Memory Loss, Behavioral Changes, and Slurred Speech in a 49-Year-Old Man

A 49-year-old man presented with slurred speech, memory loss, and behavioral changes. His clinical course was marked by decline in functional status and cognition. He had poorly controlled hypertension and hyperlipidemia. Neuroimaging was remarkable for multiple subcortical white matter lesions. We discuss the diagnostic and therapeutic approach of rapidly progressing cognitive decline in the given clinical setting

Machine Learning Regression Approach to the Nanophotonic Waveguide Analyses

Machine learning is an application of artificial intelligence that focuses on the development of computer algorithms which learn automatically by extracting patterns from the data provided. Machine learning techniques can be efficiently used for a problem with a large number of parameters to be optimized and also where it is infeasible to develop an algorithm of specific instructions for performing the task. Here, we combine the finite element simulations and machine learning techniques for the prediction of mode effective indices, power confinement and coupling length of different integrated photonics devices. Initially, we prepare a dataset using COMSOL Multiphysics and then this data is used for training while optimizing various parameters of the machine learning model. Waveguide width, height, operating wavelength, and other device dimensions are varied to record different modal solution parameters. A detailed study has been carried out for a slot waveguide structure to evaluate different machine learning model parameters including number of layers, number of nodes, choice of activation functions, and others. After training, this model is used to predict the outputs for new input device specifications. This method predicts the output for different device parameters faster than direct numerical simulation techniques. Absolute percentage error of less than 5% in predicting an output has been obtained for slot, strip and directional waveguide coupler designs. This study pave the step towards using machine learning based optimization techniques for integrated silicon photonics devices

Rheumatoid Meningitis

An 80-year-old woman with rheumatoid arthritis had gait difficulties and frequent falls. MRI of the brain showed an extra-axial enhancing lesion overlying the right frontal–parietal cortex, that progressively extended to the contralateral side. This was accompanied by further decline in her functional status. We discuss the diagnostic and therapeutic approach of a pachy–leptomeningeal process in a rheumatoid patient

Comparison of distal radial access versus standard transradial access in patients with smaller diameter radial Arteries(The distal radial versus transradial access in small transradial ArteriesStudy: D.A.T.A - S.T.A.R study).

AIMS: To evaluate safety and efficacy of distal right radial access (DRRA) compared to right radial access (RRA), for coronary procedures, in patients with smaller diameter radial arteries (SDRA) (radial artery diameter (RAD) < 2.1 mm). METHODS AND RESULTS: This is a retrospective analysis of safety and efficacy of DRRA Vs. RRA in patients undergoing coronary procedures at our cardiac catheterization laboratories over a 10- month period between September 2017 and June, 2018 (first 5 calendar months with RRA-first; next 5 calendar months with DRRA-first). All patients underwent pre-procedure ultrasound of arm arteries. All patients had RAD<2.1 mm (mean RAD 1.63 ± 0.27 mm; RAD≤1.6 mm in 73.5%). Baseline characteristics were similar between groups. Primary end-point of puncture success was significantly lower in DRRA vs RRA group [79.5% vs 98.5%, p < 0.0001]. Puncture success was also lower in the subgroup of patients with RAD <1.6 mm Vs. ≥ 1.6 mm in the DRRA group (p < 0.0001). The secondary end-point of puncture time was significantly higher (2.1 ± 1.4 min vs. 1.0 ± 0.45 min, p < 0.00001) in the DRRA Vs. RRA group. The occurrence of vascular access site complications (including access site hematomas), radial artery occlusion (RAO) and distal RAO at day 1 and day 30 were similar between RRA and DRRA groups.Non-vascular access-site complication was seen only in the DRRA group. CONCLUSION: DRRA is a safe and effective access for coronary procedures; though technically challenging in patients with SDRA (RAD<2.1 mm; mean RAD 1.63 ± 0.27 mm), with lower puncture success and higher puncture time compared to RRA

Gardner's syndrome in a 40-year-old woman: successful treatment of locally aggressive desmoid tumors with cytotoxic chemotherapy

BACKGROUND: Desmoid tumors that present as a part of Gardener's syndrome can present very difficult management problems. CASE PRESETATION: We report a case of intra-abdominal desmoid tumor causing distal small bowel obstruction that complicated the management of a more proximal enterocutaneous fistula from the jejunum. After failure of more conventional management options including imatinib, the patient's disease responded to doxorubicin and ifosfamide. The response resolved the bowel obstruction and allowed small intestinal resection to resolve the enterocutaneous fistula. CONCLUSION: Systemic cytotoxic therapy with doxorubicin and ifosfamide can be useful for patients with complications from intra-abdominal desmoid tumor

Maximising hypervolume and minimising ϵ-indicators using Bayesian optimisation over sets

This is the author accepted manuscript. The final version is available from ACM via the DOI in this recordBayesian optimisation methods have been widely used to solve problems with computationally expensive objective functions. In the multi-objective case, these methods have been successfully applied to maximise the expected hypervolume improvement of individual solutions. However, the hypervolume, and other unary quality indicators such as multiplicative -indicator, measure the quality of an approximation set and the overall goal is to find the set with the best indicator value. Unfortunately, the literature on Bayesian optimisation over sets is scarce. This work uses a recent set-based kernel in Gaussian processes and applies it to maximise hypervolume and minimise -indicators in Bayesian optimisation over sets. The results on benchmark problems show that maximising hypervolume using Bayesian optimisation over sets gives a similar performance than non-set based methods. The performance of using indicator in Bayesian optimisation over sets needs to be investigated further. The set-based method is computationally more expensive than the non-set-based ones, but the overall time may be still negligible in practice compared to the expensive objective functions.Ministry of Science and Innovation of the Spanish Governmen

Iron Deposition following Chronic Myocardial Infarction as a Substrate for Cardiac Electrical Anomalies: Initial Findings in a Canine Model

Purpose: Iron deposition has been shown to occur following myocardial infarction (MI). We investigated whether such focal iron deposition within chronic MI lead to electrical anomalies. Methods: Two groups of dogs (ex-vivo (n = 12) and in-vivo (n = 10)) were studied at 16 weeks post MI. Hearts of animals from ex-vivo group were explanted and sectioned into infarcted and non-infarcted segments. Impedance spectroscopy was used to derive electrical permittivity () and conductivity (). Mass spectrometry was used to classify and characterize tissue sections with (IRON+) and without (IRON-) iron. Animals from in-vivo group underwent cardiac magnetic resonance imaging (CMR) for estimation of scar volume (late-gadolinium enhancement, LGE) and iron deposition (T2*) relative to left-ventricular volume. 24-hour electrocardiogram recordings were obtained and used to examine Heart Rate (HR), QT interval (QT), QT corrected for HR (QTc) and QTc dispersion (QTcd). In a fraction of these animals (n = 5), ultra-high resolution electroanatomical mapping (EAM) was performed, co-registered with LGE and T2* CMR and were used to characterize the spatial locations of isolated late potentials (ILPs). Results: Compared to IRON- sections, IRON+ sections had higher, but no difference in. A linear relationship was found between iron content and (p1.5%)) with similar scar volumes (7.28%±1.02% (Iron (1.5%)), p = 0.51) but markedly different iron volumes (1.12%±0.64% (Iron (1.5%)), p = 0.02), QT and QTc were elevated and QTcd was decreased in the group with the higher iron volume during the day, night and 24-hour period (p<0.05). EAMs co-registered with CMR images showed a greater tendency for ILPs to emerge from scar regions with iron versus without iron. Conclusion: The electrical behavior of infarcted hearts with iron appears to be different from those without iron. Iron within infarcted zones may evolve as an arrhythmogenic substrate in the post MI period

Susceptibility of staphylococci isolated from a burns unit to mupirocin and other antimicrobial agents

The activity of mupirocin (Bactroban) against coagulase-positive and coagulase-negative staphylococci isolated in a burns unit was tested to ascertain its effectiveness, and to detect any resistant isolates after continuous use of mupirocin for 2.5 years. A total of 395 staphylococci, consisting of 330 Staphylococcus aureus and 65 coagulase-negative staphylococci, were tested for resistance to mupirocin and other antimicrobial agents. The results showed that 94.5% of the isolates were fully susceptible to mupirocin (MIC ≤4 mg/l), and 5.3% expressed low-level resistance (MIC 8-128 mg/l). One Staphylococcus haemolyticus isolate expressed high-level resistance (MIC >1,024 mg/l). It transferred high-level mupirocin resistance to other staphylococci in conjugation experiments, which indicated a capacity to transmit mupirocin resistance between species. The results demonstrated that mupirocin was still highly effective against staphylococci in the burns unit. However, the demonstration that the resistant S. haemolyticus isolate could transfer high-level mupirocin resistance to other staphylococci was of concern. There is a compelling need to test staphylococci from clinical materials for mupirocin resistance. Early detection of resistance can prevent the establishment and spread of the mupirocin-resistant strains in the unit

Industry-Government-University Cooperative Research Program for the Development of Structural Materials from Sulfate-Rich FGD Scrubber Sludge

The main aim of our project was to develop technology, which converts flue gas desulfurization (FGD) sulfate-rich scrubber sludge into value-added decorative materials. Specifically, we were to establish technology for fabricating cost effective but marketable materials, like countertops and decorative tiles from the sludge. In addition, we were to explore the feasibility of forming siding material from the sludge. At the end of the project, we were to establish the potential of our products by generating 64 countertop pieces and 64 tiles of various colors. In pursuit of our above-mentioned goals, we conducted Fourier transform infrared (FTIR) and differential scanning calorimetry (DSC) measurements of the binders and co-processed binders to identify their curing behavior. Using our 6-inch x 6-inch and 4-inch x 4-inch high pressure and high temperature hardened stainless steel dies, we developed procedures to fabricate countertop and decorative tile materials. The composites, fabricated from sulfate-rich scrubber sludge, were subjected to mechanical tests using a three-point bending machine and a dynamic mechanical analyzer (DMA). We compared our material's mechanical performance against commercially obtained countertops. We successfully established the procedures for the development of countertop and tile composites from scrubber sludge by mounting our materials on commercial boards. We fabricated more than 64 pieces of countertop material in at least 11 different colors having different patterns. In addition, more than 100 tiles in six different colors were fabricated. We also developed procedures by which the fabrication waste, up to 30-weight %, could be recycled in the manufacturing of our countertops and decorative tiles. Our experimental results indicated that our countertops had mechanical strength, which was comparable to high-end commercial countertop materials and contained substantially larger inorganic content than the commercial products. Our moisture sensitivity test suggested that our materials were non-water wettable and did not disintegrate on submerging the product in water for at least two months. Countertop polishing techniques were also established