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Incipient fault detection of rolling bearings is a challenging task since the weak fault features are disturbed by heavy background noise. This paper develops a periodicity-enhanced sparse representation method to address this issue. Firstly, periodicity-enhanced basis pursuit denoising (PBPD) is proposed by the theoretical derivation. Fault proportion is defined to quantify the single fault severity of sparse signals, then a periodicity-decision criterion for determining the optimal potential fault period is designed to periodically filter the last sparse signal. Secondly, the suitable linear transformation for PBPD is investigated in comparison and maximal overlapping discrete wavelet packet transform is adopted eventually. Thirdly, adaptive selection strategies are developed for the key parameters of PBPD. Simulations and experimental verifications demonstrate PBPD's excellent performance in rolling bearing incipient fault detection.

Optimal postoperative opioid stewardship combines adequate pain medication to control expected discomfort while avoiding abuse and community diversion of unused prescribed opioids. We hypothesized that an opioid buyback program would motivate patients to return unused opioids, and surgeons will use that data to calibrate prescribing.

Prospective cohort study of postambulatory surgery pain management at a level II Veterans Affairs rural hospital (2017-2019). Eligible patients were offered $5/unused opioid pill ($50 limit) returned to our Veterans Affairs hospital for proper disposal. After 6 months, buyback data was shared with each surgical specialty.

Overall, 934 of 1,880 (49.7%) eligible ambulatory surgery patients were prescribed opioids and invited to participate in the opioid buyback. see more We had 281 patients (30%) return 3,165 unused opioid pills; this return rate remained constant over the study period. In 2017, 62.4% of patients were prescribed an opioid; after data was shared with providers, prescriy surgery without an increase in refills.

Hemorrhage remains a leading cause of death among trauma patients. Resuscitative endovascular balloon occlusion of the aorta has grown in popularity as an efficient, less invasive alternative to managing patients with noncompressible hemorrhage. The aim of this study to investigate the clinical outcomes of resuscitative endovascular balloon occlusion of the aorta use in adult civilian trauma patients with and without concomitant traumatic brain injury.

This a secondary analysis of the American College of Surgeons Trauma Quality Improvement Program database from the years 2015 to 2017 of adult trauma patients with and without traumatic brain injury and who had a resuscitative endovascular balloon occlusion of the aorta. Patients who were deceased on arrival, required resuscitative thoracotomy, or had missing information regarding traumatic brain injury status were excluded. Multivariable risk adjustment was performed. The primary outcome was inpatient mortality.

Of 2,352,542 patients, 199 met the criterir injury severity and more severe hypotension on intake.

Inpatient mortality with resuscitative endovascular balloon occlusion of the aorta use does not differ between patients with or without concomitant traumatic brain injury, despite those with traumatic brain injury having significantly higher injury severity and more severe hypotension on intake.

Previous work showed that normal and abnormal parathyroid glands exhibit different patterns of autofluorescence, with the former appearing brighter and more homogenous. However, an objective algorithm based on quantified measurements was not provided. The aim of this study is to develop objective algorithms for intraoperative autofluorescence assessment of parathyroid glands in primary hyperparathyroidism using artificial intelligence.

The utility of near-infrared fluorescence imaging in parathyroidectomy procedures was evaluated in a study approved by the institutional review board. Autofluorescence patterns of parathyroid glands were measured intraoperatively. Comparisons were performed between normal and abnormal glands, as well as between different pathologies. Using machine learning, decision trees were created.

Normal parathyroid glands were brighter (higher normalized autofluorescence pixel intensity) and more homogenous (lower heterogeneity index) compared to abnormal glands. Optimal cutoffs to intraoperatively assess parathyroid glands in primary hyperparathyroidism. These results suggest that objective data can be obtained from autofluorescence signals to help differentiate abnormal parathyroid glands from normal glands.

Inhaled methoxyflurane for acute pain relief has demonstrated an analgesic effect superior to placebo. Data comparing methoxyflurane to an opioid are needed. The aim of this study was to determine the equi-analgesic doses of inhaled methoxyflurane vs i.v. fentanyl. Both drugs have an onset within minutes and an analgesic effect of 20-30min.

Twelve subjects were included in a randomised, double-blinded, placebo-controlled crossover study with four treatments placebo (NaCl 0.9%), fentanyl 25μg i.v., fentanyl 50μg i.v., or inhaled methoxyflurane 3ml. The subjects reported pain intensity using the verbal numeric rating scale (VNRS) from 0 to 10 during the cold pressor test (CPT). The CPT was performed before (CPT 1), 5min (CPT 2), and 20min (CPT 3) after drug administration.

Inhaled methoxyflurane and fentanyl 25μg reduced VNRS scores significantly compared with placebo at CPT 2 (-1.14 [estimated difference in VNRS between treatment groups with 95% confidence interval CI -1.50 to -0.78]; -1.15 [95% CI -1.51 to -0.79]; both P<0.001) and CPT 3 (-0.60 [95% CI -0.96 to -0.24]; -0.84 [95% CI -1.20 to -0.47]; both P<0.001). There were no significant differences between the two drugs. Methoxyflurane had significantly higher VNRS scores than fentanyl 50μg at CPT 2 (0.90 [95% CI 0.54-1.26]; P<0.001) and CPT 3 (0.57 [95% CI 0.21-0.94]; P<0.001).

Inhaled methoxyflurane 3ml was equi-analgesic to fentanyl 25μg i.v. at CPT 2. Both resulted in significantly less pain than placebo. Fentanyl 50μg i.v. demonstrated analgesia superior to methoxyflurane.

NCT03894800.

NCT03894800.