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Abstract Pathology provides the definitive diagnosis, and Artificial Intelligence (AI) tools are poised to improve accuracy, inter-rater agreement, and turn-around time (TAT) of pathologists, leading to improved quality of care. A high value clinical application is the grading of Lymph Node Metastasis (LNM) which is used for breast cancer staging and guides treatment decisions. A challenge of implementing AI tools widely for LNM classification is domain shift, where Out-of-Distribution (OOD) data has a different distribution than the In-Distribution (ID) data used to train the model, resulting in a drop in performance in OOD data. This work proposes a novel clustering and sampling method to automatically curate training datasets in an unsupervised manner with the aim of improving model generalization abilities. To evaluate the generalization performance of the proposed models, we applied a novel use of the Two One-sided Tests (TOST) method. This method examines whether the performance on ID and OOD data is equivalent, serving as a proxy for generalization. We provide the first evidence for computing equivalence margins that are data-dependent, which reduces subjectivity. The proposed framework shows the ensembled models constructed from models that generalized across both tumor and normal patches enhanced performance, achieving an F1 score of 0.81 for LNM classification on unseen ID and OOD samples. Interactive viewing of slide-level segmentations can be accessed on PathcoreFlow™ through https://web.pathcore.com/folder/18555?s=QTJVHJuhrfe5 . Segmentation models are available at https://github.com/IAMLAB-Ryerson/OOD-Generalization-LNM .

Introduction: Patients with hypertrophic cardiomyopathy (HCM) are at risk for lethal ventricular arrhythmia, but the electrophysiological substrate behind this is not well-understood. We used non-invasive electrocardiographic imaging to characterize patients with HCM, including cardiac arrest survivors.Methods: HCM patients surviving ventricular fibrillation or hemodynamically unstable ventricular tachycardia (n = 17) were compared to HCM patients without a personal history of potentially lethal arrhythmia (n = 20) and a pooled control group with structurally normal hearts. Subjects underwent exercise testing by non-invasive electrocardiographic imaging to estimate epicardial electrophysiology.Results: Visual inspection of reconstructed epicardial HCM maps revealed isolated patches of late activation time (AT), prolonged activation-recovery intervals (ARIs), as well as reversal of apico-basal trends in T-wave inversion and ARI compared to controls (p < 0.005 for all). AT and ARI were compared between groups. The pooled HCM group had longer mean AT (60.1 ms vs. 52.2 ms, p < 0.001), activation dispersion (55.2 ms vs. 48.6 ms, p = 0.026), and mean ARI (227 ms vs. 217 ms, p = 0.016) than structurally normal heart controls. HCM ventricular arrhythmia survivors could be differentiated from HCM patients without a personal history of life-threatening arrhythmia by longer mean AT (63.2 ms vs. 57.4 ms, p = 0.007), steeper activation gradients (0.45 ms/mm vs. 0.36 ms/mm, p = 0.011), and longer mean ARI (234.0 ms vs. 221.4 ms, p = 0.026). A logistic regression model including whole heart mean activation time and activation recovery interval could identify ventricular arrhythmia survivors from the HCM cohort, producing a C statistic of 0.76 (95% confidence interval 0.72–0.81), with an optimal sensitivity of 78.6% and a specificity of 79.8%.Discussion: The HCM epicardial electrotype is characterized by delayed, dispersed conduction and prolonged, dispersed activation-recovery intervals. Combination of electrophysiologic measures with logistic regression can improve differentiation over single variables. Future studies could test such models prospectively for risk stratification of sudden death due to HCM.

The effect of various chemical parameters such as NO3-, HCO3-, EDTA and citric acid on the uranium leaching from phosphate rock samples has been investigated by means of batch-type experiments and the total uranium concentration in the solution was analyzed by ICP-OES. EDTA has been found to leach uranium from phosphate rock at the highest rate, followed by carbonate and citrate. With the exception of nitrates, the ligand concentration (0.01 M and 0.001 M) appears to greatly enhance the leaching efficiency at the studied ligand concentrations. On other hand, the effect of pH differs significantly from one ligand to another, because EDTA is more effective in near neutral solutions (pH 6.5), whereas citrate in acidic solutions (pH 2.5).

Abstract Objective This study investigates whether psychological well‐being in post‐bariatric patients seeking body contouring procedures differs from those who do not seek body contouring procedures, those who have already undergone body contouring procedures, and those who are unsure about body contouring procedures. Methods An anonymous, nonrandomized, cross‐sectional survey study was designed. Psychological well‐being of four groups of post‐bariatric‐patients (undergone body contouring procedures, seeking body contouring procedures, not seeking body contouring procedures, unsure about body contouring procedures) were compared. Results A total of 345 patients were included in this study. No significant difference between patients seeking body contouring procedures and those not seeking body contouring procedures was found with regard to depressive symptoms, self‐esteem, and body image. Patients who had already undergone body contouring procedures scored lower on depressive symptoms (p = 0.035) and reported feeling more attractive (p

Introducción: En este artículo se presenta una caracterización de la implementación de la Interrupción Voluntaria del Embarazo en Chile, durante los 5 primeros años de entrada en vigencia la Ley No. 21.030 que despenaliza el aborto en 3 causales. Objetivo: Caracterizar la implementación de las interrupciones voluntarias de embarazos realizadas entre enero del 2018 y diciembre del 2022 en Chile. Método: Para su realización, se solicitó al Departamento de Estadística e Información en Salud (DEIS) estadísticas del aborto en tres causales entre enero del 2018 y diciembre del 2022 con información desagregada por servicio de salud, región, edad de la mujer, diagnóstico y semana gestacional de interrupción, entre otros. Resultados: En los primeros cinco años de implementación de la ley se han registrado 3.858 casos en todo el país, siendo la inviabilidad fetal la principal razón de constitución. Las mujeres de 25 a 39 años lideran en causales, mientras que las adolescentes y niñas son mayoría en casos de violación. La tasa de interrupción general es del 84,1%, llegando al 91.9% en casos de violación. Conclusiones: Las menores de 14 años tienen la menor tasa de interrupción, evidenciando posibles obstáculos a su decisión. Se sugiere investigar los desafíos específicos que enfrentan las niñas al decidir sobre sus embarazos.

Abstract Background Carbon ion radiotherapy (CIRT) has been applied in cancer treatment for over 25 years. However, guidelines for dose–volume constraints have not been established yet. The aim of this review is to summarize the dose–volume constraints in CIRT for head‐and‐neck (HN) cancer that were determined through previous clinical studies based on the Japanese models for relative biological effectiveness (RBE). Methods A literature review was conducted to identify all constraints determined for HN cancer CIRT that are based on the Japanese RBE models. Results Dose–volume constraints are reported for 17 organs at risk (OARs), including the brainstem, ocular structures, masticatory muscles, and skin. Various treatment planning strategies are also presented for reducing the dose delivered to OARs. Conclusions The reported constraints will provide assistance during treatment planning to ensure that radiation to OARs is minimized, and thus adverse effects are reduced. Although the constraints are given based on the Japanese RBE models, applying the necessary conversion factors will potentially enable their application by institutions worldwide that use the local effect model for RBE.

The overall aim of the paper is to present evidence on the factors underpinning historical deportation cases, by exploring the reasons, explanations and patterns related to deportation in Australia. The purpose is to consider whether these historical factors are antecedent to current forms of deportation occurring in Australia, and to bring to the fore potential recurring patterns. Deportation is currently conceptualised by border criminologists as a punitive tool of discipline and control, within the realm of penal powers. Some of this work on the ‘deportation regime’ asserts that certain migrants, or groups of migrants, are undesirable: their identity, (not)belonging and punishment have become inherently intertwined, and their mobility has become politicised and criminalised. This article theorises that deportation has been used in Australia, now and in the past, to expel individuals who are viewed as detrimental to the ‘health’ of the host society. The ‘deportation categories’ demonstrate that migrants’ desirability has historically been a temporary condition, shifting over time in line with the state’s requirements. They also demonstrate the historical regime of criminalisation of undesirable others enacted through Australia’s border control regime.

Background The concept of robotic microsurgery is becoming increasingly known as several robotic systems tailored to the specific needs of microsurgery are being introduced. Training with these devices is essential to draw conclusions about their potential clinical utility. This study describes the training and learning curve of experienced microsurgeons and complete novices using such a robotic surgical system in combination with an exoscope.

BackgroundAutologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV).Methods150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated.ResultsIn a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred.ConclusionsUse of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.

In this paper we explore the properties of the |$z=6.853$| obscured hyperluminous quasar COS-87259, discovered in the Cosmological Evolution Survey (COSMOS) field, with our recently developed Bayesian spectral energy distribution (SED) fitting code SMART (Spectral energy distributions Markov chain Analysis with Radiative Transfer models). SMART fits SEDs exclusively with multicomponent radiative transfer models that constitute four different types of pre-computed libraries for the active galactic nucleus (AGN) torus, the starburst, and the spheroidal or disc host. We explore two smooth radiative transfer models for the AGN torus and two two-phase models, in order to put constraints on the AGN fraction of the galaxy, the black hole mass, and its star formation rate (SFR). We find that either of the smooth tapered disc or the two-phase flared disc models provide a good fit to the SED of COS-87259. The best-fitting models predict an AGN fraction in the range |$86-92$| per cent, a bolometric AGN luminosity of |$5.8-10.3 \times 10^{13} L_\odot$|⁠ , a black hole mass of |$1.8-3.2 \times 10^{9} M_\odot$| (assuming the quasar is accreting at the Eddington limit), and an SFR in the range |$1985-2001~M_\odot \rm yr^{-1}$|⁠. The predicted space density of such objects in the redshift range |$4-7$| is |$\sim 20$| times more than that of co-eval unobscured quasars. [ABSTRACT FROM AUTHOR]

Background Idiopathic ventricular fibrillation (VF) is a diagnosis of exclusion following normal cardiac investigations. We sought to determine if exercise‐induced changes in electrical substrate could distinguish patient groups with various ventricular arrhythmic pathophysiological conditions and identify patients susceptible to VF. Methods and Results Computed tomography and exercise testing in patients wearing a 252‐electrode vest were combined to determine ventricular conduction stability between rest and peak exercise, as previously described. Using ventricular conduction stability, conduction heterogeneity in idiopathic VF survivors (n=14) was compared with those surviving VF during acute ischemia with preserved ventricular function following full revascularization (n=10), patients with benign ventricular ectopy (n=11), and patients with normal hearts, no arrhythmic history, and negative Ajmaline challenge during Brugada family screening (Brugada syndrome relatives; n=11). Activation patterns in normal subjects (Brugada syndrome relatives) are preserved following exercise, with mean ventricular conduction stability of 99.2±0.9%. Increased heterogeneity of activation occurred in the idiopathic VF survivors (ventricular conduction stability: 96.9±2.3%) compared with the other groups combined (versus 98.8±1.6%; P=0.001). All groups demonstrated periodic variation in activation heterogeneity (frequency, 0.3–1 Hz), but magnitude was greater in idiopathic VF survivors than Brugada syndrome relatives or patients with ventricular ectopy (7.6±4.1%, 2.9±2.9%, and 2.8±1.2%, respectively). The cause of this periodicity is unknown and was not replicable by introducing exercise‐induced noise at comparable frequencies. Conclusions In normal subjects, ventricular activation patterns change little with exercise. In contrast, patients with susceptibility to VF experience activation heterogeneity following exercise that requires further investigation as a testable manifestation of underlying myocardial abnormalities otherwise silent during routine testing.

Goal: Uterine contractility is known to play significant role in women's health. Ultrasonography and magnetic resonance imaging have been used for assessing uterine peristalsis, however they lack practicality, objectivity, and cost-effectiveness. In this paper, the ElectroUteroGraph (EUG) and novel electrodes are introduced, to cover the unmet need of practical intrauterine contractility assessment. The EUG measures biopotentials produced by uterine muscle contraction, similar to the basis of electrocardiography. Methods: The EUG was used to fifteen healthy, non-pregnant women of reproductive age. Amplitude and frequency-related features were derived from our recordings. Results: The EUG and novel electrodes did not cause any pain or discomfort to the patients, over their multiple recording sessions. The collected data showed difference between the proliferative and luteal phase of menstrual cycle (p < 0.05). Conclusions: The EUG can accurately measure uterine electrical activity, in a simple, standardized, safe and pain-free approach, leading to objective evaluation of uterine peristalsis.

As the current climate crisis intensifies, drought resistant crops are becoming more important due to their ability to withstand the increasingly hotter and drier summers. Such crops are valuable for pollinators as they provide food resources for wild and managed species. The carob tree (Ceratonia siliqua L.) represents an example of a heat- and drought- resistant crop, able to grow in dry areas with practically no inputs. The current study assessed over two growing seasons the diversity of wild bees and other pollinators relying on carob flowers, as well as the contribution of animal pollination to carob production. Carob flowers were subjected to two treatments: Open pollination, where inflorescences were left untreated, and wind pollination, where inflorescences were bagged in a mesh during blooming. Weekly observations during blooming showed that Apis mellifera was the most frequent floral visitor followed by wild bees and wasps. Carob flowers were visited by at least 10 different wild bee species. Open-pollinated flowers produced significantly more pods, with the benefit ranging from 4 to 16 times higher production, depending on the region. Open pollination led to pods with greater weight, length and number of seeds compared to pods derived from wind pollination. The results of the current study highlight the importance of animal pollination to carob production, as well as the significance of carob trees to wild bee conservation.