On Coverage of Critical Nodes in UAV-Assisted Emergency Networks.

Unmanned aerial vehicle (UAV)-assisted networks ensure agile and flexible solutions based on the inherent attributes of mobility and altitude adaptation. These features render them suitable for emergency search and rescue operations. Emergency networks (ENs) differ from conventional networks. They often encounter nodes with vital information, i.e., critical nodes (CNs). The efficacy of search and rescue operations highly depends on the eminent coverage of critical nodes to retrieve crucial data. In a UAV-assisted EN, the information delivery from these critical nodes can be ensured through quality-of-service (QoS) guarantees, such as capacity and age of information (AoI). In this work, optimized UAV placement for critical nodes in emergency networks is studied. Two different optimization problems, namely capacity maximization and age of information minimization, are formulated based on the nature of node criticality. Capacity maximization provides general QoS enhancement for critical nodes, whereas AoI is focused on nodes carrying critical information. Simulations carried out in this paper aim to find the optimal placement for each problem based on a two-step approach. At first, the disaster region is partitioned based on CNs' aggregation. Reinforcement learning (RL) is then applied to observe optimal placement. Finally, network coverage over optimal UAV(s) placement is studied for two scenarios, i.e., network-centric and user-centric. In addition to providing coverage to critical nodes, the proposed scheme also ensures maximum coverage for all on-scene available devices (OSAs).

Acute Myocarditis Masquerading as ST-Elevation Myocardial Infarction in a 17-Year-Old.

Myocarditis can have a variable clinical presentation, ranging from asymptomatic to full-blown fulminant heart failure with severe left ventricular dysfunction or acute coronary syndrome (ACS) even ST-Elevation Myocardial Infarction (STEMI). Clinically myocarditis mimicking STEMI can present physicians with a great diagnostic challenge, especially in the absence of pro-dormal flu-like symptoms or a recent viral illness. Cardiac MRI has demonstrated superiority in detecting myocardial abnormalities and differentiating patients with myocarditis and from those with true STEMI.

Risk Factors and Outcomes of Protein-Calorie Malnutrition in Chronic Heart Failure Patients Undergoing Elective Cardiac Surgery.

INTRODUCTION: Chronic heart failure (CHF) patients are often malnourished. Our aim was to determine the effect of protein-calorie malnutrition (PCM) on in-hospital outcomes in CHF patients following elective cardiac surgery and to identify risk factors for PCM in this patient population. METHODS: A retrospective analysis of the National Inpatient Sample (NIS) database was conducted from 2016 to 2018. In-hospital outcomes in adult patients with CHF undergoing elective coronary artery bypass graft (CABG) with cardiopulmonary bypass-assist or cardiac valve replacement surgeries were analyzed. Propensity-score matching was used to match CHF patients with and without PCM and followed by logistic regression analysis. A multivariate logistic regression model was used to identify the risk factors associated with PCM in this population. RESULTS: In total 25,940 CHF patients were identified, of which 6,271 underwent elective CABG and 19,669 underwent valve replacement surgeries. The prevalence of PCM in CHF patients undergoing CABG and valve replacement was 3.9% and 2.9%, respectively. CHF patients with PCM had significantly higher risk of in-hospital mortality, post-operative cardiac and gastrointestinal complications compared to CHF patients without PCM. The mean hospital length of stay was twice as high in the PCM group (mean days: 18.6 vs 9.9). Female gender, Black race (vs White race), a high Charlson Comorbidity Index, Medicare/Medicaid insurance status (vs private insurance), and CHF (systolic and combined systolic and diastolic) were independently associated with significantly higher risk of PCM diagnosis. CONCLUSIONS: CHF patients with PCM who undergo elective CABG or valve replacement surgeries are at a significantly higher risk of mortality, post-operative cardiac and gastrointestinal complications, and increased duration of hospital stay compared to those without PCM. Future prospective studies should assess the CHF patients who are at a higher risk of PCM and whether correcting pre-operative nutrition in this surgical population can improve outcomes following cardiac surgery.

Accessibility and Content of Fellowship Programs for Cardiovascular Disease.

Background The objective of this study was to assess the accessibility and content of the Accreditation Council for Graduate Medical Education (ACGME)-accredited general cardiology fellowship websites. Methods Using the online information provided by the Electronic Residency Application Services (ERAS), we compiled a list of ACGME-accredited cardiac fellowship programs. The program links on ERAS were evaluated followed by a standard Google search of the program name + "cardiology fellowship". Each program website was evaluated on the basis of program content, applying/recruiting and education. Results At the time of this study, we reviewed 231 general cardiology fellowship programs provided through ERAS. Of the 231 programs, 12 were excluded due to broken links, repeated links on ERAS, and websites with a general lack of content. We analyzed the data collected from the remaining 219 programs to assess the availability and general content of those websites. Data collected revealed a general lack of information regarding application processing and educational services but were sufficient in providing program descriptions and contact information. Conclusions ERAS can be used to locate general cardiology fellowships participating in the current match; however, the links provided by the program websites on ERAS are lacking in general content and accessibility. Although most websites did contain enough information about their program, there was a distinct lack of key information provided typically in the education services and application process.

A Reinforcement Learning Routing Protocol for UAV Aided Public Safety Networks.

In Public Safety Networks (PSNs), the conservation of on-scene device energy is critical to ensure long term connectivity to first responders. Due to the limited transmit power, this connectivity can be ensured by enabling continuous cooperation among on-scene devices through multipath routing. In this paper, we present a Reinforcement Learning (RL) and Unmanned Aerial Vehicle- (UAV) aided multipath routing scheme for PSNs. The aim is to increase network lifetime by improving the Energy Efficiency (EE) of the PSN. First, network configurations are generated by using different clustering schemes. The RL is then applied to configure the routing topology that considers both the immediate energy cost and the total distance cost of the transmission path. The performance of these schemes are analyzed in terms of throughput, energy consumption, number of dead nodes, delay, packet delivery ratio, number of cluster head changes, number of control packets, and EE. The results showed an improvement of approximately 42% in EE of the clustering scheme when compared with non-clustering schemes. Furthermore, the impact of UAV trajectory and the number of UAVs are jointly analyzed by considering various trajectory scenarios around the disaster area. The EE can be further improved by 27% using Two UAVs on Opposite Axis of the building and moving in the Opposite directions (TUOAO) when compared to a single UAV scheme. The result showed that although the number of control packets in both the single and two UAV scenarios are comparable, the total number of CH changes are significantly different.

Recurrent Takotsubo Cardiomyopathy Presenting With Anterior Wall ST-Elevation Myocardial Infarction.

Takotsubo cardiomyopathy (TC) or stress cardiomyopathy with the presence of transient apical ballooning of the left ventricle in the absence of obstructive coronary artery disease. The recurrence of TC is extremely rare, with an annual recurrence risk of 1.5% and approximately 5% recurrence risk after six years. We present a case of a patient with a history of TC who presented with chest pain and ST-segment elevation in her electrocardiogram and was found to have normal coronaries and diagnosed with recurrent TC.

Outcomes in Patients With COVID-19 Disease and High Oxygen Requirements.

BACKGROUND: Approximately 19% of people infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) progress to severe or critical stages of the coronavirus disease 2019 (COVID-19) with a mortality rate exceeding 50%. We aimed to examine the characteristics, mortality rates, intubation rate, and length of stay (LOS) of patients hospitalized with COVID-19 disease with high oxygen requirements (critically ill). METHODS: We conducted a retrospective analysis in a single center in Brooklyn, New York. Adult hospitalized patients with confirmed COVID-19 disease and high oxygen requirements were included. We performed multivariate logistic regression analyses for statistically significant variables to reduce any confounding. RESULTS: A total of 398 patients were identified between March 19th and April 25th, 2020 who met the inclusion criteria, of which 247 (62.1%) required intubation. The overall mortality rate in our study was 57.3% (n = 228). The mean hospital LOS was 19.1 ± 17.4 days. Patients who survived to hospital discharge had a longer mean LOS compared to those who died during hospitalization (25.4 ± 22.03 days versus10.7 ± 1.74 days). In the multivariate analysis, increased age, intubation and increased lactate dehydrogenase (LDH) were each independently associated with increased odds of mortality. Diarrhea was associated with decreased mortality (OR 0.4; CI 0.16, 0.99). Obesity and use of vasopressors were each independently associated with increased intubation. CONCLUSIONS: In patients with COVID-19 disease and high oxygen requirements, advanced age, intubation, and higher LDH levels were associated with increased mortality, while diarrhea was associated with decreased mortality. Gender, diabetes, and hypertension did not have any association with mortality or length of hospital stay.

Kir6.1- and SUR2-dependent KATP overactivity disrupts intestinal motility in murine models of Cantú syndrome.

Cantú syndrome (CS), caused by gain-of-function (GOF) mutations in pore-forming (Kir6.1, KCNJ8) and accessory (SUR2, ABCC9) ATP-sensitive potassium (KATP) channel subunit genes, is frequently accompanied by gastrointestinal (GI) dysmotility, and we describe 1 CS patient who required an implanted intestinal irrigation system for successful stooling. We used gene-modified mice to assess the underlying KATP channel subunits in gut smooth muscle and to model the consequences of altered KATP channels in CS gut. We show that Kir6.1/SUR2 subunits underlie smooth muscle KATP channels throughout the small intestine and colon. Knockin mice, carrying human KCNJ8 and ABCC9 CS mutations in the endogenous loci, exhibited reduced intrinsic contractility throughout the intestine, resulting in death when weaned onto solid food in the most severely affected animals. Death was avoided by weaning onto a liquid gel diet, implicating intestinal insufficiency and bowel impaction as the underlying cause, and GI transit was normalized by treatment with the KATP inhibitor glibenclamide. We thus define the molecular basis of intestinal KATP channel activity, the mechanism by which overactivity results in GI insufficiency, and a viable approach to therapy.

Acute Pulmonary Embolism Presenting With Angina and a Positive Cardiac Stress Test.

Acute pulmonary embolism (PE) is a commonly missed clinical entity. Prompt diagnosis of PE and the initiation of anticoagulation therapy is vital for the reduction of patient mortality. Recognizing initial electrocardiogram manifestations can aid rapid diagnosis and prompt management. The most common EKG findings associated with PE are sinus tachycardia, S1Q3T3 pattern, presence of T wave inversions in V1-V3 associated with the presence of right ventricular (RV) dysfunction, and right bundle branch block. These findings, while specific, are modestly sensitive and not always present. The gold standard of diagnosis is computerized tomographic angiography and ventilation and perfusion (V/Q). Here we present a patient who presented with symptoms mimicking angina with EKG changes in his stress test, prompting coronary angiography, which showed obstructive coronary artery disease requiring revascularization. Subsequently, further evaluation revealed a saddle pulmonary embolism that necessitated pulmonary thrombectomy.

Towards Efficient Wireless Body Area Network Using Two-Way Relay Cooperation.

The fabrication of lightweight, ultra-thin, low power and intelligent body-borne sensors leads to novel advances in wireless body area networks (WBANs). Depending on the placement of the nodes, it is characterized as in/on body WBAN; thus, the channel is largely affected by body posture, clothing, muscle movement, body temperature and climatic conditions. The energy resources are limited and it is not feasible to replace the sensor's battery frequently. In order to keep the sensor in working condition, the channel resources should be reserved. The lifetime of the sensor is very crucial and it highly depends on transmission among sensor nodes and energy consumption. The reliability and energy efficiency in WBAN applications play a vital role. In this paper, the analytical expressions for energy efficiency (EE) and packet error rate (PER) are formulated for two-way relay cooperative communication. The results depict better reliability and efficiency compared to direct and one-way relay communication. The effective performance range of direct vs. cooperative communication is separated by a threshold distance. Based on EE calculations, an optimal packet size is observed that provides maximum efficiency over a certain link length. A smart and energy efficient system is articulated that utilizes all three communication modes, namely direct, one-way relay and two-way relay, as the direct link performs better for a certain range, but the cooperative communication gives better results for increased distance in terms of EE. The efficacy of the proposed hybrid scheme is also demonstrated over a practical quasi-static channel. Furthermore, link length extension and diversity is achieved by joint network-channel (JNC) coding the cooperative link.

Factors contributing to early menarche in school girls.

OBJECTIVE: To assess the average age of menarche in Pakistani girls from different socioeconomic backgrounds. METHODOLOGY: This was a cross sectional study design carried out on female students studying in different schools of Karachi in 2014. Girls aged 10-14 years age were included. Schools from all three socio economic strata were selected through random sampling technique from a list of schools having health care services. Data was collected through a self-administered questionnaire translated in Urdu where required. Height and Weight was measured through calibrated instruments. Sample size was n=385 based on maximum proportion of 50%. Analysis was done on SPSS version 20. Chi-square and ANOVA was applied after checking data for normality. RESULTS: The total sample size was 275 after excluding poorly filled questionnaires. The mean age of menarche in our sample population was 11.73±1.2 years. Out of the total participants 127 (46%) students had reached the age of menarche. It was found that mean age of menarche was highest in participants of Kashmiri origin 14.5±0.1 years and lowest mean age was observed in those of Gujrati origin at 11.0±0.1 years (p 0.036). When mean age of menarche was compared with socioeconomic class highest mean age was observed in lower class 12.13 ±0.1 (p 0.268). CONCLUSIONS: Our study reveals a decline in the mean age of menarche of at least 2 years in girls aged 10-14 years.