A combined optimization–simulation approach for modified outside-in boarding under COVID-19 regulations including limited baggage compartment capacities

The timely handling of passengers is critical to efficient airport and airline operations. The pandemic requirements mandate adapted process designs and handling procedures to maintain and improve operational performance. Passenger activities in the confined aircraft cabin must be evaluated to potential virus transmission, and boarding procedures should be designed to minimize the negative impact on passengers and operations. In our approach, we generate an optimized seat allocation that considers passengers’ physical activities when they store their hand luggage items in the overhead compartment. We proposed a mixed-integer programming formulation including the concept of shedding rates to determine and minimize the risk of virus transmission by solving the NP-hard seat assignment problem. We are improving the already efficient outside-in boarding, where passengers in the window seat board first and passengers in the aisle seat board last, taking into account COVID-19 regulations and the limited capacity of overhead compartments. To demonstrate and evaluate the improvements achieved in aircraft boarding, a stochastic agent-based model is used in which three operational scenarios with seat occupancy of 50%, 66%, and 80% are implemented. With our optimization approach, the average boarding time and the transmission risk are significantly reduced already for the general case, i.e., when no specific boarding order is specified (random boarding). If the already efficient outside-in boarding is used as a reference, the boarding time can be reduced by more than 30% by applying our approach, while keeping the transmission risk at the lowest level

Flattened photon beams, an obsolete feature in modern linear accelerators

Background: With the advent of Intensity Modulated Radiotherapy (IMRT) and recently, Volumetric Modulated Arc Therapy (VMAT), treatment planning using Flattening Filter Free (FFF) beams can meet all of the energy requirements in radiation therapy clinics. Manufacturers of linear accelerators no longer need to install a flattening filter (FF) in gantry head. This study aims to provide evidence of the superiority of FFF to FF through both dosimetric measurements and clinical treatment plans. Materials and Methods: A 50x50x50cm3 water phantom was created in the RayStation treatment planning system (TPS) for dosimetry comparisons. Flat beam profiles were generated using FFF beam through an optimization process for 10x10 to 30x30cm2 field sizes. Next, a comparison of treatment plans was made using 21 Head and Neck and 14 Lung/Mediastinum treatment sites using 6MV and 6MV-FFF beams. Results: Using FFF beams, profiles with flatness and symmetry identical to or better than those of the flattened beams were produced. At the very edge of the optimized plans for FFF beams, horns had the highest gamma index deviation <1.5% of the normalized dose. For clinical plans evaluated, most of the mean doses to organs_atrisk (OAR) volumes receiving 5% to 30% of the prescription dose were reduced with FFF beams. Conclusion: These results indicate the feasibility of delivering flat beams with FFF quality and producing treatment plans with equal or higher qualities in PTV coverage while achieving better sparing of OAR which will allow escalation of target dose if desired. Plus, removing FF will simplify the gantry head and reduces quality assurance and machine maintenance efforts.Comment: 6 pages, 10 Figures, 2 Tables. International Journal of Radiation Research, October 202

Are Brain-Computer Interfaces Feasible withIntegrated Photonic Chips?

The present paper examines the viability of a radically novel idea for brain-computer interface (BCI), which could lead to novel technological, experimental and clinical applications. BCIs are computer-based systems that enable either one-way or two-way communication between a living brain and an external machine. BCIs read-out brain signals and transduce them into task commands, which are performed by a machine. In closed-loop the machine can stimulate the brain with appropriate signals. In recent years, it has been shown that there is some ultraweak light emission from neurons within or close to the visible and near-infrared parts of the optical spectrum. Such ultraweak photon emission (UPE) reflects the cellular (and body) oxidative status, and compelling pieces of evidence are beginning to emerge that UPE may well play an informational role in neuronal functions. In fact, several experiments point to a direct correlation between UPE intensity and neural activity, oxidative reactions, EEG activity, cerebral blood flow, cerebral energy metabolism, and release of glutamate. Therefore, we propose a novel skull implant BCI that uses UPE. We suggest that a photonic integrated chip installed on the interior surface of the skull may enable a new form of extraction of the relevant features from the UPE signals. In the current technology landsacepe, photonic technologies are advancing rapidly and poised to overtake many electrical technologies, due to their unique advantages, such as miniaturization, high speed, low thermal effects, and large integration capacity that allow for high yield, volume manufacturing, and lower cost. For our proposed BCI, we are making some very major conjectures, which need to be experimentally verified, and therefore we discuss the controversial parts, feasibility of technology and limitations, and potential impact of this envisaged technology if successfully implemented in the future.BERC.2018-2021 Severo Ochoa.SEV-2017-071

Serum levels of vitamins A and D, and zinc in children with acute diarrhea: A cross-sectional study

Background: Diarrhea is a leading cause of mortality and morbidity during the early life period especially in developing countries. Micronutrients deficiencies have been proposed either as a risk factor or a consequence of diarrhea. Association studies highlight the relation of vitamins and minerals' deficiencies with acute diarrhea. In this regard we aimed to evaluate the status of vitamins A and D, and zinc serum levels in children with acute diarrhea. Methods: In this cross sectional study performed in a referral teaching hospital, we measured and compared baseline vitamin A, 25-hydroxy vitamin D (25(OH)D), and zinc serum levels in 25 children admitted with acute diarrhea and 25 other children who were admitted for undergoing elective surgeries. Results: 25-(OH)D levels were significantly lower in the diarrhea group (p=0.03). We were unable to demonstrate a significant difference in the levels of vitamin A and zinc between the case and control groups (p= 0.14 and p=0.07, respectively). Conclusion: We observed lower serum 25(OH)D levels in children with acute diarrhea. Whether this finding indicates a premorbid risk factor or simply a consequence of diarrhea needs further studies. Regardless of the cause and effect relationship, supplementation with vitamin D in acute diarrhea remains as a plausible consideration

The Study of Cognitive Function and Related Factors in Patients With Heart Failure

Background: Cognitive impairment is increasingly recognized as a common adverse consequence of heart failure. Both Heart failure and cognitive impairment are associated with frequent hospitalization and increased mortality, particularly when they occur simultaneously. Objectives: To determine cognitive function and related factors in patients with heart failure. Materials and Methods: In this descriptive cross-sectional study, we assessed 239 patients with heart failure. Data were collected by Mini Mental status Examination, Charlson comorbidity index and NYHA classification system. Data were analyzed using descriptive statistics, Kolmogorov-Smirnov test, chi-square test, t-test and logistic regression analysis. Results: The mean score of cognitive function was 21.68 ± 4.51. In total, 155 patients (64.9%) had cognitive impairment. Significant associations were found between the status of cognitive impairment and gender (P < 0.002), education level (P < 0.000), living location (P < 0.000), marital status (P < 0.03), living arrangement (P < 0.001 ), employment status (P < 0.000), income (P < 0.02), being the head of family (P < 0.03), the family size (P < 0.02), having a supplemental insurance (P < 0.003) and the patient’s comorbidities (P < 0.02). However, in logistic regression analysis, only education and supplementary insurance could predict cognitive status which indicates that patients with supplementary insurance and higher education levels were more likely to maintain optimal cognitive function. Conclusions: More than a half of the subjects had cognitive impairment. As the level of patients cognitive functioning affects their behaviors and daily living activities, it is recommended that patients with heart failure should be assessed for their cognitive functioning

Differentiating Radiation Necrosis and Metastatic Progression in Brain Tumors Using Radiomics and Machine Learning

Objectives: Distinguishing between radiation necrosis(RN) and metastatic progression is extremely challenging due to their similarity in conventional imaging. This is crucial from a therapeutic point of view as this determines the outcome of the treatment. This study aims to establish an automated technique to differentiate RN from brain metastasis progression using radiomics with machine learning. Methods: 86 patients with brain metastasis after they underwent stereotactic radiosurgery as primary treatment were selected. Discrete wavelets transform, Laplacian-of-Gaussian, Gradient, and Square were applied to magnetic resonance post-contrast T1-weighted images to extract radiomics features. After feature selection, dataset was randomly split into train/test (80%/20%) datasets. Random forest classification(RFC), logistic regression, and support vector classification(SVC) were trained and subsequently validated using test set. The classification performance was measured by area under the curve(AUC) value of receiver operating characteristic curve, accuracy, sensitivity, and specificity. Results: The best performance was achieved using RFC with a Gradient filter (AUC=0.910, std=0.047), (accuracy 0.8, std=0.071), (sensitivity=0.796 std=0.055), (specificity =0.922, std=0.059). For SVC the best result obtains using wavelet_HHH with a high AUC of 0.890 with std=0.89, accuracy of 0.777 with std=0.062, sensitivity=0.701, std=0.084, and specificity=0.85 with std=0.112. Logistic regression using wavelet_HHH provides a poor result with AUC=0.882 & std=0.051, accuracy of 0.753 & std=0.08, sensitivity=0.717 & std=0.208, and specificity=0.816 with std=0.123. Conclusion: This type of machine-learning approach can help accurately distinguish RN from recurrence in magnetic resonance imaging, without the need for biopsy. This has the potential to improve the therapeutic outcome.Comment: 10 pages, 4 Figures, 2 Tables. American Journal of Clinical Oncology, August 202

Parameters Affecting Pre-Treatment Dosimetry Verification

To assure the accuracy and safety of radiation delivery, it is highly recommended to perform pretreatment verification for complex treatment methods such as intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) to detect any potential errors in the treatment planning process and machine deliverability. It is expected that a qualified medical physicist is aware of the underlying scientific principles of imaging and therapeutic processes to perform or supervise technical aspects of pretreatment procedures to ensure safe and effective delivery of the treatment. For this purpose, several guidelines have been published to help direct medical physicists to evaluate the accuracy of treatment planning system (TPS) in the calculation of radiation dose, and dosimetry equipment to avoid possible errors. This will require a clear understanding of abilities as well as the limitations of each TPS, the dosimetry equipment at hand, and the gamma index to perform a comprehensive pre-treatment verification

Community perceptions of enrolment of indigents into the National Health Insurance Scheme in Ghana: a case study of the Livelihood Empowerment against Poverty Programme

BACKGROUND: The Livelihood Empowerment against Poverty (LEAP) programme in Ghana as part of its beneficiary programme, identifies the poor/indigents for exemptions from premium payments in the National Health Insurance Scheme (NHIS). This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAP in order to inform policy. METHODS: The study adopted a descriptive cross-sectional study design by using a qualitative approach. The study was conducted in three geographical regions of Ghana: Greater Accra, Brong-Ahafo and Northern region representing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staff and social welfare officers/social development officers. Eighty-one in-depth interviews and 23 Focus Group Discussions were conducted across the three regions. Data were analysed thematically and verbatim quotes from participants were used to support the views of participants. RESULTS: The study shows that participants were aware of the existence of LEAP and its benefits. There was, however, a general belief that the process of LEAP had been politicized and therefore favours only people who were sympathizers of the ruling government as they got enrolled into the NHIS. Participants held the view that the process of selecting beneficiaries lacked transparency, thus, they were not satisfied with the selection process. However, the study shows the ability of the community to identify the poor. The study reports varying concepts of poverty and its identification across the three ecological zones of Ghana. CONCLUSION: There is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP programme in Ghana. Community-based approaches in the selection of the indigent are recommended to safeguard the NHIS-LEAP beneficiary process

The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review

Introduction: High-intensity laser therapy (HILT) has been used more recently in the therapeutic protocols of pain managements. Adding therapeutic interventions to laser therapy is usual in clinical practice. This study aimed to evaluate the efficacy of HILT and beneficial effects of adding co-interventions to HILT in musculoskeletal pain management.Methods: The following databases were searched up to August 2018: Medline, PubMed, EMBASE, Cochrane, Google Scholar, Springer and ISI. The keywords of pain, HILT, high power laser therapy, laser therapy, photobiomodulation, physical therapy and rehabilitation were searched. The quality of the articles was assessed using the PEDro scale. The primary measure was pain severity expected to be reported in all studies. Effect size was calculated as standardized mean differences divided by the standard deviation of either the treatment or other group.Results: Initially 52 potential studies were found. Eighteen of these studies were excluded based on title and abstract. The full text of 34 remaining articles was screened and 15 of the studies were excluded. All included studies had high quality (PEDro ≥7). Approximately, 94% of included articles (n=18) revealed positive effects of HILT on pain. The effect sizes for HILT and placebo/comparator groups were 0.9-9.11 and 0.21-11.22 respectively. Also, the differences of effect size between two groups were between 0.03 to 5.85.Conclusion: It is early to determine that HILT may be an effective non-invasive agent in the management of musculoskeletal pain, as few studies have shown its clinical efficacy. Adding related co-interventions to HILT may enhance the beneficial effects of laser therapy. The variability of the study methods and outcomes suggests that further long-term follow-up, randomized controlled clinical trials with appropriate methodological design are needed regarding the effectiveness of HILT on pain

Analysis of Switched Inductor Three-level DC/DC Converter

A non-isolated DC/DC converter with high transfer gain is proposed in this paper. The presented converter consists of the switched inductor and three-level converters. The DC/DC power converter is three-level boost converter to convert the output voltage of the DC source into two voltage sources. The main advantages of DC/DC converter are using low voltage semiconductors and high gain voltage. The steady-state operation of the suggested converter is analyzed. A prototype is developed and tested to verify the performance of the proposed converter. To sum up, the MATLAB simulation results and the experimental results have transparently approved high efficiency of proposed converter as well as its feasibility