Early lessons learnt using simulation to rapidly deploy a trained observer programme during the COVID-19 pandemic in New York City

New York City became one of the epicentres of the COVID-19 pandemic in 2020. Simulation was used to establish the COVID-19 trained observer programme to mitigate healthcare workers’ infection risk during patient care. The members of the trained observer group consisted of 32 staff members. At the start of the training programme, they were provided donning and doffing guides with a step-by-step description of personal protective equipment (PPE) usage, followed by in-situ PPE simulation training. Later on, as PPE protocols evolved, additional educational modalities were used and included training videos, picture demonstrations of common PPE mistakes and repeated in-situ simulations. The early lessons which emerged from using simulation to train observers during the COVID-19 pandemic were the following: address PPE shortages during presimulation planning, prepare to perform updates for trained observers and use multiple educational modalities to train observers. Adequate amounts of PPE should be available to train observers. Repeated simulations are necessary to update observers on PPE protocols. Multiple learning modalities should educate the trained observers and equip them for their role in COVID-19 units.

ColorViz, a New and Rapid Tool for Assessing Collateral Circulation during Stroke

Prognosis of patients with acute ischemic stroke is strictly related to the patency and prominence of the collateral leptomeningeal pathways distal to the arterial occlusion. The gold standard for assessment of collateral circulation is conventional angiography, but it is invasive and used in selected cases. To date, the most reliable technique is multiphase CTA; currently, the available classifications of collateral circles are often complex, time-consuming, and require a trained observer. The purpose of our work is to establish the effectiveness of a new semi-automatic post-processing software (ColorViz FastStroke, GE Healthcare, Milwaukee, Wisconsin) in evaluation of collateral circulation compared to the six-point classifications of multiphase CTA already validated in literature. We selected 86 patients with anterior ischemic stroke symptoms who underwent multiphasic CTA in our emergency department. Two radiologists separately evaluated the collateral leptomeningeal vessels, analyzing respectively, the multiphase CTA (using the six-point scale and its trichotomized form) and ColorViz (using a three-point scale). Then the results were matched. We found a good correlation between the two different analyses; the main advantage of ColorViz is that, while maintaining fast diagnostic times, it allows a simpler and more immediate evaluation of collateral circulation, especially for less experienced radiologists.

214 The effects of an 18-hour transit or complete feed and water restriction on feed bunk displacements and need preferences in growing feedlot steers

The objective was to investigate effects of 18 h feed and water restriction or transit on cattle behavior. Angus-cross steers (36; 353 ± 33 kg) were housed in pens of 6 and assigned to treatments: control (CON), full access to feed and water; deprived (DEPR), no feed or water for 18 h; or transported (TRANS), trucked for 18 h. Individual BW (n = 12 steers/treatment) was recorded on d 0, 1, 3, 8, and 14, and individual dry matter intake (DMI) was determined via GrowSafe bunks. Bunk displacements on d 1 were recorded for each pen (n = 2 pens/treatment) by one trained observer continuously for 2 h in 10 min intervals via video analysis. Steer need preferences were assessed as time individuals took to perform behaviors (eat, drink, lay) after treatments ended on d 1. Data were analyzed using Proc Mixed of SAS with fixed effect of treatment; displacements, BW, and DMI were analyzed as repeated measures. Upon return to pens, time to eat or drink did not differ between DEPR and TRANS (P ≥ 0.17), but time to lay was 70.5 min for DEPR vs. 16.5 min for TRANS (P = 0.01). Displacements were greater for DEPR than CON or TRANS during the first 90 min after accessing feed, while CON displaced more frequently than TRANS for the first 30 min (treatment × time; P = 0.02). While DMI for TRANS was not recovered until d 2, DEPR and CON had similar DMI on d 1 (treatment × day; P < 0.01). Similarly, TRANS BW were, and DEPR tended to be, lesser than CON on d 1; however, BW among treatments were not different on other days (treatment × day; P < 0.01). Thus, restricting feed increases aggressive interactions at the bunk and cattle trucked long distances are quick to lay down when allowed. These behaviors should be considered when managing an unintentional feed restriction event or receiving cattle into the feedlot.

Multiple Food or Non-Food Detection in Single Tray Box Image using Fraction of Pixel Segmentation for Developing Smart Nutrition Box Prototype

Smart Nutrition Box is a hardware prototype to predict food leftover measurement as well as the nutrition of the leftover. In the previous approach, there was a need of trained observer to conduct the analysis. Human observer may produce subjective judgement, so that algorithm which is embedded in a prototype is proposed to get rid of the bias. Black background of tray box is used, and two menus are served in this paper. The problem on raw dataset of images is reflection and it affects the result of segmentation, since it is considered to determine the leftover measurement precisely. In this paper, we focus on how to classify image of food and non-food image in each compartment of tray box by using pixel segmentation before going to further stage of prediction. Automatic cropping is applied by means of rectangle contour detection for each compartment. Combination of L of HSL and V color channel of HSV color spaces are utilized to remove glare in each compartment. The ratio of segmented pixel is a fraction of detected object and the area of compartment. There are 10 out of 12 of tray box images containing multiple food that are correctly classified as food and non-food. The accuracy reaches 95.83% in all compartments using luminosity (L) 50% of lower upper white masking and 100% of upper white masking. It is proved that fraction pixel segmentation is sufficient to be embedded as one of features in Smart Nutrition Box prototype.

A Freely Available, Self-Calibrating Software for Automatic Measurement of Freezing Behavior

ABSTRACTFreezing behavior is commonly used as a measure of associative fear memory. It can be measured by a trained observer, but this task is time-consuming and subject to variation. Commercially available software packages can also be used to quantify freezing; however, they can be expensive and usually require various parameters to be adjusted by the researcher, leading to additional work and variability in results. With this in mind, we developed Phobos, a freely available, self-calibrating software that measures freezing in a set of videos using a brief manual quantification performed by the user to automatically adjust parameters. To optimize the software, we used four different video sets with different features in order to determine the most relevant parameters, the amount of videos needed for calibration and the minimum criteria to consider it reliable. The results of four different users were compared in order to test intra- and interobserver variability in manual and automated freezing scores. Our results suggest that Phobos can be an inexpensive, simple and reliable tool for measurement of fear-related behavior, with intra- and interuser variability similar to that obtained with manual scoring.

Non invasive trans-cutaneous bilirubin as a screening test to identify the need for serum bilirubin assessment in healthy term neonates

INTRODUCTION: Hyperbilirubinemia is a common problem in the neonates. It can progress to develop kernicterus unless intervention is initiated. Severity of jaundice and decision for management are usually based on total serum bilirubin (TsB) estimation which technique and results closely correlates with total serum bilirubin levels. OBJECTIVES: To compare the accuracy of visual assessment of jaundice by single trained observer based on Kramer's index with total serum bilirubin levels in healthy term neonates. To compare accuracy of non invasive bilirubin assessment with serum bilirubin levels, to compare trans-cutaneous bilirubin assessment on different sites (forehead and sternum) and to develop a cutoff point oftrans-cutaneous bilirubin level for serum bilirubin assessment. METHODS: This prospective study was conducted in the Neonatal unit of the department of Paediatrics at Kasturba Hospital ,Manipal. Study period was from October 2007 to June 2008. Clinical assessment of jaundice was done in healthy term neonates by observer (Trained Paediatric Post Graduate Resident) based on Kramer's index. Transcutaneous bilirubin assessment was done on the forhead and sternum of each baby using JM-103 Minolta. Air shields bilirubino meter. Serum bilirubin level was measured within 30 minutes of the clinical assessment for each baby. RESULTS: This study included 187 healthy term neonates. The mean birth weight was 2856.83gm ± 493.89gm and mean gestation was 38.25+ 1.030 SD. Clinical assessment and Transcutaneous bilirubin(TcB) significantly correlated with total serum bilirubin (TsB), with correlation co-efficient of 0.757 and 0.801 respectively (p 0.0001). Transcutaneous bilirubin assessment over forehead showed a tendency to under estimate total serum bilirubin, with mean difference of-0.31 mg/dl, SD 1.75 mg/dl with 95% confidence interval ofthe mean -0.60 and -0.02 mg/dl (p value 0.05).Transcutaneous bilirubin assessments between 10 mg/dl to 15 mg/dl correlated accurately with total serum bilirubin levels avoiding blood sampling. CONCLUSION: Trained observer clinical assessment of jaundice can be used for screening neonatal jaundice. Non invasive transcutaneous bilirubin assessment has demonstrated significant accuracy with serum bilirubin level estimates between 48 hours to 7 days on two different sites forehead and sternum. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9567 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 17-21

The autonomic effects of cardiopulmonary decompression sickness in swine using principal dynamic mode analysis

Methods to predict onset of cardiopulmonary (CP) decompression sickness (DCS) would be of great benefit to clinicians caring for stricken divers. Principal dynamic mode (PDM) analysis of the electrocardiogram has been shown to provide accurate separation of the sympathetic and parasympathetic tone dynamics. Nine swine (Sus scrofa) underwent a 15-h saturation dive at 184 kPa (60 ft. of saltwater) in a hyperbaric chamber followed by dropout decompression, whereas six swine, used as a control, underwent a 15-h saturation dive at 15 kPa (5 ft. of saltwater). Noninvasive electrocardiograms were recorded throughout the experiment and autonomic nervous system dynamics were evaluated by heart rate series analysis using power spectral density (PSD) and PDM methods. We observed a significant increase in the sympathetic and parasympathetic tones using the PDM method on average 20 min before DCS onset following a sudden induction of decompression. Parasympathetic activities remained elevated, but the sympathetic modulation was significantly reduced at onset of cutis and CP DCS signs, as reported by a trained observer. Similar nonsignificant observations occurred during PSD analysis. PDM observations contrast with previous work showing that neurological DCS resulted in a >50% reduction in both sympathetic and parasympathetic tone. Therefore, tracking dynamics of the parasympathetic tones via the PDM method may allow discrimination between CP DCS and neurological DCS, and this significant increase in parasympathetic tone has potential use as a marker for early diagnosis of CP DCS.

Sherlock Holmes: Other Sciences

Sherlock Holmes knew more chemistry than any other science. But in this chapter, we shall find that he was well informed in a number of other sciences as well. Since mathematics contributes to all sciences, we first examine the Canon for instances of mathematical knowledge. We find a number of references to and uses of math in nearly all the early stories. After Holmes and Moriarty supposedly went over the Reichenbach Falls in The Final Problem (FINA) and Holmes returned, he rarely used math again. In A Study in Scarlet (STUD), Watson scoff s at a magazine article that claims that the conclusions of a trained observer are as “infallible as so many propositions of Euclid.” He soon learns that his new roommate Holmes is the author of the article. So here, very early on, we have Holmes drawing a mathematical analogy to his deductive work. He invokes Euclid again in the second story, Sign of Four (SIGN). This time he chides Watson about his writing style. Holmes accuses Watson of allowing romanticism to creep into his narration of the previous case, STUD. According to Holmes, this awkward technique produces “much the same effect as if you worked a love-story or an elopement into the fifth proposition of Euclid.” The fifth proposition states that if two sides in a triangle are equal, then the angles opposite those two sides will also be equal. Note that Holmes makes no calculation using Euclid’s proposition, but he depends on Watson’s knowledge of math to make a point about the way the narrative of STUD was written. This is the first time, but not the last, that he criticizes Watson the chronicler. In SIGN, Holmes’s conversation again assumes that his listener is acquainted with mathematical terms. When he sees that Tonga has left a footprint in creosote, he claims that tracking him will be as easy as using the “rule of three,” which states that if three of the four terms in a proportion are known, then the fourth may be calculated.