Characteristics of “do not resuscitate” orders among elderly patients receiving mechanical ventilation in the intensive care unit in Taiwan

ObjectiveAs patient life expectancy has increased and people are living longer than before, the rate of mechanical ventilation among elderly patients in the intensive care unit has increased. Older patients who receive mechanical ventilation and have multiple comorbidities are more likely to have a do not resuscitate order than are younger patients with fewer comorbidities. The aim of our study was to describe the patient characteristics and predictive factors of do not resuscitate orders during hospitalization among elderly patients who received ventilation in the intensive care unit.MethodsThis was a retrospective review of the electronic medical records of patients in the intensive care unit of a teaching hospital in southern Taiwan. We enrolled patients admitted to the general intensive care unit from January 1, 2018, to September 31, 2020, and patients older than 80 years who experienced respiratory failure, were intubated and received mechanical ventilation. We analyzed patient demographics, disease severity during hospitalization and comorbidities. If a patient had multiple admissions to the intensive care unit, only the first admission was recorded.ResultsOf the 305 patients over 80 years of age with respiratory failure who were intubated and placed on a ventilator, 66 were excluded because of incomplete data, and 13 were excluded because they had already signed a do not resuscitate order prior to admission to the hospital. Ultimately, 226 patients were included in this study. A higher acute physiology and chronic health evaluation II score (>30) was also associated with an increased likelihood of a do not resuscitate order (odds ratio (OR) = 3.85, 95% CI = 1.09–13.62, p = 0.0362). Patients who had acute kidney injury or cerebrovascular accident were more likely to have a do not resuscitate order (OR = 2.74, 95% CI = 1.03–7.28, p = 0.0428 and OR = 7.32, 95% CI = 2.02–26.49, p = 0.0024, respectively).ConclusionOur study showed that older age, greater disease severity, and certain critical interventions were associated with a greater propensity for do not resuscitate orders, which is crucial for understanding patient preferences and guiding end-of-life care discussions. These findings highlight the importance of clinical severity and specific health events in predicting end-of-life care preferences in older patient groups

Esophageal Food Impaction: A Homemade Suction Tube Attached to Esophagogastroduodenoscopy for Food Bolus Removal

The most common esophageal foreign body in adults is impacted food bolus. Polypectomy snares, Dormia baskets, retrieval nets, rat-tooth forceps, alligator forceps or polyp graspers are usually used to remove it. Here, we report the case of a 78-year-old woman whose esophagogastroduodenoscopy (EGD) showed a firm goose liver impacted tightly in the lower esophagus; all of the above-mentioned retrieval instruments could not remove it. We used a homemade device by attaching a modified nasogastric tube to an EGD and successfully removed the goose liver by suction under endoscopic visualization. The method is very effective to remove firm and tightly impacted materials in a narrow lumen. When the usual retrieval instruments fail, a homemade suction tube attached to an EGD is an alternative

IMECE 2005-83000 AN EFFICIENT VOLUMETRIC-ERROR MEASUREMENT METHOD FOR FIVE-AXIS MACHINE TOOLS

ABSTRACT Accurate measurement of volumetric errors plays an important role for error compensation for multi-axis machines. The error measurements for volumetric errors of five-axis machines are usually very complex and costly than that for three-axis machines. In this study, a direct and simple measurement method using telescoping ball-bar system for volumetric errors for different types of five-axis machines was developed. The method using two-step measurement methodology and incorporating with derived error models, can quickly determine the five degrees-of-freedom (DOF) volumetric errors of five-axis machine tools. Comparing to most of the current used measurement methods, the proposed method provides the advantages of low cost, high efficiency, easy setup, and high accuracy

A non-linear analytic stress model for the analysis on the stress interaction between TSVs

Thermo-elastic strain is induced by through silicon vias (TSV) due to the difference of thermal expansion coefficients between the copper (∼18 ppm/◦C) and silicon (∼2.8 ppm/◦C) when the structure is exposed to a thermal budget in the three dimensional integrated circuit (3DIC) process. These thermal expansion stresses are high enough to induce the delamination on the interfaces between the copper, silicon, and isolated dielectric. A compact analytic model for the strain field induced by different layouts of thermal copper filled TSVs with the linear superposition principle is found to result in large errors due to the strong stress interaction between TSVs. In this work, a nonlinear stress analytic model with different TSV layouts is demonstrated by the finite element method and Mohr’s circle analysis. The stress characteristics are also measured by the atomic force microscope-raman technique at a nanometer level resolution. This nonlinear stress model for the strong interactions between TSVs results in an electron mobility change ~2-6% smaller than that resulting from a model that only considers the linear stress superposition principle

Image operator learning coupled with CNN classification and its application to staff line removal

Many image transformations can be modeled by image operators that are characterized by pixel-wise local functions defined on a finite support window. In image operator learning, these functions are estimated from training data using machine learning techniques. Input size is usually a critical issue when using learning algorithms, and it limits the size of practicable windows. We propose the use of convolutional neural networks (CNNs) to overcome this limitation. The problem of removing staff-lines in music score images is chosen to evaluate the effects of window and convolutional mask sizes on the learned image operator performance. Results show that the CNN based solution outperforms previous ones obtained using conventional learning algorithms or heuristic algorithms, indicating the potential of CNNs as base classifiers in image operator learning. The implementations will be made available on the TRIOSlib project site.Comment: To appear in ICDAR 201

Extremely low nucleotide diversity in the X-linked region of papaya caused by a strong selective sweep

Collection sites of wild Costa Rican papaya. Table S2. Summary of sequencing statistics of re-sequenced papaya genomes. Table S3 Annotation of polymorphisms. Table S4. Synonymous site diversity for genes in the X-linked region. (DOCX 37 kb

Progesterone receptor does not improve the performance and test effectiveness of the conventional 3-marker panel, consisting of estrogen receptor, vimentin and carcinoembryonic antigen in distinguishing between primary endocervical and endometrial adenocarcinomas in a tissue microarray extension study

<p>Abstract</p> <p>Objective</p> <p>Endocervical adenocarcinomas (ECA) and endometrial adenocarcinomas (EMA) are uterine malignancies that have differing biological behaviors. The choice of an appropriate therapeutic plan rests on the tumor's site of origin. In this study, we propose to evaluate whether PR adds value to the performance and test effectiveness of the conventional 3-marker (ER/Vim/CEA) panel in distinguishing between primary ECA and EMA.</p> <p>Methods</p> <p>A tissue microarray was constructed using paraffin-embedded, formalin-fixed tissues from 38 hysterectomy specimens, including 14 ECA and 24 EMA. Tissue microarray (TMA) sections were immunostained with 4 antibodies, using the avidin-biotin complex (ABC) method for antigen visualization. The staining intensity and extent of the immunohistochemical (IHC) reactions were appraised using a semi-quantitative scoring system.</p> <p>Results</p> <p>The three markers (ER, Vim and CEA) and their respective panel expressions showed statistically significant (p < 0.05) frequency differences between ECA and EMA tumors. Although the additional ancillary PR-marker also revealed a significant frequency difference (p < 0.05) between ECA and EMA tumors, it did not demonstrate any supplementary benefit to the 3-marker panel.</p> <p>Conclusion</p> <p>According to our data, when histomorphological and clinical doubt exists as to the primary site of origin, we recommend that the conventional 3-marker (ER/Vim/CEA) panel is easier, sufficient and appropriate to use in distinguishing between primary ECA and EMA. Although the 4-marker panel containing PR also reveals statistically significant results, the PR-marker offers no supplemental benefit to the pre-existing 3-marker (ER/Vim/CEA) panel in the diagnostic distinction between ECA and EMA.</p