Summary
Although different injection locations for retrolaminar and erector spinae plane blocks have been described, the two procedures have a similar anatomical basis. In this cadaveric study we ...compared anatomical spread of dye in the thoracic region following these two procedures. Following randomisation, 10 retrolaminar blocks and 10 erector spinae plane blocks were performed on the left or right sides of 10 unembalmed cadavers. For each block, 20 ml of dye solution was injected at the T5 level. The back regions were dissected and the involvement of the thoracic spinal nerve was also investigated. Twenty blocks were successfully completed. A consistent vertical spread, with deep staining between the posterior surface of the vertebral laminae and the overlaying transversospinalis muscle was observed in all retrolaminar blocks. Moreover, most retrolaminar blocks were predominantly associated with fascial spreading in the intrinsic back muscles. With an erector spinae plane block, dye spread in a more lateral pattern than with retrolaminar block, and fascial spreading in the back muscles was also observed. The number of stained thoracic spinal nerves was greater with erector spinae plane blocks than with retrolaminar blocks; median 2.0 and 3.5, respectively. Regardless of technique, the main route of dye spread was through the superior costotransverse ligament to the ipsilateral paravertebral space. Although erector spinae plane blocks were associated with a slightly larger number of stained thoracic spinal nerves than retrolaminar blocks, both techniques were consistently associated with posterior spread of dye and with limited spread to the paravertebral space.
We report a measurement of electron antineutrino oscillation from the Daya Bay Reactor Neutrino Experiment with nearly 4 million reactor νover ¯_{e} inverse β decay candidates observed over 1958 days ...of data collection. The installation of a flash analog-to-digital converter readout system and a special calibration campaign using different source enclosures reduce uncertainties in the absolute energy calibration to less than 0.5% for visible energies larger than 2 MeV. The uncertainty in the cosmogenic ^{9}Li and ^{8}He background is reduced from 45% to 30% in the near detectors. A detailed investigation of the spent nuclear fuel history improves its uncertainty from 100% to 30%. Analysis of the relative νover ¯_{e} rates and energy spectra among detectors yields sin^{2}2θ_{13}=0.0856±0.0029 and Δm_{32}^{2}=(2.471_{-0.070}^{+0.068})×10^{-3} eV^{2} assuming the normal hierarchy, and Δm_{32}^{2}=-(2.575_{-0.070}^{+0.068})×10^{-3} eV^{2} assuming the inverted hierarchy.
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Motor bearings are one of the most critical components in rotating machinery. Envelope demodulation analysis has been widely used to demodulate bearing vibration signals to extract bearing defect ...frequency components but one of the main challenges is to accurately locate the major fault-induced frequency band with a high signal-to-noise ratio (SNR) for demodulation. Hence, an enhanced fault detection method combining the maximal overlap discrete wavelet packet transform (MODWPT) and the Teager energy adaptive spectral kurtosis (TEASK) denoising algorithms is proposed for identifying the weak periodic impulses. The Teager energy power spectrum (TEPS) defines the sparse representation of the filtered signals of the MODWPT in the frequency domain via the Teager energy operator (TEO); the TEASK helps determine the most informative frequency band for demodulation. The methodology is compared in terms of performance with the fast Kurtogram and the Autogram methods. The simulation and practical application examples have shown that the proposed MODWPT-TEASK method outperforms the above two methods in diagnosing defects of motor bearings.
With the rapid development of image scanning techniques and visualization software, whole slide imaging (WSI) is becoming a routine diagnostic method. Accelerating clinical diagnosis from pathology ...images and automating image analysis efficiently and accurately remain significant challenges. Recently, deep learning algorithms have shown great promise in pathology image analysis, such as in tumor region identification, metastasis detection, and patient prognosis. Many machine learning algorithms, including convolutional neural networks, have been proposed to automatically segment pathology images. Among these algorithms, segmentation deep learning algorithms such as fully convolutional networks stand out for their accuracy, computational efficiency, and generalizability. Thus, deep learning–based pathology image segmentation has become an important tool in WSI analysis. In this review, the pathology image segmentation process using deep learning algorithms is described in detail. The goals are to provide quick guidance for implementing deep learning into pathology image analysis and to provide some potential ways of further improving segmentation performance. Although there have been previous reviews on using machine learning methods in digital pathology image analysis, this is the first in-depth review of the applications of deep learning algorithms for segmentation in WSI analysis.
Background
Few studies have investigated the incidence of anaphylaxis induced by individual or structurally similar cephalosporins. The aims of the study were to assess the incidence of ...cephalosporin‐induced anaphylaxis and evaluate the clinical efficacy of screening skin tests.
Methods
In this retrospective cohort study, we obtained information on total cephalosporin use and cephalosporin‐induced anaphylaxis in intravenous cephalosporin recipients in 12 general hospitals between 2013 and 2015. Cephalosporins were divided into 4 groups according to similar side‐chain structures. The incidence of cephalosporin‐induced anaphylaxis was assessed for each cephalosporin, cephalosporin generation, and side‐chain group. To verify the efficacy of screening intradermal tests (IDT) with cephalosporin, the 12 hospitals were assigned to the intervention or control group depending on whether they performed screening IDT before the administration of cephalosporins.
Results
We identified 76 cases of cephalosporin‐induced anaphylaxis with 1 123 345 exposures to intravenous cephalosporins (6.8 per 100 000 exposures), and the incidence of fatal anaphylaxis by cephalosporin was 0.1 cases per 100 000 exposures. The highest incidences of anaphylaxis occurred in the ceftizoxime (13.0 cases per 100 000 exposures) and side‐chain group 1 (cefepime, cefotaxime, ceftizoxime, ceftriaxone, and cefuroxime; 9.3 per 100 000). There was no case of anaphylaxis induced by cefoxitin, cefmetazole, cefminox, and cefotiam. The clinical effectiveness of routine screening IDT was not significant (P = .06).
Conclusions
The incidence of cephalosporin‐induced anaphylaxis differed according to individual drugs and side‐chain structure. Screening IDT showed no clinical efficacy at a population level.
Among total 1 140 354 cephalosporin treatment courses from 12 hours hospitals, the incidence of cephalosporin induced anaphylaxis was 6.8 per 100 000 exposures and the related fatality was 1.3%. The incidence of cephalosporin induced anaphylaxis varies with each drug type, and the highest incidences of anaphylaxis occurred in the ceftizoxime (13.0 cases per 100 000 exposures). Screening intradermal tests with cephalosporin failed to show preventive effect on cephalosporin‐induced anaphylaxis.
Sustainability has become one of the key factors for long-term business success. Recent research and practice show that business model innovation is a promising approach for improving sustainability ...in manufacturing firms. To date business models have been examined mostly from the perspectives of value proposition, value capture, value creation and delivery. There is a need for a more comprehensive understanding of value in order to promote sustainability. This paper proposes value uncaptured as a new perspective for sustainable business model innovation, and develops four forms of value uncaptured: value surplus, value absence, value missed and value destroyed. This paper also proposes a framework of using value uncaptured for sustainable business model innovation. This framework has been validated in case studies in six product-service systems firms with advanced manufacturing technologies. The empirical studies identify 26 main sources of value uncaptured throughout the product life cycle. The findings show that (a) the new perspective of value uncaptured can help manufacturing firms understand the negative aspects of their business models; (b) the four forms and 26 sources can assist firms in identifying value uncaptured in a structured way; and (c) the identified value uncaptured can trigger the discovery of new value opportunities which lead to new business models with higher sustainable value. This paper extends the existing studies on business models from the perspectives of value proposition, capture, creation and delivery, to value uncaptured. The proposed framework has helped firms identify value opportunities that trigger the innovation of sustainable business models. Therefore, this paper contributes to both theory and practice in the field of sustainable business models innovation.
•Value uncaptured is proposed as a new perspective for sustainable business model innovation.•A framework of using value uncaptured for sustainable business model innovation is developed.•Four forms of value uncaptured is developed and 26 sources of value uncaptured across the produce life cycle is identified.•The 26 sources of value uncaptured provide a structured approach for guiding industrial practitioners to identify value uncaptured in practice.
In this work, an improved implicit discrete velocity method (DVM) on unstructured meshes is developed for simulation of three-dimensional (3D) flows in all flow regimes. Different from the ...conventional DVM, in which only the kinetic governing equation (i.e., Boltzmann equation) is resolved in each time step, both the kinetic and macroscopic governing equations are solved simultaneously in the present method. On one hand, the solution of macroscopic governing equation yields the predicted equilibrium distribution function at cell center, which enables the fully implicit discretization of the collision term in solving the Shakhov-model kinetic equation. On the other hand, the collisional effect at the cell interface can be incorporated into the evaluation of numerical flux through the solution process of macroscopic governing equation. Thanks to these two improvements, the developed scheme can effectively overcome the defects of low efficiency and poor accuracy of the conventional semi-implicit DVM in the continuum flow regime. In addition, for practical applications of flow problems with complicated geometry, in the present work, the unstructured mesh-based solver is developed. The accuracy, efficiency, stability and flexibility of the developed solver are demonstrated by its application to simulate pipe flow, lid-driven cavity flow and supersonic flow around a blunt body.
•An improved implicit DVM on unstructured meshes is developed for 3D flows in all flow regimes.•The OpenMP parallel technique is adopted to further speed up the calculation.•In the rarefied flow regime, the performance of the developed scheme is in line with the conventional semi-implicit DVM.•In the continuum flow regime, the developed scheme shows higher accuracy and efficiency than the original one.
Summary
Background
Asthma in the elderly (aged ≥ 65 years old) is a significant concern with high morbidity, but the pathophysiology remains unclear particularly in late‐onset asthma. Recent studies ...suggest staphylococcal enterotoxin IgE (SE‐IgE) sensitization to be a risk factor for asthma in general populations; however, the associations have not been examined in late‐onset elderly asthma.
Objective
We aimed to examine the associations of SE‐IgE sensitization with late‐onset asthma in the elderly, using a database of elderly asthma cohort study.
Methods
A total of 249 elderly patients with asthma and 98 controls were analysed. At baseline, patients were assessed for demographics, atopy, induced sputum profiles and comorbidities including chronic rhinosinusitis (CRS). Serum total IgE and SE‐IgE levels were measured. Asthma severity was assessed on the basis of asthma outcomes during a 12‐month follow‐up period.
Results
At baseline, serum SE‐IgE concentrations were significantly higher in patients with asthma than in controls median 0.16 (interquartile range 0.04–0.53) vs. 0.10 (0.01–0.19), P < 0.001. Elderly asthma patients with high SE‐IgE levels had specific characteristics of having more severe asthma, sputum eosinophilia and CRS, compared to those with lower SE‐IgE levels. In multivariate logistic regression analyses, the associations between serum SE‐IgE concentrations and severe asthma were significant, independently of covariables SE‐IgE‐high (≥ 0.35 kU/L) vs. negative (< 0.10 kU/L) group: odds ratio 7.47, 95% confidence interval 1.86–30.03, P = 0.005. Multiple correspondence analyses also showed that high serum SE‐IgE level had close relationships with severe asthma, CRS and sputum eosinophilia together.
Conclusions and Clinical Relevance
This is the first report on the significant associations of SE‐IgE sensitization with late‐onset asthma in the elderly, particularly severe eosinophilic asthma with CRS comorbidity. Our findings indicate a potential implication of SE in the high morbidity burden of elderly asthma and suggest clues to the pathogenesis of severe late‐onset eosinophilic asthma in the elderly.
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