Prevalence, Risk Factors and Residential Variation among HIV/TB co-infected Mortality in Amhara Region, Fenote Selam Hospital: Application of Multilevel Logistic Regression

The purpose of this study was to identify the factors that affect the mortality among adult HIV/TB co-infected patients and to see the nutritional difference among mortality in residence level. Retrospective cohort studies of 417 patients which fulfill our criteria were included. Multilevel logistic regression models were used. MLwiN and SPSS software are used to estimate the parameter. The variance of the random factor in the empty model was significant which indicates that there were residential differences in TB-HIV co-infected mortality and it shows multilevel analysis was an appropriate approach for further analysis. The prevalence of HIV/TB co-infected patients' death was 12.9% in study time. Functional status, age of patients, WHO clinical stages, nutritional status, CD4 counts, regimen, and BMI were found to be significant determinants of HIV/TB co-infected mortality. In our study, patients with the bedridden category of functional status, the fourth stages of WHO clinical stages (stage IV), patients with higher age, patients whose treatments were second-line regimen and low CD4 cell counts were more at risk of death. The study also revealed that; poor nutritional status increased the risk of mortality among HIV/TB co-infected patients and it varies among the residence of the patients (rural area were more at risk).

Deep Reinforcement Learning from Self-Play in No-limit Texas Hold'em Poker

Imperfect information games describe many practical applications found in the real world as the information space is rarely fully available. This particular set of problems is challenging due to the random factor that makes even adaptive methods fail to correctly model the problem and find the best solution. Neural Fictitious Self Play (NFSP) is a powerful algorithm for learning approximate Nash equilibrium of imperfect information games from self-play. However, it uses only crude data as input and its most successful experiment was on the in-limit version of Texas Hold’em Poker. In this paper, we develop a new variant of NFSP that combines the established fictitious self-play with neural gradient play in an attempt to improve the performance on large-scale zero-sum imperfect information games and to solve the more complex no-limit version of Texas Hold’em Poker using powerful handcrafted metrics and heuristics alongside crude, raw data. When applied to no-limit Hold’em Poker, the agents trained through self-play outperformed the ones that used fictitious play with a normal-form single-step approach to the game. Moreover, we showed that our algorithm converges close to a Nash equilibrium within the limited training process of our agents with very limited hardware. Finally, our best self-play-based agent learnt a strategy that rivals expert human level.

Confocal laser scanning reflection microscopy applied to the remineralization studies in incipient caries lesions

To evaluate through roughness parameters measurement the penetration of calcium phosphate stabilized by casein phosphopeptides (CPP-ACP) in the subsurface zone of the incipient caries lesions known in dentistry as white spot lesion (WSL). To our knowledge, there is no data about roughness parameters to evaluate the demineralization-remineralization process in the body of the lesion. WSL was generated in vitro in 10 dental samples and sectioned in half of them (longitudinal section). CPP-ACP was applied on the WSL (3 minutes daily for 60 days). Roughness parameters (Rp and Ra) were measured on the longitudinal section with a laser scanning confocal microscope in the reflection acquisition mode (CLSRM), either in the WSL or sound enamel, before and after applying CPP-ACP. CLSRM is a non-contact method able to detect small irregularities more precisely due to the small spot of laser illumination (0.5 μm). Mixed linear models were carried out, using the treatment as a fixed factor and the tooth as a random factor (significance level 5%). Rp and Ra values in WSL area before applying the remineralization protocol (WSL pre) were significantly higher than in the sound enamel of the same samples. After applying CPP-ACP, Rp and Ra values decreased significantly with respect to the WSL pre and were similar to the values of these parameters in sound enamel. roughness parameters were used as an indirect way to measure the porosity of WSL at subsurface level. The decrease of these parameters could be interpreted as the remineralization of WSL by the ability of CPP-ACP to penetrate the body of the lesion. Clinical significance: WSL is characterized by the loss of minerals from the enamel and an increase in porosity at the subsurface level. The effectiveness of remineralizing substances would be determined by their ability to penetrate the body of the lesion and reduce porosity.

Rim lesions are demonstrated in early relapsing–remitting multiple sclerosis using 3 T-based susceptibility-weighted imaging in a multi-institutional setting

Purpose Rim lesions, characterised by a paramagnetic rim on susceptibility-based MRI, have been suggested to reflect chronic inflammatory demyelination in multiple sclerosis (MS) patients. Here, we assess, through susceptibility-weighted imaging (SWI), the prevalence, longitudinal volume evolution and clinical associations of rim lesions in subjects with early relapsing–remitting MS (RRMS). Methods Subjects (n = 44) with recently diagnosed RRMS underwent 3 T MRI at baseline (M0) and 1 year (M12) as part of a multi-centre study. SWI was acquired at M12 using a 3D segmented gradient-echo echo-planar imaging sequence. Rim lesions identified on SWI were manually segmented on FLAIR images at both time points for volumetric analysis. Results Twelve subjects (27%) had at least one rim lesion at M12. A linear mixed-effects model, with ‘subject’ as a random factor, revealed mixed evidence for the difference in longitudinal volume change between rim lesions and non-rim lesions (p = 0.0350 and p = 0.0556 for subjects with and without rim lesions, respectively). All 25 rim lesions identified showed T1-weighted hypointense signal. Subjects with and without rim lesions did not differ significantly with respect to age, disease duration or clinical measures of disability (p > 0.05). Conclusion We demonstrate that rim lesions are detectable in early-stage RRMS on 3 T MRI across multiple centres, although their relationship to lesion enlargement is equivocal in this small cohort. Identification of SWI rims was subjective. Agreed criteria for defining rim lesions and their further validation as a biomarker of chronic inflammation are required for translation of SWI into routine MS clinical practice.

PSXI-14 Enteric methane and nitrogen emissions in cattle consuming tanniferous and non-tanniferous legumes, grass or a ration

Incorporation of legumes into forage systems has been a widely adopted strategy to increase pasture productivity and forage nutritive value, while reducing N inputs. In addition, some legumes contain beneficial chemicals like condensed tannins (CT), which could enhance the efficiency of energy and protein use in ruminants relative to other forages. We assessed (i) animal performance, (ii) methane emissions (SF6 technique), and (iii) concentration of nitrogen in urine and blood in cattle grazing a CT-containing legume (birdsfoot trefoil; BFT), a legume without tannins (cicer milkvetch; CMV), a grass (meadow brome; MB), or in cattle fed a total mixed ration (TMR). Fifteen Angus heifers were randomly assigned to one of three treatment pastures: (1) BFT, (2) CMV, and (3) MB. Each treatment had 5 spatial replications, randomly divided into three paddocks (64 × 57m), seeded with BFT, CMV or MB, and one heifer was assigned to each paddock. Five Angus heifers were randomly assigned to individual adjacent pens and received a TMR ration (25% of alfalfa hay, 25% corn silage and 50% chopped barley) during the same period. Response variables were analyzed as a split-plot design, with experimental units as the random factor and treatment as a fixed factor with day as the repeated measure. Cows grazing BFT (1.9% condensed tannins) or fed the TMR showed greater weight gains than cows grazing CMV or MB (P = 0.0006). Methane emissions did not differ among treatments (P > 0.05; Table 1). Blood urea nitrogen concentrations were similar in cows grazing BFT or CMV (P = 0.1202), but greater than in animals grazing MB or fed TMR (P < .0001). Urinary nitrogen concentrations were similar among treatments (P = 0.5266). These results suggest grazing tanniferous legumes enhanced BW gains with similar methane and urinary nitrogen emissions to grass and confinement alternatives and greater levels of production than grass or CMV.

Assessing Ecological Indicators for Remnant Vegetation Strips as Functional Biological Corridors in Chilean Vineyards

Mediterranean central Chile is globally recognized as a hotspot for terrestrial biodiversity due to its high endemism and massive habitat loss. However, within the rural landscape of central Chile, significant extents of natural areas remain, especially on less productive, steep slopes, and vegetation strips extending from the surrounding hills to agricultural areas. Accordingly, vegetation strips or corridors, within lowland farms, constitute key elements to support the conservation of biodiversity in rural landscapes. To assess the ecological performance of corridors in 22 commercials vineyards in central Chile, we characterized them in terms of width-, length-, area-, and perimeter-to-area ratios, as well as the number of connections with natural areas. Based on a set of previously defined ecological indicators (species, functional groups, and structural components), we compared their occurrence in corridors within vineyards and in the surrounding natural areas. We evaluated the effects of corridor attributes on the occurrence of the selected ecological indicators, using a generalized linear mixed model with each vineyard as a random factor. The area, width, and length of vegetation corridors varied widely (1.2–86.3 ha, 10.5–95 m, and 380–5000 m, respectively). We found significant differences in the occurrence of indicators between corridors and natural areas. All sampled ecological indicators in corridors showed a negative relationship with the distance to the nearest natural area. Vegetation strips within vineyards represent important opportunities for biodiversity conservation that significantly enhance habitat quality in the agricultural landscape for biodiversity and habitat connectivity.

Comparison of Corneal Biomechanics in Post-SMILE, Post-LASEK, and Keratoconic Eyes

Significance: Our study found that SP-A1 (stiffness parameter at time of first applanation) was statistically different between post-laser-assisted subepithelial keratomileusis (LASEK) and post-small incision lenticule extraction (SMILE) eyes. The stiffness of keratoconus was lower than that of post-refractive surgery corneas.Purpose: To compare corneal biomechanics among post-SMILE, post-LASEK, and keratoconic eyes.Methods: In this retrospective study, 36 eyes of 36 patients after SMILE, 36 eyes of 36 patients after LASEK, and 36 eyes of 36 patients with keratoconus with matching (±5 μm) central corneal thickness (CCT) were examined using Scheimpflug corneal topography (Pentacam HR) and dynamic Scheimpflug analyzer (CorVis ST). Mixed linear model analysis with Bonferroni-adjusted post-hoc comparisons was performed to compare the differences in corneal biomechanics and topographic parameters among the three groups with the CCT and the bIOP (intraocular pressure with biomechanical correction) as the random factor.Results: All groups had comparable CCT at baseline. The bIOPs between the three groups were comparable. The mean values of the Belin/Ambrósio Deviation (BAD-D) in the keratoconus group were significantly higher than those of the SMILE (post hoc p < 0.001) and LASEK groups (post hoc p < 0.001). The SP-A1 in the keratoconus group was the lowest when compared with those of the SMILE (post hoc p = 0.003) and LASEK groups (post hoc p < 0.001). The SMILE group SP-A1 values were slightly lower than those of the LASEK group (post hoc p = 0.044).Conclusions: Keratoconus eyes were significantly softer when compared to post-refractive surgery corneas with comparable corneal thickness in terms of SP-A1 and BAD-D values, while the LASEK group may have the greatest stiffness. Post-SMILE and post-LASEK corneas showed significant differences in SP-A1.

Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR

Background Previous studies have stated that hyperventilation often occurs in cardiopulmonary resuscitation (CPR) mainly due to excessive ventilation frequencies, especially when a manual valve bag is used. Transport ventilators may provide mandatory ventilation with predetermined tidal volumes and without the risk of hyperventilation. Nonetheless, interactions between chest compressions and ventilations are likely to occur. We investigated whether transport ventilators can provide adequate alveolar ventilation during continuous chest compression in adult CPR. Methods A three-period crossover study with three common transport ventilators in a cadaver model of CPR was carried out. The three ventilators ‘MEDUMAT Standard²’, ‘Oxylog 3000 plus’, and ‘Monnal T60’ represent three different interventions, providing volume-controlled continuous mandatory ventilation (VC-CMV) via an endotracheal tube with a tidal volume of 6 mL/kg predicted body weight. Proximal airflow was measured, and the net tidal volume was derived for each respiratory cycle. The deviation from the predetermined tidal volume was calculated and analysed. Several mixed linear models were calculated with the cadaver as a random factor and ventilator, height, sex, crossover period and incremental number of each ventilation within the period as covariates to evaluate differences between ventilators. Results Overall median deviation of net tidal volume from predetermined tidal volume was − 21.2 % (IQR: 19.6, range: [− 87.9 %; 25.8 %]) corresponding to a tidal volume of 4.75 mL/kg predicted body weight (IQR: 1.2, range: [0.7; 7.6]). In a mixed linear model, the ventilator model, the crossover period, and the cadaver’s height were significant factors for decreased tidal volume. The estimated effects of tidal volume deviation for each ventilator were − 14.5 % [95 %-CI: −22.5; −6.5] (p = 0.0004) for ‘Monnal T60’, − 30.6 % [95 %-CI: −38.6; −22.6] (p < 0.0001) for ‘Oxylog 3000 plus’ and − 31.0 % [95 %-CI: −38.9; −23.0] (p < 0.0001) for ‘MEDUMAT Standard²’. Conclusions All investigated transport ventilators were able to provide alveolar ventilation even though chest compressions considerably decreased tidal volumes. Our results support the concept of using ventilators to avoid excessive ventilatory rates in CPR. This experimental study suggests that healthcare professionals should carefully monitor actual tidal volumes to recognise the occurrence of hypoventilation during continuous chest compressions.

Effect of Speed and Surface Type on Individual Rein and Combined Left–Right Circle Movement Asymmetry in Horses on the Lunge

Differences in movement asymmetry between surfaces and with increasing speed increase the complexity of incorporating gait analysis measurements from lunging into clinical decision making. This observational study sets out to quantify by means of quantitative gait analysis the influence of surface and speed on individual-rein movement asymmetry measurements and their averages across reins (average-rein measurements). Head, withers, and pelvic movement asymmetry was quantified in 27 horses, identified previously as presenting with considerable movement asymmetries on the straight, during trot in hand and on the lunge on two surfaces at two speeds. Mixed linear models (p &lt; 0.05) with horse as the random factor and surface and speed category (and direction) as fixed factors analyzed the effects on 11 individual-rein and average-rein asymmetry measures. Limits of agreement quantified differences between individual-rein and average-rein measurements. A higher number of individual-rein asymmetry variables—particularly when the limb that contributed to movement asymmetry on the straight was on the inside of the circle—were affected by speed (nine variables, all p ≤ 0.047) and surface (three variables, all p ≤ 0.037) compared with average-rein asymmetry variables (two for speed, all p ≤ 0.003; two for surface, all p ≤ 0.046). Six variables were significantly different between straight-line and average-rein assessments (all p ≤ 0.031), and asymmetry values were smaller for average-rein assessments. Limits of agreement bias varied between +0.4 and +4.0 mm with standard deviations between 3.2 and 12.9 mm. Fewer average-rein variables were affected by speed highlighting the benefit of comparing left and right rein measurements. Only one asymmetry variable showed a surface difference for individual-rein and average-rein data, emphasizing the benefit of assessing surface differences on each rein individually. Variability in straight-line vs. average-rein measurements across horses and exercise conditions highlight the potential for average-rein measurements during the diagnostic process; further studies after diagnostic analgesia are needed.