Search

Monitoring the health and safety of forests has become a rising problem with the advent of global wildfires, rampant logging, and reforestation efforts. This paper proposes a model for the automatic segmentation and classification of aerial forest imagery. The model is based on U-net architecture and relies on dice coefficients, binary cross-entropy, and accuracy as loss functions. While models without autoencoder-based structures can only reach a dice coefficient of 45%, the proposed model can achieve a dice coefficient of 79.85%. In addition, for barren adn dense forestry image classification, the proposed model can achieve 82.51%. This paper demonstrates how complex convolutional neural networks can be applied to aerial forest images to help preserve and save the forest environment.

Mollaret meningitis (MM) refers to benign recurrent aseptic meningitis usually following herpes simplex virus 2 (HSV-2) infection. Neuro-ophthalmic manifestations associated with MM are rarely reported. We present a case of recurrent HSV-2 meningitis with the neuro-ophthalmic presentation of papilledema and sixth nerve palsy. To our knowledge, this is the first such description in the English language ophthalmic literature.

Background Antimicrobial resistance is a global health emergency. Persons colonized with multidrug-resistant organisms (MDROs) are at risk for developing subsequent multidrug-resistant infections, as colonization represents an important precursor to invasive infection. Despite reports documenting the worldwide dissemination of MDROs, fundamental questions remain regarding the burden of resistance, metrics to measure prevalence, and determinants of spread. We describe a multi-site colonization survey protocol that aims to quantify the population-based prevalence and associated risk factors for colonization with high-threat MDROs among community dwelling participants and patients admitted to hospitals within a defined population-catchment area. Methods Researchers in five countries (Bangladesh, Chile, Guatemala, Kenya, and India) will conduct a cross-sectional, population-based prevalence survey consisting of a risk factor questionnaire and collection of specimens to evaluate colonization with three high-threat MDROs: extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Healthy adults residing in a household within the sampling area will be enrolled in addition to eligible hospitalized adults. Colonizing isolates of these MDROs will be compared by multilocus sequence typing (MLST) to routinely collected invasive clinical isolates, where available, to determine potential pathogenicity. A colonizing MDRO isolate will be categorized as potentially pathogenic if the MLST pattern of the colonizing isolate matches the MLST pattern of an invasive clinical isolate. The outcomes of this study will be estimates of the population-based prevalence of colonization with ESCrE, CRE, and MRSA; determination of the proportion of colonizing ESCrE, CRE, and MRSA with pathogenic characteristics based on MLST; identification of factors independently associated with ESCrE, CRE, and MRSA colonization; and creation an archive of ESCrE, CRE, and MRSA isolates for future study. Discussion This is the first study to use a common protocol to evaluate population-based prevalence and risk factors associated with MDRO colonization among community-dwelling and hospitalized adults in multiple countries with diverse epidemiological conditions, including low- and middle-income settings. The results will be used to better describe the global epidemiology of MDROs and guide the development of mitigation strategies in both community and healthcare settings. These standardized baseline surveys can also inform future studies seeking to further characterize MDRO epidemiology globally.

Background In low- and middle-income countries (LMIC), neonatal healthcare-associated infections (HAI) are associated with increased morbidity, mortality, hospital stay, and costs. When resources are limited, addressing HAI through infection prevention and control (IPC) requires prioritizing interventions to maximize impact. However, little is known about the gaps in LMIC that contribute most to HAI. # Methods A literature review was conducted to identify the leading IPC gaps contributing to neonatal HAIs in intensive care units and specialty care wards in LMIC. Additionally, a panel of 21 global experts in neonatology and IPC participated in an in-person modified Delphi process to achieve consensus on the relative importance of these gaps as contributors to HAI. # Results Thirteen IPC gaps were identified and summarized into four main categories: facility policies such as prioritizing a patient safety culture and maintaining facility capacity, general healthcare worker behaviors such as hand hygiene and proper device insertion and maintenance, specialty healthcare worker behaviors such as cleaning and reprocessing of medical equipment, and infrastructural considerations such as adequate medical equipment and hand hygiene supplies. # Conclusions Through a modified Delphi process, we identified the leading IPC gaps contributing to neonatal HAIs; this information can assist policymakers, public health officials, researchers, and clinicians to prioritize areas for further study or intervention.

To gain additional experience in ultrasound-guided procedures, interventional radiology (IR)-bound surgical preliminary interns at an urban community hospital established a difficult intravenous access (DIVA) consult service. This study evaluates the efficacy, safety, and educational value for such a team. The first year of DIVA team results were followed from May 2019 to April 2020. The value of the experience for IR-bound residents vs. categorical general surgery residents (GS) was compared. 239 patients were evaluated by the DIVA team for a total of 4.3 consults per week. General surgery residents performed an additional estimated 2.5 consults per week. For IR residents, 218/230 (94.8%) PIV and 8/9 (88.9%) midline attempts were successful. There were no technical complications that required additional procedural interventions. All residents found educational value in participating in DIVA team. Residents designated to enter IR found participating in the DIVA team to be significantly more beneficial for overall educational value learning identification/access of vessels under ultrasound guidance ( P < .01). Interventional radiology residents had a higher mean number of procedures (average 60 vs. 24) before diminishing educational value was noted ( P < .05). 100% of GS and IR residents noted that upon entering PGY 2 they felt more adept than their peers at performing ultrasound-guided vascular access and all believed their experience working with DIVA team would benefit them throughout their careers. Establishment of an intern-directed difficult IV access team is beneficial to resident education as well as patient care. Monitoring of case load to avoid service over education is recommended.

A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V1,2,3, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.

This paper reviews and assesses the impacts and the benefits of energy efficiency measures on total energy consumption, electrical peak demand, and carbon dioxide emissions specific to commercial buildings for six countries part of the Gulf Cooperation Council (GCC). In particular, optimal performance of a prototypical commercial building is analyzed in each of the GCC countries including Bahrain, Kingdom of Saudi Arabia, Kuwait, Oman, Qatar, and the United Arab Emirates. Specifically, a series of parametric and sensitivity analyses is performed to investigate the potential savings from a set of energy efficiency measures for each GCC country. In addition, an optimization using life-cycle cost analysis is developed in order to select feasible energy efficiency measures as design alternatives to enhance the energy performance of commercial buildings in the GCC region. The optimized design alternatives for office buildings in all six countries in the GCC region resulted in annual energy consumption, electrical peak demand, and carbon dioxide emission savings ranging on average from 62% to 69% with payback periods ranging from 2.0 to 3.5 years to implement the feasible measures. A bottom-up analysis approach is then used to estimate the benefits for scaling-up the energy efficiency programs targeting both new and existing commercial building stocks for the GCC countries.

Objectives We examine the ways in which the 2016 Fort McMurray wildfire evacuation affected infant feeding. Our primary objective is to understand the decisions and perceptions of primary caregivers of children age 0-36 months who evacuated from Fort McMurray, Canada. Methods We used a mixed methods approach to assess the overall impact that the evacuation had on infant feeding. Specific outcome variables for the quantitative research are: decision-making, access to support and resources, and changes in routine. Participants were recruited using a purposive sampling technique through infant feeding in emergency support groups on social media in which members were primarily evacuees from the Fort McMurray wildfire. Loglinear results include a model of feeding methods before and after the wildfire evacuation. Results Content analyses results from qualitative data support findings from the loglinear model. Specifically, the findings suggest that the evacuation was associated with a reduction in breastfeeding and an increase in use of infant formula The open-ended data revealed that caregivers experienced stress during and after the evacuation due to moving from place to place, food insecurity associated with artificial feeding, warding off unhealthy food for older children, and managing family reunification. In addition, respondents reported that breastfeeding was a source of comfort for infants and contributed to a sense of empowerment. Conclusions for Practice This study sets forth important groundwork for understanding decision-making, stress, logistics, and social factors that influence infant feeding in a large-scale evacuation event. Emergency management, health workers, and nutrition experts can provide support to families in disasters to mitigate some of the adverse impacts the evacuation may have on infant feeding.

This paper evaluates potential energy savings associated with variable reflectivity envelope systems (VRCs) including cool roofs associated the application of coatings that can change their reflective properties over time depending on outdoor conditions and desired controlled strategies. It is well known that static cool roofs can save energy use during cooling periods but may increase energy consumption during swing or heating seasons due to lower beneficial heat gains. In the analysis, a two-step control strategy is considered to modify the properties of the cool roof coatings based on the temperature difference between internal and external roof surfaces. Using a simulation environment capable of modeling variable properties of outer surface of building envelope, a comparative analysis is carried out to evaluate the impact of VRCs on the heating and cooling energy end-uses for commercial buildings in four US climates. It is observed that VRCs can save heating energy use compared to static cool roofs for all four US climates for both commercial buildings. In particular, it is found that VRCs have the potential to reduce annual energy use in commercial buildings up to 11% compared to the static cool roofs.

Sticking probability (P) and deposit bond strength (ξ) are the two most important factors that determine the fouling process, but no calculation correlations were found for P and ξ in current models. This study investigated the interaction between particulate fouling and precipitation fouling based on the values of P and ξ, taking into account the growth characteristics of the combination of particulate fouling and precipitation fouling on the micro-surface of the heat transfer tube. Three kinds of fouling were measured continuously over 720 h in each of three individual tests: particulate fouling, precipitation fouling, and the combined fouling. In order to recognize the growth mechanism of the combined fouling on the heat transfer surface and to solve the engineering problems, this study provides a reliable method to calculated P and ξ. The results indicated that the solution of CaCO3 mixed with the particles of SiO2 at the mass ratio of 1:1 (CaCO3:SiO2) improved sticking probability. And the enhanced tubes, the helical ridge tube with start-number of 45 and start-number of 10, compared with the plain tube, would not easily stick, but hardly denude by flow which reduced the sticking probability and increased the deposit bond strength. For the helical ridge tube with start-number of 45, when compared with the helical ridge tube with start-number of 10, the particles were more likely to stick to the surface of, but the precipitation fouling was harder to occur. It was observed that deposits were difficult to remove once they were deposited by the particulate fouling or precipitation fouling on the surface of the helical ridge tube with start-number of 45.

This paper evaluates potential energy savings associated with dynamic insulation materials (DIMs) – material assemblies that can change their thermal resistance through a controlled exchange of liquid or gaseous media – in the exterior walls of buildings. In the analysis, a two-step control strategy is considered to modify the R -value of DIMs based on the temperature difference between internal and external wall surfaces. Using a simulation environment capable of modeling DIMs, a comparative analysis is carried out to evaluate the impact of DIMs on the heating and cooling energy end-uses for single-zone residential buildings in three US climates. Several design and operating conditions are considered to assess the performance of DIMs and their potential energy use savings. The results indicated that variable thermal resistance envelope materials (RSI-0.5/RSI-2.5) have the potential to reduce annual cooling energy use in residential buildings on average by 15% and up to 39% for all three US climates and annual heating energy use by 10% on average for mild US climates depending on the window sizes and internal heat gains.

BACKGROUND Screening individuals with AIDS for serum cryptococcal antigen (CrAg), followed by treatment of CrAg positives with antifungals, may prevent cryptococcal meningitis. This review examined data on CrAg screening and treatment in resource-limited settings. METHODS We searched articles published during 2007-2014 on the effectiveness and cost-effectiveness of CrAg screening and treatment on the outcomes of mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. We rated overall quality of individual articles, summarized the body of evidence, the expected impact, and cost-effectiveness for each outcome. RESULTS We identified 2613 articles. Eight met all inclusion criteria. Five studies addressed mortality and/or morbidity outcomes; all were observational and had small sample sizes; 3 lacked a comparison group. Ratings of study quality ranged from "medium" to "weak," and the quality of the overall body of evidence for mortality and morbidity outcomes was rated as "fair." The intervention's expected impact on mortality and morbidity was rated as "moderate." The 4 cost-effectiveness studies included in the analysis showed that CrAg screening and treatment interventions are highly cost-effective. No studies addressed retention in care, quality of life, or HIV transmission. CONCLUSIONS Although limited, the body of evidence regarding CrAg screening and treatment suggests that the intervention may have an impact on preventing cryptococcal meningitis and death in persons with AIDS. Additional research is needed to quantify the intervention's effectiveness and identify optimal treatment dosing and implementation best practices.

Park B. You're the flight surgeon: white matter hyperintensities. Aerosp Med Hum Perform. 2015; 86(12):1075-1077.

Establishing and expanding government led networks to strengthen infection prevention and control and healthcare associated infection surveillance are essential to effectively tackle antimicrobial resistance. Soumya Swaminathan and colleagues discuss the progress in India

This paper evaluated potential operational cost savings associated with optimal control strategies for hollow core ventilated slab systems used to maintain indoor thermal comfort for office buildings. First, a simplified calculation method was developed to convert two-dimensional (2D) modeling of ventilated slab thermal performance to one-dimensional (1D) analysis in order to reduce computational efforts required for optimization search while maintaining acceptable accuracy level. The total energy costs were considered to identify optimal control strategies to operate ventilated slab systems to cool and heat office spaces. Penalty functions restricted the optimization search to ensure that indoor thermal comfort was maintained during occupancy periods. Then, the consecutive time block optimization (CTBO) technique was used with a genetic algorithm (GA) based search method to identify strategies that minimize the operational costs of the ventilated slab systems. A comparative analysis was carried out to evaluate the impact of ventilated slab systems’ design properties on the optimal operational cost savings. The results of the optimization analysis showed that the proposed optimal controller can achieve up to 11% cost savings to operate ventilated slab systems.

Prior to the 2014–2016 Ebola epidemic, Sierra Leone’s Ministry of Health and Sanitation had no infection prevention and control programme. High rates of Ebola virus disease transmission in healthcare facilities underscored the need for infection prevention and control in the healthcare system. The Ministry of Health and Sanitation led an effort among international partners to rapidly stand up a national infection prevention and control programme to decrease Ebola transmission in healthcare facilities and strengthen healthcare safety and quality. Leadership and ownership by the Ministry of Health and Sanitation was the catalyst for development of the programme, including the presence of an infection prevention and control champion within the ministry. A national policy and guidelines were drafted and approved to outline organisation and standards for the programme. Infection prevention and control focal persons were identified and embedded at public hospitals to manage implementation. The Ministry of Health and Sanitation and international partners initiated training for new infection prevention and control focal persons and committees. Monitoring systems to track infection prevention and control implementation were also established. This is a novel example of rapid development of a national infection prevention and control programme under challenging conditions. The approach to rapidly develop a national infection prevention and control programme in Sierra Leone may provide useful lessons for other programmes in countries or contexts starting from a low baseline for infection prevention and control.

This paper presents a simulation environment developed to assess the energy use specific to integrated radiant heating and cooling systems. The developed simulation environment combines a transient finite difference solution for the two-dimensional model of an integrated radiant slab heating and cooling system with a resistance capacitance (RC) thermal network model for a multifloor building. The developed model of the integrated radiant system is able to account for thermal bridge effects on the energy performance of multifloor buildings. The predictions of the developed simulation environment are verified against those obtained from a detailed whole-building energy simulation tool under specific conditions. The developed simulation environment is then used to investigate the impact of thermal bridge effects on the performance of an integrated radiant heating and cooling system. Thermal bridging can affect significantly the energy performance of the integrated radiant systems by up to 8%. Several...

Background. Cryptococcus gattii (Cg) has caused increasing infections in the US Pacific Northwest (PNW) since 2004. We describe this outbreak and compare clinical aspects of infection in the United States among patients infected with different Cg genotypes. Methods. Beginning in 2005, PNW state health departments conducted retrospective and prospective passive surveillance for Cg infections, including patient interviews and chart reviews; clinical isolates were genotyped at the US Centers for Disease Control and Prevention (CDC). We examined symptom frequency and underlying conditions in US patients with Cg infection and modeled factors associated with death. Results. From 1 December 2004 to July 2011, 96Cg infections were reported to the CDC. Eighty-three were in patients in or travelers to the PNW, 78 of which were genotypes VGIIa, VGIIb, or VGIIc (outbreak strains). Eighteen patients in and outside the PNW had other molecular type Cg infections (nonoutbreak strains). Patients with outbreak strain infections were more likely than those with nonoutbreak-strain infections to have preexisting conditions (86% vs 31%, respectively; P , .0001) and respiratory symptoms (75% vs 36%, respectively; P 5 .03) and less likely to have central nervous system (CNS) symptoms (37% vs 90%, respectively; P 5 .008). Preexisting conditions were associated with increased pneumonia risk and decreased risk of meningitis and CNS symptoms. Nineteen (33%) of 57 patients died. Past-year oral steroid use increased odds of death in multivariate analysis (P 5 .05). Conclusions. Clinical differences may exist between outbreak-strain (VGIIa, VGIIb, and VGIIc) and nonoutbreak-strain Cg infections in the United States. Clinicians should have a low threshold for testing for Cg, particularly among patients with recent travel to the PNW.

Coccidioidomycosis presumably causes ≤ 33% of community-acquired pneumonias cases, although < 15% of the patients are tested for coccidioidomycosis. We assessed healthcare providers' knowledge, attitudes, and practices regarding coccidioidomycosis diagnosis and treatment in Arizona. A survey was mailed to 7,608 eligible healthcare providers licensed by the Arizona medical, osteopathic, and nursing boards in October and December 2007. We used weights to adjust for non-response and multivariate logistic regression models to identify predictors of ≥ 70% correct regarding knowledge and treatment practices. Of 1,823 (24%) respondents, 53% were physicians, 52% were male, and the mean age was 51 years. Approximately 50% reported confidence in their ability to treat coccidioidomycosis, and 21% correctly answered all four treatment questions. Predictors of ≥ 70% correct concerning knowledge and treatment practices included always counseling patients after diagnosis (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI]: 2.8–7.1); specializing in infectious diseases (AOR = 2.4; 95% CI: 1.0–5.7); and having received coccidioidomycosis continuing medical education (CME) in the last year (AOR = 1.8; 95% CI: 1.2–2.6). These findings demonstrate that coccidioidomycosis CME improves knowledge of disease diagnosis and management, underscoring the need for a comprehensive coccidioidomycosis education campaign for healthcare providers in Arizona.

Use of short-term steroids was a risk factor for infection., We investigated an unusual cluster of 6 patients with Cryptococcus neoformans infection at a community hospital in Arkansas during April–December 2013, to determine source of infection. Four patients had bloodstream infection and 2 had respiratory infection; 3 infections occurred within a 10-day period. Five patients had been admitted to the intensive care unit (ICU) with diagnoses other than cryptococcosis; none had HIV infection, and 1 patient had a history of organ transplantation. We then conducted a retrospective cohort study of all patients admitted to the ICU during April–December 2013 to determine risk factors for cryptococcosis. Four patients with C. neoformans infection had received a short course of steroids; this short-term use was associated with increased risk for cryptococcosis (rate ratio 19.1; 95% CI 2.1–170.0; p

During September 2009, we performed a rapid cross-sectional study to investigate the extent of aflatoxin contamination among common Bangladeshi foods. We collected eight common human food commodities (rice, lentils, wheat flour, dates, betelnut, red chili powder, ginger and groundnuts) and poultry feed samples from two large markets in each of three cities in Bangladesh. We quantified aflatoxin levels from pooled subsamples using fluorescence high-performance liquid chromatography. Aflatoxin levels were highest in dates and groundnuts (maximum 623 and 423 ng/g), respectively. Samples of betelnut (mean 30.6 ng/g), lentils (mean 21.2 ng/g) and red chili powder (>20 ng/g) also had elevated levels. The mean aflatoxin level among poultry feed samples was 73.0 ng/g. Aflatoxin levels were above the US maximum regulatory levels of 20 ng/g in five of eight commonly ingested human food commodities tested.

Invasive mold infections (IMIs) are a major source of morbidity and mortality among lung transplant recipients (LTRs), yet information regarding the epidemiology of IMI in this population is limited. From 2001 to 2006, multicenter prospective surveillance for IMIs among LTR was conducted by the Transplant-Associated Infection Surveillance Network. The epidemiology of IMI among all LTRs in the cohort is reported. Twelve percent (143/1173) of LTRs under surveillance at 15 US centers developed IMI infections. The 12-month cumulative incidence of IMIs was 5.5%; 3-month all-cause mortality was 21.7%. Aspergillus caused the majority (72.7%)of IMIs; non-Aspergillus infections (39, 27.3%) included Scedosporium (5, 3.5%), mucormycosis (3, 2.1%) and "unspecified" or "other" mold infections (31, 21.7%). Late-onset IMI was common: 52% occurred within 1 year posttransplant (median 11 months, range 0-162 months). IMIs are common late-onset complications with substantial mortality in LTRs. LTRs should be monitored for late-onset IMIs and prophylactic agents should be optimized based on likely pathogen.

Background Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. Methods and Findings We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77–90% of patients at $26–51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68–90% of patients at costs of $189–232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. Conclusions For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone.