Delirium-a letter update

Delirium is essentially acute brain failure that results from stressors that surpass the brain's homeostatic reserve. Delirium is caused by a combination of risk factors that are both predisposing and precipitating. Advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis are all known risks. Stressors most likely have coordinated rather than independent effects, and the systems they affect are linked rather than separate. Changes in the blood-brain barrier and the central nervous system's de novo synthesis or elaboration of inflammatory mediators account for the pathophysiology of delirium. It also seems that neuro-inflammatory activity contributes to the dysregulation of neurotransmitters

Skolem Functions for Factored Formulas

Given a propositional formula F(x,y), a Skolem function for x is a function \Psi(y), such that substituting \Psi(y) for x in F gives a formula semantically equivalent to \exists F. Automatically generating Skolem functions is of significant interest in several applications including certified QBF solving, finding strategies of players in games, synthesising circuits and bit-vector programs from specifications, disjunctive decomposition of sequential circuits etc. In many such applications, F is given as a conjunction of factors, each of which depends on a small subset of variables. Existing algorithms for Skolem function generation ignore any such factored form and treat F as a monolithic function. This presents scalability hurdles in medium to large problem instances. In this paper, we argue that exploiting the factored form of F can give significant performance improvements in practice when computing Skolem functions. We present a new CEGAR style algorithm for generating Skolem functions from factored propositional formulas. In contrast to earlier work, our algorithm neither requires a proof of QBF satisfiability nor uses composition of monolithic conjunctions of factors. We show experimentally that our algorithm generates smaller Skolem functions and outperforms state-of-the-art approaches on several large benchmarks.Comment: Full version of FMCAD 2015 conference publicatio

Similar prevalence of anxiety and depression symptoms in any ICU survivor patient relative

Background: Iwashyna et al defined a chronic critically ill (CCI) patient as any patient requiring care in ICU for more than or equal to 10 days. Physicians often assume that the prevalence of anxiety and depression symptoms in relatives of CCI patients would be higher than in those patients who are not CCI. We hypothesized that there would be no difference in the prevalence of anxiety and depression symptoms of relatives of a CCI and those whose patients are not CCI. We aimed to establish that the prevalence of anxiety and depression symptoms are similar in relatives of any ICU survivor patient. Methods: The study was a non-interventional, observational, cross-sectional study. Relatives were evaluated as early as possible after day ten following ICU admission for CCI patients and non-CCI patients on or a day before discharge from ICU. During this evaluation, anonymous demographic data of relatives were captured, and PHQ-9 and GAD-7 scales were administered and completed by the relative. Results: A total of 418 relatives consented and were included in the study [104 in CCI patient group and 314 in non-CCI group]. Overall, the prevalence of anxiety and depression symptoms in the entire study cohort was 23.2% (95% CI, 19.4-27.5) and 16.5% (95% CI, 13.2-20.4), respectively. There was no statistical difference between the two groups in the proportion of PHQ-9 total score >9 (p value: 0.577) as well as the GAD-7 total score (p value: 0.816). Conclusions: There was no difference in the prevalence of anxiety and depression symptoms in relatives of a CCI versus those whose patients are not CCI

Contact vitiligo- A chemical induced vitiligo

Contact vitiligo is the loss of skin colour (whitening of skin) due to contact with chemicals. These chemicals destroy the skin pigment cells called as melanocytes. A recent fascinating example of contact vitiligo is occurred in the summer of 2013 in Japan. When the cosmetic company “Kanebo” developed a highly effective skin lighting cream and sold it to thousands of consumers. Unfortunately over 18,000 users developed contact vitiligo after using it, leading to recall the product.  An active ingredient in the product is “Rhododendrol” also a phenol. This type of chemicals appears to be anlog of the amino acid tyrosine that disrupt melanogenesis and result in autoimmunity and melanocytes destruction

A Review of Gridhrasi

At the present era, the human society is leading a mechanical life with sedentary life style, precariously busy schedule, constant work without rest, night shift, alarming anxiety and stress in the work field, drastic changes in the environment etc. All these cause prevalence of Vatavyadhi (disorders due to vata dosha) in this modern era. Among the different Vata vyadhi (disorders due to vata), the most affected one is Gridhrasi (sciatica) which is characterized by low back ache radiating to one or both the lower limbs. In addition to the above mentioned causes, constant work schedule in improper sitting posture, travelling long distances by vehicles, lifting of heavy objects, trauma to low back region are the precipitating factors of Gridhrasi. The causes, signs and symptoms explained by different Acharyas have more relevance to the present situation. The presentation of Gridhrasi varies from person to person due to change in Nidana(causative factors), and Samprapti (pathogenesis). Close observation and thorough knowledge of our classics makes the diagnosis and treatment of Gridhrasi easier. So the present article tries to explain the Lakshana (symptoms) and treatment of Gridhrasi which will ensure a simpler and more effective treatment of the cases.Materials and Methods: Classical Ayurvedic texts, Commentaries, Various Article, Previously conducted research studies thoroughly reviewed and analysed.Conclusion: The detail study about the disease provides insight into hazards of Gridhrasi and provide valuable key for the effective managemen

Generalized Product-of-Experts for Learning Multimodal Representations in Noisy Environments

A real-world application or setting involves interaction between different modalities (e.g., video, speech, text). In order to process the multimodal information automatically and use it for an end application, Multimodal Representation Learning (MRL) has emerged as an active area of research in recent times. MRL involves learning reliable and robust representations of information from heterogeneous sources and fusing them. However, in practice, the data acquired from different sources are typically noisy. In some extreme cases, a noise of large magnitude can completely alter the semantics of the data leading to inconsistencies in the parallel multimodal data. In this paper, we propose a novel method for multimodal representation learning in a noisy environment via the generalized product of experts technique. In the proposed method, we train a separate network for each modality to assess the credibility of information coming from that modality, and subsequently, the contribution from each modality is dynamically varied while estimating the joint distribution. We evaluate our method on two challenging benchmarks from two diverse domains: multimodal 3D hand-pose estimation and multimodal surgical video segmentation. We attain state-of-the-art performance on both benchmarks. Our extensive quantitative and qualitative evaluations show the advantages of our method compared to previous approaches.Comment: 11 Pages, Accepted at ICMI 2022 Ora

Adverse reactions to intravenous iodinated contrast media: a prospective study

Background: Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be sub classified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. This study was done to determine clinical adverse effects of the iodinated contrast media.Methods: Data of 899 consecutive patients at C.U. Shah Medical College and Hospital, Surendranagar, who received sodium meglumine diatrizoate intravenous iodinated contrast media during the period of May 2011 to April 2012, were collected for any adverse drug reactions.Results: Out of 899, 189 patients developed adverse contrast reactions. The incidences of mild, moderate and severe adverse reactions were 19.47%, 1.33% and 0.28%, respectively. There were no differences in the incidence of adverse reactions according to gender (males 21.1%; females 20.7%; p= >0.05) or age (p= >0.05). The incidence of adverse reactions was significantly higher in patients with a history of previous reactions (50%) than in those with no history (21.25%; p= <0.05).Conclusions: The skin was the most commonly affected site of reactions. In reactions, mild forms were more common compared to moderate and severe

The development of an intelligent decision support framework in the contact centre environment

In a time of fast growing technology and communication systems, it is very important for the industry and the corporations to develop new contact centre environment technologies for better customer contact requirements. The integration of contact centre (CC) into day-to-day organisational operations represents one of the most promising trends in the 21 st century economy. Whatever the nature or point of contact, customers want a seamless interaction throughout their experience with the company. Customers receive more personalised experience, while the company itself can now provide a consistent message across all customer interactions. Based on the literature studies and the research carried out within the contact centre industry through the case studies, the author identified the customer and advisor behavioural attributes along with demographic, experience and others that later are used to derive the categories. Clustering technique identified the categories for customers and advisors. From the initial set of categories, fuzzy expert system framework was derived which assigned a customer or advisor with the pre-defined set of categories. The thesis has proposed two novel frameworks for categorisation of customer and advisor within contact centres and development of intelligent decision support framework that displays the right amount of information to the advisor at the right time. Furthermore, the frameworks were validated with qualitative expert judgement from the experts at the contact centres and through a simulation approach. The research has developed a novel Soft Computing based fuzzy logic categorisation framework that categorises customer and advisor on the basis of their demographic, experience and behavioural attributes. The study also identifies the behavioural aspects of customer and advisor within CC environment and on the basis of categorisation framework, assigns each customer and advisor to that of a pre-defined category. The research has also proposed an intelligent decision support framework to identify and display the minimum amount of information required by an advisor to serve the customer in CC environment. The performance of the proposed frameworks is analysed through four case studies. In this way this research proposes a fully tested and validated set of categorisation and information requirement frameworks for dealing with customer and advisor and its challenges. The research also identifies future research directions in the relevant areas.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Occurrence of Potentially Zoonotic and Cephalosporin Resistant Enteric Bacteria among Shelter Dogs in the Central and South-Central Appalachia

BACKGROUND: Antimicrobial resistance and presence of zoonotic enteropathogens in shelter dogs pose a public health risk to shelter workers and potential adopters alike. In this study we investigated the prevalence of zoonotic bacterial pathogens and cephalosporin resistant (CefR) enteric bacteria in the feces of apparently healthy shelter dogs in the Cumberland Gap Region (CGR) in the US states of Kentucky, Tennessee and Virginia. RESULTS: Fecal samples of 59 dogs from 10 shelters in the CGR of Central and South-Central Appalachia were screened for the presence of Campylobacter jejuni, Clostridium perfringens, Salmonella and CefR enteric bacteria. C. jejuni, C. perfringens were detected by PCR based assays. Culture and PCR were used for Salmonella detection. Of 59 dogs, fecal samples from 14 (23.7%) and 8 (13.6%) dogs tested positive for cpa and hipO genes of C. perfringens and C. jejuni, respectively. Salmonella was not detected in any of the tested samples by PCR or culture. CefR enteric bacteria were isolated on MacConkey agar supplemented with ceftiofur followed by identification using MALDI-TOF. Fecal samples from 16 dogs (27.1%) yielded a total of 18 CefR enteric bacteria. Majority of CefR isolates (14/18, 77.8%) were E. coli followed by, one isolate each of Enterococcus hirae, Acinetobacter baumannii, Acinetobacter pittii, and Pseudomonas aeruginosa. CefR enteric bacteria were tested for resistance against 19- or 24-antibiotic panels using broth microdilution method. Seventeen (94.4%) CefR bacteria were resistant to more than one antimicrobial agent, and 14 (77.8%) displayed multidrug resistance (MDR). CONCLUSIONS: This study shows that shelter dogs within the CGR not only carry zoonotic bacterial pathogens, but also shed multidrug resistant enteric bacteria in their feces that may pose public health risks