Forbes Hospital

Intra-abdominal hemorrhage resulting from a ruptured, large hepatic cyst in a polycystic liver disease (PCLD) patient is rare and potentially fatal if not addressed promptly. Only a few isolated cases have previously been reported. The usual patient profile consists of elderly patients on anticoagulation, as is demonstrated in our case. Intra-hepatic cysts are broadly classified into congenital, traumatic, infectious, parasitic, and neoplastic. Congenital intra-hepatic cysts can consist of both simple and PCLD, as is outlined in our case. Simple cysts are usually asymptomatic, but occasionally they may achieve larger dimensions and lead to complications such as rupture, obstruction, infection, hemorrhage, and even portal hypertension. We present an uncommon case of a 78-year-old patient with PCLD on rivaroxaban who presented initially with diffuse abdominal pain, distension, and progression into hemodynamic instability. A computerized tomography (CT) scan revealed a ruptured left hepatic lobe cyst, causing hemoperitoneum and resulting in an acute abdomen. This case was complicated by the patient's anticoagulation status and anomalous hepatic vasculature pattern. Interventional radiology (IR) successfully identified the aberrant bleeding vessel and stopped the active extravasation with super-selective coil embolization.

As a profession, geotechnical engineering is not a dominant player in data management challenges; however, our entire business revolves around the collection, compilation, interpretation, and evaluation of subsurface data. And, as a profession, we have collected this data for decades and prized this compilation as a valuable business asset. Unfortunately, the tools available to manage this data are limited, and our data have typically been stored in their proprietary structure. When a major software provider announces the end of life of one of these tools, we face the daunting challenge of migrating data to a new software platform and converting it to a new format, or, more worrisome, the demise of our archive of geotechnical data. Having worked closely with the development of DIGGS, the authors have anticipated this day and facing the data conversion challenge head on. This paper will discuss challenges experienced with converting decades of data in various formats and the future use of this data that now will be readily accessible. Further, once this data is converted into a readily accessible and possibly centralized storage facility, the opportunities for rapid compilation, interpretation, and visualization will revolutionize the ability of contractors to make rapid risk assessment and optimize pricing strategies.

The major disease caused by human death nowadays is heart disease, due it happens suddenly and without significant symptoms, leads patient to miss the best time for first aid. With the development of IoT technology combined with the healthcare industry. It is providing technical support for clinic staff to predict and monitor heart disease patients remotely. In this paper, the main goal is to review the most relevant and latest papers to find the advantages and disadvantages and gaps in this area. Furthermore, compare the different proposed method's performance and present the best framework for heart disease continuous prediction and monitoring. Many researchers have been already providing the use of different types of machine learning algorithms to predict and diagnose heart disease. However, most of the previous researchers use the data collected from the dataset. As well know, to process the data collected from IoT sensors is harder than data collected from the dataset, because it may contain more noise and missing values in IoT sensor collected data. Dealing with those issues is the main challenge in the whole prediction system. Therefore, in this paper, we expect to reduce the research gap to find the best way to continuously monitoring and predicting patient ECG signals collected from IoT sensor devices in the meantime achieved acceptable prediction accuracy.

Laryngocele is not a common clinical entity that presents itself in a trauma setting. In the literature, there are currently two types of laryngocele, internal and mixed. Laryngocele may be congenital or acquired, and most often will present later in life. Traumatic laryngocele has only been reported three times in the literature before. Herein, we report a rare case of a 22-year-old woman who presents with bilateral laryngocele secondary to sustained direct trauma. Neck Ct-scan revealed bilateral laryngocele being responsible for her dysphagia and dysphonia. She was monitored in the hospital for further exacerbation of her symptoms with feared airway occlusion in mind. On hospital day three, her dysphagia had resolved and her dysphonia had significantly improved. A second CT, revealed resolution of left laryngocele with the right decreased in size since the initial presentation. She was followed and had complete resolution of symptoms one week after the injury.

Background: Pressure Injuries (PIs) are largely preventable. Accurate documentation of PI stage or progression is a key quality measure. Local Problem: Nurses frequently fail to accurately assess and document their findings in the electronic medical record. This project sought to increase nurses’ knowledge and accuracy of staging and documentation of PIs. Method: Educational interventions; direct observation of PI status; review of nurse documentation; feedback,;and referrals to wound, ostomy, and continence nurses (WOCNs). Interventions: Nurses completed a pre- and post-test and online training modules, and participated in training sessions. Clinical experts completed direct skin observations and provided feedback about PI staging. Results: There was a statistically significant improvement in nurses’ knowledge about PIs (p = 0.004). Skin assessments were conducted on 108 patients (13 PIs identified). The bedside nurse accurately assessed a PI stage in only 31% of these observations. Referrals to WOCNs increased by 18% compared to the baseline period. Conclusions: Educational interventions enhanced nurses’ knowledge; however, appropriate PI staging may require skills development and validation to build competency. Keywords: pressure injury, pressureulcer,wound care, prevention, evidence-based practice, prevalence, assessment, documentation, education

Non-traumatic splenic rupture (NSR) is a clinical oddity. Most splenic ruptures occur due to trauma. Splenic abscess formation is also a rare occurrence. Majority of splenic infections are secondary to splenic infarction or infection that originates external to the spleen. We present a unique case of a 40-year-old previously healthy woman who presented with splenomegaly, splenic infection, infarction, non-traumatic rupture, abscess formation, and pleural empyema positive for group A Streptococcus pyogenes . She initially presented to the emergency department complaining of worsening epigastric abdominal pain, fever, chills, and progressive shortness of breath. A computed tomography (CT) scan of the chest, abdomen, and pelvis revealed hepatomegaly and splenomegaly with infarcts and lacerations. Elaborate hematologic, thromboembolic, and oncological workup were essentially negative. She was managed non-operatively with a long course of antibiotics and pleural and intra-abdominal drainage. Clin Infect Immun. 2019;4(2):31-36 doi: https://doi.org/10.14740/cii80

Damaged cartilage does not readily heal and often requires surgical intervention that only modestly improves outcomes. A synthetic material that could be injected and covalently crosslinked in situ to form a bioactive, mechanically robust scaffold that promotes stem cell chondrogenic differentiation holds promise for next-generation treatment of cartilage lesions. Here, Johnson-Claisen rearrangement chemistry was performed on graphene oxide (GO) to enable functionalization with a primary amine covalently bound to the graphenic backbone through a chemically stable linker. The primary amines are used to form covalent crosslinks with chondroitin sulfate, an important component of cartilage that promotes regeneration, to form a hydrogel (EDAG-CS). The EDAG-CS system gels in situ within 10 min, and the graphenic component imparts improved mechanical properties, including stiffness (320% increase) and toughness (70% increase). EDAG-CS hydrogels are highly porous, resistant to degradation, and enable the growth of human mesenchymal stem cells and their deposition of collagen matrix. This system has potential to improve clinical outcomes of patients with cartilage damage.

Clutches can be used to enhance the functionality of springs or actuators in robotic devices. Here we describe a lightweight, low-power clutch used to control spring engagement in an ankle exoskeleton. The clutch is based on electrostatic adhesion between thin electrode sheets coated with a dielectric material. Each electrode pair weighs 1.5 g, bears up to 100 N, and changes states in less than 30 ms. We placed clutches in series with elastomer springs to allow control of spring engagement, and placed several clutched springs in parallel to discretely adjust stiffness. By engaging different numbers of springs, the system produced six different levels of stiffness. Force at peak displacement ranged from 14 to 501 N, and the device returned 95% of stored mechanical energy. Each clutched spring element weighed 26 g. We attached one clutched spring to an ankle exoskeleton and used it to engage the spring only while the foot was on the ground during 150 consecutive walking steps. Peak torque was 7.3 N·m on an average step, and the device consumed 0.6 mW of electricity. Compared to other electrically-controllable clutches, this approach results in three times higher torque density and two orders of magnitude lower power consumption per unit torque. We anticipate this technology will be incorporated into exoskeletons that tune stiffness online and into new actuator designs that utilize many lightweight, low-power clutches acting in concert.