Lung function, inflammation, and endothelin-1 in congenital heart disease-associated pulmonary arterial hypertension

Background-—Breathlessness is the most common symptom in people with pulmonary arterial hypertension and congenital heart disease (CHD-APAH), previously thought to be caused by worsening PAH, but perhaps also by inflammation and abnormalities of lung function. We studied lung function and airway inflammation in patients with CHD-APAH and compared the results with controls. Methods and Results-—Sixty people were recruited into the study: 20 CHD-APAH, 20 CHD controls, and 20 healthy controls. Spirometry, gas transfer, whole body plethysmography and lung clearance index, 6-minute walk distance, and medical research council dyspnea scoring were performed. Inflammatory markers and endothelin-1 levels were determined in blood and induced sputum. The CHD-APAH group had abnormal lung function with lung restriction, airway obstruction, and ventilation heterogeneity. Inverse correlations were shown for CHD-APAH between medical research council dyspnea score and percent predicted peak expiratory flow (r= 0.5383, P=0.0174), percent predicted forced expiratory flow rate at 50% of forced vital capacity (r= 0.5316, P=0.0192), as well as for percent predicted forced expiratory volume in 1 s (r= 0.6662, P=0.0018) and percent predicted forced vital capacity (r= 0.5536, P=0.0186). The CHD-APAH patients were more breathless with lower 6-minute walk distance (360 m versus 558 m versus 622 m, P=0.00001). Endothelin-1, interleukin (IL)-b, IL-6, IL-8, tumor necrosis factor a, and vascular endothelial growth factor were significantly higher in CHD-APAH than controls. Serum endothelin-1 for CHD-APAH correlated with airflow obstruction with significant negative correlations with percent predicted forced expiratory flow rate at 75% of forced vital capacity (r= 0.5858, P=0.0135). Conclusions-—Raised biomarkers for inflammation were found in CHD-APAH. Significant abnormalities in airway physiology may contribute to the dyspnea but are not driven by inflammation as assessed by circulating and sputum cytokines. A relationship between increased serum endothelin-1 and airway dysfunction may relate to its bronchoconstrictive properties. (J Am Heart Assoc. 2018;7:e007249. DOI: 10.1161/JAHA.117.007249.

Prediksi Performa Linear Engine Bersilinder Tunggal Sistem Pegas Hasil Modifikasi Dari Mesin Konvensional Yamaha RS 100CC

Linear engine adalah salah satu inovasi dari engine yang dikembangkan karena memiliki performa yang lebih baik bila dibandingkan dengan mesin konvensional. Peningkatan performa yang dialami karena berkurangnya gaya gesek yang terjadi. Sehingga perlu dilakukan pembuktian untuk mengetahui performa linear engine hasil modifikasi dari mesin konvensional Yamaha RS 100 CC dengan cara memprediksi melalui simulasi. Dalam analisa ini akan dibandingkan performa mesin konvensional dengan linear engine dalam bentuk perbandingan tekanan dengan volume, daya, torque, BSFC, Brake efficiency dalam variasi kecepatan antara 3.2 m/s – 19.2 m/s. Hasil penelitian menunjukan bahwa performa yang dihasilkan linear engine hasil modifikasi tersebut meningkat. Daya maksimal dari linear engine meningkat sekitar 7.2% dari daya sebelumnya 6.9 kW menjadi 7.4 kW. Begitu juga torque yang dihasilkan meningkat menjadi 12.4 N/m , selain itu BSFC dari linear engine mengalami perbaikan sekitar 2 – 10% dari BSFC sebelumnya

Simulasi Virtual Local Area Network (VLAN) Berbasis Software Defined Network (SDN) Menggunakan POX Controller

VLAN (Virtual LAN) merupakan sebuah teknologi yang dapat mengkonfigurasi jaringan logis independen dari struktur jaringan fisik. Hasil dari penelitian sebelumnya sudah diprediksi bahwa dibutuhkan Virtual Network yang akhirnya terciptalah VLAN. Namun paradigma jaringan saat ini tidak flexible, ketergantungan terhadap vendor sangat besar karena fungsi data plane dan control plane berada dalam satu paket device. SDN (Software defined network) yang merupakan salahsatu evolusi teknologi jaringan sesuai dengan tuntutan yang berkembang dimana memisahkan fungsi data plane dan control plane pada suatu perangkat. POX Controller digunakan untuk men-simulasikan dan menguji Platform SDN (Software defined network). Pada penelitian ini menggunakan Openflow versi 1.0 untuk memasang header VLAN sehingga penelitian ini difokuskan untuk mengevaluasi performa forwarding VLAN yang memanfaatkan Openflow sebagai control plane dapat berfungsi dengan baik. Hasil penelitian ini mengusulkan penerapan karakteristik teknologi VLAN pada SDN karena telah berjalan dengan benar sesuai hasil pengujian konektifitas, verifikasi dan keamanan. Kemudian hasil pengujian lanjutan untuk melihat pengaruh SDN dengan skenario penambahan jumlah VLAN ID didapatkan bahwa set-up time akan bertambah seiring meningkatnya jumlah host dan dengan menggunakan protokol OpenFlow, latency yang terjadi di jaringan dapat dipantau dengan parameter round trip time (RTT) yang stabil direntang 0,2 sampai 6 second walaupun jumlah vlan_id dan background traffic bertambah

Perancangan dan Implementasi Aplikasi Sistem Antrian untuk Pasien pada Dokter Umum Berbasis Android dan SMS Gateway

Pada lokasi pelayanan dokter umum sering ditemui banyak pasien mengantri untuk berobat. Hal itu tidak efisien dikarenakan waktu yang bisa mereka gunakan untuk istirahat atau kegiatan lain habis untuk menunggu. Dari permasalahan tersebut, maka diperlukan suatu teknologi untuk memudahkan pasien dalam melakukan antrian. Pada paper ini dirancang sebuah aplikasi antrian secara online yang terbagi menjadi dua user; yaitu sisi pasien yang melakukan antrian menggunakan aplikasi berbasis Android dan SMS Gateway. Kemudian sisi petugas berbasis Web. Hasil keluaran dari aplikasi sistem antrian ini adalah membuat proses antrian dapat dilakukan secara online melalui smartphone android serta disediakan juga fitur notifikasi sehingga ketika nomor antrian yang terdekat dipanggil maka pasien mendapatkan reminder berupa notifikasi pada android atau SMS pada SMS Gateway untuk segera dapat kembali ke lokasi dokter

Senior men's pacing profiles at the IAAF World Cross Country Championships.

The aim of this study was to describe pacing profiles used by senior men competing in the World Cross Country Championships. Lap times were collated for 1273 competitors across 10 races. Each individual's lap times were expressed as a percentage of the eventual winner's lap times, and athletes were grouped according to finishing position. Most athletes started the race by following the pace set by the leaders but slowed relative to the winner with each successive lap. The gold medallists were faster than the other medallists only after the final lap (P < 0.001). Most athletes who dropped out (61%) had completed the first lap within 105% of the winner's lap time. The medallists used a strategy of running close to the front from an early stage, but did not separate themselves from other top 15 finishers until halfway, with the eventual medal positions decided even closer to the finish. Athletes finishing further down had positive pacing profiles relative to the winner, possibly because of early fatigue caused by a relatively quick first lap. Athletes should note that a patient approach during the early stages can benefit not only the mass field but also those who aim to win a medal

Behaviour sequelae following acute Kawasaki disease.

BACKGROUND: Kawasaki disease is a systemic vasculitis and may affect cerebral function acutely. The aim of the present study was to measure a number of behaviour and social parameters within a cohort of Kawasaki disease patients. METHODS: Parents of children with past diagnosis of Kawasaki disease were recruited to complete several behaviour screening questionnaires. Sixty five sets of questionnaires relating to the patient cohort received were eligible for inclusion. Two control groups were used, a hospital (HC) control and a sibling control (SC) group. RESULTS: 40% of the Kawasaki disease group showed elevated internalising scores in the clinical or borderline-clinical range. This compared with 18% of hospital controls and 13% of sibling controls. Additionally, the Kawasaki disease (KD) group were shown to be experiencing greater overall total difficulties when compared with the controls (KD 13.7, HC 8.6, SC 8.9). The KD group attained higher behavioural scores within the internalising sub-categories of somatic problems (KD 61, HC 57, SC 54) and withdrawn traits (KD 56, HC 53, SC 51). The KD group were also shown to be suffering more thought problems (KD 57, HC 53, SC 50) compared with the controls. Further difficulties relating to conduct (KD 3.3, HC 1.4) and social interactions (KD 6.7, HC 8.3) are also highlighted for the KD group compared with hospital controls. Positron emission tomograms were performed on nine patients to investigate severe behavioural problems. Three showed minor changes, possibly a resolving cerebral vasculopathy. CONCLUSION: Kawasaki disease can be associated with significant behavioural sequelae. This is an important consideration in the long-term follow up and referral to a clinical psychologist may be necessary in selected patients

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) self-rating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9-8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only one-third had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy

A pilot randomised controlled trial investigating a mindfulness-based stress reduction (MBSR) intervention in individuals with pulmonary arterial hypertension (PAH): the PATHWAYS study

BACKGROUND: Pulmonary arterial hypertension (PAH) is an uncommon condition with progressive heart failure and premature death. Treatment costs up to £120,000 per patient per year, and the psychological burden of PAH is substantial. Mindfulness-based stress reduction (MBSR) is an intervention with the potential to reduce this burden, but to date, it has not been applied to people with pulmonary hypertension. We wished to determine whether a trial of MBSR for people with PAH would be feasible. METHODS: A customised gentle MBSR programme of eight sessions was developed for people with physical disability due to PAH, and they were randomised to group-based MBSR or treatment as usual. The completeness of outcome measures including Beck Anxiety Index, Beck Depression Inventory and standard physical assessment at 3 months after randomisation were recorded. Health care utilisation was measured. Attendance at the sessions and the costs involved in delivering the intervention were assessed. Semi-structured interviews were conducted to explore the acceptability of the MBSR intervention and when appropriate the reasons for trial non-participation. RESULTS: Fifty-two patients were recruited, but only 34 were randomised due to patients finding it difficult to travel to sessions. Twenty-two completed all questionnaires and attended all clinics, both routine and additional in order to collect outcomes measures. The MSBR sessions were delivered in Bristol, Cardiff and London, costing, on average, between £2234 (Cardiff) and £4128 (London) per patient to deliver. Attendance at each session averaged between two patients in Bristol and Cardiff and three in London. For those receiving treatment as usual, clinician blinding was achievable. Interviews revealed that people who attended MBSR found it interesting and helpful in managing their symptoms and minimising the psychological component of their disease. CONCLUSIONS: We found that attendance at group MBSR was poor in people with chronic PAH within the context of a trial. Achieving better MBSR intervention attendance or use of an Internet-based programme might maximise the benefit of MBSR