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The objective of the research work to focus on a path planning aims to plan the route of an Unmanned Vehicle (UV) using Global Positioning System (GPS), and the most suitable path is selected avoiding the obstacles along the desired path. The coordinates of the starting point and destination are fed through programming. In addition, an obstacle avoidance algorithm is used and waypoints are given using the AVR Programming. Waypoint Navigation System for the Unmanned Ground Vehicle is use with GPS avoiding the obstacles in its path. The Waypoint Navigation System is the planning of the path of an object so that the path goes through some specified coordinates or benchmarks to the final destination thus avoiding any obstacles. The technology used to accomplish the aim includes Global Positioning System (GPS), Ultrasonic Sonic sensors and Micro-controller for programming. GPS will be the guiding medium from source to destination and two Ultrasonic Sensors will be used. These types of vehicles are used for many purposes and have been used by United States of America for Military and Defense purposes. In advanced cases, an Unmanned Aerial Vehicle may also be developed using these algorithms. [ABSTRACT FROM AUTHOR]

Phishing attacks have threatened the security of both home users and organisations in recent years. Phishing uses social engineering to fraudulently obtain information that is confidential or sensitive. Individuals are targeted to take action by clicking on a link and providing information. This research explores fear arousal and self-confidence in subjects confronted by phishing attacks. The study collected data from multiple sources (including an attempted phishing attack). The survey results indicated that when individuals had a high level of fear arousal related to providing login credentials they had a decreased intention to respond to a phishing attack. Self-confidence did not significantly moderate the relationship between fear arousal and intention to respond to a phishing attack but it did have a significant direct positive influence on intention. The results from the experiment indicated that 18% of individuals overall clicked on the link. The combined data indicated that higher level of fear arousal resulted in a decreased intention to respond to a phishing attack and a decreased actual click behaviour. The research explores how fear of providing login credentials influences both intention to respond and actual response to a phishing attack. When fear arousal is high, individuals are less likely to respond. [ABSTRACT FROM AUTHOR]

Objective: Thymic carcinomas are considered to be more aggressive than thymomas and carry a worse prognosis. We reviewed our recent experience with the surgical management of thymic tumors and compared the outcomes and patterns of relapse between patients with thymic carcinoma and those with thymoma. Methods: We performed a single-institution retrospective cohort study. Data included patient demographics, stage, treatment, pathologic findings, and postoperative outcomes. Results: During the period 1995–2006, 120 patients with thymic tumors underwent surgical intervention, including 23 patients with thymic carcinoma and 97 patients with thymoma, as classified according to the World Health Organization 2004 histologic classification. The overall 5-year survival was significantly different between patients with thymic carcinoma and those with thymoma (thymic carcinoma, 53%; thymoma, 89%; P = .01). Data on relapse were available for 112 patients. The progression-free 5-year survival was also significantly different between patients with thymic carcinoma and those with thymoma (thymic carcinoma, 36%; thymoma, 75%; P < .01). Using multivariate analysis, thymic carcinoma and incomplete resection were found to be independent predictors of progression-free survival. Relapses in patients with thymic carcinoma tended to occur earlier, and occurred significantly more frequently at distant sites than in patients with thymoma (60% vs 13%, P = .01). Conclusions: Patterns of relapse differ significantly between patients with thymic carcinoma and those with thymoma, with lower progression-free survival, earlier onset, and more distant relapses in patients with thymic carcinoma. Given the greater propensity for distant failures, the inclusion of systemic therapy in the treatment of thymic carcinoma might take on greater importance. Despite significantly higher rates of distant relapse, good overall survival in patients with thymic carcinoma can be achieved. [Copyright &y& Elsevier]

A robust and easily implemented verification procedure based on the column-integrated precipitable water (IPW) vapor estimates derived from a network of ground-based global positioning system (GPS) receivers has been used to assess the quality of the Atmospheric Infrared Sounder (AIRS) IPW retrievals over the contiguous United States. For a period of six months from April to October 2004, excellent agreement has been realized between GPS-derived IPW estimates and those determined from AIRS, showing small monthly bias values ranging from 0.5 to 1.5 mm and root-mean-square (rms) differences of 4 mm or less. When the spatial (latitude–longitude) window for the GPS and AIRS matchup observations is reduced from the initial ½° by ½° to ¼° by ¼°, the rms differences are reduced. Analysis revealed that the observed IPW biases between the instruments are strongly correlated to the reported surface pressure differences between the GPS and AIRS observational points. Adjusting the AIRS IPW values to account for the surface pressure discrepancies resulted in significant reductions of the bias between GPS and AIRS. A similar reduction can be obtained by comparing only (GPS–AIRS) match-up pairs for which the corresponding surface pressure differences are 0.5 mb or less. The comparisons also revealed that the AIRS IPW tends to be relatively dry in moist atmospheres (when IPW values >40 mm) but wetter in dry cases (when IPW values <10 mm). This is consistent with the documented bias of satellite measurements toward the first guess used in retrieval algorithms. However, additional study is needed to verify whether the AIRS water vapor retrieval process is the source of the discrepancies. It is shown that the IPW bias and rms differences have a seasonal dependency, with a maximum in summer (bias ∼ 1.2 mm, rms ∼ 4.14 mm) and minimum in winter (bias < -0.5 mm, rms ∼ 3 mm). [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) uses sophisticated algorithms to "learn" from large volumes of data. This could be used to optimise recruitment of blood donors through predictive modelling of future blood supply, based on previous donation and transfusion demand. We sought to assess utilisation of predictive modelling and AI blood establishments (BE) and conducted predictive modelling to illustrate its use. A BE survey of data modelling and AI was disseminated to the International Society of Blood transfusion members. Additional anonymzed data were obtained from Italy, Singapore and the United States (US) to build predictive models for each region, using January 2018 through August 2019 data to determine likelihood of donation within a prescribed number of months. Donations were from March 2020 to June 2021. Ninety ISBT members responded to the survey. Predictive modelling was used by 33 (36.7%) respondents and 12 (13.3%) reported AI use. Forty-four (48.9%) indicated their institutions do not utilise predictive modelling nor AI to predict transfusion demand or optimise donor recruitment. In the predictive modelling case study involving three sites, the most important variable for predicting donor return was number of previous donations for Italy and the US, and donation frequency for Singapore. Donation rates declined in each region during COVID-19. Throughout the observation period the predictive model was able to consistently identify those individuals who were most likely to return to donate blood. The majority of BE do not use predictive modelling and AI. The effectiveness of predictive model in determining likelihood of donor return was validated; implementation of this method could prove useful for BE operations., (© 2024 British Blood Transfusion Society.)

Immunotherapy has increased survival for non-small cell lung cancer (NSCLC), especially for those diagnosed with late-stage disease. However, it is not known if its use is equally distributed across races. We assessed immunotherapy use in 21 098 pathologically confirmed stage IV NSCLC patients according to race in the Surveillance Epidemiology, and End Results-Medicare linked dataset. Multivariable models were conducted to evaluate the independent association of receipt of immunotherapy with race and overall survival according to race. Black patients had statistically significantly lower odds of receiving immunotherapy (adjusted odds ratio = 0.60, 95% confidence interval = 0.44 to 0.80); receipt of immunotherapy was lower in Asian and Hispanic patients but not statistically significant. When immunotherapy was received, survival was similar across races. Immunotherapy for NSCLC is not used equally among races, underscoring the racial disparities that exist in access to the newest cancer treatment. Efforts should be directed toward expanding access to novel, efficacious treatments for advanced stage lung cancer., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Cardiovascular disease remains the leading cause of death globally and here in the United States. Diet has a major impact on the pathogenesis of atherosclerosis and subsequent cardiovascular morbidity and mortality. An unhealthy diet is the most significant potential behavioral and modifiable risk factor for ischemic heart disease. Despite these established facts, dietary interventions are far less frequent than pharmaceutical and procedural interventions in the management of cardiovascular disease. The beneficial effects of a plant-based diet on cardiovascular morbidity and mortality have been demonstrated in a number of recent clinical studies. The significant findings of each study are discussed in this review article, highlighting the role of a healthy plant-based diet in improving cardiovascular outcomes. From a clinician's standpoint, the knowledge and understanding of the facts and data points from these recent clinical studies would ensure more effective patient counseling on the substantial benefits of dietary interventions.

Competing Interests: The authors report no conflicts of interest.

Background: Self-reported smoking behavior is widely used in identifying the eligibility for lung cancer screening (LCS). In clinical trials, self-reported smoking status was shown to be a reliable measure, while its effectiveness outside of trial settings remains to be clarified. We aimed to verify self-reported smoking status with serum cotinine levels among LCS-eligible adults from the National Health and Nutrition Examination Survey (NHANES)., Methods: From the combined 1999-2018 NHANES data, we selected adults (aged ≥18 years) with complete data on serum cotinine and smoking behavior, and determined their LCS eligibility according to the United States Preventive Services Task Force recommendation. Using established race/ethnicity specific cotinine cutpoints as the gold standard, we verified self-reported current smoking status with five measures: sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and reliability Kappa. We also compared these performance measures in subgroups stratified by sex, race/ethnicity, education, family income to poverty ratio, health insurance, and secondhand smoking exposure (SHS) at home. All analyses took into account the complex survey design., Results: Approximately 9.3% (n = 2335, equivalent to 8.82 million weighted population) of all adults who currently smoke or formerly smoked were eligible for LCS. The prevalence of current smoking was 52.6% and 60.8% based on self-report and cotinine, respectively. The Se and Sp were 86.4% (95%CI: 83.9%-88.9%) and 99.7% (95%CI: 99.4%-100%), respectively; PPV and NPV were 99.8% (95%CI: 99.6%-100%) and 82.6% (95%CI: 79.4%-85.7%), respectively; and Kappa was 0.83 (95%CI: 0.80-0.86). The reliability Kappa was higher among females than males (0.87 (95%CI: 0.82-0.93)) vs 0.80 (95%CI: 0.77-0.84), the lowest among non-Hispanic white (0.82 (95%CI: 0.78-0.86)), and higher among those with SHS (0.72 (95%CI: 0.63-0.80) vs (0.68 (95%CI: 0.61-0.76))., Conclusion: Self-reported smoking status is reasonably reliable among adults with high risk for developing lung cancer in the general population., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Surgery is the preferred treatment for stage I non-small cell lung cancer (NSCLC), with radiation reserved for those not receiving surgery. Previous studies have shown lower rates of surgery among Blacks with stage I NSCLC than among Whites., Methods: Black and White men ages ≥65 years with stage I NSCLC diagnosed between 2001 and 2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Logistic regression and Cox proportional hazards models were used to examine associations between race, treatment, and survival., Results: Among the patients in the VA ( n = 7,895) and SEER ( n = 8,744), the proportion of Blacks was 13% and 7%, respectively. Overall, 16.2% of SEER patients (15.4% of Whites, 26.0% of Blacks) and 24.5% of VA patients received no treatment (23.4% of Whites, 31.4% of Blacks). In both cohorts, Blacks were less likely to receive any treatment compared with Whites [OR adj = 0.57; 95% confidence interval (CI), 0.47-0.69 for SEER-Medicare; OR adj = 0.68; 95% CI, 0.58-0.79 for VA]. Among treated patients, Blacks were less likely than Whites to receive surgery only (OR adj = 0.57; 95% CI, 0.47-0.70 for SEER-Medicare; OR adj = 0.73; 95% CI, 0.62-0.86 for VA), but more likely to receive chemotherapy only and radiation only. There were no racial differences in survival., Conclusions: Among VA and SEER-Medicare patients, Blacks were less likely to get surgical treatment. Blacks and Whites had similar survival outcomes when accounting for treatment., Impact: This supports the hypothesis that equal treatment correlates with equal outcomes and emphasizes the need to understand multilevel predictors of lung cancer treatment disparities., (©2019 American Association for Cancer Research.)

The effect of insurance type on lung cancer diagnosis, treatment, and survival in Asian patients living in the United States is still under debate. We have analyzed this issue using the Surveillance, Epidemiology, and End Results database. There were 102,733 lung cancer patients age 18-64 years diagnosed between 2007 and 2013. Multilevel regression analysis was performed to identify the association between insurance types, stage at diagnosis, treatment modalities, and overall mortality in Asian and non-Hispanic White (NHW) patients. Clinical characteristics were significantly different between Asian and NHW patients, except for gender. Asian patients were more likely to present with advanced disease than NHW patients (OR adj  = 1.12, 95% CI = 1.06-1.19). Asian patients with non-Medicaid insurance underwent lobectomy more than NHW patients with Medicaid or uninsured; were more likely to undergo mediastinal lymph node evaluation (MLNE) (OR adj  = 1.98, 95% CI = 1.72-2.28) and cancer-directed surgery and/or radiation therapy (OR adj  = 1.41, 95% CI = 1.20-1.65). Asian patients with non-Medicaid insurance had the best overall survival. Uninsured or Medicaid-covered Asian patients were more likely to be diagnosed with advanced disease, less likely to undergo MLNE and cancer-directed treatments, and had shorter overall survival than their NHW counterpart., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Mediastinal lymph node evaluation (MLNE) is considered to be the standard of care in curative lung cancer surgery although it is not always performed. This study identifies factors associated with patients not being evaluated (non-MLNE) in cases of resectable non-small cell lung cancer., Methods: A retrospective observational study using the Surveillance, Epidemiology, and End Results Program database was conducted. Adult patients diagnosed with non-small cell lung cancer stage I to IIIA (2004 to 2013) were included. Multilevel logistic regression analysis was performed to identify factors that were associated with non-MLNE., Results: There were 86,721 patients included in this study: 73,034 (84.2%) with MLNE and 13,687 (15.8%) without. The use of MLNE gradually increased from 82.7% in 2004 to 85.8% in 2013. In multivariable analysis, factors associated with non-MLNE included the following: age more than 75 years (adjusted odds ratio [OR adj ] 1.20, 95% confidence interval [CI]: 1.13 to 1.27); black (OR adj 1.11, 95% CI: 1.32 to 1.20); Native American/Alaskan (OR adj 1.63, 95% CI: 1.15 to 2.31); uninsured (OR adj 1.28, 95% CI: 1.05 to 1.56); residing in a low-income county (OR adj 1.12, 95% CI: 1.04 to 1.21); lesion at the middle lobe (OR adj 1.42, 95% CI: 1.29 to 1.56); lower lobe (OR adj 1.06, 95% CI: 1.01 to 1.11) or main bronchus (OR adj 2.38, 95% CI: 1.93 to 2.94); stage IA (OR adj 1.24, 95% CI: 1.17 to 1.32); sublobar resection (OR adj 11.08, 95% CI: 11.30 to 12.33); and preoperative treatment (OR adj 1.21, 95% CI: 1.08 to 1.36). Non-MLNE was less likely to occur in patients with adenocarcinoma (OR adj 0.88, 95% CI: 0.83 to 0.92) and more likely in other cell types (OR adj 1.23, 95% CI: 1.15 to 1.32), compared with squamous cell carcinoma., Conclusions: Patient demographics and socioeconomic status are associated with the decision to perform MLNE. Thoracic surgeons should access these factors and perform MLNE to accurately determine tumor stage and improve survival., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Early stage lung cancer is generally treated with surgical resection. The objective of the study was to identify patient and hospital characteristics associated with the type of lung cancer surgical approach utilized in New York State (NYS), and to assess in-hospital adverse events., Methods: A total of 33 960 lung cancer patients who underwent limited resection (LR) or lobectomy (L) were selected from the NYS Statewide Planning and Research Cooperative System database (1995-2012)., Results: LR patients were more likely to be older (adjusted odds ratio OR adj and [95% confidence interval]: 1.01 [1.01-1.02]), female (OR adj : 1.11 [1.06-1.16]), Black (OR adj : 1.17 [1.08-1.27]), with comorbidities (OR adj : 1.08 [1.03-1.14]), and treated in more recent years than L patients. Length of stay and complications were significantly less after LR than L (OR adj : 0.56 [0.53-0.58] and 0.65 [0.62-0.69]); in-hospital mortality was similar (OR adj : 0.93 [0.81-1.07]), and was positively associated with age and urgent/emergency admission, but inversely associated with female gender, private insurance, recent admission year, and surgery volume., Conclusions: There was a growing trend toward LR, which was more likely to be performed in older patients with comorbidities. In-hospital outcomes were better after LR than L, and were affected by patient and hospital characteristics., (© 2017 Wiley Periodicals, Inc.)

Objectives: Esophageal cancer (EC) black patients have higher mortality rates than Whites. The lower rate of surgery in Blacks may explain the survival difference. We explored the Surveillance Epidemiology and End Results database to determine the impact of surgery on mortality in Blacks and Whites EC., Methods: All cases of pathologically proven local and locoregional adenocarcinoma and squamous cell carcinoma of the esophagus from 1973 to 2011 were identified (13,678 White, 2,894 Black patients). Cervical esophageal cancer was excluded. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race., Results: Blacks had higher 1-year mortality, adjusted for age, sex, stage, year of diagnosis, histology, and therapy [adjusted hazard ratio (HRadj ): 1.24 (95% CI 1.16-1.32)]. Undergoing surgery was an independent predictor of improved survival overall (HRadj 0.30, 95% CI 0.27-0.33). Black patients treated surgically experienced significantly lower survival than Whites, but the difference was not observed in those who did not undergo surgery., Conclusions: Although surgery appears to reduce mortality overall, early survival is worse for Blacks. Investigation into racial disparities in health care access and delivery, and to skilled esophageal surgeons is warranted to improve survival for all patients, particularly Blacks. J. Surg. Oncol. 2016;113:659-664. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objectives: This study conducted a prospective, single-arm, multicenter trial to evaluate the safety and efficacy of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis, using the EkoSonic Endovascular System (EKOS, Bothell, Washington)., Background: Systemic fibrinolysis for acute pulmonary embolism (PE) reduces cardiovascular collapse but causes hemorrhagic stroke at a rate exceeding 2%., Methods: Eligible patients had a proximal PE and a right ventricular (RV)-to-left ventricular (LV) diameter ratio ≥0.9 on chest computed tomography (CT). We included 150 patients with acute massive (n = 31) or submassive (n = 119) PE. We used 24 mg of tissue-plasminogen activator (t-PA) administered either as 1 mg/h for 24 h with a unilateral catheter or 1 mg/h/catheter for 12 h with bilateral catheters. The primary safety outcome was major bleeding within 72 h of procedure initiation. The primary efficacy outcome was the change in the chest CT-measured RV/LV diameter ratio within 48 h of procedure initiation., Results: Mean RV/LV diameter ratio decreased from baseline to 48 h post-procedure (1.55 vs. 1.13; mean difference, -0.42; p < 0.0001). Mean pulmonary artery systolic pressure (51.4 mm Hg vs. 36.9 mm Hg; p < 0.0001) and modified Miller Index score (22.5 vs. 15.8; p < 0.0001) also decreased post-procedure. One GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries)-defined severe bleed (groin hematoma with transient hypotension) and 16 GUSTO-defined moderate bleeding events occurred in 15 patients (10%). No patient experienced intracranial hemorrhage., Conclusions: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis decreased RV dilation, reduced pulmonary hypertension, decreased anatomic thrombus burden, and minimized intracranial hemorrhage in patients with acute massive and submassive PE. (A Prospective, Single-arm, Multi-center Trial of EkoSonic® Endovascular System and Activase for Treatment of Acute Pulmonary Embolism (PE) [SEATTLE II]; NCT01513759)., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Malignant Pleural Mesothelioma (MPM) is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival., Methods: All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race (black or white)., Results: There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted, p = 0.01). Black patients were more likely to be female, younger, and with advanced stage and less likely to undergo cancer-directed surgery than whites, after adjustment by stage. On multivariable analysis, younger age and having surgery were associated with longer survival for both cohorts; female gender (HR 0.82 (0.77-0.88)) and early stage at diagnosis (HR 0.83 (0.76-0.90)) were predictive of longer survival in white, but not in black, patients., Conclusions: Surgery was associated with improved survival for both black and white MPM patients. However, black patients were less likely to undergo cancer-directed surgery. Increased surgical intervention in MPM black patients with early stage disease may improve their survival.

The financial impact of employing minimally invasive techniques for lobectomy compared with traditional open thoracotomy was assessed. A retrospective review was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery (VATS), and robotic VATS lobectomy to determine total average costs associated with the resultant hospital stay. The difference in total average costs was calculated for each group. Robotic VATS lobectomy had higher associated costs than VATS only, primarily attributed to increased costs of the first hospital day, but was still less costly than thoracotomy. The average cost of VATS is substantially less than thoracotomy primarily because of a decreased length of stay. The cost of robotic assistance for VATS is still less than thoracotomy, but greater than VATS alone.