The Effects of Isontonic Resistance Exercise on the Muscles of Mastication

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Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Melatonin for sundown syndrome and delirium in dementia: is it effective?

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Sleep disorders, nightmares, depression and anxiety in an elderly patient treated with low-dose metoprolol.

Contains fulltext : 89220.pdf (publisher's version ) (Closed access)In the Netherlands, the prescription of beta-blockers to patients older than 70 years has increased sharply in recent years. The neuropsychiatric adverse reactions associated with the use of beta-blockers are relatively uncommon and they are mostly seen with poisoning or overdose. We describe an 81-year-old man who developed sleep disorders, nightmares, depression and anxiety as probable adverse effect of low-dose metoprolol (25 mg/day). This case illustrates not only the neuropsychiatric adverse reactions of beta-blockers, but also that diagnosis of these reactions can be easily missed in elderly patients

Sleep disorders, nightmares, depression and anxiety in an elderly patient treated with low-dose metoprolol.

In the Netherlands, the prescription of beta-blockers to patients older than 70 years has increased sharply in recent years. The neuropsychiatric adverse reactions associated with the use of beta-blockers are relatively uncommon and they are mostly seen with poisoning or overdose. We describe an 81-year-old man who developed sleep disorders, nightmares, depression and anxiety as probable adverse effect of low-dose metoprolol (25 mg/day). This case illustrates not only the neuropsychiatric adverse reactions of beta-blockers, but also that diagnosis of these reactions can be easily missed in elderly patients

Role of plasma bilirubin as a biomarker for Alzheimer's disease: a retrospective cohort study.

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[Hallucinations and vivid dreams by use of metoprolol]

A 71-year-old man had had visual hallucinations and vivid dreams for two years after starting to take metoprolol. When metoprolol was replaced by atenolol the patient's symptoms disappeared within five days. Side-effects of beta-blockers on the central nervous system are relatively uncommon. The mechanisms underlying these side-effects are not fully understood. Lipophilic beta-blockers can cross the blood-brain barrier, whereas hydrophilic beta-blockers cannot. Doctors need to be alerted to the varying side-effects of specific beta-blockers

Severe depression and behavioral disturbance, an unusual presentation of intracerebral hemorrhage in a 78-year-old man

Item does not contain fulltextWe describe a case of a 78-year-old man who, on two occasions, had intracerebral hemorrhage with an atypical, predominantly psychiatric presentation: once with major depression without focal neurological signs and the second time with severe behavioral disturbance and only mild facial paralysis

The rise of ransomware and emerging security challenges in the Internet of Things

With the increasing miniaturization of smartphones, computers, and sensors in the Internet of Things (IoT) paradigm, strengthening the security and preventing ransomware attacks have become key concerns. Traditional security mechanisms are no longer applicable because of the involvement of resource-constrained devices, which require more computation power and resources. This paper presents the ransomware attacks and security concerns in IoT. We initially discuss the rise of ransomware attacks and outline the associated challenges. Then, we investigate, report, and highlight the state-of-the-art research efforts directed at IoT from a security perspective. A taxonomy is devised by classifying and categorizing the literature based on important parameters (e.g., threats, requirements, IEEE standards, deployment level, and technologies). Furthermore, a few credible case studies are outlined to alert people regarding how seriously IoT devices are vulnerable to threats. We enumerate the requirements that need to be met for securing IoT. Several indispensable open research challenges (e.g., data integrity, lightweight security mechanisms, lack of security software's upgradability and patchability features, physical protection of trillions of devices, privacy, and trust) are identified and discussed. Several prominent future research directions are provided