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Most of the global population have shifted to urbanization with advancements in technology. With this transition comes the responsibility of applying these technologies to promote sustainable development practice. Since energy demand is highest in the urbanized areas, it is important that proper assessment and management of energy resource is considered in policy-making and urban planning. This study investigated the estimation of cooling energy demand in Iloilo City Proper, Philippines using a 3D city model integrated with building attributes including building functions and year of construction, while also taking into consideration meteorological factors in the area. The proposed method used the application SimStadt2.0, following the German computation standard DINV18599. Building functions and year of construction were extracted from available building attributes data and satellite images respectively, using the free and open-source software QGIS. A CityGML Level of Detail 1 was generated from 3Dfier using building footprints and LiDAR point cloud data, along with the extracted building attributes of the 5,426 buildings. Meteorological data from INSEL 8 were also considered in the estimation of cooling energy demand in SimStadt2.0. Results showed a monthly energy demand of 12.33 kWh to 313,530.08 kWh in the study area. The estimated energy demand values were higher than the standard mean for different building functions in the country, but within the expected range of values for each season. Urban Heat Islands (UHIs), analyzed using Land Surface Temperature (LST) values, also have significant correlation to areas with higher cooling energy demands. However, inconsistencies can imply the need for further investigation.

Abstract. Introduction:. Ankle fractures are a common orthopaedic injury that often require surgical fixation. Because the comorbid population in the United States continues to survive longer, it has become routine to treat comorbid patients with unstable ankle fractures. The literature has identified comorbidities known to increase the risk of ankle fracture complications to include age 55 years or older, body mass index >29.9, polytrauma, open fractures, diabetes mellitus, smoking, peripheral neuropathy, and alcohol use. Methods:. We retrospectively reviewed 37 patients who received retrograde intramedullary screw fixation of the distal fibula, all of whom had preexisting conditions known to increase the rate of postoperative complications. Results:. Thirty-seven patients were included in this study, of whom 36 (97.3%) went on to union. Six of 37 patients (16.2%) had complications although only one (2.7%) was due to inadequate fixation. The average time to weight-bearing as tolerated was 57.2 days (15–115 days). Two patients (5.4%) had symptomatic instrumentation requiring removal after union. Two patients (5.4%) had delayed union of the distal fibula, which responded to the use of a bone stimulator. One patient (2.7%) developed a nonunion which led to chronic subluxation of the ankle joint. One patient (2.7%) had a minor medial ankle wound complication that was treated with oral antibiotics and local wound care. Conclusions:. Retrograde intramedullary screw fixation of the distal fibula is a viable alternative to plate and screw fixation in patients with unstable ankle fractures who have known risk factors for increased complications. However, not all distal fibula fractures are amenable to this fixation method. Level of Evidence:. Level III retrospective cohort study.

While NHL commonly affects lymph nodes, peritoneal lymphomatosis causing ascites is rare in pediatric patients. We present a unique case of DLBC lymphoma in a Peruvian child presenting as ascites associated with peritoneal lymphomatosis. The 11-year-old boy was admitted with ascites and dyspnea. Physical examination revealed collateral circulation, abdominal distension, and diminished breath sounds. Investigations led to a suspected diagnosis of peritoneal tuberculosis; however, a laparoscopic biopsy showed granulomatous infiltration consistent with high-grade diffuse B-cell lymphoma. The peritoneal lymphomatosis causing ascites is uncommon, and its initial presentation as peritoneal symptoms is even rarer. Differential diagnosis between peritoneal tuberculosis and DLBCL involvement can be challenging due to both shared signs and symptoms. Staging systems, such as the International Pediatric NHL Staging System, aid in determining the extent of the disease. DLBCL has a good prognosis, with treatment regimens such as the LMB-89 protocol showing high overall survival rates. Awareness of DLBCL's atypical presentations is crucial for timely diagnosis and management in the pediatric population. To conclude, children with ascites represent a diagnostic challenge posed by overlapping symptoms with other conditions, such as tuberculosis, and the need for a comprehensive approach to rule out different etiologies. Additionally, it is important the prompt treatment to avoid complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Principe-Collazos et al.)

Competing Interests: Dr Galvao is a scientific advisor for Apollo EndoSurgery and Keyron; consultant for GI Dynamics, Apollo EndoSurgery, USGI, Colubris Mx, Scitech, and MITech; and speaker for Olympus LA, Erbe, and Medtronics LA. Dr Horgan is a consultant for Stryker Corporation, Intuitive Surgical, Fortimedix Surgical, and Alume Biosciences. All other authors disclosed no financial relationships relevant to this publication.

Background: Multidisciplinary clinics (MDCs) are a care model in which patients see several physicians across specialties and/or other allied health professionals in a single appointment in a shared space. This study sought to better understand patients' experiences with breast cancer (BC) MDC. Methods: A total of 429 patients diagnosed with BC and seen in a MDC between November 2020 and November 2021 were invited to participate in a patient experience survey. Results: In total, 116 patient respondents (27%) with representative demographics described their experience. Most patients report feeling "somewhat prepared" for the BC MDC experience (67%, median = 3.7, interquartile range [IQR] = 1.9), but with variability. The major areas of positive feedback were that the MDC was convenient (89.3%), efficient use of time (65.2%), and a good way to get questions answered (65.2%). Major criticisms included that the MDC was overwhelming (16.1%) and/or too long (4.5%). When asked to rate the top three satisfaction areas of MDCs, patients chose seeing multiple providers during a single visit (80.4%), communication about the process before and throughout the MDC (48.2%), and inclusivity of their support system (38.4%). The highest rated dissatisfiers were the volume of information presented (42.9%) and patients' emotional comfort (anxiety/stress) during MDC appointment (30.2%). Overall, 83% of patients with BC rate the MDC experience as excellent (median = 4.8, IQR = 0.9) and would be "very likely" to recommend BC MDC (median = 4.8, IQR = 0.9). Conclusion: Patients value seeing multiple providers simultaneously in an environment inclusive of their support systems, which is described as convenient and efficient. Improving emotional distress is a key opportunity to improve patient experience.

Background: Long-term postoperative pain (POP) and patient responses to pain relief medications are not yet fully understood. Although recent studies have developed an index for the nociception level of patients under general anesthesia based on multiple physiological parameters, it remains unclear whether these parameters correlate with long-term POP outcomes., Objective: This study aims to extract unbiased and interpretable descriptions of how the dynamics of physiological parameters change over time and across patients in response to surgical procedures and intraoperative medications using a multivariate-temporal analysis. We demonstrated that there is an association (correlation) between the main features of intraoperative physiological responses and long-term POP, which has a predictive value, even without claiming causality., Methods: We proposed a complex higher-order singular value decomposition method to accurately decompose patients' physiological responses into multivariate structures evolving over time. We used intraoperative vital signs of 175 patients from a mixed surgical cohort to extract three interconnected, low-dimensional, complex-valued descriptions of patients' physiological responses: multivariate factors, reflecting subphysiological parameters; temporal factors, reflecting common intrasurgery temporal dynamics; and patients' factors, describing interpatient changes in physiological responses., Results: Adoption of the complex higher-order singular value decomposition method allowed us to clarify the dynamic correlation structure included in the intraoperative physiological responses. Instantaneous phases of the complex-valued physiological responses of 242 patients within the subspace of principal descriptors enabled us to discriminate between mild and not-mild (moderate-severe) levels of pain at postoperative days 30 and 90. Following rotation of physiological responses before projection to align with the common multivariate-temporal dynamic, the method achieved an area under curve for postoperative day 30 and 90 outcomes of 0.81 and 0.89 for thoracic surgery, 0.87 and 0.83 for orthopedic surgery, 0.87 and 0.88 for urological surgery, 0.86 and 1 for colorectal surgery, 1 and 1 for transplant surgery, and 0.83 and 0.92 for pancreatic surgery, respectively., Conclusions: By categorizing patients into different surgical groups, we identified significant surgery-related principal descriptors. Each of them potentially encodes different surgical stimulation. The dynamics of patients' physiological responses to these surgical events were linked to long-term POP development., (©Raheleh Baharloo, Jose Principe, Parisa Rashidi, Patrick Tighe. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 14.09.2022.)

Activation of peripheral nervous system (PNS) fibres to produce variable tactile and proprioceptive sensations in advanced bidirectional prosthetic limbs relies on neural stimulators with high spatial selectivity, dynamic range and resolution. A multi-channel application-specific integrated circuit (ASIC) is developed for PNS fibre activation using a wide dynamic range (10 nA-5 mA), high-resolution (30 nA step, 100 ns pulse accuracy) current stimulator, dissipating 0.73-2.75 mW at 3 V. The ASIC also enables encoding of external pressure signals via an integrate-and-fire methodology. Electrophysiological data of compound nerve action potentials were recorded for a range of stimulus amplitudes and pulse widths. This data was used to benchmark the performance of the ASIC with a known neural stimulator.

A novel functional estimator for Rényi's α -entropy and its multivariate extension was recently proposed in terms of the normalized eigenspectrum of a Hermitian matrix of the projected data in a reproducing kernel Hilbert space (RKHS). However, the utility and possible applications of these new estimators are rather new and mostly unknown to practitioners. In this brief, we first show that this estimator enables straightforward measurement of information flow in realistic convolutional neural networks (CNNs) without any approximation. Then, we introduce the partial information decomposition (PID) framework and develop three quantities to analyze the synergy and redundancy in convolutional layer representations. Our results validate two fundamental data processing inequalities and reveal more inner properties concerning CNN training.

Background: Vitamin D deficiency (VDD) is highly prevalent and increases the risk of osteoporosis, falls, and fractures. Patients in acute inpatient rehabilitation have several risk factors for VDD, the adverse effects of which may hinder long-term functional gain., Objective: To evaluate the prevalence of and risk factors for VDD in patients admitted to acute inpatient rehabilitation and to evaluate the efficacy of a standardized vitamin D screening and supplementation protocol., Design: Prospective cohort study as part of a quality improvement initiative., Setting: An academic, freestanding acute inpatient rehabilitation hospital., Participants: Patients consecutively admitted over a 4-month period between November 2014 and February 2015 (n=128 pre-intervention and n=129 post-intervention)., Intervention: Universal screening of vitamin D level on admission followed by utilization of a standard supplementation protocol., Main Outcome Measures: Vitamin D insufficiency (VDI) and VDD prevalence along with screening, and supplementation rates., Results: Preintervention, 10.2% of patients were screened for VDD, with 23.1% VDI and 46.2% VDD. Postintervention, 89.9% were screened, with 31.9% VDI and 47.4% VDD. 6.3% of all patients were supplemented on vitamin D preintervention compared to 53.5% postintervention. In multivariate analyses, the odds of VDD was significantly associated with African American race (OR 7.30, 95% CI, 1.56-34.20, P = .12) and age younger than 65 (OR 13.62 95% CI, 2.51-73.83, P = .002). Diagnoses in the "other neurologic" category were associated with decreased odds of VDD (OR 0.01, 95% CI, 0.001-0.193, P = .002)., Conclusions: Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may improve quality of care., Level of Evidence: III., (© 2019 American Academy of Physical Medicine and Rehabilitation.)

Background: Current myoelectric control algorithms for active prostheses map time- and frequency-domain features of the interference EMG signal into prosthesis commands. With this approach, only a fraction of the available information content of the EMG is used and the resulting control fails to satisfy the majority of users. In this study, we predict joint angles of the three degrees of freedom of the wrist from motor unit discharge timings identified by decomposition of high-density surface EMG., Methods: We recorded wrist kinematics and high-density surface EMG signals from six able-bodied individuals and one patient with limb deficiency while they performed movements of three degrees of freedom of the wrist at three different speeds. We compared the performance of linear regression to predict the observed individual wrist joint angles from, either traditional time domain features of the interference EMG or from motor unit discharge timings (which we termed neural features) obtained by EMG decomposition. In addition, we propose and test a simple model-based dimensionality reduction, based on the physiological notion that the discharge timings of motor units are partly correlated., Results: The regression approach using neural features outperformed regression on classic global EMG features (average R 2 for neural features 0.77 and 0.64, for able-bodied subjects and patients, respectively; for time-domain features 0.70 and 0.52)., Conclusions: These results indicate that the use of neural information extracted from EMG decomposition can advance man-machine interfacing for prosthesis control.

FEMPAR is an open source object oriented Fortran200X scientific software library for the high-performance scalable simulation of complex multiphysics problems governed by partial differential equations at large scales, by exploiting state-of-the-art supercomputing resources. It is a highly modularized, flexible, and extensible library, that provides a set of modules that can be combined to carry out the different steps of the simulation pipeline. FEMPAR includes a rich set of algorithms for the discretization step, namely (arbitrary-order) grad, div, and curl-conforming finite element methods, discontinuous Galerkin methods, B-splines, and unfitted finite element techniques on cut cells, combined with h -adaptivity. The linear solver module relies on state-of-the-art bulk-asynchronous implementations of multilevel domain decomposition solvers for the different discretization alternatives and block-preconditioning techniques for multiphysics problems. FEMPAR is a framework that provides users with out-of-the-box state-of-the-art discretization techniques and highly scalable solvers for the simulation of complex applications, hiding the dramatic complexity of the underlying algorithms. But it is also a framework for researchers that want to experience with new algorithms and solvers, by providing a highly extensible framework. In this work, the first one in a series of articles about FEMPAR, we provide a detailed introduction to the software abstractions used in the discretization module and the related geometrical module. We also provide some ingredients about the assembly of linear systems arising from finite element discretizations, but the software design of complex scalable multilevel solvers is postponed to a subsequent work., Competing Interests: Compliance with Ethical StandardsThe authors declare that they have no conflict of interest.

Modern robotic hands/upper limbs may replace multiple degrees of freedom of extremity function. However, their intuitive use requires a high number of control signals, which current man-machine interfaces do not provide. Here, we discuss a broadband control interface that combines targeted muscle reinnervation, implantable multichannel electromyographic sensors, and advanced decoding to address the increasing capabilities of modern robotic limbs. With targeted muscle reinnervation, nerves that have lost their targets due to an amputation are surgically transferred to residual stump muscles to increase the number of intuitive prosthetic control signals. This surgery re-establishes a nerve-muscle connection that is used for sensing nerve activity with myoelectric interfaces. Moreover, the nerve transfer determines neurophysiological effects, such as muscular hyper-reinnervation and cortical reafferentation that can be exploited by the myoelectric interface. Modern implantable multichannel EMG sensors provide signals from which it is possible to disentangle the behavior of single motor neurons. Recent studies have shown that the neural drive to muscles can be decoded from these signals and thereby the user's intention can be reliably estimated. By combining these concepts in chronic implants and embedded electronics, we believe that it is in principle possible to establish a broadband man-machine interface, with specific applications in prosthesis control. This perspective illustrates this concept, based on combining advanced surgical techniques with recording hardware and processing algorithms. Here we describe the scientific evidence for this concept, current state of investigations, challenges, and alternative approaches to improve current prosthetic interfaces.

Classic brain-machine interface (BMI) approaches decode neural signals from the brain responsible for achieving specific motor movements, which subsequently command prosthetic devices. Brain activities adaptively change during the control of the neuroprosthesis in BMIs, where the alteration of the preferred direction and the modulation of the gain depth are observed. The static neural tuning models have been limited by fixed codes, resulting in a decay of decoding performance over the course of the movement and subsequent instability in motor performance. To achieve stable performance, we propose a dual sequential Monte Carlo adaptive point process method, which models and decodes the gradually changing modulation depth of individual neuron over the course of a movement. We use multichannel neural spike trains from the primary motor cortex of a monkey trained to perform a target pursuit task using a joystick. Our results show that our computational approach successfully tracks the neural modulation depth over time with better goodness-of-fit than classic static neural tuning models, resulting in smaller errors between the true kinematics and the estimations in both simulated and real data. Our novel decoding approach suggests that the brain may employ such strategies to achieve stable motor output, i.e., plastic neural tuning is a feature of neural systems. BMI users may benefit from this adaptive algorithm to achieve more complex and controlled movement outcomes.

An emerging idea in olfaction is that temporal coding of odor specificity can be intrinsic to the primary olfactory receptor neurons (ORNs). As a first step towards understanding whether lobster ORNs are capable of generating odor-specific temporal activity and what mechanisms underlie any such heterogeneity in discharge pattern, we characterized different patterns of activity in lobster ORNs individually and ensemble using patch-clamp recording and calcium imaging. We demonstrate that lobster ORNs show tonic excitation, tonic inhibition, phaso-tonic excitation, and bursting, and that these patterns are faithfully reflected in the calcium signal. We then demonstrate that the various dynamic patterns of response are inherent in the cells, and that this inherent heterogeneity is largely determined by heterogeneity in the underlying intrinsic conductances.

The debilitating effects of injury to the nervous system can have a profound effect on daily life activities of the injured person. In this article, we present a project overview in which we are utilizing computational and biological principles, along with simulation and experimentation, to create a realistic computational model of natural and injured sensorimotor control systems. Through the development of hybrid in silico/biological coadaptive symbiotic systems, the goal is to create new technologies that yield transformative neuroprosthetic rehabilitative solutions and a new test bed for the development of integrative medical devices for the repair and enhancement of biological systems.

The CyberWorkstation (CW) is an advanced cyber-infrastructure for Brain-Machine Interface (BMI) research. It allows the development, configuration and execution of BMI computational models using high-performance computing resources. The CW's concept is implemented using a software structure in which an "experiment engine" is used to coordinate all software modules needed to capture, communicate and process brain signals and motor-control commands. A generic BMI-model template, which specifies a common interface to the CW's experiment engine, and a common communication protocol enable easy addition, removal or replacement of models without disrupting system operation. This paper reviews the essential components of the CW and shows how templates can facilitate the processes of BMI model development, testing and incorporation into the CW. It also discusses the ongoing work towards making this process infrastructure independent.

Objective: The purpose of this study was to investigate the spatiotemporal patterns of uterine electrical activity in normal and arrested labors., Study Design: From a database of electrohysterograms, 12 subjects who underwent cesarean delivery for active-phase arrest were each matched with 2 vaginally delivered controls. Using 30-minute segments of the electrohysterogram during the arrest, or the same dilation in controls, the center of uterine electrical activity was derived. The vertical motion of this center of uterine activity was determined for each contraction and the frequencies of movement patterns analyzed., Results: Predominantly upward movement of the center of uterine activity (longer and/or stronger contraction at the fundus) was more common with normal dilation (P = .003). Receiver operating characteristic curve analysis gave an area under the curve of 0.91 for predicting outcome (vaginal vs cesarean delivery)., Conclusion: There is a significant correlation between upward movement of the center of uterine activity (fundal dominance) and current labor progress.

In this paper, we present a design for a wearable computational DSP system that alleviates the issues of a previous design and provides a much smaller and lower power solution for the overall BMI goals. The system first acquires the neural data through a high speed data bus in order to train and evaluate prediction models. Then it wirelessly transmits the predicted results to a simulated robot arm. This system has been built and successfully tested with real and simulated data.

The spatio-temporal mechanisms underlying the generation of epileptic seizures is not yet clearly understood. In this study, we attempt to quantify the spatio-temporal interactions of an epileptic brain by using a previously proposed SOM-based Similarity Index (SI) measure. We further show that spectral clustering approach can be appropriately used to determine the average spatial mappings in the brain at different stages of a seizure, by interpreting the SOM-SI values as affinity matrices. Results involving two pairs of seizures of an epileptic patient suggest that there may not be a regular pattern associated with channels's spatio-temporal dynamics during the inter-ictal to prepost ictal transition.

Neocortical ECoG studies have unveiled the presence of active states - spatial patterns of amplitude modulation- in the beta- gamma ranges in the presence of conditioned stimuli that resemble cinematographic frames. These sequences of active frames emerge with abrupt phase resettings, followed by resynchronization and stabilization over channels, and magnified intensity. An online pattern recognizer that captures the spatial and spectral characteristics of the active frames is presented. The results of detection are confirmed via high occurrences of pragmatic information, defined by the ratio of pattern intensity to pattern stability.

In this paper, we develop a spatio-temporal memory that blends properties from long and short-term memory and is motivated by reaction diffusion mechanisms. The winning processing element of a self-organizing network creates traveling waves on the output space that gradually attenuate over time and space to diffuse temporal information and create localized spatio-temporal neighborhoods for clustering. The novelty of the model is in the creation of time varying Voronoi tessellations anticipating the learned input signal dynamics even when the cluster centers are fixed. We test the method in a robot navigation task and in vector quantization of speech. This method performs better than conventional static vector quantizers based on the same data set and similar training conditions.

Recent developments in optical instrumentation have made possible the direct, three-dimensional viewing of intravascular structures. Using an angioscope (the Trimedyne Optiscope, Trimedyne Inc., Santa Ana CA) and a xenon cold lamp (the Xenon Cold Light Fountain, Karl Storz Endoscopy America, Inc., Culver City, CA), the authors have visualized, without complications, the normal orifices of various arteries and their bifurcations in 12 dogs, the atherosclerotic aortas of eight post mortem humans, and the coronary arteries of six post mortem humans. Potential applications of the instruments include more accurate diagnosis of occlusive diseases of the blood vessels, evaluation of such interventional procedures as angioplasty, intraoperative assessment of anastomoses, and safer laser surgery. The angioscope also enables the physician to combine pressure recording and dye injection simultaneously with the visualization of the inner walls of the vessels.

Devices for visualizing blood vessels have evolved from a rigid, illuminated tube (1913), to a tube with an added convex lens (1922), to one with a transparent inflatable balloon for displacing blood from the line of vision (1943), to a flexible angioscope (1960s). Recent fiberoptic developments make it possible to visualize the orifices of the coronary arteries and simultaneous laser angioplasty. The characteristic fluorescence of hematoporphyrin derivative under ultraviolet light has been visualized angioscopically in experimental atherosclerotic plaque, where it accumulates and acts as a marker. However, several requirements need to be met in order for angioscopy to fulfill its therapeutic possibilities in angioplasty, thrombolytic therapy, intraoperative inspection of vascular anastomoses, and its diagnostic potential in distinguishing plaques from clots and pulmonary embolisms from other obstructions. These requirements are: (1) variously-sized angioscopes to accommodate iliac, femoral, renal, and coronary arteries; (2) percutaneous introducers in the various sizes to prevent back-bleeding; (3) a more flexible, easily manipulated fiberoptic; (4) a sufficiently inflatable balloon tip; (5) cross hairs and reference points in the optical system; and (6) optimal focal lengths for the areas to be visualized.