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Introduction Recurrent event rates after myocardial infarction (MI) remain unacceptably high, in part because of the continued growth and destabilization of residual coronary atherosclerotic plaques, which may occur despite lipid-lowering therapy. Inflammation is an important contributor to this ongoing risk. Recent studies have shown that the broad-acting anti-inflammatory agent, colchicine, may reduce adverse cardiovascular events in patients post-MI, although the mechanistic basis for this remains unclear. Advances in endovascular arterial wall imaging have allowed detailed characterization of the burden and compositional phenotype of coronary plaque, along with its natural history and responsiveness to treatment. One such example has been the use of optical coherence tomography (OCT) to demonstrate the plaque-stabilizing effects of statins on both fibrous cap thickness and the size of lipid pools within plaque. Methods The Phase 2, multi-centre, double-blind colchicine for coronary plaque modification in acute coronary syndrome (COCOMO-ACS) study will evaluate the effect of colchicine 0.5 mg daily on coronary plaque features using serial OCT imaging in patients following MI. Recruitment for the trial has been completed with 64 participants with non-ST elevation MI randomized 1:1 to colchicine or placebo in addition to guideline recommended therapies, including high-intensity statins. The primary endpoint is the effect of colchicine on the minimal fibrous cap thickness of non-culprit plaque over an 18-month period. Summary The COCOMO-ACS study will determine whether addition of colchicine 0.5 mg daily to standard post-MI treatment has incremental benefits on high-risk features of coronary artery plaques. If confirmed, this will provide new mechanistic insights into how colchicine may confer clinical benefits in patients with atherosclerotic cardiovascular disease. Trial Registration ANZCTR trial registration number: ACTRN12618000809235. Date of trial registration: 11th of May 2018.

This work presents a blind and robust scheme using YCbCr color space, IWT (integer wavelet transform) and DCT (discrete cosine transform) for color image watermarking. During watermark insertion, Y channel is divided into blocks and Mersenne Twister random number generator is used to select the blocks for embedding. This randomized selection of blocks required a secret key, thus improving the security of the scheme. To reduce the computational complexity, the artificial neural network architecture is developed for watermark embedding. To check the robustness, several signal processing attacks such as JPEG compression, filtering attacks, noise attacks, cropping, resizing and other common attacks are applied on the watermarked images. The proposed work is tested on different images to verify the similarity in watermarking results. The scheme provides similar results (having little variation) for different test images. Experimental results demonstrate the superior performance in terms of imperceptibility and robustness. Further, the ANN framework provides faster embedding with approximately similar parametric results. The performance comparison with existing schemes demonstrates better performance for different attacks. The proposed work can be used in robust applications (i.e. copyright protection) for efficient results and less computational time.

Background Transcatheter mitral valve implantation for degenerated bioprostheses has recently emerged as an alternative to redo mitral valve surgery, particularly in patients at high risk for reoperative cardiac surgery. We sought to examine our early experience of transcatheter transseptal mitral valve-in-valve procedures. Methods Prospectively collected data was retrospectively reviewed in patients undergoing transcatheter transseptal mitral valve-in-valve implantation using the Edwards Sapien 3 balloon expandable bioprosthesis (Edwards Lifesciences, Irvine, CA, USA). Results Seven (7) patients underwent the procedure between December 2017 and November 2018. Three (3) patients were young Indigenous Australians (age range 33–41years) who were not suitable for mechanical prostheses; four patients were elderly (age range 82–92 years) and considered high risk for reoperative surgery. The median (maximum, minimum) EuroSCORE II of the group was 7.32 (4.81, 19.89). Procedural success was obtained in six of the seven patients; these six patients had no significant complications and had a median hospital stay of 3 days. In one patient, the device displaced towards the left ventricle on inflation, resulting in left ventricular outflow tract obstruction and haemodynamic instability. Urgent redo mitral valve surgery and explantation of the transcatheter prosthesis was undertaken, however, this patient died postoperatively of multi-organ failure. Of the successfully deployed valves, the median (maximum, minimum) gradient across the new mitral prosthesis was 5.5 mmHg (4, 7) and only one patient had mild mitral regurgitation, all others had no or trivial regurgitation. At 30 days, these six patients are well and all are in New York Heart Association (NYHA) Class I. Conclusions Our early experience with transcatheter transseptal mitral valve-in-valve implantation demonstrates this procedure to be feasible in our institution with acceptable early results. Further follow-up is necessary to determine the longevity of valves implanted in this manner, especially in the younger population.

A novel deep neural network-based image watermarking method is presented to identify the source of digital data that is shared/forwarded on the internet using various messenger apps. The app that is used to share/communicate the image at the very first time is also identified in the proposed method. The ten-digit mobile number of the source (user) and identification data of particular messenger app (i.e. WhatsApp, Snapchat, Kik, Facebook messenger, etc.) is combined to get the text watermark signal. The part of the watermark signal representing specific mobile-based messenger application is obtained by randomizing the Walsh orthogonal codes using secret keys. To embed the watermark, the host image (shared/forwarded) is divided into blocks of equal size and then, slantlet transform is applied on each block. To get high reliability, three copies of the source information (user and app) are embedded during watermark embedding. Watermark extraction is performed using trained multilayer deep neural network. Furthermore, an optimal block selection logic is used to get improved results for real-time applications. The method is examined against various signal-processing attacks and high robustness with significant imperceptibility is attained. The method is also found to be fast enough for real-time applications. The prime objective of identifying the first user (source) and the shared/forwarded status (app detection) is successfully accomplished.

A multipurpose digital image watermarking scheme is proposed based on the multiple LSB bit substitution method. Fragile and robust watermarks are embedded into the host image for tamper and ownership detection respectively. Randomized insertion is used to insert a fragile watermark pattern to get better tamper detection. Secret keys are used in this scheme to secure data from forged/unauthorized access, which must be known to the end user to extract the watermark from the host. Tampering is done at random locations to cover most of the watermarked image’s area during testing of proposed scheme. Due to blind nature and randomized watermark insertion, high security is obtained. Experimental outcomes represent that the proposed method is able to achieve significant tamper detection. Proposed scheme exhibits robust nature towards common signal processing attacks and provides distortion-less robust watermark in case of no attack. This method also exhibits less execution time due to its time domain insertion methodology. A comparative analysis with the existing schemes shows that the proposed scheme has many features simultaneously such as blind extraction, high embedding capacity, low execution time, significant robustness, acceptable imperceptibility, and multipurpose nature. The proposed scheme can be utilized in fields where rapid response, ownership protection, and tamper detection are prime concerns.

Background Transcatheter mitral valve replacement (TMVR) is a rapidly evolving therapy. Follow-up of TMVR patients remains limited in duration and number treated. Objectives The purpose of this study was to examine outcomes with expanded follow-up for the first 100 patients who underwent TMVR with the prosthesis. Methods The Global Feasibility Study enrolled symptomatic patients with either primary or secondary mitral regurgitation (MR) who were at high or prohibitive surgical risk. The present investigation examines the first 100 patients treated in this study. Clinical outcomes through last clinical follow-up were adjudicated independently. Results In the cohort (mean age 75.4 ± 8.1 years; 69% men), there was a high prevalence of severe heart failure symptoms (66%), left ventricular dysfunction (mean ejection fraction 46.4 ± 9.6%), and morbidities (Society of Thoracic Surgeons Predicted Risk of Mortality, 7.8 ± 5.7%). There were no intraprocedural deaths, 1 instance of major apical bleeding, and no acute conversion to surgery or need for cardiopulmonary bypass. Technical success was 96%. The 30-day rates of mortality and stroke were 6% and 2%, respectively. The 1-year survival free of all-cause mortality was 72.4% (95% confidence interval: 62.1% to 80.4%), with 84.6% of deaths due to cardiac causes. Among survivors at 1 year, 88.5% were New York Heart Association function class I/II, and improvements in 6-min walk distance (p Conclusions In this study of TMVR, which is the largest experience to date, the prosthesis was highly effective in relieving MR and improving symptoms, with an acceptable safety profile. Further study to optimize the impact on long-term survival is needed.

This brief communication reports what appears to be the first case of an interaction between an inferior vena cava filter and a patent foramen ovale closure device. During removal of the inferior vena cava filter, the patent foramen ovale closure device was unintentionally removed. This case report serves to highlight the possible interaction of these two devices.

Acute intraprosthetic regurgitation is a rare but potentially devastating complication following the transcatheter aortic valve implantation; here, balloon dilatation could provide a potential treatment option for these patients.

Obstructive sleep apnoea (OSA) is increasingly recognized to be a risk factor for cardiovascular disease. This study assessed the prevalence and clinical predictors of OSA in patients undergoing coronary angiography. Consecutive patients undergoing coronary angiography in South Australian public hospitals from 2015 to 2018 were included. Clinical details for consecutive patients undergoing coronary angiography in South Australian public hospitals were captured by the Coronary Angiogram Database of South Australia (CADOSA) registry staff, with OSA identified by patient report. Among the 9,885 patients undergoing coronary angiography for the investigation of chest pain, 11% (n = 1,089) were documented as having OSA. Independent clinical predictors of OSA included male gender (OR 2.22, 1.86-2.65, P0.001), diabetes mellitus (OR 1.84, 1.58-2.14, P0.001), depression (OR 1.81, 1.55-2.12, P0.001), prior heart failure (OR 1.63, 1.22-2.18, P = 0.001), hypertension (OR 1.61, 1.32-1.95, P ≤ 0.001), asthma (OR 1.61, 1.34-1.93, P0.001), not a current smoker (OR 1.60, 1.30-1.96, P0.001), dyslipidaemia (OR 1.46, 1.22-1.76, P0.001), non-acute coronary syndrome presentation (OR 1.45, 1.25-1.69, P0.001), chronic lung disease (OR 1.40, 1.12-1.73, P = 0.003), cerebrovascular disease (OR 1.36, 1.07-1.73, P = 0.012), non-obstructive coronary artery disease (NOCAD) (OR 1.30, 1.10-1.55, P = 0.003) and atrial fibrillation/flutter (OR 1.30, 1.06-1.60, P = 0.012). Finally, stable angina (32.1% vs 22.7%) and NOCAD (29.1% vs 26.3%, P = 0.051) were trended more common in patients with OSA versus no OSA. In addition to established risk factors for OSA, this study found NOCAD to be independent predictor of OSA; especially in those presenting with a stable angina presentation. This suggests that coronary vasomotor disorders may be associated with OSA, although further detailed studies are required.

Background Rheumatic heart disease (RHD) is a disease of disparity most prevalent in developing countries and among immigrant populations. Mitral stenosis (MS) is a common sequalae of RHD and affects females disproportionately more than males. Rheumatic MS remains a significant management challenge as severe MS is usually poorly tolerated in pregnancy due to haemodynamic changes and increased cardiovascular demands of progressing pregnancy. Pregnancy remains contraindicated in current management guidelines based on expert consensus, due to a paucity of evidence-based literature. Case summary A 28-year-old aboriginal woman with known severe MS was found to be pregnant during routine health review, despite contraceptive efforts. Echocardiography demonstrated mean mitral valve (MV) gradient 14 mmHg; stress echocardiography demonstrated increased MV gradient 28–32 mmHg at peak exercise and post-exercise pulmonary artery pressure 56 + 3 mmHg with marked dynamic D-shaped septal flattening. Left ventricular systolic function remained preserved. She remained remarkably asymptomatic and underwent successful elective induction of labour at 34 weeks. Postpartum, she remained euvolaemic despite worsening MV gradients and new atrial fibrillation (AF). She subsequently underwent balloon mitral valvuloplasty with good result. Discussion Severe rheumatic MS in pregnancy carries significant morbidity and mortality, due to an already fragile predisposition towards heart failure development compounded by altered haemodynamics. Pregnancy avoidance and valvular intervention prior to conception or in the second trimester remain the mainstay of MS management; however, we present an encouraging case of successful near-term pregnancy with minimal complications in a medically managed asymptomatic patient with critical MS, who subsequently underwent valvular intervention post-partum.

Background Aortic stenosis (AS) is a common valvular disorder with a large symptomatic burden resulting from increased myocardial workload due to valvular obstruction. The contribution of increased afterload from arterial stiffness on symptoms is uncertain. The purpose of this analysis was to determine the symptomatic impact of arterial stiffness as determined by Applanation Tonometry. Methods Eighty-eight patients with severe AS undergoing intervention with transcatheter aortic valve replacement (TAVR) (n = 65) or surgical aortic valve replacement (SAVR) (n = 23) were prospectively enrolled. Symptoms were recorded using the NYHA Class, Kansas City Cardiomyopathy Questionnaire (KCCQ) and a 6 min walk test (6MWT) at baseline, and 1- and 6-months post intervention. Pulse Wave Analysis (PWA) using Applanation Tonometry was performed at all reviews, including the augmentation index (AIx). Results Patients undergoing TAVR were older, with worse renal function and lower aortic valve areas, but were otherwise similar. There was no significant difference between the augmentation index of our AS population compared with an age matched reference population (p = 0.89). Symptoms significantly improved after intervention according to NYHA Class, KCCQ and 6MWT. Additionally, with adjustment, the initial augmentation index correlated with the final KCCQ (Coeff. = −0.383, p = 0.02) and NYHA Class (Coeff. = 0.012, p = 0.03) and a baseline AIx value in the top quartile resulted in a significantly worse final KCCQ (95.1 v 85.2, p = 0.048) relative to the bottom 3 quartiles. Conclusions According to our analysis, an elevated baseline AIx is associated with a poorer symptomatic recovery after aortic valve intervention and so is worthy of consideration when assessing potential symptomatic benefit.

Frequency dissemination in phase-stabilized optical fiber networks for metrological frequency comparisons and precision measurements are promising candidates to overcome the limitations imposed by satellite techniques. However, in an architecture shared with telecommunication data traffic, network constraints restrict the availability of dedicated channels in the commonly-used C-band. Here, we demonstrate the dissemination of an SI-traceable ultrastable optical frequency in the L-band over a 456 km fiber network with ring topology, in which data traffic occupies the full C-band. We characterize the optical phase noise and evaluate a link instability of 4.7 × 10-16 at 1 s and 3.8 × 10-19 at 2000 s integration time, and a link accuracy of 2 × 10-18. We demonstrate the application of the disseminated frequency by establishing the SI-traceability of a laser in a remote laboratory. Finally, we show that our metrological frequency does not interfere with data traffic in the telecommunication channels. Our approach combines an unconventional spectral choice in the telecommunication L-band with established frequency-stabilization techniques, providing a novel, cost-effective solution for ultrastable frequency-comparison and dissemination, and may contribute to a foundation of a world-wide metrological network., Optics Express, 29 (16), ISSN:1094-4087

Background The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. Methods We included all patients presenting to public emergency departments in South Australia between June 2011–Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. Results 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. Conclusions Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.

Internet of things (IOT) is the fastest growing technology in today’s world and has changed the world completely. It has become an integral part of our lives and from smart home to smart cities everything is connected to the internet which has reduced the human effort and made our lives easier. As it is all about the internet, so with it comes some repercussion which are the cyber threats. These threats need to be dealt with in a proper and a phased manner so that it won’t lead to any device failure or data breaches. As there have been a lot of attacks in the past so the issue of cybersecurity in IOT is of huge importance and needs to get much more attention. This paper discusses about the ways in which the important sectors like smart cities, healthcare and industries, apply IOT on day-to-day basis and the different ways in which these sectors deal with the cybersecurity issues. This paper deeply analyses the various kinds of cyber threats as well as the consequences the system has to face because of these attacks and what preventive measures can be taken to avoid the attacks.

With the growing advancements and development in the field of digital image processing and computer vision, an individual’s heart pulse can be extracted from the human skin surfaces. This method is termed as remote photoplethysmography (rPPG). The method can be applied from the video recorded from the consumer-based mobile camera also. In this paper, the work presented has mainly twofold goals. Firstly to develop a fruitful yet simple rPPG algorithm that should be simple for any individual to understand and implement that will increase the understanding of the rPPG subject. Secondly, to compare the algorithm designed for the RGB color model with the state-of-art rPPG algorithms developed and presented in the literature. And finally, we present the comparative analysis of rPPG algorithms reported in the literature with our proposed rPPG algorithm which is simple and has demonstrated comparably high performance for the green channel as compared to other algorithms.

Background Rheumatic heart disease (RHD) affects over 40 million people globally who are predominantly young and from impoverished communities. The barriers to valvular intervention are complex and contribute to the high morbidity and mortality associated with RHD. The rates of guideline indicated intervention in patients with significant RHD have not yet been reported. Methods From 2007 to 2017, we used the Australian Northern Territory Cardiac Database to identify patients with RHD who fulfilled at least one ESC/EACTS guideline indication for mitral valve intervention. Baseline clinical status, comorbidities, echocardiographic parameters, indication for intervention, referral and any interventions were recorded. Results 154 patients (mean age 38.5 ± 14.6, 66.1% female) were identified as having a class I or IIa indication for invasive management. Symptoms, atrial fibrillation and pulmonary hypertension were the most common indications for surgery (74.5%, 48.1%, 40.9%). From the onset of a guideline indication the actuarial rates of accepted referral and intervention within two-years were 66.0% ± 4.0% and 53.1% ± 4.4% respectively. Of those who were referred and accepted for intervention, 86% received it within 2 years. The rates of accepted referral for patients with class I indications were 72.5% ± 4.2% while class IIa indications were 42.5% ± 9.0% (p Conclusions Approximately half of Aboriginal patients with significant rheumatic mitral valve disease who met ESC/EACTS guideline indications for intervention received surgery or valvuloplasty within two-years. A significant difference in referral rates was found between Class I and Class IIa indications for valvular intervention.

The healthcare organizations and life sciences are increasingly leveraging machine learning techniques such as Artificial Neural Networks (ANN) due to their potentiality. A considerable issue being faced by the healthcare organizations is to provide quality services at costs that can be easily afforded. Throughout the entire course of health care, many patients develop serious problems that can lead to severe discomfort, expensive treatment, disabilities and more. Early prediction of disease is one of the most important requirements in medical field. It allows the healthcare professionals to undertake preventive measures thereby lending a helping hand in improving patient safety, quality of care as well as reducing the medical costs too. Many prognostic methods focus on ANN to provide new and deep insights into the patient’s health condition. This paper provides the description of working and learning of predictive machine learning technique ANN, for solving many real-world decision modelling problems in context to health care. It throws light on the factors responsible for different mental diseases which are then perceived and mathematically modelled.

The differential impact of young age and female gender on transradial access (TRA) outcomes remains to be confirmed. The primary objective was to assess the impact of young age and female gender on in-hospital net adverse cardiovascular events (NACE). Among 12 346 patients from the Coronary Angiogram Database of South Australia (CADOSA) Registry, the impact of gender; men (transfemoral access [TFA] 1995, TRA 6168) and women (TFA 1249, TRA 2934), and a median split of age, ≤63 years (TFA 1617, TRA 4727) and >63 years (TFA 1627, TRA 4375) were analyzed on in-hospital outcomes by creating 5 separate propensity-matched cohorts (entire cohort, men, women, ≤63 and > 63 years). Net adverse cardiovascular event reduction with TRA was limited to the >63 years old cohort (odds ratio [OR] = 0.56, 95% CI: 0.34-0.93, P = .02) and women (OR = 0.37, 95% CI: 0.18-0.76, P = .007). In both the age groups and genders, TRA was associated with a lower risk of bleeding and all-cause mortality. On multivariate logistic regression, TRA was associated with a significant reduction in NACE, major bleeding, and mortality in the overall cohort. In conclusion, a reduction in bleeding and mortality was noted with TRA in all the subgroups in this observational study.

The development of computer networks generates several advantages in the cyber world. Because of this nice advancement, these days networking facilities are offered at terribly low cost. However, sadly this quick access becomes a threat to data security. In this paper, a completely unique color image secret writing technique is projected that is predicated on the asymmetric RSA algorithmic rule. The asymmetric RSA algorithm is one of the best algorithms which used the two different keys to complete the process. One is public key and another is private key which is generated using the two different prime numbers. In this technique, the sender has the public key used to encrypt the image and send it to the receiver and the receiver has the personal key that employed to decrypt the image and find the first that sent by sender. During this paper, primarily specialize in the protection of the color image that is finished using the proposed asymmetric RSA formula.

This document establishes the minimum standard for accreditation of institutions and operators as endorsed by the Cardiac Society of Australia and New Zealand (CSANZ) and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS). The original Joint Society Position Statement was ratified in August 2014. This 2021 update replaces the original and serves as a consensus within which the Conjoint Committee for Trancatheter Aortic Valve Implantation (TAVI) Accreditation will function, as recommended by Medical Services Advisory Committee (MSAC) Determination for TAVI. This is not a Guideline Statement but takes into consideration regional, legislative, and health system factors important to establishing requirements for TAVI accreditation in Australia.

The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals Considerations.

ObjectiveFunctional cardiac ultrasound measures are used clinically and in trials for assessing the haemodynamic status of newborn infants. Superior vena cava (SVC) flow and right ventricular output (RVO) are established measures of systemic blood flow on the first postnatal day. The objective was to assess image quality and interobserver agreement of these measures in preterm infants enrolled in a randomised trial of immediate versus delayed cord clamping.Design and settingImage quality and interobserver agreement for SVC flow, RVO and ductus arteriosus (DA) size were assessed on measurements taken at 3–6, 6–12 and 20–28 hours for the first 10 infants enrolled at each of four sites (total 40). Bland-Altman plots were constructed; mean difference (bias) and limits of agreement (LOA) were calculated. Potential sources of variation were explored.ResultsQuality was judged satisfactory for >97% of images. The mean difference and LOA between the observers were 5.4 mL/kg/min and −49.0 to 59.8 mL/kg/min for SVC flow, −26.6 mL/kg/min and −131.4 to 78.2 mL/kg/min for RVO, and 0 mm and −0.8 to 0.8 mm for DA diameter, respectively. The principal source of measurement error for SVC flow was diameter, and for RVO, diameter and velocity time integral. The difference between observers for both SVC and RVO was significantly associated with site.ConclusionInterobserver variability for SVC flow is consistent with that previously reported, but higher for RVO. The findings should be incorporated into clinical practice, training, accreditation and trial design.

Background Clinical outcomes in large patient populations from real-world clinical practice with a next-generation self-expanding transcatheter aortic valve are lacking. Objectives This study sought to document the clinical and device performance outcomes of transcatheter aortic valve replacement (TAVR) with a next-generation, self-expanding transcatheter heart valve (THV) system in patients with severe symptomatic aortic stenosis (AS) in routine clinical practice. Methods The FORWARD (CoreValve Evolut R FORWARD) study is a prospective, single-arm, multinational, multicenter, observational study. An independent clinical events committee adjudicated safety endpoints based on Valve Academic Research Consortium-2 definitions. An independent echocardiographic core laboratory evaluated all echocardiograms. From January 2016 to December 2016, TAVR with the next-generation self-expanding THV was attempted in 1,038 patients with symptomatic, severe AS at 53 centers on 4 continents. Results Mean age was 81.8 ± 6.2 years, 64.9% were women, the mean Society of Thoracic Surgeons Predicted Risk of Mortality was 5.5 ± 4.5%, and 33.9% of patients were deemed frail. The repositioning feature of the THV was applied in 25.8% of patients. A single valve was implanted in the proper anatomic location in 98.9% of patients. The mean aortic valve gradient was 8.5 ± 5.6 mm Hg, and moderate or severe aortic regurgitation was 1.9% at discharge. All-cause mortality was 1.9%, and disabling stroke occurred in 1.8% at 30 days. The expected-to-observed early surgical mortality ratio was 0.35. A pacemaker was implanted in 17.5% of patients. Conclusions TAVR using the next-generation THV is clinically safe and effective for treating older patients with severe AS at increased operative risk. (CoreValve Evolut R FORWARD Study [FORWARD]; NCT02592369)

Background: Urban slums in India are neglected communities as far as public health facilities are concerned. There is no health infrastructure since these slums are largely illegal and unauthorized. This community has poor awareness of health schemes and other social security benefits provided by the government. No initiatives have been taken to provide vocational training to empower this economically weaker and neglected section of the society. Objectives: To generate health awareness among the slum adolescents on various issues related to health, especially menstrual hygiene, personal hygiene, household methods of water purification as well as safe disposal of waste and also make them economically independent. Methodology: A summer workshop was conducted for a period of one week by MBBS students in the urban slums of Bhangel, during the summer vacations time of school going children. Two groups of slum adolescents were recognized. One group had younger adolescents and the other had older adolescents who acted as guides for the younger group. Health awareness sessions were conducted for these children everyday on community relevant health topics like personal hygiene, menstrual hygiene, water purification techniques, etc., along with teaching them some vocational skills like first aid box making, mehendi application, lipstick making, making of dust bins, etc. They were also taught marketing and selling skills. Both these groups were asked to identify another group of young adolescents and teach them what they learnt in the workshop, under observation of the medical students. Results: On comparing the pre and post workshop assessment, the results were very encouraging. Conclusion: Marked improvement was observed in the knowledge levels related to health issues and vocational independence could be promoted. However, there is a need to explore the possibility of replicating the same at a larger scale.

The use of social media is common in day to day life. People transfer digital data in the form of images, texts or videos to convey the news/information to others. Sometimes, people unintentionally forward the wrong/sensitive information over social media, which can cause negative effects in society. Most of the times this information message is only forwarded, which is being shared by others but the source of that information is the specific user. It is important to find such users, who start spreading this type of digital information over the internet. Such users should be identified and stopped them from doing such activities. A comparative analysis is proposed using two different transforms namely Slantlet transform (SLT) and discrete wavelet transform (DWT) in watermark reconstruction for user identification over the internet. In the proposed robust image watermarking, a 10-digit number is considered and each digit is assigned to a 32 bit randomized Walsh code and 8 additional digits are reserved as padding to obtain the binary watermark. The watermark insertion and extraction process are performed using two different transforms to compare their performance in terms of different watermarking parameters. Although both transforms provide significant results against many signal processing attacks, the experimental evaluation proved that the Slantlet transform gives better results as compared to the DWT.

In data analyzing and machine learning, PCA and LDA are widely used tools, these are linear transformation methods to reduce the dimension observation, and these are used in many practical applications like compression and data visualization in machine learning. Here, I have applied these two methods that are principal component analysis (PCA) and linear discriminant analysis (LDA) in handwritten digit recognition. The main motto of this paper is to present a simple and clear understanding of these methods. Here, this paper depicts that LDA can outperform PCA when training data set is huge, and PCA can outperform LDA when training data set is small.

Use of sutureless bioprostheses for aortic valve replacement has increased in recent years as compared to conventional prostheses, though with the potential issue of paravalvular leak, which requires close follow-up. We present this case report describing the successful treatment of paravalvular leak in a 65 year old man, who had NYHA class III symptoms post implantation of a 21 mm Intuity Elite rapid deployment bioprosthesis (Edwards Lifesciences, Irvine, CA). Diagnosis was established using TTE, TOE, and Cardiac MRI. Performing balloon dilatation using an Atlas Gold balloon (BARD Peripheral Vascular Inc., Tempe, AZ) treated the likely inadequate expansion of the subvalvular stent, leading to significant reduction in the paravalvular leak. At one month follow-up patient reported complete resolution of his symptoms. Successful percutaneous treatment of paravalvular leak following implantation of rapid deployment sutureless bioprosthesis provides a new treatment strategy for these patients; this strategy requires further validation.

To determine the safety and performance of the SAPIEN XT transcatheter heart valve (THV) in Australian patients with severe aortic stenosis (AS) and intermediate surgical risk.Eligible patients in this multi-centre, prospective, consecutively enrolled, non-randomised, clinical trial, received transcatheter aortic valve replacement via femoral artery access. Follow-up visits were at discharge, 30 days, and 6, 12, and 24 months. The primary endpoint was Valve Academic Research Consortium-2 composite safety at 30 days: all-cause mortality, all stroke, life-threatening bleeding, acute kidney injury-Stage 3, coronary artery obstruction requiring intervention, major vascular complication, and valve-related dysfunction requiring repeat procedure. Other endpoints were device success (successful vascular access, delivery, and deployment; correct position; intended performance mean aortic valve gradient20 mmHg, mild or less paravalvular aortic regurgitation [PAR]; and only one valve implanted) and New York Heart Association functional class (NYHA). Kaplan-Meier (KM) estimates were calculated for the primary endpoint.At baseline, mean patient (N=199) age was 85.5 years, mean Society of Thoracic Surgeon score was 5.9, and 78.4% were in NYHA class III/IV. The primary composite endpoint KM estimate was 12.1%. Device success was 88.8%. SAPIEN XT was implanted in the proper location in 98.5% (n=2: valve-in-valve procedures, n=1: no implant due to left main coronary artery occlusion). No device malfunctions were reported. The post procedure PAR was mild or less in 93.8% of patients. Mean aortic gradient decreased from baseline (50.0 mmHg) to 2 years (10.3 mmHg). Most patients (90.9%) were in NYHA class I/II at 30 days. New permanent pacemaker rate was 8.1%. Stroke at 30 days was 3.5% (1.5% disabling).SAPIEN XT was safe and improved heart failure symptoms and valve haemodynamics in this cohort of Australian patients.

Vital signs such as heart rate, respiratory rate, blood pressure, body temperature, and oxygen saturation are essential for early detection of any related significant illness. Many of the existing methods that are used to monitor the aforementioned vital signs are camera-based. In these methods, sensors are fixed to the body that are not sturdy to the motion of the subject. Another method to monitor vital signs is photoplethysmography (PPG), an emerging noncontact technique that maps, spatial blood volume variation in living tissue from the images captured through a video. Most of the camera-based methods are driven by three remote photoplethysmography algorithms. The camera-based methods are useful for detecting vital signs with an objective AAA, i.e., anyone, anywhere, and anytime. However, there exist few challenges in r-ppg methods and make it an open research problem. This paper presents an overview of the signal processing challenges faced by remote photoplethysmography for calculating the vital signs with a focus on heart rate estimation.

Harmful Melanoma, basically the most extremely dangerous sort of epidermis malignancy, has a phenomenal conclusion whenever taken care of inside the reparable early ranges. Early determination and careful extraction is presumably the most vigorous cure of melanoma. This work utilizes a record set of 184 clinical dermatoscopic pictures of skin injuries, in which 144 pictures are of dangerous sores and 40 photos are of the amiable sore, picture pre-handling, and division techniques are utilized to separate melanoma from considerate pigmented sores. Otsu and Entropy fundamentally based picture division rules are cultivated which improves the execution. The appropriate outcomes demonstrate that Havrda Entropy and Harris Corner Detector based melanoma analysis approach accomplish greater affectability concerning Otsu and Harris based joined methodology. The separated geometrical, fringe and shading highlight set is conveyed to characterize an outlining limit among considerate and dangerous classes of melanoma, and it is seen that entropy-based neural learning approach outflanks to Otsu based neural learning approach individually.

Severe aortic stenosis causes chronic increased afterload on the left ventricle (LV) resulting in myocardial hypertrophy and ultimately dysfunction if left untreated. Transcatheter aortic valve implantation (TAVI) immediately decreases the afterload on the LV by reducing the pressure gradient through the aortic valve. In our study, we aim to evaluate immediate changes in LV mechanics using intra-procedural transesophageal echocardiography (TEE) to assess circumferential and radial strain via speckle tracking. Intra-operative TEE was performed during TAVI for 53 patients (mean age 84 ± 8 years). Two-dimensional images in the transgastric view were acquired at the level of the papillary muscle. Circumferential and radial strain was calculated using speckle tracking with Philips Qlab software. Global LV afterload was measured by calculating valvulo-arterial impedance (Zva). Immediately post-TAVI, there was a change in both radial strain rate (Pre: 0.73 ± 0.04 vs. Post: 0.88 ± 0.04 per second, P < 0.001) and circumferential strain rate (-0.53 ± 0.04 (pre) vs. -0.74 ± 0.04 (post) per second, P < 0.001). There was also an immediate improvement in circumferential global strain parameters (-14.5 ± 5% (pre) vs. -16.0 ± 4.7% (post), P < 0.05), whereas there was no significant change seen in global radial strain (15.6 ± 0.8% (pre) vs. 15.2 ± 0.9% (post), P = 0.69). No significant change was seen in LV ejection fraction (51.5 ± 14.2% (pre) vs. 52.1 ± 14.0% (post), P = 0.77). Speckle tracking using TEE images is feasible and identifies significant improvements in LV strain and strain rate immediately following TAVI that is not detected by conventional measure of LV function. Refereed/Peer-reviewed

Background Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). The aim of the present study was to assess their changes early and late after trans-catheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) using cardiac magnetic resonance (CMR) tissue-tracking imaging. Methods In 59 patients with severe AS undergoing either TAVI ( n =35) or surgical AVR ( n =24), CMR with late gadolinium enhancement (LGE) imaging was performed before and early post-procedure to evaluate LV function and mass, and presence/extent of LGE. A third CMR scan was performed in 29 patients after a mean follow-up of 15±4months. Tissue-tracking analysis was applied to cine CMR images, to assess LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains. Results The TAVI and surgical AVR groups were similar with respect to baseline ( p =0.14) and early post-procedure ( p =0.16) LV ejection fraction. However, baseline LV GLS was significantly impaired in TAVI patients compared to surgical AVR patients ( p =0.025). Early post-procedure, TAVI resulted in a significant improvement of LV GLS ( p =0.003), while a significant worsening of LV GLS was observed early after surgical AVR ( p =0.012). At longer term follow-up, both TAVI and surgical AVR groups experienced a significant reduction of LV mass and a significant improvement of LV myocardial mechanics in all the three directions. Conclusions Treatment-specific differences in the changes of LV myocardial mechanics early after afterload release by TAVI and surgical AVR are present. Later, both interventions are associated with an improvement of LV myocardial deformation, alongside a regression of LV hypertrophy.

Objectives This study sought to assess the safety and effectiveness of the drug-filled stent (DFS) (Medtronic, Santa Rosa, California) in the treatment of patients with coronary artery disease. Background Polymer-free drug-eluting stents have the potential to improve clinical outcomes and facilitate shorter durations of dual antiplatelet therapy. The polymer-free DFS is made from a trilayered continuous wire with an outer cobalt chromium layer, a middle tantalum layer, and an inner lumen coated with sirolimus. Small laser-drilled holes on the abluminal stent surface control drug elution. Methods The RevElution trial enrolled 100 patients with de novo coronary lesions 2.25 to 3.50 mm in diameter and length ≤27 mm in 2 cohorts of 50 patients for angiographic, intravascular ultrasound, and clinical assessment at 9 or 24 months, with optical coherence tomography performed in a subset of 30 patients at each time period. The primary endpoint was angiographic in-stent late lumen loss at 9 months compared with Resolute zotarolimus-eluting stent (Medtronic) historical control data. Results Fifty patients with 56 lesions were treated with DFS in the 9-month cohort. In-stent late lumen loss was 0.26 ± 0.28 mm for DFS and 0.36 ± 0.52 mm for Resolute (pnoninferiority Conclusions At 9 months, the polymer-free DFS was safe and effective with high rates of early strut coverage and noninferior late lumen loss compared to Resolute. (Medtronic RevElution Trial [RevElution]; NCT02480348)

Outcomes following an initial strategy of balloon aortic valvuloplasty (BAV) prior to medical therapy or intervention with surgical or transcatheter aortic valve replacement (SAVR or TAVR) are unclear in the modern transcatheter intervention era.A retrospective, observational cohort study of the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016 was performed to compare outcomes between all patients with severe aortic stenosis (AS) treated with or without BAV prior to medical or invasive therapy.3,142 patients were available for analysis. 223 BAV treated patients had lower mortality relative to medically treated patients, particularly early (20.1% v. 7.6% at 6 months, 58.1% v. 52.5% at 5 years). Over 5 years, the adjusted hazard ratio (HR) was 0.62 (95% CI 0.48-0.80, p 0.001). Compared with 630 patients proceeding directly to intervention, 75 patients receiving BAV experienced a higher mortality (HR = 2.76, 95% CI 2.07-3.66, p 0.001). No subsequent excess perioperative mortality was observed with BAV compared with those receiving surgery directly (HR = 1.45, 95% CI 0.91-2.31, p = 0.117).The risk associated with BAV is low, and improves mortality compared with medical therapy. Balloon aortic valvuloplasty treated patients have poorer outcomes, but treatment with BAV does not increase perioperative mortality and may lessen it.

To determine associations of low superior vena cava (SVC) flow (≤55 ml/kg/min) and low right ventricular output (RVO) (≤150 ml/kg/min) in preterm infants. An observational study in infants

This paper proposes a blind image watermarking algorithm based on the transform domain approach. The insertion of watermark is done by replacing the coefficients of DWT-DCT (Discrete Wavelet & Discrete Cosine Transform) transformed host image. Secret keys are used in this method to make it secure against any unauthentic access of watermark as the keys must be known to the user before watermark extractions. The method provides good imperceptibility and also helps to attain good results against various attacks. In this study, peak signal to noise ratio (PSNR) and cross correlation coefficient (CC) are measured to analyse the effect of different attacks on watermarked image signal as well as watermarking quality. Transform domain approach helps this scheme to achieve good robustness against attacks and key based insertion makes this approach secured towards unauthentic access. Proposed method can be used for such image watermarking applications, where good robustness, blindness and security are the prime objectives.

BACKGROUND Inpatient management of cardiac patients by cardiologists results in reduced mortality and hospitalisation. With increasing subspecialisation of the field because of growing management complexity and use of technological innovations, the impact of sub-specialisation on patient outcomes is unclear. AIM To investigate whether management by subspecialty cardiologists impacts the outcomes of patients with subspecialty-specific diseases. METHODS All patients admitted to a tertiary centre over nine years with a diagnosis of heart failure, acute coronary syndrome (ACS) or primary arrhythmia were reviewed. The outcomes of these patients managed by cardiologists subspecialised in their admission diagnosis (heart failure specialists, interventionalists and electrophysiologists) were compared with those treated by general cardiologists. RESULTS Heart failure was diagnosed in 1704 patients, ACS in 7763 and arrhythmia in 4398. There was no difference in length of stay (LOS) (P = 0.26), mortality (P = 0.57) or cardiovascular readmissions (P = 0.50) in heart failure patients treated by general cardiologists compared with subspecialists. In ACS patients, subspecialty management was associated with reduced LOS, cardiovascular readmissions and mortality (all P

Long term safety and efficacy data of multi-electrode ablation system for renal denervation (RDN) in patients with drug resistant hypertension (dRHT) are limited.We studied 46 patients (age: 60 ± 10 years, 4.7 ± 1.0 antihypertensive drugs) with drug resistant hypertension (dRHT). Reduction in office BP at 24 months from baseline was -29/-13 mmHg, while the reduction in 24-hour ambulatory BP and in home BP at 24 months were -13/-7 mmHg and -11/-6 mmHg respectively (p0.05 for all). A correlation analysis revealed that baseline office and ambulatory BP were related to the extent of office and ambulatory BP drop. Apart from higher body mass index (33.3 ± 4.7 vs 29.5 ± 6.2 kg/m(2), p0.05), there were no differences in patients that were RDN responders defined as ≥10 mmHg decrease (74%, n=34) compared to non-responders. Stepwise logistic regression analysis revealed no prognosticators of RDN response (p=NS for all). At 24 months there were no new serious device or procedure related adverse events.The EnligHTN I study shows that the multi-electrode ablation system provides a safe method of RDN in dRHT accompanied by a clinically relevant and sustained BP reduction.

Background Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin–kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain. Methods We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy. Patients were randomly assigned to receive evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching placebo as subcutaneous injections. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The median duration of follow-up was 2.2 years. Results At 48 weeks, the least-squares mean percentage reduction in LDL cholesterol levels with evolocumab, as compared with placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4 mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P

Background The aim of this study was to characterise the interaction between ACS- and non-ACS-risk on the benefits of invasive management in patients presenting with acute coronary syndrome (ACS). Methods Consecutive patients admitted to a tertiary hospital's Cardiac Care Unit in the months of July–December, 2003–2011 with troponin elevation (>30 ng/L) were included. “ACS-specific-risk” was estimated using the GRACE score and “non-ACS-risk” was estimated using the Charlson-Comorbidity-Index (CCI). Inverse-probability-of-treatment weighting was used to adjust for baseline differences between patients who did or did not receive invasive management. A multivariable flexible parametric model was used to characterise the time-varying hazard. Results In total, 3057 patients were included with a median follow-up of 9.0 years. Based on CCI, 1783 patients were classified as ‘low-non-ACS risk’ (CCI ≤ 1; invasive management 81%; 12-month mortality 5%), 820 as ‘medium-non-ACS risk’ (CCI 2–3; invasive management 68%; 12-month mortality 13%), and 468 as ‘high-non-ACS risk’ (CCI ≥ 4; invasive management 47%; 12-month mortality 29%). After adjustment, invasive management was associated with a significant reduction in one-year overall-mortality in the ‘low-risk’ and ‘medium-risk’ groups (HR = 0.38, 95%CI:0.26–0.56; HR = 0.46, 95%CI:0.32–0.67); but not in the ‘high-risk’ group (HR = 1.02, 95%CI:0.67–1.56). The absolute benefit of invasive management was greatest with higher baseline ACS-risk, with a non-linear interaction between ACS- and non-ACS-risk. Conclusions There is a complex interaction between ACS- and non-ACS-risk on the benefit of invasive management. These results highlight the need to develop robust methods to objectively quantify risk attributable to non-ACS comorbidities in order to make informed decisions regarding the use of invasive management in individuals with numerous comorbidities.

The infringement of remote correspondence inside the most recent couple of decades has brought about the advancement of various transmit and get (MIMO) frameworks empowering effective constant picture and video correspondence. These preferences of numerous receiving wire frameworks nearby productive transmission furthermore coding plans might be investigated to achieve very high information rates close by enhanced information unwavering quality. Following the idea this work shows a novel come within reach of for transmitting pictures ended a boisterous channel. The anticipated strategy utilizes OFDM and clamorous encoder plans to accomplish contortion less & secure picture transmission inside the uproarious channel.

Objectives There remains a paucity of mechanistic data on the effect of transcatheter aortic valve implantation (TAVI) on early left and right ventricular function and quantitative aortic valve regurgitation. We sought to assess and compare the early effects on myocardial function and aortic valve hemodynamics of TAVI and aortic valve replacement (AVR) using serial cardiovascular magnetic resonance (CMR) imaging and echocardiography. Methods A prospective comparison study of 47 patients with severe aortic stenosis undergoing either TAVI (n = 26) or high-risk AVR (n = 21). CMR (for left ventricle/right ventricle function, left ventricular mass, left atrial volume, and aortic regurgitation) was carried out before the procedure and early postprocedure ( Results Groups were similar with respect to Society of Thoracic Surgeons score (TAVI, 7.7 vs AVR, 5.9; P = .11). Preoperative left ventricular (TAVI, 69% ± 13% vs AVR, 73% ± 10%; P = .10) and right ventricular (TAVI, 61% ± 11% vs AVR, 59% ± 8%; P = .5) ejection fractions were similar. Postoperative left ventricular ejection fraction was preserved in both groups. In contrast, decline in right ventricular ejection fraction was more significant in the TAVI group (61%-54% vs 59%-58%; P = .01). Postprocedure aortic regurgitant fraction was significantly greater in the TAVI group (16% vs 4%; P = .001), as was left atrial size (110 vs 84 mL; P = .02). Further analysis revealed a significant relationship between the increased aortic regurgitant fraction and greater left atrial size ( P = .006), and a trend toward association between the decline in right ventricle dysfunction and increased postprocedure aortic regurgitation ( P = .08). Conclusions There was no significant difference in early left ventricular systolic function between techniques. Whereas right ventricle systolic function was preserved in the AVR group, it was significantly impaired early after TAVI, possibly reflecting a clinically important pathophysiologic consequence of paravalvular aortic regurgitation.

Background:\ud \ud Neonatal endotracheal intubation is a common and potentially life-saving intervention. It is a mandatory skill for neonatal trainees, but one that is difficult to master and maintain. Intubation opportunities for trainees are decreasing and success rates are subsequently falling. Use of a stylet may aid intubation and improve success. However, the potential for associated harm must be considered.\ud Objectives\ud \ud To compare the benefits and harms of neonatal orotracheal intubation with a stylet versus neonatal orotracheal intubation without a stylet.\ud Search methods:\ud \ud We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and previous reviews. We also searched cross-references, contacted expert informants, handsearched journals, and looked at conference proceedings. We searched clinical trials registries for current and recently completed trials. We conducted our most recent search in April 2017.\ud Selection criteria\ud \ud All randomised, quasi–randomised, and cluster-randomised controlled trials comparing use versus non-use of a stylet in neonatal orotracheal intubation.\ud Data collection and analysis:\ud \ud Two review authors independently assessed results of searches against predetermined criteria for inclusion, assessed risk of bias, and extracted data. We used the standard methods of the Cochrane Collaboration, as documented in the Cochrane Handbook for Systemic Reviews of Interventions, and of the Cochrane Neonatal Review Group.\ud Main results:\ud \ud We included a single-centre non-blinded randomised controlled trial that reported a total of 302 intubation attempts in 232 infants. The median gestational age of enrolled infants was 29 weeks. Paediatric residents and fellows performed the intubations. We judged the study to be at low risk of bias overall. Investigators compared success rates of first-attempt intubation with and without use of a stylet and reported success rates as similar between stylet and no-stylet groups (57% and 53%) (P = 0.47). Success rates did not differ between groups in subgroup analyses by provider level of training and infant weight. Results showed no differences in secondary review outcomes, including duration of intubation, number of attempts, participant instability during the procedure, and local airway trauma. Only 25% of all intubations took less than 30 seconds to perform. Study authors did not report neonatal morbidity nor mortality. We considered the quality of evidence as low on GRADE analysis, given that we identified only one unblinded study.\ud Authors' conclusions:\ud \ud Current available evidence suggests that use of a stylet during neonatal orotracheal intubation does not significantly improve the success rate among paediatric trainees. However, only one brand of stylet and one brand of endotracheal tube have been tested, and researchers performed all intubations on infants in a hospital setting. Therefore, our results cannot be generalised beyond these limitations.