Dying feet in ICU : why might extracorporeal membrane oxygenation machines cause necrotic feet?

Background Extracorporeal membrane oxygenation (ECMO) is used for severe lung and/or heart failure in intensive care units (ICU). The Prince Charles Hospital (TPCH) has one of the largest ECMO units in Australia. Its use rapidly increased during the H1N1 (“swine flu”) pandemic and an increase in pedal complications resulted. The relationship between ECMO and pedal complications has been described, particularly in children, though no strong data exists. This paper presents a case series of foot complications in patients having received ECMO treatment. Methods We present nine cases of severe foot complications resulting from patients receiving ECMO treatment at TPCH in 2009–2012. Results Case ages ranged from 16 - 58 years and three were male. Six cases had an unremarkable medical history prior to H1N1 or H1N2 infection, one had Cardiomyopathy, one had received a lung transplant, and one had multi-organ failure post-sepsis. Common medications prescribed included vasopressors, antibiotics, and sedatives. All cases showed signs of markedly impaired peripheral perfusion whilst on ECMO and seven developed increasing areas of foot necrosis. Outcomes include two bilateral below knee amputations, two multiple digital amputations, one Reflex Sympathetic Dystrophy Syndrome, three pressure injuries, and three deaths. Conclusion Necrosis of the feet appears to occur more readily in younger people requiring ECMO treatment than others in ICU. The authors are conducting further studies to investigate associations between particular infections, medical history, medications, or machine techniques and severe foot complications. Some of these early results will also be presented at this conference.

Carrot red leaf and carrot mottle viruses : observations on the composition of the particles in single and mixed infections

Particles of carrot red leaf virus (CRLV; luteovirus group) purified from chervil (Anthriscus cerefolium) contain a single ssRNA species of mol. wt. about 1.8 x 106 and a major protein of mol. wt. about 25000. CRLV acts as a helper for aphid transmission of carrot mottle virus (CMotV; ungrouped) from mixedly infected plants. Virus preparations purified from such plants possess the infectivity of both viruses but contain particles indistinguishable from those of CRLV; some of the particles are therefore thought to consist of CMotV RNA packaged in CRLV coat protein. When RNA from such preparations was electrophoresed in agarose/polyacrylamide gels, CMotV infectivity was associated with an RNA band that migrated ahead of the CRLV RNA band and had an estimated mol. wt. of about 1.5 x 106, similar to that previously found for the infective ssRNA extracted directly from Nicotiana clevelandii leaves infected with CMotV alone. Preparations of dsRNA from CMotV-infected N. clevelandii leaves contained two species: one of mol. wt. about 3.2 x 106, presumably the replicative form of the infective ssRNA, and the other, mol. wt. about 0.9 x 106, of unknown origin and function. The infective agent in buffer extracts of CMotV-infected N. clevelandii was resistant to RNase (although the enzyme acted as a reversible inhibitor of infection at high concentrations) and is therefore not unprotected RNA. It may be protected within the approximately 52 nm enveloped structures previously reported.

Pitfalls in the use of kappa when interpreting agreement between multiple raters in reliability studies

OBJECTIVE To compare different reliability coefficients (exact agreement, and variations of the kappa (generalised, Cohen's and Prevalence Adjusted and Biased Adjusted (PABAK))) for four physiotherapists conducting visual assessments of scapulae. DESIGN Inter-therapist reliability study. SETTING Research laboratory. PARTICIPANTS 30 individuals with no history of neck or shoulder pain were recruited with no obvious significant postural abnormalities. MAIN OUTCOME MEASURES Ratings of scapular posture were recorded in multiple biomechanical planes under four test conditions (at rest, and while under three isometric conditions) by four physiotherapists. RESULTS The magnitude of discrepancy between the two therapist pairs was 0.04 to 0.76 for Cohen's kappa, and 0.00 to 0.86 for PABAK. In comparison, the generalised kappa provided a score between the two paired kappa coefficients. The difference between mean generalised kappa coefficients and mean Cohen's kappa (0.02) and between mean generalised kappa and PABAK (0.02) were negligible, but the magnitude of difference between the generalised kappa and paired kappa within each plane and condition was substantial; 0.02 to 0.57 for Cohen's kappa and 0.02 to 0.63 for PABAK, respectively. CONCLUSIONS Calculating coefficients for therapist pairs alone may result in inconsistent findings. In contrast, the generalised kappa provided a coefficient close to the mean of the paired kappa coefficients. These findings support an assertion that generalised kappa may lead to a better representation of reliability between three or more raters and that reliability studies only calculating agreement between two raters should be interpreted with caution. However, generalised kappa may mask more extreme cases of agreement (or disagreement) that paired comparisons may reveal.

Odometry-driven inference to link multiple exemplars of a location

A major challenge for robot localization and mapping systems is maintaining reliable operation in a changing environment. Vision-based systems in particular are susceptible to changes in illumination and weather, and the same location at another time of day may appear radically different to a system using a feature-based visual localization system. One approach for mapping changing environments is to create and maintain maps that contain multiple representations of each physical location in a topological framework or manifold. However, this requires the system to be able to correctly link two or more appearance representations to the same spatial location, even though the representations may appear quite dissimilar. This paper proposes a method of linking visual representations from the same location without requiring a visual match, thereby allowing vision-based localization systems to create multiple appearance representations of physical locations. The most likely position on the robot path is determined using particle filter methods based on dead reckoning data and recent visual loop closures. In order to avoid erroneous loop closures, the odometry-based inferences are only accepted when the inferred path's end point is confirmed as correct by the visual matching system. Algorithm performance is demonstrated using an indoor robot dataset and a large outdoor camera dataset.

Teacher Evidence Matrix : an evaluation using multiple lines of evidence

Welcome to the Teacher evidence matrix. This matrix is designed for highly qualified discipline experts to evaluate their teaching in a systematic manner. The primary purpose of the Teacher evidence matrix is to provide a tool that an academic staff member at university can annually review their teaching. The annual review will result in you being ready for performance, planning and review; promotion; awards; or employment application. This tool is designed for individual use and will lead to an action plan for implementation.

Towards bio-inspired place recognition over multiple spatial scales

This paper presents a new multi-scale place recognition system inspired by the recent discovery of overlapping, multi-scale spatial maps stored in the rodent brain. By training a set of Support Vector Machines to recognize places at varying levels of spatial specificity, we are able to validate spatially specific place recognition hypotheses against broader place recognition hypotheses without sacrificing localization accuracy. We evaluate the system in a range of experiments using cameras mounted on a motorbike and a human in two different environments. At 100% precision, the multiscale approach results in a 56% average improvement in recall rate across both datasets. We analyse the results and then discuss future work that may lead to improvements in both robotic mapping and our understanding of sensory processing and encoding in the mammalian brain.

A recommendation approach dealing with multiple market segments

A new community and communication type of social networks - online dating - are gaining momentum. With many people joining in the dating network, users become overwhelmed by choices for an ideal partner. A solution to this problem is providing users with partners recommendation based on their interests and activities. Traditional recommendation methods ignore the users’ needs and provide recommendations equally to all users. In this paper, we propose a recommendation approach that employs different recommendation strategies to different groups of members. A segmentation method using the Gaussian Mixture Model (GMM) is proposed to customize users’ needs. Then a targeted recommendation strategy is applied to each identified segment. Empirical results show that the proposed approach outperforms several existing recommendation methods.

Epidemiologic characteristics of cases for influenza A(H7N9) virus infections in China

China's National Health and Family Planning Commission announced 3 deaths caused by avian-origin influenza A(H7N9) virus in March, which was the first time that the H7N9 strain has been found in humans [1]. This is of major public health significance and raises urgent questions and global concerns [2, 3]. To explore epidemic characteristics of human infections with H7N9 virus, data on individual cases from 19 February 2013 (onset date of first case) to 14 April 2013 were collected from the China Information System for Disease Control and Prevention, which included information about sex; age; occupation; residential address; and day of symptom onset, diagnosis, and outcome for each case. The definition of an unconfirmed probable H7N9 case is a patient with epidemiologic evidence of contact …

Volcanic architecture and chemostratigraphy within the Kalkarindji Continental Flood Basalt Province, Northern Territory : implications for eruption style from multiple fissure eruptions

This thesis was the first to define individual lava flow chemical variation and a detailed definition of the Kalkarindji Continental Flood Basalt Province, a lesser known province of the Phanerozoic eon. This thesis conducted an intensive field study that yielded numerous samples for petrography and chemical analyses as well as the generation of a detailed map of a portion of the Kalkarindji province.

Performance-driven live migration of multiple virtual machines in datacenters

Live migration of multiple Virtual Machines (VMs) has become an indispensible management activity in datacenters for application performance, load balancing, server consolidation. While state-of-the-art live VM migration strategies focus on the improvement of the migration performance of a single VM, little attention has been given to the case of multiple VMs migration. Moreover, existing works on live VM migration ignore the inter-VM dependencies, and underlying network topology and its bandwidth. Different sequences of migration and different allocations of bandwidth result in different total migration times and total migration downtimes. This paper concentrates on developing a multiple VMs migration scheduling algorithm such that the performance of migration is maximized. We evaluate our proposed algorithm through simulation. The simulation results show that our proposed algorithm can migrate multiple VMs on any datacenter with minimum total migration time and total migration downtime.

Combining multiple sensor modalities for a localisation robust to smoke

This paper proposes an approach to obtain a localisation that is robust to smoke by exploiting multiple sensing modalities: visual and infrared (IR) cameras. This localisation is based on a state-of-the-art visual SLAM algorithm. First, we show that a reasonably accurate localisation can be obtained in the presence of smoke by using only an IR camera, a sensor that is hardly affected by smoke, contrary to a visual camera (operating in the visible spectrum). Second, we demonstrate that improved results can be obtained by combining the information from the two sensor modalities (visual and IR cameras). Third, we show that by detecting the impact of smoke on the visual images using a data quality metric, we can anticipate and mitigate the degradation in performance of the localisation by discarding the most affected data. The experimental validation presents multiple trajectories estimated by the various methods considered, all thoroughly compared to an accurate dGPS/INS reference.

Progesterone activates multiple innate immune pathways inChlamydia trachomatis-Infected endocervical cells

Problem Susceptibility to Chlamydia trachomatis infection is increased by oral con- traceptives and modulated by sex hormones. We therefore sought to determine the effects of female sex hormones on the innate immune response to C. trachomatis infection. Method of study ECC-1 endometrial cells, pre-treated with oestradiol or progesterone, were infected with C. trachomatis and the host transcriptome analysed by Illumina Sentrix HumanRef-8 microarray. Primary endocervical epithe- lial cells, prepared at either the proliferative or secretory phase of the menstrual cycle, were infected with C. trachomatis and cytokine gene expression determined by quantitative RT-PCR analysis. Results Chlamydia trachomatis yield from progesterone-primed ECC-1 cells was significantly reduced compared with oestradiol-treated cells. Genes upregulated in progesterone-treated and Chlamydia-infected cells only included multiple CC and CXC chemokines, IL-17C, IL-29, IL-32, TNF-a, DEFB4B, LCN2, S100A7-9, ITGAM, NOD2, JAK1, IL-6ST, type I and II interferon receptors, numerous interferon-stimulated genes and STAT6. CXCL10, CXCL11, CX3CL1 and IL-17C, which were also upregu- lated in infected secretory-stage primary cells, and there was a trend towards higher levels of immune mediators in infected secretory-phase compared with proliferative-phase cells. Conclusion Progesterone treatment primes multiple innate immune pathways in hormone-responsive epithelial cells that could potentially increase resis- tance to chlamydial infection.

Autonomous operation of multiple interconnected microgrids with self-healing capacity

This paper shows how multiple interconnected microgrids can operate in autonomous mode in a self–healing medium voltage network. This is possible if based on network self– healing capability, the neighbour microgrids are interconnected and a surplus generation capacity is available in some of the Distributed Energy Resources (DERs) of the interconnected microgrids. This will reduce or prevent load shedding within the microgrids with less generation capacity. Therefore, DERs in a microgrid are controlled such that they share the local load within that microgrid as well as the loads in other interconnected microgrids. Different control algorithms are proposed to manage the DERs at different operating conditions. On the other hand, a Distribution Static Compensator (DSTATCOM) is employed to regulate the voltage. The efficacy of the proposed power control, sharing and management among DERs in multiple interconnected microgrids is validated through extensive simulation studies using PSCAD/EMTDC.

A coordinated voltage support strategy for LV network with multiple DSTATCOMs

Voltage rise and drop are the main power quality challenges in Low Voltage (LV) network with Renewable Energy (RE) generators. This paper proposes a new voltage support strategy based on coordination of multiple Distribution Static Synchronous Compensators (DSTATCOMs) using consensus algorithm. The study focuses on LV network with PV as the RE source for customers. The proposed approach applied to a typical residential LV network and its advantages are shown comparing with other voltage control strategies.