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There are observations indicating that the central nervous system (CNS) decomposes a movement into several successive sub-movements as an effective strategy to control the motor task. In this study, we propose an algorithm in which, Arm Reaching Movement (ARM) in 3D space is decomposed into several successive phases using zero joint angle jerk features of the arm kinematic data. The presented decomposition algorithm for 3D motions is, in fact, an improved and generalized version of the decomposition method proposed earlier by Emadi and Bahrami in 2012 for 2D movements. They assumed that the motion is coordinated by minimum jerk characteristics in joint angles space in each phase. However, at the first glance, it seems that in 3D ARM joint angles are not coordinated based on the minimum jerk features. Therefore, we defined a resultant variable in the joint space and showed that one can use its jerk properties together with those of the elbow joint in movement decomposition. We showed that phase borders determined with the proposed algorithm in 3D ARM, are defined with jerk characteristics of ARM's performance variable. PF-07104091 We observed the same results in the Sit-to-Stand (STS) movement, too. Thus, based on our results, we suggested that any 3D motion can be decomposed into several phases, such that in each phase a set of principal patterns (PPs) extracted by Principal Component Analysis (PCA) method are linearly recruited to regenerate angle trajectories of each joint. Our results also suggest that the CNS, as the primary policy, may simplify the control of the ARMs by reducing the dimension of the control space. This dimension reduction might be accomplished by decomposing the movement into successive phases in which the movement satisfies the minimum joint angle jerk constraint. Then, in each phase, a set of PPs are recruited in the joint space to regenerate angle trajectory of each joint. Then, the dimension of the control space will be the number of the recruitment coefficients.Purpose Severe combined immunodeficiencies (SCID) are a heterogeneous group of fatal genetic disorders, in which the immune response is severely impaired. SCID can be cured if diagnosed early. We aim to determine the incidence of clinically defined SCID cases, acquire data of reported cases and evaluate their possible prediction by newborn screening, before introduction of a general screening program in Germany. Methods The German Surveillance Unit for rare Paediatric Diseases (ESPED) prospectively queried the number of incident SCID cases in all German paediatric hospitals in 2014 and 2015. Inclusion criteria were (1) opportunistic or severe infections or clinical features associated with SCID (failure to thrive, lacking thymus or lymphatic tissue, dysregulation of the immune system, graft versus host reaction caused by maternal T cells), (2) dysfunctional T cell immunity or proof of maternal T cells and (3) exclusion of a secondary immunodeficiency such as human immunodeficiency virus (HIV) infection. In a capture-recapture analysis, cases were matched with cases reported to the European Society for Immunodeficiencies (ESID). Results Fifty-eight patients were initially reported to ESPED, 24 reports could be confirmed as SCID, 21 patients were less than 1 year old at time of diagnosis. One SCID case was reported to ESID only. The estimated incidence of SCID in Germany is 1.6/100,000 (162,500) per year in children less than 1 year of age. Most patients reported were symptomatic and mortality in regard to reported outcome was high (29% (6/22)). The majority of incident SCID cases were considered to be probably detectable by newborn screening. Conclusions SCID is a rare disease with significant mortality. Newborn screening may give the opportunity to improve the prognosis in a significant number of children with SCID.Coronavirus disease 2019 (COVID-19) is a major healthcare disaster in the modern times. Healthcare services must adapt to effectively juggle between pandemic management and maintenance of business-as-usual services so that both COVID-19 and non-COVID-19 patients receive appropriate clinical care. We share our experience of significant cardiac rhythm abnormalities seen in COVID-19 patients in Singapore, how the viral pandemic has affected the cardiac electrophysiology and pacing service in a large acute care general hospital and the steps taken to alleviate the negative impact.Figure 1 as originally published is incorrect. On the published Fig. 1 it reads 3 patients Medtronic Sensia and 3 patients Medtronic Advisa. This should read 1 patient Medtronic Sensia and 1 patient Medtronic Advisa. Figure 1 has been corrected below.Background The impact of structural heart disease (SHD) on safety and efficacy of catheter ablation of cavo-tricuspid isthmus-dependent atrial flutter (AFLU) is unclear. In addition, recent data suggest a higher complication rate of AFLU ablation compared to the more complex atrial fibrillation (AF) ablation procedure. Methods and results Within our prospective multicenter registry, 3526 consecutive patients underwent AFLU ablation at 49 German electrophysiological centers from 2007 to 2010. For the present analysis, the patients were divided into a group with SHD (n = 2164 [61.4%]; median age 69 years; 78.5% male) and a group without SHD (n = 1362 [38.6%]; 65 years; 70.3% male). In our study, SHD mainly encompasses coronary artery disease (52.6%), left ventricular ejection fraction ≤ 50% (47.6%), and hypertensive heart disease (28.0%). The primary ablation success (97%) and the incidence of major (0.2%) or moderate (1.2%) complications did not differ significantly between the two groups (P = 1.0 and 0.87, respectively). Vascular access site complications (0.6%), AV block III° (0.2%), and bleeding (≥ BARC II 0.2%) were most common. After a median 562 days of follow-up, we observed a 2.92-fold higher one-year mortality (P less then 0.0001) in patients with SHD. Patients' satisfaction with the ablation therapy (72.0% satisfied) was close to the overall subjective tachyarrhythmia-free rate (70.7%). Conclusions The present analysis demonstrates that ablation of cavo-tricuspid isthmus dependent AFLU in patients with SHD has a comparable, excellent risk-benefit profile in our large "real-world" registry. Mortality rates expectedly are higher in patients with SHD and AFLU compared to patients without SHD. CLINICALTRIALS.GOV NCT01197638, http//clinicaltrials.gov/ct2/show/NCT01197638.
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