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Post-operative urinary retention is a medical condition where patients cannot urinate despite having a full bladder. Ultrasound imaging of the bladder is intermittently used to estimate urine volume for early diagnosis and management of urine retention. Moreover, the use of bladder ultrasound can reduce the need for an indwelling urinary catheter and the risk of catheter-associated urinary tract infection. Wearable ultrasound devices combined with machine-learning based bladder volume estimation algorithms reduce the burdens of nurses in hospital settings and improve outpatient care. However, existing algorithms are memory and computation intensive, thereby demanding the use of expensive GPUs. In this paper, we develop and validate a low-compute memory-efficient deep learning model for accurate bladder region segmentation and urine volume calculation. B-mode ultrasound bladder images of 360 patients were divided into training and validation sets; another 74 patients were used as the test dataset. Our 1-bit quantized models with 4-bits and 6-bits skip connections achieved an accuracy within 3.8% and 2.6%, respectively, of a full precision state-of-the-art neural network (NN) without any floating-point operations and with an 11.5× and 9.0× reduction in memory requirements to fit under 150 kB. The means and standard deviations of the volume estimation errors, relative to estimates from ground-truth clinician annotations, were 5.0±33 ml and 6.8±29 ml, respectively. This lightweight NN can be easily integrated on the wearable ultrasound device for automated and continuous monitoring of urine volume. Our approach can potentially be extended to other clinical applications such as monitoring blood pressure and fetal heart rate.

Introduction: Existing mobile health (mHealth) smartphone applications (apps) for stroke survivors (SS) are poorly adopted. Little is known about SS’ perceptions and preferences for such apps. We conducted a national survey of SS' preferences for a hypothetical mHealth app for post-stroke care, and studied the influence of demographic variables on these preferences. Methods: Focus groups were conducted to identify SS perceptions and knowledge of mHealth apps. Using a grounded theory approach, recurring themes were identified. A multiple-choice questionnaire of five desired app features was generated using the themes. The national survey was mailed to SS (n= 11, 720) across the United States. Survey responses, demographic variables (age, sex, race), education, and time-since-stroke were recorded. Results: Ninety-six SS participated in focus groups. High cost, complexity of use, and lack of technical support were identified as possible impediments to adoption of mHealth apps. In the national survey (n=1,194, 10% response), ability to track fitness and diet (84%) and communicating with others (70%) emerged as the most and least useful app features, respectively. African-American and Hispanic SS found the app's features (all five) more useful compared to White SS (ORs 1.73 to 4.41). Stroke survivors with stroke greater than ten years ago deemed the features less useful compared to SS with stroke within one year (ORs 0.01 to 0.78). Perceived usefulness was higher in women ( P = 0.04 to P= 0.006 to Conclusion: Successful adoption of mHealth apps among SS will likely depend on app development that is driven by patient preferences and demographics. A patient-centered app may help address health disparities in post-stroke care.

Perivascular spaces or Virchow‐Robin spaces form pathways along the subarachnoid spaces that facilitate the effective clearance of brain metabolic by‐products through intracellular exchange and drainage of cerebrospinal fluid. Best seen on magnetic resonance imaging of the brain, enlarged perivascular spaces (EPVSs) are increasingly recognized as potential imaging biomarkers of neurological conditions. EPVSs are an established subtype of cerebral small‐vessel disease; however, their associations with other cerebrovascular disorders are yet to be fully understood. In particular, there has been great interest in the association between the various parameters of EPVSs, such as number, size, and topography, and vascular neurological conditions. Studies have identified cross‐sectional and longitudinal relationships between EPVS parameters and vascular events, such as ischemic stroke (both clinical and silent), intracerebral hemorrhage, vascular risk factors, such as age and hypertension, and neurodegenerative processes, such as vascular dementia and Alzheimer disease. However, these studies are limited by heterogeneity of data and the lack of consistent results across studied populations. Existing meta‐analyses also fail to provide uniformity of results. We performed a qualitative narrative review with an aim to provide an overview of the associations between EPVSs and cerebrovascular diseases, which may help recognize gaps in our knowledge, inform the design of future studies, and advance the role of EPVSs as imaging biomarkers.

Lemierre's syndrome (LS) is an uncommon clinical entity characterized by a primary oropharyngeal infection with subsequent septic thrombophlebitis. Diagnosis is made with clinical or radiographic evidence of internal jugular vein (IJV) thrombosis, along with metastatic focus such as lungs or joints. Life threatening thrombocytopenia in Lemierre's syndrome in the absence of disseminated intravascular coagulation (DIC) is rarely reported. We present a case of a 41-year-old woman with Lemierre's syndrome caused by beta-hemolytic group C streptococci and fusobacterium species manifested as worsening pharyngitis, IJV thrombosis, and complicated by severe thrombocytopenia.

The Hall-effect magnetic sensors suffer from large offset that is described by the resistance mismatch in the Wheatstone bridge-like equivalent electrical circuit model of the Hall plate. After a first order cancellation of the raw offset using spinning current technique, a residual offset still exists, significantly limiting the accuracy of the Hall sensor in the detection of low magnetic field. In this paper we analyzed the residual offset in silicon Hall sensor using a nonlinear lumped resistor network model to derive a closed form expression. We further analyzed the residual offset in silicon Hall sensor under the influence of stress. Using these results, we show that eight-terminal, octagonal-shaped silicon Hall sensors employing eight-phase spinning current technique provide greater immunity to stress effects on residual offset due to a second order cancellation compared to the conventional four-phase spinning. The measurement results suggest superior offset performance of eight-terminal silicon Hall sensor.

Background and Purpose— To test the hypothesis that covert brain infarcts (CBIs) are more likely to be located in noneloquent brain areas compared with clinical strokes and that CBI etiological subtypes carry a differential risk of vascular events compared with people without CBI. Methods— We used brain magnetic resonance imaging from 1290 stroke-free participants in the NOMAS (Northern Manhattan Study) to evaluate for CBI. We classified CBI as cardioembolic (ie, known atrial fibrillation), large artery atherosclerosis (extracranial and intracranial), penetrating artery disease, and cryptogenic (no apparent cause). CBI localized in the nonmotor areas of the right hemisphere were considered noneloquent. We then evaluated risk of events by CBI subtype with adjusted Cox proportional models. Results— At the time of magnetic resonance imaging, 236 participants (18%) had CBI (144 [61%] distal cryptogenic, 29 [12%] distal cardioembolic, 26 [11%] large artery atherosclerosis, and 37 [16%] penetrating artery disease). Smaller (per mm, odds ratio, 0.8 [0.8–0.9]) and nonbrain stem infarcts (odds ratio, 0.2 [0.1–0.6]) were more likely to be covert. During the follow-up period (10.4±3.1 years), 398 (31%) died (162 [13%] of vascular death) and 117 (9%) had a stroke (99 [85%]) were ischemic. Risks of events varied by CBI subtype, with the highest risk of stroke (hazard ratio, 2.2 [1.3–3.7]) and vascular death (hazard ratio, 2.24 [1.29–3.88]) noted in participants with intracranial large artery atherosclerosis-related CBI. Conclusions— CBI can be classified into subtypes that have differential outcomes. Certain CBI subtypes such as those related to intracranial large artery atherosclerosis have a high risk of adverse vascular outcomes and could warrant consideration of treatment trials.

Level sensors find use in various applications for liquid-level monitoring in tanks, containers, and vessels. In this paper, an impedance spectroscopy-based sensing platform has been reported, employing a co-axial sensing probe. The supporting electronics was developed using the MSP 432 microcontroller unit (MCU) from Texas Instruments (TI) and a newly designed Impedance Analyzer-Analog Front End (IA-AFE), also developed at TI. Different signal processing and data processing methods were employed for coaxial probe impedance modeling and their results discussed. The sensor can be used for conductive as well as non-conductive liquids, including liquids with low dielectric constant. Successful measurements of liquid levels were shown for water ( ${\epsilon \sim 80}$ ) as well as vegetable oil ( ${\epsilon \sim 3}$ ). The developed sensing platform can measure water level with the accuracy of about 1.2 mm across a 400-mm-long sensing probe while exhibiting a maximum error under 0.6 mm for oil over 150-mm range. The proposed level sensing system provides an accurate and economical solution for level sensing, which is cheaper than the commercially available level sensors while outperforming the accuracy compared with the present state of the art, to the best of our knowledge.

Objectives To report a case of isolated third nerve palsy from pituitary apoplexy and perform a systematic literature review. Materials and methods MEDLINE/EMBASE databases were searched up to September 2020. Inclusion criteria: Age≥18, isolated third nerve palsy from pituitary apoplexy. Exclusion criteria: Age Results Case report: A 76-year-old woman presented with headache and right-sided ptosis. Right-eye exam revealed complete ptosis, absent pupillary constriction and accommodation, depressed and abducted eye on primary gaze, and -1 impaired depression, adduction, elevation, without other neurological findings. Brain MRI was suggestive of pituitary apoplexy. Pathology after transsphenoidal resection revealed an infarcted pituitary adenoma. Third nerve palsy resolved completely in 21 days. Systematic review: Twenty-three studies reporting 35 patients were selected from 182 abstracts. Twenty-nine (83%) had complete isolated third nerve palsy. Headache was reported in 31 (97%). Thirty-one had hemorrhage and 1 had infarction of pituitary. Cavernous sinus invasion occurred in 14 (50%). Twenty-eight were managed surgically (80%) and 7 medically (20%). Nerve palsy resolved completely in 27 (82%) and partially in 4 (11%). Conclusions Pituitary apoplexy is an important differential diagnosis in patients with isolated third nerve palsy. Isolated third nerve palsy in apoplexy appears to have favorable prognosis.

Body lateropulsion (BLP) is seen in neurological lesions involving the pathways responsible for body position and verticality. We report a case of isolated body lateropulsion (iBLP) as the presentation of lateral medullary infarction and conducted a systematic literature review.MEDLINE and EMBASE databases were searched up to December 3, 2020.age ≥ 18, presence of BLP, confirmed stroke on imaging.age18, qualitative reviews, studies with inadequate patient data. Statistical analysis was performed using IBM® SPSS® Statistics 20.A 64-year-old man presented with acute-onset iBLP. Brain MRI demonstrated acute infarction in the right caudolateral medulla. His symptoms progressed with ipsilateral Horner syndrome over the next 24 hours and contralateral hemisensory loss 10 days later. Repeat MRI showed an increase in infarct size. BLP resolved partially at discharge. Systematic review: 418 abstracts were screened; 59 studies were selected reporting 103 patients. Thirty-three patients had iBLP (32%). BLP was ipsilateral to stroke in 70 (68%) and contralateral in 32 (32%). The most common stroke locations were medulla (n = 63, 59%), pons (n = 16, 15%), and cerebellum (n = 16, 15%). Four strokes were cortical, 3 frontal and 1 temporoparietal (3%). The most common etiology was large-artery atherosclerosis (LAA) in 20 patients (32%), followed by small-vessel occlusion in 12 (19%). Seventeen (27%) had large-vessel occlusion (LVO), 12 involving the vertebral artery. Sixty (98%) had some degree of resolution of BLP; complete in 41 (70%). Median time-to-resolution was 14 days (IQR 10-21). There was no relationship between time-to-resolution and age, sex, side of BLP or side of stroke.BLP was commonly seen with medullary infarction and was the isolated finding in one-third. LAA and LVO were the most common etiologies. Recovery of BLP was early and complete in most cases.

The Distal Motor Function (DMF) sub-score of the NIH Stroke Scale (NIHSS) was measured in the NINDS rt-PA Stroke Trials but is currently not included in the NIHSS. The correlation of DMF with the NIHSS Motor Arm Function (MAF) sub-score, the effect of IV tPA treatment on DMF, and whether adding DMF changes the utility of the NIHSS have not been analyzed.MAF and DMF sub-scores were retrieved from the original NINDS rt-PA Stroke Trials for both sides of the body at baseline, 2 hours, 24 hours, 7-10 days, and 3 months after IV tPA treatment. MAF and DMF scores were correlated using Spearman correlation. Clustering of DMF and MAF scores was determined using a Bentler Comparative Fit Index (CFI) to estimate variation in NIHSS when adding DMF. The effect of IV tPA on DMF and MAF was assessed using a linear model comparing changes in scores from baseline to 3 months.MAF and DMF were highly correlated (p 0.0001) across all time points for both dichotomous and continuous data on both sides. Intravenous tPA accounted for 21% of the change in DMF (p 0.014, RIncluding DMF to the NIHSS does not appear to be of additional value. After IV tPA treatment, proximal and distal motor function in upper extremity strongly correlate over time but greater improvement in MAF is noted. Further research is needed on the role of IV tPA on minor strokes with deficits of DMF.

Background Brain amyloid- positron emission tomography (PET) imaging is highly sensitive for identifying Alzheimer disease. Currently, there is a lack of insight on the association between amyloid-PET status and the widely used Montreal cognitive assessment (MoCA). Studying this relationship may optimize the clinical use of amyloid-PET imaging. Objectives To evaluate the relationship between amyloid-PET status and MoCA scores and to identify a MoCA score cutoff that translates to amyloid-PET positivity. Methods Using retrospective chart review, patients from 2010 to 2017 with amyloid-PET scans (positive or negative) and MoCA test scores were included. We studied the relationship between amyloid-PET status and MoCA scores and the influence of age, sex, education, and race. A MoCA score cutoff for amyloid-PET positivity was estimated. Results Among the 684 clinic patients with dementia, 99 fulfilled inclusion criteria. Amyloid-PET positivity was associated significantly with lower MoCA scores (median=19, U=847, P=0.01). The MoCA score cutoff (25) used for minimal cognitive impairment (MCI) predicted amyloid-PET positivity suboptimally (sensitivity=94.6%, specificity=13.9%). A MoCA score cutoff of 20 patients had optimal sensitivity (64.2%) and specificity (67.4%). Conclusions Amyloid-PET positivity is associated with lower MoCA scores. Clinical utility of amyloid-PET scan is likely to be suboptimal at the MoCA score cutoff for minimal cognitive impairment.

In the present study, a novel N'-(4-(4-Chlorophenyl)-1,3-dicyano-5,6,7,8,9,10-hexahydrobenzo[8]annulen2-yl)- N,N-dimethylformimidamide (CBAD) crystal was grown by the slow evaporation method. The single crystal X-ray diffraction analysis and density functional theory (DFT) calculations were carried out for the CBAD crystal. The CBAD crystallizes in the Triclinic space group P-1 with a = 10.1233 (9) A, b = 10.7577 (10) A, c = 10.8471 (10) A. Hirshfeld surface and finger print plots were analysed using Crystal Explorer to confirm the existence of intermolecular, intramolecular and other weak interactions. The optimized molecular structure and vibrational wavenumbers were calculated using density functional theory (DFT/B3LYP) method with the 6–31 G (d,p) basis set using Gaussian 09 software. The optimized geometrical parameters, structures and vibrational wavenumbers were compared with the experimental results. Natural Bond Orbital analysis (NBO) was carried out to evaluate the intramolecular stabilization interactions of the crystal. The highest occupied molecular orbital (HOMO) energy, the lowest unoccupied molecular orbital (LUMO) energy and their energy gap (ΔE) of the CBAD crystal were calculated. In addition, the molecular docking analysis was carried out to explore the inhibitory nature of the crystal against CCR2, NMDA and SHP2 receptors. Docking results suggest that su the CBAD crystal could be a novel inhibitor candidate of CCR2 receptor which causes psoriasis.

A high prevalence of thrombotic events is observed in coronavirus-2019 (COVID-19). Optimal anticoagulation becomes a critical part of treatment and higher-dose prophylactic anticoagulation is being practiced. Prospective evidence to confirm the safety and efficacy of these regimens is lacking. We performed a systematic review of existing studies of anticoagulation in COVID-19. The ClinicalTrials.gov registry, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the EU Clinical Trials Register (EudraCT) were searched from inception to September 1, 2020. PRISMA guidelines were followed. Qualitative and quantitative analysis were performed. We identified 36 clinical studies involving anticoagulation in COVID-19. Most common study location was the United States (n=12, 33%). Thirty studies were randomized-controlled (83%) of which 22 were open-label. Median sample size was 309 (IQR 139-952) and study duration was 233 days (IQR 174-357). Most common study setting was critical and non-critical care (n=21, 58%). Most common single primary outcome was all-cause mortality (n=15, 42%) but thrombotic events represent the overall most common primary outcome (n=28, 77%). Low molecular weight heparin (LMWH) was the most common agent studied (n=25, 69%) followed by unfractionated heparin (UFH) (n=14, 38.8%) and factor Xa antagonists (n=8, 22.2%). Therapeutic-intensity prophylaxis was the most common dosage regimen studied in comparison to routine thromboprophylaxis dose in 76% and 86% of studies with LMWH and UFH respectively. Five studies (14%) used intermediate-dose prophylaxis. Bleeding is studied as an outcome variable in 19 studies (53%). Our review identifies studies of anticoagulation in COVID-19 and the pharmacological agents used, dosage intensities, and the outcomes analyzed.

An impedance measurement based level sensor is proposed using a co-axial probe for sensing liquid level in a container. The co-axial sensing probe is made with a hollow stainless steel outer conductor enclosing an insulated inner conductor. The impedance of the co-axial probe varies with the water level in a nonlinear fashion. The supporting electronics was developed using MSP 432 microcontroller unit (MCU) platform from Texas Instruments (TI) and a newly designed Impedance Analyzer-Analog Front End (IA-AFE) developed at TI. An inverter amplifier based circuit was implemented within the IA-AFE for impedance measurement. Discrete Fourier Transform (DFT) is calculated on the MCU platform from the sampled input and output square wave voltages of the IA-AFE. The proposed sensor shows a maximum error within ±1.5 mm, for the probe of length 40 cm. The proposed system offers an accurate and economical liquid level measurement platform outperforming the state-of-art level sensors to the best of our knowledge.

Primary Intestinal Lymphangiectasia (PIL) is a rare disease of unknown aetiology which presents in the paediatric age group with anasarca, diarrhoea, hypoproteinaemia, lymphoedema and chylous effusions. Tuberculosis, filariasis, chest trauma, malignancies and haematological disorders usually contribute to most cases of secondary lymphangiectasia and chylous effusions. We hereby describe a case of PIL presenting with chylous effusions which remained undiagnosed for eight years.

We demonstrate an optically pumped magnetometer (OPM) operated in a free-induction-decay (FID) configuration that is capable of tracking oscillating magnetic signals in the presence of a 50 uT static field. Excellent waveform reconstruction is demonstrated for low frequency modulations with respect to the Nyquist limited bandwidth. A 100 pT oscillation was successfully reconstructed using signal averaging, and an optimum sensitivity of 3.9 pT/sqrt{Hz} was measured from the spectrum of the residuals relative to the sinusoidal fit. The impact of the pump-probe repetition rate and spin depolarization on the frequency response of the sensor is investigated in detail using miniaturized vapor cell technology, with the (-3 dB) bandwidths residing beyond the Nyquist limit in each case. We also discuss technical limitations associated with the magnetometer when exposed to oscillating fields of sufficiently high amplitude or frequency. This is discussed in the context of potential distortions arising in the reproduced signals, induced by frequency-modulation (FM) and aliasing artefacts.

Design and analysis of a ΣΔ modulator with a passive switched capacitor loop filter is presented. Design steps for optimum loop filter design for quantization noise suppression and thermal noise reduction is outlined. Design specifications for sampling clock phase noise, reference buffer and input buffer settling is analyzed. Presented design has a 2nd-order loop filter and uses only metal-metal capacitors and thin oxide digital transistors with no additional components occupying less than 0.1 mm2 silicon area in 0.13 µm CMOS digital process. Measurement results show that the ADC achieves 80 dB peak SNR at a 100 kHz integration bandwidth with 1 pJ/sample conversion efficiency. With decimation filter power consumption of 0.22 mW at 104 MHz sampling rate, the ADC consumes only about 1 mA at 1.5 V for each channel.

A transceiver capable of 6.25-Gb/s data transmission across legacy communications equipment backplanes is described. To achieve a bit error rate (BER)

The asymmetric unit of the title compound, C(30)H(27)F(2)N(3)O(2), contains two independent mol-ecules. The pyrrolidine five-membered ring assumes an envelope conformation (with the CH(2) atom at the flap) in one mol-ecule and a twisted conformation in the other one. In both independent mol-ecules, the 4-piperidinone rings adopt a similar twisted chair conformation. In the crystal, the two independent mol-ecules form an R(2) (2)(8) dimer through a pair of N-H⋯O hydrogen bonds; the R(2) (2)(8) dimers are connected via weak C-H⋯O hydrogen bonds, leading to a chain extending along the c axis.

The class-D amplifier system presented in this paper is a second-order architecture that operates on a digital PWM input and eliminates the use of an external carrier signal. It consists of two identical audio channels and a common section consisting of a PLL and a reference system. Each channel has a digital interpolation filter followed by a digital DeltaSigma modulator, PWM generator and two second-order analog loops.

A transmit architecture with a programmable 4-tap feedforward equalizer for 6.25 to 12.5 Gb/s serial communications through lossy channels is described. A 16:8-channel MUX/DEMUX chip fabricated in a 0.13 /spl mu/m 7M CMOS process demonstrates a near-end jitter of 16 ps and an equalized far-end jitter of 55 ps at 6.25 Gb/s over a 36'' legacy backplane channel.

A 6.25 Gb/s serial receiver with a 4-tap adaptive DFE is implemented in a 0.13 /spl mu/m 7LM CMOS process. Direct cancellation of the first post-cursor ISI is achieved, enabling recovery of a data eye fully closed from channel losses and crosstalk. A BER

In this paper, we quantify the impact of integrating large numbers of serializer-deserializer (SERDES) macros in an ASIC chip. The impact of core induced supply and substrate noise on peripheral high-speed SERDES macros is studied. Techniques are presented which help speed up the extraction of the detailed substrate network in a large SERDES macro, which is needed for accurate power supply noise analysis. We provide a simulation methodology for quantifying the impact of supply noise on the jitter performance of a SERDES macro placed in a large ASIC chip. We support this methodology with measurements made on a chip with a large number of SERDES macros and a core noise generator.

A passive switched-capacitor /spl Sigma//spl Delta/ ADC consisting of only switches, capacitors and a comparator, is implemented in a 0.13/spl mu/m digital CMOS process. This high-speed low-voltage architecture is used in a zero-IF GSM transceiver and has a measured peak SNDR of 67dB over a bandwidth of 100kHz with a SFDR of 75dB and a dynamic range of 72dB. The ADC consumes 1mA from a 1.5V power supply at a clock rate of 104MHz.

A backplane interconnect ASIC with 62 Gb/s full-duplex aggregate throughput uses 3.1 Gb/s serial link technology organized as 20 bidirectional channels to realize bandwidth. The chip operates with

This paper describes I/O circuits that can be used in high-speed transceivers to communicate with next generation and legacy devices. We describe the transmitter and receiver front-end circuits that are designed to operate with dual termination voltage supplies. The receiver characterization, ESD protection and system level power up issues related to gate-oxide and electro-migration reliability are discussed.

The title compound, C(26)H(29)N(3)O(2), crystallizes with two mol-ecules in the asymmetric unit, having C-H⋯O inter-actions between them and resulting in a dimer characterized by an R(2) (2)(11) motif. These dimers are linked into an ABABAB chain via N-H⋯O, N-H⋯N and C-H⋯O built edge-fused R(1) (2)(5) and R(2) (2)(7) motifs. This chain is linked to its inversion-related partner via N-H⋯O bonds with an R(2) (2)(8) motif and leads to a double chain extending along the b axis characterized by an R(6) (6)(36) motif across the inversion centres. The methyl group of the phenyl ring and the oxindole of mol-ecule A and B are involved in C-H⋯π inter-actions. One C atom of the pyrrolizine ring of mol-ecule A and its attached H atoms show positional disorder, the major and minor components being in the ratio 0.706 (7):0.294 (7).