Defining sepsis on the wards: results of a multi-centre point-prevalence study comparing two sepsis definitions

Our aim was to prospectively determine the predictive capabilities of SEPSIS-1 and SEPSIS-3 definitions in the emergency departments and general wards. Patients with National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled over a 24-h period in 13 Welsh hospitals. The primary outcome measure was mortality within 30 days. Out of the 5422 patients screened, 431 fulfilled inclusion criteria and 380 (88%) were recruited. Using the SEPSIS-1 definition, 212 patients had sepsis. When using the SEPSIS-3 definitions with Sequential Organ Failure Assessment (SOFA) score ≥ 2, there were 272 septic patients, whereas with quickSOFA score ≥ 2, 50 patients were identified. For the prediction of primary outcome, SEPSIS-1 criteria had a sensitivity (95%CI) of 65% (54–75%) and specificity of 47% (41–53%); SEPSIS-3 criteria had a sensitivity of 86% (76–92%) and specificity of 32% (27–38%). SEPSIS-3 and SEPSIS-1 definitions were associated with a hazard ratio (95%CI) 2.7 (1.5–5.6) and 1.6 (1.3–2.5), respectively. Scoring system discrimination evaluated by receiver operating characteristic curves was highest for Sequential Organ Failure Assessment score (0.69 (95%CI 0.63–0.76)), followed by NEWS (0.58 (0.51–0.66)) (p < 0.001). Systemic inflammatory response syndrome criteria (0.55 (0.49–0.61)) and quickSOFA score (0.56 (0.49–0.64)) could not predict outcome. The SEPSIS-3 definition identified patients with the highest risk. Sequential Organ Failure Assessment score and NEWS were better predictors of poor outcome. The Sequential Organ Failure Assessment score appeared to be the best tool for identifying patients with high risk of death and sepsis-induced organ dysfunction

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Comparison of FFT Fingerprint Filtering Methods for Neural Network Classification

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Experimental Fingerprint Database . . . . . . . . . . . . . . . . . . . . . . . . . 6 3 Image Segmenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 4 Fingerprint Image Enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 4.1 Localized FFT Fingerprint Filter . . . . . . . . . . 12 4.2 Directional FFT Filter . . . . . . . . . . . . 14 5 Feature Extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 6 PNN Classifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 7 Method of Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 8 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 8.1 Accuracy . . . . . . . . . . . . . . 23 8.2 Speed . . . . . . . . . . . . . . . 23 9 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . ..

Binary Decision Clustering for Neural Network Based OCR

This paper presents a clusterin

NIST Form-Based Handprint Recognition System (Release 2.0)

The National Institute of Standards and Technology (NIST) has developed a new release of a standard reference form-based handprint recognition system for evaluating optical character recognition. As with the first release, NIST is making the new recognition system freely available to the general public on CD-ROM. This source code testbed, written entirely in C, contains both the original and the new recognition systems. New utilities are provided for conducting generalized form registration, intelligent form removal with character stroke preservation, robust text-line isolation in handprinted paragraphs, adaptive character segmentation based on writing style, and sophisticated MultiLayer Perceptron (MLP) neural network classification. A software implementation of the machine learning algorithm used to train the new MLP is included in the test-bed, enabling recipients to train the neural network for pattern recognition applications other than character classification. A host of data str..