Scheduling and Communication Schemes for Decentralized Federated Learning

Federated learning (FL) is a distributed machine learning paradigm in which a large number of clients coordinate with a central server to learn a model without sharing their own training data. One central server is not enough, due to problems of connectivity with clients. In this paper, a decentralized federated learning (DFL) model with the stochastic gradient descent (SGD) algorithm has been introduced, as a more scalable approach to improve the learning performance in a network of agents with arbitrary topology. Three scheduling policies for DFL have been proposed for communications between the clients and the parallel servers, and the convergence, accuracy, and loss have been tested in a totally decentralized mplementation of SGD. The experimental results show that the proposed scheduling polices have an impact both on the speed of convergence and in the final global model.Comment: 32nd International Conference on Computer Theory and Applications (ICCTA), Alexandria, Egypt, 202

Clinical Outcome Results of Stand Alone Anchored Spacer for Anterior Cervical Discectomy and Fusion

Background Data: Anterior cervical discectomy and fusion (ACDF) became the classic operation in treating degenerative cervical spondylosis. The application of anterior cervical plate helped fusion and stabilization; however, there were many reports of the complications, such as dysphagia and the possibility of adjacent segment degeneration that may develop after anterior cervical approach. Purpose: The aim of this study is to assess the outcome of the standalone anchored cervical spacers in anterior cervical discectomy and fusion. Study Design: This is a retrospective study included 30 patients suffering from degenerative cervical disc disease. The outcome measures were: the visual analogue score, Cobb’s angles for sagittal and segmental alignment, the Japanese orthopedic association score, Nurick score for myelopathic patients and the occurrence of postoperative dysphagia. Patients and Methods: 30 patients were included in this study. All these patients had an anterior approach for cervical discectomy. A standalone anchored cervical spacer was used for this purpose. All patients were regularly assessed through the follow up period of two years post surgical intervention. Results: The study included 30 patients, 22 patients had single level, and 8 patients had two levels cervical discectomy. Postoperative improvement of radicular pain VAS were statistically significant (9.0 to 1.67) as well as the improvement in Cobb’s angle (1.39±5.69 to 6.78±3.83) were statistically significant (P=0.001). Postoperative improvement in the JOA Score was significant (7.12 to 14.65). Nurick score for myelopathy improvement was statistically significant (2.6 to 0.83). Postoperative improvement in the fused levels’ height was statistically significant (p=0.001) Conclusion: Stand-alone anchored spacer has a good result regarding relief of symptoms, fusion, and is simple to insert with less post-operative dysphagia. (2018ESJ156

Emergency thoracotomy: Experience of one year in a large tertiary trauma center

Introduction: Emergency thoracotomy (ET) can be a life-saving procedure in highly selected trauma patients, especially after penetrating chest trauma. The aim of this work was to evaluate the outcome in trauma patients who were admitted to the Alexandria Main University Hospital (AMUH) during 1 year period and underwent ET as a management and to compare our results with that documented in the literature. Patients and methods: This is prospective clinical study included trauma patients who were admitted to AMUH during 1 year period (August 2013–August 2014) and underwent ET. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, systolic blood pressure (SBP), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Trauma Revised Injury Severity Score (TRISS) and mortality rate were performed. Results: Twenty-two patients who had ET were included in this study (All were males, Age range: 5–45 years; median: 23.5 ± 7.83 years). Twenty patients from twenty-two were survived. Two of them had blunt trauma while 18 had penetrating injuries. The most frequent injury encountered was isolated thoracic injury (n=13). Thoracotomy was performed in 20 patients, sternotomy in two, and one patient underwent additional laparotomy. Median ISS and TRISS were 10 (Range 9–29) and 0.98 (Range 0.54–0.99), respectively. Blood transfusion ranged between 1 and 13 units with a median of 2 units of packed red blood cells. The median time from admission to operating room was 37.50 min. Pre-operative (FAST & Thoracic Ultrasound) was done in 90.9% of patients. Most common indication for thoracotomy was shock (SBP < 90). The mortality rate was 9.1% for all patients and 10% for patients with penetrating trauma. Factors affecting mortality was ISS and the amount of blood transfusion. Conclusion: ET procedure is an important tool in management of selected trauma patients. Rapid assessment, multidisciplinary approach, good resuscitation and prompt surgical intervention reduce the mortality and improve the outcome

Knowledge of Neonatal Hyperbilirubinemia Among Primary Health Care Physicians: A Single-Center Experience

Background and objectives: To evaluate the knowledge of the primary health care physicians (PHCP) in Kalubia governorate, Egypt, about the causes, diagnosis, complications, and treatment of neonatal hyperbilirubinemia (NHB). Methods: Cross-sectional survey distributed by interview to 500 physicians working in the primary health care (PHC) sector in Kalubia. Results: Out of 500 distributed surveys, 419 (84%) PHCP completed the questionnaire. They represent 174 (90%) out of 193 PHC units and centers. About 18% were males and 82% females with mean age of 28.5 ± 5.2 years, and mean duration of work was 3.3 ± 4.4 years. All of the respondents have patients with NHB in their daily practice. The knowledge of the PHCP was good in some aspects about NHB; however, it was poor and may be even hazardous in other aspects. Conclusions: Many areas of defects are detected in PHCP knowledge about NHB. Pre-service and continuous training of the PHCP about the diagnosis and management of NHB are essential

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially