770 research outputs found
More evidence of rational market values for home energy efficiency
The “cost versus value” survey by Remodeling indicates that realtor value estimates for window replacement can be substantially explained by the market value of energy efficiency, as estimated in “Evidence of Rational Market Values for Home Energy Efficiency,” which appeared in the October 1998 issue of The Appraisal Journal.Energy; Housing
A Case Of Multifactorial Orthostatic Hypotension Complicated By Chemotherapy Associated Autonomic Toxicity
A Case Of Multifactorial Orthostatic Hypotension Complicated By Chemotherapy Associated Autonomic Toxicity
Christopher Bender, MD
Providence Portland Medical Center – Portland, OR
Additional Authors: Amy Dechet, MD
Introduction: Autonomic neuropathy is known to occur as a side effect of some chemotherapy drugs, including cisplatin. This reports presents a patient with new onset of autonomic instability and orthostatic hypotension after receiving multiple rounds of cisplatin and gemcitabine chemotherapy.
Case Presentation: An 81-year-old man with history of stage III lung cancer presented after a fall at home that occurred while getting out of bed in the middle of the night in the setting of recent malaise and poor oral fluid intake. His cancer was treated with surgical lobectomy and thoracic lymphadenectomy five months prior to his admission, and three rounds of chemotherapy with cisplatin and gemcitiabine. He had been admitted to the same hospital three days prior for weakness and back pain and was empirically started on tamsulosin for urinary retention and was discharged with a foley catheter in place.
On presentation he was noted to have marked orthostatic hypotension, and during the first night of admission he had high blood pressures while sleeping, with systolic blood pressure greater than two hundred mmHg. Postural hypotension did not improve over the first twenty-four hours after multiple intravenous fluid boluses. He was managed by discontinuing exacerbating medications including tamsulosin and benadryl, as well as treatment with physical therapy, an abdominal binder, and minimizing the amount of time spent supine. He was discharged on the fifth day of hospitalization after clearance by physical therapy.
Discussion: Although this case initially appeared to be a straightforward case of orthostatic hypotension related to hypovolemia, it became more complicated when the patient continued to display orthostatic hypotension after initial fluid resuscitation and discontinuation of associated medications. Further suggesting autonomic dysfunction was an inconsistent response of heart rate in relation to hypotension, as well as markedly elevated systolic blood pressure readings at night while the patient was supine. While not a common side effect, there are prior documented cases of autonomic neuropathy in association with cisplatin, which was determined to be the most likely etiology in this case, given the timeline of presentation. An additional factor complicating this case was the issue of addressing orthostatic hypotension in a patient with autonomic instability causing intermittent severe hypertension such that the use of midodrine was not an option. This required creative problem solving including the use of an abdominal binder and compression stockings in order to get the patient stable for discharge from the hospital.https://digitalcommons.psjhealth.org/ppmc_internal/1000/thumbnail.jp
Advanced Estimation of Coastal Storm Surge: Application of Swan+Adcirc in Northeast Florida/Georgia Storm Surge
Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchiv
Automated Mesh Development Tools for Central Florida Storm Surge Study
Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchiv
Advancing and Leveraging Tractable Likelihood Models
The past decade has seen a remarkable improvement in a variety of machine learning applications thanks to numerous advances in deep neural networks (DNN). These models are now the de facto standard in fields ranging from image/speech recognition to driverless cars and have begun to permeate aspects of modern science and everyday life. The deep learning revolution has also resulted in highly effective generative models such as score matching models, diffusion models, VAEs, GANs, and tractable likelihood models. These models are best known for their ability to create novel samples of impressive quality but are usually limited to highly structured data modalities. Expanding the capabilities and applications of likelihood models beyond conventional data formats and generative applications can increase functionality, interpretability, and intuition compared to conventional methods. This dissertation addresses shortcomings in likelihood models over less structured data and explores methods to exploit a learned density as part of a larger application. We begin by advancing the performance of likelihood models outside the standard, ordered data regime by developing methods that are applicable to sets, e.g., point clouds. Many data sources contain instances that are a collection of unordered points, such as points on the surface of scans from human organs, sets of images from a web page, or LiDAR observations commonly used in driverless cars or (hyper-spectral) aerial surveys.We then explore several applications of density models. First, we consider generative process over neural networks themselves and show that training over ensembles of these sampled models can lead to improved robustness to adversarial attacks. Next, we demonstrate how to use the transformative portion of a normalizing flow as a feature extractor in conjunction with a downstream task to estimate expectations over model performance in local and global regions.Finally, we propose a learnable, continuous parameterization of mixture models directly on the input space to improve model interpretability while simultaneously allowing for arbitrary marginalization or conditioning without the need to train new models or develop complex masking mechanisms.Doctor of Philosoph
Evaluating Mobile Remote Presence Bots for Medical Consultation in Nursing Homes
Interviews with nursing home residents and medical practitioners who used a telepresence robot aka mobile remote presence bot (MRP) for medical consultation suggest that consulting via MRP is viable option for certain types of consultations. Participants perceived communication via the MRP as generally positive and the interaction felt natural even though it clearly wasn't the same as face-to-face conversation. The interpersonal quality of communication was slightly reduced; consultations may become more effective however this may impact on the emotional relationship between patients and doctors. Medical practitioners would be able to spend more time in conversation with their patients since time spent travelling to residential homes is greatly reduced. Consulting via MRP also offers a safe option during isolation regimes like the ones that have been implemented in long term care facilities around the world during the SARS-CoVID-2 pandemic
exo-10,11-Dibromotricyclo[6.3.1.02,7]dodeca-2,4,6,9-tetraene
The title compound, C12H10Br2, is a bridged ring system based on a homobenzonorbornadiene framework. The exo configuration of one of the Br atoms was previously assigned via NMR correlations and has now been confirmed by the geometry of the solid-state structure. The compound features a Br—C—C—Br torsion angle of 66.68 (12)°, whereby the C atoms in the calculation are respectively sp
3- and sp
2-hybridized
Resolving the Intracoastal Waterway in a Storm Surge Model Applied for Floodplain Mapping for Northeast Florida
Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchiv
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