Temporary epicardial pacing wires in isolated coronary artery bypass graft: Necessity or force of habit?

Objective: To determine the frequency of Temporary epicardial pacing wires usage and its predictors in the immediate postoperative period in isolated coronary artery bypass graft surgery. Methods: The longitudinal study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to August 2020, and comprised adult patients of either gender who underwent isolated coronary artery bypass graft in the Department of Cardiothoracic Surgery. Demographic, peri-operative and post-operative Temporary Epicardial Pacing Wires use data was extracted from patient\u27s files and the institutional electronic database. Logistic regression models were built to explore predictors of Temporary epicardial pacing wires usage. Data was analysed using SPSS 22. Results: Of the 322 cases evaluated, 27(8.4%) required the use of Temporary Epicardial Pacing Wires. Mean age of the patients requiring temporary epicardial pacing wires was 66.3±8.9 years compared to 58.7±8.9 years in those who did not require it (p\u3c0.001), while the left ventricular ejection fraction percentage was 44.1±12.8 and 48.9±12.8 respectively (p=0.032). After adjusting for clinically plausible demographics and peri-operative variables, increasing age and low left ventricular ejection fraction were significantly associated with the use of temporary epicardial pacing wires in post-operative period of isolated coronary artery bypass graft patients (p\u3c0.05). Conclusions: The frequency of temporary epicardial pacing wires usage in the post-operative period of coronary artery bypass graft was found to be low

Machine Learning Classifiers: A Brief Primer

Machine learning is a prominent and an intensively studied field in the artificial intelligence area which assists to enhance the performance of classification. In this paper, the main idea is to provide the classification and comparative analysis of data mining algorithms. To support this idea, six supervised machine learning (ML) algorithms, C4.5 (J48), K-Nearest Neighbor (KNN), Logistic Regression (LR), Naive Bayes (NB), Support Vector Machine (SVM), and One Rule (OneR) along with the five UCI Datasets of ML Repository, are being applied that demonstrates the robustness and effectiveness of numerous approaches. Whereas, for analytical procedures, significant parameters have been considered: Accuracy, Area Under Curve (AUC), precision, recall, and F-measure values. Hence, the primary objective of this study is to obtain binary classification and efficiency by conducting the performance evaluation. We present experimental results that demonstrate the effectiveness of our approach to well-known competitive approaches

Effect of electrokinetic treatment time on energy consumption and salt ions removal from clayey soils

Electrokinetics effectively removes contaminants, but its field-scale applications are limited mainly due to its high energy cost. In previous studies, the energy consumption was determined either by changing the soil’s specimens initial salt concentration while keeping the treatment time fixed or by changing the treatment time and keeping the same initial salt concentrations for all the specimens. Since both the initial salt concentration and treatment time are important parameters in determining reclamation cost, therefore, in this study, the soil specimens intentionally contaminated with different concentrations of sodium chloride (NaCl), i.e., varying from 3.7 to 15.5 g kg−1, were exposed to a constant DC electric field of 1 V cm−1 for different time durations, i.e., varying from 6 to 72 h. The results show that electroosmotic flow (EOF) was directed from the anode to the cathode and higher for specimens contaminated with relatively low salt concentration, i.e., up to 7.6 g kg−1. Therefore, for these specimens, due to the combined effect of electroosmosis and electromigration, the removal of Na+ was higher than the Cl−. However, for the specimen contaminated with a higher salt concentration, i.e., 15.5 g kg−1, the Cl− removal exceeded Na+ due to the marginalization of EOF. Regardless of initial salt concentration, the electroosmotic flow and salt ions removal rates decreased with increasing treatment time, which might be attributed to the development of acidic and alkaline environments in soil. The collision of acidic and alkaline fronts resulted in a large potential gradient in a narrow soil region of pH jump, diminishing it everywhere else. This nonlinearity in the electric potential distribution in soil reduced the EOF and electromigration of salt ions

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Controller-driven vector autoregression model for predicting content popularity in programmable named data networking devices

Named Data Networking (NDN) has emerged as a promising network architecture for content delivery in edge infrastructures, primarily due to its name-based routing and integrated in-network caching. Despite these advantages, sub-optimal performance often results from the decentralized decision-making processes of caching devices. This article introduces a paradigm shift by implementing a Software Defined Networking (SDN) controller to optimize the placement of highly popular content in NDN nodes. The optimization process considers critical networking factors, including network congestion, security, topology modification, and flowrules alterations, which are essential for shaping content caching strategies. The article presents a novel content caching framework, Popularity-aware Caching in Popular Programmable NDN nodes (PaCPn). Employing a multi-variant vector autoregression (VAR) model driven by an SDN controller, PaCPn periodically updates content popularity based on time-series data, including 'request rates' and 'past popularity'. It also introduces a controller-driven heuristic algorithm that evaluates the proximity of caching points to consumers, considering factors such as 'distance cost,' 'delivery time,' and the specific 'status of the requested content'. PaCPn utilizes customized DATA named packets to ensure the source stores content with a valid residual freshness period while preventing intermediate nodes from caching it. The experimental results demonstrate significant improvements achieved by the proposed technique PaCPn compared to existing schemes. Specifically, the technique enhances cache hit rates by 20% across various metrics, including cache size, Zipf parameter, and exchanged traffic within edge infrastructure. Moreover, it reduces content retrieval delays by 28%, considering metrics such as cache capacity, the number of consumers, and network throughput. This research advances NDN content caching and offers potential optimizations for edge infrastructures.publishe

A combined approach of base and meta learners for hybrid system

The ensemble learning method is considered a meaningful yet challenging task. To enhance the performance of binary classification and predictive analysis, this paper proposes an effective ensemble learning approach by applying multiple models to produce efficient and effective outcomes. In these experimental studies, three base learners, J48, Multilayer Perceptron (MP), and Support Vector Machine (SVM) are being utilized. Moreover, two meta-learners, Bagging and Rotation Forest are being used in this analysis. Firstly, to produce effective results and capture productive data, the base learner, the J48 decision tree is aggregated with the rotation forest. Secondly, machine learning and ensemble learning classification algorithms along with the five UCI Datasets are being applied to progress the robustness of the system. Whereas, the recommended mechanism is evaluated by implementing five performance standards concerning the accuracy, AUC (Area Under Curve), precision, recall and F-measure values. In this regard, extensive strategies and various approaches were being studied and applied to obtain improved results from the current literature; however, they were insufficient to provide successful results. We present experimental results which demonstrate the efficiency of our approach to well-known competitive approaches. This method can be applied to image identification and machine learning problems, such as binary classification

A Novel Memory and Time-Efficient ALPR System Based on YOLOv5

With the rapid development of deep learning techniques, new innovative license plate recognition systems have gained considerable attention from researchers all over the world. These systems have numerous applications, such as law enforcement, parking lot management, toll terminals, traffic regulation, etc. At present, most of these systems rely heavily on high-end computing resources. This paper proposes a novel memory and time-efficient automatic license plate recognition (ALPR) system developed using YOLOv5. This approach is ideal for IoT devices that usually have less memory and processing power. Our approach incorporates two stages, i.e., using a custom transfer learned model for license plate detection and an LSTM-based OCR engine for recognition. The dataset that we used for this research was our dataset consisting of images from the Google open images dataset and the Indian License plate dataset. Along with training YOLOv5 models, we also trained YOLOv4 models on the same dataset to illustrate the size and performance-wise comparison. Our proposed ALPR system results in a 14 megabytes model with a mean average precision of 87.2% and 4.8 ms testing time on still images using Nvidia T4 GPU. The complete system with detection and recognition on the other hand takes about 85 milliseconds