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Purpose The purpose of this paper is to determine which software systems business school administrators use to support accreditation efforts and how administrators select and use these systems. This study also provides best practice suggestions from institutions using faculty data management systems to support accreditation efforts. Design/methodology/approach This study used a sequential explanatory design using an internet-based survey for business school administrators involved with accreditation reporting with follow-up interviews with survey respondents. Findings There are four major software vendors that most respondents use for managing reporting of faculty research activity and sufficiency. The location of the school appears to influence the system selected. For assurance of learning reporting, most schools used an in-house or manual system. Respondents highlighted the importance of doing a thorough needs analysis before selecting a system. Research limitations/implications Although respondents were geographically diverse, having a larger sample with schools in developing regions would provide greater generalizability of results. Practical implications This study gives business school leaders a comprehensive overview of the business schools’ data management systems, criteria used in system selection and best practices for system selection and implementation, faculty engagement and ongoing maintenance. Originality/value This study addresses the limited attention given to resources and best practices for selecting and implementing faculty data management software for accreditation in the academic and industry literature despite the significant investment of resources for schools and the importance such systems play in a successful accreditation effort.

Background: Eye health has garnered increased attention since the COVID-19 pandemic. This Round Table explored the impact mask wearing, delays in eye examinations, and increased screen time have on vision and ultimately the worker. Methods: Leading experts in the areas of occupational health, risk management, eye health, and communication were identified and invited to participate in a Round Table discussion. Questions posed to experts were based on literature that addressed eye health, such as mask wearing, communication and managing expectations when accessing professional eye health appointments, and increased screen time. Findings: Experts agreed that eye health considerations must be in place. These considerations should address not only clinical care of the patient but ways to protect workers from occupational injury associated with the eye. Conclusion/Application to practice: The occupational health professional is a key resource for assessment and training that pertains to eye health.

Pathogenesis of neonatal candidiasis (NC) is distinct from systemic candidiasis in adults and older pediatric patients due to the significant incidence of central nervous system involvement in neonates. Thus, although adequate and well-controlled trials in NC are often unfeasible due to difficulty enrolling patients, extrapolation of efficacy from antifungal drug trials in adults is generally not appropriate. However, treatment of NC is an area of great unmet need. We describe a regulatory review approach that combined the assessment of limited clinical efficacy, pharmacokinetics, and safety data from neonates and young infants along with microbiology outcomes and pharmacokinetic data from relevant nonclinical models of candidemia/invasive candidiasis to inform the use of micafungin in pediatric patients younger than 4 months, while communicating areas of remaining uncertainty in labeling.

Meningococcal disease is a sudden-onset, life-threatening illness caused by the bacterium Neisseria meningitidis. Prompt empiric antibiotic treatment can reduce morbidity and mortality among patients, and antibiotic prophylaxis can prevent secondary disease in close contacts. Historically, N. meningitidis isolates in the United States have largely been susceptible to the antibiotics recommended for treatment and prophylaxis, including penicillin and ciprofloxacin. This report describes detection of penicillin-resistant and ciprofloxacin-resistant N. meningitidis serogroup Y (NmY) isolates in the United States. NmY isolates containing a blaROB-1 β-lactamase enzyme gene conferring resistance to penicillins (1) were recovered from 33 cases reported during 2013-2020. Isolates from 11 of these cases, reported during 2019-2020, harbored a ciprofloxacin resistance-associated mutation in a chromosomal gene (gyrA). Cases were reported from 12 geographically disparate states; a majority of cases (22 of 33, 67%) occurred in Hispanic persons. These cases represent a substantial increase in penicillin-resistant and ciprofloxacin-resistant meningococci in the United States since 2013. Ceftriaxone and cefotaxime, the recommended first-line agents for empiric bacterial meningitis treatment, can continue to be used for treatment, but health care providers should ascertain susceptibility of meningococcal isolates to penicillin before switching to penicillin or ampicillin. Ongoing monitoring for antimicrobial resistance among meningococcal isolates and prophylaxis failures will be important to inform treatment and prophylaxis recommendations.

In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, pathologists can be exposed to infection handling surgical specimens. Guidelines related to safety procedures in the laboratory have been released. However, there is a lack of studies performed on biopsy and surgical resection specimens. Here we report the detection of SARS-CoV-2 in formalin-fixed paraffin-embedded samples from surgical resection of tongue squamous cell carcinoma of a patient who developed COVID-19 postsurgery. RNA of SARS-CoV-2 strain was detected in the tumour and the normal submandibular gland samples using real-time PCR-based assay. No viral RNA was found in metastatic and reactive lymph nodes. We demonstrated that SARS-CoV-2 RNA can be detected in routine histopathological samples even before COVID-19 disease development. These findings may give important information on the possible sites of infection or virus reservoir, and highlight the necessity of proper handling and fixation before sample processing.

Autoimmune diseases (ADs) are a collection of many complex disorders of unknown aetiology resulting in immune responses to self-antigens and are thought to result from interactions between genetic and environmental factors. ADs collectively are amongst the most prevalent diseases in the U.S., affecting at least 7% of the population. The diagnosis of ADs is very complex, the standard screening methods provides seeking and recognizing of Antinuclear Antibodies (ANA) by Indirect ImmunoFluorescence (IIF) based on HEp-2 cells. In this paper an automatic system able to identify and classify the Centromere pattern is presented. The method is based on the grouping of centromeres present on the cells through a clustering K-means algorithm. The performances were obtained on two public database of IIF images (A.I.D.A. and MIVIA). Our results showed a sensitivity for image of (90 ± 5)% and a Accuracy equal to (98.0 ± 0.5)%. Results demonstrate that the system is able to identify and classify Centromere pattern with accuracy better or comparable with some representative state of the art works. Moreover, it should be noted that for the classification phase the works used for the comparison used an expert-manual segmentation while, in the present work, the segmentation was obtained automatically.

This paper examines the relationship between legal policy and the Electric Vehicle market in countries from around the world. As climate change has become an increasingly more important issue in modern society, heavy emphasis has been placed on environmentally conscious alternatives to many things used in daily life. Transportation, one of the largest and most polluting sectors of the economy, has seen many advances towards an eco-friendly future. Electric Vehicles, or EVs, have been lauded as the answer to heavily-polluting Internal Combustion Engines (ICE) by governments around the world. They have dumped large amounts of money in the form of tax breaks and subsidies into the EV sector, but it is unclear if that is really having an effect on the market. This study finds no correlation between the amount of money a government is offering to subsidize the purchase of EVs and the EV market share of the country. While EV law structure varies heavily between countries, the general contribution to the sector by governments is largely the same around the world.

BACKGROUND Phrenic nerve (PN) injury is one of the recognized possible complications following epicardial ablation of ventricular tachycardia (VT). High-output pacing is a widely used maneuver to establish a relationship between the PN and the ablation catheter tip. An absence of PN capture is usually considered an indication that it is safe to ablate, and that successful ablation may be performed at adjacent sites. However, PN capture may impact the procedural outcome. Only a few cases have been reported in the literature that avoid PN injury by using different techniques. CASE SUMMARY Three patients with a previous history of myocarditis and one patient with ischemic cardiomyopathy underwent epicardial ablation for drug-refractory VT. Before the procedure, transthoracic echocardiogram, coronary angiogram, and cardiac magnetic resonance imaging were performed on all patients. Under general anesthesia, endo/epicardial three-dimensional anatomical and substrate maps of the left ventricle were accomplished. Before radiofrequency delivery, the course of the PN was identified by provoking diaphragmatic stimulation with high-output pacing from the distal electrode of the ablation catheter. In every case, a scar region with late potentials was mapped along the PN course. After obtaining another epicardial access, a second introducer sheath was placed, and a vascular balloon catheter was inserted into the epicardial space and inflated with saline solution to separate the PN from the epicardium. Once the absence of PN capture had been proven, radiofrequency was applied to aim for complete late potential elimination and avoid VT induction. CONCLUSION PN injury can occur as one of the complications following epicardial VT ablation procedures, and may prevent successful ablation of these arrhythmias. PN displacement by using large balloon catheters into the epicardial space seems to be feasible and reproducible, avoid procedure-related morbidity, and improve ablation success when performed in selected centers and by experienced operators.

15-5PH stainless steel is widely used in the aerospace industry, from precision fuse pins to forged products, due to its various high-performance properties. However, there is little systematic evaluation of heat treatment responses, especially at ultra-high temperatures above 650°C (1200°F). The objective of this work was to evaluate the mechanical and microstructural properties of 15-5 PH stainless steel at various heat treatments. Multiple heat treatment parameters were tested. The samples tested had varied chemical compositions because they were from different vendors. The experimental work included multiple aging temperatures, time, heating rates, and the effects of multiple aging treatments. A total of 38 different heat treatments were conducted on these specimens. There was a linear correlation between hardness and ultimate and yield strength. Optical microscopy showed martensitic structures with very fine grains in all the tested samples. Scanning Electron Microscope (SEM) images showed ductile fracture in all the samples.

Implantable cardioverter‐defibrillator (ICD) implantation is not indicated in patients with potentially transient or reversible causes of sudden cardiac death (SCD). Wearable cardioverter‐defibrillator (WCD) is increasingly used for SCD prevention in patients who are temporary at high risk of ventricular arrhythmia. Hereby, we describe a case of tachycardiomyopathy successfully managed with ablation and WCD backup. Implantable cardioverter‐defibrillators are a Class I indication by American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines to prevent SCD in patients with nonischemic dilated cardiomyopathy, New York Heart Association (NYHA) functional class II and III, left ventricular ejection fraction (LVEF) ≤35% and with a life expectancy of >1 year.1 In addition, current guidelines recommend deferring implantation of ICDs for 40 days or three months postmyocardial infarction (MI), depending on whether acute revascularization is achieved.1 Recently, the benefits of ICD implantation in patients with DCM have been reconsidered after the results of the DANISH trial.2 A global assessment, beyond LVEF, may help to improve the appropriateness of ICD indication by identifying those patients who may benefit more from ICD implantation. Recently, wearable cardioverter‐defibrillators (WCDs) have emerged as a reasonable choice for patients in whom recovery of the LVEF is expected.3 A small subset of patients with atrial fibrillation (AF) experience dilated cardiomyopathy (DCM) also called tachycardiomyopathy. Typically, these patients have rapid ventricular rates and persistent AF. It has been shown that patients with tachycardiomyopathy related to AF benefit from ablation with a significant improvement in the LVEF as well as a reduction in the left ventricular end‐diastolic diameter (LVEDD) and left atrial diameter (LAD).4 The outcome of patients with tachycardiomyopathy after catheter ablation did not differ from that of patients without structural heart disease.4, 5 Hereby, we describe a patient with AF and recurrent relapses of heart failure (HF) who underwent successful AF ablation and postprocedural management with the WCD.

Introduction: During atrial fibrillation (AF) ablation, it is generally considered that atrial tachycardia (AT) episodes are a consequence of ablation. Objective: To investigate the spatial relationship between localized AT episodes and dispersion/ablation regions during persistent AF ablation procedures. Methods: We analyzed 72 consecutive patients who presented for an index persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms. We characterized spontaneous or post-ablation ATs’ mechanism and location in regard to dispersion regions and ablation lesions. Results: In 72 consecutive patients admitted for persistent AF ablation, 128 ATs occurred in 62 patients (1.9 ± 1.1/patient). Seventeen ATs were recorded before any ablation. In a total of 100 ATs with elucidated mechanism, there were 58 localized sources and 42 macro-reentries. A large number of localized ATs arose from regions exhibiting dispersion during AF (n = 49, 84%). Importantly, these ATs’ locations were generally remote from the closest ablation lesion (n = 42, 72%). Conclusions: In patients undergoing a persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms, localized ATs originate within dispersion regions but remotely from the closest ablation lesion. These results suggest that ATs represent a stabilized manifestation of co-existing AF drivers rather than ablation-induced arrhythmias.

Fluorescence microscopy benefits from spatially and temporally homogeneous illumination with illumination area matched to the shape and size of the camera sensor. Fiber-coupled illumination schemes have the added benefit of straightforward and robust alignment and ease of installation compared to free-space coupled illumination. Commercial and open-source fiber-coupled, homogenized illumination schemes have recently become available to the public; however, there have been no published comparisons of speckle reduction schemes to date. We characterize three different multimode fibers in combination with two laser speckle reduction devices and compare spatial and temporal profiles to a commercial unit. This work yields a new design, the EvenField Illuminator, which is freely available along for researchers to integrate into their own imaging systems.

Large parts of the world rely on rainfed agriculture for their food security. In Africa, 90% of the agricultural yields rely only on precipitation for irrigation purposes and approximately 80% of the population’s livelihood is highly dependent on its food production. Parts of Ghana are prone to droughts and flood events due to increasing variability of precipitation phenomena. Crop growth is sensitive to the wet- and dry-spell phenomena during the rainy season. To support rural communities and small farmer in their efforts to adapt to climate change and natural variability, it is crucial to have good predictions of rainfall and related dry/wet spell indices.This research constitutes an attempt to assess the dry-spell patterns in the northern region of Ghana, near Burkina Faso. We aim to develop a model which by exploiting satellite products overcomes the poor temporal and spatial coverage of existing ground precipitation measurements. For this purpose 14 meteorological stations featuring different temporal coverage are used together with satellite-based precipitation or cloud top temperature products.We will compare conventional copula models and deep-learning algorithms to establish a link between satellite products and field rainfall data for dry-spell assessment. The deep-learning architecture used should be able to both have the feature of convolution (Convolutional Neural Networks) and the ability to capture a sequence (Recurrent Neural Networks). The deep-learning architecture used for this purpose is the Long Short-Term Memory networks (LSTMs). Regarding the copula modeling, the Archimedean, the Gaussian and the extreme copulas will be examined as modeling options.Using these models we will attempt to exploit the long temporal coverage of the satellite products in order to overcome the poor temporal and spatial coverage of existing ground precipitation measurements. Doing that, our final objective is to enhance our knowledge about the dry-spell characteristics and, thus, provide more reliable climatic information to the farmers in the area of Northern Ghana.

Purpose: The aim of this study is to describe demographic data, semiology and etiology in a pediatric population with status epilepticus (SE) and refractory SE (RSE). Method: We retrospectively reviewed patients with the following inclusion criteria: i) age between two months and eighteen years; ii) SE diagnosis; iii) admission from January 2001 to December 2016; iv) available clinical data. Results: We enrolled 124 patients. Mean and median age was 4.6 ± 4.2 years and 3.3 [1.2-7.5] years respectively. SE had a “de novo” onset in 66.9%. Focal convulsive-SE was the most common semiology (50.8%) whilst generalised (32.3%) and nonconvulsive-SE (NCSE) (16.9%) were less represented. Some etiologies showed a different age distribution: febrile in youngest age (p = 0.002, phi 0.3) and idiopathic-cryptogenic in older children (p = 0.016, phi 0.2). A statistical significance correlation was detected between semiology and etiology (p < 0.001, Cramer's V 0.4), chemotherapy and NCSE (n = 6/21 vs 3/103, p < 0.001) as well as PRES and NCSE (n = 7/21 vs 5/103, p < 0.001). Only 17.7% had a RSE. No correlation was found in demographic and clinical data, but NCSE, acute and idiopathic-cryptogenic etiologies were more frequently associated to RSE. Encephalitis was the most common diagnosis in acute etiologies whereas unknown epilepsy in idiopathic-cryptogenic group. Conclusion: Most of our findings were previously described however we found a significant role of non-antiepileptic treatments (chemotherapy-dialysis) and comorbidity (PRES) determining acute etiology and NCSE. Acute (mostly encephalitis), idiopathic-cryptogenic (mainly unknown-epilepsy) and NCSE were frequently detected in RSE. In the above mentioned conditions a high level of suspicion was recommended.

The diagnosis and monitoring of autoimmune diseases are very important problem in medicine. The most used test for this purpose is the antinuclear antibody (ANA) test. An indirect immunofluorescence (IIF) test performed by Human Epithelial type 2 (HEp-2) cells as substrate antigen is the most common methods to determine ANA. In this paper we present an automatic HEp-2 specimen system based on a convolutional neural network method able to classify IIF images. The system consists of a module for features extraction based on a pre-trained AlexNet network and a classification phase for the cell-pattern association using six support vector machines and a k-nearest neighbors classifier. The classification at the image-level was obtained by analyzing the pattern prevalence at cell-level. The layers of the pre-trained network and various system parameters were evaluated in order to optimize the process. This system has been developed and tested on the HEp-2 images indirect immunofluorescence images analysis (I3A) public database. To test the generalisation performance of the method, the leave-one-specimen-out procedure was used in this work. The performance analysis showed an accuracy of 96.4% and a mean class accuracy equal to 93.8%. The results have been evaluated comparing them with some of the most representative works using the same database.

We are applying light-sheet fluorescence microscopy with scanned Bessel beam illumination and confocal slit detection, combined with tissue expansion microscopy, to image dense axons over large brain volumes for axonal connectomics.

Although it may seem simple, setting the shelf life of perishable food products is a complex undertaking involving food safety and quality factors impacted by distribution and storage conditions. Even for food products that have a long history of production, distribution, sale, and consumption (e.g., fresh meat, pasteurized milk, fresh produce), there are frequent modifications and variations to the products, production process, packaging, and the means of distribution and display. Consumer preferences and lifestyles have impacted food product formulation, preparation, and consumption habits, and this too provides the impetus for renewed focus on shelf life determination. Various stakeholders concerned with shelf life of food products include food processors, distributors, customers, regulators, and consumers. Differing perspectives of these stakeholders coupled with the subjectivity of food quality, result in a changing value designation to perishable foods throughout shelf life. Therefore, the methods and criteria for shelf life acceptance have a considerable bearing on business. The procedures used to determine shelf life depend upon multiple factors, principally the food type and temperature. The increasing sophistication of laboratory methods for analysis means that the shelf life termination metrics are also constantly changing. Shelf life determination of novel products or traditional products produced in novel ways can require elaborate studies during the development phase. Upon commercialization, shelf life tests must be performed upon the first several lots of production in order to verify previously determined outcomes with prototypical samples. In some instances, challenge studies must be performed to validate the ongoing safety throughout shelf life. Then for ongoing food production, routine shelf life testing is an essential quality metric, albeit a lagging indicator of quality. Attributes measured include microbiological counts, chemical degradation, physical deterioration, and sensory properties. For perishable foods, the microbiological attributes are usually the primary metric, and often the most limiting factor. Shelf life testing procedures must generate data that clearly define the amount of time a product has a useable wholesome state under the expected conditions of storage using agreed upon methods and acceptance criteria.

Although colonization of artificial structures by epibenthic communities is well-documented overall, our understanding of colonization processes is largely limited to low-energy environments. In this study, we monitored epibenthic colonization of different structures associated with a tidal energy test site located in a high-energy hydrodynamic environment. Using four years of image-based underwater surveys, we characterized changes through space and time in the taxonomic composition of epibenthic assemblages colonizing two kinds of artificial structures, as well as the surrounding natural habitat. Our results highlight that ecological successions followed similar trends across the two artificial habitats, but that different habitat-specific communities emerged at the end of our survey. Deployment of these artificial structures resulted in the addition of elevated and stable substrata in an environment where natural hard substrates are unstable and strongly exposed to sediment abrasion. Although epibenthic communities colonizing artificial habitats are unlikely to have reached a mature stage at the end of our survey, these supported structurally complex taxa facilitating an overall increase in local diversity. We were able to quantify how epibenthic communities can significantly vary over time in high-energy coastal environment, and our final survey suggests that the ecological succession was still in progress five years after the deployment of artificial reefs. Thus, maintaining long-term continuous survey of coastal artificial reef habitats will be key to better discriminate between long-term ecological successions and shorter-term variability.

An increasing number of offshore structures are being deployed worldwide to meet the growing demand for renewable energy. Besides energy production, these structures can also provide new artificial habitats to a diversity of fish and crustacean species. This study characterises how concrete mattresses that stabilise the submarine power cable of a tidal energy test site can increase habitat capacity for benthic megafauna. A five-year monitoring, which relied on both visual counts and video-based surveys by divers, revealed that these mattresses provide a suitable habitat for 5 taxa of large crustaceans and fish. In particular, two commercially valuable species, i.e. the edible crab Cancer pagurus and the European lobster Homarus gammarus, showed a constant occupancy of these artificial habitats throughout the course of the project. The shape and the number of shelters available below individual mattresses largely determine potential for colonisation by mobile megafauna. Local physical characteristics of the implantation site (e.g. substratum type, topography, exposition to current etc.) significantly impact amount and type of shelters provided by the concrete mattresses. Thus, to characterise habitat potential of artificial structures, it is not only essential to consider (i) the design of the structures, but also to (ii) account for their interactions with local environmental conditions when deployed on the seafloor.

Background The breast cancer genome dynamically evolves during malignant progression and recurrence. We investigated the genomic profiles of primary early-stage breast cancers and matched relapses to elucidate the molecular underpinnings of the metastatic process, focusing on potentially actionable alterations in the recurrences. Methods A mono-institutional cohort of 128 patients with breast cancers (n = 68 luminal B HER2, n = 6 luminal B HER2+, n = 1 HER2+ non-luminal, n = 56 triple negative) and at least one recurrence in a timeframe of 17 years was evaluated. Next-generation sequencing comprehensive genomic profiling was performed on 289 formalin-fixed paraffin-embedded (FFPE) samples, including primary tumors and matched relapses. Correlations of genomic aberrations with clinicopathologic factors and time to breast cancer relapse were analyzed. Results Genomic data were available for 188 of 289 FFPE samples that achieved the sequencing quality parameters (failure rate 34.9%), including 106 primary tumors and 82 relapses. All primary and relapse samples harbored at least one genomic alteration, with a median number of six alterations per sample (range 1–16). The most frequent somatic genomic alterations were mutations of TP53 (primary tumors = 49%, relapses = 49%) and PIK3CA (primary tumors = 33%, relapses = 30%). Distinctive genomic alterations of primary tumors were significantly associated with molecular subtypes. TP53, PIK3R1, and NF1 somatic alterations were more frequently detected in triple negative tumors (p value CCND1, FGF3, and FGFR1 copy number gains were recurrently identified in luminal cases (p value TP53 mutations and MYC amplification were significantly and independently associated with a shorter time to relapse (p value Conclusions Specific genomic aberrations of primary breast cancers were associated with time to relapse. Primary tumors and matched recurrences showed a core of shared driver genomic aberrations but private actionable alterations have been identified in the relapses.

Hypothesis An open volar surgical approach with suture anchor repair of the foveal ligament and temporary pinning of the distal radioulnar joint (DRUJ) is an effective way to treat DRUJ instability associated with chronic foveal tears of the triangular fibrocartilage complex (TFCC). Methods We retrospectively reviewed nine patients with foveal ligament tears of the TFCC and DRUJ instability who underwent open repair of the TFCC using a volar surgical approach, combined with temporary pinning of the DRUJ for 8 weeks. Pain, instability, arc of motion, and functional outcomes scores were evaluated. Results Mean patient age was 40.5 years (range 16.3–56.2). Average time from injury to surgery was 8.4 months (range 2.9–23.3 months). Average final follow-up was 18.9 months from injury (range 12.0–29.3 months), 10.5 months from surgery (range 3.9–18.6 months), and 8.7 months from pin removal (range 1.7–17.2 months). At final follow-up, all patients demonstrated clinically stable DRUJ. Pain scores diminished significantly from pre to final postoperative visits, with averages of 6.8 (range 4.0–9.0) improving to a mean of 0.70 (range 0.0–2.0), respectively. Average postoperative forearm rotation was 71.1 degrees in supination and 76.1 degrees in pronation (average total arc of motion 147.2 degrees, range 90–160 degrees). Average postoperative wrist motion was 68.8 degrees in flexion and 70.6 degrees in extension (average total arc of motion 139.4 degrees, range 110–160 degrees). No patients developed crepitus, recurrent DRUJ instability, or required revision surgery (subsequent to pin removal). Conclusion Volar suture anchor repair of the foveal ligament of the TFCC with DRUJ pinning led to reliable outcomes within this patient group including a stable DRUJ with improved functional outcomes regarding pain, stability, and range of motion in patients with foveal TFCC tears and associated DRUJ instability. These results compare favorably with dorsal repair of the foveal ligament. Level of Incidence This is a Level IV, therapeutic study.

This work introduces epanetCPA, an open-source MATLAB® toolbox for modelling the hydraulic response of water distribution systems to cyber-physical attacks. epanetCPA allows users to quickly design various attack scenarios and assess their impact via simulation with EPANET, a popular public-domain model for water network analysis. The toolbox offers both demand-driven and pressure-driven simulations, enabling the users to realistically analyze cyber-physical attacks and their impacts under both pressure sufficient and pressure deficient conditions. epanetCPA is available under the MIT license.

Worldwide, there have been few reports of β-lactamases causing penicillin resistance in Neisseria meningitidis. The first known case of disease in the United States due to a β-lactamase-producing, ciprofloxacin-resistant N. meningitidis was recently identified. This has potential implications on standard laboratory testing and empiric management of meningococcal disease.

Background: Despite extensive prevention programs, dental hygiene remains inadequate, particularly among children under the age of six, and early childhood caries (ECC) are still a concern. Oral hygiene behavior and preventive practices seem difficult to change at a family level. Aim. The present study aimed to better understand the reasons behind this behavior and to identify the different barriers to the implementation of adequate preventive measures. Methods: A qualitative study was conducted in the pediatric dentistry service of the Montpellier University Hospital (France) in 2019. A thematic analysis concerning three domains was performed: family environment, dental literacy, and oral hygiene. Results. The main barriers encountered by the parents were, respectively, (1) a weakness in the organization of familial life, together with a low-medium family income and a lack of authority, (2) ignorance of the necessity of treating carious primary teeth, and (3) a lack of time for brushing or supervising their children&rsquo, s teeth. Conclusion: These results showed that oral hygiene and primary teeth care could not be easily achieved in the family environment of the participants, and oral health strategies should be focused not only on children but also on their parents.

PURPOSE: Previous research suggests that prolonged sitting may acutely reduce cerebral blood flow velocity (CBFv). The purpose of this study was to evaluate the effects of alternating standing and sitting vs prolonged sitting on CBFv. METHODS: This randomized crossover study enrolled working adults (N=25) with pre-to-stage 1 hypertension not using antihypertensive medications, and a body mass index from 25 to < 40 kg/m(2). Subjects participated in two simulated workday conditions: 1) sitting continuously (SIT), and 2) alternating standing and sitting every 30 min (SS). Beat-to-beat systolic, mean and diastolic CBFv were recorded bilaterally for 1 min via insonation of the middle cerebral artery using transcranial Doppler ultrasonography before (morning), between (midday) and following (afternoon) two 3-hr 40 min work periods. RESULTS: Mean±SD age was 42±12 years, blood pressure (BP) was 132±9/83±8 mmHg, and BMI was 32±5 kg/m(2). Cerebrovascular hemodynamics did not differ across condition (P>0.05). There were, however, significant nonlinear effects of time (decrease from morning to midday; increase from midday to afternoon) on systolic CBFv (P=0.014), mean CBFv (P=0.001), diastolic CBFv (P=0.002), and pulsatility index (P=0.038). When overall time effects were evaluated during each time interval, mean and diastolic CBFv significantly decreased morning to midday and all CBFv increased from midday to afternoon. When separated by condition, significant time effects were observed for all CBFv during SIT (P0.05). CONCLUSIONS: In individuals with elevated BP and BMI, CBFv significantly decreased by midday and increased by afternoon, especially during a workday of prolonged sitting. Future studies should evaluate the combination of frequent walks and a sit-stand desk to break up prolonged sitting.

As several cities all over the world face the exacerbating challenges posed by climate change, population growth, and urbanization, it becomes clear how increased water security and more resilient urban water systems can be achieved by optimizing the use of water resources and minimize losses and inefficient usage. In the literature, there is growing evidence about the potential of demand management programs to complement supply-side interventions and foster more efficient water use behaviors. A new boost to demand management is offered by the ongoing digitalization of the water utility sector, which facilitates accurate measuring and estimation of urban water demands down to the scale of individual end-uses of residential water consumers (e.g., showering, watering). This high-resolution data can play a pivotal role in supporting demand-side management programs, fostering more efficient and sustainable water uses, and prompting the detection of anomalous behaviors (e.g., leakages, faulty meters). The problem of deriving individual end-use consumption traces from the composite signal recorded by single-point meters installed at the inlet of each household has been studied for nearly 30 years in the electricity field (Non-Intrusive Load Monitoring). Conversely, the similar disaggregation problem in the water sector - here called Non-Intrusive Water Monitoring (NIWM) - is still a very open research challenge. Most of the state-of-the-art end-use disaggregation algorithms still need an intrusive calibration or time- consuming expert-based manual processing. Moreover, the limited availability of large-scale open datasets with end- use ground truth data has so far greatly limited the development and benchmarking of NIWM methods.In this work, we comparatively test the suitability of different machine learning algorithms to perform NIWM. First, we formulate the NIWM problem both as a regression problem, where water consumption traces are processed as continuous time-series, and a classification problem, where individual water use events are associated to one or more end use labels. Second, a number of algorithms based on the last trends in Artificial Intelligence and Machine Learning are tested both on synthetic and real-world data, including state-of-the-art tree-based and Deep Learning methods. Synthetic water end-use time series generated with the STREaM stochastic simulation model are considered for algorithm testing, along with labelled real-world data from the Residential End Uses of Water, Version 2, database by the Water Research Foundation. Finally, the performance of the different NIWM algorithms is comparatively assessed with metrics that include (i) NIWM accuracy, (ii) computational cost, and (iii) amount of needed training data.

Simulation-based optimization is widely used for designing and managing water distribution networks. The process involves the use of accurate computational models, such as EPANET, which represent the physical processes taking place in the water network and reproduce the control logic governing its operations. Unfortunately, running such models requires expensive computations, which, in turn, may hinder the application of simulation-based optimization to large and complex problems. This issue can be overcome by resorting to surrogate models, that is, simplified data-driven models that accurately mimic the behaviours of physical-based models at a fraction of the computational costs. In this work, we explore the potential of Deep Learning Neural Networks (DLNN) for building surrogate models for water distribution systems. Different DLNN architectures, including feed-forward and recurrent neural networks, are trained and validated on datasets generated through EPANET simulations. The DLNN models are then used in lieu of the original EPANET model to speed-up the evaluation of the objective function employed in a simulation-based optimization problem. The effectiveness of the proposed technique is assessed on a realistic case-study involving cyber-attacks on a water network. In particular, the DLNN surrogate models are employed by an evolutionary optimization algorithm that schedules the operations of hydraulic actuators in order to best respond to the attacks and facilitate the recovery process.

Context: Major League Baseball (MLB) players are at risk of hook of hamate fractures. There is a paucity of data assessing the effect of a hook of hamate fracture on MLB players’ future athletic performance. Objective: To determine if MLB players who sustain hook of hamate fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Design: Retrospective case-control design. Setting: Retrospective database study. Participants: 18 MLB players who sustained hook of hamate fractures. Methods: Data for 18 MLB players with hook of hamate fractures incurred over 26 seasons (1989–2014) were obtained from injury reports, press releases, and player profiles (www.mlb.com and www.baseballreference.com). Player age, position, number of years in the league, mechanism of injury, and treatment were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury for the main performance variable—Wins Above Replacement—were obtained. Eighteen controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Main Outcome Measures: Postinjury performance compared with preinjury performance and matched-controls. Results: Mean age at the time of injury was 25.1 years with a mean of 4.4 seasons of MLB experience prior to injury. All injuries were sustained to their nondominant batting hand. All players underwent operative intervention. There was no significant change in Wins Above Replacement or isolated power when preinjury and postinjury performance were compared. When compared with matched-controls, no significant decline in performance in Wins Above Replacement the first season and second season after injury was found. Conclusion: MLB players sustaining hook of hamate fractures can reasonably expect to return to their preinjury performance levels following operative treatment.

Background: Limited research examines the influence of sit-stand desks on ratings of discomfort, sleepiness, and fatigue. This study evaluated the time course of these outcomes over 1 day. Methods: Adults (N = 25) completed a randomized cross-over study in a laboratory with two 8-hour workday conditions: (1) prolonged sitting (SIT) and (2) alternating sitting and standing every 30 minutes (SIT-STAND). Sleepiness was assessed hourly. Discomfort, physical fatigue, and mental fatigue were measured every other hour. Linear mixed models evaluated whether these measures differed across conditions and the workday. Effect sizes were calculated using Cohen’s d. Results: Participants were primarily white (84%) males (64%), with mean (SD) body mass index of 31.9 (5.0) kg/m2 and age 42 (12) years. SIT-STAND resulted in decreased odds of discomfort (OR = 0.37, P = .01) and lower overall discomfort (β = −0.19, P d = 0.42) versus SIT. Discomfort during SIT-STAND was lower in the lower and upper back, but higher in the legs (all Psd = 0.26–0.42). Sleepiness (β = −0.09, P = .01, d = 0.15) and physical fatigue (β = −0.34, P = .002, d = 0.34) were significantly lower in SIT-STAND. Mental fatigue was similar across conditions. Conclusions: Sit-stand desks may reduce acute levels of sleepiness, physical fatigue, and both overall and back discomfort. However, levels of lower extremity discomfort may be increased with acute exposure.

Introduction: Much has been studied with reference to methicillin resistant Staphylococcus aureus (MRSA) and methicillin sensitive S. aureus (MSSA) colonization and associated outcomes and comorbidities. In the area of Orthopedic surgery, literature predominantly comes from the field of arthroplasty. Little is known about outcomes of fracture and Orthopedic trauma patients in the setting of S. aureus colonization. We believe that MRSA/MSSA colonization in and of itself may be a weak marker for generally poor protoplasm, potentially with complex medical history including previous hospitalization or rehab placement. This milieu of risk factors may or may not contribute to poorer outcomes after fracture and fracture nonunion surgery. The purpose of this study is to determine if nasal swabbing for S. aureus (MRSA or MSSA) carriage can predict operative culture, complications, or outcomes following fracture nonunion surgery. Methods: Sixty-two consecutive patients undergoing surgery for fracture nonunion were prospectively followed. Data analyses were performed using grouped MRSA and MSSA carriers (Staphylococcus carriers: SC). Outcomes analyzed included time to healing, need for additional surgery, and persistent nonunion. Results: Twenty-six percent of patients (16/62) were identified as MSSA carriers, an additional 6.5% (4/62) carried MRSA. Follow-up of at least 12-months was obtained on 90% (56/62) of patients. White blood cell counts, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values did not differ between SCs and non-carriers pre-operatively. Carriers were just as likely as non-carriers to culture positively for any pathogen at the time of surgery. Although SC’s were three times as likely as non-carriers to grow S. aureus (15% vs. 5%), this difference did not reach statistical significance (p = 0.3). Post-operative wound complications, antibiotic use, pain at follow-up and progression to healing did not differ between groups. Conclusions: Ultimately, pre-operative nasal swabbing for S. aureus is a simple and non-invasive diagnostic tool with prognostic implications in patients undergoing fracture nonunion surgery. This study found that MRSA and MSSA colonized patients with fracture nonunion of long bones do not have an increased association with positive cultures or a predisposition towards greater post-operative infectious complications. Keywords: MRSA, MSSA, Infection, Nasal carriage, Fracture nonunion

The aim of this review is a faithful report of the panorama of solutions adopted to fabricate a component using vat photopolymerization (VP) processes. A general overview on additive manufacturing and on the different technologies available for polymers is given. A comparison between stereolithography and digital light processing is also presented, with attention to different aspects and to the advantages and limitations of both technologies. Afterward, a quick overview of the process parameters is given, with an emphasis on the necessities and the issues associated with the VP process. The materials are then explored, starting from base matrix materials to composites and nanocomposites, with attention to examples of applications and explanations of the main factors involved.

Summary: Adolescent smoking is associated with pathological drinking later in life, but the biological basis for this vulnerability is unknown. To examine how adolescent nicotine exposure influences subsequent ethanol intake, nicotine was administered during adolescence or adulthood, and responses to alcohol were measured 1 month later. We found that adolescent, but not adult, nicotine exposure altered GABA signaling within the ventral tegmental area (VTA) and led to a long-lasting enhancement of alcohol self-administration. We detected depolarizing shifts in GABAA reversal potentials arising from impaired chloride extrusion in VTA GABA neurons. Alterations in GABA signaling were dependent on glucocorticoid receptor activation and were associated with attenuated dopaminergic neuron responses to alcohol in the lateral VTA. Importantly, enhancing chloride extrusion in adolescent nicotine-treated animals restored VTA GABA signaling and alcohol self-administration to control levels. Taken together, this work suggests that adolescent nicotine exposure increases the risk profile for increased alcohol drinking in adulthood. : Thomas et al. show that nicotine treatments during adolescence, but not adulthood, cause a long-term increase in alcohol self-administration in adult rodents. Adolescent nicotine exposure shifts GABAA receptor signaling within the ventral tegmental area circuitry, thereby altering subsequent responses to alcohol. Keywords: alcohol use disorder, reward, mesolimbic, nucleus accumbens, self-administration, chloride gradient, KCC2, glucocorticoid, gateway, dopamine

Background Evaluation of resident physicians' communications skills is a challenging task and is increasingly accomplished with standardized examinations. There exists a need to identify the effective, efficient methods for assessment of communications skills. Objective We compared objective structured clinical examination (OSCE) and direct observation as approaches for assessing resident communications skills. Methods We conducted a retrospective cohort analysis of orthopaedic surgery resident physicians at a single tertiary care academic institution, using the Institute for Healthcare Communication “4 Es” model for effective communication. Data were collected between 2011 and 2015. A total of 28 residents, each with OSCE and complete direct observation assessment checklists, were included in the analysis. Residents were included if they had 1 OSCE assessment and 2 or more complete direct observation assessments. Results There were 28 of a possible 59 residents (47%) included. A total of 89% (25 of 28) of residents passed the communications skills OSCE; only 54% (15 of 28) of residents passed the direct observation communications assessment. There was a positive, moderate correlation between OSCE and direct observation scores overall (r = 0.415, P = .028). There was no agreement between OSCE and direct observation in categorizing residents into passing and failing scores (κ = 0.205, P = .16), after adjusting for chance agreement. Conclusions Our results suggest that OSCE and direct observation tools provide different insights into resident communications skills (simulation of rare and challenging situations versus real-life daily encounters), and may provide useful perspectives on resident communications skills in different contexts.

Objective We developed a series of orthopedic unannounced standardized patient (USP) encounters for the purpose of objective assessment of residents during clinic encounters. Design Consecutive case-series. Setting NYU-Langone Multi-center Academic University Hospital System. Participants NYU-Langone/Hospital for Joint Diseases Orthopedic Surgery residents; 48 consecutive residents assessed. Methods Four orthopedic cases were developed. USPs presented themselves as patients in outpatient clinics. Residents were evaluated on communication skills (information gathering, relationship development, and education and counseling). USPs globally rated whether they would recommend the resident. Results Forty-eight USP encounters were completed over a 2-year period. Communication skills items were rated at 51% (±30) “well done.” Education and counseling skills were rated as the lowest communication domain at 33% (±33). Residents were globally recommended based on communication skills in 63% of the encounters recommended in 70% of encounters based on both professionalism and medical competence. Conclusions The USP program has been useful in assessing residents’ clinical skills, interpersonal and communications skills, and professionalism. Use of USP in orthopedic surgery training programs can be an objective means for trainee assessment.

Introduction: In the present paper, the authors have discussed anti-aging strategies which aim to slow the aging process and to delay the onset of age-related diseases, focusing on nutrient sensing pathways (NSPs) as therapeutic targets. Indeed, several studies have already demonstrated that both in animal models and humans, dietary interventions might have a positive impact on the aging process through the modulation of these pathways. Areas covered: Achieving healthy aging is the main challenge of the twenty-first century because lifespan is increasing, but not in tandem with good health. The authors have illustrated different approaches that can act on NSPs, modulating the rate of the aging process. Expert opinion: Humanity’s lasting dream is to reverse or, at least, postpone aging. In recent years, increasing attention has been devoted to anti-aging therapies. The subject is very popular among the general public, whose imagination runs wild with all the possible tools to delay aging and to gain immortality. Some approaches discussed in the present review should be able to substantially slow down the aging process, extending our productive, youthful lives, without frailty.

The search for anti-nucleus antibodies (ANA) represents a fundamental step in the diagnosis of autoimmune diseases. The test considered the gold standard for ANA research is indirect immunofluorescence (IIF). The best substrate for ANA detection is provided by Human Epithelial type 2 (HEp-2) cells. The first phase of HEp-2 type image analysis involves the classification of fluorescence intensity in the positive/negative classes. However, the analysis of IIF images is difficult to perform and particularly dependent on the experience of the immunologist. For this reason, the interest of the scientific community in finding relevant technological solutions to the problem has been high. Deep learning, and in particular the Convolutional Neural Networks (CNNs), have demonstrated their effectiveness in the classification of biomedical images. In this work the efficacy of the CNN fine-tuning method applied to the problem of classification of fluorescence intensity in HEp-2 images was investigated. For this purpose, four of the best known pre-trained networks were analyzed (AlexNet, SqueezeNet, ResNet18, GoogLeNet). The classifying power of CNN was investigated with different training modalities; three levels of freezing weights and scratch. Performance analysis was conducted, in terms of area under the ROC (Receiver Operating Characteristic) curve (AUC) and accuracy, using a public database. The best result achieved an AUC equal to 98.6% and an accuracy of 93.9%, demonstrating an excellent ability to discriminate between the positive/negative fluorescence classes. For an effective performance comparison, the fine-tuning mode was compared to those in which CNNs are used as feature extractors, and the best configuration found was compared with other state-of-the-art works.

The health sector has traditionally been one of the early adopters of databases, from the most simple Electronic Health Record (formerly Computer-Based Patient Record) systems in use in general practice, hospitals and intensive care units to big data, multidata based systems used to support diagnosis and care decisions. In this paper we present a framework to support non-invasive and early diagnosis of coeliac disease. The proposed framework makes use of well-known technologies and techniques, both hardware and software, put together in a novel way. The main goals of our framework are: (1) providing users with a reliable and fast repository of a large amount of data; (2) to make such repository accessible by means of a suitable API in multiple modes, such as intuitive web-based or mobile visual interfaces; (3) to allow for data processing and analysis, as a basis for decision support systems.

Indirect ImmunoFluorescence (IIF) assays are recommended as the gold standard method for detection of antinuclear antibodies (ANAs), which are of considerable importance in the diagnosis of autoimmune diseases. Fluorescence intensity analysis is very often complex, and depending on the capabilities of the operator, the association with incorrect classes is statistically easy. In this paper, we present a Convolutional Neural Network (CNN) system to classify positive/negative fluorescence intensity of HEp-2 IIF images, which is important for autoimmune diseases diagnosis. The method uses the best known pre-trained CNNs to extract features and a support vector machine (SVM) classifier for the final association to the positive or negative classes. This system has been developed and the classifier was trained on a database implemented by the AIDA (AutoImmunit&eacute, Diagnostic Assist&eacute, par ordinateur) project. The method proposed here has been tested on a public part of the same database, consisting of 2080 IIF images. The performance analysis showed an accuracy of fluorescent intensity around 93%. The results have been evaluated by comparing them with some of the most representative state-of-the-art works, demonstrating the quality of the system in the intensity classification of HEp-2 images.

The persistence of left superior vena cava (PLSVC) is the most common congenital anomaly of the venous return system to the heart. Because of the increasing number of patients referred for cardiac resynchronization therapy (CRT) devices implantations, it is expected to encounter this venous anatomic variation. Left ventricular lead placement at an appropriate site is an integral and technically challenging part of successful CRT. In case of cardiac abnormalities could be difficult to achieve an optimal cardiac rhythm management devices implantation. Previous reports in patients with PLSVC highlighted the challenges to achieve an optimal cardiac rhythm device implantation. Recently, a new quadripolar active fixation left ventricular lead is available for CRT device implantation. Hereby we report a case of a device upgrading from dual-chamber pacemaker to CRT with defibrillator backup using the active fixation left ventricular quadripolar lead in a patient with PLSVC and right superior vena cava atresia.

In the past years, a great deal of effort was put into research regarding Indirect Immunofluorescence techniques with the aim of development of CAD systems. In this work a method for segmenting HEp-2 cells in IIF images is presented. Such task is one of the most challenging of automated IIF analysis, because the segmentation algorithm has to cope with a large heterogeneity of shapes and textures. In order to address this problem, numerous techniques and their combinations were evaluated, in a process aimed at maximizing the figure of merit. The proposed method, for a greater definition of cellular contours, uses the active contours in the last phase of the process. The initial conditions, center position and initial curve of the active contour, were obtained using a randomized Hough transform for ellipse; the idea in identifying cells was to approximate them initially to ellipses. The purpose of the active contours, within the segmentation process, is to allow the separation of connected regions (such as two overlapping cells), in order to obtain a better definition of the objects to be analyzed (the cells). Our system has been developed and tested on public database. Segmentation performances were evaluated in terms of Dice index and the method was compared with other state-of-the-art workers. The results obtained demonstrate the goodness of the method in the characterization of HEp-2 cells. The developed method shows great strength and convergence speed. Furthermore, the flexibility of the proposed method allows it to be easily used in other biomedical contexts.

Heart failure, in its diverse forms based on the value of the ejection fraction, is associated to high mortality and the frequent need for hospitalization, with a consequent heavy burden on healthcare resources. For an appropriate treatment of heart failure with preserved ejection fraction (HFpEF), there are no specific drugs effective for this condition. Those indicated in HF with reduced EF (HFrEF) are of more benefit in that form of HF, according to the guidelines of the European Society of Cardiology of 2016: ACE-inhibitors, beta-blockers, anti-aldosterones are all indicated with a class of recommendation/level of evidence IA; therapy with loop diuretics is indicated in the case of clinical congestion (IB). Studies carried out with ACE-inhibitor (or angiotensin-receptor antagonist) or beta-blocker or anti-aldosterone to evaluate their efficacy also in HFpEF have substantially shown a benefit only on a reduction in the hospitalization rate. The same guidelines identify regular aerobic activity (IA) as more effective in the condition of HFpEF and indicate, appropriately, the need to treat comorbidities (IC) in the elderly (where they are more present and more numerous). They also recommend to avoid certain associations of drugs and, obviously, harmful (and contraindicated) medications that could worsen the clinical picture or might be potentially lethal.

Reducing prolonged sitting at work has been recommended by an expert panel, but whether intermittent standing improves vascular health is unclear. We aimed to test whether using a sit-stand desk could reduce blood pressure (BP) and pulse wave velocity (PWV) during a simulated workday.Overweight/obese adults with pre-to-Stage 1 hypertension completed a randomized crossover study with two simulated workday conditions: STAND-SIT (alternating standing and sitting condition every 30 min) and SIT (continuous sitting condition). Oscillometric BP was measured hourly. Carotid-femoral, carotid-radial, and carotid-ankle PWV were measured in the morning, mid-day, and late afternoon using tonometry.Participants [n = 25, 64% male, 84% white, mean (SD) age: 42 (12) years] had average resting SBP of 132 (9) mmHg and DBP of 83 (8) mmHg. In linear mixed models, STAND-SIT resulted in a significantly lower DBP (mean ± SE: -1.0 ± 0.4 mmHg, P = 0.020) and mean arterial pressure (MAP) (-1.0 ± 0.4 mmHg, P = 0.029) compared with SIT. SBP (-0.9 ± 0.7 mmHg, P = 0.176) was not different across conditions. Carotid-ankle PWV was significantly lower during the STAND-SIT vs. SIT condition (-0.27 ± 0.13 m/s, P = 0.047), whereas carotid-femoral PWV (-0.03 ± 0.13 m/s, P = 0.831) and carotid-radial PWV (-0.30 ± 0.18 m/s, P = 0.098) were not. Changes in MAP partially explained changes in PWV.Interrupting prolonged sitting during deskwork with intermittent standing was a sufficient stimulus to slightly, but statistically significantly, decrease DBP, MAP, and carotid-ankle PWV. Though the clinical significance of the observed effects is modest, regular use of a sit-stand desk may be a practical way to lower BP and PWV while performing deskwork.

The manageability and resilience of critical infrastructures, such as power and water networks, is challenged by their increasing interdependence and interconnectivity. Power networks often experience cascading failures, i.e. blackouts, that have unprecedented economic and social impact. Al- though knowledge exists about how to control such complex non-linear phenomena within a single power network, little is known about how such failures can spread and coevolve in the water network when failing power components energize the water distribution infrastructure, i.e. pumps and valves. This paper studies such a scenario and specifically the impact of power cascading failures on shortages of water supply. A realistic exemplary of an interconnected power-to-water network is experimentally evaluated using a modular simulation approach. Power and waterflow dynamics are simulated separately by taking into account different maximum powerlines capacities and water demand requirements. Results showcase the strong dependency of urban water sup- ply systems on the reliability of power networks, with severe shortages of water supply being caused by failures originating indistant power lines, especially for heavily loaded power networks.

12 h after the implant of a S-ICD the patient accused an inappropriate shock due to noise oversensing. ICD interrogation showed undersensing of ventricular signals on primary vector and significative noise on alternative vector. Surprisingly, 2 days full recovery of sensing of primary vector was observed. Trapped air was likely to be the cause of malfunctioning.

Infekcni endokarditida je zavažne onemocněni s vysokou morbiditou. Cardiobacterium hominis patři do skupiny mikroorganismů pod oznacenim HACEK. Popisujeme připad 56leteho muže s infekcni endokarditidou postihujici nativni mitralni chlopeň a vyvolanou bakterii Cardiobacterium hominis. Význam tohoto připadu spociva ve skutecnosti, že infekce vyvolane bakterii Cardiobacterium hominis, i když nejsou přilis caste (přibližně 1-3 % vsech připadů), jsou možnou přicinou infekcni endokarditidy se zavažnými klinickými důsledky.