Simple Surveillance Research Articles

Different sampling strategies for optimal detection of the overall genetic diversity of methicillin-resistant Staphylococcus aureus.

Surveillance schemes for methicillin-resistant Staphylococcus aureus (MRSA) are widely established at the national and international levels. Due to the simple standardization of the protocol, mainly isolates from bloodstream infections are used. However, the limitations of this simple surveillance system are well described. We conducted a comprehensive analysis of MRSA isolates in a large Slovenian region over 5 years to identify the optimal sample group for assessing the overall MRSA diversity. At the same time, this study provides to date non-available molecular characterization of Slovenian MRSA isolates. A total of 306 MRSA isolates from various sources were sequenced and phenotypically tested for resistance. The isolates exhibited significant molecular diversity, encompassing 30 multi locus sequence type (MLST) sequence types (STs), 39 ST-SCCmec genetic lineages, 49 spa types, and 29 antibiotic resistance profiles. Furthermore, the isolate pool comprised 57 resistance genes, representing 22 resistance mechanisms, and 96 virulence genes. While bloodstream isolates, commonly used in surveillance, provided insights into frequently detected clones, they overlooked majority of clones and important virulence and resistance genes. Blood culture isolates detected 21.3% spa types, 24.1% resistance phenotypes, and 28.2% MLST-SCCmec profiles. In contrast, strains from soft tissues demonstrated superior genomic diversity capture, with 65.3% spa types, 58.6% resistance phenotypes, and 71.8% MLST-SCCmec profiles. These strains also encompassed 100.0% of virulence and 82.5% of resistance genes, making them better candidates for inclusion in surveillance programs. This study highlights the limitations of relying solely on bloodstream isolates in MRSA surveillance and suggests incorporating strains from soft tissues to obtain a more comprehensive understanding of the epidemiology of MRSA.IMPORTANCEIn this study, we investigated the diversity of methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that can cause infections that are difficult to treat due to its resistance to antimicrobial agents. Currently, surveillance programs for MRSA mainly rely on isolates from bloodstream infections, employing a standardized protocol. However, this study highlights the limitations of this approach and introduces a more comprehensive method. The main goal was to determine which group of samples is best suited to understand the overall diversity of MRSA and to provide, for the first time, molecular characterization of Slovenian MRSA isolates. Our results suggest that including MRSA strains from soft tissue infections rather than just blood infections provides a more accurate and comprehensive view of bacterial diversity and characteristics. This insight is valuable for improving the effectiveness of surveillance programs and for developing strategies to better manage MRSA infections.

Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection.

Recurrence is the major challenge facing endoscopic submucosal dissection (ESD)-based treatment therapies for early gastric cancer (EGC). Urgent development of simple and easy surveillance approaches will enhance clinical treatment of the disease. To explore the role of computed tomography (CT) recurrence in evaluating EGC after ESD treatment. We retrospectively recruited patients from our endoscopy department, between January 2002 and December 2015, and analyzed their basic characteristics, including symptoms, CT results, and results of endoscopy with biopsy, among others. Among a total of 2150 patients EGC patients surveyed, 1362 met our inclusion and exclusion criteria and were therefore enrolled in our study. The cohort's sensitivity of CT for recurrent GC and specificity were 44.22% and 43.86%, respectively, with negative and positive predictive values of 40.15% (275/685) and 48.01% (325/677), respectively. The area under the curve of arterial and venous CT values for recurrent EGC were 0.545, and 0.604, respectively. Receiver operating characteristic curve revealed no statistically significant differences between arterial and venous CT values for recurrent EGC. Enhanced CT has superior diagnostic efficacy, but less accuracy, compared to gold standard techniques in patients with recurrent EGC.

Academic dishonesty and monitoring in online exams: a randomized field experiment

Cheating in online exams without face-to-face proctoring has been a general concern for academic instructors during the crisis caused by COVID-19. The main goal of this work is to evaluate the cost of these dishonest practices by comparing the academic performance of webcam-proctored students and their unproctored peers in an online gradable test. With this aim in mind, we carried out a randomized field experiment using a simple video surveillance system through Google Meet during an online closed-book final exam of an Introduction to Microeconomics course. Given that all conditions except for webcam monitoring were identical, differences in between-subjects scores are attributed to academic dishonesty. After controlling for potential confounding factors, including gender, academic degree, instructor, previous score and whether students were repeaters or not, we found that those students who were proctored via webcam obtained statistically significant lower scores in the final exam than those who were not using this surveillance system with a low level of invasiveness. Inspection of the potential factors behind these differences in scores suggests that the poorer performance of proctored students is more related to academic dishonesty than to reasons involving anxiety or heterogeneity factors.

SG-APSIC1047: Patient instrument tracking system

Background: In the post–COVID-19 era, competency of healthcare workers is very important, and new technology is imperative. The central sterile supply department (CSSD) staff must also improve their response when a patient infection is reported. The sterilization process is more important than ever. Objectives: We sought to simplify surveillance to act faster, to reduce the time to obtain patient data, and to eliminate nonvalue stream mapping in the workflow process in order to prevent patient harm and strengthen our infection prevention and control efforts. Methods: The CSSD staff met with an IT developer to determine requirements for an electronic surveillance program. Before this intervention, we scanned hard copies of patient records and stored them in a folder on a computer on a daily basis. These data were difficult to search, monitor, and display, and this method wasted time in locating patient data. The IT developer designed a program to track patients and instruments. The program collected data regarding the patient’s surgery, instruments used, and monitoring information. With the help of the IT developer, the CSSD staff tested and tweaked the new platform until accuracy and usability were achieved. Staff were trained on the use of the new system before it was implemented. Results: This project yielded simplified surveillance that improved the infection prevention process, reduced potential patient harm, and strengthened the ability of the IPC team to analyze and act on data. Conclusions: A simple surveillance system for tracking patients and instruments used assists both CSSD and IPC teams. This system assures the performance of sterilization procedures. When adverse events occur, patients who used these devices are tracked, and an analysis is performed to identify and implement improvements.

Introducing a novel "real-time" outbreak alert and notification system to monitor SARS-CoV-2 outbreaks and case fatality in elderly care facilities, the Netherlands, 2020-2022.

Surveillance systems collating individual-level data may limit timely information sharing during rapidly evolving, infectious disease outbreaks. We present a digital outbreak alert and notification system (MUIZ) in which institutional-level data are reported, allowing real-time outbreak monitoring in elderly care facilities (ECF). We describe trends in the number of outbreaks, mean case number per outbreak, and case-fatality rate (deaths/recovered + deaths) of SARS-CoV-2 in ECF notified through MUIZ in the Rotterdam area (April 2020-March 2022). Overall, 369 outbreaks were reported from 128 ECF that registered with MUIZ (approximately 85% of all ECF), and 114 (89%) notified at least one SARS-CoV-2 outbreak. Trends were consistent with the concurrent national epidemiology and societal control measures in place. MUIZ is a simple outbreak surveillance tool that was highly adopted and acceptable to users. Dutch PHS regions are increasingly adopting the system and it has potential for adaptation and further development in similar institutional outbreak settings.

Abstract IA002: DCIS: Pathological heterogeneity and prognosis definition

Abstract Ductal carcinoma in situ represents 15 to 20% of all breast carcinomas and is a non-obligate precursor of invasive carcinomas. Clinically DCIS presents most frequently as microcalcifications detected on screening mammography. DCIS is a proliferation of neoplastic cells confined to the ductulo-lobular tree. Its morphology can recapitulate the diversity of that of invasive carcinomas. DCIS lesions are classified according to the nuclear grade (low, intermediate, high), the presence of necrosis and microinvasion. In resection specimens, the extent of the disease and the quality of the margins are key element for patients management as well as the association of DCIS to the microcalcifications. The reproducibility of the DCIS grading system is relatively poor and promising help emerges from deep learning approaches. The four molecular classes of invasive carcinomas exist but with different proportion in DCIS. Triple negative represent 5-8% of DCIS. Conversely, HER2 overexpression is more frequently observed in particular in high grade DCIS (up to 60% of the cases). The analysis of Estrogens and progesterone receptors is not systematic in clinical practice unless an endocrine therapy may be decided after the patient has completed the loco-regional treatment. At initial diagnosis, it remains very challenging to predict the clinical outcome of the lesion. However, after complete surgical excision followed by whole breast irradiation therapy, the prognosis is excellent with a mortality of 3.7%. The rate of relapse is 7% at 5 years and 16% at 10 years of follow-up. Concerns about overdiagnosis and overtreatment exist worldwide. Retrospective studies identified older age, mammographic detection, small size, non-high grade histology and negative margins at excision associated with favorable outcome. Unfortunately, de-escalation clinical prospective trials based on these criteria, failed to identify the patients presenting DCIS of good prognosis. Biological parameters have been retrospectively associated with a poor prognosis (HER2 amplification, proliferation, RB loss, COX2 expression…). The molecular signature Oncotype DCIS®, has been validated retrospectively in a subgroup of patients from the ECOG E5194, and determined DCIS associated with different risk of relapse. Its prospective validation is on-going in a non randomized trial (DUCHESS). Three on-going trials based in part on clinical criteria, one adding estrogen receptors expression, the other comedonecrosis, propose after a diagnostic biopsy, a simple surveillance. Another trial, leaded by UNITRAD/UNICANCER (France), Romance is a prospective randomized study of omission of whole-breast radiotherapy following breast-conserving surgery in patients with very low risk luminal A ductal carcinoma in situ and enrolment is on. Research efforts is moving into the integration the ecosystem of DCIS (myoepithelial cells, stroma, immune cells and carcinomatous cells) to identify more accurately the DCIS associated with a higher aggressiveness that would allow secure de-escalation clinical trials. Citation Format: Anne Vincent-Salomon. DCIS: Pathological heterogeneity and prognosis definition [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr IA002.

OR09-6 Identification of MicroRNAs Critical to the Lymph Node Metastatic Process of Thyroid Cancer

Abstract The identification of thyroid tumors with the potential for poor evolution is a major concern, as current management can range from simple active surveillance to aggressive therapeutic measures. MicroRNAs are small non-coding RNAs that play a key role in the regulation of gene expression and therefore in the pathogenesis and progression of different types of cancers. Here we employed several bioinformatics tools to investigate deregulated miRNAs in the lymph node metastasis (LNM) of two different types of thyroid tumors. Using thyroid cancer RNA-seq data available on Gene Expression Omnibus (GEO), we identified 14 common deregulated miRNAs in LNM of both medullary and papillary thyroid carcinomas, three of them still negatively deregulated when compared to their respective primary tumor: miR-199a-3p, miR-199a-5p, and miR-148a-5p. Public data available on TCGA confirmed the downregulation of miR-148a-5p in LNM and tumors with advanced AJCC stage. Looking at their predicted target genes, ITGA3, PVRL1 (also called NECTIN1), SNN, and FBXO28 genes were confirmed as positively deregulated in LNM papillary thyroid carcinomas when compared to normal tissues. Public data available on TCGA once again confirmed higher expression of the ITGA3 gene in LNM, larger and invasive tumors (T4a), and stage III and IV. Similar results were observed for PVRL1 (NECTIN1) and FBXO28, but not for SNN. These bioinformatic analysis findings suggest that miR-199a-3p, miR-199a-5p, and miR-148a-5p dysregulation, leading to epithelial-mesenchymal transition and cell adhesion failure, are associated with thyroid tumors’ LNM. Presentation: Saturday, June 11, 2022 12:45 p.m. - 1:00 p.m.

An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition

ObjectiveCatheter/cannula-bloodstream infection (CBI) has been proposed as a marker of the quality of care provided to patients receiving parenteral nutrition (PN). However, surveillance criteria for CBI are variable, inconsistent, and sometimes confusing and impractical. Surveillance criteria were developed to simply and accurately demonstrate the presence or absence of CBI. The aim of this study was to establish a simple and valid surveillance tool, with consideration of changes in vital signs, to identify CBI in patients receiving PN. MethodsAdult (≥18 y) inpatients prescribed PN at a single large teaching hospital were recruited between October 11, 2017 and November 16, 2018. Common clinical and laboratory criteria, including blood culture, associated with 100 consecutive PN episodes associated with suspected CBI were examined for potential predictive markers of CBI. Using binary logistic regression, criteria were incorporated into an instrument that was validated against a reference classification of CBI established by an expert multidisciplinary group. ResultsThe reference classification comprised 12 PN episodes with CBI and 88 without. Abnormal vital signs did not significantly predict CBI, but resolution of fever (≥38°C) and low systolic blood pressure (<100 mm Hg) in response to a specific treatment for CBI (line removal/antibiotics) did. Two other criteria were also significant predictors: positive blood culture; and absence of an alternative source that could explain the septic episode other than the catheter/cannula supplying PN. These two criteria together with a positive response to treatment (temperature and/or blood pressure, incorporated into a single binary variable), resulted in 100% correct CBI classification (100% sensitivity, 100% specificity, and 1.000 area under the curve in receiver operating characteristic analysis). All criteria could be retrospectively extracted from the medical records of all PN episodes. ConclusionA CBI tool shows promise as a surveillance instrument for benchmarking and interinstitutional comparisons of the care received by hospitalized patients given PN.

Disease Progression in Older Patients With Renal Tumor Assigned to an Active Surveillance Protocol.

Active surveillance (AS) is a validated option for the treatment of small renal masses (SMRs), especially in older patients. This study investigates the oncologic outcomes and competitive mortality of older patients prospectively assigned to AS. We conducted a monocentric study on patients ≥75 years treated between 2011 and 2016 for a SMR. Treatment modalities, biopsy data, survivals (overall, specific, cancer progression) and delayed interventions were analyzed. Overall, 106 patients (median age 80.5 years) were included, of which 41 were managed by AS during a follow-up of 3.4 years [0-7.1]. Seven patients (17%) had a primary biopsy with 3 confirmed renal cell carcinomas. Fourteen patients (34.1%) presented with progression (29.2% local; 4.9% metastatic), 8 (19.5%) requiring delayed interventions (75% ablative therapy and 25% radical nephrectomy). Overall survival (OS) was 68.3% and cancer specific survival was 95.1% during the study period. Competitive mortality was higher (84.6%) than cancer specific mortality (15.4%), P=.001. The growth rate of progression including 4.9% metastatic progression underlines the value of AS compared to simple watchful surveillance in the treatment of SMRs in older patients. Of note, the higher competitive mortality confirm that AS should be preferred to active intervention at the beginning of the management.

Deep Learning-Based Object Tracking via Compressed Domain Residual Frames

The extensive rise of high-definition CCTV camera footage has stimulated both the data compression and the data analysis research fields. The increased awareness of citizens to the vulnerability of their private information, creates a third challenge for the video surveillance community that also has to encompass privacy protection. In this paper, we aim to tackle those needs by proposing a deep learning-based object tracking solution via compressed domain residual frames. The goal is to be able to provide a public and privacy-friendly image representation for data analysis. In this work, we explore a scenario where the tracking is achieved directly on a restricted part of the information extracted from the compressed domain. We utilize exclusively the residual frames already generated by the video compression codec to train and test our network. This very compact representation also acts as an information filter, which limits the amount of private information leakage in a video stream. We manage to show that using residual frames for deep learning-based object tracking can be just as effective as using classical decoded frames. More precisely, the use of residual frames is particularly beneficial in simple video surveillance scenarios with non-overlapping and continuous traffic.

Raised carbohydrate antigen 19-9 levels detect recurrences and impacts overall and disease-free survival in radically resected gallbladder cancer: A simple surveillance marker?

There are no established markers which can be used for surveillance after curative resection in gallbladder carcinoma (GBC). Though carbohydrate antigen 19-9 (CA 19-9) has low specificity as a diagnostic marker, its role as a surveillance marker has not been explored. The aim of this study is to evaluate the predictive ability of CA 19-9 as a surveillance marker to detect recurrences on follow-up. A retrospective analysis of a prospectively maintained database of radically resected GBC who were either on observation or completed adjuvant therapy (chemotherapy or chemoradiation) were followed up 3 monthly with CA 19-9 and ultrasound (US) abdomen for the first 2 years and 6 monthly CA 19-9 and US for further 3 years. Patients with raised CA 19-9 and a recurrent lesion on US abdomen were confirmed with contrast-enhanced computed tomography (CECT) abdomen and fine-needle aspiration cytology (FNAC) of recurrent lesion to establish the diagnosis of recurrence. The performance of CA 19-9 levels (20 and more units/mL) for prediction of recurrence and its impact on survival was estimated. Out of sixty patients on follow-up, 40% recurred: loco-regional (16.7%) and distant metastases (23.4%). The sensitivity, specificity, positive predictive value, and negative predictive value of CA 19-9 in detecting recurrence were 79.1%, 97.2%, 95%, and 87.5%, respectively. The median disease-free survival was 56 months versus 15 months (P = 0.008, hazard ratio [HR]: 7.4 [1.3-40]) and the median overall survival was not reached versus 20 months (P = 0.000, HR: 10.7 [confidence interval 4.2-27.3]) for CA 19-9 levels less than and more than 20 ng/mL. Based on the high positive and negative predictive value in our dataset, CA 19-9 can be used as a surveillance biomarker for follow-up of radically resected GBC. Raised levels of >20 ng/mL should be correlated with imaging findings and any suspicious lesion should be confirmed for recurrence by FNAC and CECT abdomen. Levels >20 ng/mL should be taken as a threshold for suspecting recurrence.

Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review.

BackgroundCases of spontaneous pneumothorax have been described in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in healthy patients with no underlying lung disease and who did not receive invasive mechanical ventilation.MethodsA PubMed research was conducted. The following data were collected: age, sex, side of the pneumothorax, smoking habit, time form onset of symptoms to the diagnosis of pneumothorax, the development of new bullous lesions on computed tomography and the type of treatment. In order to analyze the most homogeneous population possible, intubated patients were deliberately excluded. In total, 44 cases of spontaneous pneumothorax in otherwise healthy patients were taken into account. Since the available data were extracted from small observational studies, no particular bias risk assessment was performed. Descriptive statistics were used to synthesize results.ResultsThere were 37 male (84.1%) and 6 female (13.6%) patients. The majority of patients (66%) were treated only by chest tube thoracostomy, which most of the times resulted in a complete resolution of the pneumothorax. Simple surveillance was applied in 10 cases. Three patients underwent minimally invasive surgery. In 14 cases (31.8%) air-filled lesions were detected on imaging. Eleven patients received corticosteroids during their hospital stay. In the majority of cases (86.3%) the pneumothorax was resolved.DiscussionEven if the level of evidence, derived from case reports and small case series is low, the existence of a true secondary spontaneous pneumothorax due to SARS-CoV-2 should be recognized. Imaging techniques should be repeated throughout the clinical course of the patients in order to detect newly developed pulmonary complications. Surgical treatment is feasible and patients whose general condition permits, should be offered surgery according to the existing guidelines regarding spontaneous pneumothorax. National registries and databases are necessary in order to better understand the pathogenesis and complications of this novel entity.

Well-Flux Surveillance and Ramp-Up Method for Openhole Standalone Screen Completion

This article, written by JPT Technology Editor Judy Feder, contains highlights of paper SPE 201662, “A Well-Flux Surveillance and Ramp-Up Method for Openhole Standalone Screen Completion,” by Mehmet Karaaslan and George K. Wong, University of Houston, and Kevin L. Soter, SPE, Shell, et al., prepared for the 2020 SPE Annual Technical Conference and Exhibition, originally scheduled to be held in Denver, Colorado, 5-7 October. The paper has not been peer reviewed. Production and surveillance engineers need practical models to help maximize production while avoiding ramping up the well to an extent that the completion is damaged, causing well impairment or failure. The complete paper presents a well-flux surveillance method to monitor and ramp up production for openhole standalone screen (OH-SAS) completions that optimizes production by considering risks of production impairment and screen-erosion failure. Challenges of Increased Production vs. Well Failure The problem of increased production vs. the risk of well impairment or failure is a pressing problem for sand-control wells in deepwater, where projects tend to have a small number of high-rate wells. In such environments, any well impairments or failures greatly affect the project economics. Following unloading, well surveillance faces the critical step of ramping up to-ward the well’s designed peak rate for the first time when the actual well performance is uncertain. To reduce risk of well impairment or failure, surveillance information and models are needed to help make adjustments during the ramp-up process. Different models are available, from simple to complex and from small to large amounts of input data and computational efforts. Simple nonsurveillance models use field-derived operating limits of completion pressure drop and flow velocity or flux. They are non-surveillance models in the sense that no direct linkage of surveillance results to update flux calculations exists. Simple surveillance models use pressure transient analysis (PTA) results and completion information to evaluate changing well performance and adjust the ramp-up and long-term surveillance operations. The complex surveillance model evaluates well performance and adjusts well operations using probabilistic completion failure risks and coupled reservoir and completion simulations. These models mainly focus on cased-hole gravel pack and frac-pack applications. For openhole completions with sand control, the literature offers limited ramp-up surveillance references. The objective of the well-flux model described in the complete paper is to ramp up the well safely and optimize production using PTA results as surveillance inputs to calculate completion fluxes for well impairment or failure assessment. The method follows an approach presented in the literature.

Novel prospective umbrella-type lung cancer registry study for clarifying clinical practice patterns: CS-Lung-003 study protocol.

IntroductionConventional cancer registries are suitable for simple surveillance of cancer patients, including disease frequency and distribution, demographics, and prognosis; however, the collected data are inadequate to clarify comprehensively diverse clinical questions in daily practice.MethodsWe constructed an umbrella‐type lung cancer patient registry (CS‐Lung‐003) integrating multiple related prospective observational studies (linked studies) that reflect clinical questions about lung cancer treatment. The primary endpoint of this registry is to clarify daily clinical practice patterns in lung cancer treatment; a key inclusion criterion is pathologically diagnosed lung cancer. Under this registry, indispensable clinical items are detected in advance across all active linked studies and gathered prospectively and systematically to avoid excessive or insufficient data collection. Researchers are to input information mutually, irrespective of the relevance to each researcher's own study. Linked studies under the umbrella of the CS‐Lung‐003 registry will be updated annually with newly raised clinical questions; some linked studies will be newly created, while others will be deleted after the completion of the analysis. Enrollment began in July 2017.DiscussionWe successfully launched the umbrella‐type CS‐Lung‐003 registry. Under this single registry, researchers collaborate on patient registration and data provision for their own and other studies. Thus, the registry will produce results for multiple domains of study, providing answers to questions about lung cancer treatment raised by other researchers. Through such analysis of each linked study, this registry will contribute to the comprehensive elucidation of actual daily practice patterns in lung cancer treatment.Key points CS‐Lung‐003 registry directly integrates multiple linked studies created under the umbrella of this cancer registry to solve various clinical questions regarding daily practice patterns of lung cancer treatment.

Single-incision laparoscopic antrectomy for type I gastric neuroendocrine tumor: a case report

BackgroundType I gastric neuroendocrine tumors (GNETs) originate from hyperplasia of enterochromaffin­like (ECL) cells and are commonly detected in patients with chronic atrophic gastritis, including autoimmune gastritis. Typical treatment for type I GNETs comprises simple surveillance and/or endoscopic resection. For alleviation of hypergastrinemia resulting in ECL cell hypertrophy, antrectomy is a treatment option. Type I GNETs mostly have excellent prognosis, and if a surgical approach is chosen, the procedure must be minimally invasive. One such technique for multiple type I GNETs, minimally invasive single-incision laparoscopic antrectomy (SILA), is reported here for the first time.Case presentationWe performed SILA on a 46-year-old woman who developed type I GNETs caused by hypergastrinemia due to autoimmune gastritis. A Lap-Protector was inserted in a 3 cm incision at the umbilicus, and set an EZ Access equipped with two 5 mm trocars and one 12 mm trocar. Antrectomy without lymph node dissection was performed using a 5 mm forward-oblique viewing endoscope, a vessel sealing device, and linear staplers, while reconstruction was by Billroth I reconstruction. Side-to-side anastomosis was performed using a 45 mm linear stapler. The stapler entry hole was sutured intracorporeally using barbed suture material. The operation time was 140 min and blood loss was 5 ml. The patient was discharged ten days after surgery without complications. Serum gastrin level decreased to within the normal range on the day after the operation. One year after surgery, esophagogastroduodenoscopy showed pathological disappearance of all lesions of the remnant stomach.ConclusionsSILA is a minimally-invasive and tolerable technique for treatment of multiple type I GNETs. In this reported case there was good cohesiveness and effectiveness in normalizing gastrin levels and in elimination of remnant gastric lesions.

Validation of loop-mediated isothermal amplification for the detection of Loa loa infection in Chrysops spp in experimental and natural field conditions

BackgroundThe mass drug administration of ivermectin for onchocerciasis control has contributed to a significant drop in Loa loa microfilaria loads in humans that has, in turn, led to reduction of infection levels in Chrysops vectors. Accurate parasite detection is essential for assessing loiasis transmission as it provides a potential alternative or indirect strategy for addressing the problem of co-endemic loiasis and lymphatic filariasis through the Onchocerciasis Elimination Programme and it further reflects the true magnitude of the loiasis problem as excess human mortality has been reported to be associated with the disease. Although microscopy is the gold standard for detecting the infection, the sensitivity of this method is compromised when the intensity of infection is low. The loop-mediated isothermal amplification (LAMP) assay of parasite DNA is an alternative method for detecting infection which offers operational simplicity, rapidity and versatility of visual readout options. The aim of this study was to validate the Loa loa LAMP assay for the detection of infected Chrysops spp. under experimental and natural field conditions.MethodsTwo sets of 18 flies were fed on volunteers with either a low (< 10 mf/ml) or high (> 30,000mf/ml) microfilarial load. The fed flies were maintained under laboratory conditions for 14 days and then analysed using LAMP for the detection of L. loa infection. In addition, a total of 9270 flies were collected from the north-west, east, and south-west regions (SW 1 and 2) of Cameroon using sweep nets and subjected to microscopy (7841 flies) and LAMP (1291 flies plus 138 nulliparous flies) analyses.ResultsThe LAMP assay successfully detected parasites in Chrysops fed on volunteers with both low and high microfilariaemic loads. Field validation and surveillance studies revealed LAMP-based infection rates ranging from 0.5 to 31.6%, with the lowest levels in SW 2 and the highest infection rates in SW 1. The LAMP assay detected significantly higher infection rates than microscopy in four of the five study sites.ConclusionThis study demonstrated the potential of LAMP as a simple surveillance tool. It was found to be more sensitive than microscopy for the detection of experimental and natural L. loa infections in Chrysops vectors.Graphical

Military autonomous drones (UAVs) - from fantasy to reality. Legal and Ethical implications.

Unmanned aerial vehicles, (UAVs), called drones, have recently greatly increased their role from simple surveillance and reconnaissance to increasingly controversial targeted killings. Autonomous drones raise important judicial and ethical issues about responsibility for unintentional harm which will be discussed in this paper. Autonomy refers to respect for human autonomy (in contrast with the autonomy of a drone) and includes the free choice of individuals and groups. In the context of drones used, the ethical principle of autonomy is translated into the human values, responsibility and trust. Some features of these unmanned combat aircraft (UAVs), such as flying at high altitudes, the ability to collect effective information and their impact on civilians, influence decisions on the legality of these weapons, and the distance between the operator of the aircraft and military targets also affects the principles of international law and humanitarian law. The paper will analyze the legal and ethical issues on using drones as a weapon.

Pediatric postintensive care syndrome: high burden and a gap in evaluation tools for limited-resource settings.

This article aimed to summarize the impact and burden of pediatric postintensive care syndrome (PICS-p) in the physical, mental, cognitive, and social health domains after a review of the current pediatric literature in MEDLINE and PubMed. We also aimed to elucidate the limitations of the current evaluation tools used in limited-resource settings. PICS-p can impact a child’s life for decades. Most validated tools are time-consuming, require qualifications, and expertise, are often limited to older children, and can evaluate only one domain. A novel, simple, and comprehensive surveillance tool can aid healthcare providers in the early detection and intervention of PICS-p. Further studies should validate and refine the parameters that will enhance the outcomes of pediatric intensive care unit survivors.

Mission-based reliability prediction in component-based systems

This paper develops a framework for the extraction of a reliability block diagram in component-based systems for reliability prediction with respect to specific missions. A mission is defined as a composition of several high-level functions occurring at different stages and for a specific time during the mission. The high-level functions are decomposed into lower-level functions, which are then mapped to their corresponding components or component assemblies. The reliability block diagram is obtained using functional decomposition and function-component association. Using the reliability block diagram and the reliability information on the components such as failure rates, the reliability of the system carrying out a mission can be estimated. The reliability block diagram is evaluated by converting it into a logic (Boolean) expression. A modeling language created using the Generic Modeling Environment (GME) platform is used, which enables modeling of a system and captures the functional decomposition and function-component association in the system. This framework also allows for real-time monitoring of the system performance where the reliability of the mission can be computed over time as the mission progresses. The uncertainties in the failure rates and operational time of each high-level function are also considered which are quantified through probability distributions using the Bayesian framework. The dependence between failures of components are also considered and are quantified through a Bayesian network (BN). Other quantities of interest such as mission feasibility and function availability can also be assessed using this framework. Mission feasibility analysis determines if the mission can be accomplished given the current state of components in the system, and function availability provides information whether the function will be available in the future given the current state of the system. The proposed methodology is demonstrated using a radio-controlled (RC) car to carry out a simple surveillance mission.

Surveillance at Sea: Legal Aspects of Offshore Installation's Utilization

As the sea possesses rich variations of resources, it also imposes threats to the security and defense interests of a nation. Oil and gas exploration is one of the most important economic activities in the sea. In Indonesia, hundreds of offshore oil and gas platforms comprise thirty percent of the total oil and gas production. This signifies the importance of their establishment to the economy. However, their potentials do not stop there. As Indonesia is comprised of a very vast water area, the surveillance system still needs improvement. The article proposes to combine these interests into manifesting a simple surveillance system in offshore oil and gas platforms to improve defense and security systems, both for maritime routes in general and also the installations. The proposal prioritizes installations that are no longer operating, shifting their functions for other beneficial means. This is supported by the current law and regulations of the sea, both at the international and national levels. The international law of the sea implies that surveillance and data collection is allowed within the jurisdictional and territorial waters, whereas national levels allow functional shifting and defense system improvement in installations as long as it is coordinated with relevant ministries.