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Large Language Models (LLMs) like ChatGPT have become the most popular regenerative AI applications, used for obtaining responses for queries in different domains. The responses of ChatGPT are already becoming mainstream and are challenging conventional methods of learning. This article focuses on the application of ChatGPT for academic instructional purposes in the field of computer engineering and related majors. The capability of ChatGPT for instructional purposes is evaluated based on the responses to different questions about these engineering streams. This article explores different opportunities (with use cases), that ChatGPT can provide in augmenting the learning experience. It also provides scenarios of limitations and modifying the evaluation process to prevent the use of ChatGPT, which may lead to an inaccurate dissemination of accepted facts. In this paper, common classroom problems and their respective responses from ChatGPT in the domains of Computer Science, Cyber Security, Data Science, and Electrical Engineering are analyzed to determine the categories of queries for which ChatGPT offers reliable responses and those for which it may be factually incorrect. A student survey is performed to demonstrate that students must be made aware that ChatGPT may not be suitable for certain types of queries and means of upgrading the evaluation process.

Abstract Objective design: In June of 2024, Becton Dickinson experienced a blood culture bottle shortage for their BACTEC system, forcing health systems to reduce usage or risk exhausting their supply. Virginia Commonwealth University Health System (VCUHS) in Richmond, VA decided that it was necessary to implement austerity measures to preserve the blood culture bottle supply. Setting: VCUHS includes a main campus in Richmond, VA as well as two affiliate hospitals in South Hill, VA (Community Memorial Hospital (CMH)) and Tappahannock Hospital in Tappahannock, VA. It also includes a free-standing Emergency Department in New Kent, VA. Patients: Blood cultures from both pediatric and adult patients were included in this study. Interventions: VCUHS intervened to decrease blood culture utilization across the entire health system. Interventions included communication of blood culture guidance as well as an electronic health record order designed to guide providers and discourage wasteful ordering. Results: Post-implementation analyses showed that interventions reduced overall usage by 35.6% (P < .0001) and by greater than 40% in the Emergency Departments. The impact of these changes in utilization on positivity were analyzed, and it was found that the overall positivity rate increased post-intervention from 8.8% to 12.1% (P = .0115) and in the ED specifically from 10.2% to 19.5% (P < .0001). Conclusions: These findings strongly suggest that some basic stewardship interventions can significantly change blood culture practice in a manner that minimizes the impact on patient care.

Tsunamis are massive waves generated by sudden water displacement on the ocean surface, causing devastation as they sweep across the coastlines, posing a global threat. The aftermath of the 2004 Indian Ocean tsunami led to the establishment of the Indian Tsunami Early Warning System (ITEWS). Predicting real-time tsunami heights and the resulting coastal inundation is crucial in ITEWS to safeguard the coastal communities. Global tsunamis other than those in the Indian Ocean might weaken at Indian coasts due to distance yet still cause significant damage due to local coastal morphological amplification. The current study focuses on tsunami simulations over global oceans. A finite element (FE)-based ADvanced CIRCulation (ADCIRC) model is configured to the global domain to model global tsunamis accurately and efficiently. The model mesh has a spatial resolution of 2 km in the shallow waters and relaxed to 20 km in the deeper waters. Model simulations are performed for significant historical events, assessing their effect on near and far field regions. Computed results are compared with the observations, and it is found that the model’s predictions align well with the observations. The simulation results demonstrate that ADCIRC can be applied to real-time tsunami predictions due to its computational efficiency and accuracy.

Background About 25% of patients with acute ischemic stroke have lacunar infarct on follow‐up imaging. In this secondary analysis from the AcT (Alteplase Compared With Tenecteplase) trial, we assessed if there is variation in safety or efficacy of intravenous thrombolysis by infarct type in patients with no visible occlusion. We also determined if this effect differed between tenecteplase and alteplase. Methods and Results This is a secondary analysis from the AcT trial. Lacunar infarct was defined as single, ≤15 mm, and in regions supplied by perforating arterioles on 24‐hour imaging. Outcomes included symptomatic intracerebral hemorrhage at 24 hours, any hemorrhage on imaging, and 90‐day modified Rankin Scale score. Mixed‐effects regression models adjusted for age, sex, stroke severity, thrombolytic type, and onset‐to‐needle time were used. Of 1577 patients, 456/29.9% had no visible occlusion and interpretable follow‐up imaging (magnetic resonance imaging: 41.2%). Of these 93 (20.4%) (magnetic resonance imaging: 62.3%) had lacunar infarct, 171 (37.5%) (magnetic resonance imaging: 67.4%) had nonlacunar infarct, and 192 (42.1%) (magnetic resonance imaging: 7.3%) had no visible infarct. Four patients (2.3%) in the group with nonlacunar infarct and none in the groups with lacunar infarct and no visible infarct developed symptomatic intracerebral hemorrhage. Any intracranial hemorrhage was highest (21; 12.4%) in the group with nonlacunar infarct. There was no significant interaction between thrombolytic type and treatment outcomes. Conclusions In the AcT trial, safety of intravenous thrombolysis was similar across all infarct types in patients with no visible occlusion but functional outcomes were worst in patients with nonlacunar infarct. Safety and functional outcomes after intravenous thrombolysis were better in the groups with lacunar infarct and no visible infarct as compared with the overall trial population.

Summary: Activating mutations in the epidermal growth factor receptor (EGFR) promote ligand-independent signaling; however, the mechanisms involved are poorly defined, and it is unknown whether this generates specific vulnerabilities. We previously observed robust expression of protein kinase Cα (PKCα) in lung adenocarcinoma (LUAD) with mutant EGFR (mEGFR), which, unlike the activation of PKCα, is independent of mEGFR activity. Here, we identify a critical role for PKCα in anchorage-independent growth and survival of lung cancer cells with mEGFR. Mechanistically, signaling pathways initiated by mEGFR show a high preference for ligand-independent phosphorylation on Y992, resulting in biased activation and dependence on phospholipase-Cγ and PKCα. Moreover, through bioinformatic approaches, we find that mEGFR LUAD demonstrates a transcriptomic profile most similar to lung basal cells, which exhibit elevated levels of PKCα, suggesting that mEGFR tumors arise in cell types with high intrinsic levels of PKCα. Taken together, these findings explain the dependence of mEGFR on PKCα.

# Background Person-centered care is a concept in healthcare that aims to promote the patient's health and adapt resources and interventions based on the patient's needs and wishes. Knowledge on what person-centered physiotherapy is for patients who rehabilitate after an anterior cruciate ligament (ACL) reconstruction, and how patients experience it within the context of sports injury rehabilitation, is lacking. # Purpose The aim of this study was to explore how patients who were in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced their rehabilitation from a person-centered perspective. # Study Design Qualitative interview study. # Methods Fourteen patients (57% females), aged 18-57, treated with ACL reconstruction, were interviewed with semi-structured interviews 8-12 months after ACL reconstruction. Interviews were recorded, transcribed and analyzed with qualitative content analysis. # Results One theme: all lights on me; be seen and heard, a cornerstone for patients, supported by three main categories: 1) rehabilitation: a roller coaster of physical and psychological challenges; 2) patient involvement; 3) the physiotherapist – stronger together; emerged from the collected data. # Conclusion Patients in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced that the rehabilitation process was person-centered when they felt to be the focus and were allowed to participate via open and constructive communication with the physiotherapists.

Abstract Background The relationship between hamstring strength and hop performance after anterior cruciate ligament (ACL) reconstruction with hamstring tendon (HT) autografts has not been well elucidated. The aim was to investigate the relationship between eccentric hamstring strength, assessed with the NordBord, and concentric hamstring strength, assessed with the Biodex, with hop performance at 8 and 12 months after ACL reconstruction. Methods Registry study. Patients ≥ 16 years who had undergone primary ACL reconstruction with HT autograft, followed by muscle strength and hop tests at 8 and 12 months were included. Correlations of the relative hamstring strength (Nm/kg or N/kg) and limb symmetry index (LSI) with hop performance were analyzed. Pearson’s correlation coefficient, and coefficient of determination (r2) were used for statistical analysis. Results A total of 90 patients were included, of which 48 (53%) were women. The mean age at ACL reconstruction was 27.0 ± 8.0 years. Relative hamstring strength had significant positive correlations with hop performance, ranging from r = 0.25–0.66, whereas hamstring strength LSI had significant positive correlations which ranged from r = 0.22–0.37 at 8 and 12 months after ACL reconstruction. At 12 months, the relative hamstring strength in the Biodex explained 32.5–43.6% of the hop performance in vertical hop height, hop for distance relative to height, and the total number of side hops, whereas the relative hamstring strength in the NordBord explained 15.2–23.0% of the hop performance. Conclusion The relative hamstring strength in the Biodex test explained 32.5–43.6% of the hop performance, whereas the relative hamstring strength in the NordBord explained 15.2–23.0%. Thus, our findings suggest that relative hamstring strength, especially in the hip-flexed position may be a better indicator of hop performance at 8 and 12 months after ACL reconstruction in patients treated with HT autograft.

Stress has been recognized as a pivotal indicator which can lead to severe mental disorders. Persistent exposure to stress will increase the risk for various physical and mental health problems. Early and reliable detection of stress-related status is critical for promoting wellbeing and developing effective interventions. This study attempted multi-type and multi-level stress detection by fusing features extracted from multiple physiological signals including electroencephalography (EEG) and peripheral physiological signals. Eleven healthy individuals participated in validated stress-inducing protocols designed to induce social and mental stress and discriminant multi-level and multi-type stress. A range of machine learning methods were applied and evaluated on physiological signals of various durations. An average accuracy of 98.1% and 97.8% was achieved in identifying stress type and stress level respectively, using 4-s neurophysiological signals. These findings have promising implications for enhancing the precision and practicality of real-time stress monitoring applications.

Objectives This study aimed to compare demographic and surgical characteristics between patients who do and do not achieve minimal important change (MIC) in the Knee injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation (Sport/Rec) and Quality of Life (QoL) subscales 1 year after anterior cruciate ligament reconstruction.Design Comparative cross-sectional.Setting The MIC for the KOOS Sport/Rec subscale was ≥12.1 and ≥18.3 for the KOOS QoL subscale from before surgery to 1-year follow-up using data from the Swedish National Knee Ligament Registry.Participants In total 16 131 patients were included: 11 172 (69%) with no MIC for the Sport/Rec scale, and 10 641 (66%) for the QoL.Results Patients with no MIC for Sport/Rec and QoL had a higher body mass index (BMI) (24.8±3.5 vs 24.6±3.3 and 24.7±3.5 vs 24.6±3.2, respectively, p

Abstract Introduction Interventional treatment options for the lumbar degenerative spine have undergone a significant amount of innovation over the last decade. As new technologies emerge, along with the surgical specialty expansion, there is no manuscript that utilizes a review of surgical treatments with evidence rankings from multiple specialties, namely, the interventional pain and spine communities. Through the Pacific Spine and Pain Society (PSPS), the purpose of this manuscript is to provide a balanced evidence review of available surgical treatments. Methods The PSPS Research Committee created a working group that performed a comprehensive literature search on available surgical technologies for the treatment of the degenerative spine, utilizing the ranking assessment based on USPSTF (United States Preventative Services Taskforce) and NASS (North American Spine Society) criteria. Results The surgical treatments were separated based on disease process, including treatments for degenerative disc disease, spondylolisthesis, and spinal stenosis. Conclusions There is emerging and significant evidence to support multiple approaches to treat the symptomatic lumbar degenerative spine. As new technologies become available, training, education, credentialing, and peer review are essential for optimizing patient safety and successful outcomes.

Abstract Background Whether there is a difference in harvesting the semitendinosus tendon alone (S) or in combination with the gracilis tendon (SG) for the recovery of knee flexor strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Therefore, this study aimed to assess the recovery of knee flexor strength based on the autograft composition, S or SG autograft at 6, 12, and ≥ 24 months after ACL reconstruction. Methods A systematic review and meta-analysis was conducted following the PRISMA guidelines. A comprehensive search was performed encompassing the Cochrane Library, Embase, Medline, PEDRo and AMED databases from inception to January 2023. Inclusion criteria were human clinical trials published in English, comprised of randomized controlled trials (RCTs), longitudinal cohort-, cross-sectional and case–control studies that compared knee flexor strength recovery between S and SG autografts in patients undergoing primary ACL reconstruction. Isokinetic peak torques were summarized for angular velocities of 60°/s, 180°/s, and across all angular velocities, assessed at 6, 12, and ≥ 24 months after ACL reconstruction. A random-effects model was used with standardized mean differences and 95% confidence intervals. Risk of bias was assessed with the RoBANS for non-randomized studies and the Cochrane RoB 2 tool for RCTs. Certainty of evidence was appraised using the GRADE working group methodology. Results Among the 1,227 patients from the 15 included studies, 604 patients received treatment with S autograft (49%), and 623 received SG autograft (51%). Patients treated with S autograft displayed lesser strength deficits at 6 months across all angular velocities d = -0.25, (95% CI -0.40; -0.10, p = 0.001). Beyond 6 months after ACL reconstruction, no significant difference was observed between autograft compositions. Conclusion The harvest of S autograft for ACL reconstruction yields superior knee flexor strength recovery compared to SG autograft 6 months after ACL reconstruction, irrespective of angular velocity at isokinetic testing. However, the clinical significance of the observed difference in knee flexor strength between autograft compositions at 6 months is questionable, given the very low certainty of evidence and small effect size. There was no significant difference in knee flexor strength recovery between autograft compositions beyond 6 months after ACL reconstruction. Trial registration CRD42022286773.

This review paper identifies key stability and control screening parameters needed to design low-risk, general-purpose high-speed aircraft. These derive from MIL-STD-8785C, MIL-STD-1797, and older AGARD reports, and are suitable for assessing conceptual high-speed vehicles. We demonstrate their applicability using published ground test, computation, and flight test data from the Bell X-2, North American X-15, Martin X-24A, Northrop HL-10, Lockheed Blackbird (YF-12/SR-71), and North American XB-70 as well as the Rockwell Space Shuttle Orbiter. The relative success of the X-15 and Blackbird and the performance limitations of the others indicate the need to scrutinize lateral-directional stability at the preliminary design phase. Our work reveals the need for strong bare-airframe static directional stability to obtain favorable flying qualities.

Hand gestures are a natural and intuitive form of communication, and integrating this communication method into robotic systems presents significant potential to improve human-robot collaboration. Recent advances in motor neuroscience have focused on replicating human hand movements from synergies also known as movement primitives. Synergies, fundamental building blocks of movement, serve as a potential strategy adapted by the central nervous system to generate and control movements. Identifying how synergies contribute to movement can help in dexterous control of robotics, exoskeletons, prosthetics and extend its applications to rehabilitation. In this paper, 33 static hand gestures were recorded through a single RGB camera and identified in real-time through the MediaPipe framework as participants made various postures with their dominant hand. Assuming an open palm as initial posture, uniform joint angular velocities were obtained from all these gestures. By applying a dimensionality reduction method, kinematic synergies were obtained from these joint angular velocities. Kinematic synergies that explain 98% of variance of movements were utilized to reconstruct new hand gestures using convex optimization. Reconstructed hand gestures and selected kinematic synergies were translated onto a humanoid robot, Mitra, in real-time, as the participants demonstrated various hand gestures. The results showed that by using only few kinematic synergies it is possible to generate various hand gestures, with 95.7% accuracy. Furthermore, utilizing low-dimensional synergies in control of high dimensional end effectors holds promise to enable near-natural human-robot collaboration.

Abstract Purpose This study aimed to investigate the measurement properties, according to the Rasch Measurement Theory, of the anterior cruciate ligament return to sport after injury scale (ACL‐RSI) in patients treated with ACL reconstruction in Sweden. Methods ACL‐RSI responses from 1065 patients treated with ACL reconstruction were extracted from a rehabilitation‐specific registry. Rasch analyses were performed on ACL‐RSI item response data using the RUMM2030plus software. The analyses focused on targeting (person‐item threshold distribution), item hierarchy, response category thresholds, overall and individual item and person fit, differential item functioning (DIF), unidimensionality and reliability. Results The ACL‐RSI had compromised fit to the Rasch model, including DIF and malfunctioning response categories. Several items correlate with each other and the presumptions to aggregate item responses into one single score were not met. When accounting for local dependency, the measurement properties of the ACL‐RSI improved in terms of model fit and DIF and unidimensionality were supported. Conclusion The ACL‐RSI was found to have signs of multidimensionality and local dependency, that is, the answers to one item are influenced by the answers to other items. As such, researchers should be careful when using the ACL‐RSI as one single score to evaluate patients treated with ACL reconstruction, unless local dependency is accounted for in the scoring process. Level of Evidence Level III.

Abstract Background It is unknown whether knee flexor strength recovers after anterior cruciate ligament (ACL) reconstruction with a hamstring tendon (HT) autograft and whether persistent knee flexor strength asymmetry is associated to a second ACL injury. Objective We aimed to systematically review (1) whether knee flexor strength recovers after ACL reconstruction with HT autografts, and (2) whether it influences the association with a second ACL injury. A third aim was to summarize the methodology used to assess knee flexor strength. Design Systematic review and meta-analysis reported according to PRISMA. Methods A systematic search was performed using the Cochrane Library, Embase, Medline, PEDRo, and AMED databases from inception to December 2021 and until completion in January 2023. Human clinical trials written in English and conducted as randomized controlled trials, longitudinal cohort, cross-sectional, and case–control studies on patients with index ACL reconstructions with HT autografts harvested from the ipsilateral side were considered. Knee flexor strength was measured isokinetically in both the reconstructed and uninjured limb to enable the calculation of the limb symmetry index (LSI). The Risk of Bias Assessment Tool for Non-Randomized Studies was used to assess risk of bias for non-randomized studies and the revised Cochrane Risk of Bias tool was used for randomized controlled trials. For the meta-analysis, the LSI (mean ± standard error) for concentric knee flexor strength at angular velocities of 60°/second (s) and 180°/s preoperatively and at 3 months, 6 months, 12 months, and 24 months were pooled as weighted means with standard errors. Results The search yielded 64 studies with a total of 8378 patients, which were included for the assessment of recovery of knee flexor strength LSI, and a total of 610 patients from four studies that investigated the association between knee flexor strength and second ACL injuries. At 1 year after ACL reconstruction, the knee flexor strength LSI had recovered to 89.0% (95% CI 87.3; 90.7%) and 88.3% (95% CI 85.5; 91.1%) for the velocities of 60°/s and 180°/s, respectively. At 2 years, the LSI was 91.7% (95% CI 90.8; 92.6%) and 91.2% (95% CI 88.1; 94.2%), for velocities of 60°/s and 180°/s, respectively. For the association between knee flexor strength and second ACL injuries, there was insufficient and contradictory data. Conclusions There was low to very low certainty of evidence indicating that the recovery of knee flexor strength LSI, defined as ≥ 90% of the uninjured side, takes up to 2 years after ACL reconstruction with HT autografts. Whether knee flexor strength deficits influence the association of second ACL injuries is still uncertain. There was considerable heterogeneity in the methodology used for knee flexor strength assessment, which together with the low to very low certainty of evidence, warrants further caution in the interpretation of our results. Registration number: CRD42022286773.

Abstract Background The stress on the anterior cruciate ligament (ACL) induced by the quadriceps can be attenuated by activation of the hamstrings by exerting an opposing torque to the anterior translation of tibia. Consequently, considering the ratio between strength of the hamstrings-to-quadriceps (HQ-ratio) may be of value to reduce the odds of second ACL injuries. The objective was therefore to evaluate (1) the association between HQ-ratio and the occurrence of a second ACL injury in patients after ACL-reconstruction within 2 years of return to preinjury sport level and (2) to compare the HQ-ratio between males and females after ACL reconstruction. Methods Patients who had undergone primary ACL reconstruction and participated in knee-strenuous activity preinjury were included. Demographics, the occurrence of a second ACL injury, and muscle strength test results before returning to preinjury sport level were extracted from a rehabilitation registry. The endpoint was set at a second ACL injury or 2 years after return to preinjury sport level. A multivariable logistic regression was used to analyze the association between the HQ-ratio and a second ACL injury. Results A total of 574 patients (50.0% female) with a mean age of 24.0 ± 9.4 years at primary ACL reconstruction were included. In the univariable logistic regression analysis, the odds of sustaining a second ACL injury decreased by 3% for every 1% increase in the HQ-ratio (OR 0.97 [95% CI 0.95–1.00], p = 0.025). After adjusting for the time from reconstruction to return to preinjury sport level, sex, preinjury sport level, graft choice, age, and body mass index, the results were no longer significant (OR 0.98 [95% CI 0.95–1.01], p = 0.16). Females had a higher HQ-ratio compared with males for both the ACL-reconstructed and uninjured side (3.7% [95% CI 5.7; 1.8%], p = 0.0002 and 3.3% [95% CI 4.6; 2.1], p

Abstract Background There is a need to establish the prevalence of self-reported physical symptoms such as pain in professional gamers (PGs) and to analyse whether there are correlations between lifestyle factors and self-reported physical symptoms. The purpose of this study was to analyse the prevalence of self-reported physical symptoms including eye-related problems in PGs. A further aim was to analyse the association between physical symptoms and lifestyle factors such as sleep time, play time and physical activity. Methods This study was designed as a cross-sectional study with data based on an electronic survey, created specifically for this study, through discussion and screening of established validated questionnaires for physical symptoms in musculoskeletal conditions: the Karolinska Sleep Questionnaire and the Nordic Musculoskeletal Questionnaire. The survey comprised age and years of experience as a PG as descriptive variables, as well as questions on sleep, play time, physical activity and physical symptoms for the purpose of analysis. The directors of 10 professional gaming corporations were contacted by email with a link to the study-specific survey to distribute to all employees. Results A total of 40 answers to the electronic survey were retrieved from 40 PGs, of which 62.5% (n = 25) had experienced at least one physical symptom in the three months prior to answering the survey. There was a significant association between playing time and physical symptoms (OR = 8.0; 95% CI 1.4–44.6, p = 0.018), where playing for more than 35 h a week was positively associated with eight times higher odds of experiencing physical symptoms. Conclusion There is a high prevalence of physical symptoms, such as headache and eye symptoms, in professional eSports gamers. There was an association between playing more than 35 h per week with the prevalence of physical symptoms.

Background/Purpose: To develop a prediction model for emergency medical technicians (EMTs) to identify trauma patients at high risk of deterioration to emergency medical service (EMS)-witnessed traumatic cardiac arrest (TCA) on the scene or en route. Methods: We developed a prediction model using the classical cross-validation method from the Pan-Asia Trauma Outcomes Study (PATOS) database from 1 January 2015 to 31 December 2020. Eligible patients aged ≥18 years were transported to the hospital by the EMS. The primary outcome (EMS-witnessed TCA) was defined based on changes in vital signs measured on the scene or en route. We included variables that were immediately measurable as potential predictors when EMTs arrived. An integer point value system was built using multivariable logistic regression. The area under the receiver operating characteristic (AUROC) curve and Hosmer-Lemeshow (HL) test were used to examine discrimination and calibration in the derivation and validation cohorts. Results: In total, 74,844 patients were eligible for database review. The model comprised five prehospital predictors: age 20/minute, pulse oximetry

With the emergence of cyber-physical systems (CPSs) in utility systems like electricity, water, and gas networks, data collection has become more prevalent. While data collection in these systems has numerous advantages, it also raises concerns about privacy as it can potentially reveal sensitive information about users. To address this issue, we propose a Bayesian approach to control the adversarial inference and mitigate the physical-layer privacy problem in CPSs. Specifically, we develop a control strategy for the worst-case scenario where an adversary has perfect knowledge of the user’s control strategy. For finite state-space problems, we derive the fixed-point Bellman’s equation for an optimal stationary strategy and discuss a few practical approaches to solve it using optimization-based control design. Addressing the computational complexity, we propose a reinforcement learning approach based on the Actor-Critic architecture. To also support smart meter privacy research, we present a publicly accessible “Co-LivEn” dataset with comprehensive electrical measurements of appliances in a co-living household. Using this dataset, we benchmark the proposed reinforcement learning approach. The results demonstrate its effectiveness in reducing privacy leakage. Our work provides valuable insights and practical solutions for managing adversarial inference in cyber-physical systems, with a particular focus on enhancing privacy in smart meter applications.

Existing classical optical network infrastructure cannot be immediately used for quantum network applications due to photon loss. The first step toward enabling quantum networks is the integration of quantum repeaters into optical networks. However, the expenses and intrinsic noise inherent in quantum hardware underscore the need for an efficient deployment strategy that optimizes the placement of quantum repeaters and memories. In this article, we present a comprehensive framework for network planning, aiming to efficiently distribute quantum repeaters across existing infrastructure, with the objective of maximizing quantum network utility within an entanglement distribution network. We apply our framework to several cases including a preliminary illustration of a dumbbell network topology and real-world cases of the SURFnet and ESnet. We explore the effect of quantum memory multiplexing within quantum repeaters, as well as the influence of memory coherence time on quantum network utility. We further examine the effects of different fairness assumptions on network planning, uncovering their impacts on real-time network performance.

Abstract Background Healthcare restrictions during the COVID-19 pandemic, particularly in ophthalmology, led to a differential underutilization of care. An analytic approach is needed to characterize pandemic health services usage across many conditions. Methods A common analytical framework identified pandemic care utilization patterns across 261 ophthalmic diagnoses. Using a United States eye care registry, predictions of utilization expected without the pandemic were established for each diagnosis via models trained on pre-pandemic data. Pandemic effects on utilization were estimated by calculating deviations between observed and expected patient volumes from January 2020 to December 2021, with two sub-periods of focus: the hiatus (March-May 2020) and post-hiatus (June 2020–December 2021). Deviation patterns were analyzed using cluster analyses, data visualizations, and hypothesis testing. Results Records from 44.62 million patients and 2455 practices show lasting reductions in ophthalmic care utilization, including visits for leading causes of visual impairment (age-related macular degeneration, diabetic retinopathy, cataract, glaucoma). Mean deviations among all diagnoses are 67% below expectation during the hiatus peak, and 13% post-hiatus. Less severe conditions experience greater utilization reductions, with heterogeneities across diagnosis categories and pandemic phases. Intense post-hiatus reductions occur among non-vision-threatening conditions or asymptomatic precursors of vision-threatening diseases. Many conditions with above-average post-hiatus utilization pose a risk for irreversible morbidity, such as emergent pediatric, retinal, or uveitic diseases. Conclusions We derive high-resolution insights on pandemic care utilization in the US from high-dimensional data using an analytical framework that can be applied to study healthcare disruptions in other settings and inform efforts to pinpoint unmet clinical needs.

Abstract Background Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy (PT) clinics in terms of odds for a second ACL injury, return to pre-injury level of activity, perceived knee function, and recovery of strength and hop performance. Method Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups, 2-, 4-, 8-, and 12 months, during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. Result Of the 115 rehabilitation clinics included, 111 were classified as low-volume clinics and included 733 patients, and 4 as high-volume clinics which included 1221 patients. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first 12 months and 68 (4.0%) within 2 years. No difference in the incidence of a second ACL injury, within 12 months follow-up odds ratio (OR) 0.95 [95% CI 0.46–1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68–1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in patient-reported outcomes (PROs) and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury level of activity. Conclusion No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapist clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury level of activity.

Flight-by-feel (FBF) is an approach to flight control that uses dispersed sensors on the wings of aircraft to detect flight state. While biological FBF systems, such as the wings of insects, often contain hundreds of strain and flow sensors, artificial systems are highly constrained by size, weight, and power (SWaP) considerations, especially for small aircraft. An optimization approach is needed to determine how many sensors are required and where they should be placed on the wing. Airflow fields can be highly nonlinear, and many local minima exist for sensor placement, meaning conventional optimization techniques are unreliable for this application. The Sparse Sensor Placement Optimization for Prediction (SSPOP) algorithm extracts information from a dense array of flow data using singular value decomposition and linear discriminant analysis, thereby identifying the most information-rich sparse subset of sensor locations. In this research, the SSPOP algorithm is evaluated for the placement of artificial hair sensors on a 3D delta wing model with a 45° sweep angle and a blunt leading edge. The sensor placement solution, or design point (DP), is shown to rank within the top one percent of all possible solutions by root mean square error in angle of attack prediction. This research is the first to evaluate SSPOP on a 3D model and the first to include variable length hairs for variable velocity sensitivity. A comparison of SSPOP against conventional greedy search and gradient-based optimization shows that SSPOP DP ranks nearest to optimal in over 90 percent of models and is far more robust to model variation. The successful application of SSPOP in complex 3D flows paves the way for experimental sensor placement optimization for artificial hair-cell airflow sensors and is a major step toward biomimetic flight-by-feel.

Motor impairments caused by stroke significantly affect daily activities and reduce quality of life, highlighting the need for effective rehabilitation strategies. This study presents a novel approach to classifying motor tasks using EEG data from acute stroke patients, focusing on left-hand motor imagery, right-hand motor imagery, and rest states. By using advanced source localization techniques, such as Minimum Norm Estimation (MNE), dipole fitting, and beamforming, integrated with a customized Residual Convolutional Neural Network (ResNetCNN) architecture, we achieved superior spatial pattern recognition in EEG data. Our approach yielded classification accuracies of 91.03% with dipole fitting, 89.07% with MNE, and 87.17% with beamforming, markedly surpassing the 55.57% to 72.21% range of traditional sensor domain methods. These results highlight the efficacy of transitioning from sensor to source domain in capturing precise brain activity. The enhanced accuracy and reliability of our method hold significant potential for advancing brain–computer interfaces (BCIs) in neurorehabilitation. This study emphasizes the importance of using advanced EEG classification techniques to provide clinicians with precise tools for developing individualized therapy plans, potentially leading to substantial improvements in motor function recovery and overall patient outcomes. Future work will focus on integrating these techniques into practical BCI systems and assessing their long-term impact on stroke rehabilitation.

Abstract Background Generalised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction. Methods This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP. Results A total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen’s d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes. Conclusion A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.

Objective The purpose of this study was to review the current literature regarding the non-operative treatment of isolated medial collateral ligament (MCL) injuries.Design Systematic review, registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/E9CP4).Data sources The Embase, MEDLINE and PEDro databases were searched; last search was performed on December 2023.Eligibility criteria Peer-reviewed original reports from studies that included information about individuals who sustained an isolated MCL injury with non-surgical treatment as an intervention, or reports comparing surgical with non-surgical treatment were eligible for inclusion. Included reports were synthesised qualitatively. Risk of bias was assessed with the Risk of Bias Assessment tool for Non-randomized Studies. Certainty of evidence was determined using the Grading of Recommendations Assessment Development and Evaluation.Results A total of 26 reports (1912 patients) were included, of which 18 were published before the year 2000 and 8 after. No differences in non-operative treatment were reported between grade I and II injuries, where immediate weight bearing and ambulation were tolerated, and rehabilitation comprised different types of strengthening exercises with poorly reported details. Some reports used immobilisation with a brace as a treatment method, while others did not use any equipment. The use of a brace and duration of use was inconsistently reported.Conclusion There is substantial heterogeneity and lack of detail regarding the non-operative treatment of isolated MCL injuries. This should prompt researchers and clinicians to produce high-quality evidence studies on the promising non-operative treatment of isolated MCL injuries to aid in decision-making and guide rehabilitation after MCL injury.Level of evidence Level I, systematic review.

This study explored professional wrestlers’ experiences of the consequences of an anterior cruciate ligament (ACL) injury and their perception of whether the ACL injury could have been prevented. We interviewed 10 professional wrestlers (60% women, age range 21–34) treated with ACL reconstruction with semistructured interviews. Transcripts were analysed using qualitative content analysis: One major theme, ‘Wrestling with a ghost: facing an opponent I can neither see nor clinch’, supported by five main categories, emerged from the collected data. The five main categories were: My ACL injury: bad luck or bad planning?; The way back: a fight to return to sport; Only performance counts; The injury’s impact on life: a wrestling with emotions; In hindsight, personal growth. Professional wrestlers who experienced an ACL injury expressed that not only the injury itself but also the subsequent recovery posed major challenges that they did not know how to deal with and that, in some cases, ended the athletes’ wrestling careers. Professional wrestlers attributed their ACL injuries to bad luck or large training loads and wished that they had more support from the wrestling community when injured.

Abstract Deep learning (DL) models can harness electronic health records (EHRs) to predict diseases and extract radiologic findings for diagnosis. With ambulatory chest radiographs (CXRs) frequently ordered, we investigated detecting type 2 diabetes (T2D) by combining radiographic and EHR data using a DL model. Our model, developed from 271,065 CXRs and 160,244 patients, was tested on a prospective dataset of 9,943 CXRs. Here we show the model effectively detected T2D with a ROC AUC of 0.84 and a 16% prevalence. The algorithm flagged 1,381 cases (14%) as suspicious for T2D. External validation at a distinct institution yielded a ROC AUC of 0.77, with 5% of patients subsequently diagnosed with T2D. Explainable AI techniques revealed correlations between specific adiposity measures and high predictivity, suggesting CXRs’ potential for enhanced T2D screening.

The cell origin-specific payloads within extracellular vesicles (EVs) mediate therapeutic bioactivity for a wide variety of stem cell types. In this study, we profiled the microRNA (miRNA) and protein cargos found within EVs produced by three clinical-grade stem cell products of different ontogenies being considered for clinical application, namely bone marrow-derived mesenchymal stromal cells (BM-MSCs), heart-derived cells (HDCs), and umbilical cord-derived MSCs (UC-MSCs). Although several miRNAs (757) and proteins (420) were found in common, each producer cell type expressed unique miRNA profiles when the most highly expressed transcripts were compared. Differential expression analysis revealed that BM-MSCs and HDCs were quite similar, while UC-MSCs had the greatest number of unique miRNAs and proteins. Despite these differences, all three EVs promoted cell adhesion/migration, immune response, platelet aggregation, protein translation/stabilization, and RNA processing. EVs from BM-MSCs were implicated in apoptosis, cell-cycle progression, collagen formation, heme pigment synthesis, and smooth muscle differentiation, while HDC and UC-MSC EVs were found to regulate complement activation, endopeptidase activity, and matrix metallopeptidases. Overall, miRNA and protein profiling reveal functional differences between three leading stem cell products. These findings provide a framework for mechanistic exploration of candidate therapeutic molecules driving the salutary effects of EVs.

(1) Background: Previously, VESsel GENeration (VESGEN) software was used to map and quantify vascular changes observed on fluorescein angiography (FA) in subjects (n = 15 eyes) with retinal pathology ranging from mild non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR). In the current study, we used VESGEN for the assessment of individuals with early-stage NPDR imaged by FA (Cohort 1) and by optical coherence tomography angiography (OCTA; Cohort 2). (2) Methods: Cohort 1 included type 2 diabetics (T2D), represented 21 eyes (ranging from no DR to moderate DR), and also included nondiabetic controls (NDC; n = 15 eyes). Cohort 2 consisted of 23 eyes from T2D subjects (including no DR subjects and moderate DR subjects) and NDC (n = 18 eyes). (3) Results: In the FA-VESGEN study, total tortuosity (Tv) of microvessels (G ≥ 6) increased in T2D with mild DR compared to the controls. In contrast, the VESGEN analysis of OCTA images showed that vessel length (characterized as density) was lower in T2D subjects before the diagnosis of DR and following the diagnosis of DR when compared to the controls. Additionally, T2D showed a significant decrease in vessel area (density). (4) Conclusions: FA elucidated the vessel morphology of small-generation microvessels to a greater degree than OCTA; however, OCTA identified changes in vessel density better than FA. VESGEN analysis can be used with both standard FA and OCTA to facilitate our understanding of early events in DR, including before the clinical diagnosis of DR.

Electromyogram (EMG) has been a fundamental approach for prosthetic hand control. However it is limited by the functionality of residual muscles and muscle fatigue. Currently, exploring temporal shifts in brain networks and accurately classifying noninvasive electroencephalogram (EEG) for prosthetic hand control remains challenging. In this manuscript, it is hypothesized that the coordinated and synchronized temporal patterns within the brain network, termed as brain synergy, contain valuable information to decode hand movements. 32-channel EEGs were acquired from 10 healthy participants during hand grasp and open. Synergistic spatial distribution pattern and power spectra of brain activity were investigated using independent component analysis of EEG. Out of 32 EEG channels, 15 channels spanning the frontal, central and parietal regions were strategically selected based on the synergy of spatial distribution pattern and power spectrum of independent components. Time-domain and synergistic features were extracted from the selected 15 EEG channels. These features were employed to train a Bayesian optimizer-based support vector machine (SVM). The optimized SVM classifier could achieve an average testing accuracy of 94.39 $ \pm $ .84% using synergistic features. The paired t-test showed that synergistic features yielded significantly higher area under curve values (p

This proposed model introduces novel deep learning methodologies. The objective here is to create a reliable intrusion detection mechanism to help identify malicious attacks. Deep learning based solution framework is developed consisting of three approaches. The first approach is Long-Short Term Memory Recurrent Neural Network (LSTM-RNN) with seven optimizer functions such as adamax, SGD, adagrad, adam, RMSprop, nadam and adadelta. The model is evaluated on NSL-KDD dataset and classified multi attack classification. The model has outperformed with adamax optimizer in terms of accuracy, detection rate and low false alarm rate. The results of LSTM-RNN with adamax optimizer is compared with existing shallow machine and deep learning models in terms of accuracy, detection rate and low false alarm rate. The multi model methodology consisting of Recurrent Neural Network (RNN), Long-Short Term Memory Recurrent Neural Network (LSTM-RNN), and Deep Neural Network (DNN). The multi models are evaluated on bench mark datasets such as KDD’99, NSL-KDD, and UNSWNB15 datasets. The models self-learnt the features and classifies the attack classes as multi-attack classification. The models RNN, and LSTM-RNN provide considerable performance compared to other existing methods on KDD’99 and NSL-KDD dataset.

BackgroundWhile virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care. ObjectiveThis study aimed to understand patient advisors’ perceptions related to virtual care and potential impacts on health care quality. MethodsWe adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen’s University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants). ResultsSix themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery. ConclusionsParticipant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care.