A near-global framework for automated training data generation and land cover classification using shallow machine learning with low-density time series imagery does not exist. This study presents a ...methodology to map nine-class, six-class, and five-class land cover using two dates (winter and non-winter) of a Sentinel-2 granule across seven international sites. The approach uses a series of spectral, textural, and distance decision functions combined with modified ancillary layers (such as global impervious surface and global tree cover) to create binary masks from which to generate a balanced set of training data applied to a random forest classifier. For the land cover masks, stepwise threshold adjustments were applied to reflectance, spectral index values, and Euclidean distance layers, with 62 combinations evaluated. Global (all seven scenes) and regional (arid, tropics, and temperate) adaptive thresholds were computed. An annual 95th and 5th percentile NDVI composite was used to provide temporal corrections to the decision functions, and these corrections were compared against the original model. The accuracy assessment found that the regional adaptive thresholds for both the two-date land cover and the temporally corrected land cover could accurately map land cover type within nine-class (68.4% vs. 73.1%), six-class (79.8% vs. 82.8%), and five-class (80.1% vs. 85.1%) schemes. Lastly, the five-class and six-class models were compared with a manually labeled deep learning model (Esri), where they performed with similar accuracies (five classes: Esri 80.0 ± 3.4%, region corrected 85.1 ± 2.9%). The results highlight not only performance in line with an intensive deep learning approach, but also that reasonably accurate models can be created without a full annual time series of imagery.
The seventh annual report of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) summarizes the first 9 years of patient enrollment. The Registry includes >15,000 ...patients from 158 participating hospitals. Trends in device strategy, patient profile at implant and survival are presented. Risk factors for mortality with continuous-flow pumps are updated, and the major causes/modes of death are presented. The adverse event burden is compared between eras, and health-related quality of life is reviewed. A detailed analysis of outcomes after mechanical circulatory support for ambulatory heart failure is presented. Recent summary data from PediMACS and MedaMACS is included. With the current continuous-flow devices, survival at 1 and 2 years is 80% and 70%, respectively.
Anthropogenic noise is an important environmental stressor that is rapidly gaining attention among biologists, resource managers, and policy makers. Here we review a substantial literature detailing ...the impacts of noise on wildlife and provide a conceptual framework to guide future research. We discuss how several likely impacts of noise exposure have yet to be rigorously studied and outline how behavioral responses to noise are linked to the nature of the noise stimulus. Chronic and frequent noise interferes with animals' abilities to detect important sounds, whereas intermittent and unpredictable noise is often perceived as a threat. Importantly, these effects can lead to fitness costs, either directly or indirectly. Future research should consider the range of behavioral and physiological responses to this burgeoning pollutant and pair measured responses with metrics that appropriately characterize noise stimuli. This will provide a greater understanding of the mechanisms that govern wildlife responses to noise and help in identifying practical noise limits to inform policy and regulation.
The sixth annual report of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) summarizes the first 8 years of patient enrollment. The analysis is based on data from ...>10,000 patients and updates demographics, survival, adverse events and risk factors. Among patients with continuous-flow pumps, actuarial survival continues to be 80% at 1 year and 70% at 2 years. The report features a comparison of two eras of continuous-flow durable devices in the USA in terms of device strategy, patient profiles, adverse event burden, survival and quality of life.
Police researchers have long argued that favorable evaluations of the police eventually lead to citizens’ willingness to cooperate with the police. However, this assumption has barely been studied ...empirically. The current study examines the association between attitudes toward the police and crime reporting behavior of victims. Furthermore, the study explores the influence of victims’ characteristics on their decisions to report crime to the police. Using field data originally collected in Ghana, the study found that victims’ levels of confidence in the police and satisfaction with police work positively predict their decisions to report sexual assault and robbery to the police. Moreover, findings revealed that age, marital status, and employment status are important predictors of victims’ reporting behavior. Several practical and theoretical implications of the results are discussed.
The HeartWare left ventricular assist device (HVAD, HeartWare Inc, Framingham, MA) is the first implantable centrifugal continuous-flow pump approved for use as a bridge to transplantation. An ...infrequent but serious adverse event of LVAD support is thrombus ingestion or formation in the pump. In this study, we analyze the incidence of pump thrombus, evaluate the comparative effectiveness of various treatment strategies, and examine factors pre-disposing to the development of pump thrombus.
The analysis included 382 patients who underwent implantation of the HVAD as part of the HeartWare Bridge to Transplant (BTT) and subsequent Continued Access Protocol (CAP) trial. Descriptive statistics and group comparisons were generated to analyze baseline characteristics, incidence of pump thrombus, and treatment outcomes. A multivariate analysis was performed to assess significant risk factors for developing pump thrombus.
There were 34 pump thrombus events observed in 31 patients (8.1% of the cohort) for a rate of 0.08 events per patient-year. The incidence of pump thrombus did not differ between BTT and CAP. Medical management of pump thrombus was attempted in 30 cases, and was successful in 15 (50%). A total of 16 patients underwent pump exchange, and 2 underwent urgent transplantation. Five patients with a pump thrombus died after medical therapy failed, 4 of whom also underwent a pump exchange. Survival at 1 year in patients with and without a pump thrombus was 69.4% and 85.5%, respectively (p = 0.21). A multivariable analysis revealed that significant risk factors for pump thrombus included a mean arterial pressure > 90 mm Hg, aspirin dose ≤ 81 mg, international normalized ratio ≤ 2, and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile level of ≥ 3 at implant.
Pump thrombus is a clinically important adverse event in patients receiving an HVAD, occurring at a rate of 0.08 events per patient-year. Significant risk factors for pump thrombosis include elevated blood pressure and sub-optimal anti-coagulation and anti-platelet therapies. This suggests that pump thrombus event rates could be reduced through careful adherence to patient management guidelines.
Objectives This study sought to assess the impact of continuous flow left ventricular assist devices (LVADs) on functional capacity and heart failure-related quality of life. Background Newer ...continuous-flow LVAD are smaller and quieter than pulsatile-flow LVADs. Methods Data from advanced heart failure patients enrolled in the HeartMate II LVAD (Thoratec Corporation, Pleasanton, California) bridge to transplantation (BTT) (n = 281) and destination therapy (DT) (n = 374) trials were analyzed. Functional status (New York Heart Association NYHA functional class, 6-min walk distance, patient activity scores), and quality of life (Minnesota Living With Heart Failure MLWHF and Kansas City Cardiomyopathy Questionnaires KCCQ) were collected before and after LVAD implantation. Results Compared with baseline, LVAD patients demonstrated early and sustained improvements in functional status and quality of life. Most patients had NYHA functional class IV symptoms at baseline. Following implant, 82% (BTT) and 80% (DT) of patients at 6 months and 79% (DT) at 24 months improved to NYHA functional class I or II. Mean 6-min walk distance in DT patients was 204 m in patients able to ambulate at baseline, which improved to 350 and 360 m at 6 and 24 months. There were also significant and sustained improvements from baseline in both BTT and DT patients in median MLWHF scores (by 40 and 42 U in DT patients, or 52% and 55%, at 6 and 24 months, respectively), and KCCQ overall summary scores (by 39 and 41 U, or 170% and 178%). Conclusions Use of a continuous flow LVAD in advanced heart failure patients results in clinically relevant improvements in functional capacity and heart failure-related quality of life.
The importance of organic aerosol particles in the environment has been long established, influencing cloud formation and lifetime, absorbing and scattering sunlight, affecting atmospheric ...composition and impacting on human health. Conventionally, ambient organic particles were considered to exist as liquids. Recent observations in field measurements and studies in the laboratory suggest that they may instead exist as highly viscous semi-solids or amorphous glassy solids under certain conditions, with important implications for atmospheric chemistry, climate and air quality. This review explores our understanding of aerosol particle phase, particularly as identified by measurements of the viscosity of organic particles, and the atmospheric implications of phase state.
The HeartWare Ventricular Assist System (HeartWare Inc, Framingmam, MA) is a miniaturized implantable, centrifugal design, continuous-flow blood pump. The pivotal bridge to transplant and continued ...access protocols trials have enrolled patients with advanced heart failure in a bridge-to-transplant indication.
The primary outcome, success, was defined as survival on the originally implanted device, transplant, or explant for ventricular recovery at 180 days. Secondary outcomes included an evaluation of survival, functional and quality of life outcomes, and adverse events.
A total of 332 patients in the pivotal bridge to transplant and continued access protocols trial have completed their 180-day primary end-point assessment. Survival in patients receiving the HeartWare pump was 91% at 180 days and 84% at 360 days. Quality of life scores improved significantly, and adverse event rates remain low.
The use of the HeartWare pump as a bridge to transplant continues to demonstrate a high 180-day survival rate despite a low rate of transplant. Adverse event rates are similar or better than those observed in historical bridge-to-transplant trials, despite longer exposure times due to longer survival and lower transplant rates.
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