Referring Physicians’ Knowledge on Justification of Medical Exposure in Diagnostic Imaging in a Sub-Saharan African Country, Cameroon

Background: Justification is the process of weighing the potential benefit of the exposure against potential detriment for that individual. Its role has been largely delegated to imaging professionals. Nevertheless, justification process involves referring physicians, radiographers and radiologists. Objective: To assess the knowledge of referring physicians regarding justification of irradiating examinations in medical imaging at the university-affiliated hospitals in Yaoundé Cameroon. Materials and Methods: A questionnaire (18 questions) based on the French guide for the proper use of medical imaging tests in relation to the justification of irradiating examinations, was self-administered to 151 referring physicians in Yaounde (Cameroon) between October 2012 and January 2013. The pre-tested questionnaire was completed in the presence of the investigator. A scoring system was then adopted with a total of 15 points from the level of knowledge on justification which could be classified as satisfactory or not. Results: Referring physicians were 75 (49.7%) GPs, 53 (35.1%) residents and 23 (15.2%) specialists. Knowledge on justification was unsatisfactory for 79.5% of referring physicians with no significant difference in terms of professional experience (p = 0.95) or specialty (p = 0.119). The concepts of “useful exam” and “justified exam” were not known by 113 (74.8%) and 95 (62.9%) practitioners. MRI was selected as irradiating by 62 (41.1%), SPECT and PET-scan as non-radiating examinations by 98 (64.9%) and 115 (76.1%) participants. The main reasons for repeating a giving radiology exam were: unsatisfactory interpretation, unknown of where it was performing and poor quality exam respectively for 23 (15.2%), 37 (24.5%) and 43 (28.5%) referring physicians. Justification was the responsibility of the referring physician alone for 57% of respondent. Only 11 clinicians knew the reference of “Justification-Optimization-Limitation” to radiation protection. Conclusion: The knowledge of physicians on radiating medical procedures and justification of requests for these procedures is inadequate. Training in radiation protection and the introduction of guidelines for the proper use of imaging tests could improve physicians’ justification of radiating examinations.

Stacked Attention Networks for Referring Expressions Comprehension

Referring expressions comprehension is the task of locating the image region described by a natural language expression,which refer to the properties of the region or the relationships with other regions.Most previous work handles this problem by selecting the most relevant regions from a set of candidate regions,when there are many candidate regions in the set these methods are inefficient.Inspired by recent success of image captioning by using deep learning methods,in this paper we proposed a framework to understand the referring expressions by multiple steps of reasoning.We present a model for referring expressions comprehension by selecting the most relevant region directly from the image.The core of our model is a recurrent attention network which can be seen as an extension of Memory Network.The proposed model capable of improving the results by multiple computational hops.We evaluate the proposed model on two referring expression datasets:Visual Genome and Flickr30k Entities.The experimental results demonstrate that the proposed model outperform previous state-of-the-art methods both in accuracy and efficiency.We also conduct an ablation experiment to show that the performance of the model is not getting better with the increase of the attention layers.

Real-time Meaning in Communication and the Analysis of the Meaning of Referring Expressions

Based on a review of the theories on meaning in the field of philosophy, semantics and pragmatics, this paper suggests that language meaning, subject to constant change in real communication,is a concept different from relatively static sense and reference which are mutual inter-dependent to each other. Sense and reference constitute the personal images of any given words.Three sources of meaning are elaborated: the dictionary sense, the personal images of any given words, and the dynamic context.A combination of traditional semantic meaning and dynamic pragmatic meaning analysis is suggested through examining the meaning derivation process in the cases of the use of referring expressions in definite, indefinite descriptions, and incomplete sentences.

Interdepartmental miscommunication regarding radiology:Addressing chronic challenges and exploring solutions

Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.

Prescribed Performance Tracking Control of Time-Delay Nonlinear Systems With Output Constraints

The problem of prescribed performance tracking control for unknown time-delay nonlinear systems subject to output constraints is dealt with in this paper. In contrast with related works, only the most fundamental requirements, i.e., boundedness and the local Lipschitz condition, are assumed for the allowable time delays. Moreover, we focus on the case where the reference is unknown beforehand, which renders the standard prescribed performance control designs under output constraints infeasible. To conquer these challenges, a novel robust prescribed performance control approach is put forward in this paper.Herein, a reverse tuning function is skillfully constructed and automatically generates a performance envelop for the tracking error. In addition, a unified performance analysis framework based on proof by contradiction and the barrier function is established to reveal the inherent robustness of the control system against the time delays. It turns out that the system output tracks the reference with a preassigned settling time and good accuracy,without constraint violations. A comparative simulation on a two-stage chemical reactor is carried out to illustrate the above theoretical findings.

A 16-bit 18-MSPS flash-assisted SAR ADC with hybrid synchronous and asynchronous control logic

This paper presents a 16-bit,18-MSPS(million samples per second)flash-assisted successive-approximation-register(SAR)analog-to-digital converter(ADC)utilizing hybrid synchronous and asynchronous(HYSAS)timing control logic based on an on-chip delay-locked loop(DLL).The HYSAS scheme can provide a longer settling time for the capacitive digital-to-analog converter(CDAC)than the synchronous and asynchronous SAR ADC.Therefore,the issue of incomplete settling or ringing in the DAC voltage for cases of either on-chip or off-chip reference voltage can be solved to a large extent.In addition,the fore-ground calibration of the CDAC’s mismatch is performed with a finite-impulse-response bandpass filter(FIR-BPF)based least-mean-square(LMS)algorithm in an off-chip FPGA(field programmable gate array).Fabricated in 40-nm CMOS process,the proto-type ADC achieves 94.02-dB spurious-free dynamic range(SFDR),and 75.98-dB signal-to-noise-and-distortion ratio(SNDR)for a 2.88-MHz input under 18-MSPS sampling rate.

基于0-1膨胀二项分布的客观贝叶斯分析

在医疗卫生、金融证券等应用领域,经常会同时出现零观测值、一观测值较多的情况。为更好地拟合这类数据,提出一种0-1膨胀二项分布模型并进行客观贝叶斯分析。采用数据扩充策略,基于完全似然函数,得到Jeffreys先验和reference先验。采用WinBUGS软件和R软件进行数值模拟,设定不同的样本量和参数真值,对不同的无信息先验进行评估。对2020年1月28日与2月22日COVID-19死亡人数进行分析,结果表明,在小样本情形下基于客观贝叶斯先验π_(R3)下的拟合效果比π_(R1)和π_(R2)要好。

Evaluating the performance of genomic selection on purebred population by incorporating crossbred data in pigs

Genomic selection(GS)has been widely used in livestock,which greatly accelerated the genetic progress of complex traits.The population size was one of the significant factors affecting the prediction accuracy,while it was limited by the purebred population.Compared to directly combining two uncorrelated purebred populations to extend the reference population size,it might be more meaningful to incorporate the correlated crossbreds into reference population for genomic prediction.In this study,we simulated purebred offspring(PAS and PBS)and crossbred offspring(CAB)base on real genotype data of two base purebred populations(PA and PB),to evaluate the performance of genomic selection on purebred while incorporating crossbred information.The results showed that selecting key crossbred individuals via maximizing the expected genetic relationship(REL)was better than the other methods(individuals closet or farthest to the purebred population,CP/FP)in term of the prediction accuracy.Furthermore,the prediction accuracy of reference populations combining PA and CAB was significantly better only based on PA,which was similar to combine PA and PAS.Moreover,the rank correlation between the multiple of the increased relationship(MIR)and reliability improvement was 0.60-0.70.But for individuals with low correlation(Cor(Pi,PA or B),the reliability improvement was significantly lower than other individuals.Our findings suggested that incorporating crossbred into purebred population could improve the performance of genetic prediction compared with using the purebred population only.The genetic relationship between purebred and crossbred population is a key factor determining the increased reliability while incorporating crossbred population in the genomic prediction on pure bred individuals.

Deciphering the population structure and genetic basis of growth traits from whole-genome resequencing of the leopard coral grouper(Plectropomus leopardus)

The leopard coral grouper(Plectropomus leopardus)is a species of significant economic importance.Although artificial cultivation of P.leopardus has thrived in recent decades,the advancement of selective breeding has been hindered by the lack of comprehensive population genomic data.In this study,we identified over 8.73 million single nucleotide polymorphisms(SNPs)through whole-genome resequencing of 326 individuals spanning six distinct groups.Furthermore,we categorized 226 individuals with high-coverage sequencing depth(≥14×)into eight clusters based on their genetic profiles and phylogenetic relationships.Notably,four of these clusters exhibited pronounced genetic differentiation compared with the other populations.To identify potentially advantageous loci for P.leopardus,we examined genomic regions exhibiting selective sweeps by analyzing the nucleotide diversity(θπ)and fixation index(FST)in these four clusters.Using these high-coverage resequencing data,we successfully constructed the first haplotype reference panel specific to P.leopardus.This achievement holds promise for enabling high-quality,cost-effectiveimputationmethods.Additionally,we combined low-coverage sequencing data with imputation techniques for a genome-wide association study,aiming to identify candidate SNP loci and genes associated with growth traits.A significant concentration of these genes was observed on chromosome 17,which is primarily involved in skeletal muscle and embryonic development and cell proliferation.Notably,our detailed investigation of growth-related SNPs across the eight clusters revealed that cluster 5 harbored the most promising candidate SNPs,showing potential for genetic selective breeding efforts.These findings provide a robust toolkit and valuable insights into the management of germplasm resources and genome-driven breeding initiatives targeting P.leopardus.

Styrax japonicus functional genomics:an efficient virus induced gene silencing(VIGS)system

VIGS(Virus-induced gene silencing),a method for posttranscriptional gene silencing,is an effective technique for investigating the activities of genes in plants.Since there is no report for available VIGS system in Styrax japonicus,the application of a VIGS approach that results in a gene knockdown to study gene function is limited.In this study,we compared the characteristics that could affect the viability of VIGS in S.japonicus,including the acetosyringone(AS)concentration,the Agrobacterium’s optical density and the inoculation method.The stable reference genes of S.japonicus were selected to validate the gene’s knockdown by quantitative PCR.As a result,we successfully constructed 2 VIGS systems based on TRV virus:vacuum with AS concentration of 200μmol·L^(-1)and OD600of 0.5,and friction-osmosis with AS concentration of 200μmol·L^(-1)and OD600of 1.0,which silencing efficiency was 83.33%and 74.19%,respectively.The successfully applied VIGS method provides a rapid and effective reverse gene functional analysis approach in S.japonicus to identify unknown gene functions.

The Application of Permanent Magnet Synchronous Motor with Small Electrical Time Constant in Fiber Positioner

With the development of cutting-edge multi-object spectrographs,fiber positioners located in the focal plane are being scaled down in size,and miniature hollow-cup Permanent Magnet motors are now being considered as a suitable replacement for Faulhaber Precistep stepper motors.However,the small electrical time constant of such coreless motors poses a challenge,as the problem of severe commutation torque ripple in a fiber positioner running a position loop has been tricky.To overcome this challenge,it is advised to increase the Pulse Width Modulation(PWM)frequency as much as possible to mitigate the effects of the current fluctuation.This must be done while ensuring adequate resolution of the PWM generator.By employing a voltage open-loop field-oriented control based on a modulation frequency of 1 MHz,the drive current only costs 25 m A under a 3.3 V power supply.The sine degree of phase current is immaculate,and the repeat positioning accuracy can reach 2μm.Moreover,it is possible to further shrink the bill of devices and the layout area of the Printed Circuit Board,especially in sizesensitive applications.This device has been developed under the new generation of The Large Sky Area MultiObject Fiber Spectroscopic Telescope.

Polio eradication surveillance in Sri Lanka,2019-2023

Objective:To evaluate the polio laboratory surveillance carried out from January,2019 to May,2023 by the Polio Regional Reference Laboratory,Sri Lanka.Methods:This retrospective study analyzed all stool samples received under the acute flaccid paralysis(AFP)and immunodeficient vaccine-derived poliovirus(VDPV)surveillance at Polio Regional Reference Laboratory,Sri Lanka from January,2019 to May,2023.The results of the testing methodologies were extracted from the laboratory data system,i.e.,poliovirus virus isolation,intra-typic differentiation/VDPV real time reverse transcriptase polymerase chain reaction(ITD/VDPV rRTPCR)and sequencing,along with the data on timing of reporting results,stool adequacy and socio-demographics.Data was analyzed using descriptive statistics.Results:A total of 2141 stool samples from 1644 cases were received for AFP surveillance from Sri Lanka(93.61%),Maldives(1.52%),and immunodeficient VDPV(4.86%)surveillance.Both polioviruses(19/1644,1.15%)and non-polio enteroviruses(73/1644,4.44%)were isolated,while Sabin-like 3 virus was detected in majority(12/19,63.15%)among the poliovirus isolated.Wild polioviruses or circulating VDPVs were not detected among the cases.During all years of the study,the non-polio AFP detection rate was>1/100000 in children aged less than 15 years,whereas stool adequacy rate was>80%.All results were reported within 14 days of receipt,ensuring timely reporting as per global guidelines.Conclusions:The Polio Regional Reference Laboratory,Sri Lanka plays a vital role in maintaining the polio-free status in the country through its robust laboratory surveillance,while adhering to the surveillance indicators.Non-detection of wild polioviruses and circulating VDPV during the study period reinforces the polio-free status in the country.

Stepwise Ecological Restoration:A framework for improving restoration outcomes

Ecosystem degradation is one of the critical constraints for the sustainable development of our planet.However,recovering an ecosystem to a pre-impairment condition is often not practical.The International Restoration Standards provide the first framework for practical guidance on what constitutes the process of ecological repair and how this repair process can be influenced to improve net ecological benefits.In these Standards,Restorative Continuum is highlighted and it recognises that many do not,yet there is still value in aspiring to improvements to the highest extent possible,with some sites potentially being able to be improved in a stepwise manner.Here we elaborate on these Standards by providing a cross-ecosystem theoretical framework of Stepwise Ecological Restoration(STERE)for promoting higher environmental benefits.STERE allows the selection of suitable restorative modes by considering the degree of degradation while encouraging a transition to a higher state.These models include environmental remediation for completely modified and degraded ecosystems,ecological rehabilitation for highly modified and degraded ecosystems,and ecological restoration for degraded native ecosystems.STERE requires selecting tailored restorative modes,setting clear restorative targets and reference ecosystems,applying a systematic-thinking approach,and implementing a continuous monitoring program at all process stages to achieve a resilient trajectory.STERE allows adaptive management in the context of climate change,and when the evidence is available,to“adapt to the future”to ensure climate resilience.The STERE framework could assist in initiating and implementing restoration projects worldwide,especially in developing countries.

Fine-grained grid computing model for Wi-Fi indoor localization in complex environments

The fingerprinting-based approach using the wireless local area network(WLAN)is widely used for indoor localization.However,the construction of the fingerprint database is quite time-consuming.Especially when the position of the access point(AP)or wall changes,updating the fingerprint database in real-time is difficult.An appropriate indoor localization approach,which has a low implementation cost,excellent real-time performance,and high localization accuracy and fully considers complex indoor environment factors,is preferred in location-based services(LBSs)applications.In this paper,we proposed a fine-grained grid computing(FGGC)model to achieve decimeter-level localization accuracy.Reference points(RPs)are generated in the grid by the FGGC model.Then,the received signal strength(RSS)values at each RP are calculated with the attenuation factors,such as the frequency band,three-dimensional propagation distance,and walls in complex environments.As a result,the fingerprint database can be established automatically without manual measurement,and the efficiency and cost that the FGGC model takes for the fingerprint database are superior to previous methods.The proposed indoor localization approach,which estimates the position step by step from the approximate grid location to the fine-grained location,can achieve higher real-time performance and localization accuracy simultaneously.The mean error of the proposed model is 0.36 m,far lower than that of previous approaches.Thus,the proposed model is feasible to improve the efficiency and accuracy of Wi-Fi indoor localization.It also shows high-accuracy performance with a fast running speed even under a large-size grid.The results indicate that the proposed method can also be suitable for precise marketing,indoor navigation,and emergency rescue.

Z-Score in Fetal Echocardiography–Is there Still Room for New Studies?

Congenital heart disease(CHD)is the most common type of birth defect,representing a significant cause of peri-natal morbidity and mortality.Early diagnosis of such anomalies is crucial for improving outcomes.Current pro-tocols recommend a qualitative assessment of cardiac structures using two-dimensional ultrasound(2DUS)and color Doppler imaging.In cases of suspected abnormalities,quantitative assessments through cardiac structure measurements and reference curves can aid in accurate diagnosis.Similar to centiles widely employed in obste-trics,Z-scores provide more precise quantification of various cardiac structures,particularly at the extremes of the curve.While the development of reference curves and Z-scores has progressed over the past two decades,a lack of standardization in measurements and statistical methodology for their determination is evident.Establishing reference curves requires adherence to specific recommendations to improve their accuracy.The purpose of this study is to provide a narrative review of the major studies that have generated reference values for cardiac struc-tures using 2DUS and Z-scores,to evaluate their methodology,and to provide a summary of the results.

Comparison study on measurement of rail weld joint between inertial reference method and multi-point chord reference method

Purpose – Straightness measurement of rail weld joint is of essential importance to railway maintenance. Dueto the lack of efficient measurement equipment, there has been limited in-depth research on rail weld joint with a5-m wavelength range, leaving a significant knowledge gap in this field.Design/methodology/approach – In this study, the authors used the well-established inertial referencemethod (IR-method), and the state-of-the-art multi-point chord reference method (MCR-method). Two methodshave been applied in different types of rail straightness measurement trollies, respectively. These instrumentswere tested in a high-speed rail section within a certain region of China. The test results were ultimatelyvalidated through using traditional straightedge and feeler gauge methods as reference data to evaluate the railweld joint straightness within the 5-m wavelength range.Findings – The research reveals that IR-method and MCR-method produce reasonably similar measurementresults for wavelengths below 1 m. However, MCR-method outperforms IR-method in terms of accuracy forwavelengths exceeding 3 m. Furthermore, it was observed that IR-method, while operating at a slower speed,carries the risk of derailing and is incapable of detecting rail weld joints and low joints within the track.Originality/value – The research compare two methods’ measurement effects in a longer wavelength rangeand demonstrate the superiority of MCR-method.

Equalization Reconstruction Algorithm Based on Reference Signal Frequency Domain Block Joint for DTMB-Based Passive Radar

Channel equalization plays a pivotal role within the reconstruction phase of passive radar reference signals.In the context of reconstructing digital terrestrial multimedia broadcasting(DTMB)signals for low-slow-small(LSS)target detection,a novel frequency domain block joint equalization algorithm is presented in this article.From the DTMB signal frame structure and channel multipath transmission characteristics,this article adopts a unconventional approach where the delay and frame structure of each DTMB signal frame are reconfigured to create a circular convolution block,facilitating concurrent fast Fourier transform(FFT)calculations.Following equalization,an inverse fast Fourier transform(IFFT)-based joint output and subsequent data reordering are executed to finalize the equalization process for the DTMB signal.Simulation and measured data confirm that this algorithm outperforms conventional techniques by reducing signal errors rate and enhancing real-time processing.In passive radar LSS detection,it effectively suppresses multipath and noise through frequency domain equalization,reducing false alarms and improving the capabilities of weak target detection.

Alanine aminotransferase predicts incident steatotic liver disease of metabolic etiology: Long life to the old biomarker!

Alanine aminotransferase(ALT)serum levels increase because of hepatocellular damage.Metabolic dysfunction-associated fatty liver disease(MAFLD),which identifies steatotic liver disease(SLD)associated with≥2 metabolic abnormalities,has prominent sexual differences.The Metabolic Syndrome defines a cluster comprising abdominal obesity,altered glucose metabolism,dyslipidemia,and hypertension.Male sex,body mass index,glucose,lipids,ferritin,hypertension,and age independently predict ALT levels among blood donors.Over the last few decades,the reference range of ALT levels has been animatedly debated owing to attempts to update sex-specific reference ranges.With this backset,Chen et al have recently published a study which has two main findings.First,>80%of indi-viduals with MAFLD had normal ALT levels.Second,there was a linear increa-sing trend in the association between cumulative excess high-normal ALT levels and the rate of incident MAFLD.This study has biologically credible findings.However,it inaccurately considered sex differences in the MAFLD arena.Therefore,future studies on SLD owing to metabolic dysfunction should adopt locally determined and prospectively validated reference ranges of ALT and carefully consider sex differences in liver enzymes and MAFLD pathobiology.

A Reference Vector-Assisted Many-Objective Optimization Algorithm with Adaptive Niche Dominance Relation

It is still a huge challenge for traditional Pareto-dominatedmany-objective optimization algorithms to solve manyobjective optimization problems because these algorithms hardly maintain the balance between convergence and diversity and can only find a group of solutions focused on a small area on the Pareto front,resulting in poor performance of those algorithms.For this reason,we propose a reference vector-assisted algorithmwith an adaptive niche dominance relation,for short MaOEA-AR.The new dominance relation forms a niche based on the angle between candidate solutions.By comparing these solutions,the solutionwith the best convergence is found to be the non-dominated solution to improve the selection pressure.In reproduction,a mutation strategy of k-bit crossover and hybrid mutation is used to generate high-quality offspring.On 23 test problems with up to 15-objective,we compared the proposed algorithm with five state-of-the-art algorithms.The experimental results verified that the proposed algorithm is competitive.

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.