Development of artificial intelligence edge computing based wearable device for fall detection and prevention of elderly people

Elderly falls are a major concerning threat resulting in over 1.5-2 million elderly people experiencing severe injuries and 1 million deaths yearly. Falls experienced by Elderly people may lead to a long-term negative impact on their physical and psychological health conditions. Major healthcare research had focused on this lately to detect and prevent the fall. In this work, an Artificial Intelligence (AI) edge computing based wearable device is designed and developed for detection and prevention of fall of elderly people. Further, the various deep learning algorithms such as Convolutional Neural Network (CNN), Recurrent Neural Network (RNN), Long Short-Term Memory (LSTM), Gated Recurrent Unit (GRU) are utilized for activity recognition of elderly. Also, the CNN-LSTM, RNN-LSTM and GRU-LSTM with and without attention layer respectively are utilized and the performance metrics are analyzed to find the best deep learning model. Furthermore, the three different hardware boards such as Jetson Nano developer board, Raspberry PI 3 and 4 are utilized as an AI edge computing device and the best deep learning model is implemented and the computation time is evaluated. Results demonstrate that the CNN-LSTM with attention layer exhibits the accuracy, recall, precision and F1_Score of 97%, 98%, 98% and 0.98 respectively which is better when compared to other deep learning models. Also, the computation time of NVIDIA Jetson Nano is less when compared to other edge computing devices. This work appears to be of high societal relevance since the proposed wearable device can be used to monitor the activity of elderly and prevents the elderly falls which improve the quality of life of elderly people.

Approach to dyspnoea in pregnancy in the COVID-19 era

IMPORTANCE

Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount.

OBJECTIVE

To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise.

DESIGN, SETTING AND PARTICIPANTS

Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic.

RESULTS

Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

MobileHeart, a mobile smartphone-based application that supports and monitors coronary artery disease patients during rehabilitation

Conventional center-based cardiac rehabilitation adherence is poor, adversely affecting long-term efficacy. Innovative strategies such as telerehabilitation are perceived as promising alternatives to improve care delivery. This paper presents the results of prior and ongoing work on the design and development of MobileHeart, a telemedical smartphone-based application to be used in secondary prevention for ischemic heart disease patients. Its constituent components are discussed separately, the minimal necessary cardiovascular monitoring requirements are elaborated in more detail. The results are offered starting from a clinical perspective to stress its relevance in the establishment of scientifically/medically sound programs.

A descriptive single-centre experience of the management and outcome of maternal alloantibodies in pregnancy

BACKGROUND

Haemolytic disease of the fetus and newborn (HDFN) occurs when maternal IgG alloantibodies to fetal red blood cell antigens cross the placenta, causing haemolysis in the fetus and/or neonate. After delivery, the main concern is hyperbilirubinaemia, which can cause neurological damage.

OBJECTIVES

To summarise our current management and outcome data to inform health-care professionals counselling women whose pregnancies are at risk of HDFN and to compare these data with relevant studies.

METHODS

This is a retrospective descriptive study of all high-risk pregnancies at risk of HDFN at Guy's and St. Thomas' NHS Foundation Trust (GSTFT) Maternity Unit over a 7-year period. We defined high-risk pregnancies as those in whom anti-D, anti-c, anti-K or high (>32 or doubling strength) titres of all other antibodies were identified.

RESULTS

A total of 130 pregnancies in 112 women were followed up. A single alloantibody was found in 93 pregnancies (71.5%) and multiple alloantibodies in 37 pregnancies (28.5%). Anti-D was most commonly encountered (n = 48, 36.9%), followed by anti-c (n = 31, 23.8%) and anti-E (n = 15, 11.5%). In 65 of 130 pregnancies (50%), antibody concentrations triggered scans to screen for fetal anaemia. Of 130 pregnancies, 6 (4.6%) required intrauterine transfusions, and 31 of 130 (26%) neonates required post-natal intervention. Overall, morbidity was 0.1% and mortality 0.002%.

CONCLUSIONS

This study demonstrates that morbidity and mortality caused by HDFN is minimal. These results are reassuring for women at risk of HDFN as even severely affected cases are successfully managed in most instances. Further studies are needed to identify predictors of disease severity.

Photoresponsive, reversible immobilization of virus particles on supramolecular platforms

Covalently attached azobenzene moieties to cowpea chlorotic mottle virus (CCMV) allow for photoresponsive immobilization on cucurbit[8]uril bearing surfaces.

Short-term outcome of periviable small-for-gestational-age babies: is our counseling up to date?

OBJECTIVE

There are limited data for counseling on and management of periviable small-for-gestational-age (SGA) fetuses. We therefore aimed to investigate the short-term outcome of periviable SGA fetuses in relation to the likely underlying cause.

METHODS

This was a retrospective study of data from three London tertiary fetal medicine centers obtained between 2000 and 2015. We included viable singleton pregnancies with a severely small fetus, defined as those with an abdominal circumference ≤ 3^rd percentile, identified between 22 + 0 and 25 + 6 weeks' gestation. Data obtained included fetal biometry, presence of placental anomalies, uterine and fetal Doppler and neonatal outcome. We excluded cases with structural abnormalities, proven or suspected abnormal karyotype or genetic syndromes. Cases were classified according to the suspected underlying cause of the small fetal size into one of the following categories: uteroplacental insufficiency, evidence of placental damage with normal uterine artery Doppler, viral infection, or unclassied.

RESULTS

There were 245 cases included in the study. Of these, at diagnosis of SGA, 201 (82%) were categorized as uteroplacental cause, 13 (5%) as suspected placental cause, one (0.4%) as suspected viral cause and 30 (12%) could not be assigned to any of these categories. Overall, 101 (41%) cases survived the neonatal period; 89 (36%) underwent in-utero fetal demise, 22 (9%) died neonatally and 33 (14%) pregnancies were terminated. The diagnosis-to-delivery interval was 8.1 weeks in those that survived and 4.5 weeks in those that died neonatally.

CONCLUSIONS

Almost 90% of periviable SGA cases are associated with uteroplacental insufficiency or intraplacental damage. Survival is related to gestational age at delivery, with outcomes better than might be assumed at diagnosis and some pregnancies reaching term. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Abstract P6-07-01: Multigene profiling to identify clinically relevant actionable mutations in breast cancer: An Indian study

Background: Numerous chemotherapeutic agents are available against breast cancer (BC), but a vast majority of patients diagnosed with this disease still develop treatment resistance and eventually succumb to disease. It remains an unmet need to identify specific molecular defects against which targeted therapy are available for improving clinical outcomes in BC. Our study aims to identify frequent hotspot mutations in BCs and determine their clinical impact.

Methods: 200 women with BC(early diagnosed and/or metastatic) aged 26-75 yrs (median age 50.5yrs) diagnosed at HCG from April 2013-15 were consented to be profiled by targeted deep sequencing for hotspot mutations in 48 cancer-related genes using Illumina's TSCAP panel and MiSeq technology in an IRB-approved prospective study in a CLIA compliant laboratory. All the cases had pathology review for stage, histological type, hormonal status and Ki67. The average coverage across 220 hot spots was greater than 1000X. Data was processed using Strand Avadis NGS™. Mutations identified in the tumor were assessed for 'actionability' i.e. response to therapy and impact on prognosis. Results: Somatic variants were detected in 75% of cases with direct impact on therapy or prognosis. Genetic aberrations were identified in PI3K/AKT/ mTOR signalling pathway in substantial fraction (27%) of breast cancer cases, out of which 17% had PIK3CA activating mutations,13 and 5 cases had PTEN and AKT deletions or truncating mutations respectively. Aberration in this pathway was more prevalent in HR+ve (53%) and HER2-ve including TNBC (61%) than in HR+/HER2+ve tumors (10.6%) of IDC histology. However, no correlation was found with stage and Ki67 index of the tumor. Notably 80% of BC cases presented with liver metastasis at the time of diagnosis were detected with PIK3CA mutation indicating its role as a surrogate marker of organ specific metastasis. PIK3CA was found to be co mutated with p53 in 16 cases (9%) of which 4 cases showed npCR post NACT. Also disruptive and non-disruptive mutations in TP53 alone were found in 25% of BC, varying widely among different histologies. A follow up of few cases showed shorter PFS and poor outcome in resected BC treated with NACT indicating its robust prognostic value in NACT setting. Furthermore, two patients were detected with cKIT mutations indicating sensitivity to imatinib and therefore enrolled on a clinical trial. The other variants were found in RB1(n=8),Her2 (n=2),FGFR amplification(n=1), KRAS(n=2),NRAS(n=3)CDH1(n=1),FBXW7(n=2) and EGFR(n=1).All these variants detected indicated resistance to conventional therapy and suggested sensitivity to available targeted therapy, either approved or in clinical trials. The response and outcome are being monitored in about 20 (10%) patients who have been enrolled in clinical trials and receiving mutation specific targeted therapy. Conclusions: This study confirms the utility of multigene profiling in early diagnosed and advanced BC patients, to stratify them on their molecular profile who could potentially benefit from targeted therapy. Prospective studies and randomized clinical trials are ongoing to confirm the independent prognostic and therapeutic value of the mutations in a larger cohort of Indian population.

Citation Format: Ghosh M, Sheela ML, Choudhury S, Bahadur U, Patil S, Satheesh CT, Murugan K, Nayak R, Sridhar PS, Rao N, Mahesh B, Shashidhara HP, Krishnamoorthy N, Gupta V, Sankaran S, Subramanian K, Ajaikumar BS. Multigene profiling to identify clinically relevant actionable mutations in breast cancer: An Indian study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-07-01.

Optical control over bioactive ligands at supramolecular surfaces

Addressing whole protein and bacterial immobilization and their optical control on a β-cyclodextrin supramolecular platform.

Integrated approach for demarcating subsurface pollution and saline water intrusion zones in SIPCOT area: a case study from Cuddalore in Southern India

This paper deals with a systematic hydrogeological, geophysical, and hydrochemical investigations carried out in SIPCOT area in Southern India to demarcate groundwater pollution and saline intrusion through Uppanar River, which flows parallel to sea coast with high salinity (average TDS 28, 870 mg/l) due to back waters as well as discharge of industrial and domestic effluents. Hydrogeological and geophysical investigations comprising topographic survey, self-potential, multi-electrode resistivity imaging, and water quality monitoring were found the extent of saline water intrusion in the south and pockets of subsurface pollution in the north of the study area. Since the area is beset with highly permeable unconfined quaternary alluvium forming potential aquifer at shallow depth, long-term excessive pumping and influence of the River have led to lowering of the water table and degradation of water quality through increased salinity there by generating reversal of hydraulic gradient in the south. The improper management of industrial wastes and left over chemicals by closed industries has led surface and subsurface pollution in the north of the study area.

Relationship of intertwin crown-rump length discrepancy to chorionicity, fetal demise and birth-weight discordance

OBJECTIVES

To study the frequency and clinical significance of crown-rump length (CRL) discrepancy at 11-14 weeks of gestation in twin pregnancies from an unselected population.

METHODS

This was a retrospective analysis of all twin pregnancies that underwent a routine 11-14-week scan at a large teaching hospital. Fetal loss was defined as fetal demise of one or both twins after 14 weeks.

RESULTS

A total of 507 twin pregnancies were studied; 382 (75.3%) were dichorionic and 125 (24.7%) were monochorionic twins. The discrepancy in CRL was expressed as a percentage of the CRL of the larger twin. The 95(th) and 99(th) centile for CRL discrepancy in twins was 12.2% and 19.3%, respectively. The discrepancy in CRLs in monochorionic and dichorionic twins was not significantly different (Mann-Whitney U = 22,406, P = 0.302). In 39 twin pairs, there was subsequent intrauterine death of one or both twins. Fetal loss was more common in monochorionic twins (24/125) than in dichorionic twins (15/382) (chi-square = 30.9, P < 0.001). In monochorionic twins, the discrepancy in CRLs in the 24 cases with subsequent loss was significantly greater than in the 101 twin pairs with no subsequent loss (Mann-Whitney U = 896, P = 0.048). The discrepancy in CRLs in 15 dichorionic twins with subsequent loss was not different from that in the 367 twins with no loss (Mann-Whitney U = 2116.5, P = 0.129). The CRL discrepancy was significantly correlated with birth-weight discordance in twins (Spearman's rho = 0.128, P = 0.006). However, this was due to a significant correlation in dichorionic twins (Spearman's rho = 0.127, P = 0.016) but not in monochorionic twins (Spearman's rho = 0.145, P = 0.14).

CONCLUSIONS

Fetal loss is significantly associated with discrepancy in CRL at the 11-14-week scan in monochorionic twins and discordance in birth weights is significantly associated with discrepancy in CRL in dichorionic twins. However, intertwin CRL discrepancy is of limited value in screening for these adverse events.

Loss of growth factor receptor signaling in the oral mucosa during primary SIV infection may enhance apoptosis and promote pathogenesis

BACKGROUND

The development of susceptibility to secondary pathogenic infections in the oral cavity during HIV infection is likely to result from or coincide with deterioration of the local mucosal immune system.

METHODS

We have utilized the SIV model to investigate the kinetics and magnitude of oral pathogenesis during systemic dissemination of intravenously inoculated SIVmac251.

RESULTS

Viral replication was detected in oropharyngeal lymph nodes at 6 weeks post-infection and shown to be coincident with a broad scale loss of growth factor receptor transcription in the oral mucosa, providing multiple avenues for blocking the normal activity of apoptosis inhibitors that function through Bcl2- and p53-dependent pathways.

CONCLUSIONS

Our findings suggest that the normal balance between cell death and regeneration may be rapidly disrupted in the oral mucosa during the early stages of immunodeficiency virus infection, setting the stage for continuing deterioration of immune function and the development of susceptibility to secondary infections.

Spinodal decomposition in a model colloid-polymer mixture in microgravity

We study phase separation in a deeply quenched colloid-polymer mixture in microgravity on the International Space Station using small-angle light scattering and direct imaging. We observe a clear crossover from early-stage spinodal decomposition to late-stage, interfacial-tension-driven coarsening. Data acquired over 5 orders of magnitude in time show more than 3 orders of magnitude increase in domain size, following nearly the same evolution as that in binary liquid mixtures. The late-stage growth approaches the expected linear growth rate quite slowly.

Simian immunodeficiency virus infection induces severe loss of intestinal central memory T cells which impairs CD4+ T-cell restoration during antiretroviral therapy

BACKGROUND

Simian immunodeficiency virus (SIV) infection leads to severe loss of intestinal CD4(+) T cells and, as compared to peripheral blood, restoration of these cells is slow during antiretroviral therapy (ART). Mechanisms for this delay have not been examined in context of which specific CD4(+) memory subsets or lost and fail to regenerate during ART.

METHODS

Fifteen rhesus macaques were infected with SIV, five of which received ART (FTC/PMPA) for 30 weeks. Viral loads were measured by real-time PCR. Flow cytometric analysis determined changes in T-cell subsets and their proliferative state.

RESULTS

Changes in proliferative CD4(+) memory subsets during infection accelerated their depletion. This reduced the central memory CD4(+) T-cell pool and contributed to slow CD4(+) T-cell restoration during ART.

CONCLUSION

There was a lack of restoration of the CD4(+) central memory and effector memory T-cell subsets in gut-associated lymphoid tissue during ART, which may contribute to the altered intestinal T-cell homeostasis in SIV infection.

Time-dependent strength of colloidal gels

Colloidal silica gels are shown to stiffen with time, as demonstrated by both dynamic light scattering and bulk rheological measurements. Their elastic moduli increase as a power law with time, independent of particle volume fraction; however, static light scattering indicates that there are no large-scale structural changes. We propose that increases in local elasticity arising from bonding between neighboring colloidal particles can account for the strengthening of the network, while preserving network structure.

Limits to gelation in colloidal aggregation

We show that the dynamics of large fractal colloid aggregates are well described by a combination of translational and rotational diffusion and internal elastic fluctuations, allowing both the aggregate size and internal elasticity to be determined by dynamic light scattering. The comparison of results obtained in microgravity and on Earth demonstrates that cluster growth is limited by gravity-induced restructuring. In the absence of gravity, thermal fluctuations ultimately inhibit fractal growth and set the fundamental limitation to the lowest volume fraction which will gel.

Mucus transport in the airways by two-phase gas-liquid flow mechanism: continuous flow model

Mucus transport speed induced by two-phase gas-liquid interaction was measured in the continuous two-phase annular flow tube models, and factors influencing the transport speed were assessed in conjunction with rheological properties of mucus. The flow model was made with 1.0-cm-ID glass tubes and positioned either vertically or horizontally. During a continuous passage of airflow through the model tube, mucus stimulants were supplied into the tube at a rate of 0.5-2.0 ml/min. The advancing speed of the leading edge of the mucous layer and mean mucous layer thickness were then measured. The transport speed in the vertical tube model ranged from 1.1 to 3.1 cm/min with a mucus feed rate of 0.5 ml/min at airflow rates of 0.33-1.17 l/s and increased with increasing airflow rates but decreased rapidly with increasing viscosity of mucus. The transport speed increased almost proportionally with increasing mucus feed rate. Elasticity of mucus did not affect the transport speed itself. However, more elastic mucus caused lower flow resistance and thereby could be transported with a much reduced work load. The transport speed in the horizontal tube model was 5-60% faster than that in the vertical tube model. The mean mucous layer thickness in the vertical tube model was found to be in the range of 0.5-1.5 mm in the experimental conditions used, and decreased rapidly with increasing airflow rate and decreasing viscosity of mucus. From these data the transport speed could be functionally related to airway diameter, mucous layer thickness, and mucus production rate.

Value of endoscopic retrograde pancreatography in pancreatic ascites

Endoscopic retrograde pancreatography was easily performed preoperatively in six patients with pancreatic ascites, and no complications resulted from this procedure. The abnormalities observed during the procedure were unpredictable and varied. Endoscopic pancreatograms provided delineation of the pancreatic ductal system, showing one or more sites of ductal leaks into pseudocysts or segmental narrowing of the main pancreatic duct. This preoperative information was invaluable in selecting appropriate surgical procedures.

Pancreatic pseudocysts communicating with the stomach: demonstration by endoscopic retrograde pancreatography

The use of endoscopic retrograde pancreatography (ERP) provides important information in the management of pancreatic pseudocysts unavailable by other methods. When the pseudocysts communicate with a hollow viscus, the surgeon is better able to deal with the problem if aware of this fact prior to operative intervention. A pancreatic pseudocyst communicating with the stomach was demonstrated by ERP in each of four patients. One of these patients had pancreatic ascites and the other had left-sided pleural effusion, and both were treated successfully by distal pancreatectomy. The other two patients responded to nonoperative treatment. This report emphasizes the potential diagonstic value of ERP in determining the presence and the fate of pseudocysts.

Penetrating wounds of the neck: principles and some controversies

Some of the principles, pitfalls, and controversies in the management of penetrating wounds of the neck have been reviewed. All three policies to exploration of the neck advocated by different authors have merit and can be considered optimal under certain circumstances. Since delayed surgical treatment of major vascular and esophageal injuries results in higher morbidity and mortality, exploratory operations are appropriate when such injuries are suspected, even though preoperative studies are inconclusive. A systematic approach to the management of penetrating wounds of the base of the neck has been outlined. The role of a shount to maintain adequate cerebral blood flow during repair of carotid artery injuries has been discussed. In patients who have severe preoperative neurologic deficit and no blood flow in the injured carotid artery at operation, ligation of the artery rather than repair of injury appears to be indicated.

Pancreatic ascites: recognition and management

In a patient with chronic ascites, an abnormally raised ascitic fluid amylase concentration and a protein content above 2.5 gm/100 ml is diagnostic of pancreatic ascites. Thirty-one episodes in 26 patients treated between 1958 and 1975 have been analyzed. Twenty patients (65%) experienced abdominal pain and ten (32%) had concomitant pleural effusions roentgenographically. Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes (70%), an abdominal mass could only be palpated in two of 26 patients. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7 of 21 episodes (33%). Endoscopic retrograde pancreatography is invaluable in delineating the pancreatic ductal system and, in conjunction with intraoperative pancreatography, makes a vital contribution to rational surgical therapy. Medical treatment or external drainage during 18 episodes resulted in death in four (22%) and recurrences of ascites or pancreatic pseudocyst in nine (64%). Since routine pancreatography followed by pancreatic resection or internal drainage has been instituted, mortality and recurrence have been reduced to zero.

Thoracic aortic clamping for prophylaxis against sudden cardiac arrest during laparotomy for acute massive hemoperitoneum

Experimental studies in dogs were performed to develop a model simulating clinical patients with penetrating wounds of the major abdominal vessels who develop sudden cardiac arrest following laparotomy and decompression of an acute massive hemoperitoneum. Hypovolemic dogs with a saline-distended tense abdomen and major arterial bleeding after laparotomy develop a sudden deterioration of cardiac function despite raped blood infusion, thus simulating the clinical problem. However, thoracic aortic occlusion before laparotomy and until control of distal arterial bleeding prevented such a cardiovascular collapse. Increased intra-abdominal pressure it itself was determental to cardiovascular function; its sudden release by laparotomy was associated with an improvement in cardiovascular function. An approach of thoracic aortic control before laparotomy is recommended in patients with acute massive hemoperitoneum who remain hypotensive before laparotomy.

The natural and unnatural history of pancreatic pseudocysts

Experience with 131 pseudocysts of the pancreas in 112 patients has been analysed with a view to answering specific questions. Spontaneous regression was documented in 8 per cent. Complications occurred in 33-5 per cent of the pseudocysts, including obstruction of adjacent organs, rupture, haemorrhage and pancreatic ascites. In 14 pseudocysts, rupture into the gastrointestinal tract, the peritoneal cavity or the pleural cavity when unassociated with haemorrhage, had a mortality rate of 14 per cent. Sixteen patients with significant haemorrhage associated with a pseudocyst had a mortality rate of 61 per cent; early direct surgical control is advocated. Pancreatic ascites was associated with 14-5 per cent of the pseudocysts and had a 40 per cent recurrence rate, which can be greatly diminished when operative procedures are guided by pancreatography. The mortality rate for the surgical treatment of 97 uncomplicated pseudocysts was 6 per cent and the recurrence rate was 11 per cent. The prime cause of death was haemorrhage. Seven of the 131 pseudocysts were synchronous and 12 were metachronous. The actual figure is probably higher. Small cysts of the head of the pancreas, impalpable at operation but demonstrable by pancreatography, may be the cause of severe, continuing or recurrent symptoms.