Training Patterns Research Articles

4Dimensional XStrain Echocardiography: Comprehensive Evaluation of Non-obstructive Hypertrophic Cardiomyopathy- A Case Report and Review of Literature

Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiomyopathy, which is occasionally challenging to differentiate from hypertensive heart disease and athletes heart on the basis of morphologic or functional abnormalities alone. Imaging studies provide solution for majority of clinical presentations. Generally, transthoracic echocardiography (TTE) is employed as a first line imaging tool and contrast enhanced echocardiography (CEE), contrast tuned imaging echocardiography (CTIE), cardiac magnetic resonance (CMR), cardiac computed tomography (CCT), cardiac nuclear imaging and speckle tracking echocardiography (STE) are encouraged for either suboptimal studies because of poor visualization of left ventricular (LV) cavity or for comprehensive delineation of the cardiac anatomy, its widespread left and right ventricular involvement, associations and complications. We are reporting a case of 48-year old male presenting to us with atypical chest pain and a history of suspicious solitary episode of syncope. His routine ECG was indicative of left ventricular hypertrophy with strain pattern, and his TTE was substandard and inadequate in the apical four chamber (4CH) and five chamber (5CH) views, hence CTIE was performed without the application of intravenous contrast agents, to produce a remarkable illustration of HCM.
 Keywords: Hypertrophic cardiomyopathy, contrast echocardiography, contrast tuned imaging, speckle tracking echocardiography, 4Dimensional XStrain, Non obstructive HCM

Study on the Bending Performance of High-Strength and High-Ductility CRE-Reinforced Concrete Beams

Constant resistance energy (CRE) steel reinforcement has a yield strength of up to 750 MPa and an ultimate elongation of more than 20%. CRE reinforcement overcomes the contradiction between high yield strength and high uniform elongation of ordinary high-strength bars. This paper explores the flexural performance and load-carrying mechanisms of CRE-reinforced concrete beams through a series of experiments, while also presenting a theoretical analytical method for such specimens. Flexural tests on six CRE-reinforced concrete beams and two control tests on hot-rolled ribbed bar 400 (HRB400)-reinforced concrete beams were conducted in this paper. The study examines the influence of the shear–span ratio and reinforcement type on the mechanical response of the beams, including cracking load, yield load, and ultimate load, while analyzing the variation patterns of concrete strain and reinforcement strain. The experimental results demonstrate that as the shear–span ratio decreases, the crack resistance and load-carrying capacity of CRE-reinforced concrete beams improve. Under equivalent conditions, CRE-reinforced concrete beams exhibit higher load-carrying capacity compared to HRB-reinforced concrete beams, surpassing the latter by approximately 43% in terms of ultimate load. Additionally, this paper proposes a calculation method for the mechanical response of NPR-reinforced concrete beams and compares the theoretical values with the experimental values. The differences between the two are within 13%, which proves the reliability of the calculation method.

PENGEMBANGAN DAN POLA PEMBINAAN INDUSTRI KREATIF ‘SONGKOK RECCA’ DESA PACCING KABUPATEN BONE

The main problem in this research is how the development and pattern of fostering the Songkok Recca creative industry in Paccing Village, Awangpone District, Bone Regency. This study aims to determine the development of the Songkok Recca creative industry in Paccing Village, Awangpone District, Bone Regency and to determine the patterns of fostering and regenerating the Songkok Recca creative industry in Paccing Village, Awangpone District, Bone Regency. The method used in this research is descriptive qualitative method.The subjects in this research were craftsmen who had decades of experience and Songkok Recca entrepreneurs who had also carried out their activities for many years. This research data was obtained through observation techniques, interviews and documentation which were used to obtain concrete data related to this research problem.The results of this research show the development and pattern of fostering the Songkok Recca creative industry in Paccing village, Awangpone District, Bone Regency. Songkok Recca has undergone various developments, including developing motifs, developing shapes and developing the materials used. Likewise, the development of marketing for Songkok Recca productionIt has spread to overseas countries such as Australia and Malaysia. For training patterns for craftsmen carried out in the form of divisions. There are those that are built specifically to make just the base part, there are those that are built specifically to make only the surrounding parts and there are also those that are built to make from the base to the end a Songkok Recca. Furthermore, for regeneration training, the craftsmen hold training and training within their respective families which is intended as the next generation of their creative industry efforts so that the Songkok Recca creative industry in Paccing village, Awangpone subdistrict, Bone Regency continues to develop and be sustainable.

Complete stress-strain analysis of masonry prisms under compressive loading-unloading cycles through digital image correlation

This paper presents the findings of an experimental study focused on the behaviour of masonry structures subjected to uniaxial loading-unloading compression. The study's primary objective is to examine the impact of joint mortar on the failure mode and the development of permanent strains using the digital image correlation technique (DIC). Masonry prisms were constructed using two types of fired bricks and five different mortars, each with varying cement and lime contents. The prisms were instrumented with a linear variable differential transformer (LVDT) for displacement measurements and prepared for image processing using DIC. The prisms were then subjected to compression testing until failure to capture their complete behaviour. The experimental results obtained through DIC and LVDT measurements showed good agreement. The DIC technique proved its effectiveness in providing comprehensive strain evaluations of the brick prisms, enabling a detailed stress-strain analysis at a full-scale level. Furthermore, the study revealed that prisms with lower cement content exhibited a more ductile behaviour in the post-peak region, with strain localisation observed at the joint mortar interface.To validate DIC's reliability in characterising masonry's cyclic behaviour, the results obtained from analytical modelling were compared with those derived from DIC. This comparison aimed to confirm the accuracy and consistency of DIC measurements. Overall, this study contributes to our understanding of masonry behaviour under compression and highlights the capabilities of DIC in capturing strain patterns and providing valuable insights into the influence of joint mortar on the structural response of masonry elements.

Molecular Characterization and Antibiotic Susceptibility Pattern of Bacterial Strains Isolated From Wound of Patients With Diabetes.

Diabetic wound infections are susceptible to various pathogens, particularly bacteria, due to the immunocompromised state of diabetic patients. Staphylococcus aureus is frequently implicated in diabetic wounds. To ascertain the presence of multiple antibiotic resistance in bacterial pathogens derived from diabetic wound infections, a comprehensive analysis is required. The present cross-sectional investigation was carried out at a tertiary care facility. The samples were collected in aseptic conditions from the Endocrinology unit, specifically from local in-hospital patients (n=140). These samples were then assessed for their susceptibility to the commonly used antibacterial medications within the study area. The specimens were obtained from the lesions of individuals diagnosed with diabetes. The subjects were subjected to inoculation using various media and cultures. The findings of this study revealed that a collective sum of 122 bacterial isolates was acquired. The conclusions of the antibiotic susceptibility analysis revealed that the gram-positive isolates had a higher level of resistance to penicillin G (93.18%). However, they demonstrated sensitivity to vancomycin (100%) and linezolid (LZD) (95%). The gram-negative isolates exhibited complete resistance, at a rate of 100%, to penicillin, specifically amoxicillin (AMC), as well as to sulfonamides, such as sulfamethoxazole/trimethoprim (SXT), which belong to the antibiotic classes mentioned. In conclusion, there has been a notable rise in antibiotic resistance.

Patterns in Complex Aortic Vascular Surgery Training and Early Career Practice

Recent literature has suggested a decreasing experience with open aortic surgery among recent vascular surgery graduates. While trainees have a wide exposure to endovascular aortic repair, experience with both endovascular and open management of thoracoabdominal aneurysms, as well as the early career surgeon comfort with these procedures, remains unknown. Thus, we sought to evaluate early practice patterns in the surgical treatment of complex aortic surgery among recent U.S. vascular surgery graduates. An anonymous survey was distributed all vascular surgeons who completed vascular surgery residency or fellowship in 2020. Self-reported data assessed the number and type of cases performed in training, surgeon experience in early practice, and surgeon desire for additional training in these areas. A total of 62 surgeons completed the survey with a response rate of 35%. Seventy-nine percent of respondents completed fellowship training (as compared to integrated residency), and 87% self-described as training in an academic environment. Sixty-six percent performed fewer than 5 open thoracoabdominal aortic surgeries and 58% performed fewer than 5 four-vessel branched/fenestrated aortic repairs (F/BEVAR), including 56% who completed fewer than 5 physician modified endovascular grafts repairs. Only 11% of respondents felt adequately prepared to perform open thoracoabdominal operations following training. For both open and F/BEVAR procedures, more than 80% respondents plan to perform such procedures with a partner in their current practice, and the majority desired additional open (61%) and endovascular (59%) training for the treatment of thoracoabdominal aneurysms. The reported infrequency in open thoracoabdominal and multi-vessel branched/fenestrated aortic repair training highlights a desire and utility for an advanced aortic training paradigm for surgeons wishing to focus on this area of vascular surgery. Further research is warranted to determine the optimal way to provide such training, whether through advanced fellowships, junior faculty apprenticeship models, or regionalization of this highly complex patient care. The creation of these programs may provide pivotal opportunity, as vascular surgery and the management of complex aortic pathology continues to evolve.

Ceftiofur treatment of sows results in long-term alterations in the nasal microbiota of the offspring that can be ameliorated by inoculation of nasal colonizers

BackgroundThe nasal microbiota of the piglet is a reservoir for opportunistic pathogens that can cause polyserositis, such as Glaesserella parasuis, Mycoplasma hyorhinis or Streptococcus suis. Antibiotic treatment is a strategy to control these diseases, but it has a detrimental effect on the microbiota. We followed the piglets of 60 sows from birth to 8 weeks of age, to study the effect of ceftiofur on the nasal microbiota and the colonization by pathogens when the treatment was administered to sows or their litters. We also aimed to revert the effect of the antibiotic on the nasal microbiota by the inoculation at birth of nasal colonizers selected from healthy piglets. Nasal swabs were collected at birth, and at 7, 15, 21 and 49 days of age, and were used for pathogen detection by PCR and bacterial culture, 16S rRNA amplicon sequencing and whole shotgun metagenomics. Weights, clinical signs and production parameters were also recorded during the study.ResultsThe composition of the nasal microbiota of piglets changed over time, with a clear increment of Clostridiales at the end of nursery. The administration of ceftiofur induced an unexpected temporary increase in alpha diversity at day 7 mainly due to colonization by environmental taxa. Ceftiofur had a longer impact on the nasal microbiota of piglets when administered to their sows before farrowing than directly to them. This effect was partially reverted by the inoculation of nasal colonizers to newborn piglets and was accompanied by a reduction in the number of animals showing clinical signs (mainly lameness). Both interventions altered the colonization pattern of different strains of the above pathogens. In addition, the prevalence of resistance genes increased over time in all the groups but was significantly higher at weaning when the antibiotic was administered to the sows. Also, ceftiofur treatment induced the selection of more beta-lactams resistance genes when it was administered directly to the piglets.ConclusionsThis study shed light on the effect of the ceftiofur treatment on the piglet nasal microbiota over time and demonstrated for the first time the possibility of modifying the piglets’ nasal microbiota by inoculating natural colonizers of the upper respiratory tract.

Dynamic finite element modelling of the macaque mandible during a complete mastication gape cycle.

Three-dimensional finite element models (FEMs) are powerful tools for studying the mechanical behaviour of the feeding system. Using validated, static FEMs we have previously shown that in rhesus macaques the largest food-related differences in strain magnitudes during unilateral postcanine chewing extend from the lingual symphysis to the endocondylar ridge of the balancing-side ramus. However, static FEMs only model a single time point during the gape cycle and probably do not fully capture the mechanical behaviour of the jaw during mastication. Bone strain patterns and moments applied to the mandible are known to vary during the gape cycle owing to variation in the activation peaks of the jaw-elevator muscles, suggesting that dynamic models are superior to static ones in studying feeding biomechanics. To test this hypothesis, we built dynamic FEMs of a complete gape cycle using muscle force data from in vivo experiments to elucidate the impact of relative timing of muscle force on mandible biomechanics. Results show that loading and strain regimes vary across the chewing cycle in subtly different ways for different foods, something which was not apparent in static FEMs. These results indicate that dynamic three-dimensional FEMs are more informative than static three-dimensional FEMs in capturing the mechanical behaviour of the jaw during feeding by reflecting the asymmetry in jaw-adductor muscle activations during a gape cycle. This article is part of the theme issue 'Food processing and nutritional assimilation in animals'.

Uterine fibroid cell cytoskeletal organization is affected by altered G protein-coupled estrogen receptor-1 and phosphatidylinositol 3-kinase signaling

To determine if cyclic strain affects fibroid cell cytoskeletal organization, proliferation, and collagen synthesis differently than myometrial cells. Basic science study using primary cultures of patient-matched myometrial and fibroid cells. Academic Laboratory PATIENT(S): Premenopausal women undergoing myomectomy or hysterectomy for the treatment of symptomatic uterine fibroids. Application of uniaxial strain patterns mimicking periovulation, menses, or dysmenorrhea using the Flexcell® tension system or static control. Secondarily, inhibition of G protein-coupled ER1 (GPER1, G36), and phosphatidylinositol 3-kinase (PI3K, Ly294002). Cell alignment, cell number, and collagen content RESULT: (s): Menses-strained cells demonstrated the most variation in cell alignment, cell proliferation, and pro-collagen content between myometrial and fibroid cells. Pro-collagen content decreased in myometrial cells with increasing strain amplitude and decreasing frequency. GPER1 inhibition decreases cellular alignment in the presence of strain. (s): Mechanotransduction affecting cytoskeletal arrangement through the GPER1-PI3K pathway is altered in fibroid cells. These results highlight the importance of incorporating mechanical stimulation into the in vitro study of fibroid pathology.

New Particle‐Wise Finite Element Strain Analysis for Discrete Displacement of Fold‐And‐Thrust Belt and Horst‐And‐Graben Models

AbstractThe granular behaviors of shallow Earth materials are associated with brittle deformations and mass transport along the surface and fault zones. Green strain has been adopted to quantitatively analyze the fold‐and‐thrust belt and horst‐and‐graben discrete element (DE) models driven by contractional and extensional forces, respectively. Deriving Green strain from DE models is challenging because of the need for precise mapping of the discrete particle displacement onto differentiable meshes. Here, we developed a new Green strain calculation methodology, the implicit global‐finite element method (IG‐FEM), which inverts a global matrix to reflect the interconnectivity of all particles. The IG‐FEM obtains strain quantities associated with particles to prevent an information loss, for example, displacement, at particle positions. We validated the accuracy of IG‐FEM compared to the conventional strain analysis scheme for DE model, finite difference method (FDM), by estimating the relative root mean square error from analytical solutions for a given mathematical transformation. On average, the IG‐FEM and the FDM show 2.8% and 17.4% relative root mean square errors, respectively. Furthermore, the strain quantities in the fold‐and‐thrust belt and horst‐and‐graben DE models were computed. The strain patterns of the IG‐FEM are more consistent with the particle spin distribution, which is noninterpolated information of the DE models. We present the potential benefits of the IG‐FEM for assessing strain‐related values such as stress, pore pressure, and seismic velocities within brittle deformation zones. The IG‐FEM is applicable in analog models and geodetic surveys to extract strain from discrete displacement data.

Analyzing dynamic joint trajectories between strain and delinquency in multicultural adolescents: Application of joint trajectory modeling

This study analyzed the latent class in which the relationship between multicultural adolescents' strain and delinquency varies over time and identified the relationship between these two latent classes in order to develop intervention methods to alleviate their strain and delinquency. We utilized seven years data from MAPS of NYPI, spanning from 6th grade in elementary school to 3rd grade in high school (2013-2019). The dynamic relationships between the latent classes of strain and delinquency were analyzed using JTM, and the latent classes of these two components were analyzed using a LCGM based on a person-centered approach. Our findings revealed the existence of five distinct heterogeneous groups for strain and four for delinquency among multicultural adolescents, indicating diverse patterns of strain and delinquency behaviors. The vulnerable groups requiring welfare intervention are particularly noteworthy, constituting 17.8% of the popualtion. These groups are characterized by the following categories: S2 (“Early Low & Increasing” and S3: “Early Moderate & Increasing” in strain) and D2 (“Early Low & High Increasing” in delinquency). Given the imbalance and diversity of these latent classes, this study provides practical implications and measures for the intervention of strains and delinquency among multicultural adolescents.

Rate-dependent damage evolution and crack branching of pipe under internal gaseous detonation loading

A rate-dependent damage evolution law was derived based on the thermally activated motion of dislocations. By writing the VUMAT subroutine, it was implemented to simulate the dynamic crack propagation and branching of pipe due to internal gaseous detonation. Also, the fluid-structure coupling between detonation wave and pipe was well achieved through immersed boundary method and “softened” contact formula. The predicted fracture profiles and pressure history inside the pipe were validated with experiments and compared with available results in literatures. Results demonstrated that the developed numerical model was more accurate in predicting the dynamic crack behaviors, especially the crack branching position relative to the main crack tip. The simulated average crack speed ranged from 171 m/s to 228 m/s, which well fell within the experimental range. Instead of dramatically decreasing, the speed of branched crack was comparable to that of the main crack. The damage field around the crack tip can reflect the direction of crack propagation or branching. The maximum strain rate always appeared at the right front of crack tip regardless of the subsequent crack behavior. It was further revealed that the high strain rate contributed to the straight propagation of crack, while branching was primarily governed by the particular strain pattern around the crack tip.

Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies.

Clinical ultrasound training is essential to any emergency medicine (EM) clinician's skill set. We aim to understand the current training patterns of clinical ultrasound training within Advanced Practice Provider (APP) residencies. In a survey sent electronically to 17 active EM APP residencies, data were obtained from 21 responses to questions about structure of ultrasound faculty, quality assessment, feedback, and competency evaluation. We had a response rate of 88%. Of programs surveyed, 93% were associated with EM physician residencies with 87% led by an ultrasound fellowship-trained EM physician. Ninety-three percent of programs required proctored scanning. Sixty percent of programs do not have any required number of scans to graduate. We found that most EM APP residencies share clinical ultrasound faculty, structures, and processes with associated EM physician residencies. We believe that quality training within clinical ultrasound is attainable; however, proficiency guidelines across EM APP residency programs are lacking.

Abduction causes increased strain gradient compared to forward flexion: Evidence from a cadaver model of simultaneous strain study of the rotator cuff tendons

BackgroundVarious strain studies of the supraspinatus have been done in isolation. Given that rotator cuff muscles function as a group, it may be physiologically representative to measure strain behaviour with the glenohumeral joint intact. Here, we explored a novel method in measuring simultaneous strain behaviour of the rotator cuff tendons and investigated the effect of full-thickness anterior tear of the supraspinatus on the infraspinatus and subscapularis tendons. MethodsNine cadaveric shoulders were evaluated on a customized rig. Using linear differential variable transducers to measure strain, each shoulder was subjected to up to 60° of elevation in the coronal, scapular, and sagittal planes. We also assessed 30° of external rotation and up to 60° of internal rotation of the humerus. Full-thickness anterior tear of the supraspinatus was then made before re-assessing strain patterns in the scapular plane.Findings:Strain measurements of the intact tendons revealed a significant strain gradient between the articular and bursal sides of the supraspinatus during increasing degrees of elevation in the coronal and scapular planes. Full thickness anterior tear of the supraspinatus is localised to the tendon and does not affect the surrounding cuff musculature, with a potential shielding effect of the infraspinatus during early glenohumeral abduction. InterpretationSignificant strain gradient exists between the articular and bursal sides of the supraspinatus during abduction but not during forward flexion in an intact glenohumeral joint. Rehabilitation exercises for anterior supraspinatus tears can be appropriately targeted on the remaining intact rotator cuff musculature.

A High intensity Interval training (running and swimming) and resistance training intervention on heart rate variability and the selected biochemical factors in boys with type 1 diabetes

ObjectiveThe purpose of this research is to investigate the effect of High Intensity Interval Training and Resistance training (HIITR) on heart rate variability (HRV), blood glucose, and plasma biomarkers levels in adolescents with type 1 diabetes (T1D).Research design and methods: 24 boys with T1D (FBS: 274.66 ± 52.99, age: 15.2 ± 1.78 years, and BMI = 19.61 ± 1.11) and 12 healthy boys (FBS: 92.75 ± 5.22, age: 15.08 ± 1.67 years, and BMI = 20.26 ± 2.66) were divided into three groups: Diabetes Training (DT, n = 12), Diabetes Control (DC, n = 12), and Healthy Control (HC, n = 12). HRV (24 h) was computed in time and frequency domains, anthropometric, biochemical parameters at rest, and aerobic capacity (VO2peak) obtained during a graded exercise testing (GXT). All variables were evaluated at the baseline and following 12 weeks of exercise training, done 3 days weekly. The statistical method used for data analysis was analysis of covariance (ANCOVA) test. ResultsHRV, Hemoglobin A1c (HbA1c) and Fasting blood sugar (FBS), VO2peak, norepinephrine (NEP), and HDL-C indicated significant differences between both T1D groups compared to HC at baseline (p < 0.001). BMI, LDL-C, TC, and TG parameters were similar in all groups. HRV parameters, VO2peak and HDL-C, and NEP were significantly improved by exercise training, and HbA1c and FBS levels were significantly reduced (p < 0.001). There is a negative and significant correlation between LF/HF Ratio Difference (post-test minus pre-test) and VO2Peak Difference variables (post-test minus pre-test) (p < 0.001). ConclusionsThe present study suggests the importance of early screening for CVD risk factors in adolescent males with T1D. Also, it was revealed HIITR training compared to other training patterns, and cardiovascular health improves via enhancement of autonomic modulation, VO2peak, plasma lipids, and catecholamine levels.

Effects of species and moisture content on the behaviour of solid wood under impact

The article's main aim is to assess the effects of species and moisture content (MC) on the behaviour of solid wood material under the low velocity of impact and present a pattern for predicting loading vs time curves for these species in different moisture levels. Three groups of samples (300 × 20 × 20 mm) were made from beech, oak, and spruce wood. Each group was subdivided into two groups with low moisture content (LMC) level (10–12%) and high moisture content (HMC) level (40–60%). A drop-weight impact machine did the tests, and high-speed cameras recorded the lateral specimens' surface during the impact. The digital image correlation technique (DIC) determined the strain pattern and the deflection. The timing of the crack initiation was also observed. Also, the force–time charts, the maximum force required for crack initiation, the work needed for crack initiation, and the total work required for the breakage of every specimen were gathered. A general force–time pattern with five identifiable steps was determined for each group. It turned out that the maximum deflection and longitudinal tensile strain of the beams up to crack initiation increase with increased moisture content while maximum force decreases. Unlike beech, the required work for rupture of HMC samples of oak and spruce is higher than LMC group.

Heterogenous westerly shifts linked to Atlantic meridional overturning circulation slowdowns

The mid-latitude westerly winds are a major component of the global atmospheric circulation and a dominant factor in mid-latitude climate change. Understanding their behaviour and the controls on their variations under different climate background states is essential for assessing climate system feedback. Here we present a midlatitude North Pacific Ocean aeolian dust record from core NP02 through the last glacial cycle, during which extreme and abrupt climatic oscillations occurred. We find low dust contents during Heinrich stadials 2, 4, 5, and 5a that we attribute using proxy-model comparison to westerly transportation path changes associated with Atlantic meridional overturning circulation (AMOC) reductions, which caused North Atlantic cooling and modified the westerly wave train pattern, particularly over the Tibetan Plateau. The finding that AMOC variations had significant impacts on the westerlies half-way around the world, through ocean-atmosphere interactions, improves understanding of large-scale westerly sensitivity to different climate states.

Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1day to 21years, median 13years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.

FedEL: Federated ensemble learning for non-iid data

Federated learning (FL) is a joint training pattern that fully utilizes data information whereas protecting data privacy. A key challenge in FL is statistical heterogeneity, which arises on account of the heterogeneity of local data distributions among clients, leading to inconsistency in local optimization goals and ultimately reducing the performance of globally aggregated models. We propose the Federated Ensemble Learning (FedEL), which makes full use of the heterogeneity of data distribution among clients to train a group of weak learners with diversity to construct a global model, which is a novel solution to the non-independent identical distribution (non-IID) problem. Experiments demonstrate that the proposed FedEL can improve performance in non-IID data scenarios. Even under extreme statistical heterogeneity, the average accuracy of FedEL is 3.54% higher than the state-of-the-art FL method. Moreover, the proposed FedEL reduces model storage and reasoning costs compared with traditional ensemble learning. The proposed FedEL demonstrates good generalization ability in experiments across different datasets, including natural scene image datasets and medical image datasets.

Patient-Specific Quantitative In-Vivo Assessment of Human Mitral Valve Leaflet Strain Before and After MitraClip Repair.

Mitral regurgitation (MR) is a highly prevalent and deadly cardiac disease characterized by improper mitral valve (MV) leaflet coaptation. Among the plethora of available treatment strategies, the MitraClip is an especially safe option, but optimizing its long-term efficacy remains an urgent challenge. We applied our noninvasive image-based strain computation pipeline [1] to intraoperative transesophageal echocardiography datasets taken from ten patients undergoing MitraClip repair, spanning a range of MR etiologies and MitraClip configurations. We then analyzed MV leaflet strains before and after MitraClip implementation to develop a better understanding of (1) the pre-operative state of human regurgitant MV, and (2) the MitraClip's impact on the MV leaflet deformations. The MV pre-operative strain fields were highly variable, underscoring both the heterogeneity of the MR in the patient population and the need for patient-specific treatment approaches. Similarly, there were no consistent overall post-operative strain patterns, although the average A2 segment radial strain difference between pre- and post-operative states was consistently positive. In contrast, the post-operative strain fields were better correlated to their respective pre-operative strain fields than to the inter-patient post-operative strain fields. This quantitative result implies that the patient specific pre-operative state of the MV guides its post-operative deformation, which suggests that the post-operative state can be predicted using pre-operative data-derived modelling alone. The pre-operative MV leaflet strain patterns varied considerably across the range of MR disease states and after MitraClip repair. Despite large inter-patient heterogeneity, the post-operative deformation appears principally dictated by the pre-operative deformation state. This novel finding suggests that though the variation in MR functional state and MitraClip-induced deformation were substantial, the post-operative state can be predicted from the pre-operative data alone. This study suggests that, with use of larger patient cohort and corresponding long-term outcomes, quantitative predictive factors of MitraClip durability can be identified.