In the setting of an increasing incidence of endocarditis in the United States, we report a patient with necrotizing crescentic glomerulonephritis (GN) associated with native valve bacterial endocarditis due to Streptococcus parasanguinis. He was started on appropriate antibiotic treatment and subsequent blood cultures showed no growth. However, due to continuing decline in kidney function, immunosuppressive therapy was started. Despite immunosuppressive therapy and antibiotics, renal function did not improve and chronic hemodialysis was required. Due to rarity of condition, there are no definite treatment guidelines available. Antibiotics, steroids, immunosuppressive agents can be of help in most cases. Further research in this regard may help with early diagnosis and better treatment modalities.

The bandwidth and speed of network connections are continually increasing. The speed increase in network technology is set to soon outpace the speed increase in CMOS technology. This asymmetrical growth is beginning to causing software applications that once worked with then current levels of network traffic to flounder under the new high data rates. Processes that were once executed in software now have to be executed, partially if not wholly in hardware. One such application that could benefit from hardware implementation is high layer routing. By allowing a network device to peer into higher layers of the OSI model, the device can scan for viruses, provide higher quality-of-service (QoS), and efficiently route packets. This thesis proposes an architecture for a device that will utilize hardware-level string matching to distribute incoming requests for a server farm. The proposed architecture is implemented in VHDL, synthesized, and laid out on an Altera FPGA.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24291号 / 社医博第127号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 髙橋 良輔, 教授 阪上 優 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

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Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in an emergency department, and had cared for at least one patient at the EOL. Responses were individually reviewed and coded by the research team.Results: Major obstacles relating to ED design identified by emergency nurses included (1) many issues related to limited space, (2) poor department layout and design features, and (3) the lack of privacy. Despite EDs being a challenging place to provide EOL care, positive ED design characteristics impacted EOL care for dying patients and families.Discussion: Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed due to the immediate need for a second trauma patient and family. Nurses can evaluate existing facilities and identify areas where potential change and remodeling would improve patient care, increase patient privacy, or further utilize space. Conclusion: Understanding ED designs impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new EDs or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.

Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in an emergency department, and had cared for at least one patient at the EOL. Responses were individually reviewed and coded by the research team.Results: Major obstacles relating to ED design identified by emergency nurses included (1) many issues related to limited space, (2) poor department layout and design features, and (3) the lack of privacy. Despite EDs being a challenging place to provide EOL care, positive ED design characteristics impacted EOL care for dying patients and families.Discussion: Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed due to the immediate need for a second trauma patient and family. Nurses can evaluate existing facilities and identify areas where potential change and remodeling would improve patient care, increase patient privacy, or further utilize space. Conclusion: Understanding ED designs impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new EDs or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.

No description available.

A city walkable is about re-imagining spatial justice through access and public space in North End, East London, South Africa. The research questioned the state of East London's public space, its inner-city decay, and its vehicular dependency. East London lacks good quality public space that is walkable and accessible. A city walkable has streets that are comfortable, safe, interesting and offer choice. The urban environment must foster walkability. Before Apartheid, North End was a mixed-race community that was spatially integrated with the city because of its proximity to the CBD and its urban fabric. North Enders never needed to own a vehicle to access amenities. People could access their everyday amenities on foot and felt safe walking day or night. North End was a walkable, mixed-use neighbourhood. However, due to the Group Areas Act of 1950, people were forcibly removed from the city and relocated to what is now known as townships. Due to this removal people are forced to rely on public transport or private vehicle for mobility. Townships are not mixed-use, and streets do not foster walkability. By removing people from the city, Apartheid removed walkability. The fundamentals of living in a city are access to the convenience of amenities and work. Denying access to the city is a spatial injustice. This denial has resulted in a lack of walkable streets, unsafe public spaces, and car dependency. Since the forced removals of 1950' North End has been rezoned as a light industrial area. The research aimed to unlock the potential for walkability in East London. North End is re-imagined not only a walkable neighbourhood, but as a neighbourhood that is integrated with both township areas and the CBD. The links used to create linkages are a series of urban mixed-use corridors. Thus, creating a city that is spatially just. This makes North End a strategic place in the city which has the potential to become East London's 'knuckle'. Through various interventions, spatial strategies, and framework a more just, walkable city is envisioned.

Speech recognition is the task where a machine processes human speech into a written format. Groundbreaking scientific progress within speech recognition has been fueled by recent advancements in deep learning research, improving both key metrics of the task; accuracy and speed. Traditional speech recognition systems listen to, and analyse, the full speech utterance before making an output prediction. Streaming speech recognition on the other hand makes predictions in real- time, word by word, as speech is received. However, the improved speed of streaming speech recognition comes at a cost of reduced accuracy given the constraint of not having access to the full speech utterance at all time. In this thesis, we investigate the accuracy of streaming speech recognition systems by implementing models with state-of-the-art Transformer-based architectures. Our results show that for two similar models, one streaming, the other non-streaming, trained on a 100hr subset of Libirspeech, achieve a word error rate of 9.99%/10.76% on test- clean without using a language model. This puts the cost of streaming at a 7.2% accuracy degradation. Furthermore, the streaming models can be used “on-device” which has many benefits, including lower inference time, privacy preservation, and the ability to operate without an internet connection. / Taligenkänning är uppgiften där en dator bearbetar mänskligt tal till ett skrivet format. Forskning inom taligenkänning har drivits av de senaste framstegen inom forskning i djupinlärning, vilket har lett till att de två viktigaste mätvärdena, träffsäkerhet och hastighet, har förbättrats. Traditionella taligenkänningssystem lyssnar till och analyserar hela talsekvensen innan en prediktion görs. Strömmande taligenkänning å andra sidan gör realtids prediktioner, ord för ord, när tal tas emot. Den ökade hastigheten som strömmande taligenkänning medför kommer på bekostnad av träffsäkerhet då tillgången till hela talsekvensen inte alltid är tillgänglig. I den här avhandlingen undersöker vi träffsäkerhet av strömmande taligenkänningssystem genom att implementera ”Transformer”- baserade arkitekturer. Våra resultat visar att för två liknande modeller, en strömmande, och en icke- strömmande, tränade på 100 timmar av datasetet Librispeech, når en ordfelfrekvens på 9.99%/10.76% på ”test-clean”. Det gör att strömmande taligenkänning kommer på en bekostnad av 7.2% träffsäkerhet jämfört med icke- strömmande. De strömmande taligenkänningsmodellerna kan användas ”on-device” vilket främjar lägre slutledningstider, sekretessbevarande och förmågan att fungera utan internetanslutning.

No description available.