High-risk Scenarios Research Articles

Multi-Agent Autonomy: Advancements and Challenges in Subterranean Exploration

Artificial intelligence has undergone immense growth and maturation in recent years, though autonomous systems have traditionally struggled when fielded in diverse and previously unknown environments. DARPA is seeking to change that with the Subterranean Challenge, by providing roboticists the opportunity to support civilian and military first responders in complex and high-risk underground scenarios. The subterranean domain presents a handful of challenges, such as limited communication, diverse topology and terrain, and degraded sensing. Team MARBLE proposes a solution for autonomous exploration of unknown subterranean environments in which coordinated agents search for artifacts of interest. The team presents two navigation algorithms in the form of a metric-topological graph-based planner and a continuous frontier-based planner. To facilitate multi-agent coordination, agents share and merge new map information and candidate goal points. Agents deploy communication beacons at different points in the environment, extending the range at which maps and other information can be shared. Onboard autonomy reduces the load on human supervisors, allowing agents to detect and localize artifacts and explore autonomously outside established communication networks. Given the scale, complexity, and tempo of this challenge, a range of lessons was learned, most importantly, that frequent and comprehensive field testing in representative environments is key to rapidly refining system performance.

Diagnostic Error in Pediatrics: A Narrative Review.

A priority topic for patient safety research is diagnostic errors. However, despite the significant growth in awareness of their unacceptably high incidence and associated harm, a relative paucity of large, high-quality studies of diagnostic error in pediatrics exists. In this narrative review, we present what is known about the incidence and epidemiology of diagnostic error in pediatrics as well as the established research methods for identifying, evaluating, and reducing diagnostic errors, including their strengths and weaknesses. Additionally, we highlight that pediatric diagnostic error remains an area in need of both innovative research and quality improvement efforts to apply learnings from a rapidly growing evidence base. We propose several key research questions aimed at addressing persistent gaps in the pediatric diagnostic error literature that focus on the foundational knowledge needed to inform effective interventions to reduce the incidence of diagnostic errors and their associated harm. Additional research is needed to better establish the epidemiology of diagnostic error in pediatrics, including identifying high-risk clinical scenarios, patient populations, and groups of diagnoses. A critical need exists for validated measures of both diagnostic errors and diagnostic processes that can be adapted for different clinical settings and standardized for use across varying institutions. Pediatric researchers will need to work collaboratively on large-scale, high-quality studies to accomplish the ultimate goal of reducing diagnostic errors and their associated harm in children by addressing these fundamental gaps in knowledge.

The relationship between road traffic collision dynamics and traumatic brain injury pathology.

Road traffic collisions are a major cause of traumatic brain injury. However, the relationship between road traffic collision dynamics and traumatic brain injury risk for different road users is unknown. We investigated 2065 collisions from Great Britain’s Road Accident In-depth Studies collision database involving 5374 subjects (2013–20). Five hundred and ninety-five subjects sustained a traumatic brain injury (20.2% of 2940 casualties), including 315 moderate–severe and 133 mild–probable injuries. Key pathologies included skull fracture (179, 31.9%), subarachnoid haemorrhage (171, 30.5%), focal brain injury (168, 29.9%) and subdural haematoma (96, 17.1%). These results were extended nationally using >1 000 000 police-reported collision casualties. Extrapolating from the in-depth data we estimate that there are ∼20 000 traumatic brain injury casualties (∼5000 moderate–severe) annually on Great Britain’s roads, accounting for severity differences. Detailed collision investigation allows vehicle collision dynamics to be understood and the change in velocity (known as delta-V) to be estimated for a subset of in-depth collision data. Higher delta-V increased the risk of moderate–severe brain injury for all road users. The four key pathologies were not observed below 8 km/h delta-V for pedestrians/cyclists and 19 km/h delta-V for car occupants (higher delta-V threshold for focal injury in both groups). Traumatic brain injury risk depended on road user type, delta-V and impact direction. Accounting for delta-V, pedestrians/cyclists had a 6-times higher likelihood of moderate–severe brain injury than car occupants. Wearing a cycle helmet during a collision was protective against overall and mild-to-moderate-to-severe brain injury, particularly skull fracture and subdural haematoma. Cycle helmet protection was not due to travel or impact speed differences between helmeted and non-helmeted cyclist groups. We additionally examined the influence of the delta-V direction. Car occupants exposed to a higher lateral delta-V component had a greater prevalence of moderate–severe brain injury, particularly subarachnoid haemorrhage. Multivariate logistic regression models created using total delta-V value and whether lateral delta-V was dominant had the best prediction capabilities (area under the receiver operator curve as high as 0.95). Collision notification systems are routinely fitted in new cars. These record delta-V and automatically alert emergency services to a collision in real-time. These risk relationships could, therefore, inform how routinely fitted automatic collision notification systems alert the emergency services to collisions with a high brain injury risk. Early notification of high-risk scenarios would enable quicker activation of the highest level of emergency service response. Identifying those that require neurosurgical care and ensuring they are transported directly to a centre with neuro-specialist provisions could improve patient outcomes.

“Mitigation strategies for post-operative pancreatic fistula after pancreaticoduodenectomy in high-risk pancreas: an evidence-based algorithmic approach”—a narrative review

Postoperative pancreatic fistula (POPF) is associated with a mortality of up to 25% apart from significant morbid sequelae related to abdominal sepsis and post pancreatectomy hemorrhage. Numerous strategies to curtail the risk of POPF and associated morbidity have been largely unsuccessful. The pancreaticoenteric anastomosis post pancreaticoduodenectomy in a high-risk pancreas represents a significant surgical and clinical challenge. In this narrative review, we present the strategies for early identification and comprehensive management of the high-risk pancreas as per the available literature and present a stepwise algorithmic approach of different fistula mitigation strategies in patients undergoing pancreaticoduodenectomy. Medline, PubMed, Embase, Cochrane Library, and various center-specific guidelines were searched for the pancreas, pancreatic cancer, pancreatectomy, pancreatoduodenectomy, Whipple's operation, postoperative, complications, fistula, High-risk pancreas, risk assessment, different predictors, and scoring systems for the high-risk pancreas, current and emerging concepts in the development of POPF and mitigation strategies management and treatment in various combinations. Over the years, literature has mainly addressed the technical aspects of pancreatico-enteric anastomosis; however, the impact of different technical modifications has been at the most elusive. Recent literature has focused on other aspects like remnant ischemia, locoregional inflammation, and postoperative acute pancreatitis among others, defining their evolving role in pathophysiology of POPF. Although many pre-operative risk prediction models are available; their intra-operative implications are not clear. Furthermore, the evidence available on the mitigation strategies is limited, heterogeneous, and center specific. Fistula prediction includes numerous potentiating factors in addition to the factors described in various Fistula Risk Scores. Early identification of these high-risk scenarios allows the algorithmic application of mitigation strategies. Management of the high-risk pancreas starts in the pre-operative period by early identifications of the risk factors and then continues into the intra-operative period with strategies to decrease intraoperative blood loss, precise anastomosis, and external stenting wherever feasible; goal-directed fluid therapy as well as total pancreatectomy (TP) in certain highly selected scenarios followed by early identification of complications in the postoperative period and appropriate and early management of the same. The coherent application of these mitigation strategies provides the opportunity for the best possible outcome in this complicated scenario. At present, the zero post-operative pancreatic fistulae seem unattainable, and time has come to study the strategies outside the operation theatre. Till preventive strategies become mainstream, a strategic personalized algorithmic approach may yield best outcomes.

Evaluation of disease alert systems for postbloom fruit drop of citrus in Florida and economic impact of adopting the Citrus Advisory System

Gama, A. B., Peres, N. A., Singerman, A., and Dewdney, M. M. 2021. Evaluation of disease alert systems for postbloom fruit drop of citrus in Florida and economic impact of adopting the Citrus Advisory System. Crop Protec. XX: xx-xx.Postbloom fruit drop of citrus (PFD) is caused by Colletotrichum abscissum in the Colletotrichum acutatum species complex. PFD does not occur annually but some growers tend to apply fungicides during flowering every year, wasting resources and negatively impacting the environment. Due to its sporadicity, the Fungicide Application Decision system (PFD-FAD) and the Citrus Advisory System (CAS) were developed in Florida and Brazil in 2001 and 2017, respectively, to aid in PFD management. Our objectives were to compare the recommendations from CAS and PFD-FAD, a weekly fungicide treatment schedule, and a nontreated control. We also aimed to assess the economic impact of adopting CAS over the other fungicide schedule treatments with low- and high-risk aversion profile scenarios. Weather conditions were not favorable to PFD in seven field trials. We performed one fungicide application based on CAS over four seasons. An average of approximately 2 and 3 fungicide applications per trial was performed based on PFD-FAD and the weekly treatments, respectively. Average cost to manage PFD following CAS, PFD-FAD, and the weekly treatments were, respectively, $17.52, $186.87, and $272.35. The reduction in management costs related to CAS also translates to reduced use of commercial fungicide formulations in small properties by 382 and 573 L compared to PFD-FAD and the weekly treatments, respectively. CAS recommendations greatly reduced production costs and fungicide usage without compromising disease control and citrus yield in years of low weather favorability for PFD in Florida.

Quantitative analysis of the effectiveness of thermal insulations for mitigating the probability of thermal runaway occurrence by using 1DCAE

Battery energy storage systems (BESSs) consisting of lithium-ion batteries (LIBs) are being increasingly used to supplement the unstable electrical power derived from renewable energy sources. As stipulated by the International Electrotechnical Commission, BESSs must be assessed for any risks, including thermal runaway (TR) and thermal runaway propagation (TRP), at the module level as well as the final system level. Several studies have focused on the hazards and risk assessments (RAs) of BESSs; however, the assessment of system-level risks is challenging due to complex system-level interactions in BESSs, which involve multiphysics and dynamic phenomena. Therefore, we have focused on using 1D model, which can model multiphysics system-level interactions between system components in multiple physical domains. This study aims at a quantitative analysis of the effectiveness of thermal insulations for the prevention of the TRP scenario that a TR of a LIB propagates to other adjacent batteries as one of the high-risk scenarios in a battery module. To estimate the frequency of the scenarios, we applied the model which was able to predict the temperature profile of individual batteries in a battery module. The probability of TRP occurred in a battery module was estimated via the TRP occurrence rate by Monte Carlo simulations using the 1D model, which considers the probability distribution of the design parameters of individual LIBs or the components of a BESS. As a result, it was possible to conduct a quantitative analysis of the effectiveness on reducing the probability of a TRP scenario due to model changes.

MetaBoost: A Novel Heterogeneous DCNNs Ensemble Network With Two-Stage Filtration for SAR Ship Classification

Current synthetic aperture radar (SAR) ship classification research mainly focuses on modifying deep convolutional neural networks (DCNNs) and injecting manual features on DCNNs. Yet, the weak robustness of individual models in high-risk scenarios makes it difficult to gain the trust of SAR experts. In this letter, an automated method of heterogeneous DCNNs model ensemble based on two-stage filtration (MetaBoost) is proposed, effectively achieving robustness and high accuracy recognition on SAR ship classification. The principle of MetaBoost is generating a pool of diverse heterogeneous classifiers, selecting a subset of the most diverse and accurate classifiers, and finally fusing meta-features from the optimal subset. MetaBoost is a self-configuring algorithm that automatically determines the optimal type and number of base classifiers to be combined. Extensive experiments on the OpenSARShip and FUSAR-Ship datasets show that MetaBoost significantly outperforms individual classifiers, traditional ensemble models, and feature injection techniques.

Stress level and heart rate variability in police post-occurrence of bank robbery: an experience report.

The expectation of armed confrontation is among the most stressful elements in police work. Knowledge about perceived stress and cardiovascular markers in police officers comes from simulations. However, to date, information about psychophysiological responses during high-risk occurrences is scarce. To assess stress levels and heart rate variability in policemen before and afer atending a bank robbery. Elite police officers (30.4 ± 3.7yrs) filled in a stress questionnaire and had their heart rate variability monitored at the beginning (7:00 am) and at the end (7:00 pm) of a work shif. At about 5:30 pm, these policemen were called to respond to a bank robbery in progress. No significant changes in sources or symptoms of stress were found between before and afer the incident. However, statistical reductions were found in heart rate range interval (R-R interval [-13.6%]), pNN50 (-40.0%), and low frequency (-28%) and the low frequency/high frequency ratio increased (200%). These results suggest that although no change in the level of perceived stress was found, a significant reduction in heart rate variability may be atributed to a reduction in activation of the parasympathetic system. The expectation of armed confrontation is among the most stressful occurrences in police work. Research knowledge about perceived stress and cardiovascular markers in police officers comes from simulations. Data on psychophysiological responses post-occurrence of high-risk scenarios are scarce. This research may help law enforcement organizations find means to monitor police officers' acute stress levels afer any high-risk occurrences.

Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy: A Systematic Review and Meta-analysis.

To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking. We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link. We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%). Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.

Loss of SATB2 Occurs More Frequently Than CDX2 Loss in Colorectal Carcinoma and Identifies Particularly Aggressive Cancers in High-Risk Subgroups

Simple SummaryThe immunohistochemical analysis of Special AT-rich sequence-binding protein 2 (SATB2) is increasingly being used to detect colorectal differentiation. Our study aimed to investigate SATB2 expression levels and the prognostic relevance of SATB2 loss in colorectal carcinoma (CRC), especially in comparison with CDX2, the standard marker of colorectal differentiation. We tested SATB2 expression in 1039 CRCs and identified SATB2 as a strong prognosticator in the overall cohort as well as in specific subcohorts, including high-risk subgroups. Compared to CDX2, SATB2 showed a higher prognostic power but was lost at a much higher frequency, generally rendering SATB2 as the less sensitive marker for colorectal differentiation compared to CDX2.Background: Special AT-rich sequence-binding protein 2 (SATB2) has emerged as an alternative immunohistochemical marker to CDX2 for colorectal differentiation. However, the distribution and prognostic relevance of SATB2 expression in colorectal carcinoma (CRC) have to be further elucidated. Methods: SATB2 expression was analysed in 1039 CRCs and correlated with clinicopathological and morphological factors, CDX2 expression as well as survival parameters within the overall cohort and in clinicopathological subgroups. Results: SATB2 loss was a strong prognosticator in univariate analyses of the overall cohort (p < 0.001 for all survival comparisons) and in numerous subcohorts including high-risk scenarios (UICC stage III/high tumour budding). SATB2 retained its prognostic relevance in multivariate analyses of these high-risk scenarios (e.g., UICC stage III: DSS: p = 0.007, HR: 1.95), but not in the overall cohort (DSS: p = 0.1, HR: 1.25). SATB2 loss was more frequent than CDX2 loss (22.2% vs. 10.2%, p < 0.001) and of higher prognostic relevance with only moderate overlap between SATB2/CDX2 expression groups. Conclusions: SATB2 loss is able to identify especially aggressive CRCs in high-risk subgroups. While SATB2 is the prognostically superior immunohistochemical parameter compared to CDX2 in univariate analyses, it appears to be the less sensitive marker for colorectal differentiation as it is lost more frequently.

BNT162b2 mRNA Vaccine Effectiveness Given Confirmed Exposure: Analysis of Household Members of Coronavirus Disease 2019 Patients.

BackgroundWhile BNT162b2 vaccine-efficacy analyses were previously published, the effectiveness of the vaccine in preventing COVID-19 given confirmed exposure has not been previously demonstrated, even though it has policy implications, such as the need for self-quarantine when exposure has occurred or protective measures for vaccinated individuals in high-risk areas.MethodsIn a retrospective cohort study, we used data collected between 20/12/2020 and 17/03/2021 from the second largest healthcare provider in Israel to analyze the probability of an additional household infection occurring within 10 days after an index infection. In model 1, vaccine effectiveness was described for Fully Vaccinated individuals (7 or more days from second dose) versus either Unvaccinated participants or those Recently Vaccinated Once (0-7 days from the first dose, presumably still unprotected). Secondary analyses included correction for differing testing rates. In model 2, we conducted a separate analysis of households comprised of only adults with the same vaccination status.Results173,569 households were included, of which 6,351 households had an index infection (mean [SD] age, 58.9 [13.5] years; 50% were women).Adjusted vaccine effectiveness of Fully Vaccinated compared to Unvaccinated participants was 80.3% [95% CI, 73.5 to 85.4] and 82.0% [95% CI, 75.6 to 86.8] compared to those Recently Vaccinated Once.ConclusionsThe BNT162b2 vaccine is effective in a high-risk real-life exposure scenario, but the protection rates afforded in these settings are lower than those previously described. Household members of patients infected with SARS-CoV-2 and individuals with a confirmed significant exposure to SARS-CoV-2 are still at risk of being infected even if fully vaccinated.

UK Women's Views of the Concepts of Personalised Breast Cancer Risk Assessment and Risk-Stratified Breast Screening: A Qualitative Interview Study.

Simple SummaryRisk-based breast screening will involve tailoring the amount of screening to women’s level of risk. Therefore, women at high-risk may be offered more frequent screening and over a longer period of time than those at low risk for whom less screening may be recommended. As this will involve considerable changes to the NHS Breast Screening Programme, it is important to explore what women in the UK think and feel about this approach. Analysis of in-depth interviews revealed that some women would find both high and low-risk screening options acceptable whereas others were resistant to the prospect of reduced screening if they were assessed as low-risk. We also found that the idea of risk-based screening had little influence on the attitudes of women who were already sceptical about breast screening. These findings highlight the communication challenges that will be faced by those introducing risk-based screening and suggest a need for tailored support and advice.Any introduction of risk-stratification within the NHS Breast Screening Programme needs to be considered acceptable by women. We conducted interviews to explore women’s attitudes to personalised risk assessment and risk-stratified breast screening. Twenty-five UK women were purposively sampled by screening experience and socioeconomic background. Interview transcripts were qualitatively analysed using Framework Analysis. Women expressed positive intentions for personal risk assessment and willingness to receive risk feedback to provide reassurance and certainty. Women responded to risk-stratified screening scenarios in three ways: ‘Overall acceptors’ considered both high- and low-risk options acceptable as a reasonable allocation of resources to clinical need, yet acceptability was subject to specified conditions including accuracy of risk estimates and availability of support throughout the screening pathway. Others who thought ‘more is better’ only supported high-risk scenarios where increased screening was proposed. ‘Screening sceptics’ found low-risk scenarios more aligned to their screening values than high-risk screening options. Consideration of screening recommendations for other risk groups had more influence on women’s responses than screening-related harms. These findings demonstrate high, but not universal, acceptability. Support and guidance, tailored to screening values and preferences, may be required by women at all levels of risk.

The Conflict Between People's Urge to Punish AI and Legal Systems.

Regulating artificial intelligence (AI) has become necessary in light of its deployment in high-risk scenarios. This paper explores the proposal to extend legal personhood to AI and robots, which had not yet been examined through the lens of the general public. We present two studies (N = 3,559) to obtain people’s views of electronic legal personhood vis-à-vis existing liability models. Our study reveals people’s desire to punish automated agents even though these entities are not recognized any mental state. Furthermore, people did not believe automated agents’ punishment would fulfill deterrence nor retribution and were unwilling to grant them legal punishment preconditions, namely physical independence and assets. Collectively, these findings suggest a conflict between the desire to punish automated agents and its perceived impracticability. We conclude by discussing how future design and legal decisions may influence how the public reacts to automated agents’ wrongdoings.

Impact of the COVID-19 Pandemic on Prostate Cancer Radiotherapy Practice Patterns: A Northeast Regional Longitudinal Survey Study

Purpose/Objective(s)During the COVID-19 pandemic, the National Comprehensive Cancer Network (NCCN) provided management guidelines for prostate cancer (PCa) patients undergoing radiation therapy (RT). It is unknown whether or not radiation oncologists adopted these treatment recommendations. We assessed whether Northeast (NE) radiation oncologists managed PCa differently or according to guidelines during the 2020 Spring and the 2020-2021 Winter surges, as this region was affected profoundly by both waves.Materials/Methods847 NE radiation oncologists were identified from the ASTRO membership directory. The NE region was defined as states of: CT, MA, ME, NH, NJ, NY, PA, RI, VT. A link to an anonymous electronic survey was disseminated with hypothetical PCa patient scenarios for RT during the COVID-19 pandemic to elucidate practice patterns. Eligible participants had to indicate they regularly treat PCa patients. The initial survey was distributed in early Summer 2020 to understand practice patterns during the Spring surge. During the COVID-19 Winter peak, participants who voluntarily provided their email addresses not linked to survey responses were recontacted to complete a follow-up (FU) survey.ResultsOf 847 initial survey invitations, 333 participants indicated that they did not treat PCa. Of the remaining 514 participants, 151 indicated that they treated PCa and fully completed the survey (30% response rate). The response rate among 100 participants for the FU survey was 68%. Among initial respondents, 59% practice in non-academic settings. For favorable intermediate-risk PCa scenarios, 55% of respondents elected to delay moderately/conventionally fractionated RT in the initial survey. In the FU survey, 75% of respondents were in favor of treating without delay. For unfavorable intermediate- and high-risk PCa scenarios after three months of androgen deprivation therapy (ADT), 53.4% elected to delay scheduled RT in the initial survey, while 85% would treat as planned in the FU survey. In the above scenarios, there was little consideration of a 5 fraction RT schedule. For the post-prostatectomy salvage scenario where no ADT was considered, 35% favored treating with 1.8-2 Gy per fraction without delay during the initial survey (3% favored 20 fractions); 60% elected to move forward with RT in the FU survey.ConclusionThis survey evaluated NE radiation oncology PCa practice patterns during the COVID-19 pandemic, finding that most physicians were in favor of delaying RT during the Spring surge, in concordance with the NCCN recommendation. Subsequently, the winter surge FU survey demonstrated that physicians were more comfortable treating without delay. This is likely attributed to increased health and safety guidelines, as well as policies in place to minimize exposure in radiation oncology departments.

Pregnancy in women with hypertrophic cardiomyopathy: observational data from the tertiary referral center registry

Abstract Introduction The number of cases of hypertrophic cardiomyopathy (HCM) in pregnancy increases every year. In most cases the course of pregnancy is favorable, however in certain high–risk scenarios there is an increased risk of complications (e.g., increased ventricular ectopic activity, heart failure exacerbation). Management heavily relies on the severity of the outflow tract obstruction, extent of left ventricular hypertrophy and sudden cardiac death (SCD) risk stratification. Purpose The main objective of this study is to assess risk factors and complications during pregnancy, childbirth and the postpartum period in women with HCM. Methods In this retrospective study we included 60 pregnant women with HCM who were admitted to the tertiary referral center between October 2010 and December 2019 with a mean age of 29.1±5.19 years. ECHO was performed in all patients. Results Twenty patients (33%) have obstructive HCM (HOCM), 31 patients (51,6%) were nulliparous, 20 patients (33%) had no clinical symptoms prior to pregnancy. Since the third trimester of pregnancy we observed the onset or exacerbation of heart failure in 26 (43.3%) cases, half of these patients presented with NYHA class III–IV. SCD risk was 3.64% (2.66 –5.84) in the third trimester. Six patients (9.23%) were required ICD implantation. Caesarean section (CS) delivery was performed in 38 patients (63.3%). However, the CS proportion has decreased from 80% to 51% in the last 5 years. Despite frequent complications during pregnancy and the postpartum period, no maternal mortality has been reported. The newborns' weight in HOCM cases was significantly lower than in patients without LVOT obstruction. Conclusion Despite the favorable course of pregnancy in HCM patients, the third trimester of pregnancy was often accompanied by the onset and progression of heart failure, as well as an increase in the proportion of patients with ventricular arrhythmias. In patients with HOCM, a decrease in the weight of newborns was revealed. Funding Acknowledgement Type of funding sources: None. Characteristics of women with HCP

Automatic label-free immunoassay with high sensitivity for rapid detection of SARS-CoV-2 nucleocapsid protein based on chemiluminescent magnetic beads

Accurate and efficient early diagnosis is crucial for the control of COVID-19 pandemic. However, methods that can balance sensitivity, high throughput, detection speed and automation simultaneously are still scarce. Here, we report an automatic label-free chemiluminescence immunoassay (CLIA) for rapid SARS-CoV-2 nucleocapsid protein (NP) detection with high sensitivity and throughput. N-(4-aminobutyl)-N-ethylisoluminol and Co2+ dual-functionalized chemiluminescent magnetic beads (dfCL-MB) were first applied to the detection of protein by a novel and simple strategy. Sulphydryl polyethylene glycol was coated on the surface of dfCL-MB so as to assemble dfCL-MB and antibody conjugated gold nanoparticles through Au-S bond. Considering the high-risk application scenarios, the immunosensor was integrated with an automatic chemiluminescence analyzer so that the whole testing procedure could be carried out automatically without manual operation. A linear correlation between CL intensities and the logarithm of NP concentration was obtained in the range of 0.1–10,000 pg/mL with a detection limit of 21 fg/mL. The whole process cost 25 min and the sample compartment can bear 24 samples simultaneously. The spiked human serum samples and serum samples from COVID-19 patients were determined with satisfactory recoveries of 91.1–109.4%, suggesting that the proposed label-free CLIA is of great potential for SARS-CoV-2 NP detection in practice.

Deep Learning Based Steel Pipe Weld Defect Detection

ABSTRACT Steel pipes are widely used in high-risk and high-pressure scenarios such as oil, chemical, natural gas, shale gas, etc. If there is some defect in steel pipes, it will lead to serious adverse consequences. Applying object detection in the field of deep learning to pipe weld defect detection and identification can effectively improve inspection efficiency and promote the development of industrial automation. Most predecessors used traditional computer vision methods applied to detect defects of steel pipe weld seams. However, traditional computer vision methods rely on prior knowledge and can only detect defects with a single feature, so it is difficult to complete the task of multi-defect classification, while deep learning is end-to-end. In this paper, the state-of-the-art single-stage object detection algorithm YOLOv5 is proposed to be applied to the field of steel pipe weld defect detection and compared with the two-stage representative object detection algorithm Faster R-CNN. The experimental results show that applying YOLOv5 to steel pipe weld defect detection can greatly improve the accuracy, complete the multi-classification task, and meet the criteria of real-time detection.

Patterns of Thromboembolism in Patients with Advanced Pancreatic Cancer Undergoing First-Line Chemotherapy with FOLFIRINOX or Gemcitabine/nab-Paclitaxel.

Recent advances in prophylactic anticoagulation and antineoplastic treatment for advanced pancreatic cancer (aPC) warrant an updated reassessment of thromboembolic risk in this population. This multicenter retrospective cohort study aims to comprehensively characterize incidence, risk factors, and outcomes of venous (VTE) and arterial thromboembolism (ATE) in homogenously treated patients with aPC. Four hundred and fifty-five patients with aPC undergoing palliative first-line chemotherapy (Gemcitabine/nab-Paclitaxel (GN) or FOLIRINOX) were included. Primary outcomes were objectively confirmed VTE and/or ATE. Over a median follow-up of 26 months, 86 VTE (cumulative incidence: 20.0%; 95% confidence interval [CI]: 16.3-24.0) and 11 ATE events (cumulative incidence: 2.8%; 95% CI: 1.5-4.9) were observed. VTE diagnosis was associated with increased mortality (transition hazard ratio [THR]: 1.59 [95% CI: 1.21-2.09]) and increased risk of cancer progression (THR: 1.47 [95% CI: 1.08-2.01]), while the impact of ATE on mortality was numerically but not statistically significant (THR: 1.85 [95% CI: 0.87-3.94]). The strongest predictor of increased VTE risk was history of cancer-associated VTE (subdistribution hazard ratio [SHR]: 3.29 [95% CI: 2.09-5.18]), while the Khorana score (SHR: 0.78 [0.57-1.06]) failed to predict VTE risk. A history of cerebrovascular disease was associated with markedly increased ATE risk (SHR: 22.05 [95% CI: 6.83-71.22], p < 0.001), especially ischemic stroke. Risk of VTE/ATE did not significantly differ according to type of first-line chemotherapy. Patients with aPC undergoing palliative first-line chemotherapy with FOLFIRINOX or GN face a high risk for VTE/ATE and its diagnosis is linked to worse clinical outcomes. VTE-risk prediction models have limited ability to sub-stratify thrombotic events in this high-risk scenario.

Risk Analysis on PMMA Recycling Economics.

Poly(methyl methacrylate) (PMMA) is a versatile polymer with a forecast market of 4 Mtons/y by 2025, and 6 USD billion by 2027. Each year, 10% of the produced cast sheets, extrusion sheets, or granules PMMA end up as post-production waste, accounting for approximately 30 000 tons/y in Europe only. To guide the future recycling efforts, we investigated the risks of depolymerization process economics for different PMMA scraps feedstock, capital expenditure (CAPEX), and regenerated MMA (r-MMA) prices via a Monte-Carlo simulation. An analysis of plastic recycling plants operating with similar technologies confirmed how a maximum 10 M USD plant (median cost) is what a company should aim for, based on our hypothesis. The capital investment and the r-MMA quality have the main impacts on the profitability. Depending on the pursued outcome, we identified three most suitable scenarios. Lower capital-intensive plants (Scenarios 4 and 8) provide the fastest payback time, but this generates a lower quality monomer, and therefore lower appeal on the long term. On 10 or 20 years of operation, companies should target the very best r-MMA quality, to achieve the highest net present value (Scenario 6). Product quality comes from the feedstock choice, depolymerization, and purification technologies. Counterintuitively, a plant processing low quality scraps available for free (Scenario 7), and therefore producing low purity r-MMA, has the highest probability of negative net present value after 10 years of operation, making it a high-risk scenario. Western countries (especially Europe), call for more and more pure r-MMA, hopefully comparable to the virgin material. With legislations on recycled products becoming more stringent, low quality product might not find a market in the future. To convince shareholders and government bodies, companies should demonstrate how funds and subsidies directly translate into higher quality products (more attractive to costumers), more economically viable, and with a wider market.

The Influence of the Availability Heuristic on Physicians in the Emergency Department

Heuristics, or rules of thumb, are hypothesized to influence the care physicians deliver. One such heuristic is the availability heuristic, under which assessments of an event's likelihood are affected by how easily the event comes to mind. We examined whether the availability heuristic influences physician testing in a common, high-risk clinical scenario: assessing patients with shortness of breath for the risk of pulmonary embolism. We performed an event study from 2011 to 2018 of emergency physicians caring for patients presenting with shortness of breath to 104 Veterans Affairs (VA) hospitals. Our measures were physician rates of pulmonary embolism testing (D-dimer and/or computed tomography scan) for subsequent patients after having a patient visit with a pulmonary embolism discharge diagnosis, hypothesizing that physician rates of pulmonary embolism testing would increase after having a recent patient visit with a pulmonary embolism diagnosis due to the availability heuristic. The sample included 7,370 emergency physicians who had 416,720 patient visits for shortness of breath. The mean rate of pulmonary embolism testing was 9.0%. For physicians who had a recent patient visit with a pulmonary embolism diagnosis, their rate of pulmonary embolism testing for subsequent patients increased by 1.4 percentage points (95% confidence interval 0.42 to 2.34) in the 10 days after, which is approximately 15% relative to the mean rate of pulmonary embolism testing. We failed to find statistically significant changes in rates of pulmonary embolism testing in the subsequent 50 days following these first 10 days. After having a recent patient visit with a pulmonary embolism diagnosis, physicians increase their rates of pulmonary embolism testing for subsequent patients, but this increase does not persist. These results provide large-scale evidence that the availability heuristic may play a role in complex testing decisions.