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Purpose: The use of FDG-PET/TC for cancer staging has been leading to the increasing diagnosis of adrenal lesions, which usually represent a clinical challenge. Our aim was to characterize the adrenal lesions found in FDG-PET of patients followed in a cancer center.Methods: Retrospective analysis of all FDG-PET studies performed in our center in the last 10 years. Exams reporting adrenal lesions in the CT component and/or anomalous adrenal FDG uptake were selected. Cases were characterized regarding clinical, laboratorial, imaging and pathological findings. Results: We identified 27,427 FDG-PET studies. Of those, 7.6% evidenced adrenal findings. We included 1364 exams corresponding to 1021 patients. Only 15.6% were referred to the endocrinology department and 38% of the lesions were not studied.Malignant lesions were present in 38.9% of the studied patients: metastases in 37.5%, carcinoma in 1.2% and other malignant tumors in 0.4%. Median SUVmax of malignant lesions was significantly higher than the SUVmax of the benign findings (p0.05). Conclusion: Occult adrenal lesions discovered during FDG-PET/CT are common in cancer context and are frequently benign. SUVmax may be a useful tool in the workup of adrenal lesions but with several important caveats.

To analyze the route that transgender men take to gain access to the treatments that are available for going through the transsexualizing process at a public care and attendance center in one of the capital cities of north-eastern Brazil.A qualitative case study which used the therapeutic itinerary as a theoretical-methodological path. The research was carried out between the months of September 2019 and March 2020 in a care and attendance center for trans people. The inclusion criteria were as follows: self-recognition as transgender men, over 18 years of age, and whose transsexualizing process was being carried out in the service stage of this study. Semistructured interviews were conducted. All interviewees participated voluntarily and signed a Free and Informed Consent Form before the study.This study included 18 transgender men whose average age was 26.3 years. Of these, five (27.7%) were students, with one (5.5%) of them, as well as the others (nonstudents), performing some type of paid work. Three thematic categories emerged: (i) The (self-re-) cognition of the trans world through the internet and social media; (ii) the expression of male gender identity and the (non) support network; and (iii) access to transsexualizing process in SUS (Brazilian Public Healthcare System).The identification of the path taken by trans men, from their self-recognition and to the therapeutic care accessed through SUS' transsexualizing process, made it possible to identify the impacts of their experiences upon the construction of their gender identities.

BACKGROUND: This proof-of-concept trial examined a 6-month Prevention Plus (PP) intervention implemented in a federally qualified health center on child standardized BMI (ZBMI), using a planned clinical effect threshold of −0.16 ZBMI. The relationship between food security status and PP delivered with caregiver goals (PP+) and without caregiver goals (PP−) on energy balance behaviors (i.e., fruits and vegetables, physical activity) and child ZBMI was explored. METHODS: Seventy-three, underserved children, 4–10 years of age with a BMI ≥85th percentile, were randomized to one of two interventions, PP+ and PP−, both providing 2.5 hours of contact time, implemented in five clinics by behavioral health consultants (BHCs). Outcomes were child anthropometrics (included 9-month follow-up), implementation data collected from electronic health records, and caregiver and BHC evaluations. RESULTS: Children were 57.5% female and 78.1% Hispanic, with 32.9% from food-insecure households and 58.9% from households with an annual income of less than $20,000. Child ZBMI significantly (p

PURPOSE: To examine distance traveled to an urban community health center by gender-expansive and cisgender participants. METHODS: Client-reported zip code of residence from archival data (N=2677) was used. A chi-square test of independence and a Mann–Whitney–Wilcoxon test were conducted. RESULTS: Gender-expansive clients travel farther to access health care from this clinic; this is true for clients who live within the city, within the state, and in the neighboring states. CONCLUSION: Trans people experience travel distance as a barrier to accessing quality health care. Broadening telehealth services and working with rural health care providers to develop transition-related health care knowledge are key.

To evaluate the electro-clinical manifestations and outcomes of children with absence epilepsy at a tertiary center in Saudi Arabia.This retrospective study reviewed the medical and EEG records of patients who were diagnosed to have CAE as per the International League Against Epilepsy (ILAE) definition for CAE. The study was conducted in the pediatric neurology clinic of King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia, between January 2000 and December 2019. Patients who did not meet (ILAE) criteria, lost follow-up, and those who did not receive treatment at KKUH were excluded. Data regarding the patient's disease, electro-clinical manifestations, anti-seizure medication response, and outcomes were collected.A total of 35 patients, with an average age at diagnosis of 7 ± 2.1 y, were included in the study; among them, 51.4% were female and approximately 48.6% presented with a family history of epilepsy. Regarding clinical features, all patients experienced staring and altered awareness, 94.2% had less than 20 spells per day at the time of diagnosis, and 65.7% were provoked by the hyperventilation test. Regarding EEG findings, all patients had bilateral, symmetrical, and synchronous discharges in the form of regular 3 Hz spike-and-wave complexes, and 94.3% had a generalized initial ictal discharge. Also, 22.8% had eye fluttering with electrographic seizures. Ethosuximide (ESM) was used as the drug of choice in 45.7% of the patients. Regarding clinical outcomes, 94.3% had their disease clinically controlled, and 80% had a normalized EEG after few months of starting anti-seizure medication. Finally, 37.2% experienced complete remission of epilepsy after 3-5 y; however, one patient developed juvenile myoclonic epilepsy.This study described the electro-clinical manifestations of patients with childhood absence epilepsy and outcomes. Furthermore, early diagnosis and prompt treatment of childhood absence epilepsy improve treatment outcomes.

Introduction Youth aged 13–29 years represent 23% of the population but account for 40% of new HIV diagnoses, with risk peaking at ages 22–23 years. We assessed sexual behaviors, PrEP knowledge and attitudes among patients of 6 School-Based-Health-Centers (SBHCs) located in Northern Manhattan and the Bronx. Method 667 patients, aged 13–19 years, completed a survey in the SBHCs waiting rooms between 10/2018 – 4/2019 Results Of the survey respondents attending SBHCs, 32% reported ever having heard of PrEP and, upon learning of PrEP, 67% stated that would be very likely (35%) or somewhat likely (32%) to take PrEP if it was offered to them free of charge. Discussion Youth of color are disproportionately infected by HIV throughout the US. Efforts are needed to educate adolescents on the benefits of PrEP, SBHCs are well situated to reduce barriers in providing PrEP directly to those who would benefit from its protection..

Purpose Although cognitive impairment is a known complication of acute encephalitis syndrome (AES), few studies have evaluated cognitive outcomes in patients with encephalitis. The primary objective of this study was to assess the cognitive profiles of patients diagnosed with AES, which is pivotal for improving rehabilitation strategies and prognostic measures. Methods This study was conducted at the Tribhuvan University Teaching Hospital. Adult patients with AES who met inclusion criteria were enrolled. The Montreal Cognitive Assessment (MoCA) tool was used to assess cognitive function at admission, discharge, and 3-month follow-up.Results Thirty-six patients were enrolled in our study. The mean age of the participants was 43 ± 18 years. Fourteen patients (38.9%) were female, and 22 (61.1%) were male. Tuberculous (TB) meningoencephalitis was present in 14 cases (38.9%), with herpes simplex virus (HSV) encephalitis in 14 (38.9%), bacterial meningoencephalitis in 4 (11.1%), autoimmune encephalitis in 2 (5.6%), and Japanese encephalitis in 2 (5.6%). Patients with bacterial meningoencephalitis had the highest MoCA scores at admission, whereas those with HSV encephalitis had the highest scores at discharge and follow-up. Compared with the scores at admission, the scores at discharge and follow-up increased significantly in patients with TB meningoencephalitis and HSV encephalitis. The MoCA score at discharge was established as a significant predictor of cognitive function at follow-up. Conclusion We found that active treatment can improve the outcomes of AES patients with cognitive impairment. Although infectious etiologies are most common in low-income countries such as Nepal, autoimmune etiologies should not be overlooked.

PURPOSE: This article characterizes a telehealth program implemented during the COVID-19 pandemic for transgender and gender diverse (TGD) patients at Fenway Health, a federally qualified health center in Boston, Massachusetts, specializing in gender and sexual minority health care. Telehealth is well positioned to meet TGD patients' health needs by allowing them to conveniently and safely engage in care. METHODS: The COVID-19 pandemic has presented the opportunity to reimagine the way that Fenway Health provides care, by pivoting almost completely to a virtual model in response to this public health emergency. From March through August 2020, TGD patients (n=3189) from 24 U.S. states utilized our telehealth medical and behavioral health (BH) services. RESULTS: Fenway Health cared for close to as many unique TGD patients during this 6-month period via telehealth as it did via in-person services during calendar year 2019 (3794 medical patients in 2019 vs. 3033 in March through August 2020 [95%]; 946 BH patients in 2019 vs. 911 in March through August 2020 [96%]). TGD patients who utilized telehealth had a similar demographic profile as those who used in-person services. CONCLUSION: Fenway Health quickly pivoted to telehealth during the COVID-19 pandemic enabling gender-affirming care for TGD communities. By increasing access to clinicians trained in gender-affirming care, telehealth helps ensure that TGD patients regardless of geographic location can access crucial health services. Given the dearth of gender-affirming health care services across the United States, permanently removing state licensure requirements and payment parity for telehealth could ensure access to more gender-responsive care across state lines.

Purpose: This study examined the pedagogical experiences of former graduate teaching assistants following their teaching experiences at a youth development center. Method: A case study approach was utilized to investigate each participant case while a phenomenological approach was employed to analyze each case. The participants, Malik, Dante, and Ray, previously taught physical education at a youth development center as graduate teaching assistants. Results: The results of this study are presented as three cases centered on the participants and their experiences. The first case, “developing people from where they are, not where you want them to be . . .” (Malik) highlights the participants’ appreciation of their students’ culture and context. The second case, “resiliency to teach well regardless of circumstance or situation . . .” (Dante) features the participants’ ability to teach diverse learners. The third case, “uphill battles . . . you cannot learn this in a textbook . . .” (Ray) features the challenges faced while teaching at the youth development center. Discussion: Consistencies across participants’ experiences, the impact on their current careers, and implications for introducing culturally relevant and sustaining pedagogies via nontraditional settings are discussed.

Background Since Shiraz Transplant Center is one of the major transplant centers in Iran and the Middle East, this study was conducted to evaluate outcomes of the applied policies on COVID-19 detection and management. Methods During 4 months from March to June 2020, patient's data diagnosed with the impression of COVID-19 were extracted and evaluated based on demographic and clinical features, along with the length of hospital stay and expenses. Results Our data demonstrated that a total of 190 individuals, with a median age of 58, were diagnosed with COVID-19 during the mentioned period. Among these, 21 patients had a positive PCR test and 56 patients had clinical symptoms in favor of COVID-19. Also, 113 (59%) patients were classified as mild based on clinical evidence and were treated on an outpatient basis. Furthermore, 81 out of 450 cases (18%) of the healthcare workers at our center had either PCR of clinical features in favor of COVID-19. The mortality rate of our study was 11% and diabetes mellitus, hypertension were considered risk factors for obtaining COVID-19 infection. The direct cost of treatment and management of patients with COVID-19 amounted to 2,067,730,919 IRR, which considering the 77 patients admitted to Gary Zone per capita direct cost of treatment each patient was 26,853,648 IRR. Conclusion We demonstrated that the COVID-19 pandemic had a noticeable influence on our transplant center in aspects of delaying surgery and increased hospital costs and burden. However, by implanting proper protocols, we were able to was able to provide early detection for COVID-19 and apply necessary treatment and prevention protocols to safeguard the patients under its coverage, especially immunocompromised patients.

The p-center problem consists in selecting p centers among M to cover N clients, such that the maximal distance between a client and its closest selected center is minimized. For this problem we propose two new and compact integer formulations. Our first formulation is an improvement of a previous formulation. It significantly decreases the number of constraints while preserving the optimal value of the linear relaxation. Our second formulation contains less variables and constraints but it has a weaker linear relaxation bound. We besides introduce an algorithm which enables us to compute strong bounds and significantly reduce the size of our formulations. Finally, the efficiency of the algorithm and the proposed formulations are compared in terms of quality of the linear relaxation and computation time over instances from OR-Library., Lecture Notes in Computer Science 2018

Computer-supported collaborative problem solving requires new methodological approaches of interaction and problem solving analysis. Usually analysis of collaborative problem solving situations is done through discourse analysis or interaction analysis, where in the center of attention are the actors involved (students, tutors etc.). An alternative framework, called "Object-oriented Collaboration Analysis Framework (OCAF)" is presented here, according to which the objects of the collaboratively developed solution become the center of attention and are studied as entities that carry their own history. This approach produces a view of the process, according to which the solution is made of structural components that are 'owned' by actors who have contributed in various degrees to their development. OCAF is based on both actions and dialogues of actors, providing qualitative as well as quantitative indicators of collaboration and solution quality. The paper presents first the framework notation. Examples of its use in analysis of distance groups and face-to-face collaborative activities are provided next, followed by the dimensions of the framework supported analysis for teachers and researchers. Web-based tools supporting the OCAF approach are also presented.

LA&M met Kimberly Bonner, the director of the Center for Intellectual Property, University of Maryland, at Seton Hall University, where she was the keynote speaker at a conference that addressed copyright law and its applications in a university context. The Center for Intellectual Property, which focuses on policy research and developing conferences and workshops on issues such as the TEACH Act, the Digital Millennium Copyright Act (DMCA), peer-to-peer file sharing, and scholarly communication, also provides open-access Web services to the higher-education community.

The species Lippia integrifoliais an aromatic, sub-woody shrub, distributed from Northwest and Central Argentina to Bolivia. It is among the most important native aromatic species. It presents medicinal properties, some of which have been scientifically proven. As an alternative to harvesting, the process of domestication of the species was initiated. The objective of this work was to assess the phenotypic variability based on botanical-taxonomic and morpho-agronomic descriptors and the use of indicators to evaluate its natural situation in the west-center of Argentina. We worked in five wild populations, registering morphological variables, phenology, natural regeneration, herbivory and presence of diseases. L. integrifoliapresents a wide morphological variability, which can be explained with three morphological descriptors. Natural regeneration ́s rate is very low to zero, in four of the sites. The results obtained are of importance to make decisions related to the sustainable use in situ, and to begin a program of domestication of the species.

Critical Incident Reporting System (CIRS) have become most common patient safety tools in healthcare. The purpose of this study was to determine how effectively CIRS is used and how well healthcare professionals recognize it as a risk management tool. A quantitative approach using a cross sectional survey was adopted. The most common critical incidents were due to lack of personal attention and related to individual errors. The most of the critical incidents arise from non-adherence to guidelines and standards. CIRS can be seen as an effective clinical risk management tool that can be used to identify potential sources of critical incidents and help ensure patient safety at a healthcare organization.

Problem definition: Customers are likely to initiate retrial calls when their previous contact with a call center fails to deliver a satisfactory resolution. According to industry reports, retrials are listed as a top annoying issue for customers and hurt call centers’ profits. Though recognizing this problem, call centers find it challenging to reduce retrials without overshooting their operating expenses. Our research aims to empirically understand the mechanism of customer retrials and then provide economically feasible solutions to reduce retrials. Academic/practical relevance: Little empirical research has been done to understand customers’ strategic retrials, and theoretical research studies retrials by assuming the degree to which pickup speed and service quality impact retrials. Our research empirically investigates the mechanism of customer retrials by studying whether speed and quality truly matter and, if so, how strong the impact is from each of them and whether the impacts are different across various customer segments. The quantified mechanism can then guide service providers to reduce retrials cost-effectively. Methodology: We use a random-coefficient dynamic structural model to characterize customer decisions in pursuing a satisfactory resolution and estimate the parameters from call-by-call records of a uniquely designed call center. Our model tracks customer decisions in the online waiting stage, in which customers are waiting for an agent but weighing whether to abandon, and in the off-line waiting stage, in which customers are not directly connected but are actively debating whether to retry. Utilizing the hybrid system that sequentially places customers into queues for three distinct quality service groups, we disentangle the effects of pickup speed and service quality on customers’ abandonment and retrial decisions. Results: Our estimations confirm that high service quality and quick pickup speed reduce retrials. Moreover, we discover that private customers are more sensitive to quality but less sensitive to speed compared with business customers. We suggest two service designs to reduce retrials cost-effectively by tailoring services to customer preferences. One reallocates the service groups for different customer segments without expanding the system, and the other adjusts the staffing ratios by hiring low-cost, ordinary-quality agents. Under the two tailoring designs, business customer surplus increases by up to 14.4% and private customer surplus by up to 14.9%. Managerial implications: First, our research highlights the importance of recognizing customers’ off-line decisions, which are impacted by online service offerings and, in turn, affect future online service operations. Neglecting customer retrials leads to suboptimal service designs. Second, by understanding the mechanism of customer retrials empirically, our research guides call centers to reduce retrials cost-effectively with speed–quality balance. Third, our research develops a practical analysis framework for service providers to quantify customer preferences and design tailoring services.

This 1.5-year ethnographic study of a U.S. medical center shows that avoiding loss of autonomy and work intensification for less powerful actors during digital technology introduction and integration presents a multisited collective action challenge. I found that technology-related participation problems, threshold problems, and free rider problems may arise during digital technology introduction and integration that enable loss of autonomy and work intensification for less powerful actors. However, the emergence of new triangles of power allows for novel coalitions between less powerful actors and newly powerful third-party actors that can help mitigate this problem. I extend the political science perspective of experimentalist governance to examine how a digital technology-focused, iterative collective action process of local experimentation followed by central revision can facilitate mutually beneficial role reconfiguration during digital technology introduction and integration. In experimentalist governance of digital technology, local units are given discretion to adapt digital technologies to their specific contexts. A central unit composed of diverse actors then reviews progress across local units integrating similar digital technology to negotiate a new shared understanding of mutually beneficial technology-related tasks for each group of actors. The central unit modifies both local routines and the technology itself in response to problems and possibilities revealed by the central revision process, and the cycle repeats. Here, accomplishing mutually beneficial role reconfiguration occurs through an experimentalist, collective action process rather than through a labor-management bargaining process or a professional-led tuning process.

Purpose: We investigated what changes occurred at single hand surgery center during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, Korea using patient data of 4 years (2018–2021).Methods: This is a single-center retrospective study of patients visiting our center during the COVID-19 pandemic (January 22 to May 6, 2020) in comparison to the most recent 4 years from 2018 to 2021. Service volumes (SVs) including the number of in/outpatients, emergency room, elective, and emergency surgeries were analyzed. The demographics, injury mechanism, and place of injury of hand trauma were analyzed in patients seen during the peak period of COVID-19 (February 24 to March 9, 2020) at W Hospital.Results: SVs were significantly reduced in 2020 as compared with other years. The SVs except for the number of emergency surgeries have recovered after 2 months from the first confirmed case of COVID-19 in Daegu, Korea. At the peak period, the effect of COVID-19 was weak on emergency room-related SVs. In addition, a daily number of in/outpatients and elective surgeries had a statistically significant negative correlation with the number of COVID-19 confirmed (p

Today, on the eve of the 25th anniversary of the leader in the Moscow radiological service, Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department (used to be the Research and Practical Center of Medical Radiology until 2019), the bright quarter-century history of this institution comes to life in our me-mory, day after day has passed by since the opening of the Center, our weekdays, scientific breakthroughs, and celebrations. We would like to present to our readers a brief history of one of the aspects of the Centers complex activities, the development of professional education of radiologists. We observe a period from its launching to its recognition as the authority in radiology. The Education Department of the Moscow Center for Diagnostics and Telemedicine Technologies is currently appointed by the Ministry of Health of the Russian Federation as an expert to participate in addressing the current challenges of professional training and certification in diagnostic radiology. The article is devoted to well-known scientists and teachers, professors, and leading specialists in the industry, who are actively involved in the development of continuing education of radiologists and other specialists in diagnostic radiology at different stages of the centers existence. Specialists of the Training Center strive for the compliance of the provided professional training following the Bologna Declaration (1999), thereby creating conditions for Russian professionals to obtain European diplomas.

As human exposure to hydroclimatic extremes increase and the number of in situ precipitation observations declines, precipitation estimates, such as those provided by the Integrated Multisatellite Retrievals for Global Precipitation Measurement (GPM) (IMERG) mission, provide a critical source of information. Here, we present a new gauge-enhanced dataset [the Climate Hazards Center IMERG with Stations (CHIMES)] designed to support global crop and hydrologic modeling and monitoring. CHIMES enhances the IMERG Late Run product using an updated Climate Hazards Center (CHC) high-resolution climatology (CHPclim) and low-latency rain gauge observations. CHPclim differs from other products because it incorporates long-term averages of satellite precipitation, which increases CHPclim’s fidelity in data-sparse areas with complex terrain. This fidelity translates into performance increases in unbiased IMERGlate data, which we refer to as CHIME. This is augmented with gauge observations to produce CHIMES. The CHC’s curated rain gauge archive contains valuable contributions from many countries. There are two versions of CHIMES: preliminary and final. The final product has more copious and better-curated station data. Every pentad and month, bias-adjusted IMERGlate fields are combined with gauge observations to create pentadal and monthly CHIMESprelim and CHIMESfinal. Comparisons with pentadal, high-quality gridded station data show that IMERGlate performs well (r = 0.75), but has some systematic biases which can be reduced. Monthly cross-validation results indicate that unbiasing increases the variance explained from 50% to 63% and decreases the mean absolute error from 48 to 39 mm month−1. Gauge enhancement then increases the variance explained to 75%, reducing the mean absolute error to 27 mm month−1.

BACKGROUND: Robotic-assisted percutaneous coronary intervention (PCI) is a novel technology that permits remote operation of interventional devices. However, little is known about the safety and effectiveness of introducing a robotic PCI program in a hospital already experienced in traditional coronary angioplasty. METHODS: Prospective single-arm survey to assess the safety and effectiveness of robotic-assisted PCI in comparison to pre-defined performance goals. The study cohort comprised all consecutive cases treated with robotic PCI since its introduction. The safety primary endpoint was a composite of (I) overall death or (II) non-fatal adverse events related to target vessel complications (stent thrombosis, myocardial infarction, vessel perforation or cardiac tamponade, or repeat invasive treatment) during the index hospitalization. The efficacy primary endpoint was robotic-assisted procedural success, a composite of (I) successful dilatation of the target lesion and (II) successful robotic assistance, defined as absent non-planned manual conversion. RESULTS: A total of 83 patients and 112 lesions were prospectively enrolled. The rate of angiographic success was 99.1%. From these, 97 lesions (86.6%) were treated with only robotic PCI or with hybrid according to the pre-interventional plan. The rates of efficacy and safety primary endpoints were 85.7% and 2.4% respectively (P

PURPOSE: Abiraterone and enzalutamide are commonly used oral cancer therapies for patients with prostate cancer, both with potentially high out-of-pocket costs for patients. We investigated the prevalence of financial assistance mechanisms used to alleviate out-of-pocket costs and the association of these mechanisms with timing of treatment initiation of abiraterone or enzalutamide. METHODS: Using data from the medical center's specialty pharmacy, we identified first prescriptions for abiraterone or enzalutamide between January 1, 2017, and March 31, 2019. Prescriptions dispensed at an external pharmacy or that were discontinued for reasons unrelated to cost were excluded. Patient demographics, insurance coverage, out-of-pocket cost, and number of days between prescribed date and pill-to-mouth date were collected. RESULTS: Among 220 prescriptions in our final cohort, 185 were filled through our internal specialty pharmacy, 23 through a manufacturer-sponsored patient assistance program (PAP), and 12 were never filled because of cost. One third of the prescriptions in our final cohort (n = 66) were filled with financial assistance: PAP (10%), copay cards (9%), and grants (11%). The median amount of assistance received for the first fill was $2,860 US dollars (USD) (interquartile range $1,856-$10,717 USD). Prescriptions with an out-of-pocket cost < $100 USD were filled in the shortest time (median 5 days), whereas those filled through a PAP had the longest time to initiation (median 30.5 days). CONCLUSION: Among patients prescribed oral therapies for prostate cancer at a single institution, one third of patients received financial assistance. Although receiving assistance is likely to improve financial toxicity, waiting for assistance may lead to longer time to initiation of medication.

Energy consumption in machining processes has become a problem for today's manufacturing industry. The use of neural networks and optimization algorithms for modeling and prediction of consumption as a function of the cut-off parameters in processes of this type has aroused the interest of research groups. The present work used artificial neural networks (ANN) to predict the energy consumption of a Leadwell V-40iT® five-axis CNC machining center, based on experimental data obtained through a factorial experimental design 53. ANN was programed in Matlab®. From the study was concluded that the depth per pass (Ap) is the variable that has the most influence on the prediction model of energy consumption with a 77% of relative importance, while the feed rate is the least relevant with 9% of importance.

Synthetic aperture radar (SAR) can monitor the sea surface imprints of tropical cyclones (TCs) with high spatial resolution, day and night. Automatically locating TC center positions in SAR images is a challenging task. This article developed a two-stage, fully automatic TC-center estimation algorithm. First, the sea surface wind directions (SSWDs) at SSWD points are retrieved by the improved local gradient (ILG) method. We incrementally deflected the SSWD outward at a 0.5° angle from -50° to 10° (the negative angles represent clockwise deflection). The heat maps are generated for each of the 121 angles, and the values at each heat map are the cumulative numbers of the lines perpendicular to the compensated SSWDs. The site corresponding to the maximum cumulative number in all 121 heat maps is the coarsely estimated center position. This center search is the culmination if it falls outside the SAR image. Otherwise, the second stage is triggered, and the sub-SAR image (150 km x 150 km) centered at the coarsely estimated center position is extracted. Then, the first-stage procedure is repeated with the sub-SAR image to precisely estimate the center position. Optionally, the precisely estimated center position can be further adjusted by considering that normalized radar cross section (NRCS) is normally minimal at the TC center. We applied the algorithm to 87 SAR images. Five of these images do not contain TC centers. The results are in good agreement with the visually located TC center positions and those in the best track (BT) datasets.

Transfer centers play a vital role in the efficient triage of hospital admission requests that generate outside the emergency department (ED) of the given facility. This cohort study includes all the calls processed through the transfer center requesting an admission to Mayo Clinic, Rochester, from January 2016 to December 2018. More than 116,000 transfer request calls were processed. Of these, about 65% (75,000) were accepted for ED evaluation or direct admission. Of the 75,000 patients, >50% were accepted as direct admits. Among patients accepted for direct admission, a trend toward reduced utilization of ED reevaluation at the receiving facility was noted from 2016 to 2018. A temporal trend of overall reduced ED utilization reflects the adeptness of the transfer center. An effective transfer center promotes value-based care, optimizes the workflow in a hospital, and augments hospital administrative decisions to allocate resources.

The essays collected in the volume under review Sufis and Their Opponents in the Persianate World, pay tribute to the memory and legacy of Leonard Lewisohn, a renowned scholar of Sufi history and d...

Recent developments in the probabilistic and statistical analysis of probability density functions are reviewed. Density functions are treated as data objects for which suitable notions of the center of distribution and variability are discussed. Special attention is given to nonlinear methods that respect the constraints density functions must obey. Regression, time series and spatial models are discussed. The exposition is illustrated with data examples. A supplementary vignette contains expanded versions of data analyses with accompanying codes.

Giriş: Yeni koronavirüs hastalığı 2019 (COVID-19) dünya çapında bir pandemiye neden oldu. COVID-19'un çok çeşitli klinik belirtileri vardır. Eşlik eden hastalıkları olan 65 yaş üstü hastalar ciddi hastalıklara karşı daha savunmasızdır. Bu çalışma, hastalığın klinik, laboratuvar ve görüntüleme özelliklerini karakterize etmeyi amaçlamaktadır.Yöntemler: Bu çalışma Eskişehir Şehir Hastanesi'nde yapılmıştır. 15 Nisan 2020 ile 15 Haziran 2020 tarihleri arasında doğrulanmış COVID-19 olan 435 hastanın tıbbi kayıtları geriye dönük olarak analiz edildi. Hastalar yaşlarına göre, Introduction: The novel coronavirus disease 2019 (COVID-19) has caused a worldwide pandemic. COVID-19 has a wide range of clinical manifestations. Patients over the age of 65 who have comorbidities are more vulnerable to severe disease. This study aims to characterize the clinical, laboratory, and imaging features of the disease.Methods: This study was conducted in Eskisehir City Hospital, Turkey. Medical records of 435 patients with confirmed COVID-19 between 15 April 2020, and 15 June 2020, were analyzed retrospectively. The patients were divided into three groups according to age

We lost a long-time member of and great contributor to the IEEE EMC Society when Ron Brewer passed away last year. I'm sure many of you remember visiting with Ron at the annual IEEE EMC Symposium. He attended regularly during his time as Vice President of Electromagnetic Compatibility Services for Instrument Specialties Co., Inc. and later when he was employed as a Consulting Systems Engineer in Launch Ser-vices at the Kennedy Space Center. After he retired in 2016 to form his own consulting company, he continued to attend the Symposium to visit with colleagues and check out the technical sessions. You could also find him “shopping” in the exhibit hall searching for the latest and greatest products. We are grateful to his good colleague, Gary Fenical, who provided the following information on the illustrious EMC career of Ron Brewer.

Purpose: Acknowledging the growing ethnic and cultural gap in diverse teacher and student populations, this study examined the pedagogical experiences of undergraduate physical education teacher education seniors following a teaching experience at a youth development center. Method: A phenomenological case study approach was employed in which preservice teachers taught and participated in over 45 secondary physical education lessons. The primary data sources were reflective journals and semistructured interviews. Results: Two major themes were constructed that describe the journeys of the physical education teacher education seniors teaching at both the youth development center field experience and in their internship placements the following semester. Initially, the preservice teachers experienced nervousness, uncertainty, and concern but, across time, experienced a degree of change and growth that saw them becoming particularly aware of and appreciating the personal biographies of their students. Discussion: The extent to which the physical education teacher education seniors’ experiences at the youth development center were transferred into their internships is discussed in addition to implications for introducing culturally relevant pedagogies in nontraditional settings.

Introduction:The detection of vaginal mesh/suture exposure can be challenging due to pain and varied location. We reviewed our experience with office-based vaginoscopy to evaluate these wom...

In today’s competitive business environment, companies are striving to reduce costs and workload of call centers while improving customer satisfaction. In this study, a framework is presented that predicts and encourages taking proactive actions to solve customer problems before they lead to a call to the call center. Machine learning techniques are implemented and models are trained with a dataset which is collected from an internet service provider’s systems in order to detect internet connection problems of the customers proactively. Firstly, two classification techniques which are multi perceptron neural networks and radial basis neural networks are applied as supervised techniques to classify whether the internet connection of customers is problematic or not. Then, by using unsupervised techniques, namely Kohonnen’s neural networks and Adaptive Resonance Theory neural networks, the same data set is clustered and the clusters are used for the customer problem prediction. The methods are then integrated with an ensemble technique bagging. Each method is implemented with bagging in order to obtain improvement on the estimation error and variation of the accuracy. Finally, the results of the methods applied for classification and clustering with and without bagging are evaluated with performance measures such as recall, accuracy and Davies-Bouldin index, respectively.

Companies started to determine their strategies based on intelligent data analysis due to stagey enhance data production. Literature reviews show that the number of resources where demand estimation, location analysis, and decision-making technique applied together with the machine learning method is low in all sectors and almost none in the shopping mall domain. Within this study’s scope, a new hybrid fuzzy prediction method has been developed that will estimate the customer numbers for shopping malls. This new methodology is applied to predict the number of visitors of three shopping malls on the Anatolian side of Istanbul. The forecasting study for corresponding shopping malls is made by using the daily signaling data from indoor base stations of large-scale technology and telecommunications services provider and the features to be used in machine learning models is determined by fuzzy multi criteria decision making method. Output revealed by the application of the fuzzy multi criteria decision making method enables the prioritization of features.

In today’s economy, information technology (IT) is vitally important, and the increasing use of the Internet, telecommunications services, and internal IT networks in organizations have led to rapid growth in the demands on big data processing. In general, site selection is a fundamental part of the design of a big data center (BDC), and a poor site decision can affect the sustainability of the facility. To construct a comprehensive assessment framework for a BDC, the following three categories of indicators are determined based on the “Specification for Design of Data Center” in GB50174-2017 of China: economic factors, natural climate environment factors, and energy resources factors. After explaining the rationality of choosing these indicators in detail, an integrated method that combines the multi-criteria decision-making (MCDM) method and the multi-choice goal programming (MCGP) model is proposed. The proposed approach uses two phases to conduct the decision procedure. First, the preference ranking organization method for enrichment evaluation (PROMETHEE) method is applied to evaluate the economic factors. Then, the evaluation results are added to the MCGP model as one of the goals of multi-objective programming. Second, the remaining five sub-indicators and the evaluation results generated from the first phase are formulated as a complete MCGP model. Finally, an empirical study on the site selection for the BDC is implemented based on the proposed method. The result shows that Guiyang is the most suitable place for locating a BDC in China.

TNF-α inhibitors are used in the treatment of non-systemic variants of juvenile idiopathic arthritis (JIA) in case of ineffectiveness or intolerance to methotrexate. Despite 20 years of experience of using of etanercept in pediatric rheumatology, a long-term study of the efficacy and safety of the drug in real clinical practice remains necessary. Objective of the study: to study the efficacy and safety of etanercept for treatment of various non-systemic JIA subtypes in real clinical practice. Materials and methods of research: data from the case histories of 375 patients (242 girls and 133 boys) with articular forms of JIA for 2010–2020 were included in a retrospective, open, uncontrolled, nonrandomized, continuous multicenter cohort study. The age of debut was 6.3 (2.9; 10.7) years. Demographic characteristics, subtypes of arthritis, indicators of laboratory activity of inflammation, and outcomes were estimated: achievement of remission, exacerbation, and switching from etanercept to another genetically engineered biological drug (GEBD) were assessed. Results: remission was recorded in 78.9% on average after 6 months. The factors that determine the likelihood of achieving remission were the absence of previous therapy with GEBD (p=0.001) and compliance with therapy – OR=2.5 (95% CI: 1.3; 4.7), p=0.006. Exacerbations were recorded in 29.5% and were associated with the presence of the HLA B27 antigen – OR=2.6 (95% CI: 1.1; 6.0), p=0.028, antinuclear factor seropositivity (p=0.060). Change of etanercept to another GEBD was made in 17.4% of children and was associated with a failure to achieve remission – OR=7.7 (95% CI: 4.0–14.3), p=0.000001, with previous exacerbations – OR=14,8 (5.3; 41.2), p=0.0000001 and the development of de novo uveitis – OR=2.4 (95% CI: 1.1–5.3), p=0.038. The arthritis subtype and the presence of concomitant methotrexate therapy did not significantly affect treatment outcomes. Conclusion: achievement of remission, compliance with therapy, history of previous therapy with GEBD, exacerbation of JIA and development of de novo uveitis determined the main outcomes of etanercept therapy. The JIA subtype, as well as concomitant therapy with methotrexate, did not significantly affect the outcomes of the disease, which makes it possible to consider etanercept therapy a very effective and safe method of treating JIA as a genetically engineered first-line therapy of any variants of articular forms of JIA, even in monotherapy with ineffectiveness or intolerance to methotrexate.