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ObjectiveInvestigate whether resuming physical activity (PA) at 72 hours post concussion is safe and reduces symptoms at 2 weeks, compared with resting until asymptomatic.MethodsReal-life conditions, multicentre, single-blinded randomised clinical trial, conducted in three Canadian paediatric emergency departments (ED). Children/youth aged 10–Results456 randomised participants (EG: N=227; mean (SD) age=13.3 (2.1) years; 44.5% women; CG: N=229; mean (SD) age=13.3 (2.2) years; 43.7% women) were analysed. No AE were identified. ITT analysis showed no strong evidence of a group difference at 2 weeks (adjusted mean difference=−1.3 (95% CI:−3.6 to 1.1)). In adherent participants, initiating PA 72 hours post injury significantly reduced symptoms 2 weeks post injury, compared with rest (adjusted mean difference=−4.3 (95% CI:−8.4 to –0.2)).ConclusionSymptoms at 2 weeks did not differ significantly between children/youth randomised to initiate PA 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early PA was associated with reduced symptoms at 2 weeks. Resumption of PA is safe and may be associated with milder symptoms at 2 weeks.Level of evidence1b.Trial registration numberNCT02893969.Registry namePediatric Concussion Assessment of Rest and Exertion (PedCARE). more...

Objectives To evaluate for increased rectal bleeding following enoxaparin thromboprophylaxis in children hospitalized for ulcerative colitis (UC). Methods Retrospective cohort study (2007--2016) of 218 inpatients with active UC. Patients receiving enoxaparin were compared with a nonenoxaparin-treated patient group. Severity of UC was determined using the Pediatric Ulcerative Colitis Activity Index (PUCAI). Hemoglobin (Hb) values and packed red blood cell (pRBC) transfusions were reviewed for a 7-day period following hospital admission. A linear mixed effect model was used to compare change in Hb values between the groups. Risk of pRBC transfusion was compared using a log-rank test and Cox proportional hazard regression. A sub-analysis was also conducted restricting to patients with severe UC to provide more generalizable insight into safety profile of enoxaparin. Results Children hospitalized for UC and receiving enoxaparin were more likely to have severe disease, received infliximab therapy and be admitted after 2010. Use of enoxaparin showed there was not a difference (P = 0.60) in the fall of Hb detected among those with acute severe colitis (initial PUCAI ≥65) during the week following admission. Moreover, there was no difference in the risk of requiring a pRBC transfusion with enoxaparin use (log-rank test all patients: P = 0.80; severe UC: P = 0.88; Cox proportional hazard regression all patients: P = 0.72; severe UC: 0.85). Conclusions There was no difference in Hb levels or need for blood transfusions in children hospitalized for severe UC (PUCAI ≥65) whether or not they received enoxaparin for thromboembolism prophylaxis. more...

Peritoneal metastases (PM) are a form of metastatic spread affecting approximately 5-15% of colon cancer patients. The attitude towards management of peritoneal metastases has evolved from therapeutic nihilism towards a more comprehensive and multidisciplinary approach, in large part due to the development of cytoreductive surgery (CRS), usually coupled with heated intraperitoneal chemotherapy (HIPEC), along with the constant improvement of systemic chemotherapy of colorectal cancer. Several landmark studies, including 5 randomized controlled trials have marked the development and refinement of surgical approaches to treating colorectal cancer peritoneal metastases. This review article focuses on these landmark studies and their influence in 4 key areas: the evidence supporting surgical resection of peritoneal metastases, the identification and standardization of important prognostic variables influencing patient selection, the role of surgery and intraperitoneal chemotherapy in prevention of colorectal PM and the role of intraperitoneal chemotherapy as an adjuvant to surgical resection. These landmark studies indicate that surgical resection of colorectal PM should be considered as a therapeutic option in appropriately selected patients and when adequate surgical expertise is available. Standardized prognostic variables including the Peritoneal Cancer Index and the Completeness of Cytoreduction Score should be used for evaluating both indications and outcomes. Current evidence does not support the use of second look surgery with oxaliplatin HIPEC or prophylactic oxaliplatin HIPEC in patients with high risk colon cancer nor the use of oxaliplatin HIPEC with CRS of colorectal PM. more...

Gastrointestinal complications, predominantly anastomotic leak (AL), are the most frequent source of severe morbidity after cytoreductive surgery (CRS). The aim of this study was to present the technical standards for colorectal anastomoses developed and systematically applied to all patients undergoing CRS in a high-volume tertiary center, and the associated AL rates. This was a descriptive study reporting the technical characteristics of a standardized protocol for three types of colorectal anastomoses (colorectal, ileorectal, and ileocolic) in CRS with heated intraperitoneal chemotherapy (HIPEC), and a retrospective analysis of prospectively collected data on anastomotic outcomes. All patients (1172) undergoing CRS with HIPEC from September 2006 to September 2020 were included. The anastomotic complications were classified according to the International Study Group of Rectal Cancer Surgery (ISGRCS) classification. Overall, 1172 patients underwent 1300 procedures and 1359 gastrointestinal anastomoses. An ileocolic anastomosis was performed in 408 patients, colorectal anastomosis in 469 patients, and ileorectal anastomosis in 16 patients, none with diverting ileostomy; 345 other gastrointestinal reconstructions and 82 urinary reconstructions were performed in these patients. The AL rate was 1% (4/408) for the ileocolic anastomosis, 0.85% (4/469) for the colorectal anastomosis, and 0% (0/16) for the ileorectal anastomosis. One patient died postoperatively due to AL. Systematic application of standardized techniques adapted to ensure optimal tissue healing (stapled anastomoses avoiding overlap, accurate staple deployment, and hand-sewn reinforcement) are associated with a very high level of anastomotic safety in a large cohort of patients undergoing CRS and HIPEC. more...

Background/Aim. Diabetes mellitus (DM) can be associated with numerous skin diseases. This study aimed to determine the pattern and incidence of skin manifestations in patients with type 2 DM and their link to glycemic control. Methods. This cross-sectional study was conducted at the Skin and Venereal Diseases Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, Bosnia and Herzegovina, from January 2016 to January 2018. Adult patients of both genders suffering from type 2 DM and cutaneous manifestations participated in the study. Glycemic control was assessed according to the values of glycated hemoglobin (HbA1c) of 7%. Results. The mean age of 105 study participants (46% m ale and 5 4% female) was 6 8.4 ? 10 years, while the mean HbA1c was 8.3 ? 1.6%. Unsatisfactory glycemic control was found in 74.3% of patients with the mean HbA1c at 8.9 ? 1.4%, while satisfactory glycemic control was found in 25.7% of patients, with the mean HbA1c at 6.7 ? 0.2% (p < 0.001). Infections were the most frequent skin diseases (43.9%). Bacterial infections were most common (26.7%), followed by fungal infections (24.8%), xerosis (17.1%), psoriasis (15.2%), fibroma molle (14.3%), diabetic ulcer (7.7%), prurigo (6.7%), and stasis dermatitis (5.7%). Other skin manifestations were found at a lower rate. A significant association was found between unsatisfactory glycemic control and skin infections (p = 0.009). Conclusion. The most common skin manifestations in patients with type 2 diabetes are infections. They occurred more often in patients with unsatisfactory glycemic control. more...

Background Colorectal cancer (CRC) treatment in patients with peritoneal metastases is complex. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are under debate. The aim of this study was to assess the consensus among international experts for decision-making regarding CRS/HIPEC in CRC patients. Materials and methods Twelve of 15 experts provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Based on the objective consensus methodology, the results were transformed into decision trees, which then provided information on the consensus and discordance. Results There was only one scenario in which the consensus on performing HIPEC reached 100%, which was when treating young patients with complete cytoreduction and a peritoneal carcinomatosis index (PCI) of less than 16 in the presence of certain risk factors (RFs). Five major decision criteria were identified and displayed: age, PCI, completeness of cytoreduction (CC), extent of extraperitoneal metastases (EoM) and, in the case of nonverified extraperitoneal metastases, further RFs. There was consensus to refrain from using HIPEC in older patients with a high PCI, and the consensus further increased when addressing incomplete cytoreduction and extensive EoM. Conclusion A definite consensus concerning the use of HIPEC was only determined for very selected scenarios. These findings can be used for general guidance, but due to the heterogeneity of each individual situation and the impracticality to present this information through decision trees, as well as the unclear future of the role of HIPEC in the adjuvant setting, a one-on-one transfer to daily clinical practice cannot be achieved. more...

Background: Pediatric aortic root dilatation is a life-threatening condition that lacks guidelines for surgical management. We aimed to analyze the data on aortic valve interventions during root surgery to guide decision-making. Methods: A search was performed of MEDLINE, Embase, CENTRAL, ClinicalTrials.gov , and WHO ICTRP. Citations were screened in duplicate and independently to identify randomized controlled trials, cohorts, and case series involving populations aged 0 to 18 years, who received valve-sparing and valve-replacing aortic root surgeries between 1999 and 2019. Outcomes considered included mortality (perioperative, one year, five year), reintervention rates. Results: After duplicate removal, 689 citations were screened through abstract and full text review, identifying five eligible studies. All five were observational studies evaluating valve-sparing procedures. There were 81 patients with a mean study age range of 9.9 to 13.9 years. Both reimplantation (74%) and remodeling (26%) subtypes were done. Range of mean duration of follow-up was 1.2 to 4.4 years. There was no mortality reported until the one-year follow-up period. The long-term mortality rate was calculated as 0.02 per patient-year (95% CI: 0.01-0.05). The long-term reintervention rate was 0.08 per patient-year (95% CI: 0.05-0.13). Conclusions: There is limited experience on aortic valve intervention during aortic root surgery in children. Single-arm studies on valve-sparing surgeries show excellent survival up to one year. Mortality and reintervention rates increase in the longer term. The small sample size and lack of controlled studies do not allow for direct comparisons between procedure types. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of desmoplastic small round cell tumor, breast, and gastrointestinal stromal tumor specifically related to peritoneal surface malignancy. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for palliative care specifically related to peritoneal surface malignancies. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, gynecologic oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of neuroendocrine tumors specifically related to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare malignancy associated with poor outcomes. Recent reports have shown longer survival with radical surgery, usually combined with intraperitoneal chemotherapy. However, surgical interventions in these patients have not been extensively studied at a population level. The objective of this retrospective cohort study is to assess the prevalence of surgical and nonsurgical interventions for DMPM patients, the influence of surgery on survival outcomes, and the associations between demographic and clinical factors with treatments and outcomes. This study included adult patients diagnosed with DMPM from 2003 to 2014 and registered in the National Cancer Database (NCDB). The primary outcome was overall survival. Histologically confirmed mesothelioma was defined using International Classification of Diseases (ICD)-3 codes 9050/3, 9051/3, 90523, and 9053/3 and peritoneum as primary affected organ using ICD codes C17-19, C22-24, C26, C42, C48, and C76. Relationships between demographic and clinical variables, surgical treatments, and survival outcomes were evaluated using logistic and Cox modeling and log-rank tests. A total of 2062 patients were identified, of whom 1055 (51%) did not receive any surgery while 701 (34%) received radical surgery. Patients receiving radical surgery had overall survival of 38.4 months compared with 7.1 months for patients without surgery (p more...

Background: Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life. Objective. The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes. Method. The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%. Results. Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p more...

Introduction: According Type 2 diabetes mellitus is a chronic metabolic disease with a high prevalence characterized by elevated blood glycemic values and with progressive development of micro and macrovascular complications. Glycemia control is a very important factor in the process of „delaying“ the onset of complications by glycated hemoglobin (HbA1c) analysis. Aim: The aim of the study is to determine the association of obesity, microvascular complications with glycemic control in patients with type 2 diabetes. Methods: The study was prospective, involving 105 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska from January 2016 to January 2018. The patients were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was evaluated based on a target HbA1c value of 7%. Results: Out of the 105 patients in the study, 45.8% were male, 54.2% female. The mean age of the patients was 68.3%±10.7 years. The mean HbA1c level was 8.32±1.57%. Of the total number of patients, in 25.7% the HbA1c levels were ≤7.0%, while in 74.3% the HbA1c were ≥7.0% (p more...

Uterine leiomyosarcoma in a prior myomectomy site is a rare phenomenon. We report an unusual case of a leiomyosarcoma arising six months post myomectomy in a 16-year old female., Graphical Abstract Radiographic images (A) starting with the CT of mass on day 0 followed by the CT abdomen/pelvis of second pelvic mass leiomyosarcoma on day 185, the MRI prior to staging surgery on day 317, and finishing up with the MRI of the recurrence of malignancy. Timeline of patient events (B). Our patient initially underwent a diagnostic laparoscopy with pelvic mass biopsies showing leiomyoma which was followed by an abdominal myomectomy. She re-presented to the hospital on Day 190 and urgently underwent an exploratory laparotomy for resection of a pelvic mass which revealed a leiomyosarcoma. The patient subsequently received neoadjuvant chemotherapy (NACT) with ifosamide and doxorubicin and pelvic radiation. On day 316 she underwent surgical staging including hysterectomy and bilateral salpingo-oophorectomy which showed no residual disease. Patient received adjuvant chemotherapy with ifosamide and doxorubicin. On Day 490 patient diagnosed with recurrence of disease and on day 500 underwent exploratory laparotomy with resection of three recurrent abdominal tumors, greater omentectomy, small bowel resection, and heated intraperitoneal chemotherapy (HIPEC) with cisplatin and doxorubicin. For microscopic recurrent and persistent disease the patient will receive gemcitabine and docetaxel. Histological images (C) starting of the pelvic mass biopsy on day 0 followed by the myomectomy on day 8, the primary tumor resection on day 190, the staging surgery showing no residual leiomyosarcoma on day 316, and end with the recurrent abdominal tumor debulking surgery on day 500.Unlabelled Image, Highlights • Malignant transformation of a leiomyoma to a leiomyosarcoma is a rare phenomenon. • Leiomyosarcomas can be extremely aggressive when they present in an adolescence. • Multidisciplinary team needed to treat an adolescent with a leiomyosarcoma. more...

BackgroundRecent clinical practice changes in neonatal care resulted in higher, narrower oxygen saturation target ranges for preterm infants. The effect of targeting higher or lower oxygen saturations on respiratory outcomes of preterm infants and duration of hospitalization has not been extensively reviewed in the context of current care, but could have significant implications.MethodsA multicentre retrospective cohort of 145 preterm infants was conducted; 105 had lower oxygen saturation targets (88 to 92%), 40 had higher targets (90 to 95%). The primary outcome was bronchopulmonary dysplasia (BPD). Secondary outcomes included duration of invasive/noninvasive respiratory support, oxygen therapy, and hospitalization. The primary outcome was compared using Fisher’s exact test. Secondary outcomes were evaluated with survival analysis and Wilcoxon rank sum test.ResultsThe difference in incidence of BPD in the lower (N=56, 53.3%) and higher saturation groups (N=14, 35.0%) was not statistically significant (relative risk [RR]=0.66 [0.41, 1.04], P=0.06). The difference in duration of mechanical ventilation in the lower (median 7.8 days, interquartile range [IQR] 3.7 to 15.9) and higher saturation groups (median 4.5, IQR 1.9 to 12.3) approached statistical significance (P=0.05). There were no statistically significant differences in the durations of other respiratory supports or hospital stay between the two groups.ConclusionsThe results of this study approached statistical significance and suggest that higher, narrower oxygen saturation targets may result in a clinically important reduction in BPD incidence and duration of mechanical ventilation. These results require validation in a larger sample to refine optimal targets. more...

Current driver assistance systems and autonomous driving stacks are limited to well-defined environment conditions and geo fenced areas. To increase driving safety in adverse weather conditions, broadening the application spectrum of autonomous driving and driver assistance systems is necessary. In order to enable this development, reproducible benchmarking methods are required to quantify the expected distortions. In this publication, a testing methodology for disturbances from spray is presented. It introduces a novel lightweight and configurable spray setup alongside an evaluation scheme to assess the disturbances caused by spray. The analysis covers an automotive RGB camera and two different LiDAR systems, as well as downstream detection algorithms based on YOLOv3 and PV-RCNN. In a common scenario of a closely cutting vehicle, it is visible that the distortions are severely affecting the perception stack up to four seconds showing the necessity of benchmarking the influences of spray. more...

Primary Subject area Neonatal-Perinatal Medicine Background Sepsis adversely impacts the survival of very low birth weight infants (VLBW), with a mortality risk up to 50%. Its diagnosis in premature infants is challenging. Conversely, prolonged antibiotic use is associated with perilous potential consequences, propelling the need to better identify those at risk of sepsis. The presence of a histological intra-amniotic inflammation (IAI) response may be associated with an increased risk of early onset sepsis (EOS). Currently, it is unknown how the diagnosis of histological IAI impacts the risk of sepsis. Objectives Our research goal is to explore histological fetal and maternal inflammation in the placenta in VLBW infants and to evaluate if specific recommendations about antibiotic management of VLBW infants with histological fetal response can be proposed. Design/Methods Retrospective cohort study of all infants < 1500 g born to a mother with histologically confirmed IAI. Demographic information about the pregnancy, delivery and postnatal course up to 28 days of life was extracted. Descriptive statistical analysis was conducted to compare the characteristics of infants with histological fetal response using χ2 test or Fisher’s exact test and Wilcoxon rank sum test or ANOVA. Results Seventy-three mother-baby pairs were reviewed. EOS prevalence (19%) in our IAI group of VLBW infants is much higher than EOS observed in all VLBW infants from the Canadian Neonatal Network database (below 3%). In our cohort, the majority had fetal inflammatory stage 1 (31.6%) and fetal inflammatory grade 0 (50%). There was no statistically significant distribution amongst the fetal stages or grades. Time to sepsis event analysis showed that the earlier fetal inflammatory grade was associated with positive cultures occurring earlier, while in the later grades there demonstrated longer latency to positive cultures. This trend was also true when looking at the maternal inflammatory stages. Nine infants who had antibiotics discontinued from day of life (DOL) 2-5 developed a positive blood culture ≤ DOL8. Conclusion Our results suggest that the presence of mild fetal inflammatory changes is associated with earlier positive cultures. We hypothesize that later grades may be associated with longer infection exposure leading to prolonged maternal antibiotics, resulting in less EOS. Majority of positive cultures were within the 3-8 day window, suggesting a role of knowing the fetal inflammatory response when deciding duration of antibiotic treatment. more...

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an innovative drug delivery technique invented to be used for the treatment of peritoneal metastasis. Its application gained popularity over the past years. Several prospective clinical trials are being conducted to determine efficacy and safety. At this moment, there remain many challenges to overcome before PIPAC can be widely adopted in clinical practice. See related article by Kim et al., p. 1875 more...

Adverse weather conditions, including snow, rain, and fog, pose a major challenge for both human and computer vision. Handling these environmental conditions is essential for safe decision making, especially in autonomous vehicles, robotics, and drones. Most of today's supervised imaging and vision approaches, however, rely on training data collected in the real world that is biased towards good weather conditions, with dense fog, snow, and heavy rain as outliers in these datasets. Without training data, let alone paired data, existing autonomous vehicles often limit themselves to good conditions and stop when dense fog or snow is detected. In this work, we tackle the lack of supervised training data by combining synthetic and indirect supervision. We present ZeroScatter, a domain transfer method for converting RGB-only captures taken in adverse weather into clear daytime scenes. ZeroScatter exploits model-based, temporal, multi-view, multi-modal, and adversarial cues in a joint fashion, allowing us to train on unpaired, biased data. We assess the proposed method on in-the-wild captures, and the proposed method outperforms existing monocular descattering approaches by 2.8 dB PSNR on controlled fog chamber measurements., Comment: 2021 IEEE Conference on Computer Vision and Pattern Recognition (CVPR), project page available at https://light.princeton.edu/publication/zeroscatter/ more...

This paper presents the early results of research aiming to develop a novel system for unobtrusive and intuitive electrotactile feedback for first responders. The system leverages the multi-pad stimulation technology based on spatiotemporal modulation of the stimuli. Two-point discrimination threshold mapping was performed in potential electrode placement locations, defined from the usability perspective by the first responders in initial co-development sessions. Based on these results a custom electrode design was proposed and validated in six healthy volunteers. Psychometric testing was conducted to determine spatial discrimination between stimuli produced by the multi-pad electrode. The average success rate of 80% indicates that the proposed approach is feasible. The work presented in this paper was funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 883315. more...

This paper presents the principles, organization and course of implementation of the SEGIP project. SEGIP was Initially conceived as software that collects data from advanced measuring devices and defines operating conditions based on the collected data. In the last three years, from the beginning of the project proposal, through the evaluation and to the beginning of the development that followed the research phase, in the spirit of agile development, it is necessary to continuously redefine the direction of development to make the product competitive in the more demanding market. This paper presents the situation in the development phase of the project and shows the scope that will be achieved by this project. more...

This work shows and analyzes the LiDAR performance in real-world heavy winter conditions captured in Northern Europe. We review how low temperatures, salted roads and turbulent snow in front of a passenger car influence LiDAR systems developed for automated driving functions. Two test cars were driven in the north of Finland and Sweden for 1.5 weeks to gather a large amount of point cloud data in different urban and rural scenarios. We show that the benchmarked LiDAR sensors have surprising performance differences in winter. Some of the sensors got mechanically frozen whereas others went out of the measurement range and were completely blind. Especially the latest multi-layer sensors showed significant problems. We propose countermeasures such as heating and protecting in order to improve the performance and suggest how the software can take the performance degradation into account. more...

The fusion of multimodal sensor streams, such as camera, lidar, and radar measurements, plays a critical role in object detection for autonomous vehicles, which base their decision making on these inputs. While existing methods exploit redundant information in good environmental conditions, they fail in adverse weather where the sensory streams can be asymmetrically distorted. These rare ``edge-case'' scenarios are not represented in available datasets, and existing fusion architectures are not designed to handle them. To address this challenge we present a novel multimodal dataset acquired in over 10,000~km of driving in northern Europe. Although this dataset is the first large multimodal dataset in adverse weather, with 100k labels for lidar, camera, radar, and gated NIR sensors, it does not facilitate training as extreme weather is rare. To this end, we present a deep fusion network for robust fusion without a large corpus of labeled training data covering all asymmetric distortions. Departing from proposal-level fusion, we propose a single-shot model that adaptively fuses features, driven by measurement entropy. We validate the proposed method, trained on clean data, on our extensive validation dataset. Code and data are available here https://github.com/princeton-computational-imaging/SeeingThroughFog. more...

Objectives: To assess the individual treatment strategies among international experts in peritoneal carcinosis, specifically their decision-making in the process of patient selection for hyperthermic intraperitoneal chemotherapy (HIPEC) in women suffering from ovarian cancer, to identify relevant decision-making criteria, and to quantify the level of consensus for or against HIPEC. Methods: The members of the executive committee of the Peritoneal Surface Oncology Group International (PSOGI) were asked to describe the clinical conditions under which they would recommend HIPEC in patients with ovarian cancer and to describe any disease or patient characteristics relevant to their decision. All answers were then merged and converted into decision trees. The decision trees were then analyzed by applying the objective consensus methodology. Results: Nine experts in surgical oncology provided information on their multidisciplinary treatment strategy including HIPEC for patients with advanced ovarian cancer. Three of the total of 12 experts did not perform HIPEC. Five criteria relevant to the decision on whether HIPEC is performed were applied. In patients with resectable disease, a peritoneal cancer index (PCI) Discussion and Conclusion: Among surgical oncology experts in peritoneal surface malignancy and HIPEC, HIPEC plays an important role in primary and recurrent ovarian cancer, and the PCI is the most important criterion in this decision. more...

Objective To examine the effect on length of stay (LOS) of a preprinted order (PPO) set for children admitted to hospital with a diagnosis of bronchiolitis, as well as on quality improvement measures, medical errors, and resource utilization. Patients and methods A retrospective chart review was performed of children admitted to the inpatient units at the Children’s Hospital of Eastern Ontario (CHEO) with a discharge diagnosis of bronchiolitis. Primary and secondary outcomes were compared between the pre-PPO (December 1, 2014 to June 30, 2015) and post-PPO (December 1, 2015 to June 30, 2016) periods. The primary outcome was LOS in days. Secondary outcomes included the proportion of quality improvement measures reached, the number of medical errors, and resource utilization. Results A total of 245 patients were included; 122 patients from the pre-PPO period (December 1, 2014 to June 30, 2015) and 123 patients from the post-PPO period (December 1, 2015 to June 30, 2016). Mean LOS was 3.1 days (2.7 to 3.5 days) and 2.8 days (2.4 to 3.2 days) in the pre- and post-PPO periods, respectively (multivariate analysis, P-value = 0.13). There were significant differences between the pre- and post-PPO periods in a number of quality improvement measures, although not in the number of medical errors. Significant reductions in oxygen, corticosteroid, antibiotic, and bronchodilator use were noted post-PPO implementation. Conclusion Although our bronchiolitis PPO did not significantly shorten LOS, it led to important improvements in quality improvement measures and in resource utilization efficiency. more...

Gastrointestinal complications are the main source of severe morbidity after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), mainly in the form of anastomotic leak. Reducing the rate of anastomotic leaks is of paramount importance and should be approached both through risk factor understanding and reduction, as well as optimization of surgical team performance. We performed a study that describes the details of a technical protocol for the creation of anastomoses after colorectal resections in CRS and HIPEC and the anastomotic outcomes associated with its systematic application in a high-volume peritoneal surface malignancy center. An extremely low, near-zero anastomotic leak rate (0.85% in colorectal anastomoses, 1% in ileo-colic anastomoses, and 0% in ileo-rectal anastomoses) was observed among 1172 patients. Extremely low, near-zero rates of anastomotic leak after colorectal resections in CRS and HIPEC could be achievable in high-volume peritoneal malignancy centers. The described techniques could be adopted and validated in other high-volume peritoneal malignancy centers. more...

Purpose The purpose of this paper is to identify potential helicopter pilots’ errors during their interaction with the flight deck in the process of starting a helicopter in night-time conditions. Design/methodology/approach Systematic Human Error Reduction and Prediction Approach is used for the analysis of the pilot–flight deck interaction. This methodology was used for the identification of errors for 30 pilots during a period of 10 years. In total, 55 errors were identified, and most common errors noted are: error of omission, caused by pilots’ lack of attention or longer periods of no flying, and error of wrong execution, caused by misunderstanding a situation. Findings Hierarchical task analysis and classification of pilot’s tasks were used for the analysis of consequences, probability of occurrence, criticality and remedial strategies for the identified pilot error. Research limitations/implications This paper does not give an ergonomic analysis of the flight deck, as that is not its subject. However, results of the research presented in this paper, together with results presented in references, clearly show that there are disadvantages in the ergonomic design of flight decks. Practical implications Based on the identified pilot errors and with respect of existing ergonomic solution, it is possible to begin with the reconstruction of flight decks. Social implications Higher quality of pilot–flight deck interaction must be ensured for both pilots’ and passengers’ safety, as even a slightest error can lead to catastrophic consequences. Originality/value The value of this paper lies in the fact that it points to the need for synergy of ergonomic design and human reliability methods. more...

This paper proposes a methodological framework for the research of ergonomic risk factors in dentistry, since this is a profession with very specific and complex ergonomic challenges. When analyzing ergonomic risk factors in dental practice, three separate entities should be taken into account: the dentist, as the central figure in the office; the dental office equipment, which includes all the instruments and devices, dental chair and dentist stool; and the dental office, including the workplace layout and the working conditions. Bearing in mind that it is impossible to eliminate the risk, systematic analysis of ergonomic risk factors enabled us to propose solutions for its reduction. Risk reduction improves dentists’ work ability and working conditions in the dental office and contributes to a more humane, i.e., more functional design of dental equipment. more...

Coal is an important energy source but it has a significant negative impact on the environmental processes. This paper analyses the impact, measurement, and input of parameters representing potenti... more...

BACKGROUND: Foot drop is common gait impairment after stroke. Functional electrical stimulation (FES) of the ankle dorsiflexor muscles during the swing phase of gait can help correcting foot drop. OBJECTIVE: To evaluate efficacy of additional novel FES system to conventional therapy in facilitating motor recovery in the lower extremities and improving walking ability after stroke. METHODS: Sixteen stroke patients were randomly allocated to the FES group (FES therapy plus conventional rehabilitation program) (n=8), and control group (conventional rehabilitation program) n=8. FES was delivered for 30min during gait to induce ankle plantar and dorsiflexion. Main outcome measures: Gait speed using 10 Meter Walk Test (10 MWT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI). RESULTS: Results showed a significant increase in gait speed in FES group (p more...

Although superficial spreading melanomas (SSM) are diagnosed as thinner lesions, nodular melanomas (NM) have a more rapid growth rate and are biologically more aggressive compared with other histologic subtypes.To determine the difference in 5-year relative survival in patients with NM and SSM at the same Breslow depth and TNM stage.A population-based cross-sectional analysis compared the 5-year relative survival of patients with NM and SSM using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)∗Stat software (version 8.2.1-8.3.5). Chi-square tests compared the proportions, and Kaplan-Meier method with Z-score compared 5-year relative survival.For patients receiving a diagnosis between 2004 and 2009, 5-year relative survival was lower in NM compared with SSM (53.7% vs 87.3%; Z score, -41.35; P .001). Similarly, for patients receiving a diagnosis between 2010 and 2015, 5-year relative survival was lower in NM compared with SSM (61.5% vs 89.7%; Z score, -2.7078; P .01). Subgroup analyses showed inferior survival in NM in T1b, and survival differences remained significant after excluding patients with nodal or distant metastases.Five-year relative survival is worse in NM compared with SSM especially in T1b, T2a, and T2b melanomas. Melanoma subtype should be taken into consideration when making treatment recommendations. more...

Hearing loss is an important health concern in Canada's Arctic. The objective of this research was to provide information on the prevalence of childhood hearing loss in Nunavut.This cross-sectional study involved comprehensive audiologic assessments of school-aged children in six communities to determine overall and community-specific prevalence of hearing loss. Data were collected about hearing aid use and factors affecting use through a parent questionnaire.Assessments were completed for 644 children in kindergarten to grade 6.124 (19.3%) children had hearing loss of ≥ 30 dB HL at one or more frequencies in at least one ear (93.5% conductive loss). Applying a Canadian prevalence study definition, 148 (23.5%) children had hearing loss. Tympanic membrane perforations were present in 36.8% (The prevalence of hearing loss in Canada's North was almost three times that reported for non-indigenous children. One in five school-aged children was found to have hearing loss that is likely to affect classroom learning and social/emotional development. A hearing health strategy tailored to this population is critically needed. more...

Roll-to-roll UV nanoimprint lithography has superior advantages for high-throughput manufacturing of micro- or nano-structures on flexible polymer foils with various geometries and configurations. Our pilot line provides large-scale structure imprinting for cost-effective polymer biochips (4500 biochips/hour), enabling rapid and multiplexed detections. A complete high-volume process chain of the technology for producing structures like μ-sized, triangular optical out-couplers or capillary channels (width: from 1 μm to 2 mm, height: from 200 nm up to 100 μm) to obtain biochips (width: 25 mm, length: 75 mm, height: 100 μm to 1.5 mm) was described. The imprinting process was performed with custom-developed resins on polymer foils with resin thicknesses ranging between 125–190 μm. The produced chips were tested in a commercial point-of-care diagnostic system for multiplexed DNA analysis of methicillin resistant Staphylococcus aureus (e.g., mecA, mecC gene detections). Specific target DNA capturing was based on hybridisation between surface bound DNA probes and biotinylated targets from the sample. The immobilised biotinylated targets subsequently bind streptavidin–horseradish peroxidase conjugates, which in turn generate light upon incubation with a chemiluminescent substrate. To enhance the light out-coupling thus to improve the system performance, optical structures were integrated into the design. The limits-of-detection of mecA (25 bp) for chips with and without structures were calculated as 0.06 and 0.07 μM, respectively. Further, foil-based chips with fluidic channels were DNA functionalised in our roll-to-roll micro-array spotter following the imprinting. This straightforward approach of sequential imprinting and multiplexed DNA functionalisation on a single foil was also realised for the first time. The corresponding foil-based chips were able to detect mecA gene DNA sequences down to a 0.25 μM concentration. This research was supported by R2R BIOFLUIDICS project (http://www.r2r-biofluidics.eu/) under Horizon 2020 European Union (EU) Research and Innovation Programme with grant agreement no 646260. The research was also partially supported by NextGenMicrofluidics project (https:// www. nextgenmicrofluidics.eu/) under HORIZON2020 with grant agreement no 862092. The authors cordially thank Gerburg Schider & Gerhard Mohr, Markus Postl, Paul Patter and Alexander Wheeldon (JOANNEUM RESEARCH – Materials, Weiz, Austria) for revising the manuscript, preparing all the chip and R2R pilot line illustrations, taking the photographs and providing technical support, respectively. The authors are also grateful to Christian Wolf and Johannes Götz (JOANNEUM RESEARCH – Materials, Weiz, Austria) for their supports in the fluidic design and R2R UV-NIL structuring, respectively. We further kindly thank Alba Simon Munoz and Robert Fay (SCIENION AG, Berlin, Germany) for providing the illustration of the R2R micro-spotting line. PT specially thanks Ege Ozgun (NANOTAM, Bilkent University, Ankara, Turkey) for critically reading the manuscript. more...

The peritoneal surface is a common failure site for gastrointestinal and gynecologic tumors. For chemotherapeutic agents to effectively kill malignant cells in peritoneal implants, agents must first reach the target. The inability of the drug to reach the target is a basic mechanism of drug resistance. Chemotherapy delivered intravenously encounters the following resistances: (a) distribution through vascular space, (b) transport across microvascular wall, (c) transport through the interstitial space, (d) transport across the cell membrane, and (e) actual incorporation. This last step is complicated by the low vascularization of the peritoneum. The intraperitoneal route seems more logical as this route bypasses the first compartment, and the peritoneal cavity can absorb almost all agents and mediates the transfer of intraperitoneally administered chemotherapy, with agents entering the systemic circulation either by diffusion into the vascular compartment or by absorption through peritoneal lymphatics. In addition, the peritoneal-plasma barrier allows dose intensification providing high concentrations of the therapeutic agent while minimizing systemic toxicity. Traditionally, the selection of drugs for intraperitoneal administration has been based on beneficial pharmacokinetic and pharmacodynamic parameters, a good tolerance profile, and proven effectiveness with systemic administration. However, the process appears to be more complex. In this chapter, we will discuss how the tumor microenvironment plays a crucial role and the effects of hyperthermia, try to understand the molecular basis of drug effectiveness/resistance at the gene as well as the protein level, and explain why high concentrations of the therapeutic agent at the level of the tumor do not necessarily translate into greater efficacy. more...

Entrepreneurial skills are among the most important elements of development of each individual, both on a business plan and in any other segment of life. To be an innovative, creative and active member of society and community, prepared to constantly develop existing and create new knowledge and skills, are the fundamental determinants of overall social and economic progress. The aim of this paper is to highlight the importance of impact of school library on development of entrepreneurial skills of each individual, which should be encouraged through education from the earliest age in order for the young person to develop a thinking ability that leads to success, inventive solutions to any life problem, worked-out planning and organization strategies, real risk acceptance and responsible behavior towards oneself and society before starting an independent life. more...

We present an imaging framework which converts three images from a gated camera into high-resolution depth maps with depth accuracy comparable to pulsed lidar measurements. Existing scanning lidar systems achieve low spatial resolution at large ranges due to mechanically-limited angular sampling rates, restricting scene understanding tasks to close-range clusters with dense sampling. Moreover, today's pulsed lidar scanners suffer from high cost, power consumption, large form-factors, and they fail in the presence of strong backscatter. We depart from point scanning and demonstrate that it is possible to turn a low-cost CMOS gated imager into a dense depth camera with at least 80m range - by learning depth from three gated images. The proposed architecture exploits semantic context across gated slices, and is trained on a synthetic discriminator loss without the need of dense depth labels. The proposed replacement for scanning lidar systems is real-time, handles back-scatter and provides dense depth at long ranges. We validate our approach in simulation and on real-world data acquired over 4,000km driving in northern Europe. Data and code are available at https://github.com/gruberto/Gated2Depth. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of peritoneal mesothelioma. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness of the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The Chicago Consensus Working Group provides the following multidisciplinary recommendations for the care of patients with peritoneal surface malignancies. This article focuses on the standards of a peritoneal surface malignancy center, standards of billing and coding, standards of operative reports for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, standards of cytoreductive surgery training, and standards of intraoperative chemotherapy preparation. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of ovarian neoplasms specifically related to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, gynecologic oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

Objectives: Resource limitations and low rates of follow-up with primary care providers currently limit the impact of emergency department (ED)-based preventative strategies for children with asthm... more...

Introduction Scientific studies show that many genetic factors can significantly contribute to the onset of osteoporosis in women. Aim The aim of our study was to determine whether non-preventable risk factors (certain genetic predisposition - positive parameters of family and personal history, i.e. family history of osteoporosis, family history of fractures, osteoporotic fractures, previous fractures, menopause duration) can affect the occurrence of osteoporosis in women in postmenopausal age. Methods The study was performed as matched case and controls study. A group of cases consisted of 100 female postmenopausal women in whom by the DEXA method was newly diagnosed osteoporosis at the Clinic for Endocrinology, Diabetes and Metabolism of the University Clinical Center of Republic Srpska during 2015-2016, while the control group consisted of 100 female postmenopausal women without diagnostic signs of osteoporosis. Groups were matched by age (± 2 years). In order to collect demographic data and data on risk factors for osteoporosis and life habits of patients, the Bone Mineral Density Questionnaire for females of the Irish Society for Osteoporosis was used. Results The results of the univariate logistic regression in our study did not show that early loss of the menstrual cycle before 50 years of age was a significant factor for osteoporosis in postmenopausal women (p=0.421, OR=0.966, 95% CI=0.889-1.051). The analysis of the data of a positive family history of osteoporosis as a risk factor by the model of the multivariate of logistic regression shows that the presence of osteoporosis in close relatives (usually the mother) represents a significant and independent risk factor for the development of osteoporosis (p=0.003, OR=4.567, 95% CI=1.674- 12.460). The results of the study show that the presence of earlier fractures in the tested subjects is a significant independent risk factor for osteoporosis (p=0.015, OR=2.464, 95% CI=1.195-5.084). Conclusion The results of our study show that the presence of osteoporosis in close relatives (usually the mother) and the existence of previous fractures are significant risk factors for the occurrence of osteoporosis. The presence of these factors may be the reason for the selection of patients for further preventive or curative procedures. more...

The treatment of peritoneal metastases (PM) from colorectal cancer (CRC) has been revolutionized by the availability of cytoreductive surgery (CRS), traditionally coupled with Hyperthermic Intraperitoneal Peroperative Chemotherapy (HIPEC). The impact of HIPEC itself, over the effect of surgery is poorly understood and the presence of various HIPEC regimens for CRC PM complicates objective evaluation. A recent randomized controlled trial (RCT) evaluating one of the CRC HIPEC regimens (30 min of intraperitoneal (IP) oxaliplatin) showed no increase in survival compared to CRS alone. There is uncertainty regarding the current and future use of HIPEC in CRC PM. A reevaluation of existing and the publication of new preclinical work is needed, to analyze potential efficacy of alterantive HIPEC regimens. New advanced phase clinical trials should not be started without convincing preclinical and early phase data on new IP chemotherapy regimens. This review is a critical appraisal of the available preclinical and clinical data to support the design of an alternative HIPEC regimen for CRC focusing on CRC PM specific data. We find that current evidence supports several regimens that have not been tested in prospective clinical trials while the one tested in the PRODIGE-7 RCT has little supportive evidence. more...

Focusing on the most revisited ancient mother-daughter myth, that of Demeter and Persephone, the paper engages with some of Demeter-centered appropriations of the myth in contemporary poetry written by women. Through continual reworkings of the archetypal story about the strongest primary bond between two biologically related females and their forced separation due to male intervention, women poets are increasingly addressing the qualities of Demeter's new-era powers to regain her progeny and restore abundance. While concerned with possibilities of revival and regeneration, contemporary poetic renditions of the mythic framework offer a whole array of plots and images that tend to both perpetuate and challenge original versions of the myth by reassessing the dynamics of mother-daughter disengagement and reunion. The aim of the paper is to examine and juxtapose the strategies of performing the Demeter-Persephone myth in six contemporary Demetrian poems in which their authors extend the mythic space to incorporate other benevolent female characters and their journeys (Fainlight), situate their speakers and Persephones within a national tradition or a familiar setting (Boland), celebrate the birth of a new Persephone (Duffy), embrace the era of contradictions and its impacts on the female body (Ostriker), and fragmenting the myth through the use of various discourses to simulate instant yet profound interplays of deaths and revivals (O'Rourke). more...

36 Background: Surgical resection of peritoneal metastases of colorectal cancer (CRC PM) may benefit some patients similar to hepatic metastases. This approach remains controversial in part due to inconsistent selection criteria and reported outcomes. The impact of preoperative clinical characteristics and tumor molecular profiles on survival among surgically treated patients is incompletely understood. The aim of this study was to investigate the relationship between possible predictive variables and survival in a large cohort of patients treated on a standardized clinical pathway and to develop a clinically useful patient selection tool. Methods: This retrospective cohort study utilized the database of the Catalonian peritoneal metastases regional program, established in 2006. The program provides treatment for all PM patients within an autonomous region with a population of 7.5 million and includes a single dedicated high volume surgical unit. We included all adult patients with surgically resected CRC PM. The clinical pathway includes the administration of perioperative (neoadjuvant and adjuvant) systemic chemotherapy and has historically included a dose of heated intraoperative intraperitoneal chemotherapy (HIPEC) at the time of surgery. Demographic and clinical data was analyzed with descriptive statistics. Survival and the associated predictors were analyzed with the Cox proportional hazard model with HRs used to create a predictive nomogram. Results: A total of 538 patients (mean age 59) have been treated with surgery and a complete resection (CC0) was achieved in 94% of cases. Planned preoperative systemic chemotherapy was delivered in 95% of cases, consistent with the clinical pathway. Surgical morbidity was low (urgent reoperation 6.1%, postoperative return to the ICU 2.4%, 30-day readmission 4.3%) as was 30-day mortality (0.4%). After a median follow up of 27.5 months, the median overall survival (OS) was 43.1 months. It varied considerably by subgroup: patients with low peritoneal tumor burden had the highest OS (median 49 months) and those with signet ring cell subtype the lowest (median 19 months). Factors independently associated with survival were: N stage at diagnosis, histological subtype, quantified peritoneal tumor burden (PCI score) and presence of visceral involvement. A selection tool and predictive nomogram were designed incorporating the results of the multivariable analysis. Conclusions: A set of clinical variables can be identified that independently influences patient survival after surgical resection of CRC PM that should be used as selection criteria when considering surgery. With optimized patient selection and treatment within a specialized center, excellent survival and low morbidity can be anticipated following surgery for CRC PM. more...