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Appropriate care for patients with chronic pain is complex, requiring a thoughtful and holistic approach to pharmacologic intervention, as well as appropriate monitoring when opioids are employed as part of a multimodal regimen. The urine drug test has become an expected standard when longterm opioids are prescribed, but it should be remembered that this test is not intended to be punitive. It is ordered to promote patient safety (Dowell et al., 2022). Recent literature and events surrounding the effect of poppy seeds on urine drug test results have drawn attention to the risks of misinterpreting this test (Bloch, 2023; Lewis et al., 2021; Reisfield et al., 2023; Temple, 2023). Misinterpretation of urine drug tests creates a potential for unfounded accusations from health care workers toward patients, thus, undermining therapeutic relationships and intensifying stigma. Such circumstances may also preclude chances to offer patients needed interventions. Therefore, a valuable opportunity exists for nurses to mitigate untoward consequences by developing a robust understanding of urine drug testing, destigmatizing chronic pain and opioid use, advocating for patients, and enacting change at both an individual and a systems-level. [ABSTRACT FROM AUTHOR]

Post-intensive care syndrome is a new or worsening persistent deterioration in cognitive, mental, and/or physical health following a prolonged admission to an intensive care unit. Post-intensive care syndrome remains underexplored following cardiac surgery, with a lack of understanding of the incidence and tools used to measure the symptoms. A scoping review was conducted to determine the incidence and to identify the tools commonly used to measure symptoms of post-intensive care syndrome following cardiac surgery. The electronic databases Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Scopus, and CINAHL (EBSCOhost) and Google Scholar were searched with keywords and controlled vocabulary to describe both cardiac surgery and post-intensive care syndrome (cardiac surgical procedures, heart surgery, and post-intensive care symptoms) and symptoms (delirium, depression, mobility and quality of life). Included were articles written in English and published after 2005 that described cognitive, mental, and physical symptoms of post-intensive care syndrome following cardiac surgery. 3,131 articles were found, with 565 duplicates, leaving 2,566 articles to be screened. Of these, seven unique studies were included. Five studies explored cognitive health, three mental health, one cognitive and mental health, and none physical health. No identified studies reported the overall incidence of post-intensive care syndrome following cardiac surgery. The incidence of cognitive health issues ranged from 21% to 38%, and mental health issues ranged from 16% to 99%. In total, 17 different tools were identified − 14 for cognitive health and three for mental health. No identified studies used the same tools to measure symptoms. No single tool was found to measure all three domains. This scoping review identified a literature gap specific to the incidence and inconsistency of assessment tools for post-intensive care syndrome in cardiac surgery patients. This work impacts clinical practice for the bedside nurse by raising awareness of an emerging health issue. [ABSTRACT FROM AUTHOR]

• Large variability of image quality and dose level for CT angiography protocols. • Dose optimization is necessary for many CTs. • Model observers' strategy can lead to a global harmonization of image quality. To establish size-specific diagnostic reference levels (DRLs) for pulmonary embolism (PE) based on patient CT examinations performed on 74 CT devices. To assess task-based image quality (IQ) for each device and to investigate the variability of dose and IQ across different CTs. To propose a dose/IQ optimization. 1051 CT pulmonary angiography dose data were collected. DRLs were calculated as the 75th percentile of CT dose index (CTDI) for two patient categories based on the thoracic perimeters. IQ was assessed with two thoracic phantom sizes using local acquisition parameters and three other dose levels. The area under the ROC curve (AUC) of a 2 mm low perfused vessel was assessed with a non-prewhitening with eye-filter model observer. The optimal IQ-dose point was mathematically assessed from the relationship between IQ and dose. The DRLs of CTDI vol were 6.4 mGy and 10 mGy for the two patient categories. 75th percentiles of phantom CTDI vol were 6.3 mGy and 10 mGy for the two phantom sizes with inter-quartile AUC values of 0.047 and 0.066, respectively. After the optimization, 75th percentiles of phantom CTDI vol decreased to 5.9 mGy and 7.55 mGy and the interquartile AUC values were reduced to 0.025 and 0.057 for the two phantom sizes. DRLs for PE were proposed as a function of patient thoracic perimeters. This study highlights the variability in terms of dose and IQ. An optimization process can be started individually and lead to a harmonization of practice throughout multiple CT sites. [ABSTRACT FROM AUTHOR]

• This work presents a new methodology to assess the temporal MTF of CT protocols. • The NPWE model observer was updated to include the temporal MTF. • CT systems now overcome the trade-off between temporal and longitudinal resolution. The metrics used for assessing image quality in computed tomography (CT) do not integrate the influence of temporal resolution. A shortcoming in the assessment of image quality for imaging protocols where motion blur can therefore occur. We developed a method to calculate the temporal resolution of standard CT protocols and introduced a specific spatiotemporal formulation of the non-prewhitening with eye filter (NPWE) model observer to assess the detectability of moving objects as a function of their speed. We scanned a cubic water phantom with a plexiglass cylindrical insert (120 HU) using a large panel of acquisition parameters (rotation times, pitch factors and collimation widths) on two systems (GE Revolution Apex and Siemens SOMATOM Force) to determine the in-plane task-based transfer functions (TTF) and noise power spectra (NPS). The phantom set in a uniform rectilinear motion in the transverse plane allowed the temporal modulation transfer function (MTF) calculation. The temporal MTF appropriately compared the temporal resolution of the various acquisition protocols. The longitudinal TTF was measured using a thin tungsten wire. The detectability index showed the advantage of applying high rotation speed, wide collimations and high pitch for object detection in the presence of motion. No counterpart to the increase in these three parameters was found in the in-plane and longitudinal image quality. [ABSTRACT FROM AUTHOR]

• Deep learning image reconstruction enhances CT image quality and saves radiation dose. • Deep learning image reconstruction reduces noise while maintaining noise texture. • Deep learning image reconstruction maintains low- and high-contrast spatial resolution. • Deep learning image reconstruction improves low- and high-contrast detectability. • Deep learning image reconstruction outperforms partial model-based iterative reconstruction. We aimed to thoroughly characterize image quality of a novel deep learning image reconstruction (DLIR), and investigate its potential for dose reduction in abdominal CT in comparison with filtered back-projection (FBP) and a partial model-based iterative reconstruction (ASiR-V). We scanned a phantom at three dose levels: regular (7 mGy), low (3 mGy) and ultra-low (1 mGy). Images were reconstructed using DLIR (low, medium and high levels) and ASiR-V (0% = FBP, 50% and 100%). Noise and contrast-dependent spatial resolution were characterized by computing noise power spectra and target transfer functions, respectively. Detectability indexes of simulated acute appendicitis or colonic diverticulitis (low contrast), and calcium-containing urinary stones (high contrast) (|ΔHU| = 50 and 500, respectively) were calculated using the nonprewhitening with eye filter model observer. At all dose levels, increasing DLIR and ASiR-V levels both markedly decreased noise magnitude compared with FBP, with DLIR low and medium maintaining noise texture overall. For both low- and high-contrast spatial resolution, DLIR not only maintained, but even slightly enhanced spatial resolution in comparison with FBP across all dose levels. Conversely, increasing ASiR-V impaired low-contrast spatial resolution compared with FBP. Overall, DLIR outperformed ASiR-V in all simulated clinical scenarios. For both low- and high-contrast diagnostic tasks, increasing DLIR substantially enhanced detectability at any dose and contrast levels for any simulated lesion size. Unlike ASiR-V, DLIR substantially reduces noise while maintaining noise texture and slightly enhancing spatial resolution overall. DLIR outperforms ASiR-V by enabling higher detectability of both low- and high-contrast simulated abdominal lesions across all investigated dose levels. [ABSTRACT FROM AUTHOR]

• This work presents a new generalized methodology for assessing the SDNR. • The proposed method is valuable for objects of any shape, size and boundary condition. • The new method shows increased accuracy for small objects and is less sensitive to image noise. The standard approach to signal difference-to-noise ratio (SDNR) analysis requires a region of interest (ROI) positioned within the object to measure signal-difference, restricting this metric to flat-topped objects with large, sharply delineated areas. This work develops a generalized expression for SDNR (SDNR g) calculated from a ROI encompassing the object. Signal power, defined as the deviation of pixel values from the mean background due to the object, is used instead of signal-difference. Comparison was first made by simulating ideal flat-topped discs with sharp edges and diameters between 1 and 80 pixels, into a uniformly noisy background using a known signal-difference. For discs covering more than 20 pixels, SDNR g and standard SDNR (SDNR st) were within 3%, while for discs of less than 20 pixels, SDNR g was within 26% of the truth compared to 58% for SDNR st. Generalized and standard SDNR were compared for radiography images of three different phantoms with microcalcification-like objects (MTM-100 phantom), hemispheric objects of different thicknesses with a Gaussian intensity distribution and mammography quality control (QC) images. Applied to Gaussian details, SDNR g was between 20% and 45% higher than SDNR st , depending on object thickness, while for the QC images, SDNR g was with 1.7% of the standard SDNR. Compared to the standard SDNR, SDNR g is applicable to non-uniform signals, where an explicit contrast measurement is not suitable, and has improved accuracy when assessing SDNR of small objects. [ABSTRACT FROM AUTHOR]

Abstract In this paper, the combined influence of the load condition and the spindle speed on the tooltip dynamics of a five-axis milling machine with dominant spindle modes is evaluated. A constant preload is applied through axially and radially arranged permanent magnets while the dynamic excitation of the rotating dummy tool takes place by a force impact. The structures response is measured with non-contact sensors and Frequency Response Functions (FRFs) are calculated. The required load levels are derived from time domain simulation of the process. The so-obtained stability charts are hence functions of the rotational speed and the load condition which in turn depends on the feed rate and depth of cut. For validation, cutting tests are performed in Aluminum 7075 and results are compared against the predicted lobes. The stability boundary resulting from this approach is capable to explain the shift of the stability pocket which is observed in the cutting experiments when comparing different feed rates. [ABSTRACT FROM AUTHOR]

In light of the absence of patient and caregiver input in Enhanced Recovery After Surgery Cardiac Surgery guideline development, we conducted a scoping review to identify patient and caregiver preferences and prioritized outcomes related to perioperative care in cardiac surgery and its lifelong impact. Five electronic databases were searched to retrieve studies investigating patient or caregiver preferences and prioritized outcomes. Information was charted in duplicate and analyzed using descriptive statistics or thematic analysis. A patient and caregiver consultation workshop validated scoping review findings and solicited novel preferences and outcomes. Of the 5292 articles retrieved, 43 met inclusion criteria. Most were from Europe (n = 19, 44%) or North America (n = 15, 35%) and qualitative and quantitative designs were represented in equal proportions. Fifty-two methods were used to obtain stakeholder preferences and prioritized outcomes, the majority being qualitative in nature (n = 32, 61%). Based on the collective preferences of 3772 patients and caregivers from the review and 17 from the consultation workshop, a total of 108 patient preferences, 32 caregiver preferences, and 19 prioritized outcomes were identified. The most commonly identified theme was "information and education." Improved quality of life was the most common patient-prioritized outcome, and all caregiver-prioritized outcomes were derived from the consultation workshop. Patient and caregiver preferences overlap with Enhanced Recovery After Surgery Cardiac Surgery recommendations targeting preoperative risk reduction strategies, prehabilitation, patient engagement technology, and intra- and postoperative strategies to reduce discomfort. To support clinical practice, future research should investigate associations with key surgical outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Abtract Background Transcranial direct current stimulation (tDCS) is a non-invasive method increasingly popular for the treatment of several brain disorders, such as major depression. Despite great enthusiasm and promising results, some studies report discrepant findings and no consensus exists for the clinical use of tDCS. Objective The present study aims to (i) determine the most effective stimulation parameters to optimize antidepressant-like effect of tDCS in the forced-swim test in mice and (ii) identify brain regions recruited by tDCS and possibly involved in its behavioral effect using Fos immunohistochemistry. Results We reported that tDCS induced long-lasting antidepressant-like effect, which varied as a function of stimulation settings including number, duration, intensity and polarity of stimulation. Interestingly, the present study also demonstrated that tDCS reduced depressive-like behaviors induced by chronic corticosterone exposure. Furthermore, behavioral outcomes induced by a single stimulation were associated with neuronal activation in the prefrontal cortex, dorsal hippocampus, ventral tegmental area and nucleus accumbens, whereas no overexpression of c-fos was associated with 10 stimulations. Conclusion The strongest behavioral response was observed with an anodal stimulation of 200 μA during 20min. The repetition of this stimulation was necessary to induce long-lasting behavioral effects that are probably associated with plastic changes in the neuronal response. [ABSTRACT FROM AUTHOR]

Tabular data often refers to data that is organized in a table with rows and columns. We observe that this data format is widely used on the Web and within enterprise data repositories. Tables potentially contain rich semantic information that still needs to be interpreted. The process of extracting meaningful information out of tabular data with respect to a semantic artefact, such as an ontology or a knowledge graph, is often referred to as Semantic Table Interpretation (STI) or Semantic Table Annotation. In this survey paper, we aim to provide a comprehensive and up-to-date state-of-the-art review of the different tasks and methods that have been proposed so far to perform STI. First, we propose a new categorization that reflects the heterogeneity of table types that one can encounter, revealing different challenges that need to be addressed. Next, we define five major sub-tasks that STI deals with even if the literature has mostly focused on three sub-tasks so far. We review and group the many approaches that have been proposed into three macro families and we discuss their performance and limitations with respect to the various datasets and benchmarks proposed by the community. Finally, we detail what are the remaining scientific barriers to be able to truly automatically interpret any type of tables that can be found in the wild Web. [ABSTRACT FROM AUTHOR]

Climate risks are financial risks. To help manage them, researchers and practitioners are exploring which metrics to use to assess climate risks, and to what extent the metrics delivers heterogeneous results. We analyze a unique dataset including risk assessments from 9 providers for firms of the MSCI World Index. Convergence between metrics is higher for the firms most exposed to transition risk. The underlying modeling assumptions and scenario characteristics are associated with changes in the estimated transition risk. Users of climate risk metrics should properly understand the key assumptions underlying a metric to appropriately interpret its result. [Display omitted] • Forward-looking climate financial transition risk metrics display a significant degree of heterogeneity, but agree on the most exposed firms. • The methodology adopted affects the estimated risk value more than the chosen scenario assumptions. • It is important to know the assumptions underlying data providers' transition risk models, in order to correctly interpret the results and understand the valuation differences. [ABSTRACT FROM AUTHOR]

Given the contribution of scattered radiations to patient dose in CT, apron shielding is often used for radiation protection. In this study the efficiency of apron was assessed with a model-based approach of the contributions of the four scatter sources in CT, i.e. external scattered radiations from the tube and table, internal scatter from the patient and backscatter from the shielding. For this purpose, CTDI phantoms filled with thermoluminescent dosimeters were scanned without apron, and then with an apron at 0, 2.5 and 5 cm from the primary field. Scatter from the tube was measured separately in air. The scatter contributions were separated and mathematically modelled. The protective efficiency of the apron was low, only 1.5% in scatter dose reduction on average. The apron at 0 cm from the beam lowered the dose by 7.5% at the phantom bottom but increased the dose by 2% at the top (backscatter) and did not affect the centre. When the apron was placed at 2.5 or 5 cm, the results were intermediate to the one obtained with the shielding at 0 cm and without shielding. The apron effectiveness is finally limited to the small fraction of external scattered radiation. [ABSTRACT FROM AUTHOR]

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Abstract: A concept of active structural method dedicated to the mitigation of regenerative chatter in milling process is presented. This concept proposes an adaptronic high performance motor spindle integrating piezoelectric actuators and accelerometers combined with an optimal control strategy whose objective is to increase the productivity in chatter-free machining conditions. The control strategy, named stabilization, explicitly considers the cutting process in the controller synthesis in order to tailor the dynamics of the spindle according to the encountered machining conditions. As this strategy is based on models of machine tool, workpiece and process, modeling errors play a significant role and might corrupt the stability prediction and influence the performance of such active structural method. A series of machining tests illustrates the problematic and points out the difficulty to accurately and reliably predict the occurrence of chatter in milling process. It also indicates the current limitation of the proposed concept. [Copyright &y& Elsevier]

The authors describe an endovascular technique to reduce shunt diameter in the management of transjugular intrahepatic portosystemic shunt (TIPS)–induced refractory hepatic encephalopathy. Five patients were treated with a constrained stent-graft by using a commercially available balloon-expandable stent-graft narrowed by using a lasso catheter. This offers the possibility of an adjustable reduction of the shunt diameter. All procedures were technically successful, resulting in a significant increase in the portosystemic gradient and reopacification of the intrahepatic portal vein branches, findings that correlated with clinical improvement. This technique provides the ability to titrate the portosystemic gradient to the desired endpoint during shunt reduction. [Copyright &y& Elsevier]

Abstract: Allet L, Leemann B, Guyen E, Murphy L, Monnin D, Herrmann FR, Schnider A. Effect of different walking aids on walking capacity of patients with poststroke hemiparesis. Objective: To examine the effects of 3 different walking aids on walking capacity, temporo-spatial gait parameters, and patient satisfaction. Design: Observational study. Setting: University Hospital of Geneva. Participants: Hemiparetic inpatients (N=25) with impaired gait, at an early stage of rehabilitation, unfamiliar with any of the walking aids tested. Interventions: On 3 consecutive days subjects used, in random order, 1 of 3 walking aids: 4-point cane, simple cane with ergonomic handgrip, and Nordic stick. Main Outcome Measures: Maximal walking distance in 6 minutes, temporo-spatial gait parameters determined with a commercial electronic gait analysis system, and patients'' preference on a subjective ranking scale. Results: Walking distance was greatest with the simple cane with an ergonomic handgrip, followed by the 4-point cane and the Nordic walking stick. Walking velocity was highest with the simple cane, which was also indicated as the preferred walking aid by the patients. There was no significant difference in step length symmetry. Conclusions: The simple cane with the ergonomic handgrip was not only preferred by patients, but was also the most efficient among 3 commonly used walking aids. It appears justified to take patients'' subjective preference into account when prescribing a walking aid. [Copyright &y& Elsevier]

Purpose: To report initial experience with endovascular stent-grafting in aortic intramural hematoma (IMH). Materials and Methods: From 2000 to 2006, 15 patients (mean age, 67 years; range, 54–83 y) underwent endovascular treatment of aortic IMH. Thirteen patients were admitted for acute aortic syndrome and two for traumatic aortic injury. An endovascular procedure was performed as primary treatment for four patients (type A IMH, n = 3; type B IMH, n = 1) and as a second-line therapy in 11 patients because of unfavorable evolution (type A IMH, n = 1; type B IMH, n = 10). All stent-grafts were placed in the descending aorta, even for type A IMH. The mean follow-up was 21 months (range, 6–72 months). Results: The primary success rate was 93%, with complete exclusion of the lesion (n = 14). Exclusion was partial for one patient with a type I endoleak (7%). The 30-day mortality rate was zero. IMH evolution was favorable in all cases, with decreased aortic wall thickening (n = 8) or complete regression (n = 7). Complications associated with endovascular repair were mainly related to aneurysm formation (20%). The late death rate was 7%. Conclusions: Endovascular stent-graft treatment can be performed in the management of complicated IMH, even in some cases of type A IMH, when an intimal lesion is located in the isthmus or descending aorta with contraindications to surgery. This procedure offers low morbidity and mortality rates, representing a feasible therapeutic option especially for elderly patients with comorbidities. Further studies are necessary to confirm these preliminary results. [Copyright &y& Elsevier]

Abstract: Maintenance plays now a critical role in manufacturing for achieving important cost-savings and competitive advantage while preserving product conditions. It suggests moving from conventional maintenance practices to predictive strategy. Indeed the maintenance action has to be done at the right time according the component Remaining Useful Live (RUL) assessed by a prognosis process. The accuracy of the RUL is mainly depending on the relevance of the component degradation model used for prediction. In that way, this paper aims at discussing an efficient degradation model taking into account the operational conditions, the health monitoring and the maintenance actions. This model is based on discrete states associated with the degradation levels, and on a cumulative function modelling the transition time between successive states. The model is implemented by means of Stochastic Activity Networks (SAN). The feasibility and added value of such degradation models for prognosis is then highlighted through experimentations made on manufacturing TELMA platform. [Copyright &y& Elsevier]

Background: Multidetector-row computed tomography is often used as a first-line test in the diagnostic evaluation of cardiovascular diseases including aortic dissection, coronary artery disease and pulmonary embolism. This study evaluated the impact of reducing the tube potential from 120 kVp to 100 kVp in a selected group of patients presenting to the Emergency Room with acute chest pain. The primary end point was how the reduction of radiation dose affected image quality.Methods: The current study was performed over a period of 2 years between July, 2016 and July, 2018. This study included patients who presented to the Emergency Room or to an outpatient clinic and were suspected to have a coronary, a pulmonary (pulmonary embolism), or an aortic (aortic dissection) etiology. Suspicion was determined by the medical provider based on clinical picture, EKG, and lab results when available. All patients were referred for computed tomography angiography (CTA) testing as part of their diagnostic evaluation. A total of 84 patients were involved in the study. Seventy of the patients underwent the low acquisition Kvp technique (100 Kvp - Group I). In the remaining 14 patients, the standard acquisition technique (120-140 Kvp - Group II) was utilized.Results: This study showed the feasibility of using low energy CTA to significantly reduce the patient's radiation exposure without markedly affecting the image quality and diagnostic accuracy.Conclusion: The use of low energy CTA protocols in cases of acute chest pain revealed no major difference regarding the image quality with marked reduction of the radiation dose received by the patient. [ABSTRACT FROM AUTHOR]

Coronary angiography is one of the most common procedures done in the United States and in other developed countries. For decades, the femoral artery has been the most common vascular access site utilized for this procedure. However, the radial access has been gaining popularity for being a safer and yet practical vascular access with substantial benefits. More recently, the novel distal transradial approach has proven to be an equally or perhaps safer vascular access for diagnostic and interventional coronary and noncoronary procedures. This technique should be in every interventional cardiologist's arsenal. [ABSTRACT FROM AUTHOR]