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Medical residents must sustain acute sleep deprivation, which can lead to nonfatal and fatal consequences in hospitals due to cognitive decline. Anodal transcranial direct current stimulation (a-tDCS) is a safe noninvasive neuromodulation technique that can induce depolarization of neurons. Previous studies in pilots have shown benefits against fatigue increasing wakefulness and cognitive performance. However, the effects of a-tDCS on cognition in acute sleep deprived healthcare workers remains unknown.To evaluate cognitive changes in sleep deprived medical residents after one session of a-tDCS.Open clinical test-re-test study including 13 medical residents with acute sleep deprivation. Subjects received 1 session of bifrontal a-tDCS (2mAx20min), anodal over the left dorsolateral prefrontal region. Pre-and-post treatment subjects were tested with Beck anxiety inventory, Beck depression and HVLT tests, Rey´s and Taylor´s figures, Trail Making A/B, Stroop, Aleatory Digit retention test (WAIS), Digits and symbols and MoCA tests. Post-intervention was added the Executive functions and Frontal Lobes Neuropsychological Battery (BANFE2) test and changing the Taylor figure for Reyfigure.Twelve medical residents were analyzed; 8 men and 4 women, 29.5 (+/-2.2) years mean age. All had a mean of 21.6 (+/-1.3) hours of sleep deprivation. There were no serious adverse events. We found statistically significant difference in Rey´s/Taylor´s figures (p=0.002), Trail Making Test (p=0.005), WAIS IV symbols (p=0.003), Word Stroop (p=0.021). BANFE-2 showed that the main affected area was the orbito-medial prefrontal region.a-tDCS appears safe and improves working memory, attention, response time and distractors elimination in acute sleep deprived medical residents.

Background Electroconvulsive therapy (ECT), Vagal Nerve Stimulation (VNS), Transcranial Magnetic Stimulation (TMS) and Deep Brain Stimulation (DBS) are neuromodulation therapies that have been used to treat Status Epilepticus (SE). Objective Review the literature about the efficacy and safety of neuromodulation therapies in SE in humans. Methods We searched studies in PubMed, Scopus, Google Scholar and Science Direct (inception to June 2018). Four review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines, Oxford and GRADE scales, and Murad et al., 2018 methodological quality and synthesis of case series and case reports. Results We analyzed 27 articles (45 patients) with 4 different neuromodulation therapies. In ECT we found 80% rate of disruption of SE and 5% of adverse events was reported. Using iVNS 15/16 (93.7%) patients resolved the SE. All patients who underwent TMS and DBS aborted SE, however, 50% of patients with DBS had severe adverse events. Conclusions Case series and case reports suggest that neuromodulation therapies can abort SE in 80–100% of patients (Oxford scale and GRADE were level 4 and D) with a wide range of adverse effects, which claims for prospective studies on the relationship be-tween efficacy and safety.

Effective thermal management of traction-drive power electronics is critical to the advancement of electric-drive vehicles (EDVs) and is necessary for increasing power density and improving reliability. Replacing traditional silicon devices with more efficient, higher temperature, higher voltage, and higher frequency wide-bandgap (WBG) devices will enable increased power density but will result in higher device heat fluxes. Compact packaging of high-temperature WBG devices near low-temperature-rated components creates thermal management challenges that need to be addressed for future power-dense systems. This paper summarizes the thermal performance of on-road automotive power electronics thermal management systems and provides thermal performance metrics for select vehicles. Thermal analyses reveal that the package resistance dominates the total thermal resistance (for existing automotive systems). Advanced packaging concepts were modeled and the results were compared with existing packaging designs to quantify their thermal performance enhancements. Double-side (DS)-cooled configurations that do not use thermal interface materials (TIMs) are package concepts predicted to provide a low junction-to-fluid thermal resistance (compared to current packages). Dielectric-fluid-cooled concepts enable a redesign of the package to reduce the package resistance, can be implemented in single- and two-phase cooling approaches, and allow for cooling of passive components (e.g., capacitors) and bus bars.

Nowadays, as cameras are rapidly adopted in our daily routine, images of documents are becoming both abundant and prevalent. Unlike natural images that capture physical objects, document-images contain a significant amount of text with critical semantics and complicated layouts. In this work, we devise a generic unsupervised technique to learn multimodal affinities between textual entities in a document-image, considering their visual style, the content of their underlying text and their geometric context within the image. We then use these learned affinities to automatically cluster the textual entities in the image into different semantic groups. The core of our approach is a deep optimization scheme dedicated for an image provided by the user that detects and leverages reliable pairwise connections in the multimodal representation of the textual elements in order to properly learn the affinities. We show that our technique can operate on highly varying images spanning a wide range of documents and demonstrate its applicability for various editing operations manipulating the content, appearance and geometry of the image., ACM Transactions on Graphics 2021, to be presented in SIGGRAPH 2021

Spinal cord injury (SCI) is associated with marked bone loss and an increased risk of fracture. We randomized 61 individuals with chronic SCI and low bone mass to receive either teriparatide 20 μg/d plus sham vibration 10 min/d (n = 20), placebo plus vibration 10 min/d (n = 20), or teriparatide 20 μg/d plus vibration 10 min/d (n = 21). Patients were evaluated for 12 months; those who completed were given the opportunity to participate in an open-label extension where all participants (n = 25) received teriparatide 20 μg/d for an additional 12 months and had the optional use of vibration (10 min/d). At the end of the initial 12 months, both groups treated with teriparatide demonstrated a significant increase in areal bone mineral density (aBMD) at the spine (4.8% to 5.5%). The increase in spine aBMD was consistent with a marked response in serum markers of bone metabolism (ie, CTX, P1NP, BSAP), but no treatment effect was observed at the hip. A small but significant increase (2.2% to 4.2%) in computed tomography measurements of cortical bone at the knee was observed in all groups after 12 months; however, the magnitude of response was not different amongst treatment groups and improvements to finite element-predicted bone strength were not observed. Teriparatide treatment after the 12-month extension resulted in further increases to spine aBMD (total increase from baseline 7.1% to 14.4%), which was greater in patients initially randomized to teriparatide. Those initially randomized to teriparatide also demonstrated 4.4% to 6.7% improvements in hip aBMD after the 12-month extension, while all groups displayed increases in cortical bone measurements at the knee. To summarize, teriparatide exhibited skeletal activity in individuals with chronic SCI that was not augmented by vibration stimulation. Without additional confirmatory data, the location-specific responses to teriparatide would not be expected to provide clinical benefit in this population. © 2018 American Society for Bone and Mineral Research.

Scene Text Recognition (STR), the task of recognizing text against complex image backgrounds, is an active area of research. Current state-of-the-art (SOTA) methods still struggle to recognize text written in arbitrary shapes. In this paper, we introduce a novel architecture for STR, named Selective Context ATtentional Text Recognizer (SCATTER). SCATTER utilizes a stacked block architecture with intermediate supervision during training, that paves the way to successfully train a deep BiLSTM encoder, thus improving the encoding of contextual dependencies. Decoding is done using a two-step 1D attention mechanism. The first attention step re-weights visual features from a CNN backbone together with contextual features computed by a BiLSTM layer. The second attention step, similar to previous papers, treats the features as a sequence and attends to the intra-sequence relationships. Experiments show that the proposed approach surpasses SOTA performance on irregular text recognition benchmarks by 3.7\% on average., Comment: In CVPR 2020

We propose a framework for sequence-to-sequence contrastive learning (SeqCLR) of visual representations, which we apply to text recognition. To account for the sequence-to-sequence structure, each feature map is divided into different instances over which the contrastive loss is computed. This operation enables us to contrast in a sub-word level, where from each image we extract several positive pairs and multiple negative examples. To yield effective visual representations for text recognition, we further suggest novel augmentation heuristics, different encoder architectures and custom projection heads. Experiments on hand-written text and on scene text show that when a text decoder is trained on the learned representations, our method out-performs non-sequential contrastive methods. In addition, when the amount of supervision is reduced, SeqCLR significantly improves performance compared with supervised training, and when fine-tuned with 100% of the labels, our method achieves state-of-the-art results on standard hand-written text recognition benchmarks.

9. Visual loss associated with cardiac surgery is due primarily to retinal artery occlusion and ischemic optic neuropathy. This review summarizes current state of knowledge concerning these visually disabling complications.

Spinal cord injury (SCI) is associated with marked bone loss and an increased risk of fracture. We randomized 61 individuals with chronic SCI and low bone mass to receive either teriparatide 20 μg/d plus sham vibration 10 min/d (n = 20), placebo plus vibration 10 min/d (n = 20), or teriparatide 20 μg/d plus vibration 10 min/d (n = 21). Patients were evaluated for 12 months; those who completed were given the opportunity to participate in an open-label extension where all participants (n = 25) received teriparatide 20 μg/d for an additional 12 months and had the optional use of vibration (10 min/d). At the end of the initial 12 months, both groups treated with teriparatide demonstrated a significant increase in areal bone mineral density (aBMD) at the spine (4.8% to 5.5%). The increase in spine aBMD was consistent with a marked response in serum markers of bone metabolism (ie, CTX, P1NP, BSAP), but no treatment effect was observed at the hip. A small but significant increase (2.2% to 4.2%) in computed tomography measurements of cortical bone at the knee was observed in all groups after 12 months; however, the magnitude of response was not different amongst treatment groups and improvements to finite element-predicted bone strength were not observed. Teriparatide treatment after the 12-month extension resulted in further increases to spine aBMD (total increase from baseline 7.1% to 14.4%), which was greater in patients initially randomized to teriparatide. Those initially randomized to teriparatide also demonstrated 4.4% to 6.7% improvements in hip aBMD after the 12-month extension, while all groups displayed increases in cortical bone measurements at the knee. To summarize, teriparatide exhibited skeletal activity in individuals with chronic SCI that was not augmented by vibration stimulation. Without additional confirmatory data, the location-specific responses to teriparatide would not be expected to provide clinical benefit in this population. © 2018 American Society for Bone and Mineral Research.

Background: Transcranial direct current stimulation (tDCS) is an emerging non-invasive neuromodulation therapy in epilepsy with conflicting results in terms of efficacy and safety. Objective: Review the literature about the efficacy and safety of tDCS in epilepsy in humans and animals. Methods: We searched studies in PubMed, MedLine, Scopus, Web of Science and Google Scholar (January 1969 to October 2013) using the keywords ‘transcranial direct current stimulation’ or ‘tDCS’ or ‘brain polarization’ or ‘galvanic stimulation’ and ‘epilepsy’ in animals and humans. Original articles that reported tDCS safety and efficacy in epileptic animals or humans were included. Four review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines and Jadad Scale. A meta-analysis was not possible due to methodological, clinical and statistical heterogeneity of included studies. Results: We analyzed 9 articles with different methodologies (3 animals/6 humans) with a total of 174 stimulated individuals; 109 animals and 65 humans. In vivo and in vitro animal studies showed that direct current stimulation can successfully induce suppression of epileptiform activity without neurological injury and 4/6 (67%) clinical studies showed an effective decrease in epileptic seizures and 5/6 (83%) reduction of inter-ictal epileptiform activity. All patients tolerated tDCS well. Conclusions: tDCS trials have demonstrated preliminary safety and efficacy in animals and patients with epilepsy. Further larger studies are needed to define the best stimulation protocols and long-term follow-up.

Bruce Parsons,1 Caroline Schaefer,2 Rachael Mann,3 Alesia Sadosky,1 Shoshana Daniel,4 Srinivas Nalamachu,5 Brett R Stacey,6 Edward C Nieshoff,7 Michael Tuchman,8 Alan Anschel91Pfizer, Inc, New York, NY, USA; 2Covance Market Access Services, Inc, Gaithersburg, MD, USA; 3Covance Market Access Services, Inc, San Diego, CA, USA; 4Covance Market Access Services, Inc, Conshohocken, PA, USA; 5International Clinical Research Institute, Overland Park, KS, USA; 6Oregon Health and Science University, Portland, OR, USA; 7Rehabilitation Institute of Michigan/Wayne State University, Detroit, MI, USA; 8Palm Beach Neurological Center, Palm Beach Gardens, FL, USA; 9Rehabilitation Institute of Chicago, Chicago, IL, USABackground: Neuropathic pain (NeP) can be chronic, debilitating, and can interfere with sleep, functioning, and emotional well being. While there are multiple causes of NeP, few studies have examined the disease burden and treatment patterns associated with post-traumatic/post-surgical (PTPS) NeP.Objective: To characterize pain, health status, function, health care resource utilization, lost productivity, and costs among subjects with PTPS NeP in the United States.Methods: This observational study enrolled 100 PTPS NeP subjects recruited during routine visits from general practitioner and specialist sites. Subjects completed a one-time questionnaire with validated measures of pain severity and pain interference, health status, sleep, anxiety and depression, productivity, and study-specific items on demographics, employment status, and out-of-pocket expenses. Investigators completed a case report form based on a 6-month retrospective chart review, recording subjects' clinical characteristics as well as current and previous medications/treatments for NeP. Subjects were stratified into mild, moderate, and severe pain groups.Results: Subjects' demographic characteristics were: mean age of 54.9 years, 53% female, and 22% employed for pay. Mean pain severity score was 5.6 (0–10 scale), with 48% and 35% classified as having moderate and severe pain, respectively. The mean number of comorbidities increased with greater pain severity (P = 0.0009). Patient-reported outcomes were worse among PTPS NeP subjects with more severe pain, including pain interference with function, health state utility, sleep, and depression (P < 0.0001). Eighty-two percent of subjects were prescribed two or more NeP medications. The total mean annualized adjusted direct and indirect costs per subject were $11,846 and $29,617, respectively. Across pain severity levels, differences in annualized adjusted direct and indirect costs were significant (P < 0.0001).Conclusion: PTPS NeP subjects reported high pain scores, which were associated with poor health utility, sleep, mood, and function, as well as high health care resource utilization and costs. The quality of life impact and costs attributable to PTPS NeP suggest an unmet need for effective and comprehensive management.Keywords: trauma/surgery, neuropathic pain, quality-of-life, patient-reported outcomes, costs, productivity

Cross-sectional, observational study. Characterize demographic and clinical characteristics, health status, pain, function, productivity and economic burden in spinal cord injury-related neuropathic pain (SCI-NeP) subjects, by pain severity. United States. One hundred and three subjects diagnosed with SCI-NeP recruited during routine primary care or specialty physician office visits completed a questionnaire to assess patient-reported outcomes. Physicians completed a case report form on inclusion/exclusion criteria, subject clinical characteristics and health-care resource use (HRU) based on 6-month retrospective chart review. Subjects’ mean age was 48.7, 69.9% were male and 48.5% were unable to walk. The most frequently reported comorbidities were sleep disturbance/insomnia (28.2%), depressive symptoms (25.2%) and anxiety (23.3%). Subjects’ mean pain severity score was 5.3 (0–10 scale), and 77.7% reported moderate or severe pain. On a 0–10 scale, subjects’ reported moderate pain interference with function: mean 5.4. Subjects’ health status, as measured by the EuroQol 5-dimensions health-state utility, was 0.49 (−0.11 to 1.00 scale). Pain interference with function and health status were significantly worse among subjects with more severe pain (P

Purpose To describe the dynamic changes of the intraocular pressure (IOP) and intracranial pressure (ICP) with normal or pathological values (intracranial hypertension) in nonglaucomatous neurological patients during lumbar punction (LP). Methods Case–control study, prospective measurement of tonometry in both groups referred for LP. Intraocular pressure, ICP and translaminar pressure difference (TPD) were compared pre- and post-LP. Results Thirty-six patients (72 eyes) with mean age of 38.5 (16–64) years and BMI of 26.81 kg/m2 were analysed. The initial mean ICP was 12.81 (± 6.6) mmHg. The mean TPD before and after the LP was 1.48 mmHg and 0.65 mmHg, respectively. The mean IOP of both eyes decreased to 0.8 mmHg post-LP in patients with pathological ICP (p = 0.0193) and normal ICP (p = 0.006). Conclusions We found a statistically significant decrease of the IOP post-LP compared to the pre-LP in both groups, being higher in patients with pathological ICP. There were no significant differences of the IOP in patients with normal versus pathological ICP pre-LP/post-LP; neither was found a correlation between ICP and IOP.

a Neurophysiology Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, Mexico D.F. 14269, Mexico b Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 300 1st Ave, Charlestown, MA 02129, USA c Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, Mexico D.F. 14269, Mexico d Comprehensive Epilepsy Center of Long Island, St. Charles Hospital, 200 Belle Terre Rd., Port Jefferson, NY 11777, USA