Malignancy risk analysis in patients with inadequate fine needle aspiration cytology (FNAC) of the thyroid

Background Thyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC. Materials and Methods Retrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included. Results Out of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%). Conclusions There is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC

Multi-objective analysis of ridesharing in automated mobility-on-demand

Self-driving technology is expected to enable the realization of large-scale mobility-on-demand systems that employ massive ridesharing. The technology is being celebrated as a potential cure for urban congestion and others negative externalities of individual automobile transportation. In this paper, we quantify the potential of ridesharing with a fleet of autonomous vehicles by considering all possible trade-offs between the quality of service and operation cost of the system that can be achieved by sharing rides. We formulate a multi-objective fleet routing problem and present a solution technique that can compute Pareto-optimal fleet operation plans that achieve different trade- offs between the two objectives. Given a set of requests and a set of vehicles, our method can recover a trade-off curve that quantifies the potential of ridesharing with given fleet. We provide a formal optimality proof and demonstrate that the proposed method is scalable and able to compute such trade-off curves for instances with hundreds of vehicles and requests optimally. Such an analytical tool helps with systematic design of shared mobility system, in particular, it can be used to make principled decisions about the required fleet size.Accepted Author ManuscriptLearning & Autonomous Contro

The impact of ridesharing in mobility-on-demand systems: Simulation case study in Prague

In densely populated-cities, the use of private cars for personal transportation is unsustainable, due to high parking and road capacity requirements. The mobility-on-demand systems have been proposed as an alternative to a private car. Such systems consist of a fleet of vehicles that the user of the system can hail for one-way point-to-point trips. These systems employ large-scale vehicle sharing, i.e., one vehicle can be used by several people during one day and consequently, the fleet size and the parking space requirements can be reduced, but, at the cost of a non-negligible increase in vehicles miles driven in the system. The miles driven in the system can be reduced by ridesharing, where several people traveling in a similar direction are matched and travel in one vehicle. We quantify the potential of ridesharing in a hypothetical mobility-on-demand system designed to serve all trips that are currently realized by private car in the city of Prague. Our results show that by employing a ridesharing strategy that guarantees travel time prolongation of no more than 10 minutes, the average occupancy of a vehicle will increase to 2.7 passengers. Consequently, the number of vehicle miles traveled will decrease to 35% of the amount in the MoD system without ridesharing and to 60% of the amount in the present state.</p

The impact of ridesharing in mobility-on-demand systems: Simulation case study in Prague

In densely populated-cities, the use of private cars for personal transportation is unsustainable, due to high parking and road capacity requirements. The mobility-on-demand systems have been proposed as an alternative to a private car. Such systems consist of a fleet of vehicles that the user of the system can hail for one-way point-to-point trips. These systems employ large-scale vehicle sharing, i.e., one vehicle can be used by several people during one day and consequently, the fleet size and the parking space requirements can be reduced, but, at the cost of a non-negligible increase in vehicles miles driven in the system. The miles driven in the system can be reduced by ridesharing, where several people traveling in a similar direction are matched and travel in one vehicle. We quantify the potential of ridesharing in a hypothetical mobility-on-demand system designed to serve all trips that are currently realized by private car in the city of Prague. Our results show that by employing a ridesharing strategy that guarantees travel time prolongation of no more than 10 minutes, the average occupancy of a vehicle will increase to 2.7 passengers. Consequently, the number of vehicle miles traveled will decrease to 35% of the amount in the MoD system without ridesharing and to 60% of the amount in the present state.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Learning & Autonomous Contro

Social Trajectory Planning for Urban Autonomous Surface Vessels

In this article, we propose a trajectory planning algorithm that enables autonomous surface vessels to perform socially compliant navigation in a city's canal. The key idea behind the proposed algorithm is to adopt an optimal control formulation in which the deviation of movements of the autonomous vessel from nominal movements of human-operated vessels is penalized. Consequently, given a pair of origin and destination points, it finds vessel trajectories that resemble those of human-operated vessels. To formulate this, we adopt kernel density estimation (KDE) to build a nominal movement model of human-operated vessels from a prerecorded trajectory dataset, and use a Kullback-Leibler control cost to measure the deviation of the autonomous vessel's movements from the model. We establish an analogy between our trajectory planning approach and the maximum entropy inverse reinforcement learning (MaxEntIRL) approach to explain how our approach can learn the navigation behavior of human-operated vessels. On the other hand, we distinguish our approach from the MaxEntIRL approach in that it does not require well-defined bases, often referred to as features, to construct its cost function as required in many of inverse reinforcement learning approaches in the trajectory planning context. Through experiments using a dataset of vessel trajectories collected from the automatic identification system, we demonstrate that the trajectories generated by our approach resemble those of human-operated vessels and that using them for canal navigation is beneficial in reducing head-on encounters between vessels and improving navigation safety. Learning & Autonomous Contro

The PRIMARA study:a prospective, descriptive, observational study to review cinacalcet use in patients with primary hyperparathyroidism in clinical practice

Objective: Medical management of primary hyperparathyroidism (PHPT) is important in patients for whom surgery is inappropriate. We aimed to describe clinical profiles of adults with PHPT receiving cinacalcet. Design: Descriptive, prospective, observational study in hospital and specialist care centres. Methods: For patients with PHPT aged 23-92 years starting cinacalcet for the first time, information was collected on dosing pattern, biochemistry and adverse drug reactions (ADRs). Initial cinacalcet dosage and subsequent dose changes were at the investigator's discretion. Results: Of 303 evaluable patients with pHTP, 134 (44%) had symptoms at diagnosis (mostly bone pain [58] or renal stones [50]). Mean albumin-corrected serum calcium (ACSC) at baseline was 11.4 mg/dL (2.9 mmol/L). Reasons for prescribing cinacalcet included: surgery deemed inappropriate (35%), patient declined surgery (28%), and surgery failed or contraindicated (22%). Mean cinacalcet dose was 43.9 (SD, 15.8) mg/day at treatment start and 51.3 (31.8) mg/day at Month 12; 219 (72%) completed 12 months' treatment. The main reason for cinacalcet discontinuation was parathyroidectomy (40; 13%). At 3, 6 and 12 months from the start of treatment, 63%, 69% and 71% of patients, respectively, had an ACSC of ≤10.3 mg/dL versus 9.9% at baseline. Reductions from baseline in ACSC of ≥1 mg/dL were seen in 56%, 63% and 60% of patients, respectively. ADRs were reported in 81 patients (27%), most commonly nausea. 7.6% of patients discontinued cinacalcet due to ADRs. Conclusions: Calcium reductions of ≥1 mg/dL were observed in 60% of patients 12 months after initiating cinacalcet, without notable safety concerns.info:eu-repo/semantics/publishe

Exhaled nitric oxide - circadian variations in healthy subjects

<p>Abstract</p> <p>Objective</p> <p>Exhaled nitric oxide (eNO) has been suggested as a marker of airway inflammatory diseases. The level of eNO is influenced by many various factor including age, sex, menstrual cycle, exercise, food, drugs, etc. The aim of our study was to investigate a potential influence of circadian variation on eNO level in healthy subjects.</p> <p>Methods</p> <p>Measurements were performed in 44 women and 10 men, non-smokers, without respiratory tract infection in last 2 weeks. The eNO was detected at 4-hour intervals from 6 a.m. to 10 p.m. using an NIOX analyzer. We followed the ATS/ERS guidelines for eNO measurement and analysis.</p> <p>Results</p> <p>Peak of eNO levels were observed at 10 a.m. (11.1 ± 7.2 ppb), the lowest value was detected at 10 p.m. (10.0 ± 5.8 ppb). The difference was statistically significant (paired t-test, P < 0.001).</p> <p>Conclusions</p> <p>The daily variations in eNO, with the peak in the morning hours, could be of importance in clinical practice regarding the choice of optimal time for monitoring eNO in patients with respiratory disease.</p