Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p ¼ 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p ¼ 0.004), but not 30-d mortality (p ¼ 0.344). Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.
This paper presents an innovative approach towards the development of a green concrete. The geopolymer is an environmentally friendly construction/repairing material. In addition, glass fibers are helpful to influence the strength properties and to reduce hair line cracks and bleeding in concrete. This study is based on the use of fly ash and glass fibers as a partial replacement of cement and, subsequently, its effect on compressive strength and split tensile strength of concrete. The geopolymer is manufactured after the process of geopolymerization between class F fly ash and alkali activator fluid (sodium silicate and sodium hydroxide). In geopolymer concretes (GPC), an inorganic polymer called aluminosilicate will act as a binder, the same as conventional concrete has Portland cement (OPC)-generated C-S-H gel. The glass fibers are added in the ratios of 3%, 6%, and 10% by weight of cement. To check the effect of geopolymer and glass fibers on compressive strength and split tensile strength of concrete, concrete cubes of size 150 × 150 × 150 mm and concrete cylinders of size 150 × 300 mm with or without geopolymer and glass fibers were casted and cured for 7, 14, 21, and 28 days. The compressive strength and split tensile strength of all concrete cubes and cylinders were determined by compression testing machine. The findings of the research study revealed that concrete having geopolymer and glass fibers used as a partial replacement of cement showed lesser strength as compared to conventional concrete. Concrete having glass fibers showed reduced workability and more segregation as compared to geopolymer concrete and normal concrete. However, the concrete made either with geopolymer or glass fibers is economical as compared to conventional concrete.
Plastic wastes are a major hazard for the environment and their use in the construction industry is increasing day by day. The major drawback of the use of plastic in concrete is an exceptional reduction in strength and workability. This research work explores the effect of sand coating on two types of recycled plastic aggregates, high-density polyethylene (HDPE) and electronic-wastes (E-wastes), as partial replacement of natural aggregates. The replacement ranged from 0% to 30% along with the use of super plasticizer SP-675 and wet lock sealant. Both recycled plastic aggregates are crushed, melted, and ground to convert them into aggregates of 20 mm size. The workability of concrete containing uncoated recycled plastic aggregates (HDPE and electronic wastes), SP-675, and wet lock sealant has been found to be higher than controlled concrete samples with 0% recycled aggregates. Compressive strength, split tensile strength, and flexural strength of such type of concrete is lower than the controlled concrete samples due to the weak bond between the plastic aggregates and Ordinary Portland Cement. After applying the sand coating to improve bonding, the workability is reduced compared to uncoated samples whereas the compressive strength, split tensile strength and flexural strength of the sand coated plastic aggregate concrete is higher than uncoated plastic aggregate concrete. There is a significant increase in workability of concrete after the addition of SP-675 when added as 2% by weight of cement. The wet lock sealant positively affects the strength properties of concrete. It is recommended that the durability of concrete containing uncoated and sand coated recycled plastic aggregates be further explored in future studies.
The learning methods with multiple levels of representation is called deep learning methods. The composition of simple but now linear modules results in deep-learning model. Deep-learning in near future will have many more success, because it requires very little engineering in hands and it can easily take ample amount of data for computation. In this paper the deep learning network is used to recognize speech emotions. The deep Autoencoder is constructed to learn the speech emotions (Angry, Happy, Neutral, and Sad) of Normal and Autistic Children. Experimental results evident that the categorical classification accuracy of speech is 46.5% and 33.3% for Normal and Autistic children speech respectively. Whereas, Auto encoder shows a very low classification accuracy of 26.1% for only happy emotion and no classification accuracy for Angry, Neutral and Sad emotions.
Background: We describe single center experience of using ABVD/COPDac . This regimen was adapted due to perceived excessive toxicity with OEPA/COPDac by treating physicians. Hodgkin lymphoma is being treated with multiple treatment regimens single agent or in combination. MOPP (mechlorethamine, vincristine, procarbazine and prednisolone) has been standard treatment for almost two decads. But it had significant toxic effects including infertility in both genders, myelosuppression and second malignancies . ChlvPP( chlorambucil, vincristine, procarbazine and prednisolone ) has comparable efficacy and toxicities to MOPP . ABVD( Adriamycin, bleomycin, vincristine and doxorubicin ) was mostly used as second line with high activity without permanent male sterility, myelodysplasia or risk of leukemia. Objective : We describe single center experience of using ABVD/COPDac . This regimen was adapted due to perceived excessive toxicity with OEPA/COPDac by treating physicians. Results 62 patients out of 301( 20.6%) with age range of 2-18 years were treated with COPDac/ABVD alternating courses depending on the treatment group from 2012 to date. Out of this 62, 49 (79%) are on follow up and are free from disease relapse or recurrence. Mean duration of follow up is 12 months with a range of 8-16 months. No patient lost to follow up. No death reported due to any cause during or after completion of treatment till last follow up. 9 out of 62 has had progression of disease while on this treatment protocol (15%) and 4 out of 62(6%) has had relapse after completion of the therapy. Conclusion In our single center experience of ABVD/COPDac as first line therapy seems effective and safe when compared with historical published literature. Disclosures No relevant conflicts of interest to declare.
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