Maxmin convolutional neural networks for image classification

Convolutional neural networks (CNN) are widely used in computer vision, especially in image classification. However, the way in which information and invariance properties are encoded through in deep CNN architectures is still an open question. In this paper, we propose to modify the standard convo- lutional block of CNN in order to transfer more information layer after layer while keeping some invariance within the net- work. Our main idea is to exploit both positive and negative high scores obtained in the convolution maps. This behav- ior is obtained by modifying the traditional activation func- tion step before pooling. We are doubling the maps with spe- cific activations functions, called MaxMin strategy, in order to achieve our pipeline. Extensive experiments on two classical datasets, MNIST and CIFAR-10, show that our deep MaxMin convolutional net outperforms standard CNN

Prevention of ventilator-associated pneumonia in intensive care units: an international online survey

Background: On average 7% of patients admitted to intensive-care units (ICUs) suffer from a potentially preventable ventilator-associated pneumonia (VAP). Our objective was to survey attitudes and practices of ICUs doctors in the field of VAP prevention. Methods: A questionnaire was made available online in 6 languages from April, 1st to September 1st, 2012 and disseminated through international and national ICU societies. We investigated reported practices as regards (1) established clinical guidelines for VAP prevention, and (2) measurement of process and outcomes, under the assumption "if you cannot measure it, you cannot improve it"; as well as attitudes towards the implementation of a measurement system. Weighted estimations for Europe were computed based on countries for which at least 10 completed replies were available, using total country population as a weight. Data from other countries were pooled together. Detailed country-specific results are presented in an online additional file. Results: A total of 1730 replies were received from 77 countries; 1281 from 16 countries were used to compute weighted European estimates, as follows: care for intubated patients, combined with a measure of compliance to this guideline at least once a year, was reported by 57% of the respondents (95% CI: 54-60) for hand hygiene, 28% (95% CI: 24-33) for systematic daily interruption of sedation and weaning protocol, and 27% (95%: 23-30) for oral care with chlorhexidine. Only 20% (95% CI: 17-22) were able to provide an estimation of outcome data (VAP rate) in their ICU, still 93% (95% CI: 91-94) agreed that "Monitoring of VAP-related measures stimulates quality improvement". Results for 449 respondents from 61 countries not included in the European estimates are broadly comparable. Conclusions: This study shows a low compliance with VAP prevention practices, as reported by ICU doctors in Europe and elsewhere, and identifies priorities for improvement

What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients?

BACKGROUND: Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC. METHODS: We performed a survey of members of the ESICM POIC section to inform a Delphi consensus and to share their opinions on a care bundle to reduce POPC, the POPC-CB. We formed a team of 36 experts to participate in and complete an email-based Delphi consensus over three rounds, leading to the formulation of the POPC-CB. RESULTS: The survey had 362 respondents and informed the design of the Delphi consensus. The Delphi consensus resulted in a proposed POPC-CB that incorporates components before surgery-supervised exercise programmes and inspiratory muscle training, during surgery, low tidal volume ventilation with individualised PEEP (positive end-expiratory pressure), use of routine monitoring to avoid hyperoxia and efforts made to limit neuromuscular blockade, and post-operatively, deep breathing exercises and elevation of the head of the bed. CONCLUSION: A care bundle has been suggested for evaluation in surgical patients at high risk of POPC. Evaluation of feasibility of both implementation and effectiveness is now indicated

Cancer mortality in a Texas county with prior uranium mining and milling activities, 1950-2001

Abstract Uranium was discovered in Karnes County, Texas, in 1954 and the first uranium mill began operating in 1961 near Falls City. Uranium milling and surface and in situ mining continued in Karnes County until the early 1990s. Remediation of uranium tailings ponds was completed in the 1990s. There were three mills and over 40 mines operating in Karnes County over these years and potential exposure to the population was from possible environmental releases into the air and ground water. From time to time concerns have been raised in Karnes County about potential increased cancer risk from these uranium mining and milling activities. To evaluate the possibility of increased cancer deaths associated with these uranium operations, a mortality survey was conducted. The numbers and rates of cancer deaths were determined for Karnes County and for comparison for four 'control' counties in the same region with similar age, race, urbanisation and socioeconomic distributions reported in the 1990 US Census. Comparisons were also made with US and Texas general population rates. Following similar methods to those used by the National Cancer Institute, standardised mortality ratios (SMRs) were computed as the ratio of observed numbers of cancers in the study and control counties compared to the expected number derived from general population rates for the United States. Relative risks (RRs) were computed as the ratios of the SMRs for the study and the control counties. Overall, 1223 cancer deaths occurred in the population residing in Karnes County from 1950 to 2001 compared with 1392 expected based on general population rates for the US. There were 3857 cancer deaths in the four control counties during the same 52 year period compared with 4389 expected. There was no difference between the total cancer mortality rates in 3 Author to whom any correspondence should be addressed. Karnes County and those in the control counties (RR = 1.0; 95% confidence interval 0.9-1.1). There were no significant increases in Karnes County for any cancer when comparisons were made with either the US population, the State of Texas or the control counties. In particular, deaths due to cancers of the lung, bone, liver and kidney were not more frequent in Karnes County than in the control counties. These are the cancers of a priori interest given that uranium might be expected to concentrate more in these tissues than in others. Further, any radium intake would deposit primarily in the bone and radon progeny primarily in the lung. Deaths from all cancers combined also were not increased in Karnes County and the RRs of cancer mortality in Karnes County before and in the early years of operations , shortly after the uranium activities began and in two later time periods (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) were similar, 1.0, 0.9, 1.1 and 1.0, respectively. No unusual patterns of cancer mortality could be seen in Karnes County over a period of 50 years, suggesting that the uranium mining and milling operations had not increased cancer rates among residents

Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa

BACKGROUND: Several acute illness severity scores have been proposed for evaluating patients on admission to intensive care units but these have not been compared for patients with nosocomial bloodstream infection (nBSI). We compared three severity of illness scoring systems for predicting mortality in patients with nBSI due to Pseudomonas aeruginosa. METHODS: We performed a historical cohort study on 63 adults in intensive care units with P. aeruginosa monomicrobial nBSI. RESULTS: The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiologic Score (SAPS II), were calculated daily from 2 days prior through 2 days after the first positive blood culture. Calculation of the area under the receiver operating characteristic (ROC) curve confirmed that APACHE II and SAPS II at day -1 and SOFA at day +1 were better predictors of outcome than days -2, 0 and day 2 of BSI. By stepwise logistic regression analysis of these three scoring systems, SAPS II (OR: 13.03, CI95% 2.51–70.49) and APACHE II (OR: 12.51, CI95% 3.12–50.09) on day -1 were the best predictors for mortality. CONCLUSION: SAPS II and APACHE II are more accurate than the SOFA score for predicting mortality in this group of patients at day -1 of BSI