dataesr/scientific-paragraphs-categorization huggingface dataset:
Third, where information on covariates required for calculating the GRACE score was missing this was determined to be at random, and to minimize bias we applied multiple imputation. As data were missing in patients with type 1 and type 2 myocardial infarction in equal proportion, and we observed consistent performance in a sensitivity analysis restricted to the dataset where complete case data were available, we do not think this impacted on the results observed. Fourth, we acknowledge that our analysis of in-hospital events was post hoc and is limited by a small number of events. Finally, we acknowledge that the rates of coronary angiography were lower here than in other registries or clinical trials of selected patient populations. 29, 30 We enrolled all consecutive patients in both cohorts, where older patients with comorbidities managed out with the coronary care unit were included rather than excluded.
Funding This trial was funded by a  Special Project Grant  from the  British Heart Foundation (BHF)  ( SP/12/10/29922 ) with additional support from a  BHF   Research Excellence Award  ( RE/18/5/34216 ). A. R. C. and N. L. M. are supported by  Clinical Research Training Fellowship  ( FS/16/75/32533 ) and the  Butler Senior Clinical Research Fellowship  ( FS/16/14/32023 ) from the  BHF. A. R. C. is supported by a  Starter Grant for Clinical Lecturers  from the  Academy of Medical Sciences , which is supported by the  Wellcome Trust , the  Medical Research Council , the  British Heart Foundation , vs. Arthritis, Diabetes UK, and the  British Thoracic Society  [ SGL021/1075 ]. A. R. holds a research position funded by the regional agreement on medical training and clinical research between  Stockholm County Council and Karolinska Institutet  (20160644).
D. M. K. was supported by a grant from  Health Data Research UK  which receives its funding from  HDR UK Ltd  ( HDR-5012 ) funded by the  UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England) ,  Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government ),  Public Health Agency (Northern Ireland) ,  British Heart Foundation , and the  Wellcome Trust. M. J. H. holds research positions funded by the  Swedish Heart-Lung Foundation  ( 20170804 ) and the  Stockholm County Council  ( 20170686 ). Abbott Laboratories provided cardiac troponin assay reagents, calibrators, and controls without charge for the High-STEACS trial.
Data Analysis Data was organised using NVivo 12 software, with reflexive thematic analysis employed as the analytical approach  (Braun & Clarke, 2019). As such, findings were not predetermined but generated by the interaction of data, theoretical and paradigm influences, and researcher analytic skills  (Braun & Clarke, 2019). Consequently, findings are presented by integrating theoretical concepts and citations from the raw data, including field notes and quotations. To promote transparent analysis and reporting, we used the 15-Point Checklist of Criteria for Good Thematic Analysis Process  (Braun & Clarke, 2006). Reflexive strategies included sharing data interpretations among the research team and Advisory Panel to interrogate preliminary themes  (Smith & McGannon, 2018). Analytical memos and development of visual displays enhanced analytical rigour  (Bazeley, 2009).
In addition, a DOE study with Design Expert Software (Version 11) was conducted on the wear behaviour of the composites to develop a mathematical model for the prediction of wear index of composites and optimization of their wear performance as a function of reinforcement characteristics. The findings of this research are considered satisfactory for researchers to have a comprehensive understanding of the mechanical properties and abrasive wear behaviour of hypereutectic Al-Si alloy reinforced with SiC-ZnO-Gr inclusions. Correspondingly, the findings are expected to serve as pertinent reference material for constitutive model development and validation with respect to abrasive wear performance of ABCs.
Composites development Prior to the composites development, low-cost 2-in-1 casting moulds (Figure  1 (a)) for mechanical and abrasive test pieces were developed. The need to improve the economic viability of developing the moulds inspired the design. Impressively, the design proved effective by reducing casting duration and quantity of materials needed for the test coupons. Similarly, to improve mixture homogeneity of the constituent materials, the research featured a low-cost and user-friendly automatic stirrer designed with Solid works Software and fabricated by Shielded Metal Arc Welding as shown in Figure  1 (b) To facilitate quick melting of the as-procured Al-Si alloys (piston scraps), they were charged into a clean crucible furnace preheated to 300°C. This approach reduces the oxidation level of the process, which in turn enhances the wettability between Al-Si alloys and the reinforcing constituents  (Daramola et al.
Design Matrix in Coded Factors Factor A A[1] A[2] R7 1 0 R9 0 1 R11 -1 -1 Factor B B[1] B[2] B[3] B[4] B[5] B[6] G1 1 0 0 0 0 0 G2 0 1 0 0 0 0 G3 0 0 1 0 0 0 G4 0 0 0 1 0 0 G5 0 0 0 0 1 0 G6 0 0 0 0 0 1 G7 -1 -1 -1 -1 -1 -1 to seven levels for perfect modeling and simulation of the experimental runs in Design Expert software (Version 11). Table  3  shows the DOE table, and the flowchart showing the details of the selected approached is shown in Figure  3. In a factorial experiment, an effects model can describe the observations. The effects model is i ¼ 1; 2;. ; a x ijk ¼ / þ# i þ β j þ / β ð Þ þ ε ijk fj ¼ 1; 2;. ; b (7) k ¼ 1; 2;. ; n where x ijk is the observed response when Factor A is at the ith level and Factor B is at the jth level for kth replicate. ∝ overall mean effect, ϑ i is the effect of the ith level of the row factor A, β j is the effect of the jth level column of factor B, (α β) ij is the effect of the interaction between ϑ i and β ij , and ε ijk is the random error component.
17 Additionally, there exists no comprehensive, open access database on genetic variants in SMAD4 or BMPR1A. The aims of this retrospective study were to describe the clinical and molecular genetic features from a European, multicenter survey on JPS patients, compare them with literature-derived data on SMAD4/BMPR1A PV carriers, and provide recommendations for management on the basis of both new and previously published data. In addition, the data establish the basis for SMAD4 and BMPR1A Leiden Open Variant Databases (LOVD).
Literature-based SMAD4/BMPR1A PV carrier (LBSB) group Search and selection criteria To retrieve all published SMAD4/BMPR1A carriers of PVs reported in the medical literature, a comprehensive search for entries between 1 January 1998 and 31 December 2018 was performed using six databases: CINAHL, EMBASE, MED-LINE/PubMed, PsycINFO, Psyndex, and Web of Science. Each database was searched individually for genotype and phenotype characteristics using both free text searches as well as entry term searches (Supplementary Fig. B ). Following the selection process depicted in Supplementary Fig. C  and exclusion of (1) patients with promoter or unspecified SMAD4/BMPR1A variants, (2) patients with SMAD4associated Myhre syndrome (n = 8), and (3) ECS group patients having already been published (n = 39), 628 SMAD4/ BMPR1A variant carriers could be retrieved.
Interestingly, with regard to juvenile polyposis of infancy, the three index patients, aged between 7 months and 2 years at diagnosis, all carried BMPR1A PVs; only one, however, carried the 10q23 microdeletion while the other two harbored an exon 1 deletion and a splice site alteration (c. 430+2T>C), respectively. In SMAD4 PV carriers a more severe gastric phenotype as well as an HHT overlap phenotype were observed. In addition, index patients with SMAD4 missense PVs (n = 14) displayed a significantly younger median age at diagnosis (10. 5 years, IQR 22. 0) compared with those with SMAD4 frameshift changes (28. 0 years, IQR 31. 0, n = 29; p = 0. 028); this finding, however, was not present among nonindex patients (missense: 36 years, IQR 12. 8; frameshift: 29 years, IQR 30. 0; p = 0. 39). Even when combining the ECS and LBSB data sets no further statistically significant phenotypic differences with regard to the type of genetic variant or protein domain affected could be identified.
DISCUSSION This large comprehensive retrospective study on genotypephenotype correlations in JPS corroborates previous observations that SMAD4 carrier status is associated with HHT, multiple gastric JPs, and gastric cancer occurrence; provides recommendations for management on the basis of both new and previously published data (Table  5 ); and establishes the basis for open access SMAD4 and BMPR1A Leiden Open Variant Database-powered variant databases. 19 he reported age at diagnosis of JPS was similar for both SMAD4 and BMPR1A pathogenic variant carriers (median 28 and 25 years, respectively). The youngest index patients reported, both in the ECS and the LBSB group (median age 1. 5 and 6 years, respectively), consisted of carriers of large cytogenetic alterations at 10q23, e. g. , microdeletions encompassing the BMPR1A and PTEN loci.
Surveillance guidelines are not uniform across countries, and thus referring such patients to a local HHT specialist center would be advised (European centers can be identified at https://vascern. eu/expertise/rarediseases-wgs/hht-wg/). While JPs of the colon were twice as frequently reported in ECS index patients compared with affected family members, rectal JPs were significantly less frequent than colonic ones (32% vs. 72%; p < 0. 01), independent of the gene affected. The prevalence and number of gastric JPs, however, were significantly increased in both SMAD4 index and nonindex patients, and occurred roughly 20 years later compared with the colonic JPs (40 vs. 18 years; p < 0. 0001). Upper GI endoscopy surveillance is recommended for patients with JPS. The data presented here are sufficient, when combined with published data, to support that upper GI surveillance should be tailored to the underlying genotype.
It would be reasonable to recommend upper GI surveillance to start at age 18 years for SMAD4 carriers, with intervals ranging from 1 to 3 years depending on the number of polyps (Table  5 ). However, although approximately 18% of BMPR1A carriers develop gastric polyps, they are usually smaller and gastric cancer has not been reported. In view of these findings, starting surveillance in this group by the age of 25 years and a surveillance interval of 3 years seems reasonable until further data are available. Among the 11% to 15% of LBSB and ECS patients with cancer, colorectal cancer accounted for 58% (SMAD4) and 88% (BMPR1A) of all cancers reported and occurred about 20 years later (median age 41 years) compared with the age at diagnosis of colonic JPs (18. 5 years; p < 0. 0001). Most patients' colorectal disease is likely to be manageable endoscopically.
These observations were essentially mirrored by the LBSB group. It is likely that gastric cancer occurrence in SMAD4 carriers is underestimated since seven ECS patients with massive JP burden had prophylactic gastric resection/gastrectomy at a median age of 49. 5 years. Thus, more of these patients might have developed gastric cancer. It is difficult on the basis of current evidence to give firm recommendations regarding gastrectomy in SMAD4 carriers. There are no data regarding outcomes from endoscopic polypectomy in the stomach. Decisions will need to be made on a case-by-case basis. Those with advanced gastric polyposis are best seen in a center experienced in managing this condition. It is likely that the gastric polyps have a relatively indolent progression. However, in those with advanced polyposis in whom dysplasia is found, and in those whose stomachs cannot be adequately/ safely surveyed, a discussion through a specialist multidisciplinary team is required and then the option of prophylactic/risk-reducing surgery should be discussed with the patient.
As always, in the setting of prophylactic, riskreducing surgery, retaining the best possible quality of life is essential and therefore this surgery should be reserved to highly specialized centers. In this study small intestine polyps were reported in 15. 7% (20/127) of SMAD4 carriers and 3. 2% (3/94) of BMPR1A carriers. It should be noted that we did not distinguish duodenal from ileal/jejunal polyps and it is likely that duodenal polyps predominate here. 21 In addition, given that small bowel surveillance is not routinely recommended, the true incidence of small bowel polyps cannot be established. However, these data do support the recommendation that the small bowel should undergo evaluation for patients who develop symptoms or unexplained anemia, e. g. , with videocapsule endoscopy (VCE), to look for underlying small bowel polyps and angioectasia.
The limitations of this study obviously include its retrospective nature and, inevitably when dealing with such a rare disorder, the possibility of ascertainment and/or selection bias. In addition, differences in patient data collection as well as completeness of medical records among the participating centers will impact on data quality and comparability. Furthermore, certain of the reported phenotypic features likely represent underestimations since a particular trait may go unnoticed if not specifically searched for, e. g. , arteriovenous malformations in SMAD4-associated JPS-HHT, as reported by O'Malley et al. 9  To circumvent these issues clearly, prospective, multicenterbased studies, as exemplified by the Prospective Lynch Syndrome Database (PLSD), are needed,  22  which could also inform the outcomes of surveillance measures taken.
ACKNOWLEDGEMENTS We thank the patients and their families for participation in the study and  Sophie Grandjouan  for contributing clinical data. D. G. E. is supported through the  National Institute for Health Research (NIHR) Manchester Biomedical Research Center  ( IS-BRC-1215-20007 ). K. H. is supported by grants from the  Stiftung zur Krebsbekaempfung  (number  285 ) and the  Freiwillige Akademische Gesellschaft.
The noninvasive Presentation of preliminary data at Deutscher Anästhesie Congress (DAC) 2018 in Nuremberg. determination of blood pressure can be performed either manually or automatically. Automatic devices nowadays are commonly based on an oscillometric algorithm embedded in the device. Big database analyses showed that oscillometric techniques fail to reliably reflect very low or very high blood pressure values by overestimating low values and underestimating high values  [2]. However, data comparing oscillometric with intra-arterial pressure measurements in hypotensive emergency patients with shock are sparse. Therefore, we designed a prospective observational study investigating the accuracy of an oscillometric device in hypotensive patients admitted to the resuscitation area of the emergency department.
e. difference between invasive systolic and diastolic blood pressure < 7 mmHg, systolic blood pressure < 40 mmHg, mean arterial pressure < 30 mmHg) and artefacts (e. g. , damping phenomena, static pressure during blood withdrawal, etc. ) according to a predefined protocol, and analysed. All plausible values were included as long as the patient remained hypotensive, leading to a different number of measurements per patient (e. g. in case of refractory hypotension). The patient monitors in the resuscitation areas were checked for calibration and other technical errors by qualified technicians according to German regulations. Patients' demographic data were extracted from the medical records and the patient data management system (Narko-Data; Imeso, Gießen, Germany), as were patients' arterial lactate level, pH and base excess.
Statistical analysis A previous study comparing oscillometric and invasive blood pressure found a mean difference of 8 mmHg at the hypotension threshold of 60 mmHg mean arterial pressure  [2]. The standard deviation (SD) in this blood pressure range is 11 mmHg. Based on these values, a confidence level of 95% and a power of 80%, the recommended sample size was 30. For data analysis, we used the software Excel (Microsoft, Redmond, US) and R (The R project for statistical computing, Vienna, Austria). Simultaneously obtained mean and systolic arterial blood pressure values of each patient were analysed by the Bland-Altman method accounting for repeated measurements, resulting in bias (± SD) and 95% limits of agreement (bias ± SD × 1. 96)  [9]. An error grid analysis for comparison of arterial pressure method comparison studies was performed  [10].
Results Within the study period 33 patients with simultaneous invasive and noninvasive blood pressure measurement who had a mean arterial pressure below 60 mmHg were admitted to the emergency department. Figure  1  shows a flow chart of patient inclusion. 30 patients were included in the final analysis. Body mass index was available for 27 patients. Results of blood gas analysis and lactate levels were available for 29 patients. Table  1  shows patients' characteristics. Invasive blood pressure was measured in 19 (63%) cases in the radial artery, in 9 (30%) in the femoral and in 2 (7%) in the brachial artery. Seventy-seven simultaneous invasive and noninvasive measurements were recorded during hypotension. After screening for artefacts and excluding these values, 75 data sets of blood pressure measurement were analyzed.
Discussion We aimed to investigate the reliability of blood pressure measurement using an oscillometric device in unstable emergency patients. Our data show that it is not possible to reliably detect hypotension in the majority of patients with shock using the tested noninvasive oscillometric device. In our hypotensive patient cohort, oscillometric measurements provided values of mean arterial pressure that were on average 13 mmHg higher than values obtained by invasive blood pressure measurement, which is considered the reference standard. This finding is in accordance with other results investigating oscillometric determination of blood pressure retrospectively  [2, 13]. Wax and colleagues analysed simultaneous blood pressure data of 15,310 patients perioperatively  [2]. They described a relevant overestimation of hypotensive values by the oscillometric device  [2].
For severe hypotension linked to shock specific algorithms with higher accuracy are mandatory. To study the generalisability of our findings in hypotension for all oscillometric devices, a larger multicentre trial investigating different devices is needed. The strength of our study is the prospective approach of an emergency patient cohort suffering from shock. Data of patients in profound shock are difficult to obtain as therapeutic efforts must be made immediately in this critical state. In addition, we studied all patients in the supine position and checked for adequate positioning of pressure transducer and cuff at the mid-chest level. Another strength is that we only analysed data pairs in true hypotensive state that were not affected by artefacts. Finally, invasive arterial measurements were used as reference method which is regarded as gold standard in other critical conditions such as cardiac surgery or critical care medicine.
This paper presents an automatic speaker identification and speech recognition for Arabic digits in noisy environment. In this work, the proposed system is able to identify the speaker after saving his voice in the database and adding noise. The mel frequency cepstral coefficients (MFCC) is the best approach used in building a program in the Matlab platform; also, the quantization is used for generating the codebooks. The Gaussian mixture modelling (GMM) algorithms are used to generate template, feature-matching purpose. In this paper, we have proposed a system based on MFCC-GMM and MFCC-VQ approaches on the one hand and by using the hybrid approach MFCC-VQ-GMM on the other hand for speaker modeling. The white Gaussian noise is added to the clean speech at several signal-to-noise ratio (SNR) levels to test the system in a noisy environment.
Speaker verification, on the other hand, is the process of accepting or rejecting the identity claim of a speaker. This technique makes the speaker verify their identity and control such as security control, telephone shopping, access services to the voice mail, database access services and remote access to computers  [4]. An ASR system involves two phases: the training phase and the testing phase. At the training phase, the parameters of the classification model are estimated using a large number of training data. The extraction of features is done from all speech signals using various feature extraction techniques such as MFCC, LPC, LDA, RASTA, etc  [1, 3, 5]. These features are in the form of vectors is stored in reference models, in particular, the acoustic model, which is used to characterize that word using the classification algorithm in the testing phase  [5].
This system can recognize and respond to digits' speech inputs and compare an unknown speaker's speech against a database of N known speakers. The best match is returned as the identified speaker and the digit is spoken. -The problem: The Arabic language is among the most spoken languages in the world with around 300 million native speakers. However, compared to other languages, the research is still poor in Arabic speech recognition, especially in a noisy environment. The presence of background noise, as well as the diversity of Arabic dialects, are considered challenges for Arabic speech recognition. Studying Moroccan Arabic, which is very difficult, which is even challenging in the orthographic rules, the multiple accents and vocabulary according to the regions of Morocco. -The proposed solution: To contribute to developing Arabic speech recognition systems, we built two systems in one.
The first for speaker identification and the second for Arabic spoken digits with AWGN background noise. Wherefore, we propose the hybrid GMM-VQ model along with MFCC as a feature extraction technique. Here VQ was used for training data and for speaker identification then the GMM for recognition. The efficacy of the proposed method is observed while performing different experiments and compared to earlier work. The database for this work has been built using 100 male and female speakers, the vocabulary consists of 10 words representing the Arabic spoken digits from 0 to 9. MFCC technique has been used to extract the features and GMM, VQ, GMM-VQ models have been used for recognition. The system is tested by using test data spoken by 15 speakers and achieves an overall word-accuracy of 98. 33% in clean condition using GMM+VQ.
Testing phase In the testing phase, the system checks that the speaker's input speech is similar at that which is stored in the reference. Therefore, the system can identify the person who is speaking and the digit that saying. During this phase, 450 voice samples are recorded by 10 male voices and 5 female voices chosen from our database. These clean test data is then mixed with white Gaussian noise (AWGN) with different levels of SNRs (5, 10, 15, 20 dB). The codebook vectors are developed using the proposed VQ-GMM approach from a specific speaker's voice. Then, they will be compared with the reference models obtained in the training phase.