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Although certain risk factors have been associated with morbidity and mortality, validated emergency department (ED) derived risk prediction models specific to coronavirus disease 2019 (COVID-19) are lacking. The objective of this study is to describe and externally validate the COVID-19 risk index (CRI). A large retrospective longitudinal cohort study was performed to analyze consecutively hospitalized patients with COVID-19. Multivariate regression using clinical data elements from the ED was used to create the CRI. The results were validated with an external cohort of 1799 patients from the MI-COVID19 database. The primary outcome was the composite of the need for mechanical ventilation or inpatient mortality, and the secondary outcome was inpatient mortality. A total of 1020 patients were included in the derivation cohort. A total of 236 (23%) patients in the derivation cohort required mechanical ventilation or died. Variables independently associated with the primary outcome were age ≥ 65 years, chronic obstructive pulmonary disease, chronic kidney disease, cerebrovascular disease, initial D-dimer > 1.1 µg/mL, platelet count

Sudden cardiac death (SCD) is common after orthotopic heart transplant (OHT). No clear guidelines for implantable cardioverter defibrillator (ICD) implantation in OHT patients at high risk for SCD currently exist.To assess the safety, efficacy, and benefit of ICDs and resynchronization therapy post-OHT. We also provide a systematic review of previous reports.A retrospective multicenter cohort study within the United States. Patients with ICD post-OHT between 2000 and 2020 were identified.We analyzed 16 patients from 4 centers. The mean standard-deviation (SD) age was 43 (18) years at OHT and 51 (20) years at ICD implantation. The mean (SD) duration from OHT to ICD implantation was 9 (5) years. The mean (SD) left ventricular ejection fraction (LVEF) was 35% (17%). There were 2 (13%) postprocedural complications: 1 hematoma and 1 death. Mean (SD) follow-up was 24 (23) months. Survival rate was 63% (10/16) at 1 year and 56% (9/16) at 2 years, with 6/7 of those who died having LVEF 35% at the time of the ICD implantation. Patients were more likely to receive appropriate therapy if their ICD was implanted for secondary (5/8) rather than primary (0/8) prevention (p = .007). Of those who did, 4 patients survived to 30 days post-ICD therapy. Severe CAV was not associated with the rate of appropriate therapy.Beneficial outcomes were observed when ICDs were implanted for secondary prevention only, and in patients with higher baseline LVEF. We also observed benefits with resynchronization therapy.

Although certain risk factors have been associated with increased morbidity and mortality in patients admitted with Coronavirus Disease 2019 (COVID-19), the impact of cardiac injury and high-sensitivity troponin-I (hs-cTnI) concentrations are not well described. In this large retrospective longitudinal cohort study, we analyzed the cases of 1,044 consecutively admitted patients with COVID-19 from March 9 until April 15. Cardiac injury was defined by hs-cTnI concentration >99th percentile. Patient characteristics, laboratory data, and outcomes were described in patients with cardiac injury and different hs-cTnI cut-offs. The primary outcome was mortality, and the secondary outcomes were length of stay, need for intensive care unit care or mechanical ventilation, and their different composites. The final analyzed cohort included 1,020 patients. The median age was 63 years, 511 (50% patients were female, and 403 (40% were white. 390 (38%) patients had cardiac injury on presentation. These patients were older (median age 70 years), had a higher cardiovascular disease burden, in addition to higher serum concentrations of inflammatory markers. They also exhibited an increased risk for our primary and secondary outcomes, with the risk increasing with higher hs-cTnI concentrations. Peak hs-cTnI concentrations continued to be significantly associated with mortality after a multivariate regression controlling for comorbid conditions, inflammatory markers, acute kidney injury, and acute respiratory distress syndrome. Within the same multivariate regression model, presenting hs-cTnI concentrations were not significantly associated with outcomes, and undetectable hs-cTnI concentrations on presentation did not completely rule out the risk for mechanical ventilation or death. In conclusion, cardiac injury was common in patients admitted with COVID-19. The extent of cardiac injury and peak hs-cTnI concentrations were associated with worse outcomes.

Aims Right ventricular (RV) lead placement can be contraindicated in patients after tricuspid valve (TV) surgery. Placement of the implantable cardiac-defibrillator (ICD) lead in the middle cardiac vein (MCV) can be a viable option in these patients who have an indication for biventricular (BiV) ICD. We aim to describe the case of two patients with MCV lead placement and provide a comprehensive review of patients with complex TV pathology and indications for RV lead placement. Methods and results We describe the cases of two patients with TV pathology unsuitable for the standard transvenous or surgical RV lead placement and undergoing BiV ICD implantation. Their characteristics, procedure, and outcomes are summarized. The BiV ICD was successfully placed with the RV lead positioned in the MCV in both patients. The procedures had no complications and were well-tolerated. On follow-up, both patients had appropriate tachytherapy with no readmissions for heart failure or worsening of cardiac function. Conclusion Right ventricular lead placement of BiV ICD in the MCV can be an excellent alternative in patients with significant TV pathology and poor surgical candidacy.

BACKGROUND: Acute kidney injury is common, with a major effect on morbidity and health care utilization. Soluble urokinase plasminogen activator receptor (suPAR) is a signaling glycoprotein thought to be involved in the pathogenesis of kidney disease. We investigated whether a high level of suPAR predisposed patients to acute kidney injury in multiple clinical contexts, and we used experimental models to identify mechanisms by which suPAR acts and to assess it as a therapeutic target. METHODS: We measured plasma levels of suPAR preprocedurally in patients who underwent coronary angiography and patients who underwent cardiac surgery and at the time of admission to the intensive care unit in critically ill patients. We assessed the risk of acute kidney injury at 7 days as the primary outcome and acute kidney injury or death at 90 days as a secondary outcome, according to quartile of suPAR level. In experimental studies, we used a monoclonal antibody to urokinase plasminogen activator receptor (uPAR) as a therapeutic strategy to attenuate acute kidney injury in transgenic mice receiving contrast material. We also assessed cellular bioenergetics and generation of reactive oxygen species in human kidney proximal tubular (HK-2) cells that were exposed to recombinant suPAR. RESULTS: The suPAR level was assessed in 3827 patients who were undergoing coronary angiography, 250 who were undergoing cardiac surgery, and 692 who were critically ill. Acute kidney injury developed in 318 patients (8%) who had undergone coronary angiography. The highest suPAR quartile (vs. the lowest) had an adjusted odds ratio of 2.66 (95% confidence interval [CI], 1.77 to 3.99) for acute kidney injury and 2.29 (95% CI, 1.71 to 3.06) for acute kidney injury or death at 90 days. Findings were similar in the surgical and critically ill cohorts. The suPAR-overexpressing mice that were given contrast material had greater functional and histologic evidence of acute kidney injury than wild-type mice. The suPAR-treated HK-2 cells showed heightened energetic demand and mitochondrial superoxide generation. Pretreatment with a uPAR monoclonal antibody attenuated kidney injury in suPAR-overexpressing mice and normalized bioenergetic changes in HK-2 cells. CONCLUSIONS: High suPAR levels were associated with acute kidney injury in various clinical and experimental contexts. (Funded by the National Institutes of Health and others.)

Soil moisture remote sensing on a global scale has been an active area of research over the past few decades due to its essential role in agriculture and in the prediction of some natural disasters. In this regard, GNSS-Reflectometry (GNSS-R) is proven as an efficient tool for the measurement of soil moisture content using remote sensing techniques. GNSS-R is a bi-static radar technique that uses the L-band GNSS signals as sources of opportunity to characterize Earth's surface, due to the fact that the reflected signals are often affected by the properties of the reflecting surface. In the context of this work, it is important to detect and fastly reach the area of interest (reflecting surface) for which the soil moisture content shall be monitored. A GNSS-R setup onboard a gyrocopter meets all the requirements of our application. This paper is dedicated to the study of airborne GNSS-R techniques for soil moisture monitoring using a low-altitude airborne carrier with a high rate (1ms for GPS C/A) carrier-to-noise ratio (C/N0) observations. To cope with the rapid displacement of the satellites footprints along the receiver trajectory, high rate (1000 Hz rate) C/N0 observations are processed. For this purpose, real flight experimentation has taken place on October 19, 2020 for 45 min. During the flight, the gyrocopter maintained a low-altitude of approximately 315m above the ground with an average speed of 95 km/h. Based on that, the size of the major axis of the first Fresnel zones that constitute the detected footprints ranged between 1,316m for a minimum elevation angle of 3° and 15m for a maximum elevation angle of 75°. Concerning the temporal resolution of the application, the raw data were sampled at a frequency of 25MHz and the C/N0 estimates were realized at a rate of 1000Hz.During the flight, an average of 9 GPS satellites have been detected of which 4 GPS satellite signals were extensively analyzed to observe the reflectivity corresponding to land, beach, and sea reflections. After analyzing the Delay Doppler Maps which provides an image of the scattering cross-section in terms of time and frequency and consequently tracking the corresponding signals, the 1ms C/N0 estimations were derived using the in-phase components of the signals as observations. The reflected signals are then linked to the footprints of the satellites and thus to the reflecting surfaces from which each processed signal has reflected using the GPS time, attitude, and position provided by onboard sensors and the GPS time extracted from the digitized GNSS signals. The ultimate aim of this study is to obtain reflectivity measurements from high rate C/N0 observations in order to provide a soil moisture mapping of the studied area, where we notice that the signals reflected from the beach had the best reflectivity followed by sea then land reflections.

Aspirin use in the prevention of cardiovascular events has been a mainstay of treatment for decades. However, the use of aspirin in primary prevention of atherosclerotic cardiovascular disease has recently come under scrutiny. Several recent studies have evaluated the use of aspirin in primary prevention and the results suggest that in many patients the risks may outweigh the benefits. Closer examination of these trials suggests that the use of aspirin therapy for primary prevention may have a role but likely needs a more tailored approach and that caution is needed in prescribing aspirin for primary prevention. In conclusion, in this article we review the evolving evidence for aspirin in the primary prevention of atherosclerotic cardiovascular disease.

We report a case of a 59-year-old male in post-myocardial infarction cardiogenic shock undergoing left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) as a bridge to transplantation. The unique feature of this ECMO configuration is use of a single trans-septal cannula to provide biventricular unloading and use of a single arterial access.

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This article is dedicated to the estimation of the GNSS signal carrier-to-noise ratio using the in-phase component of the signals as observations. In a GNSS receiver, it is the statistic of the correlation provided by the code tracking loop that is used to estimate the carrier-to-noise ratio. In fact, carrier-to-noise estimation is used to monitor the performance of GNSS receivers and the quality of the received signals. In this article, we aim at high rate carrier-to-noise estimation, namely the code repetition rate (e.g. 1ms for GPS C/A), in order to maximize the time resolution of carrier-to-noise observations. We show that in a 1-bit quantization receiver, the in-phase component of the signal can provide a direct observation of the signal amplitude, and therefore of the carrier-to-noise ratio. However, the model that links the 1ms rate observations of the in-phase component with the signal amplitude is non-linear. The non-linear expression that links the maximum value of the in-phase correlation component to the signal amplitude is derived. In order to estimate the time varying amplitudes of the signals, we propose an Extended Kalman Filter to reverse the non-linear expression with the noisy observations of correlation provided by the tracking loop. The proposed model and filter inversion method are assessed on synthetic and real data, while investigating the effect of the cross-correlation contribution of the visible satellites on the estimations. We show using real data that, for a 1-bit quantization receiver, the proposed estimator can achieve the same accuracy as a widely known commercial GNSS receiver with a much higher data rate. We also show that the proposed approach can cope with abrupt changes in the observations compared to a classical C / N 0 estimate.

Background:Microvascular dysfunction is known to play a key role in patients with angina and nonobstructive coronary artery disease. We investigated the impact of ranolazine among patients with angina and nonobstructive coronary artery disease.Methods:In this randomized, double-blinded, placebo-controlled pilot trial, 26 patients with angina once weekly or more, abnormal stress test, and nonobstructive coronary artery disease (0.80) were randomized 1:1 to ranolazine or placebo for 12 weeks. Primary end point was ΔSeattle Angina Questionnaire (SAQ) angina frequency score. Baseline and 3 months follow-up SAQ, Duke Activity Status Index scores along with invasive fractional flow reserve, coronary flow reserve (CFR), hyperemic myocardial resistance, and cardiopulmonary exercise testing measurements were performed.Results:No significant differences in ΔSAQ angina frequency scores (P=0.53) or Duke Activity Status Index (P=0.76) were observed between ranolazine versus placebo, although patients on ranolazine had lesser improvement in SAQ physical limitation scores (P=0.02) compared with placebo at 3 months. There were no significant differences in ΔCFR or Δhyperemic myocardial resistance between ranolazine and placebo groups. Patients treated with ranolazine, compared with placebo, had no significant improvement in maximum rate of oxygen consumption measured during incremental exercise (VO2max) and peak metabolic equivalents of task. Interestingly, in the ranolazine group, patients with baseline CFRP=0.02).Conclusions:Ranolazine did not demonstrate improvement in SAQ angina frequency score, invasive microvascular function, or peak metabolic equivalent compared with placebo at 3 months.Registration:URL:https://www.clinicaltrials.gov. Unique identifier: NCT02147067.

Introduction: The world has been facing the COVID-19 pandemic. Primarily a pulmonary illness, most deaths have been caused by respiratory failure. Emerging information has revealed that cardiovascular complications, including cardiac injury and cor pulmonale, can also be life-threatening consequences of COVID-19. Hypothesis: Signs of right heart strain on presenting 12-lead ECG predicts mortality in patients admitted with COVID-19. Methods: We retrospectively evaluated 480 patients consecutively admitted with COVID-19. ECGs from the emergency department (ED) were read by G.S. and S.P. who were blinded to data and outcomes. Right heart strain (RHS) was defined by any new right axis deviation, S1Q3T3 pattern, incomplete or complete right bundle branch block, or ST Depressions with T-wave inversions in leads V1-3 or II, III, aVF. This study was approved by the Institutional Review Board (IRB# 13774). Results: ECGs from the ED were available for 314 patients who were included in the analysis. Almost all patients were in sinus rhythm with sinus tachycardia being the most frequent dysrhythmia. RHS findings were present in 12.7% of cases. RHS was significantly associated with mortality and was the strongest predictor even after multivariate regression for mortality [OR 18.3 (6.1-55.3), p Conclusions: Among available clinical tools, ECGs are easily performed, cost-effective, and widely available. Patients with evidence of RHS on initial ECG had significantly higher rates of mortality which has not been previously reported. Given that respiratory failure is the most common cause of death in patients with COVID-19, this information is valuable.

Introduction: CAAs are a rare but potentially life-threatening condition. Commonly defined as localized dilations greater than 1.5 times the adjacent artery, “giant” CAA (GCAA) is a term used to describe CAAs that have progressed to greater than four times the adjacent artery. Case: A 73-year-old male who presented with acute dyspnea was found to have a 4.5cm epicardial mass on computed tomography angiography (CTA) of the chest. Coronary angiography revealed a large partially thrombosed saccular aneurysm of the proximal LCx with diffuse ectasia of the remaining coronary arteries. He underwent percutaneous coronary intervention (PCI) with the placement of a covered stent from the left anterior descending to the left main artery, traversing and effectively occluding the LCx. He tolerated the procedure and was discharged on clopidogrel and apixaban. Discussion: Due to their insidious nature, CAAs are underdiagnosed and progress undetected. Serious complications include aneurysm rupture and fistula formation. CAAs are most commonly caused by atherosclerosis but have been associated with infectious, rheumatologic, and genetic etiologies. Drug-eluting stents are increasingly implicated in CAAs by the mechanism of direct vessel trauma and drug-induced inhibition of smooth muscle proliferation. The optimal management of CAAs remains unclear. Cardiovascular risk reduction and monitoring are recommended. Invasive management is usually reserved for giant or unstable aneurysms. Surgical resection or repair is conventional but percutaneous methods such as coiling and stent occlusion are increasingly utilized. Our patient underwent a successful vessel and aneurysm occlusion with favorable post-PCI outcomes. Conclusion: GCAAs are extremely rare and understudied. Percutaneous management appears effective in the management of GCAAs, but the study of long-term safety and outcomes is required.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that is responsible for the 2019-2020 pandemic. In this comprehensive review, we discuss the current published literature surrounding the SARS-CoV-2 virus. We examine the fundamental concepts including the origin, virology, pathogenesis, clinical manifestations, diagnosis, laboratory, radiology, and histopathologic findings, complications, and treatment. Given that much of the information has been extrapolated from what we know about other coronaviruses including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), we identify and provide insight into controversies and research gaps for the current pandemic to assist with future research ideas. Finally, we discuss the global response to the coronavirus disease-2019 (COVID-19) pandemic and provide thoughts regarding lessons for future pandemics.

Background Cardiovascular comorbidities and complications, including right ventricular dysfunction, are common and are associated with worse outcomes in patients with COVID-19. The data on the clinical utility of 12-lead electrocardiograms (ECG) to aid with prognosis is limited. Objectives We aim to assess the association of new right heart strain patterns on presenting 12-lead electrocardiogram (RHS-ECG) with outcomes in patients hospitalized with COVID-19. Methods We retrospectively evaluated records from 480 patients who were consecutively admitted with COVID-19. ECGs obtained at the time of presentation in the emergency department (ED) were considered as index ECGs. RHS-ECG was defined by any new right axis deviation, S1Q3T3 pattern, or ST depressions with T-wave inversions in leads V1-3 or II, III, aVF. Multivariable logistic regression was performed to assess whether RHS-ECG is independently associated with our primary outcomes. Results ECGs from the ED were available for 314 patients who were included in the analysis. Most patients were in sinus rhythm, with sinus tachycardia being the most frequent dysrhythmia. RHS-ECG findings were present in 40 (11%) patients. RHS-ECG was significantly associated with the incidence of adverse outcomes and an independent predictor of mortality (adjOR, 15.2 (95% [CI, 5.1-45.2]; P, Graphical abstract, Cardiovascular complications are associated with worse outcomes in COVID-19. The present study evaluates the likelihood of critical illness in patients who have new right heart strain patterns on presenting 12-lead electrocardiogram (RHS-ECG). RHS-ECG was defined by any new right axis deviation, S1Q3T3 pattern, or ST Depressions with T-wave inversions in leads V1-3 or II, III, aVF. Our results revealed that RHS-ECG was the strongest independent predictor of mechanical ventilation and mortality in multivariable analysis with a powerful discriminatory ability as early as the ED encounter. A structured approach is warranted for patients admitted with RHS-ECG.

Background Women with signs and symptoms of ischemia and no obstructive coronary artery disease often have evidence of diastolic dysfunction. Oxidative stress ( OS ) is associated with cardiovascular risk factors and adverse outcomes. The relationship between systemic OS and diastolic dysfunction is unknown. Methods and Results A subgroup of women (n=75) with suspected ischemia and no obstructive coronary artery disease who had both cardiac magnetic resonance imaging and OS measurements were enrolled in the WISE ‐ CVD (Women Ischemia Syndrome Evaluation—Coronary Vascular Dysfunction) study. Left ventricular end‐diastolic pressure was measured invasively. Left ventricular end‐diastolic volume and peak filling rate were assessed using cardiac magnetic resonance imaging. Aminothiol levels of plasma cystine and glutathione were measured as markers of OS . Spearman correlation and linear regression analyses were conducted. The group mean age was 54±11 years, and 61% had a resting left ventricular end‐diastolic pressure >12 mm Hg. Cystine levels correlated negatively with the peak filling rate ( r =−0.31, P =0.007) and positively with left ventricular end‐diastolic pressure ( r =0.25; P =0.038), indicating that increased OS was associated with diastolic dysfunction. After multivariate adjustment including multiple known risk factors for diastolic dysfunction and cardiovascular medications, cystine levels continued to be associated with peak filling rate (β=−0.27, P =0.049) and left ventricular end‐diastolic pressure (β=0.25; P =0.035). Glutathione levels were not associated with indices of diastolic function. Conclusions OS , measured by elevated levels of cystine, is associated with diastolic dysfunction in women with evidence of ischemia and no obstructive coronary artery disease, indicating the role of OS in patients with ischemia and no obstructive coronary artery disease. Its role in the progression of heart failure with preserved ejection fraction should be explored further.

Measurement of soil moisture content on a global scale have gained increased interest over the years, due to its essential role in agriculture and most importantly in predicting the occurrence of natural disasters. This paper is dedicated to a study on GNSS Reflectometry (GNSS-R) using a low-altitude airborne carrier for soil moisture estimation with 1 ms rate of carrier-to-noise ratio observations. The principle of GNSS-R is the exploitation of L-band navigation signals as sources of opportunity to characterize the earth surface, because the reflected signals are often affected by the nature of the reflective surface. To scan large regional surface areas and quickly reach the areas to monitor, a dynamic GNSS-R system is considered.The GNSS-R setup used in this study consists of RHCP and LHCP antennas mounted on the nose of a gyrocopter and of a Syntony front-end GNSS receiver. In addition, the gyrocopter is equipped with a signal digitizer and mass storage devices for digitizing and storing the base-band GNSS direct and reflected signals along the flight. A drone sensors board is also attached to the gyrocopter, which records the gyrocopter’s attitude and position at 1000 Hz rate along its trajectory. To cope with the rapid displacement of the satellites’ footprints along the receiver trajectory, high rate (1 ms) of carrier-to-noise ratio observations are processed with the data collection of the base-band RHCP and LHCP signals.In the context of the study, it is very important to localize the reflective surfaces (satellites’ footprints) from which each processed signal has reflected, and thus detect which areas were scanned during the flight. The link between the reflected signals and the satellites' footprints is based on the GPS time, attitude and position provided by the drone board and the GPS time extracted from the digitized GNSS signals. We show that these parameters allow to determine, at ms rate, the satellites’ footprints locations (i.e. the surface areas) from which each signal has reflected at a specific GPS Time. A Geographic Information System is developed based on this principle to map the measurements obtained from the GNSS-R airborne setup along a real receiver trajectory. The ultimate aim of this study is to link the obtained GNSS-R measurements with the scanned surfaces to provide a soil moisture mapping of the studied area.

Rationale: Circulating progenitor cells (CPCs) mobilize in response to ischemic injury, but their predictive value remains unknown in acute coronary syndrome (ACS). Objective: We aimed to investigate the number of CPCs in ACS compared with those with stable coronary artery disease (CAD), relationship between bone marrow PCs and CPCs, and whether CPC counts predict mortality in patients with ACS. Methods and Results: In 2028 patients, 346 had unstable angina, 183 had an acute myocardial infarction (AMI), and the remaining 1499 patients had stable CAD. Patients with ACS were followed for the primary end point of all-cause death. CPCs were enumerated by flow cytometry as mononuclear cells expressing a combination of CD34+, CD133+, vascular endothelial growth factor receptor 2+, or chemokine (C-X-C motif) receptor 4+. CPC counts were higher in subjects with AMI compared those with stable CAD even after adjustment for age, sex, race, body mass index, renal function, hypertension, diabetes mellitus, hyperlipidemia, and smoking; CD34+, CD34+/CD133+, CD34+/CXCR4+, and CD34+/VEGFR2+ CPC counts were 19%, 25%, 28%, and 142% higher in those with AMI, respectively, compared with stable CAD. There were strong correlations between the concentrations of CPCs and the PC counts in bone marrow aspirates in 20 patients with AMI. During a 2 (interquartile range, 1.31–2.86)-year follow-up period of 529 patients with ACS, 12.4% died. In Cox regression models adjusted for age, sex, body mass index, heart failure history, estimated glomerular filtration rate, and AMI, subjects with low CD34+ cell counts had a 2.46-fold (95% confidence interval, 1.18–5.13) increase in all-cause mortality, P =0.01. CD34+/CD133+ and CD34+/CXCR4+, but not CD34+/VEGFR2+ PC counts, had similar associations with mortality. Results were validated in a separate cohort of 238 patients with ACS. Conclusions: CPC levels are significantly higher in patients after an AMI compared with those with stable CAD and reflect bone marrow PC content. Among patients with ACS, a lower number of hematopoietic-enriched CPCs are associated with a higher mortality.

This paper provides a review of the state-of-the-art of major Programmable Logic Controller (PLC) based devices along with their security concerns. It discusses, mainly, the threats and vulnerabilities of PLCs and associated field devices—including local industrial networks. As PLC-BS are becoming more integrated and interconnected with other complex systems and open source solutions, they are becoming more vulnerable to critical threats and exploitations. Little attention and progress have been made in securing such devices if compared to that of securing overall Industrial Control Systems. This review shows the fact that major PLC based devices have several vulnerabilities and are insecure by design—firmware, code, or hardware. This paper suggests policies, recommendations, and countermeasures to secure PLC-BS. Securing PLC-BS is vital and crucial since a compromised PLC-BS would lead to significant financial loss and safety risks that could endanger human lives or the environment.

Code vulnerabilities in the ladder logic of PLCs (Programmable Logic Controllers) have not been sufficiently addressed in the literature. Most of the research related to PLC threats or attacks focuses on the hardware portion of ICS (Industrial Control Systems) or SCADA (Supervisory Control and Data Acquisition) systems such as: industrial components, peripheral devices, or networks. It does not adequately discuss PLC code-level vulnerabilities and attacks. This paper provides an overview of some critical vulnerabilities within the PLC ladder logic code or program and recommends corresponding steps or methods to keep PLCs safer and more secure. The paper focuses on ladder logic code vulnerabilities and weak points that might be exploited by malicious attacks. Those weak points could be a result of intentional malicious pieces of code embedded within the ladder logic code or inadvertent ones such as bad code practices or human errors.

Virtual Assisted Rehabilitation System (VARS) provides rehabilitation for patients suffering from lower part injuries, such as muscular dystrophy, at the lowest cost possible. VARS is a combination of software (Processing, ElectricGuru and PLX software) and hardware (pressure sensors, electromyography, accelerometers, platform and virtual reality eyeglasses). The collected data, saved on host PC, is used by the physiotherapist for status estimation. The latter then identifies specific gaming profile (type of game and time needed for treatment) for the patient depending on his status. VARS had been tested on 22 candidates (12 abnormal and 10 normal). The result showed that gaming techniques in this system simulates the muscle activity over time by simulating the action-perception. Moreover, the foot pressure distribution (FPD) profiles vary obviously between normal and abnormal patients where specific disease is determined (e.g. Rheumatism).

Background Type 2 diabetes mellitus is a major risk factor for cardiovascular disease; however, outcomes in individual patients vary. Soluble urokinase plasminogen activator receptor (su PAR ) is a bone marrow–derived signaling molecule associated with adverse cardiovascular and renal outcomes in many populations. We characterized the determinants of su PAR in African Americans with type 2 diabetes mellitus and assessed whether levels were useful for predicting mortality beyond clinical characteristics, coronary artery calcium ( CAC ), and high‐sensitivity C‐reactive protein (hs‐ CRP ). Methods and Results We measured plasma su PAR levels in 500 African Americans with type 2 diabetes mellitus enrolled in the African American‐Diabetes Heart Study. We used Kaplan‐Meier curves and Cox proportional hazards models adjusting for clinical characteristics, CAC , and hs‐ CRP to examine the association between su PAR and all‐cause mortality. Last, we report the change in C‐statistics comparing the additive values of su PAR , hs‐ CRP , and CAC to clinical models for prediction of mortality. The su PAR levels were independently associated with female sex, smoking, insulin use, decreased kidney function, albuminuria, and CAC . After a median 6.8‐year follow‐up, a total of 68 deaths (13.6%) were recorded. In a model incorporating su PAR , CAC , and hs‐ CRP , only su PAR was significantly associated with mortality (hazard ratio 2.66, 95% confidence interval 1.63‐4.34). Addition of su PAR to a baseline clinical model significantly improved the C‐statistic for all‐cause death (Δ0.05, 95% confidence interval 0.01‐0.10), whereas addition of CAC or hs‐ CRP did not. Conclusions In African Americans with type 2 diabetes mellitus, su PAR was strongly associated with mortality and improved risk discrimination metrics beyond traditional risk factors, CAC and hs‐ CRP . Studies addressing the clinical usefulness of measuring su PAR concentrations are warranted.