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While researchers have stressed the potential of automated vehicle (AV) technology in improving mobility and accessibility for a range of people, only a few attempts have been made to examine the impact of this new technology on different segments of the population in a realistic setting using high-fidelity simulation. To fill this gap, we analyze the equity implications of Automated Mobility-on-Demand (AMoD) in three full-scale prototype cities using SimMobility, a state-of-the-art activity- and agent-based framework. The prototype cities were developed based on two auto-dependent typologies, representing cities largely in the US/Canada, and a dense transit-oriented typology. We perform equity analyses at the individual and income-group level, in order to reveal the winners and losers from the introduction of AVs under two scenarios: (1) AMoD Intro, in which a low-cost AMoD service competes with mass transit, and (2) AMoD Transit Integration, where AMoD complements mass transit, via access/egress connectivity service to rapid transit stations. We evaluate the following outcomes: induced demand by age and income groups, mode share by income levels, individual kilometers traveled by different modes and income levels, and the spatial distribution of change in fare and accessibility. Outcomes are considered as equity-oriented if they reduce accessibility gaps, particularly among disadvantaged populations. Our results indicate that in large population-dense and transit-oriented cities, the most equity-oriented outcomes can be achieved, due to extensive mass transit usage, which depresses car usage and restricts induced demand for AMoD. Such cities provide greater opportunities for low-income groups. Specifically, the AMoD Transit Integration scenario results in the best outcomes and implies a new market share, as disadvantaged groups, such as children and low-income individuals, were able to travel more using the integrated AMoD-transit service. Nevertheless, in car-dependent cities, where accessibility gaps are much larger, AMoD Intro scenario performs better compared to AMoD Transit Integration, as it serves the less accessible population and significantly improves their opportunities.

Esophageal cancer survival has improved owing to improvements in surgical techniques and preoperative chemoradiation. Excessive alcohol consumption is a shared risk factor for esophageal cancer and chronic alcoholic pancreatitis. Puestow’s procedure is a treatment choice for pain relief and pancreatic duct decompression. It is logical to perform Puestow’s procedure on patients undergoing esophagectomy with underlying chronic pancreatitis to preserve pancreatic function and restore quality of life in the setting of improved esophageal cancer overall survival. Herein, we report our preliminary experience with two patients who underwent both of these procedures during the same operation and achieved acceptable outcomes.

To assess the risk of adverse maternal and neonatal outcomes as a function of the presenting twin second-stage duration. A retrospective cohort study of deliveries taking place in an academic medical center between 2005 and 2019. The study group included women with twin pregnancies with the first fetus in vertex presentation, who attempted vaginal delivery with epidural analgesia and attained the second stage of labor. Prolonged second stage (PSS) was defined as when exceeding the 95th percentile of presenting twin second-stage duration recorded among all parturients who achieved spontaneous vaginal deliveries in our center during the study period, stratified by parity: 3 h in nulliparas and 1 h in multiparas. Women with and without PSS were compared. The primary outcome was a composite of adverse maternal outcomes. A univariate analysis was conducted and followed by multivariate analysis. During the study period, 1,337 parturients (36% of twin deliveries) met study criteria, of these 22% (298) were nulliparous and 78% (1,039) were multiparous. The second stage of labor of the presenting twin was prolonged in 41 (13.8%) of the nulliparas and 64 (6.2%) multiparas. Prolonged second stage was associated with episiotomy, chorioamnionitis, endometritis, and blood product transfusion, as well as vacuum deliveries of the first and second twin, second-stage cesarean, and a higher rate of composite adverse maternal outcome in nulliparous (41.5% vs. 20.2%, p

To assess whether positive flow cytometry quantification of fetal red blood cells is associated with adverse maternal and neonatal outcomes in cases of mild trauma during pregnancy.A retrospective database study was conducted at a single tertiary center between 2013 and 2019. All pregnant women with viable gestation involved in trauma who underwent flow cytometry quantification of fetal red blood cells were included in the study. Flow cytometry was considered positive (≥0.03/≥30 ml). Composite adverse maternal and neonatal outcome was defined as one or more of the following: intrauterine fetal death, placental abruption, pre-term birth 37 weeks of gestation, immediate premature rupture of the membranes, and immediate delivery following trauma. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders, to assess the role of flow cytometry in predicting adverse maternal and neonatal outcome. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.During the study period 1023 women met inclusion and exclusion criteria. The mechanisms of injury were motor vehicle accident in 387 women (38%), falls in 367 (36%), direct abdominal injury in 353 (35%) and in 14 women (1%) other mechanism of injury. Flow cytometry was considered positive (≥0.03/≥30 ml) in 119 women (11.6%) with median result of 0.03 [0.03-0.04], and negative in 904 women (88.4%) ((≤0.03/≤30 ml) with median result of 0.01 [0.01-0.02]. Composite adverse outcome occurred in 8% of the women involved in trauma during pregnancy, with no difference between the groups with vs. without positive flow cytometry (4.2% vs. 8.5%; p = 0.1). Positive flow cytometry was not associated with any adverse maternal or neonatal outcome. This was confirmed on multivariate analysis controlling for potential confounders.Flow cytometry result is not related to adverse maternal and fetal/neonatal outcome of women involved in minor trauma during pregnancy. We suggest that flow cytometry should not be routinely assessed in pregnant women involved in minor trauma.

Purpose: This study compared the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines.Methods: From June to September 2015, 5,708 thyroid nodules (≥1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) at 26 institutions were evaluated. The US features of the thyroid nodules were retrospectively reviewed and classified according to all four guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared the diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines.Results: Of the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest for the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (>2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%).Conclusion: The modified K-TIRADS1.5cm can reduce the unnecessary FNAB rate for small nodules (1.0-2.0 cm), while maintaining high sensitivity for detecting malignancies >2.0 cm.

To evaluate the maternal and neonatal outcomes associated with vacuum-assisted vaginal delivery (VAVD) in a subset of parturients with congenital uterine anomalies.A retrospective database study was conducted at a single tertiary center between 2005 and 2019. Parturients with known congenital uterine anomalies who had vaginal deliveries were enrolled, whereas parturients with failed VAVD, didelphic uterus, and delivery after intrauterine fetal death were excluded. Various maternal and neonatal outcomes were compared between parturients who achieved spontaneous vaginal delivery (SVD) and those who delivered via VAVD. The maternal composite outcome was calculated for each group and included one or more of the following: post-partum hemorrhage, hemoglobin drop ≥ 4 gr/dL, blood transfusions, retained placental products, and obstetric anal sphincter injuries. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.After the application of the exclusion criteria, 332 parturients were found eligible. Of those, 289 (87%) had SVD and 43 (13%) had VAVD. VAVD was more common among primiparous parturients and epidural analgesia users. Parturients with VAVD had higher rates of third-degree perineal tear, postpartum hemorrhage, and blood transfusions. The maternal composite outcome was significantly more prevalent in the VAVD group (44.2% vs. 20.8%, p 0.01). After controlling for potential confounders, the maternal composite outcome was found to be independently associated with VAVD (aOR 2.3, 95% CI 1.10-4.60). The neonatal results were overall comparable, except for scalp trauma and Erb's palsy/clavicular fracture, which were more prevalent in the VAVD group.In a special population of parturients with congenital uterine anomalies, VAVD was found to be associated with significantly higher rates of adverse maternal outcomes and perinatal birth trauma. These findings should be presented to parturients during consultations about modes of delivery.

The monitoring of ionizing radiation is critical for the safe operation of nuclear and other high-power plants. Fiber-optic sensing of radiation has been pursued for over 45 years. Most protocols rely on radiation effects on the optical properties of the fiber. Here we propose a new concept, in which the opto-mechanics of standard fibers coated by thin layers of fluoroacrylate polymer are observed instead. The time-of-flight of radial acoustic waves through the coating is evaluated by forward stimulated Brillouin scattering measurements. The time-of-flight is seen to decrease monotonically with the overall dosage of gamma radiation from a cobalt source. Variations reach 15% of the initial value for 180 Mrad dose and remain stable for at least several weeks following exposure. The faster times-of-flight are consistent with a radiation-induced increase in the coating stiffness, observed in offline analysis. The effects on the coating are independent of possible changes in the optical parameters of the fiber. The combination of opto-mechanical analysis together with established fiber sensing protocols may help disambiguate the evaluation of multiple radiation metrics and reduce environmental cross-sensitivities. The technique is suitable for online monitoring and may be extended to spatially distributed measurements.

To assess whether women with mild gestational thrombocytopenia have a higher risk of postpartum hemorrhage.A retrospective computerized database. Primiparous women that delivered at our center (2005-2019) were included; we excluded women with possible etiologies for thrombocytopenia such as systemic lupus or coagulation disorders, and hypertensive disorder of pregnancy. Demographics, obstetric characteristics, and maternal as well as neonatal data were compared between groups. The exposure measure of the study was mild thrombocytopenia (100,000-150,000) versus normal thrombocyte count (150,000) at admission for labor. Postpartum hemorrhage (PPH) is defined as a clinical estimated blood loss of500 mL and/or a hemoglobin drop of ≥ 3 g/dl.Overall, 39,886 primiparous met the study's criteria, 5,209 (13.1%) had mild gestational thrombocytopenia (mean platelet count of 132.4 ± 13.2, study group) while 34,677 (86.9%) had normal platelet count at admission (mean of 221.6 ± 50.6, comparison group.) PPH occurred in 17.6% of the study group as opposed to 14% in the comparison group (Primiparous women with mild gestational thrombocytopenia are at increased risk of peripartum hemorrhage, this should be considered a risk factor when assessing parturients' risk of PPH.

Background: The prevalence of diabetes mellitus in Vietnam is relatively low compared to other Asian countries, but it is accelerating with the economic and cultural transition. This study aimed to estimate the current prevalence and clinical profile of undiagnosed diabetes mellitus in a tertiary hospital in the south of Vietnam. Methods: A cross-sectional investigation was conducted to recruit 1, 250 participants, who were at least 18 year-old and randomly sampled from Cho Ray Hospital, Ho Chi Minh City, Vietnam. Fasting plasma glucose concentration and HbA1c were measured for each individual. The American Diabetes Association criteria were used to diagnose diabetes. Demographic data and other clinical characteristics of diabetes were also documented, including age, sex, residence, educational status, weight, height, waist and hip circumferences, blood pressure, familial history of diabetes, and lipid profile. Results: The prevalence of undiagnosed diabetes mellitus was 7.5% in the population studied. Age, waist circumference, waist-hip ratio, body mass index, and hypertension, as well as dyslipidaemia were well-correlated with the diabetes rate. Conclusion: The prevalence of undiagnosed diabetes mellitus is increasing far more than expected. Newly diagnosed diabetic patients usually presented with multiple comorbidities, including overweight/ obesity, hypertension, and dyslipidaemia.

A high-gain transmit–reflect-array (TRA) antenna with asymmetric bidirectional beams using sparse-array method is presented in this communication. The proposed element consists of three-layer hexagonal-ring-patch (HRP) structure, able to achieve both amplitude (0 or 1) and phase modulation. Based on this kind of element structure, a 125 mm $\times \,\, 125$ mm square-shaped TRA is designed and fabricated. A 45.3% of the radiation units operate in transmission mode while others in reflection mode. Spatially fed by a conical horn antenna, two well-defined beams are obtained on both sides of the TRA, pointing to the direction of $\theta = 0^{\circ }$ and 170° ( $\varphi =0^{\circ }$ ), respectively. The measured results show a maximum gain of 21.4 dBi with a 1 dB gain bandwidth of 6.7% for the transmitted beam, and a maximum gain of 24.4 dBi with a 1 dB gain bandwidth of 9.3% for the reflected beam. To the authors’ best knowledge, it is the first time that the sparse-array method is employed in spatially fed antenna design. The proposed method can conveniently manipulate the pointing directions and beampattern characteristics of the bidirectional beams, providing a promising candidate for bidirectional wireless communication applications.

Editor’s notes: This article introduces a novel architecture for local learning, namely mixture of experts (MoEs), to customize a deep neural network (DNN) that is deployed on an edge device with performance improvement and low implementation overhead. — Deming Chen, University of Illinois at Urbana-Champaign

Purpose We reviewed the experience with adrenal ganglioneuroma (AGN) pathologically confirmed following adrenalectomy in medium- to high-volume medical centers. Methods The medical records of all adrenalectomy cases in 4 medical centers between 2006 and 2020 were retrospectively reviewed for demographics, clinical, radiological and laboratory findings, surgical treatment, pathology results, and outcomes. Results Twenty-five out of 875 adrenalectomy cases (2.9%) were pathologically confirmed as AGN. Those patients' average age was 40.5 years (range, 4-76 years), 13 (52.0%) were males, and 18 lesions (72.0%) were right-sided. One patient had a family history of neurofibromatosis, and another had a succinate dehydrogenase gene mutation. Abdominal/back pain attributed to mass effect was the most common symptom. All 25 patients underwent abdominal computerized tomography scanning in which the average maximal tumor diameter was 6.61 cm. The mean pre- and postcontrast Hounsfield units (HU) values were 35.2 and 59, respectively; and the mean late-phase HU value was 71.1. Twenty-two patients (88.0%) underwent minimally invasive surgery. The average tumor diameter recorded in the final pathology report was 7 cm. Isolated AGN was diagnosed in 21 cases (84.0%), and the additional components reported for the remaining 4 cases included pheochromocytoma (2), ganglioneuroblastoma (1), and neurofibroma (1). The average follow-up length was 16.8 months (range, 1-136 months), during which there was no recurrence or death. Conclusion AGN is a rare, slow-growing, large benign tumor with radiological characteristics similar to those seen in malignant tumor. Final diagnosis is established by pathology after surgical resection, preferably minimally invasive, with an overall excellent prognosis.

Background: A naturally occurring loss-of-function mutation in the gene for C-C chemokine receptor type 5 (CCR5-Δ32) has recently been reported as a protective factor in post-stroke motor and cognitive recovery. We sought to examine whether this mutation also prevented the development of depressive symptoms up to 2 years after a stroke. Methods: Participants were survivors of a first-ever mild to moderate ischemic stroke or transient ischemic attack from the TABASCO prospective study who underwent a 3 T MRI at baseline and were examined by a multiprofessional team 6, 12 and 24 months after the event, including an evaluation of depressive symptoms using the Geriatric Depression Scale. Results: CCR5-Δ32 status and a baseline depression evaluation were available for 435 patients. Compared with noncarriers, CCR5-Δ32 carriers (16.1%) had fewer depressive symptoms at admission (p = 0.035) and at 6 months (p < 0.001), 12 months (p < 0.001) and 24 months (p = 0.006) after the index event. This association remained significant at 6 and 12 months after adjustment for age, sex, education, antidepressant use, ethnicity and the presence of cortical infarcts. These findings were more robust in women. Compared to baseline, depressive symptoms in CCR5-Δ32 noncarriers tended to remain stable or grow worse over time, but in CCR5-Δ32 carriers, symptoms tended to improve. Limitations: A limitation of this study was the exclusion of patients who had a severe stroke or who had pre-stroke depression. Conclusion: Carriers of the CCR5-Δ32 allele had a lower tendency to develop depressive symptoms post-stroke, and this phenomenon was more prominent in women. These findings could have clinical implications; they suggest a mechanism-based treatment target for post-stroke depression. Drugs mimicking this loss-of-function mutation exist and could serve as a novel antidepressant therapy.

Purpose This study aims to design to assess the traditional, complementary and alternate medicine (TCAM) usage and its association with the quality of life (QOL) of Type 2 diabetic patients in a tertiary hospital (Hospital Universiti Sains Malaysia) in Malaysia. Design/methodology/approach A total of 300 respondents included in this study were divided into the following two major categories: TCAM (34.33% of respondents) and non-TCAM users (65.67% of the respondents), respectively. The mean ages of the respondents were 59.3 ± 10.2 for the TCAM users and 57.7 ± 12.0 for the non-TCAM users. Findings A greater percentage of non-TCAM users reported poor control of diabetes (14.7%) and blood glucose (55.8%) compared with the TCAM users (9.7% and 48.5%, respectively). Further, the diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Additionally, the diabetic patients with TCAM usage had a significantly better physical (p = 0.02) and overall (p = 0.03) qualities of life compared to the non-TCAM users. However, psychological, social and environmental health did not show any significant difference. Originality/value The prevalence of TCAM usage among diabetic patients was lower than in other comparable studies. Diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Further, diabetes patients on TCAM reported better QOL compared to non-TCAM users especially in terms of physical health.

Background: Migraine is known to mildly increase the risk for ischemic stroke and is associated with vascular MRI markers. However, the potential effect of chronic headache (CH) on stroke outcomes has not been studied. Objective: We aimed to assess the interrelation between CH and post-stroke cognitive impairment. Methods: Data from 455 patients with a first ever stroke from the TABASCO study was available. All patients underwent 3T brain MRI, blood analysis, and a serial cognitive assessment at baseline and 6, 12, and 24 months after. Results: Eighty-five (18.7%) patients reported suffering from CH, of whom 53 (62.4%) reported symptoms of photophobia or nausea, and 34 (40%) reported an aura. CH was associated with female sex, lower prevalence of T2DM (p

In this paper, a multi-image encryption scheme based on compressed sensing (CS) and deep learning in the optical gyrator domain is proposed. Firstly, multiple plaintext images are compressed by CS to obtain multiple measurements, and then the pixels of each measurement are scrambled by using a chaotic system. Secondly, the scrambled measurements are combined into a matrix and diffused by XOR operation with a chaotic matrix. Finally, the diffused matrix is encoded with a random phase and an optical gyrator transform to obtain a complex-valued matrix, and the amplitude of the complex-valued matrix is taken as the ciphertext. In decrypt, plaintext images are reconstructed from the CS measurements by a neural network, which achieves high reconstruction speed and quality compared with the traditional algorithm. Especially, the data amount of plaintext images can be compressed by up to 8 times while achieving high decryption quality. To our best knowledge, CS reconstruction algorithms based on deep learning is firstly used for image encryption. Moreover, the proposed scheme is highly robust against occlusion, noise, and chosen-plaintext attack.

In recent years, the polarization domain has attracted significant attention for the 4th and 5th generation (4G/5G) wireless communications owing to its benefit in channel capacity, symbol/bit error rate, and energy efficiency. One driving technology to fully utilize the polarization domain is the polarization-agile antennas that allow flexible reconfiguration of the transmitter (Tx) and receiver (Rx) polarization. The current state-of-the-art polarization-agile antennas can take several discrete polarization angles. This article proposes and analyzed a practical scheme to determine feasible optimal Tx and Rx polarization among the limited number of polarization angles to converge to theoretical channel capacity supported by the discrete polarization-agile antennas with single-RF front-end systems. Both the theoretical and simulation-based analyses for the capacity outage caused by adopting practical discrete polarization-agile antennas are provided in this article to complement communication system design in balancing channel capacity maximization and hardware cost. Comprehensive simulation results demonstrate that the multipolarization multi-input multi-output communication system toward the late revisions of 5G and beyond-5G, so called, 6G wireless communications can successfully reach the theoretically achievable channel capacity with the practical discrete polarization-agile antennas.

We aimed to evaluate the effect of epidural analgesia (EA) on maternal and neonatal outcomes.We conducted a retrospective cohort database study on primiparous women who underwent a vacuum-assisted delivery (VAD) trial between 2005 and 2019 at a university-affiliated tertiary medical center. We compared women with and without the standard "one protocol" patient-controlled EA. The primary outcome was VAD failure. Secondary outcomes were maternal and neonatal morbidities. We performed univariate analysis, followed by multivariable logistic regression analysis to control for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.Overall, 7042 primiparous women attempted VAD during the study period; 6238 (88.3%) and 804 (11.7%) women used and did not use EA, respectively. The VAD failure rate was significantly lower among women with than without EA use (2.5%EA use in primiparous women is associated with lower rates of VAD failure without an increase in adverse maternal or neonatal outcomes.

A better understanding of farmers’ investment strategies associated with climate and weather is crucial to protecting farming and other climate-exposed sectors from extreme hydrometeorological events. Accordingly, this study employed a field experiment to investigate the investment decisions under risk and uncertainty by 213 farmers from four regions of Taiwan. Each was asked 30 questions that paired “no investment,” “investment with crop insurance,” “investment with subsidized crop insurance,” and “investment” as possible responses. By providing imperfect information and various probabilities of certain states occurring, the experimental scenarios mimicked various types of weather-forecasting services. As well as their socioeconomic characteristics, the background information we collected about the participants included their experiences of natural disasters and what actions they take to protect their crops from weather damage. The sampled farmers became more conservative in their decision-making as the weather forecasts they received became more precise, except when increases in risk were associated with high returns. The provision of insurance subsidies also had a conservatizing effect. However, considerable variation in investment preferences was observed according to the farmers’ crop types. For those seeking to create comprehensive policies aimed at helping the agricultural sector deal with the costs of damage from extreme events, this study has important implications. This approach could be extended to research on the perceptions of decision-makers in other climate-exposed sectors such as the construction industry.

Contains fulltext : 235277.pdf (Publisher’s version ) (Closed access) BACKGROUND: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. METHODS: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. FINDINGS: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with a calibration slope of 0·97 (0·87-1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. INTERPRETATION: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. FUNDING: British Heart Foundation and Stroke Association.

To evaluate the incidence of brachial plexus birth palsy (BPBP) in a large, single cohort and stratify clinical 1-year outcomes. A cohort study of all births occurring at a single institution between 2011 and 2015. Hospital discharge papers were analyzed, and structured telephone interviews were conducted. Among 76,000 livebirths, 98 (0.13%) cases of BPBP were diagnosed. Of cases who fully responded to interview (66/98), at 3 months of age 77% infants made a complete recovery, and by 1 year of age an additional 20% had recovered completely. Only 3% of infants had residual longer-term neurological deficits. Predictors of a longer course of recovery were the presence of shoulder dystocia (p

Introduction: Germline mutations in predisposing genes have been found in 30-40% of pheochromocytoma/paraganglioma patients. Screening for inherited genetic mutations provide clinicians with mutation-positive patient management strategies in addition to identifying family members at risk of disease. However, genetic testing for pheochromocytoma has not been performed widely in Vietnam. Methods: Seven patients diagnosed with pheochromocytoma in Vietnam underwent germline genetic testing in known pheochromocytoma-associated genes by direct sequencing. When a germline mutation was identified the first-degree relatives were counseled and offered genetic testing for the inherited mutation. Results: Mutations were found in five of seven cases and all mutations were in RET proto-oncogene codon 634 indicating a high risk of developing aggressive medullary thyroid cancer and in some cases leading to prophylactic thyroidectomy as recommended. Conclusions: Genetic testing plays an essential role in the clinical management of pheochromocytoma patients. Genetic results have significantly changed the clinical approach in these patients and identified ‘at risk’ family members.

Introduction: Parkinson's disease is one of the fastest-growing diseases in terms of prevalence, disability, and mortality. Exposure to environmental toxic substances, such as mercury (Hg) can increase the risk of neuronal damage and neurodegenerative diseases. Purpose: The purpose of writing this article is to determine the impact of mercury exposure on the incidence of Parkinson's disease in small-scale gold mining workers. Methods: The author searches for material through the Google Scholars, NCBI, and ScienceDirect search pages by limiting the journals published in 2015-2020. In this review, the authors conducted a study of 33 scientific articles. Results: The small-scale gold mining industry is the largest source of mercury emissions in the world. Mercury gas has a negative impact on the lungs, kidneys, liver, and nervous system. Gold miners have a very high likelihood of being exposed to metallic mercury and suffering occupational mercury intoxication. Discussion: Mercury is known to be a neurotoxin that can cause neuron death and damage to the substantia nigra and other basal ganglia nuclei. Acute mercury exposure can cause tremors, memory loss, respiratory distress, and even death. Gold miners are a group that is exposed to a lot of mercury and suffers from work-induced mercury intoxication. Conclusion: Mercury-induced parkinsonism can be identified because of its predilection for accumulation and palladium and striatum damage such as damage to the substantia nigra pars in Parkinson's disease.

To examine the association between vaginal delivery of a previous macrosomic neonate (birthweight (BW)≥ 4000) among non-diabetic women and the rate of shoulder dystocia (SD) in the subsequent pregnancy.A historical prospective cohort study in a university affiliated medical center from 2005 to 2019. Women who had a singleton pregnancy and two consecutive deliveries in our medical center were included. Women with previous GDM, SD or cesarean delivery were excluded. Univariate analysis was followed by multivariate logistic regression.A total of 38,942 women were included. SD incidence among the subsequent pregnancies was 0.44 % (172 women). In univariate analysis women with previous delivery of large neonates: BW≥90th percentile for gestational age and BW ≥ 4000 g had higher risk for subsequent SD (odds ratio 2.69 [95 % confidence interval 1.89-3.84], p0.01 and 2.71 [1.66-4.44], p0.01, respectively). However, a backward stepwise multivariate logistic regression model adjusted for significant confounders for SD in the univariate analysis, showed that women with a previous delivery of macrosomic neonate ≥4000 g were not found to have higher or lower risk for SD in the subsequent delivery.Previous uneventful delivery of a macrosomic neonate to a non-diabetic mother should not be regarded as a risk factor for SD in the subsequent delivery.

A low-noise and fast optical encryption method for three-dimensional (3-D) information using the double-phase method is proposed. First, the 3-D information is encoded into a phase-only hologram (POH) by the angular-spectrum diffraction and the double-phase method. Second, the chaotic random phase mask (CRPM) is generated by the hybrid logical map and the iterative chaotic map with infinite collapses map to modulate the POH and obtain the ciphertext. As the secret key, the CRPM cannot only improve the secret key space of the scheme but also achieve the purpose of scrambling and hiding 3-D information. Third, the background noise of the decrypted image is successfully reduced by the cross-shaped filter, which is designed for the first time based on the POH spectrum distribution. The proposed scheme has successfully improved the encryption speed of the 3-D information and the quality of the reconstructed images. Numerical simulation and optical results show the effectiveness and feasibility of the proposed encryption scheme.

BackgroundIdentifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming.MethodsThe Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer.ResultsOncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms.ConclusionThe MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.

DFB lasers with ultrashort cavities or integrated DFB lasers with passive waveguide reflectors are frequently proposed to realize directly modulated lasers (DMLs) for carrying ultrahigh data rate signals. The former suffers from poor heatsink and laser cleavage yield, while the single-mode stability of the latter scheme is seldom addressed. The mode selection and device performance of a DFB laser is well known to be very sensitive to the facet reflection and external optical feedback. The DFB lasers with partial corrugated gratings and passive feedback (PCG-PFL) are proposed here to overcome the challenging issues for the aforementioned two schemes. With PCG structure, the DFB lasers can maintain high single-mode yield (SMY) even with a high-reflection-coating on the rear facet and strong reflection from the integrated passive section. This provides the robustness in applying the integrated passive reflector to reshape the modulation response or to enhance the 3-dB bandwidth by using the photon-photon resonance (PPR) effect. By designing the PCG-PFL to have 150-μm long laser section, 50-μm long passive section, and 30% front-facet reflectivity, it can have about 86% of SMY, reduced resonant peak in the intensity modulation response, and reduced waveform overshoot and undershoot for transmitting 56-Gbaud/s PAM-4 signals. By using a longer passive reflector, enhanced bandwidth can be achieved by the PPR effect.

Although virtual non-contrast (VNC) successfully removes iodinated contrast, uncertainty exists regarding the feasibility of VNC to suppress iodine for detecting thyroid calcification. Therefore, we evaluated whether both intrinsic and extrinsic iodine attenuation were suppressed on VNC images. We enrolled 128 patients (male: female 17:111; age 48.0 ± 10.4 years) who underwent dual-layer dual-energy CT (DL-DECT) examination before their thyroid cancer surgeries. Two additional sets of VNC (VNCu, VNCc) images were retrospectively generated from their true unenhanced (TUE) and true contrast-enhanced (TCE) series. We compared CT attenuation values measured on the VNCu and VNCc images by drawing identical regions of interest encompassing thyroid parenchyma, then subjectively determined the concordance of calcification. Although CT attenuation discrepancies between the VNCu and VNCc were significant (2.0 ± 5.7HU, p

The trade-off between spatial and temporal resolution remains a fundamental challenge in machine vision. A captured image often contains a significant amount of redundant information, and only a small region of interest (ROI) is necessary for object detection and tracking. In this paper, we first systematically characterize the effects of ROI on camera capturing, data transmission, and image processing. We then present the closed-loop ROI algorithm capable of high spatial and temporal resolution as well as wide scanning field of view (FOV) in single and multi-object detection and tracking via real-time wireless video streaming. With the feedback from real-time object tracking, the wireless camera is able to capture and transmit only the ROI which in turn enhances both the spatial and temporal resolution in object tracking. In addition, the proposed approach can still maintain a large FOV by processing regions outside of the ROI at lower spatial and temporal resolutions. When applied to a high spatial resolution wireless stream (5 MegaPixels), the closed-loop ROI algorithm improves the temporal resolution by up to $10\times $ (from 2.4FPS to 22.5FPS). Specifically, camera processing is improved by up to $4.7\times $ , data transmission is improved by up to $160\times $ , and PC processing is improved by up to $2.5\times $ . In a person tracking experiment, the closed-loop ROI algorithm enables a wide-angle camera to outperform both a normal wide-angle camera–which suffers from poor temporal resolution and motion blur–and a pan & tilt camera–which cannot automatically refresh tracking after the tracking is lost.

Introduction: The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for acute stroke and transient ischemic attack (TIA) in Israel, shortly after the start of the pandemic. Methods: We conducted a retrospective observational study, based on data reported to the Israeli National Stroke Registry from 7 tertiary hospitals. All hospital admissions for acute stroke or TIA that occurred between January 1 and April 30, 2020 were included. Data were stratified into 2 periods according to the timing of COVID-19 restrictions as follows: (1) “pre-pandemic” – January 1 to March 7, 2020 and (2) “pandemic” – March 8 to April 30, 2020. We compared the weekly counts of hospitalizations between the 2 periods. We further investigated changes in demographic characteristics and in some key parameters of stroke care, including the percentage of reperfusion therapies performed, time from hospital arrival to brain imaging and to thrombolysis, length of hospital stay, and in-hospital mortality. Results: 2,260 cases were included: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period. Hospital admissions significantly declined between the 2 periods, by 48% for TIA (rate ratio [RR] = 0.52; 95% CI 0.43–0.64) and by 29% for stroke (RR = 0.71; 95% CI 0.64–0.78). No significant changes were detected in demographic characteristics and in most parameters of stroke management. While the percentage of reperfusion therapies performed remained unchanged, the absolute number of patients treated with reperfusion therapies seemed to decrease. Higher in-hospital mortality was observed only for hemorrhagic stroke. Conclusion: The marked decrease in admissions for acute stroke and TIA, occurring at a time of a relatively low burden of COVID-19, is of great concern. Public awareness campaigns are needed as patients reluctant to seek urgent stroke care are deprived of lifesaving procedures and secondary prevention treatments.

In the reconstruction of cylindrical phase-only hologram (POH), speckle noise caused by the addition of random phase is rarely discussed. Although some speckle noise suppression algorithms have been proposed for planar POH, it does not work well if they are directly applied to cylindrical POH. To solve this issue, the cylindrical self-diffraction iteration (CSDI) algorithm is proposed. This is an iteration algorithm based on the cylindrical self-diffraction model which is a special case of the cylindrical backward-propagation model at a limit condition. Simulation results show that CSDI can suppress speckle noise and improve the quality of reconstructed images significantly. Furthermore, the proposed CSDI algorithm outperforms conventional algorithms, which work well in planar POH and are directly applied to cylindrical POH, in suppressing speckle noise for cylindrical POH. To our best knowledge, the models of cylindrical backward-propagation and cylindrical self-diffraction as well as the concept of CSDI are firstly proposed and applied to speckle suppression of cylindrical POH.

Background/Purpose Sjogren's syndrome (SS) is an autoimmune disease and its conventional treatment has exhibited limited therapeutic efficacy. Traditional Chinese medicine has been demonstrated to ameliorate the sicca symptoms of SS by decreasing the level of TH1 and TH2 cytokines and increasing salivary flow rate. A newly designed traditional Chinese medicine, SS-1, showed improved efficacy in alleviating the dryness symptoms of SS patients in the National Taiwan SS cohort investigation. Here, we investigated the effect of SS-1 on T cell responses. Methods SS-1 was authenticated and its major compounds were verified by high-performance liquid chromatography. We examined the effects of SS-1 on the activation and TH1, TH2, and TH17 polarization of murine T cells. We also determined the level of TH1, TH2, and TH17 cytokine RNA in peripheral blood mononuclear cells of SS patients before and after SS-1 treatment. Results SS-1 treatment inhibits the activation and TH1, TH2, and IL-17A+IFNγ+ TH polarization of murine T cells. SS-1 treatment also significantly reduces IFN-γ, IL-4, and IL-13 expression, and moderately reduces IL-17A expression in peripheral blood mononuclear cells of SS patients. Conclusion Our results suggest that SS-1 inhibits T cell activation and diminishes TH1, TH2, and IL-17+IFN-γ+ TH responses in SS patients.

Prior vaginal delivery (VD), including vaginal birth after cesarean (VBAC), is one of the greatest predictors of successful trial of labor after cesarean (TOLAC) and uterine rupture. We aimed to evaluate VBAC and uterine rupture rates associated with TOLAC in women with VD prior to cesarean delivery (CD) or with prior VBAC, and the cumulative effect of the number of prior VD's.This retrospective study included women having TOLAC between 2005-2019. The study compared the caesarean and uterine rupture rates of TOLAC in women with only prior VD as compared to women with only prior VBAC. Comparison analysis was performed by univariate analysis and followed by adjusted multiple logistic regression models. Receiver operating characteristic (ROC) and decision tree analyses (chi-square automatic interaction detection algorithm) was conducted to evaluate the influence of the number of prior VD's on the likelihood of successful TOLAC.Overall, 9,038 women met the inclusion criteria. Women with prior VBAC and prior VD showed significantly higher rates of successful VBAC compared to those with no prior VD or prior VBAC (96 % and 86 % vs 76 %; p0.01). However, women with prior VBAC but not women with prior VD showed significantly lower rates of uterine rupture compare to women with no prior VD or VBAC (0.1 % vs 0.6 % and 0.6 %; p0.01). The prevented fraction of TOLAC success was significantly higher in women with prior VBAC than that of women with VD prior to CD (83 % vs. 42 %, p0.01). ROC curve showed that the number of prior VBACs was a better predictor of TOLAC success and uterine rupture than the number of prior VD's. However, each single variable was found to have low positive predictive value (PPV) and requires other variables to improve the prediction. Finally, decision tree analysis demonstrated significant association between TOLAC success rate and prior VBAC, prior VD, and CD indications, without any association with the number of prior deliveries.Prior VBAC has some prediction value for TOLAC success and uterine rupture. However, it has low PPV as a single variable and requires other variables to improve the prediction. The number of prior VDs is not improving prediction.

Central nervous system (CNS) pathologies, such as stroke and spinal cord injury, remain debilitating issues due to the inhibitory environment in the CNS. Many research works have focused on combinatorial therapeutic approaches, such as biomaterial scaffolding, cell transplantation and biomolecule delivery, in the hope of effectively improving functional recovery in vivo. Unfortunately, to date, there is still no effective treatment to regain mobility post-injury. In search of better therapeutic strategies, injectable hydrogels are becoming a popular treatment option for CNS diseases due to their tuneable mechanical properties and the minimally invasive nature of administration. Moreover, the ability to encapsulate exogenous cells and therapeutic molecules while providing an environment that is permissive to cells and promote cell survival incentivises the use of injectable hydrogels in CNS disease treatment. In this review, we will discuss the advances that have been achieved in the recent decade in injectable hydrogel systems for tissue regeneration after stroke and spinal cord injuries. In particular, we focus on the cellular response and tissue integration related to these hydrogel systems. We hope to provide useful insights on materials choices for future research work in injectable hydrogels for stroke and spinal cord regeneration.

Thyroid squamous cell carcinoma is very rare. At present, it is limited to case reports. Since the thyroid follicular epithelium is the non-squamous epithelium, how primary squamous cell carcinoma (SCC) of the thyroid occurs is still a controversial issue. Hashimoto’s thyroiditis (HT) is considered to be an independent risk factor for thyroid cancer, under the basis of HT, how tumor cells evolve and develop to papillary thyroid carcinoma (PTC), and particularly to de-differentiate into SCC is elusive. We report a 72-year-old female patient who developed multiple subtypes of PTC on a basis of HT, and finally to de-differentiate into SCC within the local foci of lymph node metastasis. We found that there was a variety of sub-types of PTC in this patient in the background of HT. SCC was found within local lymph node metastasis. Pathomorphology, immunohistochemistry, and molecular pathology have confirmed that the SCC was derived from PTC, and then developed into poorly differentiated SCC and/or anaplastic carcinoma. We also conducted a comprehensive literature review.

Human error is a serious concern in manufacturing industries. It affects product error and liability and even leads to workplace injuries or fatalities. Malaysia has recorded a worrying figure of workplace accidents and injuries. In 2018 alone, there were more than 2700 workplace accidents which led to disabilities and death. A workplace accident would result in a no-win situation for a company. Manufacturing sectors in Malaysia make the highest claims from the total cost of accidents and injuries. The Department of Occupational Safety and Health (DOSH) in Malaysia also imposes a fine for companies who breach safety and health regulations in the workplace. Inspections are carried out to ensure that manufacturers obey the rules of occupational safety and health (OSH), and fined for being errant employers. However, these penalisations are often due to the negligence and lack of awareness among employers and employees. Hence, it is of interest for researchers to identify the root causes of human error among manufacturing industries in Malaysia. This review highlights the common causes of workplace accidents and injuries in manufacturing through observation. Several well-known human error models since 1983 are also investigated. The potential outcome of this review is to improve OSH awareness among manufacturers for a more sustainable future in their business, employment, and social well-being.

Fetal growth restriction is suspected when the estimated fetal weight is10th percentile for gestational age. Using a regional sonographic estimated fetal weight growth curve to diagnose fetal growth restriction has no known benefits; however, the traditional approach of using birthweight curves is misleading, since a large proportion of preterm births arise from pathological pregnancies. Our aim was to compare the diagnostic accuracies of sonographic versus birthweight curves in diagnosing fetal growth restriction. Our secondary aim was to compare maternal, fetal and neonatal outcome based on these two approaches.Retrospective study based on computerized medical records. Included were women with a singleton pregnancy, that underwent fetal biometry between 24 and 36.6 weeks' gestation (January 2010-February 2016) and delivered in our center. Each pregnancy was assigned to one of three groups based on the earliest sonographic estimated fetal weight performed:Six thousand and five pregnancies met inclusion criteria. Of these 5386 (89.6%) were categorized as G1, 300 (5%) as G2 and 319 (5.3%) as G3. The rate of small for gestational age neonates differed significantly between groups: G1 9.2%, G2 39.7% and G3 70%. Multivariable logistic regression modeling reiterated these rates: the odds ratios for small for gestational age were 6.47 [95% CI 4.99-8.40] and 23.99 [95% CI 18.26-31.51] for G2 and G3 respectively. Prediction of small for gestational age based on sonographic EFW curves increased the sensitivity for detection of SGA from 26% to 41% with a slight decrease in specificity from 98% to 95%, and a decrease of the positive likelihood ratio from 18.4 to 7.7, however there was no significant change in the overall test accurcy; 88.5% to 87.1%.Secondary outcomes also differed between groups: G2 and G3 had similar rates of maternal and neonatal morbidities and most parameters were higher than G1. G2 and G3 showed lower mean gestational age at delivery (36.2 weeks and 35.9 weeks vs.37.8;Pregnancies that are currently managed as appropriate for gestational age based on birthweight curves, but classified as growth restricted when prenatal sonographic curves are used, are associated with higher rates of small for gestational age and poor perinatal outcomes, at rates comparable to pregnancies that are classified as growth restricted based on birthweight curves. Furthermore, applying sonographic curves increases the sensitivity for detection of small for gestational age neonates. Consequently, consideration should be given to the use of sonographic biometry curves for defining fetal growth restriction.

Non-communicable diseases are increasing in developing countries and control of diabetes and hypertension is needed to reduce rates of the leading causes of morbidity and mortality, stroke and ischaemic heart disease. We evaluated a programme in Cambodia, financed by a revolving drug fund, which utilizes Peer Educators to manage diabetes and hypertension in the community. We assessed clinical outcomes and retention in the programme. For all people enrolled in the programme between 2007 and 2016, the average change in blood pressure (BP) and percentage with controlled hypertension (BP < 140/

Obstructive sleep apnea syndrome (OSA) is associated with cardiovascular morbidity in adults and children. NFκB activity is enhanced in circulating monocytes of adults with OSA, that decreases following positive pressure therapy. OSA children’s serum activates NFκB in a cell line. We hypothesized that OSA children’s serum can activate NFκB in cardiomyocytes (CM) and effect their viability. In order to explore the role played by NFκB in OSA cardiovascular pathophysiology, rat, mouse and human immortalized CM were exposed to human serum drawn from OSA children and matched controls. Increased expression of NFκB classical subunits p65/p50 as well as major morphological changes occurred in cardiomyocytes following OSA’s serum exposure. OSA children’s serum induced NFκB activity as measured by p65 nuclear translocation in immortalized human CM and rat cardiomyocytes as well as dense immunostaining of the nucleus. Trypan blue and XTT assays showed that OSA sera induced CM apoptosis. We conclude that NFκB is systemically activated in cardiomyocytes, who also demonstrate decreased viability and contractility following exposure to OSA serum. It supports the hypothesis NFκB plays a role in the evolution of cardiovascular morbidity in OSA. It may support the search for new therapeutic interventions controlling NFκB activation in OSA.

To evaluate the individual and combined effects of obesity and muscle mass on brain volume in a community-dwelling healthy older population. One thousand two hundred nine participants (M:F = 574:635, mean age 63.6 ± 6.9 years) were included. The cross-sectional area of visceral fat (VF), the height-adjusted appendicular skeletal muscle mass (ASM/height2), and the ratio of thigh muscle to visceral fat (TM/VF) represented obesity, muscle mass, and their integrated value, respectively. Linear regression analysis was performed to establish associations between 215 brain compartment volumes and VF, ASM/height2, and TM/VF after adjusting for covariates. On regression analysis, TM/VF had a positive correlation to the volumes of temporal lobe and cerebellum. TM/VF was associated with volumes of 10 subcompartments. TM/VF was positively correlated with the volumes of left entorhinal cortex, right temporal pole and inferior temporal gyrus related to cognition (p

The objective of this study is to evaluate the maternal and neonatal outcomes of parturients attempting trial of labor (TOL) after two previous CD versus those who had an elective third repeat CD. A retrospective computerized database cohort study was conducted at a single tertiary center between 2005 and 2019. Various maternal and neonatal outcomes were compared between parturients attempting TOL after two CD versus parturients opting for elective third repeat CD. TOL after two CD was allowed only for those who met all the criteria of our departments’ protocol. Parturients with identified contraindication to vaginal delivery were excluded from the analysis. A univariate analysis was conducted and was followed by a multivariate analysis. A total of 2719 eligible births following two CD were identified, of which 485 (17.8%) had attempted TOL. Successful vaginal delivery rate following two CDs was 86.2%. Uterine rupture rates were higher among those attempting TOL (0.6% vs 0.1% p = 0.04). However, rates of hysterectomy, re-laparotomy, blood product infusion, and intensive care unit admission did not differ significantly between the groups. Neonatal outcomes following elective repeat CD were less favorable (specifically, neonatal intensive care unit admission and composite adverse neonatal outcome). Nonetheless, when controlling for potential confounders, an independent association between composite adverse neonatal outcome and an elective repeat CD was not demonstrated. In a subgroup analysis, diabetes mellitus and hypertensive disorders of pregnancy were found independently associated with failed TOLAC. When following a strict protocol, TOL after two CD is a reasonable alternative and associated with favorable outcomes.

Objective A computer vision method was developed for estimating the trunk flexion angle, angular speed, and angular acceleration by extracting simple features from the moving image during lifting. Background Trunk kinematics is an important risk factor for lower back pain, but is often difficult to measure by practitioners for lifting risk assessments. Methods Mannequins representing a wide range of hand locations for different lifting postures were systematically generated using the University of Michigan 3DSSPP software. A bounding box was drawn tightly around each mannequin and regression models estimated trunk angles. The estimates were validated against human posture data for 216 lifts collected using a laboratory-grade motion capture system and synchronized video recordings. Trunk kinematics, based on bounding box dimensions drawn around the subjects in the video recordings of the lifts, were modeled for consecutive video frames. Results The mean absolute difference between predicted and motion capture measured trunk angles was 14.7°, and there was a significant linear relationship between predicted and measured trunk angles ( R2 = .80, p < .001). The training error for the kinematics model was 2.3°. Conclusion Using simple computer vision-extracted features, the bounding box method indirectly estimated trunk angle and associated kinematics, albeit with limited precision. Application This computer vision method may be implemented on handheld devices such as smartphones to facilitate automatic lifting risk assessments in the workplace.

Background Susac syndrome (SuS) is a rare condition characterized by a clinical triad of sensorineural hearing loss, branch artery occlusion and encephalopathy. This study reports an increased incidence of SuS in Israel. We describe the clinical characteristics of these patients, diagnostic procedures and the use and subsequent outcomes of newly published treatment guidelines. Methods This is a single center retrospective study. Patients who were diagnosed with SuS between July 2017 and August 2018 were enrolled in this study. Results Seven patients were diagnosed with SuS according to the diagnostic criteria in a time period of 13 months. The annual incidence was recently evaluated in Austria to be 0.024/100000, therefore, our case series represent at least a 5.4- fold increase in the annual incidence of SuS expected in Israel and a 7-fold increase in the annual incidence expected in our medical center. Mean time from the onset of the symptoms to diagnosis was three weeks and follow-up time was twenty four months. Recent exposure to cytomegalovirus was serologically evident in three patients and one patient had high titer of anti-streptolysin antibody. All patients underwent brain MRI, fluorescein angiography and audiometry. All patients were treated according to the newly recommended guidelines. All patients achieved clinical and radiological stability. Conclusions We report of an increased incidence of SuS in Israel. Infectious serological findings may imply a post infectious mechanism. The use of the recommended diagnostic procedures reduced the time to diagnosis. Newly published treatment guidelines led to favorable clinical outcomes.

To evaluate success rates of vaginal birth after cesarean (VBAC) and maternal and neonatal outcomes associated with trial of labor after cesarean in grand multiparous women.A retrospective computerized data base study was conducted at a single tertiary center, between 2005 and 2019. The study compared the maternal and neonatal outcomes of trial of labor after cesarean delivery in grand multiparous women (parity ≥ 6) as compared to multiparous women (parity: 3-5). Comparison analysis was performed by univariate analysis and followed by adjusted multiple logistic regression models.During the study period we identified 2749 and 4294 cases of trial of labor after cesarean in grand multiparous and multiparas, respectively. VBAC was observed in 94.6% of the grand multiparous as compared to 96.5% in the multiparous group,Trial of labor after cesarean in grand multiparous women is associated with favorable maternal and neonatal outcomes. Consideration and awareness should be given for the increased risk for postpartum hemorrhage, not associated with uterine rupture.

Achieving a sufficient level of functional ambulation remains to be a challenge to most stroke survivors. Different modes of transcranial direct current stimulation (tDCS) have been applied for improving various aspects of walking and mobility following stroke. However, systematic reviews before 2017 provided only general effects of tDCS on limited walking outcomes. Therefore, the aims of this study were to update the evidence of tDCS for improving walking and mobility after stroke with emphasis on individual outcomes and to delineate the effects of different modes of tDCS in subgroup analysis. The systematic search of PubMed, Medline, PEDro, Scopus, and Cochrane databases for studies published up to January 2019 identified 14 eligible reports. The PEDro scale indicated a good methodological quality of the included studies (score 6.8). The meta-analysis of primary outcomes revealed that active tDCS had no better effect than sham on walking speed [n = 7, standardized mean difference (SMD) = 0.189, P = 0.252] and 6-minute walking distance (n = 3, SMD = 0.209, P = 0.453). Among the secondary outcomes, significant positive effects were found on functional ambulation category (FAC) (n = 5, SMD = 0.542, P = 0.008), Rivermead Mobility Index (n = 3, SMD = 0.699, P = 0.008), and timed up and go test (TUG) (n = 5, SMD = 0.676, P = 0.001), whereas non-significant positive effects were found on Tinetti test (n = 3, SMD = 0.441, P = 0.062) and Berg Balance Scale (n = 2, SMD = 0.408, P = 0.177). In subgroup analyses, anodal tDCS had significant positive effects on FAC (n = 4, SMD = 0.611, P = 0.005) and dual-hemispheric tDCS on TUG (n = 2, SMD = 1.090, P = 0.000). The results provide up-to-date evidence of variable effects of tDCS on walking and functional mobility after stroke.

Though detectors based on deep networks have witnessed a significant boost in pedestrian detection performance, small-scale pedestrian detection remains to be a challenging task. To this end, the authors propose a scale prediction method to eliminate the dependence of most existing detectors on pre-defined anchor boxes. Due to projective transformation, a pedestrian standing afar will appear smaller than one standing closeby. For a stationary surveillance camera, different blocks on the image correspond to the views of various depths leadings to diverse sizes of object proposals. A neural network structure is developed to empirically estimate the size of a pedestrian candidate in the pixel coordinates given its central location. Comprehensive sets of experiments on two real-world datasets demonstrate that the proposed method achieves superior performance with state-of-the-art methods. Besides, significant performance advantages on small pedestrian detection are observed.

Gene augmentation therapy based on subretinal delivery of adeno-associated viral (AAV) vectors is proving to be highly efficient in treating several inherited retinal degenerations. However, due to potential complications and drawbacks posed by subretinal injections, there is a great impetus to find alternative methods of delivering the desired genetic inserts to the retina. One such method is an intravitreal delivery of the vector. Our aim was to evaluate the efficacy of two capsid-modified vectors that are less susceptible to cellular degradation, AAV8 (doubleY-F) and AAV2 (quadY-F+T-V), as well as a third, chimeric vector AAV[max], to transduce photoreceptor cells following intravitreal injection in sheep. We further tested whether saturation of inner limiting membrane (ILM) viral binding sites using a nonmodified vector, before the intravitreal injection, would enhance the efficacy of photoreceptor transduction. Only AAV[max] resulted in moderate photoreceptor transduction following intravitreal injection. Intravitreal injection of the two other vectors did not result in photoreceptor transduction nor did the saturation of the ILM before the intravitreal injection. However, two of the vectors efficiently transduced photoreceptor cells following subretinal injection in positive control eyes. Previous trials with the same vectors in both murine and canine models resulted in robust and moderate transduction efficacy, respectively, of photoreceptors following intravitreal delivery, demonstrating the importance of utilizing as many animal models as possible when evaluating new strategies for retinal gene therapy. The successful photoreceptor transduction of AAV[max] injected intravitreally makes it a potential candidate for intravitreal delivery, but further trials are warranted to determine whether the transduction efficacy is sufficient for a clinical outcome.

Housing frenzies in China have attracted widespread global attention over the past few years, but the key is how to more accurately forecast housing prices in order to establish an effective real estate policy. Based on the ubiquitousness and immediacy of Internet data, this research adopts a broader version of text mining to search for keywords in relation to housing prices and then evaluates the predictive abilities using machine learning algorithms. Our findings indicate that this new method, especially random forest, not only detects turning points, but also offers prediction ability that clearly outperforms traditional regression analysis. Overall, the prediction based on online search data through a machine learning mechanism helps us better understand the trends of house prices in China. First published online 10 June 2020