Epididymocutaneous fistula in a patient with neurogenic bladder

AbstractWe describe the development of an epididymocutaneous fistula in a patient with a complicated genitourinary history, including recurrent epididymitis and neurogenic bladder

Passive Energy Recapture in Jellyfish Contributes to Propulsive Advantage over other Metazoans

Gelatinous zooplankton populations are well known for their ability to take over perturbed ecosystems. The ability of these animals to outcompete and functionally replace fish that exhibit an effective visual predatory mode is counterintuitive because jellyfish are described as inefficient swimmers that must rely on direct contact with prey to feed. We show that jellyfish exhibit a unique mechanism of passive energy recapture, which is exploited to allow them to travel 30% further each swimming cycle, thereby reducing metabolic energy demand by swimming muscles. By accounting for large interspecific differences in net metabolic rates, we demonstrate, contrary to prevailing views, that the jellyfish (Aurelia aurita) is one of the most energetically efficient propulsors on the planet, exhibiting a cost of transport (joules per kilogram per meter) lower than other metazoans. We estimate that reduced metabolic demand by passive energy recapture improves the cost of transport by 48%, allowing jellyfish to achieve the large sizes required for sufficient prey encounters. Pressure calculations, using both computational fluid dynamics and a newly developed method from empirical velocity field measurements, demonstrate that this extra thrust results from positive pressure created by a vortex ring underneath the bell during the refilling phase of swimming. These results demonstrate a physical basis for the ecological success of medusan swimmers despite their simple body plan. Results from this study also have implications for bioinspired design, where low-energy propulsion is required

Contextual Pre-Planning on Reward Machine Abstractions for Enhanced Transfer in Deep Reinforcement Learning

Recent studies show that deep reinforcement learning (DRL) agents tend to overfit to the task on which they were trained and fail to adapt to minor environment changes. To expedite learning when transferring to unseen tasks, we propose a novel approach to representing the current task using reward machines (RM), state machine abstractions that induce subtasks based on the current task's rewards and dynamics. Our method provides agents with symbolic representations of optimal transitions from their current abstract state and rewards them for achieving these transitions. These representations are shared across tasks, allowing agents to exploit knowledge of previously encountered symbols and transitions, thus enhancing transfer. Our empirical evaluation shows that our representations improve sample efficiency and few-shot transfer in a variety of domains.Comment: IJCAI Workshop on Planning and Reinforcement Learning, 202

Re-understanding Finite-State Representations of Recurrent Policy Networks

We propose an approach for understanding control policies represented as recurrent neural networks. Recent work has approached this problem by transforming such recurrent policy networks into finite-state machines (FSM) and then analyzing the equivalent minimized FSM. While this led to interesting insights, the minimization process can obscure a deeper understanding of a machine's operation by merging states that are semantically distinct. To address this issue, we introduce an analysis approach that starts with an unminimized FSM and applies more-interpretable reductions that preserve the key decision points of the policy. We also contribute an attention tool to attain a deeper understanding of the role of observations in the decisions. Our case studies on 7 Atari games and 3 control benchmarks demonstrate that the approach can reveal insights that have not been previously noticed

Self-burning: A common and tragic way of suicide in fars province, Iran

Self-burning is the most devastating burn injury. It is a common social and medical problem in Iran. In a longitudinal prospective study, from April 2003 to March 2006, all burn patients admitted to Ghotb-eddin burn Hospital were enrolled in this study. Suicide attempts by burning accounted for 283 (21.9%) of all burn patients admitted to the hospital. Most (68.2%) of self-burning patients were female. Self-burn patients had significantly large burned body surface area (64.8±29%). Suicidal burns occurred predominantly in the age group 15-24 years (44.6%). The mortality rate for suicidal burns was (60.4%). Fars is a province composed of many different tribes and cultural minorities whereby major decisions are made by forums of clergymen. It is important to involve those clergymen in burn prevention programs to achieve a meaningful reduction in Self-burning prevalence

Hepatitis B/C virus co-infection in Iran: A seroepidemiological study

Background/aims: As hepatitis B and C virus have the same transmission routes, dual infection may occur. The aim of this study was to determine the seroprevalence of HCV in HBsAg-positive subjects. Methods: 139 HBsAg-positive subjects were enrolled in the study. Serum samples were tested using ELISA method for anti-HCV antibodies. Chi-square and Fisher's exact tests were used to compare the proportions. Results: There were 68 (48.9%) males and 71 (51.1%) females. The mean age was 41.89±11.30 years. One case was excluded because of inadequate blood sampling. Anti-HCV antibody was positive in 17 (12.3%) of the 138 remaining subjects. Seropositivity of HCV was similar between female and male patients (p=0.69). Conclusion: The seroprevalence of co-infection with hepatitis B virus and hepatitis C virus in our study was higher than such reports from some countries (Italy), but was in line with worldwide prevalence (>10%)

Ergonomic Risk Factors and Their Association with Lower Back and Neck Pain among Pharmaceutical Employees in Iran

The aim of this cross-sectional study was to explore the ergonomic risk factors for low back pain (LBP) and neck pain in an industry in which only light tasks are performed. These common disorders can be significant work-related musculoskeletal disorders. This study included 396 employees who worked in packaging units of pharmaceutical companies. The Nordic Musculoskeletal Questionnaire and the rapid upper limb assessment (RULA) were used to generate data. This study showed an association between LBP, RULA scores, and workers' education. For neck pain, an association was found with age, gender, and subjective questions about working posture (mostly sitting/standing or alternating between the two). Absence from work more than 3 days, which could have been associated with pain, was significantly associated with both disorders. Copyright © 2016 The Author(s)

Defining the substrate for ventricular tachycardia ablation: The impact of rhythm at the time of mapping

BACKGROUND: Voltage mapping is critical to define substrate during ablation. In ventricular tachycardia, abnormal potentials may be targets. However, wavefront of activation could impact local signal characteristics. This may be particularly true when comparing sinus rhythm versus paced rhythms. We sought to determine how activation wavefront impacts electrogram characteristics. METHODS: Patients with ischemic cardiomyopathy, ventricular tachycardia, and without fascicular or bundle branch block were included. Point by point mapping was done and at each point, one was obtained during an atrial paced rhythm and one during a right ventricular paced rhythm. Signals were adjudicated after ablation to define late potentials, fractionated potentials, and quantify local voltage. Areas of abnormal voltage (defined as \u3c1.5 mV) were also determined. RESULTS: 9 patients were included (age 61.3 ± 9.2 years, 56% male, mean LVEF 34.9 ± 8.6%). LV endocardium was mapped with an average 375 ± 53 points/rhythm. Late potentials were more frequent during right ventricular pacing (51 ± 21 versus 32 ± 15, p \u3c 0.01) while overall scar area was higher during atrial pacing (22 ± 11% vs 13 ± 7%, p \u3c 0.05). In 1/9 patients, abnormal potentials were seen during a right ventricular paced rhythm that were not apparent in an atrial paced rhythm, ablation of which resulted in non-inducibility. CONCLUSION: Rhythm in which mapping is performed has an impact on electrogram characteristics. Whether one rhythm is preferable to map in remains to be determined. However, it is possible defining local signals during normal conduction as well as variable paced rhythms may impart a greater likelihood of elucidating arrhythmogenic substrate