An Architectural Design for Measurement Uncertainty Evaluation in Cyber-Physical Systems

Several use cases from the areas of manufacturing and process industry, require highly accurate sensor data. As sensors always have some degree of uncertainty, methods are needed to increase their reliability. The common approach is to regularly calibrate the devices to enable traceability according to national standards and Syst\`eme international (SI) units - which follows costly processes. However, sensor networks can also be represented as Cyber Physical Systems (CPS) and a single sensor can have a digital representation (Digital Twin) to use its data further on. To propagate uncertainty in a reliable way in the network, we present a system architecture to communicate measurement uncertainties in sensor networks utilizing the concept of Asset Administration Shells alongside methods from the domain of Organic Computing. The presented approach contains methods for uncertainty propagation as well as concepts from the Machine Learning domain that combine the need for an accurate uncertainty estimation. The mathematical description of the metrological uncertainty of fused or propagated values can be seen as a first step towards the development of a harmonized approach for uncertainty in distributed CPSs in the context of Industrie 4.0. In this paper, we present basic use cases, conceptual ideas and an agenda of how to proceed further on.Comment: accepted at FedCSIS 202

Homeward bound or bound for a home? Assessing the capacity of dementia patients to make decisions about hospital discharge: Comparing practice with legal standards

Background This article stems from a larger project which considers ways of improving assessments of capacity and judgements about best interests in connection with people with dementia admitted to acute hospitals with respect to decisions about place of residence. Aims Our aim is to comment on how assessments of residence capacity are actually performed on general hospital wards compared with legal standards for the assessment of capacity set out in the Mental Capacity Act, 2005 (MCA). Method Our findings are grounded in ethnographic ward-based observations and in-depth interviews conducted in three hospital wards, in two hospitals (acute and rehabilitation), within two NHS healthcare trusts in the North of England over a period of nine months between 2008 and 2009. Twenty-nine patient cases were recruited to the study. We also draw from broader conceptions of capacity found in domestic and international legal, medical, ethical and social science literature. Results Our findings suggest that whilst professionals profess to be familiar with broad legal standards governing the assessment of capacity under the MCA, these standards are not routinely applied in practice in general hospital settings when assessing capacity to decide place of residence on discharge from hospital. We discuss whether the criteria set out in the MCA and the guidance in its Code of Practice are sufficient when assessing residence capacity, given the particular ambiguities and complexities of this capacity. Conclusions We conclude by suggesting that more specific legal standards are required when assessing capacity in this particular context

American Gut: an Open Platform for Citizen Science Microbiome Research

McDonald D, Hyde E, Debelius JW, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3):e00031-18

Antepartum percutaneous renal biopsy

Objective: To assess the value and adverse effects of an ultrasound -guided renal biopsy technique in women with normal and pathotogic pregnancies. Method: Biopsy samples were taken from 36 women with hypertensive disease (28 with pre-eclampsia) and 18 healthy pregnant women using a thin needle and an ultrasound -guided biopsy device. Results: Gtomerutar endotheliosis, a structural change typical of pre-eclampsia, was found in all hypertensive women, but it was more pronounced in the 28 pre-eclamptic women than in the 8 women with nonproteinuric hypertension. A similar change, however, was seen in 11 of the 18 controls. One serious adverse event occurred, retroperitoneat hematoma, in the woman with the most severe pre-eclampsia. Conclusion: Glomerular endotheliosis is not to be considered pathognomonic for pre-eclampsia. Few complications followed renal biopsy in this study, but complications arose in the sickest patient. It is probably not advisable to perform anteparturn renal biopsies in pregnant women with a rapidly deteriorating renal function and swollen kidneys. In these women, the biopsy does not facilitate diagnosis and is hazardous. (c) 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. AR rights reserved

Treatment and outcome in pancreatic pseudocysts

Objective. Pancreatic pseudocyst is a common complication of both acute and chronic pancreatitis. The aim of the present study was to evaluate the efficacy and complications of different treatment regimens. Material and methods. All patients >= 15 years of age admitted to Lund University Hospital from 1994 to 2003 with pancreatic pseudocysts were analysed retrospectively. Pseudocysts were defined according to the Atlanta classification. Results. Forty-four patients (29 M (66%), mean age 559/14 years) were included in the study, and all were subjected to treatment on totally 88 occasions. Mean size of pseudocysts at diagnosis was 9.69 +/- 6.8 cm (1.5-40 cm). Recurrence after treatment was 1.0 +/- 1.1 times (range 0-4). No difference was found in recurrence rate or pseudocyst size when comparing conservative versus interventional treatment, but patient weight was higher (p=0.013) and acute pancreatitis was more frequent (p=0.046) in conservatively treated patients. Surgical treatment tended to be associated with a lower recurrence rate as compared with percutaneous treatments. The rate of hospital admissions was in median 3 (0-16) and median length of stay (LOS) was 12 days (0-141 days). Six patients (14%) had complications and 3 died (7%). Pseudocysts >= 8 cm did not differ significantly from smaller pseudocysts regarding the choice of conservative treatment, LOS, recurrence and gastrointestinal obstruction, but there was a trend towards more complications in the group with larger pseudocysts ( 5 versus 1). Conclusions. Patients with pancreatic pseudocysts require frequent hospital admissions and repeated treatments. Larger pseudocysts do not imply more recurrences. The lowest recurrence rate overall was seen after open surgery

Perforated peptic duodenal ulcer in a paraesophageal hernia--a case report of a rare surgical emergency

BACKGROUND: Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare. CASE PRESENTATION: An elderly man with multiple medical conditions was admitted due to severe upper abdominal pain. The patient was found to have a paraesophageal hernia and underwent a laparotomy. In the hernia, a perforated benign peptic duodenal ulcer was found. The duodenal defect was over-sewn, the hernial defect was closed and the former hernial cavity was drained by a right-sided chest tube. The patient was discharged one month after surgery and was found to do well at follow-up one month after discharge. CONCLUSION: This is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia

Reflux, stricture and glomerular filtration rate after two antireflux techniques in continent urinary reconstruction using the right colon

In the present study the incidence of reflux, stricture formation and changes in glomerular filtration rate in patients with the submucosal tunnel or the Camey-Le Duc technique of ureteric implantation into the caecum/detubularized right colon used for continent cutaneous diversion/orthotopic bladder substitution was investigated. Reflux was found in two renal units and ureterointestinal stenosis occurred in five renal units after submucosal tunnel ureteric implantation. After Camey-Le Duc ureteric implantation, one renal unit showed reflux and none had stenosis of the ureterointestinal anastomosis during follow-up. Mean glomerular filtration rate (ml/min/1.73 m2) fell from 98 to 85 in the submucosal tunnel group and from 88 to 81 in the Camey-Le Duc group after mean follow-ups of 9 and 5 years, respectively. Both methods of ureteric implantation in this study were effective in preventing reflux, and renal function was well preserved in both groups. The absence of ureterointestinal strictures in the Camey-Le Duc group is encouraging and indicates that this is a reliable method for reflux prevention

Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients?

OBJECTIVE: Cholecystectomy is the standard treatment for acute cholecystitis, but in high-risk patients with serious comorbidity and in patients of advanced age there is substantial morbidity and mortality associated with the intervention. In these selected patients, percutaneous cholecystostomy (PCS) is an alternative mode of management. The aim of the present study was to evaluate the outcome of PCS in selected patients with acute cholecystitis. MATERIAL AND METHODS: Thirty-five patients, representing 0.6% of all acute cholecystitis patients managed during the period 1994-2003, were subjected to PCS. Patients' charts were reviewed retrospectively for age, gender, comorbidity, hospital stay, procedure, complications and final outcome, including requirement of additional interventions. RESULTS: PCS was considered successful in 34/35 patients, 26 of whom responded within 3 days. Two patients required additional cholecystectomy 3 days and 20 months, respectively, after the PCS procedure. Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and one patient underwent rotation lithotripsy. Four patients suffered recurrent biliary complaints after the acute episode of cholecystitis, while the only serious procedure-related complication was bile leakage from the gallbladder in one patient, which necessitated cholecystectomy. CONCLUSIONS: PCS is a comparatively safe and efficient procedure in the treatment of acute cholecystitis in high-risk patients with serious comorbidity and in elderly patients, contraindicating the general anaesthesia required for laparoscopic or open cholecystectomy