Halo Congenital Nevocellular Nevi Associated with Extralesional Vitiligo: A Case Series with Review of the Literature

Abstract:   Halo formation in association with congenital nevi is uncommon and is postulated to have an immunologic etiology. In this report, we present nine cases of patients with congenital nevi and vitiligo who uniquely developed both halo formation around the nevi in addition to vitiligo formation in distinctly separate locations. While the precise etiology of halo formation and vitiligo remains uncertain, several theories suggest that both phenomena result from an immunologic response to pigment cells, whether in the "normal" skin of vitiligo or in the excessively pigmented congenital nevus.     

THE SURFACE COMPOSITION OF THE TUBERCLE BACILLUS AND OTHER ACID-FAST BACTERIA

Acid-fast bacteria in the boundary surface between salt solution and a test oil (tricaprylin) are spontaneously wet and enveloped by the oil. This behavior contrasts with that of all other cells studied by the interfacial tension method. Four strains of human tubercle bacillus and an atypical bovine strain are an exception to the first statement above. These have possessed stability in the saline-oil interface; this stability is slight, however, and not comparable with that of non-acid-fast bacteria. Acid-fast bacteria subjected to prolonged extraction with alcohol show resistance to wetting by oil comparable to that of non-acid-fast bacteria. These "defatted" bacteria nevertheless retain their acid-fast staining properties. Acid fastness cannot then depend on the integrity of a surface membrane. Study of the cataphoresis of acid-fast bacteria by Freund has rendered the presence of protein in the surface highly probable. We are forced then to regard the surface of acid-fast bacteria as complex, containing at least lipoid and protein. Not improbably also carbohydrate is present.     

Pulse Oximetry as a Fifth Vital Sign in Emergency Geriatric Assessment

Abstract. Objective: To determine the utility of pulse oximetry as a routine fifth vital sign in emergency geriatric assessment.
Methods: Prospective study using pulse oximetry to measure O₂ saturation in geriatric patients presenting to ED triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to release or admit each patient. The authors measured changes in medical management and diagnoses initiated after the disclosure of pulse oximetry values. The study included 1,963 consecutive adults aged ≤ 65 years presenting to triage at a university ED. Measurements included changes in select diagnostic tests: chest radiography, complete blood count (CBC), spirometry, arterial blood gases (ABGs), pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, β-agonists, and supplemental O₂; and hospital admission and final diagnoses that occurred after complete ED evaluation when physicians were informed of triage pulse oximetry values.
Results: 397 (20.2%) geriatric patients had triage pulse oximetry values <95%. Physicians ordered repeat oximetry for 51 patients, additional chest radiography for 23, CBC for 16, ABGs for 15, spirometry for 5, and ventilation-perfusion scans for none. Physicians ordered 49 new therapies for 44 patients, including antibiotics for 14, supplemental O₂ for 29, and 3-agonists for 6. Nine patients initially scheduled for ED release were subsequently admitted to the hospital. Physicians changed or added diagnoses for 27 patients.
Conclusions: Using pulse oximetry as a routine fifth vital sign resulted in important changes in the diagnoses and treatments of a small proportion of emergency geriatric patients.     

Iterative processes: a review of semi-supervised machine learning in rehabilitation science

Abstract

Purpose: To define semi-supervised machine learning (SSML) and explore current and potential applications of this analytic strategy in rehabilitation research.

Method: We conducted a scoping review using PubMed, GoogleScholar and Medline. Studies were included if they: (1) described a semi-supervised approach to apply machine learning algorithms during data analysis and (2) examined constructs encompassed by the International Classification of Functioning, Disability and Health (ICF). The first two authors reviewed identified articles and recorded study and participant characteristics. The ICF domain used in each study was also identified.

Results: After combining information from the eight studies, we established that SSML was a feasible approach for analysis of complex data in rehabilitation research. We also determined that semi-supervised approaches may be more accurate than supervised machine learning approaches.

Conclusions: A semi-supervised approach to machine learning has potential to enhance our understanding of complex data sets in rehabilitation science. SSML mirrors the iterative process of rehabilitation, making this approach ideal for calibrating devices, classifying activities or identifying just-in-time interventions. Rehabilitation scientists who are interested in conducting SSML should collaborate with data scientists to advance the application of this approach within our field.

• Implications for rehabilitation

• Semi-supervised machine learning applications may be a feasible approach for analyses of complex data sets in rehabilitation research.

• Semi-supervised machine learning approaches uses a combination of labelled and unlabelled data to produce accurate predictive models, thereby requiring less user-input data than other machine learning approaches (i.e., supervised, unsupervised), reducing resource cost and user-burden.

• Semi-supervised machine learning is an iterative process that, when applied to rehabilitation assessment and outcomes, could produce accurate personalized models for treatment.

• Rehabilitation researchers and data scientists should collaborate to implement semi-supervised machine learning approaches in rehabilitation research, optimizing the power of large datasets that are becoming more readily available within the field (e.g., EEG signals, sensors, smarthomes).

     

Frequency and timing of severe hypoglycemia affects spatial memory in children with type 1 diabetes

OBJECTIVE: Repeated severe hypoglycemia has been reported to reduce long-term spatial memory in children with type 1 diabetes. Early exposure to hypoglycemia may be more damaging to cognitive function than later exposure. Our goal was to determine whether the age at which severe hypoglycemia occurs modulates the impact of severe hypoglycemia frequency on long-term spatial memory. RESEARCH DESIGN AND METHODS: We combined data from three independent studies to obtain a sample of children aged 6-18 years with type 1 diabetes (n = 103) and nondiabetic control subjects (n = 60). Each study evaluated previous severe hypoglycemia and tested short (5 s)- and long (60 s)-delay spatial memory with the spatial delayed response task. Type 1 diabetic participants were categorized as having zero, one to two, or three or more severe hypoglycemic episodes and as having their first severe hypoglycemic episode before or after 5 years of age. Information on chronic hyperglycemia (HbA1c values) was also collected. RESULTS: We found that repeated severe hypoglycemia (more than three episodes) reduced long-delay spatial delayed response performance, particularly when severe hypoglycemic episodes began before the age of 5 years. Age of type 1 diabetes onset and estimates of chronic hyperglycemia did not influence performance. CONCLUSIONS: High frequency of and early exposure to severe hypoglycemia during development negatively affects spatial long-term memory performance.     

Implementation of community consultation for waiver of informed consent in emergency research: one Institutional Review Board's experience.

BACKGROUND: This article describes how one Institutional Review Board (IRB) chose to implement the issue of waiver of consent for a research study involving brain trauma victims brought to an emergency department. METHODS: Presentations were conducted in the state of Mississippi among cultural and ethnic groups representative of Mississippi's demographic composition. Individuals from the neurotrauma research team, including neurosurgeons and nurse study coordinators, conducted all of the presentations. One IRB member served as an objective "community liaison" and attended all presentations. This individual administered evaluation forms to attendees that measured their levels of comprehension and acceptance for the use of waiver of consent in the brain trauma study. RESULTS: All of the 137 attendees in 7 community consultation meetings gave their approval for the use of "waiver of consent." Continued community consultations are planned for the duration of the brain trauma study. CONCLUSION: Based on our experience, we conclude that in collaborating with local IRBs, research teams can successfully develop strategies for obtaining "acceptable community consultations" as required by regulatory mandates. We suggest that standardized community consultation guidelines be developed for obtaining waivers of informed consent in emergency research. Such criteria should form the basis for local IRBs to obtain their respective community consultations.