Adventist Health Simi Valley

In this paper, we investigate how the spectrogram of multicomponent signals can be decomposed into a mode part and an interference part. We explore two approaches: (i) a variational method inspired by texture-geometry decomposition in image processing, and (ii) a supervised learning approach using a U-Net architecture, trained on a dataset encompassing diverse interference patterns and noise conditions. Once the interference component is identified, we explain how it enables us to define a criterion to locally adapt the window length used in the definition of the spectrogram, for the sake of improving ridge detection in the presence of close modes. Numerical experiments illustrate the advantages and limitations of both approaches for spectrogram decomposition, highlighting their potential for enhancing time-frequency analysis in the presence of strong interference.

INTRODUCTION Despite the many studies conducted on the factors affecting mortality in patients with COVID-19, there is ongoing debate about the role of race as a risk factor. Several studies have reported a geographic and racial disparity in COVID-19 cases in Michigan. This study aimed to examine the characteristics of the 2020 first cohort of Intensive Care Unit (ICU) COVID-19 patients admitted to a community teaching hospital in Flint, Michigan, and to determine the factors associated with ICU mortality, including race. METHODS This cross-sectional study included adult patients (≥ 18 years) with severe COVID-19 pneumonia admitted to the ICU between March and May 2020. Potential risk factors associated with ICU mortality included demographic characteristics, comorbidities, treatments, and complications. RESULTS The study sample consisted of N = 48 patients, aged 24–85 years, (mean 59.7; SD = 12.8); 56.2% (n=27) were male and 51.1% (n=24) were Black adults. The mortality rate was 51.1%. Age (aOR 1.1, 95% CI [1.01, 1.20]; p =0.03), type 2 diabetes (aOR 5.7, 95% CI [1.2, 29.1]; p =0.03), and essential hypertension (aOR 6.2, 95% CI [1.1, 34.5]; p =0.04) were all found to have statistically significant independent associations with increased risk of ICU mortality in this study sample. On the other hand, race was not found to be associated with ICU mortality. CONCLUSIONS These findings support the literature regarding the association of comorbid conditions, including type 2 diabetes and hypertension, with poorer outcomes in ICU hospitalized patients with severe COVID-19 pneumonia. This study provides insight into mortality of an ICU patient cohort earlier on during the COVID-19 pandemic in Flint, Michigan.

An 87-year-old female with a history of paraplegia/neurogenic bladder, chronic left leg wound infection, and recurrent UTI, was admitted with a primary problem of frequent falls and found to have COVID-19 infection. Upon admission, the patient was given enoxaparin for DVT prophylaxis for hypercoagulability due to COVID-19. After 3 days of initiation of enoxaparin, the patient experienced hyponatremia with trending upward levels of potassium. It was believed to be due to the furosemide and was discontinued. Despite furosemide discontinuation, the patient continued down trending of serum sodium and an uptrend of potassium occurred. After 24 hours of discontinued enoxaparin, the sodium and potassium levels plateaued. We believe this patient experienced LMWH-induced hypoaldosteronism.

Active asteroids are a mysterious population of objects on asteroid-like orbits that display comet-like activity produced by a diverse variety of mechanisms, providing glimpses of the ongoing evolution of the asteroid belt and near-Earth objects. We report the identification of a new active asteroid 2008 BJ22, from images obtained by the Subaru Telescope in 2008. The object was not detected in earlier Canada–France–Hawaii Telescope images obtained in 2005 down to a 3σ limiting magnitude of m r ∼ 24, corresponding to a V-band absolute magnitude of H V > 18.4, more than 3 mag fainter than the absolute magnitude computed from 2008 data. Analysis of later images obtained by the Dark Energy Camera on the 4.0 m Victor M. Blanco Telescope in 2013 set the object’s current V-band absolute magnitude at H V > 19.3. These results suggest that 2008 BJ22 was discovered in an active state in 2008 January.

Introduction: AL amyloidosis, known previously as primary amyloidosis, is a disorder in which fragments of monoclonal light chains deposit throughout various tissues. The incidence of amyloidosis increases after the age of 40 and a mean age of 63 years old at diagnosis. However, less than 5% of patients are diagnosed at 40 years or younger. Here we explore the case of a patient presenting with gastrointestinal symptoms diagnosed with systemic AL amyloidosis at 32 years old. Case Description/Methods: 32-year-old male presented to the emergency department with abdominal pain and hematochezia The pain was mainly in the left lower quadrant and was not associated with any nausea or vomiting. He also admitted to a 4-5 kilogram weight loss over the past year. CT abdomen and pelvis showed mild colonic wall thickening. Presumptive treatment for colitis was started but patient was not improving. Stool ova and parasites and blood cultures were negative. Biopsy specimens obtained during colonoscopy and endoscopy showed amyloidosis in the gastroesophageal junction, gastric, duodenal, terminal ileum , and colonic mucosa. Bone marrow biopsy from the right iliac showed kappa type clonal plasma cell population that made up 20-25% of marrow cellularity, consistent with plasma cell neoplasm. It was also positive for amyloid staining of small-sized blood vessels. Ultrasound-guided liver biopsy was positive for amyloidosis and fibrosis in the liver parenchyma and negative for malignancy. In summary, the test results were congruent with systemic amyloidosis involving the GI tract, liver, and multiple other organs. Discussion: AL amyloidosis, also known as systemic amyloidosis, occurs as a result of deposition of amyloid in tissue. Amyloid fibrils are composed of insoluble low molecular weight protein subunits. Deposition of amyloid into various tissues causes cellular stress and death, subversion of normal structure, organ dysfunction, and eventually death. This case illustrates the rare diagnosis of early-onset AL amyloidosis with widespread end-organ damage in multiple organ systems. It is especially important to consider both generalized symptoms, such as weight loss, as well as specific symptoms relating to end organ dysfunction, such as abdominal pain and hematochezia. GI symptoms tend to be less common, but when they are present, it may include macroglossia, dysphagia, bleeding or malabsorption. The GI tract may be involved at any level, as was the case with this patient.

Near‐Earth asteroid (101955) Bennu is an active asteroid experiencing mass loss. The activity manifests itself in the form of ejection events emitting up to hundreds of millimeter‐ to centimeter‐scale particles. The Origins, Spectral Interpretation, Resource Identification, and Security‐Regolith Explorer spacecraft monitored particle activity for a 10‐month period that included Bennu's perihelion and aphelion. Novel and classical methods were utilized to detect the particles and characterize their orbital and physical properties. Roughly 30% of the observed particle mass escaped to heliocentric orbit. A majority of particles fell back onto the surface of Bennu after ejection, with the longest‐lived particle surviving for 6 days on a temporary orbit. Particle ejection events appear to preferentially take place in the afternoon and evening and from low latitudes, although they can occur at any time or latitude. The reaccumulation of material is biased toward low latitudes resulting in the possible in‐fill of craters and growth of Bennu's equatorial bulge. Of the potential mechanisms behind this activity that were investigated in focused studies, meteoroid impacts, thermal fracturing, and ricochet—but not water ice sublimation—were found to be consistent with observations. While phyllosilicate dehydration was not investigated with a focused study, it remains a possible mechanism. These mechanisms are not unique to Bennu, suggesting that many near‐Earth asteroids may exhibit activity that has gone undetected thus far. Spacecraft missions with wide‐field imagers are encouraged to further characterize this phenomenon.

Abstract Near‐Earth asteroid (101955) Bennu is an active asteroid experiencing mass loss in the form of ejection events emitting up to hundreds of millimeter‐ to centimeter‐scale particles. The close proximity of the Origins, Spectral Interpretations, Resource Identification, and Security–Regolith Explorer spacecraft enabled monitoring of particles for a 10‐month period encompassing Bennu's perihelion and aphelion. We found 18 multiparticle ejection events, with masses ranging from near zero to hundreds of grams (or thousands with uncertainties) and translational kinetic energies ranging from near zero to tens of millijoules (or hundreds with uncertainties). We estimate that Bennu ejects ~104 g per orbit. The largest event took place on 6 January 2019 and consisted of ~200 particles. The observed mass and translational kinetic energy of the event were between 459 and 528 g and 62 and 77 mJ, respectively. Hundreds of particles not associated with the multiparticle ejections were also observed. Photometry of the best‐observed particles, measured at phase angles between ~70° and 120°, was used to derive a linear phase coefficient of 0.013 ± 0.005 magnitudes per degree of phase angle. Ground‐based data back to 1999 show no evidence of past activity for Bennu; however, the currently observed activity is orders of magnitude lower than observed at other active asteroids and too low be observed remotely. There appears to be a gentle decrease in activity with distance from the Sun, suggestive of ejection processes such as meteoroid impacts and thermal fracturing, although observational bias may be a factor.

Abstract Background: Eflapegrastim (E) represents the first myeloid growth factor innovation in more than 15 years. A novel, long-acting recombinant human granulocyte-colony stimulating factor (rhG-CSF), E consists of a rhG-CSF analog conjugated to a human IgG4 Fc fragment via a polyethylene glycol linker. Preclinical and Phase I and II pharmacodynamic and pharmacokinetic data showed increased potency for E versus pegfilgrastim (P). Two independent randomized Phase III trials comparing fixed dose E and P (E 3.6 mg G-CSF and P 6.0 mg G-CSF) for the management of chemotherapy-induced neutropenia (CIN) have recently been completed. Both trials met the primary endpoint of non-inferiority for E vs P in Cycle 1 duration of severe neutropenia (P<.001). Here we provide an integrated summary of the safety of E administered at a fixed dose in a pre-filled syringe. Patients and Methods: Patients with early-stage breast cancer (ESBC) who were candidates for adjuvant or neoadjuvant chemotherapy were randomized 1:1 in two open-label Phase III trials to E 13.2 mg (3.6 mg G-CSF) or standard P (6 mg G-CSF) administered on Day 2 following TC (docetaxel/cyclophosphamide) chemotherapy on Day 1 of each of 4 cycles. Blood for CBC and serum chemistry was collected in every cycle. Safety assessments began with the first dose of TC and continued for one year after the last dose of study drug. AEs and laboratory values were graded according to NCI CTCAE version 4.03. Immunogenicity was assessed from blood samples collected on Day 1 of each cycle, at the end-of-treatment visit, and at 6- and 12-month follow-up visits. Results: A total of 660 patients who received at least one dose of eflapegrastim (n=334) or pegfilgrastim (n=326) were included in this integrated safety analysis. The two treatment groups were well balanced for demographics and baseline disease characteristics. The mean age was 59y, ~40% were aged >65y, ~54% weighed >75kg, and ~80% were treated in the adjuvant setting. Median relative dose intensity for T and C was >99% for both groups. A similar percentage of patients in both treatment groups discontinued treatment due to AEs (4% E vs 6% P), with 2% in each group discontinuing due to AEs related to E or P. Serious AEs were similar in both groups (15% each). Incidence of AEs irrespective of causality were also similar between groups (74% E vs. 72% P). No notable differences between groups were observed in the types of study-drug-related AEs. The majority of study-drug-related AEs occurred with an incidence ≤10% for both E and P. As expected with myeloid growth factors, study-drug-related AEs occurring in >10% in either group were bone pain (E vs P: 33% vs 34%), arthralgia (15% vs 10%), back pain (14% vs 9%), myalgia (14% vs 9%), and headache (11% vs 8%). Incidence of febrile neutropenia and neutropenic complications were similar and less than 5% in each treatment group. No leukocytosis, splenic rupture, or anaphylaxis was reported in any patient receiving E or P. The overall incidence of immunogenicity was similar in both groups and there was no demonstrable impact on clinical safety or efficacy. Conclusions: Two large, randomized Phase III trials (Total n=660) of E vs P administered once-per-cycle showed E at a lower G-CSF dose to be safe and effective for the prophylaxis of CIN in patients with ESBC receiving TC chemotherapy. E is a novel long-acting rhG-CSF with increased potency and similar toxicity to P and may provide an attractive alternative for growth factor support of patients at high risk for CIN-related complications. Citation Format: Lee S Schwartzberg, Gajanan Bhat, Julio Peguero, Richy Agajanian, Jayaram Bharadwaj, Alvaro Restrepo, Osama Hlalah, Inderjit Mehmi, Shanta Chawla, Francois Lebel, Patrick W Cobb. Eflapegrastim, a novel long-acting granulocyte-colony stimulating factor: Integrated safety results in patients with early-stage breast cancer treated with TC chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-12.

Surrogate markers that accurately detect mucosal healing [MH] in patients with ulcerative colitis [UC] are urgently needed. Several stool neutrophil-related proteins are currently used as biomarkers for MH. However, the sensitivity and specificity are not sufficient to avoid unnecessary endoscopic evaluations. Novel serum neutrophil-related markers (neutrophil gelatinase B-associated lipocalin and matrix metalloproteinase-9 [NGAL-MMP-9 complex], cathelicidin LL-37 and chitinase 3-like 1 [CHI3L1]), together with C-reactive protein [CRP] and neutrophil counts were studied. Serum samples were obtained from 176 anti-tumour necrosis factor [anti-TNF]-treated UC patients (145 infliximab [IFX] and 31 adalimumab [ADM]) at baseline and after a median of 9.5 weeks. All patients had active disease prior to treatment (Mayo endoscopic subscore [MES] ≥ 2), and MH was defined as MES ≤ 1. Serum was also obtained from 75 healthy controls. Binary logistic regression analysis was used to generate the Ulcerative Colitis Response Index [UCRI]. The performance of individual markers and UCRI was tested with receiver operating characteristic analysis. All neutrophil-related markers were significantly higher in active UC patients compared to healthy controls. In the IFX cohort, CRP, NGAL-MMP-9, CHI3L1 and neutrophil count decreased significantly after treatment and all marker levels were significantly lower in healers compared to non-healers following IFX. In the ADM cohort, CRP, NGAL-MMP-9, CHI3L1 and neutrophil count decreased significantly only in healers. UCRI [including CRP, CHI3L1, neutrophil count and LL-37] accurately detected MH in both IFX-treated (area under the curve [AUC] = 0.83) and ADM-treated [AUC = 0.79] patients. The new UCRI index accurately detects MH after treatment with IFX and ADM. This panel is useful for monitoring MH in UC patients under anti-TNF treatment. This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.

Abstract Accurate measurement of the static and dynamic earth pressures acting on structures is critical to understanding the behavior of and the interaction between structures and soil. Different types of devices are commercially available to measure the soil-structure contact stress, and the advantages and limitations of some commonly used devices are summarized. A new, easily constructible, simple, and robust sensor assembly for measuring pressures at the soil-structure interface is introduced and discussed. The sensors are suitable for a variety of potential soil-structure contact situations, including static and dynamic load cases and linear and nonlinear soil behavior. One static and two dynamic experimental case studies serve as examples to describe the construction, installation, and deployment of the new sensors. The static and dynamic calibration procedure of pressure sensors with capacities of 144 kPa and 288 kPa are described. Recommendations for investigators to build and implement the sensor for individualized research applications are provided.