thermal conductivity, thermal diffusivity and specific heat capacity were measured for both undisturbed and compacted lateritic clay specimens subjected to drying and wetting with the thermal probe method. Results revealed that thermal conductivity and diffusivity of undisturbed specimens were higher than that of compacted specimens. The specific heat capacity of the undisturbed and compacted specimens was roughly the same. For the same volumetric water content, thermal conductivity of specimens produced by drying was higher than that by wetting due to hysteresis effects. Test results from the scanning electron microscope and mercury intrusion porosimetry confirmed that compared with compacted specimens, the undisturbed specimens have a relatively uniform pore system that improves the extent or quality of heat transfer paths through the contact points and water bridges, thus have higher thermal conductivity. The hysteresis effects on soil thermal conductivity can be explained by the ink-bottle effect, effects of pore size distributions induced by shrinkage and swelling, and differences in the volume of entrapped air between drying and wetting.

The evaluation and management of outcomes risk has become an essential element of a modern total joint replacement program. Our multidisciplinary team designed an evidence-based tool to address modifiable risk factors for adverse outcomes after primary hip and knee arthroplasty surgery.Our protocols were designed to identify, intervene, and mitigate risk through evidence-based patient optimization. Nurse navigators screened patients preoperatively, identified and treated risk factors, and followed patients for 90 days postoperatively. We compared patients participating in our optimization program (N = 104) to both a historical cohort (N = 193) and a contemporary cohort (N = 166).Risk factor identification and optimization resulted in lower hospital length of stay (LOS) and postoperative emergency department (ED) visits. Patients in the optimization cohort had a statistically significant decrease in mean LOS as compared to both the historical cohort (2.55 vs 1.81 days, P.001) and contemporary cohort (2.56 vs 1.81 days, P.001). Patients in the optimization cohort had a statistically significant decrease in 30- and 90-day ED visits compared to the historical cohort (POptimization of patients before elective primary total hip arthroplasty and total knee arthroplasty reduced average LOS, ED visits, and drove telerehabilitation use. Our results add to the limited body of literature supporting this patient-centered approach.

Target tracking system has strong-nonlinearity with non-Gaussian noise, thus making traditional Cubature Kalman Filter have low tracking accuracy due to sensitivity to non-Gaussian noise. Considering that the High-degree CKF and Maximum Correntropy Kalman Filter can conquer the nonlinearity of system and non-Gaussianity of measurement noise and system noise respectively, the measurement update process of HCKF is transformed to statistical linear regression equation based on the combination of Maximum Correntropy Criterion and HCKF, and adjust the kernel width adaptively, which solves the nonlinearity and non-Gaussianity problem. Simulation proves that the proposed robust generalized high-degree cubature filter is better than traditional CKF and simple MCKF both in tracing accuracy.

A dynamic sensor management algorithm based on improved efficacy function is proposed to solve the multi-sensor faced to multi-target management problem. The tracking task precision requirements (PR), target priority (TP) and sensor used cost (SC) are considered to establish the efficacy function by weighted sums the normalized value of the three factors. The PR is described by the diversities of the desired covariance matrix and the predicted Covariance matrix which is obtained by the centralized sequential Kalman filtering algorithm. The TP model is established based on multi-attribute linear weighting and SC is estimated by practical experience. The simulation results proved that the proposed method can meet the requirements of PR and adjust sensor selection according to TP and SC. This makes sensor management scheme more reasonable and effective.

With the increasing number of Electric Vehicles (EV) in this age, the power system is facing huge challenges of the high penetration rates of EVs charging stations. Therefore, a technical study of the impact of EVs charging on the distribution system is required. This paper is applied with PSCAD software and aimed to analyzing the Total Harmonic Distortion (THD) brought by Electric Vehicles charging stations in power systems. The paper starts with choosing IEEE34 node test feeder as the distribution system, building electric vehicle level two charging battery model and other four different testing scenarios: overhead transmission line and underground cable, industrial area, transformer and photovoltaic (PV) system. Then the statistic method is used to analyze different characteristics of THD in the plug-in transient, plug-out transient and steady-state charging conditions associated with these four scenarios are taken into the analysis. Finally, the factors influencing the THD in different scenarios are found. The analyzing results lead the conclusion of this paper to have constructive suggestions for both Electric Vehicle charging station construction and customers' charging habits.

A new type constant false alarm rate (CFAR) detectors based on censored mean(CM) and cell average(CA) is proposed in this paper. they use the logic operation (the mean value, the greatest value or the smallest value )of CM and CA local estimations as a noise power estimation. Under Swerling II target models and homogeneous background assumption, the analytic expressions of Pd and Pfa are derived for the three detectors. Their detection performance is analyzed in homogeneous background and in multiple interfering targets situation. The results show that the detection performance of the mean value of CM and CA detector is better.

In order to improve the preciseness of the large complex information system, this paper analysis the characteristics of the information transmission, and then a Markov model with information rework is proposed. The analyzing process of influencing factors and analysis method of information transmission error is also present in the paper. In the end,the way to reduce the information transmission error and the availability and the feasibility is proved by an example. It is of good popularization value.

For the problem of passive sensor cueing of phase array radar for target searching, the static and dynamic cueing model is given on the basis of characteristics of cueing sensors. considered the precision difference of cueing passive sensors, a probability density model under the case of multiple targets, and a kind of effective search tactics that guide the arranged of beams position are studied and presented. The Effectiveness of the model is proved by analysis and comparision from the results obtained by simulation

The cueing and handoff between sensors with intermittent observation is deeply analyzed. This paper first analyzes the cueing and handoff demand and applies IMM-UKF algorithm to design the multi-sensor fusion tracking model. Then the innovation test and fuzzy functions are adopted to form the triggering criterions between the passive sensors and radar. Finally the simulation verifies the criterions and discusses the influence of detection probability in cueing and handoff.