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Self-sustained oscillations are ubiquitous in nature and engineering. In this paper, we propose a novel output-only system-identification framework for identifying the system parameters of a self-sustained oscillator affected by Gaussian white noise. A Langevin model that characterizes the self-sustained oscillator is postulated, and the corresponding Fokker--Planck equation is derived from stochastic averaging. From the drift and diffusion terms of the Fokker--Planck equation, unknown parameters of the system are identified. We develop a numerically efficient algorithm for enhancing the accuracy of parameter identification. In particular, a modified Levenberg--Marquardt optimization algorithm tailored to output-only system identification is introduced. The proposed framework is demonstrated on both numerical and experimental oscillators with varying system parameters that develop into self-sustained oscillations. The results show that the computational cost required for performing the system identification is dramatically reduced by using the proposed framework. Also, system parameters that were difficult to be extracted with the existing method could be efficiently computed with the system identification method developed in this study. Pertaining to the robustness and computational efficiency of the presented framework, this study can contribute to an accurate and fast diagnosis of dynamical systems under stochastic forcing., 17 pages, 8 figures

An important step in the design of autonomous systems is to evaluate the probability that a failure will occur. In safety-critical domains, the failure probability is extremely small so that the evaluation of a policy through Monte Carlo sampling is inefficient. Adaptive importance sampling approaches have been developed for rare event estimation but do not scale well to sequential systems with long horizons. In this work, we develop two adaptive importance sampling algorithms that can efficiently estimate the probability of rare events for sequential decision making systems. The basis for these algorithms is the minimization of the Kullback-Leibler divergence between a state-dependent proposal distribution and a target distribution over trajectories, but the resulting algorithms resemble policy gradient and value-based reinforcement learning. We apply multiple importance sampling to reduce the variance of our estimate and to address the issue of multi-modality in the optimal proposal distribution. We demonstrate our approach on a control task with both continuous and discrete actions spaces and show accuracy improvements over several baselines.

The aging population, the elderly living alone, and the increase in lonely deaths are global social problems. The rising aging population due to an increase in life expectancy and decrease in fertility rates is emerging as an issue except for some developing countries with high fertility rates. According to the results of the 2015 Population and Housing Census, the elderly population aged 65 or older in 2015 was 13.2% of the total population, which is just before the aging society, and 19.8% in 2025, which is expected to be close to the super-aged society. One of the problems of an aging society is the lack of caregivers in homes for the aged because the shortage imposes increasing workloads on caregivers and leads to the deterioration of the quality of care for the elderly. Furthermore, preventive care policies are needed for healthy elderly people, who are potential care consumers who account for more than 80% of the total elderly population, before their health deteriorates in the future due to the absence of services. To solve these problems, we conducted a new type of elderly-friendly study that monitors sleep, movement, and the heart rate of the elderly using contactless radar sensors, and overcomes the limitations of existing face-to-face welfare services as a smart healthcare device that can respond quickly with related institutions in an emergency. As a result, recognition accuracy of 97.65% and an F1-Score of 92.59% were shown. If this is applied to the health and welfare service area, which has traditionally developed around face-to-face services, by combining the Internet of Things (IoT) and radar technology, personalized AI care services can be innovated through sleep and lifestyle analysis for the elderly.

The boom changing-state technique is to be immixture the adjacent-angle fulminant-shock status of the glaring-classification awakening level (GCAL) on the boom awakening. Awakening imagery system for boom awakening condition is associated with the fulminant-shock condition, to inspection a background of glaring dot, that are found of the boom value with background dot by the fulminant form. Concept of awakening is associated to reference of glaring-classification level with changing-state by boom shock system on the porous material. Symbolizing-angle of adjacent changing-state of GCAL of the medium-minimum by fulminant-shock imagery, boom background dot was the boom value of the far changing-state of the Bo-AI-FA-φMED-MIN with (5.80±1.20) units, boom value of changing-state of the Bo-AI-CO-φMED-MIN with (4.06±(-0.04)) units, boom value of the changing-state of the Bo-AI-BO-φMED-MIN with 0.91±0.07 units, boom value of changing-state of the Bo-AI-VI-φMED-MIN with 0.18±(-0.03) units. Fulminant shock is look into adjacent-angle with the fulminant-shock imagery by background the boom awakening level on the GCAL. We are supply the glaring-classification imagery with the awakening level system. So, We can possible to imagery from classification and using boom data of fulminant shock awakening system.

Rice is a globally cultivated crop and is primarily a staple food source for more than half of the world’s population. Various single-nucleotide polymorphism (SNP) arrays have been developed and utilized as standard genotyping methods for rice breeding research. Considering the importance of SNP arrays with more inclusive genetic information for GWAS and genomic selection, we integrated SNPs from eight different data resources: resequencing data from the Korean World Rice Collection (KRICE) of 475 accessions, 3,000 rice genome project (3 K-RGP) data, 700 K high-density rice array, Affymetrix 44 K SNP array, QTARO, Reactome, and plastid and GMO information. The collected SNPs were filtered and selected based on the breeder’s interest, covering all key traits or research areas to develop an integrated array system representing inclusive genomic polymorphisms. A total of 581,006 high-quality SNPs were synthesized with an average distance of 200 bp between adjacent SNPs, generating a 580 K Axiom Rice Genotyping Chip (580 K _ KNU chip). Further validation of this array on 4,720 genotypes revealed robust and highly efficient genotyping. This has also been demonstrated in genome-wide association studies (GWAS) and genomic selection (GS) of three traits: clum length, heading date, and panicle length. Several SNPs significantly associated with cut-off, −log10p-value >7.0, were detected in GWAS, and the GS predictabilities for the three traits were more than 0.5, in both rrBLUP and convolutional neural network (CNN) models. The Axiom 580 K Genotyping array will provide a cost-effective genotyping platform and accelerate rice GWAS and GS studies.

Content-based collaborative filtering (CCF) predicts user-item interactions based on both users' interaction history and items' content information. Recently, pre-trained language models (PLM) have been used to extract high-quality item encodings for CCF. However, it is resource-intensive to train a PLM-based CCF model in an end-to-end (E2E) manner, since optimization involves back-propagating through every content encoding within a given user interaction sequence. To tackle this issue, we propose GRAM (GRadient Accumulation for Multi-modality in CCF), which exploits the fact that a given item often appears multiple times within a batch of interaction histories. Specifically, Single-step GRAM aggregates each item encoding's gradients for back-propagation, with theoretic equivalence to the standard E2E training. As an extension of Single-step GRAM, we propose Multi-step GRAM, which increases the gradient update latency, achieving a further speedup with drastically less GPU memory. GRAM significantly improves training efficiency (up to 146x) on five datasets from two task domains of Knowledge Tracing and News Recommendation. Our code is available at https://github.com/yoonseok312/GRAM., NAACL 2022 Main Conference (Long Paper)

Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

In modern power systems, the data for the analysis, monitoring, and operation has become massive. In order to provide the present operating states of the power systems, it is required to have effective visualization methods. In this paper, we present the software to monitor and analyze the power system operations and to show the operating information of the power systems. The program includes the functions for drawing and editing the power system configuration and related information. Automatic drawing function of one line diagram for the power systems is included in the software program, using the geographical information of the buses. The information on buses, lines, transformers and shunt devices can be modified on the diagram and also in the text-based files. The developed software will be used to analyze the operating conditions of the power systems, and also to educate the power system operators.

Additional file 1: Figure S1. Characterization of the primary brain endothelial cell used in the study.Expression of tight junction protein, zona occludensa (ZO1), adhesion molecule (CD31), accumulation of acetylated low density lipoprotein(Ac-LDL), and expression of von Willebrand Factor (vWF) showing the characteristics of the brain endothelial cells were confirmed. Scale bar indicates 75μm. Figure S2. Effect of NMDA receptor activation on the integrity of the brain endothelial cell Monolayer.Primary brain endothelial cell monolayer were activated with 25μM NMDA for 1minute and stained with ZO-1 (Green) to visualize tight junction.Scale ba rindicates 50 μm. Figure S3. Time dependent effect of NMDA receptor activation on the permeability to FITC-Dextran. HBMVEC cells cultured on the porous membrane were activated with different concentration of NMDA (5,10, and 25 μM) for upto 15 min and concentration of FITC-Dextran at the bottom chambers were quantified and depicted as a graph (n=4). Figure S4. Time dependent changes of the BBB permeability to IgG upon NMDA activation. Activation of the NMDA receptor induces increased permeability to the immunoglobulin G from peripheral system in a time dependent manner. C57/BL6 mouse was injected retro-orbitally with PBS, NMDA for 1,5, and 15 min. Brain sections were stained with IgG (Red) to visualize immunoglobulin G. Scale bar indicates 200 μm. Figure S5. Activation of NMDA receptor induces permeability changes of the BBB in a heterogenous manner. Activation of the NMDA receptor induces increased permeability to the immunoglobulin G from peripheral system.C57/BL6 mouse was injected retro-orbitally with PBS, NMDA for 1 min. Brain sections were stained with CD31 (Green) and IgG (Red) to visualize endothelial cells and immunoglobulin G, respectively. Images were taken from Cortex, Hippocampus, and Ventral Striatum region. Scale bar indicates 200 and 75 μm at the top and bottom panel. Figure S6. Activation of NMDA receptor and its effect on markers for the BBB at the capillary level in the mouse hippocampus. (A–D) C57/BL6 mouse was injected retro-orbitally with PBS(A), NMDA (0.5 mg/kg) (B), NMDA with MK801 (0.5 mg/kgeach) (C), and MK801 (0.5 mg/kg) (D) for 1 min and mice were sacrificed and fixed with 4% PFA overnight. Sections were stained with different markers for the blood brain barrier (BBB), CD31 (Green,1:500), CD13 (Gray,1:500), and GFAP (Red,1:500), a marker for endothelial cells, pericyte, and astrocyte, respectively. Magnified images of each treatment are displayed at the bottom panel. Scale bar indicates 200 μm and 75 μm for upper and bottom panel, respectively. Figure S7. Activation of NMDA receptor and its effect on markers for the BBB at the capillary level in the mouse ventral striatum. (A–D) C57/BL6 mouse was injected retro-orbitally with PBS(A), NMDA (0.5 mg/kg) (B ), NMDA with MK801 (0.5 mg/kgeach) (C), and MK801 (0.5 mg/kg) (D) for 1 min and mice were sacrificed and fixed with 4% PFA overnight. Sections were stained with different markers for the blood brain barrier (BBB), CD31 (Green,1:500), CD13 (Gray,1:500), and GFAP (Red,1:500), a marker for endothelial cells, pericyte, and astrocyte, respectively. Magnified images of each treatment are displayed at the bottom panel. Scale bar indicates 200 μm and 75 μm for upper and bottom panel, respectively. Activation of NMDA receptor and absence of its toxic effect on neuronal cells. C57/BL6 mouse was injected retro-orbitally with PBS (A), NMDA (0.5 mg/kg) for 1 min and mice were sacrificed and fixed with 4% PFA overnight. Sections were stained with NeuN (yellow), a marker for neuronal cells. Scale bar indicates 500μm. Figure S8. Activation of NMDA receptor and absence of its inflammatory responses in the brain. C57/BL6 mouse was injected retro-orbitally with PBS or NMDA (0.5 mg/kg) for 1 min. (A) Fresh frozen brain sections were stained with anti-CD45 (Green) and anti-CD31 (Red), marker of peripheral immune cells and brain endothelial cells, respectively. Scale bar indicates 75 μm. (B) Fresh frozen sections were stained with anti-intercellular adhesion molecule 1 (ICAM1, red) to test the increased level of adhesion molecule. Scale bar indicates 75 μm. Activation of NMDA receptor reduces lectin and glycocalyx in the brain endothelial cells. C57/BL6 mouse was injected retro-orbitally with PBS or NMDA (0.5 mg/kg) for 1 min. (A) PFA fixed brain sections were stained with AF488-conjugated wheat germ agglutinin (Green) to stain lectin. Scale bar indicates 75 μm. (B) PFA fixed brain section was stained with alcian blue to visualize glycocalyx. Arrow indicates the presence of brain vasculature stained with alcian blue. Scale bar indicates 75 μm.

Supplemental material, sj-docx-1-tam-10.1177_17588359221097190 for Real-world outcomes of adjuvant gemcitabine versus gemcitabine plus capecitabine for resected pancreatic ductal adenocarcinoma by Sora Kang, Changhoon Yoo, So Heun Lee, Dongwook Oh, Tae Jun Song, Sang Soo Lee, Jae Ho Jeong, Do Hyun Park, Dong Wan Seo, Jin-hong Park, Dae Wook Hwang, Ki Byung Song, Jae Hoon Lee, Woohyung Lee, Bong Jun Kwak, Sarang Hong, Heung-Moon Chang, Baek-Yeol Ryoo, Kyu-pyo Kim and Song Cheol Kim in Therapeutic Advances in Medical Oncology

Incorporating solid-state quantum emitters into optical fiber networks enables the long-distance transmission of quantum information and the remote connection of distributed quantum nodes. However, interfacing quantum emitters with fiber optics encounters several challenges, including low coupling efficiency and stability. Here, we demonstrate a highly efficient fiber-interfacing photonic device that directly launches single photons from quantum dots into a standard FC/PC-connectorized single-mode fiber (SMF28). Optimally designed photonic structures based on hole gratings produce an ultra-narrow directional beam that matches the small numerical aperture of a single-mode fiber. A pick-and-place technique selectively integrates a single miniaturized device into the core of the fiber. Our approach realizes a plug-and-play single-photon device that does not require any optical alignment and thus guarantees long-term stability. The results thus represent a major step toward practical and reliable quantum lights across a fiber network., Comment: 19 pages, 10 figures including supporting information

Supplemental material, sj-docx-1-tam-10.1177_17588359221097190 for Real-world outcomes of adjuvant gemcitabine versus gemcitabine plus capecitabine for resected pancreatic ductal adenocarcinoma by Sora Kang, Changhoon Yoo, So Heun Lee, Dongwook Oh, Tae Jun Song, Sang Soo Lee, Jae Ho Jeong, Do Hyun Park, Dong Wan Seo, Jin-hong Park, Dae Wook Hwang, Ki Byung Song, Jae Hoon Lee, Woohyung Lee, Bong Jun Kwak, Sarang Hong, Heung-Moon Chang, Baek-Yeol Ryoo, Kyu-pyo Kim and Song Cheol Kim in Therapeutic Advances in Medical Oncology

Additional file 1. EDX spectrum and atomic composition analysis of MQDs and alloy QDs; TEM���EDX images of MQDs and alloy QDs; TEM images of MQDs-FA and alloy QDs-FA; TEM���EDX images of MQDs, alloy QDs, MQDs-FA, and alloy QDs-FA; QY of hydrophobic MQDs/alloy QDs, hydrophilic MQDs/alloy QDs, 3-azido-1-propanamine conjugated MQDs/alloy QDs, and dopamine conjugated MQDs/alloy QDs; QY of Qdot��� 625 ITK��� Carboxyl Quantum Dots in Invitrogen��� before and after conjugation of FA; Cell viability test of fabricated QDs via CCK-9 assay; Protein levels of mice after 24 h from injection of PBS or QDs; Liver hematoxylin and eosin (H&E) staining of PBS, MQDs, and alloy QDs treated mice; Immunohistochemistry staining for caspase-3 detection of PBS, MQDs, and alloy QDs treated mice; Caspase-3 level of PBS, MQDs, and alloy QDs treated mice.

This study aims to prove effects of exercise on stomach cancer patients through literature review and provide basic materials for development of programs of systematic exercise. In the study of Na et el.(2001) that carried out an aerobic exercise program oriented to stomach cancer patients after operation, NK cells increased in the exercise group. In the study of Choi J ini et al.(2012), according to the result of an 8-week-long exercise program oriented to stomach cancer patients under oral chemotherapy after operation, patients showed positive effects in terms of fatigue and anxiety, and improvement in NK cells and quality of life. On the other hand, the study of Sohn Yun-seon(2013) that carried out an exercise program in the complex anaerobic-aerobic form oriented to early-stage stomach cancer patients demonstrated improvement in maximal oxygen uptake. In the study of Wiebke Jansen et al.(2014), the results of an exercise program in the complex anaerobic-aerobic form oriented to gastrointestinal cancer patients under the palliative chemotherapy showed decreased level of fatigue of patients and increased sleeping hours and augmented level of muscular strength in the anaerobic exercise group. The studies confirmed that application of exercise programs for stomach cancer patients gave positive influences on them in all stages; after the operation, during the treatment and after the treatment. However, there are a small number of studies regarding development of customized exercise programs for stomach cancer patients. It is estimated that the number of stomach cancer patients will increase even more in the future because the rate of stomach cancer is steadily on the rise and the relative survival rate is also increasing after operation and treatment. It is considered highly important to provide exercise-based management for patients, during the post-diagnosis cancer treatment process and after treatment.

Introduction: Post-traumatic osteoarthritis (PTOA) is a type of osteoarthritis that develops after ligament injury, meniscus injury, or fracture. Currently, there is no specific treatment approved for PTOA. This report describes the case of a 38-year-old man who suffered from PTOA of the right second distal interphalangeal (DIP) joint after practicing judo. Patient concerns: He visited the author's clinic at 3 months after the onset of symptoms. Symptoms included pain, limited motion, and joint enlargement of the right second DIP joint. Diagnosis: Partial tear of the ulnar collateral ligament of the DIP was revealed by magnetic resonance imaging. As the symptoms appeared after the traumatic event, PTOA was diagnosed. Interventions: Intra-articular hominis placenta pharmacopuncture and joint movement manual therapy were performed on each visit. Altogether, 10 sessions were performed until the symptoms improved remarkably. Outcomes: Visual analogue scale score (VAS) for pain; Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDASH); joint circumference; and range of motion showed improvements at the end of the treatment. VAS decreased from 8.4 to 0.4, QuickDASH decreased from 44 to 13, joint circumference decreased from 5.5 to 5.4 cm, and range of motion was almost recovered, which was measured by the photographs. Lessons: There are not enough studies on phalangeal joint PTOA and its treatment. This case suggests pharmacopuncture and joint movement manual therapy as treatment options for phalangeal PTOA.

One of the challenges in a task oriented natural language application like the Google Assistant, Siri, or Alexa is to localize the output to many languages. This paper explores doing this by applying machine translation to the English output. Using machine translation is very scalable, as it can work with any English output and can handle dynamic text, but otherwise the problem is a poor fit. The required quality bar is close to perfection, the range of sentences is extremely narrow, and the sentences are often very different than the ones in the machine translation training data. This combination of requirements is novel in the field of domain adaptation for machine translation. We are able to reach the required quality bar by building on existing ideas and adding new ones: finetuning on in-domain translations, adding sentences from the Web, adding semantic annotations, and using automatic error detection. The paper shares our approach and results, together with a distillation model to serve the translation models at scale., 12 pages, 10 figures

Background Monoclonal antibodies (mAbs) have proved to be a valuable tool for the treatment of different cancer types. However, clinical use of an increasing number of mAbs, have also highlighted limitations with monotherapy for cancers, in particular for such with more complex mechanisms, requiring action on additional molecules or pathways, or for cancers quickly acquiring resistance following monotherapy. An example for the latter is the mAb trastuzumab, FDA approved for treatment of metastatic gastric carcinoma. To circumvent this, researchers have reported synergistic, anti-proliferative effects by combination targeting of HER2 and EGFR by trastuzumab and the EGFR-targeting mAb Cetuximab overcoming trastuzumab resistance. Methods Maintaining the proven functionality of trastuzumab, we have designed bi-specific antibody molecules, called AffiMabs, by fusing an EGFR-targeting Affibody molecule to trastuzumab’s heavy or light chains. Having confirmed binding to EGFR and Her2 and cytotoxicity of our AffiMabs, we analyzed apoptosis rate, receptor surface levels, phosphorylation levels of receptors and associated signaling pathways as well as differentially expressed genes on transcriptome level with the aim to elucidate the mode of action of our AffiMabs. Results The AffiMabs are able to simultaneously bind HER2 and EGFR and show increased cytotoxic effect compared to the original trastuzumab therapeutic molecule and, more importantly, even to the combination of trastuzumab and EGFR-targeting Affibody molecule. Analyzing the mode of action, we could show that bi-specific AffiMabs lead to reduced surface receptor levels and a downregulation of cell cycle associated genes on transcriptome level. Conclusion Our study shows that transcriptome analysis can be used to validate the choice of receptor targets and guide the design of novel multi-specific molecules. The inherent modularity of the AffiMab format renders it readily applicable to other receptor targets. Supplementary Information The online version contains supplementary material available at 10.1007/s40268-021-00339-2.

AIM When intravenous thrombolysis cannot be performed for cerebral infarction, antiplatelet drugs can be used before endovascular thrombectomy (EVT) to prevent procedural thromboembolism. We retrospectively compared an antiplatelet-preparation group with a no-preparation group to evaluate the effect of the antiplatelet preparation on procedural thromboembolism during EVT with diffusion-weighted imaging (DWI). MATERIAL AND METHODS From January 2017 to April 2020, EVT was performed in 60 patients with cerebral infarction. Patients were categorized into the antiplatelet-preparation group (n = 25) or the no-preparation group (n = 35). Procedural thromboembolism was defined as new DWI-positive lesions in other areas of the occluded artery after EVT. RESULTS The antiplatelet-preparation and no-preparation groups did not differ in the rate of procedural thromboembolism occurrence (6/25 [24.0%] vs. 6/35 [17.1%]; P = 0.532). Procedural thromboembolism was associated with age (74.4 ± 6.95 years vs. 65.7 ± 12.9 years; P = 0.028), atherosclerotic occlusion (66.7% vs. 29.2%; P = 0.022), and procedural time (97.4 ± 45.7 min vs. 60.1 ± 28.8 min; P = 0.001). Multivariable logistic regression analysis showed that factors affecting procedural thromboembolism during EVT for cerebral infarction were old age (odds ratio [OR], 1.133; 95% confidence interval [CI], 1.009-1.273; P = 0.035), atherosclerotic occlusion (OR, 7.434; 95% CI, 1.272-43.431; P = 0.026), and longer procedural time (OR, 1.023; 95% CI, 1.001 - 1.046; P = 0.006). CONCLUSION The antiplatelet preparation had no significant protective effect on procedural thromboembolism during EVT for cerebral infarction. Old age, atherosclerotic occlusion, and longer procedural time were independent risk factors for procedural thromboembolism during EVT for cerebral infarction.

Additional file 1.

High levels of serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) are associated with increased diabetes risk. In the present study, we investigated the combined effects of ALT and GGT on the development of diabetes in a Korean population. A total of 9405 individuals (4020 women and 5385 men) without diabetes were enrolled in this study. From the baseline health screening to the follow-up examination, the development of diabetes, based on changes in ALT and GGT quartile levels, was analyzed. In addition, we analyzed the quartiles of ALT and GGT together to determine any synergistic effect from the fourth quartile of ALT and GGT on the development of diabetes. The development of diabetes gradually increased with an increase in the circulating levels of ALT and GGT. For the fourth quartile ALT and GGT, the hazard ratios of diabetes compared with the first quartile were 1.892 (95% confidence interval [CI]: 1.26–2.83, P = .002) and 3.526 (95% CI: 2.12–5.85, P

Rationale: The challenges with reconstruction of penile defects are plenty. In addition, no single and universally accepted reconstructive method exists for penile defect repair. Herein, we present the application of a circumferential penile shaft defect reconstruction using pull-up double-opposing keystone-designed perforator island flaps (KDPIFs) in one patient. This is the first case report of a circumferential penile shaft defect reconstruction using KDPIFs. Patient concerns: A 43-year-old man who injected petroleum jelly into his penis 10 years ago presented with multiple firm nodular mass-like lesions adherent to the overlying skin along the penile shaft. Our urologic surgeon removed the foreign bodies and performed a primary closure with undermining. However, wound dehiscence developed, and skin necrosis was exacerbated 5 days postoperatively. Diagnoses: We performed debridement, and the final post-debridement defect was circumferential (5.5 × 12 cm) from the base of the glans to the midpoint of the penile shaft. Interventions: We covered the defect using pull-up double-opposing KDPIFs (10 × 13 cm each) based on the hot spots of the superficial external pudendal artery perforators on each side from the suprapubic area to the scrotum. Outcomes: The flaps survived perfectly, with no postoperative complications. The patient was satisfied with the final outcome and had no erectile dysfunction or shortening of penile length after a 6-month follow-up. Lessons: We successfully reconstructed a circumferential penile defect with pull-up double-opposing KDPIFs both esthetically and functionally. Our technique can be a good alternative modality for extensive penile defect reconstruction.

Cashier-free shopping systems like Amazon Go improve shopping experience, but can require significant store redesign. In this paper, we propose Grab, a practical system that leverages existing infrastructure and devices to enable cashier-free shopping. Grab needs to accurately identify and track customers, and associate each shopper with items he or she retrieves from shelves. To do this, it uses a keypoint-based pose tracker as a building block for identification and tracking, develops robust feature-based face trackers, and algorithms for associating and tracking arm movements. It also uses a probabilistic framework to fuse readings from camera, weight and RFID sensors in order to accurately assess which shopper picks up which item. In experiments from a pilot deployment in a retail store, Grab can achieve over 90% precision and recall even when 40% of shopping actions are designed to confuse the system. Moreover, Grab has optimizations that help reduce investment in computing infrastructure four-fold.

Background The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P

In this study, the flow analysis of center-body type diffuser was performed using the “ARCFLO4” flow analysis solver and, the performance of the diffuser according to various shapes and positions of the center-body was evaluated. Thermal equilibrium air was assumed and turbulence was considered. The performance of the diffuser was evaluated by using the pressure recovery rate of the diffuser, the velocity and the temperature at the diffuser outlet, which can determine the requirements of the heat exchanger and vacuum pump located behind the diffuser. As a result of the flow analysis, when the center-body is located in the whole diffuser area, the loss of total pressure due to the inclined shock wave generated in the hypersonic region was significant. Therefore, the diffuser which is center-body located in hypersonic region had disadvantages in the pressure recovery aspect. However, since the center-body type diffuser has advantages in cooling compressed high-temperature flow by increasing the cooling wall area inside the diffuser, a center-body diffuser located in subsonic region was proposed in this study. This new center-body type diffuser was able to cool flow while minimizing the total pressure loss due to shock waves.

The purpose of this study is to suggest the implications and implications of the results based on the results of the relationship between the attachment and the quality of relationship and the behavioral intention. In order to present the results of this study, the hypotheses were tested and verified. It is important to understand that the self-congruity of tourists is influenced by functional consistency, attachment, quality of relationship, and behavioral relationship, but it is important to continuously evaluate and evaluate such results. Therefore, it is necessary to take a lot of measures to create a love mark beyond the image of the tourist destination through the hardware and the software of the tourist resource that can attract the tourist in the tourist destination. However, this study needs to be studied through sample survey and continuous research observation through sample enlargement.

Hikari Hori. Promiscuous Media: Film and Visual Culture in Imperial Japan, 1926-1945. Ithaca, NY: Cornell University Press, 2018. 312 pp. $55 (cloth). Jennifer Coates. Making Icons: Repetition and the Female Image in Japanese Cinema, 1945-1964. Hong Kong: Hong Kong University Press, 2017. 244 pages. $65 (cloth). Hori’s analyses and interpretations of the key visual/filmic texts are absolutely riveting and powerfully stimulating, compelling us to seek out the media works in question and reevaluate their meanings with our own eyes. Coates’s sweeping readings are also extremely impressive in their propensity to bring together interdisciplinary insights from sometimes surprising sources, raising some difficult questions about how we have hitherto treated with complacency (and substantively ignored) the centrality of women in postwar Japanese cinema. With these new publications, these two scholars have made significant contributions to advancing our understanding of wartime and immediate postwar Japanese culture. Their books should be considered must-reads for any serious student of twentieth-century Japanese cinema and popular culture...