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Neuroendocrine neoplasms (NENs) are rare epithelial tumors with heterogeneous and frequently unpredictable clinical behavior. Available biomarkers are insufficient to guide individual patient prognosis or therapy selection. Peptidylglycine α-amidating monooxygenase (PAM) is an enzyme expressed by neuroendocrine cells that participates in hormone maturation. The objective of this study was to assess the distribution, clinical associations and survival implications of PAM immunoreactivity in primary NENs. Of 109 primary NENs, 7% were PAM-negative, 25% were PAM-low and 68% were PAM-high. Staining intensity was high in small bowel (p = 0.04) and low in stomach (p = 0.004) NENs. PAM staining was lower in higher grade tumors (p

Background Spinal AVF (SAVF), a potentially treatable cause of myelopathy, remains a challenging diagnosis. Its rarity and non-specific imaging findings often result in misdiagnosis despite a high index of clinical suspicion. The classically described high T2 signal in the spinal cord or prominent vascular flow voids in the intradural space were not infrequently missed on initial imaging, only to be picked up at follow-up imaging after progression of symptoms. Additionally, small sized fistulas( Case presentation First was a 50-year-old man presented with spastic paraparesis and was found to have an AVF at the cervical region arising from the vertebral artery. Second, a 45-year-old man with acute paraplegia post-operatively, initially treated for a transverse myelitis before lumbar region AVF was detected. Thirdly, a 27-year-old man presented with subacute lower thoracic myelopathy and deteriorated after corticosteroid treatment. The last patient, who initially appeared to have conus medullaris/cauda equina syndrome had a SAVF at the mid thoracic level. Presentation varied with some exhibiting acute deterioration mimicking other spinal cord pathology such as inflammatory disorders. All patients eventually underwent endovascular treatment with successful embolization of SDAVF. None of them exhibited further neurological deterioration after embolization. Conclusion Successful treatment of SAVF is possible provided the diagnosis is made early, allowing timely intervention. Certain clues may aid the diagnosis. Firstly, arteriovenous fistula can be located distant to the clinical localization of myelopathy resulting in the unexpected longitudinally extensive spinal cord signal change. This clinical-radiological discrepancy can be a useful clue in diagnosing SAVF. Secondly, an acute myelopathic presentation immediately post-surgery may be related to SAVF. Other SAVF feature of note includes progressive myelopathy mimicking immune-mediated myelitis among young adults below 30 years of age refractory to immune therapy.

Social support has been identified as a significant factor in addressing treatment barriers and facilitating treatment adherence. Using a descriptive design, this qualitative study aims at sharing personal feelings and social support-related experiences among pulmonary tuberculosis (TB) patients in Western India. A semi-structured interview guide was designed, and thirty-seven in-depth interviews were conducted. Descriptive thematic analysis was employed for reporting the themes and the results. The participants highlighted diverse social support experiences like empathy, compassion, trust, neglect, tangible aid, strained relationships with in-laws, health provider's support, strength, and motivation which influences their treatment adherent behaviour. Contrasting differences of social support experiences among adherent and non-adherent TB patients were also reported. The study has important ramifications for developing patient-centric social support intervention strategies, TB policy, and practice. The study has shown, 'if not for this support', patients would have left the treatment, and it is mainly because this debilitating disease robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered. However, we resonate that addressing social support is not the only way, and TB elimination overall will require an optimal mix of enhanced biomedical, social, economic, and policy interventions.

Retinal template matching and registration is an important challenge in teleophthalmology with low-cost imaging devices. However, the images from such devices generally have a small field of view (FOV) and image quality degradations, making matching difficult. In this work, we develop an efficient and accurate retinal matching technique that combines dimension reduction and mutual information (MI), called RetinaMatch. The dimension reduction initializes the MI optimization as a coarse localization process, which narrows the optimization domain and avoids local optima. The effectiveness of RetinaMatch is demonstrated on the open fundus image database STARE with simulated reduced FOV and anticipated degradations, and on retinal images acquired by adapter-based optics attached to a smartphone. RetinaMatch achieves a success rate over 94\% on human retinal images with the matched target registration errors below 2 pixels on average, excluding the observer variability. It outperforms the standard template matching solutions. In the application of measuring vessel diameter repeatedly, single pixel errors are expected. In addition, our method can be used in the process of image mosaicking with area-based registration, providing a robust approach when the feature based methods fail. To the best of our knowledge, this is the first template matching algorithm for retina images with small template images from unconstrained retinal areas. In the context of the emerging mixed reality market, we envision automated retinal image matching and registration methods as transformative for advanced teleophthalmology and long-term retinal monitoring.

Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [ 1 ]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [ 2 ], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [ 3 ], with further data easily accessible in electronic searches or textbooks.

It has been demonstrated that very simple attacks can fool highly-sophisticated neural network architectures. In particular, so-called adversarial examples, constructed from perturbations of input data that are small or imperceptible to humans but lead to different predictions, may lead to an enormous risk in certain critical applications. In light of this, there has been a great deal of work on developing adversarial training strategies to improve model robustness. These training strategies are very expensive, in both human and computational time. To complement these approaches, we propose a very simple and inexpensive strategy which can be used to ``retrofit'' a previously-trained network to improve its resilience to adversarial attacks. More concretely, we propose a new activation function---the JumpReLU---which, when used in place of a ReLU in an already-trained model, leads to a trade-off between predictive accuracy and robustness. This trade-off is controlled by the jump size, a hyper-parameter which can be tuned during the validation stage. Our empirical results demonstrate that this increases model robustness, protecting against adversarial attacks with substantially increased levels of perturbations. This is accomplished simply by retrofitting existing networks with our JumpReLU activation function, without the need for retraining the model. Additionally, we demonstrate that adversarially trained (robust) models can greatly benefit from retrofitting.

Idiopathic pulmonary fibrosis (IPF) is a rare and fatal restrictive respiratory disease under the idiopathic lung disease (ILD) class. IPF is a form of chronic, progressive fibrosing interstitial pneumonia and has more scarring, less inflammation, and poorer prognosis than most other ILD forms. Exacerbation of IPF is rapid, with unpredictable deterioration of lung function, and is associated with short-term mortality. The American Thoracic Society (ATS) evidence-based guidelines for diagnosis and management of IPF reports that the incidence of acute exacerbations is between 5%-10%. Limited real-world evidence has been identified in the United States that assesses patterns of hospitalization, exacerbation of IPF, and the associated economic burden.To (a) characterize patients newly diagnosed with IPF and (b) examine incidence rates and costs of all-cause hospitalizations, IPF-related hospitalizations, and exacerbations.A retrospective analysis was performed with a national commercial claims database from calendar years 2006 to 2011. Newly diagnosed IPF patients were identified with either ≥ 2 claims for idiopathic fibrosing alveolitis (IFA) or ≥ 1 claim for IFA and ≥ 1 claim for postinflammatory pulmonary fibrosis and a lung biopsy or thoracic high-resolution computed tomography within 90 days of the first claim for IFA (index date). IPF-related hospitalizations and possible IPF exacerbations were defined based on diagnoses recorded on event claims. Frequency, incidence rate, duration of events, and associated costs from the third-party payer's perspective were estimated.Among 1,735 identified IPF patients, 38.6% had at least 1 all-cause hospitalization; 10.8% had IPF-related hospitalizations; 4.6% had suspected IPF exacerbations leading to hospitalization; and 72.1% had suspected IPF exacerbations leading to urgent outpatient visits during the 1-year post-index period. Incident rates for these 4 events were 83 (95% CI = 79-88), 17 (95% CI = 14-19), 7 (95% CI = 6-9), and 277 (95% CI = 269-286) per 100 person-years, respectively. Average costs per event were $13,987 (SD = $41,988), $16,812 (SD = $66,399), $14,731 (SD = $85,468), and $444 (SD = $1,481), respectively.Hospitalizations and possible exacerbations among patients with IPF were costly. Appropriate management of IPF needs to be considered to help slow IPF disease progression.Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) provided funding for this study. Yu and Devercelli are currently salaried employees of BIPI. Wu, Chuang, Wang, Pan, and Benjamin are currently employees of Evidera, which provides consulting and other research services to pharmaceutical, device, government, and nongovernment organizations. In their salaried positions, they work with a variety of companies and organizations and are precluded from receiving payment or honoraria directly from these organizations for services rendered. Evidera received funding from BIPI to conduct the analysis. Coultas was previously a paid consultant of BIPI. The contents do not represent the views of the Department of Veterans Affairs or the U.S. government. This manuscript does not contain clinical studies or patient data. The authors have full control of all primary data, and they agree to allow the journal to review their data if requested. All authors meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors, and they are fully responsible for all content and editorial decisions and were involved at all stages of manuscript development. The manuscript was drafted by Benjamin, Wu, and Yu and revised by Wang, Pan, Yu, Coultas, and Devercelli. The study was designed by Yu, Wu, Chuang, Wang, Benjamin, and Coultas. Statistical analysis was conducted by Wu, Chuang, and Wang. Senior review was provided by Coultas and Devercelli.

Background. Human immunodeficiency virus (HIV) infection can negatively affect the exercise endurance of children. There is a lack of studies investigating the effects that home exercise programmes (HEPs) have on the exercise endurance of children in South Africa who are HIV infected. Objective. To investigate the effects of a HEP on the exercise endurance of children infected with HIV. Methods. The study was conducted at a paediatric HIV treatment clinic in Johannesburg. Sample size calculations were done using the Excel sample size calculator for continuous variables. Participants were randomised into two groups using a random number table. One group underwent a 12-week HEP while the control group continued with standard care. Exercise endurance was assessed using the sixminute walk test (6MWT) at baseline and after 12 weeks. The total distance walked was compared between groups. Results. Sixty-two children infected with HIV between the ages of seven and nine years were enrolled. After 12 weeks, the distance walked by children who had done the HEP increased, but no significant differences were found between and within the groups’ six-minute walk distance (6MWD) at baseline or at 12 weeks’ follow-up. Boys walked significantly further than girls (boys: 449.15 m; girls: 412.46 m, p =0.04) at baseline, regardless of the group. Conclusion. There was no significant difference in walking distance between the two groups. A HEP with different components and of longer duration may yield better results. Further research is needed on the impact that a HEP could have on the exercise endurance of South African children infected with HIV

We introduce a new set of algorithmic tools capable of producing scalable, low-rank decompositions of global spatio-temporal atmospheric chemistry data. By exploiting emerging randomized linear algebra algorithms, a suite of decompositions are proposed that extract the dominant features from big data sets (i.e. global atmospheric chemistry at longitude, latitude and elevation) with improved interpretability. Importantly, our proposed algorithms scale with the intrinsic rank of the global chemistry space rather than the ever increasing spatio-temporal measurement space, thus allowing for efficient representation and compression of the data. In addition to scalability, two additional innovations are proposed for improved interpretability: (i) a non-negative decomposition of the data for improved interpretability by constraining the chemical space to have only positive expression values (unlike PCA analysis), and (ii) sparse matrix decompositions, which thresholds low-correlations to zero, thus highlighting the dominant, localized spatial activity (again unlike PCA analysis). Our methods are demonstrated on a full year of global chemistry dynamics data, showing its significant improvement in computational speed and interpretability. We show that the here presented decomposition methods successfully extract known major features of atmospheric chemistry, such as summertime surface pollution and biomass burning activities. Indeed, we find that the full annual model output can be reconstructed using only 50–100 principal modes, suggesting that the presented methods offer the potential to archive model data of atmospheric chemistry with compression factors in the range of 200–4000 or greater. In the emerging area of big data, specifically global chemistry monitoring, such technologies are critically enabling for real-time and computationally tractable diagnostics of both large scale simulation and measurement data.

Fluorescence angiography (FA) is widely used for studying and diagnosing abnormalities in the retinal blood circulation, but has associated risks of nausea, skin irritation, and even death. We describe a new non-invasive angiography technique: Blood Oxygenation Modulation Angiography, in which multispectral imaging of a transient perturbation in blood-oxygen saturation, yields angiography sequences similar to FA, including key features such as sequential filling of choroidal and retinal-vessels, which underpin assessment of circulation health. This is the first non-invasive angiography technique capable of visualizing these circulation features.

There is not longtime that everywhere in the world energy needs have considerably increased, mainly due to the growing global population. This has pushed governments all over the world to focus on finding a better, why not reinventing the actual power grid in order to match these complex challenges. Existing grids are under metamorphosis to match the growing demand of energy, as well as ensuring a stable and sustainable supply of energy. Collecting the necessary and accuracy data from the power grid is one of the most important challenges when dealing with this issue. The use of Information and Communications Technology (ICT) is one of the best ways to gather all the needful data to overcome this issue. Results presented in this work are partly based on a real hardware/software study case implementation, where CSMA/CA technics are used to achieve significant improvement in interference management for multiple access on telemetering band, and White-Fi to overcome the problem of throughput and range of radio transmissions on telemetering band.

Many people in the world do not have access to electricity, a majority of them lives in rural areas that are not yet covered by the main electrical grid and may not be covered in the short term. Faced with this situation, off-grid solutions have been developed. They allow electrification outside the main electrical grid and take two main forms. Indeed, there are two types of off-grid solution: the Mini-grid and the Solar Home System SHS. The main focus of this article is to propose a new collaborative street Public Lighting system (PL) based on Bin Packing algorithm aiming to show how our proposed system can reduce significantly the energy consumption while feeding our SHS-PL collaborative system composed of the smart home and its associated public streetlamp in a rural environment. This article presents also new smart storage algorithms, which guaranty the SHS-PL energy capacity while reducing the size and the cost of battery and the renewable energy sources infrastructure. The solutions proposed in this paper are economic and inclusive, making possible, and at a low cost, to open up rural areas, and allowing them access to clean electricity and enabling them to develop local activities in line with sustainable development and thus contribute to limiting rural exodus.

Background: Dental caries is a very common disease, and this study was conductedto identify the optimum concentration of a homemade dental powder that could be used to prevent dental caries. The formulation for this dental powder was inspired from an ancient Indian powder which is still being used in remote areas where modern dentifrices are not available. The dental powder is homemade, with its four main constituents being alum, turmeric, cloves and salt all ground into a fine powder . Objective: The aim of the study was to study the effect of a homemade dental powder on a population of Streptococcus mutans. Study design: This was arandomized controlled laboratory study. Setting: The study was carried out in the histopathology laboratory, School of Dental Sciences, University of Nairobi. Materials and methods: Streptococcus mutans were cultured and the disc diffusion technique employed, where the discs had various concentrations of the dental powder, alum, turmeric, cloves and salt, which was made by titrating with distilled water so as to form a spectrum of concentrations. The diameters of the clear zones on the agar plates were then measured to assess the effect of the dental powder on the bacterial population. Results: At a concentration of 5 g/100 ml, the alum and salt showed clear zones of 5 mm which is equivalent to that of the negative control. The clear zone of the dental powder, turmeric and cloves was greater than that of distilled water, but less than that of the 2% chlorhexidine (14.6 mm). At 7.5 g/100 ml and 10 g/100 ml, salt still had a clear zone of 5 mm, and the rest of the ingredients had clear zones of greater than 5 mm, but less than 14.6 mm. At 12.5 g/100 ml, all ingredients had clear zones of greater than 5mm, and those of the dental powder and cloves were greater than 14.6 mm, while at 15 g/100 ml, in addition to cloves and powder, salt also had a clear zone of greater than 14.6 mm. Conclusion: The dental powder, alum, turmeric, cloves and salt all showed antimicrobial activity against Streptococcus mutans. The dental powder showed highest activity, followed by cloves, salt, alum and turmeric.

Sparse principal component analysis (SPCA) has emerged as a powerful technique for modern data analysis, providing improved interpretation of low-rank structures by identifying localized spatial structures in the data and disambiguating between distinct time scales. We demonstrate a robust and scalable SPCA algorithm by formulating it as a value-function optimization problem. This viewpoint leads to a flexible and computationally efficient algorithm. Further, we can leverage randomized methods from linear algebra to extend the approach to the large-scale (big data) setting. Our proposed innovation also allows for a robust SPCA formulation which obtains meaningful sparse principal components in spite of grossly corrupted input data. The proposed algorithms are demonstrated using both synthetic and real world data, and show exceptional computational efficiency and diagnostic performance.

Objective: The aim of the study was to determine the compliance to infection control of various dental laboratories in Durban. Study design: This was a qualitative survey. Setting: Dental laboratories in Durban area, South Africa. Subject: Registered laboratory technicians. Study methodology: Convenient random sampling method was used. Results: There was poor compliance to infection control procedures by most dental laboratories. Majority, 66.67%, of the dental laboratories relied on dental clinics for disinfection of dental impressions; therefore, they did not disinfect the impressions. On the other hand, only 33.33% carried out disinfection of dental impressions on their own. A high number (53.3%) of the respondents had disinfection areas within their dental laboratories, 6.7% had no disinfection areas while 40% depended upon dental clinics for all disinfections. About 60% of the dental technicians had valid vaccinations against Hepatitis B Virus while 40% had no vaccination against HBV. Conclusion: The results of this study indicated that there was substantial nonconformity to infection control measure in all dental laboratories. There should be comprehensive inspection of dental laboratories prior to licensing and thereafter by the South African Dental Technician Council’s inspectors to ensure that all dental laboratories comply with the various infection control measures.

We demonstrate a heuristic algorithm to compute the approximate low-rank singular value decomposition. The algorithm is inspired by ideas from compressed sensing and, in particular, is suitable for image and video processing applications. Specifically, our compressed singular value decomposition (cSVD) algorithm employs aggressive random test matrices to efficiently sketch the row space of the input matrix. The resulting compressed representation of the data enables the computation of an accurate approximation of the dominant high-dimensional left and right singular vectors. We benchmark cSVD against the current state-of-the-art randomized SVD and show a performance boost while attaining near similar relative errors. The cSVD is simple to implement as well as embarrassingly parallel, i.e, ideally suited for GPU computations and mobile platforms.

Introduction/Background Functional electrical stimulation (FES) can be used on individuals with upper motoneuron dysfunctions to restore grasping functions. To be functional and useful in daily tasks, the patient must be able to pilot the device by means of an interface. We have investigated two techniques that could address the situation of persons with tetraplegia: electromyography (EMG) and inertial measurement units (IMU), respectively measuring muscle activity and limb movements. Material and method One group of 8 tetraplegic patients (EMG group) was equipped with two pairs of EMG electrodes located on muscles of the upper arm. Selected muscles could be voluntary activated in a comfortable way. Another group of 9 tetraplegic patients (IMU group) was equipped with one IMU (3-axis accelerometer and 3-axis gyroscope) located on the arm. In the EMG group a threshold detection algorithm was used to detect muscle contractions while in IMU group a classification algorithm was used to detect two distinct movements of the limb where the IMU was located. The detection algorithms outputs were used to trigger two postures of a robot hand. The same outputs were also used, for patients where FES of arm muscles lead to visible hand movements, to trigger the contractions of two muscles on their contralateral lower arm. Results All the patients were able to control muscle contraction or limb movements to trigger different actions. Patients were asked to control the robotic hand, following a randomized sequence of two pre-defined postures. In EMG group the success score was of 95 and 92% in IMU group. Whenever FES was used, patients could activate grasping movements and wrist extension. Three patients were able to perform functional tasks such as grasping and relocating objects. Conclusion Despite little training, all the patients were able to voluntarily control a robotic hand and, when it was possible to test, their own hand with FES.

Primary cerebellar glioblastoma (CGB) comprises only 0.4–3.4% of all intracranial glioblastoma. The impact of surgical resection on survival and the efficacy of adjuvant therapies are uncertain as CGB is underrepresented in most studies. To elucidate prognostic factors we performed a single-institutional review of the largest series to date of CGB. The University of Texas MD Anderson Cancer Center database was reviewed from 1990 to 2010. Twenty-one consecutive patients met criteria for inclusion. The Kaplan–Meier product limit method was used to estimate overall survival (OS) and progression-free survival (PFS); groups were compared using the log-rank statistic. The multivariate Cox proportional hazards models were fitted to examine the association of resection with OS and PFS adjusted for other clinical variables. The median age was 39.9 years, and Karnofsky performance status (KPS) was ≥80 in 61.5% of patients. The mean extent of resection for contrast enhancement (EOR-CE) was 93.8% (SD = 10.4%; median = 100%), and the median follow-up was 18.4 months (range 1.5–116.1 months). There was no significant association of EOR with OS or PFS. On univariate analysis the presence of leptomeningeal disease (LMD) was associated with a worse OS (6.1 vs. 24.1 months; P = 0.0001) and PFS (3.3 vs. 9 months; P = 0.019). Patients who had adjuvant chemotherapy (CT) had extended PFS (10.1 vs. 2.8 months; P < 0.0001). Adjustment for the presence of leptomeningeal disease (LMD) tended toward an increased risk of progression (HR = 3.46; 95% confidence interval [CI], 0.83–14.5; P = 0.09) and was associated with a significantly increased risk of death (HR = 15.2; 95% CI, 1.3–180; P = 0.03). Having received adjuvant chemotherapy was associated with a decreased risk of progression (HR = 0.02; 95% CI, 0–0.26; P = 0.003). The presence of LMD is a critical factor in the clinical behavior of CGB resulting in markedly decreased OS and PFS. Adjuvant CT resulted in increased PFS but did not significantly affect OS. This was due to a lack of a sizable cohort who did not receive chemotherapy. Furthermore, three of the CT-naive patients received CT at first progression. In the context of the high EOR in this study, an OS of 18.4 months was achieved.

Proton pump inhibitor (PPI) use increases the risk of Clostridium difficile infection (CDI) despite C. difficile spores being acid resistant. Swallowed saliva contains nitrite which reacts with gastric acid, producing bactericidal nitrogen oxides. With 5mM nitrite at pH 2 (reflecting normal gastric conditions) all C. difficile spores were killed within 15 min. No reduction in count was seen with the same nitrite concentration at pH 5, representing gastric conditions in patients taking PPIs, even after 60 min. Reduced gastric acidification of salivary nitrite may explain the increased risk of CDI in patients taking PPIs.

More and more home owners fit their homes with renewable energy sources. Thus, to capitalize this, they are willing to install intelligent energy management systems to try to reduce their energy bills, which requires optimal use of energy. To deal with this, this paper presents two energy management algorithms, all based on the principle of the bin packing problem. The proposed solutions are built on prioritizing the use of renewable energy produced locally over energy provided by the main grid. A well detailed simulation was carried out to highlight the contribution of the implementation of this solution in a smart home located in Casablanca, Morocco, whose energy needs are from a daily approximation of the habits of the city residents. Moreover, a comparison between the two algorithms was made to showcase the benefits of each, and their difference.

This paper introduces a fast algorithm for randomized computation of a low-rank Dynamic Mode Decomposition (DMD) of a matrix. Here we consider this matrix to represent the development of a spatial grid through time e.g. data from a static video source. DMD was originally introduced in the fluid mechanics community, but is also suitable for motion detection in video streams and its use for background subtraction has received little previous investigation. In this study we present a comprehensive evaluation of background subtraction, using the randomized DMD and compare the results with leading robust principal component analysis algorithms. The results are convincing and show the random DMD is an efficient and powerful approach for background modeling, allowing processing of high resolution videos in real-time. Supplementary materials include implementations of the algorithms in Python., Preprint submitted to Journal of Computer Vision and Image Understanding

We demonstrate that the integration of the recently developed dynamic mode decomposition with a multi-resolution analysis allows for a decomposition of video streams into multi-time scale features and objects. A one-level separation allows for background (low-rank) and foreground (sparse) separation of the video, or robust principal component analysis. Further iteration of the method allows a video data set to be separated into objects moving at different rates against the slowly varying background, thus allowing for multiple-target tracking and detection. The algorithm is computationally efficient and can be integrated with many further innovations including compressive sensing architectures and GPU algorithms.

Agricultural extension is designed to increase farmers’ productivity and well-being through the adoption of improved agricultural extension technological recommendations. Against this background, the study was conducted to determine the effect of adoption of agricultural extension recommendations on the resourcepoor farmers’ income from yam. In conducting the study, 180 yam farmers from Cross River State were randomly selected through multi-stage stratified random sampling technique. The data collected were analyzed using linear correlation and regression analysis at 5% level. The study showed that agricultural extension through farmers’ adoption of technological recommendations significantly increased farmers’ income from yam. The null hypothesis that agricultural extension does not increase farmers’ income from yam significantly was rejected, while the alternative hypothesis was accepted.

Nitric oxide (NO) may be generated and delivered into the skin via a novel system of sodium nitrite and ascorbic acid. This placebo-controlled, double-blind trial compared the analgesic properties of this system alone and when supplemented with lidocaine. The pain of dorsal hand vein cannulation was assessed in 100 volunteers. The NO-generating system was prepared by mixing two gels, the first KY jelly and sodium nitrite (10% w/v), the second KY jelly and ascorbic acid (10% w/v). NO-generating gel was the placebo treatment, and when combined with lidocaine (final concentration 5%), formed the active treatment. The gels were applied to the dorsum of the hands bilaterally and simultaneously for 10 min. Following cannulation, pain perception was measured with a verbal rating score (VRS) and a visual analogue score (VAS). The active formulation significantly decreased the VRS (p 40% compared with placebo (p < 0.001). This investigation suggests a 10-min topical application of anaesthetic combined with the NO-generation system may provide effective analgesia for venous cannulation in adults.

Few studies have characterized healthcare resource utilization among patients with idiopathic pulmonary fibrosis. The objective of this study is to assess healthcare resource utilization among patients with idiopathic pulmonary fibrosis as compared to members without this condition.Patients newly diagnosed with idiopathic pulmonary fibrosis were identified from a national administrative claims database (2006-2011) as having ≥ 2 claims with idiopathic fibrosing alveolitis, or ≥ 1 claim with idiopathic fibrosing alveolitis and ≥ 1 claim with post-inflammatory pulmonary fibrosis (earliest claim with idiopathic fibrosing alveolitis denoted the index date), a procedure of lung biopsy or high-resolution computed tomography within ± 90 days of the index date, 12-month pre-index continuous enrollment, plus ≥ 2 confirmatory idiopathic fibrosing alveolitis diagnoses after the procedure. For each idiopathic pulmonary fibrosis patient, three members without the condition were matched by age/gender/region/payer type. Demographic/clinical characteristics were measured during the 1-year pre-index period. Healthcare resource utilization was assessed by quarter during 1-year pre- and post-index periods. Generalized estimating equation models controlling for patient characteristics were constructed to estimate adjusted post-index healthcare resource utilization.In total, 1735 patients with idiopathic pulmonary fibrosis and 5205 without (mean age = 71.5 years; 46.1% female) were included. Adjusted results revealed idiopathic pulmonary fibrosis patients were more likely to use healthcare resources than members without the condition 1-year post-index (number of hospitalizations, emergency room visits, and outpatients visits: 0.63 vs 0.31, 0.62 vs 0.48, and 5.7 vs 3.1 per person-year, respectively).Healthcare resource utilization is considerably higher among patients with idiopathic pulmonary fibrosis than members without the condition. Effective treatments for patients with idiopathic pulmonary fibrosis are needed to help reduce burden of healthcare resource use.

Presently energy consumption is increasing very fast due to many reasons. The worldwide population growth, the huge industrialization that the world is undergoing and the betterment of our well-being never cease to increase our daily energy needs. All these make energy one of the biggest challenges that the world knows today. The fact that we consider energy as a service has led us to an evolution of the classic electrical grid by turning everything in an intelligent way. This paper introduces a new energy management strategy based on the use of a smart vehicle as an energy source. In particular we focused on the use of fuel cell to offer a backup solution when renewable sources such as solar and wind cannot compensate all the energy needs of a household.

Introduction: Glucocorticoid-remediable aldosteronism (GRA) is a rare inherited cause for hypertension associated with a significant morbidity and mortality at an early age. Individuals with this abnormality frequently present with severe hypertension which is resistant to standard antihypertensive therapy, a strong family history of hypertension, intracranial haemorrhage, and sporadic hypokalaemia. However many affected individuals may appear phenotypically indistinguishable from normal essential hypertensives but remain at high risk of morbidity and mortality. Objective: To determine how effective random or targeted screening of hypertensive patients is for the detection of GRA. Design: A prospective study involving the screening of 300 hypertensive patients chosen at random attending the Aberdeen Hypertension Clinic and, during the same period, the targeted screening of patients with a medicaland family history suggestive of GRA. Setting: A University hospital with a primary catchment of 500000 inhabitants and a hypertension clinic population of over 8500 patients. Results: Random screening failed to identify any GRA mutation-positive individuals. Targeted screening of selected individuals revealed two index families and four further families containing 40 mutation-positive individuals. Conclusion: Targeted screening of hypertensive individuals with a family history of hypertension, cerebral haemorrhage, a history of hypertension from an early age, resistant hypertension which has proven difficult to control and hypokalaemia revealed two index cases and four further individuals and 30 hypertensive and 10 normotensive members of their families with GRA.

BACKGROUNDThere is evidence that endogenous nitrate synthesis is notably increased in patients with infective gastroenteritis.AIMSTo determine whether this is due to nitric oxide (NO) production via the l-arginine/NO pathway.METHODSSeven male patients with community acquired bacterial gastroenteritis and 15 healthy male volunteers participated in this study. All patients had stool culture positive infective gastroenteritis. A bolus of 200 mgl-[15N]2-arginine was administered intravenously after an overnight fast. Urine was collected for the next 36 hours. Urinary [15N:14N]nitrate ratio was assessed by dry combustion in an isotope ratio mass spectrometer.RESULTSMean 36 hour total urinary nitrate excretion in the gastroenteritis group was 5157 (577) μmol compared with 2594 (234) μmol in the control group (p15N]nitrate excretion was considerably higher in the gastroenteritis group compared with the control group (13782 (1665) versus 1698 (98) ηmol; p15N]nitrogen administered (p15N]nitrate excretion for urinary creatinine was also significantly higher in the patient compared with the control group (1934 (221) versus 303 (35) ηmol/mmol; pCONCLUSIONResults show notably enhanced nitrate synthesis due to increased activity of thel-arginine/NO pathway in patients with infective gastroenteritis.

This book deals with corporate social responsibility of Tata Steel which is over one hundred years old. The company has been involved in social welfare activities almost from the beginning and, therefore, its study from this angle was long over-due.

The consultants agree that surgery is a common cause of unilateral vocal cord paralysis in neonates. In the absence of a history of surgery, they would evaluate a neonate for cardiovascular or central nervous system anomalies. None believes a relationship between laryngomalacia and vocal cord paralysis exists. But there is disagreement regarding the additional steps required to evaluate this child. The recommendations include endoscopy under general anesthesia with assessment of cricoarytenoid mobility, evaluation for other congenital anomalies, and observation of laryngeal dynamics (Dr. Benjamin), neurologic examination (Dr. Bailey), and no further testing (Dr. Gray). Laryngeal EMG in an infant is not an established technique and none of the consultants routinely performs this test. However, EMGs are part of the research protocol for one physician (Dr. Gray). The consensus is that aspiration is unlikely to be a problem in this case. However, if aspiration does occur, all would recommend conservative treatment. Feedings should be thickened and anti-reflux precautions taken. None was convinced that severe aspiration would be a problem. However, given the need for more aggressive treatment, the considerations would include collagen or Teflon injections or a tracheotomy (Dr. Gray) or a Nissen fundoplication, nasogastric tube feedings, or a gastrostomy (Dr. Bailey). Only one consultant would defer further treatment (Dr. Benjamin). The prognosis is generally good. Two consultants (Drs. Benjamin and Bailey) would follow a child with vocal cord paralysis by periodically repeating a laryngoscopic examination. A reinnervation procedure would be considered by one consultant at the age of 3 if the voice remains weak (Dr. Gray).

It has been shown previously that 3D acquisition footprint can be attenuated either on time slices or on frequency slices by applying a wavenumber notch filter. We have recently experimented with wavenumber domain notch filtering on frequency slices on some commonly used data acquisition geometries from the Middle East and found out that this method can be used with all the geometries we have tested and with data of various geologic

Charging effects were investigated in an electron cyclotron resonance (ECR) plasma-enhanced CVD system using a variety of techniques including CHARM-2 wafers (Lukaszek et al, 1994), SPORT wafers (Roche and McVittie, 1996) and full device antenna structures. In this work, we show two factors affecting the potential at the wafer surface which can be correlated to conditions where severe plasma damage is expected to occur. The CHARM-2 wafer data detected both the time-averaged (DC) and time-varying (AC) potentials. The DC component is shown to be a function of the applied wafer bias power while the AC component appears to be related to a low frequency potential fluctuation (a possible instability in the microwave generated magnetized plasma). Both of these signals can be reduced by increasing the processing pressure. Processes with higher pressure result in improved device damage immunity.

Stress-induced gate leakage current (SILC) was used to evaluate plasma process-induced damage to ultra-thin gate oxide transistors. Even though the leakage currents increase as the oxide thickness decreases, the reliability of ultra-thin gate oxide (2.2 nm) is superior to the thicker oxides. No SILC was observed for the thinnest films, while thicker oxides show large SILC variation due to process-induced charging damage. The effect of different gate poly-Si etching processes in a high density TCP (transformer-coupled plasma) system were also evaluated. Only the gate that was etched with an abnormally high bias power overetch process, and connected to large connection ratio antenna shows SILC.

Summary Background Patients with Raynaud's syndrome have abnormal digital vasoconstriction, which may be secondary to impaired synthesis of, or impaired sensitivity to, nitric oxide. We studied the effect on microcirculation of a nitric-oxide-generating system applied topically to the finger and forearm of healthy volunteers and patients with primary Raynaud's syndrome. Methods We did a single-blind, randomised, placebocontrolled, cross-over study of the microcirculatory response to topical application of a nitric-oxide-generating gel in 20 patients with severe Raynaud's syndrome, and ten healthy volunteers. We prepared the nitric-oxide-generating system by mixing a solution of KY jelly and sodium nitrite (5% weight/volume), with a solution of KY jelly and ascorbic acid (5% weight/volume). About 0·5 mL of each solution was separately applied to the skin of the forearm (3 cm 2 ), and then mixed with a sterile cotton bud. A similar procedure was done simultaneously on the other arm with KY jelly only (placebo). The procedure was then repeated on the finger pulps. Changes in skin microcirculatory volume and flux were measured bilaterally by infrared photoplethysmography and laser doppler fluxmetry, respectively. Findings In the forearm, blood flow increased significantly after application of the active gel both in patients with Raynaud's syndrome (microcirculatory volume from mean area under the curve 98 [SE 14] to 1024 [130]; microcirculatory flux from 5060 [462] to 74 800 [3940]) and in healthy controls (volume from 85 [19] to 1020 [60]; flux from 4420 [435] to 84 500 [7000]). In the fingers, although baseline blood flow was lower in patients than in controls, both groups showed increases with application of active gel (volume from 1100 [194] to 3280 [672] and 2380 [441] to 6160 [1160], respectively; flux from 33400 [4200] to 108 000 [13 600] and 52 000 [8950] to 185 000 [19500]). Increases in blood flow with placebo gel were not significant. No adverse effects were reported. Interpretation In primary Raynaud's syndrome, topical application of a nitric-oxide-generating system can stimulate an increase in both microcirculatory volume and flux.

We examine a particular mechanism for surface charging during plasma processing, namely charged particle flux shadowing caused by surface topography. We derive an analytic model for the voltage drop across the gate oxide as a function of electron and ion shadowing and compare this mechanism's potential for inducing device damage to that caused by plasma density non-uniformity. The charge dose magnitude that can result from the shadowing mechanism is shown to be consistent with that required for damage to devices. 1. Iintroduction One thing to avoid while etching metal structures or depositing inter-layer dielectric is damage to the underlying gate oxide. Several groups have proposed models to describe how plasma nonuniformity',* and electron shadowing3 may cause device damage. En et uL2 used a circuit model to investigate if plasma non-uniformity could drive a curreint through the gate oxide, via the substrate and into the support chuck. He showed that damage can occur when plasma non-uniformity reaches orders of magnitude. Hashimoto et uL3 showed that devices can bie damaged even if the substrate is completely isolated from the chuck. They proposed that differential charging of metal structures due to electron shadowing can drive a damaging level of current through the device and back to the plasma via exposed substrate areas, as shown in Fig. 1. We combine this proposed mechanism with a simple device representation to arrive at an analytic expression for the dose of charge driven though the gate oxide, and hence the potential for damage.

Glucocorticoid remediable aldosteronism (GRA), an autosomal dominant cause of primary aldosteronism, has been described as resulting in severe hypertension with premature death from stroke. We describe two new large pedigrees which include subjects who have the abnormal chimaeric gene strongly linked to GRA. The majority of affected members, who have only mild hypertension and normal biochemistry, are clinically indistinguishable from patients with essential hypertension. It is therefore likely that this condition is underdiagnosed.

Child labour has been employed in India since time immemorial. But this subject came up for discussion after the beginning of modern industry, particularly the cotton textile industry in Bombay. The British industrialists spread exaggerated stories regarding the working conditions of child labourers. The government appointed commissions to make enquiries. It took action on their recommendations. It tried to ensure that very young children were not employed. Certifying doctors were to give certificates regarding their age. This stopped the employment of young children but up to a limit. Some millowners opened schools for the education of child labourers. But their efforts were not much of a success. The number of child labourers declined in 1920s.

Resistance vessel sensitivity to angiotensin II in vivo was studied in 13 primigravid normotensive women (16-24 weeks gestation), and in 10 non-pregnant control women. Angiotensin II was infused into the brachial artery at doses of 10, 100, 1,000 and 10,000 fmol min-1 and forearm blood flow measured by plethysmography. Reduction in forearm blood flow at all concentrations of angiotensin II was significantly greater in non-pregnant than in pregnant women. The dose-response relationships, plotted semi-logarithmically, were similar in shape in each group but sensitivity to angiotensin II was reduced in pregnant subjects compared with non-pregnant women. This is most simply explained by an effect of pregnancy on the sensitivity to angiotensin II of vascular smooth muscle in forearm resistance vessels.

BACKGROUND There is increasing evidence that neuropeptide Y (NPY) contributes to the autonomic control of the circulation. NPY coexists with noradrenaline in perivascular nerve terminals, may be released during sympathetic stimulation, and is a potent constrictor of the human coronary circulation and other vascular beds. In vitro studies show that NPY can act either directly on vascular smooth muscle or indirectly by modulation of the presynaptic release or the postsynaptic actions of noradrenaline. It is unclear to what extent these mechanisms operate in vivo. METHODS AND RESULTS The effect on forearm blood flow of intra-arterial NPY was studied in six volunteers during coinfusion of noradrenaline and during reflex sympathetic stimulation induced by lower-body negative pressure. NPY alone induced a dose-dependent reduction of forearm blood flow in all subjects studied, to a maximum of 49 +/- 6.1%. The reduction of flow during infusion of noradrenaline alone was 42 +/- 8%. The response to noradrenaline was unaffected by coinfusion of a threshold constrictor dose of NPY (50 pmol/min). Furthermore, the reflex sympathetic vasoconstrictor response to 20 cm H2O of lower-body negative pressure was similar in both the infused and control arms during the infusion of 50 pmol/min NPY. The response to noradrenaline was abolished by alpha-blockade with phentolamine, but the flow reduction induced by NPY was unaffected by alpha-blockade. CONCLUSIONS NPY is a potent constrictor of human forearm resistance vessels and has a direct effect independent of alpha-receptors. NPY has no detectable modulating effect in vivo on the action of endogenous or infused noradrenaline.

The article brings to light the deep commitment, as well as, the extremely pragmatic approach of Dr. D. R. Gadgil towards the development of the cooperative movement in India. Cooperation appealed to him because it offered an opportunity for people to come together, assume leadership of an organization and promote public accountability. His practical approach becomes evident when he spoke against officialdom but was quick enough to point out the inevitability of government participation at the early stage of the cooperative movement. The cooperative movement he dreamt of could easily accommodate people with different political views. The only condition necessary was that they should act as cooperative members and not as representatives of different political parties.