Deep Ensemble Learning-Based Models for Diagnosis of COVID-19 from Chest CT Images

Novel coronavirus (COVID-19) has been endangering human health and life since 2019. The timely quarantine, diagnosis, and treatment of infected people are the most necessary and important work. The most widely used method of detecting COVID-19 is real-time polymerase chain reaction (RT-PCR). Along with RT-PCR, computed tomography (CT) has become a vital technique in diagnosing and managing COVID-19 patients. COVID-19 reveals a number of radiological signatures that can be easily recognized through chest CT. These signatures must be analyzed by radiologists. It is, however, an error-prone and time-consuming process. Deep Learning-based methods can be used to perform automatic chest CT analysis, which may shorten the analysis time. The aim of this study is to design a robust and rapid medical recognition system to identify positive cases in chest CT images using three Ensemble Learning-based models. There are several techniques in Deep Learning for developing a detection system. In this paper, we employed Transfer Learning. With this technique, we can apply the knowledge obtained from a pre-trained Convolutional Neural Network (CNN) to a different but related task. In order to ensure the robustness of the proposed system for identifying positive cases in chest CT images, we used two Ensemble Learning methods namely Stacking and Weighted Average Ensemble (WAE) to combine the performances of three fine-tuned Base-Learners (VGG19, ResNet50, and DenseNet201). For Stacking, we explored 2-Levels and 3-Levels Stacking. The three generated Ensemble Learning-based models were trained on two chest CT datasets. A variety of common evaluation measures (accuracy, recall, precision, and F1-score) are used to perform a comparative analysis of each method. The experimental results show that the WAE method provides the most reliable performance, achieving a high recall value which is a desirable outcome in medical applications as it poses a greater risk if a true infected patient is not identified.

Combination Therapy Versus Monotherapy In The Treatment Of Stenotrophomonas Maltophilia Infections: A Systematic Review And Meta-Analysis

Background: Stenotrophomonas maltophilia is a multidrug-resistant bacteria that is difficult to treat in hospitals around the world. It has become a public health issue, as well as being linked to a high mortality rate. Several studies have shown a variety of treatment and clinical outcomes; however, the efficacy of combination therapy remains limited. Therefore, the purpose of this study is to investigate the effect of monotherapy and combination therapy for S. maltophilia infections on mortality outcome.Methods: We performed a systematic review and meta-analysis of combination therapy versus monotherapy in the treatment of S. maltophilia infections on mortality as a clinical outcome. Electronic databases, including Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Scopus, and OpenGrey, were systematically searched from the inception of the database until September 3, 2021. Results: Of which 6,524 articles identified, a total of 13 studies and 2 cohort studies were included for systematic review of combination therapy and meta-analysis, respectively. The systematic review of combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection, especially in complex or severe infection. In the fixed-effects meta-analysis of the cohort study, monotherapy was surprisingly shown to have statistically significant effects on the decreased risk of mortality (hazard ratio 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Our results found that the combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection and monotherapy has a trend toward improved better outcome than combination therapy on mortality for the treatment of S. maltophilia infections. A longitudinal study that further explores this association is warranted. Trial registration: This study was registered with the trial registration number ID: 210843 under the international prospective register of systematic reviews (PROSPERO: www.crd.york.ac.uk/PROSPERO).

Rates of sustainment in the Universal Stages of Implementation Completion

Background Sustainment is a desirable outcome of implementation, but its precise definition remains unclear, contributing to the difficulty of identifying a generalized rate of sustainment. Several studies and reviews on the topic differ on both definition and levels of analysis. Furthermore, methodological limitations might have influenced the results, including the unknown quality with which some interventions were delivered. The Universal Stages of Implementation Completion (UniSIC) is a standardized measurement tool that tracks the implementation process and milestone completion across a wide range of real-world implementations—this provides a unique opportunity to identify a generalized rate of sustainment. Methods UniSIC data was captured from the SIC website on 27 September 2020 and included data from all sites (n = 1778) that had been tracked to date. Data were restricted to sites that achieved competency in program delivery, and thus had a newly adopted program worthy of sustainment. Dates and indicator variables of implementation activities were combined to form two alternate definitions of sustainment: sustained (start-up) was achieved if sites continued to deliver services 2 years past their program start-up date; sustained (competent) was achieved if sites continued to deliver services 2 years past their competence and/or certification date. Of sites eligible for inclusion based on these definitions (N = 208), descriptive analyses were conducted to determine a rate of sustainment for all programs that successfully started a program. These definitions were also applied to a combined sample for a general rate of sustainment among all sites. Rates of competency among both a sample of sites that started up and a combined sample were also identified. Results The rate of competence was 58.5% and the rate of sustained (start-up) was 37.1%, while the rate of sustained (competent) was 25.1%. The rates of competence and sustainment among the combined samples were far lower: 15.6% for competence, 6.8% for sustained (start-up), and 4.4% for sustained (competent). Conclusions These identified rates of sustainment are accurate initial estimates of sustainment of community-based practices, or in general. Future research on rates of sustainment should carefully define measures of sustainment and be transparent about the real-world conditions on which analyses are centered.

Legal Status and Rights of the Pet (companion) Animals and Ensuring Their Harmonious Coexistence with Citizens According to Legislation of Georgia

The goal of the present article is to give the reader an insight in the problems of regulating pet issues in Georgia, as well as ongoing trends and up-to-date views in the European countries, to identify the causes of problems of legal regulation and management in the given field and to give an impetus to those interested in the topic and problems to find ways to address the problem. The source of the article was the effective legislation of Georgia, which was duly studied, including the normative acts adopted by the central authority and municipal bodies, as wellas the nation- al legislations of the European countries, international legal documents and the managerial practice of the branch in Georgia. Following the study of the problem considered in the article, it was found that Georgia lacks a single legal framework to systematically and thoroughly regulate pet issues. Neither does the country have a legislative act that would define the status of pets. Consequently, there is no quality and comprehensive legal document at the municipal level derived from the nationwide legislative act. There have been attempts at the levels of both, the central government and concrete municipalities, to address pet issues. However, such attempts are fragmental and non-systemic and fail to cover complex measures. As a result, it is impossible to obtain a desirable outcome in respect of safety of people and animals and protection of animal rights.

Safety and Efficacy of Endovascular Treatment for Progressive Stroke in Patients With Acute Basilar Artery Occlusion

Background and Purpose: It is unknown the benefit of endovascular therapy (EVT) for progressive stroke in patients with basilar artery occlusion (BAO). The aim of this study was to compare the efficacy and safety of EVT with standard medical therapy (SMT) in a population of BAO patients with progressive stroke.Methods: The EVT for Acute Basilar Artery Occlusion Study (BASILAR) is a national prospective registry of consecutive patients with acute BAO within 24 h of symptom onset. According to the applied therapy, all patients were divided into SMT and EVT groups. Subsequently, the EVT group was divided into early (≤6 h) and late groups (>6 h) according to the time window. The efficacy outcome was favorable functional outcomes (modified Rankin Scale score ≤ 3) at 90 days. The safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage (sICH) after EVT.Results: The EVT cohort presented more frequently with a favorable functional outcome (adjusted odds ratio, 5.49; 95% confidence interval, 2.06–14.61, p = 0.01) and with a decreased mortality (adjusted odds ratio, 0.3; 95% confidence interval, 0.17–0.54, p < 0.001). What's more, EVT still safe (P = 0.584, P = 0.492, respectively) and effective (P = 0.05) in patients with progressive stroke when the treatment time window exceeds 6 h.Conclusions: EVT was more effective and safer than SMT for progressive stroke in patients with BAO. Besides, EVT remains safe and effective in patients with progressive stroke when the treatment time window exceeds 6 h. Predictors of desirable outcome in progressive stroke patients undergoing EVT included lower baseline NIHSS score, higher baseline pc-ASPECTs, successful recanalization and shorter puncture to recanalization time.

CRITIQUE ON JALODARARI RASA - A MIGHTY HEPATOPROTECTOR

Ayurveda is the oldest methodical branch of knowledge that speaks its reality in the sketch of philosophy. It comprises most scientific milieu of derivation. As per ancient Ayurveda scholars for getting a desirable outcome of any medication, it should be precisely analysed before prescribing to the patient. There are several classical formulations successfully practised by Ayurveda physicians for treating various ailments, and also there are few unexplored but potent formulations that need the attention of practitioners to come to light. The present study is based to collaborate various references as well as the Pharmacological importance and mechanism of action of a distinctive hepatoprotection Jalodarari Rasa. The most common manifestation of liver dysfunction is ascites, and the most common cause of ascites is liver disease. Ascites is the accumulation of fluid in the peritoneum. Despite advanced medical facilities still, there is no definite treatment that cures a patient of ascites completely. The modern treatments only provide provisional relief with time dependant recurrence but, the fluid gets collected in the abdominal cavity repeatedly. In such cases, Ayurvedic treatment gives relief without any side effects and can be correlated with Jalodara, mentioned in Ayurvedic medical science. Jalodarari Rasa is a herbomineral preparation that is depicted in Bhaishajya Ratnavali Udararogaprakarana, its fundamental constitution being Jayapala, Tamra bhasma, pippali, maricha which are all having lekhana- pachana-bhedana action and thereby useful to evacuate the excess accumulated fluid which is needed to counteract Jalodara. Hence, here an attempt has been made to address the detailed review of Jalodarari rasa. Keywords: Ascites, hepatoprotective, Ayurveda

Body Boundaries and Discursive Practices in Life Threatening Illness: Narratives of the Self

<p>This thesis tells a story from within and between the boundaries of my professional work as a nurse and my private life as the wife of a patient with life threatening illness. The events related in the thesis are told using a technique I have called writing back to myself, where my own journals and stories of the experience of living with life threatening illness provide data for analysis. The reader is invited to participate in these representations and to consider the potential for the skilful practice of nursing which may be read in the stories, and the analysis I have developed from them. I have developed the theoretical and methodological positionings for the thesis from the work of Foucault (1975,1979,1982,1988), Deleuze (1988), Ellis (1995), Richardson (1998) and other writers who utilise genealogical or narrative approaches. The analysis of my own stories in the thesis explores the philosophical and contextual positionings of the nurse as a knowledge worker through genealogies of practice and the specific intellectual work of the nurse. Local and contextual epistemologies are considered as ways of theorising nursing practice through personal knowledge, which is surfaced through the critical analysis of contextual positionings and the process of writing as inquiry. The idea of harmonising nursing practice in the patient's local world through contingent and thinking responses, and the recognition of one's own agency as the nurse, are considered in terms of what might constitute ethical practice. The thinking nurse is a specific intellectual, who critically engages with the context of her/his own practice to form new discourses derived from local and contextual 'truths' about illness, suffering and dying. The capacities for vision that are developed through the stories in the thesis, are explored as having the potential to present new possibilities for the practice of professional nursing. Notions of what constitutes ethical practice are negotiated and contested through local conversations, which privilege the capacities of the patient and the nurse in taking up new discursive positionings as alternatives to those prescribed through the sovereignty of expert power. In the local and contextual world of the patient, visions for practice may be negotiated moment by moment through careful exploration of discursive tensions and the critical appraisal of the utility of alternative possibilities. This development of local knowledge relies on the ability of the nurse to explore and trust her/his own judgement and nursing responses in situations where visions for practice may not be clear. The 'un-picking' and 're-sewing' of stories related in the analysis of the discursive production of the cancer patient and the 'private nurse' present new possibilities for the ethical substance of nursing. This ethical substance creates the potential for new conceptualisations of practice, where nurses and other health professionals take responsibility for the effects of their activities with patients. In this 'un-picking' of the stories in the thesis, I am concerned with the discursive positionings that are taken up by the patient and the health professional in the story. I identify the means through which subjects become visible in discursive statements and the effects of these subject positionings on specific moments of practice with the patient. The 're-sewing' of events involves the telling of alternative stories, negotiated between the actors in the events, to produce a more ethically desirable outcome in the specific contexts of nursing practice.</p>

Body Boundaries and Discursive Practices in Life Threatening Illness: Narratives of the Self

<p>This thesis tells a story from within and between the boundaries of my professional work as a nurse and my private life as the wife of a patient with life threatening illness. The events related in the thesis are told using a technique I have called writing back to myself, where my own journals and stories of the experience of living with life threatening illness provide data for analysis. The reader is invited to participate in these representations and to consider the potential for the skilful practice of nursing which may be read in the stories, and the analysis I have developed from them. I have developed the theoretical and methodological positionings for the thesis from the work of Foucault (1975,1979,1982,1988), Deleuze (1988), Ellis (1995), Richardson (1998) and other writers who utilise genealogical or narrative approaches. The analysis of my own stories in the thesis explores the philosophical and contextual positionings of the nurse as a knowledge worker through genealogies of practice and the specific intellectual work of the nurse. Local and contextual epistemologies are considered as ways of theorising nursing practice through personal knowledge, which is surfaced through the critical analysis of contextual positionings and the process of writing as inquiry. The idea of harmonising nursing practice in the patient's local world through contingent and thinking responses, and the recognition of one's own agency as the nurse, are considered in terms of what might constitute ethical practice. The thinking nurse is a specific intellectual, who critically engages with the context of her/his own practice to form new discourses derived from local and contextual 'truths' about illness, suffering and dying. The capacities for vision that are developed through the stories in the thesis, are explored as having the potential to present new possibilities for the practice of professional nursing. Notions of what constitutes ethical practice are negotiated and contested through local conversations, which privilege the capacities of the patient and the nurse in taking up new discursive positionings as alternatives to those prescribed through the sovereignty of expert power. In the local and contextual world of the patient, visions for practice may be negotiated moment by moment through careful exploration of discursive tensions and the critical appraisal of the utility of alternative possibilities. This development of local knowledge relies on the ability of the nurse to explore and trust her/his own judgement and nursing responses in situations where visions for practice may not be clear. The 'un-picking' and 're-sewing' of stories related in the analysis of the discursive production of the cancer patient and the 'private nurse' present new possibilities for the ethical substance of nursing. This ethical substance creates the potential for new conceptualisations of practice, where nurses and other health professionals take responsibility for the effects of their activities with patients. In this 'un-picking' of the stories in the thesis, I am concerned with the discursive positionings that are taken up by the patient and the health professional in the story. I identify the means through which subjects become visible in discursive statements and the effects of these subject positionings on specific moments of practice with the patient. The 're-sewing' of events involves the telling of alternative stories, negotiated between the actors in the events, to produce a more ethically desirable outcome in the specific contexts of nursing practice.</p>

Blurred Lines or Stark Contrasts: Are By-laws to Restrict Short-Term Holiday Letting Permissible in Queensland Community Titles Schemes?

Complex laws regulate the development and management of Queensland community titles schemes. Different legislative regimes co-exist, including the Body Corporate and Community Management Act 1997 (Qld) (‘BCCM Act’) and its predecessor, the Building Units and Group Titles Act 1980 (Qld) (‘BUGT Act’). This article considers by-laws under the BUGT Act regulating short-term holiday letting post the decisions in Fairway Island GTP v Redman [2019] QMC 13 and Redman v The Proprietors – Fairway Island GTP 107328 [2020] QDC 68. It compares the BCCM Act and BUGT Act requirements and argues that similarities in by-law making powers under the two may appear to blur the divisions between them. However, the positions under each Act are in stark contrast, rendering the cases distinguishable for BCCM Act schemes, a desirable outcome. The article also explores arguments in favour of self-regulation, and the governmental response in New South Wales, Victoria and Western Australia.

The complexity of achieving UHC through PHC: how do we connect the competing narratives?

The commentary discusses the importance of developing Universal Health Coverage strategies through the lens of complex systems framework that evaluates policies not only in terms of the final desired outcome but also as an interplay of disparate views among diverse actors in the system. This view also confers a degree of agency and autonomy on the individual actors, whether they be patients or healthcare workers, and necessitates the inclusion of bottom-up participatory process in the development of UHC policies and interventions. These are consistent with the Primary Health Care principles articulated in the 1978 Alma Ata Declaration and will need to be integrated into the health system development framework to achieve UHC. Ultimately, this approach would encourage the creation of a more cooperative and adaptive policy environment in which each actor is encouraged to collaborate and are nudged toward a desirable outcome rather than through coercive means.