Clinical utility of tolvaptan in the management of hyponatremia in heart failure patients

Hyponatremia is an electrolyte disorder frequently observed in several clinical settings and common in hospitalized patients with decompensated heart failure (HF). It is caused by deregulation of arginine vasopressin (AVP) homeostasis associated with water retention in hypervolemic or in euvolemic states. While hypervolemic hypotonic hyponatremia is also seen in advanced liver cirrhosis, renal failure, and nephrotic syndrome, the bulk of evidence associating this electrolyte disorder to increasing morbidity and mortality can be found in the HF literature. Hospitalized HF patients with low serum sodium concentration have lower short-term and long-term survival, longer hospital stay and increased readmission rates. Conventional therapeutic approaches, ie, restriction of fluid intake, saline and diuretics, can be effective, but often the results are unpredictable. Recent clinical trials have demonstrated the effectiveness of nonpeptide AVP receptor antagonists (vaptans) in the treatment of hyponatremia. The vaptans induce aquaresis, an electrolyte-sparing excretion of free water resulting in the correction of serum sodium concentrations and plasma osmolality, without activation of the renin-angiotensin-aldosterone system (RAAS) or changes in renal function and blood pressure. Further prospective studies in a selected congestive HF population with hyponatremia, using clinical-status titrated dose of tolvaptan, are needed to determine whether serum sodium normalization will be translated into a better long-term prognosis. This review will focus on recent clinical trials with tolvaptan, an oral V2 receptor antagonist, in HF patients. The ability of tolvaptan to safely increase serum sodium concentration without activating the RAAS or compromising renal function and electrolyte balance makes it an attractive agent for treating hyponatremic HF patients

Designing Persuasive Avatars in mHealth for Arabic Culture: A Qualitative Study

Open innovation is built on the core principles of interactions, interdependence and exchange of knowledge. Clusters are believed to support organisations’ efforts to explore and source external knowledge, commercialise internal innovations and cause externalities through commercial activities. Early research on the innovation capabilities of regional clusters in Europe provides limited understandings of these cluster-based effects through which open innovation is fostered. This study investigates the role of clusters on open innovation practices relating to exploration and exploitation of external knowledge, knowledge sharing, acquisition and sale of IP rights of Indian IT organisations. The results reveal that organisations within a close geographic proximity actively participate in inbound and outbound activities and perform better in terms of innovation performance compared to the organisations outside the cluster. The findings are relevant to both the IT clusters and the IT innovation literature as this study sheds light on the role of clusters in improving an organisation’s innovation capabilities through open innovation

Tribological behaviour of refined bleached and deodorized palm olein in different loads using a four-ball tribotester

AbstractVegetable oil is one of the bio-oils that have been promoted to replace petroleum-based products due to its eco- friendly characteristics. Palm oil has high productivity rate, and so it could fulfil the demand for a bio-lubricant. In this paper, the influence of the normal load on friction and wear performance were investigated for a RBD palm olein and compared with paraffinic mineral oil using four-ball tribotester. The normal load was varied from 30 kg to 60 kg. All experimental works were conforming to ASTM D 4172. The results exhibited that the RBD palm olein has lower coefficient of friction compared to paraffinic mineral oil. However, the wear scar of ball bearings lubricated with RBD palm olein showed larger diameter compared to paraffinic mineral oil. As a conclusion, RBD palm olein has better performance compared to paraffinic mineral oil in terms of capability to reduce friction

Peroxidase extraction from jicama skin peels for phenol removal

Phenol and its derivatives exist in various types of industrial effluents, and are known to be harmful to aquatic lives even at low concentrations. Conventional treatment technologies for phenol removal are challenged with long retention time, high energy consumption and process cost. Enzymatic treatment has emerged as an alternative technology for phenol removal from wastewater. These enzymes interact with aromatic compounds including phenols in the presence of hydrogen peroxide, forming free radicals which polymerize spontaneously to produce insoluble phenolic polymers. This work aims to extract peroxidase from agricultural wastes materials and establish its application for phenol removal. Peroxidase was extracted from jicama skin peels under varying extraction conditions of pH, sample-to-buffer ratio (w/v %) and temperature. Experimental results showed that extraction process conducted at pH 10, 40% w/v and 25oC demonstrated a peroxidase activity of 0.79 U/mL. Elevated temperatures slightly enhanced the peroxidase activities. Jicama peroxidase extracted at optimum extraction conditions demonstrated a phenol removal efficiency of 87.5% at pH 7. Phenol removal efficiency was ∼ 97% in the range of 30 - 40oC, and H2O2 dosage has to be kept below 100 mM for maximum removal under phenol concentration tested

Neuroethics guiding principles for the NIH Brain Initiative

Neuroscience presents important neuroethical considerations. Human neuroscience demands focused application of the core research ethics guidelines set out in documents such as the Belmont Report. Various mechanisms, including institutional review boards (IRBs), privacy rules, and the Food and Drug Administration, regulate many aspects of neuroscience research and many articles, books, workshops, and conferences address neuroethics. (Farah, 2010; https://bioethicsarchive.georgetown.edu/pcsbi/studies.html; http://www.neuroethicssociety.org/annual-meeting). However, responsible neuroscience research requires continual dialogue among neuroscience researchers, ethicists, philosophers, lawyers, and other stakeholders to help assess its ethical, legal, and societal implications. The Neuroethics Working Group of the National Institutes of Health (NIH) Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, a group of experts providing neuroethics input to the NIH BRAIN Initiative Multi-Council Working Group, seeks to promote this dialogue by proposing the following Neuroethics Guiding Principles (Table 1)

Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

Background There is increasing focus on long-term survival, function and quality-of-life for trauma patients. There are few studies tracking longitudinal changes in functional outcome over time. The goal of our study was to compare the Glasgow Outcome Scale-Extended (GOSE) at 6 months and 12 months in blunt trauma survivors with an Injury Severity Score (ISS) of more than 15. Methods Using the Singapore National Trauma Registry 2011–2013, patients with 6-month GOSE and 12-month GOSE scores were analysed. Patients were grouped into three categories—those with the same score at 6 months and 12 months, an improvement in score, and a worse score at 12 months. Ordinal regression was used to identify risk factors for improved score. Patients with missing scores at either 6 months or 12 months were excluded. Results We identified 478 patients: 174 had an improvement in score, 233 stayed the same, and 71 had worse scores at 12 months compared to 6 months. On univariate ordinal regression, the following variables were associated with same or better function at 12-months compared to 6-months: male gender, being employed pre-injury, thoracic Abbreviated Injury Scale (AIS) of 3 or more, anatomical polytrauma (AIS of 3 or more in 2 or more body regions), and road traffic injury mechanism. Older age, low fall, increasing Charlson comorbidity scores, new injury severity score, and head and neck AIS of 3 or more were associated with worse function at 12 months compared to 6 months. ISS and revised trauma score were not significant predictors on univariate or multivariable analysis. On multivariable ordinal regression, motor vehicle mechanism (OR 2.78, 1.51–5.12, p = 0.001) was associated with improved function, while male gender (OR 1.36, 95% CI 1.02–1.82, p = 0.039) predicted improved function at 12 months. Conclusions Females experience worse functional outcomes at 12 months, potentially due to majority of female injuries being low falls in the elderly. In contrast, motor vehicle injury patients had better functional outcomes at 12 months. Additional interventional strategies for high-risk groups should be explored

Middle ear microbiome differences in indigenous Filipinos with chronic otitis media due to a duplication in the A2ML1 gene

Middle ear microbial profiles of indigenous Filipinos with chronic otitis media. All panels compare carriers with non-carriers of the A2ML1 duplication variant. Panel description: (A) ι-diversity by observed OTUs; (B) ι-diversity by the Shannon diversity index; (C) β-diversity from unweighted UniFrac principal coordinate analysis; (D) β-diversity from weighted UniFrac principal coordinate analysis. (PDF 1019 kb

How and Why Parents Guide the Media Use of Young Children

Abstract Children use electronic screens at ever younger ages, but there is still little empirical research on howand why parents mediate this media use. In line with Vygotsky’s zone of proximal development, we explored whether children’s media skills and media activities, next to parents’ attitudes about media for children, and several child and parent-family characteristics, predicted parental mediation practices. Furthermore, we investigated children’s use and ownership of electronic screens in the bedroomin relationship to the child’s media skills. Data from an online survey among 896 Dutch parents with young children (0–7 years) showed that children’s use and ownership of TV, game consoles, computers and touchscreens, primarily depended on their media skills and age, not on parent’s attitudes about media for children. Only touchscreens were used more often by children, when parents perceived media as helpful in providing moments of rest for the child. In line with former studies, parents consistently applied co-use, supervision, active mediation, restrictive mediation, and monitoring, depending on positive and negative attitudes about media. The child’s media skills andmedia activities, however, had stronger relationshipswith parental mediation styles, whereas age was not related. Canonical discriminant analysis, finally, captured how the five mediation strategies varied among infants, toddlers, preschoolers, and early childhood children, predominantly as a result of children’s media skills, and media activities, i.e., playing educational games and passive entertainment use

Exome sequencing reveals novel variants and unique allelic spectrum for hearing impairment in Filipino cochlear implantees

Genetic hearing impairment is mostly nonsyndromic (80%), and >6,000 causal variants in >100 genes have been identified. Generally in hearing-impaired patients of Asian descent, GJB2 variants are most common (36%), followed by variants in SLC26A4 (MIM 605646), MYO15A (MIM 602666) and CDH23 (MIM 605516). Here we report seven novel variants in Filipino cochlear implantees, suggesting that the allelic spectrum for non-/syndromic hearing impairment in Filipinos is unique