Vestibular symptoms and relations with postural balance, inner ear function, and long term survival

Bakgrunn: Svimmelhet og balanseproblemer er vanlige symptomer som i befolkningsstudier har vært assosiert med økt dødelighet, men det er ikke kjent om det er sykdommer i balanseapparatet som forårsaker denne økte dødeligheten. Kunnskapsgrunnlaget for å vurdere og behandle pasienter med svimmelhet har vært vurdert som dårlig og ofte er det kun pasientens beskrivelse av symptomer som danner grunnlaget for å diagnostikken. Mål: Å evaluere hvilke symptomer som gir nyttig informasjon, og undersøke sammenhenger mellom balanse, funksjonen av det indre øre og langtidsoverlevelse. Materialer og metode: En gruppe pasienter henvist for vurdering med tanke på vestibulær sykdom i perioden mellom 1992 og 2004. Resultater: De fleste pasienter (72,1%) valgte kun en tids-kategori for å beskrive sine symptomer, mens mindre enn halvparten (47,1%) valgte kun en type svimmelhet. Oppkast var assosiert med økt risiko for asymmetri på kalorisk prøve (odds ratio 1,50. 95% konfidensintervall 1,24-2,06). 10-dB økning i hørselstap på det best hørende øret var assosiert med 6,0% økning i kurvelengde. Standardisert mortalitetsrate var 1,03 (0,94-1,12). Periodiske eller korte anfall av svimmelhet var assosiert med redusert dødelighet med hasard rate på henholdsvis 0,62 (0,50-0,77) og 0,76 (0,63-0,93). Pasient-rapportert ustøhet og ustøhet målt ved posturografi var assosiert med økt dødelighet med hasard rate på 1,30 (1,08-1,47) og 1,44 (1,14 – 1,82). Konklusjon: Det bør fokuseres på tidsaspektet av vestibulære symptomer og det bør skilles mellom oppkast og kvalme. Hvilken type svimmelhet pasienten opplever gir noe tilleggsinformasjon, men virker ikke å være nyttig for å kunne gruppere pasienter. Vestibulær sykdom kunne ikke forklare sammenhengen mellom hørsel og balanse i denne studien og vestibulær sykdom ser ikke ut til å være hovedårsaken til den økte dødeligheten blant personer med svimmelhet og balanseplager i den generelle befolkningen. For å finne årsakssammenhenger er det behov for ytterligere studier på dødsårsaker blant pasienter med vestibulære symptomer, vestibulær sykdom, dårlig balanse og nedsatt hørsel.Background: Dizziness and unsteadiness are common symptoms that can be caused by pathologies in various organ-systems. In the general population such symptoms are associated with increased mortality, but it is not known if this increased mortality is caused by vestibular pathology. Today, many of the common vestibular diagnoses depend on patient-reported symptoms alone, and the evidence base for evaluating and treating patients with dizziness has been described as low. Aim: To critically evaluate which symptoms reported by dizzy patients provide useful information, and further to evaluate the interrelations between posturography, inner ear function, and long-term survival. Material and methods: A cohort of patients examined from 1992 to 2004 at an otolaryngology department for suspected vestibular disorder. Results: While most patients (72.1%) chose only one timing category, fewer than half the patients (47.1%) describe their complaints with only one type of dizziness. Vomiting was associated with increased risk for caloric asymmetry (Odds ratio 1.60, 95 % CI 1.24–2.06). A 10-dB increase in hearing loss in the best-hearing ear was associated with a 6.0% increase in path length measured on a balance platform. The standardized mortality ratio was 1.03 (0.94–1.12). Periodic or short attacks of dizziness were associated with reduced mortality with a hazard ratio of 0.62 (0.50–0.77) and 0.76 (0.63–0.93), respectively. Both self-reported and unsteadiness on posturography were associated with increased mortality with a hazard ratio of 1.30 (1.08–1.47) and 1.44 (1.14–1.82). Conclusions: The timing of vestibular symptoms and a differentiation between nausea and vomiting should be targeted when interviewing patients. The type of dizziness provides additional information but does not appear useful for categorization. The association between hearing and postural balance was not explained by unilateral vestibular disorders. Vestibular pathology is probably not the main cause of the increased mortality seen among patients with vestibular symptoms and balance problems in the general population. Further studies exploring cause of death related to vestibular symptoms, hearing, and postural balance are advocated.Doktorgradsavhandlin

Mikrofinans : en kilde til økonomisk vekst?

Denne utredningen undersøker om stor utbredelse av mikrofinans i et land fører til økt økonomisk vekst. Utredningen er i hovedsak bygget på data fra en av de fremste kildene til data fra mikrofinanssektoren – The MIX Market. Vi stadfester først hvor mikrofinans er utbredt gjennom en omfattende deskriptiv del. Bangladesh og Bolivia blir valgt ut som to av de landene hvor en del av veksten i bruttonasjonalprodukt burde kunne spores tilbake til en stor mikrofinanssektor. Ved hjelp av en neoklassisk vekstmodell finner vi et maksimalanslag på bidraget til vekst i bruttonasjonalproduktet til disse to landene i løpet av en tiårs-periode. Bangladesh får et anslag på 1,2 prosent og Bolivia 6,1 prosent. Bidragene er relativt beskjedne i forhold til antall låntakere i landene. Hovedårsaken er at kapitalakkumulasjon fra mikrofinans fortsatt utgjør en liten del av landenes totale kapitalakkumulasjon. De små investeringene kan likevel gi fattige mennesker en høyere og mer stabil inntekt som løfter dem ut av ekstrem fattigdom

NEMO: Internet of Things based Real-time Noise and Emissions MOnitoring System for Smart Cities

With the advent of ubiquitous sensors and Internet of Things (IoT) applications, research and development initiatives on smart cities are ramping up worldwide. It enables remote monitoring, management, and control of devices and the generation of fresh and actionable insight from huge quantities of real-time data. Real-time noise and emissions monitoring of vehicles remain indispensable in a smart city context. Effective management and control of noise and emissions of vehicles on the road are necessary and possible through analyzing lots of sensor data in real-time to take an actionable insight. To contribute to this, as part of an ongoing effort of the European Union project called ''NEMO: Noise and Emissions Monitoring and Radical Mitigation'', in this paper, we present the design and development of an IoT-based real-time noise and emissions monitoring system for vehicles in a smart city context. Real-world sensor data of the vehicles in some European cities are collected during the pilot tests. We have developed a complete application for infrastructure managers and analysts to monitor the sensor data related to noise and emissions of vehicles in real-time. The data of the individual road vehicles and trains in selected EU cities and from trains on a track in the Netherlands are collected in the cloud and analyzed with artificial intelligence (AI) algorithms for classification such as high emitter, medium emitter, and normal emitters. We present the development of a complete software solution that can be integrated with existing intelligent transportation systems in smart cities. Finally, we report the initial vehicle classification results from the Rotterdam (Netherlands) pilot test as a representative example for the NEMO monitoring system.acceptedVersio

Hearing as an Independent Predictor of Postural Balance in 1075 Patients Evaluated for Dizziness

Objective To evaluate the association between hearing and postural balance. Study Design Retrospective cross-sectional study. Setting Tertiary care otolaryngology clinic. Subjects and Methods Patients examined for suspected vestibular disorder were included in this study. The outcome variable was postural sway measured by static posturography during quiet standing with eyes closed. The predictor variable was pure-tone average hearing threshold on the best hearing ear at 0.5, 1, 2, and 3 kHz. Covariates were age, sex, and vestibular disease or vestibular asymmetry assessed by bithermal caloric irrigation. Results In total, 1075 patients were included. Increased hearing threshold was a strong predictor of increased postural sway (path length) after correcting for age and sex. A 10-dB increase in hearing loss on the best hearing ear predicted a mean 6.0% increase in path length (confidence interval, 2.9%-9.3%, P < .001). Of the covariates, increasing age (P < .001) and male sex (P = .009) were significant predictors of increased postural sway. The effect of increased hearing threshold was also significant after adjusting for vestibular disease. Conclusion Increased hearing threshold was an independent predictor of increased postural instability, and this effect was strongest for the best hearing ear. Unilateral vestibular disease did not seem to explain this association between hearing and postural balance. Reduced hearing is associated with impaired balance, and interventions to prevent falls should be considered for patients at risk.acceptedVersio

Long-Term Survival in 1,931 Patients With Dizziness: Disease- and Symptom-Specific Mortality

Objective: To evaluate mortality among patients referred for suspected vestibular disorder and to examine whether specific symptoms or disorders predict long-term survival among patients with dizziness or vertigo. Study Design: Retrospective cohort study. Methods: This retrospective cohort study analyzed long-term survival data. Consecutive patients examined for suspected vestibular disease at an otolaryngology clinic completed a detailed questionnaire regarding symptoms and comorbidities. Results: The study included 1,931 patients. Their mean age (standard deviation) was 50.5 (16.5) years, and 60% were women. The mean follow-up period was 20.6 years (range, 15.3–27.5 years). The standardized mortality ratio for the entire cohort compared with the Norwegian age- and sex-matched population was 1.03 (95% confidence interval [CI]: 0.94–1.12), illustrating no difference in overall survival. Patients with a cerebrovascular cause of dizziness had higher mortality in adjusted Cox regression analyses (hazard ratio [HR] 1.56, 95% CI: 1.11–2.19), whereas patients reporting periodic or short attacks of dizziness had lower mortality (HR 0.62 [0.50–0.77] and 0.76 [0.63–0.93], respectively). Reported unsteadiness between dizziness attacks was associated with higher mortality with an HR of 1.30 (95% CI: 1.08–1.57). Conclusion: This long-term study found comparable mortality rates between patients evaluated for suspected vestibular disorder and that of the general population. However, subgroup analyses showed reduced mortality in patients with periodic or short attacks of dizziness and increased mortality in patients with unsteadiness between attacks or cerebrovascular causes of dizziness. The time course of vestibular symptoms should be determined, and thorough evaluation including fall risk and comorbidities must be considered in patients with nonepisodic symptoms.publishedVersio

Degradation of the LDL receptors by PCSK9 is not mediated by a secreted protein acted upon by PCSK9 extracellularly

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) post-transcriptionally degrades the low density lipoprotein receptors (LDLR). However, it is unknown whether PCSK9 acts directly on the LDLR or if PCSK9 activates another protein that in turn causes degradation of the LDLR. RESULTS: We have transiently transfected HepG2 cells with wild-type and mutant D374Y-PCSK9 plasmids to study the effect of the conditioned medium on the LDLR of untransfected HepG2 cells. The ability of the conditioned medium to reduce the internalization of LDL was abolished by removal of recombinant PCSK9 from the conditioned medium by affinity chromatography. Thus, PCSK9 is the only factor in the conditioned medium able to mediate degradation of the LDLR. Moreover, fractionation of the conditioned medium by gel filtration showed that the ability of the fractions to reduce the internalization of LDL, closely paralleled the amount of D374Y-PCSK9 in the fractions. Incubation of a secreted, truncated LDLR without cytoplasmic and transmembrane domains, as well as membrane fractions from HepG2 cells, with conditioned medium containing PCSK9, did not reduce the amount of LDLR as determined by western blot analysis. Thus, the LDLR is not degraded by PCSK9 on the cell surface. The LDLR of HepG2 cells incubated with conditioned medium was protected from PCSK9-mediated degradation by the addition of nocodazole or ammonium chloride, but was not protected when the conditioned medium was made hypertonic. These findings indicate that the intracellular degradation of the LDLR involves intracellular transport along microtubules, an acidic intracellular compartment and that it occurs even when endocytosis through clathrin-coated pits has been blocked. CONCLUSION: Degradation of the LDLR by PCSK9 is not mediated by a secreted protein acted upon by PCSK9 extracellularly. Also the PCSK9-mediated degradation of the LDLR does not take place on the cell surface. Rather, the PCSK9-mediated degradation of the LDLR appears to take place intracellularly and occurs even when endocytosis through clathrin-coated pits is blocked by hypertonic medium

NEMO: Real-Time Noise and Exhaust Emissions Monitoring for Sustainable and Intelligent Transportation Systems

Research and development efforts on sustainable and intelligent transportation systems are accelerating globally as the transportation sector contributes significantly to environmental pollution and produces a variety of noise and emissions that impact the climate. With the emergence of ubiquitous sensors and Internet of Things (IoT) applications, finding innovative transport solutions, including adequate climate change mitigation, will all be vital components of a sustainable transport future. Thus, it is essential to continuously monitor noise and exhaust emissions from road vehicles, trains, and ships. As a contribution to addressing this as part of an effort of the European Union project called “NEMO: Noise and Emissions Monitoring and Radical Mitigation", in this paper, we propose the design and development of a real-time noise and exhaust emissions monitoring for sustainable and intelligent transportation systems. We report real-world field testing in some European cities where vehicle noise and exhaust emissions data are gathered in the cloud-enabled Nautilus platform and evaluated using artificial intelligence (AI) algorithms to determine their categorization into different classes of emitters and thereby enabling the infrastructure managers to define logic and actions to be taken by high emitters in near real-time. We outline the creation of a complete NEMO solution to monitor and reduce noise and emissions in real time for sustainable and intelligent transportation systems.acceptedVersio

Krill oil attenuates left ventricular dilatation after myocardial infarction in rats

Background: In the western world, heart failure (HF) is one of the most important causes of cardiovascular mortality. Supplement with n-3 polyunsaturated fatty acids (PUFA) has been shown to improve cardiac function in HF and to decrease mortality after myocardial infarction (MI). The molecular structure and composition of n-3 PUFA varies between different marine sources and this may be of importance for their biological effects. Krill oil, unlike fish oil supplements, contains the major part of the n-3 PUFA in the form of phospholipids. This study investigated effects of krill oil on cardiac remodeling after experimental MI. Rats were randomised to pre-treatment with krill oil or control feed 14 days before induction of MI. Seven days post-MI, the rats were examined with echocardiography and rats in the control group were further randomised to continued control feed or krill oil feed for 7 weeks before re-examination with echocardiography and euthanization. Results: The echocardiographic evaluation showed significant attenuation of LV dilatation in the group pretreated with krill oil compared to controls. Attenuated heart weight, lung weight, and levels of mRNA encoding classical markers of LV stress, matrix remodeling and inflammation reflected these findings. The total composition of fatty acids were examined in the left ventricular (LV) tissue and all rats treated with krill oil showed a significantly higher proportion of n-3 PUFA in the LV tissue, although no difference was seen between the two krill oil groups. Conclusions: Supplement with krill oil leads to a proportional increase of n-3 PUFA in myocardial tissue and supplement given before induction of MI attenuates LV remodeling