Diabetic Foot Due to Anaphylactic Shock: A Case Report

Introduction: Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite. Case Presentation: We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite. Conclusions: Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot

Quantifying Model Complexity via Functional Decomposition for Better Post-Hoc Interpretability

Post-hoc model-agnostic interpretation methods such as partial dependence plots can be employed to interpret complex machine learning models. While these interpretation methods can be applied regardless of model complexity, they can produce misleading and verbose results if the model is too complex, especially w.r.t. feature interactions. To quantify the complexity of arbitrary machine learning models, we propose model-agnostic complexity measures based on functional decomposition: number of features used, interaction strength and main effect complexity. We show that post-hoc interpretation of models that minimize the three measures is more reliable and compact. Furthermore, we demonstrate the application of these measures in a multi-objective optimization approach which simultaneously minimizes loss and complexity

Developing Core Sets for Persons With Traumatic Brain Injury Based on the International Classification of Functioning, Disability, and Health

The authors outline the process for developing the International Classification of Functioning, Disability, and Health (ICF) Core Sets for traumatic brain injury (TBI). ICF Core Sets are selections of categories of the ICF that identify relevant categories of patients affected by specific diseases. Comprehensive and brief ICF Core Sets for TBI should become useful for clinical practice and for research. The final definition of the ICF Core Sets for TBI will be determined at an ICF Core Sets Consensus Conference, which will integrate evidence from preliminary studies. The development of ICF Core Sets is an inclusive and open process and rehabilitation professionals are invited to participate

Computer-assisted Electrodynamic Modeling System for Oil and Gas Industry Electric Drives Study

Electrodynamics models of the oil and gas equipment that mainly consist of several controlled electric drives mechanisms and autonomous generators are considered. Applications of the model to drilling and pumping drives are presented.Рассмотрены электродинамические модели автоматизированного нефтяного и газового оборудования, состоящие преимущественно из управляемых электрических механизмов и автономных генераторов. Приведены примеры использования моделей для буровых и насосных установок.Розглянуто електродинамічні моделі автоматизованого нафтового і газового обладнання, які складаються переважно з керованих електричних механізмів і автономних генераторів. Наведено приклади використання моделей для бурових та насосних установок

Concept of an Effective Sentinel-1 Satellite SAR Interferometry System

This brief study introduces a partially working concept being developed at IT4Innovations supercomputer (HPC) facility. This concept consists of several modules that form a whole body of an efficient system for observation of terrain or objects displacements using satellite SAR interferometry (InSAR). A metadata database helps to locate data stored in various storages and to perform basic analyzes. A special database has been designed to describe Sentinel-1 data, on its burst level. Custom Sentinel-1 TOPS processing algorithms allow an injection of coregistered bursts into the database. Once the area of interest is set and basic processing parameters are given, the selected data are merged and processed by the Persistent Scatterers (PS) InSAR method or an optimized Small Baselines (SB) InSAR derivative. Depending on the expected deliverables, the processing results can be post-analyzed using a custom approach, in order to achieve a set of reliable measurement points. Final results can be post-processed and visualized using a custom GIS toolbox, consisting in open-source GIS functionality. The GIS post-processing is enforced by HPC power as well. To demonstrate the practical applicability of the described system, a subsidence area in Konya city, Turkey is used as the study area for Sentinel-1 InSAR evaluation

Data Standardization for Smart Infrastructure in First-Access Electricity Systems

Recent developments in renewable energy and Information Technology (IT) fields made it easier to set up power systems at a smaller scale. This proved to be a turning point for developing First-Access Electricity Systems for the underserved locations around the world. However, there are planning and operation challenges due to lack of past data on such places. Deployment of IoT devices and proliferation of smart infrastructures with additional sensors will lead to tremendous opportunities for gathering very useful data. For different stakeholders to access and manage this data, trusted and standardized mechanisms need to be in place. Storing proper data in a well-structured common format allows for collaborative research across disciplines, large-scale analytics, and sharing of algorithms and methodologies, in addition to improved customer service. Data standardization plays a more vital role in the context of electricity access in underdeveloped countries, where there is no past data on generation or consumption as in utility grids. Data collected in a standard structure, be it for a short period of time, facilitates learning from the past experiences, monitoring the current projects and delivering better results in future endeavors. It will result in ways to better assist consumers and help the industry operate more efficiently by sharing data with different stakeholders. It can also enhance competition, thus making electricity accessible faster and to more people. The focus of this paper is data standardization for first-access electricity systems, in general, and renewable energy based microgrids, in particular, different data sources and ways the corresponding data can be exploited, technological and capacity constraints for storage of data, political and governance implications, as well as data security and privacy issues, are examined. The work presented here is relevant to different stake holders such as investors, public utilities, non-governmental organizations (NGOs) and communities. Using the data standardization approach developed here, it is possible to create a much-needed first-access electricity system database. This will provide an important resource for project developers and energy companies to assess the potential of a certain unelectrified site, estimating its demand growth in time and establishing universal control systems that can seamlessly communicate with different components

Selective inhibition of FLT3 by gilteritinib in relapsed or refractory acute myeloid leukaemia: a multicentre, first-in-human, open-label, phase 1-2 study.

BackgroundInternal tandem duplication mutations in FLT3 are common in acute myeloid leukaemia and are associated with rapid relapse and short overall survival. The clinical benefit of FLT3 inhibitors in patients with acute myeloid leukaemia has been limited by rapid generation of resistance mutations, particularly in codon Asp835 (D835). We aimed to assess the highly selective oral FLT3 inhibitor gilteritinib in patients with relapsed or refractory acute myeloid leukaemia.MethodsIn this phase 1-2 trial, we enrolled patients aged 18 years or older with acute myeloid leukaemia who either were refractory to induction therapy or had relapsed after achieving remission with previous treatment. Patients were enrolled into one of seven dose-escalation or dose-expansion cohorts assigned to receive once-daily doses of oral gilteritinib (20 mg, 40 mg, 80 mg, 120 mg, 200 mg, 300 mg, or 450 mg). Cohort expansion was based on safety and tolerability, FLT3 inhibition in correlative assays, and antileukaemic activity. Although the presence of an FLT3 mutation was not an inclusion criterion, we required ten or more patients with locally confirmed FLT3 mutations (FLT3mut+) to be enrolled in expansion cohorts at each dose level. On the basis of emerging findings, we further expanded the 120 mg and 200 mg dose cohorts to include FLT3mut+ patients only. The primary endpoints were the safety, tolerability, and pharmacokinetics of gilteritinib. Safety and tolerability were assessed in the safety analysis set (all patients who received at least one dose of gilteritinib). Responses were assessed in the full analysis set (all patients who received at least one dose of study drug and who had at least one datapoint post-treatment). Pharmacokinetics were assessed in a subset of the safety analysis set for which sufficient data for concentrations of gilteritinib in plasma were available to enable derivation of one or more pharmacokinetic variables. This study is registered with ClinicalTrials.gov, number NCT02014558, and is ongoing.FindingsBetween Oct 15, 2013, and Aug 27, 2015, 252 adults with relapsed or refractory acute myeloid leukaemia received oral gilteritinib once daily in one of seven dose-escalation (n=23) or dose-expansion (n=229) cohorts. Gilteritinib was well tolerated; the maximum tolerated dose was established as 300 mg/day when two of three patients enrolled in the 450 mg dose-escalation cohort had two dose-limiting toxicities (grade 3 diarrhoea and grade 3 elevated aspartate aminotransferase). The most common grade 3-4 adverse events irrespective of relation to treatment were febrile neutropenia (97 [39%] of 252), anaemia (61 [24%]), thrombocytopenia (33 [13%]), sepsis (28 [11%]), and pneumonia (27 [11%]). Commonly reported treatment-related adverse events were diarrhoea (92 [37%] of 252]), anaemia (86 [34%]), fatigue (83 [33%]), elevated aspartate aminotransferase (65 [26%]), and increased alanine aminotransferase (47 [19%]). Serious adverse events occurring in 5% or more of patients were febrile neutropenia (98 [39%] of 252; five related to treatment), progressive disease (43 [17%]), sepsis (36 [14%]; two related to treatment), pneumonia (27 [11%]), acute renal failure (25 [10%]; five related to treatment), pyrexia (21 [8%]; three related to treatment), bacteraemia (14 [6%]; one related to treatment), and respiratory failure (14 [6%]). 95 people died in the safety analysis set, of which seven deaths were judged possibly or probably related to treatment (pulmonary embolism [200 mg/day], respiratory failure [120 mg/day], haemoptysis [80 mg/day], intracranial haemorrhage [20 mg/day], ventricular fibrillation [120 mg/day], septic shock [80 mg/day], and neutropenia [120 mg/day]). An exposure-related increase in inhibition of FLT3 phosphorylation was noted with increasing concentrations in plasma of gilteritinib. In-vivo inhibition of FLT3 phosphorylation occurred at all dose levels. At least 90% of FLT3 phosphorylation inhibition was seen by day 8 in most patients receiving a daily dose of 80 mg or higher. 100 (40%) of 249 patients in the full analysis set achieved a response, with 19 (8%) achieving complete remission, ten (4%) complete remission with incomplete platelet recovery, 46 (18%) complete remission with incomplete haematological recovery, and 25 (10%) partial remission INTERPRETATION: Gilteritinib had a favourable safety profile and showed consistent FLT3 inhibition in patients with relapsed or refractory acute myeloid leukaemia. These findings confirm that FLT3 is a high-value target for treatment of relapsed or refractory acute myeloid leukaemia; based on activity data, gilteritinib at 120 mg/day is being tested in phase 3 trials.FundingAstellas Pharma, National Cancer Institute (Leukemia Specialized Program of Research Excellence grant), Associazione Italiana Ricerca sul Cancro

Social gradients in self-reported health and well-being among adults aged 50 and over in Pune District, India

Background: India’s older population is projected to increase up to 96 million by 2011 with older people accounting for 18% of its population by 2051. The Study on Global Ageing and Adult Health aims to improve empirical understanding of health and well-being of older adults in developing countries. Objectives: To examine age and socio-economic changes on a range of key domains in self-reported health and well-being amongst older adults. Design: A cross-sectional survey of 5,430 adults aged 50 and over using a shortened version of the SAGE questionnaire to assess self-reported assessments (scales of 1–5) of performance, function, disability, quality of life and well-being. Self-reported responses were calibrated using anchoring vignettes in eight key domains of mobility, self-care, pain, cognition, interpersonal relationships, sleep/energy, affect, and vision. WHO Disability Assessment Schedule Index and WHO health scores were calculated to examine for associations with socio-demographic variables. Results: Disability in all domains increased with increasing age and decreasing levels of education. Females and the oldest old without a living spouse reported poorer health status and greater disability across all domains. Performance and functionality self-reports were similar across all SES quintiles. Self-reports on quality of life were not significantly influenced by socio-demographic variables. Discussion: The study provides standardised and comparable self-rated health data using anchoring vignettes in an older population. Though expectations of good health, function and performance decrease with age, self-reports of disability severity significantly increased with age, more so if female, if uneducated and living without a spouse. However, the presence or absence of spouse did not significantly alter quality of life self-reports, suggesting a possible protective effect provided by traditional joint family structures in India, where older people are social if not financial assets for their children

Cross-sectional survey of a sample of UK primary care dental professionals' experiences of sharps injuries and perception of access to occupational health support

Background: The 2013 Sharps Regulations were introduced to minimise the risk of sharps injuries and blood borne virus transmission throughout healthcare. Occupational health (OH) services are pivotal for helping employers implement these regulations. Despite this, no research has been conducted on the prevalence of sharps injuries, underreporting of injuries or access to OH among primary care dental professionals in the UK since 2013. Aim: To estimate the prevalence of sharps injuries, the level of underreporting and of self-reported access to an OH service both for the care of sharps injuries and for general health and wellbeing. Method: A cross-sectional survey was administered at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered questions relating to sharps injuries and OH support. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013). Results: A total of 796 delegates participated, of whom 166 (20.8%) had experienced a sharps injury in the past year and 58 (35%) did not report the incident. Of the participants, 190 (23.9%) reported no, or uncertain, access to OH support. Most respondents' practices had a sharps safety policy (771; 96.9%), but fewer (611; 76.8%) had received training on the prevention of sharps injuries and neither policy nor training were associated with incident reporting. Conclusion: Despite the introduction of the sharps regulations, sharps injuries and underreporting of injuries remain prevalent among those practising in primary dental care. Our results also suggest that there are significant shortfalls in OH support, at a time when changes to guidance on health clearance and management of BBV infected healthcare workers, in addition to sharps injury management, increase the need for such services