Common Scenarios Research Articles

An experimental investigation into the fire behaviors and smoke characteristics of continuous spill fires in road tunnels

Continuous fuel spill fires are a common accident scenario which needs to be considered for the safe operation of tunnels, given the potential threat posed to trapped persons. In this paper, a series of continuous spill fire experiments on a concrete surface were studied using a 1/8 reduced-scale tunnel model. Gasoline was used as the discharge fuel and the discharge rate varied from 1.5 to 5.2 ml/s. The burning area, steady regression rate, smoke front arrival time, and ceiling temperature were analyzed. The results show that the burning area spreads slowly following an initial rapid spill stage, with the spread process following a pattern of exponential decay. The steady regression rate is found to be approximately 63% of that of pool fires for the same burning area. At the same heat release rate, the smoke front moves faster for spill fires than pool fires because of the larger burning area, and a correlation is built to predict the smoke front arrival time. Finally, a ceiling temperature rise prediction model is developed which considers the spread and burning processes of the fire. The results are of practical importance in the quantitative risk assessment of liquid fuel fire accidents in tunnels, and their implications for personnel evacuation.

Management of autofluorescence in formaldehyde-fixed myocardium: choosing the right treatment.

Autofluorescence (AF) poses challenges for detecting proteins of interest in situ when employing immunofluorescence (IF) microscopy. This interference is particularly pronounced in strongly autofluorescent tissues such as myocardium, where tissue AF can be comparable to IF. Although various histochemical methods have been developed to achieve effective AF suppression in different types of tissue, their applications on myocardial samples have not been well validated. Due to inconsistency across different autofluorescent structures in sometypes of tissue, it is unclear if these methods can effectively suppress AF across all autofluorescent structures within the myocardium. Here, we quantitatively evaluated the performance of several commonly used quenching treatments on formaldehyde-fixed myocardial samples, including 0.3 M glycine, 0.3% Sudan Black B (SBB), 0.1% and 1% sodium borohydride (NaBH4), TrueVIEW® and TrueBlack®. We further assessed their quenching performance by employing the pre-treatment and post-treatment protocols, designed to cover two common IF staining scenarios where buffers contained detergents or not. The results suggest that SBB and TrueBlack® outperform other reagents in AF suppression on formaldehyde-fixed myocardial samples in both protocols. Furthermore, we inspected the quenching performance of SBB and TrueBlack® on major autofluorescent myocardial structures and evaluated their influence on IF imaging. The results suggest that SBB outperforms TrueBlack® in quenching major autofluorescent structures, while TrueBlack® excels in preserving IF labeling signal. Surprisingly, we found the treatment of NaBH4 increased AF signal and enhanced the AF contrast of major autofluorescent structures. This finding suggests that NaBH4 has the potential to act as an AF enhancer and may facilitate the interpretation of myocardial structures without the need for counterstaining.

Implications of the Use of Artificial Intelligence Predictive Models in Health Care Settings : A Simulation Study.

Substantial effort has been directed toward demonstrating uses of predictive models in health care. However, implementation of these models into clinical practice may influence patient outcomes, which in turn are captured in electronic health record data. As a result, deployed models may affect the predictive ability of current and future models. To estimate changes in predictive model performance with use through 3 common scenarios: model retraining, sequentially implementing 1 model after another, and intervening in response to a model when 2 are simultaneously implemented. Simulation of model implementation and use in critical care settings at various levels of intervention effectiveness and clinician adherence. Models were either trained or retrained after simulated implementation. Admissions to the intensive care unit (ICU) at Mount Sinai Health System (New York, New York) and Beth Israel Deaconess Medical Center (Boston, Massachusetts). 130 000 critical care admissions across both health systems. Across 3 scenarios, interventions were simulated at varying levels of clinician adherence and effectiveness. Statistical measures of performance, including threshold-independent (area under the curve) and threshold-dependent measures. At fixed 90% sensitivity, in scenario 1 a mortality prediction model lost 9% to 39% specificity after retraining once and in scenario 2 a mortality prediction model lost 8% to 15% specificity when created after the implementation of an acute kidney injury (AKI) prediction model; in scenario 3, models for AKI and mortality prediction implemented simultaneously, each led to reduced effective accuracy of the other by 1% to 28%. In real-world practice, the effectiveness of and adherence to model-based recommendations are rarely known in advance. Only binary classifiers for tabular ICU admissions data were simulated. In simulated ICU settings, a universally effective model-updating approach for maintaining model performance does not seem to exist. Model use may have to be recorded to maintain viability of predictive modeling. National Center for Advancing Translational Sciences.

On the Capacity of Communication Channels With Memory and Sampled Additive Cyclostationary Gaussian Noise

In this work we study the capacity of interference-limited channels with memory. These channels model non-orthogonal communications scenarios, such as the non-orthogonal multiple access (NOMA) scenario and underlay cognitive communications, in which the interference from other communications signals is much stronger than the thermal noise. Interference-limited communications is expected to become a very common scenario in future wireless communications systems, such as 5G, WiFi6, and beyond. As communications signals are inherently cyclostationary in continuous time (CT), then after sampling at the receiver, the discrete-time (DT) received signal model contains the sampled desired information signal with additive sampled CT cyclostationary noise. The sampled noise can be modeled as either a DT cyclostationary process or a DT almost-cyclostationary process, where in the latter case the resulting channel is not information-stable. In a previous work we characterized the capacity of this model for the case in which the DT noise is memoryless. In the current work we come closer to practical scenarios by modelling the resulting DT noise as a finite-memory random process. The presence of memory requires the development of a new set of tools for analyzing the capacity of channels with additive non-stationary noise which has memory. Our results show, for the first time, the relationship between memory, sampling frequency synchronization and capacity, for interference-limited communications. The insights from our work provide a link between the analog and the digital time domains, which has been missing in most previous works on capacity analysis. Thus, our results can help improving spectral efficiency and suggest optimal transceiver designs for future communications paradigms.

Robust Accurate Lane Detection and Tracking for Automated Rubber-Tired Gantries in a Container Terminal

Lane detection and tracking technique is the autonomous driving basis for Rubber-Tired Gantries (RTGs), vital to the automation and intelligence updating of man-driven container terminals. However, the existing lane detection methods developed for common road scenarios cannot meet the high-precision and robust all-weather requirements of RTG autonomous driving. In this article, we propose an Adaptive Edge-based Lane Detection and Tracking method considering RTG lanes’ characteristics in this paper. First, the candidate edges of lane lines are detected and paired based on the enhanced gradient features. Next, inverse perspective mapping is employed to search the right edges, followed by an adaptive sliding-window method. Ultimately, we develop an adaptive Kalman filter to track lane lines robustly, detecting confidence weighting by relaxing the constraint of lane line width. The proposed method is tested in an actual container yard, the lane centerline’s average position error is 2.051 pixels, and the detection success rate is close to 100%.

Back and Forth—On Automatic Exposure of Origin and Dissemination of Files on Windows

The number of Child Sexual Abuse Material (CSAM) cases has increased dramatically in recent years. This leads to the need to automate various steps in digital forensic processing, especially for CSAM investigations. For instance, if CSAM pictures are found on a device, the investigator aim at finding traces about the origin and possible further dissemination, respectively. In this article, we address this challenge with respect to the widespread Windows operating system. We model different common scenarios of system use by CSAM offenders in the scope of file inbound and outbound transfer channels. This gives us insights about digital traces in the Windows operating system and its applications to get knowledge about origin and possible destination of a file. We review available concepts and applications to support this issue. Furthermore, we develop a recursive-based approach and provide a prototype as plugin for the open source application Autopsy. We call our prototype AutoTrack . Our evaluation against the different models of Windows system usage reveals that Autotrack is superior to existing solutions and provides support for an investigator to find digital traces about the origin and possible further dissemination of files. We publish our AutoTrack plugin and thus provide full reproducibility of our approach.

Assessment of Electronic Health Literacy among Patients in an Urban, Academic Radiation Therapy Department

The COVID-19 pandemic dramatically affected health outcomes and healthcare access, especially with the abrupt transition to virtual care. Cancer patients in the New York City borough of the Bronx, a potentially marginalized community with high rates of poverty and non-English speakers, may be particularly vulnerable to healthcare disparities, given their advanced age and possible difficulty navigating telemedicine appointments due to decreased electronic health literacy (EHL). We investigated EHL levels using both subjective and objective measures and associated predictors of EHL in patients within an academic, urban radiation oncology department. We conducted a prospective IRB-approved study of patients aged ≥18 presenting for care in our department. Patients' internet access and established habits were surveyed via Health Information National Trends Survey (HINTS). Subjective EHL, self-reported comfort using the internet for health information, was assessed via the eHealth Literacy Scale (eHEALS), which calculates a score by adding participants' answers for 8 questions (each on a 1 to 5-point Likert scale). Subjective EHL was categorized as low (8-23), moderate (24-31), or good (32-40). Objective EHL was determined by the eHealth Literacy Objective Scale (eHeLiOS), which tests responses to 9 common scenarios on gathering and assessing electronic health information via multiple-choice questions. The numbers of correct answers were totaled and categorized into low (1-4), moderate (5-7), or good (8-9) EHL. Patients were enrolled between December 2020 and December 2022. 56 patients completed the subjective eHEALS assessment, while 49 completed the eHeLiOS objective test. 52% and 27% of patients identified as Black and Hispanic, respectively; 66% were male, and the median age was 67 (range 28-86). 76% reported accessing the internet regularly, of which 92% reported doing so via broadband network. The prevalence of good EHL was 10% using objective and 29% using subjective surveys. Using a proportional odds logistic model, only age was associated with EHL. For every increased year of age, there was an 11% decrease in objective (OR 0.89, p = 0.02) and 5% decrease in subjective (OR 0.95, p = 0.08) EHL odds, respectively. Gender, race/ethnicity, income, insurance, and employment status were not significantly associated with EHL. Few study patients, who represent an older and potentially marginalized population, showed good EHL levels; more perceived good EHL via subjective testing than we observed using our objective measure. These data suggest implementation of an objective EHL assessment would aid in identifying patients who may benefit from learning activities to improve EHL and support to navigate telehealth visits effectively. Further research is needed to optimize telemedicine strategies for older cancer patients with low EHL.

Standardizing Breast Adjuvant Radiation Therapy Practices in a Diverse Health System through Development of a Delphi Consensus Supported Clinical Algorithm

Adjuvant radiation therapy (RT) for early breast cancer is a highly effective treatment option. However, the multitude of available techniques backed by strong clinical evidence can result in a lack of consistency in treatment approaches, even within a single healthcare organization. This presents challenges for both providers and patients in making informed decisions. To address this issue, our radiation department, which serves a large and diverse health system, developed a clinical algorithm for adjuvant RT for breast cancer. This algorithm was created to enhance the quality and standardization of care delivered across our network. A modified Delphi technique was used. A panel of eight experienced breast radiation oncologists from our institution was assembled. The panel first identified the common clinical scenarios encountered in treating patients with adjuvant breast RT, and then made recommendations for the primary and alternative approaches for each scenario. NCCN guidelines, ASTRO executive summaries, and published national and international randomized trials were used for reference. In case of disagreements, the final recommendation was reached through a majority vote. The draft algorithm was also shared with medical oncologists, surgeons, and patient advocates to gather their input prior to final approval by the expert panel. Consensus was reached for three broad clinical scenarios for patients who have undergone lumpectomy or mastectomy: Ductal Carcinoma in Situ (DCIS), Invasive Cancer Node Negative (ICN0), and Invasive Cancer Node Positive (ICN+). The panel agreed subdivision of the scenarios into three risk groups (low, intermediate, and high) and three age groups, based on guidelines and consensus statements. For DCIS patients, size, grade, margin status, hormone receptor status, and tumor focality were used for further stratification. For ICN0 patients, HER2 receptor status and lymphovascular space invasion were also included. For ICN+ patients, nodal status (negative versus 1-3 positive nodes versus more than 3 positive nodes) was used for stratification. Additionally, DCIS and ICN0 patients were further divided into age groups. The panel reached consensus recommendations for RT, including whole breast RT, partial breast RT, chest wall RT, regional nodal irradiation, or omission of RT for each sub-group. Clinical trial enrollment was also recommended where appropriate. A breast cancer adjuvant RT algorithm was developed with the aim of standardizing care for patients with breast cancer. Implementation is expected to standardize treatment recommendations in our health system and to streamline the shared decision-making process with patients.

Global correlation coordination model for ranking decision-making units based on cross-efficiency game

DEA cross-efficiency evaluation method can rank decision making units (DMUs) more reasonably than the classical DEA model, but the existing cross-efficiency evaluation methods still have many deficiencies. The most evident drawback is that the potential multiple solutions of the optimal weights lead to the non-uniqueness of the cross-efficiency value. Moreover, the traditional cross-efficiency ranking methods neglect the interaction between DMUs. It is a common scenario that the decision-making unit will incline to give high evaluation scores to those in same coalition, and relatively low evaluation scores to those with different coalitions on the contrary in the process of cross-efficiency evaluation. Aiming at solving the above problems, this study proposes a cross-efficiency game model considering correlation coordination degree among DMUs. The generalized Shapley value of cross-efficiency game is defined, and its desirable properties are proved in detail. Finally, a global correlation coordination (GCC) model is developed for ranking decision-making units comprehensively. The comparative example and practical application on R&D efficiency evaluation are provided to illustrate the rationality and feasibility of the GCC model.

The right not to know: Non-disclosure of primary genetic test results and genetic counselors' response.

As part of clinical genetic counseling practice, patients may request that their primary genetic test results be disclosed to someone else, such as a relative or referring provider, or request that results be disclosed to no one (non-disclosure). In making these requests, patients employ the ethical principle of the "right not to know," which argues that autonomous individuals can choose not to know relevant health information. Although the right not to know has been well-studied in medicine in general, and in the return of genomic secondary findings, we are not aware of other studies that have explored the return of primary genetic test results when patients request non-disclosure or disclosure to another individual. This study aimed to describe common clinical scenarios in which these requests occur, how genetic counselors respond, and what ethical considerations they employ in their decision-making process. We recruited participants from the National Society of Genetic Counselors' (NSGC) "Student Research Surveys and Reminders" listserv and conducted semi-structured interviews with 11 genetic counselors in the United States who described genetic counseling cases where this occurred. Interviews were transcribed and coded inductively, and themes were identified. Case details varied, but in our study data the requests for non-disclosure were most commonly made by patients with poor, often oncologic, prognoses who requested their test results be disclosed to a family member instead of themselves. Genetic counselors considered similar factors in deciding how to respond to these requests: patient autonomy, medical actionability of results for the patient and family, the relationship between the patient and the person to whom results might be disclosed, and legal or practical concerns. Genetic counselors often made decisions on a case-by-case basis, depending on how relevant each of these factors were. This study adds to the growing body of literature regarding patients' "right not to know" and will hopefully provide guidance for genetic counselors who experience this situation in clinical practice.

String Indexing with Compressed Patterns

Given a string S of length n , the classic string indexing problem is to preprocess S into a compact data structure that supports efficient subsequent pattern queries. In this article, we consider the basic variant where the pattern is given in compressed form and the goal is to achieve query time that is fast in terms of the compressed size of the pattern. This captures the common client-server scenario, where a client submits a query and communicates it in compressed form to a server. Instead of the server decompressing the query before processing it, we consider how to efficiently process the compressed query directly. Our main result is a novel linear space data structure that achieves near-optimal query time for patterns compressed with the classic Lempel-Ziv 1977 (LZ77) compression scheme. Along the way, we develop several data structural techniques of independent interest, including a novel data structure that compactly encodes all LZ77 compressed suffixes of a string in linear space and a general decomposition of tries that reduces the search time from logarithmic in the size of the trie to logarithmic in the length of the pattern.

Development and application analysis of the quadrotor UAVs attitude control

Due to the economy's tremendous growth and the technology's impressive advancement, the practicality of UAVs has become a hot topic of concern for all sectors of society at present. According to the classification of flight platform configuration, drones may be split into many different types. Quadrotor drones are a common type of aerial robot, which is widely used in civilian and military fields at this stage. The safety and stability of the UAV in use are particularly important, so its flight attitude must be humanly tuned and controlled. This paper mainly analyzes the attitude control technology of quadrotor UAVs. Firstly, the key components and technical difficulties of attitude control are analyzed. Then some common control methods and application scenarios of current mainstream control methods are introduced and analyzed in detail. Finally, future research directions are analyzed and summarized based on the existing methods.

An ontology-based framework for semantic geographic information systems development and understanding

Geographic information systems (GIS) are a widely used approach for geodata manipulation, analysis, and geoinformation visualization. Although the issue of semantic heterogeneity for GIS applications has been widely addressed, the development of flexible semantic GIS systems can still be improved, and GIS interfaces can be further unified to enhance system understanding among users of various GIS systems. This study proposes an ontology-based semantic GIS conceptual framework that can seamlessly combine ontology models, GIS elements and user actions for semantic GIS application development. In addition, a GIS components ontology that encompasses the five fundamental components of GIS is proposed to integrate GIS elements that can perceive GIS operations and processes semantically and to support customized GIS system designs. Moreover, a semantic WebGIS implementation framework is designed on the basis of the proposed conceptual framework to facilitate semantic WebGIS development. The implementation uses two common application scenarios regarding urban change analysis and user interaction. The former performs semantic retrieval for urban change analysis with system understanding, whereas the latter conducts online thematic mapping with semantic interpretation. The study contributes in terms of innovation in the design of a unified GIS components ontology and successful implementation of a semantic GIS system using the ontology-driven approach, thereby providing a convincing demonstration of the latter and showing the potential for semantic GIS application paradigms.

Cardiopulmonary resuscitation: the power to save lives

Cardiopulmonary arrest (CPA) is understood as the sudden, unexpected and catastrophic cessation of systemic circulation, useful ventricular and ventilatory activity. It is essential that any individual is aware of the risk factors, epidemiology, has minimal knowledge to recognize a CPA early and can proceed appropriately to provide quality support to the victim. The advances in terms of technology, treatment and prevention are notorious, however, many lives are still lost due to the poor quality of a first care. The study aimed to understand the level of knowledge and train the population about risk factors, epidemiology, early recognition, correct initial approach, cardiac compressions and quality ventilation, in order to reduce the incidence of mortality and improve the prognosis of patients in cardiac arrest. An exploratory intervention was used, bringing knowledge objectively, through banners, folders and lectures in easy-to-understand language, providing quality and relevant information so that listeners could acquire indispensable skills and actually change lives. The actions took place in a Basic Health Unit (BHU), on previously established days and times, always striving to reach as many people as possible. Recognizing early and knowing how to conduct a CPA until specialized help arrives is of fundamental importance, but unfortunately the largest part of the population approached demonstrated to be unaware of the basics on the subject. Unpreparedness regarding risk factors, initial signs and symptoms and, mainly, regarding the initial approach and effective cardiac compressions, was present in most of the target audience. Urgent and emergency situations can result in serious clinical outcomes, sequels and even death of the victims. A trained layperson, capable of identifying and carrying out the necessary actions, can considerably improve the prognosis of victims who are in an urgent or emergency situation in society. It is important to provide quality and effective care, so that the victims do not have sequelae or, if they do, that these are minimal. Fast and efficient help is essential to avoid irreversible neurological damage, in addition to the risk of death that increases every minute. For this, it is necessary to start Cardiopulmonary Resuscitation (CPR) maneuvers as early as possible, even by a person who is not in the health area until specialized help arrives. In view of the results obtained, it is concluded that training on basic life support in cardiac arrest is still a little-known topic among the public addressed, which reflects a common scenario among the lay population and reinforces the importance of carrying out studies such as this in society, in order to disseminate basic knowledge that saves lives. It is essential that cardiopulmonary resuscitation training is not something exclusive to health professionals, the lay population needs to be guided so that they know how to act correctly in critical moments. The activities carried out spread health knowledge and provided subsidy so that the part of the contemplated population can also act as health educators.

A comparison of the American Board of Anesthesiology's in-person and virtual objective structured clinical examinations

BackgroundThe American Board of Anesthesiology's Objective Structured Clinical Examination (OSCE), as a component of its initial certification process, had been administered in-person in a dedicated assessment center since its launch in 2018 until March 2020. Due to the COVID-19 pandemic, a virtual format of the exam was piloted in December 2020 and was administered in 2021. This study aimed to compare candidate performance, examiner grading severity, and scenario difficulty between these two formats of the OSCE. MethodsThe Many-Facet Rasch Model was utilized to estimate candidate performance, examiner grading severity, and scenario difficulty for the in-person and virtual OSCEs separately. The virtual OSCE was equated to the in-person OSCE by common examiners and common scenarios. Independent-samples t-test was used to compare candidate performance, and partially overlapping samples t-tests were applied to compare examiner grading severity and scenario difficulty between the in-person and virtual OSCEs. ResultsThe in-person (n = 3235) and virtual (n = 2934) first-time candidates were comparable in age, sex, race/ethnicity, and whether U.S. medical school graduates. The virtual scenarios (n = 35, mean [0.21] ± SD [0.38] in logits) were more difficult than the in-person scenarios (n = 93, 0.00 ± 0.69, Welch's partially overlapping samples t-test, p = 0.01); there were no statistically significant differences in examiner severity (n = 390, −0.01 ± 0.82 vs. n = 304, −0.02 ± 0.93, Welch's partially overlapping samples t-test, p = 0.81) or candidate performance (2.19 ± 0.93 vs. 2.18 ± 0.92, Welch's independent samples t-test, p = 0.83) between the in-person and virtual OSCEs. ConclusionsOur retrospective analyses of first-time OSCEs found comparable candidate performance and examiner grading severity between the in-person and virtual formats, despite the virtual scenarios being more difficult than the in-person scenarios. These results provided assurance that the virtual OSCE functioned reasonably well in a high-stakes setting.

Pediatric ADHD Medication Errors Reported to United States Poison Centers, 2000 to 2021.

To investigate the characteristics and trends of out-of-hospital attention-deficit/hyperactivity disorder (ADHD) medication-related therapeutic errors among youth <20 years old reported to US poison centers. National Poison Data System data from 2000 through 2021 were analyzed. Population-based rates were calculated using US census data. There were 124 383 ADHD medication-related therapeutic errors reported to US poison centers from 2000 through 2021, with the annual frequency increasing by 299.0% during that period. Two-thirds (66.6%) of the 87 691 first-ranked exposures involved children 6 to 12 years old, three-fourths (76.4%) were among males, and half (50.5%) involved amphetamines and related compounds. Most (79.7%) therapeutic errors were single-substance exposures. Although most (82.7%) individuals did not receive treatment in a health care facility (HCF), 2.3% were admitted to a HCF and 4.2% had a serious medical outcome. Children <6 years old were more likely to experience a serious medical outcome (odds ratio = 2.1; 95% confidence interval: 1.9-2.3) or be admitted to a HCF (odds ratio = 3.4; 95% confidence interval: 3.0-3.7) than 6 to 19-year-olds. The most common scenarios were "inadvertently taken or given medication twice" (53.9%), followed by "inadvertently taken or given someone else's medication" (13.4%), and "wrong medication taken or given" (12.9%). The frequency of cases reported to poison centers of pediatric out-of-hospital therapeutic errors related to ADHD medications increased by almost 300% during the 22-year study period and is likely attributable to increased prescribing of these medications. Because therapeutic errors are preventable, more attention should be given to patient and caregiver education and development of improved child-resistant medication dispensing and tracking systems.

The role of geolocation data in U.S. political campaigning: How digital political strategists perceive it

The use of geolocation data by political campaigns is often the subject of media concern. Research has investigated the role of data in and use by political campaigns, but less attention has been paid to digital political strategists largely responsible for decisions behind the assemblage and mining of voter databases to deliver micro-targeted messages on behalf of political campaigns. In this study, we conducted interviews with 14 leading industry professionals in the United States to examine the common scenarios and associated concerns of using geolocation data to target voters. Our findings reveal that geolocation data are an important asset in political campaigns, but their value is contingent on additional factors. Concerns regarding geolocation data, as interviewees suggested, may at times be influenced more by the popular media narratives than the true reality of data, their scope, and associated capabilities. Our results point to geolocation data’s greatest usefulness to campaigns not in their own right, but when data are paired with other insights about voters’ behaviors. Ultimately, the lack of industry regulation reveals discrepancies in best practices and raises concerns over the potential misuse of geolocation data in the political space.

Super-Eddington accretion as a possible scenario to form GW190425

ABSTRACT On 2019 April 25, the LIGO/Virgo Scientific Collaboration detected a compact binary coalescence, GW190425. Under the assumption of the binary neutron star (BNS), the total mass of $3.4^{+0.3}_{-0.1}\, \mathrm{M}_\odot$ lies five standard deviations away from the known Galactic population mean. In the standard common envelope scenario, the immediate progenitor of GW190425 is a close binary system composed of an NS and a He-rich star. With the detailed binary evolutionary modelling, we find that in order to reproduce GW190425-like events, super-Eddington accretion (e.g. $1,000\, \dot{M}_{\rm Edd}$) from a He-rich star onto the first-born NS with a typical mass of 1.33 M⊙ via stable Case BB mass transfer (MT) is necessarily required. Furthermore, the immediate progenitors should potentially have an initial mass of MZamsHe in a range of 3.0–3.5 M⊙ and an initial orbital period of Pinit from 0.08 d to 0.12 d, respectively. The corresponding mass accreted onto NSs via stable Case BB MT phase varies from $0.70\, \mathrm{M}_\odot$ to $0.77\, \mathrm{M}_\odot$. After the formation of the second-born NS, the BNSs are expected to be merged due to gravitational wave emission from ∼11 Myr to ∼190 Myr.

Cardiogenic Shock in Idiopathic Dilated Cardiomyopathy Patients: Red Flag for Myocardial Decline

Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of nonischemic cardiomyopathy worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, the outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on the 1-year outcomes after CS in patients with and without IDCM. FRENSHOCK was a prospective registry including 772 patients with CS from 49 centers. The 1-year outcomes (rehospitalizations, mortality, heart transplantation [HTx], ventricular assist devices [VAD]) were analyzed and adjusted on independent predictive factors. Within 772 CS included, 78 occurred in IDCM (10.1%). Patients with IDCM had more frequent history of chronic kidney failure and implantable cardioverter-defibrillator implantation. No difference was found in 1-month all-cause mortality between groups (28.2 vs 25.8%for IDCM and others, respectively; adjusted hazard ratio 1.14 [0.73 to 1.77], p=0.57). Patients without IDCM were more frequently treated with noninvasive ventilation and intra-aortic balloon pump. At 1 year, IDCM led to higher rates of death or cardiovascular rehospitalizations (adjusted odds ratio 4.77 [95% confidence interval 1.13 to 20.1], p=0.03) and higher rates of HTx or VAD for patients aged <65 years (adjusted odds ratio 2.68 [1.21 to 5.91], p=0.02). In conclusion, CS in IDCM is a very common scenario and is associated with a higher rate of 1-year death or cardiovascular rehospitalizations and a more frequent recourse to HTx or VAD for patients aged <65 years, encouraging the consideration of it as a red flag for myocardial decline and urging for a closer follow-up and earlier evaluation for advanced heart failure therapies.

Comparison of prehospital stroke care at private homes and residential care settings

Background: Suspected stroke is a common scenario among care home residents, who are typically older and have more complex health needs than the general population. Aims: The aim of this study was to describe the care of suspected stroke patients according to their residential status. Methods: Retrospective secondary analysis was carried out using a clinical record dataset from a UK ambulance service that described the care of patients labelled as having a suspected stroke between December 2021 and April 2022. Findings: Care home patients were older (median age 86 (interquartile range (IQR) 79–91) years) than those in their own homes (median age 75 (IQR 63–83) years; P≤0.001), with more comorbidities (median of five (IQR 3–6) versus median of three (IQR 2–5); P≤0.001) and taking more medications (median of six (IQR 4–9) versus median of four (IQR 1–7); P≤0.001). They were more likely to have difficulties completing the face, arms, speech, time test (17/170 (10%) versus 39/1305 (3%); P≤0.001) and present with facial droop (85/153 (55.6%) versus 506/1266 (40%); P≤0.001). Ambulance on-scene time was longer at care homes (median 41 (IQR 32–49.5) minutes versus median 35 (IQR 27–45) minutes; P≤0.001). Conclusion: Clinician awareness of characteristics associated with residential settings may be important for delivering emergency stroke care. Research is needed to optimise ambulance assessment for care home patients.