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Background: Monte Carlo (MC) modeling of MR‐guided radiotherapy (MRgRT) treatment machines enables the characterization of photon/electron interactions in the presence of a magnetic field. The EGSnrc MC code system is a well‐established system for radiation dose calculations. The multi‐leaf collimator (MLC) component modules presently available within the EGSnrc MC code system do not include a model of the double‐focused MLC available on a low‐field (0.35T) MRI linear accelerator (MR linac). Purpose: Here we developed and validated a new component module (CM) for the low‐field MRgRT MLC using the EGSnrc/BEAMnrc/DOSXYZnrc code system. We performed detailed modeling of the treatment head and validated the model using measurements and calculations from the vendor‐specific treatment planning system (TPS). Methods: The detailed geometry of the low‐field MR linac MLC and other treatment head structures were modeled using BEAMnrc. Comparisons of DOSXYZnrc simulated dose against measurements and the low‐field MR linac TPS for a variety of AAPM TG‐53 task group report suggested square and shaped fields, as well as a step‐and‐shoot intensity‐modulated radiotherapy (IMRT) plan, are presented. Results: Our model agrees with both measured and TPS calculated data on average within 2%/2 mm (dose/DTA) criterion for square field profiles. Output factors agreed within 1% for field sizes down to 2.49 × 2.49 cm2 and within 2% of TPS data for the smallest field size of 0.83 × 0.83 cm2. Shaped field and IMRT MC calculations agreed with measured and TPS data such that the gamma pass rates (3%/2 mm) were 99.5% and (3%/3 mm) 96.2%, respectively. Conclusions: We developed and validated an MLC CM (SYNCVRMLC) for the low‐field MR linac using the EGSnrc MC code systems. This new CM will facilitate MC computation of fluence and dose distributions using BEAMnrc/DOSXYZnrc for patients treated on the low‐field MR linac. [ABSTRACT FROM AUTHOR] more...

In the strategy to combat climate change that has been caused by the world's overdependence on fossil fuels, current research is focusing on the decarbonisation of the energy sector through the production of renewable cleaner energy, such as biofuels. Spent coffee grounds (SCGs), the waste stream of the coffee brewing industry, are a potential feedstock for the production of valuable products, including biofuels. However, the environmental implications for the valorisation of this valuable waste need to be investigated. This study assesses the environmental impacts of six biomass‐to‐fuel processing technologies using SCGs as a feedstock, with the aim of identifying the most environmentally friendly technology. A cradle‐to‐gate life‐cycle assessment (LCA) was conducted on fast pyrolysis, fermentation, anaerobic digestion (AD), hydrothermal liquefaction (HTL), gasification, and biodiesel production. The mass and energy balances obtained from Aspen Plus simulations served as the life‐cycle inventory data. Using the ReCiPe 2016 midpoint (H) and Eco‐Indicator 99 as the assessment methods, potential environmental impacts were calculated in OpenLCA software. Electricity generation and carbon dioxide emissions were the biggest contributors of environmental impacts. For each category, the maximum result was set to 100% and the results of the other variants were displayed in relation to this result. AD, with the smallest total weighted score (160), was the most environmentally friendly biomass‐to‐fuel processing route, while HTL, with the biggest total weighted score (893), was the worst. A sensitivity analysis indicated that the environmental performance of biofuel production from SCGs was highly influenced by energy input flows and the source of energy generation. [ABSTRACT FROM AUTHOR] more...

Aims Materials and methods Results Conclusions To create and validate a weakly supervised artificial intelligence (AI) model for detection of abnormal colorectal histology, including dysplasia and cancer, and prioritise biopsies according to clinical significance (severity of diagnosis).Triagnexia Colorectal, a weakly supervised deep learning model, was developed for the classification of colorectal samples from haematoxylin and eosin (H&E)‐stained whole slide images. The model was trained on 24 983 digitised images and assessed by multiple pathologists in a simulated digital pathology environment. The AI application was implemented as part of a point and click graphical user interface to streamline decision‐making. Pathologists assessed the accuracy of the AI tool, its value, ease of use and integration into the digital pathology workflow.Validation of the model was conducted on two cohorts: the first, on 100 single‐slide cases, achieved micro‐average model specificity of 0.984, micro‐average model sensitivity of 0.949 and micro‐average model F1 score of 0.949 across all classes. A secondary multi‐institutional validation cohort, of 101 single‐slide cases, achieved micro‐average model specificity of 0.978, micro‐average model sensitivity of 0.931 and micro‐average model F1 score of 0.931 across all classes. Pathologists reflected their positive impressions on the overall accuracy of the AI in detecting colorectal pathology abnormalities.We have developed a high‐performing colorectal biopsy AI triage model that can be integrated into a routine digital pathology workflow to assist pathologists in prioritising cases and identifying cases with dysplasia/cancer versus non‐neoplastic biopsies. [ABSTRACT FROM AUTHOR] more...

Background and Objectives. The scarce empirical and scientific information concerning evidence-informed management reports various benefits for nurse managers, including reduced staff turnover, enhanced working environments, and improved patient outcomes and policy implementation. This review summarizes best available evidence on facilitating utilization of evidence-informed management practices by nurse managers in healthcare facilities. The review could assist in a comprehensive overview of determinants that could assist nurse managers' successful utilization of evidence-informed management. Methods. An integrative review of the literature was conducted, including peer-reviewed articles published between 2010 and 2022. The databases used were BioMed Central, CINAHL Complete, MEDLINE Complete, PubMed (via EBSCOhost), the Complimentary Index (Taylor and Francis, Elsevier, Wiley, and Springer), Sabinet, ScienceDirect, and Scopus, followed by a manual search using Google Scholar and a citation search. Johns Hopkins Nursing Evidence-based Practice Research and non-Research evidence tools were used for appraisal. Thematic analysis was used to synthesize the extracted data. Results. Based on thirteen determinants influencing nurse managers' utilization of evidence-informed management practices, three themes were identified from a total of thirteen relevant studies: (1) Nurse manager determinants in utilization of evidence-informed management (Microlevel); (2) Organizational determinants in utilization of evidence-informed management (Mesolevel); (3) External stakeholders and context determinants of utilization of evidence-informed management practices (Macrolevel). Conclusion. The themes were found to be interconnected and interdependent, facilitating the effective utilization of evidence-informed management by nurse managers at micro-, meso-, and macrolevels, but highlight the need for strengthening health systems and support. Future studies are required to provide a more comprehensive understanding of the determinants influencing nurse managers' utilization of evidence-informed management practices. Implications for Nursing Management. For nurse managers to optimally utilize evidence-informed management, executive management and policymakers require to provide resources and support such as continuous education, incentives, effective communication, funding structures, and ownership. [ABSTRACT FROM AUTHOR] more...

Small extracellular vesicles (sEVs) released by acute myeloid leukaemia (AML) cells have been reported to influence the trilineage differentiation of bone marrow‐derived mesenchymal stem cells (BM‐MSCs). However, it remains elusive which biological cargo from AML‐sEVs is responsible for this effect. In this study, sEVs were isolated from cell‐conditioned media and blood plasma using size‐exclusion chromatography and ultrafiltration and characterized according to MISEV2018 guidelines. Our results demonstrated that AML‐sEVs increased the proliferation of BM‐MSCs. Conversely, key proteins that are important for normal haematopoiesis were downregulated in BM‐MSCs. Additionally, we revealed that AML‐sEVs significantly reduced the differentiation of BM‐MSCs to osteoblasts without affecting adipogenic or chondrogenic differentiation. Next, LC‐MS/MS proteomics elucidated that various proteins, including Y‐box‐binding protein 1 (YBX1), were upregulated in both AML‐sEVs and BM‐MSCs treated with AML‐sEVs. Clinically relevant, we found that YBX1 is considerably upregulated in most paediatric AML patient‐derived sEVs compared to healthy controls. Interestingly, sEVs isolated after the downregulation of YBX1 in AML cells remarkably rescued the osteoblastic differentiation of BM‐MSCs. Altogether, our data demonstrate for the first time that YBX1 containing AML‐sEVs is one of the key players that disrupt the normal function of bone marrow microenvironment by reducing the osteogenic differentiation of BM‐MSCs. [ABSTRACT FROM AUTHOR] more...

Objectives: To investigate the impact of reducing Clinical Target Volume (CTV) to Planning Target Volume (PTV) margins on delivered radiation therapy (RT) dose and patient reported quality-of -life (QOL) for patients with localized prostate cancer. Methods: Twenty patients were included in a single institution IRB-approved prospective study. Nine were planned with reduced margins (4 mm at prostate/rectum interface, 5 mm elsewhere), and 11 with standard margins (6/10 mm). Cumulative delivered dose was calculated using deformable dose accumulation. Each daily CBCT dataset was deformed to the planning CT (pCT), dose was computed, and accumulated on the resampled pCT using a parameter-optimized, B-spline algorithm (Elastix, ITK/VTK). EPIC-26 patient reported QOL was prospectively collected pre-treatment, post-treatment, and at 2-, 6-, 12-, 18-, 24-, 36-, 48-, and 60-month follow-ups. Post -RT QOL scores were baseline corrected and standardized to a [0--100] scale using EPIC-26 methodology. Correlations between QOL scores and dosimetric parameters were investigated, and the overall QOL differences between the two groups (QOLMargin-reduced-QOLcontrol) were calculated. Results: The median QOL follow-up length for the 20 patients was 48 months. Difference between delivered dose and planned dose did not reach statistical significance (p > 0.1) for both targets and organs at risk between the two groups.At 4 years post-RT, standardized mean QOLMargin-reduced-QOLcontrol were improved for Urinary Incontinence, Urinary Irritative/Obstructive, Bowel, and Sexual EPIC domains by 3.5, 14.8, 10.2, and 16.1, respectively (higher values better). The control group showed larger PTV/rectum and PTV/bladder intersection volumes (7.2 ± 5.8, 18.2 ± 8.1 cc) than the margin-reduced group (2.6 ± 1.8, 12.5 ± 8.3 cc), though the dose to these intersection volumes did not reach statistical significance (p > 0.1) between the groups. PTV/rectum intersection volume showed a moderate correlation (r = -0.56, p < 0.05) to Bowel EPIC domain. Conclusions: Results of this prospective study showed that margin-reduced group exhibited clinically meaningful improvement of QOL without compromising the target dose coverage. [ABSTRACT FROM AUTHOR] more...

This document is a guest editorial from the journal IET Radar, Sonar & Navigation. It discusses the advances in AI-assisted radar sensing applications and the challenges that hinder its adoption in this field. The special issue of the journal features nine papers that address these challenges and offer innovative ideas and experimental results. The papers cover a range of topics, including health monitoring, human activity recognition, voice identification, elderly care health monitoring, track-to-track association, signal pre-processing, traffic congestion alleviation, and target recognition. The authors express their gratitude to the contributors and reviewers and believe that the research presented will inspire further exploration and innovation in this field. [Extracted from the article] more...

Introduction: The diagnosis of plasma cell neoplasms depends on the accurate quantification of plasma cells, traditionally done by immunohistochemical CD138 staining of bone marrow biopsies. Currently, there is no fully satisfactory reference method for this quantification. In our previous study, we compared the commonly used overview estimation method (method A) with a novel method for counting plasma cells in three representative areas (method B). Results showed comparable concordance parameters between the two methods. In this follow‐up study, we compared the previously evaluated methods with a digital analysis method (method C) that uses artificial intelligence in open‐source software, QuPath. Methods: Archived CD138 immunohistochemically stained trephine sections of bone marrow samples used in our previous study were used (n = 33). Reviewers selected three representative areas on each sample by taking images with a light microscope and camera. Digital analysis was performed using the positive cell detection function in QuPath. The entire process was repeated by each reviewer to test intraobserver concordance (concordance correlation coefficient [CCC]) in addition to interobserver concordance (intraclass correlation coefficient [ICC]). Results: Intraobserver concordance of method C showed strong agreement for all reviewers with the lowest CCC = 0.854. Interobserver concordance for method C using ICC was 0.909 and 0.949. This showed high interobserver agreement with significant differences between method C and previously assessed method A (ICC = 0.793 and 0.713) and method B (ICC = 0.657 and 0.658). Conclusion: We were able to successfully count CD138‐positive plasma cells in bone marrow biopsies using artificial intelligence. This method is superior to both manual counting and overview estimation, regardless of tumour load. [ABSTRACT FROM AUTHOR] more...

Consumers expect safe, healthy, natural, and sustainable food. Within the food industry, ingredient use is changing due to these consumer demands. While no single agreed-upon definition of clean label exists, a "clean label" in the context of food refers to a product that has a simplified and transparent ingredient list, with easily recognizable and commonly understood components to the general public. Clean-label products necessitate and foster a heightened level of transparency between companies and consumers. Dairy products are vulnerable to being contaminated by both pathogens and spoilage microorganisms. These microorganisms can be effectively controlled by replacing conventional antimicrobials with clean-label ingredients such as protective cultures or bacterial/fungal fermentates. This review summarizes the perspectives of consumers and the food industry regarding the definition of "clean label," and the current and potential future use of clean-label antimicrobials in dairy products. A key goal of this review is to make the concept of clean-label antimicrobial agents better understood by both manufacturers and researchers. [ABSTRACT FROM AUTHOR] more...

Air filtration plays a vital role in the performance and operations of engines, especially for heavy‐duty combat vehicles operating in the desert environment. Conventional cellulose media comprises micro‐fibers exhibiting low filtration efficiency for particles within the range of 0.1 to 0.5 μm (most penetrating particle size, MPPS). Nanofiber coating on cellulose media can increase the filtration efficiency, however, with the penalty of an increase in pressure drop. The features of nylon‐66 nanofibers, such as high mechanical strength, greater thermal stability, and high surface‐to‐volume ratio, will be beneficial for developing nano‐coated filter media. In this study, electrospun nylon‐66 nanofibers were coated over two cellulose‐based filter media and tested on an air filtration test rig that employs a suction‐type blower replicating the realistic condition of a heavy‐duty engine intake. The test rig was fabricated to evaluate the performance of the nano‐coated filter media in terms of pressure drop, filtration efficiency, and quality factor (Q‐factor). The experimental results demonstrated that the nylon‐66 nano‐coated media have higher Q‐factor (in the MPPS range) than the cellulose media due to the increased filtration efficiency compared to the rise in pressure drop. Therefore, such electrospun nylon‐66 nanofiber‐coated air filters can be an alternative to conventional cellulose media. [ABSTRACT FROM AUTHOR] more...

Purpose: Deep learning‐based networks have become increasingly popular in the field of medical image segmentation. The purpose of this research was to develop and optimize a new architecture for automatic segmentation of the prostate gland and normal organs in the pelvic, thoracic, and upper gastro‐intestinal (GI) regions. Methods: We developed an architecture which combines a shifted‐window (Swin) transformer with a convolutional U‐Net. The network includes a parallel encoder, a cross‐fusion block, and a CNN‐based decoder to extract local and global information and merge related features on the same scale. A skip connection is applied between the cross‐fusion block and decoder to integrate low‐level semantic features. Attention gates (AGs) are integrated within the CNN to suppress features in image background regions. Our network is termed "SwinAttUNet." We optimized the architecture for automatic image segmentation. Training datasets consisted of planning‐CT datasets from 300 prostate cancer patients from an institutional database and 100 CT datasets from a publicly available dataset (CT‐ORG). Images were linearly interpolated and resampled to a spatial resolution of (1.0 × 1.0× 1.5) mm3. A volume patch (192 × 192 × 96) was used for training and inference, and the dataset was split into training (75%), validation (10%), and test (15%) cohorts. Data augmentation transforms were applied consisting of random flip, rotation, and intensity scaling. The loss function comprised Dice and cross‐entropy equally weighted and summed. We evaluated Dice coefficients (DSC), 95th percentile Hausdorff Distances (HD95), and Average Surface Distances (ASD) between results of our network and ground truth data. Results: SwinAttUNet, DSC values were 86.54 ± 1.21, 94.15 ± 1.17, and 87.15 ± 1.68% and HD95 values were 5.06 ± 1.42, 3.16 ± 0.93, and 5.54 ± 1.63 mm for the prostate, bladder, and rectum, respectively. Respective ASD values were 1.45 ± 0.57, 0.82 ± 0.12, and 1.42 ± 0.38 mm. For the lung, liver, kidneys and pelvic bones, respective DSC values were: 97.90 ± 0.80, 96.16 ± 0.76, 93.74 ± 2.25, and 89.31 ± 3.87%. Respective HD95 values were: 5.13 ± 4.11, 2.73 ± 1.19, 2.29 ± 1.47, and 5.31 ± 1.25 mm. Respective ASD values were: 1.88 ± 1.45, 1.78 ± 1.21, 0.71 ± 0.43, and 1.21 ± 1.11 mm. Our network outperformed several existing deep learning approaches using only attention‐based convolutional or Transformer‐based feature strategies, as detailed in the results section. Conclusions: We have demonstrated that our new architecture combining Transformer‐ and convolution‐based features is able to better learn the local and global context for automatic segmentation of multi‐organ, CT‐based anatomy. [ABSTRACT FROM AUTHOR] more...

Aims: To assess the safety and feasibility of hyperthermic intraperitoneal chemotherapy (HIPEC) during cytoreduction surgery (CRS) in advanced high‐grade serous ovarian, fallopian tube and peritoneal cancer within an Australian context. Methods: Data were collected from 25 consecutive patients undergoing CRS and HIPEC from December 2018 to July 2022 at the Peritoneal Malignancy Service at the Mater Hospital Brisbane, Australia. Data collected included demographics, clinical variables, surgical procedures and complications and intra‐operative and post‐operative indexes of morbidity. Results: Twenty‐five women who underwent CRS and HIPEC from December 2018 to July 2022 were included in analysis. Findings indicate that CRS with HIPEC is associated with low morbidity. Conclusion: While judicious patient selection is imperative, HIPEC during CRS was well tolerated by all patients and morbidity was comparable to results from the previously reported OVHIPEC‐1 trial. HIPEC appears to be a safe and feasible addition to CRS for the treatment of advanced ovarian cancer in Australian practice. [ABSTRACT FROM AUTHOR] more...

Developing thermoelectric (TE) performance is impeded by the compromise of TE parameters, resulting in inadequate conversion efficiency of heat to electricity. Herein, this work reports that Mo is a particularly effective additive in Mg3Sb2‐based alloys with significantly improved electronic transport via grain‐boundary engineering and band‐structure regulation synergy. In addition, phonon transport is simultaneously suppressed by employing multiple effects, lattice imperfection scattering, reduced phonon group velocity, and enhanced atomic disorder, leading to a minimum κlat = 0.52 W m−1 K−1 at 723 K. As a result, an outstanding ZT peak of ≈1.84 at 723 K and ZTav = 1.34 within 323–723 K are achieved in Mg3Sb2‐based alloys, and the corresponding fabricated single‐leg TE module shows an exceptionally high conversion efficiency of ≈12% under a hot‐side temperature of 450 °C. These results demonstrate the great potential for advancing mid‐temperature heat harvesting in Mg3Sb2‐based materials. [ABSTRACT FROM AUTHOR] more...

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the GI tract, usually found in the stomach, jejunum, and ileum. Typically, they are KIT or PDGFR-mutated, allowing for targetable treatments with tyrosine kinase inhibitors such as imatinib. Here, we present two KRAS-mutated wild-type gastrointestinal tumours (GISTs). Both cases occurred in the small bowel of females. Immunohistochemical studies on both tumours showed KIT and DOG-1 positivity, with SDHB retained. Molecular analysis revealed a KRAS G12D mutation and a KRAS G13D mutation, respectively. Wild-type GISTs are extremely uncommon. They typically occur in the stomach or the small bowel. KRAS is one of the genes implicated in this subset of GIST, with KRAS G12D being the most frequently encountered mutation. GIST KRAS mutations can arise alone or in conjunction with KIT, PDFRA, or BRAF mutations. Identification of these rare molecular subtypes is clinically important due to their resistance to imatinib therapy. [ABSTRACT FROM AUTHOR] more...

Introduction: Bone marrow examination (BME) is a reliable and effective tool in the diagnosis of many haematological and non‐haematological diseases and may be used to investigate unexplained cytopenia in human immunodeficiency virus (HIV) infected patients. The objective of this study was to determine the diagnoses made, diagnostic yield and unique diagnostic yield of BMEs performed to investigate cytopenias in HIV infected patients. Method: A retrospective cross‐sectional descriptive study was performed involving all BMEs performed on HIV‐infected adult patients with the main indication of unexplained cytopenia over a period of 5 years and 4 months. Data was extracted from the National Health Laboratory Service's laboratory information system and clinicians' BME request forms. Results: The study included 128 BMEs, performed on 124 patients. The diagnostic yield was 32% and the unique diagnostic yield was 30.5%. The most common diagnosis was pure red cell aplasia (10.9%), followed by immune thrombocytopenic purpura (ITP) (7%), iron deficiency anaemia (6.3%), malignancy (4.7%) and disseminated infection (3.9%). Conclusion: BME is a useful investigation for unexplained cytopenia in HIV‐infected patients. Less invasive investigations to exclude haematinic deficiencies, haemolysis and sepsis are recommended on an individualised basis prior to BME. In HIV‐infected patients with therapy refractory ITP or ITP with atypical clinicopathological findings, BME is strongly recommended. As Mycobacterial and other infections are common in this group of patients, staining and culture of specimens are advised if BME is undertaken. [ABSTRACT FROM AUTHOR] more...

Key content: Tuberculosis (TB) is an important global cause of maternal and neonatal morbidity and mortality.With increasing migration, cases of tuberculosis in pregnancy or the puerperium are increasing in resource‐rich nations with advanced health care systems.Diagnosis may be delayed given the overlap of some of the symptoms with that of pregnancy.Timely diagnosis is essential to initiate appropriate treatment and prevent maternal and neonatal morbidity and mortality. Learning objectives: To understand the relevant global and UK epidemiology of the disease, including recent goals set by the World Health Organization and the UK.To review the pathophysiology of pulmonary and extrapulmonary TB, and of latent and active TB.To learn how to identify high‐risk women for antenatal assessment and gain an awareness of the screening tests available for latent TB.To gain awareness of the clinical symptoms, diagnosis and therapeutic management of active tuberculosis, including management of any drug resistance.To understand management of the neonate within high‐risk groups and where the mothers have diagnosed latent or active TB. Ethical issues: Pregnant women with TB should be fully counselled about the benefits, risks, and alternate options of management.Should healthcare professionals with high risk of acquiring TB infection be exempt from managing TB infection?Management of TB in HIV‐positive women provides additional challenges.Breastfeeding issues around seropositive mothers should be considered. [ABSTRACT FROM AUTHOR] more...

To evaluate the image quality, dosimetric properties, setup reproducibility, and planar cine motion detection of a high‐resolution brain coil and integrated stereotactic brain immobilization system that constitute a new brain treatment package (BTP) on a low‐field magnetic resonance imaging (MRI) linear accelerator (MR‐linac). Image quality of the high‐resolution brain coil was evaluated with the 17 cm diameter spherical phantom and the American College of Radiology (ACR) Large MRI Phantom. Patient imaging studies approved by the institutional review board (IRB) assisted in selecting image acquisition parameters. Radiographic and dosimetric evaluation of the high‐resolution brain coil and the associated immobilization devices was performed using dose calculations and ion chamber measurements. End‐to‐end testing was performed simulating a cranial lesion in a phantom. Inter‐fraction setup variability and motion detection tests were evaluated on four healthy volunteers. Inter‐fraction variability was assessed based on three repeat setups for each volunteer. Motion detection was evaluated using three‐plane (axial, coronal, and sagittal) MR‐cine imaging sessions, where volunteers were asked to perform a set of specific motions. The images were post‐processed and evaluated using an in‐house program. Contrast resolution of the high‐resolution brain coil is superior to the head/neck and torso coils. The BTP receiver coils have an average HU value of 525 HU. The most significant radiation attenuation (3.14%) of the BTP, occurs through the lateral portion of the overlay board where the high‐precision lateral‐profile mask clips attach to the overlay. The greatest inter‐fraction setup variability occurred in the pitch (average 1.08 degree) and translationally in the superior/inferior direction (average 4.88 mm). Three plane cine imaging with the BTP was able to detect large and small motions. Small voluntary motions, sub‐millimeter in magnitude (maximum 0.9 mm), from motion of external limbs were detected. Imaging tests, inter‐fraction setup variability, attenuation, and end‐to‐end measurements were quantified and performed for the BTP. Results demonstrate better contrast resolution and low contrast detectability that allows for better visualization of soft tissue anatomical changes relative to head/neck and torso coil systems. [ABSTRACT FROM AUTHOR] more...

This work introduces an attention mechanism that can be integrated into any standard convolution neural network to improve model sensitivity and prediction accuracy with minimal computational overhead. The attention mechanism is introduced in a lightweight network – Alexnet and its classification performance for human micro‐Doppler signatures is evaluated. The Alexnet model trained with an attention module can implicitly highlight the salient regions in the radar signatures while suppressing the irrelevant background regions and consistently improving network predictions. Network visualizations are provided through class activation mapping, providing better insights into how the predictions are made. The visualizations demonstrate how the attention mechanism focusses on the region of interest in the radar signatures. [ABSTRACT FROM AUTHOR] more...

Despite the liver being the primary site for clearance of xenobiotics utilizing a myriad of mechanisms ranging from cytochrome P450 enzyme pathways, glucuronidation, and biliary excretion, there is a dearth of information available as to how the severity of hepatic impairment (HI) can alter drug absorption and disposition (i.e., pharmacokinetics [PK]) as well as their efficacy and safety or pharmacodynamics (PD). In general, regulatory agencies recommend conducting PK studies in subjects with HI when hepatic metabolism/excretion accounts for more than 20% of drug elimination or if the drug has a narrow therapeutic range. In this tutorial, we provide an overview of the global regulatory landscape, clinical measures for hepatic function assessment, methods to stage HI severity, and consequently the impact on labeling. In addition, we provide an in-depth practical guidance for designing and conducting clinical trials for patients with HI and on the application of modeling and simulation strategies in lieu of dedicated trials for dosing recommendations in patients with HI. [ABSTRACT FROM AUTHOR] more...

Purpose: Task automation is essential for efficient and consistent image segmentation in radiation oncology. We report on a deep learning architecture, comprising a U‐Net and a variational autoencoder (VAE) for automatic contouring of the prostate gland incorporating interobserver variation for radiotherapy treatment planning. The U‐Net/VAE generates an ensemble set of segmentations for each image CT slice. A novel outlier mitigation (OM) technique was implemented to enhance the model segmentation accuracy. Methods: The primary source dataset (source_prim) consisted of 19 200 CT slices (from 300 patient planning CT image datasets) with manually contoured prostate glands. A smaller secondary source dataset (source_sec) comprised 640 CT slices (from 10 patient CT datasets), where prostate glands were segmented by 5 independent physicians on each dataset to account for interobserver variability. Data augmentation via random rotation (<5 degrees), cropping, and horizontal flipping was applied to each dataset to increase sample size by a factor of 100. A probabilistic hierarchical U‐Net with VAE was implemented and pretrained using the augmented source_prim dataset for 30 epochs. Model parameters of the U‐Net/VAE were fine‐tuned using the augmented source_sec dataset for 100 epochs. After the first round of training, outlier contours in the training dataset were automatically detected and replaced by the most accurate contours (based on Dice similarity coefficient, DSC) generated by the model. The U‐Net/OM‐VAE was retrained using the revised training dataset. Metrics for comparison included DSC, Hausdorff distance (HD, mm), normalized cross‐correlation (NCC) coefficient, and center‐of‐mass (COM) distance (mm). Results: Results for U‐Net/OM‐VAE with outliers replaced in the training dataset versus U‐Net/VAE without OM were as follows: DSC = 0.82 ± 0.01 versus 0.80 ± 0.02 (p = 0.019), HD = 9.18 ± 1.22 versus 10.18 ± 1.35 mm (p = 0.043), NCC = 0.59 ± 0.07 versus 0.62 ± 0.06, and COM = 3.36 ± 0.81 versus 4.77 ± 0.96 mm over the average of 15 contours. For the average of 15 highest accuracy contours, values were as follows: DSC = 0.90 ± 0.02 versus 0.85 ± 0.02, HD = 5.47 ± 0.02 versus 7.54 ± 1.36 mm, and COM = 1.03 ± 0.58 versus 1.46 ± 0.68 mm (p < 0.03 for all metrics). Results for the U‐Net/OM‐VAE with outliers removed were as follows: DSC = 0.78 ± 0.01, HD = 10.65 ± 1.95 mm, NCC = 0.46 ± 0.10, COM = 4.17 ± 0.79 mm for the average of 15 contours, and DSC = 0.88 ± 0.02, HD = 7.00 ± 1.17 mm, COM = 1.58 ± 0.63 mm for the average of 15 highest accuracy contours. All metrics for U‐Net/VAE trained on the source_prim and source_sec datasets via pretraining, followed by fine‐tuning, show statistically significant improvement over that trained on the source_sec dataset only. Finally, all metrics for U‐Net/VAE with or without OM showed statistically significant improvement over those for the standard U‐Net. Conclusions: A VAE combined with a hierarchical U‐Net and an OM strategy (U‐Net/OM‐VAE) demonstrates promise toward capturing interobserver variability and produces accurate prostate auto‐contours for radiotherapy planning. The availability of multiple contours for each CT slice enables clinicians to determine trade‐offs in selecting the "best fitting" contour on each CT slice. Mitigation of outlier contours in the training dataset improves prediction accuracy, but one must be wary of reduction in variability in the training dataset. [ABSTRACT FROM AUTHOR] more...

This review describes the evidence for the potential benefit of vitamin D supplementation in people with respiratory diseases who may have a higher susceptibility to coronavirus disease 2019 (COVID‐19) infection and its consequences. Clinical evidence indicates that vitamin D may reduce the risk of both upper and lower respiratory tract infections and offers benefit particularly in people with vitamin D deficiency. Some evidence exists for a higher incidence of active tuberculosis (TB) in patients who are deficient in vitamin D. An association between low levels of 25(OH)D (the active form of vitamin D) and COVID‐19 severity of illness and mortality has also been reported. In addition, low 25(OH)D levels are associated with poor outcomes in acute respiratory distress syndrome (ARDS). The cytokine storm experienced in severe COVID‐19 infections results from excessive release of pro‐inflammatory cytokines. Due to its immunomodulatory effects, adequate vitamin D levels may cause a decrease in the pro‐inflammatory cytokines and an increase in the anti‐inflammatory cytokines during COVID‐19 infections. Vitamin D deficiency was found in 82.2% of hospitalized COVID‐19 cases and 47.2% of population‐based controls (p < 0.0001). The available evidence warrants an evaluation of vitamin D supplementation in susceptible populations with respiratory diseases, such as TB, and particularly in those who are deficient in vitamin D. This may mitigate against serious complications of COVID‐19 infections or reduce the impact of ARDS in those who have been infected. [ABSTRACT FROM AUTHOR] more...

Purpose: A set of treatment planning strategies were designed and retrospectively implemented for locally advanced, non‐small cell lung cancer (NSCLC) patients in order to minimize cardiac dose without compromising target coverage goals. Methods: Retrospective analysis was performed for 20 NSCLC patients prescribed to 60–66 Gy that received a mean heart dose (MHD) ≥10 Gy. Three planning approaches were designed and implemented. The first was a multi‐isocentric (MI) volume‐modulated arc therapy (VMAT) approach (HEART_MI) with one isocenter located within the tumor and the second chosen up to 10 cm away longitudinally. The second was a noncoplanar (NCP) VMAT approach (HEART_NCP) utilizing up to three large couch angles and a standard arc at couch 0. The final planning strategy took a mixed approach (HEART_HYBRID) utilizing the HEART_NCP strategy for two thirds of the treatment combined with a plan utilizing a pair of opposite‐opposed gantry angles for the remaining treatments. Investigational plans were compared to original plans using dose–volume histogram metrics such as organ volume receiving greater than x Gy (Vx) or mean dose (Dmean). Results: Although there was a small but statistically significant decrease in internal target volume coverage for HEART_MI plans and, conversely, a statistically significant increase for HEART_NCP plans, all generated plans met physician‐prescribed target constraints. For heart dose, there were statistically significant decreases in all heart metrics and particularly MHD for the HEART_MI (9.8 vs. 15.4 Gy [p < 0.001], respectively), HEART_NCP (9.2 vs. 15.4 Gy [p < 0.001]), respectively), and HEART_HYBRID (7.9 vs. 15.4 Gy [p < 0.001], respectively) strategies. Conclusions: The strategy providing the best compromise between plan quality and cardiac dose reduction was HEART_NCP, which produced MHD reductions of 37.6% ± 12.9% (6.2 ± 3.4 Gy) relative to original plans. This strategy could potentially reduce adverse cardiac events, leading to improved quality of life for these patients. [ABSTRACT FROM AUTHOR] more...

Regular monitoring and timely repair of concrete cracks are required to minimize further deterioration. Self‐healing of cracks has been proposed as an alternative to the crack maintenance procedures. One of the proposed techniques is to use axenic cultures to exploit microbial‐induced calcite precipitation (MICP). However, such healing agents are not cost‐effective for in situ use. As the market for bio‐based self‐healing concrete necessitates a low‐cost bio‐agent, nonaxenic sulfate reducing bacterial (SRB) granules were investigated in this study through cultivation in an upflow anaerobic sludge blanket reactor. The compact granules can protect the bacteria from adverse conditions without encapsulation. This study investigated the microbial activities of SRB granules at different temperatures, pH, and chemical oxygen demand concentrations which the microbes would experience during the concrete casting and curing process. The attenuation and recovery of microbial activities were measured before and after the exposure. Moreover, the MICP yield was also tested for a possible use in self‐healing bioconcrete. The results consistently showed that SRB granules were able to survive starvation, high temperature (50–60°C), and high pH (12), together with scanning electron microscope/energy dispersive spectrometry/X‐ray diffraction analysis evidence. Microbial staining analysis demonstrated the formation of spores in the granules during their exposure to harsh conditions. SRB granule was thus demonstrated to be a viable self‐healing nonaxenic agent for low‐cost bioconcrete. [ABSTRACT FROM AUTHOR] more...

Plasmablastic lymphoma (PBL) is a highly aggressive B cell non‐Hodgkin lymphoma frequently associated with immunosuppression, particularly human immunodeficiency virus (HIV) infection. Although PBL is rare globally, South Africa has a high burden of HIV infection leading to a higher incidence of PBL in the region. Laboratory features in PBL may overlap with plasmablastic myeloma and other large B cell lymphomas with plasmablastic or immunoblastic morphology leading to diagnostic dilemmas. There are, however, pertinent distinguishing laboratory features in PBL such as a plasma cell immunophenotype with MYC overexpression, expression of Epstein–Barr virus‐encoded small RNAs and lack of anaplastic lymphoma kinase (ALK) expression. This review aims to provide a summary of current knowledge in PBL, focusing on the epidemiology, pathophysiology, laboratory diagnosis and clinical management. [ABSTRACT FROM AUTHOR] more...

Blockchain (BCT) is an emerging technology that promises many benefits for organizations, for instance, disintermediation, data security, data transparency, a single version of the truth, and trust among trading partners. Despite its multiple benefits, the adoption rate of BCT among organizations has not reached a significantly high level worldwide, thus requiring further research in this space. The present study addresses this issue in the Australian context. There is a knowledge gap in what specific factors, among the plethora of factors reported in the extant literature, affect the organizational adoption of BCT in Australia. To fill this gap, the study uses the qualitative interpretative research approach along with the technology-organization-environment (TOE) framework as a theoretical lens. The data was mainly drawn from the literature review and semi-structured interviews of the decision-makers and senior IT people from the BCT adopter and potential adopter organizations in Australia. According to the findings, perceived information transparency, perceived risks, organization innovativeness, organization learning capability, standards uncertainty, and competition intensity influence organizational adoption of BCT in Australia. These factors are exclusively identified in this study. The study also validates the influence of perceived benefits and perceived compatibility on BCT adoption that are reported in the past studies. Practically, these findings are helpful for the Australian government and public and private organizations to develop better policies and make informed decisions for the organizational adoption of BCT. The findings would guide decision-makers to think about the adoption of BCT strategically. The study also has theoretical implications explained in the discussion section. [ABSTRACT FROM AUTHOR] more...

Software defined radar (SDRadar) systems have become an important area for future radar development and are based on similar concepts to Software defined radio (SDR). Most of the processing like filtering, frequency conversion and signal generation are implemented in software. Currently, radar systems tend to have complex signal processing and operate at wider bandwidth, which means that limits on the available computational power must be considered when designing a SDRadar system. This paper presents a feasible solution to this potential limitation by accelerating the signal processing using a GPU to enable the development of a high speed SDRadar system. The developed system overcomes the limitation on the processing speed by CPU‐only, and has been tested on three different SDR devices. Results show that, with GPU accelerator, the processing rate can achieve up to 80 MHz compared to 20 MHz with the CPU‐only. The high speed processing makes it possible to run in real‐time and process full bandwidth across the WiFi signal acquired by multiple channels. The gains made through porting the processing to the GPU moves the technology towards real‐world application in various scenarios ranging from healthcare to IoT, and other applications that required significant computational processing. [ABSTRACT FROM AUTHOR] more...

Facial imaging tools have rapidly advanced in recent years and show potential for use in fetal alcohol spectrum disorder (FASD) screening and diagnosis. This scoping review describes the current state of evidence regarding the use of facial imaging being as a screening tool for FASD at a community level. This review follows the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) extension for scoping reviews and is registered with the Open Science Framework (osf.io/e4xw6). An electronic search of five databases was conducted. The time frame was limited to the period 2006 to 2022. The search included any form of imaging of the head, neck, oral cavity, and dentition. Animal and antenatal studies were excluded, as were those using only brain imaging. The search retrieved 730 unique titles. After title, abstract, and full‐text screening, 28 primary studies were included in this review. Most studies were conducted with South African participants. Imaging included 2D photographs, 3D stereophotogrammetry, 3D laser scanning, and radiographs. Various measurements and landmarks were used to discriminate FASD from non‐FASD participants, which included anthropometry, face shape analysis, and facial curvatures. Methods of data processing, analysis, and modeling ranged from manual methods to fully automated systems utilizing artificial intelligence. The use of facial imaging to screen for and diagnose patients with FASD is a rapidly advancing field. Most studies in the field remain exploratory, attempting to find accurate, reliable, and consistent landmarks and measures across different populations. For community screening, none of the tools in this review in their current form completely fulfill all the identified properties of an ideal screening tool. More research and development are needed prior to advocating for the use of any tool listed and the ethical implications are yet to be fully explored. [ABSTRACT FROM AUTHOR] more...

Key Clinical Message: Rhinoscleroma is an infectious granulomatous disease. It is important to identify pathognomonic Mikulicz cells on microscopy, as these can be rare and the chronic inflammatory infiltrate can appear otherwise nonspecific on biopsies. [ABSTRACT FROM AUTHOR] more...

Objective: To assess the feasibility of using synthetic computed tomography for treatment planning of the dominant intraprostatic lesion (DIL), a high‐risk region of interest that offers potential for increased local tumor control. Methods: A dosimetric study was performed on 15 prostate cancer patients with biopsy‐proven prostate cancer who had undergone magnetic resonance imaging. DILs were contoured based on the turbo spin echo T2‐weighted and diffusion weighted images. Air, bone, fat, and soft tissue were segmented and assigned bulk‐density HU values of –1000, 285, –50, and 40, respectively, to create a synthetic computed tomography. Simultaneous integrated boost (SIB) and standard treatment plans were created for each patient. The total dose was 79.2 Gy to the non‐boosted planning target volume for both plans with a boost of 100 Gy for the DIL in the SIB plan. A radiobiological model was created to determine individualized dose–response curves based on the patient's apparent diffusion coefficient maps. Results: Mean doses to the non‐boost planning target volume were 81.2 ± 0.3 Gy with the SIB and 81.0 ± 0.4 Gy without. For the DIL, the boosted mean dose was 102.6 ± 0.6 Gy. Total motor unit was 860 ± 100 with the SIB and 730 ±100 without. Femoral heads, rectum, bladder, and penile bulb were within established dose guidelines for either treatment technique. The average tumor control probability was 94% with the SIB compared with 78% without boosting the DIL. Conclusion: This study showed the feasibility of magnetic resonance imaging‐only treatment planning for patients with prostate cancer with a SIB to the DIL. DIL dose can be escalated to 100 Gy on synthetic computed tomography, while maintaining the original 79.2 Gy prescription dose and the organ of interest clinical dose limits. [ABSTRACT FROM AUTHOR] more...

Purpose: Evaluate custom beam models for a second check dose calculation system using statistically verifiable passing criteria for film analysis, DVH, and 3D gamma metrics. Methods: Custom beam models for nine linear accelerators for the Sun Nuclear Dose Calculator algorithm (SDC, Sun Nuclear) were evaluated using the AAPM‐TG119 test suite (5 Intensity Modulated Radiation Therapy (IMRT) and 5 Volumetric Modulated Arc Therapy (VMAT) plans) and a set of clinical plans. Where deemed necessary, adjustments to Multileaf Collimator (MLC) parameters were made to improve results. Comparisons to the Analytic Anisotropic Algorithm (AAA), and gafchromic film measurements were performed. Confidence intervals were set to 95% per TG‐119. Film gamma criteria were 3%/3 mm (conventional beams) or 3%/1 mm (Stereotactic Radiosurgery [SRS] beams). Dose distributions in solid water phantom were evaluated based on DVH metrics (e.g., D95, V20) and 3D gamma criteria (3%/3 mm or 3%/1 mm). Film passing rates, 3D gamma passing rates, and DVH metrics were reported for HD MLC machines and Millennium MLC Machines. Results: For HD MLC machines, SDC gamma film agreement was 98.76% ± 2.30% (5.74% CL) for 6FFF/6srs (3%/1 mm), and 99.80% ± 0.32% (0.83% CL) for 6x (3%/3 mm). For Millennium MLC machines, film passing rates were 98.20% ± 3.14% (7.96% CL), 99.52% ± 1.14% (2.71% CL), and 99.69% ± 0.82% (1.91% CL) for 6FFF, 6x, and 10x, respectively. For SDC to AAA comparisons: HD MLC Linear Accelerators (LINACs); DVH point agreement was 0.97% ± 1.64% (4.18% CL) and 1.05% ± 2.12% (5.20% CL); 3D gamma agreement was 99.97% ± 0.14% (0.30% CL) and 100.00% ± 0.02% (0.05% CL), for 6FFF/6srs and 6x, respectively; Millennium MLC LINACs: DVH point agreement was 0.77% ± 2.40% (5.47% CL), 0.80% ± 3.40% (7.47% CL), and 0.07% ± 2.15% (4.30% CL); 3D gamma agreement was 99.97% ± 0.13% (0.29% CL), 99.97% ± 0.17% (0.36% CL), and 99.99% ± 0.06% (0.12% CL) for 6FFF, 6x, and 10x, respectively. Conclusion: SDC shows agreement well within TG119 CLs for film and redundant dose calculation comparisons with AAA. In some models (SRS), this was achieved using stricter criteria. TG119 plans can be used to help guide model adjustments and to establish clinical baselines for DVH and 3D gamma criteria. [ABSTRACT FROM AUTHOR] more...

Objective: Chromosomal microarray (CMA) increases the diagnostic yield of prenatal genetic diagnostic testing but is not universally performed. Our objective was to identify provider and patient characteristics associated with the acceptance of CMA at the time of prenatal genetic diagnostic testing. Methods: Retrospective cohort study of patients undergoing prenatal genetic diagnostic testing (chorionic villus sampling or amniocentesis) at a single institution between 2014 and 2020. Primary outcome was the acceptance of CMA based on the genetic counselor ,GC who saw the patient. Secondary analyses assessed patient characteristics associated with the acceptance of CMA. Results: 2372 participants were included. Fifty‐eight percent of participants accepted CMA. Acceptance of CMA varied significantly by GC, ranging from 31% to 90%. Patients with public insurance and those who identified as Black or Hispanic/Latina were less likely to have CMA performed (aOR 0.24, 95% CI 0.20–0.30, and 0.68, 95% CI 0.50–0.92). Even among those with a structural anomaly present, public insurance was associated with significantly lower odds of CMA being performed (aOR 0.39, 95% CI 0.25–0.61). Conclusions: Acceptance of CMA at the time of prenatal genetic diagnostic testing varied based on the GC performing the counseling. Public insurance was associated with lower frequency of accepting CMA. Key points: What is already known about this topic?Chromosomal microarray significantly increases the diagnostic yield of prenatal diagnostic genetic testing, but is not uniformly performed. What does this study add?This study suggests that insurance status as well as genetic counselor (GC) are associated with uptake of chromosomal microarray at the time of prenatal genetic diagnostic testing. [ABSTRACT FROM AUTHOR] more...

Background: Coronavirus disease 2019 (COVID‐19) is associated with hematological abnormalities of variable severity. The full blood count (FBC) and leukocyte differential count (DIFF) could facilitate the prediction of disease severity and outcome in COVID‐19. This study aimed to assess the hematological parameters in early severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and their correlation with disease outcome. Methods: A retrospective cross‐sectional descriptive study was performed. Adults with a FBC and positive SARS‐CoV‐2 polymerase chain reaction results between March 1, and June 31, 2020 were reviewed. Basic hematological parameters (FBC, DIFF) and human immunodeficiency virus (HIV) status were recorded. Outcome measures were admission to a general ward or intensive care unit (ICU), recovery or death. Results: Six hundred and eighty‐five cases median age 51 years, were analyzed. Forty‐four percent were males and fourteen percent were HIV‐positive with no association between death and/or ICU admission (p = 0.522 and p = 0.830, respectively). Leucocytosis was predictive of ICU admission (odds ratio [OR]: 2.4, confidence interval [CI]: 1.77–3.8186) and neutrophilia, of both mortality (OR: 1.5, CI: 1.0440–2.0899) and ICU admission (OR: 4, CI: 2.5933–6.475). Median lymphocyte count was decreased and D‐dimer raised, showing no significant association with outcome. Raised neutrophil‐to‐lymphocyte‐ratio (NLR) was associated with increased odds of mortality (OR: 2.5, CI: 1.3556–3.2503) and ICU admission (OR: 4.8, CI: 2.4307–9.5430) as was monocyte‐to‐lymphocyte‐ratio (MLR) (OR: 2, CI: 1.3132–2.9064) and (OR: 2.3, CI: 1.0608–1.9935), respectively. Hospital admission and older age were significantly associated with mortality (p = 0.0008 and p < 0.0001), respectively. Conclusion: Evidence‐based interpretation of routine laboratory parameters, readily available in resource‐constrained settings, may identify patients at increased risk of mortality. The FBC, DIFF, NLR, and MLR should form part of the early COVID‐19 investigation. [ABSTRACT FROM AUTHOR] more...

Direct formic acid fuel cells (DFAFCs) are potential candidates as power sources for various applications, especially in portable electronics and medical diagnostic devices. Though they have been the subject of considerable research, commercial prototypes of DFAFCs are rudimentary compared to other liquid fuel cells, particularly the widespread methanol‐based direct methanol fuel cells. Various strategies for rationally engineering the electrocatalysts for enhancing DFAFC performance have been explored in the last few years, such as alloying noble metals with earth‐abundant transition metals, designing specific morphological and structural arrangements, decorating the surface with corrosion‐tolerant cocatalysts, and providing better catalyst support for effective catalyst dispersion. An overall approach may be necessary and should include (i) understanding the underlying mechanism, which will guide the direction of catalyst engineering, (ii) employing morphological, compositional, and structural control of the electrocatalysts to improve catalyst utilization and enhance the intrinsic activity for real‐world applications, and (iii) integrating these in a proficiently designed cell architecture suitable for targeted applications. In this review, we focus on the recent advances in electrocatalysts, formic acid electrooxidation mechanisms, and DFAFC cell architectures, which could help address the opportunities and challenges of commercializing DFAFC as a prospective alternative power source for portable applications. This article is categorized under:Fuel Cells and Hydrogen > Science and MaterialsEnergy Research & Innovation > Science and Materials [ABSTRACT FROM AUTHOR] more...

This study offers a more fine‐grained view of perceived export performance (EP) and map out the key aspects of this phenomenon from the perspective of SME managers. Particularly, we explore the differences in managers' practices and their perceptions about underlying aspects of EP, including level of analysis, type of performance, mode of assessment, criteria, time frames, and frames of references. Furthermore, we explore some of the key reasons for variations in EP assessment practices. This study adopts an inductive approach based on semistructured interviews with 20 exporting SMEs in New Zealand. We observed that firms exhibit distinctive behavior in their EP assessment depending on their type of ownership, stage of internationalization, and perceived psychic distance toward target markets. We challenge the assumption that a single, universal EP evaluation model can be used for SMEs and suggest that the appropriate conceptualization of EP should be dictated by each firm's strategic orientation. [ABSTRACT FROM AUTHOR] more...

Purpose: To implement an outcome‐driven frequency filter for improving radiomics‐based modeling of human papillomavirus (HPV) for patients with oropharyngeal squamous cell carcinoma (OPSCC). Methods and materials: One hundred twenty‐eight OPSCC patients with known HPV status (60‐HPV+ and 68‐HPV–, confirmed by immunohistochemistry‐P16 protein testing) were retrospectively studied. A 3D Discrete Fourier Transform was applied on contrast‐enhanced computed tomography (CE‐CT) images of patient gross tumor volumes (GTVs) to transform intensity distributions to the frequency domain and estimate frequency power spectrums of HPV– and HPV+ patient cohorts. Statistical analyses were performed to rank frequency bands contributing toward the prediction of HPV status. An outcome‐driven frequency filter was designed accordingly and applied to GTV frequency information. A 3D inverse discrete Fourier transform was applied to reconstruct HPV‐related frequency‐filtered images. Radiomics features (11 feature‐categories) were extracted from pre‐ and post‐frequency filtered images using our previously published "ROdiomiX" software. Least‐absolute‐shrinkage‐and‐selection‐operation (Lasso) combined with a generalized linear model (Lasso‐GLM) was developed to identify and rank feature subsets with the optimal information for prediction of HPV+/–. Radiomics‐based Lasso‐GLM classifiers (pre‐ and post‐frequency filtered) were constructed and validated using random permutation sampling and nested cross‐validation (CV) techniques. Average area under the receiver operating characteristic (AUC), and positive and negative predictive values (PPV and NPV) were computed to estimate generalization error and prediction performance. Results: Among 192 radiomic features, 15 features were found to be statistically significant discriminators between HPV+/– cohorts on post‐frequency filtered CE‐CT images. Fourteen such radiomic features were observed on pre‐frequency filtered datasets. Discriminant features included tumor morphology and intensity contrast. Performances for prediction of HPV for the pre‐ and post‐frequency filtered Lasso‐GLM classifiers were as follows: AUC/PPV/NPV = 0.789/0.755/0.805 and 0.850/0.808/0.877, respectively. Nested CV performances for prediction of HPV for the pre‐ and post‐frequency filtered Lasso‐GLM classifiers were as follows: AUC/PPV/NPV = 0.814/0.725/0.877 and 0.890/0.820/0.911, respectively. Conclusion: Albeit subject to confirmation in a larger cohort, this pilot study presents encouraging results on the importance of frequency analysis prior to radiomic feature extraction toward enhancement of model performance for characterizing HPV in patients with OPSCC. [ABSTRACT FROM AUTHOR] more...

Aim: This article describes the craniofacial and dental features of an individual with Gordon syndrome. The dental management implications and considerations of treating patients with Gordon Syndrome and similar conditions resulting in limited mouth opening are discussed. Methods: A 14‐year‐old South African male was referred to the Dental Genetics Clinic with the main complaint of carious teeth. His craniofacial characteristics included low set and posteriorly rotated ears, down‐slanted palpebral fissures, sloping shoulders, and a broad neck. A prognathic mandible and mild facial asymmetry were noted. He had a significant limitation of mouth opening (2 cm at incisors). Radiographic examination revealed multiple carious teeth, missing mandibular premolars, impacted maxillary premolars, taurodontism of the 44 and 34, and enlarged coronoid processes of the mandible. Dental extractions and restorations have been performed under local anaesthesia. Conclusion: Gordon syndrome and similar conditions, may result in limited oral opening and impaired manual dexterity. The severity of limitation of mouth opening determines management. Dental management should focus on ensuring that the patient is able to maintain good oral hygiene by customising homecare for the individual and regular dental visits. [ABSTRACT FROM AUTHOR] more...

Background: Although acetylsalicylic acid is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular events, residual atherothrombotic risk has prompted a guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary "snapshot" of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada. Methods: Canadian cardiologists (49 cardiologists from six provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy‐like criteria from May 2018 to April 2019. Results: Of the 492 (two cardiologists provided 11 patients) enroled, average age was 70 years, 25% were female, 39% had diabetes and 20% had atrial fibrillation. Prior revascularisation was common (percutaneous coronary artery intervention 61%, coronary artery bypass graft 39%), with 31% having multivessel disease. A total of 47% of patients had a Reduction of Atherothrombosis for Continued Health bleeding score of ≥11 (~2.8% risk of serious bleeding at 2 years). Single antiplatelet therapy (SAPT) alone was most commonly used (62%), while 22% were on DAPT alone. In total, 22% were on oral anticoagulation (OAC), with 16% being on non‐vitamin K oral anticoagulant alone, 5% on DPI and 1% received triple therapy. Conclusions: In contemporary Canadian clinical practice of stable ASCVD patients, a large number of patients receive antithrombotic therapy other than SAPT. Further efforts are required to guide the appropriate selection of patients in whom more potent antithrombotic therapies may safely reduce residual risk. [ABSTRACT FROM AUTHOR] more...

An impaired renal function, including acute and chronic kidney disease and end‐stage renal disease, can be the result of aging, certain disease conditions, the use of some medications, or as a result of smoking. In patients with renal impairment (RI), the pharmacokinetics (PKs) of drugs or drug metabolites may change and result in increased safety risks or decreased efficacy. In order to make specific dose recommendations in the label of drugs for patients with RI, a clinical trial may have to be conducted or, when not feasible, modeling and simulations approaches, such as population PK modeling or physiologically‐based PK modelling may be applied. This tutorial aims to provide an overview of the global regulatory landscape and a practical guidance for successfully designing and conducting clinical RI trials or, alternatively, on applying modeling and simulation tools to come to a dose recommendation for patients with RI in the most efficient manner. [ABSTRACT FROM AUTHOR] more...

Purpose: We performed quantitative analysis of differences in deformable image registration (DIR) and deformable dose accumulation (DDA) computed on CBCT datasets reconstructed using the standard (Feldkamp‐Davis‐Kress: FDK_CBCT) and a novel iterative (iterative_CBCT) CBCT reconstruction algorithms. Methods: Both FDK_CBCT and iterative_CBCT images were reconstructed for 323 fractions of treatment for 10 prostate cancer patients. Planning CT images were deformably registered to each CBCT image data set. After daily dose distributions were computed, they were mapped to planning CT to obtain deformed doses. Dosimetric and image registration results based CBCT images reconstructed by two algorithms were compared at three levels: (A) voxel doses over entire dose calculation volume, (B) clinical constraint results on targets and sensitive structures, and (C) contours propagated to CBCT images using DIR results based on three algorithms (SmartAdapt, Velocity, and Elastix) were compared with manually delineated contours as ground truth. Results: (A) Average daily dose differences and average normalized DDA differences between FDK_CBCT and iterative_CBCT were ≤1 cGy. Maximum daily point dose differences increased from 0.22 ± 0.06 Gy (before the deformable dose mapping operation) to 1.33 ± 0.38 Gy after the deformable dose mapping. Maximum differences of normalized DDA per fraction were up to 0.80 Gy (0.42 ± 0.19 Gy). (B) Differences in target minimum doses were up to 8.31 Gy (−0.62 ± 4.60 Gy) and differences in critical structure doses were 0.70 ± 1.49 Gy. (C) For mapped prostate contours based on iterative_CBCT (relative to standard FDK_CBCT), dice similarity coefficient increased by 0.10 ± 0.09 (p < 0.0001), mass center distances decreased by 2.5 ± 3.0 mm (p < 0.00005), and Hausdorff distances decreased by 3.3 ± 4.4 mm (p < 0.00015). Conclusions: The new iterative CBCT reconstruction algorithm leads to different mapped volumes of interest, deformed and cumulative doses than results based on conventional FDK_CBCT. [ABSTRACT FROM AUTHOR] more...

A pathological hallmark of the neurodegenerative disorder, Parkinson's disease (PD), is aggregation of toxic forms of the presynaptic protein, α‐synuclein in structures known as Lewy bodies. α‐Synuclein pathology is found in both the brain and gastrointestinal tracts of affected individuals, possibly due to the movement of this protein along the vagus nerve that connects the brain to the gut. In this review, we discuss current insights into the spread of α‐synuclein pathology along the gut–brain axis, which could be targeted for therapeutic interventions. The prion‐like propagation of α‐synuclein, and the clinical manifestations of gastrointestinal dysfunction in individuals living with PD, are discussed. There is currently insufficient evidence that surgical alteration of the vagus nerve, or removal of gut‐associated lymphoid tissues, such as the appendix and tonsils, are protective against PD. Furthermore, we propose curcumin as a potential candidate to prevent the spread of α‐synuclein pathology in the body by curcumin binding to α‐synuclein's non‐amyloid β‐component (NAC) domain. Curcumin is an active component of the food spice turmeric and is known for its antioxidant, anti‐inflammatory, and potentially neuroprotective properties. We hypothesize that once α‐synuclein is bound to curcumin, both molecules are subsequently excreted from the body. Therefore, dietary supplementation with curcumin over one's lifetime has potential as a novel approach to complement existing PD treatment and/or prevention strategies. Future studies are required to validate this hypothesis, but if successful, this could represent a significant step towards improved nutrient‐based therapeutic interventions and preventative strategies for this debilitating and currently incurable disorder. [ABSTRACT FROM AUTHOR] more...

The sella turcica is an important anatomical reference used in orthodontics for the evaluation of craniofacial growth. Studies have found variations in the sella turcica morphology in patients with syndromes affecting the craniofacial complex. This review aims to determine whether genetic syndromes involving the craniofacial complex are associated with abnormal radiographic sella turcica morphology and whether there is a pattern of malformation which is consistent within each syndrome. An electronic database search was conducted to identify relevant studies. We included primary studies describing the morphology of the sella turcica on lateral radiographs in human subjects with genetic syndromes involving the craniofacial complex. No restrictions were placed on language or timeframe. PROSPERO registration CRD42019148060. Thirty-eight studies were included in this review. A 'J'-shaped sella was found in patients with Hutchinson-Gilford-Progeria syndrome and other syndromes. A bulbous dorsum sellae was highly prevalent Cleidocranial dysplasia, and a bulbous dorsum sellae and uneven contours of the clivus was found in Cri du chat syndrome. A steep clivus was described in patients with Axenfeld-Rieger syndrome. An oblique anterior wall was the most frequent malformation found in Down's syndrome. Genetic syndromes affecting the craniofacial complex are associated with abnormal morphology of the radiographic sella turcica. Clinicians should be observant of abnormal sella turcica morphology which can be a sign of undiagnosed or subclinical syndromes. More high-quality studies are needed which use standardized and objective methods of determining the morphology of the sella turcica. [ABSTRACT FROM AUTHOR] more...

This review aimed to evaluate the clinical success of clopidogrel dosing based on CYP2C19 genotype and to identify the relevant additional factors that may be useful for consideration by the clinician when dosing individuals with clopidogrel. The results indicated that genotype‐guided dosing in individuals with acute coronary syndrome undergoing percutaneous coronary intervention is frequently practiced, although the advantages remain controversial. Demographic factors, such as age, ethnicity, and some comorbidities, such as diabetes mellitus, can potentially contribute to further refinement of clopidogrel dosage but additional clinical studies to guide these practices are required. Drugs that are CYP2C19 or CYP3A4 inhibitors may reduce the effectiveness of clopidogrel and should be carefully considered during co‐administration. In particular, as stated in the clopidogrel label, concomitant use with strong or moderate CYP2C19 inhibitors, such as omeprazole, should be avoided. Increased exposure and response to clopidogrel has been observed in smokers. Noteworthy, a very recent study has shown that smoking cessation in clopidogrel patients may result in reduced response and carries the risk of high on‐clopidogrel platelet reactivity. Recent studies have shown clinically significant increases in exposure to CYP2C8 substrates (repaglinide, dasabuvir, and desloratadine) and a CYP2B6 substrate (s‐sibutramine) following co‐administration with clopidogrel, indicating that therapeutic strategies with clopidogrel should avoid these drugs. [ABSTRACT FROM AUTHOR] more...

Iatrogenic aortic dissection post primary percutaneous coronary intervention (PCI) is rare but yet a serious complication. In this report, we present a case of a 40‐year‐old lady who had an aortic dissection post PCI which was initially missed by the conventional contrast images and required a gated computerized tomography aortogram to confirm the diagnosis. The patient was managed with strict blood pressure control resulting in complete healing of the dissection after 72 hours of the management. The case illustrates the importance of selecting the correct imaging to make an accurate diagnosis when aortic dissection is suspected and outlines the importance of blood pressure control in treating iatrogenic aortic dissections. [ABSTRACT FROM AUTHOR] more...

Surface modification of metallic Cu by conventional oxidation and an alternative method of oxidation using flame annealing and its influence on electrochemical reduction (ECR) of CO2 are reported in this study. The ECR of CO2 in aqueous KCl electrolyte yielded methane, ethane, ethylene, and hydrogen as the major products. The faradaic efficiency of ethane obtained at −1.2 V vs NHE for flame‐annealed Cu (34 %) was comparable to the conventionally oxidised Cu (40 %), while bare Cu yielded methane (10 %). The metal–metal oxide interface on the electrode aids in the formation of C2‐based products. Flame annealing can be regarded as an alternative electrode preparation method for C2 product formation, with its merits in high specific surface area, self‐rejuvenating mode on deactivation and ease of preparation. [ABSTRACT FROM AUTHOR] more...

Osteogenesis imperfecta (OI) is a relatively common genetic skeletal disorder with an estimated frequency of 1 in 20 000 worldwide. The manifestations are diverse and although individually rare, the several different forms contribute to the production of a significant number of affected individuals with considerable morbidity and mortality. During the last decade, there have been extensive molecular investigations into the etiology of OI and these advances have direct relevance to the medical management of the disorder, and the purpose of this review is to document the history and evolution of the nosology of OI. The current nosology, based on molecular concepts, which are crucial in the identification of genotype‐phenotype correlations in persons with OI, is also outlined. The successive revisions of the nosology and classification of OI have highlighted the importance of the nomenclature of the condition in order for it to be recognized by clinicians, scientists and patient advocacy groups. In this way, improved counseling of patients and individualized, tailored therapeutic approaches based on the underlying pathophysiology of the individual's type of OI have been facilitated. [ABSTRACT FROM AUTHOR] more...

Purpose: This study introduces an in‐house‐designed software platform (ROdiomiX) for the radiomics analysis of medical images in radiation oncology. ROdiomiX is a MATLAB‐based framework for the computation of radiomic features and feature aggregation techniques in compliance with the Image‐Biomarker‐Standardization‐Initiative (IBSI) guidelines, which includes preprocessing protocols and quantitative benchmark results for analysis of computational phantom images. Methods and Materials: The ROdiomiX software system consists of a series of computation cores implemented on the basis of the guidelines proposed by the IBSI. It is capable of quantitative computation of the following 11 different feature categories: Local‐Intensity, Intensity‐Histogram, Intensity‐Based‐Statistical, Intensity‐Volume‐Histogram, Gray‐Level‐Co‐occurrence, Gray‐Level‐Run‐Length, Gray‐Level‐Size‐Zone, Gray‐Level‐Distance‐Zone, Neighborhood‐Grey‐Tone‐Difference, Neighboring‐Grey‐Level‐Dependence, and Morphological feature. ROdiomiX was validated against benchmark values for the IBSI 3D digital phantom, as well as one designed in‐house (HFH). The intraclass correlation coefficient (ICC) for estimating the degree of absolute agreement between ROdiomiX computation and benchmark values for different features at the 95% confidence level (CL) was used for comparison. Results: Among the 11 feature categories with 149 total features including 10 different feature aggregation methods (following the IBSI guidelines), the percent difference between absolute feature values computed by the ROdiomiX software and benchmark values reported for IBSI and HFH digital phantoms were 0.14% + 0.43% and 0.11% + 0.27%, respectively. The ICC values were >0.997 for all ten feature categories for both the IBSI and HFH digital phantoms. Conclusion: The authors successfully developed a platform for computation of quantitative radiomic features. The image preprocessing and computational software cores were designed following the procedures specified by the IBSI. Benchmarking testing was in excellent agreement against the IBSI‐ and HFH‐designed computational phantoms. [ABSTRACT FROM AUTHOR] more...