Reference free auscultation quality metric and its trends

Stethoscopes are used ubiquitously in clinical settings to 'listen' to lung sounds. The use of these systems in a variety of healthcare environments (hospitals, urgent care rooms, private offices, community sites, mobile clinics, etc.) presents a range of challenges in terms of ambient noise and distortions that mask lung signals from being heard clearly or processed accurately using auscultation devices. With advances in technology, computerized techniques have been developed to automate analysis or access a digital rendering of lung sounds. However, most approaches are developed and tested in controlled environments and do not reflect real-world conditions where auscultation signals are typically acquired. Without a priori access to a recording of the ambient noise (for signal-to-noise estimation) or a reference signal that reflects the true undistorted lung sound, it is difficult to evaluate the quality of the lung signal and its potential clinical interpretability. The current study proposes an objective reference-free Auscultation Quality Metric (AQM) which incorporates low-level signal attributes with high-level representational embeddings mapped to a nonlinear quality space to provide an independent evaluation of the auscultation quality. This metric is carefully designed to solely judge the signal based on its integrity relative to external distortions and masking effects and not confuse an adventitious breathing pattern as low-quality auscultation. The current study explores the robustness of the proposed AQM method across multiple clinical categorizations and different distortion types. It also evaluates the temporal sensitivity of this approach and its translational impact for deployment in digital auscultation devices.

Constrained Synthetic Sampling for Augmentation of Crackle Lung Sounds

Crackles are explosive breathing patterns caused by lung air sacs filling with fluid and act as an indicator for a plethora of pulmonary diseases. Clinical studies suggest a strong correlation between the presence of these adventitious auscultations and mortality rate, especially in pediatric patients, underscoring the importance of their pathological indication. While clinically important, crackles occur rarely in breathing signals relative to other phases and abnormalities of lung sounds, imposing a considerable class imbalance in developing learning methodologies for automated tracking and diagnosis of lung pathologies. The scarcity and clinical relevance of crackle sounds compel a need for exploring data augmentation techniques to enrich the space of crackle signals. Given their unique nature, the current study proposes a crackle-specific constrained synthetic sampling (CSS) augmentation that captures the geometric properties of crackles across different projected object spaces. We also outline a task-agnostic validation methodology that evaluates different augmentation techniques based on their goodness of fit relative to the space of original crackles. This evaluation considers both the separability of the manifold space generated by augmented data samples as well as a statistical distance space of the synthesized data relative to the original. Compared to a range of augmentation techniques, the proposed constrained-synthetic sampling of crackle sounds is shown to generate the most analogous samples relative to original crackle sounds, highlighting the importance of carefully considering the statistical constraints of the class under study.

Effects of oral probiotic and lactoferrin interventions on iron-zinc homeostasis, oxidant/antioxidant equilibrium and diarrhoea incidence of neonatal piglets

The objective of this study was to examine the effects of early-life host specific probiotic and lactoferrin (LF) supplementations on diarrhoea incidence, iron (Fe)-zinc (Zn) balance and antioxidant capabilities in serum of neonatal piglets. A total of eight sow litters obtained from parity matched sows were randomly divided into four groups and assigned to one of the four interventions: control (2.0 ml normal saline), bovine lactoferrin (bLF) (100 mg bLF in normal saline), probiotic (Pb) (1×10⁹ cfu of swine origin Pediococcus acidilactici FT28 strain) and bLF+Pb (both 100 mg bLF and 1×10⁹ cfu of P. acidilactici FT28). All the piglets received supplementations once daily orally for first 7 days of life. The incidence of diarrhoea markedly decreased in bLF group compared to control group. Notably, no incidences of diarrhoea were recorded in Pb and bLF+Pb groups. The Zn and Fe concentrations were significantly increased from day 7 to 21 in bLF and on day 21 in bLF+Pb group. No such changes were noted in Pb group. Total antioxidant capacity (TAC) in serum was significantly increased on days 7 and 15 in bLF group and on days 7 and 21 in bLF+Pb group. Malonaldehyde concentration was markedly reduced from day 7 to 21 in bLF and bLF+Pb groups. The concentrations of nitrate on days 15 and 21 and malonaldehyde on day 7 were significantly higher in Pb group, but mean TAC was unaltered from day 0 to 21. Although no correlation between the incidence of diarrhoea and Zn/Fe and oxidant/antioxidant homeostasis was noted in the Pb group, the supplementation of P. acidilactici FT28 alone was sufficient to prevent the incidence of diarrhoea in neonatal piglets. Taken together, it is concluded that strategic supplementation of P. acidilactici FT28 in early life could help in preventing diarrhoea until weaning of piglets.

Implications of clinical variability on computer-aided lung auscultation classification

Thanks to recent advances in digital stethoscopes and rapid adoption of deep learning techniques, there has been tremendous progress in the field of Computerized Auscultation Analysis (CAA). Despite these promising leaps, the deploy-ment of these technologies in real-world applications remains limited due to inherent challenges with properly interpreting clinical data, particularly auscultations. One of the limiting factors is the inherent ambiguity that comes with variability in clinical opinion, even from highly trained experts. The lack of unanimity in expert opinions is often ignored in developing machine learning techniques to automatically screen normal from abnormal lung signals, with most algorithms being developed and tested on highly curated datasets. To better understand the potential pitfalls this selective analysis could cause in deployment, the current work explores the impact of clinical opinion variability on algorithms to detect adventitious patterns in lung sounds when trained on gold-standard data. The study shows that uncertainty in clinical opinion introduces far more variability and performance drop than dissidence in expert judgments. The study also explores the feasibility of automatically flagging auscultation signals based on their estimated uncertainty, thereby recommending further reassessment as well as improving computer-aided analysis.

CEEMDAN hybridized with LSTM model for forecasting monthly rainfall

The risks of severe weather events due to climate changes, including droughts and floods require accurate and timely forecasting of rainfall. But, the rainfall time series contains nonlinear and non-stationary data which lowers the model performance. This paper attempts to solve the nonlinear and non-stationary challenges imposed by the rainfall forecasting models by building a hybrid model based on complete ensemble empirical mode decomposition with Adaptive Noise(CEEMDAN) combined with long short-term memory (LSTM) for forecasting All India monthly rainfall. For monthly rainfall forecasting, homogeneous Indian monthly rainfall time series dataset (1871–2016) is used. Complete ensemble empirical mode decomposition decomposes the rainfall time series data into Intrinsic Mode Functions (IMF) and residual element. Each IMF and residual is forecasted using the LSTM after determining the significant lags. The forecasted intrinsic mode functions and the residual elements are reconstructed to obtain the forecasted rainfall value. The proposed model performance has been verified against existing models. Compared with single LSTM model, the forecasted values prove that the model achieves good performance in predicting monthly rainfall time series.

Microencapsulated and Lyophilized Lactobacillus acidophilus Improved Gut Health and Immune Status of Preruminant Calves

The present study was conducted to study the effect of microencapsulated, lyophilized, or fermented milk using Lactobacillus acidophilus NCDC15 as a probiotic to improve gut health, growth, nutrient utilization, and immunity status of young crossbred calves. The viable culture of L. acidophilus was used for preparation of different probiotic forms/products. To compare the efficacy of probiotic products, twenty crossbred calves (3-day old) were divided into four groups (n = 5), control (C), fed only milk and basal diet, and treatment groups, supplemented with microencapsulated, fermented, and lyophilized probiotic at 10⁸ colony-forming units, respectively. Probiotic-supplemented groups showed reduction in faecal score, faecal pH, and ammonia concentration as compared to control indicating decreased diarrheal incidence. There was an increase (P < 0.05) in the concentration of faecal lactate and butyrate in the probiotic-supplemented groups. The faecal count (log10 (CFU)/g of fresh faeces) of lactobacilli and bifidobacteria was higher (P < 0.05), whereas faecal coliforms and clostridia count were reduced (P < 0.001) in all the probiotic fed groups as compared to control. The cell-mediated immunity was improved (P < 0.05) in the microencapsulated and fermented probiotic groups. However, there was no effect on the nutrient utilization, average daily gain, and blood biochemical profile. Therefore, it is concluded that the fermented, microencapsulated and lyophilized probiotic products were superior in improving the gut health in terms of its microbiota and metabolites and cell-mediated immunity response in calves, irrespective of form of probiotic. The increased population of Lactobacillus and Bifidobacterium decreased the colonization of the gut by pathogens such as Escherichia coli and Clostridium by exclusion and production of organic acids in the intestine. This decreased the diarrhoeal incidence (1.3 vs 1.8) and days in diarrhoea (3.9 vs 5.8) in calves in probiotic fed groups as compared to control.

Impact of pH on citric acid antimicrobial activity against Gram-negative bacteria

The antimicrobial activity of citric acid (CA) is often evaluated without pH adjustment or control and its impact on micro‐organisms is better understood in acidic conditions. However, the biocidal action of the fully ionized CA molecule, predominantly available at higher pH, has not been previously investigated. The objective of this study was to evaluate the antimicrobial effect of high (10%) and low (1%) concentrations of CA, each adjusted over a wide range of pH values (4·5, 6·5 and 9·5) relative to the controls exposed to corresponding pH levels alone (no CA). The viability and morphology of Escherichia coli and Klebsiella aerogenes were evaluated using a culture‐based enumeration assay in parallel with direct SEM imaging. Overall, the highest membrane damage and loss in viability were achieved with 10% CA at pH 9·5, which yielded at least 4·6 log₁₀ CFU per ml (P < 0·001) reductions in both organisms. Insight into the superior efficacy of CA at high pH is proposed based on zeta potential measurements which reveal a more negatively charged bacterial surface at higher pH. This pH‐dependent increase in surface charge may have rendered the cells potentially more sensitive towards chelants such as CA³⁻ that interact with membrane‐stabilizing divalent metals.

An objective measure of signal quality for pediatric lung auscultations

A stethoscope is a ubiquitous tool used to 'listen' to sounds from the chest in order to assess lung and heart conditions. With advances in health technologies including digital devices and new wearable sensors, access to these sounds is becoming easier and abundant; yet proper measures of signal quality do not exist. In this work, we develop an objective quality metric of lung sounds based on low-level and high-level features in order to independently assess the integrity of the signal in presence of interference from ambient sounds and other distortions. The proposed metric outlines a mapping of auscultation signals onto rich low-level features extracted directly from the signal which capture spectral and temporal characteristics of the signal. Complementing these signal-derived attributes, we propose high-level learnt embedding features extracted from a generative auto-encoder trained to map auscultation signals onto a representative space that best captures the inherent statistics of lung sounds. Integrating both low-level (signal-derived) and high-level (embedding) features yields a robust correlation of 0.85 to infer the signal-to-noise ratio of recordings with varying quality levels. The method is validated on a large dataset of lung auscultation recorded in various clinical settings with controlled varying degrees of noise interference. The proposed metric is also validated against opinions of expert physicians in a blind listening test to further corroborate the efficacy of this method for quality assessment.

Effect of a single 1200 Mg dose of Mucinex® on mucociliary and cough clearance during an acute respiratory tract infection

BACKGROUND

Observational studies suggest that orally administered guaifenesin (GGE) may thin lower respiratory tract secretions but none have examined its effects on mucociliary and cough clearance (MCC/CC) during a respiratory tract infection (RTI). The current study was a randomized, parallel-group, double-blind, placebo-controlled study in non-smoking adults who suffered from an acute upper RTI.

METHODS

We assessed the effects of a single dose of Mucinex(®) 1200 mg (2 × 600 mg extended release tablets) (ER GGE) on 1) MCC/CC by assessing the rate of removal from the lung of inhaled radioactive tracer particles (Tc99m-sulfur colloid), 2) sputum dynamic rheology by stress/strain creep transformation over the linear part of the curve, 3) sessile drop interfacial tension by the deNouy ring technique, and 4) subjective symptom measures. MCC was measured during the morning (period 1) and compared to that in the afternoon 4 h later (period 2) immediately following either drug (n = 19) or placebo (n = 19). For both period 1 and 2 subjects performed 60 voluntary coughs from 60 to 90 min after inhalation of radio-labeled aerosol for a measure of CC. Sputum properties were measured from subjects who expectorated sputum during the cough period post treatment (n = 8-12 for each cohort).

RESULTS

We found no effect of ER GGE on MCC or CC compared to placebo. MCC through 60 min for period 1 vs. 2 = 8.3 vs. 11.8% (placebo) and = 9.7 vs. 11.1% (drug) (NS) and CC for period 1 vs. 2 was 9.9 vs. 9.1% (placebo) and 10.8 vs. 5.6% (drug) (NS). There was no significant difference in sputum biophysical properties after administration of drug or placebo.

CONCLUSIONS

There was no significant effect of a single dose of ER GGE on MCC/CC or on sputum biophysical properties compared to placebo in this population of adult patients with an acute RTI. ClinicalTrials.gov Identifier: NCT01114581.

Patterning of cells through patterning of biology

For the first time, cells have been patterned on surfaces through the spatial manipulation of native gene expression. By manipulating the inherent biology of the cell, as opposed to the chemical nature of the surfaces they are attached to, we have created a potentially more flexible way of creating patterns of cells that does not depend on the substrate. This was accomplished by bringing an siRNA that targets the expression of pten under the control of light, by modifying it with photocleavable groups. This pten-targeting siRNA has been previously demonstrated to induce dissociation of cells from surfaces. We modified this siRNA with dimethoxy nitro phenyl ethyl photocleavable groups (DMNPE) to allow the activity of the siRNA, and hence pten knockdown, to be toggled with light. Using this approach we demonstrated light dependent cell dissociation only with a DMNPE modified siRNA that targets pten and not with control siRNAs. In addition we demonstrated the ability to make simple patterns of cells through the application of masks during irradiation.

FTIR spectra and mechanical strength analysis of some selected rubber derivatives

Rubber materials have wide range of commercial applications such as, infant diapers, famine hygiene products, drug delivery devices and incontinency products such as rubber tubes, tyres, etc. In the present work, studies on mechanical properties of some selected rubber materials viz., natural rubber (NR), styrene butadiene rubber (SBR), nitrile butadiene rubber (NBR) and ethylene propylene diene monomer (EPDM) have been carried out in three states viz., raw, vulcanized and reinforced. To enhance the quality of rubber elastomers, an attempt is made to prepare new elastomers called polyblends. In the present study an attempt is made to blend NR with NBR and with EPDM. We here report, a novel approach for the evaluation of various physico-mechanical properties such as mechanical strength, tensile strength, elongation and hardness. The method is simple, direct and fast and involves infrared spectral measurements for the evaluation of these properties. With the applications of modern infrared spectroscopy, the mechanical strength of these rubber materials have been analyzed by calculating the internal standards among the methyl and methylene group vibrational frequencies obtained from FTIR spectroscopy. Also the tensile strength measurements carried out by universal testing machine. The results pertaining physico-mechanical properties of the rubber derivatives undertaken in the present study obtained by IR-based method are in good agreement with data resulted from the standard methods.

[Utilization of continuous elimination methods at the surgical ICU]

The authors inform about the causes of introduction and use of continuous veno-venous hemofiltration at theirs intensive care unit. They describe in details this technique. They present theirs experience in this field and give the overview of the development of its indication in the last years. Based on group of 46 patient results, they recommend implementation of this technique to intensive care units, where surgical patients with organ insufficiency are treated as highly positive and essential.