A cascaded classification-segmentation reversible system for computer-aided detection and cells counting in microscopic peripheral blood smear basophils and eosinophils images

Computer-aided image analysis has a pivotal role in automated counting and classification of white blood cells (WBCs) in peripheral blood images. Due to their different characteristics, our proposed approach is based on investigating the variations between the basophils and eosinophils in terms of their color histogram, size, and shape before performing the segmentation process. Accordingly, we proposed a cascaded system using a classification-based segmentation process, called classification-segmentation reversible system (CSRS). Prior to applying the CSRS system, a Histogram-based Object to Background Disparity (HOBD) metric was deduced to determine the most appropriate color plane for performing the initial WBC detection (first segmentation). Investigating the local histogram features of both classes resulted in a 92.4% initial classification accuracy using the third-degree polynomial support vector machine (SVM) method. Subsequently, in the proposed CSRS approach, transformation-based segmentation algorithms were developed to fit the specific requirements of each of the two predicted classes. The proposed CSRS system is used, where the images from an initial classification process are fed into a second segmentation process for each class separately. The segmentation results demonstrated a similarity index of 94.9% for basophils, and 94.1% for eosinophils. Moreover, an average counting accuracy of 97.4% for both classes was achieved. In addition, a second classification was carried out after applying the CSRS, achieving a 5.2% increase in accuracy compared to the initial classification process

Prediction of harvestable energy for self-powered wearable healthcare devices: filling a gap

Self-powered or autonomously driven wearable devices are touted to revolutionize the personalized healthcare industry, promising sustainable medical care for a large population of healthcare seekers. Current wearable devices rely on batteries for providing the necessary energy to the various electronic components. However, to ensure continuous and uninterrupted operation, these wearable devices need to scavenge energy from their surroundings. Different energy sources have been used to power wearable devices. These include predictable energy sources such as solar energy and radio frequency, as well as unpredictable energy from the human body. Nevertheless, these energy sources are either intermittent or deliver low power densities. Therefore, being able to predict or forecast the amount of harvestable energy over time enables the wearable to intelligently manage and plan its own energy resources more effectively. Several prediction approaches have been proposed in the context of energy harvesting wireless sensor network (EH-WSN) nodes. In their architectural design, these nodes are very similar to self-powered wearable devices. However, additional factors need to be considered to ensure a deeper market penetration of truly autonomous wearables for healthcare applications, which include low-cost, low-power, small-size, high-performance and lightweight. In this paper, we review the energy prediction approaches that were originally proposed for EH-WSN nodes and critique their application in wearable healthcare devices. Our comparison is based on their prediction accuracy, memory requirement, and execution time. We conclude that statistical techniques are better designed to meet the needs of short-term predictions, while long-term predictions require the hybridization of several linear and non-linear machine learning techniques. In addition to the recommendations, we discuss the challenges and future perspectives of these technique in our review

The Availability Degree of Organizational Health in Arab Technology Schools and its Relation with Estrangement from the Point of View of Teachers, Educational Counselors and Principals درجة توافر الصّحة التَّنظيميّة في المدارس التّكنولوجيّة العربيّة ضمن الخطّ الأخضر، وعلاقتها بالاغتراب الوظيفي كما يراها المعلّمون والمستشارون التربويّون والمديرون

Abstract: The study aimed to identify, the availability degree of organization health in Arab technology schools and its relation with estrangement from the point of view of teachers, educational counselors and principals. The study based on correlational descriptive methodology. The study population consisted of all Arab technology schools teachers, educational counselor and principals (800 teacher) in Triangle region for the year 2020/2021. The study sample was (297) teachers. A questionnaire was constructed of (58) items, in (9) fields, whose validity and reliability were confirmed. The results showed that the availability degree of organization health was high, and the estrangement feeling is low degree. Also, it indicated a close inverse correlation between the availability degree of organization health and its relation with estrangement. The researchers recommended, to provide an employee incentive system, and resources for the educational process, develop and create a healthy and positive organizational culture. ملخص: هدفت الدّراسة للكشف عن درجة توافر الصّحة التَّنظيميّة في المدارس التّكنولوجية العربيّة ضمن الخطّ الأخضر، وعلاقتها بالاغترابِ الوظيفيّ كما يراها المعلّمون والمستشارون التربويّون والمديرون. استخدمت الدّراسة المنهج الوصفي الارتباطي، وتكوّن مجتمع الدّراسة من جميع المعلّمين والمستشارين التربويين والمديرين بجميع المدارس التّكنولوجيّة العربيّة ضمن الخطّ الأخضرِ، خلال الفصل الأوّل 2020\2021 والبالغ عددهم (800) فرد. ولتحقيق أهداف الدّراسة طُوّرَت استبانة مُكوّنة من (58) فقرة مُوزّعة على (9) مجالات تمّ التأكّد من صدقها وثباتها. تكوّنت عيّنة الدّراسة من (297) معلّماً ومستشاراً ومديراً من كلا الجنسين. أشارت أهمّ النتائج أنّ توافر الصّحة التّنظيميّة لدى العيّنة جاء مرتفعًا، وأنّ الاغتراب الوظيفيّ جاء منخفضًا، ووجود علاقة ارتباطيّة عكسيّة بين توافر الصّحة التّنظيميّة والاغتراب الوظيفيّ. ومن أهمّ التّوصيات توفير نظام حوافز للعاملين وتوفير الموارد للعملية التّعليميّة والعمل على تنمية وبناء ثقافة صحيّة تنظيميّة إيجابية

Vitamin D and Foot and Ankle Trauma: An individual or societal problem?

Background Vitamin D deficiency is a worldwide health concern. Hypovitaminosis D may adversely affect recovery from bone injury. The authors aimed to perform an audit of the Vitamin D status of patients in three centres in the United Kingdom presenting with foot and ankle osseous damage. Methods Serum 25-hydroxyvitamin-D (vitamin D) levels were obtained in patients presenting with imaging confirmed foot and ankle osseous trauma. Variables including age, gender, ethnicity, location, season, month, anatomical location and type of bone injury were recorded. Results 308 patients were included from three different centres. 66.6% were female. The average age was 47.7 (range; 10–85). The mean hydroxyvitamin-D levels were 52.0 nmol/L (SD 28.5). 18.8% were grossly deficient, 23.7% deficient, 34.7% insufficient and 22.7% within normal range. 351 separate bone injuries were identified of which 104 were categorised as stress reactions, 134 as stress fractures, 105 as fractures and 8 non-unions. Age, gender, anatomical location and fracture type did not statistically affect vitamin D levels. Ethnicity did affect Vitamin D levels: non-Caucasians mean levels were 32.4 nmols/L compared to Caucasian levels of 53.2 nmol/L (p = 0.0026). Conclusion Only 18.8% of our trauma patients had a normal Vitamin D level and 22.7% were grossly deficient. Patient age, gender, anatomical location and injury type did not statistically affect vitamin D levels. No difference between trauma and elective patients were found. Hypovitaminosis D is a problem of society in general rather than specific to certain foot and ankle injury patterns or particular patient groups sustaining trauma. Level of evidence 2b

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

AVOIDING NOISE AND OUTLIERS IN K-MEANS.

Applying k-means algorithm on the datasets that include large number of noise and outlier objects, gives unclear clusters results. In this paper we proposed a new technique for avoiding these noise and outliers by applying some preprocessing and post processing steps for the dataset that have to be clustered by k-means. Our experimental results demonstrated that our scheme can avoid and eliminate the noise and outliers of the dataset in an efficient and accurate way

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit