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A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis
A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.
Journal Article
Cystic fibrosis learning network telehealth innovation lab during the COVID-19 pandemic: a success QI story for interdisciplinary care and agenda setting
IntroductionThe Cystic Fibrosis Foundation chronic care guidelines recommend monitoring clinical status of a patient with cystic fibrosis (CF) through quarterly interdisciplinary visits. At the beginning of the COVID-19 pandemic, the Cystic Fibrosis Learning Network (CFLN) designed and initiated a telehealth (TH) innovation lab (TH ILab) to support transition from the classic CF care model of quarterly in-person office visits to a care model that included TH.AimThe specific aims of the TH ILab were to increase the percentage of virtual visits with interdisciplinary care (IDC) from 60% to 85% and increase the percentage of virtual visits in which patients and families participated in shared agenda setting (AS) from 52% to 85% by 31 December 2020.MethodsThe model for improvement methodology was used to determine the ILab aims, theory, interventions and measures. In the testing phase of the ILab, data related to process and outcome measures as well as learnings from plan–do–study–act cycles were collected, analysed and shared weekly with the TH ILab teams. Participating centres created processes for IDC and AS for TH visits and developed and shared quality improvement tools specific to their local context with other centres during the ILab weekly meetings and via a secure CFLN-maintained platform.ResultsBoth specific aims were achieved ahead of the expected target date. By August 2020, 85% of the TH ILab visits provided IDC and 92% of patients were seen for CF care by teams from the TH ILab that participated in AS.ConclusionShared learning through a collaborative, data-driven process in the CFLN TH ILab rapidly led to standardised TH IDC and AS, which achieved reliable and sustainable processes which could be reproduced by other networks.
Journal Article
Bridging Digital Transformation Gaps in Southeast Asia
This thesis explores the Digital Transformation Gaps in Southeast Asia, specifically focusing on the challenges faced by companies in the region when adopting Western-based business systems such as Enterprise Resource Planning (ERP) and Customer Relationship Management (CRM) systems. While these systems are technically equipped to meet the business requirements in Southeast Asia, there is a notable disconnect in their practical application due to distinct regional differences. These disparities include variations in business culture, workforce competency, geographical constraints, economies of scale, as well as distinct best practices and processes, and workforce power dynamics.The research methodologically examines case studies and interviews of Southeast Asian companies and their experiences with Western systems, highlighting the nuances that lead to inefficiencies and operational challenges. The study delves into the cultural and structural aspects of Southeast Asian business environments, contrasting them with Western models. It argues that the one-size-fits-all 4approach of Western business systems fails to accommodate these unique regional characteristics, leading to a digital transformation gap.This thesis proposes a framework for adapting Western business systems to better align with Southeast Asian contexts. It emphasizes the importance of localizing these systems to bridge the digital transformation gap, ensuring that they are not only technically sound but also culturally and operationally relevant. The conclusion offers strategic recommendations for companies and system developers, aimed at fostering more effective and sustainable digital transformations in Southeast Asia. This work contributes to the broader understanding of global digitalization, emphasizing the need for regional customization in global business solutions.
Dissertation
An Examination of the Selective Tissue Tension Scheme, With Evidence for the Concept of a Capsular Pattern of the Knee
The purpose of this study was to examine whether there is evidence to support 2 elements of the passive-range-of-motion (PROM) portion of Cyriax's selective tissue tension scheme for patients with knee dysfunction: a capsular pattern of motion restriction and the pain-resistance sequence.
One hundred fifty-two subjects with unilateral knee dysfunction participated. The subjects had a mean age of 40.0 years (SD=15.9, range=13-82).
Passive range of motion of the knee and the relationship between the onset of pain and resistance to PROM (pain-resistance sequence) were measured, and 4 tests for inflammation were used. Interrater reliability was assessed on 35 subjects.
Kappa values for the individual inflammatory tests ranged from .21 to .66 for categorization of the joint as inflamed, based on at least 2 positive inflammatory tests (kappa=.76). Reliability of PROM measurements was indicated by intraclass correlation coefficients of .72 to .97. Reliability of measurements of the pain-resistance sequence was indicated by a weighted kappa of .28. A capsular pattern, defined as a ratio of loss of extension to loss of flexion during PROM of between 0.03 and 0.50, was more likely than a noncapsular pattern in patients with an inflamed knee or osteoarthrosis (likelihood ratio=3.2). An association was found between a capsular pattern and arthrosis or arthritis.
These findings provide evidence to support the concept of a capsular pattern of motion restriction in persons with inflamed knees or evidence of osteoarthrosis.
Journal Article
FAST AS WILDFIRE
OLATHE, KANSAS Under Immediate Response Authority, three CH-47 Chinook helicopters with crews and support personnel comprised of over 23 Soldiers, military technicians and Department of the Army civilians from the 11th Expeditionary Combat Aviation Brigade, assisted federal, state and local authorities combating wildfires that impacted more than 15 counties from March 8 through March 10, 2017. Because two thirds of the Olathe-based Bravo Company, 7th Battalion! ARAC BY THE NUMBERS Under the guidelines outlined in DoD Directive 3025.18, Immediate Response Authority authorizes local Army Reserve commanders at the request of a local civil authority to take action to save lives, prevent human suffering or mitigate great property damage in a situation of urgency for up to 72-hours when there is insufficient time to gain approval from higher headquarters.
Trade Publication Article
Disaggregate forecasting models: Application to Ameren UE's transformer usage
The importance of accurate forecasts to proper inventory management is a well known and abundantly addressed issue in industry. Maintaining appropriate inventory levels is essential when attempting to maximize potential revenue and customer satisfaction. Within the utilities industry the significance of customer satisfaction is of utmost importance and the ability to predict when and where certain materials will be needed is highly valued. This research was motivated by these requirements and was focused on creating a customized forecasting model which could address the specific needs and demand patterns experienced by Ameren. Amongst the various materials used during energy delivery, transformers were selected due to their importance and increased lead times from suppliers. The historical transformer usage was attributed to three primary causes: new construction, storm and emergency, and general maintenance. Each of these displayed a distinctive demand pattern, thus a specific forecast was made for each disaggregate segment. Creating an individual forecasting model for each type of demand provided the ability to address the uniqueness within each demand pattern. More specifically, this approach allowed for the input of a forward-looking trend, generated from external factors, during the new construction forecast, the use of a model which followed historical trends within the general maintenance data, and a long-term averaging model which limited outliers found in the storm and emergency demand pattern. These disaggregate forecasts were then added together to create a final aggregate level forecast for the item or group of items being investigated. This model showed up to a 20% improvement of accuracy over more traditional methods when compared using median absolute percent error.
Dissertation
Effects of perception range on mobile robot path efficiency
Path efficiency is the length of the path actually traversed versus the length of the optimal path. If a robot has complete knowledge of the terrain between it and its goal and unlimited time, then it is possible to plan an optimal path to that goal. Complete knowledge is not available because robot sensors have limited range. Knowledge is also limited by features in the terrain that are shadowed by other portions of terrain. This research uses data from both simulations and actual field trials to determine the effects of sensor range on rover path efficiency. Results from both simulation and field trials with the SR2 rover indicate that in terrain typical for planetary rovers (i.e., terrain without foliage and with broken features) sensor range has a surprisingly low impact on path efficiency.
Dissertation