Interpolated Joint Space Adversarial Training for Robust and Generalizable Defenses.

Adversarial training (AT) is considered to be one of the most reliable defenses against adversarial attacks. However, models trained with AT sacrifice standard accuracy and do not generalize well to unseen attacks. Recent works show generalization improvement with adversarial samples under unseen threat models such as on-manifold threat model or neural perceptual threat model. However, the former requires exact manifold information while the latter requires algorithm relaxation. Motivated by these considerations, we propose a novel threat model called Joint Space Threat Model (JSTM), which exploits the underlying manifold information with Normalizing Flow, ensuring that the exact manifold assumption holds. Under JSTM, we develop novel adversarial attacks and defenses. Specifically, we propose the Robust Mixup strategy in which we maximize the adversity of the interpolated images and gain robustness and prevent overfitting. Our experiments show that Interpolated Joint Space Adversarial Training (IJSAT) achieves good performance in standard accuracy, robustness, and generalization. IJSAT is also flexible and can be used as a data augmentation method to improve standard accuracy and combined with many existing AT approaches to improve robustness. We demonstrate the effectiveness of our approach on three benchmark datasets, CIFAR-10/100, OM-ImageNet and CIFAR-10-C.

3D-Printed PLA Scaffold with Fibronectin Enhances In Vitro Osteogenesis.

BACKGROUND: Tricalcium phosphate (TCP, Molecular formula: Ca3(PO4)2) is a hydrophilic bone graft biomaterial extensively used for guided bone regeneration (GBR). However, few studies have investigated 3D-printed polylactic acid (PLA) combined with the osteo-inductive molecule fibronectin (FN) for enhanced osteoblast performance in vitro, and specialized bone defect treatments. AIM: This study evaluated PLA properties and efficacy following glow discharge plasma (GDP) treatment and FN sputtering for fused deposition modeling (FDM) 3D printed PLA alloplastic bone grafts. METHODS: 3D trabecular bone scaffolds (8 × 1 mm) were printed by the 3D printer (XYZ printing, Inc. 3D printer da Vinci Jr. 1.0 3-in-1). After printing PLA scaffolds, additional groups for FN grafting were continually prepared with GDP treatment. Material characterization and biocompatibility evaluations were investigated at 1, 3 and 5 days. RESULTS: SEM images showed the human bone mimicking patterns, and EDS illustrated the increased C and O after fibronectin grafting, XPS and FTIR results together confirmed the presence of FN within PLA material. Degradation increased after 150 days due to FN presence. 3D immunofluorescence at 24 h demonstrated better cell spreading, and MTT assay results showed the highest proliferation with PLA and FN (p < 0.001). Cells cultured on the materials exhibited similar alkaline phosphatase (ALP) production. Relative quantitative polymerase chain reaction (qPCR) at 1 and 5 days revealed a mixed osteoblast gene expression pattern. CONCLUSION: In vitro observations over a period of five days, it was clear that PLA/FN 3D-printed alloplastic bone graft was more favorable for osteogenesis than PLA alone, thereby demonstrating great potential for applications in customized bone regeneration.

Cumulative incidence of urinary incontinence and associated factors during pregnancy and after childbirth: a cohort study.

INTRODUCTION AND HYPOTHESIS: This study examined the associated factors (i.e., obstetric and maternal-newborn factors) related to cumulative incidence of urinary incontinence and changes in urinary incontinence during pregnancy and the first year postpartum. METHODS: This prospective, longitudinal, within-subject study included 501 women who completed the Incontinence Questionnaire-Urinary Incontinence Short Form during pre-pregnancy, early pregnancy, mid-pregnancy, and late pregnancy and at five time points during the first year postpartum. Data were analyzed by multivariate logistic regression, McNemar's and analysis of variance (ANOVA) tests. RESULTS: According to the multivariate analysis, the gestational week and number of previous vaginal deliveries increased the risk of cumulative incidence of urinary incontinence (CIUI) during pregnancy (both p < 0.05). Full-time employment, higher body mass index, vaginal delivery and UI during early pregnancy and mid-pregnancy increased the risk of CIUI during the first year postpartum (all p < 0.05). CIUI tended to increase throughout the entire pregnancy (p < 0.001) and decrease from 3 to 5 days to 6 months postpartum (p = 0.028). The prevalence rates of UI at all postpartum visits were lower than those during late pregnancy (p < 0.001-0.009) but higher than those during pre-pregnancy (p < 0.001). CONCLUSIONS: The results identified the change patterns in UI and the risk factors associated with CIUI during the entire pregnancy (i.e., gestational age and number of previous vaginal deliveries) and the first year postpartum (i.e., full-time work, higher body mass index, vaginal delivery and UI during early and mid-pregnancy). Appropriate counseling should be provided to women preparing for pregnancy and during the prenatal and postpartum periods.

Risk factors for stress and urge urinary incontinence during pregnancy and the first year postpartum: a prospective longitudinal study.

INTRODUCTION AND HYPOTHESIS: We examined obstetric and maternal-newborn factors and UI history for stress urinary incontinence (UI) and urge UI during pregnancy and the first year postpartum. METHODS: This prospective cohort study included 1447 pregnant women who underwent prenatal examinations and completed an Incontinence Questionnaire-Urinary Incontinence Short Form before pregnancy, during early, mid- and late pregnancy, and at five visits during the first year postpartum. Data were analyzed using univariate/multivariate generalized estimating equation (GEE) logistic regression analyses. RESULTS: The prevalence rates of stress UI during late pregnancy (42.5%) and urge UI at 3-5 days postpartum (10.4%) were the highest throughout pregnancy and the first year postpartum. After adjusting for covariates, gestational age increased the risks of stress UI (p < 0.001) and urge UI (p = 0.003); stress UI during pre-pregnancy, number of previous vaginal deliveries and concurrent high body mass index (BMI) increased stress UI (all p < 0.05); urge UI during pre-pregnancy and full-time work increased urge UI (both p < 0.05) during pregnancy. During the postpartum period, vaginal delivery increased stress UI (p < 0.001) and urge UI (p = 0.041); stress UI during pre-pregnancy and pregnancy, women aged ≥ 30 years and vacuum extraction/forceps delivery increased stress UI (all p < 0.05). Urge UI during early, mid- and late pregnancy increased stress UI (all p < 0.05). CONCLUSIONS: Gestational age increased stress and urge UI, while previous vaginal deliveries and high BMI increased stress UI; full-time work increased urge UI during pregnancy. Vaginal delivery increased both UIs, and vacuum/forceps delivery and maternal age increased stress UI during postpartum.

ADN: Artifact Disentanglement Network for Unsupervised Metal Artifact Reduction.

Current deep neural network based approaches to computed tomography (CT) metal artifact reduction (MAR) are supervised methods that rely on synthesized metal artifacts for training. However, as synthesized data may not accurately simulate the underlying physical mechanisms of CT imaging, the supervised methods often generalize poorly to clinical applications. To address this problem, we propose, to the best of our knowledge, the first unsupervised learning approach to MAR. Specifically, we introduce a novel artifact disentanglement network that disentangles the metal artifacts from CT images in the latent space. It supports different forms of generations (artifact reduction, artifact transfer, and self-reconstruction, etc.) with specialized loss functions to obviate the need for supervision with synthesized data. Extensive experiments show that when applied to a synthesized dataset, our method addresses metal artifacts significantly better than the existing unsupervised models designed for natural image-to-image translation problems, and achieves comparable performance to existing supervised models for MAR. When applied to clinical datasets, our method demonstrates better generalization ability over the supervised models. The source code of this paper is publicly available at https:// github.com/liaohaofu/adn.

Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum.

BACKGROUND: The association between sexual function and depression has yet to be examined in a prospective cohort study with prolonged postpartum follow-up. AIM: We investigated whether sexual dysfunction predicted depressive symptoms during the 24-month postpartum period and examined the influence of obstetric factors. METHODS: This prospective 2-year cohort study with repeated measures included 196 participants who were recruited in a medical center in Taipei, Taiwan (2010-2011). Data on participants' personal characteristics, sexual function, and depression symptoms at 4-6 weeks and at 3, 6, 12, and 24 months postpartum were collected and then assessed using the Female Sexual Function Index and the Center for Epidemiologic Studies Depression Scale. RESULTS: After adjusting for time and covariates, women with sexual dysfunction had a 1.62-fold (95% confidence interval [CI]: 1.05-2.50-fold) higher estimated odds ratio (OR) for depressive symptoms during the entire 24 months after childbirth than did women without sexual dysfunction. Risk factors for depressive symptoms were a higher pain score (OR: 1.33, 95% CI: 1.13-1.57), a medical condition (OR: 1.65, 95% CI: 1.00-2.73), and severe perineal laceration (OR: 4.67, 95% CI: 1.37-15.92). Sexual satisfaction during the entire 24 months after childbirth (OR: 0.81, 95% CI: 0.70-0.95) and the highest personal income level (OR: 0.33, 95% CI: 0.11-0.99) were factors protecting against higher-scoring depressive symptoms. CONCLUSIONS: Our study provides robust evidence that sexual dysfunction and poor satisfaction, together with severe perineal laceration, greater pain, and a medical condition, predict depressive symptoms during the 24-month postpartum period.

Biochemical, hydrological and mechanical behaviors of high food waste content MSW landfill: Liquid-gas interactions observed from a large-scale experiment.

The high food waste content (HFWC) MSW at a landfill has the characteristics of rapid hydrolysis process, large leachate production rate and fast gas generation. The liquid-gas interactions at HFWC-MSW landfills are prominent and complex, and still remain significant challenges. This paper focuses on the liquid-gas interactions of HFWC-MSW observed from a large-scale bioreactor landfill experiment (5m×5m×7.5m). Based on the connected and quantitative analyses on the experimental observations, the following findings were obtained: (1) The high leachate level observed at Chinese landfills was attributed to the combined contribution from the great quantity of self-released leachate, waste compression and gas entrapped underwater. The contribution from gas entrapped underwater was estimated to be 21-28% of the total leachate level. (2) The gas entrapped underwater resulted in a reduction of hydraulic conductivity, decreasing by one order with an increase in gas content from 13% to 21%. (3) The "breakthrough value" in the gas accumulation zone was up to 11kPa greater than the pore liquid pressure. The increase of the breakthrough value was associated with the decrease of void porosity induced by surcharge loading. (4) The self-released leachate from HFWC-MSW was estimated to contribute to over 30% of the leachate production at landfills in Southern China. The drainage of leachate with a high organic loading in the rapid hydrolysis stage would lead to a loss of landfill gas (LFG) potential of 13%. Based on the above findings, an improved method considering the quantity of self-released leachate was proposed for the prediction of leachate production at HFWC-MSW landfills. In addition, a three-dimensional drainage system was proposed to drawdown the high leachate level and hence to improve the slope stability of a landfill, reduce the hydraulic head on a bottom liner and increase the collection efficiency for LFG.

Biochemical, hydrological and mechanical behaviors of high food waste content MSW landfill: Preliminary findings from a large-scale experiment.

A large-scale bioreactor experiment lasting for 2years was presented in this paper to investigate the biochemical, hydrological and mechanical behaviors of high food waste content (HFWC) MSW. The experimental cell was 5m in length, 5m in width and 7.5m in depth, filled with unprocessed HFWC-MSWs of 91.3 tons. In the experiment, a surcharge loading of 33.4kPa was applied on waste surface, mature leachate refilling and warm leachate recirculation were performed to improve the degradation process. In this paper, the measurements of leachate quantity, leachate level, leachate biochemistry, gas composition, waste temperature, earth pressure and waste settlement were presented, and the following observations were made: (1) 26.8m3 leachate collected from the 91.3 tons HFWC-MSW within the first two months, being 96% of the total amount collected in one year. (2) The leachate level was 88% of the waste thickness after waste filling in a close system, and reached to over 100% after a surcharge loading of 33.4kPa. (3) The self-weight effective stress of waste was observed to be close to zero under the condition of high leachate mound. Leachate drawdown led to a gain of self-weight effective stress. (4) A rapid development of waste settlement took place within the first two months, with compression strains of 0.38-0.47, being over 95% of the strain recorded in one year. The compression strain tended to increase linearly with an increase of leachate draining rate during that two months.

Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study.

BACKGROUND: The relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period. OBJECTIVES: We investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms. DESIGN: A prospective cohort study design was used. SETTING: Maternity unit of a medical center. PARTICIPANTS: This study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected. METHODS: Pain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression. RESULTS: After adjusting for covariates, women who had perineal pain at 4-6 weeks postpartum showed an increased risk for depression at 4-6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4-6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (ß=0.63, p=0.02). Any pain intensity score at 3-5 days postpartum predicted depression at 3 months (ß=0.01, p=0.04). Women with high depression scores at 3-5 days had a two- or three-fold higher risk for depression at 4-6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively). CONCLUSIONS: Our study provides robust evidence that perineal pain 4-6 weeks postpartum is associated with depressive symptoms 4-6 weeks and 6 months postpartum; pain at 3-5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3-5 days postpartum, predict depressive symptoms during the 6-month postpartum period.

Early supplemented low-protein diet restriction for chronic kidney disease patients in Taiwan - A cost-effectiveness analysis.

BACKGROUND: Low-protein diet (LPD) together with supplementation with ketoanalogs (KA) is associated with slower decline of estimated glomerular filtration rate (eGFR) in chronic kidney disease (CKD). We compared potential clinical and economic outcomes of KA supplement initiation at eGFR 15 - 29 mL/min/1.73 m2 vs. eGFR < 15 mL/min/1.73 m2 in CKD patients on LPD from the healthcare payer's perspective. METHODS: Markov model was designed to simulate outcomes of adult patients with eGFR 15 - 29 mL/min/1.73 m2 on two strategies LPD with KA supplementation; watchfulwaiting on LPD alone and KA initiation when eGFR declined to < 15 mL/min/1.73 m2. Medical cost and quality-adjusted life-years (QALYs) were calculated over 10 years. Results The early-initiation group gained higher QALYs (3.926 QALYs vs. 3.787 QALYs) with lower cost (USD 564,637 vs. USD 914,236) (USD 1 = NTD 30) when compared with the watchful-waiting group in base-case analysis. Sensitivity analysis indicated that early KA initiation at eGFR at 17 - 29 mL/min/1.73 m2 would be the preferred cost-effective option, if relative reduction of eGFR decline associated with LPD plus KA was > 4%. 10,000 Monte Carlo simulations showed the early-initiation group to be less costly with higher QALYs gained than the watchful-waiting group by USD 343,665 (95% CI 342,139 - 345,191) and 0.160 QALYs (95% CI 0.140 - 0.180), respectively. CONCLUSIONS: Early KA supplementation with LPD in CKD patients appeared to be cost-saving and gained higher QALYs in Taiwan. Acceptance of early supplemented LPD as cost-effective depended upon the reduction of eGFR decline associated with KA plus LPD and eGFR level to initiate KA supplementation.

Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: A prospective longitudinal study.

BACKGROUND: Childbirth has a significant impact on maternal health, and the high rate of cesarean delivery is a global health concern. Few studies have used validated measures to explore depression, pain, and sexual dysfunction following vaginal or cesarean delivery over a prolonged time period. OBJECTIVE: We examined the associations between vaginal and cesarean delivery and depressive symptoms, pain, and sexual function during the 1-year postpartum period. DESIGN: A prospective, five-time-point longitudinal study. SETTING: Maternity unit at a medical center. PARTICIPANTS: A total of 351 of 736 women completed a questionnaire that described demographic characteristics, depressive symptoms, and pain levels at 3-5 days postpartum, and updated personal data, depressive symptoms, pain levels, and sexual function at 4-6 weeks and at 3, 6, and 12 months after delivery. METHODS: Differences between the vaginal and cesarean groups in depressive symptoms, pain, and sexual function and trends of changes in these factors over the first postpartum year were examined. RESULTS: Compared with the vaginal birth group, the cesarean birth group had a significantly higher prevalence of depressive symptoms at 3 months (p=0.03); higher scores for non-localized pain at 3-5 days (p<0.001), 4-6 weeks (p=0.03), and 3 months (p=0.046); higher scores for abdominal pain at 3-5 days (p<0.001), 4-6 weeks (p<0.001), and 6 months (p=0.01); lower perineal pain scores at 3-5 days (p <0.001); and higher sexual desire scores (p=0.04) but lower sexual satisfaction scores (p=0.02) at 4-6 weeks. Differences between the vaginal and cesarean groups were significant (p=0.01, p=0.049, respectively) in terms of the decrease in non-localized pain from 3-5 days to 4-6 weeks postpartum and the increase in sexual desire from 4-6 weeks to 3 months postpartum. CONCLUSIONS: Cesarean delivery was associated with an increased prevalence of depressive symptoms at 3 months and higher pain levels that persisted at 6 months postpartum in Taiwan. We found no difference in sexual function between vaginal and cesarean delivery after 6 weeks postpartum, and no differences in the trends related to depressive symptoms or in sexual functioning (except for desire) within 1 year postpartum.

A repeated measures study of changes in health-related quality of life during pregnancy and the relationship with obstetric factors.

AIMS: To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy. BACKGROUND: Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy. DESIGN: A within-subject comparison was undertaken. METHODS: In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures. RESULTS: The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition. CONCLUSIONS: The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.

Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum.

OBJECTIVE: To examine the association between vaginal or cesarean delivery and urinary incontinence (UI) and identify the trend in the change in UI within the first 12 months postpartum. METHODS: This was a prospective longitudinal study of 330 of 749 women who completed a UI questionnaire and a personal characteristics questionnaire over five visits in a medical center. RESULTS: The vaginal delivery group had a significant higher prevalence of any UI at 4-6 weeks and at 3, 6, and 12 months (29.1-40.2% vaginal compared with 14.2-25.5% cesarean); stress urinary incontinence (SUI) at 4-6 weeks and 3 and 12 months (15.9-25.4% vaginal compared with 6.4-15.6% cesarean); and moderate or severe UI at 3-5 days, 4-6 weeks, and 6 months (7.9-18.5% vaginal compared with 4.3-11.3% cesarean); and a significant higher score for interference in daily life at 3-5 days and 4-6 weeks (1.0, 0.7 vaginal compared with 0.7, 0.4 cesarean) compared with those in the cesarean delivery group. Prevalence increased for any UI, SUI, and slight UI (all P<.02) and daily life interference score decreased (P=.02) for women who had a vaginal delivery through 1 year postpartum. CONCLUSION: Vaginal delivery was associated with higher UI prevalence that persisted for 1 year postpartum, but there was no association with interference in daily life after 6 weeks postpartum. Variation was observed in UI changes within the first year in the vaginal delivery and cesarean delivery groups.

Depressive symptoms as a predictor of sexual function during pregnancy.

INTRODUCTION: Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. AIM: To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). METHODS: Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. MAIN OUTCOME MEASURES: CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P=0.0004), arousal (P=0.0104), lubrication (P=0.0016), orgasm (P=0.0022), and pain (P<0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P=0.0005) and satisfaction (P<0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P<0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P<0.0005). Medical conditions were positive predictors of sexual desire (P=0.0023). CONCLUSIONS: The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.