Proactive Surveillance Research Articles

Detection of classⅠintegrons with phenotypic ESBL detection among enterobacteriaceae isolated from patients with urinary tract infection in Sulaimani provenance/ Iraq

Objectives: This study aims to evaluate class Ⅰ integrons and ESBL detection in members of Enterobacteriaceae obtained from Urinary tract infection samples.
 Methods: Four hundred mid-stream urine sample were collected from patients admitting to Shar teaching hospital, Sulaimani teaching hospital, Anwar Shexa medical city hospital with signs and symptoms of UTI, and inoculated on different culture media. Colony morphology, gram staining, and VITEK 2 compact were used for bacterial identification, antibiotic profile and ESBL screened phenotypically by antibiotic profile results and double disk synergy test and confirmed by combined disk test methods. Conventional PCR was used to detect classⅠ Integron by using a specific primer and the result was analyzed, sequenced and uploaded into NCBI.
 Results: Among four hundred samples the prevalence rate of Enterobacteriaceae was 67.03 which includes 86 E. coli, 32 Klebsiella pneumoniae, and two isolates of Proteus mirabilis, according to the antibiotic profile, the most sensitive antibiotic among all three isolates were Imipenem, meropenem, and nitrofurantoin, while most resistance antibiotic were nalidixic acid and third generation cephalosporin. The prevalence rate of ESBL-producing Enterobacteriaceae was 56.6% by the confirmatory test which was a combined disk test, and the prevalence rate of classⅠintegron was 54.2%.
 Conclusion: A significant majority of the isolates under study had integrons gene and were ESBL positive. As a result, proactive antibiotic surveillance systems are required in both clinical and community settings in order to stop the occurrence and spread of antibiotic resistance genes among diverse bacterial species.

The Boys in Blue Are Watching You: The Shifting Metropolitan Landscape and Big Data Police Surveillance in the United States.

Despite decades of crime decline, police surveillance has continued to expand through a range of tactics oriented towards policing social disadvantage. Yet, despite attention to the linkages between residential inequality and policing, few studies have accounted for two intertwined structural developments since the turn of the 21st century: (1) the shift away from spatially concentrated patterns of racial segregation within urban centers towards sprawling patterns of economic segregation and (2) the turn from reactive policing towards proactive surveillance. Using the case of big data policing, we create a new measure of big data surveillance in metropolitan areas to examine how changes in segregation have affected the expansion of proactive police surveillance. In contrast to theoretical accounts emphasizing the role of police surveillance in governing economic inequality and perpetuating racial segregation, we do not find evidence that racial segregation or income inequality increase big data surveillance. Instead, much of the recent rise in big data policing is explained by increases in sprawling patterns of income segregation. These results provide new insight into the linkages between policing and residential inequality and reveal how changes in metropolitan segregation influence criminal justice surveillance in the era of big data.

RaDonda Vaught, medication safety, and the profession of pharmacy: Steps to improve safety and ensure justice

The prosecution and ultimate conviction of nurse RaDonda Vaught is both a warning and a call to action for pharmacists and the profession of pharmacy. This essay outlines 9 steps that should be taken to maximize patient safety and minimize the risk of criminal prosecution for harm that result from human error. These include advocating for safe practices that reduce the risk of wrong drug errors; using pharmacy professional organizations to educate prosecutors about just culture and system safety; strengthening the focus on at risk behaviors and the normalization of deviance; training a cohort of clinicians to serve as expert witnesses for the defense; embracing communication and resolution programs as responses to unexpected harm; encouraging and supporting conservative medication use to minimize exposure to medication risks; drawing attention to production pressures and their impact on patient safety and clinician burnout; promoting proactive surveillance for adverse drug effects; and standing in solidarity with other health professions, especially nursing. This article is protected by copyright. All rights reserved.

Towards Proactive Surveillance through CCTV Cameras under Edge-Computing and Deep Learning

Weapons, usually a handgun, a revolver, or a pistol, are used in the majority of criminal acts. The traditional closed-circuit television (CCTV) surveillance and control system requires human intervention to detect such crime incidents. The purpose of this research is to develop a real-time automatic weapon carrier detection system that may be used with CCTV cameras and surveillance systems. The goal is to alarm and alert the security officials to take proactive action to prevent violent activities. In deep learning literature, region-based classifiers (R-FCN and Faster R-CNN) and regression-based detectors (Yolo invariant) are being used as promising object detection methods. Although region-based classifiers are accurate, they lack the speed of detection required for real-time detection, whereas regression-based detectors (for example, YoloV4 invariant) are fast enough for real-time detection, but lack accuracy. The method applied in this study relies on Yolov4 to quickly detect anomalies, followed by R-FCN to boost detection accuracy by filtering out any false positives. A weapon dataset comprising 4430 locally and internationally available weapon photos with a 70–30 split ratio is used to train and test the system, which is subsequently evaluated using a live surveillance camera system. This hybrid system achieved a 90% accuracy with a low false positive rate, as well as 94% precision, 86% recall, and 89% F1 score. Our results prove that the proposed hybrid system is useful for proactive real-time surveillance to alarm the existence of a suspicious weapon carrier in a surveillance area.

The association of prescription opioid use with suicide attempts: An analysis of statewide medical claims data.

BackgroundSuicides and opioid overdose deaths are among the most pressing public health concerns in the US. However direct evidence for the association between opioid use and suicidal behavior is limited. The objective of this article is to examine the association between frequency and dose of prescription opioid use and subsequent suicide attempts.Methods and findingsThis retrospective cohort study analyzed 4 years of statewide medical claims data from the Connecticut All-Payer Claims Database. Commercially insured adult patients in Connecticut (n = 842,773) who had any medical claims beginning in January 2012 were followed through December 2015. The primary outcome was suicide attempt identified using International Classification of Diseases (ICD 9) diagnosis codes. Primary predictor variables included frequency of opioid use, which was defined as the number of months with claims for prescription opioids per year, and strength of opioid dose, which was standardized using morphine milligram equivalent (MME) units. We also controlled for psychiatric and medical comorbidities using ICD 9 codes. We used Cox proportional hazards regression to examine the association between frequency, dose, and suicide attempts, adjusting for medical and psychiatric comorbid conditions. Interactions among measures of opioid use and comorbid conditions were analyzed.In this cohort study with follow-up time up to 4 years (range = 2–48 months, median = 46 months), the hazard ratios (HR) from the time-to-event analysis indicated that patients prescribed opioid medications for at least 6 months during the past year and at 20–50 MME levels or higher had 4.44 (95% CI: [3.71, 5.32]) to 7.23 (95% CI: [6.22, 8.41]) times the risk of attempted suicide compared to those not prescribed opioids. Risk of suicide attempt was sharply elevated among patients with psychiatric conditions other than anxiety who were prescribed more frequent and higher opioid doses. In contrast, more frequent and higher doses of prescription opioids were associated with lower risk of suicide attempts among patients with medical conditions necessitating pain management.This study is limited by its exclusive focus on commercially insured patients and does not include patients covered by public insurance. It is also limited to patients’ receipt of prescription opioids and does not take into account opioids obtained through other means, nor does it include measures of actual patient opioid use.ConclusionsThis analysis provides evidence of a complex relationship among prescription opioids, mental health, pain and other medical comorbidities, and suicide risk. Findings indicate the need for proactive suicide surveillance among individuals diagnosed with affective or psychotic disorders who are receiving frequent and high doses of opioids. However, appropriate opioid treatment may have significant value in reducing suicide risk for those without psychiatric comorbidities.

Germline Pathogenic Variants Impact Clinicopathology of Advanced Lung Cancer.

The genetic factors that modulate risk for developing lung cancer have not been fully defined. Here, we sought to determine the prevalence and clinical significance of germline pathogenic/likely pathogenic variants (PV) in patients with advanced lung cancer. We studied clinical and tumor characteristics of germline PV in 5,118 patients who underwent prospective genomic profiling using paired tumor-normal tissue samples in 468 cancer genes. Germline PV in high/moderate-penetrance genes were observed in 222 (4.3%) patients; of these, 193 patients had PV in DNA damage repair (DDR) pathway genes including BRCA2 (n = 54), CHEK2 (n = 30), and ATM (n = 26) that showed high rate of biallelic inactivation in tumors. BRCA2 heterozygotes with lung adenocarcinoma were more likely to be never smokers and had improved survival compared with noncarriers. Fourteen patients with germline PV in lung cancer predisposing genes (TP53, EGFR, BAP1, and MEN1) were diagnosed at younger age compared with noncarriers, and of tumor suppressors, 75% demonstrated biallelic inactivation in tumors. A significantly higher proportion of germline PV in high/moderate-penetrance genes were detected in high-risk patients who had either a family history of any cancer, multiple primary tumors, or early age at diagnosis compared with unselected patients (10.5% vs. 4.1%; P = 1.7e-04). These data underscore the biological and clinical importance of germline mutations in highly penetrant DDR genes as a risk factor for lung cancer. The family members of lung cancer patients harboring PV in cancer predisposing genes should be referred for genetic counseling and may benefit from proactive surveillance.

Harnessing the Data Universe to Understand and Reduce Clinical Deterioration in Children.

Harnessing the Data Universe to Understand and Reduce Clinical Deterioration in Children.

Identification and Control of an Ornithonyssus Bacoti Infestation in a Rodent Vivarium by Using Molecular Diagnostic Techniques.

Ornithonyssus bacoti, commonly known as the tropical rat mite, is a zoonotic ectoparasite that occasionally infests research rodent colonies. Most infestations have been attributed to wild rodents that harbor the mite and spread it to research animals, often during building construction or other activity that disrupts wild rodent populations. Although infestation may be clinically silent, severe outbreaks have been reported to cause pruritis, dermatitis, decreased reproductive performance, and anemia in rodents. In mid-2020, our institution experienced increased activity of wild mice, which were found to be infested with O. bacoti, diagnosed by microscopic exam and confirmed by fur swab PCR analysis. We elected to add O. bacoti to our quarterly health monitoring exhaust air dust (EAD) testing PCR panel, increase wild mouse control measures, and treat the environment with a sustained-release synthetic pyrethroid spray in an attempt to prevent colony animal infestation. Initial quarterly EAD health monitoring results in September of 2020 were negative for O. bacoti. However, in early 2021, multiple IVC racks tested positive for O. bacoti at quarterly testing. Treatment consisted of providing permethrin-soaked nesting material and surface spray treatment of the room and hallway with a sustained-release synthetic pyrethroid. Historically in the literature, O. bacoti outbreaks of research mice were not identified until mite burden was high enough to cause dermatitis on animal care workers. Due to modern molecular diagnostics and proactive PCR-based health monitoring surveillance, we were able to identify the outbreak earlier than would have otherwise been possible. To the best of our knowledge, this is the first report to successfully identify O. bacoti using environmental health monitoring PCR techniques. This outbreak demonstrates the importance of screening for O. bacoti in facilities with the potential for wild rodent infestation and highlights unique considerations when managing O. bacoti infestations. In addition, a novel permethrin-soaked enrichment item was developed for cage-level treatment.

Delays in Epidemic Outbreak Control Cost Disproportionately Large Treatment Footprints to Offset.

Epidemic outbreak control often involves a spatially explicit treatment area (quarantine, inoculation, ring cull) that covers the outbreak area and adjacent regions where hosts are thought to be latently infected. Emphasis on space however neglects the influence of treatment timing on outbreak control. We conducted field and in silico experiments with wheat stripe rust (WSR), a long-distance dispersed plant disease, to understand interactions between treatment timing and area interact to suppress an outbreak. Full-factorial field experiments with three different ring culls (outbreak area only to a 25-fold increase in treatment area) at three different disease control timings (1.125, 1.25, and 1.5 latent periods after initial disease expression) indicated that earlier treatment timing had a conspicuously greater suppressive effect than the area treated. Disease spread computer simulations over a broad range of influential epidemic parameter values (R0, outbreak disease prevalence, epidemic duration) suggested that potentially unrealistically large increases in treatment area would be required to compensate for even small delays in treatment timing. Although disease surveillance programs are costly, our results suggest that treatments early in an epidemic disease outbreak require smaller areas to be effective, which may ultimately compensate for the upfront costs of proactive disease surveillance programs.

A molecular surveillance-guided vector control response to concurrent dengue and West Nile virus outbreaks in a COVID-19 hotspot of Florida

Simultaneous dengue virus (DENV) and West Nile virus (WNV) outbreaks in Florida, USA, in 2020 resulted in 71 dengue virus serotype 1 and 86 WNV human cases. We hypothesized that we would find a number of DENV-1 positive mosquito pools, and that the distribution of these arbovirus-positive mosquito pools would be associated with those neighborhoods for which imported DENV cases have been recently reported in 2019 and 2020. We collected and screened Aedes aegypti, Ae. albopictus, Anopheles crucians, Culex coronator, Cx. nigripalpus, and Cx. quinquefasciatus mosquitoes from Miami-Dade County (Florida) for DENV and WNV by rRT-qPCR. Spatial statistical analyses were performed to capture positive mosquito pool distribution in relation to land use, human demography, environmental variables, mosquito trap placement and reported human travel associated DENV cases to guide future mosquito control outbreak responses. A rapid screen of 7,668 mosquitoes detected four DENV serotype 2 (DENV-2), nine DENV-4 and nine WNV-positive mosquito pools, which enabled swift and targeted abatement of trap sites by mosquito control. As expected, DENV-positive pools were in urban areas; however, we found WNV-positive mosquito pools in agricultural and recreational areas with no historical reports of WNV transmission. These findings demonstrate the importance of proactive arbovirus surveillance in mosquito populations to prevent and control outbreaks, particularly when other illnesses (e.g., COVID-19), which present with similar symptoms, are circulating concurrently. Growing evidence for substantial infection prevalence of dengue in mosquitoes in the absence of local index cases suggests a higher level of dengue endemicity in Florida than previously thought. This research was supported in part by U.S. Centers for Disease Control and Prevention (CDC) grant 1U01CK000510-03, Southeastern Regional Center of Excellence in Vector Borne Diseases Gateway Program.

A Proactive Recognition System for Detecting Commercial Vehicle Driver’s Distracted Behavior

Road traffic accidents regarding commercial vehicles have been demonstrated as an important culprit restricting the steady development of the social economy, which are closely related to the distracted behavior of drivers. However, the existing driver’s distracted behavior surveillance systems for monitoring and preventing the distracted behavior of drivers still have some shortcomings such as fewer recognition objects and scenarios. This study aims to provide a more comprehensive methodological framework to demonstrate the significance of enlarging the recognition objects, scenarios and types of the existing driver’s distracted behavior recognition systems. The driver’s posture characteristics were primarily analyzed to provide the basis of the subsequent modeling. Five CNN sub-models were established for different posture categories and to improve the efficiency of recognition, accompanied by a holistic multi-cascaded CNN framework. To suggest the best model, image data sets of commercial vehicle driver postures including 117,410 daytime images and 60,480 night images were trained and tested. The findings demonstrate that compared to the non-cascaded models, both daytime and night cascaded models show better performance. Besides, the night models exhibit worse accuracy and better speed relative to their daytime model counterparts for both non-cascaded and cascaded models. This study could be used to develop countermeasures to improve driver safety and provide helpful information for the design of the driver’s real-time monitoring and warning system as well as the automatic driving system. Future research could be implemented to combine the vehicle state parameters with the driver’s microscopic behavior to establish a more comprehensive proactive surveillance system.

Ordering Trends and Report Outcomes for Lipid Genes on a Comprehensive Cardiovascular Genetics Menu

Lead Author's Financial Disclosures M.T. is an employee of Ambry Genetics, a Konica Minolta Company. Study Funding None. Background/Synopsis By identifying the molecular etiologies for dyslipidemias, genetic testing can improve diagnostic accuracy, guide personalized medical management recommendations, and identify at-risk family members for proactive surveillance and cascade testing. The utility of genetic testing for dyslipidemias and clinical indications for testing are well described. However, many monogenic dyslipidemias, especially familial hypercholesterolemia, are vastly underdiagnosed. Objective/Purpose To assess ordering trends and genetic testing outcomes for dyslipidemia genetic testing performed at a large clinical lab. Methods We reviewed a retrospective, unselected cohort of individuals undergoing evaluation for personal or family history of dyslipidemia at our laboratory between 2014 and 2020. We classified test orders as (1) single-site genotype analysis (SSA), (2) targeted gene sequencing, next-general sequencing (NGS) panel testing for (3) familial hypercholesterolemia, (4) familial chylomicronemia or (5) sitosterolemia, or a (6) custom NGS panel of up to 167 cardiovascular-related genes chosen by the ordering provider (Table 1). Testing outcomes categorized as positive, uncertain, carrier, or negative were tabulated by test type, gene, and proband age. Statistical analysis was performed using Fisher's exact test. Results Overall, 31.42% (n=1046) of probands received a positive finding on genetic testing. Most individuals tested (69.78%) were over the age of 36, although children were significantly more likely to receive positive results (p<0.00001). Targeted gene sequencing (51.09%) and SSA (48.95%) had the highest diagnostic rates, suggesting that previous family member diagnosis or strong clinical evidence informed the specific ordering choice. Of all custom NGS panel orders, 36.27% included at least one lipid gene, of which 31.69% also included non-lipid cardiovascular genes suggesting that the patient had non-dyslipidemia cardiovascular features such as cardiomyopathy or arrhythmia. 120 patients had biallelic alterations in LDLR, one individual had biallelic alterations in PCSK9, and one individual had pathogenic alterations in LDLR and APOB. Two other individuals had a pathogenic alteration in LDLR and were carriers for a second recessive disorder (LDLRAP1 and ABCG8). Conclusions Determining a genetic cause for dyslipidemias can provide clinicians with specific guidance for optimizing patient outcomes and follow-up surveillance of at-risk family members. Multigene panel tests may identify compounding molecular diagnostics, which can help in further tailoring treatment. As the field of precision medicine continues to grow, the importance of an accurate molecular diagnosis is increasingly more vital. M.T. is an employee of Ambry Genetics, a Konica Minolta Company.

A proposed workflow for proactive virus surveillance and prediction of variants for vaccine design.

A proposed workflow for proactive virus surveillance and prediction of variants for vaccine design.

P-P28 Long term follow-up after pancreatico-duodenectomy for chronic pancreatitis; are we compliant with NICE guidelines

Abstract Background Patients with chronic pancreatitis experience malnutrition, osteoporosis, pancreatic exocrine insufficiency and have a 80% lifetime risk of diabetes (1). These are progressive consequences and require proactive surveillance for detection and optimisation of treatment. The NICE pancreatitis guidelines recommend long-term follow up for patients with chronic pancreatitis (1). European guidelines recommend regular assessment of bone density, biochemical assessment of micronutrient status and a comprehensive nutritional assessment (2). The aim of this survey was to assess compliance with the NICE guidelines by analysing current practice in patients with chronic pancreatitis after pancreaticoduodenectomy. Methods A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow-up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical, vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included. The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26). Results One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets. Eighty eight percent worked in tertiary centres. Lifelong follow up was only offered in tertiary centres (n = 12) and was only provided by surgeons or dietitians (p = 0.03). The duration of follow up did not vary by region (p = 0.463). Patients in the South of England were more likely to undergo a micronutrient screen (p = 0.027). Only 26% of all patients were offered a DEXA scan. Clinicians with more than 10-years’ experience were more likely to assess weight (p = 0.039), glucose and HbA1c (p = 0.035) and assess symptoms (p = 0.031). Conclusions This survey demonstrated a need to improve the provision of long-term follow up for patients with chronic pancreatitis. Lack of clarity on the format and who within the clinical team should take responsibility may explain the lack of structured follow-up in this patient group. The importance of long-term assessment needs to be included in training programmes for junior clinicians, to standardise management, improve nutritional screening and improve access to bone mineral density scanning and diabetes screening. Responsibility for follow up should be agreed between primary, secondary and tertiary care.

Alcohol Withdrawal Is Associated With Worse Outcomes in Patients Undergoing Primary Total Knee or Total Hip Arthroplasty.

Alcohol withdrawal (AW) syndrome is an independent risk factor for postoperative complications. This study aims to evaluate the influence of AW on perioperative outcomes in patients who underwent primary total knee (TKA) or total hip arthroplasty (THA). We used the National Inpatient Sample database to identify patients undergoing TKA/THA from 2003 to 2014. The primary exposure of interest was AW. Multivariable adjusted models were used to evaluate the association of AW with in-hospital medical complications, surgical complications, mortality, cost, and length of stay (LOS) in patients undergoing TKA/THA. There were 2,971,539 adult hospitalizations for THAs and 6,367,713 hospitalizations for TKAs included in the present study, among which 0.14% of AW for THA patients and 0.10% of AW for TKA patients. Multivariable adjustment analysis suggested that AW was associated with an increased risk of medical complications (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.79-2.42, P < .0001), surgical complications (OR 1.75, 95% CI 1.51-2.03, P < .0001), and had 4.79 times increase of in-hospital mortality, 26% increase of total cost, and 53% increase of LOS in THA procedures. For TKA procedures, AW was also associated with increased risk of medical complications (OR 3.14, 95% CI 2.78-3.56, P < .0001), surgical complications (OR 2.07, 95% CI 1.82-2.34, P < .0001) and 4.24 times increase of in-hospital mortality, 29% increase of total cost, and 58% increase of LOS after multivariable adjustment. AW is associated with increased risk of in-hospital mortality, medical and surgical complications. Proactive surveillance and management of AW may be important in improving outcomes in patients who underwent THA and TKA procedure.

Electrocardiographic biosignals to predict atrial fibrillation: Are we there yet?

The prevalence of atrial fibrillation (AF) continues to grow in an aging population, and its impact on both patients and the health care system has has made it a global burden. There are limited available options to detect individuals at risk of AF that may benefit from prevention and treatment strategies. The ECG may be an effective tool do so. In this work, we discuss the latest work by Hayiroğlu and colleagues related to this work and the use of novel ECG prediction tools to identify individuals individuals that could benefit from early and proactive screening, surveillance, and management strategies.

Emergence of Besnoitia besnoiti in Belgium.

Bovine besnoitiosis is a cattle disease caused by a protozoan parasite called Besnoitia besnoiti. It is of serious economic concern to the cattle industry and also compromises animal welfare. For several years, it has been considered an emerging disease in some countries and regions located in the north of Europe far away from the known endemic areas in the south. This study describes the situation in the southern part of Belgium, where the parasite was recently introduced through imports of animals coming from departments of France where the disease was present. It details the detection of clinical cases as well as disease transmission features related to contacts during grazing and sales of infected cattle. A tracking and monitoring system was quickly set up and detected twelve outbreaks. Several cattle were controlled, but the lack of appropriate regulations weakens disease-management efforts. Hopefully, this predictable and silent introduction triggers the awareness of decision-makers about the need for an appropriate prevention and control policy, law enforcement, and the implementation of necessary measures to avoid bovine besnoitiosis becoming endemic in Belgium or other non-endemic countries. In addition, more proactive surveillance is required from authorities through threat analysis in the context of the risk of emergence or re-emergence of infectious animal diseases.

The Impact of Atrial Fibrillation on Outcomes of Peripheral Arterial Disease: Analysis of Routinely Collected Primary Care Data

BackgroundThe combination of peripheral arterial disease and atrial fibrillation is linked with high risk of mortality and stroke. This study aims to investigate the impact of atrial fibrillation on patients with diagnosed peripheral arterial disease. MethodsThis is a retrospective study using The Health Improvement Network database, which contains prospectively collected data from participating primary care practices. Patients with a new diagnosis of peripheral arterial disease between January 8, 1995 and January 5, 2017 were identified in the database alongside relevant demographic information, clinical history, and medications. Every patient in the dataset with peripheral arterial disease and baseline atrial fibrillation (case) was matched to a patient without atrial fibrillation (control) with similar characteristics using propensity score matching. Cox-regression analysis was performed and hazard ratios (HR) calculated for the outcomes of death, stroke, ischemic heart disease, heart failure, and major amputation. ResultsPrevalence of atrial fibrillation in this cohort was 10.2%. All patients with peripheral arterial disease and atrial fibrillation (n = 5685) were matched with 5685 patients without atrial fibrillation but otherwise similar characteristics. After multivariate analysis, atrial fibrillation was independently associated with mortality (HR 1.18; 95% confidence interval [CI], 1.12-1.26; P < .01), cerebrovascular events (HR 1.35; 95% CI, 1.17-1.57; P < .01), and heart failure (HR 1.87; 95% CI, 1.62-2.15; P < .01), but not with ischemic heart disease or limb loss. ConclusionIn peripheral arterial disease patients, atrial fibrillation is a risk factor for mortality, stroke, and heart failure. This emphasizes the need for proactive surveillance and holistic management of these patients.

Sars-Cov-2 Vaccination in Patients with Pre-Existing Immune Thrombocytopenia

Sars-Cov-2 Vaccination in Patients with Pre-Existing Immune Thrombocytopenia

Intruder detection and recognition using different image processing techniques for a proactive surveillance

To innovate a proactive surveillance camera, there is a need for efficient face detection and recognition algorithm. The researchers used one of the ViolaJones algorithm and used different image processing techniques to recognize intruders or not. The goal of the research is to recognize the fastest way on how the homeowners will be informed if an intruder or burglar enters their home using a proactive surveillance device. This device was programmed based on the different recognition algorithms and a criteria evaluation framework that could recognize intruders and burglars and the design used was developmental research to satisfy the research problem. The researchers used the Viola-Jones algorithm for face detection and five algorithms for face recognition. The criteria evaluation was used to identify the best face recognition algorithm and was tested in a real-world situation and captured a series of images camera and processed by proactive face detection and recognition. The result shows that the system can detect and recognize intruders and proactively send a notification to the homeowners via mobile application. It is concluded that the system can recognize the intruders and proactively notify the household members using the mobile applications and activate the alarm system of the house.