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Actinomyces naeslundii is rarely isolated in cases of actinomycosis. We present a case of thoracoabdominal actinomycosis caused by inadvertent enterotomy and gallstone spillage during a laparoscopic cholecystectomy. The actinomycosis initially presented as recurrent episodes of pneumonia, shortness of breath and unintentional weight loss. Initial CT imaging demonstrated pleural thickening along the right lung base as well as ill-defined consolidation in the right lower lobe. Repeat CT imaging showed progression of the mass-like region of consolidation with extrapulmonary spread to involve the abdomen, retroperitoneum and retrohepatic areas. Treatment involved intravenous antibiotics with concurrent abscess drainage followed by oral antibiotics.

Cities where water supply system follows trivial analog system like Dhaka city, a twenty-four hours monitoring is required to start the water pump immediately when water is available in the main water supply line. A significant amount of water can be wasted only for the reason of overflowing the water tank. Thus, the aim of this paper is to propose an automated water pumping system to minimize the wastage of time, money, labor and water loss. A high-fidelity prototype system was designed and developed using the Arduino Uno, water pump, potentiometer and relay switch; and able to control its operation automatically with respect to the availability and amount of water in the main water supply line and the reserve water. An evaluation study was also conducted to assess the availability and reliability of the system. The evaluation results showed that the proposed system is reliable, available and cost-effective.

Elasticity is one of the primary reasons of the popularity of cloud computing. However, a frequent problem is affecting this popularity - longer processing time for the acquired Virtual Machines (VM) to be ready for usage. This problem hinders the advantages of elasticity. This processing time, known as VM startup time, depends on various factors. VM startup time varies due to space-time trade-off. Comparing VM startup time according to distinctive factors allows users to choose their desirable VM. They have options to select among the VMs as per their preferences. In this paper, we benchmark VM startup time in Amazon EC2, Microsoft Azure and Google Cloud for factors like instance type, time of the day, instance location, cluster creation and cluster resize.

Blindness is the inability to see due to any neurological or physical condition. Blind people find it really hard to walk through busy roads and travel new places and so the walking stick becomes their daily companion. The main objective of this paper is to introduce a small hand-carrying system which can be used as a substitute of the walking stick. This system will work based on ultrasonic sensors and GPRS module which will be able to detect obstacles, manholes and potholes; and by pressing a button user will be able to SMS user’s location to user’s close ones. This will make moving around easier and safer for the blind people without getting noticed or without taking help of others.

Background Influenza is associated with increased mortality and morbidity for older adults. High-dose egg grown trivalent inactivated influenza vaccine (Fluzone HD) is safe and provides superior immune responses in older adults compared with standard dose (SD). Recently, two new vaccines have been licensed in the United States: cell cultured inactivated vaccine FluCelVax and baculovirus-expressed pure hemagglutinin (HA) vaccine FluBlok. Data from one study demonstrated higher efficacy with FluBlok than SD Fluzone in older adults. There is no data however comparing HD Fluzone to FluBlok and FluCelVax has not been studied at all. The purpose of this study was to assess hemagglutinin inhibition (HAI) antibody responses to vaccination with three vaccines in adults ≥ 60 years. Methods Adults ≥ 60 years were randomly assigned to receive one of the three vaccines: Fluzone HD, FluBlok and FluCelVax (Figure 1). Active influenza-like illness (ILI) surveillance was conducted with bi-weekly telephone calls. Serum samples were collected prior to vaccination and at day 7, 14, 28 and 180 and antibody responses assessed by HAI titer to A/Singapore/INFIMH-16–0019(H3N2), A/Michigan/45/2015(H1N1) and B/Colorado/6/2017 (Victoria) viruses as well as a circulating H3N2 strain. The primary endpoint was a 4-fold rise in antibody titer at day 28. Results 48 subjects were vaccinated in October 2018. Mean age was 69 and 65% were female. Two subjects reported ILI symptoms and one was positive for infection (H1N1). A majority of subjects demonstrated pre-existing antibody to all three viruses (Figure 2, Blue). Geometric mean titers (GMT) for antibody responses to the influenza A viruses were similar for FluBlok (FB) and HD Fluzone (FZ) but lower for FluCelVax(FCB) subjects (Figure 2, Orange). A higher percent of FlubBlok subjects demonstrated 4-fold rise in antibody responses to the Victoria influenza B virus (FB GMT 140 vs. FZ GMT 116, P = 0.26). Conclusion In this small study, antibody responses were similar or higher in older adults after vaccination with FluBlok compared with Fluzone HD with lower responses demonstrated with FluCelvax. Emerging concerns about HA egg adaptation during vaccine development compels further study to determine the appropriate vaccination strategy for this vulnerable population. Disclosures All authors: No reported disclosures.