Platelet Profile as Prognostic Factor in Critically ill Children

BACKGROUND: Previous studies showed that platelet profile may reflect the platelet function better than the platelet count itself, but the study on its use as a prognostic indicator in critically ill children is still limited. AIM: We analyzed the association between platelet profile such as platelet count, plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) and mortality, also its correlation with pediatric logistic organ dysfunction-2 (PELOD-2) score in critically ill children admitted to the pediatric intensive care unit (PICU). METHODS: A prospective cohort study was conducted in PICU Haji Adam Malik General Hospital, Medan. Assessment of platelet profile (platelet count, PCT, MPV, and PDW) and PELOD score on the 1st and 3rd day of PICU admission were performed. RESULTS: Eighty-three subjects were recruited in this study, 44 were boy with a median age of 6 (1–17) years old. The septic patient was 43 subjects (51.8%). Platelet count on the 1st day (p = 0.024) and PDW on the 3rd day (p = 0.018) of PICU admission was significantly associated with mortality. There was no correlation between platelet profile and PELOD-2 score on day 1 and 3. However, the difference between MPV on days 1 and 3 (ΔMPV) significantly correlated with the change of PELOD-2 score (r = 0,647, p < 0.0001). CONCLUSION: Platelet count on 1st day and PDW on the 3rd day had a significant association with mortality but no correlation between platelet profile and PELOD-2 score

The Application of Water Cooling on Reducing NOx from a Gas Burner System

A gas burner system applying water cooling has been investigated using a 140mm inside diameter combustor of 294-mm length. The combustor was placed vertically upwards. All tests were conducted using natural gas only. A fixed straight blade radial swirler with 76-mm outlet diameter was placed at the inlet plane of the combustor. An orifice plate of 59 mm was inserted at the exit plane of the swirler to enhance turbulence and help in mixing of the fuel and air. Fuel was injected at the back plate of the swirler using central fuel injector with eight fuel holes pointed radially outward. Tests were conducted at 5mmH 20 pressure loss. A reduction of about 21.53% on NOx emissions was achieved at equivalence ratio of near stoichiometric (0.88) and a reduction of 35.7% was achieved at equivalence ratio of 0.42. Other emissions such as carbon monoxide were well under 100 ppm except below the equivalence ratio of 0.5 due to cooling effect. Unburned hydrocarbon emissions were well below 10 ppm except below the equivalence ratio of 0.5

Local probing of ionic diffusion by electrochemical strain microscopy: spatial resolution and signal formation mechanisms

Electrochemical insertion-deintercalation reactions are typically associated with significant change of molar volume of the host compound. This strong coupling between ionic currents and strains underpins image formation mechanisms in electrochemical strain microscopy (ESM), and allows exploring the tip-induced electrochemical processes locally. Here we analyze the signal formation mechanism in ESM, and develop the analytical description of operation in frequency and time domains. The ESM spectroscopic modes are compared to classical electrochemical methods including potentiostatic and galvanostatic intermittent titration (PITT and GITT), and electrochemical impedance spectroscopy (EIS). This analysis illustrates the feasibility of spatially resolved studies of Li-ion dynamics on the sub-10 nanometer level using electromechanical detection.Comment: 49 pages, 17 figures, 4 tables, 3 appendices, to be submitted to J. Appl. Phys

Global gene expression profiling identifies new therapeutic targets in acute Kawasaki disease.

BACKGROUND: Global gene expression profiling can provide insight into the underlying pathophysiology of disease processes. Kawasaki disease (KD) is an acute, self-limited vasculitis whose etiology remains unknown. Although the clinical illness shares certain features with other pediatric infectious diseases, the occurrence of coronary artery aneurysms in 25% of untreated patients is unique to KD. METHODS: To gain further insight into the molecular mechanisms underlying KD, we investigated the acute and convalescent whole blood transcriptional profiles of 146 KD subjects and compared them with the transcriptional profiles of pediatric patients with confirmed bacterial or viral infection, and with healthy control children. We also investigated the transcript abundance in patients with different intravenous immunoglobulin treatment responses and different coronary artery outcomes. RESULTS: The overwhelming signature for acute KD involved signaling pathways of the innate immune system. Comparison with other acute pediatric infections highlighted the importance of pathways involved in cell motility including paxillin, relaxin, actin, integrins, and matrix metalloproteinases. Most importantly, the IL1β pathway was identified as a potential therapeutic target. CONCLUSION: Our study revealed the importance of the IL-1 signaling pathway and a prominent signature of innate immunity and cell migration in the acute phase of the illness

Development of a near-infrared (NIR) forearm subcutaneous vein extraction using deep residual u-net

Impotence to locate the forearm subcutaneous vein leads to multiple intravenous (IV) attempts causing pain and injuries to patients such as bruise or vein damages. Various technologies and techniques were proposed and developed to overcome the multiple IV access problems. The standard techniques used in research and hospitals are Transillumination, Ultrasound Imaging, and Near-Infrared (NIR). Among those techniques, NIR is the most optimal way of locating the subcutaneous vein because of its non-invasive properties, low-cost implementation. The device can be assembled in a small size product. Nevertheless, the NIR forearm images contain noises that cause difficulties in extracting the vein features. Hence, the performance of NIR vein extraction is having the bottleneck of detecting the vein pixel accurately. Many research studies have been conducted to work on the NIR forearm subcutaneous vein detection due to such a limitation. Artificial intelligence is one of the powerful technology that would benefit this study. However, a limited number of articles were found on the patentability search, and thus we propose an automatic vein extraction algorithm using Deep Residual U-Net architecture. Our algorithm shows 75 percent of the accuracy in extracting the NIR vein from the experiments that tested. These results show the evidence that the Deep Residual U-Net can be applied to extract the NIR vein

Performance Characteristics Of Non-Arc Double Stator Permanent Magnet Generator

The improvement in the power density in the double stator configurations is feasible with increase in the electrical loading of the electrical machines. This type of newer configuration is finding significant applications in improvising energy generation, more commonly for renewable energy generation. Various double stator configurations with non-arc permanent magnet machines for power density are modelled and analyzed in this paper. Finite Element Method (FEM) is used to simulate for the generation capability including the electromagnetics parameters such as flux linkage and open circuit voltage. A new slotted rotor structure is evolved based on the magnetic flux flow control inside the machine. The proposed structure is then fabricated in the laboratory and tested for operating characteristics with load circuit. The proposed machine produces a maximum power of 600W at speed of 2000 rpm with 75% of maximum efficiency with the micro-hydro generation unit

Mycobacterium tuberculosis whole genome sequencing provides insights into the Manila strain and drug-resistance mutations in the Philippines.

The Philippines has a high incidence of tuberculosis disease (TB), with an increasing prevalence of multidrug-resistant Mycobacterium tuberculosis (MDR-TB) strains making its control difficult. Although the M. tuberculosis "Manila" ancient lineage 1 strain-type is thought to be prevalent in the country, with evidence of export to others, little is known about the genetic diversity of circulating strains. By whole genome sequencing (WGS) 178 isolates from the Philippines National Drug Resistance Survey, we found the majority (143/178; 80.3%) belonged to the lineage 1 Manila clade, with the minority belonging to lineages 4 (European-American; n = 33) and 2 (East Asian; n = 2). A high proportion were found to be multidrug-resistant (34/178; 19.1%), established through highly concordant laboratory drug susceptibility testing and in silico prediction methods. Some MDR-TB isolates had near identical genomic variation, providing potential evidence of transmission. By placing the Philippine isolates within a phylogeny of global M. tuberculosis (n > 17,000), we established that they are genetically similar to those observed outside the country, including a clade of Manila-like strain-types in Thailand. An analysis of the phylogeny revealed a set of ~200 SNPs that are specific for the Manila strain-type, and a subset can be used within a molecular barcode. Sixty-eight mutations known to be associated with 10 anti-TB drug resistance were identified in the Philippine strains, and all have been observed in other populations. Whilst nine putative streptomycin resistance conferring markers in gid (8) and rrs (1) genes appear to be novel and with functional consequences. Overall, this study provides an important baseline characterisation of M. tuberculosis genetic diversity for the Philippines, and will fill a gap in global datasets and aid the development of a nation-wide database for epidemiological studies and clinical decision making. Further, by establishing a molecular barcode for detecting Manila strains it will assist with the design of diagnostic tools for disease control activities

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere