Introduction: Ventricular arrhythmia (VA) from the left ventricular summit (LVS) is a common origin of VA, which resulting LV dysfunction in some patients. However, the predictors of LV cardiomyopathy were not well-elucidated. The present study sought to investigate the risk factor of LV cardiomyopathy and the outcome in patients with LVS VA Methods: Between 2013 and 2018, a total of 139 patients (60.7% men; mean age 53.2 ± 13.9 years-old) underwent catheter ablation for LVS VA from two centers. Detailed patient demographics, electrocardiograms, electrophysiological characteristics, and clinical outcomes were extracted for analysis. LV cardiomyopathy was defined as LV ejection fraction (LVEF) <50%. Results: Acute procedural success was achieved in 92.8 % of patients. There were 40 patients (28.8%) with LV cardiomyopathy, and the mean LVEF improved from 37.5 ± 9.3% to 48.5 ± 10.2% after ablation ( p < 0.001). After multivariate analysis, the independent predictors of LV dysfunction were wider QRS duration of the VA (odds ratio [OR]1.02; 95% confidence interval [CI]: 1.00-1.04; p = 0.046) and the absolute earliest activation time discrepancy (AEAD) between epicardium and endocardium (OR 1.05; 95% confidence interval CI: 1.00-1.09; p = 0.048). After ablation, the LV function was completely recovered in 20 patients (50%). The predictors for irreclaimable LV function included wider PVC QRS duration (OR 1.09; 95% CI: 1.02-1.17; p = 0.012) and poorer LVEF (OR 0.85; 95% CI: 0.74-0.97; p = 0.020). Conclusion: In patients with VA from LVS, PVC QRS duration and AEAD predicted the deteriorating LV systolic function. Catheter ablation could reverse the LV remodeling. Narrower QRS duration and better LVEF predicted a better recovery of LV function after ablation.

Compared with scripted test, exploratory testing has the advantages of finding more defects and higher quality defects. However, in decades there are few researches on the proprietary testing methods for exploratory testing. In this paper, a new express delivery testing method is proposed based on the inspiration of the FedEx tour method and the express industry mode. The test types of the express delivery testing method are expanded from data to data, interaction objects and activities, states of internal and external and sequence of activities. Through practice verification, compared with the FedEx tour method, this method can excavate hidden test points that are easy to be missed, design more test cases, find more faults, and has higher test effectiveness.

In this paper, a novel decentralised control framework based on decentralised fully probabilistic design (DFPD) is proposed for a class of stochastic dynamic complex systems with multiple multiplicative noises. Compared with the existing conventional DFPD, the new procedure is improved by modifying the Riccati equation in order to deal with multiple multiplicative noises. Considering the stochastic nature of complex systems, the systems’ dynamical behaviours are fully charaterised by probabilistic state-space models. In this way, a complete description of the components of the subsystems is provided. In addition, probabilistic message passing architecture is introduced to provide communication between neighbouring subsystems and to harmonise the actions between the local nodes. To illuminate the effectiveness of the proposed framework, a three inverted pendulum system numerical example is presented and the results are compared with the conventional DFPD.

Accurate assessment of wind energy potential can provide important implication regarding the optimalization of micro-siting of wind turbines and increase of wind power generation. It is, however, noteworthy that most previous studies on wind energy resource assessment focused solely on wind speed, whereas the dependence of wind energy on wind direction was much less considered and documented. In the current study, a copula-based method is proposed to better characterize the direction-related wind energy potential at six typical sites in Hong Kong. In the first step, several widely used statistical models are adopted to fit the marginal distributions of wind speed and direction. The joint probability density function (JPDF) of wind speed and wind direction is therewith constructed by various copula models. The goodness-of-fit evaluation indicates that Frank copula has the best performance to fit the JPDF at hilltop and offshore sites, while Gumbel copula outperforms other models at downtown sites. More importantly, the derived JPDFs are applied to estimate the direction-related wind power density at each of the considered sites, finding a maximum value of wind energy potential of 506.4 W/m2 at a hilltop site. In addition, site-to-site variability is also identified regarding the prevailing wind resource directions. The outcome of this study is expected to be useful for the site selection of wind turbines, as well as the strategic development of wind energy in Hong Kong. Notably, the proposed copula-based method can also be applied to characterize the direction-related wind energy potential somewhere other than Hong Kong.

Objectives. To evaluate the efficacy and safety of a mixed wavelength laser 10600 and 1540 nm using low-power 5 W CO2, on the vaginal maturation value (VMV) and genitourinary syndrome of menopause (GSM). Design. randomized single-blind sham-controlled trial. Setting. Hospital Universitari Sant Joan de Reus, Spain. Population. 31 postmenopausal women with GSM symptoms and VMV <50%. Methods. Patients were randomized to laser or sham intervention, consisting of monthly laser or sham treatments for three consecutive months. Evaluations were at baseline, 3- and 9-months post-intervention. Main outcome measures. The primary outcome was the effect on VMV; secondary outcomes were vaginal pH, and visual analogue scale (VAS) for GSM symptoms at 3 and 9 months. Also, adverse events were evaluated. Results: 27 patients completed the study, 14 were randomly assigned to the laser arm and 13 to the sham arm. At 3 months, VMV increased significantly in the laser group (44.5% ± 4.4) compared to sham group (27.7% ± 6.3) (P = 0.033), at 9 months, VMV in the laser group was similar to baseline values and VAS scores for GSM decreased for dyspareunia in the laser group compared to the sham group (P = 0.049). Vaginal pH remained unchanged. Treatment was well tolerated with adverse effects equivalent to the sham group. Conclusions: At the first 3 months, mixed laser wavelengths 10600 + 1540 nm increased VMV and at 9 months, dyspareunia was reduced. Laser treatment was safe and well tolerated with adverse effects similar to the sham group. ClinicalTrialRegistry NCT039565

Background: Sinonasal undifferentiated carcinoma (SNUC) is an exceedingly rare head and neck malignancy. No consensus exists on treatment for metastatic disease. Case: A 56-year-old female was diagnosed with SNUC after endorsing sinus congestion, diplopia, and right orbital pain. Initially treated with surgery and radiation, she later developed significant metastatic disease. She demonstrated progression of her hepatic metastases under pembrolizumab therapy. However, the addition of ipilimumab and a COX-2 inhibitor resulted in significant improvement in her lesions as well as an ongoing durable response. Her regimen was complicated by immune-related adverse events successfully treated with steroids.Conclusion: Dual checkpoint inhibition deserves consideration when treating metastatic SNUC, especially after single agent therapy has failed. The positive effect of this treatment may be augmented by IDO1 inhibition.

Inguinal lymph node involvement is the most robust predictor of mortality in women with vulval cancer and sentinel lymph node biopsy is recognised as a safe diagnostic modality provided strict patient criteria as defined by the GROINSS-V study are respected. Studies have largely concentrated on the efficacy of different intraoperative detection modalities or histopathological protocols whilst the literature describing a standardised surgical technique remains deficient. We hereby propose a reproducible operative technique based on anatomical landmarks and an appreciation of the territorial mapping of inguinal sentinel lymph nodes.

Observing flows on land surfaces, streams, and rivers is complex, expensive, and time-consuming. Simultaneously, accurate runoff and stream flow data are scarce. Therefore, a simple rainfall-runoff model that mimics the real-world system becomes indispensable. Although wide ranges of rainfall-runoff methods/models have been developed in the past, most have inherent limitations in simulating different hydrological systems. With a thorough evaluation and review of rainfall-runoff methods, a new conceptual model that can simulate alternative runoff generation, infiltration, and saturation excess, has developed. The new model quantifies the stream flow with a multi-layered approach and well separates the contributions of infiltration-excess runoff (IRun), saturation excess runoff (SRun), sub-soil lateral flow or interflow (IFlow), and the base flow (BFlow). The model’s performance has also been proved using the calibration and validation processes of six randomly selected gauged catchments from different river basins in Ethiopia as representative of tropical-monsoon hydrological systems. The ranges of statistical values for R-square, RMSE, NSE, and PBIAS were 0.77- 0.87, 0.47 -1.04, 0.52- 0.93, and 0.0, respectively, confirming that the new model performs well for different hydrological systems. Moreover, the single-user-interface computer programs for the model running also facilitate its use as plugging with various tools, including GIS packages and database catalog systems.

Focusing properties―especially the focus width―of circular airy beams (CABs) with emission angles are investigated for microwave near-field applications. The CABs are described as the solutions of the para-axial wave equation which are numerically solved. The suggested CAB can produce a narrow focal point with a 3-dB-width of 0.23λ and requires a relatively small phase shift in the aperture. The results are verified by a theoretical model for antenna arrays composed of half-wavelength unit cells.

Asthma deaths following ergometrine and syntometrineWilliam FS SellersThe 2017 to 2019 maternal mortality report (MBRRACE-UK) described a death of an asthmatic possibly from air embolism at Caesarean section. What kind of uterine constrictor drug, or if one was used is not described, and because reports are confidential this information is unavailable. Ergometrine was reported to have caused bronchospasm in an asthmatic after delivery by Caesarean section1 and this stimulated a case report from Anaesthetist Professor Selwyn Crawford of a death of an asthmatic patient after receiving ergometrine, although at the time this cause had not been considered.2 To find if ergometrine and syntometrine were involved in any other maternal deaths, the Royal College of Obstetricians and Gynaecology library’s complete collection of triennial reports from 1952 to 2019 was studied. The 1976-1978 Report page 80 describes the death reported by Selwyn Crawford. The 1988-1990 Report has two asthma deaths. Page 71 reports a death of a patient who had concealed her asthma and died following a legal termination at seven weeks gestation from sudden and severe bronchospasm. Whether a uterine constrictor was used is not mentioned. Page 89 describes an asthmatic patient who died after a legal termination at six weeks under general anaesthesia and an injection of 1ml of syntometrine, after which she developed difficulty in breathing and became cyanosed. A tracheal tube was passed but manual ventilation was impossible because of severe bronchospasm. The report goes on to state: “The cause of the acute bronchospasm is not clear.” Ergometrine and syntometrine constrict vascular, uterine, and bronchial smooth muscle and should be avoided in pregnant asthmatics.References.Sellers WFS, Long DR. Bronchospasm following ergometrine, Anaesthesia 1979;34:909 doi/pdf/10.1111/j.1365-2044.1979.tb08556.xCrawford JS. Bronchospasm following ergometrine, Anaesthesia 1980;35:397-8 doi: 10.1111/j.1365-2044.1980.tb05138.x.

Due to the rapid growth of China’s security market, the early detection of accounting violations by listed companies has become increasingly urgent. However, the current lack of regulatory efficiency means that such problems are often not detected and solved. To solve these issues, researchers have proposed traditional methods and artificial intelligence methods in recent decades. However, some existing methods have high requirements for setting indicators and parameters, and their detection accuracy could be improved. To take advantage of the concept of the self-attention mechanism, we built a modified transformer encoder network with Bi-LSTM to analyze accounting data and identify whether there are violations by listed companies. This model attempts to enhance the long-term feature capture capability for processing structural data, such as accounting data, through Bi-LSTM and stacking multiple transformer encoder networks while reducing the speed of computation due to the parallel power of the self-attention mechanism. Several experiments were conducted on the accounting dataset released by the open-source China Stock Market & Accounting Research (CSMAR). The results show that the proposed model, by the composition of Bi-LSTM as the input layer and three layers of transformer encoder network, has the best detection performance in comparison to the deep neural network (DNN), random forest models, etc., with a testing accuracy of 0.9758 and an AUC of 0.98. Furthermore, we embedded the pretrained model in a WeChat miniprogram to provide a better interactive experience for users during the preliminary detection of a single file with the required accounting data.

Awareness of cutaneous manifestations of non-accidental injury (NAI) is essential for healthcare professionals working with children. Some cutaneous conditions may present with bruise-like lesions that can mimic NAI. We present the case of a male infant referred for investigation of NAI, who was subsequently diagnosed with cutaneous mastocytosis.

Background: Patients are admitted to the hospital for respiratory illness at different stages of their disease course. It is important to appropriately analyse this heterogeneity in surveillance data to accurately measure disease severity among those hospitalized. The purpose of this study was to determine if unique baseline clusters of influenza patients exist, and to examine the association between cluster membership and in-hospital outcomes. Methods: Patients hospitalized with influenza at two hospitals in Southeast Michigan during the 2017/2018 (n=242) and 2018/2019 (n=115) influenza seasons were included. Physiologic and laboratory variables were collected for the first 24 hours of the hospital stay. K-medoids clustering was used to determine groups of individuals based on these values. Multivariable linear regression or Firth’s logistic regression were used to examine the association between cluster membership and clinical outcomes. Results: Three clusters were selected for 2017/2018, mainly differentiated by blood glucose level. After adjustment, those in C171 had 5.6 times the odds of mechanical ventilator use than those in C172 (95%CI: 1.49,21.1) and a significantly longer mean hospital length of stay than those in both C172 (mean 1.5 days longer, 95%CI: 0.2,2.7) and C173 (mean 1.4 days longer, 95%CI: 0.3,2.5). Similar results were seen between the two clusters selected for 2018/2019. Conclusion: In this study of hospitalized influenza patients, we show that distinct clusters with higher disease acuity can be identified and could be targeted for evaluations of vaccine and influenza antiviral effectiveness against disease attenuation. The association of higher disease acuity with glucose level merits evaluation.

We explore model performance for the Alfvén Wave Solar atmosphere Model (AWSoM) with near-real-time (NRT) synoptic maps of the photospheric vector magnetic field. These maps, produced by assimilating data from the Helioseismic Magnetic Imager (HMI) onboard the Solar Dynamics Observatory (SDO), use a different method developed at the National Solar Observatory (NSO) to provide a near contemporaneous source of data to drive numerical models. Here, we apply these NSO-HMI-NRT maps to simulate three Carrington rotations (CRs): 2107-2108 (centered on 2011/03/07 20:12 CME event), 2123 (integer CR) and 2218-2219 (centered on 2019/07/2 solar eclipse), which together cover a wide range of activity level for solar cycle 24. We show simulation results, which reproduce both extreme ultraviolet emission (EUV) from the low corona while simultaneously matching in situ observations at 1 au as well as quantify the total unsigned open magnetic flux from these maps.

High level of fault currents has become one of the most challenging issues, along with increased electrical energy consumption and power grid expansion. However, some of the previous work was limited to installing limiters on designs and installing them on small plans. In this study, the optimal placement of a resistive-type superconducting fault current limiter (RSFCL) to achieve good power system transient stability is proposed. The proposed method has several advantages. First, procedure fault analysis is applied to consider the magnitude of the short-circuit currents and the line located close to the generator for the placement of the device. Compared with other methods, it can directly find the exact line to be installed RSFCL. Second, the stability assessment is validated using the time domain simulation by installing limiters with varying capacities in any location. Third, parameters were analysed to evaluate the proposed method’s effectiveness, including angular speed, rotor angular velocity, and generator rotor angle in a multi-machine system. The result reveals that the placement of the limiter on the line with the most significant short-circuits value on the line closest to the generator increases the power system stability more than the placement in other locations.

With the rapid development of online car-hailing, car-hailing-related crashes have become a key issue with public concern. Identifying and predicting aggressive driving behaviors is critical to reducing traffic crashes. In this paper, we propose a method to recognize aggressive driving behavior based on association classification that integrates multisource features such as driver emotion, vehicle kinematic characteristics, and road environment. The model performs best in 10-fold cross-test when the minimum support and minimum confidence are set as 0.01 and 0.8, respectively. Besides, we also compare the performance of aggressive driving behavior recognition classifiers constructed using association classification with other rule-based classification methods, including ID3, C4.5, CART, and Random Forest. The results show that association classification performs better than other classification methods. Thirty-six if-then rules generated by the association classification are used to analyze the influencing factors and mechanisms of aggressive driving behavior. The study found that aggressive driving behavior is highly correlated with driver anger and disgust emotion. Aggressive driving behavior is more likely to occur when there are no passengers in the car than in the trip with passenger stage. Driver entertainment behavior and passenger interference also affect driving behavior. Drivers are prone to aggressive driving when making a U-turn. This research not only proposed a new identification method for aggressive driving behavior but also provided a comprehensive understanding of influencing factors of aggressive driving behavior and ideas for in-depth research and development of safety assistance driving devices.

As the waters of marine primary production, the euphotic zone is the primary living environment for aquatic organisms. Eddies account for 90% of the ocean’s kinetic energy and affect marine organisms’ habitats by the excitation of vertical velocities and the horizontal advection of nutrients and ecosystems. Satellite observations indicate that anticyclones mainly deepen the euphotic zone depth, while cyclones do the opposite. Eddy-induced euphotic zone depth is inversely correlated with the eddy-induced chlorophyll concentration. The anomalies reach 5m on average in the region of high eddy amplitude and frequent eddy occurrence. In addition, we found that the anomalies have an extreme value in each of the 5°-23° and 23°-55° and reach a maximum at around 40 degrees with the increase of latitude. Secondly, the anomalies are characterized by large near-summer and small near-winter. In the eddy-center coordinate system, the minus gradient direction of the negative anomaly is consistent with the background flow field and the direction of eddy movement. Meanwhile, the anomaly increases along the radial direction to about 0.2r and then decreases. Finally, there is a significant linear correlation between the anomaly magnitude and eddy amplitude. The conclusion of this research and related mechanism explanation contributes to marine biology research and conservation, estimates of marine primary productivity, and understanding of the biogeochemical properties of eddy modulation in the upper water column.

A document by Brendan Cych. Click on the document to view its contents.

Preterm infants are at risk for developing bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD). Pulmonary malformations are typically congenital or occur in the elderly adult populations. This case is of a 6-month-old infant who was born at 23 weeks gestation. At 3 months of life, the infant developed a clinically significant right sided lobar emphysema. This infant had no know congenital pulmonary malformations. Right upper lobectomy was performed. There are multiple reported cases of neonates requiring a lobectomy for congenital pulmonary malformations. This case demonstrates improved clinical outcome for an extremely preterm infant after surgical resection of an acquired lobar emphysema (ALE).

Due to increases in travel and tourism, the effects of trampling by humans at popular tourist sites have intensified and they can potentially negatively affect the soil quality. In the present study, we investigated the effects of various human trampling intensities on the soil quality in Zijin Mountain Urban Forest Park. The incessant growth of tourism worldwide has exacerbated the trampling of forest soils but its impacts on the quality of soil are complex and controversial. Thus we quantified the physical and chemical properties, and enzymatic activities of forest soils under different levels of human trampling (light disturbance; moderate disturbance; moderate to severe disturbance; severe disturbance; and extreme disturbance in Zijin Mountain Urban Forest Park to assess the changes in soil nutrients was altered. The results indicated that the soil water contents, and the maximum, minimum, and capillary water-holding capacities, etc., these parameters gradually decreased with greater trampling intensity increased. The soil physicochemical properties and enzyme activities were significantly correlated with the vegetation coverage (P < 0.01), which had a negative effect on the soil bulk density of the soil (P < 0.001). Furthermore, the vegetation coverage (P > 0.05) had no significant impacts on the capillary porosity, pH, or catalase activity. The results obtained in this study provided a reference for soil quality improvement and ecological restoration. Intriguingly, correlations were found between human trampling and some soil properties, where moderate trampling enhanced the soil fertility levels whereas severe trampling decreased them.

Nirmatrelvir/ritonavir, a newly authorized drug for the treatment of COVID-19, is a strong CYP3A4 inhibitor, which can interact with a large number of drugs, such as tacrolimus, reducing its metabolism. The reported case is a renal transplant patient who experienced a strong increase in tacrolimus blood concentration (up to 112ng/ml, more than ten times the reference range) when treated with both drugs at the same time, which caused a neurological condition that required hospital admission its control and treatment. The resolution of the symptoms was rapid, but the elevation of tacrolimus concentration remained for several days, even after discontinuation of both drugs. This study shows the importance of developing a protocol for the management of this interaction to guarantee the efficacy and safety of treatment with nirmatrelvir/ritonavir in transplant patients.

Conventional method of calculation of reference interval (RI) for complete blood count (CBC) parameters for elderly population is challenging as finding healthy elderly volunteers is difficult. This study was carried out to assess the possibility of use of stored patient data of CBC reports of elderly patients in calculation of RI for CBC parameters. A retrospective, cross sectional study was carried out in a hospital laboratory using stored data of patients >65 years of age (n=3094). Relevant clinical criteria and statistical tools were used to refine data to obtain representative samples for each CBC parameter. RI were calculated using standard statistical tools. Calculated RI were compared with RI provided by the manufacturer (RI for >18years old) and with RI defined in five other countries. All data sets showed normal distribution thus, parametric approach was adopted to calculate RI. The RI of all CBC parameters were similar to those of other countries. The RI obtained in this study for red cell indices, platelet count and white blood cells are similar to the RI provided by the manufacturer for adults. The RI obtained for RBC, Hb, PCV were clinically significantly lower compared to the RI provided by the manufacturer for adults. When appropriate selection criteria and relevant statistical tools are applied, patient data can be effectively used to calculate RI for CBC parameters in elderly.

For better serving people's complex needs the subsequent movement to person-centered integrated care, requires inter-organizational cooperation and service provision by domain-overarching networks and alliances. In the development to these networks, it is relevant to explore which accountability approaches are appropriate for local inter-organizational healthcare governance. Therefore, in a scoping review we studied the current state of knowledge and practice of accountability in healthcare in the Netherlands. We found that two of the included 41 studies show characteristics of accountability towards healthcare with characteristics of integration care components, such as integration of services with accompanying accountability arrangements and development of networked accountability. The first studies are found in the literature which report on accountability in integrated care. With this we add to the international discussion about accountability as an aspect of integrated care governance, by providing insight into the current state of art of accountability in Dutch healthcare.

Sergei V. Jargin