Mean platelet volume as a predictor of clinical outcomes in patients of acute myocardial infarction

Background: High levels of mean platelet volume (MPV), as an indicator of larger, more reactive platelets resulting from an increased platelet turnover, may represent a risk factor for overall vascular mortality and other cardiovascular events, including myocardial infarction (MI). The present study was undertaken to see the predictive value of MPV in accessing the clinical outcomes in acute myocardial infarction, (AMI).Methods: Total consecutive 114 cases of AMI admitted to intensive care unit were enrolled in the study and were compared with the equal number of age and gender-matched controls. The clinical evaluation of cases was done at admission and on day 7 in terms of a) Cardiogenic shock, b) Arrhythmia and c) Effect of thrombolysis. Patients were classified according to tertile of baseline MPV.Results: The mean age of cases was 55.56±12.19 years. Males (66.67%) were outnumbering females (33.33%) in cases and controls showing male to female ratio of 2:1. Mean MPV was 10.2±1.27fl in cases and 7.26±0.79fl in controls which was statistically significant. Correlation of MPV with cardiogenic shock, arrhythmia and mortality was significant. Correlation of MPV with risk factor shows that diabetes was the only risk factor significant in AMI. Multiple logistic regression of risk factors with mortality in AMI shows that high MPV and obesity was found to be independently associated with mortality in AMI.Conclusions: Mean platelet volume is simple, easily available and cheap method. Serial estimation of MPV is a predictor of adverse clinical outcome in AMI so treating doctor can be more vigilant

AN OVERVIEW ON DIFFERENT METHODS OF FAULT LOCATION IN UNDERGROUND CABLE SYSTEM

ABSTRACT Finding and designing new methods for determining type and exact location of faults in power system has been a major subject for power system protection. One of the main capabilities that can improve the efficiency of new protection relays in power systems is exact fault location. In this paper various approaches used for determiningfault location in underground cable systems and the factors that affects the fault location are discussed

Content analysis of nutritional information in paediatric oral health education leaflets

Background: The aim of this study was to determine if paediatric oral health education leaflets with a food and nutritional focus provide messages that are clear and consistent with the current Australian Dietary Guidelines and the Infant Feeding Guidelines. Methods: Forty-three leaflets aimed at parents were sourced from Australian state and territory Health Departments, oral health industry partners and commercial organisations, and a content analysis was performed. Recommendations on food and drink type, consumption frequency and general diet and nutrition advice were considered and cross-referenced with the Australian Dietary Guidelines and the Infant Feeding Guidelines to identify areas of consistency and discrepancy. Results: Twenty leaflets recommended reducing the consumption of sugary and/or acidic food, while 23 leaflets recommended reducing the consumption of sugary and/or acidic drinks. The majority of the leaflets advised water (n = 35) and milk (n = 23) to drink. Although 33 leaflets encouraged a healthy diet, seven of these did not specify what a healthy diet was. Twenty-eight leaflets provided early childhood-related (0-2 years) feeding advice. Confusing messages were found in nine leaflets, with ambiguous recommendations that were open to individual interpretation. Conclusions: There were some inconsistencies between the leaflets and the dietary and infant feeding guidelines in Australia; and across the leaflets, as not all important messages were included in any one leaflet. Government Health Departments and other relevant agencies should ensure that advisory messages regarding diet, particularly those with dental implications, are clear, complete and consistent across all dental educational leaflets. © 2017 The Author(s)

REST APIs: A large-scale analysis of compliance with principles and best practices

Quickly and dominantly, REST APIs have spread over the Web and percolated into modern software development practice, especially in the Mobile Internet where they conveniently enable offloading data and computations onto cloud services. We analyze more than 78GB of HTTP traffic collected by Italy’s biggest Mobile Internet provider over one full day and study how big the trend is in practice, how it changed the traffic that is generated by applications, and how REST APIs are implemented in practice. The analysis provides insight into the compliance of state-of-the-art APIs with theoretical Web engineering principles and guidelines, knowledge that affects how applications should be developed to be scalable and robust. The perspective is that of the Mobile Internet

An Empirical Analysis of the Relationship between Land Size, Ownership, and Soybean Productivity - New Evidence from the Semi-Arid Tropical Region in Madhya Pradesh, India

The intervention of the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) at the benchmark site in Madhya Pradesh, India is part of a larger project – “Improving Management of Natural Resources for Sustainable Rainfed Agriculture” funded by the Asian Development Bank (ADB). The main aim of the project is to increase the productivity and sustainability of the medium and high water-holding capacity soils in the intermediate rainfall ecoregions in India, Vietnam, and Thailand. This study examines the relationship between land size and various variables including the soybean productivity relationship among owner-operated and share cropper-operated farms. Primary data was collected using an interview schedule from the villages of Jaoti, Kundhankhedi, Kherkhedi, and Lalatora in Vidisha district, Madhya Pradesh for the 1999 rainy season crop. The productivity of evaluated owner-operated farms is marginally higher at 0.72 t ha-1 compared to 0.68 t ha-1 in case of share cropped farms. The productivity of evaluated trial farms in Lalatora micro-watershed which is used as a demonstration micro-watershed for evaluating improved management practice has been higher at 1.1 t ha-1. The inverse-relationship between land size and productivity is found for both owner-operated (r = 0.27) and share cropper-operated farms (r = 0.30). The average profit is higher among owner-operated farms at Rs. 2045 ha-1 compared to Rs. 1773 ha-1 among share cropped farms. The profitability for the landlords and share croppers is documented and evidence is presented on the exploitative nature of the emerging 20:80 crop sharing contract. The low productivity has been due to waterlogging which occurred due to heavy rains during the sowing period

Friedreich's ataxia-associated childhood hypertrophic cardiomyopathy: a national cohort study

OBJECTIVE: Hypertrophic cardiomyopathy (HCM) is an important predictor of long-term outcomes in Friedreich's ataxia (FA), but the clinical spectrum and survival in childhood is poorly described. This study aimed to describe the clinical characteristics of children with FA-HCM. DESIGN AND SETTING: Retrospective, longitudinal cohort study of children with FA-HCM from the UK. PATIENTS: 78 children (<18 years) with FA-HCM diagnosed over four decades. INTERVENTION: Anonymised retrospective demographic and clinical data were collected from baseline evaluation and follow-up. MAIN OUTCOME MEASURES: The primary study end-point was all-cause mortality (sudden cardiac death, atrial arrhythmia-related death, heart failure-related death, non-cardiac death) or cardiac transplantation. RESULTS: The mean age at diagnosis of FA-HCM was 10.9 (±3.1) years. Diagnosis was within 1 year of cardiac referral in 34 (65.0%) patients, but preceded the diagnosis of FA in 4 (5.3%). At baseline, 65 (90.3%) had concentric left ventricular hypertrophy and 6 (12.5%) had systolic impairment. Over a median follow-up of 5.1 years (IQR 2.4-7.3), 8 (10.5%) had documented supraventricular arrhythmias and 8 (10.5%) died (atrial arrhythmia-related n=2; heart failure-related n=1; non-cardiac n=2; or unknown cause n=3), but there were no sudden cardiac deaths. Freedom from death or transplantation at 10 years was 80.8% (95% CI 62.5 to 90.8). CONCLUSIONS: This is the largest cohort of childhood FA-HCM reported to date and describes a high prevalence of atrial arrhythmias and impaired systolic function in childhood, suggesting early progression to end-stage disease. Overall mortality is similar to that reported in non-syndromic childhood HCM, but no patients died suddenly

Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism

Spontaneous ruptures of the extensor mechanism of the knee are very rare. They tend to increase considerably in patients with metabolic diseases such as chronic renal failure, hyperparathyroidism, diabetes, gout, and systemic lupus erythematosus. The reported case regards a 48-year-old man with chronic, spontaneous and simultaneous quadriceps, and contra-lateral patellar tendon rupture. The patient suffered from chronic renal failure and for the past year from tertiary hyperparathyroidism. Ruptured tendons were repaired and both knee were evaluated monthly for the next 12 months. Good functional recovery was achieved on both knees without relapse. This case emphasizes the importance of long-term high parathyroid hormone level in the etiology of tendons ruptures

Optimal liability sharing and court errors: an exploratory analysis

We focus in this paper on the effects of court errors on the optimal sharing of liability between firms and financiers, as an environmental policy instrument. Using a structural model of the interactions between firms, financial institutions, governments and courts we show, through numerical simulations, the distortions in liability sharing between firms and financiers that the imperfect implementation of government policies implies. We consider in particular the role played by the efficiency of the courts in avoiding Type I (finding an innocent firm guilty of inappropriate care) and Type II (finding a guilty firm innocent of inappropriate care) errors. This role is considered in a context where liability sharing is already distorted (when compared with first best values) due not only to the courts' own imperfect assessment of safety care levels exerted by firm but also to the presence of moral hazard and adverse selection in financial contracting, as well as of noncongruence of objectives between firms and financiers on the one hand and social welfare maximization on the other. Our results indicate that an increase in the efficiency of the court system in avoiding errors raises safety care levels, thereby reducing the probability of accident, and allowing the social welfare maximizing government to impose a lower liability [higher] share for firms [financiers] as well as a lower standard level of care

Sudden cardiac death in childhood RASopathy-associated hypertrophic cardiomyopathy: Validation of the HCM risk-kids model and predictors of events

Background: RASopathies account for nearly 20% of cases of childhood hypertrophic cardiomyopathy (HCM). Sudden cardiac death (SCD) occurs in patients with RASopathy-associated HCM, but the risk factors for SCD have not been systematically evaluated. Aim: To validate the HCM Risk-Kids SCD risk prediction model in children with RASopathy-associated HCM and investigate potential specific SCD predictors in this population. Methods: Validation of HCM Risk-Kids was performed in a retrospective cohort of 169 patients with a RASopathy-associated HCM from 15 international paediatric cardiology centres. Multiple imputation by chained equations was used for missing values related to the HCM Risk-Kids parameters. Results: Eleven patients (6.5%) experienced a SCD or equivalent event at a median age of 12.5 months (IQR 7.7–28.64). The calculated SCD/equivalent event incidence was 0.78 (95% CI 0.43–1.41) per 100 patient years. Six patients (54.54%) with an event were in the low-risk category according to the HCM Risk-Kids model. Harrell's C index was 0.60, with a sensitivity of 9.09%, specificity of 63.92%, positive predictive value of 1.72%, and negative predictive value of 91%; with a poor distinction between the different risk groups. Unexplained syncope (HR 42.17, 95% CI 10.49–169.56, p < 0.001) and non-sustained ventricular tachycardia (HR 5.48, 95% CI 1.58–19.03, p < 0.007) were predictors of SCD on univariate analysis. Conclusion: Unexplained syncope and the presence of NSVT emerge as predictors for SCD in children with RASopathy-associated HCM. The HCM Risk-Kids model may not be appropriate to use in this population, but larger multicentre collaborative studies are required to investigate this further

Mechanical Strain Stabilizes Reconstituted Collagen Fibrils against Enzymatic Degradation by Mammalian Collagenase Matrix Metalloproteinase 8 (MMP-8)

Collagen, a triple-helical, self-organizing protein, is the predominant structural protein in mammals. It is found in bone, ligament, tendon, cartilage, intervertebral disc, skin, blood vessel, and cornea. We have recently postulated that fibrillar collagens (and their complementary enzymes) comprise the basis of a smart structural system which appears to support the retention of molecules in fibrils which are under tensile mechanical strain. The theory suggests that the mechanisms which drive the preferential accumulation of collagen in loaded tissue operate at the molecular level and are not solely cell-driven. The concept reduces control of matrix morphology to an interaction between molecules and the most relevant, physical, and persistent signal: mechanical strain.The investigation was carried out in an environmentally-controlled microbioreactor in which reconstituted type I collagen micronetworks were gently strained between micropipettes. The strained micronetworks were exposed to active matrix metalloproteinase 8 (MMP-8) and relative degradation rates for loaded and unloaded fibrils were tracked simultaneously using label-free differential interference contrast (DIC) imaging. It was found that applied tensile mechanical strain significantly increased degradation time of loaded fibrils compared to unloaded, paired controls. In many cases, strained fibrils were detectable long after unstrained fibrils were degraded.In this investigation we demonstrate for the first time that applied mechanical strain preferentially preserves collagen fibrils in the presence of a physiologically-important mammalian enzyme: MMP-8. These results have the potential to contribute to our understanding of many collagen matrix phenomena including development, adaptation, remodeling and disease. Additionally, tissue engineering could benefit from the ability to sculpt desired structures from physiologically compatible and mutable collagen