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Hypoglycemia is a common safety event when attempting to optimize glycemic control in diabetes (DM). While electronic medical records provide a natural ground for detecting and analyzing hypoglycemia, ICD codes used in the databases may be invalid, insensitive or non-specific in detecting new hypoglycemic events. We developed text preprocessing methods to improve automatic detection of hypoglycemia from analysis of clinical encounter text notes.We set out to improve hypoglycemia detection from clinical notes by introducing three preprocessing methods: stop word filtering, medication signaling, and ICD narrative enrichment. To test the proposed methods, we selected clinical notes from VA Maryland Healthcare System, based on various combinations of three criteria that are suggestive of hypoglycemia, including ICD-9 code of diabetes and hypoglycemia, laboratory glucose values70 md/dL, and text reference to a proximate hypoglycemia event. In addition, we constructed one dataset of 395 clinical notes from year 2009 and another of 460 notes from year 2014 to test the generality of the proposed methods. For each of the datasets, two physician judges manually reviewed individual clinical notes to determine whether hypoglycemia was present or absent. A third physician judge served as a final adjudicator for disagreements.Each of the proposed preprocessing methods contributed to the performance of hypoglycemia detection by significantly increasing the F1 score in the range of 5.3∼7.4% on one dataset (p .01). Among the methods, stop word filtering contributed most to the performance improvement (7.4%). Combining all the preprocessing methods led to greater performance gain (p .001) compared with using each method individually. Similar patterns were observed for the other dataset with the F1 score being increased in the range of 7.7%∼9.4% by individual methods (p .001). Nevertheless, combining the three methods did not yield additional performance gain.The proposed text preprocessing methods improved the performance of hypoglycemia detection from clinical text notes. Stop word filtering achieved the most performance improvement. ICD narrative enrichment boosted the recall of detection. Combining the three preprocessing methods led to additional performance gains.

A new kind of contactless electromagnetic bandgap (EBG) structure in the form of interdigital-pin bed of nails is introduced for the first time in this paper. It consists of two metal plates with interdigital-pin bed of nails face to face with each other, where each pin is surrounded by four pins on the other plate. The working mechanism of the interdigital-pin contactless EBG structure is suppressing the modes supported by the parallel plate waveguide (PPW) by loading interdigital pins inside the PPW. The advantage of the interdigital-pin lattice is there is a significant pin gap increase. This lattice makes the minimum pin gap that could be processed by the machining center, after assembling, reduced from the diameter of the milling clutter to its radius. It provides a way to process EBG structures at higher frequency band with the same milling cutter. The cases the pins allocated between the two plates in a random manner are also studied. Compared to its traditional counterpart, the stopband is stable with a small variation. A W-band groove gap waveguide (GGW) prototype with interdigital-pins and a Ka-band GGW with randomly allocated pins are designed, manufactured, and tested. The measured results agree well with the simulation.

Objectives The study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation. Design Prospective, randomized and controlled trial. Setting A Cantonese cardiac center in China. Participants Two hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018. Interventions Patients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system. Measurements and Main Results The primary outcome was the lowest oxygen saturation (SpO2). Secondary outcomes included the incidence of hypoxia (SpO2 Conclusion When compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.

The new coronavirus (COVID-19) has been characterized as a world pandemic by WHO since March 11, 2020. Although it is likely that COVID-19 transmission is primarily via droplets and close contact, airborne transmission and fecal-oral route remains a possibility. The medical staff working in the operating room, such as anesthesiologists, surgeons and nurses, are at high risk of exposure to virus due to closely contacting patients. The perioperative management is under great challenge while performing surgeries for patients suffering COVID-19, including emergency cesarean section, which is one of the most common surgeries under such circumstances. How to prevent medical staff from cross-infection is an issue of great concern. In this article, we give a practice of anesthesia scenario design for emergency cesarean section in a supposed standard patient suffering COVID-19, aimed to optimize the work flow and implement the protective details through simulation of a real operation scenario, which may be useful for training and clinical practice of anesthesia management for patients suffering COVID-19 or other fulminating infectious diseases.

Right ventricular (RV) dysfunction is the main determinant of mortality in patients with pulmonary arterial hypertension (PAH) and while inflammation is pathogenic in PAH, there is limited information on the role of RV inflammation in PAH. Sulforaphane (SFN), a potent Nrf2 activator, has significant anti-inflammatory effects and facilitates cardiac protection in preclinical diabetic models. Therefore, we hypothesized that SFN might play a comparable role in reducing RV and pulmonary inflammation and injury in a murine PAH model. We induced PAH using SU5416 and 10% hypoxia (SuHx) for 4 wk in male mice randomized to SFN at a daily dose of 0.5 mg/kg 5 days per week for 4 wk or to vehicle control. Transthoracic echocardiography was performed to characterize chamber-specific ventricular function during PAH induction. At 4 wk, we measured RV pressure and relevant measures of histology and protein and gene expression. SuHx induced progressive RV, but not LV, diastolic and systolic dysfunction, and RV and pulmonary remodeling, fibrosis, and inflammation. SFN prevented SuHx-induced RV dysfunction and remodeling, reduced RV inflammation and fibrosis, upregulated Nrf2 expression and its downstream gene NQO1, and reduced the inflammatory mediator leucine-rich repeat and pyrin domain-containing 3 (NLRP3). SFN also reduced SuHx-induced pulmonary vascular remodeling, inflammation, and fibrosis. SFN alone had no effect on the heart or lungs. Thus, SuHx-induced RV and pulmonary dysfunction, inflammation, and fibrosis can be attenuated or prevented by SFN, supporting the rationale for further studies to investigate SFN and the role of Nrf2 and NLRP3 pathways in preclinical and clinical PAH studies. NEW & NOTEWORTHY Pulmonary arterial hypertension (PAH) in this murine model (SU5416 + hypoxia) is associated with early changes in right ventricular (RV) diastolic and systolic function. RV and lung injury in the SU5416 + hypoxia model are associated with markers for fibrosis, inflammation, and oxidative stress. Sulforaphane (SFN) alone for 4 wk has no effect on the murine heart or lungs. Sulforaphane (SFN) attenuates or prevents the RV and lung injury in the SUF5416 + hypoxia model of PAH, suggesting that Nrf2 may be a candidate target for strategies to prevent or reverse PAH.

Background Adverse Event (AE) ontology can be used to support interoperability and computer-assisted reasoning of AEs. Despite significant progress in developing biomedical ontologies, they are facing the obstacle of adoption partly because those ontologies are too general to meet the requirements of a specific domain. Understanding and representing of AEs for a specific domain such as Chronic Kidney Disease (CKD) has both theoretical and clinical significance. CKD patients are at a high risk for an array of disease-intervention specific AEs, and these in turn can contribute to disease progression unlike other diseases. This study proposes Disease Specific Ontology of Adverse Events (DSOAE) to address specific requirements of CKD, and applies it to different usage scenarios with real data. Methods We introduce a method for developing DSOAE through the extension and adaption of general ontologies by incorporating domain-specific information and usage requirements. It starts with specifying the goal and scope of a target domain (i.e. selecting seed ontologies), followed by identifying main AE classes and relations, extracting and creating classes and relations, aligning and identifying upper-level classes and lower-level classes, and finally populating the ontology with instances. Any of these steps may be repeated to refine the ontology. Results DSOAE contains 22 CKD-specific AE classes, which are grouped into two general categories: patient-reported AEs and biochemical/laboratory-related AEs. In addition, disease history and comorbidity classes as introduced in this study help model patient-related risk factors for AEs. With the support of DSOAE, we build a knowledge base of CKD-specific AEs using data from different sources (e.g. patient cohort data and social media), and apply the knowledge base to data analysis and data integration. Conclusions DSOAE enables the interoperability of AEs across different sources and supports the development of a knowledge base of domain-specific AEs. DSOAE can also meet the needs of different usage scenarios. The approach to constructing DSOAE is generalizable and can be used to develop AE ontology in other domains.

Motivated by the role of product features in enabling personalized recommendations and marketing, this research aims to extract product features from online consumer reviews. Previous studies are dominated by statistical-based techniques or focused on subjective features that are associated with opinions. In this research, we propose RubE-unsupervised rule-based methods that extract both subjective and objective features from online consumer reviews. We identify objective features by incorporating part–whole relation and review-specific patterns. We extract subjective feature by extending double propagation with indirect dependency and comparative construction. The experiment results demonstrate that RubE significantly outperforms the state-of-the-art techniques for product feature extraction and is generalizable from search goods to experience goods.

BACKGROUND: The optimal fluid therapy in elderly patients undergoing major abdominal surgery remains unclear. Although some trials have reported a restrictive fluid therapy may lead to better outcomes, there is no evidence whether it is suitable for elderly patients. METHODS: In a double-blinded pragmatic trial, 107 elderly patients undergoing major abdominal surgery were randomized to receive either a liberal (L group) or restrictive intravenous-fluid therapy (R group) . The postoperative fluid therapy was similar in the two groups. The primary outcome was vital organ injury included Myocardial injury after noncardiac surgery (MINS) and acute kidney injury（AKI）, the secondary outcomes included hypotension needed intervention intraoperatively, length of stay (LOS) , death and other complications defined up to 30 days. Analysis was performed by intention-to-treat. RESULT: 50 patients in the L group had an average intravenous fluid of 1943ml, as compared to 1295.61ml in 57 patients in the R group (P

Introduction Circulating tumor DNA (ctDNA) has provided a minimally invasive approach for the detection of genetic mutations in glioma. However, the diagnostic value of ctDNA in glioma remains unclear. This meta-analysis was designed to investigate the diagnostic value of ctDNA, compared with the current "criterion standard" tumor tissues. Materials and methods The included studies were collected by searching PubMed, Web of Science, Cochrane Library, and Embase databases. All statistical analyses were performed using the STATA12.0 and Meta-DiSc1.4 software. Result A total of 11 studies comprising 522 glioma patients met our inclusion criteria. The pooled sensitivity and specificity were 0.69 (95% confidence interval [CI] 0.66-0.73) and 0.98 (95% CI 0.96-0.99), respectively. The pooled diagnostic odds ratio was 23.27 (95% CI 13.69-39.53) and the area under the curve of the summary receiver operating characteristics curve was 0.90 (95% CI 0.89-0.92). Conclusions ctDNA analysis is an effective method to detect the genetic mutation status in glioma patients with high specificity and relatively moderate sensitivity. The application of high-throughput technologies, the detection of patients with high-grade glioma, and sampling from cerebrospinal fluid could have higher diagnostic accuracy. The improvement of detection methods and more large-sample case-control studies are required in the future.

The increasing prevalence of diabetic cardiomyopathy (DCM) is an important threat to health worldwide. While left ventricular (LV) dysfunction in DCM is well recognized, the accurate detection, diagnosis, and treatment of changes in right ventricular (RV) structure and function have not been well characterized. The pathophysiology of RV dysfunction in DCM may share features with LV diastolic and systolic dysfunction, including pathways related to insulin resistance and oxidant injury, although the RV has a unique cellular origin and composition and unique biomechanical properties and is coupled to the lower-impedance pulmonary vascular bed. In this review, we discuss potential mechanisms responsible for RV dysfunction in DCM and review the imaging approaches useful for early detection, protection, and intervention strategies. Additional data are required from animal models and clinical trials to better identify the onset and features of altered RV and pulmonary vascular structure and function during the onset and progression of DCM and to determine the efficacy of early detection and treatment of RV dysfunction on clinical symptoms and outcomes.

OBJECTIVEGlutamate excitotoxicity and neuronal apoptosis are suggested to contribute to early brain injury after subarachnoid hemorrhage (SAH). Annexin A7 (ANXA7) has been shown to regulate glutamate release. However, the role of ANXA7 in early brain injury after SAH has not been illustrated. In this study, we aimed to investigate the effect of ANXA7 knockdown in reducing the severity of early brain injury after SAH, and determine the underlying mechanisms.METHODSEndovascular perforation was performed to induce SAH in male Sprague-Dawley rats. ANXA7-siRNA was administered via intraventricular injection 5 days before SAH induction. Neurological test, evaluation of SAH grade, assessment of blood-brain barrier (BBB) permeability, measurement of brain water content, Western blot, double immunofluorescence staining, TUNEL staining, and enzyme-linked immunosorbent assay (ELISA) were performed at 24 hours of SAH induction.RESULTSANXA7 protein expression increased significantly after SAH induction and was seen mainly in neurons. High expression of ANXA7 was associated with poor neurological status. ANXA7 knockdown dramatically ameliorated early brain injury through alleviating BBB disruption and brain edema. Further investigation of the mechanism showed that inhibiting ANXA7 expression can rescue neuronal apoptosis. In addition, ANXA7 knockdown also significantly reduced glutamate release, which was consistent with a significant increase of Bcl-2 expression and decreases of Bax and cleaved caspase-3 expression.CONCLUSIONSANXA7 can induce neuronal apoptosis by affecting glutamate release in rats with SAH. Downregulating the expression of ANXA7 can significantly attenuate early brain injury after SAH. Future therapy targeting ANXA7 may be a promising new choice.

When a user receives a phone call, his mobile phone will normally ring or vibrate immediately regardless of whether the user is available to answer the call or not, which could be disruptive to his ongoing tasks or social situation. Mobile call management systems are a type of mobile applications for coping with the problem of mobile interruption. They aim to reduce mobile interruption through effective management of incoming phone calls and improve user satisfaction. Many existing systems often utilize only one or two types of user context (e.g., location) to determine the availability of the callee and make real-time decisions on how to handle the incoming call. In reality, however, mobile call management needs to take diverse contextual information of individual users into consideration, such as time, location, event, and social relations. The objective of this research is to propose a conceptual framework called CaCM (Context-aware Call Management) for mobile call management and implement a prototype system based on CaCM that incorporates rich context factors, including time, location, event, social relations, environment, body position, and body movement, and leverages machine learning algorithms to build call management models for individual mobile phone users. An empirical evaluation via a field study shows promising results that demonstrate the effectiveness of the proposed approach.

Recent advances in sensing and wireless communication technologies have led to an explosion in the use of touch-screen mobile devices such as smartphones and tablets in mobile commerce and other daily work and life activities. These activities have resulted in more and more private and sensitive information stored on those devices. Therefore, improving the security of mobile devices by effective user authentication to prevent unauthorized information access becomes an imminent task. Mobile user authentication refers to the process of checking a user’s identity and verifying whether he/she is authorized to access a device. Due to the increasing incidence of mobile phones getting lost, stolen, or snatched while being used by the owner, continuous user authentication (CUA) after logging in a mobile device has attracted increasing attention. Prior research has shown that traditional password authentication is insufficient or ineffective for CUA. Despite the recent research progress in CUA, many existing methods are explicit by nature in that they require users to perform specific operations, which can cause interruptions to users’ ongoing activities or may be easily learned from observation by others. In this research, we propose a new touch dynamics based approach to CUA on touch screen mobile devices that authenticates users while they are interacting with mobile devices. Touch dynamics, which is rich in cognitive quality and unique to individuals, has yet to be explored for implicit CUA. We conducted a longitudinal study to evaluate the proposed mobile CUA approach. The results demonstrate that our method can improve the security of CUA for touch screen mobile devices. The findings have significant implications for the security and adoption of m-commerce.

Objectives This study investigates the public’s opinions on a new school meals policy for childhood obesity prevention, discovers aspects concerning those opinions, and identifies possible gender and regional differences in the U.S. Methods We collected 14,317 relevant tweets from 11,715 users since the national policy enactment on Feb 9, 2010 through Dec 31, 2015. We applied opinion mining techniques to classify tweets into positive, negative, and neutral categories, and conducted content analysis to gain insights into aspects of opinions in terms of target, holder, source, and function. Results There were more negative tweets about the school meals policy than positive ones (16.8% vs. 12.9%), in addition to neutral tweets (70.3%). The main targets for negative opinions were campaign and food, and those for positive opinions were policy and health benefits. The opinion holders represent a wide range of policy stakeholders. The first-hand source dominated the opinions. Statement accounted for the function of most opinions. Females (62.5%) were more involved than males (37.5%), and people in the South and the West regions (64.2%) engaged themselves more than people in the Northeast and the Midwest (35.8%) of the U.S. Conclusions Negative opinions about the school meals policy consistently outnumbered positive ones. The findings discovered the public’s opinions for policy improvement, contributed to the evidence base of health benefits for policy promotion and community collaboration, and revealed interesting gender and regional differences in the opinions. The social media analytics offers significant methodological implications for discovering the public opinions on food policies.

The development of three-dimensional (3D) printing technology provides a new method for surgical treatment, but currently there are few reports on its application in the treatment of aneurysm. The aim of the present study was to explore the materials and methods of fabricating 3D printed individual aneurysm model and its value in the treatment of intracranial aneurysm. Twenty-four patients with intracranial aneurysm diagnosed by CTA who had undergone operation in our hospital were analyzed retrospectively. CTA Data collected at the time of surgery was used for reconstruction. Soft Mimics 17.0 was used to reconstruct the thin layer CTA scan data into 3D image and the final data was sent to the 3D printer for fabricating the model. We compared the proposed 3D printed model-based preoperative plan and the actual approach used in the surgery based on CTA data to evaluate the value of the 3D printed model in preoperative planning, and picked out the materials which were more suitable for the clinic. Twenty-four aneurysm models with high degree of reality were fabricated successfully with 3D-printing technology. The patients’ blood vessels, skulls and aneurysms were printed into the reality model at a ratio of 1:1. It is reported that the soft material-based, 3D printed vascular and aneurysm model more closely resembled the characteristics of the real blood vessels, thus provides a better simulation compared to the plaster-based model. Compared with the original operation plan, 3D printed model could be used for pre-operative aneurysm clip selection, and provide more intuitive information in selection of operational approach. 3D printed model can be used as an operational physical model to design operative schemes, choose the best operative paths and select suitable aneurysm clips by its high simulation degree and individualized characteristics. The model is helpful for surgical planning, especially for the preoperative plan of treating refractory multiple aneurysms and giant aneurysms.

Fingerprint segmentation is a crucial step in fingerprint recognition system, and determines the results of fingerprint analysis and recognition. This paper proposes an efficient approach for fingerprint segmentation based on modified fuzzy c-means (FCM). The proposed method is realized by modifying the objective function in the Szilagyi’s algorithm via introducing histogram-based weight. Experimental results show that the proposed approach has an efficient performance while segmenting both original fingerprint image and fingerprint images corrupted by different type of noises.

Introduction: The purpose of this study was to evaluate the feasibility of left bundle ablation guided by left bundle potential (LBP) and three dimensional mapping system (EnSite NavX system) in canine models. Methods and Results: The canines were sequentially allocated into two groups, left bundle branch ablation guided by LBP and either fluoroscopy or NavX system. An LBP (mean LBP-V 17.8 ? 2.6 ms; 13-21) was identified resulting in successful left bundle ablation in 9 dogs. The A:V electrogram ratio at the successful LBP ablation site was

Understanding text requires not only the extraction of individual concepts, but the identification of semantic relationships among concepts as well. Lexical resources have been applied to analyzing text in a wide range of applications. However, manual compilation of lexical resources is difficult to keep up with the rapid increase of the volume and diversity of user-generated content on the web. Automatic concept hierarchy construction has been considered as one solution to the above problem. Despite extensive effort on automatic construction of concept hierarchies, few studies have focused on the concepts of specific domains. In this study, we propose a comprehensive framework for building a domain-specific concept hierarchy. By synthesizing different types of measurements of relatedness among concepts, we propose an integrated method for building a multi-branch hierarchy of product features from online consumer reviews. The experiment results show that the proposed algorithm successfully reconstructs almost an entire hierarchy except for missing a few concepts and links. Starting from scratch, the algorithm reconstructed about 60% of the manually constructed hierarchy. The proposed method can be used to improve search results by better understanding user queries, and to facilitate personalized recommendations in e-commerce.

A simplified stick model for the nonlinear dynamic analysis of a building structure is presented. Based on the strong-column-weak-beam design philosophy, similar deformation shapes for all the columns in the same storey of a building structure is assumed. Therefore, while subjected to horizontal earthquake excitation, the inflection points of beam elements of building structures are assumed at either the middle of the spans or the locations of the plastic hinges in beam elements. After stacking all the column lines of the building structure and making use of the technique of static condensation for the stiffness matrices of beam elements, the simplified stick model with intermediate rotational constraints at all the floor levels can be set up. Bilinear behavior for beam and column elements is adopted for the nonlinear analysis. The advantage of using the proposed stick model for nonlinear dynamic analysis is to slash the computational cost, since the number of the degrees of freedom for each floor level is only two and the bandwidth of the stiffness matrix for total structure system is four. Some numerical results and some comparisons with the results of DRAIN-TABS are presented in order to show the effectiveness of the simplified model, and some possible extentions of the stick model are also discussed.

Metasearch has been proved to be a quite effective method to integrate information spaces provided by underlying search engines. But how to admit new resources dynamically was almost neglected. Current solutions include software recoding or resource rebinding by metasearch engine developers. Besides extra cost in time and money, both tactics might be futile for resources in a controlled network (e.g. a campus network using virtual IP address) or fail to keep pace with the emerging of new resources.