Papillary muscle–to–anterior annulus stitches: Another technique to prevent systolic anterior motion after mitral valve repair

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Processing and decisions relating to water resources data: The case of Morocco

The national water strategy has been an essential vector of government strategy for a long time. The management of water resources is an integral part of the economic development of Morocco. Nevertheless, the definition of the strategic axes of this component and the adequate decision-making depends directly on the collection and use of all the data relating to water resources. If big data technologies present a suitable solution to ensure optimal and rapid use of its data, the success of functional and technical designs can only be provided after total control of the processing and decision-making processes relating to the water domain. In this paper, we will try to identify the aspects relating to the processes of data collection, processing, consolidation, and decision-making through the use of the results of field surveys and interviews with business managers

Efficient Biomedical Signal Security Algorithm for Smart Internet of Medical Things (IoMTs) Applications

Due to the rapid development of information and emerging communication technologies, developing and implementing solutions in the Internet of Medical Things (IoMTs) field have become relevant. This work developed a novel data security algorithm for deployment in emerging wireless biomedical sensor network (WBSN) and IoMTs applications while exchanging electronic patient folders (EPFs) over unsecured communication channels. These EPF data are collected using wireless biomedical sensors implemented in WBSN and IoMTs applications. Our algorithm is designed to ensure a high level of security for confidential patient information and verify the copyrights of bio-signal records included in the EPFs. The proposed scheme involves the use of Hahn’s discrete orthogonal moments for bio-signal feature vector extraction. Next, confidential patient information with the extracted feature vectors is converted into a QR code. The latter is then encrypted based on a proposed two-dimensional version of the modified chaotic logistic map. To demonstrate the feasibility of our scheme in IoMTs, it was implemented on a low-cost hardware board, namely Raspberry Pi, where the quad-core processors of this board are exploited using parallel computing. The conducted numerical experiments showed, on the one hand, that our scheme is highly secure and provides excellent robustness against common signal-processing attacks (noise, filtering, geometric transformations, compression, etc.). On the other hand, the obtained results demonstrated the fast running of our scheme when it is implemented on the Raspberry Pi board based on parallel computing. Furthermore, the results of the conducted comparisons reflect the superiority of our algorithm in terms of robustness when compared to recent bio-signal copyright protection schemes

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used