CCGN: Centralized collaborative graphical transformer multi-agent reinforcement learning for multi-intersection signal free-corridor.

Tackling traffic signal control through multi-agent reinforcement learning is a widely-employed approach. However, current state-of-the-art models have drawbacks: intersections optimize their own local rewards and cause traffic to waste time and fuel with a start-stop mode at each intersection. They also lack information sharing among intersections and their specialized policy hinders the ability to adapt to new traffic scenarios. To overcome these limitations, This work presents a centralized collaborative graph network (CCGN) with the core objective of a signal-free corridor once the traffic flows have waited at the entry intersection of the traffic intersection network on either side, the subsequent intersection gives the open signal as the traffic flows arrive. CCGN combines local policy networks (LPN) and global policy networks, where LPN employed at each intersection predicts actions based on Transformer and Graph Convolutional Network (GCN). In contrast, GPN is based on GCN and Q-network that receives the LPN states, traffic flow and road information to manage intersections to provide a signal-free corridor. We developed the Deep Graph Convolution Q-Network (DGCQ) by combining Deep Q-Network (DQN) and GCN to achieve a signal-free corridor. DGCQ leverages GCN's intersection collaboration and DQN's information aggregation for traffic control decisions Proposed CCGN model is trained on the robust synthetic traffic network and evaluated on the real-world traffic networks that outperform the other state-of-the-art models.

Does Heart Failure Mask Candida Tricuspid Endocarditis?

Infective endocarditis (IE) carries high morbidity and mortality. Although minimal in incidence, fungal causes (mostly Candida species) carry the highest mortality among all cases of infective endocarditis. We describe a rare case of a 47-year-old male with a past medical history of cerebral vascular accident (CVA), heart failure with reduced ejection fraction status post (SP) automated implantable cardioverter defibrillator (AICD) placement, paroxysmal atrial fibrillation, coronary artery disease (CAD), infective endocarditis with mitral valve replacement and tricuspid valve replacement, and pulmonary hypertension who presented to the emergency department (ED) with complaints of shortness of breath and weakness for four days. The patient was admitted to the cardiac care unit (CCU) due to persistent hypotension despite being on a continuous milrinone drip at home. The patient was initially started on antimicrobial agents for sepsis most likely secondary to pneumonia. Echocardiographic imaging showed a large vegetation on the tricuspid valve; hence, blood cultures were sent and came back positive for Candida sp. Appropriate antifungals (micafungin) were added to the medication regimen, and the patient was transferred to a tertiary hospital for surgical intervention. Patients with bioprosthetic valve replacement require regular follow-ups as this would allow providers to catch symptoms of developing endocarditis and prevent disease progression. These appointments may also decrease other risk factors for the disease, including but not limited to infected lines.

A Rare Case of Intravenously Managed Hypertensive Emergency Arising from a Perirenal Hematoma Subsequent to a Native Kidney Biopsy.

Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter, the subcapsular region surrounding the renal tissue may cause blanket compression, leading to the activation of the renin-angiotensin-aldosterone system secondary to renal hypoperfusion. While most cases of Page kidney are secondary to blunt trauma to the costovertebral angle, herein we present a case of Page kidney due to renal parenchymal core needle biopsy. The rarity of our case is not due to the cause of such an incidence but because our case resulted in a hypertensive emergency treated with dual intravenous infusions.