Fast Fractional Fourier Transform-Aided Novel Graphical Approach for EEG Alcoholism Detection.

Given its detrimental effect on the brain, alcoholism is a severe disorder that can produce a variety of cognitive, emotional, and behavioral issues. Alcoholism is typically diagnosed using the CAGE assessment approach, which has drawbacks such as being lengthy, prone to mistakes, and biased. To overcome these issues, this paper introduces a novel paradigm for identifying alcoholism by employing electroencephalogram (EEG) signals. The proposed framework is divided into various steps. To begin, interference and artifacts in the EEG data are removed using a multiscale principal component analysis procedure. This cleaning procedure contributes to information quality improvement. Second, an innovative graphical technique based on fast fractional Fourier transform coefficients is devised to visualize the chaotic character and complexities of the EEG signals. This elucidates the properties of regular and alcoholic EEG signals. Third, thirty-four graphical features are extracted to interpret the EEG signals' haphazard behavior and differentiate between regular and alcoholic trends. Fourth, we propose an ensembled feature selection method for obtaining an effective and reliable feature group. Following that, we study many neural network classifiers to choose the optimal classifier for building an efficient framework. The experimental findings show that the suggested method obtains the best classification performance by employing a recurrent neural network (RNN), with 97.5% accuracy, 96.7% sensitivity, and 98.3% specificity for the sixteen selected features. The proposed framework can aid physicians, businesses, and product designers to develop a real-time system.

Racial and Ethnic Disparities in Peripheral Vascular Disease Admissions Using a Nationally Representative Sample.

Our study aimed to identify clinical outcomes and resource utilization associated with race and ethnicity in patients admitted with peripheral vascular disease (PVD) across the United States. We queried the National Inpatient Sample database from 2015 to 2019 and identified 622,820 patients admitted with PVD. Patients across 3 major race and ethnic categories were compared in terms of baseline characteristics, inpatient outcomes, and resource utilization. Black and Hispanic patients were more likely to be younger and of the lowest median income but incur higher total hospital costs. Black race predicted higher rates of acute kidney injury, need for blood transfusion, and need for vasopressor but lower rates of circulatory shock, and mortality. Black and Hispanic patients were less likely to undergo limb-salvaging procedures and more likely to undergo amputation than White patients. In conclusion, our findings indicate that Black and Hispanic patients experience health disparities in resource utilization and inpatient outcomes for PVD admissions.

Independent Risk Factors for Thromboembolic Events in High-Risk Patients With Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TCM) is characteristically associated with left ventricular apical ballooning and regional wall motion abnormalities that predispose to the formation of left ventricular (LV) thrombi and subsequent thromboembolic events (VTE). There is limited data about the risk factors of developing stroke in the absence of LV thrombi in patients with TCM. Identify risk factors that predispose patients with TCM to develop VTE and stroke. We retrospectively reviewed all patients admitted with a primary diagnosis of stress induced or Takotsubo cardiomyopathy at a large tertiary care center from 2005 to 2019. Patients who met the echocardiographic criteria of TCM, had resolution of WMA on repeat echocardiogram, did not have coronary artery disease if angiography was performed and survived for > 3 months after index presentation were included in the analysis. Patients were followed for up to a period of 1 year. Multivariate analysis was performed to identify predictors of thromboembolism. Among the 400 patients who presented with TCM, 146 patients were included in the analysis. A total of 13 patients (8.9%) had documented thromboembolic events. Patients with VTE more often had Atrial fibrillation (30.8% vs 6.8%, P = 0.018), higher LV mass (224.5g vs 184g, P = 0.04), lower EF on presentation (31.5% vs 40%, P = 0.011) and were less likely to have undergone coronary angiography following diagnosis (23.1% vs 54.9%, P = 0.04). On multivariate analysis, atrial fibrillation (OR 9.15, CI 1.15-72.70) and low ejection fraction on admission (OR 0.88, CI 0.81-0.97) were independent risk factors for the development of VTE. Atrial fibrillation and low ejection fraction on presentation were associated with higher risk of developing thromboembolic events in patients with TCM.

Usefulness of non-gated chest computed tomography scans in the diagnosis of acute myocardial infarction.

Contrast-enhanced computed tomography (CT) is frequently utilized to evaluate patients who present to the emergency department with chest pain for a pulmonary or aortic disease but is not routinely used to evaluate for acute myocardial infarction (AMI). Decreased myocardial enhancement in non-electrocardiogram-gated contrast-enhanced CT has been proposed to indicate AMI. These two cases highlight the importance of carefully evaluating the myocardium for perfusion defects on non-gated chest CT scans in patients suspected of having AMI.

Identification of suitable habitat for Taxus wallichiana and Abies pindrow in moist temperate forest using maxent modelling technique.

Conservation of any species necessitates knowledge of its biology and natural history, as well as prospective locations or newer adaptive landscapes where the species can survive and thrive. This study presents habitat suitability and local conservation status of Taxus wallichiana and Abies pindrow in moist temperate forest of Hazara division, Pakistan. Data was collected through field surveys based on 363 samples from field, topographical and bioclimatic variables. In the present study, we employed the MaxEnt model exclusively for each tree species along with 23 independent or environment variables (19 bioclimatic and 4 topographic). The jackknife test was used to demonstrate the significance of variables with the highest gain, and it was found that overall tree cover, annual temperature range was the factors with the highest gain, while slope was amongst the least important. The MaxEnt model produced high accuracy for each tree species, with receiver operating characteristic (ROC), area under the curve (AUC), training mean testing values for Taxus wallichiana was 0.966 followed by 0.944 for Abies pindrow. Local conservation status of Taxus wallichiana and Abies pindrow was evaluated using IUCN criteria 2001. Taxus wallichiana was declared critically endangered locally as the population size reduced by 87%. In contrast, Abies pindrow was declared as endangered as population size reduced by 69% falling under endangered criteria A of IUCN. The decline in population size of Taxus wallichiana and Abies pindrow species were due to human cause anthropogenic activities such as exploitation and loss of habitat, the extent of occurrence, and slow regeneration of tree species. Results and field-based observation revealed that suitable habitat modeling showed unsuitable (0.0-0.2), less suitable (0.2-0.4), moderately (0.4-0.6), highly (0.6-0.7), and very highly (0.7-1.0) suitable habitat for Taxus wallichiana and Abies pindrow. Results also revealed that both species were distributed irregularly in the moist temperate forest of Hazara division. Habitat suitability of Taxus wallichiana and Abies pindrow can be considered one of most significant points toward conserving these tree species. Habitat loss is a major threat to their occurrence, which should be overcome by ensuring the protection of suitable habitat and conservation approaches. Considering the species ecological and economic value, it is essential to understand how the species distribution may vary as a result of climate change to establish effective conservation policies. This study also includes significant environmental elements that influence species distribution, which could help locate regions where the species could be planted. Forest tree species require effective, scientific, and long-term management and conservation techniques in the study area. Furthermore, the formulation and implementation of protective laws and policies are required to conserve and protect both the conifer species.

Disparities in the Prescription of Statins in the Primary Care Setting: A Retrospective Observational Study.

Despite the high disease burden of atherosclerosis, evidence exists for the disparity in the prescription of guideline-indicated medications between genders, racial groups, socioeconomic groups, and ages. We aim to perform a retrospective study looking at the disparity in statin prescription for primary and secondary prevention in these groups. Data were collected from a single center and included patients with an LDL level >190 mg/dL, diagnosis of diabetes mellitus with LDL level >70 mg/dL, and diagnosis of cardiovascular disease regardless of LDL level. Patients older than 75 or younger than 21 were excluded from the study. Complex samples multivariable logistic and linear regression models were used to calculate the adjusted odds ratio and 95% confidence interval. The total study population was n = 56,995. Of those, 57.89% (n = 32,992) were female. Only 59.56 % of these patients for whom statin therapy was indicated received it. Most patients were White (53.21%) followed by African Americans (35.98%), Asians (2.43%), American Indian/Native Alaskans (0.40%), and Native Hawaiian/Pacific Islander (0.18%). There is a clear disparity in statin prescription favoring males, the elderly, and people of white ethnicity. Interestingly, Asians were more likely to be prescribed statins as opposed to whites. Self-pay patients were more likely to receive statins than patients on Medicare.Despite being indicated, Statins are under prescribed. Disparities based on race, gender, and insurance type mirror previous trends in the literature. Some results have shown a reversal in trends such as the higher prescription for Asian-Americans. Multiple patient-specific, provider-related, institutional factors might explain these disparities and must be investigated.

Determining the Safety of Radiofrequency Ablation in Cardiovascular Implantable Electronic Devices.

Radiofrequency catheter ablation (RFCA) is an effective treatment for arrhythmias. The effects of RFCA on cardiovascular implantable electronic devices (CIED) function have varied. We aim to study the effect of RFCA on device parameters and clinical outcomes in patients with CIED. We conducted a single-center retrospective cohort study between 2011 and 2018. Generator and lead parameters were compared pre- and post-ablation using paired sample t-test. The median follow-up interval for documentation of procedure-related complications and clinical outcomes was 8 weeks. We identified 119 eligible patients; whose mean age was 64.5 ± 11.91 years and 22 (18.4%) were females. Types of CIED include single-chamber implantable cardioverter defibrillators (8.93%), dual-chamber implantable cardioverter defibrillators (41.96%), and either dual-chamber or biventricular pacemakers (44.54%). Arrhythmias for which patients underwent RFCA include atrial fibrillation/atrial tachycardia (15.22%), atrial flutter (38.14%), atrioventricular node reentrant tachycardia (13.56%), and premature ventricular complex or ventricular tachycardia (20.34%). No statistically significant difference was observed in pre- and post-ablation: (1) atrial sensing thresholds, pacing thresholds, lead impedance; (2) right ventricle sensing and pacing thresholds; and (3) left ventricle pacing threshold and impedance. A decrease in right ventricle impedance after ablation (549.77 ± 173 ohm vs 507.40 ± 129.0 ohm, P-value <0.004) was observed. Zero complications or deaths were observed. In this single-center study, RFCA did not significantly impact CIED function and was not associated with short-term complications. However longer follow-up is required to confirm these findings.

Incidence of food and aero allergies among patients visiting Allergy center National Institute of Health (NIH), Islamabad.

Objective: To identify the most common allergy type among patients visiting an urban allergy centre. METHODS: The descriptive cross-sectional study was conducted at the Allergy Centre of the National Institute of Health, Islamabad, Pakistan, from December 2019 to June 2020, and comprised subjects of either gender aged 20-50 years. Skin prick test was used to determine the skin reactivity for 11 common allergen extracts. Patients with a wheal diameter >3mm were considered positive. Data was analysed using SPSS 22. RESULTS: Of the 100 patients, 55(55%) were males and 45(45%) were females. The overall mean age was 34.03±8.16 years. Majority of the respondents 93(93%) were sensitive to aeroallergen, 7(7%) to food allergens, and 2(2%) exhibited sensitivity against both types of allergens. Poly-sensitisation was found among 86(86%) respondents. Conclusion: Aeroallergens were found to be the main triggering factor for allergies compared to the food allergens.

How to Teach Professionalism in a Clinical Context?

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Exploiting pretrained CNN models for the development of an EEG-based robust BCI framework.

Identifying motor and mental imagery electroencephalography (EEG) signals is imperative to realizing automated, robust brain-computer interface (BCI) systems. In the present study, we proposed a pretrained convolutional neural network (CNN)-based new automated framework feasible for robust BCI systems with small and ample samples of motor and mental imagery EEG training data. The framework is explored by investigating the implications of different limiting factors, such as learning rates and optimizers, processed versus unprocessed scalograms, and features derived from untuned pretrained models in small, medium, and large pretrained CNN models. The experiments were performed on three public datasets obtained from BCI Competition III. The datasets were denoised with multiscale principal component analysis, and time-frequency scalograms were obtained by employing a continuous wavelet transform. The scalograms were fed into several variants of ten pretrained models for feature extraction and identification of different EEG tasks. The experimental results showed that ShuffleNet yielded the maximum average classification accuracy of 99.52% using an RMSProp optimizer with a learning rate of 0.000 1. It was observed that low learning rates converge to more optimal performances compared to high learning rates. Moreover, noisy scalograms and features extracted from untuned networks resulted in slightly lower performance than denoised scalograms and tuned networks, respectively. The overall results suggest that pretrained models are robust when identifying EEG signals because of their ability to preserve the time-frequency structure of EEG signals and promising classification outcomes.

A novel computer-aided diagnosis framework for EEG-based identification of neural diseases.

Recent advances in electroencephalogram (EEG) signal classification have primarily focused on domain-specific approaches, which impede algorithm cross-discipline capability. This study introduces a new computer-aided diagnosis (CAD) system for the classification of two distinct EEG domains under a unified sequential framework. The key motivation to consider two neural diseases by one framework is to develop a unified algorithm for EEG classification. The main contributions of this study are five-fold. First, EEG signals are decomposed into 10 intrinsic mode functions (IMFs) with the help of empirical wavelet transform. Second, a novel two-dimensional (2D) modeling of IMFs is plotted to visualize the complexity of EEG signals. Third, several new geometrical features are extracted to analyze the dynamic and chaotic essence. Fourth, significant features are selected by binary particle swarm optimization algorithm (B-PSO). Fifth, selected features are fed to the k-nearest neighbor classifier for EEG signal classification purposes. All the experiments are executed on one depression and two epileptic EEG datasets in a leave one out cross-validation strategy. The proposed CAD system provides an average classification accuracy of 93.35% in depression detection, 99.33% for regular against ictal, and 97.33% for interictal versus ictal respectively. The overall empirical analysis authenticates that the proposed CAD outperforms the existing domain-specific methods in terms of classification accuracies and multirole adaptability, thus, can be endorsed as an effective automated neural rehabilitation system.

Simultaneous Power Feedback and Maximum Efficiency Point Tracking for Miniaturized RF Wireless Power Transfer Systems.

Near-field interfaces with miniaturized coil systems and low output power levels, such as applied in biomedical sensor systems, can suffer from severe efficiency degradation due to dynamic impedance mismatches, reducing battery life of the power transmitter unit and requiring to increase the level of electromagnetic emission. Moreover, the stability of weakly-coupled power transfer systems is generally limited by transient changes in coil alignment and load power consumption. Hence, a central research question in the domain of wireless power transfer is how to realize an adaptive impedance matching system under the constraints of a simultaneous power feedback to increase the system's efficiency and stability, while maintaining circuit characteristics such as small size, low power consumption and fast reaction times. This paper presents a novel approach based on a two-stage control loop implemented in the primary-side reader unit, which uses a digital PI controller to maintain the rectifier output voltage for power feedback and an on-top perturb-and-observe controller configuring the setpoint of the voltage controller to maximize efficiency. The paper mathematically analyzes the AC and DC transfer characteristics of a resonant inductive link to design the reactive AC matching network, the digital voltage controller and ultimately the DC-domain impedance matching algorithm. It was found that static reactive L networks result in suitable efficiency levels for coils with sufficiently high quality factor even without adaptive tuning of operational frequency or reactive components. Furthermore, the regulated output voltage of the rectifier is a direct measure of the DC load impedance when using a regular DC/DC converter to supply the load circuits, so that this quantity can be tuned to maximize efficiency. A prototype implementation demonstrates the algorithms in a 40.68 MHz inductive link with load power levels from 10 to 100 mW and tuning time constants of 300 ms, while allowing for a simplified receiver with a footprint smaller than 200 mm2 and a self-consumption below 1 mW. Hence, the presented concepts enable adaptive impedance matching with favorable characteristics for low-energy sensor systems, i.e., minimized footprint, power level and reaction time.

Exploring the Relationship between Attitudes, Risk Perceptions, Fatalistic Beliefs, and Pedestrian Behaviors in China.

Road safety has become a worldwide public health concern. Although many factors contribute to collisions, pedestrian behaviors can strongly influence road safety outcomes. This paper presents results of a survey investigating the effects of age, gender, attitudes towards road safety, fatalistic beliefs and risk perceptions on self-reported pedestrian behaviors in a Chinese example. The study was carried out on 543 participants (229 men and 314 women) from 20 provinces across China. Pedestrian behaviors were assessed by four factors: errors, violations, aggressions, and lapses. Younger people reported performing riskier pedestrian behaviors compared to older people. Gender was not an influential factor. Of the factors explored, attitudes towards road safety explained the most amount of variance in self-reported behaviors. Significant additional variance in risky pedestrian behaviors was explained by the addition of fatalistic beliefs. The differences among the effects, and the implications for road safety intervention design, are discussed. In particular, traffic managers can provide road safety education and related training activities to influence pedestrian behaviors positively.

Very High Bit Rate Near-Field Communication with Low-Interference Coils and Digital Single-Bit Sampling Transceivers for Biomedical Sensor Systems.

The evolution of microelectronics increased the information acquired by today's biomedical sensor systems to an extent where the capacity of low-power communication interfaces becomes one of the central bottlenecks. Hence, this paper mathematically analyzes and experimentally verifies novel coil and transceiver topologies for near-field communication interfaces, which simultaneously allow for high data transfer rates, low power consumption, and reduced interference to nearby wireless power transfer interfaces. Data coil design is focused on presenting two particular topologies which provide sufficient coupling between a reader and a wireless sensor system, but do not couple to an energy coil situated on the same substrate, severely reducing interference between wireless data and energy transfer interfaces. A novel transceiver design combines the approaches of a minimalistic analog front-end with a fully digital single-bit sampling demodulator, in which rectangular binary signals are processed by simple digital circuits instead of sinusoidal signals being conditioned by complex analog mixers and subsequent multi-bit analog-to-digital converters. The concepts are implemented using an analog interface in discrete circuit technology and a commercial low-power field-programmable gate array, yielding a transceiver which supports data rates of up to 6.78 MBit/s with an energy consumption of just 646 pJ/bit in transmitting mode and of 364 pJ/bit in receiving mode at a bit error rate of 2×10-7, being 10 times more energy efficient than any commercial NFC interface and fully implementable without any custom CMOS technology.

A genome-wide analysis in consanguineous families reveals new chromosomal loci in specific language impairment (SLI).

Language is a uniquely human ability, and failure to attain this ability can have a life-long impact on the affected individuals. This is particularly true for individuals with specific language impairment (SLI), which is defined as an impairment in normal language development in the absence of any other developmental disability. Although SLI displays high heritability, family-based linkage studies have been hampered by an unclear mode of Mendelian segregation, variable disease penetrance, and heterogeneity of diagnostic criteria. We performed genome-wide parametric linkage analysis and homozygosity mapping in 14 consanguineous families from Pakistan segregating SLI. Linkage analysis revealed a multipoint LOD score of 4.18 at chromosome 2q in family PKSLI05 under a recessive mode of inheritance. A second linkage score of 3.85 was observed in family PKSLI12 at a non-overlapping locus on chromosome 2q. Two other suggestive linkage loci were found in family PKSLI05 on 14q and 22q with LOD scores of 2.37 and 2.23, respectively, that were also identified in homozygosity mapping. Reduction to homozygosity was observed on chromosomes 2q, 5p, 8q, 14q, 17q, and 22q. Each homozygosity region occurred in multiple PKSLI families. We report new SLI loci on chromosomes 2 and 8 and confirm suggestive SLI linkage loci on chromosomes 5, 14, 17, and 22 reported previously in the population of Robinson Crusoe Island. These findings indicate that linkage and homozygosity mapping in consanguineous families can improve genetic analyses in SLI and suggest the involvement of additional genes in the causation of this disorder.

Acute Appendicitis Complicating into Portal and Superior Mesenteric Vein Thrombosis.

This case report describes a young man who presented with 9-day history of sudden-onset epigastric and right-sided lower abdominal pain. He was tachycardiac with temperature of 102°F. Tenderness was present in the peri-umbilical area and right iliac fossa. Investigations revealed a raised total leucocyte count (predominantly neutrophilic). Triphasic CTscan abdomen found thrombosis of right portal vein and its hepatic tributaries alongwith superior mesenteric vein (SMV) and its tributaries. Co-existent fluid in right hemipelvis abutting the cecum and appendiceal tip was suggestive of acute appendicitis. He was resuscitated with fluids and analgesics and started on intravenous metronidazole and ceftriaxone. Anticoagulation with subcutaneous heparin was commenced and eventually switched over to warfarin. Appendicectomy was not performed as the patient responded to conservative treatment. Appendicitis is associated with multiple complications but secondary venous thrombosis has rarely been reported with it.

Differences in detection rates for serious neonatal diseases before and after institution of newborn rounds by paediatricians in a private sector hospital.

BACKGROUND: Perinatal and infant mortality are two major contributors to child mortality in developing world. It is widely recognised that synergistic efforts by paediatric and obstetric healthcare providers result in improvement of neonatal and infant survival. Close working relationship between the 2 disciplines with attendance of all high risk births by paediatric healthcare providers and routine examination of all neonates is required for this purpose. Objectives were to compare 2 continuums of 100 neonatal cases for detection of serious neonatal disease. One set of neonates being examined by neonatal/paediatric service and other without this service in place. METHODS: One hundred Neonatal Exam sheets were selected randomly from records of 2007-2008 and compared with 100 Neonatal Exam Sheets of 2006-2007. Records were analysed for detection of serious neonatal conditions at 24 hours age. Data was analysed using MS EXCEL. Odds ratio was calculated for each disease with Haldane correction. RESULTS: Odds ratio was significantly higher for detection of serious neonatal diseases in 2007-2008 group when neonatal service was actively involved in newborn examinations of all neonates. Highest odds ratios were obtained for detection of Heart Murmur and neonatal sepsis. CONCLUSIONS: Newborn Examination within 24-48 hours of birth by trained neonatal healthcare provider is paramount for adequate detection of serious neonatal diseases. Such services should be instituted in all obstetric units for better neonatal outcome.