Ruptured gallbladder as the first presentation of breast cancer

<p>Abstract</p> <p>Background</p> <p>Perforation of the gall bladder as a first presentation of breast cancer has not been reported.</p> <p>Case presentation</p> <p>Here we present a case of an elderly lady with acute abdomen with evidence of possible perforation of gall bladder on CT scan. Histopathology of the cholecystectomy specimen revealed invasive lobular breast cancer.</p> <p>Her metastatic breast cancer with right sided primary discovered subsequent to her presentation with acute abdomen is managed successfully with Anastrozole.</p> <p>Conclusion</p> <p>We present a rare case of gall bladder perforation from metastatic breast cancer.</p

Two-Step Active Learning for Instance Segmentation with Uncertainty and Diversity Sampling

Training high-quality instance segmentation models requires an abundance of labeled images with instance masks and classifications, which is often expensive to procure. Active learning addresses this challenge by striving for optimum performance with minimal labeling cost by selecting the most informative and representative images for labeling. Despite its potential, active learning has been less explored in instance segmentation compared to other tasks like image classification, which require less labeling. In this study, we propose a post-hoc active learning algorithm that integrates uncertainty-based sampling with diversity-based sampling. Our proposed algorithm is not only simple and easy to implement, but it also delivers superior performance on various datasets. Its practical application is demonstrated on a real-world overhead imagery dataset, where it increases the labeling efficiency fivefold.Comment: UNCV ICCV 202

Cluster trajectory of SOFA score in predicting mortality in sepsis

Objective: Sepsis is a life-threatening condition. Sequential Organ Failure Assessment (SOFA) score is commonly used to assess organ dysfunction and predict ICU mortality, but it is taken as a static measurement and fails to capture dynamic changes. This study aims to investigate the relationship between dynamic changes in SOFA scores over the first 72 hours of ICU admission and patient outcomes. Design, setting, and participants: 3,253 patients in the Medical Information Mart for Intensive Care IV database who met the sepsis-3 criteria and were admitted from the emergency department with at least 72 hours of ICU admission and full-active resuscitation status were analysed. Group-based trajectory modelling with dynamic time warping and k-means clustering identified distinct trajectory patterns in dynamic SOFA scores. They were subsequently compared using Python. Main outcome measures: Outcomes including hospital and ICU mortality, length of stay in hospital and ICU, and readmission during hospital stay, were collected. Discharge time from ICU to wards and cut-offs at 7-day and 14-day were taken. Results: Four clusters were identified: A (consistently low SOFA scores), B (rapid increase followed by a decline in SOFA scores), C (higher baseline scores with gradual improvement), and D (persistently elevated scores). Cluster D had the longest ICU and hospital stays, highest ICU and hospital mortality. Discharge rates from ICU were similar for Clusters A and B, while Cluster C had initially comparable rates but a slower transition to ward. Conclusion: Monitoring dynamic changes in SOFA score is valuable for assessing sepsis severity and treatment responsiveness.Comment: 26 pages, 4 figures, 2 table

Theoretical Basis and Application for Measuring Pork Loin Drip Loss Using Microwave Spectroscopy

During cutting and processing of meat, the loss of water is critical in determining both product quality and value. From the point of slaughter until packaging, water is lost due to the hanging, movement, handling, and cutting of the carcass, with every 1% of lost water having the potential to cost a large meat processing plant somewhere in the region of  50,000 per day. Currently the options for monitoring the loss of water from meat, or determining its drip loss, are limited to destructive tests which take 24–72 h to complete. This paper presents results from work which has led to the development of a novel microwave cavity sensor capable of providing an indication of drip loss within 6 min, while demonstrating good correlation with the well-known EZ-Driploss method (R2 = 0.896)

Development and Testing of Retrieval Augmented Generation in Large Language Models -- A Case Study Report

Purpose: Large Language Models (LLMs) hold significant promise for medical applications. Retrieval Augmented Generation (RAG) emerges as a promising approach for customizing domain knowledge in LLMs. This case study presents the development and evaluation of an LLM-RAG pipeline tailored for healthcare, focusing specifically on preoperative medicine. Methods: We developed an LLM-RAG model using 35 preoperative guidelines and tested it against human-generated responses, with a total of 1260 responses evaluated. The RAG process involved converting clinical documents into text using Python-based frameworks like LangChain and Llamaindex, and processing these texts into chunks for embedding and retrieval. Vector storage techniques and selected embedding models to optimize data retrieval, using Pinecone for vector storage with a dimensionality of 1536 and cosine similarity for loss metrics. Human-generated answers, provided by junior doctors, were used as a comparison. Results: The LLM-RAG model generated answers within an average of 15-20 seconds, significantly faster than the 10 minutes typically required by humans. Among the basic LLMs, GPT4.0 exhibited the best accuracy of 80.1%. This accuracy was further increased to 91.4% when the model was enhanced with RAG. Compared to the human-generated instructions, which had an accuracy of 86.3%, the performance of the GPT4.0 RAG model demonstrated non-inferiority (p=0.610). Conclusions: In this case study, we demonstrated a LLM-RAG model for healthcare implementation. The pipeline shows the advantages of grounded knowledge, upgradability, and scalability as important aspects of healthcare LLM deployment.Comment: N

The Hong Kong Statement on Practice Research 2017 : Contexts and Challenges of the Far East

This statement on social work practice research highlights the contributions of scholars, practitioners, and conference participants in the Fourth International Conference on Practice Research (ICPR) in 2017, hosted by The Hong Kong Polytechnic University in May 2017. It focuses on the contexts and challenges of carrying out practice research in the Far East and beyond as well as raises pertinent questions about the development of practice research. It begins with a brief description of the context of social work practice research in the Far East. The second part explores the organizational and community contexts and challenges of practice research with special attention to the perspectives of practitioners. It concludes with reviewing some of the continuing challenges that will guide the program planning for the Fifth ICPR in 2020 in Melbourne, Australia, located at the crossroads between East and West.Peer reviewe

REMOVAL OF BASIC BLUE 3 AND REACTIVE ORANGE 16 BY ADSORPTION ONTO QUARTENIZED SUGAR CANE BAGASSE

Abstract The effectiveness of using sugar cane bagasse, an agricultural by-product, as a sorbent to remove basic and reactive dyes from aqueous solution was studied. The quartenized sugar cane bagasse (QSB) is capable in removing both Basic Blue 3 (BB3) and Reactive Orange 16 (RO16). The sorption of dye solutions was strongly affected by pH, where the optimum pH is 6-8. The kinetics of the dye sorption processes fitted a pseudo-second order kinetic model. Results indicated that the adsorption isotherms fitted well into both the Langmuir and Freundlich isotherms. The removal of BB3 was favourable at higher temperature, indicating that the sorption process was endothermic. On the other hand, sorption of RO16 on QSB was more favourable at low temperature. Keywords: Sugar cane bagasse; quartenization; sorption; reactive dyes; basic dyes Abstrak Keberkesanan menggunakan sisa tebu, produk sampingan pertanian, sebagai penjerap untuk menyingkirkan pewarna basik dan reaktif daripada larutan telah dikaji. Sisa tebu yang diquarternasi (QSB) adalah berupaya untuk menyingkirkan keduadua pewarna Basik Biru 3 (BB3) dan Reaktif Oren 16 (RO16). Penjerapan pewarna adalah dipengaruhi oleh pH, di mana pH optimum ialah 6-8. Kinetik proses erapan pewarna didapati mengikut model kinetik tertib pseudo-kedua. Keputusan eksperimen menunjukkan bahawa isoterma penjerapan mematuhi kedua-dua isoterma Langmuir dan Freundlich. Penyingkiran BB3 adalah lebih baik pada suhu tinggi, menunjukkan proses erapan adalah endotermik. Manakala erapan RO16 ke atas QSB adalah lebih digemari pada suhu rendah

Thermal modelling of gas generation and retention in the Jurassic organic-rich intervals in the Darquain field, Abadan Plain, SW Iran

The petroleum system with Jurassic source rocks is an important part of the hydrocarbons discovered in the Middle East. Limited studies have been done on the Jurassic intervals in the 26,500 km2 Abadan Plain in south-west Iran, mainly due to the deep burial and a limited number of wells that reach the basal Jurassic successions. The goal of this study was to evaluate the Jurassic organic-rich intervals and shale gas play in the Darquain field using organic geochemistry, organic petrography, biomarker analysis, and basin modelling methods. This study showed that organic-rich zones present in the Jurassic intervals of Darquain field could be sources of conventional and unconventional gas reserves. The organic matter content of samples from the organic-rich zones corresponds to medium-to-high-sulphur kerogen Type II-S marine origin. The biomarker characteristics of organic-rich zones indicate carbonate source rocks that contain marine organic matter. The biomarker results also suggest a marine environment with reducing conditions for the source rocks. The constructed thermal model for four pseudo-wells indicates that, in the kitchen area of the Jurassic gas reserve, methane has been generated in the Sargelu and Neyriz source rocks from Early Cretaceous to recent times and the transformation ratio of organic matter is more than 97%. These organic-rich zones with high initial total organic carbon (TOC) are in the gas maturity stage [1.5–2.2% vitrinite reflectance in oil (Ro)] and could be good unconventional gas reserves and gas source rocks. The model also indicates that there is a huge quantity of retained gas within the Jurassic organic-rich intervals

The development of a 16S rRNA gene based PCR for the identification of Streptococcus pneumoniae and comparison with four other species specific PCR assays

<p>Abstract</p> <p>Background</p> <p><it>Streptococcus pneumoniae </it>is one of the most frequently encountered pathogens in humans but its differentiation from closely related but less pathogenic streptococci remains a challenge.</p> <p>Methods</p> <p>This report describes a newly-developed PCR assay (Spne-PCR), amplifying a 217 bp product of the 16S rRNA gene of <it>S. pneumoniae</it>, and its performance compared to other genotypic and phenotypic tests.</p> <p>Results</p> <p>The new PCR assay designed in this study, proved to be specific at 57°C for <it>S. pneumoniae</it>, not amplifying <it>S. pseudopneumoniae </it>or any other streptococcal strain or any strains from other upper airway pathogenic species. PCR assays (psaA, LytA, ply, spn9802-PCR) were previously described for the specific amplification of <it>S. pneumoniae</it>, but <it>psaA</it>-PCR was the only one found not to cross-react with <it>S. pseudopneumoniae</it>.</p> <p>Conclusion</p> <p>Spne-PCR, developed for this study, and psaA-PCR were the only two assays which did not mis-identify <it>S. pseudopneumoniae </it>as <it>S. pneumoniae</it>. Four other PCR assays and the AccuProbe assay were unable to distinguish between these species.</p

Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh

© 2018 The Author(s). Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful