Palliative Care for the Medically Complex Child

**From the AAMC website: Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by August 12, 2016** Children with special health care needs are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. The Complex Care Curriculum was developed to provide a multi-modal educational curriculum for providers with the overall goal of improving inpatient care for this population. The curriculum is composed primarily of a series of topic-specific learning modules. This particular resource was created to provide pediatricians with educational materials related to palliative care for the medically complex child. This resource includes a multimedia, narrated PowerPoint show for asynchronous learning, a PowerPoint presentation adapted for didactic teaching, as well as accompanying facilitator guides, suggested multiple choice questions with answer key, an evaluation tool, and a complete list of references and resources. The target audience is pediatric hospitalists and other general pediatric providers or trainees who care for medically complex children in an inpatient setting, although it may also be applicable to health care providers in outpatient settings. This resource can be used to study independently or to teach to other learners in small group settings. This module was created as part of a larger Complex Care Curriculum by authors in the Pediatric Hospitalist Division at Children\u27s National Medical Center in Washington, DC. This curriculum was developed for providers who care for medically complex patients in a busy inpatient setting to have an opportunity to increase knowledge, skills and awareness through asynchronous learning modules. Implementation of this curriculum was based on a previously completed needs assessment that identified preferred modalities of learning, as well as topics of greatest need, which included palliative care for the medically complex child. The curriculum was implemented in 2012 and a pilot study of participants was conducted. Impact on knowledge, skills and attitudes was assessed. Fifteen study participants completed the palliative care module. Of these participants, 93% either agreed or strongly agreed that the module increased their comfort with the topic and that it would change their clinical practice. All agreed that the learning format was appropriate to their learning needs. Results of the pilot study showed a statistically significant increase in test scores on the palliative care questions specifically. Comments from participants on this learning module included: Material was well organized ; The case really centered the topic ; Excellent overview and enjoyed specific case references ; Academic references were appreciated ; Covered highlights of what should be known by the general hospital pediatrician . Many participants highlighted the graphics as what they liked best about the presentation. Based on this study, this module along with others in the curriculum continues to be offered to trainees and new faculty to augment their knowledge and skills in this area. MedEdPORTAL publication ID 9538. Link to original

Central Lines in Children

Children with special health care needs are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. However, exposure to this patient population during training varies from provider to provider. No published educational curricula are specific to the inpatient care of this population. This publication is a self-directed education module on central lines in children, including indications for placement, types of lines available, and prevention and treatment of complications. The module includes a PowerPoint slide show, instructor guide, and questions for assessment. The purpose of this project is to build a multimodal educational curriculum for providers with the overall goal of improving inpatient care for this at-risk population. This curriculum is primarily composed of a series of topic-specific multimedia learning modules. Asynchronous learning modules, utilized appropriately, can augment learning by providing individualized instruction and mastery of fundamentals. This module has been piloted among pediatric hospitalists in two institutions with effectiveness measured by pre- and posttest surveys. Please see the file attachment entitled CCC Central Lines Module Pilot Data.pdf. AAMC MedEdPORTAL publication ID 10246. Link to origina

Experiments in Diversifying Flickr Result Sets

The 2013 MediaEval Retrieving Diverse Social Images Task looked to tackling the problem of search result diversification of Flickr results sets formed from queries about geographic places and landmarks. In this paper we describe our approach of using a min-max similarity diversifier coupled with pre-filters and a reranker. We also demonstrate a number of novel features for measuring similarity to use in the diversification step

Removal of metal oxide defects through improved semi-anisotropic wet etching process

Thesis (M. Eng. in Manufacturing)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 52).Data recently collected from an industrial thin film manufacturer indicate that almost 8% of devices are rejected due to excess metal, or unwanted metal on the device surface. Experimentation and analysis suggest that almost half of these defects are caused by incomplete removal of nickel oxides that form on top of the conductive nickel surface throughout the heated environment of the upstream process. This study classified and identified the composition of these excess metal defects, evaluated recommended wet etch methods to remove nickel oxide, and finally proposes a wet etch process that will rapidly remove defects while continuing to maintain the desired semi-anisotropic etch profile, uncharacteristic of most wet immersion etch processes. Results attested that rapid exposure to dilute (40%) nitric acid followed by immediate immersion into a cleaning agent, proprietary nickel etchant, and titanium tungsten etchant removed all nickel oxide defects. Upon implementation, this method has the potential to reduce scrap due to excess metal by 3% and reduce overall etch process time by 25%. In addition, a process was developed to completely etch patterned substrates with high defect density mid process and rework them from raw substrates.by Neha H. Dave.M.Eng.in Manufacturin

Detection of Multi-drug Resistant \u3cem\u3eEscherichia coli\u3c/em\u3e in the Urban Waterways of Milwaukee, WI

Urban waterways represent a natural reservoir of antibiotic resistance which may provide a source of transferable genetic elements to human commensal bacteria and pathogens. The objective of this study was to evaluate antibiotic resistance of Escherichia coli isolated from the urban waterways of Milwaukee, WI compared to those from Milwaukee sewage and a clinical setting in Milwaukee. Antibiotics covering 10 different families were utilized to determine the phenotypic antibiotic resistance for all 259 E. coli isolates. All obtained isolates were determined to be multi-drug resistant. The E. coli isolates were also screened for the presence of the genetic determinants of resistance including ermB (macrolide resistance), tet(M) (tetracycline resistance), and β-lactamases (blaOXA, blaSHV, and blaPSE). E. coli from urban waterways showed a greater incidence of antibiotic resistance to 8 of 17 antibiotics tested compared to human derived sources. These E. coli isolates also demonstrated a greater incidence of resistance to higher numbers of antibiotics compared to the human derived isolates. The urban waterways demonstrated a greater abundance of isolates with co-occurrence of antibiotic resistance than human derived sources. When screened for five different antibiotic resistance genes conferring macrolide, tetracycline, and β-lactam resistance, clinical E. coli isolates were more likely to harbor ermB and blaOXA than isolates from urban waterway. These results indicate that Milwaukee’s urban waterways may select or allow for a greater incidence of multiple antibiotic resistance organisms and likely harbor a different antibiotic resistance gene pool than clinical sources. The implications of this study are significant to understanding the presence of resistance in urban freshwater environments by supporting the idea that sediment from urban waterways serves as a reservoir of antibiotic resistance

Identifying the Geographic Location of an Image with a Multimodal Probability Density Function

There is a wide array of online photographic content that is not geotagged. Algorithms for efficient and accurate geographical estimation of an image are needed to geolocate these photos. This paper presents a general model for using both textual metadata and visual features of photos to automatically place them on a world map

Social Event Detection via sparse multi-modal feature selection and incremental density based clustering

Combining items from social media streams, such as Flickr photos and Twitter tweets, into meaningful groups can help users contextu- alise and effectively consume the torrents of information now made available on the social web. This task is made challenging due to the scale of the streams and the inherently multimodal nature of the information to be contextualised. We present a methodology which approaches social event detection as a multi-modal clustering task. We address the various challenges of this task: the selection of the features used to compare items to one another; the construction of a single sparse affinity matrix; combining the features; relative importance of features; and clustering techniques which produce meaningful item groups whilst scaling to cluster large numbers of items. In our best tested configuration we achieve an F1 score of 0.94, showing that a good compromise between precision and recall of clusters can be achieved using our technique

Baseline T cell dysfunction by single cell network profiling in metastatic breast cancer patients.

BackgroundWe previously reported the results of a multicentric prospective randomized trial of chemo-refractory metastatic breast cancer patients testing the efficacy of two doses of TGFβ blockade during radiotherapy. Despite a lack of objective responses to the combination, patients who received a higher dose of TGFβ blocking antibody fresolimumab had a better overall survival when compared to those assigned to lower dose (hazard ratio of 2.73, p = 0.039). They also demonstrated an improved peripheral blood mononuclear cell (PBMC) counts and increase in the CD8 central memory pool. We performed additional analysis on residual PBMC using single cell network profiling (SCNP).MethodsThe original trial randomized metastatic breast cancer patients to either 1 or 10 mg/kg of fresolimumab, every 3 weeks for 5 cycles, combined with radiotherapy to a metastatic site at week 1 and 7 (22.5 Gy given in 3 doses of 7.5 Gy). Trial immune monitoring results were previously reported. In 15 patients with available residual blood samples, additional functional studies were performed, and compared with data obtained in parallel from seven healthy female donors (HD): SCNP was applied to analyze T cell receptor (TCR) modulated signaling via CD3 and CD28 crosslinking and measurement of evoked phosphorylation of AKT and ERK in CD4 and CD8 T cell subsets defined by PD-1 expression.ResultsAt baseline, a significantly higher level of expression (p < 0.05) of PD-L1 was identified in patient monocytes compared to HD. TCR modulation revealed dysfunction of circulating T-cells in patient baseline samples as compared to HD, and this was more pronounced in PD-1+ cells. Treatment with radiotherapy and fresolimumab did not resolve this dyfunctional signaling. However, in vitro PD-1 blockade enhanced TCR signaling in patient PD-1+ T cells and not in PD-1- T cells or in PD-1+ T cells from HD.ConclusionsFunctional T cell analysis suggests that baseline T cell functionality is hampered in metastatic breast cancer patients, at least in part mediated by the PD-1 signaling pathway. These preliminary data support the rationale for investigating the possible beneficial effects of adding PD-1 blockade to improve responses to TGFβ blockade and radiotherapy.Trial registrationNCT01401062

Hydatid cyst of ovary: an unusual site

Discovering a hydatid cyst in pelvic region, especially as primary localization, is a rare event; as a matter of fact according to data provided by literature the incidence is between 0.2 and 2.25%. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. When possible the optimal treatment is represented by radical laparotomic cystectomy. We report a case of an old postmenopausal woman presented with intermittent dull aching pain with 16 weeks cystic pelvic mass which mimicked the ovarian malignancy even after imaging techniques. We treated the case with laprotomic cystectom

A STUDY OF SEVERITY OF STROKE AND HOMOCYSTEINE LEVEL IN SOUTHERN PART OF RAJASTHAN, INDIA

Objective: Till date, a very few prospective studies have examined the association between serum homocysteine levels and the risk of stroke and stroke subtypes in Indian populations. Methods: A prospective, case - control study of Indian subjects 10–90 years of age was conducted using frozen serum samples from 103 participants in cardiovascular risk surveys collected from December 2017 to November 2018. By the end of 103, we identified 55 incidents of severe strokes, one control subject per case was selected by matching for sex, age, community, year of serum storage, and fasting status. Serum total homocysteine levels were measured by Cobas c-311. Results: Compared with control subjects, total (n_206), hemorrhagic (n_106), and ischemic (n_87) strokes had higher geometric mean values of total homocysteine and higher proportions of homocysteine −25.0 μ mol/L. Homocysteine was estimated after adjustment for body mass index, smoking, alcohol intake, hypertension, and other cardiovascular risk factors. The excess risk of total and ischemic strokes did not vary significantly according to sex, age, smoking status, or hypertensive status. Conclusion: High total homocysteine concentrations were associated with the increased risk of total stroke, more specifically ischemic stroke) Capsuloganglionic and frontoparietal infarct (8 each)., among Indian men and women