Laparoscopic omentoplasty and split skin graft for deep sternal wound infection and dehiscence patient

Treatment of sternotomy dehiscence secondary to infection is complex. We describe a case where following debridement and negative pressure therapy the greater omentum was harvested laparoscopically, pedicled on the right gastroepiploic artery and transposed through a subxiphoid window and laid into the chest wound. The omentum was covered with a split skin graft. The omental transposition provided a healthy vascular bed for the skin graft to be laid on top of. This technique allows for larger defects to be closed when due to the amount of bone loss the sternum cannot be brought together. Such procedures are normally performed when all other measures have failed and myocutaneous flaps cover the omentoplasty. Our case is novel in that the laparoscopic harvest and the use of direct skin grafting make this an option to be considered earlier as a single definitive procedure.peer-reviewe

Discussant\u27s response to a multi-attribute model for audit evaluation

https://egrove.olemiss.edu/dl_proceedings/1135/thumbnail.jp

Self-Policing: Dissemination and Adoption of Police Eyewitness Policies in Virginia

Professional policing organizations emphasize the importance of the adoption of sound police policies and procedures, but traditionally doing so has been left to individual agencies. State and local government typically does not closely regulate police, and neither federal constitutional rulings nor state law typically sets out in any detail the practices that police should follow. Thus, law enforcement agencies must themselves draft and disseminate policy. This paper presents the results of studies used to assess the adoption of eyewitness identification policies by law enforcement agencies in Virginia. Policymakers were focused on this problem because Virginia experienced a series of DNA exonerations in cases involving eyewitness misidentifications. In 2005, lawmakers enacted a law that required agencies to have some written policy in place. However, there was little guidance on what that policy should be. To remedy this problem, the state law enforcement policy agency, the Virginia Department of Criminal Justice Services (DCJS) promulgated, in 2011, a detailed model policy on eyewitness procedure. Nevertheless, as reported in a 2013 study, those model practices were only haltingly adopted. In particular, many agencies did not use blind or blinded lineups, in which the administrator does not know which photo is that of a suspect or cannot view which photo the eyewitness is examining. In Fall 2018, all of the over-three hundred law enforcement agencies in Virginia had their policies on this subject requested, using the state freedom of information law. The results show that there has now been widespread adoption of the DCJS model policy. Improved eyewitness identification practices have been adopted by the vast majority of agencies, including large and small agencies. This Article concludes by asking what contributed to the extensive dissemination of a model police policy, and what its implications are for improving police policy and practice without the use of regulation

Binary operation based hard exudate detection and fuzzy based classification in diabetic retinal fundus images for real time diagnosis applications

Diabetic retinopathy (DR) is one of the most considerable reasons for visual impairment. The main objective of this paper is to automatically detect and recognize DR lesions like hard exudates, as it helps in diagnosing and screening of the disease. Here, binary operation based image processing for detecting lesions and fuzzy logic based extraction of hard exudates on diabetic retinal images are discused. In the initial stage, the binary operations are used to identify the exudates. Similarly, the RGB channel space of the DR image is used to create fuzzy sets and membership functions for extracting the exudates. The membership directives obtained from the fuzzy rule set are used to detect the grade of exudates. In order to evaluate the proposed approach, experiment tests are carriedout on various set of images and the results are verified. From the experiment results, the sensitivity obtained is 98.10%, specificity is 96.96% and accuracy is 98.2%.  These results suggest that the proposed method could be a diagnostic aid for ophthalmologists in the screening for DR

Informative and misinformative interactions in a school of fish

It is generally accepted that, when moving in groups, animals process information to coordinate their motion. Recent studies have begun to apply rigorous methods based on Information Theory to quantify such distributed computation. Following this perspective, we use transfer entropy to quantify dynamic information flows locally in space and time across a school of fish during directional changes around a circular tank, i.e. U-turns. This analysis reveals peaks in information flows during collective U-turns and identifies two different flows: an informative flow (positive transfer entropy) based on fish that have already turned about fish that are turning, and a misinformative flow (negative transfer entropy) based on fish that have not turned yet about fish that are turning. We also reveal that the information flows are related to relative position and alignment between fish, and identify spatial patterns of information and misinformation cascades. This study offers several methodological contributions and we expect further application of these methodologies to reveal intricacies of self-organisation in other animal groups and active matter in general