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Research question To evaluate the efficacy of sequential 2D transvaginal ultrasound (US) and hysterosalpingo-foam sonography (HyFoSy) after methotrexate (MTX) treatment for tubal pregnancy among patients who desire a future pregnancy. Design A prospective trial was conducted between May 2019 and November 2020. Only patients who had a suspected tubal ectopic pregnancy diagnosed by US and treated by MTX were included. These patients underwent sequential transvaginal 2D-US assessment of the pelvic organs and a complementary HyFoSy for tubal patency. The primary outcome was tubal obstruction in the affected side. Results During a study period, a total of 360 women underwent sequential transvaginal 2D-US assessment of the pelvic organs and a complementary HyFoSy for tubal patency. Of them, 40 (11.1%) women fulfilling the inclusion criteria were enrolled. In 6/40 (15%), hydrosalpinx of the affected tube was found during the initial transvaginal US examination and were excluded from further investigation. In the remaining 34/40 (85%) patients, HyFoSy was performed. Tubal block was found in 10/34 (29.4%) the patients. Of these, 8/34 (23.5%) and 2/34 (5.9%) had a proximal block of the affected tube and bilateral proximal obstruction, respectively. HSG confirmed the tubal obstruction in all the affected cases. No procedure-related complications were documented. Conclusions In this preliminary study, almost every second woman who was treated by MTX for tubal pregnancy was diagnosed as having a tubal obstruction. We suggest that sequential transvaginal US and HyFoSy be part of the routine follow-up for these women, thus offering them timely referral to the appropriate specialist. This approach should be considered in clinical guidance addressing the follow-up of women with tubal pregnancy treated with MTX.

A primeira metodologia foi aplicada no processo ���17 - Integra����o CCEE��� por meio do m��todo de regress��o (regressor Random Forest), e atendendo a duas ��reas distintas: (i) ��rea de Medi����o: atrav��s de metodologia computacional di��ria relatar a integridade dos dados de medi����o e mensalmente relatar �� equipe a an��lise dos dados com a inten����o de detectar anomalias atrav��s do comportamento dos dados desses medidores; (ii) ��rea de Mercado: aplicada com a inten����o de coleta e prepara����o dos dados para a an��lise dos especialistas. J�� a segunda metodologia foi aplicada ao processo ���04 - Cr��tica de leitura (rural)��� que atrav��s de m��todo de classifica����o inteligente (classificador Random Forest) utilizando de caracter��sticas sist��micas e hist��rico de consumo, para tomar decis��o sobre a corre����o de determinada leitura. As duas metodologias foram implementadas em ferramentas de software desenvolvidas em Linguagem Python, cujos c��digos podem ser ativados por rob��s da plataforma Automation Anywhere.

This article addresses coding and liability related to obstetric and gynecologic ultrasound examinations. The coding section includes an overview of general concepts, highlighting the differences between coding in hospital-owned facilities and provider-owned clinics. It also addresses the importance of correct International Classification of Diseases, 10th edition, coding, emphasizing the use of the most specific applicable codes. This section discusses proper coding and applicable parameters for early pregnancy and gynecologic ultrasound examination. The liability section addresses common errors leading to litigation in obstetric and gynecologic ultrasound practice. Examples are given demonstrating how such errors lead to liability actions.

Objectives To assess the diagnostic performance of the fetal cardiac axis (CA) and/or cardiac position (CP) versus the congenital pulmonary malformation volume ratio (CVR) in predicting any and severe neonatal respiratory morbidity in fetal congenital lung lesions. Methods This work was an 11-year retrospective cohort study. The sensitivity, specificity, positive predictive value, and negative predictive value of CA and/or CP assessment in prediction of respiratory morbidity were calculated before 24 weeks' gestation and between 24 and 32 weeks and compared to CVR cutoffs obtained from the literature. Results Fifty-three patients were included. CA and/or CP abnormalities were present in 45% and 38% of patients before 24 weeks and between 24 and 32 weeks and were significantly more common in left- versus right-sided lesions (60% versus 17%; P = .003). The sensitivity, specificity, positive predictive value, and negative predictive value of an abnormal CA and/or CP for any and severe respiratory morbidity were 0.67, 0.61, 0.33, and 0.86 and 0.8, 0.58, 0.17, and 0.97 before 24 weeks and 0.75, 0.73, 0.45, and 0.91 and 0.8, 0.67, 0.20, and 0.97 between 24 and 32 weeks, respectively. An abnormal CA and/or CP had higher sensitivity for any respiratory morbidity compared to the CVR at 0.5 and 0.8 cutoffs both before 24 weeks and between 24 and 32 weeks (P Conclusions An abnormal CA and/or CP before 24 weeks and between 24 and 32 weeks has higher sensitivity for the detection of any respiratory morbidity at birth compared to the CVR at both 0.5 and 0.8 cutoffs. A normal CA and CP have a high negative predictive value for excluding any respiratory morbidity at birth both before 24 weeks and between 24 and 32 weeks.

O problema da localiza����o de faltas nas subesta����es blindadas implica ainda hoje uma tarefa de porte, pois uma localiza����o err��nea implica em uma quantidade expressiva de trabalho e atraso na solu����o do problema. Quando ocorre uma falta neste tipo de subesta����o, deve-se estabelecer sua localiza����o, o que significa especificar o compartimento em que esta falta ocorreu. Da�� deve-se extrair o g��s do compartimento e realizar sua abertura, corrigir o defeito, lacrar o compartimento, recolocar o g��s e fazer todos os testes de estanqueidade necess��rios. Por��m, ao se abrir o compartimento e se verificar que n��o foi nele que o defeito ocorreu, todos os procedimentos de retirada e recoloca����o do g��s, bem como todos os testes de estanqueidade, devem ser realizados, e se partir para o pr��ximo compartimento suspeito de ter ocorrido a falta. Isto ocorre pela falta de observabilidade que ocorre em v��rios compartimentos da subesta����o.

BACKGROUND Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. OBJECTIVE The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. METHODS The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. RESULTS The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. CONCLUSIONS The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. CLINICALTRIAL ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30757

Studies show decreased well-being during the COVID-19 pandemic, especially for healthcare providers from Asia. Less is known about the psychological responses of working during the pandemic on hospital-based registered nurses (RNs) in the United States (US). Therefore, the purpose of this paper is to report the well-being of U.S.-based hospital RNs working during the initial acute phase of COVID-19 and compare it with well-being among healthcare workers described in two global meta-analyses. We conducted a cross-sectional survey in May-June 2020 (N = 467). Well-being was measured using the following tools: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depressive symptoms, Impact of Events Scale-Revised for traumatic stress, and the Insomnia Severity Index. Compared with global rates from two meta-analyses, US-based RNs reported significantly more traumatic stress (54.6% vs. 11.4% and 21.5%; p .001) and depressive symptoms (54.6% vs. 31.8% and 21.7%; p .001). Rates of insomnia were also higher in U.S.-based RNs than in the meta-analysis that reported insomnia (32.4% vs 27.8%; p .033). Rates of anxiety symptoms among US-based RNs did not differ from that reported in one meta-analysis (37.3% vs. 34.4%), while it was significantly higher in the other (37.3% vs. 22.1%; p .001). Hospital-based RNs from the US exhibited over twice the rates of trauma and nearly double the rates of depressive symptoms than shown in reports from hospital workers globally during the acute phase of the COVID-19 pandemic. The lasting effects of this distress are unknown and warrant ongoing evaluation and solutions to better support emotional well-being and prevent burnout in the workplace.

Este processo de robotiza����o de processos administrativos foi incorporado ao processo ���Cr��tica de leitura rural���, onde a equipe de cr��tica de leitura recebe para an��lise manual os casos em que o consumo atual de energia de determinado consumidor extrapolou, para baixo ou para cima, os valores m��dios determinados para este consumidor segundo um crit��rio (ajust��vel) no sistema CIS (Sonda). A tarefa desta equipe �� ent��o a de determinar se a leitura est�� correta ou n��o, caso negativo, sendo necess��rio corrigi-la ou solicitar releitura. Dado que o problema da cr��tica de leitura consiste em identificar em qual categoria (c��digo de motivo de altera����o) uma determinada leitura, que n��o passou no processo de cr��tica autom��tica, pode ser enquadrada, a abordagem adotada para esse processo foi a utiliza����o de um modelo de aprendizagem de m��quina (Machine Learning) supervisionado de classifica����o. Nesta metodologia foi poss��vel implantar um classificador inteligente para criticar as leituras e na sequ��ncia estabelecidas regras de neg��cio, diretamente no algoritmo em Python, a fim de reduzir a quantidade de leituras que permanecer��o para a equipe analisar.

Este processo de robotiza����o de processos administrativos foi incorporado ao processo ���Integra����o CCEE (C��mara de Comercializa����o de Energia El��trica)���, passando a ser poss��vel interagir com as ferramentas que s��o utilizadas para a an��lise dos dados de medi����o, sendo estas os sistemas API CCEE/SCDE, Outlook e Excel. Foi poss��vel organizar as informa����es de forma autom��tica e analisar via Machine Learning o comportamento dos medidores, possibilitando a realiza����o de an��lises que antes n��o eram observadas. Esta arquitetura est�� fortemente embasada em tr��s pilares: (1) Plataforma de RPA da Automation Anywhere, adotada pela COPEL, fornecendo a estrutura de base para os rob��s; (2) Algoritmos de Machine Learning e outras funcionalidades implementadas em linguagem Python e integradas aos rob��s; e (3) a plataforma Microsoft 365, padr��o da COPEL, fornecendo os meios para a operacionaliza����o da solu����o. Os testes funcionais referentes ao processo ���Integra����o CCEE��� foram implementados segundo duas aplica����es: Medi����o e Mercado.

Metal-oxide based Electrochemical Random-Access Memory (MO-ECRAM) has shown unique potential as a nonvolatile element for analog in-memory computation of deep learning tasks. Using a specially designed interdigitated device geometry, we investigate transient effects of MO-ECRAM and correlate them with programming speed, read speed and read-after write speed. Programming speed is shown to exponentially increase with programming voltage. Read speed reached the ns range, while read-after-write delay can be limited by decay of write transients in the studied devices. Two mechanisms of channel modulation were found; a prompt field effect and a field-induced memory effect. The charge control of the prompt effect was vastly greater than that of the memory effect. So to reduce and mitigate transient impact, we discuss both device improvements, and learning algorithm engineering strategies.

Este projeto visa desenvolver uma metodologia, e aplic��-la em um prot��tipo, para avalia����o preditiva das condi����es operacionais de disjuntores, baseado na informa����o fornecida durante a opera����o de abertura e fechamento de seus polos, associada com uma minera����o inteligente dos dados do hist��rico. Outro objetivo dessa metodologia �� criar modelos capazes de avaliar os diversos aspectos relacionados �� manuten����o dos disjuntores. Pretende-se poder responder a quest��es referentes �� conformidade do hist��rico de eventos nos disjuntores com os valores especificados pelos fabricantes, �� estima����o do custo de manuten����o em fun����o das condi����es de opera����o e dos disjuntores, �� influ��ncia de fatores tais como a topologia da rede no desempenho dos equipamentos etc. Para dar apoio �� metodologia desenvolvida, o projeto confeccionar�� um programa de Data Analytics voltado para a manuten����o de disjuntores. O sistema desenvolvido ser�� testado em laborat��rio e instalado em uma subesta����o da COPEL.

Aim This concept analysis aims to formulate a unique theoretical definition of the term remission as used in cancer survivorship. Background Inadequate communication between healthcare providers and cancer survivors is a shared burden affecting survivor well-being. Healthcare providers regularly use the term remission in cancer prognosis, treatment, and long-term cancer management; yet, how healthcare providers and cancer survivors define and interpret the concept of remission is less understood. Design The Walker and Avant method of concept analysis was applied to define the term remission within the domain of cancer survivorship. DATA SOURCE: Three health sciences databases were chosen for the literature search, including PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline. REVIEW METHODS: Included research articles were evaluated to define the antecedents, attributes, consequences, and empirical referents of the term remission. Results A cancer diagnosis is the most commonly cited antecedent to cancer remission. During remission, most cancer patients are free of measurable or symptomatic disease; however, the remission milestone is complemented by multiple physical and psychological symptoms. More specific cancer remission attributes include anxiety, recurrence fears, self-perseverance, and loss of social support. Both positive and negative outcomes accompany cancer remission, including acceptance of the treatment journey, appreciation for life, hope, persistent anxiety, personal relief, and triggered memories. Conclusions This concept analysis reviewed numerous publications to understand remission in the context of cancer survivorship. Advanced practice and registered nurses have a continued opportunity to improve the communication methods of patient-centered teaching and care planning for cancer patients in remission.

Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings.

Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings.

In this paper we present a methodology and first results of seafloor compressional sound speed estimation in a compacting passive margin setting of the southeastern Mediterranean Sea, offshore Israel. The estimation was obtained through a coupled wide-angle reflection-refraction travel time analysis of standard commercial 2D multichannel seismic data, acquired with a 7.2km long horizontal receivers array, and geoacoustic inversion. We found that three parameters were needed to model the observed travel times: 1) the compressional sound speed at water-sediment interface c0; 2) a constant velocity gradient K within the sub-bottom sediments layer; and 3) the thickness of the relevant sub-bottom layer H2. The model considered consists of a water layer with a vertically varying sound speed profile according to the season. The thickness of this layer is constrained by the pre-known seafloor bathymetric depth of 1200 m. The base of the model is the top of a regional salt layer, which underlies the investigated sub-bottom layer and constrains H2. The estimated c0 and K are 1550 m s−1 and 0.7 s−1, respectively. The proposed method allows to estimate a relatively low (∼1500-1650 m s−1) sound speed at water-sediment interface, where it is challenging to use conventional refraction-based methods.