Real-time artificial intelligence predicts adverse outcomes in acute pancreatitis in the emergency department: Comparison with clinical decision rule.

OBJECTIVE: Artificial intelligence (AI) prediction is increasingly used for decision making in health care, but its application for adverse outcomes in emergency department (ED) patients with acute pancreatitis (AP) is not well understood. This study aimed to clarify this aspect. METHODS: Data from 8274 ED patients with AP in three hospitals from 2009 to 2018 were analyzed. Demographic data, comorbidities, laboratory results, and adverse outcomes were included. Six algorithms were evaluated, and the one with the highest area under the curve (AUC) was implemented into the hospital information system (HIS) for real-time prediction. Predictive accuracy was compared between the AI model and Bedside Index for Severity in Acute Pancreatitis (BISAP). RESULTS: The mean ± SD age was 56.1 ± 16.7 years, with 67.7% being male. The AI model was successfully implemented in the HIS, with Light Gradient Boosting Machine (LightGBM) showing the highest AUC for sepsis (AUC 0.961) and intensive care unit (ICU) admission (AUC 0.973), and eXtreme Gradient Boosting (XGBoost) showing the highest AUC for mortality (AUC 0.975). Compared to BISAP, the AI model had superior AUC for sepsis (BISAP 0.785), ICU admission (BISAP 0.778), and mortality (BISAP 0.817). CONCLUSIONS: The first real-time AI prediction model implemented in the HIS for predicting adverse outcomes in ED patients with AP shows favorable initial results. However, further external validation is needed to ensure its reliability and accuracy.

Fitness Use Innovativeness, Usage Patterns and Revisit Intention: The Moderating Role of Other-Efficacy.

Extant research has confirmed the importance of consumer innovativeness toward innovation adoption, but relatively little is known about the relationship between fitness use innovativeness, post-adoption behavior and the moderating role of fitness consumer's efficacy belief. This study aims to examine the moderating role of other-efficacy on the relationships between the fitness player's usage patterns (usage variety and usage frequency) under the influence of use innovativeness, and revisit intention within the context of fitness services. This study utilizes the diffusion model for conceptual development. The proposed hypotheses are empirically tested using fitness players from a public sports center. There were 205 valid questionnaires obtained for quantitative data analysis. The findings confirm that the fitness player's use innovativeness has a direct impact on usage variety and usage frequency, while the player's training partner efficacy positively moderates the usage patterns and revisit intention. Based on the extent of fitness use innovativeness and training partner efficacy, we categorize fitness customers into four segments. The managerial implications for each segment are then discussed.

Seneca Valley virus replicons are packaged in trans and have the capacity to overcome the limitations of viral transgene expression.

Oncolytic viruses (OVs) promote the anti-tumor immune response as their replication, and the subsequent lysis of tumor cells, triggers the activation of immune-sensing pathways. Arming OVs by expressing transgenes with the potential to promote immune cell recruitment and activation is an attractive strategy to enhance OVs' therapeutic benefit. For picornaviruses, a family of OVs with clinical experience, the expression of a transgene is limited by multiple factors: genome physical packaging limits, high rates of recombination, and viral-mediated inhibition of transgene secretion. Here, we evaluated strategies for arming Seneca Valley virus (SVV) with relevant immunomodulatory transgenes. Specificially in the contex of arming SVV, we evaluated transgene maximum size and stabiltity, transgene secretion, and the impact of transgene inclusion on viral fitness. We find that SVV is not capable of expressing secreted payloads and has a transgene packaging capacity of ∼10% of viral genome size. To enable transgene expression, we developed SVV replicons with greater transgene size capacity and secretion capabilities. SVV replicons can be packaged in trans by virus in co-infected cells to express immunomodulatory transgenes in surrounding cells, thus providing a means to enhance the potential of this therapeutic to augment the anti-tumor immune response.

Single-Line Bidirectional Optical Add/Drop Multiplexer for Ring Topology Optical Fiber Networks.

A new type of passive single-line bidirectional optical add/drop multiplexer (SBOADM) is proposed and experimentally demonstrated. When the proposed SBOADM is placed as a node of a ring topology optical fiber network, the special routing function of the SBOADM can always drop down the desired downstream signals whether the signals are injected into the SBOADM in either the clockwise (CW) or counterclockwise (CCW) direction and can upload and send back the upstream signals via the reversed optical pathway of the downstream signals. Once fiber link failure occurs in the optical network, the blocked network connections can be recovered immediately by sending out the downstream signals in both the CW and CCW directions of the fiber ring. As in all passive devices, the SBOADM needs no power supply or complicated network management to achieve the bidirectional function. Thus, the proposed device is an optimal solution to enhance the stability and reliability of rapidly developed optical fiber networks.

Fiber Link Health Detection and Self-Healing Algorithm for Two-Ring-Based RoF Transport Systems.

A two-ring-based radio over fiber (RoF) transport system with a two-step fiber link failure detection and self-healing algorithm is proposed to ensure quality of service (QoS) by automatically monitoring the health of each fiber link in the transport system and by resourcefully detecting, locating, and bypassing the blocked fiber links. With the assistance of the fiber Bragg grating remote sensing technique, preinstalled optical switches, and novel single-line bidirectional optical add/drop multiplexers, the optical routing pathways in the RoF transport system can be dynamically adjusted by the proposed algorithm when some fiber links are broken. Simulation results show that except in some extreme situations, the proposed algorithm can find the blocked fiber links in the RoF transport system and animatedly adjust the status of preinstalled optical switches to restore all blocked network connections, thereby ensuring QoS in the proposed RoF transport system.

Probability of New-Onset Cancer Between Patients with Traumatic Brain Injury and a Comparison General Population Cohort.

BACKGROUND: Traumatic brain injury (TBI) has been reported as a risk factor for the development of brain tumors. However, whether TBI affects systemic cancer remains to be determined. We investigated the incidence and factors associated with cancer development in patients with TBI. METHODS: A propensity score (age, gender, and comorbidity)-matched longitudinal cohort study of 34,556 patients with pre-existing TBI and 69,112 patients without TBI from January 2000 to December 2015 was presented using the Taiwan's National Health Insurance Research Database. The Cox proportional hazard regression model was used to estimate the hazard ratio of developing cancer adjusted by the potential confounding factors. The stratified analysis of age, gender, and comorbidities for each cancer type was evaluated using forest plot analysis. RESULTS: The cancer incidence rate in the patients with TBI (4.38%) was greater than that in patients without TBI (3.88%). The interval to cancer development in those with TBI (5.65 ± 3.58 years) was shorter than that in those without TBI (6.02 ± 3.65 years). The cancer risk in those with TBI was increased 1.27-fold compared with that in the general population. Of the patients with TBI, age <55 years and male gender indicated a greater incidence of cancer than that of the general population. The patients with TBI had greater cancer frequencies in the head and neck structures compared with those in the general population. CONCLUSIONS: TBI is a risk factor for cancer development, especially in males and those aged <55 years. We hope this information will remind physicians to consider the long-term effects of TBI on cancer development.

Traumatic Brain Injury Increases the Risk of Major Adverse Cardiovascular and Cerebrovascular Events: A 13-Year, Population-Based Study.

BACKGROUND: Previous studies have indicated traumatic brain injury (TBI) as a risk factor for stroke and myocardial injury. Whether TBI increases new onset of major adverse cardiovascular and cerebrovascular events (MACCE) is not well established. METHODS: Patients with a diagnosis of TBI from 2000 to 2012 were 1:2 age-, sex-, and age-adjusted comorbidities matched with normal population cohorts. The MACCE, which included coronary artery disease, heart failure and arrhythmia, ischemic and hemorrhagic stroke, and death, was defined as one inpatient admission with MACCE diagnosis. The maximum follow-up duration to MACCE after the initial TBI diagnosis was 5 years. The baseline comorbidities before TBI, including hypertension, diabetes mellitus, renal disease, and liver disease, also were considered to estimate the risk of MACCE. RESULTS: In total, 16,211 patients with TBI and 32,422 people from the control group were enrolled in the current study. Our results showed that patients with TBI had a 2.77-fold risk of MACCE, 1.72-fold risk of cardiovascular disease, 2.10-fold risk of ischemic stroke, 6.02-fold risk of hemorrhagic stroke, and 3.13-fold risk of mortality compared with the control group (all P < 0.0001) after adjusting the confounding factors. In addition, the trend of cumulated incidence risk among MACCE, cardiovascular disease, ischemic and hemorrhagic stroke, and mortality presented the greatest incidence within the first year after diagnosis and persisted during the 5 years of follow-up. CONCLUSIONS: Our results showed that patients with TBI have a significantly greater risk of MACCE than the control group. We hope this information will remind critical-care physicians and neurosurgeons to keep in mind the long-term effects of TBI on MACCE.

Systemic lupus erythematosus presenting with cardiac symptoms.

BACKGROUND: The objective of this study was to describe the characteristics of patients presenting to the emergency department with cardiac symptoms subsequently diagnosed to have systemic lupus erythematosus (SLE). METHODS: The authors performed a review of newly diagnosed SLE patients at 2 hospitals in Tainan city between January 2010 and December 2013. Patients initially presenting with cardiac symptoms were included. Demographic data, presenting symptomatology, laboratory data, and imaging studies were obtained and analyzed. RESULTS: Eight cases, including 5 female and 3 male patients, were identified during the 4-year study period. The mean age was 37 (range, 15-54) years. Pericardial effusion (63%) and mitral regurgitation (63%) were the most common cardiac abnormalities, followed by impairment of left ventricular systolic function (25%) and tricuspid regurgitation (13%). Most patients showed signs of increased generalized inflammation and immunological activity with elevated levels of C-reactive protein (100%) and anti-dsDNA (88%) and decreased complement levels (63%). The median duration from admission to the diagnosis of SLE was 6.3 (range, 1-13) days, and all patients showed multiple-organ involvement in addition to the cardiovascular system. CONCLUSIONS: Patients presenting to the emergency department with cardiac symptoms without a history of cardiopulmonary disease or traditional cardiovascular disease risk factors should be assessed for an underlying cause of cardiac decompensation. If the patients exhibit extracardiac manifestations or their illnesses involve multiple-organ systems, screening tests for autoimmune diseases such as SLE are mandatory.

Bidirectional hybrid PM-based RoF and VCSEL-based VLLC system.

A bidirectional hybrid phase modulation (PM)-based radio-over-fiber (RoF) and vertical cavity surface emitting laser (VCSEL)-based visible laser light communication (VLLC) systems employing injection-locked VCSEL-based PM-to-intensity modulation (IM) converters and optical interleavers (ILs) is proposed and demonstrated. To be the first one of using injection-locked VCSEL-based PM-to-IM converters and optical ILs in such bidirectional hybrid RoF and VLLC systems, the downstream light is successfully phase-remodulated with RoF signal for up-link transmission. Through a serious investigation in systems, bit error rate (BER) and eye diagram perform brilliantly over a 40-km single-mode fiber (SMF) transport and a 12-m free-space transmission. Such a bidirectional hybrid RoF and VLLC system would be very attractive for the integration of fiber backbone and in-door networks to provide broadband integrated services, including Internet and telecommunication services.

A full-duplex lightwave transmission system with an innovative VCSEL-based PM-to-IM converter.

A full-duplex lightwave transmission system employing innovative VCSEL-based PM-to-IM converters to deliver intensity-modulated CATV/phase-modulated RoF/intensity-remodulated RoF signals over two 40-km SMFs links is proposed and demonstrated. To be the first one of employing VCSEL-based PM-to-IM converters in full-duplex lightwave transmission systems, the downstream light is successfully intensity-remodulated with RoF signal for up-link transmission. Good performances of CNR/CSO/CTB are achieved for downstream CATV signal transmission, and low BER values are obtained for both downstream and upstream RoF signals transmissions. Our proposed systems present brilliant performances in delivering hybrid CATV and RoF signals. Such a full-duplex lightwave transmission system would be very attractive for fiber trunk applications to provide broadband integrated services.

10m/500 Mbps WDM visible light communication systems.

A wavelength-division-multiplexing (WDM) visible light communiction (VLC) system employing red and green laser pointer lasers (LPLs) with directly modulating data signals is proposed and experimentally demonstrated. With the assistance of preamplifier and adaptive filter at the receiving sites, low bit error rate (BER) at 10 m/500 Mbps operation is obtained for each wavelength. The use of preamplifier and adaptive filter offer significant improvements for free-space transmission performance. Improved performance of BER of <10(-9), as well as better and clear eye diagram were achieved in our proposed WDM VLC systems. LPL features create a new category of good performance with high-speed data rate, long transmission length (>5m), as well as easy handling and installation. This proposed WDM VLC system reveals a prominent one to present its advancement in simplicity and convenience to be installed.

A hybrid CATV/OFDM long-reach passive optical network architecture.

A hybrid CATV/OFDM long-reach PON architecture is proposed and experimentally demonstrated. By multiplexing the OFDM and CATV signals in different frequency bands, the overall network structure is simplified and the available bandwidth for the OFDM signals is increased. Furthermore, by carefully adjusting the driving voltage of the employed CATV transmitter, the overall transmission performance can be optimized by eliminating a large amount of unwanted distortions. Unlike the current fiber optical CATV transport system in which the CATV signals need to be amplified in every 30 ~40 km transmission span, the proposed architecture has successfully extended the transmission span to 60 km. This can practically remove the needs of electrical power provisioning and monitoring between the central office (CO) and each local exchange (LE). Good transmission performances of carrier-to-noise ratio (CNR), composite second-order (CSO), composite triple beat (CTB) and bit error rate (BER) were obtained for the transmitted CATV and OFDM signals. All of these experimental results prove the practice and efficiency of the proposed architecture in providing simplicity and extended reach services to customers.

Full-duplex lightwave transport systems employing phase-modulated RoF and intensity-remodulated CATV signals.

A full-duplex lightwave transport system employing phase-modulated radio-over-fiber (RoF) and intensity-remodulated CATV signals in two-way transmission is proposed and experimentally demonstrated. The transmission performances of RoF and CATV signals are investigated in bidirectional way, with the assistance of only one optical sideband and optical single sideband (SSB) schemes at the receiving sites. The experimental results show that the limitation on the optical modulation index (OMI) of the downlink RoF signal can be relaxed due to the constant intensity of phase modulation scheme. Impressive transmission performances of bit error rate (BER), carrier-to-noise ratio (CNR), composite second-order (CSO), and composite triple-beat (CTB) were obtained over two 20-km single-mode fiber (SMF) links. This proposed system reveals an outstanding one with economy and convenience to be installed.

RoF transport systems with OSNR enhanced multi-band optical carrier generator.

A combination of an economic multi-band optical carrier generator and a novel optical signal to noise ratio (OSNR) enhancement circuit is proposed and demonstrated for radio over fiber (RoF) transport systems. Different from normal RoF transport systems which a central station (CS) needs multiple dedicate wavelength laser diodes (LDs) to support various base stations (BSs), the proposed scheme can employ a single LD to provide multiple optical carriers for various BSs. To verify this scheme, 8 coherent optical carriers are firstly generated using a single LD and a local oscillator (LO). Subsequently, their OSNR values are optimized by the developed OSNR enhancement circuit. An up to 15 dB OSNR enlargement in those optical carriers is experimentally achieved. To demonstrate the practice of the proposal, a pair of those optical carriers is employed to experimentally achieve frequency up-conversion process in a RoF transport system. Clear eye diagram and error free transmission reveal that with a proper carrier selector the proposed scheme can be employed to support multiple RoF transmissions. Furthermore, this proposal also presents a high possibility to achieve 60 GHz RoF transmission using a 10 GHz LO, a LD and a low frequency external modulator.

Hybrid CATV/16-QAM OFDM in-building networks over SMF and GI-POF transport.

A hybrid CATV/16-QAM OFDM in-building network over a combination of single-mode fiber (SMF) and graded-index plastic optical fiber (GI-POF) transport is proposed and experimentally demonstrated with good qualities of service. In this system, a 1556 nm optical signal is directly transmitted along with two fiber spans (20-km SMF + 25-m GI-POF). Without using any wavelength conversion or bridge circuit between SMF and POF connection, error free transmissions with sufficient low bit error rate (BER) values are achieved for 2.5 Gbps/2.5 GHz and 5 Gbps/2.5 GHz OFDM signals; as well as good performances of carrier-to-noise ratio (CNR), composite second-order (CSO), and composite triple beat (CTB) are obtained for CATV one. This proposed network reveals an outstanding one with economy and convenience to be installed.

Hybrid cable television and orthogonal-frequency-division-multiplexing transport system basing on single wavelength polarization and amplitude remodulation schemes.

A hybrid community antenna television (CATV) and orthogonal-frequency-division-multiplexing (OFDM) transport system is proposed and experimentally demonstrated to transmit multiple CATV channels and bi-directional radio frequency signals on a single optical carrier. By polarization remodulating an optical CATV signal with downstream OFDM signals and then amplitude remodulating upstream OFDM signals with the hybrid CATV/OFDM signals, this architecture can efficiently utilize only one optical carrier to support optical analog/digital CATV transmission and bi-directional wireless broadband services for each client. Good experimental results prove that this architecture provides a proper wavelength utilization scheme for future multiwavelength optical transport systems.

Fiber optical CATV transport systems based on PM and light injection-locked DFB LD as a duplex transceiver.

A bidirectional fiber optical CATV transport system employing phase modulation (PM) scheme and frequency up-conversion technique to deal with downstream CATV signals, and using light injection-locked distributed feedback laser diode (DFB LD) as a duplex transceiver at the receiving site is proposed and experimentally demonstrated. With optimum injection wavelength and power level, a DFB LD is efficiently employed for both the transmitter and receiver operations. Such DFB LD is used to replace the functions of delay interferometer (DI) and CATV receiver, and also to be as the upstream light source. To the best of our knowledge, it is the first time to successfully utilize a DFB LD to detect the phase-modulated CATV signals. Impressive experimental results prove that our proposed systems not only can employ the PM scheme and the frequency up-conversion technique to optimize the overall performances of systems, but also can use an injection-locked DFB LD to detect the downstream phase-modulated CATV signals as well as to transmit the upstream CATV ones simultaneously.

Simplified radio-over-fiber transport systems with a low-cost multiband light source.

In this Letter, low-cost radio-over-fiber (ROF) transport systems are proposed and experimentally demonstrated. By utilizing a laser diode (LD) and a local oscillator (LO) to generate coherent multiband optical carriers, as well as a self-composed wavelength selector to separate every two carriers for different ROF transport systems, no any other dedicated LD or electrical frequency upconverting circuit/process is needed in the central station (CS). Compared with current ROF systems, the required numbers of LDs, LOs, and mixers in a CS are significantly reduced. Reducing the number of components not only can simplify the network structure but can also reduce the volume and complexity of the relative logistics. To demonstrate the practice of the proposed ROF transport systems, clear eye diagrams and error-free transmission performance are experimentally presented.

Direct CATV modulation and phase remodulated radio-over-fiber transport system.

A novel transport system, with directly modulating community antenna television (CATV) signal downstream and phase-remodulating radio-over-fiber (ROF) signal upstream, is proposed and experimentally demonstrated. By modulating multi-carriers CATV signal in amplitude domain and ROF signal in phase domain, a single optical wavelength is able to serve these two applications simultaneous. To be the first system of communicating CATV signal downstream and phase remodulating radio signal upstream, the performances of transmitting CATV and radio signals over 20 km single-mode fiber (SMF) were experimentally verified. Good performances of carrier-to-noise ratio (CNR), composite second-order (CSO), and composite triple beat (CTB) were obtained for CATV applications as well as high extinction ration (ER) and low bit error rate (BER) values were measured for ROF transmission.

A broadband ASE light source-based full-duplex FTTX/ROF transport system.

A full-duplex fiber-to-the-X (FTTX)/radio-over-fiber (ROF) transport system based on a broadband amplified spontaneous emission (ASE) light source is proposed and demonstrated for rural wide-spread villages. Combining the concepts of long-transmission transmission and ring topology, a long-haul single-mode fiber (SMF) trunk is sharing with multiple rural villages. Externally modulated baseband (BB) (1.25 Gbps) and radio-frequency (RF) (622 Mbps/10 GHz) signals are successfully transmitted simultaneously. Good bit error rate (BER) performance was achieved to demonstrate the practice of providing wire/wireless connections for long-haul wide-spread rural villages. Since our proposed system uses only a broadband ASE light source to achieve multi-wavelengths transmissions, it also reveals an outstanding one with simpler and more economic advantages.