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  • Snider Harding posted an update 3 days, 8 hours ago

    36 h [12-60] for bowel sounds [P = 0.001], 48 h [12-108] vs. 72 h [36-156] for passage of flatus [P = 0.001], and 84 h [36-180] vs. 96 [60-156] for passage of stools [P = 0.013]). Perioperative complication rate (12 patients (44.4%) vs. 14 (51.9%), P = 0.786) was similar. Conclusions ERAS protocol leads to faster bowel recovery compared to conventional care in patients undergoing open RC but fails to demonstrate a shorter length of stay and lower complication rate.There is an increasing gulf between demand and supply for kidneys in end-stage renal failure patients worldwide, especially Asia. Renal transplantation is often the treatment of choice for long-suffering patients who have to undergo dialysis on a regular basis. The utilization of expanded criteria donors (ECDs) to address the donor pool shortage has been proven to be a legitimate solution. Metzger first described the classification of standard criteria donor and ECD in 2002. Since then, the criterion has undergone various modifications, with the key aims of optimizing organ procurement rate while minimizing discard and rejection rates. We review the methods to improve selection, characterization of risks, and surgical techniques. Although the ECD kidneys have a higher risk of impaired donor and recipient outcome than the “standard criteria” transplants, it may be justified by the improved overall survival of these patients compared to those who remained on dialysis. It is, therefore, crucial that we perform meticulous selection, along with state of the art surgical techniques to maximize the use of this scarce resource. In this article, we review the pre-procurement and post-procurement processes implemented to preserve outcomes.Penile skin (PSG) and the buccal mucosa (BMGs) are the most commonly used grafts for substitution urethroplasty. The aim of this study was to compare the success rates of substitution urethroplasty using either of these grafts. We systematically searched PubMed/Medline, EMBASE, Scopus and Web of science to identify studies comparing the two types of graft urethroplasties. Search strategy was based on Patient, Intervention, Control and Outcome guidelines. Studies reporting data on success of PSG versus BMG within the same manuscript were included. Standard Preferred reporting Items for Systematic reviews and Metaanalysis guidelines were followed while conducting this review and study protocol was registered with PROSPERO in priori (CRD42018114258). Sixteen studies, including 5 prospective and 11 retrospective studies, with a total of 1406 (896 BMG and 510 PSG) patients were included in the final analysis. check details In the overall analysis, BMG had significantly higher success rate (83.7% vs. 76.1%, P ≤ 0.0001). Duration of followup was heterogeneous across the studies, ranging from 15.9 to 201 months. Comparing the five studies where the data on duration of follow up was available, BMG showed a significantly higher success rate compared to PSG (90% vs. 80.4%; P = 0.02). In the subgroup of patients with bulbar urethral strictures, BMG urethroplasty had significantly higher success rate (87.4% vs. 78.0%; P = 0.0001). From the results of this study, buccal mucosa may appear to be a better choice, however, the data is still immature and a properly conducted randomized controlled trial with an adequate duration of followup is required.Recent success in Artificial Intelligence (AI) and Machine Learning (ML) allow problem solving automatically without any human intervention. Autonomous approaches can be very convenient. However, in certain domains, e.g., in the medical domain, it is necessary to enable a domain expert to understand, why an algorithm came up with a certain result. Consequently, the field of Explainable AI (xAI) rapidly gained interest worldwide in various domains, particularly in medicine. Explainable AI studies transparency and traceability of opaque AI/ML and there are already a huge variety of methods. For example with layer-wise relevance propagation relevant parts of inputs to, and representations in, a neural network which caused a result, can be highlighted. This is a first important step to ensure that end users, e.g., medical professionals, assume responsibility for decision making with AI/ML and of interest to professionals and regulators. Interactive ML adds the component of human expertise to AI/ML processes by enabling them to re-enact and retrace AI/ML results, e.g. let them check it for plausibility. This requires new human-AI interfaces for explainable AI. In order to build effective and efficient interactive human-AI interfaces we have to deal with the question of how to evaluate the quality of explanations given by an explainable AI system. In this paper we introduce our System Causability Scale to measure the quality of explanations. It is based on our notion of Causability (Holzinger et al. in Wiley Interdiscip Rev Data Min Knowl Discov 9(4), 2019) combined with concepts adapted from a widely-accepted usability scale.We propose a novel active fault-tolerant control strategy that combines machine learning based process monitoring and explicit/multiparametric model predictive control (mp-MPC). The strategy features (i) data-driven fault detection and diagnosis models by using the support vector machine (SVM) algorithm, (ii) ranking via a nonlinear, kernel-dependent, SVM-based feature selection algorithm, (iii) data-driven regression models for fault magnitude estimation via the random forest algorithm, and (iv) a parametric optimization and control (PAROC) framework for the design of the explicit/multiparametric model predictive controller. The resulting explicit control strategies correspond to affine functions of the system states and the magnitude of the detected fault. A semibatch process, an example for penicillin production, is presented to demonstrate how the proposed framework ensures smart operation for which rapid switches between a priori computed explicit control action strategies are enabled by continuous process monitoring information.Elder mistreatment is an important public health problem that can be prevented. By investing in upstream prevention and taking a multigenerational approach, the U.S. can help create communities where older adults are safe, thriving, and living out the remainder of their lives free from abuse and exploitation. The need to do so has never been more pressing as the U.S. is on the precipice of historic population changes that could place a substantial burden on families, communities, and systems of care and protection for older adults. This article describes these changes and how public health efforts can make a difference.

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