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Background The secretome of the dental pulp mesenchymal stem cells (DPMSCS-S) have an array of regenerative potential and could aid in the rehabilitation of cancer patients post-therapeutic interventions, although caution is required as DPMSC-S have shown to augment prostate cancer cells. Thus, it is vital to assess if these pro-carcinogenic effects extend to other cancer types. Objective To assess if DPMSC-S has any pro-carcinogenic effect on oral cancer, breast cancer, and melanoma cell lines. Materials and methods Conditioned media obtained from the isolated and characterized DPMSC (DPMSC-CM) were profiled using bead-based multiplex assay. AW13515 (oral cancer), MDA-MB-231 (breast cancer), and A-375 (melanoma) cell lines were exposed to 20%, 50%, and 100% DPMSC-CM for 24, 48, and 72 h. DPMSC-CM effect on the cancer cell properties and secretome were assessed. Results DPMSC-CM augmented invasion, adhesion, multi-drug resistance, DNA repair, and mitochondrial repair in AW13516 through upregulation of growth factors Ang-2, EGF, M−CSF, PDGF-AA, PDGF-BB, pro-inflammatory cytokines TNF-α, IL-2, downregulation of anti-inflammatory cytokine TGF-β1, and pro-inflammatory cytokine IL-4. In MDA-MB-231, invasion, and multi-drug resistance were augmented through upregulation of growth factors EGF, EPO, G-CSF, HGF, M−CSF, PDGF-AA, and pro-inflammatory cytokine TNF-α, CXCL10, IL-12p70. EMT, invasion, migration, and adhesion were augmented in A-375 through upregulation of growth factors Ang-2, EGF, PDGF-BB, TGF-α, pro-inflammatory cytokines TNF-α, and IL-17A. Conclusion DPMSC-CM can augment the carcinogenic properties of oral cancer, breast cancer, and melanoma cells, further animal model studies are required to validate our in-vitro findings.

Background: More than 250,000 laparoscopic sleeve gastrectomy (LSG) are performed annually accounting for about 61.4% of all bariatric procedures. The national average cost for LSG ranges between $...

Introduction: There is paucity of data regarding C reactive protein/Albumin (CRP/Alb) ratio in patients with SARS-CoV-2 infection. We aimed to evaluate the significance of CRP/Alb ratio in COVID-19 patients. Methodology: Patients hospitalized between March – April 2020 with COVID-19, who had CRP and Albumin levels documented within 24 hours from admission were retrospectively analyzed. Unpaired Student’s t-test was used for continuous and Pearson Chi-square (χ²) test for categorical variables. Univariate and multivariate logistic regression models were developed to assess the relationship between CRP/Alb and mortality. Nonparametric correlations were calculated using Spearman’s Rho correlation coefficient. Results: 75 patients were included. Mean age was 62.92, 26 females (34.67%) and 49 males (65.33%), mean Body Mass Index (BMI) 29.86, mean body temperature 101.3 and mean length of stay (LOS) was 14.80 days. 24 (32%) patients required invasive mechanical ventilation and 51 (68%) did not, mean CRP/Alb ratio was 6.89 and 4.7 respectively (p = 0.036). 15 (20%) patients died, 60 (80%) survived and the mean CRP/Alb difference between these groups was also statistically significant (7.74 vs 4.83, p = 0.02). LOS (OR 0.71, 95% CI 0.57.-0.88, p < 0.001) and BUN (OR 1.04, 95% CI 1.01.-1.07, p = 0.006) were independent predictors of mortality by multivariate logistic regression, whereas CRP/Alb (OR 1.21, 95% CI 0.96.-1.51, p = 0.06) was not. Conclusions: CRP/Alb ratio could be useful as a prognostic indicator of disease severity in COVID-19, but we could not corroborate its potential to predict mortality. The work was conducted at Columbia University College of Physicians and Surgeons at Harlem Hospital.

Transgender surgeries are increasingly performed across the globe and in the United States. Although comprehensive centers exist, which are well equipped to cater and tailor to the needs of this population subset, quite often their resultant complications are handled at a different institution owing to the acuity of the condition. However, interestingly the psychosocial needs, medical pathophysiology, available surgical procedures, and their resultant complications are still not a part of the regular medical curriculum. This translates into inadequate care when physicians from vast majority of institutions that do not routinely perform transgender surgery encounter these patients with complications from gender-affirming surgeries. We present a case of a patient who underwent complex multiple gender-affirming surgeries, presenting to our emergency department with an acute abdomen; this resulted in a diagnostic and management dilemma and review of brief pertinent literature. We recommend that transgender medicine and its basics needs should be exposed to currently practicing physicians by continuing medical education, trainees and medical students alike via incorporation into their curriculum, to decrease health disparities among the lesbian, gay, bisexual, transgender, and queer community.

Hiatal hernia is frequently encountered intraoperatively during bariatric surgery. There is scarce research pertaining to the diagnostic accuracy of a preoperative diagnostic modality in comparison to intraoperative diagnosis, along with patient characteristics and related factors contributing to hiatal hernia.To identify the prevalence and associations of hiatal hernia in the bariatric patient population, we compared the diagnostic accuracy of upper gastrointestinal series and esophagogastroduodenoscopy with the intraoperative findings across various patient characteristics.Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, Teaching Hospital, New York, USA.Retrospective study of patients from 2015 to 2018 who met National Institutes of Health criteria for bariatric surgery.There were 1094 patients included (135 males, 959 females), with an age range of 18 to 74 years. The diagnostic accuracy was determined by a sensitivity of 64.71% (95% confidence interval [CI] .55-.70), specificity of 74.38% (95% CI .71-.70), positive predictive value of 29.86% (95% CI .24-.30), negative predictive value of 92.59% (95%CI .89-90), likelihood ratio of 2.526, and P value.0001 for esophagogastroduodenoscopy; a sensitivity of 14.02% (95% CI .08-0), specificity of 98.23% (95% CI .96-.90), positive predictive value of 71.43% (95% CI .50-.80), negative predictive value of 78.35% (95% CI .74-.80), likelihood ratio 7.921, and P value.0001 were used for upper gastrointestinal series. Hiatal hernia with age60 years was 17.09% versus 48.44% at60 years (P .0001). Hiatal hernia incidence was 17% in Hispanics, 22.5% in Caucasians, and 23.10% in blacks.The prevalence of hiatal hernia is 18.92%. There is strong association between hiatal hernia and age and ethnicity and no association based on sex and body mass index. The diagnostic accuracy of upper gastrointestinal series is very low compared with that of esophagogastroduodenoscopy for hiatal hernia. Preoperative diagnosis of hiatal hernia in the bariatric population is not required based on our study. Not only does it lessen the economic burden, patient wait time, and discomfort of an additional study, but preoperative diagnosis does not change, alter, or aid in the intraoperative management of hiatal hernia considering the suboptimal accuracy of preoperative diagnostics, thus deeming them unwarranted.

Background In the midst of the coronavirus disease pandemic, emerging clinical data across the world has equipped frontline health care workers, policy makers, and researchers to better understand and combat the illness. Objective The aim of this study is to report the correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and the mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We did a review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and nonintubated, and subgrouped to alive and deceased. A comprehensive analysis using the following parameters were performed: age, sex, ethnicity, BMI, comorbidities, inflammatory markers, laboratory values, cardiac and renal function, electrocardiogram (EKG), chest x-ray findings, temperature, treatment groups, and hospital-acquired patients with SARS-CoV-2. Results A total of 184 patients were included in our study with ages ranging from 28-97 years (mean 64.72 years) and including 73 females (39.67%) and 111 males (60.33%) with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), and 1 Caucasian (0.54%), with a mean of 1.70 comorbidities. Overall, the mortality rate was 17.39% (n=32), 16.30% (n=30) of our patients required mechanical ventilation, and 11.41% (n=21) had hospital-acquired SARS-CoV-2 infection. Pertinent and statistically significant results were found in the intubated versus nonintubated patients with confirmed SARS-CoV-2 for the following parameters: age (P=.01), BMI (P=.07), African American ethnicity (P Conclusions We arrived at the following conclusions based on a comprehensive review of our study group, data collection, and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature, EKG findings with sinus tachycardia, and bilateral diffuse pulmonary infiltrates on the chest x-rays. Those intubated exhibited increased disease severity with significantly elevated levels of serum procalcitonin, CRP, LDH, mean glucose, creatinine, and BUN. Mortality was strongly correlated with BMI, African American ethnicity, hypertension, presence of multiple comorbidities (with a mean of 2.32), worsening renal function with acute kidney injury or acute chronic kidney injury, and EKG findings of arrhythmias and heart blocks.

A retrospective case series.The aim of this study was to report the immunosuppression and secondary bacterial infection after dengue viral infection and the predilection of these infections in the spine. This can trigger further research in to this fact. The possibility of change in the serotype of dengue virus, which are neurotropic, may be looked into.This is the largest case series of epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection.We performed a retrospective review of all the eight cases treated for epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection in our center during the period of 3 months from June 2017 to August 2017.Of the eight cases, three of them were infected with Methicillin Resistant Saphylococcus Aureus and all of them grew the bug in the blood culture. Three of them had Methicillin Sensitive Staphylococcus Aureus (MSSA), one with MSSA septicemia, and one had associated Elizabeth Kingia meningoseptica infection and one patient had positive Acid Fast Bacilli stained in smears. Two patients were infected with pseudomonas. Some patients had multiple site abscess and epidural abscess without spondylodiscitis. Five of them had neurological deficit, which recovered with abscess drainage and antibiotic treatment. The Erythrocyte Sedimentation rate, C-Reactive Protein, and serum ferritin were elevated in these patients.This is a large case series of epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection. The predilection of dengue virus for the neural tissue should be further investigated. Post dengue immunosuppression also needs further study.4.

The main aim of this project is to provide a solution to unmanned railway crossing using a Smartphone based warning system. Protection of common people is indeed a challenge in today's world with the enormous growth in the transportation field over the past 5 years, around 613 have become victims to unmanned railways crossings and the count is increasing at an alarming rate. Statistics states that there are a total of 9340 unmanned level crossings in India which is prone to accidents. This system is mainly used to prevent these accidents through alarms by the use of GPS technologies. GPS communication plays an important role in the implementation of this system. The GPS can calculate the co ordinate positions with the centre of the Earth as the origin by receiving signals from the satellite. The signals thus received help us to perceive the location of the user and the train. Thus, this system aims to detect dangerous situations and to avoid untimely and false alarms. Noorul Shajitha Banu H | Sangeeth T | Saravana Pandi M | Swathi M | Vishnu R "Alert System for Unmanned Railway Crossing using GPS - A Survey" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-3 , April 2018, URL: https://www.ijtsrd.com/papers/ijtsrd10779.pdf

Obesity is a growing global epidemic with tremendous financial burden and health care costs worldwide. Restrictive surgery has emerged as the definitive treatment option to combat morbid obesity and its associated comorbidities. The advent of endoscopy has new grounds in obesity with the introduction of inflatable balloon placed in the stomach that decreases satiety by volume restriction. We report a first case of gastric perforation with peritonitis after ReShape intragastric balloon placement that needed emergent surgical intervention. Decision was made to proceed with exploratory laparotomy, device deflation, and removal with subsequent gastric defect repair. Postoperative period was uneventful, drain was removed on postoperative day 2, and patient tolerated diet and was discharged home subsequently. Biopsy of the perforation site demonstrated mild non-specific chronic gastritis. In the modern era of minimal invasiveness, any new approach would roar popularity among patients and hence is of utmost importance for clinicians to be constantly educated on scientific research and innovations in their field.

Objectives/Hypothesis To evaluate the usefulness of elastic scattering spectroscopy (ESS) as a diagnostic adjunct to frozen section analysis in patients with diagnosed squamous cell carcinoma of the oral cavity. Study Design Prospective analytic study. Methods Subjects for this single institution, institutional review board–approved study were recruited from among patients undergoing surgical resection for squamous cell cancer of the oral cavity. A portable ESS device with a contact fiberoptic probe was used to obtain spectral signals. Four to 10 spectral readings were obtained on each subject from various sites including gross tumor and normal-appearing mucosa in the surgical margin. Each reading was correlated with the histopathologic findings of biopsies taken from the exact location of the spectral readings. A diagnostic algorithm based on multidimensional pattern recognition/machine learning was developed. Sensitivity and specificity, error rate, and area under the curve were used as performance metrics for tests involving classification between disease and nondisease classes. Results Thirty-four (34) subjects were enrolled in the study. One hundred seventy-six spectral data point/biopsy specimen pairs were available for analysis. ESS distinguished normal from abnormal tissue, with a sensitivity ranging from 84% to 100% and specificity ranging from 71% to 89%, depending on how the cutoff between normal and abnormal tissue was defined (i.e., mild, moderate, or severe dysplasia). There were statistically significant differences in malignancy scores between histologically normal tissue and invasive cancer and between noninflamed tissue and inflamed tissue. Conclusions This is the first study to evaluate the effectiveness of ESS in guiding mucosal resection margins in oral cavity cancer. ESS provides fast, real-time assessment of tissue without the need for pathology expertise. ESS appears to be effective in distinguishing between normal mucosa and invasive cancer and between “normal” tissue (histologically normal and mild dysplasia) and “abnormal” tissue (severe dysplasia and carcinoma in situ) that might require further margin resection. Further studies, however, are needed with a larger sample size to validate these findings and to determine the effectiveness of ESS in distinguishing visibly and histologically normal tissue from visibly normal but histologically abnormal tissue. Level of Evidence NA Laryngoscope, 127:S1–S9, 2017

Extremity muscles are grouped and divided by strong fascial membranes into compartments. Multiple pathological processes can result in an increase in the pressure within a muscle compartment. An increase in the compartment pressure beyond the adequate perfusion pressure has the potential to cause extremity compartment syndrome. There are multiple sites where compartment syndrome can occur. In this article, an arm and forearm compartment syndrome ensued secondary to a minor crushing injury that lead to supracondylar and medial epicondylar non-displaced fractures. A pure motor radial and ulnar nerve deficits noted on presentation, worsened with progression of the compartment syndrome. Ultimately, a surgical fasciotomy was carried out to release all compartments of the right upper arm and forearm.

Omental infarction is an uncommon cause of acute abdomen but one that clinically mimics more serious and common causes of acute abdomen like appendicitis and cholecystitis. Historically, it was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen. But with the increase in the use of imaging, especially abdominal computed tomography (CT) scan in the work-up for acute abdomen, more cases of omental infarction are being diagnosed preoperatively. This has also led to the observation that omental infarction is a self-limiting condition which can be managed conservatively. Currently, conservative management and surgery are the only treatment options for omental infarction with no consensus as to the best treatment modality. Having a patient with both acute appendicitis and omental infarction simultaneously is extremely rare with only two reported cases in the literature thus far. Here, we present a 10-year-old obese female who presented to our hospital with acute abdomen and was found to have acute appendicitis and omental infarction. The patient underwent laparoscopic appendectomy and resection of the infarcted omentum and had uneventful recovery and was discharged on the second postoperative day. In this report, we present a review of current literature on omental infarction and highlight the importance of imaging especially abdominal CT scan in the nonoperative diagnosis and treatment of omental infarction.

In the past decade, a variety of thermoacoustic engines (TAEs) were devised to convert thermal energy to acoustic power. In this paper, we optimized the design of a standing wave thermoacoustic generator that can provide high intensity acoustic pressure and convert it into electrical power output using a low cost alternator. Three prototypes of standing wave thermoacoustic generator (TAG) were designed to optimize the overall efficiency. The first prototype of standing wave TAG could produce an acoustic pressure of 0.9 kPa (153 dB) with an input thermal power of 210 W. Further, the maximum heat to electrical conversion efficiency was 0.045% with an input thermal power of 250 W. However, the performance of this system was not fully optimized. The performance of TAE depends upon various parameters including stack position, stack length and resonator length. Hence, a new second prototype of tunable TAG was developed to tune these critical parameters in order to improve the overall efficiency. A compact third prototype of TAG was successfully built with optimized parameters and has been tested. In the improved design, high intensity acoustic pressure of 2.9 kPa (163.5 dB) was observed for the same 210 W input thermal power. The maximum heat to electrical energy conversion efficiency was 0.084% with an input of 250 W which is 87% higher as compared to the first prototype. The major reason for the lower conversion efficiency is due to the low efficiency of the alternator. In future, high efficiency alternator designs can be employed along with careful impedance matching to obtain higher conversion efficiencies. The results described in this paper demonstrate the potential of developing compact portable acoustic power and electricity generators for decentralized power applications.

Bluetooth technology is a standard prescribed for short-range wireless communication that uses low-power radio frequency at a low cost. It is interoperable with all devices as it consumes a very small amount of energy. The Bluetooth Core Specification provided by Bluetooth Special Interest Group (SIG) will be adding direction finding feature in the Low Energy (LE) standard. This feature will enable a tracker to find the target by estimating the relative angle between the tracker and target. It uses either Angle of Arrival (AoA) or Angle of Departure (AoD) method with multiple antennas switching for direction estimation. To support this feature, the packet structure in LE physical layer is modified. The frames of the LE uncoded packets like the Protocol Datagram Unit (PDU) Header is modified and an additional frame known as Constant Tone Extension (CTE) is added to the LE packet structure. To implement the above ideas, we need to generate a portion of the LE packets in the National Instruments (NI) Bluetooth measurement toolkit. NI Bluetooth measurement toolkit is used for testing and measurement of Bluetooth RF signals. The results show that the CTE, which is needed for direction finding capability, is successfully incorporated in the BLE.5.1 packet structure.

Myocardial infarction, commonly known as heart attack, is one of the major causes of death around the world. For many, heart attacks are unexpected and can occur at any time, especially if a person previously had a heart attack or any type of heart disease. The suddenness of a heart attack makes it difficult to detect and prevent it from occurring, resulting in death or irreversible injury to the heart. Finding a method of detecting a heart attack even five minutes before the attack occurs can be the time between life and death. My research aims to use a machine learning algorithm incorporated into a noninvasive biosensor for early detection of heart attacks. Users first enter factors such as biometrics, history of cardiac diseases, and habits. The biosensor will have a live feed of ECG data from the user. The neural network algorithm will take these initial factors as well as the ECG data to determine whether or not a user is experiencing a myocardial infarction. The neural network is trained by data from the PTB Diagnostic ECG Database from PhysioNet. This project will allow early detection of a heart attack, thus early treatment and a decreased possibility of death and long term tissue damage, and can also be used to track user heart health over a period of time.

We present an incidental finding and management of a urethral diverticulum containing mixed composition of struvite and ammonium urate stones. Status post sleeve gastrectomy, patient presented to our bariatric clinic with epigastric pain associated with nausea and vomiting. A computed tomography scan was performed to rule out any complications of the procedure in which urethral stones were reported contained within a diverticulum. This finding, in retrospect, correlated with patient's past history of recurrent urinary tract infections. Over all, urethral diverticulum with struvite stones is a rare entity with few reported cases in literature thus a high index of suspicion is needed in patients with related symptoms. Here a case presentation and treatment rationale are described along with a brief review of existing literature.

Autonomous landing is an essential function for micro air vehicles (MAVs) for many scenarios. We pursue an active perception strategy that enables MAVs with limited onboard sensing and processing capabilities to concurrently assess feasible rooftop landing sites with a vision-based perception system while generating trajectories that balance continued landing site assessment and the requirement to provide visual monitoring of an interest point. The contributions of the work are twofold: (1) a perception system that employs a dense motion stereo approach that determines the 3D model of the captured scene without the need of geo-referenced images, scene geometry constraints, or external navigation aids; and (2) an online trajectory generation approach that balances the need to concurrently explore available rooftop vantages of an interest point while ensuring confidence in the landing site suitability by considering the impact of landing site uncertainty as assessed by the perception system. Simulation and experimental evaluation of the performance of the perception and trajectory generation methodologies are analyzed independently and jointly in order to establish the efficacy and robustness of the proposed approach.

The advent of endoscopic techniques has transformed the surgical therapy of Zenker's diverticula. Although the treatment paradigm has shifted to minimally invasive approaches with endoscopic stapling-assisted or laser-assisted repair, traditional transcervical procedures can still play a role in selected cases. The goal of this article is to illustrate our tailored approach to patients with Zenker's diverticula and illustrate our open surgical and endoscopic techniques. The discussion will also include the evidence-based rationale for our preoperative assessment and choice of technique.

Hernioscopy is essentially hernia sac laparoscopy. Hernia repair has evolved over the years with better outcomes; however, strangulated inguinal hernias are acute surgical emergencies which require emergent operative intervention. During anesthesia induction and/or after incision, hernia self-reduction is possible, with or without compromised bowel, back into the abdominal cavity. It is pivotal to examine the bowel to decide on further operative course. A simple alternative to unnecessary laparotomy or standard laparoscopy is hernioscopy, which is quite uncommon. We present a case of an acute symptomatic strangulated left-sided inguinal hernia which got self-reduced during anesthesia induction and was successfully repaired after hernioscopy was used to evaluate the incarcerated hernia content. We provide a brief review of literature about hernioscopy and an algorithm to guide surgeons in emergent cases.

Arterial aneurysms (AA) can be classified as true aneurysms, characterized by the persistence of all three layers of the arterial wall with progressive dilation and wall thinning; arterial pseudoaneurysms (APAs) are characterized by a tear in the vessel wall and a periarterial hematoma formation. They could occur due to a visceral, retroperitoneal, or peripheral origin. Most AA/APA are usually found incidentally, and it is imperative to be vigilant in order to diagnose and manage them due to their potentially life-threatening complications. We present a case of a 35-year-old woman presenting with right-sided abdominal pain mimicking renal colic with an initial misdiagnosis of ureteral calculus. Post-cystoscopy, a misdiagnosis was confirmed, and subsequently, the patient had a right retroperitoneal mass excision. The histopathology report concluded the calcified retroperitoneal mass to be pseudoaneurysm. Such pitfalls in diagnosis are essential to be shared with the larger medical community for increased vigilance and optimal management of pseudoaneurysms.

Acute gastrointestinal obstruction can have a varied spectrum of clinical presentation and etiologies. It has been studied in detail and the management criteria have been well defined for the most part in our era. The etiologies are usually well defined. However, acute small bowel obstruction (SBO) due to intussusception caused by an inverted Meckel's diverticulum is a rare phenomenon that is often times missed on initial presentation and/or consequently until resected and visualized on pathological examination. We present a case of a 34-year-old presenting with symptoms and signs of acute intestinal obstruction and radiographic exam showing ileo-ileal intussusception. The patient failed to improve initially following conservative management and was taken to the operating room for small bowel resection which then revealed an inverted Meckel's diverticulum.

A retained intra-abdominal foreign body is a common occurrence that is frequently underreported due to its medicolegal implications. Sponges, gauzes, surgical instruments, abdominal drains, etc. have been reported in the literature. The most common presentation for a retained intra-abdominal foreign body is postoperative abdominal infections or bleeding, frequently seen in the immediate postoperative period. Most of these foreign bodies are removed by exploratory laparotomy owing to recent abdominal surgeries or presentation as complicated abdominal masses. Here, we report a case with retained intra-abdominal drains for 15 years with minimal symptoms presenting as an intermittent abdominal pain; the drains were removed using laparoscopic intervention.

This work presents Experience-driven Predictive Control (EPC) as a fast technique for solving nonlinear model predictive control (NMPC) problems with uncertain system dynamics. EPC leverages an affine dynamics model that is updated online via Locally Weighted Projection Regression (LWPR) to capture nonlinearities, uncertainty, and changes in the system dynamics. This model enables the NMPC problem to be re-cast as a quadratic program (QP). The QP can then be solved via multi-parametric techniques to generate a mapping from state, reference, and dynamics model to a locally optimal, affine feedback control law. These mappings, in conjunction with the basis functions learned via LWPR, define a notion of experience for the controller as they capture the full input-output relationship for previous actions the controller has taken. The resulting experience database allows EPC to avoid solving redundant optimization problems, and as it is constructed online, enables the system to operate more efficiently over time. We demonstrate the performance of EPC through a set of hardware-in-the-loop simulation studies of a quadrotor micro air vehicle that is subjected to unmodeled exogenous perturbations.

Planetary surface exploration missions are becoming increasingly complex and future missions promise to be even more ambitious than those that have occurred thus far. To deal with this complexity, this paper proposes a fractionated approach to planetary surface exploration. Fractionation involves splitting up large vehicles into several smaller ones that work together in order to achieve the science goals. It is believed that fractionation of rovers can lead to increased value delivery and productivity, as well as helping manage complexity. A science goal-driven methodology for generating a tradespace of multi-vehicle architectures in the early stages of mission design is detailed. A set of carefully designed metrics are then put forward as a way to help compare multi-vehicle architectures to each other and to the single vehicle (monolithic) equivalent. These include science value delivery, productivity, system- and vehicle-level complexity, and mass metrics. Through two Mars-based case studies, the advantages and limitations of fractionation are explored. Fractionation is found to be particularly advantageous when the science goals are broad, when there are competing requirements between goals, and when the exploration environment is particularly treacherous. Additionally, multi-vehicle systems entail simpler vehicles with lower vehicle-level complexity, lower mission risk and higher productivity over the mission duration, as well as being more easily upgradeable. On the other hand, they lead to higher system-level complexity, and can somewhat increase the overall mass of the system. Thus, through this methodology, it was demonstrated that the fractionation of planetary surface exploration systems leads to mass being traded for higher science return and lower risk during the mission, and to complexity being shifted from design complexity to operational complexity. Multi-vehicle systems involve more testing and on-board automation than single vehicles, but they also lend themselves more easily to collaboration between different agencies, and can benefit from several emergent properties that increase the overall functionality of the system.

This case describes an intraoperative incidental finding and surgical removal of ectopic liver tissue attached to the gallbladder during a standard laparoscopic cholecystectomy for acute cholecystitis. These anomalies are rare, with interesting associations and possible clinically relevant complications. The details of the case, along with a brief literature review of embryology, common ectopic sites, and associations/complications, are presented in this paper. Since laparoscopic cholecystectomy is a very common procedure, it is important to increase vigilance of ectopic liver tissues during surgeries to minimize complications and provide optimal management.

Over 42 million people suffer from peripheral neuropathy: deterioration of the nerves in the peripheral nervous system which controls the flow of information from the central nervous system (the brain and spinal cord) to other parts of the body, especially the extremities. Peripheral neuropathy may be caused by autoimmune diseases, metabolic and endocrine disorders, diabetes, cancer, chemotherapy, alcoholism, and more. One symptom of peripheral neuropathy is a lack of ability to sense temperature especially in the extremities such as fingers and toes. If a peripheral neuropathy patient's finger is entered into a high temperature unsafe zone, the patient does not have the quick reaction to move away from the heat source. This makes even simple daily activities such as cooking and operating machinery dangerous as patients are highly susceptible to injury like burns and frostbite, leading to ulcers and more complications.

This work presents an experiment-driven aerodynamic disturbance modeling technique that leverages experiences from past flights to construct a predictive model of the exogenous forces acting on an aerial robot. Specifically, we consider operation in turbulent air stemming from the interaction between wind and nearby surfaces. To construct the disturbance model, we employ Locally Weighted Projection Regression and relate the aerial robot’s state and an experimentally learned freestream wind model to the disturbance forces estimated during flight through the environment. The approach is experimentally validated through a set of flight tests in an indoor environment with artificially generated turbulent airflow that illustrate the computation of this disturbance model, its generalizability across flow conditions, and its utility for disturbance-aware motion planning.

Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threatening postoperative complication following laparoscopic sleeve gastrectomy. From our extensive review of literature, there is no existing report of acute pancreatitis with splenic infarction postsleeve gastrectomy to this date.

The ability to classify driver behavior lays the foundation for more advanced driver assistance systems. In particular, improving safety at intersections has been identified as a high priority due to the large number of intersection-related fatalities. This paper focuses on developing algorithms for estimating driver behavior at road intersections and validating them on real traffic data. It introduces two classes of algorithms that can classify drivers as compliant or violating. They are based on (1) support vector machines and (2) hidden Markov models, which are two very popular machine learning approaches that have been used successfully for classification in multiple disciplines. However, existing work has not explored the benefits of applying these techniques to the problem of driver behavior classification at intersections. The developed algorithms are successfully validated using naturalistic intersection data collected in Christiansburg, VA, through the U.S. Department of Transportation Cooperative Intersection Collision Avoidance System for Violations initiative. Their performances are also compared with those of three traditional methods, and the results show significant improvements with the new algorithms.

This paper presents a novel approach to address the challenge of planning paths for multi-agent systems subject to complex constraints. The technique, called the Decentralized Multi-Agent Rapidly-exploring Random Tree (DMA-RRT) algorithm, extends the Closed-loop RRT (CL-RRT) algorithm to handle multiple agents while retaining its ability to plan quickly. A core component of the DMA-RRT algorithm is a merit-based token passing coordination strategy that makes use of the tree of feasible trajectories grown in the CL-RRT algorithm to dynamically update the order in which agents replan. The reordering is based on a measure of each agent's incentive to change the plan and allows agents with a greater potential improvement to replan sooner, which is demonstrated to improve the team's overall performance compared to a traditional, scripted replan order. The main contribution of the work is a version of the algorithm, called Cooperative DMA-RRT, which introduces a cooperation strategy that allows an agent to modify its teammates' plans in order to select paths that reduce their combined cost. This modification further improves team performance and avoids certain common deadlock scenarios. The paths generated by both algorithms are proven to satisfy inter-agent constraints, such as collision avoidance, and numerous simulation and experimental results are presented to demonstrate their performance.

Highlights • Penumoperitoneum is rarely reported complication of chest compressions. • Possible risk factors include peptic ulcers and airway disease. • Presence of an OG tube during CPR may have been a contributing factor. • Clinicians must decide if patient is stable enough to warrant laparotomy for repair of perforation., INTRODUCTION Chest compressions are performed routinely and have several well-known complications, however one of the rare complications is pneumoperitoneum caused by air entry through a perforation of the viscus. The exact cause of the perforation is not always clear. Furthermore, this rarely reported condition does not have clear management guidelines. PRESENTATION OF CASE We present an uncommon complication of pneumoperitoneum following successful resuscitation possibly caused by the presence of an orogastric tube at the time of compressions in a 79 year old Hispanic male. Following chest compressions, a distended and tympanic abdomen was noted and air seen under the diaphragm in X-ray imaging. DISCUSSION A review of previous case reports along with etiology and evaluation of risk factors is presented. CONCLUSION Although the exact cause of pneumoperitoneum cannot be confirmed, emergency personnel should be aware of the risk factors associated with viscus perforation during chest compressions.

We explore the use of scintillation detectors coupled with silicon photomultipliers (SiPMs) as position sensitive hard x-ray spectroscopic detectors for potential applications in the field of high-energy astrophysics. X-ray photons on interaction with scintillation crystals generate optical photons and the distribution of these scintillation light photons is captured with the array of SiPM pixels, providing the spectral and spatial information of the incident x-ray photons. As the position is estimated by fitting the distribution of optical photons, it should be possible to achieve spatial resolution lesser than the pixel size. Development of two detector modules with CsI (Tl) and CeBr3 scintillators coupled with different sets of array of SiPM pixels is presented here. Spectral and spatial resolutions of both detector modules are characterized with experiments using x-ray lines from laboratory radioactive sources. It is shown that a faster scintillator with an array of low-noise SiPM pixels provides better spectral and spatial resolution and it is possible to achieve subpixel spatial resolution with such a detector module.

Introduction: In addition to the fluid intake in the form of intravenous maintenance or boluses in intensive care unit (ICU) patients, there are sources of fluids that may remain unrecognized but contribute significantly to the overall fluid balance. We hypothesized that fluids not ordered as boluses or maintenance infusions—“hidden obligatory fluids”—may contribute more than a liter to the fluid intake of a patient during any random 24 hours of critical care admission. Methods: Patients admitted to the Harlem Hospital ICU for at least 24 hours were included in this study (N = 98). Medical records and nursing charts were reviewed to determine the sources and volumes of various fluids for the study patients. Results: The mean hidden obligatory volume for an ICU patient was calculated to be 978 mL (standard deviation [SD]: 904, median: 645) and 1571 mL (SD: 1023, median: 1505), with enteral feeds compared to the discretionary volume of 2821 mL (SD: 2367, median: 2595); this obligatory fluid volume was affected by a patient’s need for pressor support and renal replacement therapy. Conclusion: Hidden obligatory fluids constitute a major source of the fluid intake among patients in a critical care unit. Up to 1.5 L should be taken into account during daily decision making to effectively regulate their volumes.

Ischemic heart disease is the foremost cause of death in the United States and the developed countries. Stable angina is the initial manifestation of ischemic heart disease in one half of the patients and becomes a recurrent symptom in survivors of myocardial infarction (MI) and other forms of acute coronary syndromes (ACS). There are multiple therapeutic modalities currently available for treatment of anginal symptoms in patients with stable CAD. These include anti‐anginal drugs and myocardial revascularization procedures such as coronary artery bypass graft surgery (CABGS), percutaneous transluminal coronary angioplasty (PTCA) and percutaneous coronary intervention (PCI). Anti‐anginal drug therapy is based on treatment with nitrates, beta blockers, and calcium channel blockers. A newly approved antianginal drug, ranolazine, is undergoing phase III evaluation. Not infrequently, combination therapy is often necessary for adequate symptom control in some patients with stable angina. Howerever, there has not been a systematic evaluation of individual or combination antianginal grug therapy on hard clinical end points in patients with stable angina. Most revascularization trials that have evaluated treatment with CABGS, PTCA, or PCI in patients with chronic CAD and stable angina have not shown significant improvement in survival or decreased incidence of non‐fatal MI compared to medical treatment. In the CABGS trials, various post‐hoc analyses have identified several smaller subgroups at high‐risk in whom CABGS might improve clinical outcomes. However, there are conflicting findings in different reports and these findings are futher compromised due to the heterogeneous groups of patients in these trials. Moreover, no prospective randomized controlled trial (RCT) has confirmed an advantage of CABGS, compared to medical treatment, in reduction of hard clinical outcomes in any of the high‐risk subgroups. Based on the available data, it appears reasonable to conclude that for most patients (except perhaps in those with presence of left main disease > 50% stenosis) there is no apparent survival benefit of CABGS compared to medical therapy in stable CAD patients with angina. Although these trial have reported better symptom control associated with the revascularization intervention in most patients, this has not been adequately compared using modern medical therapies. Available data from recent studies also suggest treatment with an angiotensin converting enzyme inhibitor (ACEI), a statin and a regular exercise regimen in patients with stable CAD and angina pectoris. Copyright © 2007 Wiley Periodicals, Inc.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare clinical condition with only about 100 cases reported in the literature. It is characterized by primary hyperplasia of pulmonary neuroendocrine cells (PNECs) which are specialized epithelial cells located throughout the entire respiratory tract, from the trachea to the terminal airways. DIPNECH appears in various forms that include diffuse proliferation of scattered neuroendocrine cells, small nodules, or a linear proliferation. It is usually seen in middle-aged, nonsmoking women with symptoms of cough, dyspnea, and wheezing. We present a 45-year-old, nonsmoking woman who presented with symptoms of DIPNECH associated with bilateral pulmonary nodules and left hilar adenopathy. Of interest, DIPNECH in our patient was associated with metastatic pulmonary carcinoids, papillary carcinoma of the left breast, oncocytoma and angiomyolipoma of her left kidney, and cortical nodules suggestive of tuberous sclerosis. She had video assisted thoracoscopic surgery (VATS), modified radical mastectomy with reconstruction, and radical nephrectomy. She is currently symptom-free most of the time with over two years of follow-up.

The aim of this paper is to bring the concept of linear algebra and Digital Signal Processing together. This methodology helps in efficient solving of signal processing problems. Linear algebra tool box is created to visualize the signal by ‘click and drag’ approach. In platform like MATLAB, tapping of the signals is not possible (conventional code has to be written for solving the problem). This problem can be solved with the help of a freeware called GNU Radio Companion (GRC). In GRC each problem can be modeled in the form of a module. In this paper, problem like L1 norm, L2 norm, Frobenius norm, unit vector normalization and least square fitting are solved. Quantified results are open in this paper.