Francis Daniels Moore: one of the brightest minds in the surgical field.

Francis Daniels Moore was a pioneer ahead of his time who made numerous landmark contributions to the field of surgery, including the understanding of metabolic physiology during surgery, liver and kidney transplant, and the famous Study on Surgical Services of the United States (SOSSUS) report of 1975 that served for decades as a guideline for development of surgical residencies. He was the epitome of what a physician should be, a compassionate and dedicated surgeon, innovative scientist, and a medical professional dedicated to quality medical education across all specialties

Reducing Cost and Contention of P2P Live Streaming through Locality and Piece Selection

The use of locality within peer-to-peer (P2P) networks is ensuring the construction of overlay networks that are both economically viable for network operators and scalable. However, the underlying protocols on which traditional P2P overlays are based are rapidly having to evolve in order to better support more time sensitive, real-time video delivery systems. This shift places greater demand on locality mechanisms to ensure the correct balance between bandwidth savings and successful timely playback. In this paper, we investigate the impact of peer locality within live streaming P2P systems and consider the pertinent challenges when designing locality based algorithms to support efficient P2P live streaming services. Based on our findings we propose an algorithm for supporting locality and harmonised play points in a live streaming P2P system. We present our results and in-depth analysis of its operation though a series of simulations which measure bandwidth consumption at network egress points, failure rates and each peer’s play point relative to the live stream

Factors affecting the role of human resource department in private healthcare sector in Pakistan: a case study of Rehman Medical Institute (RMI)

The role of Human Resource Management in healthcare sector and challenges it faces has always been an important area of research both in developed and developing countries. The objective of this study is to evaluate the role of HR department in private healthcare sector in the province of Khyber Pakhtunkhwa (KPK), Pakistan and to analyze the challenges/factors affecting the role of HR department. Being the largest private sector hospital in KPK the researchers have selected RMI as a case for this study. Data was collected through interviews from different levels of employees in RMI. Constant comparative method was used for analyzing the data. Results present that HR department plays the role of an administrative expert in RMI. The major internal factors include workload, top management interference, management style and organizational culture which negatively effect motivation, performance and morale of the employees. While small labour market, undue interference of government and other higher authorities and trade unions are the external factors that affect the role of HR department in RMI. All these external factors create difficulties for HR department to attract and retain the desired workforce

Hepatic Angioembolization in Trauma Patients: Indications and Complications.

BACKGROUND: Hepatic angiography (HA) and hepatic angioembolization (HAE) are increasingly used to diagnose and treat intrahepatic arterial injuries. This study was performed to review indications, outcomes, and complications of HA/HAE in blunt trauma patients who underwent HAE as adjunct management of hepatic injury. METHODS: A retrospective review of consecutive cases of HA/HAE at a Level I trauma center during an 8-year period. Data include demographics, physiologic condition, liver injury grade, HA/HAE indications, outcomes, morbidity, and mortality. RESULTS: Seventy-nine patients underwent diagnostic HA; 31 (39%) had subsequent HAE. Fifty-eight hemodynamically stable patients had computerized axial tomographic (CT) scan followed by HA. HA was performed for contrast blush on CT in 30 (52%) of 58 patients, high-grade liver injury in 4 (7%), subsequent hemodynamic instability in 15 (27%), and angiography planned for other purpose in 9 (17%). HA confirmed arterial injury and led to HAE in 50% of patients with contrast blush on CT or high-grade liver injury. HA was negative when performed for hemodynamic instability or for other primary purposes. Twenty-one hemodynamically unstable patients underwent emergent laparotomy followed by postoperative HA with 11 (50%) requiring HAE. Overall mortality in HAE group was 16%, and liver-related morbidity was 29% usually presenting as gallbladder or liver necrosis. CONCLUSION: HA/HAE should be used when CT scan suggests associated intrahepatic arterial or high-grade injury in the management of hepatic injuries and should also be considered after laparotomy and perihepatic packing to control inaccessible intrahepatic hemorrhage. Mortality related to HAE is uncommon, but morbidity occurs frequently

Pregnancy Outcomes in HIV-Infected Women: Our Experience at a Tertiary Health-Care Center, Ahmedabad, Western India

Background: HIV prevalence has been increasing among pregnant women in many regions within the country. Illiteracy, early marriage, violence and sexual abuse against women are the major socioeconomic reasons for their vulnerability to HIV infection. Estimating the HIV seroprevalence in a low risk population such as pregnant women provide essential information for monitoring trend of HIV in general population and assist in prevention from mother to child transmission.  Methods: This study is a retrospective computer based data analysis, conducted at Sheth V.S. General and Sheth C.M. Hospital, Smt. N.H.L Municipal Medical College, Ahmedabad, a tertiary health care center in Gujarat, India between January 2012 to December 2019. This study includes 68330 pregnant women who attended antenatal clinic or directly admitted in labor room in emergency. Blood sample collected after pretest counselling and informed consent, tested for HIV antibodies as per NACO guidelines. HIV sero-positive mothers and babies were managed at ART center of our institute according to latest guidelines of the same. Results: Out of 68330 pregnant women, 166 found to be HIV-positive with seroprevalence rate of 0.24%. Majority of seropositive women (49.4%) were in the age group of 25-30 Years. Out of 150 live births, 3 babies were found to be HIV sero-positive result at 18 months and were managed with ART according to latest NACO guidelines. Conclusions: Mother to child transmission of HIV infection during pregnancy, delivery or breast feeding is responsible for more than 90% of pediatrics AIDS. Proper antenatal screening, interventions and preventive strategies during pregnancy, delivery and breastfeeding will bring down the mother to child transmission of HIV. A multidisplinary team approach to management involving an HIV physician, experienced obstetrician, and neonatologist are essential to optimize maternal and fetal outcome

Host attachment and fluid shear are integrated into a mechanical signal regulating virulence in Escherichia coli O157:H7

Enterohemorrhagic Escherichia coli (EHEC) is a foodborne pathogen causing hemorrhagic colitis and hemolytic uremic syndrome. EHEC colonizes the intestinal tract through a range of virulence factors encoded by the locus of enterocyte effacement (LEE), as well as Shiga toxin. Although the factors involved in colonization and disease are well characterized, how EHEC regulates its expression in response to a host encounter is not well understood. Here, we report that EHEC perceives attachment to host cells as a mechanical cue that leads to expression of LEE-encoded virulence genes. This signal is transduced via the LEE-encoded global regulator of LEE-encoded regulator (Ler) and global regulator of Ler and is further enhanced by levels of shear force similar to peristaltic forces in the intestinal tract. Our data suggest that, in addition to a range of chemical environmental signals, EHEC is capable of sensing and responding to mechanical cues to adapt to its host’s physiology

Role of Non-Selective Beta Blockers in Hepatocellular Carcinoma: An Analysis in Patients with Cirrhosis and Portal Hypertension

There are many different biochemical processes responsible for the hepatocelluar carcinoma (HCC) development that can be targeted for the prevention or halt progression of the HCC. Non-selective betablockers (NSBB) affects a multitude of intracellular biochemical and signaling pathways involved in carcinogenesis. Aim: To determine if NSBB may be protective for HCC in patients with cirrhosis and portal hypertension. Methods: We retrospectively enrolled 200 patients from medical records diagnosed with cirrhosis and portal hypertension between January 2001 and December 2013. Eighteen patients were excluded (taking selective beta-blocker and/or unavailable medical records). The etiology of cirrhosis, use of NSBB, demographics and the presence of HCC was collected. Result: There were 140 males and 42 females. The mean age for portal hypertension with cirrhosis without HCC was 53.5 ± 11.4 & with HCC was 62.2 ± 9.5 years. Univariate analysis of the association of NSBB with HCC yielded OR = 0. 11 (95% CI: 0.04 to 0.25); p \u3c 0.0001, suggesting a protective effect of NSBB. Multivariable analysis suggests virtually no change when the Odds ratio (OR) was adjusted for diabetes mellitus (DM), alcohol use, Hepatitis B virus (HBV) status, Black race and age ≥ 53. There was a slight increase in the OR adjusted for statin use. Conclusion: This study highlights association of NSBB use in the patients with liver cirrhosis and portal hypertension for prevention of HCC

Brainomaly: Unsupervised Neurologic Disease Detection Utilizing Unannotated T1-weighted Brain MR Images

Harnessing the power of deep neural networks in the medical imaging domain is challenging due to the difficulties in acquiring large annotated datasets, especially for rare diseases, which involve high costs, time, and effort for annotation. Unsupervised disease detection methods, such as anomaly detection, can significantly reduce human effort in these scenarios. While anomaly detection typically focuses on learning from images of healthy subjects only, real-world situations often present unannotated datasets with a mixture of healthy and diseased subjects. Recent studies have demonstrated that utilizing such unannotated images can improve unsupervised disease and anomaly detection. However, these methods do not utilize knowledge specific to registered neuroimages, resulting in a subpar performance in neurologic disease detection. To address this limitation, we propose Brainomaly, a GAN-based image-to-image translation method specifically designed for neurologic disease detection. Brainomaly not only offers tailored image-to-image translation suitable for neuroimages but also leverages unannotated mixed images to achieve superior neurologic disease detection. Additionally, we address the issue of model selection for inference without annotated samples by proposing a pseudo-AUC metric, further enhancing Brainomaly's detection performance. Extensive experiments and ablation studies demonstrate that Brainomaly outperforms existing state-of-the-art unsupervised disease and anomaly detection methods by significant margins in Alzheimer's disease detection using a publicly available dataset and headache detection using an institutional dataset. The code is available from https://github.com/mahfuzmohammad/Brainomaly.Comment: Accepted in WACV 202