Search

A key task of emergency departments is to promptly identify patients who require hospital admission. Early identification ensures patient safety and aids organisational planning. Supervised machine learning algorithms can use data describing historical episodes to make ahead-of-time predictions of clinical outcomes. Despite this, clinical settings are dynamic environments and the underlying data distributions characterising episodes can change with time (data drift), and so can the relationship between episode characteristics and associated clinical outcomes (concept drift). Practically this means deployed algorithms must be monitored to ensure their safety. We demonstrate how explainable machine learning can be used to monitor data drift, using the COVID-19 pandemic as a severe example. We present a machine learning classifier trained using (pre-COVID-19) data, to identify patients at high risk of admission during an emergency department attendance. We then evaluate our model’s performance on attendances occurring pre-pandemic (AUROC of 0.856 with 95%CI [0.852, 0.859]) and during the COVID-19 pandemic (AUROC of 0.826 with 95%CI [0.814, 0.837]). We demonstrate two benefits of explainable machine learning (SHAP) for models deployed in healthcare settings: (1) By tracking the variation in a feature’s SHAP value relative to its global importance, a complimentary measure of data drift is found which highlights the need to retrain a predictive model. (2) By observing the relative changes in feature importance emergent health risks can be identified.

Introduction: Guided single implant placement ensures an optimal implant position, enables in-surgery immediate loading, and creates a predisposition for predictable treatment results. Aim: This article aims to present the surgical and loading protocols and assess the accuracy of two guided implant systems. Materials and methods: Ten patients missing a single molar were included. The semi-guided procedures with the two implant systems – AB Dental and Alpha Bio-Tec, were randomly assigned to each participant. The computer-assisted planning was performed with Implant Studio (3Shape, Denmark). Surgical guides and long-term, temporary, screw-retained restorations were virtually generated within the 3Shape system. Surgical appliances were printed from SG resin (Formlabs, USA), and crowns were milled from Telio CAD (Ivoclar Vivadent, Lichtenstein). Planning accuracy was evaluated based on the crown’s fit and relation to the adjacent teeth and antagonists. Results and discussion: The patients included for preliminary analysis (6 female and 4 male) were with a mean age of 33.42. The youngest was 24, and the oldest 49 years old. There were no surgical and technical complications for the period of evaluation, which ranged from 1 to 3 months. The crown’s fit was excellent in 8 cases. In two cases, minor adjustments were necessary – 1 in relation to the antagonists and 1 to the adjacent teeth. In one case, a healing screw was placed for 48 hours to facilitate adequate soft-tissue space for the Ti-base. Conclusion: The preliminary results presented in this report suggest that the clinical and laboratory protocols used for guided implantation and immediate loading are highly efficient.

Small interfering RNA (siRNA) targeting liver angiotensinogen (AGT) lowers blood pressure, but its effectiveness in hypertensive chronic kidney disease is unknown. Considering that the kidney may generate its own AGT, we assessed the effectiveness of liver-targeted AGT siRNA in the 5/6th Nx (5/6th nephrectomy) rat—a hypertensive chronic kidney disease model. Five weeks after 5/6th Nx (baseline), rats were subjected to vehicle, AGT siRNA, AGT siRNA+losartan, losartan, or losartan+captopril. Baseline mean arterial pressure was 160±6 mm Hg. Over the course of 4 weeks, mean arterial pressure increased further by ≈15 mm Hg during vehicle treatment. This rise was prevented by AGT siRNA. Losartan reduced mean arterial pressure by 37±6 mm Hg and increased plasma Ang (angiotensin) II. Both AGT siRNA and captopril suppressed these effects of losartan, suggesting that its blood pressure–lowering effect relied on stimulation of vasodilator Ang II type 2 receptors by high Ang II levels. Proteinuria and cardiac hypertrophy increased with vehicle, and these increases were comparably abrogated by all treatments. No intervention improved glomerular filtration rate, while siRNA and losartan equally diminished glomerulosclerosis. AGT siRNA±losartan reduced plasma AGT by >95%, and this was accompanied by almost complete elimination of Ang II in kidney and heart, without decreasing renal AGT mRNA. Multiple linear regression confirmed both mean arterial pressure and renal Ang II as independent determinants of proteinuria. In conclusion, AGT siRNA exerts renoprotection in the 5/6th Nx model in a blood pressure–independent manner. This relies on the suppression of renal Ang II formation from liver-derived AGT. Consequently, AGT siRNA may prove beneficial in human chronic kidney disease.

This is the first article that identifies contracts whose breach could cause non-pecuniary losses. It argues that in all cases where the outcome of the promised performance leads to something other than an enhancement of the promisee’s financial standing, the breach will cause him non-pecuniary losses. This proposition provides greater consistency in the law of contract damages. It provides a powerful argument against the existing notion of partial recovery of non-pecuniary losses and replaces it with a more principled and comprehensive approach that is more closely aligned with the general conceptual framework of contemporary contract law. If the principles identified in the present article are applied, all damages, including those for non-pecuniary losses, will be recoverable when the promisee’s performance interest is not satisfied.

A low-cost disposable lipase activity sensor was developed and characterized overcoming the main drawbacks of the already existing disposable ones: insufficient reproducibility to be applied for automatic lipase activity quantification and complicated and long manual analytical procedure performed by qualified personnel. The sensor is based on a capacitor formation on an electrode surface by a substrate layer deposition possessing high electrical resistivity and dielectric constant (composite of olive oil mixed with BaTiO3 nanoparticles) serving as both: sensor sensitive layer and capacitor dielectric. Its decomposition by lipase catalyzed hydrolysis causes its thickness decrease resulting in capacitance increase proportional to the lipase activity. The sensor was characterized in terms of limit of quantification, linear quantification range, sensitivity, response time, precision, repeatability, storage time and the results are presented and discussed. The validation experiment showed excellent agreement with the standardized titrimetric method.

We report an extremely rare case of an 82-year-old woman with pseudoaneurysm of the brachial artery developed 22 months after a plate osteosynthesis with angularly stable locking plates for the proximal humerus. The condition was initially misdiagnosed as a tumor by the attending physician, and the patient was referred to an oncological unit. The case was successfully managed by a multidisciplinary team consisting of orthopedic and vascular surgeons. An up-to-date review of the available literature is also provided. The pseudo-aneurysms of the axillary and the distal peripheral arteries of the upper limb are a rare but potentially dangerous complication because the thromboembolism could lead to gangrene and amputation of the extremity. Despite casuistic, they should be taken into consideration in the differential diagnosis after plate osteosynthesis. Proper operative technique and constant vigilance when orthopedic implants are used are of paramount importance, which is actually the emphasis of this report.

Introduction: Sufficient bone volume, as well as the bone quality characteristics are necessary prerequisites to ensure optimal mechanical stability of the implants and subsequent osseointegration. Aim: The aim of the present study was to assess the correlation between bone density values obtained by cone-beam computed tomography (CBCT), the primary stability of dental implants and the histomorphometric analysis of bone quality. Materials and methods: Following tooth extraction, socket preservation with frieze-dried bone allograft or protein-rich fibrin (PRF) was performed on 30 patients with 30 maxillary teeth in the region from second premolar to second premolar. Four months after the procedure, CBCT was used to assess the bone density (Hounsfield units) in the area of extraction. Thirty bone samples were harvested from implant sites using a trephine drill. They were analyzed with Image J software. Immediately after placing the implant, the implant stability quotient was measured using the Osstell Idx device. Results: The results revealed significant correlations between bone density and primary stability along the vestibulo-oral (r=0.392, p=0.032) and mesiodistal axes (r=0.407, p=0.026). Bone density also correlated strongly with the percentage of newly formed bone (r=0.776, p Conclusion: Bone quality, in terms of bone density measured in CBCT and new bone formation are correlated to the primary stability of the dental implants and vice versa.

We propose reframing one of the key questions in the field of language evolution as what was the original human-specific communicative system? With the help of cognitive semiotics, first we clarify the difference between signals, which characterize animal communication, and signs, which do not replace but complement signals in human communication. We claim that the evolution of bodily mimesis allowed for the use of signs, and the social-cognitive skills needed to support them to emerge in hominin evolution. Neither signs nor signals operate single-handedly, but as part of semiotic systems. Communicative systems can be either monosemiotic or polysemiotic—the former consisting of a single semiotic system and the latter, of several. Our proposal is that pantomime, as the original human-specific communicative system, should be characterized as polysemiotic: dominated by gesture but also including vocalization, facial expression, and possibly the rudiments of depiction. Given that pantomimic gestures must have been maximally similar to bodily actions, we characterize them as typically (1) dominated by iconicity, (2) of the primary kind, (3) involving the whole body, (4) performed from a first-person perspective, (5) concerning peripersonal space, and (6) using the Enacting mode of representation.

The aim of the article is to present a narrative review of the literature related to the different shade guides available for dental practitioners. A literature search was performed in the online databases – PubMed, Science Direct, MedLine and GoogleScholar with the following keywords – shade guide, shade matching, dental, dentistry. Furthermore, a hand search, including “grey” literature and printed resources available to the authors, was conducted. More than 2100 unique articles, including the selected keywords, were identified. After a critical review and elimination process, 39 of the papers were included. Dental shade guides are a set of colour standards mimicking the colour of tissues, which dentists aim to restore – tooth structures, gingival tissues or facial structures in facial prosthodontics - skin, mucosa, eyes etc. They can be systematized based on the following principles – fabrication process, the material of manufacturing or restoration and according to the tissues, which are restored. The most commonly used shade guides in the dental practice are structured around Munsell’s 3-dimensional colour system and are aimed at the restoration of tooth colour. The colour standards for gingival and facial restoration are not routinely utilized since they are aimed at specialists in prosthetic dentistry and facial prosthodontics and are underdeveloped to some degree in comparison with the aforementioned. The contemporary development in aesthetic restorative materials and procedures requires an adequate follow up in the evolution of shade guides since they present the only means of communication between the dental office and laboratory.

Introduction: Spinal cord metastases represent a small proportion of intramedullary tumors. The occurrence of such lesion over the course of malignant disease is usually a predictor for shortened life expectancy and is often associated with severe neurological deficits. Treatment options include microsurgical excision, radio-, chemo- or palliative therapy. Despite these possibilities the optimal management of patients with intramedullary spinal cord metastases (ISCM) is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Materials: We are presenting a case of a 68-year-old male with gradually increasing spinal neurological deficit – axial low back pain, numbness and muscle weakness in both legs and gait disturbance. Arterial hypertension was pointed as the only comorbidity of the patient. The MRI showed an intramedullary solitary lesion in the lumbar intumescence at the level of Th12 and L1 vertebra. Results: The patient underwent surgery and the tumor was totally excised. The symptoms improved dramatically. The histology evidence a metastasis from a lung adenocarcinoma. Six months later he presented with severe back pain, progression of the paresis and urinary retention. Tumour recurrence was detected by MRI. After careful decision making and taking into consideration the risk of permanent neurological deficit a reoperation was performed. The lesion was gross-totally removed with improvement in functions and no neurological deterioration registered in the postoperative period. Conclusion: It is possibly the symptoms from an intramedullary metastatic lesion to precede the detection of the primary tumour. The low frequency of occurrence and the absence of a manifested and diagnosed primary malignant process should not stop us thinking in the direction of metastasis. Surgical resection with function preservation is highly aimed. Operation and even reoperation in some cases is acceptable.

Background Sudden restoration of normothermic conditions upon reperfusion of cold-stored grafts has been suggested to entail a massive energy demand not yet met by the cells that still suffer from hypothermic torpor. An adapted and gentle rise of graft temperature by ex-vivo machine perfusion has, therefore, been proposed. This should now be tested in the clinical setting. Methods In a first clinical series, six ECD-kidneys were subjected to controlled oxygenated rewarming (COR) during short term pre-implantation machine perfusion. Matched kidneys that were conventionally kept on ice served as controls. Results Early allograft function after transplantation was significantly improved by COR. On post-operative day 7, clearance of creatinine was more than twofold higher after COR and fractional excretion of sodium in the normal range, while significantly elevated in control kidneys. Good correlations were seen between ulterior graft function and real-time parameters obtained during pre-transplant machine perfusion (Lactate: r2 = .9; TIMP2: r2 = .74). Conventional denominators of graft viability like kidney donor risk index KDRI were far less predictive (r2 = .26). Conclusion It is concluded that COR can be safely applied to renal grafts and appears to be a valuable tool to predict and improve early renal function after transplantation.

Recent developments in prostate-specific membrane antigen (PSMA) targeted diagnostic imaging and therapeutics (theranostics) promise to advance the management of primary, biochemically recurrent, and metastatic prostate cancer. In order to maximize the clinical impact of PSMA-targeted theranostics, a coordinated approach between the clinical stakeholders involved in prostate cancer management is required. Here, we present a vision for multidisciplinary use of PSMA theranostics from the viewpoints of nuclear radiology, medical oncology, urology, and radiation oncology. We review the currently available and forthcoming PSMA-based imaging and therapeutics and examine current and potential impacts on prostate cancer management from early localized disease to advanced treatment-refractory disease. Finally, we highlight the clinical and research opportunities related to PSMA-targeted theranostics and describe the importance of multidisciplinary collaboration in this space.

The aim of the present clinical study was to assess and compare the histomorphometric results and efficacy of freeze-dried bone allograft (FDBA) in combination with platelet-rich fibrin (PRF), and PRF as a sole grafting material for socket preservation. Ninety patients in need of tooth extraction and implant restoration were included in this study. The participants were randomly divided into three groups based on post-extraction clinical protocol: socket preservation procedure with allograft in combination with a PRF membrane (PRFm), PRF as a sole grafting material, and a control group. A total of 90 implants were placed four months post-extraction. During the surgical re-entry a bone biopsy was harvested with a trephine drill. Histological samples were prepared and analyzed for percentage vital bone and connective tissue. One-way ANOVA with Bonferroni post-hoc analysis were used to assess the results. Both test groups revealed a significantly higher percentage of vital bone formation compared to the control group. No statistically significant differences regarding vital bone formation and connective tissue quantity between the tested groups were observed (FDBA + PRFm: 3.29 ± 13.03%, and PRF: 60.79 ± 9.72%). From a clinical and histological point of view, both materials in the test groups are suitable for the filling of post-extraction sockets without bone defects. Both of the tested groups revealed a significantly higher percentage of vital bone formation compared to the control group.

Background Normothermic machine perfusion (NMP) provides a promising strategy for preservation and conditioning of marginal organ grafts. However, at present high logistic effort limits normothermic renal perfusion to a short, postponed machine perfusion at site of the recipient transplant center. Thus, organ preservation during transportation still takes place under hypothermic conditions, leading to significantly reduced efficacy of NMP. Recently it was shown that gentle and controlled warming up of cold stored kidneys compensates for hypothermic induced damage in comparison to end ischemic NMP. This study aims to compare controlled oxygenated rewarming (COR) with continuous up- front normothermic perfusion in a porcine model of transplantation. Methods Following exposure to 30 minutes of warm ischemia kidneys (n=6/group) were removed and either cold stored for 8 hours (CS), cold stored for 6 hours with subsequent controlled rewarming up to 35 °C for 2 hours (COR) or directly subjected to 8 hours of continuous normothermic machine perfusion (NMP). Kidney function was evaluated using a preclinical autotransplant model with follow up for 7 days. Results NMP and COR both improved renal function in comparison to CS and displayed similar serum creatinine and urea levels during follow up. COR resulted in less tenascin C expression in the tissue compared to CS, indicating reduced proinflammatory upregulation in the graft by gentle rewarming. Conclusion COR seems to be a potential alternative in clinical application of NMP, thereby providing logistic ease and usability.

In the present work, software tools have been adapted to improve the operation of a drip irrigation system for orchids, which can be used to meet the specific watering requirements of these plants. The orchids used are divided into two groups - those with a single watering and to which an irrigation system is used. The parameters of the control object are obtained. It has been proven that the proposed system is sustainable and workable. Simulation made through open and closed loop control systems. It was found that the closed loop system significantly improves the irrigation process of the studied plants. An improvement in the operation of an automatic drip irrigation system is proposed by sharing data on the change in the color indices of the plant leaves and the resistance of the orchid mixture. Guidelines are given for the practical use of the developed precise system for watering orchids.

Background: This study aims to evaluate whether there is a correlation between implant stability, bone density, vital bone formation and implant diameter and length. Methods: Ninety patients were enrolled in this study. They underwent a socket preservation procedure with allograft or PRF and after 4 months, a total of 90 implants were placed. CBCT scans were assigned prior to implant placement in order to assess the bone density. During the surgical re-entry, a bone biopsy was harvested with a trephine drill. Immediately after implant insertion, the primary stability was measured. The secondary stability was measured 4 months after implant placement. Results: Primary stability showed a significant positive linear correlation with bone density (r = 0.471, p &lt, 0.001) as well as with percentage of new bone formation (r = 0.567, p &lt, 0.001). An average significant association of secondary stability with bone density (rs = 0.498, p &lt, 0.001) and percentage of newly formed bone (r = 0.477, p &lt, 0.001) was revealed. The mean values of primary stability in all three implant sizes, regarding the diameter of the implants, were similar (narrow 67.75, standard 66.78, wide 71.21) with no significant difference (p = 0.262). The same tendency was observed for secondary stability (narrow 73.83, standard 75.25, wide 74.93), with no significant difference (p = 0.277). Conclusions: The study revealed a high correlation between primary and secondary implant stability, and bone density, as well as with the percentage of vital bone formation. Implant length and diameter revealed no linear correlation with the implant stability.

Preliminary theoretical analyzes have been made, which show that heavy acceleration reduces comfort are available. This applies both to the acceleration when starting and stopping. High levels of acceleration are most common when braking. An analysis of passenger comfort based on accelerometer data and a survey was conducted. The speed of travel, the acceleration in the direction of accelerometer X axis, the rotation axis C have a significant influence on the degree of passenger discomfort. The results obtained complement and partly improve those from the available literature with a model using only one linear and one rotary axis, by which the discomfort is described with sufficient accuracy. A regression model has been obtained, which is a suitable basis for building a driver assistance system to provide passenger comfort in public road transport. A model of a “Driver Assistant” microprocessor system based on studies is proposed.

Access to the circulatory system is essential for continuous monitoring and long-term experimental study. One of the commonest methods for venous access is femoral vein cannulation. The aim of the presented protocol was to elaborate a surgical model for cannulation of femoral vein in rat. Temporary cannulae such as butterfly needles can be used in short-term procedures, whereas long-term monitoring required surgical implantation of a biocompatible cannula. The protocol allows direct venous access, continuous monitoring and evaluation of the tested compounds in experimental pharmacology and toxicology – the tested compounds reach the systemic circulation immediately and the dose can be accurately titrated against response. The protocol can be applied as an alternative for venous access in experimental clinical settings.

We analyzed structural magnetic resonance imaging data from 58 cognitively normal and 101 mild cognitive impairment subjects. We used a general linear regression model to study the association between cognitive performance with hippocampal atrophy and ventricular enlargement using the radial distance method.Bilateral hippocampal atrophy was associated with baseline and longitudinal memory performance. Left hippocampal atrophy predicted longitudinal decline in visuospatial function. The multidomain ventricular analysis did not reveal any significant predictors.

OBJECTIVE To examine the incidence of perioperative complications after radical cystectomy (RC) and assess their impact on 90-day postoperative mortality during the index stay and upon readmission. PATIENTS AND METHODS A total of 57 553 patients with bladder cancer (unweighted cohort: 9137 patients) treated with RC, at 360 hospitals in the USA between 2005 and 2013 within the Premier Healthcare Database, were used for analysis. The 90-day perioperative mortality was the primary outcome. Multivariable regression was used to predict the probability of mortality; models were adjusted for patient, hospital, and surgical characteristics. RESULTS An increase in the number of complications resulted in an increasing predicted probability of mortality, with a precipitous increase if patients had four or more complications compared to one complication during hospitalisation following RC (index stay; 1.0-9.7%, P

Today's competitive advantage of the apparel industry stems from the ability to quickly identify and follow new fashion trends with high quality products. The paper presents the quality control procedure for men's sports shirts. The sampling method allows a decision to be accepted or refused. The basic set is evaluated with one or more samples, while the sample is representative of the whole series. The AQL method controls a portion of randomly selected units. The results indicate that better interfacial control in the sport shirt fabrication process should be introduced. The sampling procedure, type and method of inspection, as well as the procedures for testing discrete elements by attributes, are carried out on the basis of ISO 2859-1 and the request of the client.

Brokerage and brokering are pervasive and consequential organizational phenomena. Prevailing models underscore social structure and focus on the consequences that come from brokerage—occupying a br...

Background: Gingivectomy is a procedure often performed in everyday clinical practice using numerous instruments. Aim: To evaluate and compare the gingival cut surface after gingivectomy with 6 different surgical instruments – a surgical scalpel, an Er:YAG laser, a CO2 laser, a ceramic bur, an electrocautery device, and a diode laser. Materials and methods: Gingivectomy using the above listed instruments was performed in 18 patients. The histological samples excised with a surgical scalpel were assigned as a control group and the other five types – as test groups. The following histological parameters were measured: coagulation layer thickness (in μm); presence or absence of a microscopic rupture and presence or absence of hemostasis in-depth. Results: The best instrument of the above listed ones which demonstrated excellent results is the CO2 laser. The Er:YAG laser has a thin coagulation layer and lack of hemostasis in-depth. The diode laser has the widest coagulation layer which is an advantage from a clinical point of view. Electrocautery proved to be as effective as the diode laser, but it should not be used around metal restorations. The ceramic bur has less pronounced hemostasis in-depth. Conclusions: Modern dentistry uses a wide variety of methods that are designed to be applied in everyday practice. Good knowledge of the ways to use them, their advantages and disadvantages is essential to obtaining the optimal result depending on the clinical case.

Supervised machine learning algorithms deployed in acute healthcare settings use data describing historical episodes to predict clinical outcomes. Clinical settings are dynamic environments and the underlying data distributions characterising episodes can change with time (a phenomenon known as data drift), and so can the relationship between episode characteristics and associated clinical outcomes (so-called, concept drift). We demonstrate how explainable machine learning can be used to monitor data drift in a predictive model deployed within a hospital emergency department. We use the COVID-19 pandemic as an exemplar cause of data drift, which has brought a severe change in operational circumstances. We present a machine learning classifier trained using (pre-COVID-19) data, to identify patients at high risk of admission to hospital during an emergency department attendance. We evaluate our model’s performance on attendances occurring pre-pandemic (AUROC 0.856 95%CI [0.852, 0.859]) and during the COVID-19 pandemic (AUROC 0.826 95%CI [0.814, 0.837]). We demonstrate two benefits of explainable machine learning (SHAP) for models deployed in healthcare settings: (1) By tracking the variation in a feature’s SHAP value relative to its global importance, a complimentary measure of data drift is found which highlights the need to retrain a predictive model. (2) By observing the relative changes in feature importance emergent health risks can be identified.

The study presents a concept for micro hydropower system that uses hydrokinetic energy of river flows. The design is based on crossflow turbine with vertical axis. This concept is developed to be applied as "in stream" hydropower system, especially for rivers. It is initially developed using virtual prototyping techniques and a physical prototype is designed. Major focus is set on physical prototype testing using experimental channel. Obtained test results from physical prototyping are to be used further for virtual prototype adjustment.

Short-term reattendances to emergency departments are a key quality of care indicator. Identifying patients at increased risk of early reattendance could help reduce the number of missed critical illnesses and could reduce avoidable utilization of emergency departments by enabling targeted post-discharge intervention. In this manuscript, we present a retrospective, single-centre study where we created and evaluated an extreme gradient boosting decision tree model trained to identify patients at risk of reattendance within 72 h of discharge from an emergency department (University Hospitals Southampton Foundation Trust, UK). Our model was trained using 35,447 attendances by 28,945 patients and evaluated on a hold-out test set featuring 8847 attendances by 7237 patients. The set of attendances from a given patient appeared exclusively in either the training or the test set. Our model was trained using both visit level variables (e.g., vital signs, arrival mode, and chief complaint) and a set of variables available in a patients electronic patient record, such as age and any recorded medical conditions. On the hold-out test set, our highest performing model obtained an AUROC of 0.747 (95% CI 0.722–0.773) and an average precision of 0.233 (95% CI 0.194–0.277). These results demonstrate that machine-learning models can be used to classify patients, with moderate performance, into low and high-risk groups for reattendance. We explained our models predictions using SHAP values, a concept developed from coalitional game theory, capable of explaining predictions at an attendance level. We demonstrated how clustering techniques (the UMAP algorithm) can be used to investigate the different sub-groups of explanations present in our patient cohort.

We partnered with Walmart to test 22 nudges designed to boost vaccination rates in their pharmacies. Nudges were delivered via text message to over 650,000 Walmart pharmacy patients in the fall of 2020 and encouraged patients to visit Walmart for a flu vaccine. We demonstrate that behaviorally informed messages increase pharmacy vaccination rates by an average of 6.7% over a roughly three-month follow-up period. The most effective messages in our field experiment matched the tone of typical pharmacy communications and reminded patients that a flu shot was waiting for them. These insights suggest that carefully crafted messages informed by the results of this study could nudge the adoption of other vaccines for other infectious diseases, including COVID-19.

Motion-event typology has moved into a “post-Talmian” terrain of approaches focusing on an open-ended number of patterns across languages and constructions. Following a proposal to distinguish between four typological clusters, we systematically compared the motion event descriptions in four languages suggested to exemplify these clusters: Swedish, French, Thai and Telugu, with the help of an elicitation-based study. 20 adult native speakers of each language were asked to describe 52 motion events, 38 of which were translocative. The stimuli varied with respect to the parameters caused/uncaused, bounded/unbounded motion as well as the viewpoint from which they were filmed. The descriptions were analyzed following Holistic Spatial Semantics and compared with respect to the categories Path, Direction, Region, Landmark, Manner and Cause, as well as the means of expressing these. The four languages patterned differently in significant ways. In terms of Path expression, French lagged behind the other languages, but with respect to Direction, it patterned together with Swedish. We demonstrate a number of such criss-crossing patterns, showing that there is no way to group the languages, thus implying at least four distinct typological prototypes. Further, we show that different kinds of motion situations, corresponding to different constructions, need to be compared separately.

Short-term reattendances to emergency departments are a key quality of care indicator. Identifying patients at increased risk of early reattendance could help reduce the number of missed critical illnesses and could reduce avoidable utilization of emergency departments by enabling targeted post-discharge intervention. In this manuscript we present a retrospective, single-centre study where we created and evaluated an extreme gradient boosted decision tree model trained to identify patients at risk of reattendance within 72 hours of discharge from an emergency department (University Hospitals Southampton Foundation Trust, UK). Our model was trained using 35,447 attendances by 28,945 patients and evaluated on a hold-out test set featuring 8,847 attendances by 7,237 patients. The set of attendances from a given patient appeared exclusively in either the training or the test set. Our model was trained using both visit level variables (e.g., vital signs, arrival mode, and chief complaint) and a set of variables available in a patients electronic patient record, such as age and any recorded medical conditions. On the hold-out test set, our highest performing model obtained an AUROC of 0.747 (95% CI : 0.722-0.773) and an average precision of 0.233 (95% CI : 0.194-0.277). These results demonstrate that machine-learning models can be used to classify patients, with moderate performance, into low and high-risk groups for reattendance. We explained our models predictions using SHAP values, a concept developed from coalitional game theory, capable of explaining predictions at an attendance level. We demonstrated how clustering techniques can be used to investigate the different sub-groups of explanations present in our patient cohort.

The aim of the study is to modify an uninterruptible power supply (UPS) system consisting of a radial asynchronous electric motor/generator connected to a kinetic energy accumulator (a flywheel) in such a way that the stator windings of the electrical machine are kept excited when the flywheel is in a condition in which it rotates freely and the electric machine consumes the energy accumulated in it. This modification is realized in the rotor package of the asynchronous electric machine with the insertion of prismatic permanent neodymium magnets with perpendicular magnetization of the surface, located at 180 degrees in two rows in the rotor package. This helps with the reduction of the switching time between motor and generator mode in the event of a power outage.

In today’s modern energy sector, driven more and more towards decentralization, which includes many smaller energy producers rather than huge government projects, security against cyber-attacks is becoming more crucial for the energy grid. Since many small energy plants do not have the resources to finance very expensive existing cyber-security systems, they often have no security system in place at all. Although with small energy producers, the risks of being under attack are not as devastating as in a huge power plants, they still pose a serious threat to the energy system and to the supply of electricity to whole regions. Moreover, in the era of technology, such cyber-attacks could be carried out simultaneously at many locations, thus risking the lack of electricity to larger areas. Since there was a clearly identified need for such an instrument, the SPEAR consortium, started to develop tailor made solution for different types of actors in the energy sector, to prevent such occurrences and help secure the energy system. One of the use cases, investigated in the project, is a real operating hydro power plant in the mountain area of Bulgaria called Leshnitsa, which will be one of the four sites to first test the functionality of the finished product. The plant had no previous cyber-security system in place and had already experienced one attack, where one of the computers in the plant was hacked and a ransom was demanded from the attackers to unlock it. Exactly events like this one are proof, that the energy sector has a need to protect the growing number of small independent actors in the energy system..

BackgroundClinicians’ use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence.ObjectiveTo assess physicians’ abilities to predict how common choice frames influence people’s choices.MethodsWe conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured interviews. Participants were senior resident physicians from a large health system. Of 160 eligible participants, 93 (58.1%) completed the scenario-based questionnaire and 15 completed the semistructured interview. The primary outcome was choice architecture competency, defined as the number of correct answers on the eight-item scenario-based choice architecture competency questionnaire. We generated the scenarios based on existing decision science literature and validated them using an online sample of lay participants. We then assessed senior resident physicians’ choice architecture competency using the questionnaire. We interviewed a subset of participating physicians to explore how they approached the scenario-based questions and their views on choice architecture in clinical medicine and medical education.ResultsPhysicians’ mean correct score was 4.85 (95% CI 4.59 to 5.11) out of 8 scenario-based questions. Regression models identified no associations between choice architecture competency and measured physician characteristics. Physicians found choice architecture highly relevant to clinical practice. They viewed the intentional use of choice architecture as acceptable and ethical, but felt they lacked sufficient training in the principles to do so.ConclusionClinicians assume the role of choice architect whether they realise it or not. Our results suggest that the majority of physicians have inadequate choice architecture competency. The uninformed use of choice architecture by clinicians may influence patients and family members in ways clinicians may not anticipate nor intend.

Purpose: In many individuals with spinal cord injury a return of volitional bladder voiding is considered more important than regaining motor function. Recently a predictive model using only composite bilateral lower extremity motor scores for levels L2-S1 (range 0 to 50) was proposed by the EMSCI (European Multicenter Study about Spinal Cord Injury) group. The model showed exceptional predictive power with an AUC of 0.912. We sought to further validate the EMSCI model in a national spinal cord injury cohort.Materials and Methods: We created models of volitional voiding using the United States NSCID (National Spinal Cord Injury Database) for 2007 to 2016. In addition to testing lower extremity motor scores, we evaluated other patient variables that we hypothesized might affect volitional voiding.Results: Volitional voiding was present in 1,333 of the cohort of 4,327 individuals (30.8%) at 1-year followup. While younger age, female gender, increased sacral sparing, improved AIS (American Spinal Injury Asso...

A simple and rapid reagent less nephelometric method for on-line H2O2 quantification in semiconductors etching solutions was developed, optimized, characterized and validated. The intensity of the light scattered by the oxygen gas suspension resulted from H2O2 catalytic decomposition by immobilized MnO2 was registered as analytical response. The influences of the light wave length, the agitation rate, the temperature and the catalyst surface area on the response amplitude were studied and optimization was done. The achieved linear concentration range from 10 to 150mmolL-1 at 0.9835 calibration curve correlation coefficient, precision from 3.65% to 0.95% and response time from 35 to 20s respectively, at sensitivity of 8.01µAmmol-1 L and LOD of 2.9mmolL -1 completely satisfy the semiconductor industry requirements.

In this article a possibility of application of the ultrasonic non-contact method for assessing the quality of yogurt was researched. A prediction assessment was made by an ultrasound based on four parameters – pH, conductivity, fat content, and viscosity. An ultrasonic device was developed to determine the parameters of yoghurt by modified ultrasound sensor available commercially. In order to obtain data for post-processing, a software application was designed for recognizing the ultrasonic signal through the image processing and analysis techniques.The developed algorithms and procedures were applied to determine the distance between the object and the sensor, whereby basic physico-chemical parameters of yogurt could be predicted with the lowest relative error. The working distance was 35 cm for the considered system. The survey results show that the parameters fat content, pH, conductivity, and viscosity of yogurt could be predicted by the proposed system for contactless measurement with accuracy of 94-97%.

Consumption of clothing, water and energy by washing laundry is one of the most widespread housework in the Egypt. Today, washing machines do this work in many private households, using water, energy, chemical substances, and process time. Although energy efficiency is in the focus of many regulations which have already achieved significant improvements, the question remains, how relevant these processes are in terms of the absolute impact on resources and whether there are possibilities to improve even further by looking abroad. This survey, which is based on published data, compares the energy and water consumption for automatic laundry washing in an average private household with the total energy and water consumption of private households. Only little data are available on resource consumption for laundry washing based on in-use measurements are hard to obtain. But although some of the data in this report are poor, this is the first work that tries to elucidate the contribution of automatic laundry washing to the total energy and water consumption of households in selected countries North Africa. The report estimates the resource consumption of roughly about 37.72 Million only household washing machines in five countries (Egypt, Libya, Algeria Tunes, Morocco,) with about 188.6 Million people, which is about one third of the North Africa population. The results of this work show that laundry washing in private households is done with quite different amounts of energy and water in different parts of the North Africa both in absolute and relative comparison to the overall household consumption. But due to different consumer habits in dealing with the achieved washing performance in the different global regions, the best practice in washing laundry in a most sustainable way cannot be determined yet. Further research is needed to form a basis for a most sustainable development of resource consumption in Private households.

A persistent controversy in language evolution research has been whether language emerged in the gestural-visual or in the vocal-auditory modality. A “dialectic” solution to this age-old debate has now been gaining ground: language was fully multimodal from the start and remains so to this day. In this paper, we show this solution to be too simplistic and outline a more specific theoretical proposal, which we designate as pantomime-first. To decide between the multimodal-first and pantomime-first alternatives, we review several lines of interdisciplinary evidence and complement it with a cognitive-semiotic experiment. In the study, the participants saw – and then matched to hand-drawn images – recordings of short transitive events enacted by 4 actors in two conditions: visual (only body movement) and multimodal (body movement accompanied by nonlinguistic vocalization). Significantly, the matching accuracy was greater in the visual than the multimodal condition, though a follow-up experiment revealed that the emotional profiles of the events enacted in the multimodal condition could be reliably detected from the sound alone. We see these results as supporting the proposed pantomime-first scenario.

Introduction: A drastic increase in the number of published medical papers per year is observed. This makes the identification, analysis and categorization of significant studies a difficult task. Natural (human) Language Processing and text mining are methods, part of the scientific branch computer linguistics that transfer the informational overload from a human to a computer. It enables easier processing and analysis of large volumes of unstructured textual data. Purpose: The current study aims to familiarize researchers working in the field of dentistry with the capabilities of NLP and TM for a quick and concise analysis of large volumes of unstructured textual information and identification of dependencies between different factors important for a given subject. Materials and Methods: To demonstrate the capabilities of text mining, an important topic in the field of dentistry was chosen – factors influencing the esthetics of a smile. The analysis was carried out with “R”- a computer language for statistical processing. A literature search was conducted in the “PubMed” database with key-words – “dental, esthetic and factor”. The resulting abstracts were saved as a local copy, imported and processed. Word frequencies and associations between different terms were analyzed. Results and discussion: Weak to moderate correlation was established between the significant, most frequent terms in the text - “esthetics, „smile“, „arc“, „buccal“, „gingival”, “lip” and “midline”./0.1

Background Evidence suggests that the sequence of accrual of conditions varies considerably and affects outcomes. We aimed to explore whether sentinel conditions (the first long-term condition occurring in the life course) and accrual sequences of long-term conditions in the development of early onset multimorbidity can be characterised using birth cohort and primary care data. Methods In this retrospective cohort study, we used data from the 1970 British Birth Cohort Study (BCS70) and pseudonymised data from the Care and Health Information Analytics database (CHIA). Age 26 years is the first BCS70 adulthood sweep (round of data collection) age 46 years the most recent (age 50 sweep delayed by COVID-19) and we investigated an exemplar multiple long-term condition multimorbidity (MLTC-M) group with adequate numbers (ie, mental ill-health, backpain, and high blood pressure). In CHIA we defined MLTC-M as two or more (of 21) conditions occurring by age 50. Sequencing identified the timepoint at which sentinel conditions were reported. Findings The BCS70 age 46 years sample comprised of 8581 participants (4427 [52%] women and 4154 [48%] men). For participants who reported the exemplar MLTC-M outcome (n=163), mental ill-health was the sentinel condition for 25% (n=41), with 12% (n=20) reporting mental ill-health at age 26 years. Pain was the second commonest sentinel condition (21%; n=35) with 16% (n=26) reporting pain at age 26 years. 45% (n=74) reported their sentinel condition by age 26. For the exemplar MLTC-M group the most common accrual sequence was mental ill-health and back pain followed by high blood pressure (n=35; 21%). The CHIA sample included 702 265 participants (373 553 [53%] women and 328 712 [47%] men). Out of a total 335 963 people under 50, 65 757 (20%) had MLTC-M. Common sentinel conditions were asthma (44%; n=29 228) and anxiety or depression (37%; n=24 634). Hypertension was a sentinel condition for 4% (n=2580). Interpretation We identified possible sentinel conditions of burdensome MLTC-M in birth cohort and primary care datasets. Continued development of this methodology, drawing together learning from complementary datasets, might help inform the timing and nature of interventions endeavouring to alter health trajectories and preventing the development of MLTC-M. Funding National Institute for Health Research (number NIHR202644).

Introduction Clean intermittent catheterization (CIC) is the gold standard for neurogenic bladder management in most patients with spinal cord injury (SCI). There is nonetheless a lack of long-term adherence to CIC, with up to 50% discontinuance at 5-year follow-up. We hypothesize that limitations in upper extremity (UE) motor function represent a strong predictor for long-term CIC adoption. Methods We assessed Forms I and II data from the 2000-2013 National SCI Database. Bladder management was determined at initial discharge and 1-year follow-up. Upper extremity (UE) motor scores were transformed using a previously published algorithm to predict a patient's ability to independently self-catheterize. Uni- and multivariable logistic regression modeling was performed to assess risk factors affecting: a) a lack of CIC adoption at rehabilitation discharge, b) CIC discontinuance by 1-year follow-up (CIC “dropout”), and c) adherence to management with an indwelling catheter rather than conversion to CIC at 1-year follow-up. Results For all three modeled scenarios, UE motor function represented the most significant predictor for lack of CIC adoption (OR range 2.1-6.3, P ≤ 0.003 for all). Other predictors included increasing age (OR 1.01-1.02, P ≤ 0.001 for all models) and female gender (OR 1.6-1.7, P

A simple, rapid, and reagent-less calorimetric method for H2O2 quantification, applicable automatically on-line was developed, analytically characterized and tested with real SC-1 alkaline etching solutions used in the semiconductor technology. Being based on H2O2 catalytic decomposition by immobilized solid catalyst, the proposed method possesses excellent specificity toward the H2O2 without any interference. The total quantification time was found to be less than 60s, RSD lies in the range from 4.7% to 1.8% for the linear concentration range from 2.8 10-2 to 2molL-1 respectively and the LOD was determined to be as low as 9.3 10-3molL-1.

At the current level of science and technology is used semi-automatic measurement of body parts of the bees, yielding images taken with a reference object via a camera or a scanner and then perform measurement by software using a pointing device. There are attempts to fully automated process of measuring the morphological characteristics of bees, at this stage there are conversions for Measuring wings, but this process for other parts are still made by manual way. The informative colour features for the separation of tergite and probotics from background in the image are selected by distance functions and correspondence analysis. Distances are determined between the values of the colour components of the object and background. From statistical analysis is found that appropriate for the separation of an object from background are S and V colour components of the HSV colour model. Algorithms and program in Matlab environment for separating tergite and proboscis from the background of the image and definition of their main sizes are developed. From the analysis of the results is found that the major influence on the accuracy of the measurement is the angle at the disposal of the bee body part in the image.

The diagnosis of deviations in quality of yogurt is performed by approved methods set out in the Bulgarian national standard (BNS) and its adjacent regulations. The basic method of evaluation of the microbiological quality of the product is the microscopic. The method is subjective and requires significant processing time of the samples. The precision of diagnosis is not high and depends on the qualifications of the expert. The systems for pattern recognition in the most natural way interpret this specific expert activity. The aim of this report is to assess the possibility of application of a method of processing and image analysis for determination of the microbiological quality of yogurt. Selected method is template matching. A comparative analysis is made of the methods for template matching. The comparative analysis of available algorithms showed that the known ones have certain disadvantages associated with their rapid-action, the use of simplified procedures, they are sensitive to rotation of the object in the template. It is developed algorithm that complement these known and overcome some of their disadvantages.

OBJECTIVES: To develop and externally validate a model that quantifies the likelihood that a pathologically node-negative in a patient with clear cell renal cell carcinoma (cRCC) has, indeed, no Lymph node metastasis (LNM). PATIENTS AND METHODS: Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. For external validation, we used data from 2270 patients in the Surveillance, Epidemiology and End Results (SEER) database. We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node-negative as a function of the number of examined lymph nodes (LNs). RESULTS: The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD: 6.6, interquartile range, IQR: 7.0) in the development cohort and 5.6 and 2.0 (SD: 8.6, IQR: 5.0) in the validation cohort, respectively. The probability of missing a positive LN decreased with increasing number of LNs examined. In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman Grade. CONCLUSIONS: The number of examined LNs needed for adequate nodal staging in cRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patients counseling, decision-making regarding risk stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.

A single dose of small interfering ribonucleic acids (siRNA) targeting angiotensinogen (AGT) provides a strong and sustained antihypertensive effect, lasting weeks to months in preclinical models. It is not known whether conventional vasopressors are effective to reverse RNAi-mediated blood pressure lowering. Here, we investigated whether conventional vasopressors can elevate arterial pressure under conditions of AGT depletion. Spontaneously hypertensive rats on a low-salt diet (