Postural balance and acceleration threshold detection for anterior horizontal translation in diabetic and non-diabetic elderly

Slips and falls, and even the fear of failing, can represent a major medical and functional deterrent to living independently, especially among the elderly population. Various groups of elders are at known risk for falling including, but not limited to, those with vestibular dysfunction, those with low visual acuity including visual neuropathies, and those with peripheral neuropathies. The first two groups are fairly well studied, but the relationship between the level of peripheral neuropathy and extent of falling has received relatively less attention. In this study, using sliding linear investigative platform for analyzing lower limb stability (SLIP-FALLS), the psychophysical thresholds and strategies used for, detecting uItra-low-vibration horizontal translations in the elderly population (age range of 50 and 75 years) with adult-onset diabetes or peripheral neuropathy were determined. Acceleration thresholds for anterior horizontal movements of 1, 4, and 16 mm were determined. These detection thresholds were compared with healthy young adults (age \u3c 35 years) and age-matched elders without neuropathy. The extent of peripheral neuropathy was quantified by standard clinical nerve conduction tests of the sensory and motor nerves of the lower extremity by the Neurological Service of the Overton Brooks VAMC. Psychophysically, the acceleration thresholds have a negative power law relationship with the perturbation distance and are significantly higher for the elderly population when compared to young adults. A predictive Balasubramanian-Robinson model for determining acceleration thresholds for perturbation has been presented. Among the elderly, neurologically intact individuals were found to have a lower threshold for detection than those with neurological impairments. Conversely, the conduction velocities of the sensory and motor nerves were lower in case of the elderly with adult-onset diabetes or peripheral neuropathy. It was also found that cognitive and tactile sensory responses alone cannot be used to differentiate between the two groups of elderly. The diabetic elderly had a significantly higher lateral sway and increased reaction time for foot touch, platform perturbation, and auditory stimuli. These factors probably contribute to the increased risk of failing in the diabetic elderly

Clinical review: Ketones and brain injury

Although much feared by clinicians, the ability to produce ketones has allowed humans to withstand prolonged periods of starvation. At such times, ketones can supply up to 50% of basal energy requirements. More interesting, however, is the fact that ketones can provide as much as 70% of the brain's energy needs, more efficiently than glucose. Studies suggest that during times of acute brain injury, cerebral uptake of ketones increases significantly. Researchers have thus attempted to attenuate the effects of cerebral injury by administering ketones exogenously. Hypertonic saline is commonly utilized for management of intracranial hypertension following cerebral injury. A solution containing both hypertonic saline and ketones may prove ideal for managing the dual problems of refractory intracranial hypertension and low cerebral energy levels. The purpose of the present review is to explore the physiology of ketone body utilization by the brain in health and in a variety of neurological conditions, and to discuss the potential for ketone supplementation as a therapeutic option in traumatic brain injury

A Fake Profile Detection Model Using Multistage Stacked Ensemble Classification

Fake profile identification on social media platforms is essential for preserving a reliable online community. Previous studies have primarily used conventional classifiers for fake account identification on social networking sites, neglecting feature selection and class balancing to enhance performance. This study introduces a novel multistage stacked ensemble classification model to enhance fake profile detection accuracy, especially in imbalanced datasets. The model comprises three phases: feature selection, base learning, and meta-learning for classification. The novelty of the work lies in utilizing chi-squared feature-class association-based feature selection, combining stacked ensemble and cost-sensitive learning. The research findings indicate that the proposed model significantly enhances fake profile detection efficiency. Employing cost-sensitive learning enhances accuracy on the Facebook, Instagram, and Twitter spam datasets with 95%, 98.20%, and 81% precision, outperforming conventional and advanced classifiers. It is demonstrated that the proposed model has the potential to enhance the security and reliability of online social networks, compared with existing models

Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution

Introduction: As even small concentrations of acetate in the plasma result in pro-inflammatory and cardiotoxic effects, it has been removed from renal replacement fluids. However, Plasma-Lyte 148 (Plasma-Lyte), an electrolyte replacement solution containing acetate plus gluconate is a common circuit prime for cardio-pulmonary bypass (CPB). No published data exist on the peak plasma acetate and gluconate concentrations resulting from the use of Plasma-Lyte 148 during CPB

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock.

Background Whether hydrocortisone reduces mortality among patients with septic shock is unclear. Methods We randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days or until death or discharge from the intensive care unit (ICU), whichever came first. The primary outcome was death from any cause at 90 days. Results From March 2013 through April 2017, a total of 3800 patients underwent randomization. Status with respect to the primary outcome was ascertained in 3658 patients (1832 of whom had been assigned to the hydrocortisone group and 1826 to the placebo group). At 90 days, 511 patients (27.9%) in the hydrocortisone group and 526 (28.8%) in the placebo group had died (odds ratio, 0.95; 95% confidence interval [CI], 0.82 to 1.10; P=0.50). The effect of the trial regimen was similar in six prespecified subgroups. Patients who had been assigned to receive hydrocortisone had faster resolution of shock than those assigned to the placebo group (median duration, 3 days [interquartile range, 2 to 5] vs. 4 days [interquartile range, 2 to 9]; hazard ratio, 1.32; 95% CI, 1.23 to 1.41; P<0.001). Patients in the hydrocortisone group had a shorter duration of the initial episode of mechanical ventilation than those in the placebo group (median, 6 days [interquartile range, 3 to 18] vs. 7 days [interquartile range, 3 to 24]; hazard ratio, 1.13; 95% CI, 1.05 to 1.22; P<0.001), but taking into account episodes of recurrence of ventilation, there were no significant differences in the number of days alive and free from mechanical ventilation. Fewer patients in the hydrocortisone group than in the placebo group received a blood transfusion (37.0% vs. 41.7%; odds ratio, 0.82; 95% CI, 0.72 to 0.94; P=0.004). There were no significant between-group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the number of days alive and out of the hospital, the recurrence of mechanical ventilation, the rate of renal-replacement therapy, and the incidence of new-onset bacteremia or fungemia. Conclusions Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo. (Funded by the National Health and Medical Research Council of Australia and others; ADRENAL ClinicalTrials.gov number, NCT01448109 .)

Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis

BACKGROUND: The comparative efficacy and safety of balanced crystalloid solutions and saline for fluid therapy in critically ill adults remain uncertain. METHODS: We systematically reviewed randomized clinical trials (RCTs) comparing the use of balanced crystalloids with saline in critically ill adults. The primary outcome was 90-day mortality after pooling data from low-risk-of-bias trials using a random-effects model. We also performed a Bayesian meta-analysis to describe the primary treatment effect in probability terms. Secondary outcomes included the incidence of acute kidney injury (AKI), new treatment with renal replacement therapy (RRT), and ventilator-free and vasopressor-free days to day 28. RESULTS: We identified 13 RCTs, comprising 35,884 participants. From six trials (34,450 participants) with a low risk of bias, the risk ratio (RR) for 90-day mortality with balanced crystalloids versus saline was 0.96 (95% confidence interval [CI], 0.91 to 1.01; I2 = 12.1%); using vague priors, the posterior probability that balanced crystalloids reduce mortality was 89.5%. The RRs of developing AKI and of being treated with RRT with balanced crystalloids versus saline were 0.96 (95% CI, 0.89 to 1.02) and 0.95 (95% CI, 0.81 to 1.11), respectively. Ventilator-free days (mean difference, 0.18 days; 95% CI, −0.45 to 0.81) and vasopressor-free days (mean difference, 0.19 days; 95% CI, −0.14 to 0.51) were similar between groups. CONCLUSIONS: The estimated effect of using balanced crystalloids versus saline in critically ill adults ranges from a 9% relative reduction to a 1% relative increase in the risk of death, with a high probability that the average effect of using balanced crystalloids is to reduce mortality

Comprehensive computational investigations on various aerospace materials under complicated loading conditions through conventional and advanced analyses: a verified examination

Most failures develop as a result of a lack of resistivity information at the internal structure level during typical loading situations such as shock load and impact load. Impact loads have a significant impact on a component’s structural performance. A careful, organized examination of impact load settings and their side effects can reveal how well something can withstand peak loads. First, this study investigated the impact analyses on nine varied lightweight composite materials through a conventional experimental setup and computational tools. So, the best three lightweight materials are shortlisted for further investigation under complicated explicit analysis. Second, the study investigated the behavior of composite materials subjected to rapid loading circumstances in several real-time applications. The applications chosen include bullet crash analysis, unmanned aerial vehicle (UAV) propellers, and car bumpers. The three different principal composites, carbon fiber-reinforced polymer (CFRP), glass fiber-reinforced polymer (GFRP), and Kevlar fiber-reinforced polymer (KFRP), are selected and applied in crash analysis using ANSYS Workbench’s explicit technique-based finite element analysis (FEA). The comparison assessments are conducted using stumpy structural characteristics such as impact stress and equivalent strain. Two distinct grid convergence tests were performed to check whether the computational processes and discretization were correct. The standard methodologies were used on all three selected real-time applications, resulting in error percentages that were within acceptable bounds, ensuring the generation of dependable structural outputs. The ideal composite material is a Kevlar fiber-based composite with minimal defect affectability for all types of crash applications. Furthermore, multidisciplinary optimizations are performed, and the KFRP is verified to give good crash load resistance with reduced dense contribution

Understanding Technology as Situated Practice: Everyday use of Voice User Interfaces Among Diverse Groups of Users in Urban India

Abstract: As smartphones have become ubiquitous across urban India, voice user interfaces (VUIs) are increasingly becoming part of diverse groups of users’ daily experiences. These technologies are now generally accessible as a result of improvements in mobile Internet access, [-8.5pc]Biography is Required. Please provide. introduction of low-cost smartphones and the ongoing process of their localisation into Indian languages. However, when people engage with technologies in their everyday lives, they not only enact the material attributes of the artifact but also draw on their skills, social positions, prior experience and societal norms and expectations to make use of the artifact. Drawing on Orlikowski’s analytical framework of “technologies-in-practice” we engage in an interview-based exploratory study among diverse groups of users in urban India to understand use of VUIs as situated practice. We identify three technologies-in-practice emerging through enactment of VUIs on users’ smartphones: looking up, learning and leisure. We argue that – instead of asking why and how users appropriate VUIs – identifying different kinds of enactments of VUIs present researchers and practitioners with a more nuanced understanding of existing and potential use of VUIs across varied contexts

Angiotensin II for the Treatment of Vasodilatory Shock

BACKGROUND Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated the effectiveness of angiotensin II for the treatment of patients with this condition. METHODS We randomly assigned patients with vasodilatory shock who were receiving more than 0.2 mu g of norepinephrine per kilogram of body weight per minute or the equivalent dose of another vasopressor to receive infusions of either angiotensin II or placebo. The primary end point was a response with respect to mean arterial pressure at hour 3 after the start of infusion, with response defined as an increase from baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, without an increase in the dose of background vasopressors. RESULTS A total of 344 patients were assigned to one of the two regimens; 321 received a study intervention (163 received angiotensin II, and 158 received placebo) and were included in the analysis. The primary end point was reached by more patients in the angiotensin II group (114 of 163 patients, 69.9%) than in the placebo group (37 of 158 patients, 23.4%) (odds ratio, 7.95; 95% confidence interval [CI], 4.76 to 13.3; P<0.001). At 48 hours, the mean improvement in the cardiovascular Sequential Organ Failure Assessment (SOFA) score (scores range from 0 to 4, with higher scores indicating more severe dysfunction) was greater in the angiotensin II group than in the placebo group (-1.75 vs. -1.28, P = 0.01). Serious adverse events were reported in 60.7% of the patients in the angiotensin II group and in 67.1% in the placebo group. Death by day 28 occurred in 75 of 163 patients (46%) in the angiotensin II group and in 85 of 158 patients (54%) in the placebo group (hazard ratio, 0.78; 95% CI, 0.57 to 1.07; P = 0.12). CONCLUSIONS Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors. (Funded by La Jolla Pharmaceutical Company; ATHOS-3 ClinicalTrials.gov number, NCT02338843.)Peer reviewe

Understanding consumer intention to participate in online travel community and effects on consumer intention to purchase travel online and WOM: an integration of innovation diffusion theory and TAM with trust

The growing presence of online travel communities is leading to great developments in the travel industry. Grounded in the innovation diffusion theory (IDT) and the technology acceptance model (TAM), this paper seek to develop and empirically test a comprehensive framework to examine the antecedents of customers' intention to participate in online travel community. Using SEM to analyse the data collected from a sample of 495 members, the results indicate that innovation diffusion theory and TAM with trust provide an appropriate model for explaining consumers' intention to participate; this intention in turn has a positive influence on intention to purchase and positive WOM. Furthermore, religiosity plays an important role in understanding consumers' behavioural intention. The results offer important implications for online service provider and are likely to stimulate further research in the area of online travel community