Patients' understanding of warfarin treatment was poor, despite their high level of compliance.

We explore the use of deep convolutional neural networks (CNNs) trained on overhead imagery of biomass sorghum to ascertain the relationship between single nucleotide polymorphisms (SNPs), or groups of related SNPs, and the phenotypes they control. We consider both CNNs trained explicitly on the classification task of predicting whether an image shows a plant with a reference or alternate version of various SNPs as well as CNNs trained to create data-driven features based on learning features so that images from the same plot are more similar than images from different plots, and then using the features this network learns for genetic marker classification. We characterize how efficient both approaches are at predicting the presence or absence of a genetic markers, and visualize what parts of the images are most important for those predictions. We find that the data-driven approaches give somewhat higher prediction performance, but have visualizations that are harder to interpret; and we give suggestions of potential future machine learning research and discuss the possibilities of using this approach to uncover unknown genotype × phenotype relationships.

Inadequately and/or untreated sewage, activated sewage from the waste water treatment plants are main anthropogenic sources of Antibiotic Resistance Bacteria (ARB) encompassing ARG. Concomitant residual (sub‐therapeutic dose) of antibiotics and/or its metabolic intermediates impart a selection pressure on the ARB amending the ARGs with which modified ARB promulgate indeterminately. Implementation of following preventive measure would diminish the potential of bio sludge induced ARP: i. determine and advocate the cost effective and environmentally friendly site/location specific bioremediation method in a global context, while sustaining the processed water/clean water with 0.3 NTU/ FNU, ii. “the sludge from these hotspots should be incinerated instead of being disposal in the regular landfill”, iii. complete review of Clean Water Act, addressing the ARB with ARGs in the environment and amendment of EPA's NPDES, iv. Mandatory testing of the pre‐sewage, treated water/clean water, bio‐sludge/ bio‐solids for the levels of Lactam, sulfonamide, and tetracycline antibiotics, biocides, ARB (CFU's) and corresponding ARGs that are most frequently detected in the wastewater, v. longer hydraulic residence times in the sewage treatment process, vi. intensive research and development effort to determinant the role of bio sludge acts as metal chelate (chelater) in combination with or without fertilizer to reduce the metal toxicity to the plant, vii. determination of chlorine (gas) resistant mutant ARB across the globe in all of the sewage treatment plant & clean water, obtain the ARGs profile data and make it available online for access by academia, viii. annual report on the detection of antibiotics in the influents and effluents from WWTPs; ix. determination antibiotics, its metabolic intermediates concentration in the activated sludge and implementation of relevant antibiotic removable pathways (adsorption, biodegradation, disinfection, membrane separation, hydrolysis, photolysis and volatilization), x. determination of OTU (operational taxonomic unit) of major ARGs, sub types, in the activated sludge, comparative analysis of bacterial count at every stage of the WWTP, xi. identification of “Hot Spots”, xii. universal ban on biological waste water treatment for pharmaceutical waste water, universal adaptation of the membrane ultrafiltration technology as a pretreatment method, xiii. universal practice of incinerating the activated sludge from the “Hot Spots”, xiv. routine update of the database and annotation pipeline for the efficient analysis of the data sets available across the globe for timely data processing, xv. global report on functional screening based on the phenotype environmental sampling of the activated sludge application site and the waste water system for novel ARG, its host and associated mobile genetic elements, xvi. report on the heavy metal contamination on the activated sludge from the “Hot Spots” (environment impacted by the anthropogenic activities).Support or Funding InformationSupported by the professional development funds provided by the SWTJC to Subburaj KannanThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

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Antibiotic prophylaxis (AP) for an inpatient surgical care unit (SCU) and also intensive care unit (ICU) remains a controversial treatment option. Though in a many instances AP is considered as an invaluable measure to minimize the mortality rate, in other instances AP has been shown to exacerbate the Antibiotic Resistance Pathogen (ARP) induced mortality rate in both SCU and ICU. A rationale is presented to purge the practice of AP in STBI/TBI admitted in ICU to Rout AR Induced Mortality. In a case report where the role of “Colonization Pressure” (CP) (i.e., the proportion of other patients colonized with ARP) analysis indicate, that in an ICU the average expected median time until the acquisition of Vancomycin‐Resistant Enterococci (VRE) ‐ is approximately 19 days when both antibiotic pressure and CP are 25% but 6 days when CP is 75% and antibiotic pressure is 25%. In an another case report, 250 trauma patients in a Surgical Intensive Care Unit (SICU) requiring an one or more surgical modality requiring a stay of 3 days or more received AP by 1 antibiotic (Cefoxitin sodium or ampicillin sodium/sulbactam sodium) for 24 hours (SHORT group or 1 or more antibiotics ( a combination of piperacillin sodium sterile and tazobactam sodium, or the combination of ampicillin, gentamicin sulfate, and metronidazole) prophylaxis administered longer than 24 hours with multiple antibiotics fail to improve morbidity. In a case report focused on patients admitted to the trauma intensive care unit (TICU) from January, 2001 through December, 2004 with blunt, non‐operative traumatic brain injury who is managed solely with an intracranial pressure (ICP) monitor, among those receiving no antibiotics prior to or during ICP monitoring ; and those already receiving antibiotics at the time of ICP monitor insertion were, n = 84. This study concluded that AP does not reduce the CNS infection rate and is associated with more MDR pathogens in any subsequent infectious complications. In a study aimed to determine the role of nosocomial transmission in both deployed hospitals and receiving military medical centers (MEDCENs) eighteen thousand five hundred sixty of 21,272 patients (2005 to 2009) were screened for Multidrug‐resistant organism (MDRO) colonization. Although colonization with Acinetobacter (ACB) declined during the following 5 years, an increase ARP including extended spectrum β‐lactamase (ESBL) ‐producing Enterobacteriaceae were shown to be increasing. However, the risk of ARP selection caused by the antibiotic administration for 48 hours or more, outweighed potential benefits. A study aimed to determine the impact of prolonged use of CNS device for dispensing AP as a factor in inducing the ARP and Clostridium difficile where, patient receiving AP, n = 116, and control group patients had mean APACHE II scores of 17.7 ± 9.2 and 15.1 ± 10.6 with 53.4 and 24.6 % receiving craniotomies. A higher incidence of ARP in patients receiving prolonged AP with a CNS device, but incidence of C. difficile were not significant compared to controls. Taken together, in the absence of Glasgow Coma Scale (GCS) rating upon admission of STBI/TBI patients in ICU, performing culture and sensitivity assay in CSF, implementing prudent antibiotic stewardship and implementing Antibiotic Time Out (ATO) followed by induction of “Trans” state possibly to make suggestions enabling a psychological propensity to sojourn the infectious state would limit the AR induced mortality.Support or Funding InformationSupported by Professional Development funds of SWTJC to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Based on an appraisal of the criteria required for deriving the SAPS‐II scores reinforced by statistical significance, a rationale is presented to include factors determining AR, thus enable the clinical decision making to withdraw life support in TBI subsequent to coma (Glasgow Coma Scale (GCS) ranging from a Severe: GCS 3–8; Moderate: GCS 9–12; Mild: GCS 13–15). The SAPS‐II is a severity score and mortality estimation tool developed from a large sample of medical and surgical patients in North America and Europe. The SAPS II includes 17 variables of which 12 physiological variables, age, types of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Within the first 24 hours of admission to Intensive Care Unit (ICU), following factors which determine AR, are suggested to be included: a. performing a culture and sensitivity lab test on the patient's Cerebrospinal fluid (CSF), b. generating an Antibiograms (Antimicrobial Susceptibilities of Selected Pathogens), c. implementation of antibiotics timeout (ATO), and also d. performing antibiotic prophylaxis in case of surgical intervention in TBI is essential for an acceptable neurological outcome. In the event of using the External ventricular device (EVD) for monitoring intracranial pressure (ICP), it is pivotal to monitor the infection of central nervous system (CNS). Acinetobacter baumannii is a known risk factor as a nosocomial infectious agent and associated with high mortality ranging from 15% to 71%. (J Neurosci Rural Pract 2016;7:450–2). Data shows that continuation of antibiotic therapy in TBI with scheduled surgical, or unscheduled surgical cases, are determined based on the detection of AR pathogens causing sepsis. If the patient had antibiotic resistance pathogen including (Colistin resistance) septicemia (Sepsis (Blood Infection) and Septic Shock (J. Neurotrauma 2007;24 Suppl 1: S45–54; Lancet Infect Dis 2009;9:245–55; Infection 2014;42:801–9) a poor neurological outcome is likely. Colistimethate sodium (CMS) as primary or salvage therapy for multi‐drug resistant (MDR) Gram‐negative organisms are known to cause nephrotoxicity, and neurotoxicity in critically ill patients (Ann Intensive Care. 2011; 1:14). Detection of Colistin resistant pathogens in a TBI patient is a reflection of impending septicemia, nephrotoxicity and/or renal failure (associated with poor neurological outcome. Though renal failure depends on the total cumulative dose and duration of Colistin therapy, the severity of TBI, factors such as AR, age, are at a higher risk for nephrotoxicity, possibly a higher rate of mortality. In essence, it is suggested that inclusion of factors causing AR, and SAPS‐II scores ranging from 77 to >80 points would be a determining factor in the clinical decision to withdraw life support in TBI patients in ICU by forestalling an irreversible coma. In the event of the patient (TBI) with Moderate: GCS 9–12; to Mild: GCS 13–15, measures to mitigate AR would plausibly increase acceptable neurological outcome with a possibility of recovery (Lancet.1974 Jul 13; 2(7872):81–4); J Trauma Acute Care Surg. 2015 Oct; 79(4 Suppl 2): S197–203Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj Kannan.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.