Surgical treatment for thyrotoxic hypokalemic periodic paralysis: case report

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules

High-Frequency Sea Level Variations Observed by GPS Buoys Using Precise Point Positioning Technique

In this study, sea level variation observed by a 1-Hz Global Positioning System (GPS) buoy system is verified by comparing with tide gauge records and is decomposed to reveal high-frequency signals that cannot be detected from 6-minute tide gauge records. Compared to tide gauges traditionally used to monitor sea level changes and affected by land motion, GPS buoys provide high-frequency geocentric measurements of sea level variations. Data from five GPS buoy campaigns near a tide gauge at Anping, Tainan, Taiwan, were processed using the Precise Point Positioning (PPP) technique with four different satellite orbit products from the International GNSS Service (IGS). The GPS buoy data were also processed by a differential GPS (DGPS) method that needs an additional GPS receiver as a reference station and the accuracy of the solution depends on the baseline length. The computation shows the average Root Mean Square Error (RMSE) difference of the GPS buoy using DGPS and tide gauge records is around 3 - 5 cm. When using the aforementioned IGS orbit products for the buoy derived by PPP, its average RMSE differences are 5 - 8 cm, 8 - 13 cm, decimeter level, and decimeter-meter level, respectively, so the accuracy of the solution derived by PPP highly depends on the accuracy of IGS orbit products. Therefore, the result indicates that the accuracy of a GPS buoy using PPP has the potential to measure the sea surface variations to several cm. Finally, high-frequency sea level signals with periods of a few seconds to a day can be successfully detected in GPS buoy observations using the Ensemble Empirical Mode Decomposition (EMD) method and are identified as waves, meteotsunamis, and tides

NEFTune: Noisy Embeddings Improve Instruction Finetuning

We show that language model finetuning can be improved, sometimes dramatically, with a simple augmentation. NEFTune adds noise to the embedding vectors during training. Standard finetuning of LLaMA-2-7B using Alpaca achieves 29.79% on AlpacaEval, which rises to 64.69% using noisy embeddings. NEFTune also improves over strong baselines on modern instruction datasets. Models trained with Evol-Instruct see a 10% improvement, with ShareGPT an 8% improvement, and with OpenPlatypus an 8% improvement. Even powerful models further refined with RLHF such as LLaMA-2-Chat benefit from additional training with NEFTune.Comment: 25 pages, Code is available on Github: https://github.com/neelsjain/NEFTun

SARS Exposure and Emergency Department Workers

Of 193 emergency department workers exposed to severe acute respiratory syndrome (SARS), 9 (4.7%) were infected. Pneumonia developed in six workers, and assays showed anti-SARS immunoglobulin (Ig) M and IgG. The other three workers were IgM-positive and had lower IgG titers; in two, mild illness developed, and one remained asymptomatic

Worshipers and Warriors

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68415/2/10.1177_009770047600200102.pd

Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan

Background. With international concern over emerging infectious diseases (EID) and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS) capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC) starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making. Methods. Between June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005. Results. Taiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p < 0.001). It also identified increases in the upper, lower, and total gastrointestinal (GI) syndrome groups starting in November 2004 and two clear spikes in enterovirus-like infections coinciding with the two school semesters. Using ED-SSS for surveillance of influenza-like illnesses and enteroviruses-related infections has improved Taiwan's pandemic flu preparedness and disease control capabilities. Conclusion. Taiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration. © 2008 Wu et al; licensee BioMed Central Ltd

Comparison of trauma systems in Asian countries: a cross-sectional study.

OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS). METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics. RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%). CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies