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Purpose: A trauma center project for treating patients with trauma has been established in Korea. A trauma team is activated based on the Centers for Disease Control and Prevention (CDC) field triage Step 1 for patient triage. Here, we determined if the currently applied criteria were appropriate for the triage of patients with trauma in Korea.Methods: This retrospective study included patients who were taken to the regional trauma center from January 1, 2016 to December 31, 2019, and were registered in the Korean Trauma database. The rates for undertriage and overtriage were calculated from the in-field and in-hospital triage according to the CDC guidelines Step 1.Results: Among the 9,383 patients transferred to the trauma center, 3,423 were directly transferred from the site and were investigated. The overall rates for undertriage and overtriage of these patients were 28.13% and 30.35%, respectively. For the patients who received in-field triage and were directly transferred to the trauma center, the rates for undertriage and overtriage were 27.92% and 32.39%, and 25.92% and 29.11% for in-hospital triage, respectively. The concordance rate of triage was 87.09%.Conclusion: The current use of in-hospital triage physiological criteria as set out in the CDC guidelines Step 1, indicated an undertriage rate which was high and an overtriage rate within the acceptable range. Further studies on triaging patients with trauma are warranted. Improvements in the guidelines of the trauma center project are necessary and this needs to be supported by resources and training for field personnel.

Purpose: The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0–1 (age and Injury Severity Score) or 0–3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0–11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P

Purpose The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals’ service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea. Methods We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Results The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4–19 days] vs. 16 days [IQR 8–28 days], p

A new button-shaped electrical device was developed for a smart fabric. This electric button can be sewn anywhere on the garment, similar to a traditional button fastener. t not only performs a decorative function but also makes the fabric suitable for use in Internet of Things (IoT) applications. It has metallic through-holes such that it can be fastened onto a fabric by conductive sewing threads. When threaded through metallic holes, the button can communicate with the external device by transmitting and receiving data. In addition, it adds specific functions by stacking a detachable application layer on the base layer. It is robust to frequent washing, and thus has excellent repeatability for use as an IoT device. The feasibility of the electric button was successfully demonstrated by its ability to identify the physical activities of walking and running, monitoring ambient temperature, and turning on LED lights.

Research shows teacher influence in school decision-making is related to improving individual job satisfaction and professional commitment. However, few empirical studies investigate how different domains of school decision-making may have a distinct relationship with both individual teacher job satisfaction and professional commitment. Using the Schools and Staffing Survey 2011–2012 and the National Teacher and Principal Survey 2015–2016 which are national samples of U.S. primary and secondary schools, this study examines teacher influence in managerial and instruction domains of school decision-making and whether both are associated with job satisfaction and professional commitment. Results showed that teacher influence in the instruction domain has a statistically stronger relationship with teacher professional commitment than job satisfaction. In contrast, teacher influence in the managerial domain of school decision-making has a statistically stronger relationship with teacher job satisfaction than professional commitment. The results have policy implications for involving teachers in school decision-making and improving their overall job satisfaction.

Deep Learning techniques have been successfully used to solve a wide range of computer vision problems. Due to their high computation complexity, specialized hardware accelerators are being proposed to achieve high performance and efficiency for deep learning-based algorithms. However, soft errors, i.e., bit flipping errors in the layer output, are often caused due to process variation and high energy particles in these hardware systems. These can significantly reduce model accuracy. To remedy this problem, we propose new algorithms that effectively reduce the impact of errors, thus keeping high accuracy. We firstly propose to incorporate an Error Correction Layer (ECL) into neural networks where convolution is performed multiple times in each layer and majority reporting is conducted for the outputs at bit level. We found that ECL can eliminate most errors while bypassing the bit-error when the bits at the same position are corrupted multiple times under the simulated condition. In order to solve this problem, we analyze the impact of errors depending on the position of bits, thus observing that errors in most significant bit (MSB) positions tend to severely corrupt the output of the network compared to the errors in the least significant bit (LSB) positions. According to this observation, we propose a new specialized activation function, called Piece-wise Rectified Linear Unit (PwReLU), which selectively suppresses errors depending on the bit positions, resulting in an increased model resistance against the errors. Compared to existing activation functions, the proposed PwReLU outperforms with large accuracy margins of up-to 20% even with very high bit error rates (BERs). Our extensive experiments show that the proposed ECL and PwReLU work in a complementary manner, achieving comparable accuracy to the error-free networks even at a severe BER of 0.1% on CIFAR10, CIFAR100, and ImageNet.

Fully automated system for sample preparation in molecular diagnostics was developed. The small cartridge with multiple chambers and a rotating valve was designed for automated processes such as extraction, separation and purifications during the DNA sample preparation. The automated processes such as injection, mixing, capturing and valve on/off motions were controlled by an affordable, motorized control system. We demonstrated the automated DNA extraction of pathogenic bacteria using this system. The deviations in the purity and real-time polymerase chain reaction (PCR) detection of the automated DNA extraction samples were clearly decreased. The device provided rapid, reliable, and reproducible sample preparation in comparison with manual DNA extraction. This automated platform can be utilized in emergent point-of-care testing of infectious disease and foodborne bacteria.

Introduction Transarterial embolisation (TAE) is an effective intervention for management of arterial haemorrhage associated with pelvic fracture. However, its effects on survival and clinical outcomes are unclear. Methods Trauma patients with survival data between November 2015 and December 2019 were identified using a trauma database. Patients were divided between TAE and non-TAE groups, and a propensity score was developed using multivariate logistic regression. Survival at 28 days was compared between the groups after propensity score matching. Results Among 881 patients included in this study, 308 (35.0%) were treated with TAE. After propensity score matching, 130 pairs were selected. Survival at 28 days was significantly higher among patients treated with TAE than among those treated without TAE [122 (93.9%) vs. 112 (86.2%); odds ratio = 2.45; 95% CI 1.02–5.86; p = 0.039]. Conclusions TAE use was associated with improved survival at 28 days in patients with pelvic fracture and should therefore be considered in the management of severely injured patients with pelvic fracture.

We predict a quantum phase shift of a moving electric dipole in the presence of an external magnetic field at a distance. On the basis of the Lorentz-covariant field interaction approach, we show that a phase shift appears in the internal dipole state under the condition that the dipole is moving in the field-free region, which is distinct from the topological He-McKellar-Wilkens phase generated by a direct overlap of the dipole and the field. We discuss the experimental feasibility of detecting this phase with atomic interferometry and argue that detection of this phase will resolve the question of the locality in quantum electromagnetic interaction.

A body pressure relief system was newly developed with optical pressure sensors for pressure ulcer prevention. Unlike a conventional alternating pressure air mattress (APAM), this system automatically regulates air flow into a body supporting mattress with adaptive inflation (or deflation) duration in response to the pressure level in order to reduce skin stress due to prolonged high pressures. The system continuously quantifies the body pressure distribution using time-of-flight (ToF) optical sensors. The proposed pressure sensor, a ToF optical sensor in the air-filled cell, measures changes in surface height of mattress when pressed under body weight, thereby indirectly indicating the interface pressure. Non-contact measurement of optical sensor usually improves the durability and repeatability of the system. The pressure sensor was successfully identified the 4 different-predefined postures, and quantitatively measured the body pressure distribution of them. Duty cycle of switches in solenoid valves was adjusted to 0&ndash, 50% for pressure relief, which shows that the interface pressure was lower than 32 mmHg for pressure ulcer prevention.

In this paper we demonstrate how performance of Edge-AI-Inference hardware can be enhanced by effectively using emerging commodity MRAM chips inside specific accelerator pipelines. We consider the special case of IoT-centric ‘normally-off/low-frequency’ AI inference workloads to benchmark the proposed approach. The proposed Non-Volatile AI Inference Accelerator (NVIA) is realized using FPGA and off-the-shelf MRAM chips. NVIA is benchmarked for Human activity recognition (HAR) dataset. Significant power gains, ∼9x (with Toggle-MRAM (180 nm)) and ∼750x (with STT-MRAM (22 nm)), were achieved compared to volatile SRAM.

A novel cartridge-based platform was developed to perform fully automated sample preparation, amplification, and analysis of nucleic acids. The cartridge consists of three layers: multiple reagent chambers, a mixing reservoir, and elutes and waste chambers. The fluidic manipulation and solution mixing inside the cartridge were controlled by motor systems. After loading a sample specimen, each reagent solution in the chambers of the cartridge was sequentially injected into the mixing reservoir. Extracted nucleic acids were captured by magnetic beads and transferred into a small eluates chamber. Automated sample preparation and isothermal amplification of nucleic acids for pathogenic bacteria were demonstrated in this all-in one cartridge platform. This cartridge system provides rapid and reproducible sample preparation in comparison with manual methods. In addition, real-time detection of isothermal amplification using the implemented photometric system was compared with that of using a commercial polymerase chain reaction (PCR) device. This system has the potential to become a more reliable diagnostic tool for fast detection of contagious, foodborne, and emergency point-of-care (POC) diseases.

We developed an integrated PCR system that performs automated sample preparation and fast polymerase chain reaction (PCR) for application in point-of care (POC) testing. This system is assembled from inexpensive 3D-printing parts, off-the-shelf electronics and motors. Molecular detection requires a series of procedures including sample preparation, amplification, and fluorescence intensity analysis. The system can perform automated DNA sample preparation (extraction, separation and purification) in ≤5 min. The variance of the automated sample preparation was clearly lower than that achieved using manual DNA extraction. Fast thermal ramp cycles were generated by a customized thermocycler designed to automatically transport samples between heating and cooling blocks. Despite the large sample volume (50 μL), rapid two-step PCR amplification completed 40 cycles in ≤13.8 min. Variations in fluorescence intensity were measured by analyzing fluorescence images. As proof of concept of this system, we demonstrated the rapid DNA detection of pathogenic bacteria. We also compared the sensitivity of this system with that of a commercial device during the automated extraction and fast PCR of Salmonella bacteria.

We developed a sensitive and reliable thermal micro-flow sensor (TμFS) to measure extremely low flow rates for a drug infusion system. The TμFS exploits a calorimetric principle. Various temperature differences upstream and downstream of a heated area were monitored by three temperature sensors to enable measurement of both cooling and heating effects at the multiple temperature-sensing areas. The flow rate was measured by subtraction or summation of the temperature differences between selected locations upstream and downstream. The temperature differences between heat loss and diffusion increased sensitivity of flow rate detection in range of 0–100 mL/h. The TμFS takes non-invasive and non-intrusive measurements by monitoring thermal variations on the outer surface of a silicone IV tube. The TμFS could detect flow rates as low as ∼0.1 mL/h, with uncertainty

In this paper, an inductive-power-transmission (IPT) system for a wearable textile heater is proposed to comfortably provide heating to a user&rsquo, s body. The conductive thread, which has high electrical resistance, was sewn into a receiver (Rx) coil on clothing to generate high temperature with a low current. The proposed wearable heaters are completely washable thanks to their nonmetallic materials, other than conductive threads in the clothing. We introduced series-none (SN) topology to eliminate a resonant capacitor in the wearable textile heater. A single resonant capacitor in a transmitter (Tx) in SN mode was implemented to resonate both Tx and Rx, resulting in increased power delivered to the load (PDL) while maintaining high-power transfer efficiency (PTE), comparable with conventional series-series (SS) topology. When the supply voltage of the power amplifier was 7 V, while the PTE of the SS and SN modes was 85.2% and 75.8%, respectively, the PDL of the SS and SN modes was 2.74 and 4.6 W, respectively.

Background Achromobacter species are non-fermentous Gram-negative bacilli that are primarily found in contaminated soil or water, but is rare in human. Although their low virulence, Achromobacter xylosoxidans is considered one of the emerging nosocomial agents in immunocompromised patients, including those with hematologic malignancy, diabetes, and renal failure. This organisms can cause pneumonia, catheter-related blood stream infection, urinary tract infection, and meningitis. We investigated the clinical manifestations and outcomes associated with A. xylosoxidans infection in a mid-sized community-based hospital in Korea. Methods We retrospectively analyzed all consecutive episodes of A. xylosoxidans in a mid-sized community-based hospital from October 2015 to April 2019. Results A total 181 clinical isolates of A. xylosoxidans were obtained from 123 patients. Of these, 117 (95%) had nosocomial infection that mostly received previous antibiotic therapy. A. xylosoxidans was isolated from respiratory tract (68%, 84/123), peritoneal fluid (11%, 13/123), urine (8%, 10/123) and blood (6%, 7/123). Seven cases of A. xylosoxidans bacteremia was associated with intravenous catheter sepsis. Seventy-eight cases (63%) had polymicrobial infection; P. aeruginosa (n = 21) was most commonly coisolates organisms, followed by S. maltophilia (n = 20) and methicillin-resistant S. aureus (n = 15). The main underlying diseases were neurologic disease (41%), diabetes mellitus (36%), and solid cancer (25%). Of these, 53 patients (43%) were categorized as in an immunocompromised state. The in-hospital mortality rate was 23%. Based on multivariate analysis, neurologic disease (hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 0.08–0.67; P = 0.007) and the age-adjusted Charlson comorbidity score (HR: 1.31% CI: 1.038–1.65; P = 0.02) were associated with increased mortality. Conclusion We concludes that, though rare, A. xylosoxidans could be pathogenic in immunocompromised patients who are in hospital. A. xylosoxidans can cause nosocomial infection and bacteremia is mostly originating from intravenous catheter. The potential impact on the clinical outcome, further investigations are required to delineate the role of A. xylosoxidans. Disclosures All authors: No reported disclosures.

A self-contained cartridge and an integrated operating prototype for automated molecular testing are described. This newly developed polymeric cartridge consists of multiple chambers self-containing all necessary reagents such as specimens, lysis, wash, and elution buffers. The cartridge is designed for optimal point-of-care testing. The operator can simply load a specimen into a chamber of the cartridge, then install the cartridge, and run the operating instrument. The fluidic movement inside the cartridge including reagents mixing, nucleic acids capturing, wastes-out and eluates collection are controlled by pneumatic actuations of syringe/piston sets and magnet/valve controls. The performance of the sample preparation efficiency on the cartridge was tested using Salmonella bacteria. The cartridge and the operating protocols need further modifications for optimal performance. However, the cartridge and the operating prototype have the potential to become applicable as a sample-in-answer-out tool of molecular diagnostics such as polymerase chain reaction (PCR) or other amplification methods such as isothermal amplification, and further cell-free DNA isolation and analysis.

Coronary artery dissection and intramural hematoma after blunt chest trauma are rare, but life-threatening, complications. Coronary intramural hematoma extension is even rarer. A 31-year-old man was transferred to our hospital for worsening left chest pain during while he was admitted at a nearby hospital due to blunt chest trauma. Bedside echocardiography showed akinesis of the left ventricular apex and anterior wall as well as hypokinesis of the mid-to-basal anteroseptal wall and mid-to-basal lateral and posterior walls of the left ventricle. Computed tomography coronary angiography revealed intramural hematoma in the left main (LM) coronary and proximal left anterior descending (LAD) arteries. Percutaneous coronary intervention, with bare metal stent implantation from the LM coronary artery to the proximal LAD artery, was performed to treat the occlusion caused by the hematoma. After stenting, the hematoma that compressed the LM coronary artery shifted the left circumflex (LCX) artery, and the intramural hematoma developed and extended to the LCX artery. To resolve this occlusion, a drug-eluting stent was successfully implanted in the LCX artery. The patient was discharged without complications. At 2-month follow-up, he remained asymptomatic, with no recurrence of cardiovascular symptoms. Delayed chest pain after trauma should be suspected during coronary dissection, and on treatment, care must be taken to extend the hematoma.

Ulcerative colitis (UC) is a chronic and debilitating disorder, characterized by inflammation of the colonic mucosa. UC can be considered a systemic disorder but UC-related manifestations in the central nervous system (CNS) are quite rare. A 29-year-old man was admitted to the emergency department with repeated generalized tonic-clonic (GTC) type seizures. Based on brain CT, brain metastasis or hemorrhagic infarct was suspected. Diffusion-weighted image of brain MRI showed high signal in the left thalamus and heterogenous enhancement in the right parietal and left frontal lobes. This image indicated a cerebral infarct, but could not completely rule out cerebral metastasis and vasculitis, or any other pathology. However, the brain biopsy revealed multiple thromboemboli with acute inflammation and necrosis. Thus, the patient was diagnosed with multiple cerebral infarcts with cerebral vasculitis, occurring as a complication of UC. In conclusion, CNS manifestations of UC are rare. However, clinicians should consider uncommon diagnoses like vasculitis and thromboembolism in patients with UC presenting with seizures.

Encryption is a method to convert information to no-sense code in order to prevent data from being lost or altered by use of illegal means. Audit logging creates audit log of users` activities, exceptions, and information security events, and then conserves it for a certain period for investigation and access-control auditing. Our paper suggests that confidentiality and integrity of information should be guaranteed when transmitting and storing important information in encryption. Encryption should consider both one-way encryption and two-way one and that encryption key should assure security. Also, all history related to electronic financial transactions should be logged and kept. And, it should be considered to check the details of application access log and major information. In this paper, we take a real example of encryption and log audit for safe data transmission and periodic check.

A direct-conversion active matrix flat panel X-ray imaging detector was fabricated with an HgI2 photoconductor. The HgI2 photoconductive layer was coated on an amorphous Si thin film transistor panel with a particle-in-binder process. The micro-morphological properties of the HgI2 photoconductive layer were characterized by micro-computed tomography, X-ray diffraction, and scanning electron microscopy. The volume density of HgI2 in the layer was 40.9%. The effect of the bias voltage on the sensitivity of the HgI2 photoconductor was investigated with different photon irradiations such as ultraviolet and visible light as one of reset processes. The sensitivity of the HgI2 photoconductor was increased with the help of ultraviolet radiation before X-ray radiation, which released trapped carriers inside the photoconductor and increased the sensitivity of the HgI2 photoconductor. Moreover, ultraviolet irradiation with a DC bias stabilized the sensitivity variation. An X-ray imaging detector in conjunction with anHgI2 photoconductor shows a very high signal-to-noise ratio.