Artificial neural network, machine learning modelling of compressive strength of recycled coarse aggregate based self-compacting concrete.

This research study aims to understand the application of Artificial Neural Networks (ANNs) to forecast the Self-Compacting Recycled Coarse Aggregate Concrete (SCRCAC) compressive strength. From different literature, 602 available data sets from SCRCAC mix designs are collected, and the data are rearranged, reconstructed, trained and tested for the ANN model development. The models were established using seven input variables: the mass of cementitious content, water, natural coarse aggregate content, natural fine aggregate content, recycled coarse aggregate content, chemical admixture and mineral admixture used in the SCRCAC mix designs. Two normalization techniques are used for data normalization to visualize the data distribution. For each normalization technique, three transfer functions are used for modelling. In total, six different types of models were run in MATLAB and used to estimate the 28th day SCRCAC compressive strength. Normalization technique 2 performs better than 1 and TANSING is the best transfer function. The best k-fold cross-validation fold is k = 7. The coefficient of determination for predicted and actual compressive strength is 0.78 for training and 0.86 for testing. The impact of the number of neurons and layers on the model was performed. Inputs from standards are used to forecast the 28th day compressive strength. Apart from ANN, Machine Learning (ML) techniques like random forest, extra trees, extreme boosting and light gradient boosting techniques are adopted to predict the 28th day compressive strength of SCRCAC. Compared to ML, ANN prediction shows better results in terms of sensitive analysis. The study also extended to determine 28th day compressive strength from experimental work and compared it with 28th day compressive strength from ANN best model. Standard and ANN mix designs have similar fresh and hardened properties. The average compressive strength from ANN model and experimental results are 39.067 and 38.36 MPa, respectively with correlation coefficient is 1. It appears that ANN can validly predict the compressive strength of concrete.

Prolonged Hourly Neurologic Examinations are Associated with Increased Delirium and No Discernible Benefit in Mild/Moderate Geriatric Traumatic Brain Injury.

BACKGROUND: Serial neurologic examinations (NE) are routinely recommended in the ICU within the first 24 hours following a TBI. There are currently no widely accepted guidelines for the frequency of NE. Disruptions to the sleep-wake cycles increase the delirium rate. We aimed to evaluate whether there is a correlation between prolonged Q1-NE and development of delirium and to determine if this practice reduces the likelihood of missing the detection of a process requiring emergent intervention. METHODS: Retrospective analysis of patients with mild/moderate TBI, admitted to the ICU with serial-NE. Cohorts were stratified by the duration of exposure to Q1-NE, into Prolonged(≥24 h) and Not Prolonged(<24 h). Our primary outcomes of interest was delirium, evaluated using the Confusion Assessment Method (CAM-ICU), radiological progression from baseline images, neurological deterioration (focal neurological deficit, abnormal pupillary exam, or GCS decrease >2), and neurosurgical procedures. RESULTS: A total of 522 patients were included. No significant differences were found in demographics. Patients in the Prolonged Q1-NE group (26.1%) had higher ISS with similar AIS Head, and significantly higher delirium rate [59% vs 35%, p < .001], and a longer Hospital/ICU length of stay when compared to the Not Prolonged Q1-NE group. No neurosurgical interventions were found to be performed emergently as a result of findings on NE. Multivariate analysis demonstrated that Prolonged Q1-NE was the only independent risk factor associated with a 2.5-fold increase in delirium rate. The Number Needed to Harm for prolonged Q1-NE was 4. CONCLUSIONS: Geriatric patients with mild/moderate TBI exposed to Q1-NE for periods longer than 24 h had nearly a 3-fold increase in ICU-Delirium rate. One out of five patients exposed to prolonged Q1-NE is harmed by the development of delirium. No patients were found to directly benefit as a result of more frequent neurological examinations.

Does Negative Pressure Wound Therapy Impact the Outcome for Patients With Necrotizing Soft Tissue Infection Infected With Anaerobic Bacteria?

Background: A notable improvement in the treatment of necrotizing soft tissue infections (NSTIs) is the development of negative pressure wound therapy (NPWT). Clinicians are still debating whether NPWT is as successful as conventional wet-to-dry dressings at removing bacteria. Recent research has revealed potential oxygen deprivation effects of NPWT in underlying wound tissues, although clinical trials regarding the effects of reduced oxygen on anaerobic bacterial soft tissue infections remain noticeably lacking. Hypothesis: We hypothesized that NPWT-treated patients with NSTIs who were solely infected by anaerobic bacteria would have worse outcomes than those who were infected with other bacterial species. Patients and Methods: Our study included a retrospective examination of the 2008-2022 period of our Acute and Critical Care Surgery database. Patients who had been identified as having necrotizing fasciitis, Fournier gangrene, or gas gangrene and who had their conditions verified by positive wound cultures acquired during the initial debridement and subsequently received NPWT made up the study cohort. Comorbidities, surgical techniques, and clinical results were all covered by the data. Based on their wound infections, patients were divided into two groups: those with exclusively anaerobic NSTIs and those with different bacterial groups (such as polymicrobial and aerobic). Multiple regression, χ2 analysis, and analysis of variance (ANOVA) were among the analytical methods used. Results: One hundred twelve patients with NSTI who had received NPWT comprised the study cohort. Sixteen of these patients (14.3%) had NSTIs that were exclusively anaerobic, whereas the remaining 96 (85.7%) had NSTIs that were mixed aerobic, facultative, or polymicrobial. Between the two groups, there was no difference in the initial wound size. Patients with anaerobic NSTI who underwent NPWT showed a statistically significant increase in the number of debridements (3 [interquartile range {IQR},1-9] vs. 2 [IQR, 1-4]; p = 0.012) and an increased 100-day re-admission rate (37.5% vs. 12.5%; p = 0.012) when compared with patients with non-anaerobic NSTI. The 100-day re-admission rate increased three-fold in NPWT-treated anaerobic NSTIs, according to a logistic regression analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.06-12.44; p = 0.04). Conclusions: In contrast to patients with other bacterial strains, our data show that patients with NSTI treated with NPWT who only have anaerobic bacterial infections have a larger number of debridements and are much more likely to require re-admission within 100 days. We call for additional prospective studies to be conducted to identify additional risk factors and consider alternate treatment options for individuals with exclusively anaerobic NSTIs in light of these findings.

Negative Pressure Wound Therapy With and Without Instillation in Necrotizing Soft Tissue Infections.

Background: Necrotizing soft tissue infections (NSTIs) are rare but deadly infections that require early and often extensive surgical debridement. After debridement, patients frequently have substantial morbidity because of large, open wounds. Hypothesis: Negative pressure wound therapy with instillation (NPWTi) results in higher wound closure rates compared with traditional negative pressure wound therapy (NPWT) or wet to dry dressings (moist wound care dressing). Patients and Methods: A prospectively maintained Acute and Critical Care Surgery database spanning 2008-2018 was queried for patients with a diagnosis of necrotizing fasciitis, Fournier gangrene, or gas gangrene. Data were collected on patient comorbidities, operative management, and clinical outcomes. Patients were stratified by use of moist wound care dressing, traditional NPWT, or NPWTi. Data were analyzed using analysis of variance (ANOVA), χ2, and logistic regression. Results: During the 10-year study period, patients were treated for NSTI; 173 were managed with moist wound care dressing, 150 with NPWT, and 48 with NPWTi. Patients were similar in terms of demographics, body mass index (BMI), diabetes mellitus, and smoking rates. Overall, complication rates were not substantially different, but mortality was higher in the moist wound care dressing group (16.2% vs. 10.7% NPWT vs. 2.1% NPWTi; p = 0.02). In the moist wound care dressing group, 81.5% of patients had an open wound at discharge compared with 52.7% of the NPWT group and only 14.6% of the NPWTi group (p < 0.001). On multivariable regression, NPWTi was associated with closure rates five times higher than the NPWT group (odds ratio [OR], 5.28; 95% confidence interval [CI], 2.40-11.61; p < 0.001) after controlling for smoking status, intravenous drug use, number of operations, and involvement of the most common region of the body. Conclusions: Negative pressure wound therapy with instillation is associated with higher rates of wound closure without increasing complication rates in patients with NSTI compared with traditional NPWT or moist wound care dressing. Although prospective studies are needed, this indicates the potential to improve patient quality of life through reduced pain and outpatient home health needs.

Ludwig's Angina: Higher Incidence and Worse Outcomes Associated With the Onset of the Coronavirus Disease 2019 Pandemic.

Background: Ludwig's angina (LA) is a diffuse cellulitis of the submandibular space and adjacent tissues. During the coronavirus disease 2019 (COVID-19) pandemic, odontogenic treatments were often delayed because of the implementation of safety measures to avoid the spread of the virus. We hypothesized that delayed odontogenic treatments associated with the onset of the COVID-19 pandemic would be associated with an increase in the incidence of LA and worse outcomes related to these infections. Patients and Methods: Patients from June 2018 to June 2022 with computed tomography images suggestive of LA and confirmed by ear, nose, throat (ENT) consult were included. We abstracted demographics, outcomes, clinical management, and microbiology. Patients were stratified into pre-COVID and COVID-onset. Our primary outcome, incidence of LA, was defined as: (new LA cases) ÷ (ED evaluations of oral or dental infections × 1.5 years). Results: In the pre-COVID group, we identified 32 of 1,301 patients with LA for an incidence of 0.02 per year. The COVID-onset group consisted of 41 of 641 patients, with an incidence of 0.04 per year. In the COVID-onset group, progression to necrotizing fasciitis was more likely (0% vs. 15%; p < 0.024), and they returned to the operating room for repeated debridement (3% vs. 22%; p < 0.020). Likewise, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were higher (4.3 ± 3.5 vs. 9.5 ± 11.3; 1.1 ± 1.2 vs. 9.5 ± 7.1; 0.3 ± 1 vs. 3.6 ± 7.1; p < 0.001). Conclusions: Although the prognosis for dental infections diagnosed early is generally favorable, we observed a notable increase in the incidence of LA after the onset of the COVID-19 pandemic. Moreover, complications stemming from these infections became more severe in the COVID-onset era. Specifically, the likelihood of necrotizing fasciitis showed a substantial increase, accompanied by an increased risk of respiratory failure and mediastinitis.

Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Assault.

Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.

A deep learning approach for prediction of Parkinson's disease progression.

This paper proposes a deep neural network (DNN) model using the reduced input feature space of Parkinson's telemonitoring dataset to predict Parkinson's disease (PD) progression. PD is a chronic and progressive nervous system disorder that affects body movement. PD is assessed by using the unified Parkinson's disease rating scale (UPDRS). In this paper, firstly, principal component analysis (PCA) is employed to the featured dataset to address the multicollinearity problems in the dataset and to reduce the dimension of input feature space. Then, the reduced input feature space is fed into the proposed DNN model with a tuned parameter norm penalty (L2) and analyses the prediction performance of it in PD progression by predicting Motor and Total-UPDRS score. The model's performance is evaluated by conducting several experiments and the result is compared with the result of previously developed methods on the same dataset. The model's prediction accuracy is measured by fitness parameters, mean absolute error (MAE), root mean squared error (RMSE), and coefficient of determination (R2). The MAE, RMSE, and R2 values are 0.926, 1.422, and 0.970 respectively for motor-UPDRS. These values are 1.334, 2.221, and 0.956 respectively for Total-UPDRS. Both the Motor and Total-UPDRS score is better predicted by the proposed method. This paper shows the usefulness and efficacy of the proposed method for predicting the UPDRS score in PD progression.

Influence of plant extracts mixed with endodontic sealers on the growth of oral pathogens in root canal: An in vitro study.

INTRODUCTION: Microbes are considered as the primary etiological agents in endodontic diseases. Ways of reducing these agents are root canal debridement and antibacterial filling materials. One of the factors in determining the success of endodontic treatment previously was sealing root canals with materials possessing potent bactericidal effect. Due to cytotoxic reactions of sealers and their inability to eliminate bacteria completely from dentinal tubules, trend to use natural plants extracts have been introduced. AIM: To compare antimicrobial activity of endodontic sealers added to herbal extracts. MATERIALS AND METHOD: Three sealers mixed with three herbal extracts were evaluated against seven strains of bacteria at various time intervals using Agar Diffusion Test. The mean zones of inhibition were measured. STATISTICAL ANALYSIS: All statistical analysis was performed using the SPSS 15 statistical software version, Chicago. Intergroup comparison was evaluated using Kruskal Walls test along with Mann Whitney U test. The Intragroup comparison was evaluatd using Friedman test along with Wilcoxon test. RESULTS: Statistically significant zones of bacterial growth inhibition were observed largest with Zinc Oxide Eugenol based sealer when mixed with Glycyrrhiza glabra (Licorice) followed in descending order by zinc oxide eugenol based sealer mixed with Tinospora cordifolia (Guduchi) and Mimusops elengi (Bakul) respectively. CONCLUSION: Zinc Oxide Eugenol based sealer with herbal extracts produced largest inhibitory zones followed in descending order by Resin based sealer and Calcium hydroxide along with three herbal extracts respectively.

The Era of Device Colonizers: Chryseobacterium indologenes Infections from a Tertiary Care Center in North India.

BACKGROUND: Chryseobacterium indologenes is a hospital environment contaminant and can cause healthcare-associated infections. METHODS: Patients with C. indologenes infections in a tertiary care center in North India for 6 months were evaluated for susceptibility patterns, comorbidities, mechanical devices, risk factors, and treatment outcomes. The organism was provisionally identified phenotypically, and identification was confirmed by the BD Phoenix automated microbiology system. Minimum inhibitory concentration values of antibiotic susceptibility were determined. RESULTS: A total of 12 isolates of C. indologenes were recovered from 11 patients. Five patients had C. indologenes bloodstream infection (BSI), one had ventilator-associated pneumonia (VAP), and one had both BSI and VAP. In four others, the organism was isolated from the catheterized urinary tract. All VAP and BSI patients were admitted to the Intensive Care Units and mechanically ventilated; all had central lines and history of colistin therapy during the past 15 days. The common underlying risk factors were diabetes, hypertension, and coronary artery disease. CONCLUSIONS: C. indologenes infections are increasing because of higher use of carbapenems and colistin, to which it is intrinsically resistant.

Bimetallic cages.

We report the results of density functional theory for 39 clusters A(x)B(y) (x + y = 10 or 12) where A and B are metals from group 1, 2, 11, 12, 13, or 14 of the periodic table. The chemical compositions were chosen to satisfy an electronic shell closing criterion. We performed an unbiased search for the global minimum (GM) by taboo search in descriptor space in each case. Eight of the 39 putative GM are cages even though none of the clusters contains gold, a metal with a well known propensity to form cages. These cages are large enough to accommodate a dopant atom with an atomic radius varying between 0.7 Å and 1.2 Å. The chemical compositions most likely to produce cages have an element of group 11 alloyed with an element of group 2, 12, or 13.