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Abstract Background The Covid-19 pandemic has caused immense pressure on Intensive Care Units (ICU). In patients with severe ARDS due to Covid-19, respiratory mechanics are important for determining the severity of lung damage. Lung auscultation could not be used during the pandemic despite its merit. The main objective of this study was to investigate associations between lung auscultatory sound features and lung mechanical properties, length of stay (LOS) and survival, in adults with severe Covid-19 ARDS. Methods Consecutive patients admitted to a large ICU between 2020 and 2021 (n = 173) were included. Digital stethoscopes obtained auscultatory sounds and stored them in an on-line database for replay and further processing using advanced AI techniques. Correlation and regression analysis explored relationships between digital auscultation findings and lung mechanics or the ICU outcome. The resulting annotated lung sounds database is also publicly available as supplementary material. Results The presence of squawks was associated with the ICU LOS, outcome and 90-day mortality. Other features (age, SOFA score & oxygenation index upon admission, minimum crackle entropy) had significant impact on outcome. Additional features affecting the 90-d survival were age and mean crackle entropy. Multivariate logistic regression showed that survival was affected by age, baseline SOFA, baseline oxygenation index and minimum crackle entropy. Conclusions Respiratory mechanics were associated with various adventitious sounds, whereas the lung sound analytics and the presence of certain adventitious sounds correlated with the ICU outcome and the 90-d survival. Spectral features of crackles sounds can serve as prognostic factors for survival, highlighting the importance of digital auscultation.

IntroductionCancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the disease process is challenging but critical for management.ObjectivesThe main objective of this study was to determine the prevalence of CC stage overall and by sex and race and ethnicity among treatment-naïve PDAC cases using clinical, nutritional, and functional criteria. Secondary objectives included identifying the prevalence and predictors of higher symptom burden, supportive care needs, and quality of life (QoL), and examining their influence on overall survival (OS).Materials and methodsA population-based multi-institutional prospective cohort study of patients with PDAC was conducted between 2018 and 2021 by the Florida Pancreas Collaborative. Leveraging patient-reported data and laboratory values, participants were classified at baseline into four stages [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca), and refractory cachexia (RCa)]. Multivariate regression, Kaplan Meier analyses, and Cox regression were conducted to evaluate associations.ResultsCC stage was estimated for 309 PDAC cases (156 females, 153 males). The overall prevalence of NCa, PCa, Ca, and RCa was 12.9%, 24.6%, 54.1%, and 8.4%, respectively. CC prevalence across all CC stages was highest for males and racial and ethnic minorities. Criteria differentiated NCa cases from other groups, but did not distinguish PCa from Ca. The most frequently reported symptoms included weight loss, fatigue, pain, anxiety, and depression, with pain significantly worsening over time. The greatest supportive care needs included emotional and physical domains. Males, Black people, and those with RCa had the worst OS.ConclusionsUsing clinical, nutritional, and functional criteria, nearly one-quarter of the PDAC cases in our diverse, multi-institutional cohort had PCa and 62.5% had Ca or RCa at the time of diagnosis. The PCa estimate is higher than that reported in prior studies. We recommend these criteria be used to aid in CC classification, monitoring, and management of all incident PDAC cases. Findings also highlight the recommendation for continued emotional support, assistance in alleviating pain, and supportive care needs throughout the PDAC treatment journey.

In ship detection by means of Polarimetric SAR imagery, a very promising feature is the characterization of the pixels of the ship based on the elementary scattering mechanisms that can be extracted using different decomposition algorithms. Elementary scattering mechanisms provide information regarding the physical, electrical and geometrical properties of the scatterers in each Polarimetric SAR pixel. In this work, the newly established algorithm of the Double Scatterer Model is applied to interpret each pixel of the Polarimetric SAR image with the contributions of two elementary scattering mechanisms, namely, primary and secondary. The main idea is to construct a binary image while preserving the rich information content in order to proceed in simple and fast image processing for target detection. The present algorithm is applied to datasets with different inherent characteristics acquired by Radarsat-2 and ALOS-PALSAR. The results presented by this new perspective on ship monitoring are remarkable.

Feature extraction plays a pivotal role in processing remote sensing datasets, especially in the realm of fully polarimetric data. This review investigates a variety of polarimetric decomposition techniques aimed at extracting comprehensive information from polarimetric imagery. These techniques are categorized as coherent and non-coherent methods, depending on their assumptions about the distribution of information among polarimetric cells. The review explores well-established and innovative approaches in polarimetric decomposition within both categories. It begins with a thorough examination of the foundational Pauli decomposition, a key algorithm in this field. Within the coherent category, the Cameron target decomposition is extensively explored, shedding light on its underlying principles. Transitioning to the non-coherent domain, the review investigates the Freeman–Durden decomposition and its extension, the Yamaguchi’s approach. Additionally, the widely recognized eigenvector–eigenvalue decomposition introduced by Cloude and Pottier is scrutinized. Furthermore, each method undergoes experimental testing on the benchmark dataset of the broader Vancouver area, offering a robust analysis of their efficacy. The primary objective of this review is to systematically present well-established polarimetric decomposition algorithms, elucidating the underlying mathematical foundations of each. The aim is to facilitate a profound understanding of these approaches, coupled with insights into potential combinations for diverse applications.

In this paper, a supervised land cover classification is presented based on the extracted information from polarimetric synthetic aperture radar (PolSAR) images. The analysis of the polarimetric scattering matrix is accomplished according to the Double Scatterer Model which interprets each PolSAR cell by a pair of elementary scattering mechanisms. Subsequently, by utilizing the contribution rate of the two fundamental scatterers, a novel data representation is accomplished, providing great informational content. The main component of the research is to highlight the robust new feature-tool and afterwards to present a classification scheme exploiting a fully connected artificial neural network (ANN). The PolSAR images used to verify the proposed method were acquired by RADARSAT-2 and the experimental results confirm the effectiveness of the presented methodology with an overall classification accuracy of 93%, which is considered satisfactory since only four feature-vectors are used.

Abstract Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide accompanied by a substantial social and economic burden for the patient and the society. Poor sleep quality among COPD patients is frequently unnoticed and unaddressed by physicians and patients themselves, although it is a major source of further deterioration of these patients’ quality of life. The aim of the present study was to record the quality of sleep in COPD patients among the Greek population and correlate these findings with various features of these patients, using the COPD and Asthma Sleep Impact Scale (CASIS). This was a cross-sectional observational study. Forty different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, CASIS questionnaire results, COPD assessment test, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, inhaled COPD treatment report) were collected from 3454 nation-wide COPD patients (Greece). The study sample consisted of COPD patients, mainly male (73%) with a median age of 69 years and a median BMI of 27.2. More than half of COPD patients (60.6%) suffered from moderate disease severity and 23.8% from severe disease, while less than half (42.1%) suffered from at least one exacerbation of the disease over the last year prior study enrollment. About 14% reported frequent to very frequent issues affecting their sleep quality, between a fourth and a third of them reported occasional night sleep disturbances, and at least half of them reported no or very infrequent problems in their night sleep. Our study indicates that the COPD assessment test (CAT) and the spirometry-based disease severity can predict the poorness in the quality of sleep (F2,3451 = 1397.5, p

The NCCN Guidelines for Hepatobiliary Cancers provide treatment recommendations for cancers of the liver, gallbladder, and bile ducts. The NCCN Hepatobiliary Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding locoregional therapy for treatment of patients with hepatocellular carcinoma.

In this paper we report our experiences from a University outreach program with primary and secondary education teachers of various specialties. Our goal was to improve the coding abilities of teachers through Scratch activities. The participants can in turn teach their students, multiplying that way the benefitted population. To increase the participation and the completion percentage, the activities are designed as a course in Moodle realized in discrete runs with manageable groups, in a blended learning approach. The educational material was a combination of learning objects with specific objectives, video material and try-out activities. The course has been completed by 559 teachers from various Greek districts, mainly of regional areas, with a high completion rate of 65%. The participants found the experience highly satisfying, interesting and agreed that they had been supported effectively throughout the process. In the paper we describe the rational of our approach, the design and implementation phases of the project, the outcomes and the main findings of the evaluation of the user opinions.

Paragangliomas are rare neuroendocrine tumors that can vary in size and metabolic activity. We report a case of giant bilateral malignant retroperitoneal paragangliomas (PGL) in a patient with germline succinate dehydrogenase B (SDHB) mutation. This patient, who presented in an emaciated and debilitated state, was managed with adrenergic blockade followed by radical primary surgery. After being metabolically and radiographically disease free for 4 years, he underwent salvage resection for recurrent retroperitoneal disease and palliative radiation to a site of solidary vertebral metastasis. We review incidence and prognosis of metastatic PGL.

Within the context of the 'visual turn' images can no longer be considered as neutral artefacts but as social constructs, closely connected with specific 'regimes of truth'. As an integral part of 'visual ideologies', they function as 'condensation symbols' and 'ideological markers,' that could either support or question dominant narratives. Furthermore, in the case of refugee populations, images from the lost home/homeland, often but not exclusively combined with a discourse about loss, may have a significant impact on the construction of the group's 'cultural memory' and, ultimately, on the formation of their identities. These issues are addressed through the example of the Greek-speaking refugees from Sinasos, Anatolia, who were forced to flee their homeland in 1924 under the Lausanne Treaty for the Compulsory Exchange of Populations between Greece and Turkey. Before leaving, they organized a photo shoot of their hometown by two amateur photographers. Analysing the album that resulted from this endeavour, in combination with written sources and oral interviews, this article explores the socio-historical contexts of production of these images along with all their subsequent conceptualizations and uses from 1924 until the present day. As it turned out, these photos had an immense impact in shaping the collective memory of both the refugees from Sinasos and their descendants. [ABSTRACT FROM AUTHOR]

Objectives:. Our objective was to compare outcomes following combined versus isolated resections for metastatic colorectal cancer and/or liver metastases using a large, contemporary national database. Background:. Controversy persists regarding optimal timing of resections in patients with synchronous colorectal liver metastases. Methods:. We analyzed 11,814 patients with disseminated colorectal cancer and/or liver metastases who underwent isolated colon, rectal, or liver resections (CRs, RRs, or LRs) or combined colon/liver or rectal/liver resections (CCLRs or CRLRs) in the National Surgical Quality Improvement Program Participant Use File (2011–2015). We examined associations between resection type and outcomes using univariate/multivariate analyses and used propensity adjustment to account for nonrandom receipt of isolated versus combined resections. Results:. Two thousand four hundred thirty-seven (20.6%); 2108 (17.8%); and 6243 (52.8%) patients underwent isolated CR, RR, or LR; 557 (4.7%) and 469 (4.0%) underwent CCLR or CRLR. Three thousand three hundred ninety-five patients (28.7%) had serious complications (SCs). One hundred forty patients (1.2%) died, of which 113 (80.7%) were failure to rescue (FTR). One thousand three hundred eighty-six (11.7%) patients experienced unplanned readmission. After propensity adjustment and controlling for procedural complexity, wound class, and operation year, CCLR/CRLR was independently associated with increased risk of SC, as well as readmission (compared with LR). CCLR was also independently associated with increased risk of FTR and death (compared with LR). Conclusions:. Combined resection uniformly confers increased risk of SC and increased risk of mortality after CCLR; addition of colorectal to LR increases risk of readmission. Combined resections are less safe, and potentially more costly, than isolated resections. Effective strategies to prevent SC after combined resections are warranted.

The present paper presents a systematic review of the last 30 years that concerns records on Smart Toys and focuses on toys regarding early childhood and primary education children (3–12 years old). This paper aims to analyse and categorise smart toys (50 articles) in terms of their technological and educational affordances. The results show that the toys are designed based on four main technological affordances and their combinations. The educational affordances of smart toys are studied in terms of different use modes and their learning objectives aimed to identify specific objectives in different subjects and objectives based on transversal competencies such as problem solving, spatial thinking, computational thinking, collaboration and symbolic thinking. Finally, with the multiple correspondence analysis, the correlations between smart toys’ individual technological and educational affordances are grouped with the evolution of affordances related to their development date. In conclusion, in recent years, smart toys concern special sciences (programming) and some 21st-century skills (STEM and computational thinking). In contrast, in the first 20 years, the interest focused more on transverse skills, such as collaboration, emotional thinking, symbolic thinking, story-telling and problem solving.