Access Technique Research Articles

Three-dimensional deformation imaging to detect myocardial scar

Abstract Introduction Myocardial scar or fibrosis has significant implications in patient management and prognosis. Currently, cardiovascular magnetic resonance (CMR) is the reference technique for detection and quantification of scar though other imaging modalities have been proven to be useful as well. Purpose This study aims to investigate the usefulness of 3D strain echocardiography to identify myocardial scar in patients with ischaemic and non-ischaemic myocardial fibrosis using late gadolinium enhancement (LGE) CMR as a reference. Methods 149 individuals with ischaemic (89), non-ischaemic scar (26) and no scar (34) on LGE CMR underwent 3D transthoracic echocardiography. The 3D data sets were processed with the 4D LV analysis tool by TOMTEC Imaging Systems GmbH, Germany. The longitudinal, circumferential, radial, and principal tangential strain were calculated. Using a 16 LV-segment model the areas of LGE were assessed on CMR images, and a correlation between 3D strain values and LGE was investigated. Results A multivariate binary logistic regression model was built with the conditional backward elimination method using LGE as the dependent variable. The predictors made a significant contribution to the model (Wald test: 49.985, p<0.001). The Cox & Snell R-square was 0.141, and Nagelkerke R-square was 0.232, suggesting that the final model explains 14.1% or 23.2% of LGE variability. By logistic regression analysis, less negative peak principal tangential strain (P-PTS), peak circumferential strain (P-SC), and end-systolic circumferential strain (ES-CS) increased the odds, whereas increased peak radial strain (P-RS) decreased the likelihood of LGE (Table 1). The LGE extent was calculated as the average LGE transmurality of all 16 segments and was used as the dependent variable in linear regression models. The LGE extent was significantly correlated with all strain indices (Table 2). By stepwise linear regression analysis, P-PTS (B=0.029, 95%CI:0.019-0.040, P<0.001) outperformed the remaining strain variables in terms of linear association with LGE extent. Association between strain indices and the presence or absence of myocardial fibrosis in each of the 16 segments was tested by point biserial correlation (Table 3). PTS and CS indices were associated with myocardial fibrosis in 10/16 segments; RS indices were associated with LGE in 9/16 segments, and LS was not related to the presence of LGE in 15/16 segments. Septal (basal-mid-apical) and mid/apical anterior and inferior segmental strain showed more consistent associations with corresponding myocardial fibrosis. Conclusion 3D strain echocardiography is a promising and easily accessible technique, that can be used to identify areas of myocardial scar as it correlates well with LGE in many LV segments. Echocardiography is a bedside and widely available technique, and it could be used in patients with contraindications or no access to CMR or myocardial perfusion scan.Table 3

A Multicenter Retrospective Study Evaluating Distal Radial Access vs. Conventional Transradial or Transvenous Access for Endovascular Treatment of Malfunctioning Dialysis Fistulas

Background: This study aims to evaluate the feasibility, efficacy, and safety of distal transradial access (dRA) for the endovascular management of malfunctioning dialysis fistulas. This study also compares dRA with conventional access techniques, such as proximal radial and transvenous access, focusing on technical success, clinical outcomes, and vascular access site complications (VASCs). Methods: A retrospective multicenter study was conducted across four hospitals, including 292 patients treated between January 2019 and June 2024. Of these, 57 patients underwent dRA, and 235 received proximal radial or transvenous access. Key outcomes included technical success (successful completion of the procedure), clinical success (restoration of functional dialysis access), and complication rates. Data were collected on procedure times and complication profiles. Results: Technical success was achieved in 96.5% of patients undergoing dRA, compared to 98.3% in those receiving conventional access (p = 0.388). Clinical success was similar between groups (96.5% vs. 97%, p = 0.835). The overall complication rate was 10.5% for dRA and 8.5% for conventional access (p = 0.632). Cannulation time was longer for dRA (109.1 vs. 91.9 s, p < 0.001), but total procedure duration was comparable between the groups. No major complications were observed in either cohort, and improved post-procedure access flow rates were recorded in all patients. Conclusions: Distal transradial access is a feasible and effective approach for the endovascular management of malfunctioning dialysis fistulas, with outcomes comparable to conventional access techniques. It provides a safe alternative, particularly for patients with complex fistulas, while maintaining a low complication profile.

Perioperative Point-of-Care Ultrasound (POCUS) for Anaesthetists: Is It Time to Introduce Formal Training?

This article reviews point-of-care ultrasound (POCUS) in the perioperative period. Ultrasound-guided techniques for regional anaesthesia and vascular access have been well-established in anaesthesia for many years. However, integration of whole-body POCUS into UK anaesthetic practice remains limited. There is a growing body of evidence highlighting the benefits of POCUS throughout the perioperative period. Widespread use may help to improve patient care in anaesthesia.

BER Analysis of Underlay Cooperative Cognitive Radio-based NOMA System

Background: The integration of Cooperative Communications (CC), Cognitive Radio (CR) technology, and Non-Orthogonal Multiple Access (NOMA) techniques, termed Cooperative Cognitive Radio used NOMA (CCR-NOMA) systems, has emerged as a promising solution to address spectrum scarcity and connectivity challenges anticipated in sixth generation (6G) networks. Aim: This studyaims to investigate the Bit Error Rate (BER) performance of underlay CCRNOMA systems. Methods: We derive precise closed-form expressions for BER at distant users under perfect and imperfect Channel State Information (CSI) conditions. These mathematical formulations are validated through Monte Carlo simulations. Results: Our results indicate that the near user CU! exhibits superior performance compared to the far user CU!. Additionally, distant users utilizing the CCR-OMA protocol demonstrate better BER performance than those employing the CCR-NOMA protocol. Conclusion: The presence of imperfect CSI adversely affects BER performance. Moreover, the derived closed-form expressions for BER in the investigated system align well with Monte Carlo simulations. These findings provide valuable insights for optimizing the performance of CCR-NOMA systems in real-world scenarios.

Detecting Amyloid Positivity Using Morphometric Magnetic ResonanceImaging.

Early detection of amyloid-β (Aβ) positivity is essential for an accurate diagnosis and treatment of Alzheimer's disease (AD), but it is currently costly and/or invasive. We aimed to classify Aβ positivity (Aβ+) using morphometric features from magnetic resonance imaging (MRI), a more accessible and non-invasive technique, in two clinical population scenarios: one containing AD, mild cognitive impairment (MCI) and cognitively normal (CN) subjects, and another only cognitively impaired subjects (AD and MCI). Demographic, cognitive (Mini-Mental State Examination [MMSE] scores), regional morphometry MRI (volumes, areas, and thicknesses), and derived morphometric graph theory (GT) features from all subjects (302 Aβ+, age: 73.3±7.2, 150 male; 246 Aβ-, age: 71.1±7.1, 131 male) were combined in different feature sets. We implemented a machine learning workflow to find the best Aβ+ classification model. In an AD+MCI+CN population scenario, the best-performing model selected 120 features (107 GT features, 12 regional morphometric features and the MMSE total score) and achieved a negative predictive value (NPVadj) of 68.4%, and a balanced accuracy (BAC) of 66.9%. In a AD+MCI scenario, the best model obtained NPVadj of 71.6%, and BAC of 70.7%, using 180 regional morphometric features (98 volumes, 52 areas and 29 thicknesses from temporal, parietal, and frontal brain regions). Although with currently limited clinical applicability, regional MRI morphometric features have clinical usefulness potential for detecting Aβ status, which may be augmented by a combination with cognitive data when cognitively normal subjects make up a substantial part of the population presenting for diagnosis.

NOMA Visible Light Communications with Distinct Optical Beam Configurations

Visible light communication (VLC) has been viewed as one promising candidate to mitigate the challenging spectrum crisis and radio frequency interference in future 6G mobile communications and networking. Due to the relatively limited baseband modulation bandwidth of VLC light sources—typically, light-emitting diodes—non-orthogonal multiple access (NOMA) techniques have been proposed and explored to enhance the spectral efficiency (SE) of VLC systems. However, almost all reported NOMA VLC schemes focus on well-discussed applications employing a Lambertian light beam configuration and ignore the potential applications with distinct non-Lambertian optical beam configurations. To address this issue, in this work, the performance of non-Lambertian optical beam configuration-based NOMA VLC is comparatively investigated for future 6G mobile networks. The numerical results demonstrate that, for a fundamental two-user application scenario with the far user located at the corner position, a maximum sum rate gain of about 15.6 Mbps could be provided by the investigated distinct non-Lambertian beam-based NOMA VLC, compared with the maximum sum rate of about 93.3 Mbps for the conventional Lambertian configuration with the same power splitting factor.

Correction of a widespread bias in pooled chemical genomics screens improves their interpretability.

Chemical genomics is a powerful and increasingly accessible technique to probe gene function, gene-gene interactions, and antibiotic synergies and antagonisms. Indeed, multiple large-scale pooled datasets in diverse organisms have been published. Here, we identify an artifact arising from uncorrected differences in the number of cell doublings between experiments within such datasets. We demonstrate that this artifact is widespread, show how it causes spurious gene-gene and drug-drug correlations, and present a simple but effective post hoc method for removing its effects. Using several published datasets, we demonstrate that this correction removes spurious correlations between genes and conditions, improving data interpretability and revealing new biological insights. Finally, we determine experimental factors that predispose a dataset for this artifact and suggest a set of experimental and computational guidelines for performing pooled chemical genomics experiments that will maximize the potential of this powerful technique.

Resuscitative endovascular balloon occlusion of the aorta in the patient with obesity.

Palpation of anatomic landmarks is difficult in patients with obesity, which could increase difficulty of achieving femoral access and resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. The primary aim of this study was to examine the association between obesity and successful REBOA placement. We hypothesized that higher body mass index (BMI) would decrease first-attempt success and increase time to successful aortic occlusion (AO). A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was performed on patients who underwent REBOA placement with initiation systolic blood pressure >0 mm Hg from years 2013-2022. Patients were excluded if they received cardiopulmonary resuscitation on arrival, underwent open AO, or missing data entries for variables of interest. Body mass index categorization was as follows: non-obese (<30), class I (30-34.9), class II (35-39.9), and class III (40+) obesity. Patients were also stratified by access technique, including use of palpation or ultrasound guidance. Inclusion criteria were met by 410 patients. On binary analysis, no primary outcomes of interest, including rate of success, time to placement, or mortality, were significantly impacted by BMI. Among BMI subgroups, there was no statistical difference in injury severity, admission systolic blood pressure (SBP), or augmented SBP. At initiation of aortic occlusion, patients with class II and class III obesity had higher median SBP compared with non- and class I obese patients (p = 0.03). Body mass index subgroup did not impact likelihood of first-attempt success or conversion to open procedure. When stratified by access technique, there was no difference in success rates, time to success or mortality between groups. Body habitus did not impact success of REBOA placement, time to successful AO, or mortality. Further, ultrasound guidance was not superior to landmark palpation for arterial access. Following traumatic injury without hemodynamic collapse, obesity should not deter providers from considering REBOA placement. Therapeutic/Care management, Observational, Cross-sectional; Level IV.

National Sentiments and Regional Flavour- A Socio-economic Study of Huvina Hadagali Jasmine

Background This socio-economic analysis studies the influence of jasmine production on the economic well-being of farmers in Huvina Hadagali, a region known for its high-quality jasmine flowers. The Vijaya Nagara district’s Havina Hadagali area is well known throughout the country for its jasmine flower farming. In addition to being referred to as Mallige Nadu, this location is also known as Malligeya Tavaru. The cultivation of the jasmine flower is protected by the Geographical Indication (GI) Tag, and this flower has been popular in this region for a substantial amount of time. Methods Data was collected from a sample of 364 jasmine growers using a structured questionnaire in Huvina Hadagali, Vijayanagar district. The data focused on different socio-economic factors such as income levels, employment, market access, and agricultural techniques. The study is analysed using IBM SPSS through frequency analysis and 2-step clustering. Result The results demonstrate that the cultivation of jasmine makes a substantial contribution to the local economy, serving as a main or additional source of income for numerous households. Jasmine farming often contributes 40% of the whole household income, and during peak seasons, it provides significant economic advantages. Nevertheless, the highlighted obstacles were volatile market pricing, pest infestations, and limited access to contemporary farming practices. The study emphasises the crucial significance of cooperative societies and local marketplaces in stabilising income and offering essential resources and training to farmers. Conclusion The research highlights the necessity of governmental interventions focused on developing market infrastructure, offering financial assistance, and improving access to agricultural innovations to maintain and augment the economic advantages of jasmine cultivation in Huvina Hadagali.

Exploring the potential of 5G uplink communication: Synergistic integration of joint power control, user grouping, and multi-learning Grey Wolf Optimizer

Non-orthogonal Multiple Access (NOMA) techniques offer potential enhancements in spectral efficiency for 5G and 6G wireless networks, facilitating broader network access. Central to realizing optimal system performance are factors like joint power control, user grouping, and decoding order. This study investigates power control and user grouping to optimize spectral efficiency in NOMA uplink systems, aiming to reduce computational difficulty. While previous research on this integrated optimization has identified several near-optimal solutions, they often come with considerable system and computational overheads. To address this, this study employed an improved Grey Wolf Optimizer (GWO), a nature-inspired metaheuristic optimization method. Although GWO is effective, it can sometimes converge prematurely and might lack diversity. To enhance its performance, this study introduces a new version of GWO, integrating Competitive Learning, Q-learning, and Greedy Selection. Competitive learning adopts agent competition, balancing exploration and exploitation and preserving diversity. Q-learning guides the search based on past experiences, enhancing adaptability and preventing redundant exploration of sub-optimal regions. Greedy selection ensures the retention of the best solutions after each iteration. The synergistic integration of these three components substantially enhances the performance of the standard GWO. This algorithm was used to manage power and user-grouping in NOMA systems, aiming to strengthen system performance while restricting computational demands. The effectiveness of the proposed algorithm was validated through numerical evaluations. Simulated outcomes revealed that when applied to the joint challenge in NOMA uplink systems, it surpasses the spectral efficiency of conventional orthogonal multiple access. Moreover, the proposed approach demonstrated superior performance compared to the standard GWO and other state-of-the-art algorithms, achieving reduced system complexity under identical constraints.

An energy-efficient JT-CoMP enabled framework with adaptive OMA/NOMA in HetNets

The increasing demand for higher data rates and improved energy efficiency (EE) in next-generation wireless networks necessitates the optimized selection of multiple-access and coordination techniques. A hybrid joint transmission (JT)-coordinated multi-point (CoMP) enabled orthogonal multiple access (OMA)/non-orthogonal multiple access (NOMA) technique, combining the spectral efficiency (SE) and capacity benefits of CoMP NOMA with the interference mitigation of CoMP OMA, offers a highly adaptable solution for future wireless networks. This paper studies the joint optimization of CoMP/non-CoMP selection, OMA/NOMA selection, power allocation, and user pairing, with the objective of maximizing the EE in the network. A Dynamic CoMP user selection with energy-efficient adaptive multiple access (DCEAMA) algorithm to solve the formulated problem is proposed. Our Monte Carlo simulations show that the DCEAMA surpasses both the pure CoMP OMA and CoMP NOMA schemes in terms of EE, with an average increase of 38% and 26% respectively. We compare our heuristic technique to an exhaustive search strategy to evaluate its efficiency. The findings indicate that our strategy produces comparable EE across various power levels with reduced computational complexity.

Assessment of blood flow parameters in a hybrid-digital model of the cardiovascular system applying recurrent neural networks

End-systolic elastance of the left ventricle along with the waveforms of pressure and volumetric blood flow in particular sectors of the circulatory system are of importance in diagnosing various problems like dilated cardiomyopathy, left-ventricular hypertrophy, pulmonary hypertension, or ischemic heart disease. The objective of the paper is to broaden the spectrum of available methods to estimate those parameters since currently accessible techniques are often costly or troublesome. Six models have been developed − three of them estimate end-systolic elastance, two perform regression of volumetric blood flow, and one predicts blood pressure. Training datasets have been collected applying the unique hybrid-digital model. The input of the designed models consists of two or three different waveforms representing pressure and volumetric blood flow in particular areas, including heart ventricles, atria, and pulmonary vessels, in addition to the heart rate value. The basis of each model comprises bidirectional Long Short-Term Memory layers along with the dropout and feed-forward layers. Models that estimate end-systolic elastance achieved various accuracy. One of them performed exceptionally well since the absolute error did not exceed 0.169 mmHgcm3 which is a negligibly small value. The root-mean-square error (RMSE) of the model predicting pressure waveform reached 0.165 mmHg in the worst case. Regression of the volumetric blood flow resulted in 6.062 cm3s worst-case RMSE for the model focusing on the pulmonary valve and 15.979 cm3s for pulmonary veins model. Computed results, especially those of the models estimating end-systolic elastance, indicate that it is possible to utilize neural networks to estimate those parameters with sufficient accuracy.

Energy minimization for IRS-and-UAV-assisted mobile edge computing

Intelligent reconfigurable surface (IRS) is an emerging technology for the enhancement of spectrum and energy efficiency. We propose a novel IRS-and-unmanned aerial vehicle (UAV)-Assisted mobile edge computing (MEC) framework, where a MEC server installing on an UAV to facilitate task calculations by mobile users (MUs), and an IRS modulates channels between MUs and the UAV. Non-orthogonal multiple access (NOMA) is employed for further improving system-wide spectral efficiency. There are needs for joint optimization of multiple parameters, e.g., the task partition parameters and the transmit power of all MUs, the reflection coefficient matrix of the IRS and the movement trajectory of the UAV, and such needs raises the challenge of minimizing the long-term total energy consumption of all MUs while satisfying required transmission rate and task completion delay. We divide optimization tasks into two sub-problems and propose specific solutions respectively, i.e., relevant decisions about the UAV and MUs to be solved by deep reinforcement learning (DRL); and the reflection coefficient matrix of the IRS to be solved by block coordinate descent (BCD). A series of experiments have verified the effectiveness of the proposed communication techniques and optimization algorithms. Simulation results demonstrate that (1) NOMA-IRS technique achieves better energy efficacy compared to the cases where random IRS or no IRS is deployed and the conventional orthogonal multiple access (OMA) technique with IRS. (2) our proposed deep deterministic policy gradient (DDPG)-BCD algorithm outperforms other four benchmark algorithms in solving the complex and dynamic optimization problem.

Meta-algorithmic optimized power allocation in cybertwin-based sixth generation cooperative communication system

The sixth-generation (6G) communication paradigm, powered by an Internet of Everything (IoE), promises unprecedented data density and transformative applications across various sectors like smart cities, healthcare, transportation, and agriculture. This study explores an emerging hybrid cybertwin-enabled 6G cooperative network architecture, focusing on secrecy capacity analysis. The approach involves Base Stations (BS) employing Non-Orthogonal Multiple Access (NOMA) techniques to transmit data to cybertwin hosts and servers via direct wireless links with Nakagami-m fading. Additionally, a Power Line Communication (PLC) link, subjected to Rayleigh fading, supplements the wireless link for communication between cybertwin hosts and servers. Bio-meta-heuristic optimization algorithms are introduced to optimize NOMA power allocation, specifically Grey Wolf Optimization (GWO) and a hybrid of Grey Wolf Optimization with Krill Herd Optimization (KHO). The system's capability to ensure secure data transmission while mitigating eavesdropping risks is assessed through thorough secrecy capacity and throughput analyses. Simulation results highlight the efficacy of the hybrid GWO-KHO-based NOMA power allocation scheme, showcasing superior efficiency over traditional methods. This study contributes novel insights into optimized power allocation and efficiency in cybertwin-enabled 6G networks, underscoring the significance of hybrid optimization approaches in future communication systems.

Ultrasound-guided modified dynamic needle tip positioning technique for distal radial artery catheterization: A randomized controlled trial.

The distal radial artery presents a particular challenge for puncture and catheterization due to its diminutive size, tortuous path, and tendency to spasm, increasing the risk of procedural failure and injury. Ultrasound guidance improves success rates and reduces risk in radial artery catheterization. This study evaluates the efficacy and safety of a refined dynamic needle tip positioning technique for distal radial artery access. One hundred twelve patients were randomized to either the modified dynamic needle tip positioning technique (MDNTP) or palpation guidance groups (palpation group), each with 56 participants. The primary outcomes were the success rate of the initial puncture and overall puncture success rate, while secondary outcomes included procedural time and complications such as puncture site hematoma and radial artery occlusion within 24 h. The MDNTP group exhibited superior initial puncture success (71.43% vs 46.43%, p < 0.05) and fewer puncture attempts (median 1 (1, 2) vs 2 (1, 4), p < 0.05), resulting in a higher overall puncture success rate (98.21% vs 87.50%, p = 0.028). Notably, sheath insertion times were significantly shorter (17 (12, 21) s vs 57 (32, 100) s, p = 0.001) and the Sheath insertion success rate was higher (96.43% vs 82.14%, p = 0.015) in the MDNTP group. Furthermore, the incidence of puncture site hematomas was reduced (5.36% vs 19.64%, p = 0.022), although puncture time was longer (60 (28, 116) s vs 40 (15, 79) s, p = 0.033). Despite these differences, total procedural time and the incidence of radial artery occlusion at 24 h postoperatively were comparable between the two groups. The MDNTP technique boosts the success of distal radial artery puncture and catheterization, reducing the risk of complications associated with the procedure.

Improvement of Single-port Laparoscopic Cholecystectomy

The desire of both surgeons and patients to reduce the trauma of the operation and shorten the length of hospital stay, on the one hand, and on the other hand, the development of new technologies and the emergence of special devices led to the development and implementation of video endoscopic minimally invasive methods of surgical intervention. The results of single-port laparoscopic cholecystectomy and the possibility of choosing instrumental support when performing these operations should be analyzed. Our study included 116 patients hospitalized for planned surgical treatment with chronic calculous cholecystitis from 2019 to 2023. The patients were divided into two groups: the first main group consisted of 52 (44.8%) patients with chronic calculous cholecystitis who underwent single-port laparoscopic cholecystectomy (SLP) using the single access technique (SAL). The second group (TLCE) consisted of 64 (55.2%) patients with CCC who underwent laparoscopic four-port cholecystectomy. A comparative analysis of the results of the intraoperative and early postoperative periods in patients after TLCE using the single access method, the number of complications was minimal than with TLCE using a four-port approach. Long-term results of surgical treatment of patients with cholelithiasis after OLCE using the single access method are characterized by the least complications, high cosmetic effect, and low morbidity.

Features of Performing Single-port Laparoscopic Cholecystectomy

The advantages of endoscopic surgery are well known, which has been confirmed by domestic and world experience in the use of minimally invasive technologies. Along with this, the widespread introduction of operative laparoscopy has led to complications specific to this technology. When performing laparoscopic operations, 3 to 6 trocars are inserted into the abdominal cavity. A large number of undesirable consequences of the introduction of trocars into the abdominal cavity, the so-called trocar complications (iatrogenic damage to internal organs, blood vessels, extraperitoneal insufflation, development of trocar hernias with deterioration of the aesthetic result, increased postoperative pain, increased risk of complications associated with the occurrence of hematomas, wound infections), served as the basis for the search for less invasive techniques. The rapid development of endoscopic surgery has contributed to the emergence of a wide range of surgical methods that do not leave gross scar changes on the skin of the anterior abdominal wall. These include single-port laparoscopic cholecystectomy, which reduces trauma to the anterior abdominal wall and improves cosmetic results. The clinical significance of the single laparoscopic approach (SLA) technique in the surgical treatment of patients with chronic calculous cholecystitis should be substantiated. The study included 116 patients hospitalized for planned surgical treatment with a diagnosis of gallstone disease. Chronic calculous cholecystitis” from 2019 to 2023 on the basis of the National Chemical Center named after M.M. Mamakeev of the Ministry of Health of the Kyrgyz Republic, Bishkek. The use of a single laparoscopic access technique for removing the gallbladder with proper selection of patients and strict adherence to methodological and technical principles makes it possible to achieve better results in the treatment of patients with cholelithiasis with access along the upper edge around the navel than with a longitudinal transubial approach.

A national survey and roadmap on complete streets infrastructure asset management policy

Complete Streets are being implemented across the US, and transportation agencies need to incorporate them into asset management systems cost-effectively maintain functionality. Although there has been a range of progress at the state level, many gaps need to be filled to include Complete Streets in asset management policies and improve practices, and there is no national guidance or comprehensive plan to achieve this. This study developed a roadmap to fill those gaps regarding infrastructure asset management. To create this roadmap, the study completed the following tasks: 1) develop and implement a survey supplement it with in-depth surveys with several agencies, 2) synthesize survey outcomes, 3) identify current statuses, challenges, and needs, and 4) develop a roadmap for Complete Streets infrastructure asset management. All 50 state transportation departments participated in the national survey. This paper synthesizes the outcomes of the surveys and literature review. The survey results showed that many agencies have some Complete Streets guidance (39/50), but only seven agencies have Complete Streets performance measures and no agency has bike/ped specific condition measures. The three primary challenges are: 1) inadequate funding related to organizational structure 2) the need for performance measures, and 3) the need for improved data accessibility, collection methods, and management techniques. The proposed Roadmap to Complete Streets Asset Management Policies includes pathways for 1) asset management performance measure development and 2) data collection and analysis. The roadmap organizes existing needs into a step by step framework for incorporating Complete Streets into infrastructure asset management programs and policies. Policy implications include the need for network-level performance measures and targets that the entire agency is responsible for, improved data collection techniques, and internal structural adjustments to encourage collaboration and data sharing within departments of transportation.

A detailed reinforcement learning framework for resource allocation in non‐orthogonal multiple access enabled‐B5G/6G networks

AbstractThe world of communications technology has recently undergone an extremely significant revolution. This revolution is an immediate consequence of the immersion that the fifth generation B5G and 6G have just brought. The latter responds to the growing need for connectivity and it improves the speeds and qualities of the mobile connection. To improve the energy and spectral efficiency of these types of networks, the non‐orthogonal multiple access (NOMA) technique is seen as the key solution that can accommodate more users and dramatically improve spectrum efficiency. The basic idea of NOMA is to achieve multiple access in the power sector and decode the required signal via continuous interference cancelation. A resource allocation approach is proposed for the B5G/6G‐NOMA network that aims to maximise system throughput, spectrum and energy efficiency and fairness among users while minimising latency. The proposed approach is based on reinforcement learning (RL) with the use of the Q‐Learning algorithm. First, the process of resource allocation as a problem of maximising rewards is formulated. Next, the Q‐Learning algorithm is used to design a resource allocation algorithm based on RL. The results of the simulation confirm that the proposed scheme is feasible and efficient.

Gasless trans-axillary endoscopic versus conventional open hemithyroidectomy for thyroid cancer patients: A propensity score-matched analysis of quality of life and oncological outcomes: A cross-sectional questionnaire study

BackgroundThyroid cancer predominantly affects young females who seek surgical intervention not only for excellent oncological outcomes but also for a high quality of life (QOL) and favorable cosmetic and functional outcomes. The gasless trans-axillary endoscopic (GTAE) approach is a commonly used remote access technique for thyroid surgeries. It holds the potential for comparable oncological outcomes and superior QOL, cosmetic, and functional outcomes. However, robust evidence supporting this hypothesis is scarce. Materials and MethodsWe collected data from patients diagnosed with papillary thyroid carcinoma who underwent hemithyroidectomy with central compartment dissection at Peking Union Medical College Hospital (PUMCH) between December 2019 and January 2023. After applying propensity-score matching analysis (PSMA), a total of 424 cases were included. For oncological outcomes, patients in both groups were prospectively followed through regular outpatient visits. The QOL, functional, and cosmetic outcomes were assessed using a cross-sectional online questionnaire, including EORTC-THY34 for QOL, PSAQ for cosmetic outcomes, SIS-6 for swallowing functions, and VHI-10 for voicing functions. We further compared oncological outcomes, QOL, functional, and cosmetic outcomes between these two groups. ResultsA total of 274 cases provided validated responses: 141 underwent the GTAE approach, and 134 underwent the conventional open (CO) approach. The operation time was approximately 60 minutes longer in the GTAE group. Notably, there was no difference in complications between the two approaches. Rates of suspicious recurrence in both groups remained low and showed no significant differences (2.55% vs. 1.57%, p>0.05). No pathological confirmed recurrence was reported in either group. Patients with the GTAE approach showed better body image and less joint pain (EORTC-THY34), better swallowing (SIS-6), and better cosmetic outcomes (PSAQ). Voice outcomes showed no difference between these two approaches (VHI-10). ConclusionCompared to the CO approach, hemithyroidectomy with central compartment dissection via the GTAE approach in low-risk patients maintains comparable oncological outcomes while offering better QOL, cosmetic benefits, and functional outcomes.