Surgery for Patients in Extremis: Reasonable Care or Surgical Futility?

Critically ill patients in extremis often undergo abdominal exploration despite the subjectively high incidence of morbidity and mortality. To evaluate the efficacy of intervention, records of patients undergoing laparotomy while in extremis by the Acute Care Surgery service at an academic medical were retrospectively reviewed. Outcomes were stratified by patient demographics, primary service, surgical findings, preoperative physiology, and mortality. Overall mortality was 55.6%. Surgical bedside explorations revealed a mortality rate of 53.3% without identified abdominal pathology and 90% with identified pathology. Significant differences in survival were noted for Lactate level, vasopressor use, acute kidney injury, leukocytosis, and anemia. Therapeutic bedside exploration’s extremely high mortality rate likely represents futile care. OR procedures for patients in extremis also carries significant mortality that may be predicted by preoperative physiology. This data suggests that surgical consultation for patients in extremis should be scrutinized for efficacy prior to offering surgical intervention

Precise Image Exploration With Cluster Analysis

Since the rise of digital multimedia in our present age, when looking for an image that closely matches their needs and preferences, the number of images a user must sort through has become more and more unmanageable. Even when searching for a narrow topic, it can be nearly impossible to find an image that meets a specific preference by going through all the possible images. To combat this growing problem, we describe an exploration system built on deep neural networks to empower the users to quickly sort through all the possible images by quickly narrowing down to their preferred images. By design, our exploration system goes around the need to match the user’s query directly to a small group of images to serve users images that would traditionally be too difficult to group together and match to a query. We propose to use deep metric learning and clustering to group the images, which we will see cleverly manages problems that hold back traditional neural networks in this problem—unseen image groups and shifting definitions

Genome Sequence and Phenotypic Characterization of Caulobacter Segnis

Caulobacter segnis is a unique species of Caulobacter in that it is slow growing, found in soil samples, and has other phenotypic differences from the freshwater Caulobacter that it is most closely related to. Initially deemed Mycoplana segnis, it was reclassified after a 16s rRNA analysis and found to be most closely related to the Caulobacter NA1000 branch. Because the annotated sequence available in GenBank contained a large number of pseudogenes (126), we compared the original sequencing data to the GenBank sequence and determined that many of the pseudogenes were due to sequence errors in the Genbank sequence. Consequently, we used multiple approaches to correct and reannotate the C. segnis genome sequence. In total there were 247 nucleotide deletions, 14 insertions, and 8 substitutions resulting in 233 fewer bases in our corrected sequence. The corrected sequence contains only 27 pseudogenes compared to the 126 of the original annotation. Furthermore it was found that C. segnis does produce prosthecae when grown in low nutrient conditions and the swarmer cells have a single, polar flagellum not peritrichous flagella. In addition we confirmed that Riboflavin is essential for growth. At 30°C C.segnis had a doubling time of 200 minutes and it was also able to grow slowly at 4°C

Development of foreign body detection methodology in industrial food preparation process

Several techniques for the detection of the FB in food were studied and the advantages and disadvantages of each technique were analyzed. Among all the available techniques, ultrasound technique was found to be most promising in the detection of FB. The system for the FB detection using ultrasound was based upon pulse echo technique and was analyzed by the means of simulation, using COMSOL multiphysics 5.2 software. The model includes food pipe, transducer and possible FBs inside the liquid food. The applicability of ultrasound to the detection of FB as small as 0.1 mm in radius was established, temperature and frequency dependence was studied. A multiple time shifted transducer scheme was designed to cover maximum area of the food pipe

Near Optimal Receive Antenna Selection Scheme for MIMO System under Spatially Correlated Channel

Spatial correlation is a critical impairment for practical Multiple Input Multiple Output (MIMO) wireless communication systems. To overcome from this issue, one of the solutions is receive antenna selection. Receive antenna selection is a low-cost, low-complexity and no requirement of feedback bit alternative option to capture many of the advantages of MIMO systems. In this paper, symbol error rate (SER) versus signal to noise ratio (SNR) performance comparasion of proposed receive antenna selection scheme for full rate non-orthogonal Space Time Block Code (STBC) is obtained using simulations in MIMO systems under spatially correlated channel at transmit and receive antenna compare with several existing receive antenna selection schemes. The performance of proposed receive antenna selection scheme is same as conventional scheme and beat all other existing schemes

Optimization of Simple and Inexpensive Paper-Based Assay for Lead

The Environmental Protection Agency (EPA) guidelines state that lead is a toxic metal that humans should not be exposed to in any amount. Due to corrosion of water pipes, lead can enter drinking water and be consumed by millions of people. As a group, we decided to reduce this issue by creating a simple and inexpensive paper-based test to detect lead(II) in water. The signal for this test results from encapsulating a phenanthroline-based probe in synthesized polymer nanoparticles. This test will display a colorimetric change, turning from yellow to bright orange if lead(II) is present in the water system. In an attempt to optimize the response of the test, different variables were adjusted to analyze the nanoparticles’ effectiveness. In this work, polymer type, polymer concentration, solvent, probe concentration, and synthetic method were explored and the optimal method for lead(II) detection was determined. Future directions for our research include focusing on the selectivity of the test to confirm it does not respond to other metals, such as copper and zinc, and optimizing the attachment of the nanoparticles to the test strip itself

Acquired Vitelliform Macular Degeneration: Characteristics and Challenges of Managing Subretinal Fluid

Purpose: To highlight diagnostic challenges in patients with acquired vitelliform macular degeneration (AVMD) with subretinal fluid (SRF) and to examine the characteristics of image findings in patients with AVMD. Methods: In this retrospective review, the electronic medical record of 22 eyes of 16 patients with AVMD was studied. The rates of SRF, drusen, pigment epithelial detachment (PED), and patient clinical information such as age, length of follow-up, and BCVA were assessed. Results: The mean age at diagnosis with AVMD was 72 years with a mean follow-up time of 29 months. Median best-corrected visual acuity (BCVA) was 20/33 at presentation and 20/33 at final follow-up. Drusen was found in 13 of 22 eyes (59.1%), PEDs in 4 of 22 eyes (18.2%), and SRF in 10 of 22 eyes (45.5%) at some point during their follow-up. Of the 10 eyes with SRF, 70% were center involving, and recurrence occurred in 40%, all in the same location as the initial presentation of SRF. Three eyes received an anti-vascular endothelial growth factor injection for SRF. In 66% of cases receiving an injection, the fluid later relapsed and remitted without further injections during the course of follow-up. Conclusion: AVMD occurs in the same demographic as age-related macular degeneration (AMD) and has many common features. SRF in AVMD tends to be center involving and recurs usually in the same location as its origin. The use of anti-VEGF injections did not seem to improve SRF in contrast to the SRF seen in wet AMD. Proper differentiation of AVMD may prevent unnecessary long-term treatment with intravitreal anti-VEGF injections

A retrospective study of 50 cases of lower limb soft tissue infection and its different modalities of presentation and its management

Background: Soft tissue infections are common in everyday practice. They show great variations in their severity. Skin and soft tissue infections are usually preceded by minor traumatic events. Among them soft tissue bacterial infections of lower limbs are more common. Patients having diabetes makes the scenario even worst. Diagnosis, intervention and treatment of these infections are very important. This study aims at understanding the pathology involved for lower limb soft tissue infections, spectrum of organisms and different treatment modalities in various age group and gender.Methods: 50 cases of lower limb soft tissue infections were included in this study. Detailed history, clinical examination, investigations, pre-operative preparation, intraoperative details and post-operative management were included.Results: 94% patients were having history of trauma.88% patients were having history of diabetes. Staphylococcus aureus was the most common (43%) organism cultured from swabs followed by pseudomonas (36%) out of total cases. Minimum stay in hospital was of 4 days to a maximum of 34 days. Most of the patients were managed with regular dressing and debridement.Conclusions: The patients sought treatment only when they had extensive lesions which affect their daily living. Health education regarding foot care forms an integral part of surgical management of lower limb soft tissue infections. Readmissions are mainly due to inadequate local control or fluctuating blood sugar levels and improper foot care due to illiteracy, poverty, ignorance and lack of adequate primary care facilities