Creating a Perioperative Glycemic Control Program

Hyperglycemia in the surgical population is a recognized risk factor for postoperative complications; however, there is little literature to date regarding the management of hyperglycemia in the perioperative period. Here, we detail the strategies that our institutions have employed to identify and treat hyperglycemia in patients with diabetes who present for surgery. Our approach focuses on the recognition of hyperglycemia and metabolic abnormalities, control of glucose levels via insulin infusion when needed, monitoring for hypoglycemia and a comprehensive multidisciplinary approach that provides standardized recommendations for patients at all points in care as they transition from the preoperative clinic into the operating room, and then into the hospital

Impact of Sensor Networks on Aquatic Biodiversity in Wetland: An Innovative Approach

Aquatic biodiversity is in the central field of environmental conservation issues in a wetland. Yet it determinately faced aquatic conservation authorities the loss of biodiversity as a very important global issue for several years due to misuse wireless sensor technology. The study attempts to re-look at the sensor networks that affect the aquatic biodiversity within and around the Tanguar Haor- wetland study at Sunamganj district in Bangladesh. Key aquatic conservation tools provided at the Tanguar Haor and its challenges with gaps in policies for wetland management practices are highlighted. The study shows the aquatic biodiversity-related rules and regulations amended were apex in Bangladesh from 2010 to 2018. The study represents the impact of processed sensor networks on aquatic biodiversity in a wetland to be compared to larger, medium, and smaller animals in a bright, dark and optimum environment, facilitating the design and misuse of wireless sensor networks within GPS locations. Approximately 64% of the respondents agreed on the development of aquatic biodiversity for managing the wetland at Sunamganj with secure peripheral sensor networks. The research also found that the Tanguar Haor is at risk due to misuse of wireless sensor networks compared to other wetlands in the Sylhet Division. Scientific knowledge is indispensable in wetland resource management but it poorly identified such knowledge while various performances are still below par. The research is unique and represents the innovative idea to improve the existing wetland policy linking with the appropriateness for the Ramsar Wetland Conservation Strateg

Do Islamic indices provide diversification to bitcoin? A time-varying copulas and value at risk application

This is an accepted manuscript of an article published by Elsevier in Pacific-Basin Finance Journal on 08/04/2020, available online: https://doi.org/10.1016/j.pacfin.2020.101326 The accepted version of the publication may differ from the final published version.© 2020 The emergence of new asset classes offers avenues to international investment community however understanding relationship between any two assets in a single portfolio is important. We investigate the risk dependence between daily Bitcoin and major Islamic equity markets spanning over from July 2010 to March 2018. We start by examining long memory properties of Bitcoin and sampled Islamic indices and report significant results. The residuals from fractionally integrated models are then used in bivariate time invariant and time varying copulas to investigate dependence structure. Among all Islamic indices, DJIUK, DJIJP and DJICA exhibit time varying dependence with Bitcoin. In addition, we apply VaR, CoVaR and ΔCoVaR as risk measure to examine spillover between Bitcoin and Islamic equity markets. VaR of Bitcoin exceeds from VaR of Islamic indices and CoVaR of both Islamic and Bitcoin exceeds their respective VaR, suggesting presence of risk spillover between each other. Our results also report asymmetry between downside and upside ΔCoVaR suggesting implications for investors with different risk preferences. Finally, the diversification benefits indicate that Islamic equity market serves as an effective hedge in a portfolio along with Bitcoin.Accepted versio

Safety of 4-factor prothrombin complex concentrate (4F-PCC) for emergent reversal of factor Xa inhibitors

Abstract Background Although factor Xa inhibitors have become a popular choice for chronic oral anticoagulation, effective drug reversal remains difficult due to a lack of specific antidote. Currently, 4-factor prothrombin complex concentrate (4F-PCC) is considered the treatment of choice for factor Xa inhibitor-related major bleeding. However, safety of 4F-PCC and its risk of thrombosis when used for this off-label purpose remain unclear. The purpose of this retrospective study is to determine the rate of thromboembolism when 4F-PCC is used for the emergent reversal of factor Xa inhibitors. Methods We conducted a single-center retrospective review of medical records between 2013 and 2017. Patients were included if they received 4F-PCC to reverse rivaroxaban, apixaban, or edoxaban for emergent invasive procedures or during episodes of major bleeding defined as bleeding with hemodynamic instability, fall in hemoglobin of 2 g/dL, or bleeding requiring blood transfusion. Thrombotic events including myocardial infarction, pulmonary embolism, deep vein thrombosis, cerebral vascular accident, and arterial thrombosis of the limb or mesentery were recorded if they occurred within 14 days of 4F-PCC administration. Data was analyzed using point and interval estimation to approximate the rate and confidence interval of thromboembolic events. Results Forty-three patients were identified in our review. Doses of 4F-PCC were determined by the treating physician and mainly ranged from 25 to 50 IU/kg. Twenty-two patients (51.2%) received both sequential compression devices (SCDs) and subcutaneous heparin for DVT prophylaxis. Twenty-one patients (48.8%) were placed on SCDs only. Three patients received concomitant FFP. Thrombotic events within 14 days of 4F-PCC administration occurred in 1 out of 43 patients (2.1%, 95% CI [0.1–12.3]). This thrombotic event was an upper extremity DVT which occurred 1 day after the patient received 1325 IU (25 IU/kg) of 4F-PCC to reverse rivaroxaban for traumatic intracranial hemorrhage. The patient was taken for emergent decompressive craniotomy after rivaroxaban reversal. In patients who did not undergo surgery or who underwent minor invasive procedures, no thrombotic events were noted. Conclusion Based on our preliminary data, the thromboembolic rate of 4F-PCC when given at a dose of 25–50 IU/kg to emergently reverse rivaroxaban and apixaban appears acceptable. Since many patients who require 4F-PCC to emergently reverse factor Xa inhibitors will be at high risk of developing thrombotic events, practitioners should be highly vigilant of these complications. Large, multicenter prospective trials are needed to further determine this risk

Initial response in HRI - a case study on evaluation of child with autism spectrum disorders interacting with a humanoid robot NAO.

The evolution of human-robot interaction (HRI) is now expanding its wings to aid children with Autism Spectrum Disorders (ASD) in areas of socialization, communication and playful behavior through robot-based intervention. Herein we present our holistic, longstanding goal to contribute to the lives of children with ASD; who suffer a lifelong developmental disability. The purpose of this paper is to elaborate on a case study in our pilot experiment where a child with ASD is exposed to the humanoid robot NAO in order to gauge his initial response and behavior in the presence of a robot. NAO robot is the chosen robotic agent as it is a commercially available humanoid with simpler in appearance compared to real humans, thus appears more approachable to children with ASD. The pilot procedures involve the robot executing basic, simple components of interaction through a series of 5 different modules. In this study, the principal results show that the basic HRI carried out by the robot is able to suppress the child’s autistic behavior during the child-robot interaction. Also, more eye contact is observed between the child and robot compared to the child with his teacher during regular class session. Relating this to the child’s IQ which falls in the moderate category, it is suggested that children with ASD in the same IQ group will be receptive to robot-based intervention even in the first interaction session. Hence, it can be concluded that the humanoid robot NAO has potential to serve as a platform to support and initiate interaction in children with ASD

Humanoid robot NAO interacting with autistic children of moderately impaired intelligence to augment communication skills

This report presents the findings from our pilot study on the initial behavior of autistic children of moderately impaired intelligence when exposed to simple human-robot interaction (HRI) modules executed by a humanoid robot NAO. All 5 children have been specifically assessed using the Autism Diagnostic Observation Schedule (ADOS) and their diagnosis is classified as autistic disorder. We hypothesize that NAO’s human-like appearance, its capability to blink its eyes, speak and play music; coupled with the simplicity of the HRI modules will be able to entice the children’s interest to engage in communication. Hence, this would significantly reduce the children’s autistic characteristics in communication behavior compared to the usual class setting. In this study, the principal result shows that 4 out of the 5 children exhibited a decrease of autistic behavior (in communication subscale) when the robot is executing HRI modules during the single session of child-robot interaction. This promising outcome indicates that the NAO robot were able to attract the children’s attention, keep each child engaged with the robot during interaction and hence give positive impact to the children’s communication behavior. Relating this to the children’s FSIQ, it can be deducted that autistic children with FSIQ of moderately impaired (from 40-54) are receptive to robotbased intervention. This is again showed by the lower autistic traits observed during the HRI modules compared to in-class setting. Overall, this research suggests that autistic children of moderately impaired intelligence show good response to robot-based intervention. This finding is crucial to form a solid foundation and proof on the positive utilization of the humanoid robot NAO for the children affected by autism

Initial response of autistic children in human-robot interaction therapy with humanoid robot NAO

The overall context proposed in this paper is part of our long-standing goal to contribute to a group of community that suffers from Autism Spectrum Disorder (ASD); a lifelong developmental disability. The objective of this paper is to present the development of our pilot experiment protocol where children with ASD will be exposed to the humanoid robot NAO. This fully programmable humanoid offers an ideal research platform for human-robot interaction (HRI). This study serves as the platform for fundamental investigation to observe the initial response and behavior of the children in the said environment. The system utilizes external cameras, besides the robot’s own visual system. Anticipated results are the real initial response and reaction of ASD children during the HRI with the humanoid robot. This shall leads to adaptation of new procedures in ASD therapy based on HRI, especially for a non-technical-expert person to be involved in the robotics intervention during the therapy session

Variation in propofol induction doses administered to surgical patients over age 65

Background/ObjectivesAdvanced age is associated with increased susceptibility to acute adverse effects of propofol. The present study aimed to describe patterns of propofol dosing for induction of general anesthesia before endotracheal intubation in a nationwide sample of older adults presenting for surgery.DesignRetrospective observational study using the Multicenter Perioperative Outcomes Group data set.SettingThirty‐six institutions across the United States.ParticipantsA total of 350,766 patients aged over 65 years who received propofol for general anesthetic induction and endotracheal intubation between 2014 and 2018.InterventionNone.MeasurementsTotal induction bolus dose of propofol administered.ResultsThe mean (SD) weight‐adjusted propofol dose was 1.7 (0.6) mg/kg. The mean prevalent propofol induction dose exceeded the upper bound of what has been described as the typical geriatric dose requirement across every age category examined. The percent of patients receiving propofol induction doses above the described typical geriatric range was 64.8% (95% CI 64.6–65.0), varying from 73.8% among patients aged 65–69 to 45.8% among patients aged 80 and older.ConclusionThe present study of a large multicenter cohort demonstrates that prevalent propofol dosing commonly falls above the published typically required dose range for patients aged ≥65 in nationwide anesthetic practice. Widespread variability in induction dose administration remains incompletely explained by known patient variables. The nature and clinical consequences of these unexplained dosing decisions remain important topics for further study. Observed discordance between expected and actual induction dosing raises the question of whether there should be reconsideration of widespread provider practice or, alternatively, whether what is published as the typical propofol induction dose range should be revisited.See related editorial by Devinney et al. in this issue.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169351/1/jgs17139_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169351/2/jgs17139-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169351/3/jgs17139.pd