Notes

US-guided transforaminal cervical neural root stop: the sunday paper lateral in-plane tactic.
From a biological perspective, our linear model mostly confirms known gene-subtype annotations. Conversely, deep approaches model non-linear relationships, which is reflected in a more varied and still unexplored set of representative omic features that may prove useful for breast cancer subtyping.We have proposed a new tumor sensitization and targeting (TST) framework, named in vivo computation, in our previous investigations. The problem of TST for an early and microscopic tumor is interpreted from the computational perspective with nanorobots being the "natural" computing agents, the high-risk tissue being the search space, the tumor targeted being the global optimal solution, and the tumor-triggered biological gradient field (BGF) providing the aided knowledge for fitness evaluation of nanorobots. This natural computation process can be seen as on-the-fly path planning for nanorobot swarms with an unknown target position, which is different from the traditional path planning methods. Our previous works are focusing on the TST for a solitary lesion, where we proposed the weak priority evolution strategy (WP-ES) to adapt to the actuating mode of the homogeneous magnetic field used in the state-of-the-art nanorobotic platforms, and some in vitro validations were performed. In this paper, we focus on t swarm intelligence algorithms using this strategy considering the realistic in-body constraints. The performance is compared against that of the "brute-force" search, which corresponds to the traditional systemic tumor targeting, and also against that of the standard swarm intelligence algorithms from the algorithmic perspective. Furthermore, some in vitro experiments are performed by using Janus microparticles as magnetic nanorobots, a two-dimensional microchannel network as the human vasculature, and a magnetic nanorobotic control system as the external actuating and tracking system. Results from the in silico simulations and in vitro experiments verify the effectiveness of the proposed Se-TS for two representative BGF landscapes.Functional electrical stimulation (FES) is commonly used for individuals with neuromuscular impairments to generate muscle contractions. Both joint torque and stiffness play important roles in maintaining stable posture and resisting external disturbance. However, most previous studies only focused on the modulation of joint torque using FES while ignoring the joint stiffness. A model that can simultaneously modulate both ankle torque and stiffness induced by FES was investigated in this study. This model was composed of four subparts including an FES-to-activation model, a musculoskeletal geometry model, a Hill-based muscle-tendon model, and a joint stiffness model. The model was calibrated by the maximum voluntary contraction test of the tibialis anterior (TA) and gastrocnemius medial (GAS) muscles. To validate the model, the estimated torque and stiffness by the model were compared with the measured torque and stiffness induced by FES, respectively. The results showed that the proposed model can estimate torque and stiffness with electrically stimulated TA or/and GAS, which was significantly correlated to the measured torque and stiffness. The proposed model can modulate both joint torque and stiffness induced by FES in the isometric condition, which can be potentially extended to modulate the joint torque and stiffness during FES-assisted walking.Maintaining the pairwise relationship among originally high-dimensional data into a low-dimensional binary space is a popular strategy to learn binary codes. One simple and intuitive method is to utilize two identical code matrices produced by hash functions to approximate a pairwise real label matrix. However, the resulting quartic problem in term of hash functions is difficult to directly solve due to the non-convex and non-smooth nature of the objective. In this paper, unlike previous optimization methods using various relaxation strategies, we aim to directly solve the original quartic problem using a novel alternative optimization mechanism to linearize the quartic problem by introducing a linear regression model. Additionally, we find that gradually learning each batch of binary codes in a sequential mode, i.e. batch by batch, is greatly beneficial to the convergence of binary code learning. Based on this significant discovery and the proposed strategy, we introduce a scalable symmetric discrete hashing algorithm that gradually and smoothly updates each batch of binary codes. To further improve the smoothness, we also propose a greedy symmetric discrete hashing algorithm to update each bit of batch binary codes. Moreover, we extend the proposed optimization mechanism to solve the non-convex optimization problems for binary code learning in many other pairwise based hashing algorithms. Extensive experiments on benchmark single-label and multi-label databases demonstrate the superior performance of the proposed mechanism over recent state-of-the-art methods on two kinds of retrieval tasks similarity and ranking order. The source codes are available on https//github.com/xsshi2015/Scalable-Pairwise-based-Discrete-Hashing.Anticipating actions before they are executed is crucial for a wide range of practical applications, including autonomous driving and robotics. In this paper, we study the egocentric action anticipation task, which predicts future action seconds before it is performed for egocentric videos. Previous approaches focus on summarizing the observed content and directly predicting future action based on past observations. We believe it would benefit the action anticipation if we could mine some cues to compensate for the missing information of the unobserved frames. We then propose to decompose the action anticipation into a series of future feature predictions. We imagine how the visual feature changes in the near future and then predicts future action labels based on these imagined representations. Differently, our ImagineRNN is optimized in a contrastive learning way instead of feature regression. We utilize a proxy task to train the ImagineRNN, i.e., selecting the correct future states from distractors. We further improve ImagineRNN by residual anticipation, i.e., changing its target to predicting the feature difference of adjacent frames instead of the frame content. This promotes the network to focus on our target, i.e., the future action, as the difference between adjacent frame features is more important for forecasting the future. Extensive experiments on two large-scale egocentric action datasets validate the effectiveness of our method. Our method significantly outperforms previous methods on both the seen test set and the unseen test set of the EPIC Kitchens Action Anticipation Challenge.Palmprint direction patterns have been widely and successfully used in palmprint recognition methods. Most existing direction-based methods utilize the pre-defined filters to achieve the genuine line responses in the palmprint image, which requires rich prior knowledge and usually ignores the vital direction information. In addition, some line responses influenced by noise will degrade the recognition accuracy. Furthermore, how to extract the discriminative features to make the palmprint more separable is also a dilemma for improving the recognition performance. To solve these problems, we propose to learn complete and discriminative direction patterns in this study. We first extract the complete and salient local direction patterns, which contains a complete local direction feature (CLDF) and a salient convolution difference feature (SCDF) extracted from the palmprint image. Afterwards, two learning models are proposed to learn sparse and discriminative directions from CLDF and to achieve the underlying structure for the SCDFs in the training samples, respectively. Lastly, the projected CLDF and the projected SCDF are concatenated forming the complete and discriminative direction feature for palmprint recognition. Experimental results on seven palmprint databases, as well as three noisy datasets clearly demonstrates the effectiveness of the proposed method.Reconstructing 3D human shape and pose from monocular images is challenging despite the promising results achieved by the most recent learning-based methods. The commonly occurred misalignment comes from the facts that the mapping from images to the model space is highly non-linear and the rotation-based pose representation of the body model is prone to result in the drift of joint positions. In this work, we investigate learning 3D human shape and pose from dense correspondences of body parts and propose a Decompose-and-aggregate Network (DaNet) to address these issues. DaNet adopts the dense correspondence maps, which densely build a bridge between 2D pixels and 3D vertexes, as intermediate representations to facilitate the learning of 2D-to-3D mapping. The prediction modules of DaNet are decomposed into one global stream and multiple local streams to enable global and fine-grained perceptions for the shape and pose predictions, respectively. Messages from local streams are further aggregated to enhance the robust prediction of the rotation-based poses, where a position-aided rotation feature refinement strategy is proposed to exploit spatial relationships between body joints. Moreover, a Part-based Dropout (PartDrop) strategy is introduced to drop out dense information from intermediate representations during training, encouraging the network to focus on more complementary body parts as well as neighboring position features. The efficacy of the proposed method is validated on both indoor and real-world datasets including Human3.6M, UP3D, COCO, and 3DPW, showing that our method could significantly improve the reconstruction performance in comparison with previous state-of-the-art methods. Our code is publicly available at https//hongwenzhang.github.io/dense2mesh.How to effectively fuse temporal information from consecutive frames remains to be a non-trivial problem in video super-resolution (SR), since most existing fusion strategies (direct fusion, slow fusion or 3D convolution) either fail to make full use of temporal information or cost too much calculation. To this end, we propose a novel progressive fusion network for video SR, in which frames are processed in a way of progressive separation and fusion for the thorough utilization of spatio-temporal information. We particularly incorporate multi-scale structure and hybrid convolutions into the network to capture a wide range of dependencies. We further propose a non-local operation to extract long-range spatio-temporal correlations directly, taking place of traditional motion estimation and motion compensation (ME&MC). This design relieves the complicated ME&MC algorithms, but enjoys better performance than various ME&MC schemes. Finally, we improve generative adversarial training for video SR to avoid temporal artifacts such as flickering and ghosting. In particular, we propose a frame variation loss with a single-sequence training method to generate more realistic and temporally consistent videos. Extensive experiments on public datasets show the superiority of our method over state-of-the-art methods in terms of performance and complexity. Our code is available at https//github.com/psychopa4/MSHPFNL.Online image hashing has received increasing research attention recently, which processes large-scale data in a streaming fashion to update the hash functions on-the-fly. To this end, most existing works exploit this problem under a supervised setting, i.e., using class labels to boost the hashing performance, which suffers from the defects in both adaptivity and efficiency First, large amounts of training batches are required to learn up-to-date hash functions, which leads to poor online adaptivity. Second, the training is time-consuming, which contradicts with the core need of online learning. In this paper, a novel supervised online hashing scheme, termed Fast Class-wise Updating for Online Hashing (FCOH), is proposed to address the above two challenges by introducing a novel and efficient inner product operation. To achieve fast online adaptivity, a class-wise updating method is developed to decompose the binary code learning and alternatively renew the hash functions in a class-wise fashion, which well addresses the burden on large amounts of training batches. Quantitatively, such a decomposition further leads to at least 75% storage saving. To further achieve online efficiency, we propose a semi-relaxation optimization, which accelerates the online training by treating different binary constraints independently. Without additional constraints and variables, the time complexity is significantly reduced. Such a scheme is also quantitatively shown to well preserve past information during updating hashing functions. We have quantitatively demonstrated that the collective effort of class-wise updating and semi-relaxation optimization provides a superior performance comparing to various state-of-the-art methods, which is verified through extensive experiments on three widely-used datasets.We propose Scene Graph Auto-Encoder (SGAE) that incorporates the language inductive bias into the encoder-decoder image captioning framework for more human-like captions. Intuitively, we humans use the inductive bias to compose collocations and contextual inferences in discourse. For example, when we see the relation "a person on a bike", it is natural to replace "on" with "ride" and infer "a person riding a bike on a road" even when the "road" is not evident. Therefore, exploiting such bias as a language prior is expected to help the conventional encoder-decoder models reason as we humans and generate more descriptive captions. Specifically, we use the scene graph-a directed graph (G) where an object node is connected by adjective nodes and relationship nodes-to represent the complex structural layout of both image (I) and sentence (S). In the language domain, we use SGAE to learn a dictionary set (D) that helps reconstruct sentences in the S → G S → D → S auto-encoding pipeline, where D encodes the desired s. Furthermore, we validate the transferability of SGAE on two more challenging settings transferring inductive bias from other language corpora and unpaired image captioning. Once again, the results of both settings confirm the superiority of SGAE.A mechanism for concentrating carbon dioxide has for the first time been successfully transferred into a species that lacks such a process.The Dietary Guidelines for Americans (DGA), 2015-2020 (1), recommends consuming different types of vegetables, including dark green, red or orange, starchy, and other vegetables, and fruit, especially whole fruit. Fruits and vegetables are part of healthy eating patterns; they are sources of many essential nutrients, fiber and phytochemicals, and are associated with decreased risk of chronic diseases (1-3). This report examines the percentage of children and adolescents aged 2-19 who consumed fruits and vegetables on a given day in 2015-2018.made by adults aged 18 and over with documented hypertension by age, sex, and race and ethnicity during 2014-2016. Methods-Data are from the 2014-2016 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal, officebased physicians. The study population includes all office-based physician visits made by nonpregnant adults aged 18 and over with complete data on patient residence. Patient residence is based on the county of patient residence. The primary outcome is the percentage of visits with diagnosed hypertension, as defined by documentation of hypertension in their medical record. Variation in visits with documented hypertension was assessed by patient residence, sex, age, and race and ethnicity. Results-During 2014-2016, the percentage of visits by adults aged 18 and over with diagnosed hypertension who lived in large metro suburban areas (34.2%) was lower than visits by adults who lived in small-medium metro areas (37.9%) and rural areas (40.1%). The percentage of visits by men with hypertension (41.0%) was higher than women (33.5%) overall and in large metro suburban areas (38.7% for men and 31.0% for women), small-medium metro areas (43.5% for men and 33.8% for women), and rural areas (44.9% for men and 36.5% for women). The percentage of visits by adults with hypertension increased with age, from 10.3% for adults aged 18-44 to 58.6% for adults aged 75 and over. This same pattern was observed in all patient residence areas. The percentage of visits by non-Hispanic black adults with hypertension (47.3%) was higher than for non-Hispanic white adults (35.7%) and for Hispanic adults (34.6%). This same pattern was observed in large metro urban and large metro suburban areas.Objectives-This report presents complete period life tables for the United States by Hispanic origin, race, and sex, based on age-specific death rates in 2018. Methods-Data used to prepare the 2018 life tables are 2018 final mortality statistics; July 1, 2018 population estimates based on the 2010 decennial census; and 2018 Medicare data for persons aged 66-99. The methodology used to estimate the life tables for the Hispanic population remains unchanged from that developed for the publication of life tables by Hispanic origin for data year 2006. The methodology used to estimate the 2018 life tables for all other groups was first implemented with data year 2008. In 2018, all 50 states and the District of Columbia reported deaths by race based on the 1997 Office of Management and Budget revised standards for the classification of federal data on race and ethnicity. As a result, race-specific life tables for 2018 presented in this report are based on the new standard and show estimates for single-race groups. These estimates are not completely comparable with those of previous years, which are based on bridged-race groups. To show trends and document the impact of changing to the 1997 standards, life expectancy estimates for 2006-2018 are reported for bridged-race categories that were in use starting with data year 2000. Results-In 2018, the overall expectation of life at birth was 78.7 years, increasing from 78.6 in 2017. Between 2017 and 2018, life expectancy at birth increased by 0.1 year for males (76.1 to 76.2) and females (81.1 to 81.2). In 2018, life expectancy at birth was 81.8 for the Hispanic population, 78.6 for the non-Hispanic single-race white population, and 74.7 for the non-Hispanic single-race black population.In recent years, urgent care centers and health clinics within grocery or retail stores have been delivering health care services to an increasing number of children and adults (1-3). Urgent care centers and retail health clinics may be able to deliver preventive care, such as routine vaccinations, and nonemergency acute or after-hours care (3-5). This report describes the utilization of urgent care centers or retail health clinics in 2019 among children aged 0-17 years in the past 12 months by selected characteristics.Obesity (body mass index [BMI] of 30.0 and over) has risen in the United States in recent decades (1). Obesity varies by demographic factors, such as age, race and Hispanic origin, and socioeconomic status (2,3). Maternal obesity has been linked to a variety of adverse health outcomes for mothers and newborns, including gestational diabetes, hypertension, preeclampsia, cesarean delivery, preterm delivery, large size for gestational age, and infant death (4-10). The 2016 natality data file is the first for which prepregnancy BMI is available for all states and the District of Columbia (D.C.). This report presents trends in prepregnancy obesity for 2016 through 2019 by maternal race and Hispanic origin, age, and educational attainment. Trends by state for 2016-2019 and 2019 rates also are shown.
Substance use disorder (SUD) treatment in general medical settings remains underutilized. We evaluated 5 years of a hospital-wide SUD initiative which included an inpatient addiction consult team (ACT), low-threshold Bridge Clinic, recovery coaches, and office-based addiction treatment (OBAT) nurses.
Naturalistic registry study. We calculated frequencies of patient contacts, types of substance use diagnoses, and medication treatment initiation and duration.
From 2014 to 2019, 7,036 unique patients were seen, including 4,959 by ACT, 1,197 in Bridge Clinic, 2,250 by a recovery coach, and 979 by an OBAT nurse. The median age was 47, 31% were women, 80% were white, 7% were black, 6% were Hispanic/Latinx, and 25% were experiencing homelessness. Alcohol use disorder was seen in 62%, opioid use disorder in 54%, cocaine use disorder in 29%, benzodiazepine use disorder in 14%, and stimulant use disorder in 7%. Co-occurring medical and psychiatric illnesses were common; 35% had hepatitis C, 59% depression, 66% cation treatment episodes were longer with buprenorphine.
People who use illicit drugs (PWUD) experience significant barriers to healthcare. However, little is known about levels of attachment to primary care (defined as having a regular family doctor or clinic they feel comfortable with) and its association with unmet healthcare needs in this population. In a Canadian setting that features novel publicly-funded interdisciplinary primary care clinics, we sought to examine the prevalence and correlates (including attachment to primary care) of unmet healthcare needs among PWUD.
Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and November 2018. Multivariable logistic regression was used to identify factors associated with self-reported unmet healthcare needs among participants reporting any health issues.
In total, 743 (83.6%) of 889 eligible participants reported attachment to primary care and 220 (24.7%) reported an unmet healthcare need. In multivariable analyses, attachment to primary care at an inte Despite the high level of attachment to primary care, a quarter of our sample reported an unmet healthcare need. Our findings suggest that multi-level interventions are required to address the unmet need, including pain management and integrated care, to support PWUD with complex health needs.
Dual use of tobacco and cannabis is increasingly common, but it is unclear how it impacts individuals' interest in or ability to stop smoking. If dual users fail to engage in treatment or have worse treatment outcomes, it would suggest that tobacco treatment programs may need to be tailored to the specific needs of those using cannabis and tobacco.
We conducted an observational study using electronic treatment records from adults (18 years and older) who (a) were enrolled in a regional healthcare system in Washington state, (b) sought tobacco cessation treatment through an insurance-covered quitline from July 2016 to December 2018 and (c) had cannabis use frequency during the period of their quitline enrollment documented in their electronic health record (EHR) (
 = 1,390). Treatment engagement was defined by the total number of quitline counseling calls and web-logins completed. Point prevalent self-reported tobacco abstinence was assessed 6 months post-quitline enrollment.
Thirty-two percent of parave a cannabis use disorder Tobacco quitlines can be leveraged to identify and intervene with dual users of tobacco and cannabis.Background Low-income, racial/ethnic minority individuals face significant barriers in access to substance use (SU) treatment. Peer recovery coaches (PRCs), individuals with lived experience with substance use disorder (SUD), may be uniquely well suited to assist those encountering barriers to treatment. PRCs can also help reach those not engaged in treatment to promote harm reduction and support linkage-to-care when embedded in community rather than clinical settings. This study evaluated a community-based program in which a PRC facilitated linkage to and supported retention in SU treatment. Methods Guided by the RE-AIM framework, we evaluated implementation of the intervention in a community resource center (CRC) serving homeless and low-income residents of Baltimore City. We examined the reach, effectiveness, adoption, and implementation of this PRC model. Results Of 199 clients approached by or referred to the PRC, 39 were interested in addressing their SU. Of those interested in addressing SU, the PRC linked 64.1% (n = 25) to treatment and was able to follow up with 59.0% (n = 23) at prespecified time points after linkage (24-48 hours, 2 weeks, and 1 month). Fifty-two percent (n = 13) of clients linked to SU treatment remained in treatment at 30 days post-linkage. Of clients who did not remain in treatment, 77% (n = 10) continued contact with the PRC. Conclusions Results indicate the utility of the CRC's approach in linking people to treatment for SU and addressing barriers to care through work with a PRC. Findings also highlight important barriers and facilitators to implementation of this model, including the need for adaptation based on individual goals and fluctuations in readiness for treatment.In this article, I analyze the experience and consequences of grief among the Ayoreo from the Paraguayan Chaco through the study of mourning songs. As a methodological proposal, I suggest that the study of verbal art in conjunction with an ethnography of everyday domestic life can provide clues to understanding the experience of grief and its relation to expected behavior. This study shows that grief among the Ayoreo can be socially disruptive if not dealt with properly, as songs depict grieving Ayoreo as opposite to healthy people in terms of sociability and expected role fulfillment.
Intracranial atherosclerotic stenosis is a highly prevalent cause of stroke worldwide with important ethnic disparities. Widely considered to be a common cause of stroke in Asian and Afro-Caribbean populations, relatively less is known about the burden and significance of intracranial atherosclerotic stenosis in Caucasians.

We aim to highlight recent insights and advances into the prevalence, prognosis, and treatment of symptomatic and asymptomatic atherosclerotic intracranial atherosclerotic stenosis in Caucasian patients.

We identified 48 articles studying intracranial atherosclerotic stenosis in Caucasian patients with ischemic stroke or transient ischemic attack. Most studies were on hospital-based cohorts of consecutive patients and half were graded as "fair" quality. There was significant variation between studies in the definition of intracranial atherosclerotic stenosis and in the imaging modalities used to detect intracranial atherosclerotic stenosis. Overall, 12.1% of Caucasian patients were fy been neglected as a cause of stroke in Caucasians but is highly prevalent at older ages and frequently discovered with the growing use of noninvasive angiography. Intensive medical therapy is the treatment of choice, but there is a need to develop novel treatments or therapeutic approaches to lower the risk of stroke in higher risk patients.India's National Viral Hepatitis Control Programme recommends screening outpatients for hepatitis B at tertiary care centres. We aimed to assess the yield of screening and reasons for refusal for testing. We included adult outpatients at a tertiary care centre, South India during September and October 2019. Participants' willingness to be tested and the reasons for refusal were noted. Fingerstick blood sample was tested for HBsAg using rapid kit. Of a total of 700 participants, 157 (22%, 95% CI 19.4-25.7%) were unwilling to be tested. Men were more unwilling (26%) compared to women (19%) (aPR 1.90 95% CI 1.22-2.94; p = 0.004). 'Lack of time' was the most common reason reported for refusal (10%). Of 543 participants tested, 15 (2.8%, 95% CI 1.6-4.5%) were positive for HBsAg. Similar studies from other regions in India are required for the estimation of yield of opportunistic approach.While the world battles to wrestle with the impact of the COVID-19 pandemic, regions with endemic dengue fever are confronting the possibility of a double pandemic that could completely overpower health care services administrations. Simultaneous outbreaks of dengue and COVID-19, as well as probable cases of overlapping infections, have already started in Latin America and certain Asian countries. There, the healthcare framework is already overburdened and such a deadly duo may completely overwhelm hospital emergency services quite apart from a country's economy. Precise epidemiological and contact history-taking joined with due attention to false-positive dengue serology and the chance of co-infections are key devices for frontline doctors to overcome this seemingly insurmountable challenge.Almost 2 billion adults in the world are overweight and more than half of them are classified as obese while nearly 1/3 of children globally experience poor growth and development. Given the vast amount of knowledge that has been gleaned from decades of research on growth and development, a number of questions remains as to why the world is now in the midst of a global epidemic of obesity accompanied by the "double burden of malnutrition" where overweight coexists with underweight and micronutrient deficiencies. This challenge to the human condition can be attributed to nutritional and environmental exposures during pregnancy that may program a fetus to have a higher risk of chronic diseases in adulthood. To explore this concept, frequently called the developmental origins of health and disease (DOHaD) or metabolic diseases (DOMD), this review considers a host of factors and physiological mechanisms that drive a fetus or child towards a higher risk of obesity, fatty liver disease, hypertension, and/or type 2 diabetes (T2D). To that end, this review explores the epidemiology of DOHaD with discussions focused on adaptations to human energetics, placental developmental, dysmetabolism, and key environmental exposures that act to promote chronic diseases in adulthood. These areas are complementary and additive in understanding how providing the best conditions for optimal growth can create the best possible conditions for lifelong health. Moreover, understanding both physiological as well as epigenetic and molecular mechanisms for DOMD is vital to most fully address the global issues of obesity and other chronic diseases.Small arteries, which play important roles in controlling blood flow, blood pressure, and capillary pressure, are under nervous influence. Their innervation is predominantly sympathetic and sensory motor in nature, and while some arteries are densely innervated, others are only sparsely so. Innervation of small arteries is a key mechanism in regulating vascular resistance. In the second half of the previous century, the physiology and pharmacology of this innervation were very actively investigated. In the past 10-20 yr, the activity in this field was more limited. With this review we highlight what has been learned during recent years with respect to development of small arteries and their innervation, some aspects of excitation-release coupling, interaction between sympathetic and sensory-motor nerves, cross talk between endothelium and vascular nerves, and some aspects of their role in vascular inflammation and hypertension. We also highlight what remains to be investigated to further increase our understanding of this fundamental aspect of vascular physiology.Purpose Many speech-language pathologists (SLPs) experience challenging behaviors during service delivery and also report minimal training in effective behavior management strategies. The purpose of this tutorial is to present low-effort behavior management strategies that SLPs can adopt, adapt, and implement. Method After providing an overall rationale for effective behavior management strategies, we present two evidence-based behavior management strategies aimed at improving positive behavior and engagement. We provide descriptions, steps, and applied examples for implementing visual activity schedules and behavior-specific praise. We include three implementation scenarios and resources for SLPs to access specifically tailored to speech-language pathology practice. Conclusions Visual activity schedules and behavior-specific praise are two flexible behavior management strategies that can be collaboratively created by SLPs and educators and implemented during a variety of instructional arrangements during speech and language therapy. Implementing evidence-based behavior management strategies may improve students' engagement and achievement in speech and language-focused outcomes.Objective Physical activity is a major challenge to glycemic control for people with type 1 diabetes. Moderate-intensity exercise often leads to steep decreases in blood glucose and hypoglycemia that closed-loop control systems have so far failed to protect against, despite improving glycemic control overall. Research Design and Methods Fifteen adults with type 1 diabetes (42 ± 13.5 years old; hemoglobin A1c 6.6% ± 1.0%; 10F/5M) participated in a randomized crossover clinical trial comparing two hybrid closed-loop (HCL) systems, a state-of-the-art hybrid model predictive controller and a modified system designed to anticipate and detect unannounced exercise (APEX), during two 32-h supervised admissions with 45 min of planned moderate activity, following 4 weeks of data collection. Primary outcome was the number of hypoglycemic episodes during exercise. Continuous glucose monitor (CGM)-based metrics and hypoglycemia are also reported across the entire admissions. Results The APEX system reduced hypoglycemic episodes overall (9 vs. 33; P = 0.02), during exercise (5 vs. 13; P = 0.04), and in the 4 h following (2 vs. 11; P = 0.02). Overall CGM median percent time 180 mg/dL (18.5% vs. 16.6%, P = 0.15). Overnight control was notable for both systems with no hypoglycemia, median percent in time 70-180 mg/dL at 100% and median percent time 70-140 mg/dL at ∼96% for both. Conclusions A new closed-loop system capable of anticipating and detecting exercise was proven to be safe and feasible and outperformed a state-of-the-art HCL, reducing participants' exposure to hypoglycemia during and after moderate-intensity physical activity. ClinicalTrials.gov NCT03859401.
Patients with primary oesophageal squamous cell carcinoma are at risk of developing multiple primary tumours in the upper aero digestive tract. To date, most studies are performed in the Asian population. We aimed to evaluate the risk of multiple primary tumours in the upper aero digestive tract and stomach in patients with oesophageal squamous cell carcinoma in a Western population.

We performed a nationwide, retrospective cohort study in collaboration with the Netherlands Cancer Registry. Patients with primary oesophageal squamous cell carcinoma, diagnosed between 2000-2016, were included. Primary endpoints were synchronous and metachronous multiple primary tumour risk.

The cohort consisted of 9058 patients, diagnosed with oesophageal squamous cell carcinoma (male 57.3%, median age 67 years). In 476 patients (5.3%), 545 multiple primary tumours have been diagnosed. Most of them were located in the head and neck region (49.5%). Among all multiple primary tumours, 329 (60.4%) were diagnosed synchronouslith oesophageal squamous cell carcinoma.
Approximately one in 20 patients with primary oesophageal squamous cell carcinoma have a second primary tumour in the upper aero digestive tract or stomach, either at the time of oesophageal squamous cell carcinoma diagnosis or at a later stage. As second primary tumours occur at an increased risk compared to the general population, prospective studies are necessary to investigate the yield and survival benefit of screening for second primary tumours in patients with oesophageal squamous cell carcinoma.Background There is paucity of data on the potential value of early palliative home care for patients with hematologic malignancies. Objective To compare costs, use of resources, and clinical outcomes between an early palliative home care program and standard hospital care for active-advanced or terminal phase patients. Patients and Methods In this real-life, nonrandomized comparative study, the allocation of advanced/terminal phase patients to either home or hospital was based on pragmatic considerations. Analysis focused on resources use, events requiring blood unit transfusions or parenteral therapy, patient-reported symptom burden, mean weekly cost of care (MWC), cost-minimization difference, and incremental cost-effectiveness ratio (ICER). Results Of 119 patients, 59 patients cared at home were more debilitated and had a shorter survival than the 60 in hospital group (p = 0.001). Nevertheless, symptom burden was similar in both groups. At home the mean weekly number of transfusions (1.45) was lower than that at hospital (2.77). Higher rate of infections occurred at hospital (54%) versus home (21%; less then 0.001). MWC for hospitalization was significantly higher in a 31 ratio versus home care. Compared with hospital, domiciliary assistance produced a weekly saving of € 2314.9 for the health provider, with a charge of € 85.9 for the family, and was cost-effective by an ICER of € -7013.9 of prevented days of care for avoided infections. Conclusions Current findings suggest that costs of early palliative home care for patients with hematologic malignancies are lower than standard hospital care costs. Domiciliary assistance may also be cost-effective by reducing the number of days to treat infections.
In recent decades, diagnosis and treatment recommendations for idiopathic pulmonary fibrosis (IPF) have changed. In Korea, the average life expectancy has increased, unmet healthcare needs have been reduced, and the number of computed tomography (CT) examinations performed has nearly doubled. The Korean Interstitial Lung Disease (ILD) Study Group conducted a nationwide cohort study for idiopathic interstitial pneumonia, including IPF, and established a registry for IPF.

Using study data collected by the study group, this study aimed to evaluate longitudinal changes in clinical features, diagnosis, treatment, and mortality and analyze the extent to which changes in medication usage affected IPF-associated mortality.

The study population included newly diagnosed IPF patients from a cohort study (January 2002-September 2008, n=1839, 2008 group) and prospective registry (January 2012-August 2018, n=1345, 2018 group). Survival curves were estimated using the Kaplan-Meier method, and Cox regression models werearlier, steroid and immunosuppressive agent use was reduced, and antifibrotic agents were administered. The survival of IPF patients has improved over the decades, and antifibrotic use was consistently associated with improved survival. Clinical trial registered with ClinicalTrials.gov (NCT04160715).
This study analyzed national IPF cohort data spanning 17 years. In clinical practice, the IPF diagnosis was made earlier, steroid and immunosuppressive agent use was reduced, and antifibrotic agents were administered. The survival of IPF patients has improved over the decades, and antifibrotic use was consistently associated with improved survival. Clinical trial registered with ClinicalTrials.gov (NCT04160715).Most randomized trials are designed and analyzed using frequentist statistical approaches such as null hypothesis testing and P values. Conceptually, P values are cumbersome to understand, as they provide evidence of data incompatibility with a null hypothesis (e.g., no clinical benefit) and not direct evidence of the alternative hypothesis (e.g., clinical benefit). This counterintuitive framework may contribute to the misinterpretation that the absence of evidence is equal to evidence of absence and may cause the discounting of potentially informative data. Bayesian methods provide an alternative, probabilistic interpretation of data. The reanalysis of completed trials using Bayesian methods is becoming increasingly common, particularly for trials with effect estimates that appear clinically significant despite P values above the traditional threshold of 0.05. Statistical inference using Bayesian methods produces a distribution of effect sizes that would be compatible with observed trial data, interpreted in the context of prior assumptions about an intervention (called "priors"). These priors are chosen by investigators to reflect existing beliefs and past empirical evidence regarding the effect of an intervention. By calculating the likelihood of clinical benefit, a Bayesian reanalysis can augment the interpretation of a trial. However, if priors are not defined a priori, there is a legitimate concern that priors could be constructed in a manner that produces biased results. Therefore, some standardization of priors for Bayesian reanalysis of clinical trials may be desirable for the critical care community. In this Critical Care Perspective, we discuss both frequentist and Bayesian approaches to clinical trial analysis, introduce a framework that researchers can use to select priors for a Bayesian reanalysis, and demonstrate how to apply our proposal by conducting a novel Bayesian trial reanalysis.
Congenital portal vein aneurysm is a rare vascular anomaly with poorly understood natural history. Whereas asymptomatic aneurysms are often managed conservatively, surgery has been used in symptomatic cases complicated by thrombosis or rupture. Surgical experience in management of portal aneurysms is restricted to case studies with limited comparative data and inconsistent reporting of outcomes. A hybrid open and endovascular approach has rarely been described in the literature.

We present a case of an extrahepatic portal aneurysm which demonstrated changes on surveillance imaging concerning for early asymptomatic thrombosis. Acute thrombus was identified at the time of open aneurysm repair. We review the limited literature regarding management of portal vein aneurysms in non-cirrhotic patients.

Our case was complicated by intrahepatic thrombo-embolism, which necessitated hybrid thrombectomy and anticoagulant therapy. The patient remains asymptomatic at three-year follow-up with no recurrent aneurysm or thrombosis on surveillance Doppler and CT imaging.

Altered hemodynamic appearances on Doppler ultrasound and contrast-enhanced CT may warn of impending thrombosis in portal vein aneurysms. Hybrid open and endovascular surgical repair ensures vessel patency and a durable surgical result.
Altered hemodynamic appearances on Doppler ultrasound and contrast-enhanced CT may warn of impending thrombosis in portal vein aneurysms. Hybrid open and endovascular surgical repair ensures vessel patency and a durable surgical result.
Takayasu's arteritis is a large vessel vasculitis which usually involves the aorta and its first generation branches. Aortic dissection, however, is a rare manifestation of Takayasu's arteritis and for this reason optimum management in both short and long term is unknown.

This is a case of a 31-year-old female presenting with acute type B AD in association with underlying TA which failed to respond to conservative management and underwent thoracic stent grafting (TEVAR).

Despite successful coverage of the intimal breach in the thoracic aorta by TEVAR there were complications with delivery of the stent which required a conduit sutured to the right common iliac artery. Also post-TEVAR computed tomography showed a localised dissection of the origin of the left common carotid artery which may have been iatrogenic possibly due to the stiff guidewire used during delivery of the stent graft to the thoracic aorta.

The use of TEVAR for an acute type B AD in those with TA may be problematic. The fragility of the major arteries increases the likelihood of iatrogenic periprocedural complications and long-term surveillance is essential due to significant chance of further arterial complications in type B AD occurring in TA.
The use of TEVAR for an acute type B AD in those with TA may be problematic. The fragility of the major arteries increases the likelihood of iatrogenic periprocedural complications and long-term surveillance is essential due to significant chance of further arterial complications in type B AD occurring in TA.Background Primary lower limb lymphedemas (LLLEs; not present at birth) are classified as early- and late-onset. In both groups, distal lymphangiopathy distal dermal backflow (DDB) may be observed and, in clinically unilateral edema, abnormalities may be present at the level of contralateral limb. The aim of this study is to report the frequency of heterolateral lesions in these patients based on lymphoscintigraphic investigations (LySc). Methods and Results Retrospective review (CE2048) among our database of patients who were referred for LySc of clinically unilateral LLLE and for whose LySc showed DDB. Fifty-six patients could be classified as early-onset ("praecox" group 1 8 men and 48 women median age at investigation = 32.5 years edema was right sided in 26 and left sided in 30) and 47 (8 men and 39 women edema was right sided in 25 and left sided in 22) as late-onset ("tarda" group 2). DDB at the level of the opposite nonedematous limb was found in 38.8% of the whole series but more frequently (p  less then  0.001) in group 2 (70%) than in group 1 (15%). In group 1, bilateral disease were seen as frequently (in 4 cases) among the (33) patients less then 35 years old than in other patients (4 out of 23). Conclusions These differences between these two clinical groups could support the following hypothesis we are facing, either two different lymphatic diseases, or, a single disease but affecting two populations of different susceptibility.
To examine the geographic distribution of physician and pharmacist workforce specialized in oncology in the United States.

Using the National Provider Identifier data, we identified two types of oncology workforce via the healthcare provider taxonomy codes. Oncologists were physicians self-identified as providing oncologic care to patients. Oncology pharmacists were pharmacists with an oncology subspecialty. We calculated the geographic density of physician and pharmacist oncology workforce and used county-level cancer crude rates to quantify the demand for oncology workforce. We used spatial data to plot the density of oncology workforces relative to county-level cancer rates and compared the county-level density of oncologists and oncology pharmacists.

Of the 30,553 members of the oncology workforce in 2019, 28,681 were oncologists and 1,090 were oncology pharmacists. The mean county-level density of oncologists was 2.94 (SD = 7.32) per 100,000 persons. Sixty-four percent of counties had no oncologiste.Background Injectable fillers are used worldwide to improve the appearance of the nose by nonsurgical methods. The procedure is not without risks, as blindness and skin necrosis have been reported as a consequence of filler injections in the nose. Objective To determine an overall adverse event (AE) rate for the nonsurgical rhinoplasty (NSR) procedure and to assess whether previous surgical rhinoplasty increases the odds of an AE. Methods A retrospective chart review of 2275 patients and 2488 NSR procedures for a 10-year period from a single physician injector was conducted. Results The overall procedural AE rate was 7.6%, with five cases (0.20%) considered serious (ischemia and necrosis). Previous surgical rhinoplasty patients had a greater AE rate (10.8%) than those patients without previous surgery (7.4%), with a significant odds ratio of 1.51 (95% confidence interval 1.03-2.18); p = 0.032. Injecting the tip and sidewall of the nose had the highest AE rates for both categories of patients. Conclusions NSR is a relatively safe procedure with the majority of AEs common injection site reactions. Patients with previous surgical rhinoplasty demonstrated significantly increased odds of an AE potentially due to surgical changes in anatomy.Recently, growing evidence has shed light on the competitive endogenous RNAs (ceRNAs) activity of long noncoding RNAs (lncRNAs) in carcinogenesis and tumor progression. To better elucidate the regulatory mechanisms of lncRNA in muscle-invasive bladder cancer (MIBC), we identified aberrantly expressed mRNAs, lncRNAs, and miRNAs in tumor tissues by using RNA sequence profiles from The Cancer Genome Atlas. The MIBC-specific ceRNA network, including 58 lncRNAs, 22 miRNAs, and 52 mRNAs, was constructed and visualized in Cytoscape. Further, using the univariate and multivariate Cox regression model, we screened 8 lncRNAs (AC078778.1, LINC00525, AC008676.1, AP000553.1, SACS-AS1, AC009065.1, AC127496.3, and MYO16-AS1) to construct an lncRNA signature for predicting the overall survival of MIBC patients. Kaplan-Meier analysis and a receiver operating characteristic curve were applied to evaluate the performance of the signature. Real-time quantitative PCR analysis was carried out to test expression levels of the 8 lncRNAs in MIBC patient tissues. Transwell assays demonstrated that overexpressing MYO16-AS1 can enhance UMUC2 migration and invasion. Our study offers a novel lncRNA-correlated ceRNA model to better understand the molecular mechanisms involved in MIBC. In addition, we developed an independent 8-lncRNAs biomarker for prognostic prediction and identified MYO16-AS1 as an oncogenic lncRNA in bladder cancer.Background The Australian Lymphoedema Education, Research and Treatment Program (ALERT) at Macquarie University in Sydney, Australia is one of the flagship programs of Australia's first fully integrated academic health sciences centre, MQ Health. The aim of this study was to describe our findings of compensatory drainage demonstrated by indocyanine green (ICG) lymphography in cancer-related upper and lower limb lymphedema and how this may be translated into clinical practice. Methods and Results Retrospective data from 339 patients aged between 18 and 90 years with secondary cancer-related unilateral or bilateral lymphedema of the upper or lower limb who underwent ICG lymphography assessment at the ALERT clinic between February 2017 and March 2020 were analyzed. In patients with upper limb lymphedema, the ipsilateral axilla was the most frequent drainage region (74.9%), followed by clavicular (41.8%) and parasternal (11.3%). For patients with mild upper limb lymphedema, 94.4% drained to the ipsilateral axilla. No patients drained to the ipsilateral inguinal region. For lower limb lymphedema, drainage to the ipsilateral inguinal was most common (52.3%), followed by contralateral inguinal (30.7%), popliteal (26.1%), and gluteal (21.6%) regions. Three main patterns of superficial lymphatic compensation were identified based on which anatomical structure carried lymph fluid. Manual lymphatic drainage (MLD) was used to facilitate movement of the dye. A light/effleurage technique was sufficient to move the dye through patent lymphatic vessels; a slow and firmer technique was required to move the dye through areas of bridging dermal backflow. Conclusion The introduction of ICG lymphography to our program and its use in guiding personalized conservative management plans, including facilitative MLD techniques, has translated into clinical practice and changed research and educational priorities within the ALERT program.
Here's my website: