Implementation of sonopartogram: multicenter feasibility study.

OBJECTIVES: Well-established clinical practice to assess progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for women. In this study, our aim is to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, psAOP, HPD and SCD to monitor labor progress in women undergoing induction of labor (IOL). We also aim at determining if ultrasound can reduce women's pain during examinations. METHODS: Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37+0 and 41+6 weeks' gestation. A baseline combined transabdominal and transperineal scan was performed, including the assessment of fetal biometry, umbilical artery and middle cerebral artery Dopplers, amniotic fluid index (AFI), fetal spine and occiput positions, psAOP, HPD, SCD, and cervical length. Intrapartum scans were performed instead of VEs according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score from 0 - 10 (with 0 representing no pain) during assessment. The repeated measures data were analyzed by mixed effect models to identify the significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery. RESULTS: 223 intrapartum ultrasound scans with a median of 2 scans per participant (interquartile range (IQR) = 1 - 3), and 151 VEs were performed with a median of 1 per participant (IQR = 0 - 2). There were no adverse fetal or maternal outcomes. After excluding those with epidural anesthesia during examination, median pain score for intrapartum scan was 0 (IQR = 0 - 1) and 3 for VE (IQR = 0 - 6). Cesarean delivery and epidural anesthesia were significantly associated with slower rate of change in psAOP, HPD and SCD. Maternal height, parity and neonatal birth weight did not affect ultrasound measurements of labor progress. CONCLUSIONS: Comprehensive transabdominal and transperineal ultrasound assessment can be successfully used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and VE examinations during labor. This article is protected by copyright. All rights reserved.

Prediction of spontaneous preterm birth and preterm prelabor rupture of membranes using maternal factors, obstetric history and biomarkers of placental function at 11-13 weeks.

OBJECTIVES: To determine whether first-trimester biomarkers of placental function can be used to screen for spontaneous preterm birth (sPTB), and to develop prediction models using maternal factors, obstetric history and biomarkers of placental function at 11-13 weeks for the calculation of patient-specific risk for sPTB. METHODS: This was a retrospective secondary analysis of data derived from a prospective cohort study on first-trimester screening for pre-eclampsia in singleton pregnancies attending for routine Down syndrome screening at 11 + 0 to 13 + 6 weeks' gestation at a tertiary obstetric unit between December 2016 and September 2019. A split-sample internal validation method was used to explore and develop prediction models for all sPTB at < 37 weeks and for PTB at < 37 weeks after preterm prelabor rupture of membranes (PPROM) using maternal risk factors, uterine artery Doppler indices, serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and ß-human chorionic gonadotropin (ß-hCG). Screening performance was assessed using receiver-operating-characteristics (ROC)-curve analysis, with calculation of the areas under the ROC curves (AUCs). RESULTS: A total of 9298 singleton pregnancies were included in this study. sPTB at < 37 weeks occurred in 362 (3.89%) cases, including 231 (2.48%) cases of PPROM. sPTB at < 34 weeks occurred in 87 (0.94%) cases, including 39 (0.42%) cases of PPROM. Identified maternal risk factors for sPTB at < 37 weeks included chronic hypertension, conception using in-vitro fertilization and history of PTB. Maternal risk factors for PPROM at < 37 weeks included conception using in-vitro fertilization and history of PTB. Median PlGF multiples of the median (MoM) and PAPP-A MoM were significantly reduced in women with sPTB at < 37 weeks, as well as in those who had PPROM, compared to those who delivered at term. Screening by a combination of maternal risk factors, PAPP-A and PlGF achieved better performance in predicting sPTB at < 37 weeks (AUC, 0.630 vs 0.555; detection rate (DR), 24.8% vs 16.6% at a false-positive rate (FPR) of 10%; P ≤ 0.0001) and PPROM at < 37 weeks (AUC, 0.643 vs 0.558; DR, 28.1% vs 17.0% at a FPR of 10%; P ≤ 0.0001) than using maternal risk factors alone. Both models were successfully applied to the internal validation dataset, with AUCs of 0.628 and 0.650, respectively. CONCLUSIONS: We demonstrated that low levels of maternal serum PAPP-A and PlGF in the first trimester are associated with increased risks of sPTB and PPROM at < 37 weeks. However, further research is needed to identify additional biomarkers to improve the screening performance of the combined model that includes maternal risk factors, PAPP-A and PlGF before clinical application. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Multipactor experiments on an S-band coaxial test cell.

Radio frequency vacuum electronics are prone to multipactor discharges. These electron discharges, driven by secondary electron emission, can disrupt and damage devices and are particularly important in satellite communication systems. We present results from a new S-band coaxial multipactor test cell which demonstrates scaling to much higher frequencies (3.05 GHz) than previous coaxial experiments (10-150 MHz). The multipactor breakdown threshold has been found to agree very well with our earlier simulated predictions. The significant effect from multipactor self-conditioning has also been demonstrated and characterized. Future experiments will use this test cell to investigate various multipactor mitigation strategies.

[From digital virtual human, three-dimensional visualization to digital intelligence in liver surgery].

Digital intelligent hepatobiliary surgery has evolved over decades.It has experienced an evolution course from digital virtual human technology to the establishment of a quality-controlled and homogeneous three-dimensional visualization system for precision diagnosis and treatment of diseases, from three-dimensional visualization to the clinical transformation of digital intelligent technology and changes in the diagnosis and treatment model, from empirical diagnosis of diseases to the application of deep learning for the intelligent diagnosis and treatment of diseases, from empirical surgery to real-time multi-modal image guidance during surgery, and from the morphological diagnosis of tumors to accurate diagnosis from molecular imaging.During the whole process, only through continuous innovation in research, theory and technology can the "life" of digital intelligent surgery be endowed with new vitality.In the future, the definition of tumor boundary from the molecular and cellular levels and the early diagnosis and treatment of liver tumor through the functional visualization of key molecules will have significant clinical value for changing the prognosis of liver cancer.In addition, in order to realize intelligent navigation for hepatectomy and break through the technical bottleneck, it is of great clinical significance to develop an intelligent robot real-time navigation hepatectomy system with automatic navigation technology, machine learning intelligent planning technology and multimodal image fusion technology.This provides unprecedented opportunities and challenges for the development of digital intelligent hepatobiliary surgery.

[Construction and application of the core technology system of digital intelligent diagnostic and treatment for hepato-biliary-pancreatic diseases].

Digital intelligent diagnostic and treatment technology is a novel technology which is based by combining modern medicine with digitalized and intelligent high-tech to form a multidisciplinary and multi-knowledge domain. This technology plays an important role in areas including precision diagnosis, preoperative planning and surgical navigation. Its core technologies are: (1) quality control research on high-quality CT imaging data acquisition; (2) quality control and homogenization research on three-dimensional (3D) reconstruction; (3) high-quality 3D printed physical models; (4) virtual reality 3D simulation platform; (5) molecular fluorescence imaging to define tumor boundaries; (6) non-rigid registration multi-mode image fusion surgical navigation system; (7) image feature extraction and prediction model establishment. The workflow of this system includes: First, CT data acquisition and 3D visualization of hepatobiliary and pancreatic diseases; followed by individualized vascular assessment, liver volume calculation and surgical planning using the 3D model; then virtual simulation surgery, 3D printing, virtual reality technology and molecular fluorescence imaging accordance to the required specific conditions. Preoperative radiomics are used to predict the risk of complications and long-term follow-up results. Intraoperative multi-modal fusion image navigation and its consistency are evaluated with the findings in actual surgery and preoperative planning. This technology, hopefully, will bring in novel strategies and approaches in the diagnosis and treatment of hepatobiliary and pancreatic diseases.

[Ten years retrospective review of the application of digital medical technology in general surgery in China].

Digital medical technology is a powerful tool which has forcefully promoted the development of general surgery in China. In this article, we reviews the application status of three-dimensional visualization and three-dimensional printing technology in general surgery, introduces the development situation of surgical navigation guided by optical and electromagnetic technology and preliminary attempt to combined with mixed reality applied to complicated hepatectomy, looks ahead the development direction of digital medicine in the era of artificial intelligence and big data on behalf of surgical robot and radiomics. Surgeons should proactively master these advanced techniques and accelerate the innovative development of general surgery in China.

[The clinical advantage of using three dimensional visualization technology in hepatic surgery].

The three-dimensional body visible system is a further development of the three-dimensional CT reconstruction system. It has a lot of merits over the latter system. Clinical application of the three-dimensional body visible system in liver surgery showed the system to have the following merits: (1) The system can support the Couinaud classification of liver anatomy into two hemilivers, four sectors and eight segments. As the system can rotate the liver to any angle and it has the ability to make part or whole of the liver transparent thus making the internal blood vessels and bile ducts visible. Learning liver anatomy and liver surgery becomes easier. (2)The system can clearly localize liver tumors within the liver segment(s). (3)It can help clinicians to decide and to plan different operations on an individual. (4)By carrying out simulation partial hepatectomy using this system, it can help clinicians to estimate the difficulty and the risks involved in different options of liver resection and finally.(5)The system helps clinicians to identify anomalies in hepatic artery, portal vein, hepatic vein and bile duct, thus making the operation safer. In conclusion, this system significantly improves on the conventional three-dimensional CT reconstruction system. It is especially useful for inexperienced liver surgeons.

Therapeutic inertia in the management of hyperlipidaemia in type 2 diabetic patients: a cross-sectional study in the primary care setting.

OBJECTIVES: To study the prevalence of therapeutic inertia in lipid management among type 2 diabetic patients in the primary care setting and to explore associated factors. METHODS: This was a cross-sectional study involving type 2 diabetic patients with suboptimal lipid control followed up in all general out-patient clinics of Kowloon Central Cluster in Hong Kong from 1 October 2011 to 30 September 2013. Main outcome measures included prevalence of therapeutic inertia in low-density lipoprotein management among type 2 diabetic patients and its association with patient and physician characteristics. RESULTS: Based on an agreed standard, lipid control was suboptimal in 49.1% (n=9647) of type 2 diabetic patients who attended for a regular annual check-up (n=19 662). Among the sampled 369 type 2 diabetic patients with suboptimal lipid control, therapeutic inertia was found to be present in 244 cases, with a prevalence rate of 66.1%. When the attending doctors' profiles were compared, the mean duration of clinical practice was significantly longer in the therapeutic inertia group than the non-therapeutic inertia group. Doctors without prior training in family medicine were also found to have a higher rate of therapeutic inertia. Patients in the therapeutic inertia group had longer disease duration, a higher co-morbidity rate of cardiovascular disease, and a closer-to-normal low-density lipoprotein level. Logistic regression analysis revealed that lack of family medicine training among doctors was positively associated with the presence of therapeutic inertia whereas patient's low-density lipoprotein level was inversely associated. CONCLUSIONS: Therapeutic inertia was common in the lipid management of patients with type 2 diabetes in a primary care setting. Lack of family medicine training among doctors and patient's low-density lipoprotein level were associated with the presence of therapeutic inertia. Further study of the barriers and strategies to overcome therapeutic inertia is needed to improve patient outcome in this aspect of chronic disease management.

Ultrafast strong-field photoelectron emission from biased metal surfaces: exact solution to time-dependent Schrödinger Equation.

Laser-driven ultrafast electron emission offers the possibility of manipulation and control of coherent electron motion in ultrashort spatiotemporal scales. Here, an analytical solution is constructed for the highly nonlinear electron emission from a dc biased metal surface illuminated by a single frequency laser, by solving the time-dependent Schrödinger equation exactly. The solution is valid for arbitrary combinations of dc electric field, laser electric field, laser frequency, metal work function and Fermi level. Various emission mechanisms, such as multiphoton absorption or emission, optical or dc field emission, are all included in this single formulation. The transition between different emission processes is analyzed in detail. The time-dependent emission current reveals that intense current modulation may be possible even with a low intensity laser, by merely increasing the applied dc bias. The results provide insights into the electron pulse generation and manipulation for many novel applications based on ultrafast laser-induced electron emission.

Technique for fabrication of ultrathin foils in cylindrical geometry for liner-plasma implosion experiments with sub-megaampere currents.

In this work, we describe a technique for fabricating ultrathin foils in cylindrical geometry for liner-plasma implosion experiments using sub-MA currents. Liners are formed by wrapping a 400 nm, rectangular strip of aluminum foil around a dumbbell-shaped support structure with a non-conducting center rod, so that the liner dimensions are 1 cm in height, 6.55 mm in diameter, and 400 nm in thickness. The liner-plasmas are imploded by discharging ∼600 kA with ∼200 ns rise time using a 1 MA linear transformer driver, and the resulting implosions are imaged four times per shot using laser-shadowgraphy at 532 nm. This technique enables the study of plasma implosion physics, including the magneto Rayleigh-Taylor, sausage, and kink instabilities on initially solid, imploding metallic liners with university-scale pulsed power machines.

Absolute Instability near the Band Edge of Traveling-Wave Amplifiers.

Applying the Briggs-Bers "pole-pinch" criterion to the exact transcendental dispersion relation of a dielectric traveling wave tube (TWT), we find that there is no absolute instability regardless of the beam current. We extend this analysis to the circuit band edges of a linear beam TWT by approximating the circuit mode as a hyperbola in the frequency-wave-number (ω-k) plane and consider the weak coupling limit. For an operating mode whose group velocity is in the same direction as the beam mode, we find that the lower band edge is not subjected to absolute instability. At the upper band edge, we find a threshold beam current beyond which absolute instability is excited. The nonexistence of absolute instability in a linear beam TWT and the existence in a gyrotron TWT, both at the lower band edge, is contrasted. The general study given here is applicable to some contemporary TWTs such as metamaterial-based and advanced Smith-Purcell TWTs.

Does the environmental background (intensive v. outdoor systems) influence the behaviour of piglets at weaning?

Under intensive pig husbandry, outdoor systems offer a more complex physical and social environment compared with indoor systems (farrowing sheds). As the rearing environment affects behavioural development, it can, therefore, influence behavioural responses of pigs to stressful environments in later stages of production. We tested how the rearing environment influenced behavioural responses to a novel arena test in piglets on the day that they were weaned and mixed into large groups. We recorded video footage and compared the behavioural responses of 30 outdoor-raised and 30 farrowing shed-raised piglets tested in an experimental arena and sequentially exposed to four challenges (each for 5 min) on the day of weaning. Quantitative and qualitative behavioural measures were recorded using time budgets and scoring demeanour or 'qualitative behavioural expression' (using Qualitative Behavioural Assessment (QBA)). When held in isolation (challenge 1), both groups were scored as more 'scared/worried', while outdoor-raised piglets spent more time eating and jumping against the arena walls. Both groups interacted with a plastic ball (challenge 2: exposure to a novel object) during which they were scored as more 'playful/curious' than other challenges. When a food bowl was introduced (challenge 3), farrowing shed-raised piglets were more interested in playing with the food bowl itself, whereas outdoor-raised piglets spent more time eating the feed. Finally, there were no significant differences in social behaviour (challenge 4: introduction of another piglet) between the two groups in terms of the latency to contact each other, amount of time recorded engaged in aggressive/non-aggressive social interactions or QBA scores. Although piglets spent 30% of their time interacting with the other piglet, and half of this time (47%) was engaged in negative interactions (pushing, biting), the levels of aggression were not different between the two groups. Overall, outdoor-raised piglets ate more and were scored as more 'calm/passive', whereas farrowing shed-raised piglets spent more time investigating their environment and were scored as more 'playful/inquisitive'. In conclusion, we did not find differences in behaviour between outdoor-raised and farrowing shed-raised piglets that would highlight welfare issues. The differences found in this study may reflect conflicting affective states, with responses to confinement, neophobia and motivation for exploration evident.

Novel scaling laws for the Langmuir-Blodgett solutions in cylindrical and spherical diodes.

It is found that the Langmuir-Blodgett solutions for the space charge limited current density, for both cylindrical and spherical diodes, may be approximated by Japp=(4/9)ε0sqrt[(2e/m)](Ec3/2/sqrt[D]) over a wide range of parameters, where Ec is the surface electric field on the cathode of the vacuum diode and D is the anode-cathode spacing. This dependence is valid whether Ra/Rc is greater than or less than unity, where Ra and Rc are, respectively, the anode and cathode radius. Minor empirical corrections to the above scaling yield fitting formulas that are accurate to within 5% for 3×10(-5)

Anisotropy and feedthrough in magneto-Rayleigh-Taylor instability.

The magneto-Rayleigh-Taylor instability (MRT) of a finite slab is studied analytically using the ideal MHD model. The slab may be accelerated by an arbitrary combination of magnetic pressure and fluid pressure, thus allowing an arbitrary degree of anisotropy intrinsic to the acceleration mechanism. The effect of feedthrough in the finite slab is also analyzed. The classical feedthrough solution obtained by Taylor in the limit of zero magnetic field, the single interface MRT solution of Chandrasekhar in the limit of infinite slab thickness, and Harris' stability condition on purely magnetic driven MRT, are all readily recovered in the analytic theory as limiting cases. In general, we find that MRT retains robust growth if it exists. However, feedthrough may be substantially reduced if there are magnetic fields on both sides of the slab, and if the MRT mode invokes bending of the magnetic field lines.

Rapid aneuploidy screening with fluorescence in-situ hybridisation: is it a sufficiently robust stand-alone test for prenatal diagnosis?

OBJECTIVES: To assess the clinical utility of fluorescence in-situ hybridisation with chromosomes 13, 18, 21, X and Y as a stand-alone test in detecting chromosomal abnormalities, and the types of chromosomal abnormalities missed. DESIGN: Retrospective analysis. SETTING: A restructured Government hospital in Singapore and an academic hospital in the United States. PARTICIPANTS: Cytogenetic data of prenatal specimens and results of fluorescence in-situ hybridisation of 5883 patients performed between January 2000 and August 2007 were reviewed. RESULTS: Fluorescence in-situ hybridisation detected 558 (9.5%) patients with chromosomal abnormalities. Abnormal ultrasounds (70%) and maternal serum screens (21%) were the most indicative of chromosomal abnormalities. When comparing fluorescence in-situ hybridisation data with karyotype results for the five chromosomes of interest, the sensitivity and specificity were 99.3% and 99.9%, respectively. When comparing fluorescence in-situ hybridisation data with karyotype results for all chromosomes, the sensitivity decreased to 86.8%, whereas the specificity remained at 99.9%. Of 643 cases with karyotype abnormalities, 85 were fluorescence in-situ hybridisation-negative (false negative rate, 13.2%), which included structural rearrangements, chromosome mosaicism, and other trisomies. Despite abnormal ultrasound indications, fluorescence in-situ hybridisation missed 32 cases which included structural rearrangements, mosaicisms, and other trisomies. CONCLUSION: This study does not support fluorescence in-situ hybridisation as a stand-alone test. Institutions supporting fluorescence in-situ hybridisation as a stand-alone test must seriously consider the risks of a missed diagnosis.

Microwave window breakdown experiments and simulations on the UM/L-3 relativistic magnetron.

Experiments have been performed on the UM/L-3 (6-vane, L-band) relativistic magnetron to test a new microwave window configuration designed to limit vacuum side breakdown. In the baseline case, acrylic microwave windows were mounted between three of the waveguide coupling cavities in the anode block vacuum housing and the output waveguides. Each of the six 3 cm deep coupling cavities is separated from its corresponding anode cavity by a 1.75 cm wide aperture. In the baseline case, vacuum side window breakdown was observed to initiate at single waveguide output powers close to 20 MW. In the new window configuration, three Air Force Research Laboratory-designed, vacuum-rated directional coupler waveguide segments were mounted between the coupling cavities and the microwave windows. The inclusion of the vacuum side power couplers moved the microwave windows an additional 30 cm away from the anode apertures. Additionally, the Lucite microwave windows were replaced with polycarbonate windows and the microwave window mounts were redesigned to better maintain waveguide continuity in the region around the microwave windows. No vacuum side window breakdown was observed in the new window configuration at single waveguide output powers of 120+MW (a factor of 3 increase in measured microwave pulse duration and factor of 3 increase in measured peak power over the baseline case). Simulations were performed to investigate likely causes for the window breakdown in the original configuration. Results from these simulations have shown that in the original configuration, at typical operating voltage and magnetic field ranges, electrons emitted from the anode block microwave apertures strike the windows with a mean kinetic energy of 33 keV with a standard deviation of 14 keV. Calculations performed using electron impact angle and energy data predict a first generation secondary electron yield of 65% of the primary electron population. The effects of the primary aperture electron impacts, combined with multiplication of the secondary populations, were determined to be the likely causes of the poor microwave window performance in the original configuration.

Effect of soft metal gasket contacts on contact resistance, energy deposition, and plasma expansion profile in a wire array Z pinch.

Soft metal gaskets (indium and silver) were used to reduce contact resistance between the wire and the electrode in an aluminum wire Z pinch by more than an order of magnitude over the best weighted contact case. Clamping a gasket over a Z-pinch wire compresses the wire to the electrode with a greater normal force than possible with wire weights. Average contact resistance was reduced from the range of 100-3000 Omega (depending on wire weight mass) to 1-10 Omega with soft metal gaskets. Single wire experiments (13 microm Al 5056) on a 16 kA, 100 kV Marx bank showed an increase in light emission (97%) and emission volume (100%) of the plasma for the reduced contact resistance cases. The measured increases in plasma volume and light emission indicate greater energy deposition in the ablated wire. Additionally, dual-wire experiments showed plasma edge effects were significantly decreased in the soft metal gasket contact case. The average height of the edge effects was reduced by 51% and the width of the edge effects was increased by 40%, thus the gasket contact case provided greater axial uniformity in the plasma expansion profile of an individual wire.

Metal-oxide-junction, triple point cathodes in a relativistic magnetron.

Triple point, defined as the junction of metal, dielectric, and vacuum, is the location where electron emission is favored in the presence of a sufficiently strong electric field. To exploit triple point emission, metal-oxide-junction (MOJ) cathodes consisting of dielectric "islands" over stainless steel substrates have been fabricated. The two dielectrics used are hafnium oxide (HfO(x)) for its high dielectric constant and magnesium oxide (MgO) for its high secondary electron emission coefficient. The coatings are deposited by ablation-plasma-ion lithography using a KrF laser (0-600 mJ at 248 nm) and fluence ranging from 3 to 40 J/cm(2). Composition and morphology of deposited films are analyzed by scanning electron microscopy coupled with x-ray energy dispersive spectroscopy, as well as x-ray diffraction. Cathodes are tested on the Michigan Electron Long-Beam Accelerator with a relativistic magnetron, at parameters V=-300 kV, I=1-15 kA, and pulse lengths of 0.3-0.5 micros. Six variations of the MOJ cathode are tested, and are compared against five baseline cases. It is found that particulate formed during the ablation process improves the electron emission properties of the cathodes by forming additional triple points. Due to extensive electron back bombardment during magnetron operation, secondary electron emission also may play a significant role. Cathodes exhibit increases in current densities of up to 80 A/cm(2), and up to 15% improvement in current start up time, as compared to polished stainless steel cathodes.

Role of ions in a crossed-field diode.

The effect of ions in a magnetically insulated crossed-field gap is studied using a single particle orbit model, shear flow model, and particle-in-cell simulation. It is found that, in general, the presence of ions in a crossed-field gap always increases the electrons' excursion toward the anode region, regardless of the location of the ions. Thus, the rate at which the electrons migrate toward the anode, which is a measure of the diode closure rate, is related to the rate at which ions are introduced into the crossed-field gap. This anode migration of electrons is unrelated to crossed-field ambipolar diffusion. The implications of these findings are explored, such as pulse shortening in relativistic magnetrons and bipolar flows in pulsed-power systems.