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Evaluating the handling of a tilting tricycle with variable stability.

Understanding the strengths and weaknesses of machine learning (ML) algorithms is crucial to determine their scope of application. Here, we introduce the Diverse and Generative ML Benchmark (DIGEN), a collection of synthetic datasets for comprehensive, reproducible, and interpretable benchmarking of ML algorithms for classification of binary outcomes. The DIGEN resource consists of 40 mathematical functions that map continuous features to binary targets for creating synthetic datasets. These 40 functions were found using a heuristic algorithm designed to maximize the diversity of performance among multiple popular ML algorithms, thus providing a useful test suite for evaluating and comparing new methods. Access to the generative functions facilitates understanding of why a method performs poorly compared to other algorithms, thus providing ideas for improvement.

Modern changes in warfare have shown an increased incidence of lumbar spine injuries caused by underbody blast events. The susceptibility of the lumbar spine during these scenarios could be exacerbated by coupled moments that act with the rapid compressive force depending on the occupant’s seated posture. In this study, a combined loading lumbar spine vertebral body fracture injury criteria (Lic) across a range of postures was established from 75 tests performed on instrumented cadaveric lumbar spine specimens. The spines were predominantly exposed to axial compressive forces from an upward vertical thrust with 64 of the tests resulting in at least one vertebral body fracture and 11 in no vertebral body injury. The proposed Lic utilizes a recommended metric (κ), based on prismatic beam failure theory, resulting from the combination of the T12-L1 resultant sagittal force and the decorrelated bending moment with optimized critical values of Fr,crit = 5824 N and My,crit = 1155 Nm. The 50% risk of lumbar spine injury corresponded to a combined metric of 1, with the risk decreasing with the combined metric value. At 50% injury risk the Normalized Confidence Interval Size improved from 0.24 of a force-based injury reference curve to 0.17 for the combined loading metric.

Objective To examine the use of physician assistants (PAs) as solo providers in rural EDs. Methods This study compared ED metrics and patient characteristics between physicians and PAs at a critical access hospital in Arizona. Results Nearly 26,000 patient encounters from the ED of the host institution were analyzed. Although minor variances in metrics were appreciated, transfers, 72-hour returns, and death rates were all similar among provider types. Results from this work do not demonstrate a clinically meaningful difference among ED metrics between physicians and PAs. Conclusions Results from this study suggest that an appropriately trained and experienced PA can meet commonly used metrics in the care of patients presenting to this rural ED.

Fracture to the lumbo-pelvis region is prevalent in warfighters seated in military vehicles exposed to under-body blast (UBB). Previous high-rate vertical loading experimentation using whole body post-mortem human surrogates (PMHS) indicated that pelvis fracture tends to occur earlier in events and under higher magnitude seat input conditions compared to lumbar spine fracture. The current study hypothesizes that fracture of the pelvis under high-rate vertical loading reduces load transfer to the lumbar spine, thus reducing the potential for spine fracture. PMHS lumbo-pelvis components (L4-pelvis) were tested under high-rate vertical loading and force and acceleration metrics were measured both inferior-to and superior-to the specimen. The ratio of inferior-tosuperior responses was significantly reduced by unstable pelvis fracture for all metrics and a trend of reduced ratio was observed with increased pelvis AIS severity. This study has established that pelvis fracture reduces compression forces at the lumbar spine during high-rate vertical loading, thus reducing the potential for fracture to the lumbar spine. Therefore, pelvis injury potential should be considered when implementing lumbar injury criteria specific to UBB.

A Computer Vision enabled Smart Tray (CVST) was designed for use in medical training for Central Venous Catheterization (CVC). The effects of background color on the ability of the computer vision algorithm to distinguish between tools and the tray was investigated. In addition, the computer vision algorithm was evaluated for accuracy in tool detection. Results indicate that a white monochromatic background is the most useful for segregating background from medical tools, and the algorithm was successfully able to detect 5 different CVC tools both individually and as a group in various arrangements, even when tools overlapped or touched. When the system was in error, it was nearly always due to one tool which has a color similar to that of the background. The CVST shows promise as a CVC training tool and demonstrates that computer vision can be used to accurately detect medical tools.

Colonoscopy procedures are commonly performed to screen the colon for cancer-causing polyps. These procedures require highly trained practitioners and extensive training is necessary to perform proficiently. The Endoscopic Control Assessment System (ECAS) was developed to train and assess practitioners using a magnetic tracker and camera imaging. The magnetic tracker is used to track the tip motion of an endoscope during the insertion and retraction procedure of colonoscopy. In addition, camera imaging is used to track the angle of the control knobs during the procedure. The colon deflection of a manikin during a colonoscopy was successfully tracked to be averaged as 31, 54, and 10 mm for the three trials. Visual processing showed the control knob motion could be successfully tracked during a manikin colonoscopy procedure. The ECAS system was shown to be able to successfully measure user inputs during a manikin procedure.

Laparoscopic surgery is a common minimally invasive procedure typically used in intestinal surgery. Several small incisions are made to allow specialized instruments to be inserted and operated in an inflated abdomen. There is limited mobility in these procedures and additional training must be completed for surgeons to become proficient. To increase the freedom of motion and reduce the required skill for the surgeon, the novel single incision, free motion (SIFM) laparoscopic surgical system is introduced. This device will allow for free motion of the tools with a single incision inside the body, using electromagnets, hydraulic, and motor actuation. Using a low friction material, an electromagnet on the outside of the skin translates the tool inside the body. Hydraulic and motor actuation allows for further control of the tool under the skin by tilting, extending and retraction. Experimentation was performed to measure the frictional forces of different materials gliding over porcine skin tissue. The results show that of the tested materials, Teflon performed the best with high consistency and low coefficients of friction across a range of pressures. Future work will explore magnetic force and actuation to work with the low friction materials of SIFM.

Needle insertion has been used as a minimally invasive technique in many diagnostic or therapeutic procedures such as prostate biopsy or brachytherapy. While the success of these procedures relies on accurate positioning of the needle tip at target positions, the intraoperative movement of the tissue (and consequently the target) has caused physicians some difficulties in acquiring the target. This paper presents a method to estimate tissue movement during a needle insertion task within tissue. The movement of the tissue is valuable information for guidance, navigation, and control of the needle inside tissue towards the target. A needle insertion task was performed using an active needle bending. Ultrasound images were captured at four needle insertion stages of initial needle insertion, bending, unbending, and needle retraction. Ultrasound images were then analyzed to estimate the tissue movement at each stage. The study showed that needle retraction, insertion, bending, and unbending stages correspond to largest to lowest tissue movement, respectively.

Endotracheal intubation is a common procedure that is performed for patients who are unable to adequately breathe. This procedure is often more successful when performed inside a hospital, but there are emergency situations that require out of hospital intubations. For both in-hospital and out of hospital, the statistics for flawed and failed intubation attempts are high. The primary risk associated with prolonged and failed intubation attempts are hypoxia leading to brain injury and death. To mitigate these risks, a motion-based feedback training system is proposed. Experimentation is performed to track the position of a laryngoscope during a manikin intubation. It was found that during intubation there was a significant range of motion in the x direction up to 120 and 114 mm. Also, it was found that for one trial the tortuosity value was significantly higher at 75. Overall results show that significant delicate movements are necessary, and that user movement varied between cases.

Background Quality assurance (QA) of insecticide-treated nets (ITNs) delivered to malaria-endemic countries is conducted by measuring physiochemical parameters, but not bioefficacy against malaria mosquitoes. The cone bioassay provides a simple evaluation of ITN bioefficacy and its conditions and parameters are prescribed by the World Health Organization (WHO). This study explored utility of cone bioassays for pre-delivery QA of pyrethroid ITNs in two test facilities using different mosquito species to test the assumption that cone bioassays are consistent and reproducible across locations, mosquito strains, and laboratories. Methods Double-blinded bioassays were conducted on unused pyrethroid ITNs of 4 brands (5 nets/brand, 5 subsamples/net) that had been delivered for mass distribution in Papua New Guinea (PNG) having passed physiochemical testing of chemical content. Cone bioassays were performed on adjacent net pieces following WHO guidelines at the PNG Institute of Medical Research (PNGIMR) using pyrethroid susceptible Anopheles farauti s.s. and at Ifakara Health Institute (IHI), Tanzania using pyrethroid susceptible Anopheles gambiae s.s. Additionally, WHO tunnel tests was conducted at IHI on ITNs that did not meet cone bioefficacy thresholds. Results from IHI and PNGIMR were compared using Spearman’s Rank, Bland Altman and Cohen’s kappa. A literature review on the utility of cone bioassays for unused pyrethroid ITNs testing was also conducted. Results In cone bioassays, 13/20 nets (65%) met WHO bioefficacy criteria at IHI and 8/20 (40%) at PNGIMR. All nets met WHO bioefficacy criteria on combined cone/tunnel tests. Results from IHI and PNGIMR correlated on 60-minute knockdown (rs=0.6,p=0.002,n=20) and 24-hour mortality (rs=0.9,p<0.0001,n=20) but there was systematic bias between the results measured by Bland Altman. Of the 5 nets with discrepant result between IHI and PNGIMR, three had confidence intervals overlapping the 80% mortality threshold, with averages within 1-3% of the threshold. The agreement between the results to predict ITN failure was good with kappa=0.79 (0.53-1.00) and 90% accuracy. Conclusions WHO cone is a reproducible means to measure pyrethroid ITN bioefficacy using a combination of knockdown and mortality. In the absence of an alternative tests, cone tests could be used to assess the availability of active ingredients at the surface of ITN (where mosquitoes encounter it) as part of pre-delivery QA.

In this article, we show how close attention to language throughout a socio-scientific investigation supports upper elementary Arabic-speaking students to learn English while participating ...

BackgroundThe intensity of vector mosquito biting is an important measure for malaria epidemiology and control. The human landing catch (HLC) is an effective entomological surveillance tool, but is labour-intensive, expensive and raises safety issues. The Centres for Disease Control light trap (CDC LT) and the human decoy trap (HDT) are less costly and exposure-free alternatives. This study compared the CDC LT and HDT against the HLC for measuring Anopheles (An.) biting in rural Tanzania and assessed their suitability as HLC proxies.MethodsIndoor mosquito surveys using HLC and CDC LT and outdoor surveys using HLC and HDT were conducted in 2017 and in 2019 in Ulanga, Tanzania in 19 villages, with one trap per house per night. Species composition, sporozoite rates and the numbers of mosquitoes caught by different trap types were compared. Aggregating the data by village and month, the Bland-Altman approach was used to assess agreement. ResultsOverall, 66,807 Anopheles funestus and 14,606 An. arabiensis adult females were caught from 6,013 CDC LT, 339 indoor HLC, 136 HDT and 195 outdoor HLC collections. Overall, the CDC LT caught fewer malaria vectors than indoor HLC: An. arabiensis (Adjusted rate ratio (Adj.RR) =0.35 (95% confidence interval (CI):0.27-0.46)) and An. funestus (Adj.RR=0.63(95%CI:0.51-0.79)). HDT caught fewer malaria vectors than outdoor HLC: An. arabiensis (Adj.RR=0.04(95%CI:0.01-0.14)) and An. funestus (Adj.RR=0.10(95%CI:0.07-0.15)). The bias and variability of the ratios of geometric mean mosquitoes caught by CDC LT and HDT relative to HLC collections for the same village-month were dependent on mosquito densities. The relative efficacies of both CDC LT and HDT declined with mosquito abundance. The variability in the ratios was substantial for low HLC counts and decreased as mosquito abundance increased. CDCLT caught a higher proportion of infected An. arabiensis and An. funestus than HLC, and HDT caught no infected mosquitoes.ConclusionsIf caution is taken in appreciation of its limitations, the CDC LT is suitable for use in routine entomological surveys and may be preferable for measuring sporozoite rates for Afrotropical mosquitoes. Use of HLC is useful to estimate human exposure to mosquitoes for estimating Entomological Inoculation Rate (EIR). The present design of the HDT is not amenable for use to conduct large-scale entomological surveys.

Capitalocene

Background Insecticidal mosquito vector control products are vital components of malaria control programmes. Test facilities are key in assessing the effectiveness of vector control products against local mosquito populations, in environments where they will be used. Data from these test facilities must be of a high quality to be accepted by regulatory authorities, including the WHO Prequalification Team for vector control products. In 2013–4, seven insecticide testing facilities across sub-Saharan Africa, with technical and financial support from Innovative Vector Control Consortium (IVCC), began development and implementation of quality management system compliant with the principles of Good Laboratory Practice (GLP) to improve data quality and reliability. Methods and principle findings We conducted semi-structured interviews, emails, and video-call interviews with individuals at five test facilities engaged in the IVCC-supported programme and working towards or having achieved GLP. We used framework analysis to identify and describe factors affeting progress towards GLP. We found that eight factors were instrumental in progress, and that test facilities had varying levels of control over these factors. They had high control over the training programme, project planning, and senior leadership support; medium control over infrastructure development, staff structure, and procurement; and low control over funding the availability and accessibility of relevant expertise. Collaboration with IVCC and other partners was key to overcoming the challenges associated with low and medium control factors. Conclusion For partnership and consortia models of research capacity strengthening, test facilities can use their own internal resources to address identified high-control factors. Project plans should allow additional time for interaction with external agencies to address medium-control factors, and partners with access to expertise and funding should concentrate their efforts on supporting institutions to address low-control factors. In practice, this includes planning for financial sustainability at the outset, and acting to strengthen national and regional training capacity.

Background Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribution. This study investigated the factors associated with the decision of users to discard LLINs. Methods A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn’t participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8–10 adults were conducted; older women (40–60 years), older men (40–60 years), younger women (18–39 years), younger men (18–39 years). During the FGDs, participants visually inspected seven samples of LLINs that were “too-torn” based on Proportionate Hole Index recommended by the World Health Organization (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analysed in this study. Results In FGDs, integrity of LLIN influenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO “too-torn” net as “good”. The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO “too-torn” LLIN increased [OR = 1.05 (95%CI (1.04–1.07)), p Conclusion Integrity of LLIN was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with socioeconomic status of the household, and the age and gender of respondents. WHO “too torn” nets are encouraged to be used instead of none until replacement, and disposal of nets should be based on recommendation.

Virtual reality is a growing platform for live entertainment, offering the feeling of embodiment and immersion that is central to storytelling for both audience and performers. Find out how several different artists are bringing the magic of theater to digital playhouses around the world.

This study was conducted to quantify the human tolerance from inferior to superior impacts to whole lumbar spinal columns excised from 43 post mortem human subjects. The specimens were fixed at the ends, aligned in a consistent seated posture, load cells were attached to the proximal and distal ends of the fixation, and the impact was applied using a custom accelerator device. Pretest X-rays and computed tomography (CT) scans, prepositioned X-rays, and posttest X-rays, CT scans and dissection data were used to identify injuries. Right, left, and interval censoring processes were used for the survival analysis, 16 were right censored, 24 were interval censored, and three were left censored observations. Force-based injury risk curves were developed, and the optimal metric describing the underlying response to injury was identified using the Brier score metric. Material, geometry (disc and body areas), and demographic covariates were included in the analysis. The distal force was found to be optimal metric. The bone mineral density was a significant covariate for distal and proximal forces. Both material and geometrical factors affected the transmitted force in this mode of loading. These quantified data serve as the first set of human lumbar spinal column injury risk curves.

Membranous nephropathy is a cause of the nephrotic syndrome in adults; it can be a primary or secondary process. Secondary causes include solid organ and lymphoid malignancies. Prostate cancer has been reported as the second most common causative malignancy. Remission of membranous nephropathy following treatment of metastatic prostate cancer is well established. In this case, we describe a patient with localised prostate cancer who developed severe nephrotic syndrome (urine protein creatinine ratio 1,616 mg/mmol and serum albumin 17 g/L) secondary to membranous nephropathy. The prostate cancer was deemed of low risk and so was being managed with active surveillance rather than medical treatment. Given the severity of the nephrotic syndrome a trial of androgen deprivation therapy with bicalutamide was agreed between the nephrology and urology teams. Full remission of the nephrotic syndrome was observed within 6 months of commencement of treatment (normalisation of serum albumin, non-nephrotic range urine protein creatinine ratio and resolution of oedema). The bicalutamide has been continued indefinitely.

Background COPD is a complex heterogeneous disease influenced by both environmental and genetic risk factors. Traditional genome wide association studies (GWAS) have been successful in identifying many reproducible risk variants of moderate to small effect. Polygenic risk scores (PRS) were developed as way to aggregate risk alleles weighted by their effect size to produce a score which could be used in clinical practice to identify individuals at high risk of disease. A limitation of both GWAS and PRS is that they make the important assumption that the effect of each allele is independent and not modified by other genetic or environmental factors. Machine learning methods such as deep learning (DL) neural networks complement the GWAS and PRS paradigm by making fewer assumptions about the nature of the genetic effects being modeled. For example, the hidden layers of a DL model have the potential to model gene-gene interactions with non-additive effects on disease risk. The goal of the present study was to develop a DL neural network approach to GWAS and PRS and to compare it to the prevailing paradigm based on modeling independent effects. We applied our DL-PRS method to genetic association data from several GWAS studies of chronic obstructive pulmonary disease (COPD).Results We developed a DL learning algorithm for modeling the relationship between genetic variation from GWAS and risk of COPD in several population-based studies. We then developed a DL-PRS based on nodes and associated weights from the first and second layer of the DL neural network. Our DL-PRS framework has overall satisfactory performance in the prediction of COPD and provides significant contribution to prediction in addition to the current PRS methods. Moreover, regarding the clinical relevance of COPD, our DL-PRS has a consistent and closer relationship regarding individual deciles and lung functions such as FEV1/FVC and predicted FEV1%. Conclusions Not only does DL-PRS show favorable predictive performance with current benchmark PRS methods, but it also extends the ranges of PRS deciles in predicting different stages of COPD. Moreover, our DL-PRS results were replicated in an independent cohort. This study opens the door to the use of machine learning for developing risk scores from models developed using fewer assumptions about the nature of the genetic effects.

Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members are prioritized to use remaining ITNs. This study assessed how nets are allocated within households to individuals of different age categories as ITNs are lost or damaged and as new ITNs are obtained. The study also explored how ITN allocation affects ITN durability. Methods A cross-sectional household survey and ITN durability study was conducted among 2,875 households across Tanzania to determine the proportion of nets that remain protective (serviceable) 22 months after net distribution aiming for universal coverage. Allocation of study nets within houses, and re-allocation of ITNs when new universal replacement campaign (URC) nets arrived in study households in Musoma District, was also assessed. Results Some 57.0% (95% CI 53.9–60.1%) of households had sufficient ITNs for every household member, while 84.4% (95% CI 82.4–86.4%) of the population had access to an ITN within their household (assuming 1 net covers every 2 members). In households with sufficient nets, 77.5% of members slept under ITNs. In households without sufficient nets, pregnant women (54.6%), children 65 years (32.6%) sleeping under ITNs. Crowding ($$\ge$$ ≥ 3 people sleeping under nets) was twice as common among people residing in houses without sufficient nets for all age groups, apart from children $$\ge$$ ≥ 3 people slept under them (OR 0.50 (95% CI 0.40–0.63)), or if nets were used by school-age children (OR 0.72 (95% CI 0.56–0.93)), or if the net product was Olyset®. One month after the URC, only 23.6% (95% CI 16.7–30.6%) of the population had access to a URC ITN in Musoma district. Householders in Musoma district continued the use of old ITNs even with the arrival of new URC nets. Conclusion Users determined the useful life of ITNs and prioritized pregnant women and children

Research into AI implementations for healthcare continues to boom. However, successfully launching these implementations into healthcare clinics requires the co-operation and collaboration of multiple stakeholders in healthcare including healthcare professionals, administrators, insurers, legislators, advocacy groups, as well as the patients themselves. The co-operation and collaboration of these interprofessional groups is necessary not just in the final stages of launching AI based solutions in healthcare, but along each stage of the research design and analysis. In this workshop, we solicited talks from researchers who have embraced the idea of interprofessional collaboration across many different stakeholder groups at multiple stages of their research. We specifically focus on projects which included heavy collaborations from healthcare professionals, embraced the research subjects' communities as critical research partners, as well as included researchers who are advocating for systemized changes to include interprofessional stakeholders as evaluators of AI research in healthcare.

Background N,N-Diethyl-3-methylbenzamide (DEET) topical mosquito repellents are effective personal protection tools. However, DEET-based repellents tend to have low consumer acceptability because they are cosmetically unappealing. More attractive formulations are needed to encourage regular user compliance. This study evaluated the protective efficacy and protection duration of a new topical repellent ointment containing 15% DEET, MAÏA® compared to 20% DEET in ethanol using malaria and dengue mosquito vectors in Bagamoyo Tanzania. Methods Fully balanced 3 × 3 Latin square design studies were conducted in large semi-field chambers using laboratory strains of Anopheles gambiae sensu stricto, Anopheles arabiensis and Aedes aegypti. Human volunteers applied either MAÏA® ointment, 20% DEET or ethanol to their lower limbs 6 h before the start of tests. Approximately 100 mosquitoes per strain per replicate were released inside each chamber, with 25 mosquitoes released at regular intervals during the collection period to maintain adequate biting pressure throughout the test. Volunteers recaptured mosquitoes landing on their lower limbs for 6 h over a period of 6 to 12-h post-application of repellents. Data analysis was conducted using mixed-effects logistic regression. Results The protective efficacy of MAÏA® and 20% DEET was not statistically different for each of the mosquito strains: 95.9% vs. 97.4% against An. gambiae (OR = 1.53 [95% CI 0.93–2.51] p = 0.091); 96.8% vs 97.2% against An. arabiensis (OR = 1.08 [95% CI 0.66–1.77] p = 0.757); 93.1% vs 94.6% against Ae. aegypti (OR = 0.76 [95% CI 0.20–2.80] p = 0.675). Average complete protection time (CPT) in minutes of MAÏA® and that of DEET was similar for each of the mosquito strains: 571.6 min (95% CI 558.3–584.8) vs 575.0 min (95% CI 562.1–587.9) against An. gambiae; 585.6 min (95% CI 571.4–599.8) vs 580.9 min (95% CI 571.1–590.7) against An. arabiensis; 444.1 min (95% CI 401.8–486.5) vs 436.9 min (95% CI 405.2–468.5) against Ae. aegypti. Conclusions MAÏA® repellent ointment provides complete protection for 9 h against both An. gambiae and An. arabiensis, and 7 h against Ae. aegypti similar to 20% DEET (in ethanol). MAÏA® repellent ointment can be recommended as a tool for prevention against outdoor biting mosquitoes in tropical locations where the majority of the people spend an ample time outdoor before going to bed.

Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs . 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs . 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.

Background The ability of external investigators to reproduce published scientific findings is critical for the evaluation and validation of biomedical research by the wider community. However, a substantial proportion of health research using electronic health records (EHR), data collected and generated during clinical care, is potentially not reproducible mainly due to the fact that the implementation details of most data preprocessing, cleaning, phenotyping and analysis approaches are not systematically made available or shared. With the complexity, volume and variety of electronic health record data sources made available for research steadily increasing, it is critical to ensure that scientific findings from EHR data are reproducible and replicable by researchers. Reporting guidelines, such as RECORD and STROBE, have set a solid foundation by recommending a series of items for researchers to include in their research outputs. Researchers however often lack the technical tools and methodological approaches to actuate such recommendations in an efficient and sustainable manner. Results In this paper, we review and propose a series of methods and tools utilized in adjunct scientific disciplines that can be used to enhance the reproducibility of research using electronic health records and enable researchers to report analytical approaches in a transparent manner. Specifically, we discuss the adoption of scientific software engineering principles and best-practices such as test-driven development, source code revision control systems, literate programming and the standardization and re-use of common data management and analytical approaches. Conclusion The adoption of such approaches will enable scientists to systematically document and share EHR analytical workflows and increase the reproducibility of biomedical research using such complex data sources.

Wearable technologies (wearables) have emerged as useful tools in the assessment of individuals within controlled settings. By utilizing wearables during assessments, objective digital data can be used to better inform clinical decisions. Of recent pragmatic interest has been the emergence of inertial sensor-based wearables (e.g., accelerometers, gyroscopes) that can provide high resolution temporal, spatial, and frequency-based outcomes that could be used to better quantify balance, gait, and other physical functioning tasks. This chapter explores the background to the instrumentation of physical functioning tasks, with the fundamentals required to capture and analysis inertial signals.

Background Intravenous iron is often used to treat iron deficiency anaemia in non-dialysis chronic kidney disease (ND-CKD), but the optimal dosing regimen remains unclear. We evaluated the impact of high- versus low-dose intravenous iron isomaltoside on the probability of retreatment with intravenous iron in iron-deficient ND-CKD patients. Methods This real-world, prospective, observational study collected data from 256 ND-CKD patients treated for anaemia in the UK. Following an initial course of iron isomaltoside, patients were followed for ≥12 months. Iron dose and the need for retreatment were determined at the investigators’ discretion. The primary study outcome was the need for retreatment at 52 weeks compared between patients who received >1000 mg of iron during Course 1 and those who received ≤1000 mg. Safety was evaluated through adverse drug reactions. Results The probability of retreatment at Week 52 was significantly lower in the >1000 mg iron group (n = 58) versus the ≤1000 mg group (n = 198); hazard ratio (95% confidence interval [CI]): 0.46 (0.20, 0.91); p = 0.012. Mean (95% CI) haemoglobin increased by 6.58 (4.94, 8.21) g/L in the ≤1000 mg group and by 10.59 (7.52, 13.66) g/L in the >1000 mg group (p = 0.024). Changes in other blood and iron parameters were not significantly different between the two groups. Administering >1000 mg of iron isomaltoside saved 8.6 appointments per 100 patients compared to ≤1000 mg. No serious adverse drug reactions were reported. Of the patients who received ≤1000 mg of iron in this study, 82.3% were eligible for a dose >1000 mg. Conclusions The >1000 mg iron isomaltoside regimen reduced the probability of retreatment, achieved a greater haemoglobin response irrespective of erythropoiesis-stimulating agent treatment, and reduced the total number of appointments required, compared to the ≤1000 mg regimen. Many of the patients who received ≤1000 mg of iron were eligible for >1000 mg, indicating that there was considerable underdosing in this study. Trial registration ClinicalTrials.gov NCT02546154, 10 September 2015.

Background N, N-Diethyl-3-methylbenzamide (DEET) topical mosquito repellents are effective personal protection tools. However, DEET-based repellents tend to have low consumer acceptability because they are cosmetically unappealing. More attractive formulations are needed to encourage regular user compliance. This study evaluated the protective efficacy and protection duration of a new topical repellent ointment containing 15% DEET, MAÏA® compared to 20% DEET in ethanol using malaria and dengue mosquito vectors in Bagamoyo Tanzania.Methods Fully balanced 3x3 Latin square design studies were conducted in large semi-field chambers using laboratory strains of Anopheles gambiae sensu stricto, Anopheles arabiensis and Aedes aegypti. Human volunteers applied either MAÏA® ointment, 20% DEET or ethanol to their lower limbs six hours before the start of tests. Approximately 100 mosquitoes per strain per replicate were released inside each chamber, with 25 mosquitoes released at regular intervals during the collection period to maintain adequate biting pressure throughout the test. Volunteers recaptured mosquitoes landing on their lower limbs for six hours over a period of six to 12-hours post-application of repellents. Data analysis was conducted using mixed-effects logistic regression.Results The protective efficacy of MAÏA® and 20% DEET was not different for each of the mosquito strains: 95.9% vs 97.4% against An. gambiae (OR=1.53 [95% CI: 0.93–2.51] p=0.091); 96.8% vs 97.2% against An. arabiensis (OR =1.08 [95% CI: 0.66 –1.77] P=0.757); 93.1% vs 94.6% against Ae. aegypti (OR=0.76 [95% CI: 0.20-2.80] p=0.675). Average complete protection time (CPT) of MAÏA® and that of DEET was similar for each of the mosquito strains: 571.6 minutes (95% CI: 558.3-584.8) vs 575.0 minutes (95% CI: 562.1-587.9) against An. gambiae; 585.6 minutes (95% CI: 571.4-599.8) vs 580.9 minutes (95% CI: 571.1-590.7) against An. arabiensis; 444.1 minutes (95% CI: 401.8-486.5) vs 436.9 minutes (95% CI: 405.2-468.5) against Ae. aegypti.Conclusions MAÏA® repellent ointment provides complete protection for 9 hours against both An. gambiae and An. arabiensis, and 7 hours against Ae. aegypti similar to 20% DEET (in ethanol). MAÏA® repellent ointment can be recommended to be used as a tool for prevention of outdoor biting mosquitoes in tropical locations as it protects for more than 6 hours.

Modern changes in warfare have shown an increased incidence of lumbar spine injuries caused by underbody blast events. The susceptibility of the lumbar spine during these scenarios could be exacerbated by coupled moments that act with the rapid compressive force depending on the occupant's seated posture. In this study, a combined loading lumbar spine vertebral body fracture injury criteria (L

Background: N,N-Diethyl-3-methylbenzamide (DEET) topical mosquito repellents are effective personal protection tools. However, DEET-based repellents tend to have low consumer acceptability because they are cosmetically unappealing. More attractive formulations are needed to encourage regular user compliance. This study evaluated the protective efficacy and protection duration of a new topical repellent ointment containing 15% DEET, MAÏA® compared to 20% DEET in ethanol using malaria and dengue mosquito vectors in Bagamoyo Tanzania.Methods: Fully balanced 3x3 Latin square design studies were conducted in large semi-field chambers using laboratory strains of Anopheles gambiae s.s, An. arabiensis and Aedes aegypti. Human volunteers applied either MAÏA® ointment, 20% DEET or ethanol to their lower limbs six hours before the start of tests. Approximately 100 mosquitoes per strain per replicate were released inside each chamber, with 25 mosquitoes released at regular intervals during the collection period to maintain adequate biting pressure throughout the test. Volunteers recaptured mosquitoes landing on their lower limbs for six hours over a period of six to 12-hours post-application of repellents. Data analysis was conducted using mixed-effects logistic regression.Results: The protective efficacy of MAÏA® and 20% DEET was not different for each of the mosquito strains: 95.9% vs 97.4% against An. gambiae (OR=1.53 [95% CI: 0.93–2.51] p=0.091); 96.8% vs 97.2% against An. arabiensis (OR =1.08 [95% CI: 0.66 –1.77] P=0.757); 93.1% vs 94.6% against Ae. aegypti (OR=0.76 [95% CI: 0.20-2.80] p=0.675). Average complete protection time (CPT) of MAÏA® and that of DEET was similar for each of the mosquito strains: 571.6 minutes (95% CI: 558.3-584.8) vs 575.0 minutes (95% CI: 562.1-587.9) against An. gambiae; 585.6 minutes (95% CI: 571.4-599.8) vs 580.9 minutes (95% CI: 571.1-590.7) against An. arabiensis; 444.1 minutes (95% CI: 401.8-486.5) vs 436.9 minutes (95% CI: 405.2-468.5) against Ae. aegypti.Conclusions: MAÏA® repellent ointment provides complete protection for 9 hours against both An. gambiae and An. arabiensis, and 7 hours against Ae. aegypti similar to 20% DEET (in ethanol). MAÏA® repellent ointment can be recommended to be used as a tool for prevention of outdoor biting mosquitoes in tropical locations as it protects for more than 6 hours.

Background Spatial repellents that drive mosquitoes away from treated areas, and odour-baited traps, that attract and kill mosquitoes, can be combined and work synergistically in a push-pull system. Push-pull systems have been shown to reduce house entry and outdoor biting rates of malaria vectors and so have the potential to control other outdoor biting mosquitoes such as Aedes aegypti that transmit arboviral diseases. In this study, semi-field experiments were conducted to evaluate whether a push-pull system could be used to reduce bites from Aedes mosquitoes. Methods The push and pull under investigation consisted of two freestanding transfluthrin passive emanators (FTPE) and a BG sentinel trap (BGS) respectively. The FTPE contained hessian strips treated with 5.25 g of transfluthrin active ingredient. The efficacies of FTPE and BGS alone and in combination were evaluated by human landing catch in a large semi-field system in Tanzania. We also investigated the protection of FTPE over six months. The data were analyzed using generalized linear mixed models with binomial distribution. Results Two FTPE had a protective efficacy (PE) of 61.2% (95% confidence interval (CI): 52.2–69.9%) against the human landing of Ae. aegypti. The BGS did not significantly reduce mosquito landings; the PE was 2.1% (95% CI: −2.9–7.2%). The push-pull provided a PE of 64.5% (95% CI: 59.1–69.9%). However, there was no significant difference in the PE between the push-pull and the two FTPE against Ae. aegypti (P = 0.30). The FTPE offered significant protection against Ae. aegypti at month three, with a PE of 46.4% (95% CI: 41.1–51.8%), but not at six months with a PE of 2.2% (95% CI: −9.0–14.0%). Conclusions The PE of the FTPE and the full push-pull are similar, indicative that bite prevention is primarily due to the activity of the FTPE. While these results are encouraging for the FTPE, further work is needed for a push-pull system to be recommended for Ae. aegypti control. The three-month protection against Ae. aegypti bites suggests that FTPE would be a useful additional control tool during dengue outbreaks, that does not require regular user compliance.

Background: Long-lasting insecticidal nets (LLINs) are the most sustainable and effective malaria control tool currently available. Global targets are for 80% of the population living in malaria endemic areas to have access to (own) and use a LLIN. However, current access to LLINs in endemic areas is 56% due to system inefficiencies and budget limitations. Thus, cost-effective approaches to maximize access to effective LLINs in endemic areas are required. This study evaluated whether LLINs that had been stored for five years under manufacturer’s recommended conditions may be optimally effective against Anopheles mosquitoes, to inform malaria control programmes and governments on the periods over which LLINs may be stored between distributions, in an effort to maximize use of available LLINs. Methods: Standard World Health Organization (WHO) bioassays (cone and tunnel test) were used to evaluate the bio-efficacy and wash resistance of Olyset® and DawaPlus® 2.0 (rebranded Tsara® Soft) LLINs after five years of storage at 25°C to 33.4°C and 40% to 100% relative humidity. In addition, a small scale Ifakara Ambient Chamber test (I-ACT) was conducted to compare the bio-efficacy of one long stored LLINs to one new LLIN of the same brand, washed or unwashed. LLINs were evaluated using laboratory reared fully susceptible Anopheles gambiae sensu stricto (s.s.) (Ifakara strain) and pyrethroid resistant Anopheles arabiensis (Kingani strain). Results: After five years of storage, both unwashed and washed, Olyset® and DawaPlus® 2.0 (Tsara® Soft) LLINs passed WHO bio-efficacy criteria on knockdown (KD60) ≥95%, 24-hour mortality ≥80% and ≥90% blood-feeding inhibition in WHO assays against susceptible An. gambiae s.s. DawaPlus® 2.0 LLINs also passed combined WHO bioassay criteria against resistant An. arabiensis. Confirmatory I-ACT tests using whole nets demonstrated that long-stored LLINs showed higher efficacy than new LLINs on both feeding inhibition and mortality endpoints against resistant strains.Conclusions: Even after long-term storage of around 5 years, both Olyset® and DawaPlus® 2.0 LLINs remain efficacious against susceptible Anopheles mosquitoes at optimal storage range of 25°C to 33.4°C for temperature and 40% to 100% relative humidity measured by standard WHO methods. DawaPlus® 2.0 (Tsara® Soft) remained efficacious against resistant strain.

Background Long-lasting insecticidal nets (LLINs) are the most sustainable and effective malaria control tool currently available. Global targets are for 80% of the population living in malaria endemic areas to have access to (own) and use a LLIN. However, current access to LLINs in endemic areas is 56% due to system inefficiencies and budget limitations. Thus, cost-effective approaches to maximize access to effective LLINs in endemic areas are required. This study evaluated whether LLINs that had been stored for 5 years under manufacturer’s recommended conditions may be optimally effective against Anopheles mosquitoes, to inform malaria control programmes and governments on the periods over which LLINs may be stored between distributions, in an effort to maximize use of available LLINs. Methods Standard World Health Organization (WHO) bioassays (cone and tunnel test) were used to evaluate the bio-efficacy and wash resistance of Olyset® and DawaPlus® 2.0 (rebranded Tsara® Soft) LLINs after 5 years of storage at 25 °C to 33.4 °C and 40% to 100% relative humidity. In addition, a small scale Ifakara Ambient Chamber test (I-ACT) was conducted to compare the bio-efficacy of one long stored LLINs to one new LLIN of the same brand, washed or unwashed. LLINs were evaluated using laboratory reared fully susceptible Anopheles gambiae sensu stricto (s.s.) (Ifakara strain) and pyrethroid resistant Anopheles arabiensis (Kingani strain). Results After 5 years of storage, both unwashed and washed, Olyset® and DawaPlus® 2.0 (Tsara® Soft) LLINs passed WHO bio-efficacy criteria on knockdown (KD60) ≥ 95%, 24-h mortality ≥ 80% and ≥ 90% blood-feeding inhibition in WHO assays against susceptible An. gambiae s.s. DawaPlus® 2.0 LLINs also passed combined WHO bioassay criteria against resistant An. arabiensis. Confirmatory I-ACT tests using whole nets demonstrated that long-stored LLINs showed higher efficacy than new LLINs on both feeding inhibition and mortality endpoints against resistant strains. Conclusions Even after long-term storage of around 5 years, both Olyset® and DawaPlus® 2.0 LLINs remain efficacious against susceptible Anopheles mosquitoes at optimal storage range of 25 °C to 33.4 °C for temperature and 40% to 100% relative humidity measured by standard WHO methods. DawaPlus® 2.0 (Tsara® Soft) remained efficacious against resistant strain.