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Transvaginal Ultrasonographic Measurement of Lower Uterine Segment in Term Pregnant Patients with Previous Cesarean Section

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Open Journal of Obstetrics and Gynecology 2015年第11期5卷 646-653页

作者： Anitha Thomas grace rebekah Reeta Vijayaselvi Ruby Jose Christian Medical College Vellore India

Background: With an aim to reduce the rates of repeat cesarean section in women with a previous scar, prediction of scar rupture or dehiscence is important. If we could predict the risk of rupture by measuring the scar thickness closer to term, we could pursue a trial of scar safely. Aims: To evaluate the use of ultrasound measured thickness of lower uterine segment as one of the predictors of scar rupture or dehiscence in labour and establish a cut off beyond which trial of labour can be attempted safely. Methodology: 187 randomly selected pregnant women with history of one previous cesarean section in the past who satisfied the inclusion criteria, attending the outpatient clinic over a period of six months, at a tertiary level teaching institution in southern India were selected and counseled to undergo a transvaginal measurement of the scar region. These women were then followed up until delivery and the outcome of trial of scar, successful vaginal delivery, rupture or dehiscence of uterus was analysed in relation to the scar thickness and various other contributing factors. Results: 187 women with history of previous cesarean section, attending the outpatient clinic were randomly chosen to undergo trans vaginal scan at term. 52 underwent elective cesarean section and 135 went through trial of scar. The median cut-off of the lower uterine segment in this study population of 135 was 2.4 mm. The sensitivity was 90.9%, specificity was 43.5%, positive predictive value was 12.5%, and negative predictive value was 98.3% at this cut-off for scar rupture or dehiscence. Conclusions: The lower uterine scar thickness could be a useful tool to predict scar rupture. This could aid in making decisions regarding induction of labour with oxytocin in women with previous cesarean section.

关键词： TOLAC Transvaginal Ultrasonography Scar Thickness

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Pediatric Anesthesia Emergence Delirium Scale:A diagnostic metaanalysis

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World Journal of Clinical Pediatrics 2022年第2期11卷 196-205页

作者： Paul Swamidhas Sudhakar Russell Priya Mary Mammen Satya Raj Shankar Shonima Aynipully Viswanathan grace rebekah Sushila Russell Richa Earnest Swetha Madhuri Chikkala Child and Adolescent Psychiatry Unit Christian Medical CollegeVellore 632002Tamil NaduIndia Department of Biostatistics Christian Medical CollegeVellore 632002Tamil NaduIndia

BACKGROUND Emergence delirium(EmD)is a troublesome motoric,emotional,and cognitive disturbance associated with *** is often misdiagnosed despite being present in a substantial proportion of children and adolescents during emergence from *** To evaluate the summary diagnostic accuracy of Pediatric Anesthesia Emergence Delirium Scale(PAEDS)for EmD among children and *** Two researchers electronically and hand searched the published literature from May 2004 to February 2021 that evaluated the diagnostic accuracy of PAEDS for EmD among children and adolescents,using appropriate *** independent researchers extracted the diagnostic parameters and appraised the study quality with ***,the diagnostic accuracy of the measures was calculated with the summary receiver operating characteristic curve(SROC),the summary sensitivity and specificity,and diagnostic odds ratio(DOR)for *** diagnostic cut-off points were evaluated for their diagnostic *** was analyzed by *** Nine diagnostic accuracy studies of EmD that conformed to our selection criteria and PRISMA guidelines were included in the final *** was no publication *** area under the SROC was 0.97(95%confidence interval[CI]:95%-98%).Summary sensitivity and specificity were 0.91(95%CI:0.81-0.96;I2=92.93%)and 0.94(95%CI:0.89-0.97;I2=87.44%),*** summary DOR was 148.33(95%CI:48.32-455.32).The effect size for the subgroup analysis of PAEDS cut-off scores of<10,≥10,and≥12 was 3.73,2.19,and 2.93,respectively;they were not statistically significantly *** setting of the study and reference standard were statistically significantly related to the sensitivity of PAEDS but not *** The PAEDS is an accurate diagnostic measure for the diagnosis of EmD among children and *** studies should document its clinical utility.

关键词： Anesthesia Children Emergence delirium Diagnostic accuracy Measure Meta-analysis

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Prevalence of intellectual disability in India:A meta-analysis

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World Journal of Clinical Pediatrics 2022年第2期11卷 206-214页

作者： Paul Swamidhas Sudhakar Russell Sahana Nagaraj Ashvini Vengadavaradan Sushila Russell Priya Mary Mammen Satya Raj Shankar Shonima Aynipully Viswanathan Richa Earnest Swetha Madhuri Chikkala grace rebekah Child and Adolescent Psychiatry Unit Christian Medical CollegeVellore 632002Tamil NaduIndia Department of Psychiatry Christian Medical CollegeVellore 632002Tamil NaduIndia Department of Biostatistic Christian Medical CollegeVellore 632002Tamil NaduIndia

BACKGROUND Burden due to intellectual disability(ID) is only third to the depressive disorders and anxiety disorders in India. This national burden significantly contributes to the global burden of ID and hence one has to think globally and act locally to reduce this burden. At its best the collective prevalence of ID is in the form of narrative reviews. There is an urgent need to document the summary prevalence of ID to enhance further policymaking, national programs and resource *** To establish the summary prevalence of ID during the past 60 years in *** Two researchers independently and electronically searched Pub Med, Scopus, and the Cochrane library from January 1961 to December 2020 using appropriate search terms. Two other investigators extracted the study design, setting, participant characteristics, and measures used to identify ID. Two other researchers appraised the quality of the studies using the Joanna Briggs Institute critical appraisal format for Prevalence Studies. Funnel plot and Egger’s regression test were used to ascertain the publication and small study effect on the prevalence. To evaluate the summary prevalence of ID, we used the random effects model with arcsine square-root transformation. Heterogeneity of I^(2)≥ 50% was considered substantial and we determined the heterogeneity with meta-regression. The analyses were performed using STATA(version 16).RESULTS Nineteen studies were included in the meta-analysis. There was publication bias;the trim-and-fill method was used to further ascertain bias. Concerns with control of confounders and the reliable measure of outcome were noted in the critical appraisal. The summary prevalence of ID was 2% [(95%CI: 2%, 3%);I^(2)= 98%] and the adjusted summary prevalence was 1.4%. Meta-regression demonstrated that age of the participants was statistically significantly related to the prevalence;other factors did not influence the prevalence or *** The summary preva

关键词： India Intellectual disability Prevalence Children and adolescents Meta-analysis

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Employing electrochemically derived pH gradients for Lab-on-PCB protein preconcentration devices

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Microsystems & Nanoengineering 2024年第1期10卷 79-87页

作者： grace Maxted Pedro Estrela Despina Moschou Department of Electronic and Electrical Engineering University of BathBath BA27AYUK Centre for Bioengineering and Biomedical Technologies(CBio) University of BathBath BA27AYUK

Protein preconcentration is an essential sample preparation step for analysis in which the targeted proteins exist in low concentrations,such as bodily fluids,water,or ***,very few practical implementations of miniaturized protein preconcentration devices have been demonstrated in practice,and even fewer have been integrated with other microanalytical *** approaches rely heavily on additional chemicals and reagents and introduce complexity to the overall *** this paper,we propose a novel miniaturized isoelectric focusing-based protein preconcentration screening device based on electrochemically derived pH gradients rather than existing chemical reagent *** this way,we reduce the need for additional chemical reagents to zero while enabling device incorporation in a seamlessly integrated full protein analysis microsystem via Lab-on-PCB *** apply our previously presented Lab-on-PCB approach to quantitatively control the pH of a solution in the vicinity of planar electrodes using electrochemical acid generation through redox-active self-assembled *** presented device comprises a printed circuit board with an array of gold electrodes that were functionalized with 4-aminothiophenol;this formed a self-assembled monolayer that was electropolymerized to improve its electrochemical *** preconcentration was performed in two *** first was open and needed the use of a holder to suspend a well of fluid above the electrodes;the second used microfluidic channels to enclose small volumes of *** here are the resulting data for protein preconcentration in both these forms,with a quantitative concentration factor shown for the open form and qualitative proof shown for the microfluidic.

关键词： electrochemical proof qualitative

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Relating estimates of wood properties of birch to stem form, age and species

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Journal of Forestry Research 2024年第3期35卷 1-11页

作者： grace Jones Maria Ulan Mateusz Liziniewicz Johan Lindeberg Stergios Adamopoulos Teagasc Forestry Development Department Ashtown Research CentreDublin 15 D15DY05Ireland Research Institutes of Sweden(RISE) GoteborgSweden The Forest Research Institute of Sweden(Skogforsk) Ekebo 225026890SvalovSweden Department of Forestry and Wood Technology Linnaeus University35195VaxjoSweden Department of Forest Biomaterials and Technology Swedish University of Agricultural SciencesBox 700875007 UppsalaSweden

Birch has long suffered from a lack of active forest management,leading many researchers to use mate-rial without a detailed management *** collected from three birch(Betula pendula Roth,*** Ehrh.)sites in southern Sweden were analyzed using regression analysis to detect any trends or differences in wood proper-ties that could be explained by stand history,tree age and stem *** sites were genetics trials established in the same *** of acoustic velocity(AV)from non-destructive testing(NDT)and predicted AV had a higher correlation if data was pooled across sites and other stem form factors were considered.A subsample of stems had radial profiles of X-ray wood density and ring width by year created,and wood density was related to ring number from the pith and ring *** seemed likely that wood density was negatively related to ring width for both birch *** models had slight improvements if site and species were included,but only the youngest site with trees at age 15 had both birch *** paper indicated that NDT values need to be considered separately,and any predictive models will likely be improved if they are specific to the site and birch species measured.

关键词： Acoustic velocity Non-destructive testing Predictive models Regression analysis Wood density

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Eco-ableism and access circularity in natural building

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Frontiers of Architectural Research 2024年第2期13卷 235-248页

作者： grace Schleck Lola Ben-Alon Barnard College Department of Architecture New YorkUSA Columbia University Graduate School of Architecture Planningand Preservation(GSAPP)New YorkUSA

The climate crisis disproportionately impacts disabled people. Yet climate-related advocacy, planning, and policymaking often neglect to thoughtfully include disabled people. Responding to this gap, disabled and neurodivergent environmental activists coined the term eco-ableism to describe discrimination and silencing toward disabled and neurodivergent people (i.e., ableism) arising in environmental spaces (i.e., eco-ableism). Relatedly, building operations and construction practices contribute a significant percentage of global, energy-related CO_(2) emissions annually, which calls into question the relationships between the impending climate crisis, disability justice, and architecture. Climate-specific, natural building materials and methods present a potential pathway toward a more sustainable built future: low-carbon, locally sourced, minimally processed, and nontoxic materials. Despite a critical overlap, there is little published research on material access in the production phase and human access in the occupation phase of natural buildings. Applying eco-ableism and material circularity in an architectural framework, this research aims to investigate the gaps and possibilities of access, natural material applications, and resulting US natural buildings informed by scholarship in critical disability studies and semi-structured interviews with natural building professionals.

关键词： Eco-ableism Critical disability studies Climate crisis and architecture Naturalmaterialsand methods

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An adaptive machine learning-based optimization method in the aerodynamic analysis of a finite wing under various cruise conditions

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Theoretical & Applied Mechanics Letters 2024年第1期14卷 27-34页

作者： Zilan Zhang Yu Ao Shaofan Li grace X.Gu Department of Mechanical Engineering University of CaliforniaBerkeley 94720USA Department of Engineering Peking UniversityBeijing 100871China Department of Civil and Environmental Engineering University of CaliforniaBerkeley 94720USA

Conventional wing aerodynamic optimization processes can be time-consuming and imprecise due to the complexity of versatile flight *** of existing literature has considered two-dimensional infinite airfoil optimization,while three-dimensional finite wing optimizations are subject to limited study because of high computational *** we create an adaptive optimization methodology built upon digitized wing shape deformation and deep learning algorithms,which enable the rapid formulation of finite wing designs for specific aerodynamic performance demands under different cruise *** methodology unfolds in three stages:radial basis function interpolated wing generation,collection of inputs from computational fluid dynamics simulations,and deep neural network that constructs the surrogate model for the optimal wing *** has been demonstrated that the proposed methodology can significantly reduce the computational cost of numerical *** also has the potential to optimize various aerial vehicles undergoing different mission environments,loading conditions,and safety requirements.

关键词： Aerodynamic optimization Computational fluid dynamics Radial basis function Finite wing Deep learning neural network

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Cross-comparative review of Machine learning for plant disease detection:apple,cassava,cotton and potato plants

Artificial Intelligence in Agriculture

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Artificial Intelligence in Agriculture 2024年第2期12卷 127-151页

作者： James Daniel Omaye Emeka Ogbuju grace Ataguba Oluwayemisi Jaiyeoba Joseph Aneke Francisca Oladipo Department of Computer Science Federal UniversityLokojaNigeria Department of Computer Science Dalhousie UniversityHalifaxCanada Department of Computer Science Hampton UniversityVirginiaUSA

Plant disease detection has played a significant role in combating plant diseases that pose a threat to global agri-culture and food *** these diseases early can help mitigate their impact and ensure healthy crop *** learning algorithms have emerged as powerful tools for accurately identifying and classifying a wide range of plant diseases from trained image datasets of affected *** algorithms,including deep learning algorithms,have shown remarkable success in recognizing disease patterns and early signs of plant *** early detection,there are other potential benefits of machine learning algorithms in overall plant disease management,such as soil and climatic condition predictions for plants,pest identification,proximity detection,and many *** the years,research has focused on using machine-learning algorithms for plant disease ***,little is known about the extent to which the research community has ex-plored machine learning algorithms to cover other significant areas of plant disease *** view of this,we present a cross-comparative review of machine learning algorithms and applications designed for plant dis-ease detection with a specific focus on four(4)economically important plants:apple,cassava,cotton,and *** conducted a systematic review of articles published between 2013 and 2023 to explore trends in the research community over the *** filtering a number of articles based on our inclusion criteria,including articles that present individual prediction accuracy for classes of disease associated with the selected plants,113 articles were considered *** these articles,we analyzed the state-of-the-art techniques,challenges,and future prospects of using machine learning for disease identification of the selected *** from our re-view show that deep learning and other algorithms performed significantly well in detecting plant *** addition,we fou

关键词： Machine learning Plant diseases Agriculture Plant disease management Convolutional neural networks

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Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

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World Journal of Hepatology 2024年第4期16卷 650-660页

作者： Dorothy Liu Mark M Youssef Josephine A grace Marie Sinclair Department of Gastroenterology Austin HealthMelbourne 3084VictoriaAustralia Victorian Liver Transplant Unit Austin HealthMelbourne 3084VictoriaAustralia Department of Medicine University of MelbourneMelbourne 3084VictoriaAustralia

BACKGROUND De novo malignancy is a leading cause of late morbidity and mortality in liver transplant *** immunosuppression has been shown to contribute to post-transplant malignancy(PTM)*** is emerging evidence on the differential carcinogenic risk profile of individual immunosuppressive drugs,independent of the net effect of *** inhibitors such as tacrolimus may promote tumourigenesis,whereas mycophenolic acid(MPA),the active metabolite of mycophenolate mofetil,may limit tumour *** transplantation(LT)is relatively unique among solid organ transplantation in that immunosuppression monotherapy with either tacrolimus or MPA is often achievable,which makes careful consideration of the risk-benefit profile of these immunosuppression agents particularly relevant for this ***,there is limited clinical data on this subject in both LT and other solid organ transplant *** To investigate the relative carcinogenicity of tacrolimus and MPA in solid organ *** A literature search was conducted using MEDLINE and Embase databases using the key terms“solid organ transplantation”,“tacrolimus”,“mycophenolic acid”,and“carcinogenicity”,in order to identify relevant articles published in English between 1st January 2002 to 11th August *** terms,synonyms and explosion of MeSH terms,Boolean operators and truncations were also utilised in the *** lists of retrieved articles were also reviewed to identify any additional *** duplicates,abstracts from 1230 records were screened by a single reviewer,whereby 31 records were reviewed in ***-text articles were assessed for eligibility based on pre-specified inclusion and exclusion *** A total of 6 studies were included in this *** studies were large population registries or cohort studies,which varied in transplant era,type of organ transplanted and immunosuppression protocol us

关键词： Immunosuppression Solid organ transplantation Liver transplantation Carcinogenicity Tacrolimus Mycophenolate

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Primary care providers practice patterns regarding female pelvic floor disorders

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Family Medicine and Community Health 2024年第1期12卷 9-15页

作者： Anna Weimer Jennifer L Hallock Chi Chiung grace Chen Magee-Women's Hospital of UPMC PittsburghPennsylvaniaUSA Kaiser Permanente Northern California SacramentoCaliforniaUSA Johns Hopkins Medical Institutions Campus BaltimoreMarylandUSA

Introduction Pelvic floor disorders(PFDs)pose substantial physical and psychological burdens for a growing number of *** the ubiquity of these conditions and known patient reluctance to seek care,primary care providers(PCPs)have a unique opportunity to increase treatment and provide appropriate referrals for these *** An online survey was administered to PCPs to assess provider practices,knowledge,comfort managing and ease of referral for *** regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest:discomfort with management and difficulty with referral of *** Of the 153 respondents to the survey,more felt comfortable managing stress urinary incontinence(SUI)and overactive bladder(OAB),compared with pelvic organ prolapse(POP)and faecal incontinence(FI)and were less likely to refer patients with urinary *** providers elicited symptoms for POP and FI as compared with SUI and *** variables that were significantly associated with discomfort with management varied by PFD,but tended to correlate with less exposure to PFDs(eg,those with fewer years of practice,and internal medicine and family physicians as compared with geriatricians);whereas the factors that were significantly associated with difficulty in referral,again varied by PFD,but were related to practice characteristics(eg,specialist network,type of practice,practice setting and quantity of patients).Conclusion These findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols,as well as collaboration with pelvic floor specialists to improve screening,treatment and referral for patients with PFDs.

关键词： bladder floor difficulty

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