Investigating indoor concentrations of PM<Subscript>10</Subscript> in an underground loading dock in Malaysia

Risky air contaminants including PM₁₀ can accumulate inside underground confined loading docks because of the enclosed nature and limited contacts of loading docks with ambient air. Exposure to PM₁₀ can increase morbidity and mortality rates. Hence, this study aimed to investigate and model PM₁₀ concentrations in an underground loading dock located at Kuala Lumpur city center, Malaysia. For this purpose, a real-time air quality monitoring instrument was used for measuring PM₁₀ concentrations for 20 consecutive weeks starting from November 8, 2014. After that, the Statistical Package for Social Sciences (SPSS) software was used to analyze measured PM₁₀ concentrations through series of statistical analyses, whereas MATLAB R2013a was employed for developing prediction models of future PM₁₀ concentrations. Moreover, PM₁₀ temporal variation was examined using time series plots. The results showed that short-term PM₁₀ concentrations did not exceed the Malaysian indoor allowable limit of 150 μg/m³. Despite that, PM₁₀ had 8 % probability of exceedance of WHO standard concentration of 50 μg/m³. This indicates that the occupants will be under the risk of prolonged exposure to PM₁₀ even at low concentrations. The results confirmed a strong correlation between PM₁₀ concentrations and diesel-powered vehicles flow. Contrarily, the flow of gasoline-powered vehicles was poorly correlated. Finally, future daily-averaged PM₁₀ concentrations were predicted for the three weekdays that followed the measurement period using single exponential smoothing. The obtained accuracy was at 70 % of measured PM₁₀ concentrations. Future hourly-averaged PM₁₀ concentrations were estimated using single linear regression with an accuracy of 53 %.     

Machine Learning for Cardiovascular Biomechanics Modeling: Challenges and Beyond

Recent progress in machine learning (ML), together with advanced computational power, have provided new research opportunities in cardiovascular modeling. While classifying patient outcomes and medical image segmentation with ML have already shown significant promising results, ML for the prediction of biomechanics such as blood flow or tissue dynamics is in its infancy. This perspective article discusses some of the challenges in using ML for replacing well-established physics-based models in cardiovascular biomechanics. Specifically, we discuss the large landscape of input features in 3D patient-specific modeling as well as the high-dimensional output space of field variables that vary in space and time. We argue that the end purpose of such ML models needs to be clearly defined and the tradeoff between the loss in accuracy and the gained speedup carefully interpreted in the context of translational modeling. We also discuss several exciting venues where ML could be strategically used to augment traditional physics-based modeling in cardiovascular biomechanics. In these applications, ML is not replacing physics-based modeling, but providing opportunities to solve ill-defined problems, improve measurement data quality, enable a solution to computationally expensive problems, and interpret complex spatiotemporal data by extracting hidden patterns. In summary, we suggest a strategic integration of ML in cardiovascular biomechanics modeling where the ML model is not the end goal but rather a tool to facilitate enhanced modeling.

     

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

ABSTRACT: BACKGROUND: A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated largescale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. METHODS: Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations intervention changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. SUMMARY: New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries.     

Diabetes mellitus aggravates ranolazine-induced ECG changes in rats

Journal of Interventional Cardiac Electrophysiology - Diabetes mellitus (DM) is known to affect the pharmacokinetics of drugs. In this study, we evaluated the effect of DM on the liver content of...     

A double‐blind,randomized, controlled trial on N‐acetylcysteine for the prevention of acute kidney injury in patients undergoing allogeneic hematopoietic stem cell transplantation

Acute kidney injury (AKI) is one of the complications of hematopoietic stem cell transplantation and is associated with increased mortality. N‐acetylcysteine (NAC) is a thiol compound with antioxidant and vasodilatory properties that has been investigated for the prevention of AKI in several clinical settings. In the present study, we evaluated the effects of intravenous NAC on the prevention of AKI in allogeneic hematopoietic stem cell transplantation patients. A double‐blind randomized placebo‐controlled trial was conducted, and 80 patients were recruited to receive 100 mg/kg/day NAC or placebo as intermittent intravenous infusion from day ?6 to day +15. AKI was determined on the basis of the Risk–Injury–Failure–Loss–End‐stage renal disease and AKI Network criteria as the primary outcome. We assessed urine neutrophil gelatinase‐associated lipocalin (uNGAL) on days ?6, ?3, +3, +9 and +15 as the secondary outcome. Moreover, transplant‐related outcomes and NAC adverse reactions were evaluated during the study period. Statistical analysis was performed using appropriate parametric and non‐parametric methods including Kaplan–Meier for AKI and generalized estimating equation for uNGAL. At the end of the trial, data from 72 patients were analysed (NAC: 33 patients and placebo: 39 patients). Participants of each group were not different considering baseline characteristics. AKI was observed in 18% of NAC recipients and 15% of placebo group patients, and the occurrence pattern was not significantly different (p = 0.73). Moreover, no significant difference was observed between groups for uNGAL measures (p = 0.10). Transplant‐related outcomes were similar for both groups, and all patients had successful engraftment. Three patients did not tolerate NAC because of abdominal pain, shortness of breath and rash with pruritus and were dropped from the intervention group before transplantation. However, the frequency of adverse reactions was not significantly different between groups. In conclusion, our findings could not show any clinical benefits from high‐dose NAC particularly for AKI prevention in allogeneic hematopoietic stem cell transplantation patients. Copyright © 2014 John Wiley & Sons, Ltd.     

Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations

Background

Few studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison.

Granulocyte Colony-Stimulating Factor for Amyotrophic Lateral Sclerosis: A Randomized,Double-Blind,Placebo-Controlled Study of Iranian Patients

MethodsForty subjects with ALS were randomly assigned to two groups, which received either subcutaneous G-CSF (5 µg/kg/q12h) or placebo for 5 days. The subjects were then followed up for 3 months using the ALS Functional Rating Scale-Revised (ALSFRS-R), manual muscle testing, ALS Assessment Questionnaire-40, and nerve conduction studies. CD34+/CD133+ cell count and monocyte chemoattractant protein-1 (MCP-1) levels were evaluated at baseline.ResultsThe rate of disease progression did not differ significantly between the two groups. The reduction in ALSFRS-R scores was greater in female subjects in the G-CSF group than in their counterparts in the placebo group. There was a trend toward a positive correlation between baseline CSF MCP-1 levels and the change in ALSFRS-R scores in both groups (Spearman''s ρ=0.370, p=0.070).ConclusionsWith the protocol implemented in this study, G-CSF is not a promising option for the treatment of ALS. Furthermore, it may accelerate disease progression in females.     

Preparation of a novel injectable in situ-gelling nanoparticle with applications in controlled protein release and cancer cell entrapment

Temperature sensitive injectable hydrogels have been used as drug/protein carriers for a variety of pharmaceutical applications. Oligo(ethylene glycol) methacrylate (OEGMA) monomers with varying ethylene oxide chain lengths have been used for the synthesis of in situ forming hydrogel. In this study, a new series of thermally induced gelling hydrogel nanoparticles (PMOA hydrogel nanoparticles) was developed by copolymerization with di(ethylene glycol) methyl ether methacrylate (MEO₂MA), poly(ethylene glycol) methyl ether methacrylate (300 g mol⁻¹, OEGMA₃₀₀), and acrylic acid (AAc). The effects of acrylic acid content on the physical, chemical, and biological properties of the nanoparticle-based hydrogels were investigated. Due to its high electrostatic properties, addition of AAc increases LCST as well as gelation temperature. Further, using Cy5-labelled bovine serum albumin and erythropoietin (Epo) as model drugs, studies have shown that the thermogelling hydrogels have the ability to tune the release rate of these proteins in vitro. Finally, the ability of Epo releasing hydrogels to recruit prostate cancer cells was assessed in vivo. Overall, our results support that this new series of thermally induced gelling systems can be used as protein control releasing vehicles and cancer cell traps.

At body temperature, thermosensitive nanoparticles release erythropoietin to lure metastatic cancer cells.     

Vagus nerve stimulation in drug-resistant epilepsy: the efficacy and adverse effects in a 5-year follow-up study in Iran

Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy. Implantations were performed in the neurosurgery department of Loghman Hospital, Tehran, Iran. Follow-up visits were done on monthly bases for 5 years. Forty-four patients completed the study. Mean age of patients was 24.4 years. Mean years of epilepsy history was 14 years. The mean number of anti-epileptic drugs did not significantly change over five years (p = 0.15). There was no exacerbation of epilepsy; however, one patient discontinued his therapy due to unsatisfactory results. Five patient had more than 50 %, and 26 patients (59 %) had 25–49 % reduction in the frequency of monthly seizures persistently. Overall mean frequency of monthly seizures decreased by 57.8, 59.6, 65, 65.9, and 67 %, in 1st, 2nd, 3rd, 4th, and 5th years of follow-up, respectively. Most common side effects were as follows: hoarseness (25 %) and throat discomfort (10 %). We found VNS as a safe and effective therapy for drug-resistant epilepsy, with an approximate long-term decrease in mean seizure frequency of 57.8–67 %. Thus, VNS is recommended for suitable patients in developing countries.