-
Sensors (Basel, Switzerland) Apr 2023Temperature-controlled closed-loop systems are vital to the transportation of produce. By maintaining specific transportation temperatures and adjusting to environmental...
Temperature-controlled closed-loop systems are vital to the transportation of produce. By maintaining specific transportation temperatures and adjusting to environmental factors, these systems delay decomposition. Wireless sensor networks (WSN) can be used to monitor the temperature levels at different locations within these transportation containers and provide feedback to these systems. However, there are a range of unique challenges in WSN implementations, such as the cost of the hardware, implementation difficulties, and the general ruggedness of the environment. This paper presents the novel results of a real-life application, where a sensor network was implemented to monitor the environmental temperatures at different locations inside commercial temperature-controlled shipping containers. The possibility of predicting one or more locations inside the container in the absence or breakdown of a logger placed in that location is explored using combinatorial input-output settings. A total of 1016 machine learning (ML) models are exhaustively trained, tested, and validated in search of the best model and the best combinations to produce a higher prediction result. The statistical correlations between different loggers and logger combinations are studied to identify a systematic approach to finding the optimal setting and placement of loggers under a cost constraint. Our findings suggest that even under different and incrementally higher cost constraints, one can use empirical approaches such as neural networks to predict temperature variations in a location with an absent or failed logger, within a margin of error comparable to the manufacturer-specified sensor accuracy. In fact, the median test accuracy is 1.02 degrees Fahrenheit when using only a single sensor to predict the remaining locations under the assumptions of critical system failure, and drops to as little as 0.8 and 0.65 degrees Fahrenheit when using one or three more sensors in the prediction algorithm. We also demonstrate that, by using correlation coefficients and time series similarity measurements, one can identify the optimal input-output pairs for the prediction algorithm reliably under most instances. For example, discrete time warping can be used to select the best location to place the sensors with a 92% match between the lowest prediction error and the highest similarity sensor with the rest of the group. The findings of this research can be used for power management in sensor batteries, especially for long transportation routes, by alternating standby modes where the temperature data for the OFF sensors are predicted by the ON sensors.
PubMed: 37177507
DOI: 10.3390/s23094303 -
American Journal of Epidemiology Nov 2018Few investigations have explored temperature and birth outcomes. In a retrospective cohort study, we examined apparent temperature, a combination of temperature and...
Few investigations have explored temperature and birth outcomes. In a retrospective cohort study, we examined apparent temperature, a combination of temperature and relative humidity, and term low birth weight (LBW) among 43,629 full-term LBW infants and 2,032,601 normal-weight infants in California (1999-2013). The California Department of Public Health provided birth certificate data, while meteorological data came from the California Irrigation Management Information System, US Environmental Protection Agency, and National Centers for Environmental Information. After considering several temperature metrics, we observed the best model fit for term LBW over the full gestation (per 10-degrees-Fahrenheit (°F) increase in apparent temperature, 13.0% change, 95% confidence interval: 4.1, 22.7) above 55°F, and the greatest association was for third-trimester exposure above 60°F (15.8%, 95% confidence interval: 5.0, 27.6). Apparent temperature during the first month of pregnancy exhibited no significant risk, while the first trimester had a significantly negative association, and second trimester, last month, and last 2 weeks had slightly increased risks. Mothers who were black or older, delivered male infants, or gave birth during the warm season had infants at the highest risks. This study provides further evidence for adverse birth outcomes from heat exposure for vulnerable subgroups of pregnant women.
Topics: Adolescent; Adult; Age Factors; Body Mass Index; California; Female; Humans; Humidity; Infant; Infant, Low Birth Weight; Infant, Newborn; Male; Pregnancy; Pregnancy Trimesters; Racial Groups; Residence Characteristics; Retrospective Studies; Risk Factors; Seasons; Socioeconomic Factors; Temperature; Young Adult
PubMed: 29901701
DOI: 10.1093/aje/kwy116 -
SAGE Open Medical Case Reports 2021Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we...
Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we are unaware of reports of central nervous system serotonin toxicity in COVID-19. We present two cases that resemble serotonin syndrome in COVID-19, but without identifiable inciting medications. A 54-year-old with multiple sclerosis and diabetes mellitus presented with altered mental status. His altered sensorium was attributed to diabetic ketoacidosis, but his condition quickly deteriorated with fever to 105 degrees Fahrenheit, rigidity in all extremities, inducible clonus, and hyperreflexia. He was intubated and was treated for possible meningitis and seizure. Neurologic workup was negative for acute pathology. Despite acetaminophen, his core temperature remained elevated to 105 degrees Fahrenheit. He was treated with external cooling and cyproheptadine and within 48 h, his fever, rigidity, hyperreflexia, and clonus resolved. He was extubated and discharged home on day 14. A 72-year-old with hyperlipidemia was admitted with tremors, 4 days after testing positive for COVID-19. His symptoms rapidly worsened, and he was transferred to the Intensive Care Unit on day 3 , febrile to 104.4 degrees Fahrenheit, heart rate of 180 beats per minute, and apparent whole body myoclonus. He was intubated and developed fever refractory to acetaminophen requiring external cooling. Extensive neurologic workup was negative. He received cyproheptadine and slowly improved. He was extubated and discharged to rehab on day 11. These cases represent a unique presentation in COVID-19 that must be considered and requires a high index of suspicion.
PubMed: 34290872
DOI: 10.1177/2050313X211032089 -
Cureus May 2024subspecies () is a zoonotic pathogen that primarily infects horses, pigs, and dogs. Although rare, it has also been shown to infect humans who consume unpasteurized...
subspecies () is a zoonotic pathogen that primarily infects horses, pigs, and dogs. Although rare, it has also been shown to infect humans who consume unpasteurized dairy food or have direct contact with horses. Here, we present a case of bacteremia in a patient without a clear mode of transmission. An 86-year-old male with a past medical history of coronary artery disease, heart failure with reduced ejection fraction, complete heart block status post pacemaker, hypertension, hyperlipidemia, and type 2 diabetes mellitus presented to the Emergency Department with fever and chills. He had fevers and rigors for three days but denied weight loss, cough, sore throat, or rashes. In the Emergency Department, vital signs revealed a fever of 101.2 degrees Fahrenheit and a heart rate of 110 with other stable vital signs. The physical exam was unremarkable except for tachycardia, and laboratory work revealed no leukocytosis but elevated inflammatory markers and elevated lactate. Computed tomography of the chest, abdomen, and pelvis did not reveal any source of infection. Blood cultures grew and the Infectious Diseases team was consulted, who started the patient on Penicillin G. Due to concern for pacer-lead infective endocarditis, transthoracic and transesophageal echocardiograms were performed, which did not show valvular vegetations. Repeat blood cultures showed clearance of the infection, and the patient was ultimately discharged on amoxicillin. While our patient denied consuming unpasteurized dairy products or having direct contact with horses, upon further questioning, he did endorse family members who occasionally interacted with horses. This case is valuable as it adds to the sparse literature on infections specifically in humans. Extensive history taking is of utmost importance when a clear source of infection is not easily identifiable. Further research is also needed to better understand the various modes of transmission of this bacterium to better target and caution those at an increased risk of infection.
PubMed: 38854287
DOI: 10.7759/cureus.59911 -
Cureus Jun 2020Cardiac manifestations of coronavirus disease 19 (COVID-19), including arrhythmia, have been described in the literature. However, to our knowledge, association of...
Cardiac manifestations of coronavirus disease 19 (COVID-19), including arrhythmia, have been described in the literature. However, to our knowledge, association of COVID-19 with bradycardia has not been reported. This case study describes sinus bradycardia as a potential manifestation of COVID-19. This is a retrospective case series of four patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to St. Luke's University Health Network ICU between 24 March 2020 and 5 April 2020. Medical records of these patients were reviewed using the EPIC electronic health record system. Demographic, clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. The patient group comprised two males and two females. Two patients had pre-existing cardiovascular (CV) comorbidities but no history of arrythmias. Heart rates ranged between 66 and 88 beats/min on admission. The lowest rates during bradycardia were between 42 and 49 beats/min. The onset of sinus bradycardia in patients 1, 2, and 3 were day nine, 15, and five of illness, respectively. Patient 4 had three episodes of bradycardia, starting on day 10 of illness. Patients' bradycardia episodes lasted one to 14 days. During bradycardia, maximum body temperatures ranged between 99.9 and 100.2 degree Fahrenheit. Patients 2, 3, and 4 required vasopressors to maintain mean arterial pressure > 65 mmHg during episodes. All four patients were on propofol at some point during bradycardia with patients 1, 2, and 3 also receiving dexmedetomidine. There was no consistent correlation of these medications with bradycardia. Electrocardiogram (ECG) findings included sinus bradycardia. Prolonged QTc interval observed in patient 2 on admission improved during bradycardia. Transient sinus bradycardia is a possible manifestation of COVID-19 and is important for close CV surveillance. Etiology can be multifactorial, but severe hypoxia, inflammatory damage of cardiac pacemaker cells, and exaggerated response to medications are possible triggers. High levels of pro-inflammatory cytokines may act directly on the sinoatrial (SA) node contributing to the development of bradycardia. This may be a warning sign of the onset of a serious cytokine storm. An increased awareness of possible exaggerated bradycardia response is important to consider with the use of empiric medications which have arrhythmogenic effects.
PubMed: 32550090
DOI: 10.7759/cureus.8599 -
PloS One 2022This study characterized associations between annually scaled thermal indices and annual heat stress illness (HSI) morbidity outcomes, including heat stroke and heat...
This study characterized associations between annually scaled thermal indices and annual heat stress illness (HSI) morbidity outcomes, including heat stroke and heat exhaustion, among active-duty soldiers at ten Continental U.S. (CONUS) Army installations from 1991 to 2018. We fit negative binomial models for 3 types of HSI morbidity outcomes and annual indices for temperature, heat index, and wet-bulb globe temperature (WBGT), adjusting for installation-level effects and long-term trends in the negative binomial regression models using block-bootstrap resampling. Ambulatory (out-patient) and reportable event HSI outcomes displayed predominately positive association patterns with the assessed annual indices of heat, whereas hospitalization associations were mostly null. For example, a one-degree Fahrenheit (°F) (or 0.55°C) increase in mean temperature between May and September was associated with a 1.16 (95% confidence interval [CI]: 1.11, 1.29) times greater rate of ambulatory encounters. The annual-scaled rate ratios and their uncertainties may be applied to climate projections for a wide range of thermal indices to estimate future military and civilian HSI burdens and impacts to medical resources.
Topics: Humans; Military Personnel; Heat Stress Disorders; Temperature; Climate; Heat-Shock Response
PubMed: 36417342
DOI: 10.1371/journal.pone.0263803 -
Annals of Clinical and Laboratory... Jan 2024To present the case of an athlete with hypereosinophilic syndrome (HES).
OBJECTIVE
To present the case of an athlete with hypereosinophilic syndrome (HES).
CASE REPORT
We present a 25-year-old female athlete, with no significant past medical history, who had a two-month history of progressive dry cough, wheezing, exertional dyspnea, and chest pain. Physical examination revealed patient to be febrile to 101.6 degrees Fahrenheit and tachycardic to 120 beats per minute with new leukocytosis of 35.9x10/L and eosinophilia of 24,000/μL. She was also found to have elevated troponins ~1.5 ng/mL and creatine kinase (CK) 203 U/L. Her overall clinical picture was concerning for hypereosinophilic syndrome with multiorgan system involvement.
CONCLUSION
Findings endorse the diagnosis of HES. HES is a rare condition that is difficult to diagnose. Early clinical diagnostic signs of HES may include fatigue, cough, breathlessness, and fever.
Topics: Humans; Female; Adult; Hypereosinophilic Syndrome; Cough; Athletes
PubMed: 38514061
DOI: No ID Found -
Cureus Sep 2022Although rare in the U.S invasive Fusariosis (IF) is increasingly being recognized as a cause of severe invasive fungal disease in patients with neutropenia in the...
Although rare in the U.S invasive Fusariosis (IF) is increasingly being recognized as a cause of severe invasive fungal disease in patients with neutropenia in the setting of hematologic malignancy and hematopoietic stem cell transplants (HSCT). IF in these patients is associated with high mortality, moreover there are no guidelines on effective therapy, thus early diagnosis and involvement of an expert with experience in treating Fusariosis are imperative. We present a case of IF in a patient with profound prolonged neutropenia in the setting of chemotherapy for relapsed, refractory acute myeloid leukemia. A 33-year-old woman with relapsed acute myeloid leukemia (AML) was hospitalized for re-induction chemotherapy. Five days post cycle 1 she became neutropenic. She was treated with prophylactic antimicrobials that included acyclovir, levofloxacin, and Posaconazole. On day sixty she began to run a high-grade fever. The physical exam was remarkable for a temperature of 102 degrees Fahrenheit and a heart rate of 116 beats per minute. Complete blood count was remarkable for 130 WBC/ml, Hb 6.5 g/dl, hematocrit (HCT) 18.7%, 13000 platelets/ml, absolute neutrophils counts (ANC) of 0. Her CT chest showed new bilateral lung nodules. Antibiotics were changed to cefepime, vancomycin, and metronidazole on day sixty-two without response. On day sixty-five meropenem was started and cefepime stopped. On day sixty-eight posaconazole was stopped and amphotericin B was started and two days later fever became low grade. She developed hyperpigmented skin lesions with necrotic centers on extremities that were biopsied. Histopathology staining favored the presence of rare fungal hyphae. The culture of the biopsy sample grew that was identified by DNA sequencing as . Voriconazole and terbinafine were added. Her fevers resolved within the next 24 hours and she remained afebrile. is a hyaline mold present in the environment. Infection is acquired by inoculation into the skin, intravascular devices, or inhalation. IF incidence is low in the United States. and are the most predominant disease-causing species complexes. Invasive Fusariosis (IF) is a rare disease seen in patients with hematologic malignancy and hematopoietic stem cell transplants (HSCT) with profound neutropenia. Immunocompromised patients suffer disseminated disease to multiple sites as in this case, with mortality rates of between sixty to eighty percent in this patient population. Blood and skin lesions biopsy cultures are diagnostic. Blood cultures are positive in up to sixty percent of cases in about four days. Polymerase chain reaction (PCR) can identify but species identification by PCR is difficult. Newer molecular methods are better for species identification. Histopathology can be helpful. Differential diagnoses include invasive aspergillosis (IA), mucormycosis, mycobacterial and dimorphic fungal infections. There are no guidelines for standard therapy. Amphotericin B or voriconazole are preferred. Combination therapy may be indicated. Neutrophil recovery is crucial. Adjunctive and preventive measures have roles.
PubMed: 36277532
DOI: 10.7759/cureus.29303 -
Surgical Neurology International 2021Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly...
BACKGROUND
Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam.
CASE DESCRIPTION
Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3.
CONCLUSION
Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.
PubMed: 34992919
DOI: 10.25259/SNI_1046_2021 -
Vaccine Nov 2016We describe the establishment of a dynamic database linking mothers to newborns with the goal of studying vaccine safety in both pregnant women and their children and...
BACKGROUND/OBJECTIVE
We describe the establishment of a dynamic database linking mothers to newborns with the goal of studying vaccine safety in both pregnant women and their children and provide results of a study utilizing this database as a proof of concept.
METHODS
All Kaiser Permanente Northern California (KPNC) live births and their mothers were eligible for inclusion in the pregnancy database. We used the medical record number (MRN), a unique identifier, to retrieve information about events that occurred during the pregnancy and at delivery and linked this same MRN to newborns for post-partum follow up. We conducted a retrospective cohort study to evaluate the association between receipt of tetanus, diphtheria and acellular pertussis (Tdap) vaccine during pregnancy and fever 0-3days after the first dose of diphtheria tetanus and acellular pertussis (DTaP) vaccine in the infant. The study included infants who were born at ⩾37weeks gestation from January 1, 2009 - October 1, 2015 and who received their first DTaP vaccine between 6 and 10weeks of age. We utilized diagnostic codes from inpatient, emergency department, outpatient clinics, and telephone calls. We identified fever using ICD 9 code 780.6, recorded temperature ⩾101 degree Fahrenheit, or parental report.
RESULTS
The database contained the starting and ending date of each pregnancy and basic demographic characteristics of mothers and infants. There were 859,699 women and 873,753 children in the database as of January 2016. The proof of concept study included 148,699 infants. In a multivariable logistic regression analysis, Tdap vaccination during pregnancy was not associated with infant fever 0-3daysafter first dose of DTaP (adjusted odds ratio=0.92, 95% CI 0.82-1.04).
CONCLUSION
The KPNC pregnancy database can be used for studies investigating exposure during pregnancy and outcomes in mothers and/or infants, particularly monitoring vaccine safety and effectiveness.
Topics: Adult; California; Cohort Studies; Databases, Factual; Diphtheria; Diphtheria-Tetanus-acellular Pertussis Vaccines; Female; Humans; Infant; Infant, Newborn; Insurance, Health; Logistic Models; Pertussis Vaccine; Postpartum Period; Pregnancy; Pregnant Women; Proof of Concept Study; Retrospective Studies; Tetanus; Vaccination; Vaccines; Whooping Cough; Young Adult
PubMed: 27727029
DOI: 10.1016/j.vaccine.2016.10.006