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This chapter introduces heat flow in the subsurface. It begins with defining heat, energy, and enthalpy and proceeds to an overview of conductive and advective heat transport. It then reviews the general equations of heat flow and examines two analytic solutions for one-dimensional heat flow, which are useful for examining vertical groundwater flow rates. The chapter continues with discussion of crustal-scale heat flow followed by discussion of shallow heat flow and temperature profiles. This latter discussion includes an examination of evidence of climate change, and methods for estimating recharge rates and groundwater discharge rates. The following section describes hydrothermal systems, hot springs, and geysers. The chapter concludes with sections covering geothermal energy production and ground-source heat pump systems.

Millimeter wave components, such as circulators and isolators, frequently use magnetic fields to break symmetry of the signal propagation and provide unidirectional signal transmission. While effective, these components have not seen the level of miniaturization of other millimeter wave components, primarily due to the discrete nature of the magnets used in the components. Using circulators in the 40-50 GHz range as a motivating application, requirements arise for the deposited films, namely immunity to eddy currents, sufficient magnetization to act as self-biasing magnets, and out-of-plane orientation of the self-biasing field. Based on these required properties, hexaferrite materials are selected for their strong magnetocrystalline anisotropy (MCA) and low conductance. The difficulty of integrating these components monolithically with monolithic microwave integrated circuits (MMIC) originates from the incompatibility of crystal structure with standard semiconductor materials and process conditions. Additive manufacturing using a composite of strontium hexaferrite (SrFe12O19) particles and photoresist has been chosen as a method to overcome the difficulties of integrating hexaferrite material to semiconductor substrates. Due to their large internal anisotropy field, the particles of strontium hexaferrite tend to rotate to the field direction instead of changing magnetization direction under application of an external magnetic field (less than the anisotropy field). We have developed a method for 3D printing composites of high strontium hexaferrite concentration (up to 20% by volume) in a liquid photoresist, SU8. Rotation of hexaferrite particles in polymer matrix and thus magnetic anisotropy has been demonstrated in the composite, which is subsequently cured to hold the physical position and orientation of the particles. The anisotropy of the self-biasing field provided by the films has been experimentally characterized, and a ferromagnetic resonance (FMR) frequency ~43 GHz has been observed. We have also characterized the viscosity of the particle-laden polymer at different particle concentrations. 3D printing of this composite with poling will make it possible to directly print magnetic components that require out-of-plane anisotropic magnetization.

Objective The objective was to develop a novel scoring system that would be predictive of postoperative pulmonary complications in critically ill patients after cardiac and major vascular surgery. Methods A total of 17,433 postoperative patients after coronary artery bypass graft, valve, or thoracic aorta repair surgery admitted to the cardiovascular intensive care units at Cleveland Clinic Main Campus from 2009 to 2015. The primary outcome was the composite of postoperative pulmonary complications, including pneumonia, prolonged postoperative mechanical ventilation (>48 hours), or reintubation occurring during the hospital stay. Elastic net logistic regression was used on the training subset to build a prediction model that included perioperative predictors. Five-fold cross-validation was used to select an appropriate subset of the predictors. The predictive efficacy was assessed with calibration and discrimination statistics. Post hoc, of 13,353 adult patients, we tested the clinical usefulness of our risk prediction model on 12,956 patients who underwent surgery from 2015 to 2019. Results Postoperative pulmonary complications were observed in 1669 patients (9.6%). A prediction model that included baseline and demographic risk factors along with perioperative predictors had a C-statistic of 0.87 (95% confidence interval, 0.86-0.88), with a corrected Brier score of 0.06. Our prediction model maintains satisfactory discrimination (C-statistics of 0.87) and calibration (Brier score of 0.07) abilities when evaluated on an independent dataset of 12,843 recent adult patients who underwent cardiovascular surgery. Conclusions A novel prediction nomogram accurately predicted postoperative pulmonary complications after major cardiac and vascular surgery. Intensivists may use these predictors to allow for proactive and preventative interventions in this patient population.

Magnetic circuit components have long been the largest and most difficult components to miniaturize. Printed circuit board (PCB) fabrication methods cannot achieve small diameter, high aspect-ratio vias for high winding turn numbers to achieve high inductance, and microelectronics methods cannot achieve the high-quality and thick ferrite core materials. In this paper, we present an alternative breakthrough method of printed circuit fabrication to significantly reduce the effective via diameter for embedded magnetic devices, boosting the inductance per unit area. To reduce the effective via diameter, high-density via plugs are ex-situ fabricated and shaped, and then embedded into PCB substrate in the same process as standard magnetic core embedding. The structure of the plug is such that precise placement within the substrate, or alignment to the plug with the winding pattern, is not necessary. Devices presented in this paper use via plugs with an effective diameter of 40 μm and a theoretically unlimited aspect ratio, though refinements in the plug fabrication process are expected to reduce the via diameter down to 10μm. The process is experimentally demonstrated with a 14-turn racetrack shaped transformer; novel diagnostic methods using magneto-optic garnet films to image current paths are also demonstrated.

This brief proposes a low voltage ultra-low power 10-bit 100-MS/s successive approximation register (SAR) analog-to-digital converter (ADC). To overcome the performance degradation due to the signal-related current fluctuation under lower supply voltage, an adaptive-biasing comparator with current self-compensation (CSC) technique is proposed to obtain a constant working current, reducing the minimum supply voltage from 0.7V in conventional ADCs to 0.55V. Since full-scale range shrinks with the supply voltage, voltage undershoot in power rail caused by capacitor digital-to-analog converter (C-DAC) deteriorates effective-number-of-bits (ENOB). Conventional solutions involve enhanced regulators and large decoupling capacitors, which cost remarkable power dissipation and large chip area. This brief presents a pulse-injection undershoot compensation technique which reduces the DAC-related supply fluctuation from a typical 15mV to 1.8mV, and improves the ENOB by 0.4 bit. The prototype was fabricated in TSMC 28nm HPC CMOS technology. The proposed SAR ADC achieves an SNDR of 54.7dB and an SFDR of 68dB with the power consumption of 0.16mW under 0.55V supply voltage, a figure of merit (FoM) of 3.6-fJ/conversion-step is achieved. The chip area of the ADC core is 130μm×225μm.

In this work, we consider transferring the structure information from large networks to compact ones for dense prediction tasks in computer vision. Previous knowledge distillation strategies used for dense prediction tasks often directly borrow the distillation scheme for image classification and perform knowledge distillation for each pixel separately, leading to sub-optimal performance. Here we propose to distill structured knowledge from large networks to compact networks, taking into account the fact that dense prediction is a structured prediction problem. Specifically, we study two structured distillation schemes: i) pair-wise distillation that distills the pair-wise similarities by building a static graph; and ii) holistic distillation that uses adversarial training to distill holistic knowledge. The effectiveness of our knowledge distillation approaches is demonstrated by experiments on three dense prediction tasks: semantic segmentation, depth estimation and object detection. Code is available at: https://git.io/StructKD, Comment: v1:10 pages cvpr2019 accepted; v2:15 pages for a journal version; Code is available at: https://github.com/irfanICMLL/structure_knowledge_distillation; fix typos

This paper studies the coordinated use of smart inverters with legacy voltage regulating devices to help increase the energy savings from conservation voltage reduction (CVR) in distribution systems with high photovoltaic penetration. Two voltage optimization algorithms are developed to evaluate the CVR benefit by considering two types of smart inverter functions: aggregated reactive power control and autonomous volt/VAR control. In each algorithm, smart inverters are coordinately controlled with the operation of legacy voltage regulating devices including load tap changers and capacitor banks. Both algorithms are tested on representative utility distribution system models. Simulation results demonstrate that the proposed algorithms can achieve around 1.8-3.6% energy savings when only using legacy voltage regulating devices and an additional 0.3-0.9% when adding smart inverters.

The prone position is extensively used to improve oxygenation in patients with severe acute respiratory distress syndrome caused by SARS-CoV-2 pneumonia. Occasionally, these patients exhibit cardiac and respiratory functions so severely compromised they cannot tolerate lying in the supine position, not even for the time required to insert a central venous catheter. The authors describe three cases of successful ultrasound-guided internal jugular vein cannulation in prone position. The alternative approach here described enables greater safety and well-being for the patient, reduces the number of episodes of decompensation, and risk of tracheal extubation and loss of in-situ vascular lines.

The steep voltage slopes of today’s wide-bandgap (WBG), fast-switching power semiconductors — like SiC and GaN — lead amongst other challenges to reflection on long cables and thereby overvoltage at inductive loads. To enable the use of these inverters with motors without specially reinforced insulation the voltage slopes need to be slowed down. This article presents a new low-loss countermeasure, which involves the parallel connection of two half-bridges via an interphase transformer. For this one half-bridge is delayed relative to the other one by a delay tuned to a resonant circuit. Undesired DC components in the cross-current of the interphase transformer occur due to non-idealities in the voltage symmetry. The subsequent DC magnetization ultimately can cause the core to saturate. The paper describes the effects due to inaccurate timings and the aspects to keep in mind when dimensioning the magnetic core. Also, this article describes an approach to deal with the undesired current components using a closed-loop control. For that, a special differential-mode shunt is used which enables a dedicated measurement of the cross-current mean value and mitigates the influence of the switching frequency. Finally, the controller concept is presented. The controller is implemented and verified on a 500 kVA SiC inverter test bench.

Background Coma is one of the frequently encountered clinical conditions in any intensive care unit (ICU), which is responsible for considerable morbidity and mortality. Therefore, this study was designed to look at the clinical and EEG profile of Nonconvulsive Status Epilepticus (NCSE) in comatose ICU patients using portable electroencephalography (EEG). Methods In all 102 patients of unresponsive coma (GCS ≤ 8), who remained in poor sensorium despite 48 h of optimum treatment in ICU, were included in the study. All patients underwent 1 h of electroencephalography (EEG) monitoring with a portable EEG machine. All EEGs were screened according to Salzburg Consensus Criteria (SCC) for Nonconvulsive Status Epilepticus (NCSE). Patients with evidence of NCSE were administered parenteral Antiepileptic Drugs (AED). A repeat EEG was done after 24 h of baseline to ascertain the effect of AED. The primary outcome was the recognition of patients with NCSE on the basis of established EEG criteria. The secondary outcome measure was the Glasgow outcome scale (GOS) at the time of discharge. Results Out of 102 cases enrolled, 12 (11.8%) cases were detected to have NCSE on portable EEG. The mean age of patients with NCSE was 52.2 years. In terms of gender distribution, 2/12 (17%) were female, and 10/12 (83%) were male (M: F = 5:1). Median GCS was 6 (range 3–8). Looking at CNS infections, 4/12 (33.3%) had evidence of some form of CNS infection in the NCSE group, compared to 16/90 (18%) in the group without NCSE. This difference was statistically significant (P-value 2 points) after administration of AED’ was noted with good clinical outcomes (GOS 5). In five of these 12 cases, death was the final outcome (GOS 1). Conclusions NSCE should be considered in the differential diagnosis of all unresponsive comatose ICU patients. In resource-limited settings, where continuous EEG monitoring may not be feasible, bedside portable EEG testing can be used to diagnose patients with NCSE. Treating NCSE reverses epileptiform EEG changes and improves clinical outcomes in a subset of comatose ICU patients.

Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone.Prospective, randomized, controlled, single-blinded, non-inferiority.Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10.Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P0.001; PhoRTE + EMST M = -9.58, P0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm HThis study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.

Background Carbapenemase producing gram-negative bacteria (GNB) has become a huge problem in majority of tertiary care centers worldwide. They are associated with very high morbidity and mortality rates, especially when they cause invasive infections. Therefore, rapid detection of these organisms is very important for prompt and adequate antibiotic therapy as well as infection control. The aim of this study was rapid detection of carbapenemase genes and thereby likely carbapenem resistance, 24–48 hours in advance, directly from the positive-flagged blood culture bottles using CHROMagar and Xpert® Carba-R. Methods Aspirate from positively flagged blood culture bottles was subjected to differential centrifuge. All gram-negative bacilli on gram stain from the deposit were processed in Xpert® Carba-R and inoculated on CHROMagar. The presence of genes and growth on CHROMagar was compared with carbapenem resistance on VITEK-2 Compact. Results A total of 119 GNB isolates were processed. One or more of the carbapenemase genes were detected in 80 isolates. On comparison with VITEK-2 result, 92 samples showed concordance for carbapenem resistance 48 hours in advance. There was discordance in 21 isolates with 12 major errors and 09 minor errors. The sensitivity of direct Xpert® Carba-R test for rapid detection of carbapenem resistance, 48 hours in advance, was 81.42%. The sensitivity of direct CHROMagar test for accurate detection of carbapenem resistance, 24 hours in advance, was 92.06%. Conclusion The ability to detect carbapenem resistance with very high accuracy, 48 hours in advance, helps in appropriate antibiotic therapy and implementation of effective infection control practices.

Statement of problem Bilateral balanced occlusion has been advocated over nonbalanced occlusion for improved removable complete denture stability and function. However, assessments of quality of life and patient satisfaction studies between the 2 occlusion schemes are lacking. Purpose The objective of this parallel randomized control trial was to determine the difference in quality of life and patient satisfaction between the nonbalanced and bilaterally balanced occlusal schemes. Material and methods Sixty participants were included in the parallel randomized control trial of nonbalanced and bilaterally balanced complete dentures. Thirty were recruited into each group with definitive inclusion and exclusion criteria as per the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Quality of life was estimated from the oral health quality of life (Oral Health Impact profile) for edentulous patients questionnaire, and patient satisfaction was analyzed from a visual analog scale. The estimation was made at 0, 3, and 6 months after denture insertion. The data were statistically analyzed with the Friedman, Mann-Whitney, and t test (α=.05). Results The mean ±standard deviation Oral Health Impact profile score was 60.81 ±8.87 for nonbalanced dentures and 64.12 ±8.98 for bilaterally balanced dentures. The mean ±standard deviation visual analog scale score was 2.84 ±0.28 for nonbalanced dentures and 2.90 ±0.31 for bilaterally balanced dentures. The Mann-Whitney and t test indicated nonsignificant differences between the 2 groups and at different time intervals for Oral Health Impact profile and visual analog scale scores (P>.05). Conclusions The study detected no significant differences between the 2 occlusal schemes in quality of life or patient satisfaction.

Investigating the prognostic value of the Murray law-based quantitative flow ratio (μQFR) on the clinical outcome after treatment of in-stent restenosis (ISR) with a drug-coated balloon (DCB).Patients participating in a previous randomized clinical trial for DCB-ISR were post-hoc analyzed. The primary endpoint was vessel-oriented composite endpoint (VOCE), defined as cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. μQFRs at baseline and after DCB angioplasty was calculated, and its prognostic value as a predictor of VOCE was explored in Cox regression.A total of 169 lesions in 169 patients were analyzed. At one-year follow-up, 20 VOCEs occurred in 20 patients. Receiver-operating characteristic curve analysis identified a post-procedural μQFR of ≤ 0.89 as the best cut-off to predict VOCE (area under curve [AUC]: 0.74; 95% confidence interval [CI]: 0.67-0.80; p0.001), superior to post-procedural in-stent percent diameter stenosis (DS), which reported an AUC of 0.61 (95% CI: 0.53-0.68; p = 0.18). Post-procedural μQFR was significantly lower in patients with VOCE compared with those without (0.88 [interquartile range: 0.79-0.94] vs. 0.96 [interquartile range: 0.91-0.98], respectively; p0.001). After correction for potential confounders, post-procedural μQFR ≤ 0.89 was associated with a 6-fold higher risk of VOCE than lesions with μQFR0.89 (hazard ratio: 5.94; 95% CI: 2.33-15.09; p0.001).Post-procedural μQFR may become a promising predictor of clinical outcome after treatment of DES-ISR lesions by DCB angioplasty.

Power components such as High Electron Mobility Transistors (HEMTs) are used for high power and high frequency applications. These tend to overheat and destroy their packaging and connections to the wire bondings. This paper presents planar micro-thermoelectric sensors (μTESs) developed to measure partial heat flow dissipated by the HEMTs to avoid the HEMTs from reaching critical temperatures. These sensors use the same active materials as well as the same fabrication process as the HEMTs, enabling them to be fabricated simultaneously for a simple integration. The HEMTs’ active layers consist in AlGaN/GaN heterostructures resulting in the formation of a 2D Electron Gas (2DEG) at the interface. Tension factors of 47 mV/(K.mm2) were obtained with these sensors and heat flows of 0.2 W to 7 W were measured.

BackgroundDespite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia.MethodsA parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, proACT-S, or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up.ResultsIntention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's d = 0.86, 95% CI (−10.11 to −5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's d = 1.00, 95% CI (−5.93 to −3.53)], and anxiety [Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A): Cohen's d = 0.83, 95% CI (−3.75 to −1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's d = 0.91, 95% CI (−3.34 to −1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment.ConclusionproACT-S is an efficacious sleep-focused self-help treatment for major depression and insomnia.Trial registrationClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. https://clinicaltrials.gov/ct2/show/NCT04228146

Statement of problem A consensus on the clinical performance of implant-supported removable partial dentures (ISRPDs) is lacking. Purpose The purpose of this systematic review and meta-analysis was to evaluate the clinical performance of ISRPDs in terms of the implant survival rates, marginal bone loss, and patient-reported outcome measures (PROMs). Material and methods Four electronic databases (MEDLINE/PubMed, EMBASE, Web of Science, and Cochrane Library) were independently searched by 2 reviewers for articles published up to December 2020. A single-arm meta-analysis was performed to evaluate the implant survival rates and marginal bone loss by using the R program. The Cochrane collaboration tool was used to evaluate the risk of bias of randomized controlled trials (RCTs), and the Newcastle-Ottawa scale for non-RCT studies. Results Sixteen studies were included, with a total of 334 participants and a mean age of 58 years. The participants received a total of 581 dental implants, 475 conventional and 106 mini-implants. All included studies reported implant survival rate above 90% (range: 92% to 100%). Meta-analysis indicated a high proportion of implant survival rates of 3% (95% confidence interval [CI]: 2% to 5%) and a low mean raw score of marginal bone loss 0.98 mm (CI: 0.61 to 1.36 mm). Compared with conventional RPDs, improved patient quality of life and satisfaction were reported by studies that evaluated ISRPDs. RCT studies exhibited a low risk of bias for most domains, while most non-RCT studies were classified as good quality. Conclusions ISRPDs exhibited high implant survival rates and acceptable bone loss with improvement in the quality of life and satisfaction of patients when compared with conventional RPDs. Therefore, they can be considered suitable for the rehabilitation of partially edentulous patients.

Relay selection solutions for underwater acoustic cooperative networks suffer significant performance degradation as they fail to adapt to incomplete information, noisy interference and overwhelming dynamics. To address this challenge, a hierarchical adversarial multi-armed bandit learning framework by proposing an online reward estimation layer is designed to improve adaptive relay decision control. In online reward estimation layer, adaptive Kalman filter estimator is developed to properly handle noisy observation to support accurate reward. Meanwhile an online predict mechanism is projected for all relays to enrich learning information. Furthermore, based on estimate error variance, an adaptive exploration structure is developed to accelerate the balance between exploration and exploitation. All gathered information are exploited to learn relay quality for the decision-making. Accordingly, we present a Hierarchical Adversarial Bandit Learning (HABL) algorithm to fully exploit the heuristic interaction between the hierarchical framework. HABL integrates reward estimation, information prediction, adaptive exploration and decision making carefully in a holistic algorithm to maximize the learning efficiency. Thereby, the HABL-based relay selection algorithm has higher system throughput and lower communication cost. Further, we rigorously analyze the convergence of HABL algorithm and give its upper bound on the cumulative regret. Finally, extensive simulations elucidate the effectiveness of the HABL.

The vetiver is an excellent source for essential oil, fodder, thatching, handicrafts, and mulching. Besides its various utility, a limited study has been done as fodder for ruminants. The major studies in the vetiver were focused on oil production, soil/water conservation. The study related to livestock cattle feeding on vetiver is very meager. The essential oil content, yield, nutritional, and protein quality of the fodder are highly affected by the G × E interaction. Objectives were to determine the extent of genotype × environment interaction for the nutritional quality of fodder, oil yield and to identify stable genotypes for the future breeding program. The thirty lines were evaluated to meet the above objectives to select genotypes with high oil yield and fodder quality. The genotypes were planted in RBD at the Institute in three years. The observations were recorded on twenty traits. The roots were distilled for oil by hydro-distillation for 24 h. GC analysis was performed in a Varian CP 3800 system using an Elite-5 fused silica column (30 m × 0.25 mm × 0.25 μm). The pooled mean observations of all characters were analyzed for stability by the GGE biplot. For after the pooled ANOVA across years, all the twenty traits showed highly significant variations except four. Except for one variable, essential oil content, genotype was very significant for all twenty traits (%). For maturity stage × year interaction, all the twenty traits also showed high significance except four traits. For the maturity stage × genotypes interaction, all the twenty traits also showed highly significant variations except four traits. For years × genotypes interaction, all twenty traits also showed highly significant differences. For the maturity stage× years × genotypes interaction, all the twenty traits also showed high significance except one trait. The genotype Vg-11/selection 24 expressed the highest performance for eight traits: digestibility, protein, potassium, phosphorus (%), iron, copper, and manganese (mg/Kg) in vetiver leaves and the root yield/plot (g). The genotype Vg-15 for the three traits: calcium (%), khusinol, and β-vetivone (%) in essential oil. Despite the importance of essential oil, its leaves are vital due to their nutritional quality and can be used as fodder. Genotype Vg-11/selection 24 may recommend as a suitable and nutritious fodder and Vg-13 for high oil. The vetiver also has a perfect opportunity to be as nutritious fodder in livestock for nutrition and production.

In VANETs, it is important to support fast and reliable multi-hop broadcast for safety-related applications. The performance of multi-hop broadcast schemes is greatly affected by relay selection strategies. However, the relationship between the relay selection strategies and the expected broadcast performance has not been fully characterized yet. Furthermore, conventional broadcast schemes usually attempt to minimize the waiting time difference between adjacent relay candidates to reduce the waiting time overhead, which makes the relay selection process vulnerable to internal interference, occurring due to retransmissions from previous forwarders and transmissions from redundant relays. In this paper, we jointly take both of the relay selection and the internal interference mitigation into account and propose a fast, reliable, opportunistic multi-hop broadcast scheme, in which we utilize a novel metric called the expected broadcast speed in relay selection and propose a delayed retransmission mechanism to mitigate the adverse effect of retransmissions from previous forwarders and an expected redundancy probability based mechanism to mitigate the adverse effect of redundant relays. The performance evaluation results show that the proposed scheme yields the best broadcast performance among the four schemes in terms of the broadcast coverage ratio and the end-to-end delivery latency.

This paper presents a framework for telepresence operation by touching live video on a touchscreen. Our goal is to enable users to use a smartpad to teleoperate everyday objects by touching the objects live video they are watching. To this end, we coined the term teleinteractive device to describe such an object with an identity, an actuator, and a communication network. We developed a touchable live video image-based user interface (TIUI) that empowers users to teleoperate any teleinteractive device by touching its live video with touchscreen gestures. The TIUI contains four modules touch, control, recognition, and knowledge to perform live video understanding, communication, and control for telepresence operation. We implemented a telepresence operation system that consists of a telepresence robot and teleinteractive devices at a local site, a smartpad with the TIUI at a remote site, and communication networks connecting the two sites. We demonstrated potential applications of the system in remotely controlling telepresence robots, opening doors with access control panels, and pushing power wheelchairs. We conducted user studies to show the effectiveness of the proposed framework.

Abstract: Sexual dysfunction can adversely affect the quality of life, self-confidence, and interpersonal relationships. Some studies reported a relationship between vitamin supplementation and sexual health. This systematic review aimed to evaluate the effect of vitamins on female and male sexual function. All relevant English and Persian articles published in English databases (Medline, Scopus, Cochrane Library, Web of Sciences, Psycho-Info, and Proquest) and Farsi databases (SID and Magiran) until July 2020 were searched. The Cochrane Handbook for Systematic Reviews of Interventions was used for assessing the risks of bias. A total of 11 randomized controlled trials (RCTs) on 337 women, 472 men, and 35 couples were included. One study reported that vitamin D 300000 IU supplement administrated twice through intramuscular injection (at the beginning and after four weeks) had a significant effect on female sexual function (p0.05). A study reported the significant effect of niacin (vitamin B3) 1500 mg daily for 12 weeks on erectile function (p=0.004). The results showed that vitamins A, C, and E had no significant effect on male and female sexual function. The conduction of trials with long-term interventions is recommended to reach a more definitive conclusion about the effect of vitamins on sexual function.

Objectives Deep hypothermic circulatory arrest (DHCA) is often required for patients undergoing repair of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm via left thoracotomy when proximal crossclamping is not feasible or when aneurysmal disease extends into the transverse aortic arch. Historical literature suggests higher complications rates due to the technical complexity of this approach; we examined outcomes with this approach at our center. Methods Between January 2008 and May 2018, 84 patients with DTAA or Crawford extent I thoracoabdominal aortic aneurysm underwent open repair. DHCA was employed in 46 of 84 (55%) patients, of which 33 (72%) required repair of distal arch and DTAA, and 13 (28%) required repair of the distal arch and extent I thoracoabdominal aortic aneurysm. Patients who underwent DHCA had more chronic dissections than those in the non-DHCA group (70% vs 34%; P ≤ .05). Results Major adverse outcomes for the DHCA group versus non-DHCA group were as follows: early mortality 3 out of 46 (7%) versus 4 out of 38 (11%) (P = .70), stroke 3 out of 46 (7%) versus 1 out of 38 (3%) (P = .62), permanent spinal cord deficit 2 out of 46 (4%) versus 3 out of 38 (8%) (P = .65), permanent renal failure necessitating dialysis 1 out of 46 (2%) versus 2 out of 38 (5%) (P = .59). Freedom from major adverse outcomes was 38 out of 46 (83%) versus 31 out of 38 (82%) for DHCA versus non-DHCA (P = 1). Conclusions DHCA can be employed via left thoracotomy for combined arch and DTAA or extent I thoracoabdominal aortic aneurysm open repair.

Uterine rupture can be associated with severe maternal and neonatal morbidity and mortality. It should be considered as a differential diagnosis in all pregnant women who present with acute abdomen, haemoperitoneum and have specific risk factors, even during the first trimester. This is a case report of a 25-year-old woman who presented to emergency department with abdominal pain and vaginal bleeding at approximately 6–8 weeks gestation. She developed an acute surgical abdomen and required urgent surgical management. Despite intervention, she had massive haemorrhage, disseminate intravascular coagulation, admission to intensive care unit and prolonged hospital stay as complications. Posterior uterine wall rupture while rare, must be considered as a differential diagnosis as early intervention is crucial to prevent bad outcomes.

Purpose: The current study aims to quantify the effect of brief behavioral treatment for insomnia (BBTI) studies through meta-analysis. Method: Searches were performed from inception to February 2020, reporting on the effects of BBTI using randomized controlled trials (RCT) (adults aged 32 to 84). The main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE%), and total sleep time (TST). Results: BBTI showed improved SOL compared with control group in mean difference at early (-15.42 [95% CI: -33.05 to -12.01; I2 =49%]) and late follow-up (-10.52 [95% CI: -1.12 to 0.54; I2=93%]). This was statistically significant at early follow-up, but not at late follow-up. The improvement of WASO by BBTI over the control group was shown at early follow-up (-17.47 [95% CI: -2.67 to 0.45; I2=90%]), and was statistically significant. For WASO, a non-statistically significant improvement of BBTI over the control group was shown at late follow-up (-12.77 [95% CI: -22.47 to -3.08; I2=0%]). SE% was shown improved statistically significant by BBTI over control group at early (4.47 [95% CI: -0.35 to 9.29; I2=98%]) and at late follow-up (6.52 [95% CI: -4.00 to 17.05; I2=89%]). The TST was shown no improvement by BBTI at early follow-up in mean difference (-2.97 [95% CI -38.83 to 32.90; I2=96%]). At late follow-up, TST was shown improvement in BBTI with mean difference (14.52 [95% CI: -31.64 to 60.68; I2=94%]) compared with the control group.Conclusion: Current evidence suggests that BBTI can be considered preliminarily efficacious and can be used for samples of middle-aged and older adults.

In 1961, K Merendino ‘in pure curiosity’, while tracking the murmur of mitral regurgitation, placed his stethoscope ‘on the vertex of the head’, and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the ‘Murmur on Top of the Head’ building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves. Here, we report on a case of the ‘Murmur on Top of the Head’ and provide the reader/listener with a direct recording of the ‘Merendino murmur’ (as well as its spinal correlate) in an elderly woman with a bioprosthetic mitral valve.

A fit middle aged man presented to the emergency department with headache, myalgia, vomiting, fever and rigours. He was hypotensive with mottled peripheries, tachycardic and dyspnoeic. The only significant medical history noted was an emergency splenectomy 30 years previously following a road traffic accident. The patient had been on prophylactic antibiotics initially and was vaccinated in line with recommendations at the time following splenectomy with no significant health issues in the intervening years. The patient was treated empirically for septic shock and meningitis based on presentation and admitted to the intensive care unit for pressor support and subsequently required intubation and ventilation. Investigations revealed bilateral pneumonia. Streptococcal pneumoniae urinary antigen and serum S. pneumoniae PCR were positive supporting a diagnosis of invasive pneumococcal infection. A lumbar puncture was negative for meningitis. Distal mottling affecting all limbs progressed with resultant bilateral upper limb digit and below knee amputation. The patient subsequently required extensive rehabilitation. Following a prolonged tertiary and rehabilitation hospital admission, the patient made an exceptional recovery and was discharged home with ongoing appropriate support and home adaptation.

Transparan İletken Oksit (TCO) ince filmler günümüzde güneş pilleri, LED’ler, lazerler gibi optoelektronik cihazlarda sıklıkla kullanılmaktadır. Bu kontakların kullanımı cihazların verimliliğini doğrudam etkilemektedir. Bu çalışmanın amacı heteroeklemli güneş hücrelerinin (HJSCs) (n+) a-Si:H yüzünde ve yüksek elektron hareketliliği olan tranzistörlerde (HEMT) kullanmak üzere atomik katman kaplama (ALD) tekniği kullanarak alüminyum katkılı çinko oksit (AZO) üretmek ve optimize etmektir. Bu çalışmada büyütme sıcaklığı ve alüminyum katkılama oranının ALD’de büyütülmüş AZO’nun yapısal, elektriksel ve optik özelliklerine etkisi çalışılmıştır.Sonuçlar göstermiştir ki filmler görünür bölgede %80-90 arasında ışık geçirgenliğine, düşük elektriksel rezistansa (2.04x10-3 ohm.cm) ve 5.25 cm2/V.s değerinde mobiliteye sahiptir., Transparent Conductive Oxide (TCO) films are widely used in optoelectronic devices, such as solar cells, LEDs, and Lasers. Utilization of these contacts directly affects the device efficiencies. Purpose of this study is to produce and optimize properties of Aluminum doped Zinc Oxide (AZO) using a vapor phase technique, Atomic Layer Deposition (ALD) for (n+) a-Si:H surface of silicon Heterojunction Solar Cells (HJSCs) and High Electron Mobility Transistor (HEMT) applications. This study is focused on the effect of the deposition temperature and aluminum atomic concentration on structural, electrical and optical properties of ALD grown AZO ohmic contact films. The results show that as-deposited films have 80-90% transmittance in the visible spectra, low resistance (2.04x10-3 ohm.cm) and mobility value of 5.25 cm2/V.s.

Long bone metastases are a disease of high social importance. The goals of surgical treatment are to relieve pain, maintain or restore joint function, and prevent or treat pathological fractures. "Oligometastases" is a disease with a limited number (3-5) of metastatic lesions in the same body district, where an aggressive treatment can be carried out with "curative" intent. This study aimed to evaluate patients with bone metastases surgically treated to determine how surgical treatment can influence prognosis and quality of life, comparing solitary metastasis, oligometastases, and multiple metastases.This is a retrospective analysis of 130 patients with long bone metastases surgically treated between October 2015 and August 2019: 40 patients had solitary metastasis; 38 had less than three metastases (oligometastases), and 52 had multiple metastases. Surgery was resection and reconstruction with a cemented prosthesis (95) or nailing (35).Overall survival was significantly better in patients with solitary metastasis or oligometastases than in those with multiple metastases (p0.0001). Patients treated with resection and prosthesis had significantly better survival than those treated with nailing (p0.0001). Implant complications requiring surgical revision occurred in 20 patients treated with prostheses, while no complications occurred in patients treated with nailing.Survival of cancer patients has improved in the last two decades, leading to an increase of diagnosed metastases. Patients with oligometastases have a survival similar to those with a single metastasis. Optimal implants survival curves should stay above the curves of patients survival.Since there are no differences in survival, patients with oligometastases should be treated as patients with a solitary lesion, with more aggressive surgery (wide resection and reconstruction with prosthesis). Intramedullary nailing is still indicated in metaphyseal or diaphyseal metastases in patients with advanced disease or poor prognosis when the life expectancy does not overcome the expected survival of the nail, avoiding the need for further surgery.

Introduction: The Activated Clotting Time (ACT) is commonly used to manage anticoagulation during cardiac surgery. The aim of this study was to compare the older manually operated Hemochron® Response and the automated Hemochron® Signature Elite. Methods: In this observational study the clinically relevant differences of both devices were investigated simultaneously, using duplicate measurements, in 29 patients who underwent a Coronary Artery Bypass Grafting (CABG) or Aortic Valve Replacement (AVR) in order to determine reliability, bias, and to detect which method has the lowest variation. Blood samples were obtained from the arterial line prior to surgery, after administration of 300 IU/kg heparin, 5 minutes after initiation of cardiopulmonary bypass and successively every 30 minutes, and after protamine administration. Results: A total of 202 measurements were performed. Of these 10 measurements were out of range in the Response and 9 in the Elite. About 27 single unstable magnet errors were seen in the Response versus no measurement errors in the Elite. No statistically significant differences between the Response (p = 0.22, Wilcoxon rank) and Elite (p = 0.064) duplicates were observed. The Response values were consistently higher during heparinization than the Elite measurements (p = 0.002, repeated measurements) with an average positive bias of around 56 seconds during heparinization (Bland-Altman). Overall, the coefficient of variation (CoV) increased during heparinization. Conclusion: The Elite was more reliable, but the variation was higher for the Elite than the Response. The observed positive bias in the Response compared to the Elite could affect heparin administration during surgery making the two systems not interchangeable.

Accurately assessing a firm's human capital and its relative position compared to other firms is critical, as it has strong implications for many stakeholders to understand the firm's strategic competitiveness. The traditional way of assessing firm human capital is mostly based on survey method and the accuracy depends on a large group of survey respondents. In this article, we propose to adopt the PageRank algorithm in the context of a firm network formed by actual flow of employees among firms. The PageRank score obtained provides a good assessment of the firm's human capital, which is validated by both the regression model and the random forest model. Our work contributes to the literature by proposing a more accurate, faster, and more cost-effective assessment approach for measuring firm's human capital. This novel approach is also friendly to real-time and big data of the current business world and provides important implications for the development of a more effective third-party ranking system regarding human capital of firms.

BACKGROUND The search for aesthetic non-surgical procedures is growing. The use of polymethylmethacrylate (PMMA) as a filling material in the nose represents one of the many options among these aesthetic procedures. Its use, however, can lead to complications. The treatment of these complications is often challenging. METHODS We performed a retrospective clinical analysis of the medical records of patients undergoing treatment of PMMA granulomas of the nose at a private clinic from January, 2015, to January, 2021. A short-pulsed neodymium-YAG (Nd:YAG) laser was applied intranasally or directly by cutaneous incision in the granulomas. Laser-tissue interaction heats the alloplastic material, fragments the product and creates cleavage paths, thereby facilitating the removal of PMMA, either by intercartilaginous removal or aspiration. RESULTS Twenty-seven patients were included in the study. All had a history of PMMA injection in the nose. All patients were treated with an intralesional pulsed 1064nm Nd:YAG laser. The material removed after laser-tissue interaction was sent for histopathological examination; this showed the presence of microparticles of exogenous material compatible with PMMA. The partial removal of the alloplastic material was shown to be effective in all cases. One patient developed a small blister in the nasal dorsum. Follow-up ranged from six to 47 months. CONCLUSIONS The use of intralesional Nd:YAG laser for the treatment of PMMA granulomas on the nose proved to be an effective and safe procedure with improvement of nasal shape, without compromising respiratory function. This technical option represents yet another alternative in the treatment of PMMA granuloma complications. J Drugs Dermatol. 2021;20(11): 1161-1166. doi:10.36849/JDD.6550.

Objective The study objective was to investigate the impact of multiple arterial grafting on long-term all-cause mortality in women undergoing isolated coronary artery bypass grafting. Methods A comprehensive search was performed to identify observational studies reporting outcomes after coronary artery bypass grafting reported by sex and stratified into multiple arterial grafting versus single arterial grafting strategies. Articles were considered for inclusion if they were written in English and were propensity-matched observational studies. Included studies were then pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was long-term all-cause mortality. Secondary outcomes were operative mortality and spontaneous myocardial infarction. Meta-regression was used to explore the effects of preoperative and intraoperative variables on the primary outcome. Results A total of 6 studies with 32,793 women (25,714 single arterial grafting and 7079 multiple arterial grafting) were included. Women who received multiple arterial grafting had lower long-term mortality (incidence rate ratio, 0.86; 95% confidence interval, 0.76-0.96; P = .007) and spontaneous myocardial infarction (incidence rate ratio, 0.80; 95% confidence interval, 0.68-0.93; P = .003) compared with women who received single arterial grafting, but the difference in mortality disappeared when including only the 3 largest studies. There was no difference between groups in operative mortality (odds ratio, 0.99; 95% confidence interval, 0.84-1.17; P = .91). Meta-regression did not identify any associations with the incidence rate ratio for long-term mortality. Conclusions The use of multiple arterial grafting in women undergoing coronary artery bypass grafting is associated with lower long-term mortality, although the difference is mostly driven by small series. Further studies, including randomized trials, are needed to evaluate the efficacy of multiple arterial grafting in women undergoing coronary artery bypass grafting.

An investigation was carried out to improve the seismic performance of concrete columns reinforced with high-strength steel bars and subsequently retrofitted with vertical and horizontal carbon-fibre-reinforced polymer (CFRP) strips. Seven columns were constructed and tested under constant axial and cyclic lateral loading. The results showed that attaching CFRP vertical strips in or over grooves outperformed conventional externally bonded reinforcement, as evidenced by greater energy dissipation and strength. Furthermore, the use of corner strip–battens for the horizontal CFRP strips was found to outperform conventional wrapping, as evidenced by greater ductility and energy dissipation. Confining stresses were also more uniformly distributed and strip rupture shifted from the edges to the mid-sides of the section.

There is a growing demand for multi-port power converters for managing multiple energy sources and loads. To that end, a dual-input single-output dc-dc converter is proposed in this article. The converter integrates two different and low-voltage dc sources into a dc bus. Pulse width modulation is used to control the transfer energy from the input ports to the output port. The discontinuous conduction mode (DCM) operation of the converter has enabled the soft-switching operation in the primary switches. Moreover, it helps avoid the high-frequency transformer (HFT) saturation when the two input voltage sources have different values. The detailed analysis of the proposed dc-dc converter is presented in this article along with the simulation and experimental results obtained from a 150 W hardware prototype to validate its operation.

Statement of problem Evidence for the efficacy and safety of natural products for the treatment of denture stomatitis is lacking. Purpose The purpose of this systematic review was to answer the question “Are topical natural substances effective and safe compared with conventional antifungals in the treatment of denture stomatitis?” Material and methods A structured search in 11 databases, including non-peer-reviewed, was undertaken. Two authors independently selected the studies, extracted the data, assessed the study quality, and graded the evidence, with disagreement resolved with a third reviewer. Data were evaluated descriptively by following Synthesis Without Meta-analysis (SWiM) reporting items. This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42020216213. Results After the removal of duplicates, 1925 records remained, and after a 2-phase reading of abstracts and full texts, 17 studies were included. Propolis, green tea, ginger, Zataria multiflora, chitosan, garlic, Artemisia, Schinus terebinthifolius Raddi, Uncaria tomentosa, Punica granatum, and Ricinus communis appeared to have similar efficacy and safety when compared with nystatin or miconazole. Most of the studies presented a high risk of bias. Conclusions Certainty in the body of evidence that natural products might be appropriately used in the treatment of denture stomatitis is low. Well-designed randomized controlled trials are still needed to evaluate the topic better because there is high heterogeneity among the studies.

Monitoring the degradation of induction motors is an essential concern for industries, especially when there are high costs related to maintenance and their stops. Nowadays, there are many non-invasive ways to monitor the health status of induction motors, including sensors to measure temperature, magnetic field, vibration, current, and power. However, installing these sensors may not be a simple task since intrusive procedures such as engine disassembling, wire separation, and engine interruption are commonly observed. Thus, we propose MUCLA (Multiphase Clamp and Tracking - patent pending) as a new device and methodology for monitoring motor degradation by analyzing its stator current. MUCLA introduces a non-invasive current sensors array on a proposed clamp in the hardware perspective, while a spectral tracking methodology refers to our novelty in the software viewpoint. For end-users, the main MUCLA contribution relies on the combination of the simplicity of installation and the possibility of using the proposed device even when considering Variable-Frequency Drive powered engines. The results obtained with both simulation and practical tests show encouraging results over different input workloads and emulated degradation. Compared to the current initiatives, we can classify MUCLA as a better solution for industrial plants in terms of installation time, installation complexity, and cost.

This paper presents the internal energy balance of a modular multilevel cascade converter with photovoltaic arrays as distributed energy resources. This converter is characterized by a modular arm structure composed of bidirectional cascaded chopper cells with floating DC capacitors, where each cell is connected to a photovoltaic array through a DC/DC converter. A continuous model and a control method are proposed to maintain the internal energy balance and achieve independent voltage control of all the floating DC capacitors, allowing the tracking of the maximum power point for each photovoltaic array. The operation with asymmetric energy generation at different levels of irradiance is discussed to maintain the internal energy balance without distortions in the DC link and AC output currents, focusing on the operation with individual cells with zero energy generated from PV array. This topology and control method is suitable for hybrid multi-terminal high voltage DC systems and hybrid generation systems, such as wind-solar energy systems. Experiments are presented to validate the proposed model and control method.

PURPOSE To evaluate the efficacy and tolerability of two doses of gefitinib (Iressa [ZD1839]; AstraZeneca, Wilmington, DE), a novel epidermal growth factor receptor tyrosine kinase inhibitor, in patients with pretreated advanced non–small-cell lung cancer (NSCLC). PATIENTS AND METHODS This was a randomized, double-blind, parallel-group, multicenter phase II trial. Two hundred ten patients with advanced NSCLC who were previously treated with one or two chemotherapy regimens (at least one containing platinum) were randomized to receive either 250-mg or 500-mg oral doses of gefitinib once daily. RESULTS Efficacy was similar for the 250- and 500-mg/d groups. Objective tumor response rates were 18.4% (95% confidence interval [CI], 11.5 to 27.3) and 19.0% (95% CI, 12.1 to 27.9); among evaluable patients, symptom improvement rates were 40.3% (95% CI, 28.5 to 53.0) and 37.0% (95% CI, 26.0 to 49.1); median progression-free survival times were 2.7 and 2.8 months; and median overall survival times were 7.6 and 8.0 months, respectively. Symptom improvements were recorded for 69.2% (250 mg/d) and 85.7% (500 mg/d) of patients with a tumor response. Adverse events (AEs) at both dose levels were generally mild (grade 1 or 2) and consisted mainly of skin reactions and diarrhea. Drug-related toxicities were more frequent in the higher-dose group. Withdrawal due to drug-related AEs was 1.9% and 9.4% for patients receiving gefitinib 250 and 500 mg/d, respectively. CONCLUSION Gefitinib showed clinically meaningful antitumor activity and provided symptom relief as second- and third-line treatment in these patients. At 250 mg/d, gefitinib had a favorable AE profile. Gefitinib 250 mg/d is an important, novel treatment option for patients with pretreated advanced NSCLC.

Background The impact of online care on patients’ functional and psychological outcomes is critical to determine yet still unknown. Objective To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving psoriasis patients’ functional status and mental health. Methods This 12-month randomized controlled equivalency trial randomized psoriasis patients 1:1 to online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions (EQ-5D-5L) and Patient Health Questionnare-9 (PHQ-9). Results 296 patients were randomized to online or in-person groups. The between-group difference in overall improvement in EQ VAS (EuroQol Visual Analogue Scale) was -0.002 (95% CI -2.749, 2.745), falling within equivalence margin ±8. The between-group difference in overall improvement in EQ-5D-5L index was 0 (95% CI -0.003, 0.003), falling within equivalence margin ±0.1. The between-group difference in overall improvement in PHQ-9 was -0.33 (95% CI -1.20, 0.55), falling within equivalence margin ±3. Limitations Slightly different attrition rates between online and in-person arms (11% versus 9%), but no impact on outcomes. Conclusion The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in psoriasis patients.

With the recent advancement in baseband integrated circuits and radio frequency (RF) technology, there is a strong demand to minimize the size of array-based microwave systems. However, array aperture miniaturization often leads to strong mutual coupling in the arrays. To date, mitigating and/or compensating the mutual coupling (nonlinear) effect remains a technical challenge. For instance, realizing microwave orientations in the presence of strong mutual coupling is a challenge. In this paper, we propose a unified electromagnetic machine learning (EMML) technique for overcoming this challenge. Antenna current’s Green function (ACGF) is employed for characterization of the EM response of elements in form of digital signal processing (DSP) module with the inclusion of mutual coupling effect among the elements. An EMML framework is then formulated and combined with the DSP module based on ACGF, to consequently come up with a nonlinear mutual coupling mitigation framework that provides better decoupling capability than the previous linear techniques. EMML is verified by application to a multiple signal classification (MUSIC)-based direction-of-arrival estimation scenario, and compared with the conventional methods. The results obtained show the validity, effectiveness of the EMML method. This method can be further used in coupled array-based beam forming, steering, and nulling applications.

In laser powder bed fusion (LPBF) additive manufacturing, the melt pool (MP) characteristics are key indicators for process and part defects. For example, the laser scan location on the build plate...

Background and Objectives The literature supporting Mohs micrographic surgery and staged excision in treating primary cutaneous melanoma is growing but has not been critically reviewed for bias. Methods Articles concerning Mohs micrographic surgery and staged excision for melanoma were assessed using modified “Risk of Bias in Non-randomized Studies of Interventions” (ROBINS-I) criteria, which measures bias in 7 categories. Results Forty-seven of 48 (97.9%) studies reviewed had serious or critical bias. None were randomized controlled trials. The most frequent cause of critical bias was poorly defined outcomes. The least frequent form of bias observed was change in intervention. Limitations The modified ROBINS-I criteria cannot account for all study limitations. Modification of the criteria leads to some degree of subjectivity. Conclusion The current body of literature suffers from limitations due to serious or critical bias in 1 or more ROBINS-I criteria. Local recurrence rate definitions are often poorly defined or not defined at all. Longer follow-up times, clear tumor classifications, and prospective, randomized study designs are necessary to improve the quality of future research.

Objective To evaluate the benefits and harmful effects of conservative versus liberal oxygen therapy in patients admitted to the Intensive Care Unit (ICU). Design A systematic review and meta-analysis was carried out. Setting ICU. Participants Adult patients (aged 18 years or older) were randomized to either a lower oxygenation target strategy (conservative oxygen therapy) or a higher oxygenation target strategy (liberal oxygen therapy) in the ICU. Interventions Patients received different oxygenation target strategies. Results Ten studies involving 5429 adult patients admitted to the ICU were included in the meta-analysis. The pooled results showed no decreased all-cause mortality at 28 days (RR 0.90; 95%CI 0.75–1.09; p = 0.28), 90 days (RR 1.02; 95%CI 0.92–1.13; p = 0.71) or longest follow-up (RR 0.97; 95%CI 0.88–1.08; p = 0.63) among patients administered conservative oxygen therapy. Secondary outcomes were comparable between the two groups. The results of sensitivity analyses and subgroup analyses were consistent with the main analyses. Conclusion No beneficial or harmful effects of conservative oxygen therapy were found compared to liberal oxygen therapy in relation to all-cause mortality among adult patients in the ICU. Conservative oxygen therapy did not reduce all-cause mortality at 28 days, 90 days or longest follow-up. Other important clinical outcomes were also comparable between the two groups.

The 0 to 10 numeric rating scale (NRS) of pain intensity is a standard outcome in randomized controlled trials (RCTs) of pain treatments. For individuals taking analgesics, there may be a disparity between “observed” pain intensity (the NRS, irrespective of concurrent analgesic use), and “underlying” pain intensity (what the NRS would be had concurrent analgesics not been taken). Using a contemporary causal inference framework, we compare analytic methods that can potentially account for concurrent analgesic use, first in statistical simulations, and second in analyses of real (non-simulated) data from an RCT of lumbar epidural steroid injections (LESI). The default analytic method was ignoring analgesic use, which is the most common approach in pain RCTs. Compared to ignoring analgesic use and other analytic methods, simulations showed that a quantitative pain and analgesia composite outcome based on adding 1.5 points to observed pain intensity for those who were taking an analgesic (the QPAC1.5) optimized power and minimized bias. Analyses of real RCT data supported the results of the simulations, showing greater power with analysis of the QPAC1.5 as compared to ignoring analgesic use and most other methods examined. We propose alternative methods that should be considered in the analysis of pain RCTs.