Are patients admitted to emergency departments with regular supraventricular tachycardia (SVT) treated appropriately?

Regular supraventricular tachycardia (SVT) is frequently encountered in clinical practice. Guidelines are available from the National Service Framework (NSF) for the treatment of patients attending emergency departments (ED) with SVT. These recommend a thyroid-function test (TFT) and arrhythmia electrocardiography (ECG), and referral to a heart-rhythm specialist on discharge. Hospital admission is rarely required. In our multicentre study, we examined the implementation of these guidelines among patients attending the ED with SVT. Only 34% of patients had specialist referrals, with an average wait of 50.3 days (the majority of delays resulted from referral requests from general practitioners). A history of previous SVT, the mode of tachycardia termination, patient age and/or comorbidities were similar for the 27 (23.5%) patients who were admitted overnight. Of these, 15 (13%) of the total 115 patients who attended ED with regular SVT were referred for Holter monitoring despite having ECGs demonstrating arrhythmia. Low referral rates, unnecessary investigations and admissions indicate a need for improvement for better patient care and to minimise healthcare costs. We have formulated a standard operating procedure, which will be available via the College of Emergency Medicine website

Utilising Building Component Data from BIM for Formwork Planning

Advancements in the computing realm have assisted the Architecture, Engineering, and Construction (AEC) industry to progress significantly by automating several design tasks and activities. Building Information Modelling (BIM) authoring tools have played a significant role in automating design tasks and reducing the efforts required by the designer in redundant, repetitive or production-oriented activities. This paper explores one such approach that, with the help of BIM authoring tool and its Application Programming Interface (API), reduces the efforts expended on formwork design for concrete structures. The paper utilises the concept of using BIM data as input to compute the quantity of formwork, and generate visualisations and schedule of formwork. The developed approach first takes data input from semantic BIM to the API environment for computation and design of formwork systems, which is then placed within the BIM model, to generate visualisation and prepare schedules. The research work utilises a structural concrete wall as an example to demonstrate the presented approach. The approach will be influential in streamlining the formwork design process in the BIM environment and reducing efforts required by the designer and the planning engineer. Since the formwork elements are generated as 3-Dimensional (3D) solids and smart BIM elements, the generated model of formwork can be used for resolving clashes, scheduling, and resource planning

Aging display's effect on interpretation of digital pathology slides

It is our conjecture that the variability of colors in a pathology image effects the interpretation of pathology cases, whether it is diagnostic accuracy, diagnostic confidence, or workflow efficiency. In this paper, digital pathology images are analyzed to quantify the perceived difference in color that occurs due to display aging, in particular a change in the maximum luminance, white point, and color gamut. The digital pathology images studied include diagnostically important features, such as the conspicuity of nuclei. Three different display aging models are applied to images: aging of luminance & chrominance, aging of chrominance only, and a stabilized luminance & chrominance (i.e., no aging). These display models and images are then used to compare conspicuity of nuclei using CIE deltaE2000, a perceptual color difference metric. The effect of display aging using these display models and images is further analyzed through a human reader study designed to quantify the effects from a clinical perspective. Results from our reader study indicate significant impact of aged displays on workflow as well as diagnosis as follow. As compared to the originals (no-aging), slides with the effect of aging simulated were significantly more difficult to read (p-value of 0.0005) and took longer to score (p-value of 0.02). Moreover, luminance+chrominance aging significantly reduced inter-session percent agreement of diagnostic scores (p-value of 0.0418)

Exploring the Impact of Evolutionary Computing based Feature Selection in Suicidal Ideation Detection

© 2019 IEEE. The ubiquitous availability of smartphones and the increasing popularity of social media provide a platform for users to express their feelings, including suicidal ideation. Suicide prevention by suicidal ideation detection on social media lights the path to controlling the rapidly increasing suicide rates amongst youth. This paper proposes a diverse set of features and investigates into feature selection using the Firefly algorithm to build an efficient and robust supervised approach to classifying tweets with suicidal ideation. The development of a suicidal language to create three diverse, manually annotated datasets leads to the validation of the proposed model. An in-depth result and error analysis lead to an accurate system for monitoring suicidal ideation on social media along with the discovery of optimal feature subsets and selection methods using a penalty based Firefly algorithm

Metastatic Invasive Lobular Carcinoma of the Breast Masquerading as a Primary Renal Malignancy

Breast cancer is known to metastasise to different organs in the body, but an initial presentation of breast cancer with loin pain secondary to a metastatic renal mass is extremely rare. We report a 58-year-old woman who presented with recurrent left loin pain due to a metastatic deposit of invasive lobular carcinoma of the breast. The detection of a renal mass on computed tomography led to the assumption of a renal pelvic malignancy. The diagnostic dilemma posed by the detection of a breast mass during staging and the usefulness of immunohistochemistry in the confirmation of diagnosis are discussed

An Aggressive Sphenoid Wing Meningioma Causing Foster Kennedy Syndrome

Foster Kennedy syndrome is a rare neurological condition with ophthalmic significance that can manifest as acute visual loss. It is classically characterised by unilateral optic nerve atrophy and contralateral papilledema resulting from an intracranial neoplasm. Physicians should consider Foster Kennedy syndrome in patients who present with visual loss and who have a history of intracranial neoplasm. In addition to ophthalmologic examination, neuroimaging is essential for the diagnosis of Foster Kennedy syndrome

Epicardial catheter ablation for ventricular tachycardia on uninterrupted warfarin: A safe approach for those with a strong indication for peri-procedural anticoagulation?

BACKGROUND: Current guidelines for epicardial catheter ablation for ventricular tachycardia (VT) advocate that epicardial access is avoided in anticoagulated patients and should be performed prior to heparinisation. Recent studies have shown that epicardial access may be safe in heparinised patients. However, no data exist for patients on oral anticoagulants. We investigated the safety of obtaining epicardial access on uninterrupted warfarin. METHODS: A prospective registry of patients undergoing epicardial VT ablation over two years was analysed. Consecutive patients in whom epicardial access was attempted were included. All patients were heparinised prior to epicardial access with a target activated clotting time (ACT) of 300-350s. Patients who had procedures performed on uninterrupted warfarin (in addition to heparin) were compared to those not taking an oral anticoagulant. RESULTS: 46 patients were included of which 13 were taking warfarin. There was no significant difference in clinical and procedural characteristics (except INR and AF) between the two groups. Epicardial access was achieved in all patients. There were no deaths and no patients required surgery. A higher proportion of patients in the warfarin group had a drop in haemoglobin of >2g/dL compared to the no-warfarin group (38.5% versus 27.3%, p=0.74) and delayed pericardial drain removal (7.8% versus 3.03%, p=0.47). There was no difference in overall procedural complication rate. No patients required warfarin reversal or blood transfusion. CONCLUSION: Epicardial access can be achieved safely and effectively in patients' anticoagulated with warfarin and heparinised with therapeutic ACT. This may be an attractive option for patients with a high stroke risk

Moving from a Product-Based Economy to a Service-Based Economy for a More Sustainable Future

Traditionally, economic growth and prosperity have been linked with the availability, production and distribution of tangible goods as well as the ability of consumers to acquire such goods. Early evidence regarding this connection dates back to Adam Smith's Wealth of Nations (1776), in which any activity not resulting in the production of a tangible good is characterized as unproductive of any value." Since then, this coupling of economic value and material production has been prevalent in both developed and developing economies throughout the world. One unintended consequence of this coupling has been the exponential increase in the amount of solid waste being generated. The reason is that any production and consumption of material goods eventually generates the equivalent amount of (or even more) waste. Exacerbating this problem is the fact that, with today's manufacturing and supply chain management technologies, it has become cheaper to dispose and replace most products rather than to repair and reuse them. This has given rise to what some call a disposable society." To put things in perspective: In 2012 households in the U.K. generated approximately 22 thousand tons of waste, which amounted to 411 kg of waste generated per person (Department for Environment, Food & Rural Affairs, 2015). During the same time period, households in the U.S. generated 251 million tons of waste, which is equivalent to a person generating approximately 2 kg of waste every day (U.S. Environmental Protection Agency, 2012). Out of these 251 million tons of total waste generated, approximately 20% of the discarded items were categorized as durable goods. The disposal of durable goods is particularly worrisome because they are typically produced using material from non- renewable resources such as iron, minerals, and petroleum-based raw materials

Adoption of BIM by architectural firms in India: technology–organization–environment perspective

Building information modelling (BIM) is being heralded as a remarkable innovation in the built environment sector with expectations of lofty sector-wide improvements. Some countries have shown remarkable levels of uptake of BIM, along the way documenting some evidence of benefits stemming from BIM. However, countries such as India and China are late entrants in the BIM adoption journey and are seeing a slower adoption rate. This study develops a model using the technology–organization–environment framework to study the factors influencing BIM adoption by architectural firms in India and reasons for this slow adoption. The proposed model of BIM adoption is tested using the partial least square method against responses collected from 184 industry professionals based in India. Findings reveal that the adoption of BIM by Indian architectural firms is at the ‘experimentation’ stage with variables such as expertise, trialability, and management support exhibiting a strong positive influence on BIM adoption. The study also explains the status of BIM adoption in India with the help of a multi-level social construct, which places the level of BIM adoption in India between the micro- and meso-levels of organizational scales. Similarities and dissimilarities with previous findings are discussed in the paper to highlight the findings of this study. © 2016 Informa UK Limited, trading as Taylor & Francis Grou