Search

Objectives To assess the currently available evidence regarding associations between spinal cord stimulator (SCS) lead type, clinical indications for device placement, and interference between SCSs and cardiac pacemakers (CPMs)/implantable cardioverter-defibrillators (ICDs). Study design Review of case reports and original research studies assessing the interference between SCS and CPM/ICD. Materials and methods PubMed and Cochrane databases were searched for articles commenting on the interference between SCS and CPM/ICD. The search criteria which generated the greatest number of relevant studies was (spinal cord stimulator AND [pacemaker OR implantable cardioverter defibrillator]). Additional, empiric review was conducted using JSTOR, ScienceDirect, and EBSCOhost databases; however, no additional eligible studies were identified. Data were extracted, summarized into tables, and quantitatively analyzed using LibreTexts and MedCalc software. Results There was no statistically significant interference observed between SCS and CPM/ICD devices in patients regardless of indication for SCS placement and SCS lead polarity. Limitations Limited by variability of patient cases and variability in maximum frequency and amplitude of SCS devices tried in individual cases. Also limited by small sample size and the absence of a standard definition for device interference across studies. Conclusions Interference between cardiac devices and SCSs is a rare occurrence. As there are currently no published guidelines, devices should be interrogated on a case-by-case basis in the SCS trial period (if implanted after cardiac device), during permanent implantation, and during scheduled follow-up visits. Peri-operative testing should include increasing the SCS settings to maximally tolerated levels with cardiac device set at its maximum sensitivity.

Objectives To evaluate overall image quality and visibility of anatomic structures on low-dose cone beam computed tomography (CBCT) scans and the effect of a noise reduction filter for assessment of the anterior maxilla. Methods We obtained 48 CBCT volumes on eight skull-phantoms using six protocols: two clinical default protocols [standard definition (SD) and high definition (HD)] and four low-dose protocols, two with a noise reduction filter [ultra-low-dose with high definition (ULDHD) and ultra-low-dose (ULD)] and two without [low-dose with high definition (LDHD) and low-dose (LD)]. Overall image quality and visibility of eight anatomic structures were assessed by five observers and statistically analyzed using the Wilcoxon signed rank test. Intra- and interobserver agreement was measured using Cohen's weighted kappa. Results HD provided higher overall image quality than diagnostically required; LD scored lower than diagnostically acceptable. ULDHD, ULD, and LDHD were acceptable. For anatomic structures, ULDHD and ULD were acceptable. LDHD and LD showed significantly inferior visibility for one and four structures, respectively. Mean values of intra- and interobserver agreement were 0.395-0.547 and 0.350 -0.370, respectively. Conclusions ULDHD, ULD, and LDHD may be recommended for assessment of impacted maxillary canines. The noise reduction filter affects image quality positively only at low exposure.

Although the definition of sequential equilibrium can be applied without change to games of imperfect recall, doing so leads to arguably inappropriate results. We redefine sequential equilibrium so that the definition agrees with the standard definition in games of perfect recall while still giving reasonable results in games of imperfect recall. The definition can be viewed as trying to capture a notion of ex ante sequential equilibrium. The picture here is that players choose their strategies before the game starts and are committed to it, but they choose it in such a way that it remains optimal even off the equilibrium path. A notion of interim sequential equilibrium is also considered.

Aims Persistent and permanent atrial fibrillation (AF) often occurs in the presence of multiple comorbidities and is linked to adverse outcomes. It is unclear whether the sustained pattern of AF itself is prognostic or if it is confounded by underlying comorbidities. Here, we tested the association between the temporal patterns of AF and the risks of ischemic stroke and all‐cause mortality. Methods and Results In a prospective multicenter cohort, 3046 non‐valvular AF patients were consecutively enrolled and followed for adverse outcomes of all‐cause mortality and ischemic stroke. The risks of both outcomes were adjusted for underlying comorbidities, and compared between the patterns of AF. At baseline, the patients were classified as paroxysmal (N = 963, 31.6%), persistent (N = 604, 19.8%), and permanent AF (N = 1479, 45.6%) according to the standard definition. Anticoagulants were administered in 75% of all patients and 83% of those with CHA2DS2‐VASc score ≥2 in males or ≥3 in females. During a mean follow up of 26 (SD 10.5) months, all‐cause mortality occurred less in paroxysmal AF (2.5 per 100 patient‐years) than in persistent AF (4.4 per 100 patient‐years; adjusted hazard ratio [HR] 0.66, 95% CI, 0.46‐0.96; P = .029) and permanent AF (4.1 per 100 patient‐years; adjusted HR 0.71, 95% CI, 0.52‐0.98; P = .036). The risk of ischemic stroke was similar across all patterns of AF. Conclusions In this multicenter cohort of AF patients, persistent and permanent AF was associated with higher all‐cause mortality than paroxysmal AF, independent of baseline comorbidities. Clinical Trial Registration Thai Clinical Trial Registration; Study ID: TCTR20160113002 (http://www.thaiclinicaltrials.org/show/TCTR20160113002)., Kaplan‐Meier Cumulative Probability Curve of All‐cause Mortality by Pattern of Atrial Fibrillation.

We show that some types for supercuspidal representations of tamely ramified $p$-adic groups that appear in Jiu-Kang Yu's work are geometrizable. To do so, we define a function-sheaf dictionary for one-dimensional characters of arbitrary smooth group schemes over finite fields. In previous work we considered the case of commutative smooth group schemes and found that the standard definition of character sheaves produced a dictionary with a nontrivial kernel. In this paper we give a modification of the category of character sheaves that remedies this defect, and is also extensible to non-commutative groups. We then use these commutative character sheaves to geometrize the linear characters that appear in the types introduced by Jiu-Kang Yu, assuming that the character vanishes on a certain derived subgroup. To define geometric types, we combine commutative character sheaves with Gurevich and Hadani's geometrization of the Weil representation and Lusztig's character sheaves., Updated to fix problem with characters not vanishing on derived subgroup. 27 pages

Polypharmacy and heart failure are becoming increasingly common due to an ageing population and the rise of multimorbidity. Treating heart failure necessitates prescribing of multiple medications, in-line with national and international guidelines predisposing patients to polypharmacy. This review aims to identify how polypharmacy has been defined among heart failure patients in the literature, whether a standard definition in relation to heart failure could be identified and to describe the prevalence. The Healthcare Database Advanced Search (HDAS) was used to search EMBASE, MEDLINE, PubMed, Cinahl and PsychInfo from inception until March 2021. Articles were included of any design, in patients ≥ 18 years old, with a diagnosis of heart failure; that explicitly define and measure polypharmacy. Data were thereafter extracted and described using a narrative synthesis approach. A total of 7522 articles were identified with 22 meeting the inclusion criteria. No standard definition of polypharmacy was identified. The most common definition was that of “ ≥ 5 medications.” Polypharmacy prevalence was high in heart failure populations, ranging from 17.2 to 99%. Missing or heterogeneous methods for defining heart failure and poor patient cohort characterisation limited the impact of most studies. Polypharmacy, most commonly defined as ≥ 5 medications, is highly prevalent in the heart failure population. There is a need for an internationally agreed definition of polypharmacy, allowing accurate review of polypharmacy issues. Whether an arbitrary numerical cut-off is a suitable definition, rather than medication appropriateness, remains unclear. Further studies are necessary to understand the relationship between polypharmacy with specific types of heart failure and related comorbidities. Supplementary Information The online version contains supplementary material available at 10.1007/s10741-021-10135-4.

There is a deficiency in publications on the topic of midfoot cavus. The limited research available does not have a standard definition for the diagnosis of this deformity and lacks a reliable algorithm for its surgical management. The authors performed an extensive review of the literature that found a majority of patients are satisfied with the Cole osteotomy and the dorsiflexory first metatarsal osteotomy for treatment of this condition. High patient satisfaction has been observed with lateralizing calcaneal osteotomies in the setting of midfoot cavus with a secondary rigid rearfoot deformity. Further research on this topic is encouraged.

Anemia, a frequently occurring condition in older patients, has no standard definition; however, in most studies, it is defined as hemoglobin level

Definitions in relatively new fields of science need to be clearly articulated by researchers, even if the field has yet to adopt a standard definition. In this article, we discuss the various definitions of positive affect and positive emotion. We then review evidence related to defining an emotion as subjectively enjoyed (i.e. attitudes toward emotions). We also review evidence that suggests that the most commonly used measure of positive affect is problematic and does not cleanly measure positive affect. Finally, we review evidence that suggests that positive affect and approach motivation are not invariably positively associated, as many prior theories had proposed.

A new definition of continuous-time equilibrium controls is introduced. As opposed to the standard definition, which involves a derivative-type operation, the new definition parallels how a discrete-time equilibrium is defined and allows for unambiguous economic interpretation. The terms “strong equilibria” and “weak equilibria” are coined for controls under the new and standard definitions, respectively. When the state process is a time-homogeneous continuous-time Markov chain, a careful asymptotic analysis gives complete characterizations of weak and strong equilibria. Thanks to the Kakutani–Fan fixed-point theorem, the general existence of weak and strong equilibria is also established under an additional compactness assumption. Our theoretic results are applied to a two-state model under nonexponential discounting. In particular, we demonstrate explicitly that there can be incentive to deviate from a weak equilibrium, which justifies the need for strong equilibria. Our analysis also provides new results for the existence and characterization of discrete-time equilibria under infinite horizon.

Introduction No standard definition for urinary continence after radical prostatectomy exists, and there are discrepancies in continence rates reported in the literature, as well as rates reported by physicians and patients. Therefore, we used two tools, a validated questionnaire and daily pad use, to identify the criteria that best reflects patients' perceptions of continence recovery. Material and methods This is a prospective study of 74 patients who underwent nerve-sparing laparoscopic radical prostatectomy. Continence was assessed monthly for 3 months following catheter removal using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) and by recording the number of pads the patients used on a daily basis. According to daily pad use, patients were categorized as either dry (no-pads), socially continent (0-1 pad) or incontinent (≥2 pads). Results Seventy-four patients were enrolled with a mean age of 64.3 (±5.6) years. There were no significant differences in continence rates using scores from the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-UI SF) or no-pad use (29.7% vs 32.4%, 45.9% vs 48.6% and 54.1% vs. 54.1%, at the 1-, 2- and 3-month follow-ups, respectively). However, the number of socially continent patients was significantly higher (59.5%, 70.3% and 81.1%, at the 1-, 2- and 3-month follow-ups, respectively [p

Brittleness is an important parameter controlling the mechanical behavior and failure characteristics of rocks under loading and unloading conditions, such as fracability, cutability, drillability and rockburst proneness. As such, it is of high practical value to correctly evaluate rock brittleness. However, the definition and measurement method of rock brittleness have been very diverse and not yet been standardized. In this paper, the definitions of rock brittleness are firstly reviewed, and several representative definitions of rock brittleness are identified and briefly discussed. The development and role of rock brittleness in different fields of rock engineering are also studied. Eighty brittleness indices publicly available in rock mechanics literature are compiled, and the measurement method, applicability and limitations of some indices are discussed. The results show that (1) the large number of brittleness indices and brittleness definitions is attributed to the different foci on the rock behavior when it breaks; (2) indices developed in one field usually are not directly applicable to other fields; and (3) the term “brittleness” is sometimes misused, and many empirically-obtained brittleness indices, which lack theoretical basis, fail to truly reflect rock brittleness. On the basis of this review, three measurement methods are identified, i.e. (1) elastic deformation before fracture, (2) shape of post-peak stress–strain curves, and (3) methods based on fracture mechanics theory, which have the potential to be further refined and unified to become the standard measurement methods of rock brittleness. It is highly beneficial for the rock mechanics community to develop a robust definition of rock brittleness. This study will undoubtedly provide a comprehensive timely reference for selecting an appropriate brittleness index for their applications, and will also pave the way for the development of a standard definition and measurement method of rock brittleness in the long term.

Over several decades, novel-and-appropriate has become established as the standard definition of creativity; while allowing for variations in the exact wording, the requirement that creativity requ...

STUDY OBJECTIVES: Sleep is one of the most common factors related to health, yet a standard definition of sleep quality has not been identified. Polysomnography provides important information about objective sleep variables. However, the relationship between objective sleep variables and perception of sleep quality remains unclear. The purpose of this review was to (1) summarize the current methods of measuring objective sleep macrostructure and microstructure, including electroencephalography arousals, spectral frequency, cyclic alternating pattern, and self-report sleep quality, and (2) investigate the relationship between objective measures of sleep physiology and self-report sleep quality in healthy adults. METHODS: A literature search was conducted using Medline, PubMed, and PsycInfo databases and cited reference searches. Eligible studies included a comparison between self-report sleep quality and polysomnography sleep measures in healthy adults. RESULTS: Thirteen studies were identified. Measurement of self-report sleep quality varied widely across studies. Total sleep time and sleep efficiency were most consistently related to sleep quality, while other objective sleep variables, including electroencephalography spectral analysis, were not reliably predictive of self-report sleep quality in healthy adults. There is preliminary support that microstructural sleep analysis with cyclic alternating pattern may be related to self-reported sleep quality. CONCLUSIONS: Further research is needed to define and standardize self-report measures of sleep quality and investigate the microstructure of sleep. Objective measures of sleep and experiences of “quality” sleep are not as closely related as one may expect in healthy individuals, and understanding this relationship further is necessary to improve the clinical utility of sleep physiology. CITATION: Cudney LE, Frey BN, McCabe RE, Green SM. Investigating the relationship between objective measures of sleep and self-report sleep quality in healthy adults: a review. J Clin Sleep Med. 2022;18(3):927–936.

Background Definitions for stable dose of warfarin varies in the reported studies. International warfarin pharmacogenetic consortium (IWPC) algorithm was generated from the data based on these definitions. Objective In the present study, we primarily evaluated whether any significant differences exist between the definitions for stable warfarin dose. Methods A prospective cross-sectional study in adults receiving warfarin for at least 3 months was carried out. Stable doses of warfarin as defined in previous studies were compared with the standard definition. Bland-Altman plots, Pearson’s correlation and intra-class coefficients (ICC) were used to assess the correlation, reliability and agreements between the doses. Results Sixty-four patients were recruited. Twenty definitions were obtained from the previous studies. We observed that all but one showed very high or high positive correlations; and either excellent or good ICC. No significant differences between the doses initiated and predicted by IWPC algorithm. Conclusion We observed similar stable doses between the definitions except for one. Hence, IWPC algorithm may not have any bias associated with inclusion of any studies with variable definitions for stable warfarin dose.

Reverse left ventricular (LV) remodeling and recovery of LV function are associated with improved clinical outcomes in patients with heart failure with reduced ejection fraction. A growing body of evidence suggests that even among patients who experience a complete normalization of LV ejection fraction, a significant proportion will develop recurrent LV dysfunction accompanied by recurrent heart failure events. This has led to intense interest in understanding how to manage patients with heart failure with recovered ejection fraction (HFrecEF). Because of the lack of a standard definition for HFrecEF, and the paucity of clinical data with respect to the natural history of HFrecEF patients, there are no current guidelines on how these patients should be followed up and managed. Accordingly, this JACC Scientific Expert Panel reviews the biology of reverse LV remodeling and the clinical course of patients with HFrecEF, as well as provides guidelines for defining, diagnosing, and managing patients with HFrecEF.

For a given ring (domain) in $$\overline{\mathbb {R}}^n$$ , we discuss whether its boundary components can be separated by an annular ring with modulus nearly equal to that of the given ring. In particular, we show that, for all $$n\ge 3$$ , the standard definition of uniformly perfect sets in terms of the Euclidean metric is equivalent to the boundedness of the moduli of the separating rings. We also establish separation theorems for a “half” of a ring. As applications of those results, we will prove boundary Holder continuity of quasiconformal mappings of the ball or the half space in $$\mathbb {R}^n$$ .

The purpose of the study is to find out: (1) The purpose of financial system stability; (2) Indicators used to declare financial system instability; (3) The work mechanism of the financial system stability committee; (4) Role and function of the IDIC in participating in managing financial system stability; (5) The maximum value of deposits guaranteed by LPS; (6) Many banks are included in the LPS oversight and actions taken by the LPS. This research uses the case study method with qualitative descriptive analysis. The results of the study: (1) There is no standard definition of financial system stability that is accepted by the international world, but at least a stable, healthy and strong financial system is able to allocate sources of funds, perform intermediary functions, carry out payments, spread risk well, prevent and resistant to disruption to the real sector and financial system; (2) There are 2 indicators, namely prudential microeconomic and macroeconomic; (3) KSSK has the duty to oversee economic indicators so that financial system stability is achieved; (4) DIC functions to guarantee customer deposits and handle failed banks; (5) Deposit guaranteed by LPS is a maximum of Rp 2 billion; (6) In 2019 there were 100 banks handled by LPS. An unstable financial system will affect the stability of the overall economic system. LPS has succeeded in arousing public trust to save. Keywords: Financial System Stability, Financial System Crisis, KSSK, LPS

Objective This study aimed to evaluate the performance of the California Maternal Quality Care Collaborative (CMQCC) admission risk criteria for stratifying postpartum hemorrhage risk in a large obstetrics population. Study Design Using detailed electronic health record data, we classified 261,964 delivery hospitalizations from Kaiser Permanente Northern California hospitals between 2010 and 2017 into high-, medium-, and low-risk groups based on CMQCC criteria. We used logistic regression to assess associations between CMQCC risk groups and postpartum hemorrhage using two different postpartum hemorrhage definitions, standard postpartum hemorrhage (blood loss ≥1,000 mL) and severe postpartum hemorrhage (based on transfusion, laboratory, and blood loss data). Among the low-risk group, we also evaluated associations between additional present-on-admission factors and severe postpartum hemorrhage. Results Using the standard definition, postpartum hemorrhage occurred in approximately 5% of hospitalizations (n = 13,479), with a rate of 3.2, 10.5, and 10.2% in the low-, medium-, and high-risk groups. Severe postpartum hemorrhage occurred in 824 hospitalizations (0.3%), with a rate of 0.2, 0.5, and 1.3% in the low-, medium-, and high-risk groups. For either definition, the odds of postpartum hemorrhage were significantly higher in medium- and high-risk groups compared with the low-risk group. Over 40% of postpartum hemorrhages occurred in hospitalizations that were classified as low risk. Among the low-risk group, risk factors including hypertension and diabetes were associated with higher odds of severe postpartum hemorrhage. Conclusion We found that the CMQCC admission risk assessment criteria stratified women by increasing rates of severe postpartum hemorrhage in our sample, which enables early preparation for many postpartum hemorrhages. However, the CMQCC risk factors missed a substantial proportion of postpartum hemorrhages. Efforts to improve postpartum hemorrhage risk assessment using present-on-admission risk factors should consider inclusion of other nonobstetrical factors.

Intensive discussions on a wide range of topics took place at the conference which was focused on measuring income and wealth in CIS countries and Eastern Europe, organized by IARIW and Higher School of Economics in Moscow in September 2019. The article deals with some topics of the conference.As the macroeconomic analysis shows, the impact of globalization on the distribution of global income is one of the factors changing the global centers of power. Research on multifactor productivity, the slowdown of which is observed according to some estimates during two recent decades, becomes more important. The development of tools using the purchasing power parities provides additional capacity in assessing the stratification of economies and helps expand macroeconomic estimates and analysis’ base.Along with the macroeconomic topics, the article deals with the key points of discussion on measuring income. One of the focus areas today is assessing poverty based on the multidimensional approach which allows enhancing substantively the poverty analysis. While considering the income stratification, the attention in the article is also paid to the definition of the middle class basing on the expenditures’ pattern, in addition to a standard definition based on the income level.

This study is an exploration of the shift from standard definition (SDTV) to high-definition (HDTV) on television newscasts in the United States. This paper examines how this major historic shift affected the thinking, behavior, and trends of female newscasters when using makeup to see what themes arose. Despite the ubiquity of female newscasters, academic research into the influence of HD broadcasting and makeup appearance is limited. Due to this lack of information, the present study provides a cultural approach to examining historical information about this switch. News West 9 broadcasted in Midland-Odessa and interviews to a female newscaster, a news director, and a makeup artist who experienced this shift are utilized to address the historical issues facing high-definition broadcasting during this time.

This article considers two compilations containing photographs of undressed women. The first is an album in the standard definition, “compiled by a painter for figure studies” in the 1890s. The sec...

This paper argues that the existing definition of pandemics is not nuanced enough, because it is predicated solely on the criterion of spread, rather than on the criteria of spread and severity. This definitional challenge is what I call ‘the conflation problem’: there is a conflation of two different realities of global health, namely global health emergencies (i.e., severe communicable diseases that spread across borders) and nonemergencies (i.e., communicable or noncommunicable diseases that spread across borders and that may be severe). To put this argument forth, this paper begins by discussing the existing and internationally accepted definition of pandemics, its requirements, as well as its strengths (section 1). Section 2 then considers the problem with the standard definition of pandemics (i.e., the conflation problem) and some examples of it. Finally, section 3 evaluates some practical implications of the conflation problem to then explore conceptual clarity as the adequate solution.

Linearizability is a widely accepted notion of correctness for concurrent objects. Recent research has investigated redefining linearizability for particular hardware weak memory models, in particular for TSO. In this paper, we provide an overview of this research and show that such redefinitions of linearizability are not required: under an interpretation of specification behaviour which abstracts from weak memory effects, the standard definition of linearizability is sound and complete on all hardware weak memory models.We prove our result with respect to a definition of object refinement which takes a weak memory model as a parameter. The main consequence of our findings is that we can leverage the range of existing techniques and tools for standard linearizability when verifying concurrent objects running on hardware weak memory models.

La asignación de valores veritativos que le asigna la lógica bivalente al condicional, en la definición tabular estándar, se basa en categorías de índole gnoseológica, incompatibles con el carácter formal y abstracto de las estructuras lógicas. La lógica pretende calificar con categorías gnoseológicas, estructuras formales no-gnoseológicas. Esta asignación evade el rigor de logicidad que demanda toda estructura formal y por lo tanto, carece de necesidad racional.

Relevance. In the second decade of the 21st century, mumps still attracted the attention of scientists and practitioners around the world for their epidemiological, social and economic importance. A ubiquitous but uneven spread of mumps infection has been established in various regions of the world: in Europe, the Eastern Mediterranean, Southeast Asia, Africa, America, and the Western Pacific. Aim. Present the current state of the incidence of mumps in the Russian Federation. Conclusions. The current epidemic situation of mumps in the Russian Federation is characterized by a predominance in the age structure of the incidence of adolescents and young working age people and determines the need to develop and introduce in medical activity a standard definition of the clinical case of mumps for correct verification of the diagnosis with subsequent laboratory confirmation. The emergence of the phenomenon of «growing up» of mumps and the registration of periodic outbreaks in the long-term practice of vaccination dictates the need to improve further vaccination prevention tactics with an emphasis on the adult population as part of the implementation of the National preventive vaccination calendar.

Objective: The study was conducted to quantitatively evaluate the dosimetric effects of high definition (2.5 mm) and standard definition (5.0 mm) MLC on the quality of SBRT plans using SIB-IMRT and SIB-VMAT technique for carcinoma prostate and also to evaluate the dosimetric advantage of one technique over the other. Materials and Methods: Seventeen annonymized planning CT data sets were used to generate plans for both VMAT and IMRT techniques using 2.5 mm and 5.0 mm MLC.The prescription to the nodule was 45Gy in 5 fractions and to the prostate was 35Gy in 5 fractions.CI, GI, D2%, D98%, D50% and V95% for target; D2%, Dmean, V80%, V20% for OAR’s; V5% of the irradiated volume, and delivered MU’s were analyzed.An independent t-test was used to compare the plans. Patient specific QA for all plans were also performed and analyzed. Results: Minor difference in dosimetric indices was observed between 2.5mm and 5mm MLC VMAT plans, except D2% (PTV35) and D98% (GTV45) were better in 2.5mm MLC plans (p

Digital analysis of cancer specimens using spectroscopic imaging coupled to machine learning is an emerging area that links spatially localized spectral signatures to tissue structure and disease. In this study, we examine the role of spatial-spectral tradeoffs in infrared spectroscopic imaging configurations for probing tumors and the associated microenvironment profiles at different levels of model complexity. We image breast tissue using standard and high-definition Fourier Transform Infrared (FT-IR) imaging and systematically examine the localization, spectral origins, and utility of data for classification. Results demonstrate that higher spatial detail provides high sensitivity and specificity of tissue segmentation, despite the increased subcellular variability. High definition imaging also allows accurate analysis of complex, multiclass models of breast tissue without compromising accuracy. A comparison of results also highlights the key differences in the data distributions and classification performance across modalities to better guide decision making for acquiring and analyzing IR imaging data for specific histopathological models.

Hyperkalemia represents a widespread and potentially lethal condition that affects millions of people across their lives. Despite the prevalence and severity of the condition, there are no consensus guidelines on the treatment of hyperkalemia or even a standard definition. Herein, we provide a succinct review of what we believe to be the most significant misconceptions encountered in the emergency care of hyperkalemia, examine current available literature, and discuss practical points on several modalities of hyperkalemia treatment. Additionally, we review the pathophysiology of the electrocardiographic effects of hyperkalemia and how intravenous calcium preparations can antagonize these effects. We conclude each section with recommendations to aid emergency physicians in making safe and efficacious choices for the treatment of acute hyperkalemia.

Author(s): Rios, Julie S; Coward, R Matthew; Hansen, Karl R; Barnhart, Kurt T; Cedars, Marcelle I; Legro, Richard S; Diamond, Michael P; Krawetz, Stephen A; Usadi, Rebecca; Baker, Valerie L; Sun, Fangbai; Wild, Robert; Smith, James F; Santoro, Nanette; Zhang, Heping; Steiner, Anne Z | Abstract: ObjectiveTo examine the factors associated with increased deoxyribonucleic acid fragmentation index (DFI), evaluate the pregnancy outcomes of men with increased DFI, and compare three independent DFI assays.DesignSecondary analysis.SettingNine US-based fertility centers.PatientsInfertile men (N = 147) with sperm concentration ≤15 × 106/mL, motility ≤40%, or normal morphology ≤4% were enrolled. The female partners were ovulatory, ≤40 years old, and had documented tubal patency.InterventionsAt a baseline visit, the men provided a semen sample. The couples attempted conception without assistance for 3 months and with ovarian stimulation and intrauterine insemination in the subsequent 3 months.Main outcome measuresThe DFI was analyzed using the sperm chromatin structure assay (SCSA) with increased DFI defined as g30%. The predictors of increased DFI were determined by a multivariable linear regression model. The pregnancy outcomes were compared using the χ2 test. The independent DFI assays (SCSA, deoxynucleotidyl transferase-mediated dUTP nick end labeling, and Comet) were compared with Pearson and Spearman correlations.ResultsThe 19% of men with increased DFI were older (36.0 vs. 33.0 years) and had lower total sperm motility (38.2% ± 20.5% vs. 45.2% ± 15.6%). Increased male age was found to be a significant predictor of DFI (0.75, 95% confidence interval [0.06, 1.45]). Increased DFI was not associated with conception or live birth. There was a modest correlation of the deoxynucleotidyl transferase-mediated dUTP nick end labeling assay with the SCSA (r = 0.34) and Comet assay (r = 0.19).ConclusionsOlder age was associated with increased DFI among infertile men. The DFI assays were only weakly correlated, indicating a standard definition of DFI is needed to truly interrogate how sperm deoxyribonucleic acid fragmentation impacts male fertility.

Medical interventions are usually categorized as "invasive" when they involve piercing the skin or inserting an object into the body. Beyond this standard definition, however, there is little discussion of the concept of invasiveness in the medical literature, despite evidence that the term is used in ways that do not reflect the standard definition of medical invasiveness. We interviewed psychiatrists, patients with depression, and members of the public without depression to better understand their views on the invasiveness of several psychiatric electroceutical interventions (treatments that involve electrical or magnetic stimulation of the brain) for the treatment of depression. Our study shows that people recognize several kinds of invasiveness: physical, emotional, and lifestyle. In addition, several characteristics of therapies influence how invasive they are perceived to be; these include the perceived capacity of an intervention to result in harm; how localized the effects of the intervention are; the amount of control retained by the person receiving the intervention; how permanent its effects are perceived as being; and how familiar it seemed to participants. Our findings contribute to a small literature on the concept of invasiveness, which emphasizes that categorizing an intervention as invasive, or as noninvasive, evokes a variety of other normative considerations, including the potential harm it poses and how it compares to other potential therapies. It may also draw attention away from other salient features of the intervention.

The vaccine efficacy is a crucial determining factor in choosing a vaccine candidate for human use. When the choices of vaccines are many, the decision-making becomes difficult. General public resorts to the media and news, which talks about efficacies of various vaccines as observed for COVID-19. In this paper, for the first time, a concise mathematical framework for analyzing the efficacy of vaccines is introduced based on the standard definition of vaccine efficacy. The framework is then generalized to incorporate multi-variants. Finally, we introduce the idea of combined efficacy to characterize a vaccine efficacy as obtained from various clinical trials carried out across the world for Covid-19. We show that the efficacy reported by vaccine manufacturers from clinical trial data need not always directly translate to percentage efficacy. The efficacy of a vaccine is inherently a spatio-temporal statistical measure that characterizes a vaccine, which depends on the geographical location, the sample size, and the time of the clinical trials. Here, the dependence of efficacy on spatio-temporal parameters is expounded in detail, using hypothetical clinical trials conducted for different regions at different time intervals using real-world data.

International audience; In the standard definition of the classical gambler's ruin game, a persistent player enters in a stochastic process with an initial budget b 0 , which is, round after round, either increased by 1 with probability p, or decreased by 1 with probability 1 − p. The player wins the game if the budget reaches a given objective value g, and loses the game if the budget drops to zero (the gambler is ruined). This article introduces the decisional gambling process, where the parameter p is hidden, and the player has the possibility to stop the game at any round keeping earnings. In this case, the best a player can do is to maintain an estimate of p based on the observed outcomes, and use it to decide whether is better to stay or quit the game. The main contribution of this article is to bring the question of finding the optimal stopping time to the gambler's ruin game. Different heuristics are analyzed and evaluated according to their performance in maximizing the gambler's expected final budget.

The current definition of rate-induced tipping is tied to the idea of a pullback attractor limiting in forward and backward time to a stable quasi-static equilibrium. Here we propose a new definition that encompasses the standard definition in the literature for certain scalar systems and includes previously excluded $N$-dimensional systems that exhibit rate-dependent critical transitions., Comment: 11 pages, 5 figures

Introduction: Daily patient volume in emergency departments (ED) varies considerably between days and sites. Although studies have attempted to define “high-volume” days, no standard definition exists. Furthermore, it is not clear whether the frequency of high-volume days, by any definition, is related to the size of an ED. We aimed to determine the correlation between ED size and the frequency of high-volume days for various volume thresholds, and to develop a measure to identify high-volume days. Methods: We queried retrospective patient arrival data including 1,682,374 patient visits from 32 EDs in 12 states between July 1, 2018–June 30, 2019 and developed linear regression models to determine the correlation between ED size and volume variability. In addition, we performed a regression analysis and applied the Pearson correlation test to investigate the significance of median daily volumes with respect to the percent of days that crossed four volume thresholds ranging from 5–20% (in 5% increments) greater than each site’s median daily volume. Results: We found a strong negative correlation between ED median daily volume and volume variability (R2 = 81.0%; P < 0.0001). In addition, the four regression models for the percent of days exceeding specified thresholds greater than their daily median volumes had R2 values of 49.4%, 61.2%, 70.0%, and 71.8%, respectively, all with P < 0.0001. Conclusion: We sought to determine whether smaller EDs experience high-volume days more frequently than larger EDs. We found that high-volume days, when defined as days with a count of arrivals at or above certain median-based thresholds, are significantly more likely to occur in lower-volume EDs than in higher-volume EDs. To the extent that EDs allocate resources and plan to staff based on median volumes, these results suggest that smaller EDs are more likely to experience unpredictable, volume-based staffing challenges and operational costs. Given the lack of a standard measure to define a high-volume day in an ED, we recommend 10% above the median daily volume as a metric, for its relevance, generalizability across a broad range of EDs, and computational simplicity.

The cognitive phenomenon wherein operators lock in on one source of information to the detriment of perceiving or processing others has been referenced using a variety of different names, including attentional tunneling. Unregulated and often used interchangeably, this list of terms makes cataloging research in this area unwieldy, and compiling existing literature on design interventions difficult. A search of relevant databases resulted in a review of literature on attentional tunneling and its variants. Terms and the contexts in which they are used are compared against a standard definition to organize the use of vocabulary. Next, a series of adaptive display interventions for attentional tunneling in the literature are summarized. A characterization is proposed to help organize and inform attentional tunneling literature for research planning and design.

Objective Health services research on the differences in care between pediatric and general emergency departments (EDs) is limited by ambiguity regarding the definition of a pediatric ED. Our goal was to determine the proportion of EDs captured by commonly used definitions of pediatric ED. Methods We linked data for 2016 from two databases from New York State – the State Emergency Department Database and State Inpatient Database (SEDD/SID) and the National Emergency Department Inventory‐USA (NEDI‐USA). We examined the following 4 common definitions of pediatric ED: (1) admission capability, (2) physically distinct pediatric area in the ED, (3) membership in the Children's Hospital Association, and (4) volume of pediatric ED visits (patients

Purpose : To analyze the effect of video characteristics on eye movements, by using the eye movement tracking device (eyetracker). Methods : Sixty four adult males and females(22.44±3.68 yr) who agree with the purpose of this study were recruited. The subjects viewed 4 videos with a playback time of 30 min and the counts of eye blinking, fixation, saccade, and pupil diameter was measured by using the eye movement tracking device (eyetracker). Two different videos (action and discussion) in relation to movement of objects were produced with high and standard definition, to distinguish the relative movement and resolution quality. Results : When viewing action images, compared to viewing discussion images, the pupil diameter was larger(p