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The patient decompensated and was intubated. Botulism antitoxin was given, and the patient eventually recovered. Prompt decision-making based on clinical suspicion and an informed presumptive diagnosis, administration of botulism antitoxin, and aggressive provision of supportive care can arrest the progression of paralysis and be life-saving. With the rise of opioid use in the United States, leading to a reversion to heroin as a cheaper form of opioids, cases of wound botulism may be on the rise. Clinician attentiveness to obtaining substance history and being aware of botulism presentation may lead to life-saving treatments for these patients.Pacific Islanders represent a minority population with a disproportionate amount of risk factors for cholangiocarcinoma, including chronic liver disease, obesity, and diabetes mellitus, compared to other populations in the United States, but are poorly studied independently from Asians. Thus, this study aimed to characterize cholangiocarcinoma in a group of Pacific Islanders compared to Asians. This study retrospectively assessed a population of 40 Pacific Islander and 215 Asian cholangiocarcinoma patients from Hawai'i's primary liver transplant center from 1993 to 2020. Overall, Pacific Islanders were younger at diagnosis and had a higher prevalence of obesity compared to Asians. find more There were no differences in hepatitis B or C infection, tumor markers, extrahepatic cholangiocarcinoma to intrahepatic cholangiocarcinoma ratio, or surgical resection. When divided into extrahepatic and intrahepatic cholangiocarcinoma, the extrahepatic cholangiocarcinoma cohort reflected the Pacific Islanders' younger age, higher proportion of obesity, and larger tumor size. The Pacific Islanders in the intrahepatic cholangiocarcinoma cohort had a greater prevalence of obesity and significantly more multifocal tumor presentation compared to Asians. Ultimately, Pacific Islanders presented younger, with higher body mass index, and with more advanced cholangiocarcinoma when divided into extrahepatic and intrahepatic types, but experienced no differences in receipt of surgical resection or 5-year survival compared to Asians. Awareness of cholangiocarcinoma occurrence in younger Pacific Islanders and assessment of premalignant biliary or hepatic pathologies may aid in the earlier identification and intervention of cholangiocarcinoma in Pacific Islanders.Due to the low scoring nature of football (soccer), shots are often used as a proxy to evaluate team and player performances. However, not all shots are created equally and their quality differs significantly depending on the situation. The aim of this study is to objectively quantify the quality of any given shot by introducing a so-called expected goals (xG) model. This model is validated statistically and with professional match analysts. The best performing model uses an extreme gradient boosting algorithm and is based on hand-crafted features from synchronized positional and event data of 105, 627 shots in the German Bundesliga. With a ranked probability score (RPS) of 0.197, it is more accurate than any previously published expected goals model. This approach allows us to assess team and player performances far more accurately than is possible with traditional metrics by focusing on process rather than results.Overuse injuries are common in basketball. Wearable technology enables the workload to be monitored in sport settings. However, workload-injury models lack a biological basis both in the metrics recorded and how workload is accumulated. We introduce a new metric for monitoring workload weighted jump height, where each jump height is weighted to represent the expected effect of the jump magnitude on damage to the tendon. The objectives of this study were to use principal components analysis to identify distinct modes of variation in all workload metrics accumulated over 1, 2, 3, and 4 weeks and to examine differences among the modes of variation in workload metrics between participants before the injury and uninjured participants. Forty-nine youth basketball players participated in their typical basketball practices and games, and lower extremity injuries were classified as patellar or Achilles tendinopathy, other overuse, or acute. An inertial measurement unit recorded the number and height of all jumps, and ump height, and weighted jump height before injury compared with the weeks before no injury. Weighted jump height represents the cumulative damage experienced by tissues due to repetitive loads. Injured youth basketball athletes had a low previous 3- and 4-week workloads coupled with a high previous 1-week workload.Late intrauterine growth restriction (IUGR) is a fetal pathological condition characterized by chronic hypoxia secondary to placental insufficiency, resulting in an abnormal rate of fetal growth. This pathology has been associated with increased fetal and neonatal morbidity and mortality. In standard clinical practice, late IUGR diagnosis can only be suspected in the third trimester and ultimately confirmed at birth. This study presents a radial basis function support vector machine (RBF-SVM) classification based on quantitative features extracted from fetal heart rate (FHR) signals acquired using routine cardiotocography (CTG) in a population of 160 healthy and 102 late IUGR fetuses. First, the individual performance of each time, frequency, and nonlinear feature was tested. To improve the unsatisfactory results of univariate analysis we firstly adopted a Recursive Feature Elimination approach to select the best subset of FHR-based parameters contributing to the discrimination of healthy vs. late IUGR fetuses. A fine tuning of the RBF-SVM model parameters resulted in a satisfactory classification performance in the training set (accuracy 0.93, sensitivity 0.93, specificity 0.84). Comparable results were obtained when applying the model on a totally independent testing set. This investigation supports the use of a multivariate approach for the in utero identification of late IUGR condition based on quantitative FHR features encompassing different domains. The proposed model allows describing the relationships among features beyond the traditional linear approaches, thus improving the classification performance. This framework has the potential to be proposed as a screening tool for the identification of late IUGR fetuses.
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