Achieving Information Security by multi-Modal Iris-Retina Biometric Approach Using Improved Mask R-CNN

The need for reliable user recognition (identification/authentication) techniques has grown in response to heightened security concerns and accelerated advances in networking, communication, and mobility. Biometrics, defined as the science of recognizing an individual based on his or her physical or behavioral characteristics, is gaining recognition as a method for determining an individual\u27s identity. Various commercial, civilian, and forensic applications now use biometric systems to establish identity. The purpose of this paper is to design an efficient multimodal biometric system based on iris and retinal features to assure accurate human recognition and improve the accuracy of recognition using deep learning techniques. Deep learning models were tested using retinographies and iris images acquired from the MESSIDOR and CASIA-IrisV1 databases for the same person. The Iris region was segmented from the image using the custom Mask R-CNN method, and the unique blood vessels were segmented from retinal images of the same person using principal curvature. Then, in order to aid precise recognition, they optimally extract significant information from the segmented images of the iris and retina. The suggested model attained 98% accuracy, 98.1% recall, and 98.1% precision. It has been discovered that using a custom Mask R-CNN approach on Iris-Retina images improves efficiency and accuracy in person recognition

Correction of anterior hypospadias without urethroplasty: glanular rotation procedure (the Hay technique)

Objectives: The aim was to present a simple technique for the correction of anterior hypospadiases without meatal advancement or urethroplasty.Background: Most of the techniques described for the correction of anterior hypospadias had the risk of complications: recession, flaying of the glans, fistula, and meatal stenosis that is not accepted when dealing with a trivial anomaly that is done only for cosmetic correction. A simple technique for correcting granular and some forms of coronal hypospadias without meatal advancement or urethroplasty is presented.Patients and methods: From June 2013 to June 2016, 183 patients presented for surgical repair of glanular or coronal hypospadias. The technique of glanular rotation procedure (GRP) was applied only for those cases that matched the criteria settled after degloving of the penis with an incision made 2mm proximal to the meatus touching the glans on both sides for 3–4 mm. Once the uppermost part of the meatus is at the same line with the upper end of the glans on both sides, the technique is applicable. The patients were followed in the OPD for 1 year after the repair for the evaluation of the results of the technique: the urinary stream, meatal size and position, presence of fistula, and the final cosmetic appearance.Results: Ninety-eight out of 183 (53.6%) boys had matched the criteria for application of the GRP technique. Their age ranged from 6 months to 3 years. All but three had an apical, slit-like meatus with good stream without stenosis and 2–3mm glans tissue encircling the ventral side of the meatus. Four cases had complications in the form of meatal stenosis in two cases, disruption of the glans in one case, and coronal fistula in one case. The overall complication rate was 4.1%.Conclusion: In properly selected cases, GRP is a simple efficient technique that has the advantage of reconstructing the glans over the urethra without the need of meatal advancement or urethroplasty.Keywords: coronal hypospadias, glanular hypospadias, without urethroplast

Electrical properties of organic light emitting diodes with post fabrication heat and electric field treatments

The current work presents post-fabrication heat treatment and a combined external electric field-heat post-fabrication treatments for organic light emitting diodes (OLEDs). The devices were fabricated in the same run with a standard device without annealing for comparison, with an identical structure of ITO/PVK/Rhodamine B/Pb. After depositing the Rhodamine B layer on the PVK film, the samples were thermally annealed at different temperatures before depositing Pb. Some of the samples were thermally annealed without any external electric field while others were treated by an external electric field during heating. It is found that the annealing temperature of PVK/Rhodamine B layers increases the turn-on voltage of the device. On the other hand, in the electric field-heat treatment, the turn-on voltage is observed to decrease and the maximum current density of the device is dramatically enhanced

Dietary Supplementation of Nile Tilapia (Oreochromis niloticus) With Panax ginseng Essential Oil: Positive Impact on Animal Health and Productive Performance, and Mitigating Effects on Atrazine-Induced Toxicity

The present study assessed the impact of Panax ginseng essential oil (GEO) supplementation on physiological parameters related to productive performance and health status in Nile tilapia reared under standard conditions and exposed to a sub-lethal atrazine (ATZ) concentration. Fish were allocated into 6 groups: the control group was reared in clean water and fed with a commercial basal diet (CNT), two groups were fed with the basal diet supplemented with two different levels of GEO (GEO1 and GEO2, respectively), one group was intoxicated with 1/5 of ATZ 96-h lethal concentration 50 (1.39 mg/L) (ATZ group), and the remaining two groups were fed with the GEO-supplemented diets and concurrently exposed to 1.39 mg ATZ/L (GEO1+ATZ and GEO2+ATZ, respectively). The experiment lasted for 60 days. GEO supplementation exerted a significantly positive influence on fish growth, feed utilization, and hepatic antioxidant defense systems at both levels of supplementation. ATZ exposure significantly reduced fish survival rates and impaired fish growth and feed utilization, with the lowest final weights, weight gain, total feed intake, and the highest feed conversion ratio being recorded in the ATZ-intoxicated group. ATZ exposure caused significant changes in intestinal digestive enzyme activity (decreased lipase activity), hematological indices (decreased hemoglobin, packed cell volume, erythrocytes, and leukocytes), blood biochemical variables (decreased total proteins, albumin, globulins, and immunoglobulin M; increased total cholesterol, triglycerides, and cortisol), and hepatic oxidative/antioxidant indices (decreased glutathione level, superoxide dismutase and catalase enzyme activity and mRNA expression levels, and increased malondialdehyde content). Moreover, in the hepatic tissue of ATZ-intoxicated Nile tilapia, histopathological alterations and upregulated mRNA expression levels of stress- and apoptosis-related genes (Hsp70, caspase 3, and p53) were observed. GEO supplementation in ATZ-treated groups significantly attenuated the aforementioned negative effects, though some parameters did not reach the CNT values. These findings provide further and partly new evidence that sub-lethal ATZ toxicity induces reduced survivability, growth retardation, impaired digestive function, anemia, immunosuppression, hepatic oxidative stress damage, and overall increased stress level in Nile tilapia, and suggest that GEO supplementation may be useful for mitigating this toxicity and provide more general support to the productive performance and health status of this fish species

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone