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Background: Many patients in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) had a significant improvement (> 10%) in the left ventricular ejection fraction (LVEF) during the course of the study, but the factors and outcomes associated with such improvement are uncertain. Methods: We examined factors and rates of mortality, cause-specific mortality, and implantable cardioverter defibrillator (ICD) shocks associated with improvement in LVEF by analyzing patients in the SCD-HeFT who were randomized to placebo or an ICD and who had an LVEF checked during follow-up. Results: During a median follow-up of 3.99 years, of 837 patients who had at least two follow-up LVEF measurements, 276 (33%) patients had > 10% improvement in LVEF and 561 (67%) patients had no significant change in LVEF. Factors significantly associated with LVEF improvement included female sex, white race, history of hypertension, a QRS duration < 120 ms, and beta-blocker use. Improvement in LVEF was associated with a significant improvement in survival. There was no significant association between improvement in LVEF and cause-specific death, but there was a significant association between improvement in LVEF and reduced risk of receiving appropriate ICD shocks. Conclusions: About a third of patients in this analysis, who were randomized to placebo or an ICD in SCD-HeFT, had a significant improvement in LVEF during follow-up; improvement in LVEF was associated with improved survival but not with cause-specific death, and with decreased likelihood of receiving appropriate ICD shocks.

The increasing complexity of Intelligent Transportation Systems (ITS), that comprise a wide variety of applications and services, has imposed a necessity for high-performance Modern Hardware Devices (MHDs). The performance challenge has become more noticeable with the integration of Machine Learning (ML) techniques deployed in large-scale settings. ML has effectively supported the field of ITS by providing efficient and optimized solutions to problems that were otherwise tackled using traditional statistical and analytical approaches. Addressing the hardware deployment needs of ITS in the era of ML is a challenging problem that involves temporal, spatial, environmental, and economical factors. This survey reviews the recent literature of ML-driven ITS, in which MHDs were utilized, with a focus on performance indicators. A taxonomy is then synthesized, giving a complete representation of what the current capabilities of the surveyed ITS rely on in terms of ML techniques and technological infrastructure. To alleviate the difficulties faced in the non-trivial task of selecting suitable ML techniques and MHDs for an ITS with a specific complexity level, a performance evaluation framework is proposed. The presented survey sets the basis for developing suitable hardware, facilitating the integration of ML within ITS, and bridging the gap between research and real-world deployments.

Cardiac implantable electronic devices, including implantable cardioverter-defibrillators and therapy, are part of guideline-indicated treatment for a subset of patients with heart failure with reduced ejection fraction. Current technological advancements in cardiac implantable electronic devices have allowed the detection of specific physiological parameters that are used to forecast clinical decompensation through algorithmic, multiparameter remote monitoring. Other recent emerging technologies, including cardiac contractility modulation and baroreflex activation therapy, may provide symptomatic or physiological benefits in patients without indications for cardiac resynchronization. Our goal in this state-of-the-art review is to describe the new commercially available technologies, their purported mechanisms of action, and the evidence surrounding their clinical roles, limitations and future directions. Finally, we underline the need for standardized workflow and close interdisciplinary management of this population to ensure the delivery of high-quality care.

Background A computable phenotype is an algorithm used to identify a group of patients within an electronic medical record system. Developing a computable phenotype that can accurately identify patients with autosomal dominant polycystic kidney disease (ADPKD) will assist researchers in defining patients eligible to participate in clinical trials and other studies. Our objective was to assess the accuracy of a computable phenotype using International Classification of Diseases 9th and 10th revision (ICD-9/10) codes to identify patients with ADPKD. Methods We reviewed four random samples of approximately 250 patients on the basis of ICD-9/10 codes from the EHR from the Kansas University Medical Center database: patients followed in nephrology clinics who had ICD-9/10 codes for ADPKD (Neph+), patients seen in nephrology clinics without ICD codes for ADPKD (Neph−), patients who were not followed in nephrology clinics with ICD codes for ADPKD (No Neph+), and patients not seen in nephrology clinics without ICD codes for ADPKD (No Neph−). We reviewed the charts and determined ADPKD status on the basis of internationally accepted diagnostic criteria for ADPKD. Results The computable phenotype to identify patients with ADPKD who attended nephrology clinics has a sensitivity of 99% (95% confidence interval [95% CI], 96.4 to 99.7) and a specificity of 84% (95% CI, 79.5 to 88.1). For those who did not attend nephrology clinics, the sensitivity was 97% (95% CI, 93.3 to 99.0), and a specificity was 82% (95% CI, 77.4 to 86.1). Conclusion A computable phenotype using the ICD-9/10 codes can correctly identify most patients with ADPKD, and can be utilized by researchers to screen health care records for cohorts of patients with ADPKD with acceptable accuracy.

Background Patients with sudden cardiac arrest occurring in the acute phase of myocardial infarction (MI-SCA) are believed to be at similar risk of death after revascularization compared with MI patients without SCA (MI-no SCA). Among patients with anterior MI, we examined whether those with MI-SCA were at greater risk of all-cause mortality or sudden cardiac death (SCD) than MI-no SCA patients. Methods The Home Automated External Defibrillator Trial enrolled patients with anterior MI who had not received or were candidates for an implantable cardioverter defibrillator (ICD). Our cohort included patients with a reported SCA event, in the acute phase of an MI, prior to HAT trial enrollment. Cox proportional hazards models examined the adjusted association between MI-SCA versus MI-no SCA patients and all-cause mortality and sudden cardiac death (SCD). We also determined whether the relationship between prior SCA and outcomes changed with subsequent events (syncope, revascularization, and recurrent MI) during follow-up. Results Of 6849 patients, 650 (9.5%) had MI-SCA before trial enrollment. Approximately 48% of patients had the MI-SCA event ≤ 1 year prior to enrollment; 71% of SCA events were in-hospital. MI-SCA patients were younger, more frequently white, and had higher rates of prior PCI versus MI-no SCA patients. There were no differences in adjusted all-cause mortality (hazard ratio [HR 0.95; 95% CI 0.65-1.38]) or SCD (HR 1.12; 95% CI 0.68-1.83) for MI-SCA vs. MI-no SCA. After ICD implantation, MI-SCA patients experienced higher all-cause mortality risk (HR 5.01, 95% CI 1.05-23.79) versus MI-no SCA patients; there was no mortality difference between MI-SCA and MI-no SCA patients without ICD implantation (HR 0.89, 95% CI 0.60- 1.31), [interaction p=0.035]. Conclusions Patients with MI-SCA had similar adjusted risk of all-cause mortality and SCD compared with MI-no SCA. After ICD implantation, MI-SCA patients had higher mortality compared with MI-no SCA patients.

OBJECTIVE We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients. METHODS We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI). RESULTS Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups. CONCLUSION For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events. LEVEL OF EVIDENCE 1 Laryngoscope, 2021.

Periodic Fever, Aphthous Ulcers, Pharyngitis and Adenitis (PFAPA) Syndrome’s etiology is not well understood. The objective of this study is to explore the association between vitamin D level and PFAPA syndrome. A systematic review of all publications addressing the association between vitamin D level and PFAPA syndrome prior to May 2019 was conducted. Data were collected from online medical databases namely, PubMed, Ovid Medline, Embase, Cochrane Library, Google Scholar, and Scopus. The review adhered to the PRISMA statement and was performed in 3 main phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. 3 prospective review-based and one case report articles were included with a total of 281 patients, 98 of whom were cases of PFAPA, while 183 were controls. Vitamin D levels were deficient in 27% of PFAPA group as compared with the control. Vitamin D supplementation was given as an initial treatment in 25/98 of the patients. Only 1 patient received it as a second treatment. After vitamin D supplementation, a marked reduction of the number of febrile episodes and modification of the mean duration were recognized. There may be an association between Vitamin D deficiency and a higher frequency of PFAPA episodes. Vitamin D supplementation in children with PFAPA may reduce the frequency of episodes and help manage the condition.

Background Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. Objective To describe pacing outcomes and programming changes with AV-synchronous leadless pacemakers in clinical practice. Methods Consecutive patients without persistent atrial fibrillation who received an AV-synchronous leadless pacemaker and completed follow-up between February 2020 and April 2021 were included. We evaluated tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP), total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch), use of programming optimization, and improvement in AV synchrony after optimization. Results Fifty patients met the inclusion criteria. Mean age was 69 ± 16.8 years, 24 (48%) were women, 24 (48%) had complete heart block, and 17 (34%) required ≥50% pacing. Mean tracking index was 41% ± 34%. Thirty-five patients (70%) received ≥1 programming change. In 36 patients with 2 follow-up visits, tracking improved by +9% ± 28% (P value for improvement = .09) and +18% ± 19% (P = .02) among 15 patients with complete heart block. Average total AV synchrony increased from 89% [67%, 99%] to 93% [78%, 100%] in all patients (P = .22), from 86% [52%, 98%] to 97% [82%, 99%] in those with complete heart block (P = .04), and from 73% [52%, 80%] to 78% [70%, 85%] in those with ≥50% pacing (P = .09). Conclusion In patients with AV-synchronous leadless pacemakers, programming changes are frequent and are associated with increased atrial tracking and increased AV synchrony in patients with complete heart block., Graphical abstract

To evaluate the influence of posterior corneal asphericity on the refractive error using SRK-T and Barrett formulas for the intraocular lens (IOL) power calculation for Lucidis Extended Depth of Focus (EDOF) IOL.This study was carried out at a tertiary ophthalmology center in Geneva, Switzerland.A retrospective study. Medical records from all enrolled patients were analyzed and the following information was extracted retrospectively, over 1 month following surgery.We retrospectively reviewed 75 eyes that underwent cataract surgery and were implanted with a Lucidis EDOF IOL. We measured the posterior corneal asphericity (Q value), axial length (AL), and anterior chamber depth (ACD) and then calculated the IOL power using SRK-T and Barrett formulas.Seventy-five eyes were included, all of which had 1-month postoperative data. In the cohort, 32 eyes were from females (43%) and 43 from males (57%). The mean age of the study population was 73 ± 8.8 years. The mean AL was 23.5 ± 0.98 and the mean ACD was 3.13 ± 0.3. The mean posterior Q value was - 0.35 ± 0.2. In a regression analysis, we found a statistically significant relationship between the error in refraction prediction and the posterior Q value, irrespective of the formula used. The relationship between posterior corneal asphericity and the refraction prediction error was stronger for the Barrett II Universal formula than for the SRK-T formula.Posterior corneal asphericity was correlated with the refractive error of calculation of both SRK-T and Barrett formulas, with a stronger correlation to the latter formula.ZIEL: Den Einfluss der posterioren Hornhautasphärizität auf den refraktiven Fehler der mit SRK‑T- und Barrett-Formeln kalkulierten Intraokularlinsenberechnungen (IOL-Berechnungen) für Lucidis-Extended-Depth-of-Focus-Intraokularlinsen (EDOF: Extended Depth of Focus) zu evaluieren. ORT: Diese Studie wurde in einem Tertiärzentrum für Augenheilkunde in Genf, Schweiz, durchgeführt.Eine retrospektive Studie. Die Gesundheitsakten aller in die Studie aufgenommenen Patienten wurden analysiert; die Daten für den 1. Monat nach der Operation wurden retrospektiv extrahiert.Es wurden 75 Augen nach Kataraktoperation mit Implantation einer Lucidis-EDOF-IOL retrospektiv überprüft. Wir haben die posteriore Hornhautasphärizität (Q-Wert), axiale Länge (AL) und Vorderkammertiefe (VKT) gemessen; die IOL-Berechnung wurde mit den SRK‑T- und Barrett-Formeln durchgeführt.Es wurden 75 Augen in die Studie aufgenommen. Für alle Augen lagen die postoperativen Daten für den 1. Monat nach der Operation vor. In dem Patientenkollektiv waren 32 Augen von Frauen (43%) und 43 von Männern (57%). Das Durchschnittsalter der Studienpopulation betrug 73 ± 8,8 Jahre. Die durchschnittliche AL betrug 23,5 ± 0,98 und die mittlere VKT betrug 3,13 ± 0,3. Der durchschnittliche Q-Wert der hinteren Hornhautfläche betrug − 0,35 ± 0,2. Bei der Regressionsanalyse fanden wir eine statistisch signifikante Beziehung zwischen dem refraktiven Vorhersagefehler und dem Q-Wert der hinteren Hornhautfläche, ungeachtet der für die Berechnung verwendeten Formel. Die Verbindung zwischen posteriorer Hornhautasphärizität und refraktivem Vorhersagefehler war mit der Barrett-Universal-II-Formel stärker als mit der SRK‑T-Formel.Die posteriore Hornhautasphärizität korrelierte sowohl mit dem mit der SRK‑T-Formel als auch mit dem mit der Barrett-Formel kalkulierten refraktiven Fehler, wobei die Korrelation mit der letztgenannten Formel stärker ausgeprägt war.

In the 21st era, technological progressions challenged the dental professional to perform extremely risky and multifaceted procedures more reliably and harmless way using the finite element method (FEM) that can simulate and analyze the dental structures. As orthodontic revolve about the forces so FEM is one of the most accurate tools for the researchers in this ground. This review highlights the use of the finite element method in orthodontics and craniofacial research. This stores the different researches performed by using the finite element model to study the growth of the cranial structure, biomechanical reaction to orthopedic forces, orthodontic tooth movement, orthognathic surgeries application, and orthodontic implants

To survey Otolaryngology residents to evaluate their operative airway exposure during their training and to assess if the exposure was adequate to decide whether to pursue fellowship in pediatric. A modified and validated survey was distributed among otolaryngology trainees in the Western region of Kingdom of Saudi Arabia. It assesses operative airway exposure during training, adequacy of experience to decide on whether to pursue fellowship in pediatric otolaryngology, and plan to perform the following six procedures (diagnostic rigid bronchoscopy, diagnostic flexible bronchoscopy, endoscopic airway foreign body removal, rigid esophagoscopy with or without foreign body removal, suspension microlaryngoscopy procedures, open tracheostomy) in practice. Only 24/60 (60%) of respondents perceived that they had adequate training as to whether or not to make them decide to pursue fellowship in pediatric. In regard to over all assessment of the level of exposure: the vast majority of trainees regarded the training as adequate 30/60 (50%), 3/60 (5%) thought it was excellent, 6/60 (10%) thought it was good, and 21/60 (35%)assessed the training adequacy as poor. 24/33 (72.7%) perceived that the presence of a pediatric fellow with them enhanced their training. In regards to performing surgeries after training, 78% were planning to perform rigid bronchoscopy, flexible bronchoscopy (58%), endoscopic airway FB removal (92%), esophagoscopy (54%), suspension microlaryngoscopy (82%), and open tracheostomy (100%). The presence of a pediatric fellow in service was thought of by most residents as being beneficial, however, the exposure to airway surgeries were not adequate as to inform trainees if they want to pursue fellowship in pediatric, when they were not exposed to a fellow.

Sickle cell disease (SCD) typically manifests in early childhood as attacks of pain known as vaso-occlusive crises. Infection and hypoxemia have been linked with these recurrent episodes and with prolonged hospitalization in SCD patients. However, adenoids and tonsils as sources of infection and causes of hypoxemia have not been adequately investigated in association with vaso-occlusive crises in SCD. To assess the association between adenotonsillectomy and frequency of vaso-occlusive crisis in SCD patients who underwent this procedure at our Hospital, and between adenotonsillectomy and frequency of blood transfusions and emergency department and intensive care unit admissions. We used medical record data to conduct a retrospective review of SCD patients who underwent adenoidectomy and/or tonsillectomy between 2005 and 2017. Eligible subjects were assessed for frequency of vaso-occlusive crises, blood transfusions, and emergency department and intensive care unit admissions. Using the Wilcoxon signed rank test, we compared the frequencies of each outcome preoperatively and 1, 3, 5, and 10 years postoperatively. Of 524 records reviewed, 40 eligible patients were included in the study. Minimal reduction was observed in the frequency of vaso-occlusive crisis episodes within 1 and 3 years after adenotonsillectomy (p = 0.337 and p = 0.549, respectively). Although the 5- and 10-year postoperative vaso-occlusive crisis frequency tended to be higher than that in the preoperative period, none of the results reached statistical significance. The number of emergency department admissions showed a statistically significant increase 3 years postoperatively compared with that in the preoperative period (P = 0.043). There were no statistically significant differences in perioperative blood transfusion frequency or number of intensive care unit admissions in any period. Adenotonsillectomy in SCD patients does not seem to be related to the frequency of vaso-occlusive crises, blood transfusions, or emergency department or intensive care unit admissions. Prospective studies with larger sample sizes are recommended to further evaluate these findings.

BackgroundThe present study investigated the ameliorative effect of melittin, a major polypeptide in the venom of honeybee (Apis mellifera), on isoniazid-(INH) and rifampicin-(RIF) induced hepatotoxicity in male albino rats.MethodThirty rats (140-200 g) were divided into five groups (n = 6): normal control (NC) received normal saline orally (NaCl, 0.9%; toxic (T) group received INH + RIF (each rat received 100 mg/kg, p.o.); melittin (Mel15, Mel30) groups (each rat received 15 or 30 μg/kg s.c); and normal recovery (NR) group received INH + RIF (each rat received 100 mg/kg, p.o.). Blood and liver samples were collected for biochemical, hematological and histopathological studies respectively.ResultsThe administration of melittin was found to prevent the antitubercular drug-induced alterations in the diagnostic markers; reduced glutathione (GSH), direct bilirubin (DB), total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and total serum protein (TSP). Besides, hematological alterations were significantly high in Mel groups when compared to the toxic group. The NR group exhibited lower levels of DB, TB, ALP, LDH and TSP. In addition, treatment with melittin offered protection in the NR group with respect to MDA levels.ConclusionEvidence from this study suggests that melittin is beneficial for the prevention of acute hepatic failure in antitubercular drug-induced hepatoxicity and could be used as a potential therapeutic agent.

Background: Nurses are the first to encounter a patient in pain. A nurse’s knowledge of pain management in patients receiving hemodialysis allows them to provide optimal pain management. Objective: The aim of this qualitative study is to explore the experiences, perceptions, and beliefs of nurses in the hemodialysis unit regarding pain management practices and identify nurses’ educational needs to improve nurses’ pain management in practice. Methods: A purposive sample of 16 nurses working in four out-patient hemodialysis units in Amman, Jordan, was recruited. The data was collected through semi-structured interviews. The interviews were audio-recorded and transcribed manually for the following content analysis scheme. Results: The five themes and fifteen sub-categories were extracted from the nurses' experiences regarding nurses’ knowledge of pain management. The five categories that emerged from the analysis were (1) nurses’ knowledge of pain management, (2) nurses’ self-learning pain management strategy, (3) nurses’ approach to pain management, (4) patients continue to suffer unrelieved pain, (5) nurses’ educational needs. Relevance to Clinical Practice: This data will prove to be useful for evaluating pain management practices for patients on maintenance hemodialysis, developing educational programs for nurses working in hemodialysis units with a focus on improving pain management, and providing knowledge regarding these issues. More research is recommended among nurses for understanding pain knowledge in patients on maintenance hemodialysis. Conclusion: This qualitative analysis indicated that nurses are not fully aware of various strategies for pain management. Nurses’ perception of pain and pain management was found to be limited to pain assessment and some non-pharmacological management strategies. It has been revealed that nurses require educational interventions regarding pain management in practice.

Sugarcane plays an essential role in the economy of the India. During 2018, 79.9% of total sugarcane production of India was used in the manufacture of white sugar, 11.29% was used for jaggery production, and 8.80% was used as seed and feed materials. 840.16 Mt sugarcane was exported in the year 2019. Prediction of production level is basic to effective decision-making for policymakers. The objective of this study is thus to find the suitable models of forecasting for sugarcane production. India and major sugarcane producing states, namely Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu and Uttar Pradesh were selected. Sugarcane production data from 1950 to 2015 were used for training and 2016 to 2018 was used to test the model. ARIMA method was used to model the production process. Order selection was done using AIC. RMSE, MAPE and Theils’ U statistic were used to test the accuracy of the models fitted to the data. ARCH process was found for Karnataka, Tamil Nadu and Uttar Pradesh. Autocorrelation was not present in all the data series analyzed. Forecast accuracy on MAPE criteria ranged from 0.046 to 0.197 percent.

The congestion problem at the router buffer leads to serious consequences on network performance. Active Queue Management (AQM) has been developed to react to any possible congestion at the router buffer at an early stage. The limitation of the existing fuzzy-based AQM is the utilization of indicators that do not address all the performance criteria and quality of services required. In this paper, a new method for active queue management is proposed based on using the fuzzy logic and multiple performance indicators that are extracted from the network performance metrics. These indicators are queue length, delta queue and expected loss. The simulation of the proposed method show that in high traffic load, the proposed method preserves packet loss, drop packet only when it is necessary and produce a satisfactory delay that outperformed the state-of-the-art AQM methods.

Background: Cardiac resynchronization therapy (CRT) has been demonstrated to improve heart failure (HF) symptoms, reverse LV remodeling, and reduce mortality and HF hospitalization (HFH) in patients with a reduced left ventricular (LV) ejection fraction (LVEF). Prior studies examining outcomes based on right ventricular (RV) lead position among CRT patients have provided mixed results. We performed a systematic review and meta-analysis of randomized controlled trials and prospective observational studies comparing RV apical (RVA) and non-apical (RVNA) lead position in CRT. Methods: Our meta-analysis was constructed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. We searched EMBASE and MEDLINE. Eligible studies reported on at least one of the following outcomes of interest: all-cause mortality, the composite endpoint of death and first HFH hospitalization, change in LVEF, New York Heart Association (NYHA) class improvement, and change in LV end systolic volume (LVESV). We performed meta-analysis summaries using a DerSimonian-Laird random-effects model and conservatively used the Knapp-Hartung approach to adjust the standard errors of the estimated model coefficients. Results: We included nine studies representing a total of 1832 patients. Of those, 1318 (72%) patients had RVA lead placement and 514 (28%) had RVNA lead placement. The mean age of patients was 65.5 ± 4.4 years, and they were predominantly men (69%–97%). There was no statistically significant difference in all-cause mortality by RVA vs. RVNA (OR = 0.77, 95% CI 0.32–1.89; I2 = 16.7%, p = 0.31), or in the combined endpoint of all-cause mortality and first HFH (OR 0.88, 95% CI 0.62–1.25; I2 = 0%, p = 0.84). Also, there was no difference between RVA and RVNA for NYHA class improvement (OR = 1.03, 95% CI 0.9–1.17; I2 = 0%, p = 0.99), change in LVEF (mean difference (MD) = 1.33, 95% CI -1.45 to 4.10; I2 = 47%; p = 0.093), and change in LVESV (MD = −1.11, 95% CI −3.34 to 1.12; I2 = 0%; p = 0.92). Conclusion: This meta-analysis shows that in CRT pacing, RV lead position does not appear to be associated with clinical outcomes or LV reverse remodeling. Further studies should focus on the relationship of RV lead vis-a-vis LV lead location, and its clinical importance.

Atrial Fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF) frequently coexist, resulting in significant morbidity and mortality. Therapeutic options for patients with AF and HFrEF are limited due to few antiarrhythmic drug (AAD) choices and historically equivocal effects of procedural interventions on mortality. However, recent randomized trials examining catheter ablation (CA) in AF patients with HFrEF have shown a beneficial effect on arrhythmic burden and HF symptoms, as well as an improvement in mortality. This review focuses on the role of CA for AF patients with HFrEF.

Understanding how to modulate appetite in humans is key to developing successful weight loss interventions. Here, we showed that postprandial glucose dips 2–3 h after a meal are a better predictor of postprandial self-reported hunger and subsequent energy intake than peak glucose at 0–2 h and glucose incremental area under the blood glucose curve at 0–2 h. We explore the links among postprandial glucose, appetite and subsequent energy intake in 1,070 participants from a UK exploratory and US validation cohort, who consumed 8,624 standardized meals followed by 71,715 ad libitum meals, using continuous glucose monitors to record postprandial glycaemia. For participants eating each of the standardized meals, the average postprandial glucose dip at 2–3 h relative to baseline level predicted an increase in hunger at 2–3 h (r = 0.16, P

Purpose The purpose of this paper is to identify the effect of organisational culture by its two dimensions (innovative organisational culture and conservative organisational culture) on innovative performance and also investigate the moderating role of the job type on innovative performance in the relationship between innovative organisational culture and conservative organisational culture. Design/methodology/approach For this study’s purposes, 321 questionnaires from employees of Jordanian private universities were analysed. Convergent validity and discriminant validity tests were performed. Data reliability was confirmed. A bootstrapping technique was used to analyse the data. The multi-group analysis was performed to investigate the moderating role of job type. Findings The results of this study indicate that the innovative organisational culture will improve innovative performance and that a conservative culture reduces innovation opportunities. Moreover, innovative organisational culture promotes innovative performance for all employees regardless of who holds administrative positions. Research limitations/implications This cross-sectional study provides a snapshot at a given moment in time, a methodological limitation that affects the generalisation of its results. Moreover, this study adopted subjective measures and the results are limited to one country, Jordan. Practical implications This paper contributes to drawing the attention of senior management to the importance of innovation culture in the performance of innovation at Jordanian private universities surveyed, in particular, and other organisations in general. Social implications The social impact of this study is to respond to the challenge of building an innovation-based culture and to limit the effects of a conservative culture that limits the response to innovation. Originality/value This study has important implications for leaders in general. It also highlights the need for organisations to develop an orientation towards innovative organisational culture instead of the classic approach based on the conservative culture of all its members (both administrative and non-administrative employees) and to invest in training that supports this trend, thus increasing their innovative performance, which contributes to raising their capabilities to excel, compete and achieve high levels of performance.

Shaher M Samrah,1 Abdel-Hameed Al-Mistarehi,2 Tariq Kewan,3 Sohaib M Al-Khatib,4 Ali M Ibnian,1 Randa S Samrah,5 Basheer Y Khassawneh1 1Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; 4Department of Pathology and Laboratory Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Shaher M SamrahFaculty of Medicine, Jordan University of Science and Technology, P.O.Box: 630001, Irbid, 22110, JordanEmail samrah@just.edu.joAbdel-Hameed Al-MistarehiDepartment of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box: 630001, Irbid, 22110, JordanEmail awalmistarehi18@med.just.edu.joBackground: Coronavirus disease 2019 (COVID-19) viral course and behavior remain unpredictable. This study describes incubation time and viral clearance of COVID-19 hospitalized cases in Northern Jordan.Methods: All COVID-19 confirmed cases hospitalized from March 15 to June 09, 2020, were included. Nasopharyngeal swabs were collected, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) was performed every two days in all cases. The viral cure was defined when two negative RT-PCR tests were obtained ≥ 24 hours apart. Viral clearance time (VCT) reflects the time from the first positive nasopharyngeal swab to the first of two consecutive negative tests.Results: In this cohort, a total of 157 patients were included. Most cases resulted from two major outbreaks. The median incubation period was 6 days (IQR, 3– 10) and ranged from 1 to 17 days. The median VCT was 13 days (IQR, 7– 2) and ranged from 1 to 40 days. Symptomatic presentation and abnormal chest radiograph were predictors for a prolonged VCT (p=0.015 and p=0.014, respectively). The median time of resolution of symptoms was 7 days (IQR, 3– 10 days). Most symptomatic cases (91.7%) remained RT-PCR positive for up to 20 days after symptoms resolution, with a median of 13.5 days. VCT significantly correlated with the incubation period (p=0.013).Conclusion: Viral cure lagged for as long as 20 days after resolution of symptoms. Continuing with social-distancing, frequent hand hygiene, and wearing facial mask remains essential and is recommended even after clinical resolution of symptoms.Keywords: viral clearance, viral shedding, incubation period, COVID-19, coronavirus, pandemic, CDC

Background: Digital health is transforming healthcare delivery. Objective: To compare the current digital health landscape in select groups of cardiac electrophysiology (EP) professionals prior to and during the COVID-19 era. Methods: Two online surveys were emailed to 4 Heart Rhythm Society communities and tweeted out to Twitter EP, 1 before and 1 during the pandemic. Categorical variables were analyzed using the χ2 test and reported as absolute numbers and percentages. Results: There were 253 pre-pandemic (S1) and 273 follow-up surveys (S2) completed. The majority of respondents to both surveys were male, aged

Sous-vide cooking was recently introduced to the meat catering and hospitality in Lebanon. It is a heat cooking process that includes either precooked, packed products that need little or no additional heat treatment prior to consumption, doesn’t have low pH or low water activity, has an extended chilled shelf life, or ismarketed in sealed packages or containers. The aim of this study is to assess the microbial load and food safety of sous-vide meat produced in Lebanon while maintaining quality and palatable characteristics. Sous-vide process used tenderloin meat as raw material. Tenderloin meat was trimmed, cleaned, vacuum packed in plastic pouches and cooked atdifferent low heat, followed by chilled storage. After 6 hours, 24 hours, 5 days and 10 days of chilled storage samples were unpacked, portioned into steakandreheated. Samples were evaluated physicochemically by analysing pH, moister content and extract release volume and microbiologically by preparing a culture media followed by API experimental procedure. Results showed that ERV and moisture content decreased significantly but within acceptable limits and that the cooking method had no effect onpH.A significant decrease to zero microorganisms was observed after sous-vide cooking which remained constant throughout the storage period and after reheating, while pathogenic organisms were not detected. Thus, the present study indicates that sous-vide cooking is a safe technique for mass production of steak with an improved shelf life.

BackgroundDiabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).MethodsThis retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.ResultsOf the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%,p ConclusionsHalf of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.

The Ejector refrigeration system can operate using renewable energy such as solar or wasted heat. A mathematical model for an ejector refrigeration system powered by solar energy was developed. The Ejector refrigeration system depends on many factors, such as ejector geometry, NXP, and operating conditions. A flat plate solar collector is designed to predict the heat transfer performance for the whole system, and the primary factors affecting the heat transfer performance. Outlet temperature of 134.95 °C was achieved from the setup of five solar collectors (two square meters each) when the solar irradiance was 985.69 W/m2. The water needs total power of 5016 W to reach this temperature.

Das Essverhalten ist ein wichtiger Faktor bei Entstehung, Verlauf und Prognose eines Diabetes mellitus. Es wird wie jedes andere menschliche Verhalten durch Zusammenwirken sozialer, psychischer und biologischer Faktoren bedingt. In der Auffassung von den Grenzen "normalen Essens" und der Korperform spiegeln sich gesellschaftliche Normen und Korperideale wider. Das Binge Eating, als eine relativ neu definierte Einheit gestorten Essverhaltens, ist haufig bei Menschen mit Ubergewicht und Adipositas zu beobachten, besonders bei jenen mit Typ-2-Diabetes.

Background The use of cardiac magnetic resonance imaging (c-MRI) in risk stratification for clinical outcomes of patients with ischemic cardiomyopathy (ICM) remains low. This systematic review investigated the prognostic value of myocardial fibrosis as assessed by late gadolinium enhancement (LGE) on c-MRI in patients with ICM for ventricular tachyarrhythmia, sudden cardiac death (SCD), or all-cause mortality. Methods We conducted a systematic review of the electronic databases Pubmed and Embase for relevant prospective English-language studies published between January 1990 and February 2019. All included articles were prospective studies that comprised of human participants older than 18 years with ICM and a primary or secondary prevention implantable cardioverter/defibrillator (ICD); had a sample size >30 participants; had at least 6 months of follow-up; and reported on ventricular tachyarrhythmia, SCD, and all-cause mortality. A total of 90 articles related to ICM were identified and were subsequently screened independently by 2 authors. Pooled sensitivity and specificity of LGE were calculated using random-effects model. Results Eight studies with 1,085 participants were included in the final analysis. The mean age of patients varied from 43 to 83 years, with most patients being men. The most common comorbidities reported included history of diabetes mellitus (22%-62%), hyperlipidemia (40%-86%), and hypertension (35%-88%). The ejection fraction of each study was reported as mean or median and varied from 22% to 35%. During a follow-up that ranged from 8.5 to 65 months, there were 110 ventricular arrhythmic events reported. The pooled sensitivity and specificity of LGE for ICD therapy delivered for ventricular arrhythmias were 0.79 (95% CI: 0.66-0.87) and 0.28 (95% CI: 0.14-0.46), respectively. For all-cause mortality, the pooled sensitivity and specificity of LGE were 0.76 (95% CI: 0.40-0.93) and 0.41 (95% CI: 0.14-0.75), respectively. Although SCD was of significant interest to our review, only 1 of the studies reported on the association between LGE and SCD, leading to the subsequent exclusion of SCD from the end point analysis. Conclusions LGE has high prognostic value in predicting adverse outcomes in patients with ICM and may provide helpful information for clinical decision making related to SCD prevention. Our findings illustrate how LGE may improve current risk stratification, prognostication, and selection of patients with ICM for ICD therapy.

Background and objectives Patients on dialysis are at high risk of complications related to implantable cardioverter defibrillator (ICD) implantation; use of subcutaneous ICDs may be preferred over transvenous devices due to lower risk of bloodstream infection and interference with vascular access sites. We evaluated trends in use and in-hospital outcomes of subcutaneous compared with transvenous ICDs among patients on dialysis in the United States. Design, setting, participants, & measurements Retrospective analysis of ICD implants from 2012 to 2018 among patients on dialysis reported to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD Registry. We examined overall trends in subcutaneous ICD adoption as a proportion of all eligible ICD implants among patients on dialysis and then compared in-hospital outcomes between eligible subcutaneous ICD and transvenous ICD recipients using inverse probability of treatment weighting. Results Of the 23,136 total ICD implants in patients on dialysis during the study period, 3195 (14%) were subcutaneous ICDs. Among eligible first-time ICD recipients on dialysis, the proportion of subcutaneous ICDs used increased yearly from 10% in 2012 to 69% in 2018. In propensity score–weighted analysis of 3327 patients, compared with transvenous ICDs, patients on dialysis receiving subcutaneous ICDs had a higher rate of in-hospital cardiac arrest (2% versus 0.4%, P=0.002), but there was no significant difference in total in-hospital complications (2% versus 1%, P=0.08), all-cause death, or length of hospital stay. Conclusions The utilization of subcutaneous ICDs among US patients on dialysis has been steadily increasing. The overall risk of short-term complications is low and comparable with transvenous ICDs, but higher risks of in-hospital cardiac arrest merits closer monitoring and further investigation. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_23_CJN07920520.mp3

AimsThe ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial randomised patients with atrial fibrillation at risk of stroke to apixaban or warfarin. We sought to describe patients from ARISTOTLE who prematurely permanently discontinued study drug.Methods/ResultsWe performed a posthoc analysis of patients from ARISTOTLE who prematurely permanently discontinued study drug during the study or follow-up period. Discontinuation rates and reasons for discontinuation were described. Death, thromboembolism (stroke, transient ischaemic attack, systemic embolism), myocardial infarction and major bleeding rates were stratified by ≤30 days or >30 days after discontinuation. A total of 4063/18 140 (22.4%) patients discontinued study drug at a median of 7.3 (2.2, 15.2) months after randomisation. Patients with discontinuation were more likely to be female and had a higher prevalence of cardiovascular disease, diabetes, renal impairment and anaemia. Premature permanent discontinuation was more common in those randomised to warfarin than apixaban (23.4% vs 21.4%; p=0.002). The most common reasons for discontinuation were patient request (46.1%) and adverse event (34.9%), with no significant difference between treatment groups. The cumulative incidence of clinical events ≤30 days after premature permanent discontinuation for all-cause death, thromboembolism, myocardial infarction, and major bleeding was 5.8%, 2.6%, 0.9%, and 3.0%, respectively. No significant difference was seen between treatment groups with respect to clinical outcomes after discontinuation.ConclusionPremature permanent discontinuation of study drug in ARISTOTLE was common, less frequent in patients receiving apixaban than warfarin and was followed by high 30-day rates of death, thromboembolism and major bleeding. Initiatives are needed to reduce discontinuation of oral anticoagulation.

OptiVol (Medtronic PLC, Minneapolis, MN) is a diagnostic feature of some cardiac implantable electronic devices (CIEDs) based on changes in thoracic impedance (TI) over time. Changes in TI can predict heart failure (HF) hospitalizations and mortality in HF populations. However, the utility of this feature is unknown in patients with a left ventricular assist device (LVAD). To determine if OptiVol and TI correlate with clinical HF events in a population of LVAD patients, hospitalization outcomes were collected retrospectively from the electronic health records at a single academic medical center in 80 LVAD patients with an OptiVol-capable CIED. Demographics, medical history, and available clinical data were reviewed and reported. The primary outcomes of interest were TI and OptiVol trends before and after hospitalization, and association of trends before and after these events was evaluated. Most patients had a HeartMate II LVAD and most CIEDs were defibrillators, and 23 (29%) had at least one HF hospitalization during the study period. HF hospitalizations were preceded by signs of volume overload in Optivol (60%) and TI (78%) with recovery of these measures post hospitalization in 33% and 25% of patients, respectively. Monitoring of TI and OptiVol may be one effective component of HF management in LVAD patients as part of a comprehensive program.

Although aortopulmonary collaterals (APCs) frequently develop in patients with single ventricle palliation, there is a lack of understanding of pathophysiology, natural history, and outcomes with no universal guidelines for management and interventional practice. We conducted a study to assess the views held by interventional congenital cardiologists regarding the hemodynamic impact of APCs in patients with single ventricle palliation, and their embolization practice. An electronic survey using the Pediatric Interventional Cardiology Symposium (PICS) mailing list was conducted between February and March 2019 with one reminder sent 2 weeks after initial invitation for participation. Of the 142 interventional cardiologist respondents, 95 (66.9%) reside in North America and 47 (33.1%) worldwide. We elected to exclude the data from interventionalists outside North America in this analysis as it was not representative of worldwide practice. Hypoxemia was considered to be the most common trigger for development of APCs by 56 (58.9%) respondents. After completion of total cavopulmonary connection, 30 (31.6%) respondents reported the APC burden stays the same while 31 (32.6%) feel it decreases. In evaluating the burden of APC flow, only 4 (4.2%) reported measuring oxygen saturation at different pulmonary artery segments, 21 (22.1%) perform segmental aortic angiograms, and 18 (19%) perform selective bilateral subclavian artery angiograms. A majority of respondents, 71 (74.7%), occlude the feeder vessel at different locations, while 10 (10.5%) occlude only the origin of the vessel. Our study demonstrates significant variation in the understanding of the cause and prognosis of APCs in patients with single ventricle palliation. Furthermore, there is variation in the approach for diagnosis and management among interventional cardiologists. Further studies are required to improve understanding of APCs and develop universal management guidelines.

The sense of hearing is the first most important sense among our five senses. The studies indicate hearing disability is more harmful to persons than visual disability, and their effects appear on their personal characteristics, such as linguistic, Social, Psychological and Academic. On the other hand, researchers in the field of deaf education agree that their mental abilities are normal and may exceed the normal level for some others. Hence, a deaf person with good education can compete with a healthy individual, learn the same educational and vocational skills, and can even excel in that. With the global increase in the interest in people with special needs, the two researchers saw the need to shed light on the category of hearing disability and their potential inherent skills that must be exploited by providing appropriate educational conditions, and training programs to open the way for them to rely on themselves and meet their living requirements by setting up micro-projects that do not need large capital funds. The researchers have used the remnants of velvet fabrics in the designs of some flowers to enrich the home furnishings as it is one of the smoothest and softest fabrics among all other types of fabrics. Velvet fabrics are specially made and processed due to their distinctive properties. Velvet fabric is used in garments including pants, shirts and many more. It is also used in bed sheets, covers, curtains, etc. They are no less than silk in any reviews, whether they are glossy or matte. The velvet fabric, due to its high-quality look and price-fit, in addition to being non-reproducible which made it the most preferred fabric. Research problem: What is the possibility of providing a training program for persons with hearing disability and deaf to develop their skill in producing home furnishings using velvet residue for the development of micro-projects? What is the possibility of benefiting from the remnants of velvet fabrics (velor) and recycling them in the production of some furniture pieces and home decoration accessories. To what extent are the aesthetic and functional values of the pieces executed to be used in the labor market achieved? How successful are the pieces executed from the specialists' point of view? Results: There are statistically significant differences between the average scores of trainees with hearing and health disabilities in the knowledge gained in implementing some furnishings and home decoration supplements Before and after training in favor of post-training, where the mean levels of tribal application (6.7) and standard deviation (2.09) and the average degrees of post-application (19.5) and standard deviation (2.99), and the value of "T" (30.58) and the level of significance (0.001), which indicates statistically significant differences between the two applications in the cognitive test in favor of the post-application.

Background Many digital health technologies capable of atrial fibrillation (AF) detection are directly available to patients. However, adaptation into clinical practice by heart rhythm healthcare practitioners (HCPs) is unclear. Objective To examine HCP perspectives on use of commercial technologies for AF detection and management. Methods We created an electronic survey for HCPs assessing practice demographics and perspectives on digital devices for AF detection and management. The survey was distributed electronically to all members of 3 heart rhythm professional societies. Results We received 1601 responses out of 73,563 e-mails sent, with 43.6% from cardiac electrophysiologists, 12.8% from fellows, and 11.6% from advanced practice practitioners. Most respondents (62.3%) reported having recommended patient use of a digital device for AF detection. Those who did not had concerns about their accuracy (29.6%), clinical utility of results (22.8%), and integration into electronic health records (19.8%). Results from a 30-second single-lead electrocardiogram were sufficient for 42.7% of HCPs to recommend oral anticoagulation for patients at high risk for stroke. Respondents wanted more data comparing the accuracy of digital devices to conventional devices for AF monitoring (64.9%). A quarter (27.3%) of HCPs had no reservations recommending digital devices for AF detection, and most (53.4%) wanted guidelines from their professional societies providing guidance on their optimal use. Conclusion Many HCPs have already integrated digital devices into their clinical practice. However, HCPs reported facing challenges when using digital technologies for AF detection, and professional society recommendations on their use are needed.

The interrelationships between atrial fibrillation (AF) and heart failure (HF) are complex and poorly understood, yet the number of patients with AF and HF continues to increase worldwide. Thus, there is a need for initiatives that prioritize research on the intersection between AF and HF. This article summarizes the proceedings of a virtual workshop convened by the US National Heart, Lung, and Blood Institute to identify important research opportunities in AF and HF. Key knowledge gaps were reviewed and research priorities were proposed for characterizing the pathophysiological overlap and deleterious interactions between AF and HF; preventing HF in people with AF; preventing AF in individuals with HF; and addressing symptom burden and health status outcomes in AF and HF. These research priorities will hopefully help inform, encourage, and stimulate innovative, cost-efficient, and transformative studies to enhance the outcomes of patients with AF and HF.

Introduction Among the Jordanian population, brain tumors are the tenth most common type of cancers in both males and females, comprising 2.8% of all newly diagnosed neoplasms. Diffuse gliomas are the most prevalent and the most aggressive primary brain tumors in adults. The incidence of diffuse gliomas varies among different populations; this variation is partially linked to genetic polymorphisms. The purpose of the study is to examine the association between (BRCA1 rs799917G>A, rs1799966T>C, EXO1 rs1047840G>A, EME1 rs12450550T>C, ERCC2 rs13181T>G, rs1799793C>T, and XRCC1 rs1799782G>A) DNA repair gene polymorphisms and glioblastoma multiforme (GBM) susceptibility, and survival in the Jordanian Arab population. Methods Eighty-four patients diagnosed with glioblastoma multiforme at the King Abdullah University Hospital (KAUH) between 2013 and 2018 and 225 healthy cancer-free control subjects with similar geographic and ethnic backgrounds to the patients were included in the study. Genomic DNA was extracted from the formalin-fixed paraffin-embedded tissues of the subjects. The Sequenom MassARRAY® sequencer system (iPLEX GOLD) was used. The analyses included assessments of population variability and survival. Results This study is the first to address the relationship between BRCA1 rs1799966 and rs799917 SNP, and the risk of GBM among the Arab Jordanian population. The findings of the study show that BRCA1 rs799917 is associated with decreased risk of GBM in the recessive model (AA vs G/G-A/G: OR, 0.46, 95% CI, 0.26-0.82, p=0.01) and the same SNP is associated with increased risk of GBM in the overdominant model (AG vs G/G-A/A: OR, 1.72, 95% CI, 1.02-2.89, p=0.04).

الملخص: أهداف البحث: يستخدم الأطباء عقار الوبيورينول في كثير من الأحيان لاضطرابات ترسب حمض اليوريك. ومع ذلك، هناك تقارير عن استخدام غير مناسب ويعتقد أنه قد يوصف بغير حاجة. تهدف هذه الدراسة لتحديد معدل الوصف غير المناسب للألوبيرينول في مركز سعودي واحد. طرق البحث: كانت هذه دراسة وصفية مستعرضة لجميع المرضى البالغين الذين وُصف لهم الوبيورينول في مستشفى الدكتور سليمان فقيه بجدة، بالمملكة العربية السعودية، خلال الفترة من ١/١/٢٠١٦ حتى ١/١/٢٠١٧. تم استرداد البيانات الديموغرافية ونتائج المختبر من الملفات الإلكترونية للمرضى. تم تقييم أسباب الوصفة الطبية من سجلات الحالة الإلكترونية. اعتبرنا الأسباب الصحيحة ما يلي: فرط حمض اليوريك في الدم لأكثر من ١٣مغ/دل عند الرجال وأكثر من ١٠مغ/دل عند النساء، والنقرس المؤكد، وفرط حمض اليوريك في البول لأكثر من ١١٠٠مغ في اليوم، وحصوات حمض اليوريك أو حصوات الكلى المتكررة بسبب أكسالات الكالسيوم، والسرطانات وانحلال الدم. واعتبرنا الأسباب التالية أنها صحيحة للوصف: النقرس غير المؤكد، والأنواع غير المؤكدة من حصوات الكلى. اعتبرنا المؤشرات التالية غير صالحة للوصف: لا يوجد سبب موثق في الملف الإلكتروني، زيادة حمض اليوريك في الدم بنسبة غير ذات أهمية. النتائج: شُمل ما مجموعه ١٩٧٨ مريضا في هذه الدراسة: ٧٦.٤٪ كانوا من الذكور و٢٣.٦٪ من الإناث. ومتوسط الانحراف المعياري: العمر ٥٣ سنة و٤ أشهر ± ١٥ سنة. كان متوسط الانحراف المعياري لسنوات مدة الوصفة الأولى ١.٥٣ ± ٢.٢ سنة. تم وصف الوبيورينول دون وجود سبب صحيح ل ١٥٣٩ مريضا (٧٧.٨ ٪). أكثر من ٣٩٪ من جميع الوصفات الطبية لم تكن بوجود سبب موثق في الملف الإلكتروني و٣٨.٨٪ كانت لزيادة حمض يوريك الدم بنسبة غير ذات أهمية. الاستنتاجات: كانت النسبة لوصف الوبيورينول بدون سبب صحيح في مركزنا مرتفعة بشكل ملحوظ. هذا النهج هو تعريض المرضى لآثار جانبية خطيرة دون فائدة إضافية. Abstract: Objective: Physicians frequently prescribe allopurinol for uric acid deposition disorders. However, reports have emerged of the inappropriate use and overprescription of allopurinol. We conducted this study to determine the rate of inappropriate prescription of allopurinol in a Saudi institution. Methods: This cross-sectional descriptive study was conducted on all adult patients who had been prescribed allopurinol in Doctor Soliman Fakeeh Hospital Jeddah KSA. Demographic data and laboratory results were retrieved from patients’ electronic health records (EHR). We considered valid indications of allopurinol as significant hyperuricemia (>13 mg/dL in men and >10 mg/dL in women), confirmed gout, hyperuricosuria of more than 1100 mg/day, uric acid stones or recurrent calcium oxalate kidney stones, malignancy, and haemolysis. The possible valid indications were unconfirmed gout and unconfirmed type of kidney stones, whereas no documented indication or insignificant hyperuricemia was considered as an invalid indication. Results: We included 1978 patients in this study. The cohort was composed of 76.4% men and 23.6% women. The mean ± standard deviation of age of this patient cohort was 53 and 4 months ± 15 years. The mean ± standard deviation of duration since the first prescription was 1.53 ± 2.2 years. Physicians prescribed allopurinol without a valid indication in 1539 patients (77.8%). More than a third of the patients (39%) did not have a documented indication and 38.8% were prescribed allopurinol for insignificant hyperuricemia. Conclusion: This study revealed a markedly high number of allopurinol prescriptions without a clear indication in our centre. This approach may potentially expose patients to serious side effects of allopurinol without added benefits.

Summary Objective This study was conducted to assess cortical bone thickness in the alveolar process of maxilla and mandible and to investigate its association with different orthodontic implant positions in Eastern Mediterranean young adults. Materials and methods Computed tomography images of 50 patients aged between 18–35 years were included. Buccal, palatal and lingual cortical bone thicknesses were measured at 2, 4, 6, and 8 mm from cemento-enamel junction starting from the mesial side of the second molar to the contralateral side. Pearson correlation was used to assess the association between cortical bone thickness and proposed orthodontic implant positions at all inter-radicular sites (p Results The highest value of buccal cortical bone thickness was found mesial to the second molar in the maxilla and mandible for both genders. The value of palatal cortical bone thickness was found to be at the highest rate mesial to canine and first premolar in males and females respectively. On the other hand, the highest value of lingual cortical bone thickness was recorded to be mesial to the first molar in both genders. In addition to that, the buccal cortical bone thickness was significantly higher than palatal at the area mesial to the second molar at all four levels from the cemento-enamel junction. A significant correlation was found between cortical bone thickness and 2, 4, 6, and 8 mm orthodontic implant levels in all inter-radicular sites. The values of correlation coefficients ranged from 0.280 to 0.674 in the maxillary arch and from 0.266 to 0.605 in the mandibular arch. Conclusions From this study, we can conclude that as the position of the orthodontic implant moved more posteriorly and apically more cortical bone thickness was expected to be found in both jaws. A significant correlation was found between cortical bone thickness and the site of the orthodontic implant. Cortical bone thickness and its relationship with implant position should be taken into consideration when attempts are made to insert the orthodontic implant.

Muscular pulmonary atresia with intact ventricular septum (PA/IVS) in neonates is traditionally managed by surgery. We describe hybrid approach to decompress the right ventricle (RV) and establish RV to pulmonary artery connection in a neonate avoiding cardiopulmonary bypass. A 21-gauge access needle was used to perforate the atretic pulmonary valve via periventricular approach followed by stent placement. This case is an example of how patients with congenital heart disease can be palliated in creative ways through thoughtful collaboration between surgical and interventional cardiology teams.

Magnetic millirobots can be controlled remotely by external magnetic fields, making them promising candidates for biomedical and engineering applications. This letter presents a low-cost millirobot that is simple in design, easy to fabricate, highly scalable, and can be used as modular sub-units within complex structures for large-scale manipulation. The rectangular-shaped millirobots were 3D printed using a polylactic acid (PLA) filament, where two cylindrical permanent magnets were subsequently embedded at each end. Individual millirobots are highly agile and capable of performing a variety of locomotive tasks such as pivot walking, tapping, and tumbling. A comparative study is presented to demonstrate the advantages and disadvantages of each locomotion mode. However, among these modes of locomotion, pivot walking at millimeter length scale is demonstrated for the first time in this letter, and our experimental data shows that this is the fastest and the most stable of the motion modes examined. Further, we demonstrate that the millirobot could be deployed through an esophagus-like bent tube and a maze-like path with combined motion modes. Later, to extend the functionality of our millirobots, we present two systems utilizing multiple millirobots combined together: a stag beetle and a carbot. Using a powerful electromagnetic coil system, we conduct extensive experiments to establish feasibility and practical utility of the magnetically actuated millirobot.

Space modulation techniques (SMTs) are multiple-input multiple-output based communication systems that recently gained definitions for a family of hardware implementations. As such, several new components, such as radio frequency (RF) switches, combiners, and splitters, are needed to efficiently implement variant SMT transmitters. Besides, existing techniques for channel estimation and frame synchronization need to be redesigned considering the specific nature of SMT operation. In order to make these implementations realizable, various studies need to be conducted to analyze system performance and potential hardware effects. Modeling SMTs using simulation can provide an appropriate medium to achieve that exactly. Moreover, modeling hardware using simulations has been proven already in the past, to reduce development cycles and to minimize costly mistakes. In this paper, a baseband modeling framework for a family of eight SMT transmitter hardware system models is defined and explained. The models are based on Simulink and leverage the RF Blockset toolbox. The bit error performance of the models is also verified against analytical bounds.

This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers.