Definitive Assessment Research Articles

Serial postoperative ctDNA monitoring of breast cancer recurrence.

562 Background: Up to 30% of patients with breast cancer relapse after primary treatment. There are no sensitive or reliable tests to monitor these patients and detect distant metastases before overt recurrence. Here, we demonstrate the use of personalized circulating tumour DNA (ctDNA) profiling performed postoperatively, postadjuvantly, and serially for detection of recurrence in breast cancer. Methods: Patients with primary breast cancer (n=188) were recruited following surgery and adjuvant therapy and were followed-up for up to 10 years with semi-annual blood sampling for ctDNA analysis. Patients (n=29) with insufficient residual tumour for whole exome sequencing (WES) were excluded from the analysis. Tumour WES profiles were generated for 159 patients; samples from 2 patients failed WES QC requirements and a personalised ctDNA panel could not be generated for 1 patient. In 156 patients, plasma samples (n=1141) were retrospectively tested for the presence of ctDNA using personalized Signatera assays (mPCR-NGS) targeting up to 16 somatic single nucleotide variants selected from primary tumour WES. Results: Plasma ctDNA was detected ahead of clinical or radiologic relapse in 30 of the 34 relapsed patients (sensitivity of 88%). Metastatic relapse was predicted with a lead interval of up to 2 years (median: 10 months, range: 0-39 months); median lead intervals for HR+/HER2- were 15 (2 - 39); for HR-/HER2+ 6 (0.5 – 12) for HR+/HER2+ 8 (5 – 14) and 9 (0-20) for TNBC. Patients with a positive ctDNA test had poorer relapse-free-survival (RFS) (HR=47.5; 95% CI 18.5-161.4; p <0.001) from surgery and all four breast cancer subgroups showed a similarly reduced RFS. Overall survival was also significantly reduced for patients who were ctDNA positive (HR=84.15; 95%CI 16.43-1538; p <0.001). The number of variants, mean VAF and MTM/mL varied between patients, with significantly higher values at the time closest to relapse than in the first ctDNA positive sample (p =0.0002). Among the 4 relapsed patients not detected in the study all were HR+/HER2-, 1 had a local recurrence, 2 had bone recurrence (1 with axillary LN involvement) and 1 had cancer cells in pleural fluid. Of the remaining 122 patients, only 5 developed ctDNA-positivity, all with low VAF, none of them have relapsed by the follow-up census date (31 December 2021). However, follow-up for some of these patients limits definitive assessment. Lastly, 4 patients developed a second primary cancer (2 breast, 2 lung) all of whom were ctDNA-negative. Conclusions: This study demonstrates that serial post-operative ctDNA analysis has strong prognostic value. More importantly, earlier detection of metastatic disease provides a possible window for therapeutic intervention, while repeated negative ctDNA tests can provide reassurance to patients. Future interventional studies may assess the clinical utility of ctDNA-based risk-stratification.

Proportionate mortality and national rate of death from COVID-19 among US law enforcement officers: 2020

PurposeThe goal of the present study is to determine the proportionate mortality and national rate of duty-related deaths from COVID-19 among US law enforcement officers during the year 2020.Design/methodology/approachData for the current study were obtained from the National Law Enforcement Officer Memorial Fund (NLEOMF) database for the year 2020. The database contains deaths designated as caused by incidents that occurred while in the line of duty. The chi-square test and two-sample t-test were used to compare characteristics of officers who died of COVID-19 versus other causes of death. Both the proportionate mortality and rates of death were calculated. To compute the rate of death, the authors obtained data on the total number of law enforcement officers employed in the United States (and therefore at risk) for the year 2020 from Bureau of Labor Statistics.FindingsCOVID-19 deaths (n = 182) accounted for 62% of all duty-related law enforcement officer deaths during 2020. The national rate of death due to COVID-19 (12.8/100,000 per year) for law enforcement officers was higher compared to all other causes of death combined (8.0/100,000 per year).Research limitations/implicationsA limitation of the study is the uncertainty of a definitive assessment that the viral infection was acquired through work (versus at home or other non-work-related community settings). Although highly unlikely, deaths designated as duty related entail financial benefits for the survivors and may be a potential source of bias. Given the complexity of personal exposures, the percentage of COVID-19 deaths attributed to duty may represent an over or under estimation of the actual value. Therefore, the data should be interpreted cautiously.Practical implicationsThese findings provide police organizations with information needed to understand the risk of death among officers during the COVID-19 pandemic and to make informed decisions about future preparedness strategies.Originality/valueThere are presently no published scientific studies that examine both the proportionate mortality and national rate of death from COVID-19 among law enforcement officers for the year 2020.

V03-10 THULIUM LASER VS DUAL ACTION ULTRASONIC/BALLISTIC CYSTOLITHOLAPAXY

You have accessJournal of UrologyCME1 May 2022V03-10 THULIUM LASER VS DUAL ACTION ULTRASONIC/BALLISTIC CYSTOLITHOLAPAXY Matthew Beamer, and Scott Weiner Matthew BeamerMatthew Beamer More articles by this author , and Scott WeinerScott Weiner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are many options available to perform a transurethral cystolitholapaxy including ultrasonic, ballistic, pneumonic, laser, and mechanical lithotripsy. Both holmium laser lithotripsy and ultrasonic lithotripsy are commonly used for the treatment of bladder stones. Both have been deemed safe and have been shown to produce less mucosal bleeding when compared to other methods. Recently the thulium laser has been used for the treatment of nephrolithiasis. Proponents suggest that this laser creates smaller stone fragments with greater stone ablation, allowing for shorter operative times and higher stone free rates when compared to the holmium laser. Here we compare the thulium laser and dual action ultrasonic/ballistic lithotripsy for the treatment of bladder stones in a single patient. METHODS: A 76-year-old male presented with two bladder stones of equal size (1.6cm) and Hounsfield units (1300). Both stones were treated transurethrally during a single procedure. The first stone was treated with the thulium laser where a 550-micron fiber was placed through a 28 French resectoscope. A frequency of 8Hz and energy of 18.8kJ was used. The second stone was treated with an Olympus ShockPulse (dual action ultrasonic/ballistic) lithotripter placed through a 24 French nephroscope. The two procedures were evaluated objectively based on time to completion and subjectively based on visualization, mucosal bleeding, and stone retropulsion. RESULTS: The thulium laser cystolitholapaxy was completed in 29 minutes and 10 seconds, while the ultrasonic/ballistic lithotripsy was completed in 36 minutes and 6 seconds. Both were effective at clearing the stone burden. Subjectively, the thulium laser allowed for less stone retropulsion and greater stone ablation. There was minimal mucosal damage and excellent visualization. The ultrasonic/ballistic lithotripter produced larger stone fragments and significant stone movement, leading to mucosal bleeding with decreased visualization. CONCLUSIONS: A thulium laser cystolitholapaxy may provide shorter operative times, minimal stone movement, decreased mucosal bleeding, and improve visualization when compared to ultrasound/ballistic cytsolitholapaxy. Future prospective or retrospective analysis is needed to make a definitive assessment. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e204 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Beamer More articles by this author Scott Weiner More articles by this author Expand All Advertisement PDF DownloadLoading ...

Sarcomatoid Mesothelioma with Bland Histologic Features: A Potential Pitfall in Diagnosis.

Sarcomatoid mesotheliomas can be challenging to diagnose on small biopsy specimens, where limited material may preclude definitive assessment of invasion and lesional cells can have relatively bland cytology with no mesothelial marker expression. We report a case of a patient who presented with a pleural effusion and had subsequent pleural biopsy that showed a bland, uniform spindle cell proliferation in a mildly myxoid background. There was little if any collagen; no chest wall, soft tissue, or fat; and mesothelial markers were negative. The cells were positive for pancytokeratin and GATA3 by immunohistochemistry, and in situ hybridization showed a "negative" result for homozygous loss of CDKN2A; however, there was partial (heterozygous) loss of one allele. A diagnosis of atypical spindle cell proliferation was made based on these findings. Several months later, the patient had a repeat pleural biopsy that showed spindled cells with more pleomorphism, areas of invasion into the chest wall, and the same partial loss of CDKN2A, consistent with a sarcomatoid mesothelioma. This case underscores the challenges present on small biopsy specimens, the fact that sarcomatoid mesotheliomas can be relatively bland appearing with focal pleomorphism, and that heterozygous loss of CDKN2A should be considered a positive result indicative of a neoplastic process.

Global Regulatory and Public Health Initiatives to Advance Pediatric Drug Development for Rare Diseases.

The literature thoroughly describes the challenges of pediatric drug development for rare diseases. This includes (1) generating interest from sponsors, (2) small numbers of children affected by a particular disease, (3) difficulties with study design, (4) lack of definitive outcome measures and assessment tools, (5) the need for additional safeguards for children as a vulnerable population, and (6) logistical hurdles to completing trials, especially with the need for longer term follow-up to establish safety and efficacy. There has also been an increasing awareness of the need to engage patients and their families in drug development processes and to address inequities in access to pediatric clinical trials. The year 2020 ushered in yet another challenge—the COVID-19 pandemic. The pediatric drug development ecosystem continues to evolve to meet these challenges. This article will focus on several key factors including recent regulatory approaches and public health policies to facilitate pediatric rare disease drug development, emerging trends in product development (biologics, molecularly targeted therapies), innovations in trial design/endpoints and data collection, and current efforts to increase patient engagement and promote equity. Finally, lessons learned from COVID-19 about building adaptable pediatric rare disease drug development processes will be discussed.

Psychometric Properties of the Persian Short Version of the Problematic Pornography Consumption Scale (PPCS-6)

The short version of the Problematic Pornography Consumption Scale (PPCS-6) is a valid and reliable scale for assessing problematic pornography use. However, due to the lack of a single definition and gold standard assessment for problematic pornography use, a valid multilingual instrument can help establish standard diagnostic criteria. This cross-sectional study enrolled 115 randomly selected men and women who filled out an online questionnaire in 2021. After translating and back-translating the questionnaire, we assessed face, content, construct validity, and reliability. The results indicated excellent face validity (impact score >1.5 for every item on the questionnaire), content validity (S-CVI/Ave = 0.95 and I-CV = 0.89–1 for all the items using the K* method) and construct validity (KMO = 0.67, Sig = p < 0.001). The construct validity results indicated that the PPCS-6 included two factors in the Iranian population. The scale also had excellent reliability (Cronbach's alpha = 0.97, intra-cluster correlation coefficients = 0.97, 95%CI (0.92–0.98)(. Due to the acceptable validity and reliability of the Persian version of PPCS-6, this scale can be used in large-scale studies where several instruments are employed, and there is often a time limitation. The psychometric examination of this instrument can contribute to achieving a unified concept and assessment of problematic pornography use.

Gross Tumor Volume Definition and Comparative Assessment for Esophageal Squamous Cell Carcinoma From 3D 18F-FDG PET/CT by Deep Learning-Based Method.

BackgroundThe accurate definition of gross tumor volume (GTV) of esophageal squamous cell carcinoma (ESCC) can promote precise irradiation field determination, and further achieve the radiotherapy curative effect. This retrospective study is intended to assess the applicability of leveraging deep learning-based method to automatically define the GTV from 3D 18F-FDG PET/CT images of patients diagnosed with ESCC.MethodsWe perform experiments on a clinical cohort with 164 18F-FDG PET/CT scans. The state-of-the-art esophageal GTV segmentation deep neural net is first employed to delineate the lesion area on PET/CT images. Afterwards, we propose a novel equivalent truncated elliptical cone integral method (ETECIM) to estimate the GTV value. Indexes of Dice similarity coefficient (DSC), Hausdorff distance (HD), and mean surface distance (MSD) are used to evaluate the segmentation performance. Conformity index (CI), degree of inclusion (DI), and motion vector (MV) are used to assess the differences between predicted and ground truth tumors. Statistical differences in the GTV, DI, and position are also determined.ResultsWe perform 4-fold cross-validation for evaluation, reporting the values of DSC, HD, and MSD as 0.72 ± 0.02, 11.87 ± 4.20 mm, and 2.43 ± 0.60 mm (mean ± standard deviation), respectively. Pearson correlations (R2) achieve 0.8434, 0.8004, 0.9239, and 0.7119 for each fold cross-validation, and there is no significant difference (t = 1.193, p = 0.235) between the predicted and ground truth GTVs. For DI, a significant difference is found (t = −2.263, p = 0.009). For position assessment, there is no significant difference (left-right in x direction: t = 0.102, p = 0.919, anterior–posterior in y direction: t = 0.221, p = 0.826, and cranial–caudal in z direction: t = 0.569, p = 0.570) between the predicted and ground truth GTVs. The median of CI is 0.63, and the gotten MV is small.ConclusionsThe predicted tumors correspond well with the manual ground truth. The proposed GTV estimation approach ETECIM is more precise than the most commonly used voxel volume summation method. The ground truth GTVs can be solved out due to the good linear correlation with the predicted results. Deep learning-based method shows its promising in GTV definition and clinical radiotherapy application.

Hemorrhagic dot score as a follow up marker in psoriasis on treatment: A prospective observational study.

Psoriasis assessment tools in use presently lack reproducibility and are cumbersome to use. An easily reproducible, objective tool with ability to maintain visual records for follow up is hence desirable. We conducted a study with the aim to assess dermoscopic changes in psoriasis while on treatment by recording the number of hemorrhagic dots (Hemorrhagic Dot Score-HDS) in a representative plaque and comparing it to the PASI score. A longitudinal prospective study was conducted between October 2018 to March 2020 in a dermatology centre of a tertiary hospital on cases of chronic plaque psoriasis on treatment over 6months, assessed at baseline and thereafter monthly for 6 months. Hundred consenting patients of chronic plaque psoriasis were assessed, clinically, PASI and dermoscopically. HDS and other dermoscopic features were noted at every visit. ANOVA and F test of testing of equality of Variance; effect size in terms of Cohen were used to report the strength of an apparent relationship. Percentage improvement in the mean PASI scores and HDS and percentage improvement of mean was found significant in each month on follow up. Systemic therapy as compared to topical therapy showed higher effect size of 6.1 and 1.7, respectively. Hemorrhagic dot score can be used as an objective, definite assessment tool correlating with clinical severity of psoriasis with more accuracy which shows changes early following institution of therapy.

Abstract P1-02-07: Accuracy and predictive value of resection margin assessment by intraoperative frozen section after neoadjuvant therapy: An analysis of the ABCSG 24 and 34 trials

Abstract Data on the accuracy of intraoperative resection margin assessment and its influence on survival after neoadjuvant therapy (NT) are scarce. In the present study, we analyzed the accuracy of resection margin assessment by intraoperative frozen section (IFS) in the prospectively randomized neoadjuvant clinical trials ABCSG 24 and ABCSG 34.164 patients with early breast cancer who received NT within the ABCSG 24 and ABCSG 34 trials between 2005 and 2015, and received IFS resection margin assessment were included in our analysis. Resection margin status by IFS was compared to subsequent FFPE resection margin status, which was considered the gold standard. According to the rate of FFPE-based false-negative and false-positive diagnoses, we determined sensitivity and specificity of IFS. Correlation of IFS diagnosis with definitive FFPE assessment was described by Cohen´s kappa coefficient, the distributional probability was analyzed by McNemar test. The association of patient- and tumor-related factors (menopausal status, residual tumor size, tumor grade, lymph node status, multifocality, DCIS component, lymph vessel invasion, ER/PR/HER2/Ki67 expression and RCB category) with correct IFS diagnosis was analyzed by chi2 test and Fisher´s exact test. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier method and log-rank test. Median age of patients was 55 years. IFS diagnosis for negative margins (no tumor on ink) was correct in 131 (80%) cases, translating into a sensitivity of 0.571 and specificity of 0.877 (false negative rate: 43%, false positive rate 12%). Correlation coefficient for IFS and FFPE diagnosis yielded a Cohen´s kappa value of 0.459. 58 patients (35%) were re-excised during the first operation, in 27 patients (17%), a second surgical intervention was performed. Overall re-excision rates in patients with true positive, false positive and false negative IFS diagnoses were 96%, 93% and 78%, respectively. Rate of second surgical interventions in patients with true positive, false positive and false negative IFS diagnoses were 38%, 7% and 44%, respectively. Correct IFS diagnosis correlated with smaller residual tumor size (p=0.032), lymph node status (p=0.007), HER2 negativity (p=0.049), presence of a DCIS component (p=0.013) and absence of lymph vessel invasion (p=0.007). Despite of re-operation resulting in negative margins, false negative IFS diagnosis was associated with worse recurrence-free survival (p=0.0278). The impact of IFS diagnosis on OS did not reach statistical significance (p=0.0995), although patients with false negative IFS diagnosis showed a shorter OS. IFS assessment of margins after NT displayed high specificity and limited sensitivity in the ABCSG 24 and ABCSG 34 trials. Residual tumor size, lymph node status, HER2 positivity, presence of a DCIS component and lymph vessel invasion correlated with accuracy of IFS. Patients with false negative IFS margin status showed a significantly shorter RFS despite of a second intervention yielding negative margins. Larger studies are needed to confirm the effects of IFS margin assessment on OS. Our data could help to lower rates of subsequent surgical interventions for re-excision after NT and identify patients by the above mentioned tumor characteristics who are at an increased risk of recurrence despite negative margin status. Citation Format: Karin Rokitte, Kristina Tendl-Schulz, Ulrike Heber, Kerstin Wimmer, Rupert Bartsch, Stephanie Kacerovsky-Strobl, Georg Pfeiler, Günther G. Steger, Christian F. Singer, Dominik Hlauschek, Michael Gnant, Florian Fitzal, Zsuzsanna Bago-Horvath. Accuracy and predictive value of resection margin assessment by intraoperative frozen section after neoadjuvant therapy: An analysis of the ABCSG 24 and 34 trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-02-07.

A critical perspective on uncertainty appraisal and sensitivity analysis in life cycle assessment

AbstractIn this study, we review approaches for uncertainty appraisal in the life cycle assessment literature. We cover the acknowledgment of stochastic and epistemic uncertainty in uncertainty and sensitivity analysis and knowledge quality assessment, respectively. Consistent with previous works, our findings indicate that uncertainty is only appraised in a few studies on life cycle assessment. Most of these contributions cover only one of the phases of life cycle assessment, mainly the life cycle inventory phase. Less attention has been devoted to the phases of goal and scope definition and life cycle impact assessment. Additionally, in most studies, uncertainty analysis and sensitivity analysis have been applied independently, as it is wrongly assumed they cover different uncertainty spaces. We also identify the scope for improvement in the appraisal of epistemic uncertainty and the correct definition of the probability distribution of the uncertain factors. We conclude by highlighting studies in which sensible practices have been adopted, identifying open challenges, and suggesting possible ways forward.

Acute and chronic exercise training in patients with Class II pulmonary hypertension: effects on haemodynamics and symptoms.

More than half of heart failure (HF) patients have concomitant pulmonary hypertension, impacting symptoms and prognosis. The role of exercise in this category of patients is still unclear, probably because of the lack of a clear relationship between exercise and acute and chronic pulmonary artery pressure variations and related changes in symptoms. The limited evidence on this topic is contradictory and hardly comparable due to use of different exercise programmes and pulmonary artery pressure assessment techniques. This is further compounded by different functional and structural classes of HF making definite assessments and interpretations of exercise effect on outcomes difficult. Exercise training programmes were proven beneficial in HF patients; however, the lack of data about their pulmonary haemodynamic effects prevents clear indications on the best exercise types for patients presenting secondary pulmonary hypertension and different HF categories. Indeed, some data suggest that not all HF patients have similar responses to training, leading to either beneficial or detrimental effects, depending on the HF type. Future studies, involving modern technologies such as continuous pulmonary artery pressure monitoring implantable devices, may clarify the current gaps in this field, aiming at patient‐tailored exercise training rehabilitation programmes, in order to improve clinical outcomes, quality of life, and hopefully prognosis.

Exploring the Clinical Utility of Pancreatic Cancer Circulating Tumor Cells.

Pancreatic ductal adenocarcinoma (PDAC) is the most frequent pancreatic cancer type, characterized by a dismal prognosis due to late diagnosis, frequent metastases, and limited therapeutic response to standard chemotherapy. Circulating tumor cells (CTCs) are a rare subset of tumor cells found in the blood of cancer patients. CTCs has the potential utility for screening, early and definitive diagnosis, prognostic and predictive assessment, and offers the potential for personalized management. However, a gold-standard CTC detection and enrichment method remains elusive, hindering comprehensive comparisons between studies. In this review, we summarize data regarding the utility of CTCs at different stages of PDAC from early to metastatic disease and discuss the molecular profiling and culture of CTCs. The characterization of CTCs brings us closer to defining the specific CTC subpopulation responsible for metastasis with the potential to uncover new therapies and more effective management options for PDAC.

New metabolic health definition might not be a reliable predictor for diabetes in the nonobese Chinese population

AimTo investigate the predictive values of the new metabolic health (MH) definition for future diabetes in a nonobese Chinese population, compared with the MH definition from metabolic syndrome (MetS). MethodsThe data were collected in 1992 and then again in 2007 from the same group of 653 participants. The risk assessment of the new MH definition and the MH definition from MetS for future diabetes was performed by Cox regression analysis with overlap weighting as the primary analysis. ResultsDuring the follow-up, 62 participants were diagnosed with diabetes. In the primary analysis with overlap weighting, there was no significant association between new MH and diabetes (HR: 1.12; 95% CI: 0.45–2.78, p = 0.803); conversely, based on the MH definition from MetS, the participants with MH were less likely to have had diabetes than the participants with MUHs (HR: 0.41; 95% CI: 0.22–0.78, p = 0.007). Furthermore, other analysis methods also confirmed the reproducibility of abovementioned results. In addition, sensitivity analysis excluding participants with prediabetes also demonstrated similar results with the primary analysis. ConclusionIn contrast to the previous MH definition from MetS, the new MH definition was not a reliable predictor for future diabetes in the nonobese Chinese population.

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects.

BackgroundMillions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear.MethodsSearches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan.ResultsTwenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks.ConclusionThe existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.

Urban road pavements monitoring and assessment using bike and e-scooter as probe vehicles

Comfort and safe-mobility are two aspects that should be provided to non-motorized users that are an increasing component of the urban micro-mobility (e.g. bikes and e-scooters). For these road users, road pavement unevenness, cracks, potholes and other surface defects can make riding uncomfortable and potentially hazardous. Traditionally, road managers use standardized surveys and Key Performance Indicators (KPIs) of pavement to make decision for maintenance programs and pavement management of road urban network poses challenges in the survey of pavement surface for International Roughness Index (IRI) and distress assessment both for operational and cost constrains. Moreover, there are theoretically limitations of IRI model for low speed urban roads and low-damped vehicles like bikes and e-scooters. In such framework aims of the paper is to investigate the use of smartphone sensors to collect data for the assessment of pavement conditions and definition of KPIs for bike and e-scooter users’ ride comfort and safety. A controlled experiment was performed with repeated runs of a bicycle and e-scooter equipped with a smartphone and an android application was used to collect acceleration and position data. Detailed pavement conditions have been identified with an advanced survey equipment. After data treatments for removing signal noise, adjustment for speed variability and outlier detection, root mean square (RMS) of vertical acceleration signal and weighted frequency content of the vibrations according to ISO 2631–1, have been confirmed suitable KPIs of pavement conditions and comfort rating that can be collected by bikes and e-scooter. Results confirmed the lack of correlation of vibrations in bikes and e-scooter with analogous parameters collected with car as probe vehicle and with IRI standard values, as well. Instead, pavement monitoring by bikes and e-scooter can provide effective detection of typologies and severities of distresses not detectable by similar approaches in damped vehicles. Good correlations have been identified between RMS and medium severity alligator, longitudinal and transversal cracks. High severity pavement distress and potholes have been identified by outliers in RMS.

Prevalence, Predictors, and Prognostic Benefits of Remission Achievement in Patients With Systemic Lupus Erythematosus: A Systematic Review.

To systematically review and evaluate the prevalence, potential predictors, and prognostic benefits of remission achievement in patients with systemic lupus erythematosus (SLE). Studies reporting on the prevalence, predictors, and prognostic benefits of remission in adult patients with SLE were searched and selected from PubMed and Embase databases. Studies were reviewed for relevance and quality. Two reviewers independently assessed the studies and extracted data. Data from 41 studies including 17,270 patients were included and analyzed. Although no consensus has been achieved on the definition of remission, clinical disease activity, serologic activity, duration, and treatment are agreed to be critical components of defining remission status. In most studies published in the recent 5 years, 42.4-88% of patients achieved and maintained the remission status for 1 year, and 21.1-70% did so for at least 5 years. Factors associated with remission included older age at diagnosis, lower baseline disease activity, and absence of major organ involvement, while positive serologic results were shown to be negatively associated with remission. Remission (especially prolonged remission) when achieved, demonstrated an association with lower accrual of damage and better quality of life among patients with SLE. Remission is an achievable and desirable target for SLE patients and proven to be associated with prognostic benefits. Further development and assessment of a clear remission definition, a risk stratification model, as well as a full algorithm with frequency of monitoring time points for treatment adjustment and drug withdrawal are required.

Detecting calcified pulp stones in patients with periodontal diseases using digital panoramic and periapical radiographies

Background/purposePulp stones are discrete calcified masses appearing in the dental pulp of healthy, disease and unerupted teeth. They are presented freely within the pulp tissue or attached and embedded in any part of coronal and radicular dentin. Here, the purposes of this study were to identify the presence of pulp stones in periodontal patients using digital panoramic and periapical radiographies, and to determine the association with gender, age, tooth type and dental arch.Materials and methodsThis is a retrospective study on selected records of 465 dental samples obtained between January and December, 2020. Data were collected from patients diagnosed with generalized chronic periodontitis and accepted the full periodontal treatment covered by the Government's Periodontal Health Care Program. Their digital panoramic (DPR) examination and full mouth periapical radiographic (DPA) examination (including 12 periapical and 4 bitewing images) were performed at the Outpatient Clinics of the Department of Stomatology, Taichung Veterans General Hospital. Patients were segregated into various groups according to their age, gender and tooth locations. All radiographic images were examined by a dental radiologist and two dentists to identify the presence of pulp stone calcifications and their associated factors using the Sirona applications software. Records were analyzed using SPSS version 22.0 based on tests of Pearson Chi-square and McNemar correlation.ResultsFrom 271 males and 194 females, a total of 465 DPR and 7440 DPA radiographs were studied. Pulp stone calcifications were identified in 270 (58.0%) subjects in DPR images and 348 (74.8%) subjects in DPA images (for 1 or more teeth per subject). We detected calcified opacities in 1031 teeth with DPR images and in 1326 teeth with DPA images from a total of 12,407 teeth. The incidence of pulp stones was similar across genders, but different in tooth locations and dental arch sextant. Moreover, pulp stones were detected more often on maxillary molars and subjects of old ages (>40 years). Digital panoramic and periapical radiography showed significant differences in the detection of pulp stone calcifications (P < 0.05), and detected better with digital periapical radiography examination.ConclusionWe found 58.0% (n = 645) of our patients with pulp stones using digital panoramic radiography, and 74.8% using digital periapical radiography. Regarding individual teeth, only 8.5% of pulp stones were observed in digital panoramic radiography and 10.6% in digital periapical radiography. Pulp stones were more often seen in maxillary molar teeth and old patients of ages >40 years old using periapical radiography examination especially in those patients with periodontally condition. As a two-dimensional imaging system, digital periapical radiography is recommended for a definitive and routine assessment in patients suspected of hard tissue abnormality and pulp calcification formation.

Evolving images of intimacy and sexuality

Images of intimacy and human sexuality have evolved in our culture. They have long been recognized for their great importance to the individual, community and culture. They were recognized better by studying their images, practices and symbols in other cultures, as well as changes in European culture itself and social change processes. The concepts of the turn of the century and the 20th century discovery of the meaning of these spheres of human life (Freud, Foucault) were also of considerable importance. Images have evolved, knowledge and tolerance seemed to increase (Giddens), but their changes have not ceased to occur and this is assessed in a variety of ways today; there is no definitive assessment. They strongly penetrate the iconosphere of our culture, but they did not automatically caused growth of the consciousness of the importance of fusing them with the differing emotional sphere; it seems, therefore, in some theoretical approaches that it is the thing that lacks most in contemporary imagery. This article analyzes the development of image of intimacy and sexuality in European culture from Freud to the present day. The transformation of the perception of these images is justified by the trends of social development associated with the development of new communication channels; the cosmetic medicine industry based on the self-perception of a person in society. And all this is happening under the pressure of the digital society on the sphere of communications, which massively broadcasts stereotypes through new media that form both individual and collective culture.

Utility of Mini-Clinical Evaluation Exercise in the Assessment of Medical Interns in Simulation based Medical Education: A Pilot Study

Introduction: Medical graduates skill assessment in simulation is underdeveloped and needs due attention in making them proficient. The mini-Clinical Evaluation Exercise (mini-CEX) could be an important tool in assessing and making them perfect through Competency-Based Medical Education (CBME). Aim: To determine utility of mini-CEX as a definitive and reliable assessment tool in high fidelity medical simulation. Materials and Methods: This pilot study was conducted at School of Virtual Learning (SVL) affiliated with JNMC, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (M), Wardha, Maharashtra, India between 1st November 2021- 31st December 2021, on 50 medical interns. The learners were taught of basic clinical examination on SimMan simulator along with training in MiniCEX exercise. The case scenarios on Hypertensive, Valvular, Acute Coronary artery disorders and dysrhythmias cardiac medical emergencies were allotted and the performance of administrators and learners were assessed by mini-CEX. The mini-CEX rating form was used to evaluate the competence and student satisfaction score form was sent to learners for their feedback. The data was collected on online Google form and was tabulated and analysed, descriptive statistics, mean with standard deviation was calculated. Results: The mean age of participants was 22.5±0.53 years. There were 15 males (30%) and 35 females (70%). Average satisfaction score for the assessors was 7.4±1.2 and for the interns was 8.2±0.2. Conclusion: Excellent level of satisfaction was observed in the learners as well as the administrators by use of Mini-CEX format. Hence this exercise can be applied in accessing high fidelity simulation.

Analysis of Trends in Stock Market

Abstract: In the period of AI applications for each and every fragment of examination, breaking down financial exchange costs and patterns has become more famous than previously. We have gathered information of securities exchange utilizing python back end and have proposed a far reaching customization of element designing and profound learning based model for anticipating the pattern of market, The proposed arrangement incorporates pre-handling of the securities exchange dataset, usage of various element designing strategies, joined with a redid profound learning based framework for pattern forecast, Evaluations have been directed on the models and reason that our proposed arrangement beats because of element designing that we constructed. Framework accomplishes decent exactness without the distant element of information overfitting and because of definite assessment of term lengths and strategies, this adds to the stock examination research local area both in monetary and specialized areas. Keywords: Machine-learning, Deep-learning, Python, API, Metrics, Feature Engineering, Stock Market.