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ObjectiveTo evaluate the impact of Breast Reconstructive Surgery (BRS) on patients' satisfaction and quality of life following mastectomy for breast cancer.MethodsA multi-method design study comprising quantitative and qualitative research was conducted between October to December 2019. The quantitative component consisted of a cross-sectional study using the Breast-Q questionnaire and the qualitative component involved in-depth interviews with eligible patients (N = 16) who underwent BRS following mastectomy for breast cancer. Quantitative analysis was performed including Fisher's exact test and One-way Analysis of Variance where a p-value of Results14 out of 16 eligible patients participated in the study. We observed the lowest-scale score was for 'satisfaction with nipples' (mean score 32.7), followed by 'physical well-being: abdomen' (mean score 69.5). Despite a median score of 70 for 'satisfaction with breasts', patients were satisfied with the overall outcome of BRS (median score 80.5). Thematic analysis yielded three themes i.e. "I feel beautiful again" that described patients' satisfaction with aesthetic outcome with autologous reconstruction; "Striving for normality" that indicated BRS established back a sense of normality and improve their self-confidence and lastly, "I was well taken care of" highlighted the importance of providing 'well-informed' care to ensure overall satisfaction of their BRS journey.ConclusionThe uptake of BRS remains low since its availability in 2012, despite an overall increase in breast cancer cases in Brunei annually. Patients who underwent BRS have shown an increase BREAST-Q scores in breast satisfaction, psychosocial and sexual well-being after breast cancer treatment. Delivering high-quality patient-centred services and providing adequate information can influence the level of satisfaction for overall outcome. BRS should be considered as an important healthcare priority in Brunei and routinely be offered in the management of breast cancer.

Carbon nanofiller-modified composites possess extraordinary potential for structural health monitoring because they are piezoresistive and therefore self-sensing. To date, considerable work has been done to understand how strain affects nanocomposite conductivity and to utilize electrical impedance tomography for detecting strain or damage-induced conductivity changes. Merely detecting the occurrence of mechanical effects, however, does not realize the full potential of piezoresistive nanomaterials. Rather, knowing the mechanical state that results in the observed conductivity changes would be much more valuable from a structural health monitoring perspective. Herein, we make use of an analytical piezoresistivity model to inversely determine the displacement field of a strained carbon nanofiber/polyurethane nanocomposite from conductivity changes obtained via electrical impedance tomography. From the displacements, kinematic and constitutive relations are used to calculate strains and stresses, respectively. A commercial finite element simulation is then used to validate the accuracy of these predictions. These results concretely demonstrate that it is possible to inversely determine displacements, strains, and stresses from conductivity data thereby enabling unprecedented insight into the mechanical response of piezoresistive nanofiller-modified materials and structures. [ABSTRACT FROM AUTHOR]

The development of hardware-based cognitive computing systems critically hinges upon the integration of memristor devices capable of versatile weight expression across a spectrum of resistance levels while preserving consistent electrical properties. This investigation aims to explore the practical implementation of a digit recognition system utilizing memristor devices with minimized weighting levels. Through the process of weight quantization for digits represented by 25 or 49 input signals, the study endeavors to ascertain the feasibility of digit recognition via neural network computation. The integration of memristor devices into the system architecture is poised to streamline the representation of the resistors required for weight expression, thereby facilitating the realization of neural-network-based cognitive systems. To minimize the information corruption in the system caused by weight quantization, we introduce the concept of "weight range" in this work. The weight range is the range between the maximum and minimum values of the weights in the neural network. We found that this has a direct impact on weight quantization, which reduces the number of digits represented by a weight below a certain level. This was found to help maintain the information integrity of the entire system despite the reduction in weight levels. Moreover, to validate the efficacy of the proposed methodology, quantized weights are systematically applied to an array of double-layer neural networks. This validation process involves the construction of cross-point array circuits with dimensions of 25 × 10 and 10 × 10, followed by a meticulous examination of the resultant changes in the recognition rate of randomly generated numbers through device simulations. Such endeavors contribute to advancing the understanding and practical implementation of hardware-based cognitive computing systems leveraging memristor devices and weight quantization techniques.

Penicillin allergy delabeling may benefit antimicrobial stewardship (AS). Cost of initial penicillin treatments following risk-stratified inpatient delabeling were compared to two hypothetical treatment regimens if delabeling had not occurred: (1) AS-guided and (2) Common Treatment. Penicillin allergy delabeling improved antimicrobial spectrum index, was cost-neutral, and averted unnecessary penicillin desensitizations., Competing Interests: MS is an employee of Veterans Health Administration; however, the views expressed herein are hers and do not necessarily represent those of the US Government or Veterans Health Administration. All other authors report no conflicts of interest relevant to this work., (© The Author(s) 2024.)

Objectives: This study investigated whether the earliest total Vasculitis Damage Index (VDI) score could significantly predict all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)., Methods: This study included AAV patients who were first diagnosed at this hospital from 2001 to 2022. The earliest total VDI score was defined as the first VID assessed more than 3 months after AAV diagnosis in 93.5% of patients or after the first AAV presentation in 6.5% of patients. The optimal cut-off of the earliest total VDI score for all-cause mortality was obtained using the receiver operating characteristic curve., Results: The median age and earliest VDI score were 60.0 years (35.5% men), and 3.0. The most common damaged system in the earliest VDI was the pulmonary (55.3%) system. Among the AAV patients, 39 (13.3%) died. When the optimal cut-off of the earliest total VDI score for all-cause mortality was set at 3.0 (sensitivity 64.1%, specificity 75.2%), AAV patients with the earliest total VDI score ≥3.0 exhibited a significantly higher risk for all-cause mortality than those without (relative risk 6.090). AAV patients with the earliest total VDI score ≥3.0 exhibited a significantly lower cumulative patients' survival rate than those without. In the multivariable Cox hazards model analyses, not only the earliest total VDI score but also the earliest total VDI score ≥3.0 were independently associated with all-cause mortality., Conclusions: This study was the first to demonstrate that the earliest total VDI score could predict all-cause mortality during follow-up in AAV patients.

Experience during childbirth is an important predictor of mothers' later well-being. Using the framework of Self-Determination Theory and, we hypothesized that the degree to which women felt autonomy over their choices during childbirth would be reflected in their later confidence as parents, termed Parental Self-Efficacy (PSE). We assessed PSE as well as depressive symptoms before birth (T1, approximately 36 weeks pregnant) and after birth (T2, approximately 5 weeks postpartum). Perceptions of autonomy during childbirth were measured at T2 using the Perceived Control in Childbirth scale. Using hierarchical linear regression, we found that mothers' perceived autonomy during childbirth predicted their postpartum PSE, controlling for prenatal PSE, pre- and postnatal depression, number of childbirth interventions, and overall birth satisfaction. These data suggest that care providers' support for women's autonomy in childbirth impacts how women feel about themselves as mothers in the postpartum months., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although immediate potentially allergic reactions have been reported after dose 1 of mRNA coronavirus disease 2019 (COVID-19) vaccines, comprehensively defined subtypes have not been clearly distinguished., Objective: To define distinct clinical phenotypes of immediate reactions after dose 1 of mRNA COVID-19 vaccination, and to assess the relation of clinical phenotype to mRNA COVID-19 vaccine second dose tolerance., Methods: This retrospective study included patients with 1 or more potentially allergic symptoms or signs within 4 hours of receiving dose 1 of an mRNA COVID-19 vaccine and assessed by allergy/immunology specialists from 5 U.S. academic medical centers (January-June 2021). We used latent class analysis-an unbiased, machine-learning modeling method-to define novel clinical phenotypes. We assessed demographic, clinical, and reaction characteristics associated with phenotype membership. Using log-binomial regression, we assessed the relation between phenotype membership and second dose tolerance, defined as either no symptoms or mild, self-limited symptoms resolving with antihistamines alone. A sensitivity analysis considered second dose tolerance as objective signs only., Results: We identified 265 patients with dose-1 immediate reactions with 3 phenotype clusters: (1) Limited or Predominantly Cutaneous, (2) Sensory, and (3) Systemic. A total of 223 patients (84%) received a second dose and 200 (90%) tolerated their second dose. Sensory cluster (all patients had the symptom of numbness or tingling) was associated with a higher likelihood of second dose intolerance, but this finding did not persist when accounting for objective signs., Conclusions: Three novel clinical phenotypes of immediate-onset reactions after dose 1 of mRNA COVID-19 vaccines were identified using latent class analysis: (1) Limited or Predominantly Cutaneous, (2) Sensory, and (3) Systemic. Whereas these clinical phenotypes may indicate differential mechanistic etiologies or associations with subsequent dose tolerance, most individuals proceeding to their second dose tolerated it., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Just over 1 year following rollout of the first vaccines for coronavirus disease 2019, 572 million doses have been administered in the United States. Compared with the number of vaccines administered, adverse effects such as anaphylaxis have been rare, and seemingly, the more serious the effect, the rarer the occurrence. Despite these adverse effects, there are few, if any, true contraindications to coronavirus disease 2019 vaccination and most individuals recover without further sequelae. This review provides guidance for the allergist/immunologist regarding appropriate next steps based on patient's known allergy history or adverse reaction after receipt of coronavirus disease 2019 vaccine to assist in safe global immunization., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an effective strategy to prevent serious coronavirus disease 2019 (COVID-19) and is important for oncology patients. mRNA-based COVID-19 vaccines are contraindicated in those with a history of severe or immediate allergy to any vaccine component, including polyethylene glycol (PEG)2000. Patients with acute lymphoblastic leukemia/lymphoma receive asparaginase conjugated to PEG5000 (PEG-ASNase) and those with PEG-ASNase-associated hypersensitivity may be unnecessarily excluded from receiving mRNA COVID-19 vaccines. We, therefore, surveyed oncologists on COVID-19 vaccine counseling practice and vaccination outcomes in COVID-19 vaccination-eligible patients and show safe receipt of mRNA vaccines despite PEG-ASNase hypersensitivity., (© 2022 Wiley Periodicals LLC.)

Background: Patients with COVID-19 acute respiratory distress syndrome (ARDS) have been shown to have high sedation requirements., Objective: The purpose of this study was to compare sedative use between patients with COVID-19 ARDS and non-COVID-19 ARDS., Methods: This was a retrospective study of patients with COVID-19 ARDS compared with historical controls of non-COVID-19 ARDS who were admitted to 2 hospitals from March 1, 2020, to April 30, 2020, and April 1, 2018, to December 31, 2019, respectively. The primary outcome was median cumulative dose of propofol (µg/kg) at 24 hours after intubation., Results: There were 92 patients with COVID-19 ARDS and 37 patients with non-COVID-19 ARDS included. Within the first 24 hours of intubation, patients with COVID-19 ARDS required higher total median doses of propofol: 51 045 µg/kg (interquartile range, 26 150-62 365 µg/kg) versus 33 350 µg/kg (9632-51 455 µg/kg; P = 0.004). COVID-19 patients were more likely receive intravenous lorazepam (37% vs 14%; P = 0.02) and higher cumulative median doses of midazolam by days 5 (14 vs 4 mg; P = 0.04) and 7 of intubation (89 vs 4 mg; P = 0.03) to achieve the same median Richmond Analgesia-Sedation Scale scores. COVID-19 ARDS patients required more ventilator days (10 vs 6 days; P = 0.02). There was no difference in 30-day mortality., Conclusion and Relevance: Patients with COVID-19 ARDS required higher doses of propofol and benzodiazepines than patients with non-COVID-19 ARDS to achieve the same median levels of sedation.

Augmented reality (AR) is an interactive experience of a real-world environment where the objects that reside in the real world are enhanced by computer-generated perceptual information. Despite its attractive features, AR has not become popular because of the visual fatigue that many people face when they experience it. Many methods have been introduced to solve this visual fatigue problem and one of these methods is an integral imaging system that provides images almost continuous viewpoints and full parallax. However, the integral imaging system, which uses a lens array with a fixed focal length, has limited depth of focus (DOF) range. As a result, images that are outside of the DOF range become distorted. In this paper, a vari-focal liquid lens array was fabricated and the optical characteristics of the lens array were evaluated. Using the vari-focal liquid lens array, the DOF range was extended and high-resolution images are realized without restriction of depth range in an AR system.

In the era of omics-driven research, it remains a common dilemma to stratify individual patients based on the molecular characteristics of their tumors. To improve molecular stratification of patients with breast cancer, we developed the Gaussian mixture model (GMM)-based classifier. This probabilistic classifier was built on mRNA expression data from more than 300 clinical samples of breast cancer and healthy tissue and was validated on datasets of ESR1, PGR , and ERBB2 , which encode standard clinical markers and therapeutic targets. To demonstrate how a GMM approach could be exploited for multiclass classification using data from a candidate marker, we analyzed the insulin-like growth factor I receptor (IGF1R), a promising target, but a marker of uncertain importance in breast cancer. The GMM defined subclasses with downregulated (40%), unchanged (39%), upregulated (19%), and overexpressed (2%) IGF1R levels; inter- and intrapatient analyses of IGF1R transcript and protein levels supported these predictions. Overexpressed IGF1R was observed in a small percentage of tumors. Samples with unchanged and upregulated IGF1R were differentiated tumors, and downregulation of IGF1R correlated with poorly differentiated, high-risk hormone receptor-negative and HER2-positive tumors. A similar correlation was found in the independent cohort of carcinoma in situ , suggesting that loss or low expression of IGF1R is a marker of aggressiveness in subsets of preinvasive and invasive breast cancer. These results demonstrate the importance of probabilistic modeling that delves deeper into molecular data and aims to improve diagnostic classification, prognostic assessment, and treatment selection. SIGNIFICANCE: A GMM classifier demonstrates potential use for clinical validation of markers and determination of target populations, particularly when availability of specimens for marker development is low., (©2019 American Association for Cancer Research.)

Recently, a planoconvex structure electrowetting lenticular lens capable of 2D/3D conversion through a varifocal property by an electrowetting phenomenon has been developed. However, even though it has a similar planoconvex structure to that of a commercial solid lenticular lens, comparable 3D performance could not be realized because the refractive index difference between nonconductive liquid and conductive liquid was not large. Therefore, the goal of the present study is to obtain better 3D performance compared to the conventional planoconvex structure by introducing a novel biconvex structure using ETPTA. The newly developed biconvex structure electrowetting lenticular lens showed greatly improved characteristics compared to the planoconvex structure: dioptric power (171.69D → 1,982.56D), viewing angle (26degrees → 46degrees), and crosstalk ratio (27.27% → 16.18%). Thanks to these improvements, a fine 3D image and a natural motion parallax could be observed with the biconvex structure electrowetting lenticular lens. In addition, the novel biconvex structure electrowetting lenticular lens was designed to achieve a plane lens state with a no voltage applied condition, and as such it could show a clean 2D image at 0 V. In conclusion, a novel biconvex structure electrowetting lenticular lens showed 2D/3D switchable operation as well as excellent 3D performance compared to a solid lenticular lens.

In this paper, we introduce a method for improving the lens diopter of 2D/3D convertible devices using electro-wetting. For stable operation, an electro-wetting device requires high dioptric performance and this was achieved using bi-convex liquid-liquid-solid phases. 1-Chloronaphthalene with a refractive index of 1.633 was used as an oil phase to achieve high diopters. ETPTA (trimethylolpropane ethoxylate triacrylate), a UV-sensitive material with low chemical reactivity to the 1-Chloronaphthalene, was used as a chamber material. This resulted in a diopter of 3030D for high quality multi-view images without unstable oil movement or trembling. The ETPTA was molded on a 0.3mm thick glass substrate that was coated with UV adhesive (NOA 81). The maximum diopter capable of stable operation was 3425D. 2D and 3D conversion and parallax motion were demonstrated.

Holographic data storage (HDS) has attracted much attention as a next-generation storage medium. Because HDS suffers from two-dimensional (2D) inter-symbol interference (ISI), the partial-response maximum-likelihood (PRML) method has been studied to reduce 2D ISI. However, the PRML method has various drawbacks. To solve the problems, we propose a modified decision feedback equalizer (DFE) for HDS. To prevent the error propagation problem, which is a typical problem in DFEs, we also propose a reliability factor for HDS. Various simulations were executed to analyze the performance of the proposed methods. The proposed methods showed fast processing speed after training, superior bit error rate performance, and consistency.

A displacement measurement system fusing a low cost real-time kinematic global positioning system (RTK-GPS) receiver and a force feedback accelerometer is proposed for infrastructure monitoring. The proposed system is composed of a sensor module, a base module and a computation module. The sensor module consists of a RTK-GPS rover and a force feedback accelerometer, and is installed on a target structure like conventional RTK-GPS sensors. The base module is placed on a rigid ground away from the target structure similar to conventional RTK-GPS bases, and transmits observation messages to the sensor module. Then, the initial acceleration, velocity and displacement responses measured by the sensor module are transmitted to the computation module located at a central monitoring facility. Finally, high precision and high sampling rate displacement, velocity, and acceleration are estimated by fusing the acceleration from the accelerometer, the velocity from the GPS rover, and the displacement from RTK-GPS. Note that the proposed displacement measurement system can measure 3-axis acceleration, velocity as well as displacement in real time. In terms of displacement, the proposed measurement system can estimate dynamic and pseudo-static displacement with a root-mean-square error of 2 mm and a sampling rate of up to 100 Hz. The performance of the proposed system is validated under sinusoidal, random and steady-state vibrations. Field tests were performed on the Yeongjong Grand Bridge and Yi Sun-sin Bridge in Korea, and the Xihoumen Bridge in China to compare the performance of the proposed system with a commercial RTK-GPS sensor and other data fusion techniques., Competing Interests: The authors declare no conflict of interest.

In this paper, we used a thin polycarbonate (PC) chamber to improve the performance of an electrowetting lenticular lens array. The polycarbonate chamber changed the radius of curvature (ROC) of the oil acting as a lens, which increased the dioptric power of the liquid lens to 1666.7D. The increase in dioptric power required a reduction in the distance between the optical center of the lens and the display pixels under the chamber, which was accomplished by reducing the thickness of the chamber. The optimal thickness of the chamber was determined to be 0.5mm. Using this thin PC chamber, transmittance and viewing angle were measured and compared with an electrowetting lenticular lens with a conventional 1mm poly methyl methacrylate (PMMA) chamber was done. Crosstalk which degrades clear 3D images, is an inevitable factor in lenticular lens type multi-view systems. With the 0.5mm PC chamber, the viewing zone was expanded and the ratio of the crosstalk area was reduced, which resulted in a clear 3D image. The new method of depositing the electrode layer also ensured the uniform operation of the liquid lens array.

Introduction: Vascular surgery patients have multiple risk factors for renal dysfunction, but acute kidney injury (AKI) is poorly studied in this group. The purpose of this study was to define the incidence, risk factors, and outcomes of AKI in high-risk vascular patients., Methods: Critically ill vascular surgery patients admitted during January-December 2012 were retrospectively analyzed with 1-year follow-up. The endpoint was AKI by established RIFLE creatinine criteria. The primary analysis was between patients with or without AKI, with secondary analysis of post-operative AKI. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function., Results: One-hundred and thirty six vascular surgery patients were included, representing 27% of all vascular surgery admissions during the study period. Sixty-five (48%) developed AKI. Independent global risk factors for AKI were diabetes, increasing critical illness severity, and sepsis. While intraoperative blood loss and hypotension were associated with subsequent renal dysfunction, post-operative AKI rates were similar for patients undergoing aortic, carotid, endovascular, or peripheral vascular procedures. All RIFLE grades of AKI were associated with worse outcomes. Overall, patients with AKI had significantly increased short- and long-term mortality, longer inpatient lengths of stay, and worse discharge renal function., Conclusion: AKI is common among critically ill vascular surgery patients. Importantly, the type of surgical procedure appears to be less important than intra- and perioperative management in determining renal dysfunction. Regardless of its severity, AKI is a clinically significant complication that is associated with substantially worse patient outcomes.

Purpose: Acute kidney injury (AKI) is common in critically ill patients but is poorly defined in surgical patients. We studied AKI in a representative cohort of critically ill surgical patients., Methods: This was a retrospective 1-year cohort study of general surgical intensive care unit patients. Patients were identified from a prospective database, and clinical data were reviewed. Acute kidney injury events were defined by risk, injury, failure, loss, and end-stage renal classification criteria. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Risk factors for AKI and outcomes were compared by univariate and multivariate analyses., Results: Of 624 patients, 296 (47%) developed AKI. Forty-two percent of events were present upon admission, whereas 36% occurred postoperatively. Risk, injury, failure, loss, and end-stage renal classification distributions by grade were as follows: risk, 152 (51%); injury, 69 (23%); and failure, 75 (25%). Comorbid diabetes, emergency admission, major surgery, sepsis, and illness severity were independently associated with renal dysfunction. Patients with AKI had significantly worse outcomes, including increased inpatient and 1-year mortality. Acute kidney injury starting before admission was associated with worse renal dysfunction and greater renal morbidity than de novo inpatient events., Conclusions: Acute kidney injury is common in critically ill surgical patients and is associated with increased mortality, persisting renal impairment and greater resource use., (Copyright © 2014 Elsevier Inc. All rights reserved.)