Background: The Second Victim Phenomenon (SVP) significantly impacts the well-being of healthcare professionals and patient safety. While SVP has been explored in various healthcare settings, there is limited data on its prevalence and associated factors among nurses in Austria. This study investigates the prevalence, symptomatology, and preferred support measures for SVP among Austrian nurses. Methods: A nationwide, cross-sectional, anonymous online survey was conducted using the SeViD questionnaire (Second Victims in German-speaking Countries), which includes the Big Five Inventory-10 (BFI-10). Statistical analyses included binary logistic regression and multiple linear regression using the bootstrapping, bias-corrected and accelerated (BCa) method based on 5000 bootstrap samples. Results: 928 participants responded to the questionnaire. Among the respondents, 81.58% (744/912) identified as Second Victims (SVs). The primary cause of becoming a SV was aggressive behavior from patients or relatives. Females reported a higher symptom load than males, and higher agreeableness was linked to increased symptom severity. Notably, 92.47% of SVs who sought help preferred support from colleagues, and the most pronounced desire among participants was to process the event for better understanding. Conclusions: The prevalence of SVP among Austrian nurses is alarmingly high, with aggressive behavior identified as a significant trigger. The findings emphasize the necessity for tailored support strategies, including peer support and systematic organizational interventions to mitigate the impact of SVP on nurses and to improve overall patient care. Further research should focus on developing and implementing effective prevention and intervention programs for healthcare professionals in similar settings.

Monitoring of clients living with HIV encompasses a specific array of activities that routinely check on various aspects of ART following its initiation depending on the availability of resources in that particular state, among other factors as per guidelines from the World Health Organisation. This is a significant practice as it promotes positive health outcomes for patients and efficient utilisation of ART regimens to reduce resistance to the medication – hence it is a measure to guard avoidable costs. It also forms a basis on which decisions are made from. It can be done clinically by assessing for signs e.g., skin rash and symptoms e.g., nausea and vomiting, checking vital organ function and measuring weights across all populations, or can be also be done by assessing specimens for their respective viral loads, white blood cell count, pregnancy status or other infections such as hepatitis B. There have not been any special indications required for one to be eligible for monitoring during ART in developing countries; all qualify for routine monitoring even though some may be more frequent than others in cases of comorbidities such as renal failure where medications can be attributed to exacerbating the condition.

The Range–Doppler (R-D) model is extensively employed for the geometric processing of Synthetic Aperture Radar (SAR) images. Refining the sensor motion state and imaging parameters is the most common method for achieving high-precision geometric processing using the R-D model, comprising a process that involves numerous parameters and complex computations. In this study, we introduce a novel approach to improve the positioning accuracy of the R-D model, implementing a low-order polynomial to compensate for the original imaging errors without altering the initial positioning parameters. We also design low-order polynomial compensation models with different parameters. The models are evaluated on various SAR images from different platforms and bands, including spaceborne TerraSAR-X and GF3-C images, manned airborne SAR-X images, and unmanned aerial vehicle-mounted miniSAR-Ku images. Furthermore, image positioning experiments involving the use of different polynomial compensation models and various numbers and distributions of Ground Control Points (GCPs) are conducted. The experimental results demonstrate that geometric processing accuracy comparable to that of the classical rigorous positioning method can be achieved even when applying only an affine transformation model to the images. Compared to classical refinement models, however, the proposed image-compensated R-D model is much simpler and easy to implement. Thus, this study provides a convenient, robust, and widely applicable method for the geometric positioning processing of SAR images, offering a potential approach for the joint-positioning processing of multi-source SAR images.

We were tasked by Canada’s COVID-19 Immunity Task Force to describe severe adverse events (SAE) associated with emergency department (ED) visits and/or hospitalizations in immune-mediated inflammatory diseases (IMID). At 8 Canadian centres, data were collected from adults with rheumatoid arthritis (RA), axial spondyloarthritis (AxS), systemic lupus (SLE), psoriatic arthritis (PsA) and inflammatory bowel disease (IBD). We administered questionnaires, analyzing SAEs experienced within 31 days following SARS-CoV-2 vaccination. About two-thirds (63%) of 1556 participants were female; mean age was 52.5 years. BNT162b2 (Pfizer) vaccine was the most common, with mRNA-1273 (Moderna) being second. Forty-nine percent of participants had IBD, 27.4% RA, 14.3% PsA, 5.3% SpA, and 4% SLE. Twelve SAEs leading to ED visit or hospitalization were self-reported, occurring in 11 participants. SAEs included 6 ED visits (including one Bell’s Palsy 31 days after first vaccination) and 6 hospitalizations (including one Guillain-Barré syndrome 15 days after the first vaccination). Two SAEs involved pericarditis, one in SLE (considered a serious disease flare) and one in RA. Thus, in the 31 days after SARS-CoV-2 vaccination in IMID, though several serious AEs occurred, these were relatively few. As SARS-CoV2 continues to be a common cause of death, our findings may help optimize vaccination acceptance.

Positioning based on wireless signals such as mobile communication networks has become an important means to provide high-precision location services in environments where satellite signals are blocked. In complex environments such as indoor and underground, wireless signal propagation is obstructed and non-line-of-sight (NLOS) phenomena appears due to serious occlusion and reflection. The time delay caused by NLOS effects has little impact on communication system but can significantly increase positioning errors in positioning systems. Therefore, effective suppression of NLOS errors is crucial to improving 5G positioning accuracy. To address the insufficient feature extraction of existing NLOS error suppression methods, the neglect of residual NLOS measurement errors, and poor stability of position estimation results, this paper innovatively proposes a NLOS mitigation and location estimation method for 5G positioning terminals. Simulation and experimental test results demonstrate that the proposed method outperforms the comparative methods both theoretically and practically, achieving an average positioning accuracy of 1.85 meters in complex indoor NLOS environments. The method proposed in this paper provides a new strategy for NLOS error suppression in indoor 5G positioning, which can significantly contribute to high-precision location services based on commercial 5G networks.

Protection suit is vital for fireman’ safety. Traditional protection suit just physically protects fireman from empyrosis, but can not locate the body injury position from the impact debris. Herein, we present a wearable impact debris positioning system for fireman protection suit alarming based on accelerometer array. The wearable piezoelectric accelerometers with distribute regularly on the suit to detect the vibration on different body parts, which is conducive to positioning injured body parts. In addition, the injured parts can be displayed on the dummy body model on the upper computer with a higher localization accuracy of 4 cm. The positioning alarm system has a rapid response time of 0.11ms attributing to smart signal processing method. This work provides a reliable and smart method for locating and assessing the body injury position from the impact debris, which is significant for fire disaster commander to rescue injured fireman in time.

Management of sarcomas in specialist centers delivers significant benefits. In much of the world specialists are not available and development of expertise is identified as a major need. However the terms ‘specialist’ or ‘expert’ center are rarely defined. Our objective is to offer a definition for patient advocates and a tool for healthcare providers to underpin improving the care of people with sarcoma. SPAGN developed a discussion paper for a workshop at the SPAGN 2023 Conference, attended by 75 delegates. A presentation to the Connective Tissue Oncology Society (CTOS) and further discussion led to this paper. Core Principles were identified that underlie specialist sarcoma care. The primary principle is the multi-disciplinary team discussing every patient, at first diagnosis and during treatment. Principles for optimal sarcoma management include accurate diagnosis followed by safe, high-quality treatment, with curative intent. These Principles are supplemented by Features describing areas of healthcare, professional involvement, and service provision and identifying further research and development needs. These allow for variations because of national or local policies and budgets. We propose the term ‘Sarcoma Intelligent Specialist Network’ to recognize expertise wherever it is found in the world. This provides a base for further discussion and local refinement.

Pedestrian Dead Reckoning (PDR) is a promising algorithm for indoor positioning. However, the accuracy of PDR degrades due to the accumulated error, especially in multi-floor buildings. This paper introduces a three-dimensional (3D) positioning method based on terrain feature matching to reduce the influence of accumulated error in multi-floor scene. The proposed method involves two steps: motion pattern recognition and position matching calibration. The motion pattern recognition aims to detect different motion states, i.e., taking the stairs or horizontal walking, from the streaming data. Then, stair entrances and corridor corners are matched with transition points of motion states and pedestrian turning points, respectively. After matching, calibration is performed to eliminate the accumulated errors. By carrying out experiments on a two-floor closed-loop path with a walking distance about 145 m, it is shown that this method can effectively reduce the accumulated error of PDR , achieving accurate 3D positioning . The average error is reduced from 6.60 m to 1.83 m.

(1) Background: Second Victims are health care workers negatively affected by adverse events and are prone to developing dysfunctional coping strategies compromising not only their own, but also patient safety. An effective way to address this issue is the implementation of peer support programs. This paper reports on the effectiveness of a peer support program at the Austrian Hietzing Clinic (KHI). (2) Methods: Telephone interviews were carried out after peer support sessions using a questionnaire. Descriptive analysis was carried out reporting frequencies and proportions for nominal variables, means with standard deviations for ordinal and interval-scaled variables. (3) Results: So far, 45 peer supporters have completed telephone interviews after a peer support session. The main reasons for the session were bad news from the private sphere and death of a patient. The peer supporters rated the helpfulness of the sessions for their colleagues as very high while not feeling very burdened themselves afterwards. (4) Conclusions: Underutilization of the program is probable. However, the high rating of helpfulness of the carried-out sessions by the peer supporters in combination with them not feeling very burdened, shows that the program is safe for the peer supporters and an upscaling is warranted.

Antifragility, a concept pioneered by Nassim Nicholas Taleb, has undergone significant development over the past decades. In his work, Taleb describes antifragility as the opposite of fragility—a system that not only withstands stress and volatility but actually thrives and improves as a result. However, many existing systems, including those in Information Technology (IT) and complex economic models, tend to fail under stress. This paper aims to explore the potential implementation of antifragility principles into software architecture. By embracing the concept of an- tifragility, software systems could be designed to not only withstand stressors but also harness them to enhance their robustness and performance. The authors recognize that traditional approaches to software architecture often focus on minimizing failure points and ensuring stability. While these approaches are valuable, they often neglect the dynamic nature of real-world systems and fail to adapt to unforeseen challenges. The paper proposes an alternative perspective that considers stress as an opportunity for improvement. By introducing antifragile elements into software architec- ture, such as decentralized decision-making, self-healing mechanisms, and adaptive resource allocation, the authors argue that software systems can become more resilient, responsive, and capable of capitalizing on stress-induced dis- ruptions. To validate their ideas, the authors present case studies and practical examples of how antifragile software architectures could operate in various domains. They also discuss potential challenges and trade-offs associated with implementing antifragility, such as increased complexity and resource requirements. By shedding light on the possi- bility of embracing antifragility in software architecture, this paper seeks to inspire further research and innovation in creating more adaptive and robust software systems that thrive in the face of stress and uncertainty.

Traditional seismic wave-based tunnel advanced geological forecasting techniques are primarily designed for drill and blast method construction tunnels. However, given the fast excavation speed and limited prediction space in Tunnel Boring Machine (TBM) construction tunnels, traditional methods have significant technical limitations. This paper analyzes the characteristics of different types of TBM construction tunnels and, considering the practical construction conditions, identifies an effective observation system and data acquisition method. Utilizing numerical simulation, a model for advanced detection of typical unfavorable geological formations is established by obtaining the wave field response characteristics of seismic waves in three-dimensional space. The seismic wave reflection method can effectively receive information from unfavorable geological formations in front of the tunnel face. To address the challenges in advanced forecasting for TBM construction tunnels, a method of ellipsoid positioning velocity analysis, which takes into account the constraints of three-component data directions, is proposed. Based on the characteristics of the advanced forecasting observation system, the method compares the maximum values on the spatial isochronous ellipsoidal surface to determine the average velocity of the geological layer rays, thereby enabling accurate inversion of the spatial distribution ahead. Field verification of advanced geological forecasting based on ellipsoid positioning velocity analysis for TBM tunnels is conducted. The results indicate that this method can be used to obtain the three-dimensional velocity of the predicted unfavorable geological formations in front of the tunnel and is effective for the application of geological forecasting in TBM construction tunnels, thus providing crucial references and assurances for construction.

Introduction. Intra-abdominal cystic formations represent heterogeneous pathologies with varied localization and clinical manifestation. The first challenge of a giant intra-abdominal cystic lesion is identifying the organ of origin. The clinical presentation of intra-abdominal cystic lesions varies from acute manifestations to non-specific symptoms or accidental discovery. Case presentation: A 2-year-old girl presents to the emergency unit with a fever of 38.5 Celsius, loss of appetite, and apathy. The investigations showed a gigantic intra-abdominal mass whose organ belonging could not be specified. Postoperatively, a giant mesenteric lymphangioma was evident, which was completely excised. Discussions Giant cystic formations modify the anatomical reports and become space-replacing formations, and the starting point is even more challenging to assess preoperatively. Nevertheless, the careful evaluation of the characteristics of the formation, the effect on the adjacent organs, the age of the patient, and the clinical picture can provide elements of differential diagnosis.

Underwater natural gas pipelines constitute critical infrastructure for energy transportation. Any damage or leakage in these pipelines poses serious security risks, directly threatening marine and lake ecosystems and potentially causing operational issues and economic losses in the energy supply chain. Due to the difficulty in detecting deterioration over time and regularly inspecting these submerged pipelines by divers, the use of unmanned underwater vehicles (UUVs) becomes crucial in this field. In this study, an underwater pipeline tracking experiment was carried out by providing autonomous features to a remote-controlled unmanned underwater vehicle. During the tracking of the underwater pipeline, damages were identified, and the locations of these damages were determined. The navigation information of the underwater vehicle, including orientation in the x, y, z axes (roll, pitch, yaw) from a gyroscope integrated with magnetic compass, speed and position information in the three axes from an accelerometer, and the distance to the water surface from a pressure sensor, was integrated into the vehicle. Pre-tests determined the necessary pulse width modulation values for the thrusters of the vehicle, enabling autonomous operation by providing these values as input to the thruster motors. In this study, the vehicle moves in 3D was achived by the vertical thruster of the vehicle was activated to maintain a specific depth, and applying equal force to the vehicle’s right and left thrusters forward movement, while differential force induced deviation angles. In pool experiments, the unmanned underwater vehicle autonomously tracked the pipeline as intended, identifying damages on the pipeline using images captured by the vehicle's camera. The images for damage assessment were processed using a convolution neural network (CNN) algorithm, which is a deep learning method. The position of the damage relative to the vehicle was estimated from the pixel dimensions of the identified damage. The location of the damage relative to its starting point was obtained by combining these two positional pieces of information from the vehicle's navigation system. The all study was performed within the Python environment.

The domain of construction engineering and management is evolving rapidly. Optimizing resource positioning is crucial for meeting the challenges of efficiency and productivity. This research presents a novel methodology that incorporates Agent-Based Modeling (ABM), Building Information Modeling (BIM), and Bluetooth Low Energy (BLE) technologies, augmented with a Client Early Warning System (CEWS) and a Decision Support System (DSS). What makes this study unique is that it provides a real-time methodology for resource allocation and project management, tailored to address the complexities of modern construction projects. The application of this integrated technological framework marks a significant leap in construction management, empowering data-driven decision-making and significantly improving project efficiency. Empirically validated through a case study at Helwan University's College of Engineering and substantiated by expert surveys, this research showcases a transformative model for resource management. The findings not only underscore the practical applicability of this approach but also open new horizons for its adoption in global construction practices, offering insights for future research endeavors focused on expanding these methodologies to a wider range of resources.

Aim: The aim of the study is to analyze quantitatively the scientific literature covering nursing studies on patient safety. Method: The Web of Science database is queried in this retrospective bibliometric analysis to identify relevant publications. The study themes, contributing journals, countries, institutions, and authors were evaluated quantitatively. Thus, a total of 5470 publications concerning patient safety in nursing were included and analyzed. Findings: The number of studies conducted increased every year from 1992 to 2023. While the country whose articles receive the most citations (31072) is the United States of America (USA), Turkey is ranked as last with the lowest number of citations (581). Journal of Clinical Nursing, with 338 articles, appeared to have the highest number of publications, Chaboyer W. appeared to have the highest number of citations with a total of 1426 and 45 publications. The countries that have the strongest international cooperation for research in this field are the USA, England, Australia and China. Results: After examining the literature in the field of patient safety in nursing through bibliometric analysis, it is seen that themes such as patient safety, medication errors, nursing care, nursing, education, systematic review, quality care and leadership were emphasized as important considerations.

Spatial light modulators (SLMs) have been widely used to achieve dynamic control of optical traps. Often, holographic optical tweezers have been presumed to provide nanometer or sub-nanometer positioning accuracy. It is known that some features concerning the digitalized structure of SLMs cause a loss in steering efficiency of the optical trap, but their effect on trap positioning accuracy has been scarcely analyzed. On the one hand, the SLM look-up-table, which we found to depend on laser power, produces positioning deviations when the trap is moved at the micron scale. On the other hand, phase quantization, which makes linear phase gratings become phase staircase profiles, leads to unexpected local errors in the steering angle. We have tracked optically-trapped microspheres with sub-nanometer accuracy to study the effects on trap positioning, which can be as high as 2 nm in certain cases. We have also implemented a correction strategy that enabled the reduction of errors down to 0.3 nm.

Lichen Amyloidosis (LA) is a type of cutaneous amyloidosis characterized by brownish hyperkeratotic and itchy papules on the lower leg, back, forearm or thigh. It is associated with itching and Atopic Dermatitis (AD) according to an etiopathogenetic mechanism that has not yet been fully elucidated. Currently, available therapies for this condition include oral antihistamines, laser, cyclosporine, topical corticosteroids and phototherapy, but in light of the overlap with AD, Dupilumab may also be indicated. We report the case of a female, 52 years old, suffering from AD and LA for about 27 years. She had lesions attributable to both diseases on the trunk and lower limbs associated with severe itching and had proved resistant to cyclosporine therapy. It was decided to opt for Dupilumab with induction of 2 fl of 300 mg and maintenance with 1 fl every other week. The therapy proved effective, returning a total resolution of both diseases one year after the beginning of the treatment. Dupilumab demonstrated efficacy and safety in LA related to AD and led to clinical and quality of life improvement in this patient. Therefore, Dupilumab should be considered when treating LA. Further studies should be conducted focusing on the efficacy of the drug on LA (whether or not related to AD), changes in skin lesions after discontinuation, and the safety of long-term application.

A relativistic positioning system is a set of four emitters broadcasting their proper times by means of light signals. The four emitter times received at an event constitute the emission coordinates of the event. Covariant quantities associated with relativistic positioning systems are analysed relatively to an observer in Minkowski space-time by splitting them in their relative space-like and time-like components. The location of a user in inertial coordinates from a standard set of emission data (emitted times and satellite trajectories) is solved in the underlying 3+1 formalism. The analytical location solution obtained by Kleusberg for the GPS system is recovered and interpreted in a Minkowskian context.

The formal transfer of GNSS under water is not possible. It probably makes sense to talk only about the transformation of GPS into LPS, that is, in the Local Position System. However, the basic methods that are used to solve the problem of Spoofing Detection above water can be used under water. It should be understood that engineering problems are significantly different, since the nature of the propagation of acoustic waves in water and electromagnetic waves in the atmosphere are fundamentally different. In this article, we will limit the navigation with acoustically passive receiver. The receiver “listens” to the buoys and solves the problem of finding its own position based on the coordinates of the buoys (such systems are called GNSS-like Underwater Positioning Systems or GNSS-like UPS). Depending on the scale of system service areas, GNSS-like UPS are divided into global, regional, zonal and local system. In this article, we will limit ourselves to considering only local GNSS-like UPS. The acoustic signal generator transmits a signal simulation of several satellites. If the level of the simulated signal exceeds the signal strength of real satellites, the receiver of UPS will “capture” the fake signal and calculate the false position based on it.

(1) Background: As part of the Scottish Governments five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients’ experience of this new service; (2) Method: Adult patients (≥18yrs age) who consented to participate in the Community Pharmacy Hospital Dis-charge and Medicines Reconciliation Service were invited for interview within 21 days of dis-charge from hospital. Qualitative, one-to-one, semi-structured, patient interviews were conducted by telephone and audio-recorded using Microsoft Teams®. The interview audio recordings were transcribed verbatim and underwent thematic analysis; (3) Results: 12 patients were inter-viewed, evenly split by sex and with a median age of 62 years (range; 36 to 88 years). Analysis generated main five themes; Patient Engagement, Stakeholder Communication, Practical Factors, Human Factors, and Comparative Experiences. Many of these were interdependent; (4) Con-clusions: Patients appreciated that the service ensured a quicker discharge from hospital. Good stakeholder communication, practical factors (including choice, location, and the realities of ob-taining their medication from the community pharmacy), and a pre-existing and trusted rela-tionship in their usual community pharmacy were the key factors that regulated the patient ex-perience. In the main, patients were positive about the introduction of this new service. However, a lack of previous relationship or trust with a community pharmacy, and previous experiences with medication supply problems were factors which had the potential to negatively impact on patient experiences.

(1) Background: The study of microbiome is being crucial for his role in major systemic diseases, in particular the oral and gut microbiota. In the last years the study of microorganism correlated for example with neurodegenerative disease is increasing the prospective of a possible link between gut microbiota and brain. Here we report a new case report about a patient evaluated genetically firstly for dementia and late-onset dyskinesia, and then tested with 16S metagenomics sequencing. (2) Methods: Starting from buccal swab, we extracted bacterial DNA and then we performed a NGS metagenomics sequencing based on the amplification of hypervariable regions of the 16S in bacteria. (3) Results: The sequencing revealed the presence of Spirochaetes Phylum, a pathogenic bacterium generally known to be able to migrate to the Central Nervous System and not only. (4) Conclusions: Oral infections as our results shows could be possible contributing factors to various neurodegenerative conditions.

Aiming at the defects of low precision and time cumulative error, an external wireless signal weighted centroid localization algorithm aided inertial positioning method is designed in this paper. According to the signal strength of each anchor node received at the test point, the distance between the anchor node and the anchor node is obtained by using the attenuation model of the wireless signal. Three anchor nodes are used to measure the distance between the anchor node and the measured point. We can obtain the area to be measured according to the actual situation, the position of the measured point is obtained by the weighted centroid localization algorithm and a combined model of wireless signal aided inertial navigation system is established. The simulation results show that the method can greatly improve the positioning accuracy and restrain the divergence of the longitude error and latitude error.

Wi-Fi fingerprinting positioning systems have been deployed for a long time in location-based services for indoor environments. Combining mobile crowdsensing and Wi-Fi fingerprinting systems could reduce the high cost for collecting the necessary data enabling the deployment of the resulting system for outdoor positioning in areas with dense Wi-Fi coverage. In this paper, we present the results attained in the designing and evaluation of an urban fingerprinting positioning system based on crowdsensed Wi-Fi measurements. We first asses the quality of the collected measurements, highlighting the influence of received signal strength on data collection. We then, evaluate the proposed system by comparing the influence of the crowdsensed fingerprints on the overall positioning accuracy for different scenarios. The evaluation helps gain valuable insight into the design and deployment of urban Wi-Fi positioning systems while also allowing the proposed system to match GPS-like accuracy in similar conditions.

This study sheds light on personal characteristics of and the coping strategies that older Canadians self-identifying as severely anxious post-COVID-19 were more and less prone to gravitate to. Our studied sample consisted of 606 older people residing in 10 Canadian provinces. Participants completed the Geriatric Anxiety Scale – 10 and a personal checklist of everyday coping strategies for mitigating anxiety. Severely anxious older Canadians tended to be in their 60s, and in poor to fair health. They were not significantly more likely to be women or to be chronically ill, nor to self-identify as non-binary or as having a life partner. Older Canadians experiencing severe anxiety were, however, far more likely to normalize their fear and anxiety, challenge their worries, and to relax or meditate. They were less inclined to decrease other sources of stress in their lives, to stay active, and to get enough sleep. We offer anticipatory guidance for mental health program planners and practitioners, and researchers, fruitful avenues of inquiry.

A method for infrared and cameras sensor fusion, applied to indoor positioning in intelligent spaces, is proposed in this work. The fused position is obtained with a maximum likelihood estimator from infrared and camera independent observations. Specific models are proposed for variance propagation from infrared and camera observations (phase shifts and image respectively) to their respective position estimates and to the final fused estimation. Model simulations are compared with real measurements in a setup designed to validate the system. The difference between theoretical prediction and real measurements is between 0.4 cm (fusion) and 2.5 cm (camera), within a 95% confidence margin. The positioning precision is in the cm level (sub-cm level can be achieved at most tested positions) in a 4x3 m locating cell with 5 infrared detectors on the ceiling and one single camera, at distances from target up to 5 m and 7 m respectively. Due to the low cost system design and the results observed, the system is expected to be feasible and scalable to large real spaces.

This paper addresses the problem of assessing and optimizing acoustic positioning system for underwater target localization with range measurements only. We present a new three-dimensional assessment model to assess the optimal geometric beacon formation whether meet user needs. For the sake of mathematical tractability, it is assumed that the measurements of the range between the target and beacons are corrupted with white Gaussian noise with variance is distance-dependent. Then by adopting dilution of precision (DOP) parameters in the assessment model, the relationship between DOP parameters and positioning accuracy is derived. In addition, the optimal geometric beacon formation that will yield the best performance is achieved by minimizing the values of geometric dilution of precision (GDOP) on condition that the position of target is known and fixed. Next, in order to make sure whether the estimate positioning accuracy over interesting region satisfy the precision needed by the users, geometric positioning accuracy (GPA), horizonal positioning accuracy (HPA) and vertical positioning accuracy (VPA) are utilized to assess the optimal geometric beacon formation. Simulation examples are designed to illustrate the exactness of the conclusion. Unlike other work which only use GDOP to optimize the formation and cannot assess the performance of the specified dimensions, this new three-dimensional assessment model can assess the optimal geometric beacon formation in each dimension for any point in three-dimensional space, which can provide users with guidance advices to optimize performance of every specified dimension.

As people grow a custom to effortless outdoor navigation there is a rising demand for similar possibility indoors as well. Unfortunately, indoor localization, being one of the necessary requirements for navigation, continues to be problem without a clear solution. In this article we are proposing a method for an indoor positioning system using a single image. This is made possible using small preprocessed database of images with known control points as the only preprocessing needed. Using feature detection with SIFT algorithm we can look through the database and find image which is the most similar to the image taken by user. Pair of images is then used to find coordinates of database image using PnP problem. Furthermore, projection and essential matrices are determined allowing for the user image localization ~ determining the position of the user in indoor environment. Benefits of this approach lies in the single image being the only input from user and no requirements for new onsite infrastructure and thus enables a simpler realization for the building management.

This study proposes a mobile positioning method which adopts recurrent neural network algorithms to analyze the received signal strength indications from heterogeneous networks (e.g., cellular networks and Wi-Fi networks) for estimating the locations of mobile statioThis study proposes a mobile positioning method which adopts recurrent neural network algorithms to analyze the received signal strength indications from heterogeneous networks (e.g., cellular networks and Wi-Fi networks) for estimating the locations of mobile stations. The recurrent neural networks with multiple consecutive timestamps can be applied to extract the features of time series data for the improvement of location estimation. In practical experimental environments, there are 4,525 records, 59 different base stations, and 582 different Wi-Fi access points detected in Fuzhou University in China. The lower location errors can be obtained by the recurrent neural networks with multiple consecutive timestamps (e.g., 2 timestamps and 3 timestamps); the experimental results can be observed that the average error of location estimation was 9.19 meters by the proposed mobile positioning method with 2 timestamps.

Hemophagocytic lymphohistiocytosis (HLH) is a serious haematologic condition that can be re-lated to various diseases, including tuberculosis (TB). The patient is a previously healthy 26-years-old man, originally from Western Africa, admitted to hospital for fever and weight loss. Given the results of computed tomography (CT) scan, ocular examination and microbiologic tests, a miliary TB with pulmonary, lymph nodal and ocular involvement was diagnosed. Following introduction of antitubercular treatment (ATT) an increase in inflammation indexes and severe pancytopenia were observed; at this point the patient presented six of eight diagnostic criteria for HLH and the diagnosis of HLH secondary to TB was raised. Therefore, HLH treatment with high dose of dexamethasone was started with a good clinical response. We performed a literature re-view of TB-related HLH, which shows a high mortality rate; ATT is necessary to ensure patient survival to remove the antigenic driver. Our patients developed HLH after initiation of ATT as a paradoxical reaction, that may be linked to the release of antigens due to the bactericidal effect of ATT.

The process of developing therapies to treat rare diseases is fraught with financial, regulatory, and logistical challenges that have limited our ability to build effective treatments. Recently, a novel type of therapy called antisense therapy has shown immense potential for the treatment of rare diseases, particularly through single-patient N-of-1 trials. Several N-of-1 antisense therapies have been developed recently for rare diseases, including the landmark study of milasen. In response to the success of N-of-1 antisense therapy, the Food and Drug Administration (FDA) has developed unique guidelines specifically for the development of antisense therapy to treat N-of-1 rare diseases. This policy change establishes a strong foundation for future therapy development, and addresses some of the major limitations that previously hindered the development of therapies for rare diseases.

Background: Our previous study highlighted important healthcare access and utilization concerns among new immigrants. Hence, in this study, we aimed to explore the role of public and patient involvement (PPI) may have in enhancing the accessibility and their contribution to migration health studies. Method: An open and in-depth interactive consecutive virtual discussion was conducted among volunteer asylum seekers and refugees from Eritrea and Syria in Switzerland. The novel PPI establishment had three phases; inception, training phase, and contribution phase. Result: At the beginning, the concept of PPI was apprehensive to grasp, as it was a new approach. After training and consecutive discussions, volunteers were ardent to engage actively. Hence, among the prime findings were the PPI's role and effect in raising awareness, PPI's role in exploring and communicating the healthcare system accessibilities and utilization among their community, the impact of PPI in echoing the healthcare needs of their fellow migrants, and PPI's contribution in enhancing and strengthening migration health researches. Conclusion: The PPI volunteers in the study were keen to raise their community's awareness through their networks, and bridge the research gap between researchers and the public.

This paper systematically examines Chinese academic discourse that concurrently addresses Indonesia and Timor-Leste, analysing 137 articles from the China National Knowledge Infrastructure (CNKI) and indexed by the Chinese Social Sciences Citation Index (CSSCI). The analysis reveals significant publication trends, particularly during periods of heightened geopolitical and economic engagement, such as the global expansion of the Belt and Road Initiative (BRI). It identifies predominant themes such as economic cooperation, security concerns, and historical-cultural dynamics. The findings highlight China’s strategic interests and leadership aspirations in Southeast Asia， providing insights into how Chinese scholars perceive and articulate China’s strategic interests and diplomatic efforts in the region involving Indonesia and Timor-Leste.

Background: With the rapid improvement of the healthcare technologies, security and privacy of the most sensitive data, health data is at risk. Protecting patient privacy has many components, even though the data are in electronic format. Although patient privacy is thoroughly discussed in the literature, there is no study presenting all components of patient privacy protection. Methods: In this study, a complete evaluation framework is presented, as an evaluation tool, an inventory is developed, reliability and validity of the inventory is examined. Study is conducted in three phases: Conceptual framework development, inventory development and an evaluation case study. In the evaluation, fuzzy conjoint analysis is employed to handle the subjectivity and am-biguity. As the result of the evaluation, the institution is given a patient privacy protection ma-turity grade, between 1 and 5, where 1 is the worst and 5 is the best grade. Results: In the case study, XXX’s biggest hospital, employing 800 nurses, is evaluated. Half of the nurses, 400, have partici-pated in the study. Literature tells healthcare institutions do not invest enough to protect patient privacy, and the study results support this finding. Institution’s maturity grade resulted as level 2, which is bad. Conclusion: The study measures he privacy maturity with many evaluation com-ponents. Result of the evaluation explains to the patients and the public if their data is safe or not. With this maturity grade, patients have an idea about which institution to choose, public can conclude the institutions’ reliability in terms of patient privacy.

There is a growing demand for indoor positioning systems (IPS) in a wide range of applications. However, traditional solutions such as GPS face many technical challenges. In recent years, a promising alternative has been emerging: IPS based on visible light communication (VLC), which offers a combination of which is highly accurate, low cost and energy efficient. This article presents a comprehensive review of VLC-based IPS, providing a tutorial-like overview of the system. It begins by comparing various positioning systems and providing background information on their inherent limitations. The mechanisms of VLC-based IPS are then discussed, including a comprehensive examination of their performance metrics and underlying assumptions. The complexity and efficiency of VLC-based IPS is examined by analyzing factors such as channel modeling, signal processing, and localization algorithms. To optimize the system, a variety of strategies are explored. These include the design of efficient modulation schemes, the development of advanced encoding and decoding algorithms, the implementation of adaptive power control, and the use of state-of-the-art localization algorithms. Additionally, system parameters such as LED placement, receiver sensitivity, and transmit power are carefully examined to highlight their impact on energy efficiency and localization accuracy. Altogether, this paper serves as a comprehensive guide to VLC IPS, providing in-depth insights into its vast potential and the challenges it presents.

The increasing focus on the development of positioning techniques reflects the growing interest in applications and services based on indoor positioning. Many applications necessitate precise indoor positioning or tracking of individuals and assets, leading to rapid growth in products based on these technologies in certain market sectors. Ultrasonic systems have already proven effective in achieving the desired positioning accuracy and refresh rates. The typical signal used in ultrasonic positioning systems for estimating the range between the target and reference points, specifically the linear chirp, can undergo shape aberration due to the effects of acoustic diffraction when the aperture exceeds a certain limit. The extent of the aberration is influenced by the shape and size of the transducer, as well as the angle at which the transducer is observed by the receiver. This aberration also impacts the shape of the cross-correlation, causing it to lose its characteristic easily detectable single global peak. In such instances, cross-correlation techniques yield results with a significantly higher error than anticipated. In this study, an alternative technique to global peak detection is proposed, leveraging the inherent symmetry observed in the shape of the aberrated cross-correlation. The numerical simulations, performed using the academic acoustic simulation software Field II, conducted using a typical ultrasonic chirp and ultrasonic emitter, compare the classical and the proposed range techniques in a standard office room. The results demonstrate that the proposed technique enables accurate range estimation even in the presence of severe cross-correlation shape aberrations. This allows the use of emitting transducers with a much larger aperture than that allowed by the classical cross-correlation technique. Consequently, it becomes possible to have greater acoustic power available, leading to improved Signal-to-Noise Ratio (SNR).

Infrared sensors incorporating suspended zinc oxide (ZnO) pyroelectric films and thermally-insulated silicon substrates are fabricated using conventional MEMS-based thin-film deposition, photolithography, and etching techniques. The responsivity of the pyroelectric film is improved through annealing at 500℃ for 4 h. The voltage response of the fabricated sensors is evaluated experimentally for a substrate thickness of 1 µm over a sensing range of 30 cm. The results show that the voltage signal varies as an inverse exponential function of the distance. A positioning system based on three infrared sensors is implemented in LabVIEW. It is shown that the position estimates obtained using the proposed system are in excellent agreement with the actual locations. In general, the results presented in this study provide a useful source of reference for the further development of MEMS-based pyroelectric infrared sensors.

Indoor Positioning Systems (IPSs) are designed to provide solutions for location-based services. Wireless local area network (WLAN)-based positioning systems are the most widespread around the globe and are commonly found to have a ready-to-use infrastructure composed mostly of access points (APs). They provide useful information on signal strength to be processed by adequate location algorithms, which are not always capable of achieving the desired localization error only by themselves. In this sense, this paper proposes a new method to improve the accuracy of IPSs by optimizing some of their most relevant infrastructure components. Included are the arrangement of APs over the environment, the number of reference points (RPs), and the number of samples per location estimation test. A simulation environment is also proposed, in which the impact of key influencing factors on system accuracy is analyzed. Finally, a case study is simulated to validate an optimal combination of design parameters and its compliance with the requirements of localization error and the limited number of access points. Our simulation results clearly show that the desired localization accuracy, which is set as a goal, can be achieved while maintaining the factors already mentioned at minimal levels, which decreases both system deployment costs and computational effort.

Endometriosis is known to be a chronic, debilitating disease. The pathophysiological mechanisms of endometriosis development include local chronic inflammation and a certain degree of local immune deficit. We investigated the relationship between the endometriosis severity, IL-8, IL-10, BDNF, VEGF-A serum and tissue levels, patient-related pain, and physical activity in a cohort of 46 patients diagnosed with endometriosis who underwent surgery. The same panel of biomarkers was investigated in a control group of 44 reproductive-aged patients with non-endometriotic gynecological pathology who underwent surgical intervention. Our data show a high statistical significance between tissue expression of IL-8, IL-10, patient-related pain and the severity of endometriosis. No relationship was identified between serum or tissue levels of VEGF-A and BDNF and the severity of endometriosis. These results validate the presence of local chronic inflammation and immune deficit, thereby creating, alongside other studies in the field, an opportunity for the development of innovative and personalized treatment approaches in endometriosis.

The supply chain has incorporated products by putting them into hair scarfs. This study introduces the use of mini chips in health and beauty products and can reduce fatigue through enhanced sleep patterns. The mini chip could be placed in the scarf and used as a prototype. RFID technology provides the supply chain with specific information that is used to identify products and make communication easier. (Muhammad, et. al. 2013) This paper presents a new tool herein referred to as a scarf prototype which is developed to analyse EMG (electromyogram), ECG (electrocardiography), EEG (electroencephalogram), and EOG (electro-oculogram) signals that focuses in the area of sleep disorders. The mini chips used can be used to determine a solution for sleep disruption by using automated analytics. This could lead to improvement in our understanding of sleep disruption and overall sleep physiology. Automated technology allows repeated measurements, evaluation of sleep patterns, and provide suggestions to improve a person’s quality of sleep. This analysis compares the use of polysomnography and the scarf prototype. The analytics provide models and shows correlation between variables, such as EMG, ECG, EEG, and EOG. This study shows that the results from the scarf prototype is just as reliable as the original method, polysomnography.

Background/Objectives: Patient positioning during surgery can influence intra- and postoperative complications. Therefore, we assessed the impact of the sitting and park-bench positions on anesthetic parameters and complications in neurosurgical patients. Methods & Patients: For this retrospective study, 314 adults who underwent neurosurgical procedures for posterior fossa pathologies were divided into two groups: sitting (n=231) and park bench (n=83). The following data were collected, monitored, recorded and compared: age, sex, tumor type, surgical approach, cardiovascular and respiratory complications, and postoperative surgical complications. The association of hypotension with position was further investigated through multivariate logistic regression models by adjusting for CO2 decrease, desaturation and documented gas embolism. Results: The average age was significantly lower in the sitting group (55 years, interquartile range (IQR)=43-63; female proportion=59.74%) than in the park-bench group (62 years, IQR=45-74; female proportion=57.83%) (p<0.001). Cerebellopontine angle tumors were detected in 37.23% of the patients who underwent operation in the sitting position and in 7.26% who underwent operation on in the park-bench position (p<0.001). Patients in the sitting position had significantly greater anesthetic complication (91.77% vs. 71.08%, p<0.001), hypotension (61.9% vs. 16.87%),and >2-mmHg CO2 decrease (35.06% vs. 15.66%, p<0.001) incidences. Hypoxemia and death occurred more frequently in the park-bench group (8.43% vs. 1.73% and 6.03% vs. 1.3%, respectively). Conclusions: Compared with the park-bench position, the sitting position was associated with a greater specific anesthetic complication incidence and lower postoperative mortality rate, indicating a need for careful risk‒benefit assessment when selecting each individual patient’s surgical position.

Background. The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods. Forty persons with RA were purposefully recruited to participate in semi-structured interviews. The interviews were then analyzed qualitatively using thematic analysis. Results. The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions. To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA.

Pulmonary complications are frequently observed in patients with ulcerative colitis (UC), with large airway disease being the most prevalent manifestation. In this case study, we explore the potential for Immunosuppressant, a monoclonal antibody, to induce pulmonary hemorrhage—a side effect not previously documented with its use. The subject, a young male in his twenties with a six-year history of UC, tragically died suddenly. Found in a pool of blood without external injuries, extensive post-mortem examinations were required to determine the cause of death. The patient had been on biologic therapy, receiving Immunosuppressant intermittently over the past two years, including an infusion five days prior to death. External examination revealed bloody, pinkish foamy material expelling from his nose and mouth. An autopsy supported an atypical presentation of UC, while histopathology confirmed diffuse pulmonary hemorrhage, marked by edema and emphysematous changes. Additionally, there was a notable lymphomonocytic infiltration around the arterial walls, and signs of bronchiolitis and focal pleural fibrosis were evident. We concluded that the cause of death was Diffuse Alveolar Hemorrhage (DAH), directly associated with the recent administration of Immunosuppressant. This finding underscores the need for vigilant pulmonary monitoring in patients treated with monoclonal antibodies to promptly identify and manage potential fatal adverse reactions.

Aortic stenosis (AS) is a prevalent valvular disorder that often requires surgical aortic valve replacement (SAVR) to alleviate symptoms and improve survival. However, the selection of an appropriate prosthetic valve size is crucial to avoid patient-prosthesis mismatch (PPM), which can lead to suboptimal hemodynamic outcomes. Von Willebrand factor (VWF), a key component of hemostasis, has been shown to be altered in AS patients and may contribute to the hemostatic imbalance observed following valve replacement. This prospective study aimed to investigate the impact of PPM on postprocedural VWF levels in patients undergoing SAVR for severe AS. The study included 31 consecutive patients diagnosed with severe AS who underwent SAVR. By focusing on the relationship between PPM and VWF dynamics, this study sought to provide valuable insights into the potential role of VWF as a marker for hemostatic changes associated with PPM, ultimately informing strategies for optimal valve selection and perioperative management to minimize complications.

Centimeter-level localization and rotation angle estimation of flatbed trucks are major problems in unmanned forklift automated loading scenes. To solve it, this study proposes a method for high-precision positioning and rotation angle estimation of flatbed trucks based on BeiDou and vision. First, an unmanned forklift equipped with a ToF camera and double antenna mobile receiver for BeiDou positioning collects depth images and localization data near the front and rear endpoints of the flatbed. Then DDRNet-23-slim was used to segment the flatbed from the depth image and extract the straight lines at the edges of the flatbed using the Hough transform and compute the set of intersection points of the lines. A neighborhood feature vector was designed to locate the endpoint of a flatbed from a set of intersection points by feature screening. Finally, the relative coordinates of the endpoints were converted to a customized forklift navigation coordinate system by BeiDou positioning, and rotation angle estimation was performed by the front and rear endpoints. Experiments showed that the endpoint positioning error was less than 3 cm and the rotation angle estimation error was less than 0.1°. The precision of the method meets the demand for automated flatbed truck loading by unmanned forklifts.

We present a case report of a 26-years-old female suffering from Coffin Siris Syndrome, who underwent orthodontic treatment and surgery to solve her malocclusion and improve her aes-thetics and functional occlusion. Methods: The presurgical phase involved multibracket self-ligating attachments, Damon prescription. The patient underwent maxillofacial surgery to correct the severe skeletal malocclusion and relocate the bone bases in the right relationship. The post-surgical orthodontic treatment was performed to complete the alignment. Results: The pa-tient improved her aesthetics and functional abilities. Conclusions: Syndromic patients can un-dergo orthodontictreatment if comorbidities and collaboration allow it. Support and collaboration of families and psychotherapists must be considered, but clinical cases of syndromic patients can be faced and solved. Obviously, each syndromic patient is considered unique, and the risk-benefit ratio must be correctly assessed for each one.

Background: Permanent tracheostomy because of total laryngectomy surgery entails great conse-quences for the patient regarding respiratory physiopathology such as the filtering, humidifying, and heating function of the air by the nose is lost. The use of special stomal filters can determine adequate protection of the trachea-broncho-pulmonary system with a reduction in respiratory pathologies. In fact, in most cases laryngectomee patients are first cigarette smokers who for this reason already have also respiratory diseases such as chronic obstructive pulmonary disease (COPD). Despite the availability of tracheal filters, multiple times, as reported in the literature, the patient tends to limit their use due to reported breathing difficulties, especially in conditions of intense breathing. Methods: The objective of this clinical study was to evaluate the most suitable stomal filter for the laryngectomee patient during physical activity. The filters studied were an INHEALTH device (Blom-Singer SpeakFree HME); two ATOS devices (Provox® Life™ Energy HME and Provox® Life™ Home HME); and an FAHL device (Laryvox HME Sport). Results: For this purpose, the performances of 31 laryngectomee patients, subjected to medi-um-high physical effort, were analyzed through a standardized pneumological test, the Six Minute Walking Test (6MWT) which involves a sustained walk lasting six minutes, with evaluation , every 60 seconds, heart rate, oxygen saturation and meters travelled; furthermore, it examines two sub-jective indices, namely, the basal and final dyspnea index and the initial and final muscular fatigue index.

The CoDRIVE solution builds on R&amp;D in the development of connected and autonomous vehicles (CAVs). The mainstay of the system is a low-cost GNSS receiver integrated with a MEMS grade IMU powered with CoDRIVE algorithms and high precision data processing software. The solution integrates RFID (radio-frequency identification) localisation information derived from tags installed in the roads around the University of Nottingham. This aids the positioning solution by correcting the long-term drift of inertial navigation technology in the absence of GNSS. The solution is informed of obscuration of GNSS through city models of skyview and elevation masks derived from 360-degree photography. The results show that predictive intelligence of the denial of GNSS and RFID aiding realises significant benefits compared to the inertial only solution. According to the validation, inertial only solutions drift over time, with an overall RMS accuracy over a 300 metres section of GNSS outage of 10 to 20 metres. After deploying the RFID tags on the road, experiments show that the RFID aided algorithm is able to constrain the maximum error to within 3.76 metres, and with 93.9% of points constrained to 2 metres accuracy overall.

We report the case of a 61-year-old woman who was referred to the Oral Surgery and Implantology Unit of the University Hospitals of Geneva to take care edentulous sites after dental avulsions of teeth 11 and 21 following traumatic shock due to endotracheal intubation under general anaesthesia. The dental history revealed that the patient had a history of generalized chronic periodontitis that had been treated several years earlier. Treatment consisted, for the first time to our knowledge, of immediate insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure and immediate restorations.

Malawi has developed an excellent, nation-wide system for monitoring people infected with HIV and keeping track of key epidemic markers. Their success lies in two things: the focus on simplicity and the use of data collection not only to track the epidemic and identify problems but also to give regular feedback and support to every clinic in the country. This achievement is the more remarkable given that Malawi is one of the poorest countries in the world, ranking 190 out of 194 countries by GDP, but has one of the most severe epidemics of HIV in the world, ranking 9th out of 168 countries by HIV prevalence. We first discuss the current state and likely future epidemic trends in Malawi: unless we know where we are and where we are going we cannot decide what to do or how to do it to in order to achieve a better outcome. We then discuss the history and development of Malawi’s patient monitoring system, as reported in their Integrated HIV Program Reports,ix which have been published quarterly since the beginning of 2004. We consider the current state of patient monitoring and support as reflected in the most recent report for the third quarter (Q3) of 2016 and comment on some of the questions that this raises. Finally, we consider ways in which the current system could be improved by strengthening Malawi’s analytical capacity and making better use of this unique data set. The focus here is on HIV in adultsv because if ART is initiated early in all adults living with HIV this should include testing all pregnant women for HIV and starting them on treatment immediately. However, PMTCT is especially important and care must be given to reducing MTCT and identifying the long-term child survivors of mother-to-child transmission and this demands a complementary assessment. There is an ongoing debate about the relative merits of treatment and prevention in reducing transmission and it should be made clear that the primary reason for starting people on treatment early is that it is in the best interest of the individual patient to start treatment as soon as possible after becoming infected. Allowing a person’s immune system to deteriorate to any degree is not consistent with the clinician’s commitment to ‘first do no harm’ and even those with the highest CD4⁺ cell count are at a substantially increased risk of death. What matters, therefore, is to get as many people as possible onto ART, ensure that they remain virally suppressed, and consider prevention in this context.

Goldenhar Syndrome (GS), also known as oculoauriculovertebral spectrum (OVAS), is a rare congenital condition characterized by impaired development of structures such as ears, eyes, nose, palate, lip, mandible, maxilla, and teeth. The etiopathogenesis is multifactorial and dependent on genetic and environmental factors, yet the syndrome has many unknowns. We report a case of a 31-year-old male diagnosed clinically with GS as an infant with an absent left ear, hearing loss, absent left lung lobe, reduced growth of left upper limb, decreased size of left face, absent left kidney, and a missing left thumb, who was seen in the genetic clinic for prenatal genetic counseling. A microarray comparative genome hybridization (aCGH) was performed for copy number abnormalities and targeted NGS panels were performed for hereditary hearing loss and limb/digital malformations. aCGH revealed a 471kb loss at 16p12.2 and a mosaic 7.3Mb gain at 19p12q12. Metaphase FISH confirmed the orientation of 19p12q12 gain as small supernumerary ring chromosome 19. NGS revealed multiple variants (MYH14 c.4001C&gt;T, PDE1C c.8C&gt;T, ADGRV1 c.15502A&gt;G, CDH23 c.8772C&gt;A, MYO3A c.484G&gt;A, ADAMTS10 c.506G&gt;A, CHUK c.1294C&gt;T, CSPP1 c.1972A&gt;G, and TCTN2 c.160G&gt;A). Due to the heterogeneous clinical manifestation and genetic heterogeneity of GS, a comprehensive genetic testing strategy is needed for timely diagnosis and better patient care.

The COVID-19 pandemic has highlighted the critical need for telehealth and remote patient monitoring in healthcare delivery. Despite the growing use of on-body wearable sensors for continuous monitoring and predicting adverse events, such as hospitalizations or falls, their widespread adoption within the healthcare ecosystem remains a significant challenge. While the pandemic has accelerated the acceptance of these technologies, achieving widespread integration requires their sustained incorporation into routine healthcare practices beyond emergency situations. In this study, we extend the application of our previously developed remote patient monitoring system, originally designed for the geriatric frail population, to COVID-19 patients. Our objective is to assess whether the metrics obtained from this system, which includes physical activity and indoor localization sensors, along with vital sign monitoring, can provide additional insights into the recovery trajectory of individuals affected by COVID-19.

Background: Over the past decades, efforts have been made to improve the nutritional well-being in people with cystic fibrosis (pwCF). Due to the correlation observed between nutritional indices and lung function, prevailing recommendations consistently advocate for BMI percentile goals at or above the 50th percentile in pwCF. Recent global trends show a notable increase in overweight and obese statuses among pwCF. This study aims to explore the nutritional status of Italian pwCF. Methods: Data from the Italian CF Patient’s Registry were analysed to assess the proportion of individuals categorized as underweight, target weight, overweight, and obese from 2010 to 2021. Patient-level comparison data from 2021 were also examined to identify potential determinants of overweight and obesity. Results: Analysis spanning 2010 to 2021 reveals a decrease of approximately 40% in underweight status among adults, while the proportion of malnourished patients 90, and lower prevalence of Pseudomonas aeruginosa colonization. Conclusions: Our study confirms the evolving nutritional status landscape among Italian adult pwCF, with a significant shift towards overweight and obesity over the past decade. These trends highlight the need for proactive measures within CF standards of care to adapt and address the changing needs of patients.

The nematode Caenorhabditis elegans, with its highly sensitive olfactory system, has emerged as a promising tool for testing chemotaxis. In the field of cancer diagnostics, there is a growing interest in the development of non-invasive screening methods for the detection of volatile organic compounds in a patient's urine. The objective of this study was to contribute to the existing body of knowledge by evaluating the ability of a Caenorhabditis elegans-based chemotaxis assay to discriminate between urine samples from healthy individuals and patients diagnosed with breast or colon cancer. Following synchronization of the developmental stages of C. elegans, nematodes were exposed to the urine of cancer patients and healthy individuals. Subsequently, chemotactic indices were calculated for each urine sample. Our results demonstrated a statistically significant difference in the chemotactic response of C. elegans to urine samples from cancer patients compared to healthy volunteers (p < 0.001). Moreover, the test exhibited promising diagnostic utility, with a sensitivity of 98%, a specificity of 62%, and a detection rate of 78%. Our findings expand on previous observations, confirming the remarkable sensitivity of C. elegans hermaphrodites to discriminating cancer-related volatile organic compounds in urine samples.

In this paper, four types of open service signals of BDS-3 satellite (B1I, B1C, B2a, and B3I) and B2I signals broadcasted by BDS-2 satellites were used in the time frequency transfer and positioning experiments with signal coexisting in BDS system, and the single frequency PPP (precise point positioning) method was used. Modified GRoup And PHase Ionospheric Correction (GRAPHIC) method was proposed and verified by the experiment. The results show that 18 selected stations can achieve decimeter-level positioning results with single frequency. Compared with the general observation method, the proposed modified GRAPHIC method improves the stability and precision of positioning and timing significantly, and the positioning accuracy of 5 frequency signals is increased 40.4%, 32.2%, 80.3%, 12.4%, and 10.3%, respectively. The frequency stability can reach the same accuracy as that of dual-frequency with BDS in the current state.

Placing a nasogastric tube (NGT) is a frequent nursing technique in intensive care units. The gold standard for its correct positioning is the chest X-ray due to its high sensitivity but represents a radiation source for critically ill patients. Our study aims to analyze whether the ultrasound performed by an intensive care nurse is a valid method to verify the NGT’s correct positioning and to evaluate the degree of interobserver agreement between this nurse and an intensive care physician in the NGT visualization using ultrasound. Its correct positioning was verified by direct visualization of the tube in the stomach and indirect visualization by injecting fluid and air through the tube ("dynamic fogging" technique). 23 critically ill patients participated in the study. A sensitivity of 35% was achieved using direct visualization, increasing up to 85% using indirect visualization. The degree of interobserver agreement was 0.88. Therefore, the NGT indirect visualization by an intensive care nurse using ultrasound could be a valid method to check its positioning. However, the low sensitivity obtained by direct visualization suggests the need for further training of intensive care nurses in ultrasonography. According to the high degree of agreement obtained, ultrasound could be performed by both professionals.

One of the important issues being explored in Industry 4.0 is a collaborative mobile robots. This collaboration requires precise navigation systems, especially indoor navigation systems where GNSS (Global Navigation Satellite System) cannot be used. To enable precise localization of robots, different variations of navigation systems are being developed, mainly based on trilateration and triangulation methods. Triangulation systems are distinguished by the fact that they allow precise determination of an object’s orientation, which is important for mobile robots. An important feature of positioning systems is the frequency of position updates based on measurements. For most systems it is 10-20 Hz. In our work, we propose a high-speed 50 Hz positioning system based on the triangulation method with infrared transmitters and receivers. In addition, our system is completely static, i.e. it has no moving/rotating measurement sensors, which makes it more resistant to disturbances (caused by vibrations, wear and tear of components, etc.). In this paper we describe the principle of the system as well as its design. Finally, we present tests of the built system, which show centimeter positioning accuracy with a position update frequency of 50 Hz.

Accurate localization of road agents is the basis of intelligent transportation systems, which is still difficult to achieve for GNSS positioning in urban areas due to the signal interferences from buildings. Various collaborative positioning techniques are recently developed to improve the positioning performance by the aid from neighboring agents. However, it is still challenging to study their performances comprehensively. The GNSS measurement error behavior is complicated in urban areas and unable to be represented by naive models. On the other hand, real experiment requiring numbers of devices is hard to be conducted, especially for a large-scale test. Therefore, a GNSS realistic urban measurement simulator is developed to provide measurements for collaborative positioning studies. The proposed simulator employs a ray-tracing technique searching for all possible interferences in the urban area. Then, it categorizes them into direct, reflected, diffracted, and multipath signal to simulate the pseudorange, carrier-phase, 〖C/N〗_0, and Doppler shift measurements correspondingly. The performance of the proposed simulator is validated through real experimental comparisons with different scenarios. The proposed simulator is also applied with different positioning algorithms, which verifies it is sophisticated enough for the collaborative positioning studies in the urban area.

We propose an iterative scheme for feature-based positioning using a new weighted dissimilarity measure with the goal of reducing the impact of large errors among the measured or modeled features. The weights are computed from the location-dependent standard deviations of the features and stored as part of the reference fingerprint map (RFM). Spatial filtering and kernel smoothing of the kinematically collected raw data allow efficiently estimating the standard deviations during RFM generation. In the positioning stage, the weights control the contribution of each feature to the dissimilarity measure, which in turn quantifies the difference between the set of online measured features and the fingerprints stored in the RFM. Features with little variability contribute more to the estimated position than features with high variability. Iterations are necessary because the variability depends on the location, and the location is initially unknown when estimating the position. Using real WiFi signal strength data from extended test measurements with ground truth in an office building, we show that the standard deviations of these features vary considerably within the region of interest and are neither simple functions of the signal strength nor of the distances from the corresponding access points. This is the motivation to include the empirical standard deviations in the RFM. We then analyze the deviations of the estimated positions with and without the location-dependent weighting. In the present example the maximum radial positioning error from ground truth are reduced by 40% comparing to kNN without the weighted dissimilarity measure.

When an earthquake or a large fire has occurred, it is difficult to secure communication networks for rescue in the building due to the destruction of commercial communication networks. Although analog radio systems such as VHF (very high frequency) and UHF (ultra-high frequency) are used for rescue operation in general, communication failure occurs in closed spaces, causing difficulties in smooth rescue operations. When the communication infrastructures have been destroyed in a building in the disaster, an emergency wireless telecommunication environment should be constructed to secure a safer disaster response environment. In this study, along with comparison of the performances of diverse communication frequencies, UWB (Ultra-Wide Band) wireless telecommunication networks were evaluated under five building indoor environment conditions including open spaces. UWB communication modules were fabricated to satisfy the IEEE (The Institute of Electrical and Electronics Engineers) 802.15.4a standard performance to measure distances in which communications are possible according to the indoor environment for each of six channels with different UWB communication frequencies. The results indicated that the distances in which communications are possible for each the six channels were average 15.5 m, maximum 20 m in open spaces; average 17.33 m, maximum 20 m in corridors; average 15.3 m, maximum 20 m in indoor office environments with office fixtures; average 4.33 m, maximum 6 m in vertical spaces of stairs; and average 6.5 m, maximum 17 m in closed horizontal spaces with a fire door. In this case, the communication performance and distance performance were shown to be the most excellent at a frequency (Centre Frequency) of 6489.6 and a band of 5980.3 – 6998.9 MHz, which is UWB 7ch. In conclusion, it is judged that if UWB communication modules are installed in the disaster area at intervals of 20 m and multi-channels are used, communication environments can be constructed even in closed spaces

Dysmenorrhea symptoms are frequent and often self-treated using non-prescription medicines. To further characterize women with dysmenorrhea using a combination of hyoscine butylbromide and paracetamol (PLUS) for self-management of their complaints, we performed a secondary analysis of a published pharmacy-based patient survey. 314 women (mean age 32.3 years) with dysmenorrhea reported a pain and cramps intensity of 7.45 ± 2.13 on a 0-10 Likert scale, which was reduced to 2.86 ± 1.81 upon treatment. Associated impairments of work/daily chores, leisure activities, and sleep were improved by 64.6%, 62.2% and 70.4%, respectively. The onset of symptom relief was within 60 min in 84.7%. Tolerability was rated as very good or good by 97.2%. These findings confirm the efficacy and tolerability data on PLUS from randomized controlled trials in a larger group of women conducting self-management of their dysmenorrhea.

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stay and amputation. We suggest a remote-monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, wound characteristics, and clinical parameters, such as cognitive function, were integrated, contributing to a comprehensive risk factor profile. We evaluated the feasibility of this platform with 124 DFU patients over 12 weeks; 39% experienced unfavorable outcomes such as dropout, adverse events, or non-healing. Digital biomarkers were benchmarked (0-10), categorized into low, medium, and high risk for unfavorable outcomes, and visually represented using color-coded radar plots. The initial results of case reports illustrate the value of this holistic visualization to pinpoint the underlying risk factors for unfavorable outcomes, including a high number of steps, poor adherence, and cognitive impairment. Although future studies are needed to validate the effectiveness of this visualization in personalizing care and improving wound outcomes, early results in identifying risk factors for unfavorable outcomes are promising.

As most of the current dynamic positioning systems are based on model ships, they cannot accu-rately reflect the motion state, position changes, and mutual influence of each part of the dynamic positioning system of actual ships in complex environments. Other actual ships such as cargo ships cannot add various sensors and auxiliary equipment to verify and analyze the positioning system. This article takes the intelligent research and training dual-use ship of Dalian Maritime University, which integrates scientific research and training, as the object of study. This ship will not be affected by the voyage period and route and can choose a suitable sea area for research. Therefore, in order to improve the accuracy and reliability of the dynamic positioning system, research on the ship’s dynamic positioning system was carried out. Firstly, an accurate mathematical model of ship motion was established, and the hydrodynamic derivatives of ship model motion were obtained by nu-merical calculation, and applied to the three-degree-of-freedom model of the intelligent research and training dual-use ship. Then, the model was used as part of the closed-loop simulation model of the ship’s dynamic positioning system, and the terminal sliding mode controller was used for sim-ulation and emulation, thereby obtaining ideal simulation test results. This research helps to im-prove the accuracy and reliability of the dynamic positioning system and provides new ideas and methods for ship motion control.

3D-mapping-aided (3DMA) global navigation satellite system (GNSS) positioning that improves positioning performance in dense urban areas has been under development in the recent years, but it still faces many challenges. This paper details a new algorithm that explores the potential of using building boundary for positioning. Rather than applying complex simulations to analyze and correct signal reflections by buildings, the approach utilizes a convolutional neural network to differentiate between the sky and building in a sky-pointing fisheye image. A new skymask matching algorithm is then proposed to match the segmented fisheye images with skymasks generated from a 3D building model. Each matched skymask holds a latitude and longitude coordinate to determine the precise location of the fisheye image. The results are then compared with the conventional GNSS and advanced 3DMA GNSS positioning methods. The aims of the proposed algorithm are to increase positioning and heading accuracy in a rich urban environment.

The most commonly used real-time augmentation services in China are International GNSS Service (IGS) real-time service, PPP-B2b service, and BeiDou Satellite-Based Augmentation System (BDSBAS) dual-frequency augmentation service. However, the research on the performance evaluation, comparison and application scope of these three products is still unknown and unrevealed. This article introduces methods for obtaining real-time augmentation information and real-time orbit and clock offset recovery. Based on real-time orbit and clock offset accuracy, positioning accuracy, and positioning availability, it systematically evaluates the performance of CNES, PPP-B2b, and BDSBAS augmentation information. The results indicate that the radial accuracy of CNES and PPP-B2b real-time orbit products is consistent, and the Root Mean Square (RMS) is better than 5 cm. CNES can achieve centimeter-level accuracy in both along-track and cross-track components, surpassing the decimeter-level accuracy of PPP-B2b. Both services demonstrate consistent accuracy in real-time clock offset, with PPP-B2b showing similar standard deviations (STD) of 0.16 ns for different satellites. However, for CNES, the STD of real-time clock offset varies for GPS, BDS-3 MEO, and BDS-3 IGSO satellites, with values of 0.10 ns, 0.19 ns, and 0.60 ns, respectively. The accuracy and availability of the two PPP services exhibit the same levels, with centimeter-level accuracy achieved after convergence and positioning availability exceeding 99%. Therefore, the difference between the two services in application areas depends on the acquisition of augmentation information. However, BDSBAS, which concentrates on code observations, demonstrates lower accuracy in real-time orbit and clock offset, positioning accuracy, and positioning availability compared to the other two services. Its primary application is in the aviation and maritime domains, where there is a greater need for service integrity, continuity, and reliability.

An novel indoor positioning method of pigsty based on Ultra Wideband (UWB) technology is proposed via reasonably arranging the base stations (BTS) and positioning tags, which can provide a strong support for the accurate positioning of specific pig pens in the pig house. The distribution of Dilution of Precision (DOP) values are analysed in different deployment schemes which includes the amount, the height, the deployment shape and distance of BTS, though positioning simulation. Moreover, the positioning effect of dynamic following positioning (DFP), the root-mean-square error (RMSE) and variance of static positioning (SP) are measured. It is noteworthy that Kalman filtering algorithm is adopted to smooth the DFP experimental data for reducing the positioning error. The simulated results show that the DOP values decrease with the increasing of the height and the distance, and these results and laws are consistent with the experimental results. However, the DOP values are reached best when the height is from 1.75 m to 2.75 m, and the distance is over 3.00 m. Furthermore, the DOP values of quadrilateral deployment is smaller than the one of triangle. In addition, variance of SP and DFP are decreased by utilizing Kalman filtering algorithm. Therefore, the excellent positioning system and its solutions in pigsty can be provided by our proposed indoor positioning method.

With the renewed interest for lunar surface exploration, the European Space Agency envisions to stimulate the creation of lunar communications and navigation services (LCNS) to enable, among others, autonomous navigation capabilities for lunar rovers. As the number of satellites foreseen in such a service is much smaller compared to Earth based global navigation satellite systems (GNSS), different complementary technologies are pursued to improve the attainable navigation accuracy for lunar rovers. One way to improve the position accuracy provided by the LCNS satellites is to constrain the vertical position using a high resolution digital elevation model (DEM). This article presents the results of a variance covariance analysis of an extended Kalman filter (EKF) implementation in which the LCNS ranging measurements are used together with DEM from the LRO LOLA instrument. Assuming a realistic orbit determination and time synchronization (ODTS) accuracy of the LCNS satellites, the usage of a navigation grade IMU and an oven controlled crystal oscillator (OCXO), a 3-sigma position accuracy of less than 10 meters can be obtained. Furthermore, the availability is substantially improved as the DEM aided solution enables a position solution in case of only 3 visible satellites.

The node position information is critical in the wireless sensor network (WSN). However, the existing positioning algorithms commonly have low positioning accuracy because of noise interferences in communication. To solve this problem, this paper presents an iterative positioning model based on distance correction to improve the positioning accuracy of the target node in WSN. First, the log-distance distribution model of received signal strength indication (RSSI) ranging is built and the noise impact factor is derived based on the model. Second, the initial position coordinates of the target node are obtained based on the triangle centroid localization algorithm, thereby calculating the distance deviation coefficient under the influence of noise. Then, the ratio of the distance measured by the log-normal distribution model to the median distance deviation coefficient is taken as the new distance between the anchor node and the target node. Based on the new distance, the triangular centroid positioning algorithm is used again to calculate the target node coordinates. Finally, the iterative positioning model is constructed, and the distance deviation coefficient is updated repeatedly to update the positioning result until the set number of iterations is reached. Experiment results show that the proposed iterative positioning model can improve positioning accuracy effectively.

In recent years, the application of Indoor Positioning Systems (IPS) has experienced a significant increase in demand, with the aging of the world’s population and their changing lifestyles. While outdoor positioning systems, such as the Global Positioning System (GPS), have significantly advanced over the years, indoor positioning has been restrained by the limitations of the employed technologies. This paper presents a hybrid wireless positioning system able to locate wearables indoor accurately. It is based on the Wi-Fi and Bluetooth technologies, by using trilateration to determine the position of Bluetooth low energy (BLE) wearable devices with an accuracy of up to 1.8 meters. A graphical user interface (GUI) was used to illustrate the performance of the proposed systems, by allowing users to visualize the captured data in two dimensions and three- dimensions in real-time.

Thyroidectomy has been post-operatively managed by hormone replacement therapy in order to satisfy the reference ranges of thyroid stimulating hormone (TSH) and thyroxine (T4) levels. While medication and standardized reference ranges have proven to be effective, many patients continue to report unintentional weight gain despite adequate amounts of treatment and levels of TSH and T4. Physicians, over the years, have become complacent to these “normal” ranges, and have ignored the metabolic consequences that are affecting thyroidectomy patients. This paper aims to redefine the approach to post-thyroidectomy clinical care by: challenging the current standardized hormonal range values, exploring the gaps in thyroid hormone conversion, investigating the metabolic pathways of T3, considering the influence of inflammatory markers, and proposing the future for patient-centered management.

This study aimed to investigate the impact of specific single nucleotide polymorphisms (SNPs) on clinical and laboratory outcomes in COVID-19 patients receiving Paxlovid treatment. The primary focus was on genetic variants in IFNAR2, OAS1, OAS3, and ACE2. Laboratory parameters were assessed at admission and discharge, including oxygen saturation, white blood cell count, absolute neutrophil and lymphocyte counts, erythrocyte sedimentation rate, platelet count, hematocrit, and various liver and kidney function tests. The results demonstrated significant associations between certain SNPs and clinical outcomes. Patients with the IFNAR2 rs2236757 G allele exhibited improved oxygen saturation and lower eosinophil counts. The OAS3 rs10735079 and OAS1 rs10774671 G allele was associated with lower eosinophil and total bilirubin levels. Furthermore, patients with the ACE2 rs2074192 C allele showed increased segmented neutrophils and AST levels, while the T allele was associated with lower total bilirubin levels. These findings indicate that the efficacy of Paxlovid treatment may be influenced by genetic variations in IFNAR2, OAS1, OAS3, and ACE2. Further research is warranted to investigate the potential therapeutic implications of these genetic markers.

This study presents a strategic approach to developing applications focused on implementing Large Language Models using the Langchain framework in Python. Three language models are highlighted: GPT-3.5 (turbo mode), LLaMA 2, and Vicuna 7B, each with their distinctive features and capabilities. The methodology used is described in detail, including data extraction from medical reports using zero-shot prompting data extraction techniques, interaction with language models, and structured storage of results. The performance of the models in data extraction is evaluated, presenting metrics such as precision, recall, and F1 score. The results demonstrate high model capability in extracting information, although areas for improvement are identified, particularly in data extraction precision. In conclusion, the efficacy of the models in extracting information from medical histories is not considerably acknowledged, with an emphasis on the importance of improving precision and increasing the volume of trained data for future research in healthcare digitalization.

Background. Malignant pleural mesothelioma (MPM) is still a rather incurable disease. Many classes of compounds with various mechanisms of action have been tested in vivo and ex-vivo, with rather disappointing results. This is partly due to preclinical studies mostly performed in models that fail to recapitulate MPM complexity and do not retain the intra-tumor heterogeneity, a propelling force for tumor progression. Additionally, we and others have shown that, under stress-induced chemotherapy, profound rearrangements take place in MPM cultures to fuel the emergence of chemoresistant cell subpopulations. Thus, finding clinically actionable modulators of MPM resistance is still a very urgent need. Methods. Setup and propagation of patient-derived organoid cultures from MPM pleural effusions; flow cytometry-based validation of organoid cultures, isola-tion and propagation of mesothelioma-associated fibroblasts; co-cultures, Lu-minex-based Cytokine array, ELISA assay to quantitate IL-6 in the conditioned media, qRT-PCR to assess mRNA expression of cancer stem cell markers and fibroblast markers. Results. Organoid cultures were obtained from eight MPM patients by using specific growth media and conditions to propagate pleural effusion-derived cells. We proved that primary MPM specimens and serially passaged (mesothelio-ma-Patient-Derived-Organoids) mPDOs were cytologically similar, with the obtained mPDOs expressing mesothelial markers similarly to the originating specimen. As expected from a clinically relevant model, the size and number of mPDOs were altered, in a patient-specific way, when pharmacologically relevant doses of chemotherapy drugs were added. We derived Mesothelio-ma-Associated-Fibroblasts (MAFs) and the addition of MAFs, to various ratios, altered the response of the mPDOs to pemetrexed + cisplatin, toward a reduced sensitivity to the latter anticancer agents. Additionally, organoid formation and size were altered by MAF-conditioned media, and this correlated with increased expression of cancer stem cell markers. We showed increased levels of IL-6 in the media of the treated cocultures and showed that this latter was derived from the MAFs. Conclusions. Increased secretion of IL-6 by mesothelioma-associated fibroblasts (MAFs) contributes to the resistance of the MPM to therapy.

To enhance industrial competitiveness and increase productivity, every country has strived to create a smart factory by introducing technologies such as Internet of Things, big data and artificial intelligence into production line and build cyber-physical system for the purpose of promoting manufacturing efficiency. For mission assignment, production line management or manufacturing field analysis, the location information of employee, machine and material is very essential. To promote manufacturing efficiency, of course, the location information became more important. A Bluetooth low energy (BLE) positioning system for the manufacturing is developed in this research. A "Tag tracking" mechanism is addressed and adopted, which uses Beacon to catch the location information and a BLE receiver is also used to receive the broadcasting information from Beacon. The position information from the BLE receiver will be compared with the data in the database for calculating the location of the target. The status of the target may also be obtained by using the data from the BLE receiver. Comparing with the mobile device, this method can reduce energy consumption and make the maintenance simple and easy. In the real applications, the target may not be limited to human. The "Regional label positioning technology" is also investigated in this research. Defining a suitable zone location and arranging BLE receiver location, and positioning analysis theory are the key factors included in this developed technology. The developed system will be tested for real industry applications. The test results show that the feasibility of this technology.

Alzheimer’s disease (AD) is an irreversible neurodegenerative disease characterized by progressive cognitive decline. The two cardinal neuropathological hallmarks of AD include buildup of cerebral β amyloid (Aβ) plaques and neurofibrillary tangles of hyperphosphorylated tau. The current disease-modifying treatments are still not effective enough to lower the rate of cognitive decline. The paucity of early detection and disease progression biomarkers also seems to present a major obstacle to AD drug development. The current established readouts based on expression levels of amyloid beta, tau and phospho tau have shown many discrepancies in patient samples when linked to disease progression. There is an urgent need to identify diagnostic and disease progression biomarkers from blood, CSF or other biofluids that can facilitate early detection of the disease and provide pharmacodynamic readouts for new drugs being tested in clinical trials. Advances in proteomic approaches using state-of-the-art mass spectrometry, are now being increasingly applied to study AD disease mechanisms, identify drug targets and novel disease biomarkers. In this report, we describe applications of the quantitative proteomic approaches for understanding AD pathophysiology, summarize the current knowledge gained from proteomic investigations of AD and discuss development and validation of new predictive and diagnostic disease biomarkers.

INTRODUCTION: While postmenopausal osteoporosis management evolved in recent years, it nonetheless remains underdiagnosed and undertreated. Given that general practitioners are the keystone of patient screening and referral in France, the present study was conducted to assess their professional positioning in the management of postmenopausal osteoporosis. METHODS: The present is a qualitative study based on semi-directed interviews, carried out between July 2020 and February 2021, with randomly chosen Alsatian general practitioners. Interviews were conducted until data saturation. Consolidated criteria for qualitative research reporting grid was used as well as Nvivo software to categorize the datas. RESULTS: Twenty-three general practitioners (GPs) were interviewed. Study participants recognized that the investigation and treatment of osteoporosis begins at a primary care level, typically with the GP. While some initiated screening by prescribing bone mineral density (BMD) assessments, only few prescribed the associated laboratory assessment and spinal X-rays in search of curable osteopathy or vertebral fracture. For those GPs who do take the opportunity to initiate treatments for patients, there is an understanding that first line options often include calcium and vitamin D, at a “preventive” level. The interviewed physicians interacted mainly with gynecologists and rheumatologists. Fracture liaison services were widely acclaimed. Several barriers were identified in their care management. The absence of a defined role between specialists and the lack of communication between the latter were an additional highlighted barrier. CONCLUSION: This study sheds further light on the discrepancy between the means available to treat osteoporosis, and the modest impact of the care observed.

Monitoring of the surface operations using movement and surveying radar (MSR) can prevent loss of life, equipment, production and loss of the mine. Slope monitoring using MSR is an important aspect of open-pit mining as it provides real-time movement of deformation data for the slope. It is therefore important that the radar is accurately geo-referenced in order to provide accurate real-time movement data. Geo-referencing is defined as the process of determining an instrument’s position (in the form of Easting, Northing, Height) as well as the orientation with respect to the mine’s local coordinate system. This helps in getting geo-referenced data points from the radar that are identified by a unique set of coordinates in relation to the mine’s coordinate system which allows the radar to track movement for a specific set of coordinates. In this research, we assess the performance of geo-referencing a radar using the total station method and compare it with the integration of Advance Navigation – Spatial Dual GPS system connected via RS422 on the MSR. This includes usage of the Spatial Dual navigation coordinates output to calculate the radar’s position relative to the mine local coordinates and mapping the radar’s azimuth, elevation and Range (Az, El and Rl) values to the measured pit-slope data points. Furthermore, a comparison of key attributes of both methods of geo-referencing is performed using a matrix system and giving an overall performance appraisal of both systems. Integrating a navigation system allows the radar to have an auto geo-referencing functionality that will reduce the time spent in completing this process. The findings reveal that the GPS obtained a higher score than the total station with prism method on the weighted matrix system. The total station was found to be more accurate than the GPS however, the deployment time for the GPS is quicker than that of the total station. This is important for different operation such as strip and open-pit mining to choose the preferred method of geo-referencing depending on the level of accuracy required.

Precise and fast position tracking is essential for the correct operation of many industrial robots and CNC machine tools. This subject is also important in the control of the mount of the astronomical telescope, especially for the tracking of artificial satellites. As system parameters can change, a control method that is robust to changes in parameters must be used. Such a method is the sliding control, which, however, ensures the robustness only after reaching the sliding surface. Therefore, a new method was proposed in the paper, which eliminates the phase of reaching the sliding surface. The method consists of using a reference trajectory generator and determining the generalized error in relation to this trajectory. The procedure for designing the control system is presented. Next, the proposed method was verified on the laboratory stand. The described control method provides a robust system operation and can be easily implemented in the control system.

This paper proposes a real-time local positioning system (RT-LPs) utilizing a mobile platform equipped with three anchor nodes placed in a right-angle triangle formation for a real-time locating system (RTLS). After deriving an analytic formula to calculate the target position utilizing the measured distances among anchor nodes and the target node, we find that four parameters have an effect on the position error of the target node. The spacing between anchors is a design parameter that must be large enough to the reduce position error. However, the distance from the anchor node to the target node is an operation parameter that must be small enough to reduce the position error. Additionally, the measured ranges among the anchors and the target node have probabilistic distributions with a mean and variance, which are dominant parameters that have effects on the position error. A comparison study was conducted to determine the effects of the parameters of the target position in both a simulation and an experiment, showing rates of approximately 4% ~ 10%. These findings indicate that our simulation can work properly with the proposed method after assuming that the distance error is a Gaussian model.

Sepsis is a serious disease that can lead to mortality. The etiology of the disease is connected to how the body as a host reacts toward microbes such as bacteria, viruses, and fungi invasion. Current research shows that during sepsis, the reaction toward microbe attacks takes two main phases. The first is known as a cytokine storm, while the second is a vicious cycle of pro-inflammatory responses followed by a strict anti-inflammatory response led by CD4+ Tregs. Various immunomodulatory therapies have been proposed to break the cycle of pro- and anti-inflammatory reactions to sepsis. However, clinical trials did not show promising results, indicating further research into the mechanism that Treg uses to inhibit proinflammatory reactions. We used next-generation sequencing (NGS) analysis of bulk RNA-seq and single-cell RNA-seq data to examine the exact molecular pathways used by Treg to inhibit the immune response in sepsis. Our approach identified ACOD1 (Aconitate Decarboxylase 1) as a primary mediator of Treg suppression of immune cells. We identified and validated CD36 as a downstream target of ACOD1. CD36 is a known metabolite regulator in Tregs. Taken together, our results indicate that targeting ACOD1 could prove valuable in regulating Treg function during sepsis.

High systolic blood pressure and increased blood pressure variability after the onset of ischemic stroke are associated with poor clinical outcomes. One of the key determinants of blood pressure is arteriolar size, determined by vascular smooth muscle tone and vasodilatory and vasoconstrictor substances that are released by the endothelium. The aim of this study is to outline alterations in vasomotor function in isolated peripheral arteries following ischemic stroke. The reactivity of thoracic aortic segments from male C57BL/6 mice to dilators and constrictors was quantified using wire myography. Acetylcholine induced endothelium-dependent vasodilation was impaired after ischemic stroke (LogIC50 Sham=-7.499, LogIC50 Stroke=-7.350, P=0.0132, n= 19, 31 respectively). Vasodilatory responses to SNP were identical in isolated aortas in sham and stroke groups. Phenylephrine induced vasoconstriction was impaired in aortas isolated from stroke animals in comparison to sham counterparts (Sham LogEC50= -6.652 vs Stroke LogEC50=-6.475, P< 0.001). Our study demonstrates that 24 hours post-ischemic stroke, peripheral vascular responses are impaired in remote arteries. Aortas from stroke animals exhibited reduced vasoconstrictor and endothelium-dependent vasodilator responses, while endothelium-independent vasodilatory responses were preserved. Since both vasodilatory and vasoconstrictor responses of peripheral arteries are impaired following ischemic stroke, our findings might explain increased blood pressure variability following ischemic stroke.

To identify factors associated with interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) and build an algorithm to better define this association, for a personalized application in clinical practice. Methods. 78 SSc patients underwent HRCT to assess ILD. Demographic, clinical and laboratory variables were collected, focusing on those associated either directly or indirectly with lung involvement. The discriminant value of each variable was determined using the operating characteristic curves (ROC) and included in a model to estimate the strength of ILD association in SSc. Results. Thirty-three (42.31%) patients showed ILD on HRCT. DLco, M-Borg, GERD-Q, and capillary density were significantly associated with the presence of ILD-SSc. A model including these variables had a coefficient of determination (R2) of 0.697. DLco had an AUC of 0.861 (p&lt;0.001) with a cut-off ≤72.3% (sensitivity 78.8%, specificity 91.1%, +LR 8.86). The m-Borg scale showed an AUC of 0.883 (p&lt;0.001) with a cut-off &gt;2 (sensitivity 84.8%, specificity 82.2%, +LR 4.77), GERD-Q had an AUC of 0.815 (p&lt;0.001) with a cut-off &gt;7 (sensitivity 72.7%, specificity 86.7%, +LR 5.45). The capillary density showed an AUC of 0.815 (p&lt;0.001) with a cut-off ≤4.78 (sensitivity 87.9%, specificity 68.9%, +LR 2.82). Based on the pre-test probability values, these four variables were applied to Fagan's nomogram to calculate the post-test probability of this association. Conclusions. Our study identified four associated clinical factors of ILD in SSc patients. Moreover, their inclusion in an algorithm for the post-test probability, tailored to the specific patients’ characteristics, significantly increases the ability to find out the presence of SSc-ILD.

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patient’s knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p &lt; 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients' hypertension knowledge was sufficient, however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

As previous study in many countries shown that stroke patient onsets are not distributed randomly, but associate with meteorological factors. However, the relationship between stroke occurence and meteorological factors remain unknown in mountain area in Guizhou China. This paper firstly introduces multi-source fusion data which is integrated by the mountain meteorological factor, geographic mapping elevation information data and stroke population monitoring of Guizhou province. Mainly elaborates from a few aspects, which concludes data collection, data sorting, data extraction, data cleaning and data production in detail. A completed and detailed meteorological stroke data set was successfully established and multi-source data fusion was realized by the use of Gbase and unified data service interface of Guizhou meteorological big data cloud platform. And we report the impact of meteorological variables in Guizhou mountain area climate on stroke. In this study, we performed a statistical fusion data between January 2017 and December 2020 about stroke incidence rate and meteorological factors respectively, for instance, concerning the mean (Mean), maximum (Max), minimum (Min), median (Median), standard deviation (Std) . We calculated stroke rates (date stroke occurence)/(year stroke occurence) and we investigated the distribution of days included in the label. Results: the distribution of the incidence rate basically conforms to the normal distribution with the label Max 0.007399, label Min 0.000204, label Mean 0.002738, label Median 0.002643, label Std 0.00076. We observed a positive significant correlation of stroke incidence rate directly proportional to the daily temperature difference (between 0 and 20 degrees Celsius), as the value of this factor exhibits variation larger, the incidence rate is gradually increasing. And we investigated from the Pearson correlation coefficients that stroke incidence increasing when meteorological factors at low humidity (less than 40% (RH 80%), temperature higher than 31℃); the 24-hour daily temperature difference varies between 6 and 10℃ (6

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old patient, with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient showed a body mass index (BMI) of 37.8 kg/m2 with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea hypopnea index: AHI=32) and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on occurrence of OSA according to its dimensions and local extension.

With the urgent need of precise positioning faced by internet of things (IoT) applications, the universality and cost of indoor positioning devices become key factors. Since the 5G network has been widely deployed, new opportunity is brought by tightly fusing the traditional low-cost sensors, i.e., the magnetometer. In this study, using 5G channel state information (CSI) and geomagnetic data, a multi-input convolutional neural network (CNN) localization system was proposed. First, to generate a data tensor that is easy for CNN processing, the raw data was reconstructed individually. Then, to comprehensively incorporate the features of 5G CSI and geomagnetic strength data, the ReLU function was chosen as the activation function of the convolutional layer. After that, a multi-input CNN was trained using the incorporated geomagnetic strength and CSI amplitude in the off-line side, and the trained CNN was recorded as a location fingerprint, which can be used for the user position prediction. Finally, in the online side and using a multi-input CNN, the 2-D coordinates are estimated and tested indoors in a typical conference room scenario. The results showed that longer sampling time of fingerprint data result in better uniqueness of the reference point, while the data collection time of locating points does not need to be long. Taking the positioning efficiency and accuracy into consideration, a sampling time of 3s at the reference point and 0.2s at the locating point are recommended. The positioning accuracy using the proposed method was 1.41 m, with an improvement of 22.9% compared with the 5G positioning, and an improvement of 18.0% compared with the 5G and geomagnetic fusing positioning using single CNN.

Tumor to stroma ratio is a highly debated prognostic factor in the management of several solid tumors and there is no universal agreement on its practicality. In our study we proposed to confirm or dismiss the hypothesis that a simple measurement of stroma quantity is an easy-to-use and strong prognostic tool. We have included 74 consecutive patients with colorectal cancer who underwent primary curative abdominal surgery. The tumors have been grouped into stroma-poor (stroma &lt;10%), medium-stroma (between 10 and 50%) and stroma-rich (over 50%). The proportion of tumor stroma ranged from 5% to 70% with a median of 25%. Very few, only 6.8% of patients had stroma-rich tumors, 4% stroma-poor tumors and 89.2%tumors with a medium quantity of stroma. The proportion of stroma, at any cut-off, had no statistically significant influence on the disease specific survival. This can be explained by the low proportion of stroma-rich tumors in our patient group and the inverse correlation of stroma proportion with tumor grade. The real-life proportion of stroma-rich tumors and the complex nature of the stroma-tumor interaction has to be further elucidated.

Visual Patient technology is a situation awareness–oriented visualization technology that translates numerical and waveform patient monitoring data into a new user-centered visual language. Vital sign values are converted into colors, shapes, and rhythmic movements—a language humans can easily perceive and interpret—on a patient avatar model in real time. In this review, we summarize the current state of the research on the Visual Patient, including the technology, its history, and its scientific context. We also provide a summary of our primary research and a brief overview of research work on similar user-centered visualizations in medicine. In several computer-based studies under various experimental conditions, Visual Patient transferred more information per unit time, increased perceived diagnostic certainty, and lowered perceived workload. Eye tracking showed the technology worked because of the way it synthesizes and transforms vital sign information into new and logical forms corresponding to the real phenomena. The technology could be particularly useful for improving situation awareness in settings with high cognitive demand or when users must make quick decisions. This comprehensive review of Visual Patient research is the foundation for an evaluation of the technology in clinical applications, starting with a high-fidelity simulation study in early 2020.

Background: Positive person-centered attributes of inpatient rehabilitation need to be identified from the patient perspective to be further developed and sustained. Purpose: To identify which attributes patients openly evoke as being great care experiences, using an open appreciative inquiry during the inpatient rehabilitation stay. Methods: Qualitative secondary analysis of appreciative patient comments during a bedside patient experience rounding, facilitated by a neutral party. Two independent analysts employed an inductive, summative form of content analysis. Results: Among 150 patients rounded, 122 provided categorizable appreciative accounts. Over two thirds of the patients (67.2%) focused on “staff attributes” in their great-experience accounts. Those attributes were mostly interpersonal such as being “attentive & caring - beyond clinical duty” and being “encouraging (but not too hard) & reassuring”. These interpersonal staff attributes were reported with words showing deep levels of personal significance or patient appreciation. Beyond staff attributes, the perceived quality of the “patient care” (31.1%) and opportunities for “leisure and social activities” (9.0%) were also frequently evoked. Amenities like food or costumer service were the least evoked, rarely so as an exclusive attribute (0.8% for each). Conclusions: The human(e) factor, especially the interpersonal qualities of staff, emerged as greatly appreciated from the patient experience perspective during inpatient rehabilitation. These experiences help identify which person-centered attributes of care might be further developed and sustained.

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.

Unmanned aerial vehicles (UAVs)-based communication system is a promising solution to meet coverage and capacity requirements of future wireless networks. However, UAV-enabled communications is constrained with its coverage, energy consumption, and flying regulations, and the number of works focusing on the sustainability aspect of UAV-assisted networking has been limited in the literature so far. In this paper, we propose a solution to this limitation; particularly, we design a $Q$-learning-based UAV positioning scheme for sustainable wireless connectivity considering key constraints, that are, altitude regulations, non-flight zones, and transmit power. The objective is to find the optimal position of the UAV base station (BS) and minimize the energy consumption while maximizing the number of users covered. Moreover, a weighting mechanism is developed, where the energy consumption and number of users covered can be prioritized according to network/battery conditions. The proposed Q-learning-based solution is compared to the baseline k-means clustering method, where the UAV BS is positioned at the centroid location that minimizes the cumulative distance between the UAV BS and the users. The results demonstrate that the proposed solution outperforms the baseline k-means clustering-based method in terms of the number of users covered while achieving the desired minimization of the energy consumption.

As a part of the proposed article, the authors presented comprehensive data analysis for movement data that comes from a positioning system based on ultra-wide band (UWB) technology. For purpose of this article, a test was carried out during which the car equipped with cruise control overcame the given path at a speed from 10 km/h to 60 km/h. The obtained motion models (information about position) have been filtered through a series of filters - from fundamentals filters with a variable window (median, moving average, Savitzky-Golay filter), through more complex ones like the Wiener or Kalman filter. As a result, the authors proposed a form of data analysis and filtration depending on the speed of the moving object. In addition, the maximum accuracy that can be obtained for a given traffic model was also determined. The whole research proves that it is possible to use a system based on UWB technology in positioning objects for urban applications - smart city, in industry 4.0 applications as well as for positioning autonomous vehicles in urban applications, such as well as on highways to maintain cohesion of convoys vehicles.

Background: Having a laboratory renal profile for medical imaging examinations requiring contrast media (CM) administration is strongly advised. Creatinine helps identify patients at risk of contrast-induced nephropathy (CIN). GEM® Premier™ ChemSTAT (Werfen) is a point-of-care (POC) analyzer with 12 emergency parameters including creatinine assay. The aim of this study consists to compare ChemSTAT with the central analytical solution of the University Hospital of Clermont-Ferrand and to evaluate the interest of the POC creatinine in the emergency department (ED) in optimizing the flow of patients, especially if CM used. Methods: More than 200 whole blood (WB) samples from the ED were evaluated on the ChemSTAT analyzer. As comparative methods, the plasma aliquots from the same samples were assayed on an Atellica® CH (Siemens Healthineers). The clinical concordance was assessed ac-cording the decision cut-offs of the French Society of Radiology for the risk of CIN. The availability times of biological results between ChemSTAT and the central laboratory were studied. Results: WB results from ChemSTAT correlated well with those from Atellica® CH, except for tCO2 (known bias between Siemens and Cobas Roche methods predicting ChemSTAT values). The results of creatinine assay allow to have identical medical decisions compared to the renal risk cut-offs. The availability of biological results is reduced by 50 min on average with ChemSTAT vs the central laboratory. Computed tomography was performed for 44.7% of patients including the injection of the CM in 68% of cases. For these patients, the availability of creatinine results relative to imaging time is faster with the ChemSTAT on average of 45.2 min. Conclusions: Great analytical and clinical correlations for creatinine assay allow safe iden-tification of patients at risk of CIN and improve patient flow in ED especially for those requiring computed tomography with use of CM.

Combined hepatocellular cholangiocarcinoma (cHCC-ICC) is a rare malignancy that involves a combination of features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma (ICC). cHCC-ICC is generally considered to exhibit a more aggressive clinical course compared to ICC; however, its risk factors and outcomes remain largely undefined. A single-center retrospective study of 82 patients diagnosed with ICC or cHCC-ICC from June 2011 and January 2023, all of whom underwent surgical resection. Our analysis included 70 patients with resected ICC and 12 with resected cHCC-ICC. The overall survival (OS) for the entire cohort was 21.6 months, with a recurrence-free survival (RFS) of 11.8 months. The cHCC-ICC group had significantly higher levels of AST and ALT (AST median 206 vs. 46; ALT median 165.5 vs. 48; p=0.012 and p=0.013, respectively), whereas the ICC group had higher alkaline phosphatase (median 66 vs. 104; p=0.03). CA 19-9 values (p=0.02) were higher in the ICC group, while AFP values were higher in the cHCC-ICC group (p=0.0004). The cHCC-ICC group had a significantly higher rate of recurrence (83% vs. 47%, p=0.028) with a significantly decreased RFS (4.7 months vs. 12.4 months; log-rank p=0.007). cHCC-ICC is a rare entity that needs to be further studied to improve patient outcomes. Our study showed that RFS is lower in the cHCC-ICC group as compared to ICC patients alone. Further studies are warranted and possibly suggest the need for more aggressive initial treatment strategies in patients diagnosed with cHCC-ICC.

Background: There are limited evidence-based data to guide treatment recommendations for breast cancer (BC) patients ≥ 80 years (P80+). Identifying and addressing unmet needs are critical. Aims: Advocate-BREAST80+ compared the needs of P80+ vs. patients < 80 years (P80-). Methods: In 12/2021, a REDCap survey was circulated electronically to 6,918 persons enrolled in the Mayo Clinic Breast Disease Registry. The survey asked about concerns and satisfaction with multiple aspects of BC care. Results: 2,437 participants responded (35 % response rate); 202 (8.3%) were P80+. P80+ were less likely to undergo local regional and systemic therapies vs. P80- (p

Pheochromocytoma is a rare neuroendocrine tumor that affects people in the 4th and 5th decades of life. It can be benign or malignant, and present as isolated tumors or along with other neuroendocrine syndromes. We present a case of an elderly man who underwent laparoscopic adrenalectomy for pheochromocytoma when he was 58 years only to have a recurrence of metastatic malignant pheochromocytoma in his seventies. We also conducted a literature review to understand the epidemiology and presentation of the tumor and to emphasize that there should be a low threshold of suspicion for timely diagnosis and management of recurrent pheochromocytoma.

The EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI), and other patient-reported outcomes (PROs), such as the visual analog scale (VAS) for symptoms and EULAR sicca score (ESS), are used to assess the disease activity of primary Sjögren’s syndrome (pSS). Recently, Clinical ESSDAI (ClinESSDAI) and Clinical Trials ESSDAI (ClinTrialsESSDAI) were developed for objective clinical disease activity indexes. However, the relationship of ClinESSDAI and ClinTrialsESSDAI with PROs as well as that between ESSPRI and other PROs and the objective parameters of glandular function in pSS have not been established. Herein, we investigated the correlation of ESSPRI and other PROs with the objective parameters of glandular function and the relationship of PROs with ClinESSDAI and ClinTrialsESSDAI in 66 patients with pSS. Correlations were calculated with Spearman’s correlation coefficient. ClinTrialsESSDAI was correlated with ESSPRI, dryness (ESSPRI-Dryness), fatigue, and pain domains of ESSPRI, VAS for oral dryness (oral-VAS), and patient’s global assessment. Although ESSPRI did not correlate with the objective parameters of glandular function, ESSPRI-Dryness, ESS, and oral- and ocular-VAS did. These results suggest that ESSPRI-Dryness, ESS, and VAS for symptoms, but not ESSPRI, reflect the glandular dysfunction and that ClinTrialsESSDAI correlates with PROs for dryness in pSS.

The World Health Organization(WHO) in 2016 considered mHealth as: “the use of mobile wireless technologies including smart devices such as smartphones and smartwatches for public health” as an important resource for health services delivery and public health given their ease of use, broad reach and acceptance. WHO emphasizes the potential of this technology to increase access to health information, services and skills as well as promoting positive changes in health behaviors and management of diseases. In this regard, the capability of smartphones and smartwatches for m-health monitoring as well as verification of the patient the signal has become an important component of mHealth system. Most of the smartwatches could extract more than one bioelectrical signal therefore, therefore they provide suitable platform for extracting health data for e-monitoring. The existing approaches have not considered the integrity of data obtained from these smart devices. Therefore, it is important that the integrity of the collected data be verified continuously through user authentication. This could be done using any of the bioelectrical signals extracted and transmitted for e-monitoring. In this article, a smartwatch is used for extracting bioelectrical signal before decomposing the signal into sub-bands of Detail and Approximation Coefficient for user authentication. To select suitable features using biorthogonal wavelet decomposition of signal from a non-intrusive extraction, a detailed experiment is conducted extracting suitable statistical features from the bioelectrical signal from 30 subjects using different biorthogonal wavelet family. Ten features are extracted using Biorthogonal wavelet to decompose the signal into three levels of sub-band Detail and Approximation Coefficient and features extracted from each level the decomposed Detail and Approximation Coefficients. Comparison analysis is done after the classification of the extracted features based on the Equal Error Rate (EER). Using Neural Network (NN) classifier, Biorthogonal Wavelet Detail Coefficient Sub-band level 3 of bior1.1 achieved the best result of EER 13.80% with the fusion of the best sub-band three levels of bior1.1 achieving a better result of 12.42% EER.

South Africa is afflicted with the worst epidemic of HIV in the world a legacy of the system of oscillating migrant labour in the region and the consequent social disruption that was the legacy of Apartheid. The initial response from the national government was slow and ineffective but once the magnitude of the epidemic became apparent the government began to respond. The investment in HIV- and TB-related activities in 2013 was R22 Bn or (US$2.5; 2013 exchange rate) of which the South Africa government contributed 80% and the Presidents Emergency Plan for AIDS Relief (PEPFAR) 17%. South Africa now has the more people on anti-retroviral therapy than any other country and treatment is being started much sooner after infection. Much of the best biomedical, virological, immunological, mathematical and social science around the treatment and prevention of HIV and AIDS and the associated epidemic of TB has been done by South African’s and their international collaborators. If the efforts to control the epidemic are maintained South Africa is on track to meet the UNAIDS 90-90-90target by 2020 and to End AIDS by 2030 in spite of the magnitude of the problem. While individual, patient level data are increasingly available, especially in the Western Cape, much greater efforts need to be made to ensure that the information collected in this way is used to give feedback and support to clinic staff, to ensure that health clinics are providing the best possible service, and to individual patients and people living with HIV to ensure that they are receiving the best possible care and support. South Africa needs to make better use of the rich and detailed data that are being collected from individual clinics and their patients to identify problems or difficulties at the clinic level and to ensure that individual patients are retained on treatment, are virally suppressed and receive the best possible care and support.

INTRODUCTION Recently there has been a significant increase in age in the United States. It is necessary to better understand the physiological and surgical needs of these patients in order to optimize outcomes. The vast majority of procedures performed in adult patients are low-risk operations, such as laparoscopic cholecystectomy. Our aim is to investigate the outcomes, including length of stay, morbidity, mortality, re-admission and discharge disposition of the elderly population (>80) undergoing low-risk operations in our tertiary community hospital. METHODS A retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Patients were excluded only on the basis of their age (< 80) at the time of operation. RESULTS There were a total of 30 patients who underwent laparoscopic cholecystectomy from 2011 to 2015. 21 patients (70%) were female and 9 (30%) were male. No patients were converted to an open procedure. The average age was 86.4 years and average ASA classification prior to surgery was 2.88. Higher ASA class, specifically those that were class III/IV were more likely to have an increased length of stay that was statistically significant. Overall age greater than 80 was an independent risk factor for transfer to a higher level of care upon discharge (SNF, LTAC, etc.), a surrogate marker for physical decompensation following surgery. CONCLUSIONS Routine surgery, such as the laparoscopic cholecystectomy, effects the elderly population in a more substantial way, and early recognition coupled with increased education for physicians regarding geriatric patients can help to reduce length of stay, morbidity, and overall physical and mental deconditioning.

Aiming at the problem of underactuated unmanned surface vehicles (USVs) performing fixed-point operations in the sea but without dynamic positioning control system. This paper introduces an original approach for positioning control, and the method is named as virtual anchor control method. This method is applicable in slow-varying current environments, and this approach does not need the prior knowledge of current information or vessel motion model parameters, thus offering convenient usability. This method is comprised by four steps. Firstly, a linear concise motion model with unknown disturbances is proposed. Then, the motion planning law is designed by imitating underlying principles of ship anchoring. Next, an adaptive disturbance observer is proposed for estimating uncertainties in the motion model. Last step, based on the observer, a sliding-mode method is used for heading control law designing, and thrust control law is also conducted by applying the Lyapunov method. Finally, numerical simulation experiments with significant disturbances and tidal current variations are conducted, which demonstrate that the proposed method has good control effect and robustness.