Learning agile soccer skills for a bipedal robot with deep reinforcement learning.

We investigated whether deep reinforcement learning (deep RL) is able to synthesize sophisticated and safe movement skills for a low-cost, miniature humanoid robot that can be composed into complex behavioral strategies. We used deep RL to train a humanoid robot to play a simplified one-versus-one soccer game. The resulting agent exhibits robust and dynamic movement skills, such as rapid fall recovery, walking, turning, and kicking, and it transitions between them in a smooth and efficient manner. It also learned to anticipate ball movements and block opponent shots. The agent's tactical behavior adapts to specific game contexts in a way that would be impractical to manually design. Our agent was trained in simulation and transferred to real robots zero-shot. A combination of sufficiently high-frequency control, targeted dynamics randomization, and perturbations during training enabled good-quality transfer. In experiments, the agent walked 181% faster, turned 302% faster, took 63% less time to get up, and kicked a ball 34% faster than a scripted baseline.

A review of _urban water networks management using GIS.

Use of computer technology is common in the construction since the 90's .Geographical Information System is a very useful technology in any data driven industry. The present paper reviews on the application and management of water works through GIS. GIS Data can be categorized as spatial and non-spatial data, which can be stored, manipulated, analysed and displayed with multiple users which can help in comprehensive solutions in a systematic way. GIS application is very common in construction industry, construction safety, flood studies, pipeline management which includes water works and sewerage. Project management through GIS is different from GIS based projects, the review briefs about the difference between the two. The pipe network management includes planning, designing, and management of the network, the planning is done using Remote sensing, photogrammetry drone or field survey method depending on the budget and objectives of the project. The designing of the network is done in GIS or separate application environment. The final step is the operations and management of the network which is in GIS.

Interplay between quantum diffusion and localization in the atom-optics kicked rotor.

Atom-optics kicked rotor represents an experimentally reliable version of the paradigmatic quantum kicked rotor system. In this system, a periodic sequence of kicks are imparted to the cold atomic cloud. After a short initial diffusive phase the cloud settles down to a stationary state due to the onset of dynamical localization. In this paper, to explore the interplay between localized and diffusive phases, we experimentally implement a modification to this system in which the sign of the kick sequence is flipped after every M kicks. This is achieved in our experiment by allowing free evolution for half the Talbot time after every M kicks. Depending on the value of M, this modified system displays a combination of enhanced diffusion followed by asymptotic localization. This is explained as resulting from two competing processes-localization induced by standard kicked rotor type kicks, and diffusion induced by the half Talbot time evolution. The experimental and numerical simulations agree with one another. The evolving states display localized but nonexponential wave function profiles. This provides another route to quantum control in the kicked rotor class of systems.

Invasive cutaneous mucormycosis: A case report on a deadly complication of a severe burn.

A 38 year old woman presented with burns totaling 45 % total body surface area, following an explosion resulting from manufacturing cannabis wax. Initial debridement, was delayed to hospital day 7 due to hemodynamic instability. Over the course of her, hospitalization, she required multiple debridements and grafting to her lower, extremities; grafted tissue never survived longer than 72 h. Her bilateral lower, extremities began to exhibit visible mold growth. She underwent repeated, debridements down to vitalized tissue only for recurrent necrosis and mold growth to, occur. She underwent serial amputations eventually reaching the level of her midthigh, At this point her clinical condition deteriorated further resulting in multiorgan failure., Ultimately family made the decision to remove her from life support, and she expired, within a few hours. Postmortem analysis identified Rhizopus spp, Fusarium spp, and, Geotrichum candidum. Mucormycosis species are a frequent infector of Cannabis, sativa, which our patient was working with in the inciting explosion. Cutaneous, mucormycosis is a documented but rare manifestation. We propose that the patient's, relatively young age, severity of burns, and exposure to cannabis plants resulted in this, unusual presentation.

Septic Pulmonary Embolism Causing Recurrent Pneumothorax in an Intravenous Drug User without Right-Sided Valvular Vegetation in Infective Endocarditis.

The following report illustrates a case of a 36-year-old Caucasian male with intravenous drug use (IVDU) induced septic thrombophlebitis presenting with recurrent unilateral pneumothoraces from septic pulmonary embolism (SPE) without the presence of obvious right-sided valvular vegetation in infective endocarditis (IE), defined as tricuspid or pulmonary valve lesions. Pneumothorax (PTX) has been observed as a rare complication of SPE and is commonly associated with infective right-sided IE, IVDU, and intravascular indwelling catheters. However, this case is novel as it is the very rare documented case of recurrent, unilateral, spontaneous right PTX refractory to multiple chest tube placements in such a setting. Therefore, the absence of detectable right-sided valvular vegetation in IE does not obviate the risk of SPE-induced PTX in IVDU and further expands the realm of infectious and pulmonary consequences of SPE and IVDU.

ANCA vasculitis: A manifestation of Post-Covid-19 Syndrome.

The SARS-CoV-2 infection has been found to present with different degrees of response and variable levels of inflammation. Patients who have recovered from the initial infection can develop long-term symptomatology. We present a unique case of a middle aged-healthy man who developed complications of ANCA-associated vasculitis after recovering from a mild COVID-19 infection. A previously healthy 53-year-old male presented with hemoptysis and acute renal failure. One month prior, the patient tested positive for COVID-19; not requiring hospitalization. Physical exam findings included bilateral lower extremity petechiae. CT Chest showed bilateral diffuse patchy lung consolidations with cavitary lesions with urinalysis revealing erythrocytes, +1 protein. Hemodialysis and workup for pulmonary-renal syndromes were initiated. Infectious workup results included: negative COVID-19, negative MTB-PCR, respiratory culture revealing yeast. Additional workup revealed; elevated CRP, D-Dimer, and Fibrinogen. Notably, the patient had; decreased C3 and C4 levels; negative Anti-GBM antibody; negative Anti-streptolysin-O; and positive ANCA assay, Proteinase antibody, and mildly positive Myeloperoxidase antibody. Worsening coagulopathy and atrophic kidneys delayed renal biopsy for definitive diagnosis. The patient's respiratory status acutely worsened during hemodialysis with imaging showing markedly increased pulmonary infiltrates. Upon urgent intubation, active frank red bleeding was noted, and the patient sustained 2 cardiac arrests with eventual expiration. Much is to be learned from the Novel SARS-CoV-2 virus and suspected complications. This case highlights a unique complication of COVID-19 leading to a possible AAV and the importance of keeping a broad differential when treating patients who have recovered from the initial infection.

Preprocedural Hypertension Is Not a Risk Factor for Postoperative Bleeding following Image-Guided Core Needle Breast Biopsy.

OBJECTIVE: To evaluate the association between preprocedural hypertension and the risk of prolonged bleeding following image-guided core needle breast biopsy in nonpregnant/nonlactating women. METHODS: A single institution-based, retrospective cohort study of 400 women who underwent image-guided core needle breast biopsy was conducted. Males and pregnant and lactating women were excluded. Preprocedural systolic or diastolic blood pressure greater than 140 or 90 mm of Hg, respectively, was defined as hypertension. Prolonged bleeding was defined >15 minutes of local, manual pressure required to achieve hemostasis following the biopsy. Severe bleeding complications defined as clinical significant hematoma formation, prolonged bleeding requiring an ER visit, hospitalization, or surgical intervention were also recorded. RESULTS: The difference in the mean time for which manual pressure was held after biopsy for patients with and without preprocedural hypertension was not statistically significant (13 ± 7 vs. 13 ± 8 minutes, respectively, P = 0.856). There was no difference in the number of patients requiring manual postoperative pressure >15 minutes between those with preprocedural hypertension and the normotensive patients (13% vs. 12%, respectively, P = 0.765). Bivariate analysis demonstrated statistically significant association between prolonged bleeding and current antithrombotic or antiplatelet medication use (P = 0.010), the use of stereotactic guidance (P = 0.019), and a tethered vacuum-assisted device (P = 0.045). The use of a tethered vacuum-assisted biopsy device was the only variable associated with prolonged bleeding in the multivariate model (P = 0.044). CONCLUSION: Preprocedural hypertension is not a risk factor for prolonged bleeding following image-guided core needle breast biopsies in nonpregnant/nonlactating women.

Cleaning of water bodies using coastal sea bin (CSB).

The rivers in Mumbai are highly polluted with plastic waste and these rivers end up in the Arabian Sea, which brings all this waste back to the land during high tides. This garbage keeps piling up on land and it is difficult to manage this waste. Plastic waste causes harm to wildlife, environment, and human beings. Therefore. it is decided to design a rectangular suspended sea bin with the non-return flaps, facing the waves. The floating garbage that is flowing along the waves will enter the cage through the flaps and thus get trapped. The waves will thus progress without any hinderance due to the cage openings on the rear side. A comprehensive study is done with the weight, center of gravity and metacentric height of a rectangular coastal sea bin (CSB) for different materials. Aluminum is considered as an ideal material for the case study as it is durable, light- weight and non-corrosive. A simulated 3D CSB model with the scale ratio of 1:12.5 is also prepared.•Plastic waste causes harm to wildlife, environment, and human beings•A rectangular cage type rectangular coastal see bin (CSB) is designed with the non-return flaps, facing the waves for plastic collection•A simulated 3D CSB model with the scale ratio of 1:12.5 is also prepared.

The Anesthetic Effectiveness of J-Tip Needle-Free Injection System Prior to Trigger Finger Injection: A Double-Blind Randomized Clinical Trial.

Background: The aim of this preliminary study was to evaluate the effectiveness of a J-tip needle-free injection system (JNFS) to reduce pain associated with corticosteroid injection of the tendon sheath for treatment of trigger finger. Methods: Thirty-four consecutive trigger fingers occurring in 28 unique patients who met inclusion/exclusion criteria were consented and enrolled into this double-blind randomized controlled study. Patients were randomly assigned to the control (JNFS loaded with sterile normal saline) or treatment group (JNFS loaded with buffered 1% lidocaine). Both the fellowship-trained hand surgeon and patient were blinded to the allocation group. Prior to each trigger finger injection, each patient rated pain associated with stubbing toe and papercut on the visual analog scale (VAS), in addition to a postprocedure VAS pain score. Results: A total of 28 patients and 34 digits were enrolled in this study. There was no difference in patient demographics or preintervention pain perception between the control and treatment groups. The use of JNFS demonstrated lower mean pain VAS score when comparing the control group (n = 17) with the treatment group (n = 17), with VAS pain scores of 49 (SD = 31) and 39 (SD = 36), respectively. However, this difference was not statistically significant (P = .389). Conclusions: The use of JNFS loaded with 1% buffered lidocaine may reduce pain associated with trigger finger injections, although our results did not find a statistically significant difference. We hypothesize that the pain caused by the acidity of lidocaine is the primary driver of pain and discomfort during injection, and the pain from the needle stick is secondary. As a result, any pain reduction from JNFS is masked by the most painful part of injection-the delivery of injectate. Based on the findings and experience obtained from this study, we hypothesize that a follow-up study using buffered lidocaine may be able to better reveal the benefits of JNFS.

Lactobacillus-Associated Spontaneous Bacterial Peritonitis in a Liver Cirrhosis Patient on Probiotics.

The efficacy of over the counter probiotics has been an area of scientific debate. While the benefits of probiotics are heavily disputed, probiotics are considered generally safe. We present a case of a liver cirrhosis patient, who presented with hepatic encephalopathy. The patient was taking daily probiotics and receiving weekly therapeutic paracentesis. His workup revealed spontaneous bacterial peritonitis (SBP). Despite starting the patient on empiric ceftriaxone and vancomycin, the patient's leukocytosis did not improve. The paracentesis fluid and blood cultures grew Lactobacillus gasseri. Antibiotics were switched to piperacillin/tazobactam, after which the patient improved clinically. The case highlights the importance of vigilance in using probiotics, especially in liver cirrhosis patients. Also, patients with Lactobacillus-associated SBP may not improve with empiric antibiotic treatment of cephalosporins.

Factors Influencing Recommended Cancer Screening in Low-Income African American Women in Tennessee.

OBJECTIVE: This study examined the factors that predict recommended screening compliance to cervical, breast, and colorectal cancers in low-income African American women. It also examined obstacles to screenings by geographic region and screening status. METHODS: As a part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 308) were selected from the Meharry CNP community survey database. RESULTS: There were several predictors to recommended screening such as being employed and having health insurance (P < 0.05). Additionally, the obstacles to screening posed a similar level of difficulty for participants from different geographic areas. DISCUSSION: Sociodemographic differences and obstacles of screening need to be addressed in educational interventions aimed at improving cancer screenings.

A simple atomic beam oven with a metal thermal break.

We report the design and construction of a simple, easy to machine high temperature oven for generating an atomic beam in laser cooling experiments. This design eliminates the problem of thermal isolation of the oven region from the rest of the vacuum system without using a glass or ceramic thermal break. This design simplifies the construction and operation of high temperature ovens for elements having low vapor pressure. We demonstrate the functionality of such a source for strontium (Sr) atoms. We generate a high flux of Sr atoms for use in laser cooling and trapping experiments. The optimization of the design of the metal thermal break is done using a finite element analysis.

The extent of pediatric orthopaedic research in low- and middle-income countries and the impact of academic collaboration on research quality: a scoping review.

INTRODUCTION: This review aims to (1) assess the breadth of pediatric orthopaedic research in low- and middle-income countries (LMICs) and (2) determine the impact of academic collaboration (an LMIC and a non-LMIC investigator) in published LMIC research. METHODS: Pediatric orthopaedic clinical studies conducted in LMICs from 2004 to 2014 were extracted from Embase, Cochrane, and Pubmed databases. Of 22,714 searched studies, 129 met inclusion criteria. RESULTS: 85% generated low-quality evidence (level IV or lower). 21% were collaborative, and these were more likely than non-collaborative papers to generate level III evidence or higher (25% vs 13%, p = 0.141). DISCUSSION: Pediatric orthopaedic research produced by LMICs rarely achieves level I-III evidence, but collaborative studies are associated with higher levels of evidence. LEVEL OF EVIDENCE: N/A.

Orthopaedic Trauma in the Developing World: Where Are the Gaps in Research and What Can Be Done?

PURPOSE: There are an estimated 1.2 million deaths from road traffic injuries annually, disproportionately affecting patients in low-resource settings. The purpose of this scoping review is to identify knowledge gaps in global orthopaedic trauma in an effort to help prioritize future research. METHODS: Using the 6-stage Arksey and O'Malley framework for conducting a scoping review, orthopaedic trauma literature was reviewed over a ten-year period from 2004 to 2014. Studies from low-resource settings were included and categorized by geographic location, anatomic region, study type, and level of evidence. RESULTS: Of 548 included studies, 51.4% were from low- and middle-income countries in South Asia and 33.7% were from sub-Saharan Africa. Therapeutic (53.3%), epidemiologic (26.4%), and qualitative (8.9%) studies were most common. Only 10.2% of the studies were considered high level of evidence, whereas the vast majority (89.8%) was level 3 or below. Overall, lower extremity injuries were much more frequently represented in the literature compared with upper extremity injuries (233 vs. 78). Pelvic and acetabular fractures were the least studied anatomic region of the lower extremity (3.4%). CONCLUSIONS: Our study identified a lack of cost-effectiveness analyses pertaining to injury and intervention, paucity of high-quality research, and under-representation of pelvic, acetabular, and upper extremity injuries. Improved and prioritized research in low- and middle-income countries may help optimize care and inform policy makers of how to reduce the global burden of musculoskeletal trauma.

Variability in the Clock Face View Description of Femoral Tunnel Placement in ACL Reconstruction Using MRI-Based Bony Models.

Though controversial, the "clock face view" of the intercondylar notch remains a way some surgeons communicate regarding placement of the femoral tunnel in anterior cruciate ligament reconstruction. The purpose of this study was to quantify the differences in angle measurement between several previous descriptions of the clock face view by using a new reference standard. Three-Tesla magnetic resonance imaging (MRI) was used to scan 10 human knees to create three-dimensional MRI-based bony models which were used for measurements. A standardized clock face view was developed with the knee flexed to 90° using the junction of the cartilage and cortex of the medial and lateral surfaces of medial and lateral femoral condyles as the 3 o'clock and 9 o'clock, respectively, with the 12 o'clock established as the midpoint of the roof of the intercondylar notch. With the knee viewed at 90° of flexion, an "idealized" femoral tunnel position was plotted on the medial wall of the lateral femoral condyle at 30° (corresponding to the 10 o'clock or 2 o'clock position). The clock faces as described by Edwards et al, Heming et al, and Mochizuki et al were each then overlaid on this same model and the difference in measurement calculated. The average angles measured when the previously described clock faces were projected onto the idealized clock face view comparing a mark made at 30° were 47.7°, 7.2°, and 49.8° for the methods described by Edwards et al, Heming et al, and Mochizuki et al, respectively (all p < 0.001). Significant variation exists between angle measurements in simulated femoral tunnel placement based on the varying descriptions of the intercondylar clock face.

A Community-Driven Intervention for Improving Biospecimen Donation in African American Communities.

INTRODUCTION: Human biospecimens are an invaluable resource for addressing cancers and other chronic diseases. The purpose of this study was to assess the impact of an educational intervention on biospecimen knowledge and attitudes. METHODS: The participants consisted of 112 African Americans, 18 years and older, and who had not provided biospecimens for any health-related research in the past. A total of 55 participants received the educational brochure, and 57 received the educational video. The main outcomes of the study were knowledge and attitudes for biospecimen donation. This information was collected pre- and post-intervention. RESULTS: The average knowledge scores increased (p < 0.0001) and the average attitude scores for biospecimen donation improved (p < 0.0001) post-intervention for both the video and brochure conditions. There was an interaction between the intervention condition and knowledge where the participants who received the educational video showed a greater increase in knowledge pre-to-post compared to those who received the educational brochure (p = 0.0061). There were no significant interactions between the two intervention conditions for attitudes toward biospecimen donation. DISCUSSION: The results of this study demonstrated the feasibility and efficacy of an academic institution collaborating with the African American community in developing educational tools for biospecimen donation.

Impact of academic collaboration and quality of clinical orthopaedic research conducted in low- and middle-income countries.

BACKGROUND: Little is known about the quality of orthopaedic investigations conducted in low- and middle-income countries (LMICs). Academic collaboration is one model to build research capacity and improve research quality. Our study aimed to determine (1) the quality of clinical orthopaedic research conducted in LMICs, (2) the World Bank Regions and LMICs that publish the highest quality studies, (3) the pattern of collaboration among investigators and (4) whether academic collaboration between LMIC and non-LMIC investigators is associated with studies that have higher levels of evidence. METHODS: Orthopaedic studies from 2004 to 2014 conducted in LMICs were extracted from multiple electronic databases. The World Bank Region, level of evidence and author country-affiliation were recorded. Collaboration was defined as a study that included an LMIC with non-LMIC investigator. RESULTS: There were 958 studies that met inclusion criteria of 22,714 searched. Ninety-seven (10.1%) of included studies achieved Level 1 or 2 evidence, but case series (52.3%) were the most common. Collaboration occurred in 14.4% of studies and the vast majority of these (88.4%) were among academic institutions. Collaborative studies were more likely to be Level 1 or 2 (20.3% vs. 8.4%, p < 0.01), prospective (34.8% vs. 22.9% p = 0.04) and controlled (29.7% vs. 14.4%, p < 0.01) compared to non-collaborative studies. CONCLUSIONS: Although orthopaedic studies in LMICs rarely reach Level 1 or 2 evidence, studies published through academic collaboration between LMIC and non-LMIC investigators are associated with higher levels of evidence and more prospective, controlled designs.

Risk Factors Associated With Carbapenem-Resistant Pseudomonas aeruginosa.

INTRODUCTION: Pseudomonas aeruginosa infections resistant to carbapenem antimicrobials have increased. Traditional risk factors for non-carbapenem resistance include intensive care unit stay, mechanical ventilation, previous hospitalization, and major comorbidities. As microbes evolve, our understanding of their risk factors for resistance also should evolve. METHODS: We conducted a retrospective study of adult inpatients and outpatients with a positive Pseudomonas aeruginosa culture during 2014. Cultures were obtained from system laboratories and medical records were reviewed through our electronic medical record. Pearson's chi-squared test with Yates correction and 2-sample t-tests were performed on categorical and continuous variables, respectively. Binary regression was used for multivariable modeling. RESULTS: Patients (N=1,763), of mean age 68.0 years and body mass index (BMI) 30.4 kg/m2, were more likely to be women (51.3%) and were predominately white (89.3%). Resistance to imipenem or meropenem (14.0%) on univariable analysis was associated with several variables of interest. Non-white race (odds ratio [OR] =1.67; P=0.009), respiratory cultures (OR=1.95; P=0.003), recent institutional transfer (OR=2.50; P<0.0001), vasopressor use (OR=1.98; P=0.001), central line placement (OR=1.55; P=0.036), and peripherally inserted central catheter placement (OR=1.74; P=0.002) remained significant predictors of carbapenem resistance in multivariable modeling. CONCLUSION: Demographic and traditional risk factors, as well as respiratory cultures, were predictive of carbapenem resistance and may guide initial antibiotic treatment. Use of "last resort" antibiotics for Pseudomonas aeruginosa based solely on patient chronic conditions may not be necessary. Fortunately, <1% of strains were resistant to all drugs tested. Ongoing efforts to face drug-resistant organisms are warranted.

Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study.

OBJECTIVE: The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. METHODS: Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. RESULTS: Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, ß = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. CONCLUSIONS: This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.