Search

During the operations, firefighters can be injured or killed because of the smoke and heat emission from the fire area, broken structure elements such as floors, walls, or boiling liquid ejection and gas explosion. Therefore, this paper aims to develop an efficient and portable system to monitor falls and high CO level through integrating a three degrees of freedom accelerometer and an MQ7 sensor to recorded acceleration and measured CO concentration with the embedded fall and high CO detection algorithms. The embedded fall detection algorithm can detect fall events with ultra-high accuracy without mistakenly identifying normal activities such as walking, standing, jogging, and jumping as fall events. The posture recognition and cascade posture recognition after three seconds are proposed in this paper to gain the accuracy of our proposed fall detection system. If a firefighter falls and is unable to stand up, the alert signal message will be sent to their commander outside through the GSM/GPRS module. The embedded high CO detection algorithm used to alert the dangerous CO level to recommend using self-contained breathing apparatuses (SCBA) and saving fresh air with acceptable CO level. We carefully investigated the proposed thresholds and window size before embedding them into the microcontroller. The sensitivity and accuracy achieved were around 96.5% and 93% respectively in our recorded data. Furthermore, the proposed fall detection algorithm also achieved higher geometric mean in comparison with Support Vector Machine classifier (SVM) and a nearest neighbor rule (NN) in the public datasets with the achieved around 99.44%, 98.41% and 95.76% respectively.

BACKGROUND Although previous studies have shown that participating in a structured national quality improvement program improves healthcare utilization for patients with inflammatory bowel disease (IBD), it is not known whether the extent of active participation influences health outcomes. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which facilitates disease surveillance and patient-provider co-production of care. This study assesses the relationship between active patient participation and IBD-related healthcare utilization outcomes. METHODS We reviewed electronic health records and surveys of patients with IBD from a private community gastrointestinal practice participating in Qorus for two years after they submitted the first pre-clinic survey. The study period was from 2016 to 2021. Primary outcomes were times from the first survey to an IBD-related ED visit/hospitalization, urgent message*, and CT-scan use. Participation score was calculated as a ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio RESULTS Out of 244 patients, 122 were inactive participants and 122 were active participants. Among inactive participants, 23.8% experienced an IBD-related ED visit/hospitalization, 27.9% sent an urgent message, and 12.3% received a CT scan. Among active participants, 18.9 % experienced an IBD-related ED visit/hospitalization, 21.3% sent an urgent message, and 12.3% received a CT scan (Table 1). Active and inactive (reference) Qorus participants were not statistically different in their healthcare utilization: ED visit/hospitalization (HR 0.61[95% CI 0.34-1.09]), sending an urgent message (HR 0.68 [95% CI 0.40-1.15]), and CT scan use (HR 1.00 [95% CI 0.47-2.13]), after adjusting for confounders (Table 2). CONCLUSION Although active participants show numerically less frequent ED visit/hospitalization and urgent message than inactive participants, there was not a statistically significant association between participation and healthcare utilization. A greater sample size is needed to draw further conclusions to inform future strategies to engage patients and optimize health outcomes.

BACKGROUND Patient-provider co-production of care is integral to managing inflammatory bowel diseases (IBD), chronic and incurable conditions that affect patients’ quality of life. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which helps their providers develop patient-centered treatment plans. This study examines factors that predict patients’ active participation in the program to inform future strategies to promote programmatic engagement and continuity of care. METHODS A retrospective cohort study was performed using electronic health records and survey results from a private community gastrointestinal practice engaged with Qorus between 2016 and 2021. Patients with IBD who consented to participate in Qorus were followed for two years after they submitted the first pre-clinic visit survey. The primary outcome was the ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio RESULTS Among 244 patients who met the inclusion criteria, 122 were inactive participants and 122 were active participants. Inactive participants completed a median of 0 (IQR 0-1) surveys and 3 (IQR 1-5) clinic visits, while active participants completed a median of 2 (IQR 1-3) surveys and 2 (IQR 2-4) clinic visits (Table 1). Multivariable logistics regression shows that older age, history of anxiety or depression, and higher number of clinic visits were associated with inactive participation. Compared to the age group 18-24 years old, patients ≥35 were less likely to participate actively: 35-44 (OR 0.32 [95% CI 0.11-0.90]), 45-54 (OR 0.24 [95% CI 0.07-0.72]), ≥55 (OR 0.34 [95% CI 0.12-0.94]). Patients with a history of anxiety or depression showed less active participation than those without (OR 0.44 [95% CI 0.25-0.77]). Higher number of clinic visits was also associated with less active participation (OR 0.88 [95% CI 0.78-0.99]) (Table 2). CONCLUSION Age ≥35, history of anxiety or depression, and frequent clinic visits were associated with less active participation in an IBD Learning Health System. Lack of familiarity with digital health resources, concomitant mental health disorders, or participation fatigue may potentially explain these findings. Further research is needed to investigate the causes of inactive participation to design interventions that address these causes.

Background Although validated patient-reported outcome (PRO) measurements can categorize patients with inflammatory bowel disease (IBD) into clinical remission or active disease, patients may have different definitions of remission. The purpose of this study was to compare patient-defined remission to remission based on PRO measures and physician global assessment (PGA) and to understand the clinical and demographic factors associated with disagreements. Methods We retrospectively analyzed 3257 de-identified surveys from 2004 IBD patients who consented to participate in the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System between September 2019 and February 2021. We used logistic regression models with generalized estimating equations to analyze the clinical and demographic factors (eg, age, disease duration, health confidence) associated with discordance between patient-defined remission (yes/no) and PRO-defined remission for ulcerative colitis (UC; PRO2: stool frequency, rectal bleeding) and Crohn’s disease (CD; PRO-3: average number of liquid stools, abdominal pain, well-being). Results Among patients with UC, overall concordance was 79% between patient self-report and PRO2-defined remission and 49% between patient self-report and PGA-defined remission. Among patients with CD, overall concordance was 69% between patient self-report and PRO3-defined remission and 54% between patient self-report and PGA-defined remission. Patients in PRO-defined remission were more likely to report active disease if they had IBD Conclusion Discordance exists between how remission is defined by patients, PRO measures, and PGA.

BACKGROUND Social factors such as race, education, and financial hardships have been shown to affect health outcomes of patients with inflammatory bowel disease (IBD). Although early identification of socially vulnerable patients is critical for targeted interventions, it is still limited by screening tools that are incomprehensive and time-consuming. We investigate the utility of the social vulnerability index (SVI), a census tract-specific measure estimated by the Centers for Disease Control and Prevention, for predicting patients' healthcare utilization, based on 15 different social determinant variables including employment, housing, and transportation. METHODS We reviewed the electronic health records and surveys of patients with IBD at a private community practice enrolled in IBD Qorus Learning Health System, a national quality improvement consortium, from 2016-2021. Each patient's home address was mapped to an SVI value, ranging from 0 to 1 and increasing as the patient's vulnerability increased. An SVI was considered low if it was less than the median SVI and high if it was greater than or equal to the median SVI. Cox proportional hazards regression was performed to determine the relationship between SVI and healthcare utilization (IBD-related ED visit/hospitalization, urgent message*, and CT scan use), controlling for potential confounders such as IBD subtype, baseline clinical disease activity, physician global assessment, steroid use, and six-months-prior IBD-related ED visit/hospitalization and CT scan use. The “survival time” was defined as the time from when the patient first joined the program to IBD-related healthcare utilization events, loss of follow-up in the electronic health records, or the end of the study period, whichever occurred earliest. RESULTS Among 280 eligible patients, the median SVI was 0.288 (IQR 0.121-0.433) (Figure 1). Among the low SVI group, 16.4% experienced an IBD-related ED visit/hospitalization, 20.0% sent an urgent message, and 10.0% received a CT scan. Among the high SVI group, 23.6% experienced an IBD-related ED visit/hospitalization, 26.4% sent an urgent message, and 12.9% received a CT scan. High and low SVI groups (reference) were not significantly different in their healthcare utilization: ED visit/hospitalization (HR 1.66 [95% CI 0.96-2.89]), sending an urgent message (HR 1.62 [95% CI 0.94-2.70]), and CT scan use (HR 2.31 [95% CI 0.98-5.47]), after adjusting for confounders (Table 1). CONCLUSION IBD-related healthcare utilization was not associated with social vulnerability at the census tract level in this cohort. The lack of statistical significance was likely due to the cohort’s low sample size and lack of demographic variability (92% white and 96.8% non-Hispanic). Additional research with a larger and more diverse sample may help clarify the association between SVI and outcomes.

We evaluated trends in Medicare reimbursement for common gastrointestinal (GI) services from 2007 to 2022.Top GI procedures and office/inpatient visits were identified. The Physician Fee Schedule Look-Up Tool from Centers for MedicareMedicaid Services was queried to extract reimbursement data. Reimbursement trends were analyzed, accounting for inflation.GI procedures exhibited an average decrease in unadjusted and adjusted reimbursement of 7.0% and 33.0%, respectively. Reimbursement for patient visits exhibited an inflation-adjusted decrease of 4.9%.The analysis revealed a steady decline in adjusted reimbursement for both GI procedures and patient visits in the past 15 years.

Nowadays, closure of the perforation with or without omental patch is the main surgical approach for most perforated duodenal ulcer. There have been limited high-quality studies to clarify the role of drainage after perforated duodenal ulcer laparoscopic repair. We performed this study to evaluate the role of abdominal drainage after simple closure for the treatment of low-risk perforated duodenal ulcer. A consecutive case series was conducted including patients with size of duodenal perforation no more than 5 mm who underwent single-port laparoscopic simple repair at Hue University of Medicine and Pharmacy Hospital from January 2012 to June 2018. In this study, sixty-five executive perforated duodenal ulcer patients with the size of the perforation no more than 5 mm, an ASA score equal or less than 3, and a Boey score of 0 or 1 were treated by single-port laparoscopic simple repair. All patients (100%) had a perforation of the anterior side of duodenum. The mean size of the perforations was 3.4 mm. We did not use abdominal drainage after single-port laparoscopic simple closure without omentoplasty. There were no documented leakage of the repair site and no residual abscess postoperatively. The mean analgesic use duration was 2.8 ± 0.8 days. The mean hospital stay duration was 5.6 ± 0.8 days. At 30-day follow-up, one patient (1.5%) had wound infection. No port-site hernia was found and there was no mortality. For small-size and low-risk perforated duodenal ulcer, no-drainage after single-port laparoscopic simple repair is safe and effective. The patients without abdominal drainage require less analgesic use and have short hospital stay.

Laparoscopic single-port surgery has widely been introduced for the treatment of various abdominal conditions. But controversies still exist regarding its potential advantages and risks, especially for emergency surgery. The aim of this study was to evaluate the results of a single-port laparoscopic repair using straight laparoscopic instruments for the treatment of perforated duodenal ulcers. A prospective consecutive case series was conducted including all patients with a perforated duodenal ulcer who underwent a laparoscopic single-port repair at a single institution from January 2012 to June 2018. The operation was performed through a single port using conventional straight laparoscopic instruments and intra-corporeal knot tying techniques. Out of 75 patients, simple closure of the perforation without omental patch was accomplished in 96% of cases. Conversion to an open operation was required in one patient (1.3%) due to a posterior duodenal perforation, and additional trocar placement was needed in another patient (1.3%). The mean incision length was 2.0 ± 0.2 cm. The mean operation time was 63.0 ± 26.6 min. Meantime a nasogastric tube remained in place was 2.9 ± 0.8 days. Mean duration of analgesic use was 2.8 ± 0.8 days. The rate of postoperative complications was 2.7%, including two patients with wound infections. There were no instances of intestinal leak or abscess. The postoperative hospital stay was 5.7 ± 1.2 days. Laparoscopic single-port repair using conventional straight laparoscopic instruments with intra-corporeal knot tying technique was safe and feasible for patients with perforated duodenal ulcers with low risk factors. This method offers results comparable to those expected with the standard multiport laparoscopic approach with the addition of improved cosmetic outcomes.

Highlights • Left-sided gallbladder without situs viscerum inversus is a rare congenital anomaly. • Left-sided gallbladder is accompanied by anatomic variations: portal vein and/or biliary system anomalies, segment IV atrophy, variations in hepato-biliary vascular anatomy. • Left-sided gallbladder can present significant intraoperative challenges due to associated variations in ductal and vessel anatomy. • There are three proposed, embryologic mechanisms for Left-sided gallbladder without situs viscerum inversus. • Even the face of routine preoperative testing, ultrasound, and CT scan, left-sided gallbladder often remains undetected until surgery. • Laparoscopic antegrade cholecystectomy can be performed safely for left-sided gallbladder., Introduction Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is defined as a gallbladder located under the left lobe of the liver; to the left of the round/falciform ligament, but with all other viscera maintaining normal anatomical relationships. This is a rare congenital anomaly with a reported prevalence that ranges from 0.04% to 1.1%. It is usually an incidental intraoperative finding, and can be associated with anatomic abnormalities of the biliary tree, portal system and vasculature. LSG and associated variations may present significant challenges even for experienced surgeon. Presentation of case LSG-woSVI was unexpectedly discovered in a 49-year-old, Vietnamese female during laparoscopic cholecystectomy. There were no pre-operative indications of sinistroposition. The cystic duct joined the common hepatic duct on the right side, and the cystic artery crossed anterior to the common bile duct in a right-to-left direction. Antegrade cholecystectomy was performed without intraoperative or postoperative complications. Discussion LSG is a rare anatomical variation that often remains undetected with ultrasound and pre-operative tests. Several hypotheses suggest underlying embryologic mechanisms for LSG and associated anomalies in ductal, portal and vascular anatomy, but the exact cause remains a mystery. Safe laparoscopic cholecystectomy can be done; however, there is an increased risk of injury to the major biliary structures compared to orthotopic gallbladder. Conclusion Laparoscopic antegrade cholecystectomy is feasible for LSG. However, surgeons need to be cognizant of anatomy, so that rapid modifications of surgical technique can ensure positive patient outcomes.

In this paper we estimate both the Hurst and the stable indices of a H-self-similar stable process. More precisely, let $X$ be a $H$-sssi (self-similar stationary increments) symmetric $\alpha$-stable process. The process $X$ is observed at points $\frac{k}{n}$, $k=0,\ldots,n$. Our estimate is based on $\beta$-variations with $-\frac{1}{2}

In this paper we are interested in multifractional stable processes where the self-similarity index $H$ is a function of time, in other words $H$ becomes time changing, and the stability index $\alpha$ is a constant. Using $\beta$- negative power variations ($-1/2, Comment: 22 pages

A Study on Dioxin Contamination in Herbicide Sprayed Area in Vietnam by GIS