New Technology Add-On Payment (NTAP) for Viz LVO: a win for stroke care

The Centers for Medicare and Medicaid Services (CMS) recently granted a New Technology Add-on Payment (NTAP) for Viz ContaCT (Viz LVO) by Viz.ai, Inc, an applied artificial intelligence healthcare company.1 This is the first time CMS has reimbursed an artificial intelligence (AI)-based software using this designation. It applies to Viz.ai’s acute ischemic stroke product, Viz LVO, officially known as Viz ContaCT, under which the ICD-10 Procedure Coding System (ICD-10-PCS) procedure code 4A03×5D was established. Viz ContaCT is an AI-based system that creates a parallel alert system whenever it detects a large vessel occlusion (LVO) on a computed tomography angiogram. The images are viewable on a mobile application which combines HIPAA (Health Insurance Portability and Accountability Act)-compliant group messaging functionality with a mobile PACS Viewer. Users can view the images, make triage decisions, and communicate with other members of the care team through chat functionality. Beyond the specific designation, this decision may have far-reaching implications for stroke care and for reimbursement of AI-enabled applications

Worked Example of X-by-Wire Technology in Electric Vehicle: Braking and Steering

The chapter emphasizes on the worked example of braking system and steering system for electric vehicle. The x-by-wire technology is investigated and validated comprehensively. Brake-by-wire is considered a new brake technology that uses electronic devices and control system instead of conventional brake components to carry out braking function based on wire-transmitted information. However, the physical parameters associated with braking function cause nonlinear characteristics and variations in the braking dynamics, which eventually degrade stability and performance of the system. Therefore, this study presents the design of fuzzy-PID controller for brake-by-wire (BBW) to overcome these undesired effects and also to derive optimal brake force that assists to perform braking operation under distinct road conditions and distinct road types. Electric power-assisted steering (EPAS) system is a new power steering technology for vehicles especially for electric vehicles (EV). It has been applied to displace conventional hydraulic power-assisted steering (HPAS) system due to space efficiency, environmental compatibility, and engine performance. An EPAS system is a driver-assisting feedback system designed to boost the driver input torque to a desired output torque causing the steering action to be undertaken at much lower steering efforts

Burden of Right Ventricular Infarction in Patients with Inferior Myocardial Infarction in Babylon

هدف الدراسة: هده الدراسة تهدف الى المقارنة في نسبة حصول الصدمة القلبية والوفاة للمرضى الدين يحصل لديهم احتشاء للعضلة القلبية السفلى والمرضى الدين بحصل لديهم احتشاء للعضلة القلبية السفلى مع احتشاء البطين الايمن . طريقة الدراسة : هده دراسة مقارنة اجريت في مدينة مرجان الطبية في وحدة الانعاش للفترة من 1-2-2014 الى 30-9-2014 للمرضى الدين الدين  أصيبوا باحتشاء العضلة القلبية السفلى .تم تقسيم المرضى الى مجموعتين ,المجموعة الاولى هم المرضى المصابين باحتشاء العضلة القلبية السفلى والمجموعة الثانية هم المرضى المصابين باحتشاء العضلة القلبية السفلى مع احتشاء البطين الايمن للقلب .تم متابعة المرضى طول فترة بقائهم بالمستشفى لأي تعقيدات ممكن ان تحدث. النتائج: مجموع 80 مريض ادخلوا في الدراسة وقسموا الى مجموعتين : المجموعة الاولى26 مريض أصيبوا باحتشاء العضلة القلبية السفلى مع احتشاء البطين الايمن ,والمجموعة الثانية 54 اصيبوا باحتشاء العضلة القلبية السفلى ,المجموعتين لديهم نفس الخصائص .معدل العمر للمرضى هو 59.30 للمجموعة الاولى , 55.03 للمجموعة الثانية .نسبة الذكور للمجموعة الاولى هو 17 (65.4%)  و33(61.1%) للمجموعة الثانية .نسبة الوفيات للمجموعة الاولى هو 4(15.4) و1 (1.9) للمجموعة الثانية . قيمو البي 0.036 وتعتبر نسبة مهمة .عدد المرضى الدين اصيبوا بالصدمة القلبية للمجموعة الاولى هو 7(26.9) وللمجموعة الثانية هو 5(5.6) ,قيمة البي هي 0.011 وتعتبر مهمة . الاستنتاجات: 1-المرضى المصابين باحتشاء العضلة القلبية السفلى والبطين الايمن لديهم نسبة عالية لحدوث الصدمة القلبية اكثر من المرضى المصابين باحتشاء العضلة القلبية السفلى في فترة بقائهم بالمستشفى . 2- المرضى المصابين باحتشاء العضلة القلبية السفلى والبطين الايمن لديهم نسبة عالية للوفاة  اكثر من المرضى المصابين باحتشاء العضلة القلبية السفلى في فترة بقائهم بالمستشفىAim of study:the study aim to comparing the rate of cardiogenic shock and mortality rate between patient with RV infarction and inferior MI and the patient with inferior MI alone. Patient and method: Across sectional study conducted in coronary care unit in merjan medical city at time from the first of March 2014 to the 30th of September 2014 for patient with inferior MI. patients were divided  to two group, the first group for patients with inferior MI and RV infarction and the second group for patients with inferior MI alone. The both groups were monitor in the hospital for any complications that can take place in the hospital stay. Result: A total of 80 patient were enrolled in the study and divided  to two groups, the first group (26 patients) for patients with inferior MI and RV infarction and the second group (54 patients) for patients with inferior MI alone,  both group had the same baseline characteristic. The mean age was 59.30 ± 7.56 for first group and it was 55.03 ± 5.18 for second group, male patients were 17 (65.4%) and 33 (61.1%) in the first and second group respectively. The in hospital mortality was 4 (15.4%) and 1(1.9%) in the first and second group respectively and the P value was 0.036 (significant).The risk of cardiogenic shock was 7 (26.9%) and 5 (5.6%) for first and second group respectively with P value 0.011(significant). Conclusion: 1- The patients with RV infarction and inferior MI expose to higher rate of cardiogenic shock than the patients with inferior MI alone during the time of his hospital stay. 2- The patient with RV infarction and inferior MI had higher in hospital mortality rate when compared with patient with inferior MI alone. &nbsp

Comparing Three Different Algorithms to Estimate Parameters of new Generated Marshal – Olkin Uniform Distribution

This paper deals with constructing a new generated Marshal – Olkin Uniform family distribution which include finding the probability density function

Predictors of improved clinical outcome following mechanical thrombectomy on South Texas patients with posterior circulation stroke

The South Texas population is well-acquainted with hypertension, Diabetes Mellitus Type 2 (DM2), and hyperlipidemia, all well-known risk factors for stroke1. Both anterior and posterior circulation strokes can lead to detrimental life changes, and although posterior circulation, or vertebrobasilar, strokes make up about 20% of all ischemic strokes2, their elusive characteristics often overlap with anterior circulation symptoms. In this study, we study factors that may influence the outcome of patients with posterior circulation stroke (PCS) following successful recanalization using mechanical thrombectomy. In this paper, the clinical outcome is evaluated by the primary endpoint, Modified Rankin Scale (mRS) at discharge. The outcomes (mild, moderate, severe) refer to the degree of severity of clinical impact. The current evidence that is available points towards a general poorer prognosis for recanalization of PCS than anterior circulation strokes (ACS)3. This paper seeks to investigate both patient related factors and treatment related factors that may influence the outcomes of cases PCS following mechanical thrombectomy and offers future direction that can improve our understanding of PCS

Gender detection in children’s speech utterances for human-robot interaction

The human voice speech essentially includes paralinguistic information used in many real-time applications. Detecting the children’s gender is considered a challenging task compared to the adult’s gender. In this study, a system for human-robot interaction (HRI) is proposed to detect the gender in children’s speech utterances without depending on the text. The robot's perception includes three phases: Feature’s extraction phase where four formants are measured at each glottal pulse and then a median is calculated across these measurements. After that, three types of features are measured which are formant average (AF), formant dispersion (DF), and formant position (PF). Feature’s standardization phase where the measured feature dimensions are standardized using the z-score method. The semantic understanding phase is where the children’s gender is detected accurately using the logistic regression classifier. At the same time, the action of the robot is specified via a speech response using the text to speech (TTS) technique. Experiments are conducted on the Carnegie Mellon University (CMU) Kids dataset to measure the suggested system’s performance. In the suggested system, the overall accuracy is 98%. The results show a relatively clear improvement in terms of accuracy of up to 13% compared to related works that utilized the CMU Kids dataset

Potential Perioperative Complications Due To Difference In Timing Of Systemic Heparinization During Ruptured Aneurysm Coiling

Potential Perioperative Complications Due To Differences in Timing Of Systemic Heparin Distribution During Ruptured Aneurysm Coiling Introduction: In general, systematic heparin anticoagulation is standard in regards to neurovascular intervention. When coiling ruptured aneurysms, many neurointerventionalists have their own protocol as to timing of systemic heparinization. There is ample research and literature reviewing the frequency of perioperative events, predictors and outcomes, as well as the efficacy in the use of anticoagulants and/or antiplatelets before, during, and after neurovascular procedures to prevent adverse outcomes. However, there currently exists a dearth of research in regards to timing of distribution of heparin intraoperatively and its potential effects on adverse patient outcomes. We performed this analysis to evaluate the effect on the frequency of perioperative complications in relation to when systemic heparin is given to patients intraoperatively, particularly if earlier administration increases bleeding diathesis and if later administration increases ischemic events. Methods: We used a single hospital retrospective study of patients with a primary diagnosis of subarachnoid hemorrhage due to ruptured aneurysm to assess the relationship between the timing of intraoperative systemic heparin distribution during coiling. Patients were subdivided into two groups: those who received heparin at the start of the procedure and those that received heparin after deployment of first coil. Outcomes of interest were perioperative re-rupture of aneurysm and/or stroke. Other factors analyzed were age, sex, Hunt and Hess Scale, modified Fisher Scale, and aneurysm size at presentation. Continuous variables were expressed as the mean with standard error of the mean (±SE). Categorical variables are expressed as percentages. Comparisons between groups were performed using ANOVA for continuous variables and either the Chi-squared test or the Fisher’s exact test for categorical parameters. P \u3c 0.05 was considered statistically significant. Results: We analyzed 246 patients with ruptured aneurysms undergoing endovascular coiling (mean age 57.70 ± 1.00). Perioperative complications were seen in a total of 17 patients (6.91%). In univariate analysis, patients who received systemic heparin at the beginning of the procedure vs. those who received it after placement of first coil did not have worse outcomes both in re-rupture of aneurysm (1.08% vs. 6.54%, p= 0.056) or perioperative stroke (2.15% vs. 2.61%, p= 1). In our analysis, timing of systemic heparin did not seem to influence the rate of intraoperative complications regardless of hemorrhagic vs, thromboembolic. Conclusion: Timing of systemic heparin distribution and its potential effects on perioperative events remains an understudied area of interventional neurology. However, our data suggests that the different timepoints that are currently regarded as standard for its distribution have little bearing on adverse patient outcomes intraoperatively. This can lead us to rethink time guidelines for patients and decrease the apprehension in heparin distribution with regards to adverse outcomes

Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Background: The purpose of this study was to report the safety and performance of aspiration thrombectomy with the Penumbra System for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) and late onset to treatment. Methods: This is a retrospective subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with AIS due to LVO and a pre-stroke modified Rankin Scale score (mRS) of 0 or 1 who were treated first-line with aspiration thrombectomy either alone (A Direct Aspiration First Pass Technique [ADAPT]) or in combination with the 3D Revascularization Device (ADAPT + 3D). This subset analysis included all patients in the registry who had anterior circulation LVO, an Alberta Stroke Program Early CT Score of at least 6, and late onset to treatment (\u3e6 h from stroke onset to puncture). Results: Of the 650 patients in the COMPLETE registry, 167 were included in this subset analysis. The rate of successful revascularization (modified thrombolysis in cerebral infarction score 2b-3 achieved) at the end of the procedure was 83.2%, the rate of good functional outcome (mRS 0-2) at 90 days was 55.4%, and the all-cause mortality rate at 90 days was 14.4%. No device-related serious adverse events (SAEs) occurred. Procedure-related SAEs occurred in 9 patients (5.4%) within 24 h and in 12 patients (7.2%) overall. The rate of successful revascularization was higher for patients treated first-line with ADAPT (88.0%) than for patients treated first-line with ADAPT + 3D (75.0%; p = 0.035); no significant difference was observed between the ADAPT and ADAPT + 3D groups for any other primary or secondary outcome. Conclusion: For patients with AIS due to anterior circulation LVO and with late onset to treatment, aspiration thrombectomy with the Penumbra System appears to be safe and effective. The rates of good functional outcome and all-cause mortality from this study compared favorably with those rates from the medical management arms of the DAWN and DEFUSE-3 studies. Clinical trial registration: https://www.clinicaltrials.gov, NCT03464565

Effect of Manganese and Potassium Humate on some Vegetative and Yield Parameters of Tomato Plant Lycopersicon esculentum Mill Grown in Plastic House

       نفذت تجربة حقلية في احد البيوت البلاستيكية لمنطقة المسيب شمال محافظة بابل وللموسم الزراعي 2016/2017، في تربة رملية مزيجة لدراسة تأثير رش ثلاثة  مستويات من التسميد بعنصر المنغنيز (صفر ، 20 ، 40 ملغم منغنيز.لتر‾¹) بأستعمال كبريتات المنغنيز المتأدرتة  وأربعة مستويات من المادة العضوية (هيومات البوتاسيوم) (صفر ، 10 ، 20 ، 30 مل.لتر‾¹)  وتداخلهما على بعض مؤشرات نمو  الطماطة وحاصلها صنف شهيرة وباربعة  رشات كل 20 يوم، صممت التجربة وفق تصميم القطاعات تامة التعشية RCBD  وقورنت المتوسطات بأختبار اقل فرق معنوي L.S.D وبمستوى معنوية 5%.        اشارت النتائج الى تفوق معاملة رش المنغنيز بمستوى (40 ملغم.لتر‾¹) معنويا في زيادة متوسطات  أطوال  النبات ، اعداد الاوراق والمساحة الورقية للنبات والوزن الجاف للمجموع الخضري ومحتوى الاوراق من الكلوروفيل ونسبة المادة الجافة في الاوراق وعدد النورات الزهرية وعدد الازهار بالنورة وعدد الثمار في النبات ووزن الثمرة وحاصل النبات وحاصل المتر المربع وبأعلى قيم بلغت 212.65 سم ، 42.7 ورقة،  172.6 دسم2 ، 185.9 غم ، 45.03 spad ، 11.8% ، 10.2 نورة، 11.7 زهرة ، 47.6 ثمرة ، 101.8 غم ، 4.880 كغم و 16.252 كغم.م2 22 بالتتابع ، وهو نفس سلوك معاملة الرش بهيومات البوتاسيوم اذ تفوقت المعاملة (30 مل.لتر-1) في جميع الصفات اعلاه واعطت اعلى قيم بلغت 226.4 سم ، 44.4 ورقة ، 180.2 دسم2 ، 196.4 غم، 46.53 spad ، 11.8% ، 10.3 نورة ، 11.7 زهرة ، 51 ثمرة ، 105.5 غم ، 5.394 كغم، و 17.862 كغم.م2 بالتتابع . اما معاملات التداخل فقد اظهرت تفوق معاملة الرش بتوليفة من (40 ملغم Mn.لتر-1 + 30 مل.لتر-1 هيومات البوتاسيوم) واعطائها اعلى القيم لجميع الصفات اعلاه.       Afield experiment was conducted in a plastic house in Al-wattifiyah / Babylon Province during 2016/2017 season , soil texture was Loamy Sand with 3 levels of manganese element (0 , 20 , and  40 mg .L-1) using MnSO4.4H2O, and 4 levels of  potassium humate  (0 , 10 , 20 , and 30 ml.L-1) , and their interaction on some vegetative and yield  parameters of tomato plant Shahira  variety. 4 spraying date among 20 days each, The experiment design was according to RCBD with 3 replicates, means were compared using L.S.D at 0.05 probability level.        The result show, the treatment (40 mg  Mn.L-1) gave significant increases in plant height, total leaf  No. , leaf area , plant dry matter , leaf content from chlorophyll, leaf dry matter percent, inflorescence number per plant , and No. of flowers per  inflorescence, No. of fruit per plant, fruit weight, total yield of plant , and total yield per m2  gave high value was 212.65 cm, 42.7 leaf , 172.6 ds2 , 185.9 gm , 45.03 spad , 11.8 inflorescence , 10.2 flowers , 47.6 fruits , 101.8 g m , 4.880 kg, and 16.252 kg.m2 respectively . While potassium humate  spraying  treatment (30 ml.L-1) gave high value to same parameters above with 226.4 cm , 44.4 leaf , 180.2 ds2 , 196.4 gm , 46.53 spad , 11.8 inflorescence, 10.3 flowers, 51 fruits , 105.5 gm , 5.394 kg , and 17.862 kg.m2respectively . The interaction treatment (40 mgm Mn.L-1  + 30 ml.L-1 potassium humate) gave the highest value of all parameters mentioned  above