Bulletin of Computer Science and Electrical Engineering (BCSEE)
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Use of Mechanical Ventilation Across 3 Countries
No full textThe ability to provide invasive mechanical ventilation (IMV) is a mainstay of modern intensive care; however, whether rates of IMV vary among countries is unclear.
To estimate the per capita rates of IMV in adults across 3 high-income countries with large variation in per capita intensive care unit (ICU) bed availability.
This cohort study examined 2018 data of patients aged 20 years or older who received IMV in England, Canada, and the US.
The country in which IMV was received.
The main outcome was the age-standardized rate of IMV and ICU admissions in each country. Rates were stratified by age, specific diagnoses (acute myocardial infarction, pulmonary embolus, upper gastrointestinal bleed), and comorbidities (dementia, dialysis dependence). Data analyses were conducted between January 1, 2021, and December 1, 2022.
The study included 59 873 hospital admissions with IMV in England (median [IQR] patient age, 61 [47-72] years; 59% men, 41% women), 70 250 in Canada (median [IQR] patient age, 65 [54-74] years; 64% men, 36% women), and 1 614 768 in the US (median [IQR] patient age, 65 [54-74] years; 57% men, 43% women). The age-standardized rate per 100 000 population of IMV was the lowest in England (131; 95% CI, 130-132) compared with Canada (290; 95% CI, 288-292) and the US (614; 95% CI, 614-615). Stratified by age, per capita rates of IMV were more similar across countries among younger patients and diverged markedly in older patients. Among patients aged 80 years or older, the crude rate of IMV per 100 000 population was highest in the US (1788; 95% CI, 1781-1796) compared with Canada (694; 95% CI, 679-709) and England (209; 95% CI, 203-214). Concerning measured comorbidities, 6.3% of admitted patients who received IMV in the US had a diagnosis of dementia (vs 1.4% in England and 1.3% in Canada). Similarly, 5.6% of admitted patients in the US were dependent on dialysis prior to receiving IMV (vs 1.3% in England and 0.3% in Canada).
This cohort study found that patients in the US received IMV at a rate 4 times higher than in England and twice that in Canada in 2018. The greatest divergence was in the use of IMV among older adults, and patient characteristics among those who received IMV varied markedly. The differences in overall use of IMV among these countries highlight the need to better understand patient-, clinician-, and systems-level choices associated with the varied use of a limited and expensive resource
Predicting significant wave height with artificial neural networks in the South Atlantic Ocean: a hybrid approach
No full textAccurate simulations of significant wave height (Hs) are extremely important for the safety of navigation, port operations, and oil and gas exploration. Thus, accurate forecasts of Hs are essential for accident prevention and maintenance of services vital to the economy. Considering the limitations of traditional numerical modeling, such as the typical model underestimation of Hs under severe conditions, forecasting Hs using artificial neural networks is a promising method and a complementary approach. In this study we develop a post-processing model using Long Short-Term Memory (LSTM) algorithm to improve outputs from the numerical model WAVEWATCH III (WW3) at Santos Basin, Brazil. The hybrid scheme is focused on the simulations of 1-, 2-, 3- and 4-day residues (difference between observations and WW3) using measurements from a local wave buoy moored in deep water. The results of the hybrid model (WW3+LSTM) show a better performance compared with WW3, being capable of better representing the peak of the events and storms. On average, the gains from using WW3+LSTM reach 3.8% in Correlation Coefficient (CORR), 14.2% in Bias (BIAS), 10.2% in Root Mean Squared Error (RMSE), and 10.7% in Scatter Index (SI). The hybrid model developed allows high-skill forecasts to be carried out on large domains and through longer horizons
Uterine cervical stenosis: from classification to advances in management. Overcoming the obstacles to access the uterine cavity
No full textAbstract Background To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. Purpose In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. Methods The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. Results Various strategies have been proposed to address cervical stenosis, including surgical and non-surgical methods. Medical treatments such as the preprocedural use of cervical-ripening agents or osmotic dilators have been explored. Surgical options include the use of cervical dilators and hysteroscopic treatments. Conclusions Cervical stenosis can present challenges in achieving successful intrauterine procedures. Operative hysteroscopy has been shown to have the highest success rate, particularly in cases of severe cervical stenosis, and is currently considered the gold standard for managing this condition. Despite the availability of miniaturized instruments that have made the management of cervical stenosis more feasible, it remains a complex task, even for experienced hysteroscopists
Endophthalmitis associated with XEN stent implantation
No full textThe aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants DESIGN: This is a retrospective, noncomparative consecutive case series.
Clinical and microbiological review was performed for eight patients presenting to the Bascom Palmer Eye Institute Emergency Room from 2021 to 2022 with XEN stent related endophthalmitis. Data collected includes clinical characteristics of patients at presentation, organisms identified in ocular cultures, treatments received, and visual acuity at last follow up.
The current study included eight eyes from eight patients. All cases of endophthalmitis occurred greater than 30 days after implantation of the XEN stent. At time of presentation, there was external exposure of the XEN stent in four out of the eight patients. Five of the eight patients had positive intraocular cultures, all of which were variants of staphylococcus and streptococcus species. Management included intravitreal antibiotics in all patients, explantation of the XEN stent in five patients (62.5%), and pars plana vitrectomy in six patients (75%). At last follow-up, six of the eight patients (75%) had a visual acuity of hand motion or worse.
Endophthalmitis in the setting of XEN stents results in poor visual outcomes. The most common causative organisms are staphylococcus or streptococcus species. At time of diagnosis, prompt treatment with broad spectrum intravitreal antibiotics is recommended. Consideration can be made to explant the XEN stent and perform early pars plana vitrectomy
Transition to Adulthood for Women on the Spectrum: A Brief Narrative Review
No full textResearch in the field of autism spectrum disorders (ASD) focuses mainly on school-aged children and male participants. This has left substantial gaps in our understanding of the life course of autistic individuals, particularly autistic females, once they reach adulthood. The objective of this concise narrative review is to discuss the current literature on autistic women with a focus on transitioning to adulthood, specifically in the areas of quality of life, post-secondary education and employment. Given that the evidence so far suggests widely inconsistent findings, we conclude that future research is needed to more carefully elucidate the unique needs of women on the spectrum during the process of transitioning to adulthood, and to identify evidence-based practices that could better support this population
"ActuaYa": A Preliminary Efficacy Study of a Chronic Disease Prevention and Health Promotion Intervention for Older Hispanic Women
No full textChronic diseases (CDs) are increasingly common among the aging population. Some evidence suggests that older Hispanic women ages 50 years and older (OHW) are at an increased risk for CDs and poorer outcomes than other groups. This study investigated the preliminary efficacy of ActuaYa, a culturally tailored CD prevention and health promotion intervention for OHW. A prospective, single-group, repeated measures study (50) was conducted in Florida. Clinical measures and surveys were collected at baseline and post-intervention at 3- and 6-month follow-up. Descriptive statistics, paired-sampletests, and McNemar tests were used for analysis. At baseline, more than half of the participants had a CD. Post-intervention results showed a significant decrease in participants' MAP, BMI, and A1C, and a significant increase in self-efficacy for exercise and HIV knowledge compared to baseline measures. The results of this study support the preliminary efficacy of ActuaYa in preventing CDs and increasing health promotion among OHW
Predictors of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease: A Prespecified Secondary Analysis of the STROKE AF Randomized Clinical Trial
No full textThe Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) trial found that approximately 1 in 8 patients with recent ischemic stroke attributed to large- or small-vessel disease had poststroke atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. Identifying predictors of AF could be useful when considering an ICM in routine poststroke clinical care.
To determine the association between commonly assessed risk factors and poststroke detection of new AF in the STROKE AF cohort monitored by ICM.
This was a prespecified analysis of a randomized (1:1) clinical trial that enrolled patients between April 1, 2016, and July 12, 2019, with primary follow-up through 2020 and mean (SD) duration of 11.0 (3.0) months. Eligible patients were selected from 33 clinical research sites in the US. Patients had an index stroke attributed to large- or small-vessel disease and were 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor. A total of 496 patients were enrolled, and 492 were randomly assigned to study groups (3 did not meet inclusion criteria, and 1 withdrew consent). Patients in the ICM group had the index stroke within 10 days before insertion. Data were analyzed from October 8, 2021, to January 28, 2022.
ICM monitoring vs site-specific usual care (short-duration external cardiac monitoring).
The ICM device automatically detects AF episodes 2 or more minutes in length; episodes were adjudicated by an expert committee. Cox regression multivariable modeling included all parameters identified in the univariate analysis having P values <.10. AF detection rates were calculated using Kaplan-Meier survival estimates.
The analysis included the 242 participants randomly assigned to the ICM group in the STROKE AF study. Among 242 patients monitored with ICM, 27 developed AF (mean [SD] age, 66.6 [9.3] years; 144 men [60.0%]; 96 [40.0%] women). Two patients had missing baseline data and exited the study early. Univariate predictors of AF detection included age (per 1-year increments: hazard ratio [HR], 1.05; 95% CI, 1.01-1.09; P = .02), CHA2DS2-VASc score (per point: HR, 1.54; 95% CI, 1.15-2.06; P = .004), chronic obstructive pulmonary disease (HR, 2.49; 95% CI, 0.86-7.20; P = .09), congestive heart failure (CHF; with preserved or reduced ejection fraction: HR, 6.64; 95% CI, 2.29-19.24; P < .001), left atrial enlargement (LAE; HR, 3.63; 95% CI, 1.55-8.47; P = .003), QRS duration (HR, 1.02; 95% CI, 1.00-1.04; P = .04), and kidney dysfunction (HR, 3.58; 95% CI, 1.35-9.46; P = .01). In multivariable modeling (n = 197), only CHF (HR, 5.06; 95% CI, 1.45-17.64; P = .05) and LAE (HR, 3.32; 1.34-8.19; P = .009) remained significant predictors of AF. At 12 months, patients with CHF and/or LAE (40 of 142 patients) had an AF detection rate of 23.4% vs 5.0% for patients with neither (HR, 5.1; 95% CI, 2.0-12.8; P < .001).
Among patients with ischemic stroke attributed to large- or small-vessel disease, CHF and LAE were associated with a significantly increased risk of poststroke AF detection. These patients may benefit most from the use of ICMs as part of a secondary stroke prevention strategy. However, the study was not powered for clinical predictors of AF, and therefore, other clinical characteristics may not have reached statistical significance.
ClinicalTrials.gov Identifier: NCT02700945
Systematic Literature Reviews on Rapid Application Development Information System
No full textRapid Application Development (RAD) is one of the Software Development Cycle (SDLC) methodologies that are often used by development teams that prioritize time efficiency. The RAD methodology is considered as one of the methodologies that has the shortest completion time compared to other SDLC methodologies. This study aims to validate, update, and expand the previous discussion regarding the universal conditions of RAD model research in the world of software feature development. Objectives can be obtained using a narrative review procedure, which is applied to previously collected literature. This study aims to make conclusions about the model of the RAD methodology which is very effective, supports and constrains the RAD model, and is efficient compared to other development models. Not only that, this research also guides the universal stages in SDLC and the RAD methodology used to integrate these stages
Music Assisted Progressive Muscle Relaxation and Virtual Reality Exposure Therapy for Specific Phobia: Two Case Studies
No full textSpecific phobia is a prevalent psychiatric disorder characterized by an irrational fear disproportionate to the threat that the object or situation poses. This anxiety disorder profoundly impacts individuals, affecting their personal, social, and occupational spheres. This study aimed to explore the use of Music Assisted Progressive Muscle Relaxation (M+PMR) and Virtual Reality Exposure Therapy (VRET) in the treatment of specific phobia.Music therapy techniques, such as M+PMR, have shown potential in optimizing therapeutic outcomes when treating specific phobia or prior to exposure therapy. These techniques involve utilizing music elements like slow tempo, major mode, simple rhythms, and calming instrumental timbres. Additionally, VRET is a type of exposure therapy that provides a safe and controlled environment for confronting phobias. Being mentally present and physiologically aware during VRET sessions is essential for successful therapy, as high arousal during VRET eventually leads to symptom reduction and decreased avoidance behaviors. By exploring the utilization of M+PMR and VRET to treat specific phobias, we can further investigate their effectiveness.In this study, the participants, Andrew and Natalie, experienced a state of relaxation during the M+PMR sessions. The incorporation of music and progressive muscle relaxation seemed to enhance their awareness of physiological responses, leading to a heightened attentiveness to bodily sensations during the intervention. The use of soothing piano music, slow tempo, and soft tones complemented the PMR script, facilitating a state of relaxation and presence.Moreover, both Andrew and Natalie expressed a sense of being present in the moment during the M+PMR sessions. Furthermore, the results indicated that both participants felt prepared for exposure therapy following the M+PMR sessions. The relaxation and calmness induced by M+PMR seemed to contribute to their readiness to confront their phobic triggers in the virtual environment
Molecular Recognition in Sensing and Therapeutics
No full textThis work focuses on the application of molecular recognition in developing sensors and targeted delivery of therapeutics. The generation of synthetic, biomimetic, and engineered host molecules to selectively bind to the guest molecule (chemicals, drugs, proteins, etc.) is a topic of interest. Anion recognition has attracted extensive attention in host-guest chemistry as measuring the level of anions is crucial to physiological function as well as various industrial processes. The design of an anion-selective host (ionophore) is challenging due to the complexity of synthesizing hosts with a large cavity to accommodate anions. CH-hydrogen bonding provides access to new building blocks for making macrocyclic ionophores with high degrees of preorganization and selective anion recognition. While the electronegativity of carbon is low compared to conventional hydrogen bond donors, it can be enhanced by introducing electron-withdrawing groups. The CH-hydrogen donor is superior to the NH hydrogen donor in design of an ionophore as the earlier generate neutral ionophores that are not susceptible to protonation. The application of neutral ionophores in the design of anion-selective electrodes is beneficial in developing sustainable ISEs to detect several anions. Biosensors can also contain molecular recognition elements that are either of biological or abiotic nature and transduce a signal upon ligand binding to the sensing element of the sensor. This signal is related to the level of the ligand in the sample. Enzyme-based biosensors are the most commonly used, while some of them suffer from limitations such as oxygen dependency and indirect measurement of the analyte. Engineering proteins as sensing elements in the development of reagentless non-enzymatic biosensors to detect the analyte of interest directly is in need. Integrating a reporter group directly into sensing components and translating their behavior to analyte binding is a valuable strategy in engineering reagentless biosensors. </p