CT-based fractional flow reserve: development and expanded application

Computations of fractional flow reserve, based on CT coronary angiography and computational fluid dynamics (CT-based FFR) to assess the severity of coronary artery stenosis, was introduced around a decade ago and is now one of the most successful applications of computational fluid dynamic modelling in clinical practice. Although the mathematical modelling framework behind this approach and the clinical operational model vary, its clinical efficacy has been demonstrated well in general. In this review, technical elements behind CT-based FFR computation are summarised with some key assumptions and challenges. Examples of these challenges include the complexity of the model (such as blood viscosity and vessel wall compliance modelling), whose impact has been debated in the research. Efforts made to address the practical challenge of processing time are also reviewed. Then, further application areas – myocardial bridge, renal stenosis and lower limb stenosis – are discussed along with specific challenges expected in these areas

The Right to the World\u27s Longest River: Reopening the Vexing Case of the Nile River

Disputes over rivers and water resources extend back to early civilizations. Yet, the current dispute between Egypt and Ethiopia may rank among the most vexing water disputes in modern history. The Grand Ethiopian Dam filling is close to completion, and, if no cooperative or legal solution is reached, many adverse consequences will start appearing gradually on the Egyptian share of the Nile River, which may ultimately pose a threat to the African peace. Currently, the international community is standing in vain after multiple unsuccessful attempts at negotiation and mediation. While legal and political scholars have discussed mechanisms and substantive standards applicable to water disputes, no scholarship currently exists regarding the application of those mechanisms and standards specifical to the Nile River dispute. Accordingly, this Article scrutinizes the current legal, political, and quasi-legal mechanisms and substantive standards governing water disputes to determine the most suitable mechanism of dispute resolution to adopt in the Nile River dispute. Further, it assesses the landmark U.S. Supreme Court decisions in interstate water disputes to identify the most adequate substantive standard that may likely resolve the Nile River dispute

Litigating Terror in The Sinai After The Egyptian Spring Revolution: Should States Be Liable to Foreign Investors for Failure to Prevent Terrorist Attacks?

The ambiguity of the due diligence standard of the Full Protection and Security obligation in investment treaties persists to this day. A recent ICSID tribunal found a developing state liable for breaching the Full Protection and Security obligation due to its inability to protect a foreign investment against terrorist attacks in a remote deserted area. In this article, we analytically criticize the Ampal v. Egypt arbitral award against the comprehensive factual matrix behind the case. Based on our criticism of Ampal, we argue that developing states should not be liable for failing to prevent or stop terrorist attacks under the Full Protection and Security obligation when they exert efforts relevant to their limited capacity to offer such protection. Further, we argue that investors should also optimize political risk insurance offered by the Multilateral Investment Guarantee Agency when they choose to invest in a host state that might be vulnerable to terrorist attacks, might face potential insurgencies, or suffer from political turmoil. Finally, we highlight the importance of integrating other subfields of international law – such as international human rights law – to the international investment arbitration system, especially in defining what acts or omissions are required of a host state to fulfill the due diligence standard of the Full Protection and Security Obligation

Pengembangan Algoritma Pembelajaran Untuk Jaringan Syaraf Tiruan Diagonal Recurrent Dalam Sistem Kendali Derau Akustik Secara Aktif

Active Noise Control (ANC) system emphasizes at USAge of adaptation algorithm and adaptive control structure. In this research is presented experimental result of active noise control system at free space using Diagonal Recurrent Artificial Neural Network control structure. The objective of this research is to develop an Extended Kalman Filter (EKF) algorithm for Diagonal Recurrent Artificial Neural Network control structure, named as Extended Kalman Filter Diagonal Recurrent (EKFDR) algorithm. Experimental result shows that amount of neuron in artificial neural network can be reduced by using diagonal recurrent artificial neural network, without lessening control system performance. Nonlinearity of secondary path in active noise control system can complicate control process. Experimental result shows that diagonal recurrent artificial neural network with EKFDR algorithm produced a better performance than linear controller in compensating of secondary path nonlinearity

Isolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage

We describe isolated cranial nerve-III palsy as a rare clinical finding in a patient with perimesencephalic subarachnoid hemorrhage. In this unusual case, the patient presented with complete cranial nerve-III palsy including ptosis and pupillary involvement. Initial studies revealed subarachnoid hemorrhage in the perimesencephalic, prepontine, and interpeduncular cisterns. Angiographic studies were negative for an intracranial aneurysm. The patient’s neurological deficits improved with no residual deficits on follow-up several months after initial presentation. Our case report supports the notion that patients with perimesencephalic subarachnoid hemorrhage have an excellent prognosis. Our report further adds a case of isolated cranial nerve-III palsy as a rare initial presentation of this type of bleeding, adding to the limited body of the literature

Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy.

Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4-37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29g/m2 versus 154±36g/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function

Digital and technological innovation in vector-borne disease surveillance to predict, detect, and control climate-driven outbreaks

Vector-borne diseases are particularly sensitive to changes in weather and climate. Timely warnings from surveillance systems can help to detect and control outbreaks of infectious disease, facilitate effective management of finite resources, and contribute to knowledge generation, response planning, and resource prioritisation in the long term, which can mitigate future outbreaks. Technological and digital innovations have enabled the incorporation of climatic data into surveillance systems, enhancing their capacity to predict trends in outbreak prevalence and location. Advance notice of the risk of an outbreak empowers decision makers and communities to scale up prevention and preparedness interventions and redirect resources for outbreak responses. In this Viewpoint, we outline important considerations in the advent of new technologies in disease surveillance, including the sustainability of innovation in the long term and the fundamental obligation to ensure that the communities that are affected by the disease are involved in the design of the technology and directly benefit from its application