Heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies

Reinforcement Learning-based Access Schemes in Cognitive Radio Networks

In this thesis, we propose different MAC protocols based on three Reinforcement Learning (RL) approaches, namely Q-Learning, Deep Q-Network (DQN), and Deep Deterministic Policy Gradient (DDPG). We exploit the primary user (PU) feedback, in the form of ARQ and CQI bits, to enhance the performance of the secondary user (SU) MAC protocols. Exploiting the PU feedback information can be applied on the top of any SU sensing-based MAC protocol. Our proposed model relies on two main pillars, namely, an infinite-state Partially Observable Markov Decision Process (POMDP) to model the system dynamics besides a queuing-theoretic model for the PU queue; the states represent whether a packet is delivered or not from the PU’s queue and the PU channel state. The proposed RL access schemes are meant to design the best SU’s access probabilities in the absence of prior knowledge of the environment, by exploring and exploiting discrete and continuous action spaces, based on the last observed PU’s feedback. The performance of the proposed schemes show better results compared to conventional methods under more realistic assumptions, which is one major advantage of our proposed MAC protocols

Radiation in medicine: Origins, risks and aspirations.

The use of radiation in medicine is now pervasive and routine. From their crude beginnings 100 years ago, diagnostic radiology, nuclear medicine and radiation therapy have all evolved into advanced techniques, and are regarded as essential tools across all branches and specialties of medicine. The inherent properties of ionizing radiation provide many benefits, but can also cause potential harm. Its use within medical practice thus involves an informed judgment regarding the risk/benefit ratio. This judgment requires not only medical knowledge, but also an understanding of radiation itself. This work provides a global perspective on radiation risks, exposure and mitigation strategies

NaNog: A pluripotency homeobox (master) molecule.

One of the most intriguing aspects of cell biology is the state of pluripotency, where the cell is capable of self-renewal for as many times as deemed necessary , then at a specified time can differentiate into any type of cell. This fundamental process is required during organogenesis in foetal life and importantly during tissue repair in health and disease. Pluripotency is very tightly regulated, as any dysregulation can result in congenital defects, inability to repair damage, or cancer. Fuelled by the relatively recent interest in stem cell biology and tissue regeneration, the molecules implicated in regulating pluripotency have been the subject of extensive research. One of the important molecules involved in pluripotency, is NaNog, the subject of this article

An evaluation of secondary prophylaxis for rheumatic heart disease in rural Egypt.

Although essentially disappeared from the industrialized world, rheumatic heart disease (RHD) is still prevalent in developing countries, with 300,000 new cases identified each year. In Aswan, Egypt, RHD affects about 2.3% of children with over 90% of the cases being subclinical. Secondary prophylaxis has proved to be an effective method of preventing the progression of RHD. However, its efficacy is limited by low patient adherence. A systematic, generalizable tool is necessary to outline, and ultimately address these barriers.A 43-item semi-structured questionnaire was developed based on the three domains outlined by Fishbein (capability, intention, and health care barriers). A preliminary evaluation of the barriers to RHD prophylaxis use in Aswan, Egypt was carried out as a pilot study using this tool. Participants were local school children diagnosed with RHD or flagged as high-risk (as per a set of echocardiographic criteria developed by the Aswan Heart Centre) through a previous screening program of randomly selected 3,062 school children in Aswan.29 patients were interviewed (65.5% adherent to RHD prophylaxis). Compared to non-adherent patients, adherent patients had better understanding of the disease (68.4% versus 20% in the non-adherent group, p = 0.021), and were more aware of the consequences of missing prophylaxis doses (79% versus 40% of non-adherent patients, p = 0.005). Furthermore, 90% of non-adherent patients consciously choose to miss injection appointments (as compared to 31.6% of adherent patients, p = 0.005). Clinic wait time was the most frequently reported deterrent for both groups.A standardized tool that systematically outlines barriers to prophylaxis is a necessary first step to improving adherence to penicillin. Although individually developed tools exist for specific populations, a generalizable tool that takes into account the demographic and cultural differences in the populations of interest will allow for more reliable data collection methodology. Application of this tool will be used to further explore barriers to prophylaxis adherence and inform the basis for the design of future KT interventions

Hepatoprotective effect of basil (Ocimum basilicum L.) on CCl4-induced liver fibrosis in rats

The hepatoprotective effect of basil (Ocimum basilicum) extract against liver fibrosis-induced by carbon tetrachloride (CCl4) was studied in rats. Rats were allocated into five groups: Group I (control group); Group II [CCl4 group; rats were injected subcutaneously with CCl4 (1 ml/kg b.w.) twice weekly for 4 weeks (phenobarbital, 350 mg/L, was added to the drinking water throughout the experiment)]; Group III received daily oral doses of basil extract of 200 mg/kg b.w. along with CCl4 and phenobarbital for 6 weeks; Groups IV and V rats were treated with phenobarbital and CCl4 for 6 weeks then treated daily with oral dose of 200 mg/kg b.w basil extract, or by 300 mg/kg b.w dimethyl diphenyl bicarboxylate (DDB), respectively for 6 weeks. Basil-treatment significantly reduced the liver content of hydroxyproline and significantly increased the activity of hyaluronidase (HAase). The hepatic activity of superoxide dismutase (SOD) was stimulated while the lipid peroxidation was significantly reduced by the effect of basil extract. Treatment with CCl4 significantly increased the activities of transaminases [aspartate aminotransferase (AST), alanine aminotransferase (ALT)], and alkaline phosphatase (ALP). These activities were significantly decreased by basil extract. The higher levels of serum urea and creatinine in CCl4 group were significantly guarded by the protection of basil.Key words: Carbon tetrachloride, liver fibrosis, antioxidant, Ocimum basilicum, dimethyl diphenyl bicarboxylate

Exploring Safety Aspects in Dental School Clinics Including Droplet Infection Prevention

BACKGROUND: Health-care safety focuses on improving patient’s and worker’s safety in a safe working clinics’ environment and prevent infection transmission including droplet infections as seasonal influenza and novel coronavirus (COVID-19). Dental health-care personnel (DHCP) are the target of safety measures and are themselves responsible for elimination of preventable harm. Dental schools are expected to demonstrate the model for quality safe care. AIM: This study aims to achieve high-quality safe dental care at dental clinics, Faculty of Dentistry, Cairo University. METHODS: A cross-sectional survey study was conducted at two Dental Outpatient Clinics, Cairo University. Disk review of policies, observation checklists for practices and awareness questionnaires of DHCP were used. RESULTS: DHCP showed good awareness for most of infection control (IC) and X-ray safety items. However, there are no policies or procedures to control droplet infections in the clinics. The clinics were closed in the current COVID-19 pandemic. There were poor patient safety practices, hand hygiene compliance, and personal protective equipment (PPE) use except for protecting clothes and disposable gloves. Students showed better compliance for patient safety guidelines. Other safety policies were poorly communicated. CONCLUSION: There should be preparedness plan to deal with any droplet infection outbreak, epidemic or pandemic as COVID-19 in all dental settings. There is a need to initiate dental safety unit in dental schools to implement, communicate, train, and supervise all dental safety practices including infection control

Cup versus bottle feeding for hospitalized late preterm infants in Egypt: A quasi-experimental study

<p>Abstract</p> <p>Background</p> <p>Although previous studies have demonstrated beneficial breastfeeding outcomes when cup feeding rather than bottle feeding was used for feeding preterm infants, cup feeding has not been implemented in Egypt. The aim of the current study was to examine the effect of using cup feeding as an exclusive method of feeding preterm infants during hospitalization on breastfeeding outcomes after discharge.</p> <p>Methods</p> <p>A quasi-experimental design, with the control group studied first, was used to examine the effect of cup feeding for preterm infants on breastfeeding outcomes after discharge. Sixty preterm infants (mean gestational age was 35.13 weeks and mean birth weight was 2150 grams) were recruited during Neonatal Intensive Care Unit (NICU) stay. Control group infants (n = 30) received only bottle feedings during hospitalization and the experimental group (n = 30) received only cup feedings during hospitalization. Both groups were followed up after discharge for six weeks to evaluate infant's breastfeeding behavior and mother's breastfeeding practices. Data were analyzed using descriptive statistics and repeated measures ANOVA for testing the differences between the cup feeding and bottle feeding groups over six weeks after discharge.</p> <p>Results</p> <p>Cup fed infants demonstrated significantly more mature breastfeeding behaviors when compared to bottle fed infants (p < 0.01) over six weeks, and had a significantly higher proportion of breast feedings one week after discharge (p = 0.03).</p> <p>Conclusion</p> <p>Cup fed infants were more exclusively breast fed one week after discharge, supporting the Baby Friendly Hospital Initiative recommendations for using cup feeding and avoiding bottle feeding when providing supplementation for preterm infants. The current study provides initial evidence for the implementation of cup feeding as a method of supplementation for late preterm infants during hospitalization.</p> <p>Trial Registration</p> <p>Clinical Trial NCT00756587.</p

Scalable and Adaptive Online Joins

Scalable join processing in a parallel shared-nothing environment requires a partitioning policy that evenly distributes the processing load while minimizing the size of state maintained and number of messages communicated. Previous research proposes static partitioning schemes that require statistics beforehand. In an online or streaming environment in which no statistics about the workload are known, traditional static approaches perform poorly. This paper presents a novel parallel online dataflow join operator that supports arbitrary join predicates. The proposed operator continuously adjusts itself to the data dynamics through adaptive dataflow routing and state repartitioning. The operator is resilient to data skew, maintains high throughput rates, avoids blocking behavior during state repartitioning, takes an eventual consistency approach for maintaining its local state, and behaves strongly consistently as a black-box dataflow operator. We prove that the operator ensures a constant competitive ratio 3.75 in data distribution optimality and that the cost of processing an input tuple is amortized constant, taking into account adaptivity costs. Our evaluation demonstrates that our operator outperforms the state-of-the-art static partitioning schemes in resource utilization, throughput, and execution time