These evidence-based guidelines support patients, clinicians, and other stakeholders in decisions about the use of intranasal corticosteroids (INCS), biologics, and aspirin therapy after ...desensitization (ATAD) for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP). It is important to note that the current evidence on surgery for CRSwNP was not assessed for this guideline nor were management options other than INCS, biologics, and ATAD. The Allergy-Immunology Joint Task Force on Practice Parameters formed a multidisciplinary guideline panel balanced to include the views of multiple stakeholders and to minimize potential biases. Systematic reviews for each management option informed the guideline. The guideline panel used the Grading of Recommendations Assessment, Development and Evaluation approach to inform and develop recommendations. The guideline panel reached consensus on the following statements: (1) In people with CRSwNP, the guideline panel suggests INCS rather than no INCS (conditional recommendation, low certainty of evidence). (2) In people with CRSwNP, the guideline panel suggests biologics rather than no biologics (conditional recommendation, moderate certainty of evidence). (3) In people with aspirin (nonsteroidal anti-inflammatory drug)-exacerbated respiratory disease, the guideline panel suggests ATAD rather than no ATAD (conditional recommendation, moderate certainty of evidence). The conditions for each recommendation are discussed in the guideline.
Summary
Ships and icebergs are similar in size and intensity in SAR images, so it is difficult to distinguish them in remote sensing images. Deep learning is a technique based on neural networks, ...which has played an important role in image information processing. In order to address the challenge of ship and iceberg classification, we present a convolutional neural network (CNN) based classification method for iceberg and ship discrimination from Sentinel‐1 SAR images with different polarizations and incidence angles. The method is based on the fixed constant false alarm rate (CFAR) detector and the CNN model has three input channels, then the model was trained using parallel algorithm. The CNN is trained using 1443 images and tested using 161 images. The CNN model is also compared with support vector machine (SVM) and k nearest neighbors (kNN) using the same dataset. Comparison shows the CNN‐based method performs the best, and it achieved a validation accuracy of 96%.
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a significant disease burden. The optimal use of and administration route for intranasal corticosteroids (INCS) when managing ...CRSwNP are unclear.
We systematically synthesized the evidence addressing INCS for CRSwNP.
We searched studies archived in Medline, Embase, and Central from database inception until September 1, 2021, for randomized controlled trials comparing INCS using any delivery method to placebo or other INCS administration types. Paired reviewers screened records, abstracted data, and rated risk of bias (CLARITY revision of Cochrane Risk of Bias version 1 tool) independently and in duplicate. We synthesized the evidence for each outcome using random effects network meta-analyses. We critically appraised the evidence following the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) approach.
We analyzed 61 randomized controlled trials (7176 participants, 8 interventions). Sinusitis-related quality of life might improve with INCS rinse (mean difference MD −6.83, 95% confidence interval CI −11.94 to −1.71) and exhalation delivery system (EDS) (MD −7.86, 95% CI −14.64 to −1.08) compared to placebo (both low certainty evidence). Nasal obstruction symptoms are likely improved when receiving INCS via stent/dressing (MD −0.31, 95% CI −0.54 to −0.08), spray (MD −0.51, 95% CI −0.61 to −0.41), and EDS (MD −0.35, 95% CI −0.51 to −0.18) (all moderate to high certainty) compared to placebo. We found no important differences in adverse effects among interventions (moderate certainty for INCS spray, very low to low certainty for others).
Multiple delivery forms of INCS are viable therapeutic options for CRSwNP, resulting in improvement of patient-important outcomes. INCS via stent, spray, and EDS appear to be beneficial across the widest range of considered outcomes.
Display omitted
Various approaches have been discussed in the literature for the clustering of data, such as partitioning, hierarchical, and machine learning methods. Most of the approaches require some prior ...knowledge about the clusters, such as their total number. Furthermore, some previous algorithms are not robust enough to process higher-dimensional data or require a large amount of memory for computations. We propose, herein, a data clustering algorithm, Piecemeal Clustering, that successfully clusters data without prior knowledge of the number of clusters. The proposed clustering algorithm uses the similarity and density of the data to identify the number of clusters in the data set and works with both low- and high-dimensional data. We demonstrate the power of the proposed Piecemeal Clustering algorithm with two real-world data sets. It is found that the proposed algorithm outperforms seven other state-of-the-art algorithms on both of these data sets.
In this paper, curve-fitting and intensity-level-selection (ILS)-based algorithms for wind parameter extraction from shipborne X-band nautical radar images are investigated. First, to exclude the ...rain cases and low-backscatter images, a data quality control process is designed for both algorithms. An additional process is then introduced for the ILS-based method to improve the accuracy of wind measurements, including the recognition of blockages and islands in the temporally integrated radar images. For the low sea states, a dual-curve-fitting is proposed. These wind algorithms are tested using radar images and shipborne anemometer data collected on the east coast of Canada. It is shown that the dual-curve-fitting algorithm produces improvements in the mean differences between the radar and the anemometer results for wind direction and speed of about 5.7° and 0.3 m/s, respectively, under sea states with significant wave height lower than 2.30 m. Also, a harmonic function that is least-squares fitted to the selected range distances vector as a function of antenna look direction is applied. Compared with the original ILS-based algorithm, the modified procedure reduces the standard deviation for wind direction and speed by about 4° and 0.2 m/s, respectively. Finally, the performance of these two modified methods are compared.
In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more ...significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.
The paper illustrates how software can be described precisely using LD-relations, how these descriptions can be presented in a readable manner using tabular notations, and one way such descriptions ...can be used to test programs. The authors describe an algorithm that can be used to generate a test oracle from program documentation, and present the results of using a tool based on it to help test part of a commercial network management application. The results demonstrate that these methods can be effective at detecting errors and greatly increase the speed and accuracy of test evaluation when compared with manual evaluation. Such oracles can be used for unit testing, in situ testing, constructing self-checking software, and ensuring consistency between code and documentation.
Before designing safety- or mission-critical real-time systems, a specification of the required behavior of the system should be produced and reviewed by domain experts. After the system has been ...implemented, it should be thoroughly tested to ensure that it behaves correctly. This is best done using a monitor, a system that observes the behavior of a target system and reports if that behavior is consistent with the requirements. Such a monitor can be used both as an oracle during testing and as a supervisor during operation. Monitors should be based on the documented requirements of the system. If the target system is required to monitor or control real-valued quantities, then the requirements, which are expressed in terms of the monitored and controlled quantities, will allow a range of behaviors to account for errors and imprecision in observation and control of these quantities. Even if the controlled variables are discrete valued, the requirements must specify the timing tolerance. Because of the limitations of the devices used by the monitor to observe the environmental quantities, there is unavoidable potential for false reports, both negative and positive, This paper discusses design of monitors for real-time systems, and examines the conditions under which a monitor will produce false reports. We describe the conclusions that can be drawn when using a monitor to observe system behavior.
The European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life questionnaire for anal cancer (QLQ-ANL27) supplements the EORTC cancer generic measure (QLQ-C30) ...to measure concerns specific to people with anal cancer treated with chemoradiotherapy. This study tested the psychometric properties and acceptability of the QLQ-ANL27.
People with anal cancer were recruited from 15 countries to complete the QLQ-C30 and QLQ-ANL27 and provide feedback on the QLQ-ANL27. Item responses, scale structure (multitrait scaling, factor analysis), reliability (internal consistency and reproducibility) and sensitivity (known group comparisons and responsiveness to change) of the QLQ-ANL27 were evaluated.
Data from 382 people were included in the analyses. The EORTC QLQ-ANL27 was acceptable, comprehensive, and easy to complete, taking an average 8 minutes to complete. Psychometric analyses supported the EORTC QLQ-ANL27 items and reliability (Cronbach's α ranging from 0.71-0.93 and test-retest coefficients above 0.7) and validity of the scales (particularly nonstoma bowel symptoms and pain/discomfort). Most scales distinguished people according to treatment phase and performance status. Bowel (nonstoma), pain/discomfort, and vaginal symptoms were sensitive to deteriorations over time. The stoma-related scales remained untested because of low numbers of people with a stoma. Revisions to the scoring and question ordering of the sexual items were proposed.
The QLQ-ANL27 has good psychometric properties and is available in 16 languages for people treated with chemoradiotherapy for anal cancer. It is used in clinical trials and has a potential role in clinical practice.
PDF
