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As a result of the ease with which the internet and cell phones can be accessed, online social networks (OSN) and social media have seen a significant increase in popularity in recent years. Security and privacy, on the other hand, are the key concerns in online social networks and other social media platforms. On the other hand, cyberbullying (CB) is a serious problem that needs to be addressed on social media platforms. Known as cyberbullying (CB), it is defined as a repetitive, purposeful, and aggressive reaction performed by individuals through the use of information and communication technology (ICT) platforms such as social media platforms, the internet, and cell phones. It is made up of hate messages that are sent by e-mail, chat rooms, and social media platforms, which are accessed through computers and mobile phones. The detection and categorization of CB using deep learning (DL) models in social networks are, therefore, crucial in order to combat this trend. Feature subset selection with deep learning-based CB detection and categorization (FSSDL-CBDC) is a novel approach for social networks that combines deep learning with feature subset selection. The suggested FSSDL-CBDC technique consists of a number of phases, including preprocessing, feature selection, and classification, among others. Additionally, a binary coyote optimization (BCO)-based feature subset selection (BCO-FSS) technique is employed to select a subset of features that will increase classification performance by using the BCO algorithm. Additionally, the salp swarm algorithm (SSA) is used in conjunction with a deep belief network (DBN), which is known to as the SSA-DBN model, to detect and characterize cyberbullying in social media networks and other online environments. The development of the BCO-FSS and SSA-DBN models for the detection and classification of cyberbullying highlights the originality of the research. A large number of simulations were carried out to illustrate the superior classification performance of the proposed FSSDL-CBDC technique. The SSA-DBN model has exhibited superior accuracy to the other algorithms, with a 99.983 % accuracy rate. Overall, the experimental results revealed that the FSSDL-CBDC technique beats the other strategies in a number of different aspects.

A 45-year-old man was walking his dog at 5:30 am in June 2009 and developed crushing 10/10 substernal chest pain. He called 911 at 6:05 am after his symptoms persisted for 35 minutes. Emergency medical services (EMS) paramedics arrived at the scene at 6:09 am and obtained a brief history and examination showing a diaphoretic man, pulse of 92 bpm, blood pressure of 170/140 mm Hg, normal respiratory rate, and no rales or murmurs. Treatment was initiated including supplemental oxygen, sublingual nitroglycerin, and aspirin. A 12-lead prehospital (PH) ECG was acquired at the scene at 6:16 am and interpreted by paramedics as showing acute ST-elevation myocardial infarction (STEMI) (Figure 1). On the basis of the PH ECG, paramedics made a single phone call to the closest community hospital emergency department and activated the PH ECG STEMI protocol at 6:17 am. The closest community hospital was located within 5 miles and did not have capability for percutaneous coronary intervention (PCI). The STEMI protocol activation consisted of autolaunching helicopter transport to intercept the patient at the community hospital and alerting the cardiac catheterization team at the tertiary PCI center located 50 miles away with the estimated patient arrival time. The patient arrived at the community hospital emergency department (door 1) by ground ambulance at 6:26 am. Helicopter transport picked up the patient and departed the community hospital at 6:37 am with a door 1 in–to–door 1 out time of 11 minutes. The patient arrived at the tertiary PCI center (door 2) at 7:10 am and was transported directly to the cardiac catheterization laboratory. During transport from the helipad to the cardiac catheterization laboratory, the patient had ventricular fibrillation in the elevator, and a shock was delivered with 120 J of selected energy. Coronary angiography showed a thrombotic occlusion of the …

Most events covered by insurance happen at a fixed point in time. Accordingly, in the typical context, timing issues relating to coverage under commercial general liability (CGL) insurance policies relate to whether the bodily injury or property damage happened during a particular policy period. This question is usually described as whether the policy is “triggered.” In the context of the usual claim, a court simply determines when the injury or damage took place, and whether the relevant policy was in effect at that time. Environmental, toxic tort, and some products liability claims, however, present more complex timing issues. These types of claims often involve progressive injuries or damage happening over substantial timeframes. In the insurance industry, such losses are often called “longtail” claims. Many long-tail claims involve injury or damage spanning multiple policy years. A court considering timing issues relating to coverage for such claims is faced not only with the challenge of determining which policies are triggered, but also with a far more complicated question: whether and how to allocate the damages between the relevant insurers and between the insurers and the policyholder. The most common approach used to determine how to allocate longtail losses among multiple triggered policy years is often called “pro rata

Background— Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized. Methods and Results— A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes, and long-term risk of SCAD recurrence or major adverse cardiac events were evaluated. Mean age was 42.6 years; 82% were female. Extreme exertion at SCAD onset was more frequent in men (7 of 16 versus 2 of 71; P Conclusions— SCAD affects a young, predominantly female population, frequently presenting as ST-elevation myocardial infarction. Although in-hospital mortality is low regardless of initial treatment, percutaneous coronary intervention is associated with high rates of complication. Risks of SCAD recurrence and major adverse cardiac events in the long term emphasize the need for close follow-up. Fibromuscular dysplasia is a novel association and potentially causative factor.

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A 75-year-old woman with familial hypercholesterolemia was admitted with unstable angina. Thirteen years earlier, she had undergone coronary artery bypass grafting with a left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and subsequently bilateral common carotid bypass surgery through a second sternotomy 3 years later. Physical examination revealed left brachial hypotension, a left subclavian bruit, and features of severe aortic stenosis. Transthoracic echocardiography demonstrated severe valvular and supravalvular aortic obstruction with an area of 0.50 cm2. Noncontrast computed tomography showed complete calcification of the ascending aorta (porcelain aorta) and confirmed supravalvular obstruction with calcific plaque (Figure 1). She was subsequently offered placement of a left ventricular apex-descending aorta conduit through a left thoracotomy. Preoperative diagnostic angiography revealed a critical ostial left subclavian artery stenosis, with flow reversal in the vertebral artery and preferential entering of contrast into the LIMA (steal phenomenon, Figure 2, Movie 1). The LIMA graft was widely …

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 71-year-old man with a history of coronary artery bypass grafting 10 years earlier presented with recurrent angina. A repeat coronary angiogram revealed a large pseudoaneurysm in the saphenous vein graft supplying the right

Cleft mitral valve is a rare congenital anomaly that may present in isolation or accompany other cardiac malformations. Our illustrative case series highlights the advantages of three-dimensional over conventional two-dimensional echocardiography in the diagnosis and morphologic assessment cleft mitral valve in adults.

Quadricuspid aortic valve is a rare congenital anomaly. It may present as an isolated anomaly but is occasionally associated with aortic regurgitation. Sinus of Valsalva aneurysm (SVA) is also an infrequent congenital anomaly, typically associated with tricuspid aortic valves. There are only a few reported cases of SVA (ruptured) associated with quadricuspid aortic valves in the literature. We report the first case of the association of quadricuspid aortic valve with an unruptured SVA in an adult patient.

Melanoma is a neoplasm notorious for its dismal prognosis and its propensity for cardiac involvement. Roughly a third of patients diagnosed with primary cutaneous melanoma develop pulmonary, osseous, cerebral or hepatic metastatic disease ante mortem. In contrast, ante mortem cardiac involvement is reported in 2% of cases but in over 50% of patients with metastatic melanoma postmortem.1 Cardiac involvement is usually multifocal, believed to disseminate hematogenously and commonly involves the epicardium, myocardium, pericardium or may present as intracavitary tumors.2 The surgical management of cardiac tumors can be challenging, particularly when they occur in locations that make surgical access and resection technically difficult. Recent refinements in myocardial perfusion imaging, computerized tomography, and cardiac magnetic resonance imaging help provide precise information on anatomic location, vascularity, and tumor extension into adjacent mediastinal structures.3 Early detection of cardiac melanoma has important therapeutic and prognostic …

The study was conducted to identify epidemiological sero-distribution of Leptospira serovars representing serogroups of antibodies in Odisha, Eastern part of India. Samples were collected from livestock during 2011-2014. A total of 537 non-purposive random serum samples from 12 districts in Odisha were tested at 1:100 dilutions in microscopic agglutination test (MAT) using live antigens of 18 reference Leptospira serovars. The overall prevalence of 36.69% (197/537) with 36.13% in cattle, 54.28% in buffaloes, 28.33% in goats and 44.44% in sheep was observed. Out of 197 reacted sera, 100 samples showed reactivity with more than one serovars representing 50.76% prevalence of multiple serovars. On analysis, the seroprevalence of leptospirosis in cattle (·2 = 63.41, P