In the context of the study of plants in the Bible, some translation problems are related to the identification of the plant species referred to in the biblical text. One of the unresolved problems ...concerns the plant living in the desert of Jer 17:6, because the botanists’ proposals have not been understood in the same way by the exegetes: it is not clear whether it is a tree, a bush or a shrub and to which plant species it refers. After presenting the general characteristics of the study of plants in the Bible, the research presents proposals for identification by botanists and how these have been received by exegetes. The study of the biblical context integrated with the dynamics of plant growth allows a better understanding of the two opposing metaphorical images of Jeremiah: the plant living in the desert and the tree that grows along streams. The analysis indicates a generic tree which, due to the difficult environmental conditions, cannot develop as such and remains smaller in size. The best translation is therefore a generic shrub, which also allows the different interpretations to be reconciled.
Converting coppices into high forests with continuous cover has often been established during the last decades as a management goal in hilly and mountainous Mediterranean areas to attenuate the ...negative effects that frequent clearcutting may have on soil, landscape and biodiversity conservation. The silvicultural tool usually adopted for this purpose is the gradual thinning of sprouts during the long span of time required to complete the conversion, that also allows the owner to keep harvesting some wood. This research compared the effects of various thinning intensities (three treatments plus control) on the stand growth and structure of a beech coppice with standards. The optimal density after thinning was assessed by expressing mean tree spacing as a function of main stand attributes like stand height and stand dbh. This system was preferred to the empirical evaluation of the percentage of basal area to be removed in order to give forest managers general reference guidelines to adapt to the varying environments of the Mediterranean mountains. Results confirmed that the positive effects of thinning on mean stem volume is due more to the higher diameter increment than to different height growth. The acceleration of crown growth in the thinned plots allowed canopy closure to be achieved 13 years after thinning. This reduced the negative effects of the opening of the stand overlayer and the elimination of most suppressed trees on soil protection. Under the conditions examined, the best thinning intensity proved to be a stand density 20% lower than normal prescribed by the yield tables elaborated for beech high forests in Central and Southern Italy.
One-fourth of colorectal neoplasias are missed during screening colonoscopies; these can develop into colorectal cancer (CRC). Deep learning systems allow for real-time computer-aided detection ...(CADe) of polyps with high accuracy. We performed a multicenter, randomized trial to assess the safety and efficacy of a CADe system in detection of colorectal neoplasias during real-time colonoscopy.
We analyzed data from 685 subjects (61.32 ± 10.2 years old; 337 men) undergoing screening colonoscopies for CRC, post-polypectomy surveillance, or workup due to positive results from a fecal immunochemical test or signs or symptoms of CRC, at 3 centers in Italy from September through November 2019. Patients were randomly assigned (1:1) to groups who underwent high-definition colonoscopies with the CADe system or without (controls). The CADe system included an artificial intelligence–based medical device (GI-Genius, Medtronic) trained to process colonoscopy images and superimpose them, in real time, on the endoscopy display a green box over suspected lesions. A minimum withdrawal time of 6 minutes was required. Lesions were collected and histopathology findings were used as the reference standard. The primary outcome was adenoma detection rate (ADR, the percentage of patients with at least 1 histologically proven adenoma or carcinoma). Secondary outcomes were adenomas detected per colonoscopy, non-neoplastic resection rate, and withdrawal time.
The ADR was significantly higher in the CADe group (54.8%) than in the control group (40.4%) (relative risk RR, 1.30; 95% confidence interval CI, 1.14–1.45). Adenomas detected per colonoscopy were significantly higher in the CADe group (mean, 1.07 ±1.54) than in the control group (mean 0.71 ± 1.20) (incidence rate ratio, 1.46; 95% CI, 1.15–1.86). Adenomas 5 mm or smaller were detected in a significantly higher proportion of subjects in the CADe group (33.7%) than in the control group (26.5%; RR, 1.26; 95% CI, 1.01–1.52), as were adenomas of 6 to 9 mm (detected in 10.6% of subjects in the CADe group vs 5.8% in the control group; RR, 1.78; 95% CI, 1.09–2.86), regardless of morphology or location. There was no significant difference between groups in withdrawal time (417 ± 101 seconds for the CADe group vs 435 ± 149 for controls; P = .1) or proportion of subjects with resection of non-neoplastic lesions (26.0% in the CADe group vs 28.7% of controls; RR, 1.00; 95% CI, 0.90–1.12).
In a multicenter, randomized trial, we found that including CADe in real-time colonoscopy significantly increases ADR and adenomas detected per colonoscopy without increasing withdrawal time. ClinicalTrials.gov no: 04079478
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In this paper, we address the clock synchronization problem for wireless sensor networks. In particular, we consider a wireless sensor network where nodes are equipped with a local clock and ...communicate in order to achieve a common sense of time. The proposed approach consists of two asynchronous consensus algorithms, the first of which synchronizes the clocks frequency and the second of which synchronizes the clocks offset. This work advances the state of the art by providing robustness against bounded communication delays. A theoretical characterization of the algorithm properties is provided. Simulations and experimental results are presented to corroborate the theoretical findings and show the effectiveness of the proposed algorithm.
False positive (FP) results by computer-aided detection (CADe) hamper the efficiency of colonoscopy by extending examination time. Our aim was to develop a classification of the causes and clinical ...relevance of CADe FPs, and to assess the relative distribution of FPs in a real-life setting.
In a post-hoc analysis of a randomized trial comparing colonoscopy with and without CADe (NCT: 04079478), we extracted 40 CADe colonoscopy videos. Using a modified Delphi process, 4 expert endoscopists identified the main domains for the reasons and clinical relevance of FPs. Then, 2 expert endoscopists manually examined each FP and classified it according to the proposed domains. The analysis was limited to the withdrawal phase.
The 2 main domains for the causes of CADe FPs were identified as artifacts due to either the mucosal wall or bowel content, and clinical relevance was defined as the time spent on FPs and the FP rate per minute. The mean number of FPs per colonoscopy was 27.3 ± 13.1, of which 24 ± 12 (88%) and 3.2 ± 2.6 (12%) were due to artifacts in the bowel wall and bowel content, respectively. Of the 27.3 FPs per colonoscopy, 1.6 (5.7%) required additional exploration time of 4.8 ± 6.2 seconds per FP (ie, 0.7% of the mean withdrawal time). In detail, 15 (24.2%), 33 (53.2%), and 14 (22.6%) FPs were classified as being of mild, moderate, or severe clinical relevance. The rate of FPs per minute of withdrawal time was 2.4 ± 1.2, and was higher for FPs due to artifacts from the bowel wall than for those from bowel content (2.4 ± 0.6 vs 0.3 ± 0.2, P < .001).
FPs by CADe are primarily due to artifacts from the bowel wall. Despite a high frequency, FPs result in a negligible 1% increase in the total withdrawal time because most of them are immediately discarded by the endoscopist.
EUS-guided biopsy sampling is the method of choice for obtaining pancreatic tissue. Next-generation sequencing (NGS) has been applied to EUS-guided biopsy sampling and may classify patients based on ...specific molecular profiles. Our study aimed to compare side-by-side the diagnostic yield achievable by genetic identification of somatic mutations detected with NGS versus histologic and cytologic typing in locally advanced pancreatic carcinoma (LAPC) in samples acquired under EUS guidance.
We conducted a prospective comparative pilot study at Humanitas Research Hospital. The study included 33 patients referred for LAPC who underwent EUS-guided tissue acquisition using a 22-gauge Franseen needle. Material was obtained for both pathologic diagnosis and DNA extraction and targeted NGS analysis with the AmpliSeq Comprehensive Panel v3 (Illumina Inc, San Diego, Calif, USA). Twenty-one genes were prioritized for somatic mutation detection.
The final diagnosis was pancreatic ductal adenocarcinoma (PDAC) in all patients (100%). A macroscopic core was obtained in 30 patients (91%). In 3 lesions no cores adequate for histologic analysis were obtained, but cytologic analysis revealed tumoral cells from PDAC. DNA was extracted from 32 of 33 samples (97%), most of which (27/32) carried at least 2 clearly pathogenic mutations in different genes. Detection of K-ras mutation allowed for molecular diagnosis of PDAC in most of the patients (30/32).
In our study we demonstrated that proper tissue specimens obtained under EUS guidance allowed DNA sample extraction and subsequent NGS analysis in 97% of cases. These results support the potential role of NGS as a complementary diagnostic test to be implemented in association with standard diagnostic modalities. (Clinical trial registration number: NCT03578939.)
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