Predictive healthcare modeling for early pandemic assessment leveraging deep auto regressor neural prophet

In this paper, NeuralProphet (NP), an explainable hybrid modular framework, enhances the forecasting performance of pandemics by adding two neural network modules; auto-regressor (AR) and lagged-regressor (LR). An advanced deep auto-regressor neural network (Deep-AR-Net) model is employed to implement these two modules. The enhanced NP is optimized via AdamW and Huber loss function to perform multivariate multi-step forecasting contrast to Prophet. The models are validated with COVID-19 time-series datasets. The NP's efficiency is studied component-wise for a long-term forecast for India and an overall reduction of 60.36% and individually 34.7% by AR-module, 53.4% by LR-module in MASE compared to Prophet. The Deep-AR-Net model reduces the forecasting error of NP for all five countries, on average, by 49.21% and 46.07% for short-and-long-term, respectively. The visualizations confirm that forecasting curves are closer to the actual cases but significantly different from Prophet. Hence, it can develop a real-time decision-making system for highly infectious diseases.

Multi-item economic production quantity model under single valued bipolar neutrosophic environment based on possibilistic theory

 It is challenging for a decision-maker to decide a proper decision in severe situations of multi-aspirated real-life problems.So there is always an ambiguity in the mind of decision maker. Keeping such vagueness in mind, this paper aims to incorporate some situation parameters imprecise in nature. The imprecise parameters are taken in single-valued bipolar neutrosophic environments. Different arithmetic operations on the single-valued bipolar neutrosophic number using the (α, β) cut method are proposed in this paper. Using this we have calculated the possibility mean of single valued bipolar neutrosophic numbers. A multi-item economic production quantity model with one time only discount is considered here with some parameters in single valued bipolar neutrosophic number as a case study of our proposed work. A possibilistic mean de-fuzzification technique is used here using possibility measures. Finally, numerical illustration and sensitivity analysis is done for different variables to emphasize the excellence of our proposed work.

A Novel CNN-LSTM Hybrid Model for Prediction of Electro-Mechanical Impedance Signal Based Bond Strength Monitoring

The recent application of deep learning for structural health monitoring systems for damage detection has potential for improvised structure performance and maintenance for long term durability, and reliable strength. Advancements in electro-mechanical impedance (EMI) techniques have sparked attention among researchers to develop novel monitoring techniques for structural monitoring and evaluation. This study aims to determine the performance of EMI techniques using a piezo sensor to monitor the development of bond strength in reinforced concrete through a pull-out test. The concrete cylindrical samples with embedded steel bars were prepared, cured for 28 days, and a pull-out test was performed to measure the interfacial bond between them. The piezo coupled signatures were obtained for the PZT patch bonded to the steel bar. The damage qualification is performed through the statistical indices, i.e., root-mean-square deviation (RMSD) and correlation coefficient deviation metric (CCDM), were obtained for different displacements recorded for axial pull. Furthermore, this study utilizes a novel Convolutional Neural Network-Long Short-Term Memory (CNN-LSTM)-based hybrid model, an effective regression model to predict the EMI signatures. These results emphasize the efficiency and potential application of the deep learning-based hybrid model in predicting EMI-based structural signatures. The findings of this study have several implications for structural health diagnosis using a deep learning-based model for monitoring and conservation of building heritage.

Ayurvedic management of necrozoospermia - A case report

Male factors are responsible for more than forty percent of the infertility cases. Necrozoospermia is one among the main cause for infertility in male. Necrospermia i.e. 100% immotile and 0% viable spermatozoa in ejaculate, is a rare and poorly documented cause of male infertility. A 56-year-old man was referred for reproductive counseling with secondary infertility and diagnosed as necrozoospermia (ShukraDosha). He presented with complaints of having no issues since 7 years of married life with his second wife. The patient has a son from divorced first wife. After the thorough clinical examination and laboratory investigations, diagnosis was confirmed as necrozoospermia. The patient was administered Koshtha-Shuddhi (purgation) with ErandaTaila (castor oil) as per the guidelines of Ayurvedic treatment. After the proper purificatory procedures depending on dominance of deranged Dosha, the patient was given ArogyavardhiniVati, ChandraprabhaVati, Shilapravanga and PhalaGhrita (medicated ghee) as Sneha (internal oleation). At the end of 3½ month, semen analysis showed marked improvement in sperm count and increase in the sperm motility. The present finding and the effective management of necrozoospermia with Ayurvedic formulations with no adverse effect highlight the promising scope of traditional medicine in male infertility disorders.

Utility of mangled extremity severity score in severely injured lower limbs

Introduction: Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Medical and surgical advances of the past two decades have improved the ability to reconstruct severely injured limb. Limbs that once would have been amputated are now routinely managed with complex reconstruction protocol. Mangled extremity severity score is one of the scoring systems to predict the fate of limbs after severe limb injuries.Methods: Patients fulfilling the inclusion criteria were evaluated with MESS, at the same time treatment protocol for management of injuries of lower limb were followed independently by attending orthopedic surgeon. Mean MESS for salvaged and amputated limbs were calculated and its reliability for prediction of fate of injured limb was assessed using software SPSS v16.Result: The age of patient ranges from 10 to 65 yrs with mean age 35.83. The most common mechanism of injury was Road Traffic Accident followed by fall from height. The mean MESS score for salvaged limbs was 4.18 and for amputated limbs was 8.12 suggesting significant difference in mean scores. The sensitivity (the probability that limbs requiring amputation will have MESS at or above 7) was found to be 75%. The specificity of MESS (the probability that salvage limbs will have MESS < 7) was 95.45%.Conclusion: MESS is a reliable indicator in decision making process whether a limb can be salvaged or needs amputation. The mangled lower extremity with the score of less than 7 may be salvaged and 7 or more may need amputation.JSSN 2015; 18 (1), Page: 23-25

Efficacy of vacuum erectile devices (VEDs) after radical prostatectomy: the initial Irish experience of a dedicated VED clinic

Controversy exists regarding optimal penile rehabilitation program following radical prostatectomy (RP). Vacuum erectile devices (VEDs) have become an important component of penile rehabilitation protocols. The aim of this study was to assess the efficacy and patient satisfaction of a dedicated VED clinic. A voluntary telephone questionnaire was performed of all patients who attended a VED clinic to date in two university teaching hospitals. Patient demographics, histopathological characteristics and functional status (International Index of Erectile Function (IIEF) scores) were obtained from a retrospective review of a prospectively maintained database. Sixty-five men attended the dedicated VED clinic in the two university teaching hospitals. Forty-men (76.3%) men purchased a VED following the dedicated clinic. There was significant differences noted between the mean preoperative and the 3-month postoperative IIEF scores (22.08±3.16 vs 11.3±3.08, P=0.0001) and between the 3-month postoperative IIEF score and the post-VED use IIEF score (11.3±3.08 vs 16.74±2.62, P=0.0001). Despite VED use, there was a significant reduction in erectile function from presurgery status (22.08±3.16 vs 16.74±2.62, P=0.0001). All patients reported that the dedicated VED was helpful and would recommend it to other patients. Our study demonstrates that, despite a reduction in erectile function after RP, successful erections are attainable with a VED. There is potential and need for the development of a standard penile rehabilitation program and treatment of ED after RP internationally.

Combined laparoscopic-assisted nephrectomy and complete mesocolic excision for synchronous renal and colon cancers

Cancers of the colon and kidney are common malignancies, however, the occurrence of primary synchronous neoplasms of these two organs is uncommon. To the best of our knowledge, this is the first case report of a laparoscopic radical left nephrectomy and extended right complete mesocolic excision (CME) for a patient with synchronous renal and colon cancers. While a radical nephrectomy has long been the standard of care for a renal malignancy, CME has only recently been used. Combined surgeries provide the patient with various benefits such as decreased hospital stay, less postoperative pain and morbidity, early return to work and better cosmoses.

Paediatric urology training: what does the future hold?

BACKGROUND

Paediatric urology training is not a mandatory part of higher surgical training in urology in Ireland. It is predicted there will be a shortfall of surgeons trained in paediatric surgery in the coming years leading to a reliance on specialist paediatric surgical centres.

AIM

The aim of this study was to assess the attitudes of urological trainees regarding the current state of paediatric urology training and to address the potential future changes to training structures.

METHODS

A voluntary anonymous internet-based survey was emailed to all urological trainees. Parameters assessed included sex, level of training, attitudes towards paediatric urology training and levels of competence regarding core paediatric urological procedures.

RESULTS

69.2 % (n = 18) responded to the survey. 94.4 % (n = 17) would favour mandatory paediatric training-of these, 52.9 % (n = 9) would favour this in a dedicated paediatric hospital with a paediatric urologist. 66.7 % (n = 12) would like to provide a paediatric urology service as a consultant. 55.6 % (n = 10) felt they were competent to perform circumcision or scrotal exploration independently and manage all associated complications. No trainee felt themselves to be competent to perform orchidopexy independently and manage all complications.

CONCLUSION

Our study demonstrates a promising desire to provide paediatric services in the future. A greater emphasis on structured paediatric urology training is required to maintain the standard currently offered by adult urologists.

The use of smartphone applications by urology trainees

OBJECTIVE

Mobile phone technology is continuously advancing- the smartphone allows users instant access to information via the internet. Downloadable applications (apps) are becoming widespread across medical specialities. The aim of this study was to assess the use of smartphone apps among urology trainees in Ireland.

METHODS

An anonymous electronic survey was distributed via Survey Monkey(®) to all urology trainees in Ireland assessing their ownership and use of smartphones and downloadable apps. A search of urology apps was performed using the Apple App Store and the Android Market.

RESULTS

36 (81.8%) of trainees responded with 100% ownership of smartphones. 28 (77%) report downloading apps with 11 (30.6%) reporting paying for them. The mean number of apps downloaded was 4 (Range 1-12). 16 (44.4%) trainees think apps for smartphones are very useful in clinical practice, 14 (42.4%) think they are useful. A total of 126 urology apps were available. 76 (60.3%) were designed for physicians, 46 (36.5%) for patients, 2 (1.6%) for students and 2 (1.6%) for urological nurses.

CONCLUSION

There are an ever increasing number of urology apps available. Urology trainees are using smartphones as an educational and reference tool and find them a useful aide in clinical practice.

Paediatric orchidopexy: a need for dedicated paediatric surgical training among urologists?

BACKGROUND

Undescended testis (UDT) is one of the most common congenital abnormalities with a prevalence of about 1% at the age of 1 year. UDT is associated with an increased risk of testicular tumours and infertility.

AIMS

The aim of this study was to assess who is carrying out paediatric orchidopexy in Ireland.

METHODS

A survey was distributed via Survey Monkey to all Consultant Paediatric Surgeons and Urologists in Ireland.

RESULTS

Twenty-seven (64.3%) urologists and five (71.4%) paediatric surgeons responded to our online survey. Of the urologists, 100% reported formal training in paediatric orchidopexy. Eight (29.6%) underwent a dedicated paediatric fellowship. 13 (48.1%) currently perform paediatric orchidopexy. Nine (33%) think it should be carried out by a urologist, whereas eight (29.6%) think it should be carried out by paediatric surgeon. The mean age at which urologists think an orchidopexy for UDT should be performed by was 18 months (range 1-4 years). Approximately 400 orchidopexies are performed per year by the surveyed urologists. Of the paediatric surgeons, three (60%) feel it should be carried out by a paediatric surgeon whereas two (40%) feel it does not matter. All paediatric surgeons feel it should be performed by 1 year of age. Approximately 700 orchidopexies are performed per year by the surveyed paediatric surgeons.

CONCLUSION

UDT is a concerning condition which requires intervention at an early stage. Dedicated training in core paediatric procedures is required to continue to meet this need for the future to prevent delayed orchidopexy and resultant increased risk of testicular tumours.

Sign reversal of junction magnetoresistance in p-La0.7Ca0.3MnO3/SiO2/n-Si heterostructure: a possibility in spintronics application

We have fabricated a p-La0.7Ca0.3MnO3/SiO2/n-Si heterostructure, consisting of a p-type manganite (La0.7Ca0.3MnO3) and n-type Si with a interfacial layer of SiO2 with typical thickness of about 9 nm using pulsed laser deposition technique. The junction exhibits rectifying behavior over the temperature range of 10-300 K with rectification factor 52 at room temperature. Investigation on the electrical properties of p-La0.7Ca0.3MnO3/SiO2/n-Si heterostructure exhibits nonlinear J-V characteristics in a wide temperature range. A crossover from negative to positive junction magnetoresistance (JMR) is observed in p-La0.7Ca0.3MnO3/SiO2/n-Si heterostructure in current perpendicular to film plane (CPP) geometry. The temperature dependent sign of junction magnetoresistance of the heterojunction has been investigated carefully in details. It is found that the junction exhibits the positive junction magnetoresistance when the temperature is greater than the ferromagnetic to paramagnetic transition temperature (Tc) of the top highly spin-polarized half-metallic ferromagnetic La0.7Ca0.3MnO3 manganite film layer. The relation between junction magnetoresistance and external magnetic field is found to be of (delta rho/rho approximately equal alphaHbeta) type having both alpha and beta temperature dependent. We attribute the emergence of negative JMR at lower temperature (< Tc) and positive JMR at higher temperature (> Tc) to the quantum mechanical tunneling transport mechanism across the heterojunction. Our results might be very useful to fabricate artificial devices using the manganite-based heterojunction grown on single crystalline n-Si (100) in spintronics device applications.

Design and development of modified atmosphere packaging system for guava (cv. Baruipur)

Modified atmosphere packaging (MAP) is a dynamic system during which respiration and permeation occur simultaneously. Hence factors affecting both respiration and permeation were considered for designing a package. In the design of MA packages for guava (cv. Baruipur) a total of 13 variables were considered. The independent variables includes: weight of fruits, surface area of packaging film, free volume of the package, thickness of the film and permeabilities of film to O2 and CO2 gas. The fixed variables considered were: the surrounding gas composition and temperature, the respiration rates for O2 consumption and CO2 evolution, and the equilibrium gas compositions to be attained in the package so that the fruit's shelf-life is extended. Two types of MA packages, having package size of 19 cm × 19 cm for a fill weight of 1,000 ± 100 g were developed. Packages were designed to accommodate a fill weight range of 0.90-1.10 kg. Various package parameters were optimized to facilitate establishment of dynamic equilibrium at target levels of O2 and CO2 concentration in the package. The storage study of MA packages was performed at 10, 15, 20 and 25 °C temperatures. The performance of film packages was evaluated for their ability to establish equilibrium at target levels and to extend the shelf life of the packaged fruit. The MA packaging system increased the shelf life of guava by 128-200 % compared to the unpacked fruits at various storage temperatures with a quality comparable with the freshly harvested commodity.

Mini-open reduction and intramedullary interlocking nailing of fracture shaft of tibia without an image intensifier

Intramedullary interlocking tibial nailing is usually performed using an image intensifier. But being expensive, it is not available in the most of the hospitals of resource-poor countries of the world. The purpose of this study is to analyze the results of interlocking nailing without the use of an image intensifier. This is the retrospective study of 55 diaphyseal tibial fractures treated with minimally open reduction and internal fixation with interlocked intramedullary nail fixation. The proximal locking of the nail with the screws was made using external jig and for the distal locking direct visualization of the hole was carried out. There were 15 females and 40 males. The average age in years was 32 with a range of 18 to 64 years. The surgical approach was medial parapatellar. The average follow up period was 4 months. This period ranged from 3 months to 14 months. The union time in an average was 4 months. The complication mainly was distal screw loosening leading to valgus deformity and shortening in 1 case. It is, therefore, concluded that interlocking intramedullary nailing can be performed with proximal and distal locking accurately without the use of an image intensifier.

Achieving distal locking without an image intensifier

The tibia is commonly fractured bone frequently caused by high energy trauma leading to the complications and major disabilities. Different types of intramedullary nails have been employed by surgeons over 500 years. Today, the intramedullary interlocking tibial nailing is the leading modality of treatment because of its biomechanical advantage over the other modalities. This procedure is done in the advanced centers under the C-arm image intensifier. Yet, there is no facility of C- arm image intensifier in the operation theatre at the tertiary level public hospitals in Nepal. Most of the peripheral hospitals do not have portable X- ray facility. The purpose of this study was to study the success rate of distal locking in the intramedullary nailing of tibial shaft fractures with the aid of distal aiming device (DAD). The distal locking were done in 65 tibial shaft fractures. In this technique the distal hole was directly visualized after proper drilling. All the distal locking could be done without image intensifier. So this technique can be useful where the imaging facilities are not available and even in the advanced centers to avoid radiation hazards.

Bullying of junior doctors prevails in Irish health system: a bitter reality

Workplace bullying in health systems is a well known fact. It leads to not only breakdown in teamwork but also has significant affect on the individual's personal life. True prevalence of bullying in junior doctors working in Ireland is unknown. Our aim of study was to find out the prevalence of bullying in junior doctors working hospitals in south and western counties of Ireland and to assess its effects on the productivity of work and family life and to identify the common source of bullying. We carried out a questionnaire survey. A total of 950 questionnaires were sent. Response rate was 51%. Our sample is 15% of the target population of all the hospital junior doctors. 30% of the responders claimed to be subjected to one or more bullying behaviors. Doctors from European Union (EU) reported significantly less rate of bullying compares to non EU doctors. Our results are in line with the results of studies conducted in United Kingdom. This study shows the magnitude and source of the problem. We conclude that bullying is a common problem in Irish health system. Increased awareness and zero tolerance are required to eradicate bullying.

Ureteral endometriosis and ovarian mucinous cystadenoma presenting with acute pyonephrosis

BACKGROUND

Endometriosis is a common disease, but ureteral involvement is rare. Nonspecific clinical presentations of ureteral endometriosis may result in diagnostic difficulty.

AIM

To discuss the diagnosis and management of such a case.

METHODS

To report a case of ureteral involvement with endometriosis and review the literature.

RESULTS

The case presented with right lower quadrant pain giving rise to initial diagnostic possibility of acute appendicitis. Subsequent evaluation revealed the diagnosis of right pyonephrosis due to midureteral endometriosis with right ovarian mucinous cystadenoma.

CONCLUSION

The diagnosis of ureteral endometriosis requires a high index of clinical suspicion. The importance of ultrasound in the evaluation of acute abdomen in women can not be overemphasised.

TREATMENT OF IDIOPATHIC SCOLIOSIS BY HARRINGTON INSTRUMENTATION

An adolescent idiopathic right-sided thoracolumbar scoliosis has been correctedsurgically with Harrington distraction and compression instrumentation with posteriorfusion for the first time in Nepal.Key Words: Idiopathic scoliosis, Harrington system.