Variations in the management of pneumonia in pediatric emergency departments: Compliance with the guidelines

Objective: We sought to assess compliance with evidence-based guidelines for the management of pediatric pneumonia, including the variations in tests ordered and antimicrobials prescribed. Our primary hypothesis was that compliance with the treatment recommendations from the most current guidelines would be low for antimicrobial prescriptions. Methods: We conducted a chart review at the Children\u27s Hospital in London, Ont., to assess variation in the management of pediatric pneumonia. All patients aged 3 months to 18 years seen at the pediatric emergency department between Apr. 1, 2006, and Mar. 31, 2007, with a diagnosis of pneumonia were eligible for inclusion in the study. Results: Compliance with management guidelines was 59.7% (95% confidence interval [CI] 53%-66%, n = 211) in children 5-18 years old and 83.0% (95% CI 80%-86%, n = 605) in children 3 months to 5 years old. Significant variation existed in the choice of antimicrobial agent for children with pneumonia, with nonrecommended agents frequently prescribed. Conclusion: Significant variation existed in the management of pediatric pneumonia, and adherence to guidelines was low for the group of patients aged 5-18 years. Future studies should attempt to provide guidance to distinguish between viral and bacterial etiology to allow judicious use of antimicrobials

Serum anti-Müllerian hormone as a predictor of polycystic ovarian syndrome among women of reproductive age

BackgroundPolycystic ovarian syndrome (PCOS) affects up to one-fifth of women of reproductive age and causes anovulatory subfertility. Some studies have recommended that an anti-Müllerian hormone (AMH) level greater than 3.8–5 ng/mL can be used for diagnosing PCOS. This study aims to analyse serum AMH levels among PCOS women of reproductive age to use AMH as a biomarker predictor along with other Rotterdam criteria.MethodsIn this cross-sectional study, a total of 98 women visiting the fertility center of a private hospital in Lahore, Pakistan, were screened. Data were obtained from 51 PCOS newly diagnosed women aged 28.24 years (SD ± 4.84 years) meeting at least two of the Rotterdam criteria and specific inclusion criteria. Baseline variables, menstrual cycle length, ovarian morphology on ultrasound, hirsutism, sex hormones, gonadotropin, and serum AMH levels were analysed during the follicular phase (1–5 days) of the menstrual cycle. Serum AMH was measured by an enzyme-linked immunosorbent assay.ResultsA high serum AMH level (7.23 ± 4.67 ng/ml) was recorded with normal sex hormone levels. Women with oligo-/amenorrhea had a significant mean difference for luteinizing hormone (p = 0.02) and AMH levels (p = 0.03) when compared with women of normal menstrual cycle length. PCOS women with high AMH levels (≥ 3.9 ng/ml) showed a significant difference in ovarian morphology (p < 0.05) when compared with the normal AMH group.ConclusionsAn elevated serum AMH level can be used as a strong predictor to reflect the certainty of PCOS diagnosis among women of reproductive age when study concurrently with the other Rotterdam criteria

Comparison of physical activity levels and dietary habits between women with polycystic ovarian syndrome and healthy controls of reproductive age: A case-control study

BackgroundPolycystic ovarian syndrome (PCOS) is a reproductive hormonal anomaly prevalent among women of reproductive age, with an alarmingly high prevalence of 52% among Pakistani women. This study aims to compare the daily physical activity and dietary habits of women with PCOS with age-matched healthy controls living in Lahore, Pakistan.MethodsA case–control study design was used to collect data from a private hospital situated in Lahore, Pakistan. Data was collected from 115 participants of reproductive age (18–45 years) using a researcher-administered questionnaire. Demographic variables, reproductive characteristics, anthropometric measurements, and seven days of physical activity levels using the international physical activity questionnaire (IPAQ-Short version) and seven days of dietary intake using the food frequency questionnaire (7 days-FFQ) were used to measure the dietary habits of the participants. Mosby’s Nutritac v4.0 software was used to estimate the macronutrients, vitamins, and minerals present in dietary intake. The glycaemic index and glycaemic load were calculated to compare the quality and quantity of carbohydrate consumption between the two groups.ResultsThe 49 PCOS cases, newly identified using the Rotterdam criteria, mean age 24.63 years (SD ± 4.76), and 66 healthy controls, mean age 23.24 years (SD ± 5.45), were compared. A significant difference (p ≤ 0.05) was found for reproductive characteristics, daily physical activity, and polyunsaturated fat and vitamin intake between the two groups. A binary logistic regression analysis showed that food with a low glycaemic index (GI ≤ 40) reduced the odds of PCOS occurrence by OR = 1.94. Similarly, food nutrients with a low glycaemic load (GL ≤ 10) can reduce PCOS occurrence by OR = 1.60.ConclusionThe daily physical activity levels and dietary habits of women of reproductive age can influence their reproductive characteristics and polycystic ovarian morphology. A diet with a low glycaemic load and index can produce beneficial reproductive health effects among women of reproductive age.<br/

An investigation of spatial signal transduction in cellular networks

<p>Abstract</p> <p>Background</p> <p>Spatial signal transduction plays a vital role in many intracellular processes such as eukaryotic chemotaxis, polarity generation and cell division. Furthermore it is being increasingly realized that the spatial dimension to signalling may play an important role in other apparently purely temporal signal transduction processes. It is increasingly being recognized that a conceptual basis for studying spatial signal transduction in signalling networks is necessary.</p> <p>Results</p> <p>In this work we examine spatial signal transduction in a series of standard motifs/networks. These networks include coherent and incoherent feedforward, positive and negative feedback, cyclic motifs, monostable switches, bistable switches and negative feedback oscillators. In all these cases, the driving signal has spatial variation. For each network we consider two cases, one where all elements are essentially non-diffusible, and the other where one of the network elements may be highly diffusible. A careful analysis of steady state signal transduction provides many insights into the behaviour of all these modules. While in the non-diffusible case for the most part, spatial signalling reflects the temporal signalling behaviour, in the diffusible cases, we see significant differences between spatial and temporal signalling characteristics. Our results demonstrate that the presence of diffusible elements in the networks provides important constraints and capabilities for signalling.</p> <p>Conclusions</p> <p>Our results provide a systematic basis for understanding spatial signalling in networks and the role of diffusible elements therein. This provides many insights into the signal transduction capabilities and constraints in such networks and suggests ways in which cellular signalling and information processing is organized to conform to or bypass those constraints. It also provides a framework for starting to understand the organization and regulation of spatial signal transduction in individual processes.</p

Transcatheter Aortic Valve Replacement Incidentalomas: A Multimodality Imaging Case of Giant Right Coronary Aneurysm

Giant coronary artery aneurysms (CAAs) are defined as having a diameter of greater than 2 cm. We report a case of an 82-year-old male with severe aortic stenosis incidentally diagnosed with giant right coronary artery aneurysm (gRCAA) while undergoing evaluation for transcather aortic valve replacement (TAVR). It was causing a mass effect on the right cardiac chambers but was otherwise asymptomatic. Our patient was successfully treated with surgical excision of aneurysm with concomitant coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). The patient remained stable at discharge and on serial follow-ups for two years. In conclusion, due to the associated complication and increased risk of mortality with giant coronary aneurysms, we recommend surgical approach instead of medical management alone. We also call for evidence-based recommendations and guidelines for management of TAVR incidentalomas

A Survey on FPGA-Based Sensor Systems: Towards Intelligent and Reconfigurable Low-Power Sensors for Computer Vision, Control and Signal Processing

The current trend in the evolution of sensor systems seeks ways to provide more accuracy and resolution, while at the same time decreasing the size and power consumption. The use of Field Programmable Gate Arrays (FPGAs) provides specific reprogrammable hardware technology that can be properly exploited to obtain a reconfigurable sensor system. This adaptation capability enables the implementation of complex applications using the partial reconfigurability at a very low-power consumption. For highly demanding tasks FPGAs have been favored due to the high efficiency provided by their architectural flexibility (parallelism, on-chip memory, etc.), reconfigurability and superb performance in the development of algorithms. FPGAs have improved the performance of sensor systems and have triggered a clear increase in their use in new fields of application. A new generation of smarter, reconfigurable and lower power consumption sensors is being developed in Spain based on FPGAs. In this paper, a review of these developments is presented, describing as well the FPGA technologies employed by the different research groups and providing an overview of future research within this field.The research leading to these results has received funding from the Spanish Government and European FEDER funds (DPI2012-32390), the Valencia Regional Government (PROMETEO/2013/085) and the University of Alicante (GRE12-17)

Structure and function of membrane proteins encapsulated in a polymer-bound lipid bilayer

New technologies for the purification of stable membrane proteins have emerged in recent years, in particular methods that allow the preparation of membrane proteins with their native lipid environment. Here, we look at the progress achieved with the use of styrene-maleic acid copolymers (SMA) which are able to insert into biological membranes forming nanoparticles containing membrane proteins and lipids. This technology can be applied to membrane proteins from any host source, and, uniquely, allows purification without the protein ever being removed from a lipid bilayer. Not only do these SMA lipid particles (SMALPs) stabilise membrane proteins, allowing structural and functional studies, but they also offer opportunities to understand the local lipid environment of the host membrane. With any new or different method, questions inevitably arise about the integrity of the protein purified: does it retain its activity; its native structure; and ability to perform its function? How do membrane proteins within SMALPS perform in existing assays and lend themselves to analysis by established methods? We outline here recent work on the structure and function of membrane proteins that have been encapsulated like this in a polymer-bound lipid bilayer, and the potential for the future with this approach

Tribological performance of palm kernel oil with addition of pour point depressants as a lubricant using four-ball tribotester under variable load test

The growing of worldwide trend for promoting the use of the renewable material such as vegetable oil is due to the increasing concern about environmental damage that caused by the use of mineral oil which is not biodegradable. Vegetable oil has a potential to replace mineral oil as a lubricant because of its specific properties that is non-toxic and biodegradable. The main problem in using vegetable oil is having poor low temperature performance. In this research palm kernel oil (PKO) that behave a semi solid phase is used as a bio lubricant mixing with different weightage percentage of poor point depressant (PPD) to investigate the low temperature behaviour performance and also to determine the effect of lubricity performance when blended with different percentage of PPD (5w%, 10wt%, 20wt% and 30wt %). The experiment is according to ASTM D4172 with variation load test. The result of the experiment show that for low temperature performance, PKO with 20wt%PPD (A2-20%) and 30wt%PPD (A2-30%) show great performance which can withstand 15° C. The sample A2-20% shows good lubricity performance in terms of coefficient of friction compare to the other sample. The lubricity performance in terms of wear scar diameter (WSD) it can see that the different percentage PPD do not affect the WSD properties of the pure palm kernel oil. The most consistent and the desired value of the sample in terms of surface roughness is A2-5% and A2-10% where the surface roughness value is stable through the entire load test

Fuzzy logic-based controller of the bidirectional direct current to direct current converter in microgrid

Microgrids are small-scale power networks that include renewable energy sources, load, energy storage systems, and energy management systems (EMS). Lithium-ion batteries are the most used battery for energy storage in microgrids due to their advantages over other types of batteries. However, to protect the battery from the explosion and to manage to charge and discharge based on state-of-charge (SoC) value, this type of battery requires the use of an energy management system. The main objective of this paper is to propose an intelligent control strategy for energy management in the microgrid to control the charge and discharge of Li-ion batteries to stabilize the system and reduce the cost of electricity due to the high cost of grid electricity. The proposed technique is based on a fuzzy logic controller (FLC) for voltage control. The FLC is based on the measured voltage of the direct current (DC) bus and the fixed reference voltage to generate buck/boost converter signal control. The proposed technique has been simulated and tested using MATLAB/Simulink software which illustrates the tracking of desired power and DC bus voltage regulation. The simulation results confirm that the proposed systems can diminish the deviations of the system's voltage