A case of missed thoracic fracture masquerading as intra-abdominal injury

Altered mental status in the setting of polytrauma poses a challenge to the emergency team managing the patient. The tendency to miss positive findings in these circumstances increases several folds due to multiple factors such as depressed mental status/intoxication, presence of distracting injuries and concurrent life-threatening injuries that require more urgent attention. In view of this, NEXUS (National Emergency X-Radiography Utilization Study) criteria of clearing the cervical spine was adopted and used worldwide. Consensus on clearance of the other parts of spine is still lacking. This case reports highlights the findings in a 18-yrs-old male who presented with altered mental status, facial pain and abrasion, following a motor vehicle accident. Facial bone fracture was diagnosed and he was discharged. Three days later, he came with severe epigastric pain. Tenderness on palpation was noted at the spine and Computed Tomography (CT) scan was done. Multiple thoracic vertebra fractures were seen. As a conclusion, thorough primary and secondary survey should be done in patients who have regained full consciousness prior to discharge in order to avoid overlooking other serious injuries

The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model

As maladaptive disgust responses are linked to mental health problems, and cancer patients may experience heightened disgust as a result of treatments they receive, we explored the associations between disgust-related side-effects and symptoms of depression and anxiety in people treated for cancer. One hundred and thirty two (83 women, Mage = 57.48 years) participants answered questions about their treatments, side-effects, disgust responding, and mental health. Experiencing bowel and/or bladder problems, sickness and/or nausea (referred to here as “core” disgust-related side-effects) was significantly related to greater symptoms of depression and borderline increased anxiety. Further, these links were explained by a moderated mediation model, whereby the effects of core disgust side-effects on depression and anxiety were mediated by (physical and behavioural) self-directed disgust, and disgust propensity moderated the effect of core disgust side-effects on self-disgust. These findings stress the importance of emotional responses, like disgust, in psychological adaptation to the side-effects of cancer treatments

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Anterior penetrating chest injury with left ventricular thrombus.

Urban cities are synonym with a high incidence of penetrating chest injuries either from accidents or interpersonal violence. The outcome of penetrating chest wound can vary from immediate death to a prolonged morbidity. We here report a case of 39-year-gentleman who presented to Emergency Department Hospital Raja Permaisuri Bainun, Ipoh, Perak after being stabbed to the chest. His anterior penetrating chest wound was located at the 5th intercostal space medial to the midclavicular line. The stab wound penetrated the myocardium, causing minimal myocardial rupture. He also suffered from left haemothorax and hemopericardium. The haemothorax was drained with insertion of 32 French chest tube. The patient was admitted under the cardiothoracic team and discharged five days later without surgical intervention. He presented again to the Emergency Department with complains of shortness of breath and pleuritic pain. A left ventricular thrombus was detected via echocardiography. Unfortunately, he took his own discharge. Five days later he came again to Emergency Department with sporadic of loss of vision. The mural thrombus dislodged and embolized to the retinal artery causing amaurosis fugax. The patient was treated with aspirin 150mg and his symptoms subsequently resolved

Deep Learning in Controlled Environment Agriculture: A Review of Recent Advancements, Challenges and Prospects

Controlled environment agriculture (CEA) is an unconventional production system that is resource efficient, uses less space, and produces higher yields. Deep learning (DL) has recently been introduced in CEA for different applications including crop monitoring, detecting biotic and abiotic stresses, irrigation, microclimate prediction, energy efficient controls, and crop growth prediction. However, no review study assess DL’s state of the art to solve diverse problems in CEA. To fill this gap, we systematically reviewed DL methods applied to CEA. The review framework was established by following a series of inclusion and exclusion criteria. After extensive screening, we reviewed a total of 72 studies to extract the useful information. The key contributions of this article are the following: an overview of DL applications in different CEA facilities, including greenhouse, plant factory, and vertical farm, is presented. We found that majority of the studies are focused on DL applications in greenhouses (82%), with the primary application as yield estimation (31%) and growth monitoring (21%). We also analyzed commonly used DL models, evaluation parameters, and optimizers in CEA production. From the analysis, we found that convolutional neural network (CNN) is the most widely used DL model (79%), Adaptive Moment Estimation (Adam) is the widely used optimizer (53%), and accuracy is the widely used evaluation parameter (21%). Interestingly, all studies focused on DL for the microclimate of CEA used RMSE as a model evaluation parameter. In the end, we also discussed the current challenges and future research directions in this domain

Confirmatory factor analysis of oral communication's learning outcomes for integrating generic employability skills into mechanical engineering curriculum in Nigerian polytechnics

Employers are currently seeking for employees with added value on top of the relevant technical content knowledge and skills (Generic employability skills).However, recent studies have shown that most employers in Nigeria are not satisfied with the affective skills (Generic Employability Skills) possessed by the Polytechnic graduates especially in terms of language communication skills, social and interpersonal skills, and critical thinking and problem solving skills among others. The Polytechnic’s Mechanical Engineering curriculum for National Diploma Certificate is criticized for not reflecting generic employability skills development with learning outcome of Oral Communication Skill. It is therefore needful to identify the learning outcomes that should be considered while integrating generic employability skills into the curriculum in Nigerian Polytechnics. The design of the study was quantitative research which made use of questionnaire for data collection. The sample of the study consisted of randomly selected 536 respondents comprising of 234 polytechnic lecturers and 302 industrial workers. One research question was raised and analyzed with descriptive statistics and Confirmatory factor Analysis (CFA) using SPSS version 20 and AMOS 18 for data analysis. The results of the studys howed that the learning outcomes of oral communication to be considered towards integrating employability skills into mechanical engineering curriculum in Nigerian Polytechnics met the modification indicescriteria (CFI=1.000, IFI=1.001and TLI=1.002). TheChi-square=1.769 with the df=2. Hence, the ratio of the Chi-square and the df (less than3) =.885. The RMSEA(< or =.080) =.000. The items retainedinclude the Ability to speak clearly using correct grammar, Ability to present ideas confidently and effectively, Ability to listen attentively and ask questions and Ability to give a clear direction. The Cronbach Alpha obtained was 0.74

Genetic algorithm and simulated annealing to estimate optimal process parameters of the abrasive waterjet machining

In this study, two computational approaches, Genetic Algorithm and Simulated Annealing, are applied to search for a set of optimal process parameters value that leads to the minimum value of machining performance. The objectives of the applied techniques are: (1) to estimate the minimum value of the machining performance compared to the machining performance value of the experimental data and regression modeling, (2) to estimate the optimal process parameters values that has to be within the range of the minimum and maximum coded values for process parameters of experimental design that are used for experimental trial and (3) to evaluate the number of iteration generated by the computational approaches that lead to the minimum value of machining performance. Set of the machining process parameters and machining performance considered in this work deal with the real experimental data of the non-conventional machining operation, abrasive waterjet. The results of this study showed that both of the computational approaches managed to estimate the optimal process parameters, leading to the minimum value of machining performance when compared to the result of real experimental data