TFS-ViT: Token-Level Feature Stylization for Domain Generalization

Standard deep learning models such as convolutional neural networks (CNNs) lack the ability of generalizing to domains which have not been seen during training. This problem is mainly due to the common but often wrong assumption of such models that the source and target data come from the same i.i.d. distribution. Recently, Vision Transformers (ViTs) have shown outstanding performance for a broad range of computer vision tasks. However, very few studies have investigated their ability to generalize to new domains. This paper presents a first Token-level Feature Stylization (TFS-ViT) approach for domain generalization, which improves the performance of ViTs to unseen data by synthesizing new domains. Our approach transforms token features by mixing the normalization statistics of images from different domains. We further improve this approach with a novel strategy for attention-aware stylization, which uses the attention maps of class (CLS) tokens to compute and mix normalization statistics of tokens corresponding to different image regions. The proposed method is flexible to the choice of backbone model and can be easily applied to any ViT-based architecture with a negligible increase in computational complexity. Comprehensive experiments show that our approach is able to achieve state-of-the-art performance on five challenging benchmarks for domain generalization, and demonstrate its ability to deal with different types of domain shifts. The implementation is available at: https://github.com/Mehrdad-Noori/TFS-ViT_Token-level_Feature_Stylization

A Systematic Design of a Compact Wideband Hybrid Directional Coupler Based on Printed RGW Technology

Printed ridge gap waveguide (PRGW) is considered among the state of art guiding technologies due to its low signal distortion and low loss at Millimeter Wave (mmWave) spectrum, which motivates the research community to use this guiding structure as a host technology for various passive microwave and mmWave components. One of the most important passive components used in antenna beam-switching networks is the quadrature hybrid directional coupler providing signal power division with 90° phase shift. A featured design of a broadband and compact PRGW hybrid coupler is propose in this paper. A novel design methodology, based on mode analysis, is introduced to design the objective coupler. The proposed design is suitable for mmWave applications with small electrical dimensions ( 1.2λo×1.2λo ), low loss, and wide bandwidth. The proposed hybrid coupler is fabricated on Roger/RT 6002 substrate material of thickness 0.762 mm. The measured results highlight that the coupler can provide a good return loss with a bandwidth of 26.5% at 30 GHz and isolation beyond 15 dB. The measured phase difference between the coupler output ports is equal 90∘± 5∘ through the interested operating bandwidth. A clear agreement between the simulated and the measured results over the assigned operating bandwidth has been illustrated

Temporal Dynamics and Impact of Climate Factors on the Incidence of Zoonotic Cutaneous Leishmaniasis in Central Tunisia

Old world cutaneous leishmaniasis is a vector-borne disease occurring in rural areas of developing countries. The main reservoirs are the rodents Psammomys obesus and Meriones shawi. Zoonotic Leishmania transmission cycle is maintained in the burrows of rodents where the sand fly Phlebotomus papatasi finds the ideal environment and source of blood meals. In the present study we showed seasonality of the incidence of disease during the same cycle with an inter-epidemic period ranging from 4 to 7 years. We evaluated the impact of climate variables (rainfall, humidity and temperature) on the incidence of zoonotic cutaneous leishmaniais in central Tunisia. We confirmed that the risk of disease is mainly influenced by the humidity related to the months of July to September during the same season and mean rainfall lagged by 12 to 14 months

Fuzzy Logic Based Self-Adaptive Handover Algorithm for MobileWiMAX.

It is well known that WiMAX is a broadband technology that is capable of delivering triple play (voice, data, and video) services. However, mobility in WiMAX system is still a main issue when the mobile station (MS) moves across the base station (BS) coverage and be handed over between BSs. Among the challenging issues in mobile WiMAX handover are unnecessary handover, handover failure and handover delay, which may affect real-time applications. The conventional handover decision algorithm in mobile WiMAX is based on a single criterion, which usually uses the received signal strength indicator (RSSI) as an indicator, with the other fixed handover parameters such as handover threshold and handover margin. In this paper, a fuzzy logic based self-adaptive handover (FuzSAHO) algorithm is introduced. The proposed algorithm is derived from the self-adaptive handover parameters to overcome the mobile WiMAX ping-pong handover and handover delay issues. Hence, the proposed FuzSAHO is initiated to check whether a handover is necessary or not which depends on its fuzzy logic stage. The proposed FuzSAHO algorithm will first self-adapt the handover parameters based on a set of multiple criteria, which includes the RSSI and MS velocity. Then the handover decision will be executed according to the handover parameter values. Simulation results show that the proposed FuzSAHO algorithm reduces the number of ping-pong handover and its delay. When compared with RSSI based handover algorithm and mobility improved handover (MIHO) algorithm, respectively, FuzSAHO reduces the number of handovers by 12.5 and 7.5 %, respectively, when the MS velocity is <17 m/s. In term of handover delay, the proposed FuzSAHO algorithm shows an improvement of 27.8 and 8 % as compared to both conventional and MIHO algorithms, respectively. Thus, the proposed multi-criteria with fuzzy logic based self-adaptive handover algorithm called FuzSAHO, outperforms both conventional and MIHO handover algorithms

First Molecular Epidemiological Study of Cutaneous Leishmaniasis in Libya

Cutaneous leishmaniasis (CL) is caused by protozoan parasites of the genus Leishmania. The disease is characterized by the formation of chronic skin lesions followed by permanent scars and deformation of the infected area. It is distributed in many tropical and subtropical countries with more than 2 million cases every year. During the past few years CL has emerged as a major public health problem in Libya. So far, diagnosis was based on clinical symptoms and microscopic observation of parasites. Disease outbreaks were not investigated and the causative leishmanial species of CL were not identified so far. Our study indicates the presence of two coexisting species: Leishmania major and Leishmania tropica. These results are crucial in order to provide accurate treatment, precise prognosis and appropriate public health control measures. The recent armed conflict in Libya that ended with the Gadhafi regime collapse on October 2011 has affected all aspects of the life in the country. In this study we discussed multiple risk factors that could be associated with this conflict and present major challenges that should be considered by local and national health authorities for evaluating the CL burden and highlighting priority actions for disease control

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding