Franciscan Health Mooresville

Abstract The high rigidity and load‐bearing capacity of concrete‐filled stainless steel‐tube (CFSST) structures make them a common choice for high‐rise building construction. CFSST columns exhibit intricate interactions between concrete and stainless steel, leading to challenges in accurately modeling their behavior under axial loading conditions. Stainless steel tubular circular columns with axially loaded concrete and ultra‐high strength concrete are predicted to perform using a hybrid technique. The proposed hybrid strategy is the collaborative implementation of Attention Pyramid Convolutional Neural Network (APCNN) and Giant Trevally Optimizer (GTO). It is hence called the APCNN‐GTO technique. The primary goal of the proposed approach is to increase the CFSST columns' ultimate axial load‐carrying capability in comparison to conventional reinforced concrete (RC). The data is initially extracted from the dataset of steel tubular columns filled with concrete. They then feed the data into a pre‐processing approach based on federated neural collaborative filtering (FedNCF). To extract the best features, the dual‐tree biquaternion wavelet transform (DTBWT) is used for the pre‐processing result. For circular CFSST columns subjected to axial loading, the ultimate axial load is predicted using the APCNN technique. Next, APCNN's weight parameters are tuned with GTO. The proposed technique's implementation in the MATLAB platform is described as follows: the proposed solution outperforms existing approaches such as CNN, FNN, and RNN by 98% and has a 0.1% lower error rate, paving the path for advanced applications in high‐rise and heavy‐load construction.

Lightning strikes pose a significant risk to pipelines. The extremely high temperatures and electrical currents generated by a lightning strike can cause structural damage to pipelines. This damage can lead to environmental pollution and economic losses. In addition, lightning strikes can compromise the integrity of coatings and insulation. Finally, personal protection must also be considered. Various protective measures are therefore essential to ensure the safety and integrity of pipelines.

Background: Immune checkpoint inhibitors (ICI) have shown efficacy in treating a wide spectrum of malignancies, but have a known risk of cancer therapy related cardiac toxicity. We present a case that demonstrates how conduction system disease can rapidly progress in a patient with suspected nivolumab (PD1) induced fulminant myocarditis. Case: An 82-year-old male with a history of esophageal carcinoma presented with agonal breathing and altered mental status. He had received his second dose of PD1 therapy three days prior. He was intubated and admitted for hypoxic respiratory failure and elevated troponin. His initial EKG demonstrated new marked 1st degree AV block with right bundle branch block (RBBB) morphology. A stat echocardiogram noted an EF of 60-65% with no wall motion abnormalities. Decision-making: On Day 2, Mobitz Type I block was appreciated on telemetry. The patient met criteria for acute myocarditis with his clinical presentation, new conduction system disease, and high sensitivity troponin of 13,000. Given recent PD1 therapy, lack of infectious prodrome, and lack of prior heart disease, suspicion for ICI induced myocarditis was high. High dose steroid therapy was initiated. On Day 3, the patient was noted to have alternating left bundle branch block and RBBB. On Day 4, he progressed to complete heart block, prompting transvenous pacemaker (PM) placement with subsequent permanent PM placement. A repeat echo showed global hypokinesis with an EF of 40-45% and reduced RV function. He also required vasopressor support meeting criteria for fulminant myocarditis. Due to his hemodynamic instability and low clinical suspicion, he did not receive cardiac catheterization. Cardiac MRI and cardiac biopsy were not readily available in this institution. Conclusion: The clinical findings, lack of infectious prodrome, and worsening arrhythmia requiring pacing and vasopressor support, in patient with recent PD1 treatment suggests nivolumab induced fulminant myocarditis. In institutions without advanced testing infrastructure, rapid recognition of progressive conduction system disease may be used as an early marker for diagnosis, treatment initiation, and referral to tertiary care centers for advanced management of fulminant ICI myocarditis.

Introduction: Catheter ablation is used increasingly as a 1st-line (1L) alternative to antiarrhythmic drugs (AAD) including dronedarone in patients with atrial fibrillation (AF). Healthcare resource utilization (HCRU)-related costs with dronedarone vs 1L ablation are unknown. Methods: We conducted a retrospective, observational cohort study using Optum Clinformatics Data Mart® from Jan 2012-Jan 2022 among US adults with AF and no prior rhythm control therapy who received new AAD therapy with dronedarone (index: date of incident dronedarone fill) vs those who received 1L ablation, or a non-dronedarone AAD followed by ablation within 3 mo (index: date of first recorded ablation or AAD). Patients were required to have ≥24 mo of pre-index data, and ≥3 mo follow-up. Patients in the 1L ablation cohort were propensity score matched 2:1 to the dronedarone cohort. Mean payer costs per patient per month (PPPM) during the 24-mo post-index period were calculated for total HCRU, inpatient visits, emergency room (ER) visits, outpatient physicians’ office visits, and all outpatient visits, and compared by zero-inflated negative binomial (ZINB) regression model. Results: Post-matching, the dronedarone (n=1440) and 1L ablation (n=2253) cohorts had similar baseline characteristics (mean age at index: 68.4 vs 67.7 years; male: 57.7% vs 59.3%; mean time from AF diagnosis to index: 80.2 vs 91.6 days; Charlson comorbidity index: 2.3 vs 2.2; CHADS2-VASc score: 3.4 vs 3.2). Mean PPPM costs were lower with dronedarone vs 1L ablation for all-cause total HCRU, inpatient visits, any outpatient visit, ER visit, and outpatient office visit (Table). ZINB analyses showed significant cost differences for all-cause total HCRU and any outpatient visit events. Conclusion: In patients with AF and no prior rhythm control therapy, 1L dronedarone was associated with lower total HCRU and outpatient visit costs during 24-mo follow-up vs 1L ablation; future studies will assess cost-effectiveness.

Using patient-reported outcome measures (PROMs) in care planning has the potential to improve care, but information about routine implementation in settings serving disadvantaged groups is needed. Two primary care clinics serving populations predominantly eligible for Medicaid and diverse in race/ethnicity implemented the PROMIS-29 as part of clinical care planning. Of the target population with diabetes, 26% (n = 490) completed the PROMs; the proportion that set a goal based on the PROMs differed by site. This report describes factors influencing the PROMs process and the results of interviews with patients and members of the care team about PROMs' implementation and impact.

It was mentioned in section 4.5 that the switching-mode charger will be treated in a standing alone chapter. The reason of doing so was also given. Without wasteful verbiage, we shall treat first a boost charger, then a charger in buck mode. For both chargers, some circuit blocks are given detailed analytical expressions and their derivations, considering their respective degree of importance. Others are omitted, or given only their end results, if doing so will not create misunderstanding or ambiguity. By covering most mathematical basis first, then steady state closed-loop formulation follows. The goal of the second step obviously is aiming at providing insight for steady-state charge (current) regulation. The performance merit in this regard basically resides in the quantitative study of charge current sensitivities against control loop parameters including active device characteristic and passive part values. Time domain study concludes the chapter.

Total knee arthroplasty has been reported in many short-term and mid-term followup reports. As emphasized in this symposium, however, a minimum of 10-years followup is required before a claim of success may be made. Reviews with less than a 10-year followup often show no problems with the new design unless major flaws are identified. The articles in this symposium emphasize not only success of cement or cementless fixation but also the problems associated with polyethylene wear in modular components. Surgeons today must correlate the track record of the system they are implanting with long-term reports of other systems such as the total condylar knee replacement. The Guest Editors and all the authors are privileged to dedicate this symposium to the late Dr. John Insall. It is through the pioneering efforts John made that tremendous strides have occurred in knee arthroplasty for which all of us have benefited. All of the designs to date are offshoots of his original total condylar knee replacement. Without people such as John Insall, total knee replacement would be very slow in progressing.

Dear Sir: There is no question that all of the concerns voiced by Dr. Jenny could be factors and their possibility cannot be disputed. However, during the past 5 years since externally rotating the femoral component, the lateral release rate in my experience is practically nil and there have been no cases of patella fracture or loosening. Second, as large as the database is in my practice, hopefully the validity of the results is realistic. It cannot be disputed, however, that there may be other causes but it is important to try to avoid a lateral release during total knee replacement. Merrill A. Ritter, MD