PATHOPHYSIOLOGY, INVESTIGATIONS, AND MANAGEMENT IN CASES OF MYOCARDIAL INFARCTION

Background: Reduced or full suspension of blood flow to a region of the myocardium causes myocardial infarction (MI), sometimes known as "heart attack." Myocardial infarction can be "silent," causing hemodynamic deterioration and abrupt death, or it can be a catastrophic event that causes hemodynamic deterioration and death. The most common cause of myocardial infarction is coronary artery disease, which is the leading cause of death in the United States. The myocardium is deprived of oxygen when a coronary artery is blocked. Myocardial cell loss and necrosis can occur when the myocardium is deprived of oxygen for an extended period. Patients may complain of chest pain or pressure that spreads to the neck, jaw, shoulder, or arm. Myocardial ischemia may be accompanied by ECG alterations and elevated biochemical markers such as cardiac troponins, in addition to the history and physical exam. This exercise covers the etiology, diagnosis, and treatment of myocardial infarction, as well as the role of the interprofessional team in enhancing patient care. Conclusion: This review article aims to review the basic pathophysiology of myocardial infarction, explain the management protocol when a patient is diagnosed with acute myocardial infarction, including all necessary laboratory and another diagnostic testing, summarise long-term management and rehabilitation for a patient post-MI, and explain interprofessional team strategies for improving care coordination and communication to advance the prevention and management of myocardial infarction

Improving the recovery of monthly regional water storage using one year simulated observations of two pairs of GRACE-type satellite gravimetry constellation

Increasing the spatial sampling isotropy is a major issue in designing future missions dedicated to continue the task of the Gravity Recovery And Climate Experiment (GRACE) mission. From various possible future satellite gravimetry scenarios, the two-pair multi-orbit satellite configuration (Bender-type in the sequence), consisting of a coupled semi-polar pair (the same as GRACE) and an inclined pair of satellites seems to be an optimal mission choice. This contribution examines the performance of a Bender-type scenario at altitudes of 335 km and 352 km and inclinations of 89° and 63°, respectively, for improving the regional recovery of hydrological signals. To this end, we created one full year of simulated observations of the GRACE and Bender-type configurations. Our investigations include: 1) evaluating the feasible spatial resolution for the recovery of terrestrial water storage (TWS) changes in the presence of realistic instrumental noise and errors in the background models; 2) assessing the influence of aliasing errors in the TWS recovery and its separation from instrumental noise and introduced hydrological signals; and 3) analyzing the regional quality of the gravity-derived TWS results by assessing water storage changes over the 33 world major river basins. From our simulations, the Bender-derived spectral error curves indicate that, in spite of the instrumental noise, aliasing errors still contaminate the gravity fields above geopotential spherical harmonic coefficient (SHC) degree and order (d/o) 80 till 100. Regarding to the TWS recovery, we found notable improvements for the Bender-type configuration results in medium and small-scale basins, such as the Brahmaputra, Euphrates, Ganges, Indus, Mekong basins in Asia and the Yellow and Orange basins in South Africa. These results were achieved without applying post-processing, which was unachievable using simulations of one pair of GRACE-like configuration. Comparing the magnitudes of errors in the Bender-derived solutions with those of GRACE indicate that the accuracy derived from the Bender-type fields is about two times better than that of GRACE, specifically at medium spatial resolutions of 250 km (SHC d/o 80). We truncated the TWS recovery up to SHC d/o 80 in the spectral domain, whereas all comparisons are demonstrated in the spatial domain after a truncation of the solutions and WGHM field at d/o 60, since beyond this range; a relatively strong instrumental and aliasing errors contaminate the solutions. Our numerical results indicate that the spatial resolution of the Bender-type TWS recovery can be even higher for the basins with strong temporal water storage variations such as the Amazon basin. Short wavelength mass variations in basins with relatively weaker temporal TWS magnitude, such as the Murray basin, might still need the application of a filter with small averaging kernel

The politics of voluntary restraint : the evolution of print media codes of ethics in Britain and New Zealand

This thesis presents a comparative study of the evolution of print media codes of ethics in Britain and New Zealand. Through exploring how ethics codes have come to be employed by the print media as self-regulatory structures, the study contributes to an understanding of how press policy has evolved over the twentieth century in the two countries. By providing an illustration of the pressures and processes underpinning the adoption of ethics codes by the print media, the study also offers an insight into the role and functions of codes, and their efficacy as self-regulatory tools. The thesis explores the concept of 'voluntary restraint' in order to establish a theoretical framework from which to assess and compare the evolution of ethics codes by the British and New Zealand print media. The manner in which the principles of voluntary restraint have manifested themselves in the respective regulatory histories of the print media in Britain and New Zealand is analysed. Parallels are identified concerning the nature of internal reform of self-regulation out of which codes of ethics have emerged as self-regulatory structures. It is concluded that in both Britain and New Zealand, the evolution of codes of ethics reflects a divergence with the principles of voluntary restraint, which is also evident in the content of the emergent codes themselves. Thus, a re-thinking of the concept of journalistic accountability is advanced as a basis from which ethics codes as self­ regulatory structures might be reformed and reapplied in the spirit of voluntary restraint for the future

Simulated Satellite Formation Flights for Detecting the Temporal Variations of the Earth’s Gravity Field

In this thesis, the concept of satellite formation flight (SFF) is studied by means of simulated satellite observations. With various formation types enabling inter-satellite measurements in various directions (e.g. along-track, cross-track or radial), the principal tasks in global gravity field recovery are tackled: the determination of the static gravity field and the detection of its temporal variations. The investigated formation flight types include GRACE, Pendulum, GRACE-Pendulum, Radial wheel and Inclined wheel configurations. For each formation type, appropriate orbit parameters are determined to receive homogeneous subsatellite track patterns required for a high spatial resolution. In addition, orbit designs are developed which allow an enhancement of the temporal resolution (i.e. sub-month solutions). The investigated formation flight types of this case include GRACE-24days, GRACE-12days, Multi-GRACE ΔM and Multi-GRACE ΔΩ configurations. In the static gravity field analysis, the test scenarios cover different spectral ranges of the Earth’s gravity field up to the spherical harmonics degree 180. The detection of the temporal variations is performed using physical models from ocean tides, atmosphere, ocean and continental hydrology. The numerical computations show that significant improvements are achieved from the formation flights for the recovery of the global static gravity field and the detection of its temporal variations. Thus, the study provides an outlook on the progress in the gravity field modeling that is achievable by future satellite missions.Simulierte Satellitenformationsflüge zur Bestimmung der temporalen Variationen des Erdgravitationsfeldes In der vorliegenden Arbeit wird mit Hilfe simulierter Satellitenbeobachtungen das Konzept des Satellitenformationsflugs (SFF) untersucht. Mit verschiedenen Formationstypen, mit denen Intersatellitenmessungen in verschiedenen Richtungen gesammelt werden können (z.B. along-track, cross-track oder radial), werden die beiden wesentlichen Aufgaben der globalen Gravitationsfeldbestimmung bearbeitet, die Bestimmung des statischen Gravitationsfeldes und die Bestimmung seiner zeitlichen Variationen. Die untersuchten Formationstypen umfassen GRACE, Pendulum, GRACE-Pendulum, Radial wheel and Inclined wheel Konfigurationen. Für jeden Formationstyp werden geeignete Bahnparameter ermittelt, um die für eine hohe räumliche Auflösung notwendige gleichmäßige Überdeckung der Erde mit Subsatellitenbahnen zu erreichen. Außerdem werden Formationsdesigns entworfen, die eine Verbesserung der zeitlichen Auflösung erlauben (submonatliche Lösungen). Die untersuchten Formationstypen dieses Falls umfassen GRACE-24days, GRACE-12days, Multi-GRACE ΔM und Multi-GRACE ΔΩ Konfigurationen. Bei der Bestimmung des statischen Schwerefeldes werden den Testszenarien unterschiedlich hoch aufgelöste Feldmodelle bis Grad 180 der Kugelfunktionsentwicklung zugrunde gelegt. Die Simulation der zeitlichen Variationen erfolgt mit physikalischen Modellen für die Ozeangezeiten, für die Massenverlagerungen in Atmosphäre und Ozeanen und für die kontinentale Hydrologie. Die numerischen Untersuchungen zeigen, dass signifikante Verbesserungen sind von Satellitenformationsflügen zur Bestimmung des statischen Gravitationsfeldes und der Bestimmung seiner zeitlichen Variationen erreicht. Die Arbeit liefert damit einen Ausblick auf den Fortschritt in der Gravitationsfeldbestimmung, der mit zukünftigen Satellitenmissionen möglich sein wird

Automated Software Debugging Using Hybrid Static/Dynamic Analysis

With the increasing complexity of today's software, the software development process is becoming highly time and resource consuming. The increasing number of software configurations, input parameters, usage scenarios, supporting platforms, external dependencies, and versions plays an important role in expanding the costs of maintaining and repairing unforeseeable software faults. To repair software faults, developers spend considerable time in identifying the scenarios leading to those faults and root-causing the problems. While software debugging remains largely manual, it is not the case with software testing and verification. The goal of this research is to improve the software development process in general, and software debugging process in particular, by devising techniques and methods for automated software debugging, which leverage the advances in automatic test case generation and replay. In this research, novel algorithms are devised to discover faulty execution paths in programs by utilizing already existing software test cases, which can be either automatically or manually generated. The execution traces, or alternatively, the sequence covers of the failing test cases are extracted. Afterwards, commonalities between these test case sequence covers are extracted, processed, analyzed, and then presented to the developers in the form of subsequences that may be causing the fault. The hypothesis is that code sequences that are shared between a number of faulty test cases for the same reason resemble the faulty execution path, and hence, the search space for the faulty execution path can be narrowed down by using a large number of test cases. To achieve this goal, an efficient algorithm is implemented for finding common subsequences among a set of code sequence covers. Optimization techniques are devised to generate shorter and more logical sequence covers, and to select subsequences with high likelihood of containing the root cause among the set of all possible common subsequences. A hybrid static/dynamic analysis approach is designed to trace back the common subsequences from the end to the root cause. A debugging tool is created to enable developers to use the approach, and integrate it with an existing Integrated Development Environment. The tool is also integrated with the environment's program editors so that developers can benefit from both the tool suggestions, and their source code counterparts. Finally, a comparison between the developed approach and the state-of-the-art techniques shows that developers need only to inspect a small number of lines in order to find the root cause of the fault. Furthermore, experimental evaluation shows that the algorithm optimizations lead to better results in terms of both the algorithm running time and the output subsequence length

Evaluation of stresses developed in different bracket-cement-enamel systems using finite element analysis with in vitro bond strength tests

BACKGROUND: The purpose of this study was to determine the bond strength of different orthodontic bracket materials (ceramic, stainless steel, and titanium) as well as stresses developed in bracket-cement-enamel systems using finite element (FE) analysis. METHODS: One hundred and thirty-five extracted human caries-free upper central incisors were divided into three groups (n = 45/group) according to the type of orthodontic bracket materials (stainless steel, ceramic, and titanium). Each group was further subdivided into three subgroups (n = 15/group) according to the bond strength test loading mode (shear short side, shear long side, and tensile). After debonding, the fractured specimen was examined, and the adhesive remnant index (ARI) was determined. FE analysis models analyzed the stress distribution within the cement and enamel. Bond strengths were analyzed using ANOVA and Tukey's test, and the ARI scores were analyzed using chi-square (χ(2)) test. RESULTS: Shear loading at the short side of the bracket resulted in the highest bond strength and lowest maximum principal stress both on cement and enamel compared with the other loading modes (P < 0.05). Ceramic brackets presented with higher bond strength and lower maximum principal stress than metallic brackets (P < 0.05). There was a significant difference for ARI scores between the type of brackets (χ(2) = 64.852, P < 0.001). CONCLUSION: The findings suggest that the manner of loading orthodontic brackets and the selection of orthodontic bracket materials affect the bond strength and stresses developed both on cement and enamel

Microbiological assessment of COVID-19 associated acute invasive fungal rhinosinusitis: A tertiary hospital based study

Background:&nbsp;&nbsp;Acute invasive fungal rhinosinusitis (AIFRS) is an emerging disease on top of SARS CoV-2 virus infection and associated with severe and fatal prognosis especially in the presence of other immunosuppressive conditions.&nbsp;Aim of study:&nbsp;Identification of the causative agents of AIFRS in COVID-19 patients and its impact on the survival outcome.&nbsp;Methods:&nbsp;This retrospective study was carried out on 70 clinically and radiologically diagnosed AIFRS patients either in concomitant with COVID-19 infection or following recovery. Exudates from the lesions were collected during surgical debridement. Both microbiological and pathological examinations were done to identify the type of the causative fungi followed by assessment of the relation between different type of fungi and the outcome in the affected patients.&nbsp;Results:&nbsp;Positive fungal cultures were detected in 54 cases out of 70 where&nbsp;Mucor&nbsp;species were the most common isolates (42 patients) and only 12 cases were proven to be&nbsp;Aspergillus&nbsp;species. All patients were diabetic and under steroid therapy. Mortality rate was 42.9% and 25% in mucormycosis and aspergillosis respectively. High dose of steroid together with&nbsp;Mucor&nbsp;species infection were the most important risk factors in determining the prognosis and the outcome of the infection.&nbsp;Conclusion:&nbsp;Microbiological diagnosis together with other methods plays an important role in accurate and rapid diagnosis of AIFRS in association with COVID-19 for proper management and improving the outcome

Comparisons of atmospheric mass variations derived from ECMWF reanalysis and operational fields, over 2003 to 2011

There are two spurious jumps in the atmospheric part of the Gravity Recovery and Climate Experiment-Atmosphere and Ocean De-aliasing level 1B (GRACE-AOD1B) products, which occurred in January-February of the years 2006 and 2010, as a result of the vertical level and horizontal resolution changes in the ECMWFop (European Centre for Medium-Range Weather Forecasts operational analysis). These jumps cause a systematic error in the estimation of mass changes from GRACE time-variable level 2 products, since GRACE-AOD1B mass variations are removed during the computation of GRACE level 2. In this short note, the potential impact of using an improved set of 6-hourly atmospheric de-aliasing products on the computations of linear trends as well as the amplitude of annual and semi-annual mass changes from GRACE is assessed. These improvements result from 1) employing a modified 3D integration approach (ITG3D), and 2) using long-term consistent atmospheric fields from the ECMWF reanalysis (ERA-Interim). The monthly averages of the new ITG3D-ERA-Interim de-aliasing products are then compared to the atmospheric part of GRACE-AOD1B, covering January 2003 to December 2010. These comparisons include the 33 world largest river basins along with Greenland and Antarctica ice sheets. The results indicate a considerable difference in total atmospheric mass derived from the two products over some of the mentioned regions. We suggest that future GRACE studies consider these through updating uncertainty budgets or by applying corrections to estimated trends and amplitudes/phases

Calibration of the Latest Generation Superconducting Gravimeter iGrav-043 Using the Observatory Superconducting Gravimeter OSG-CT040 and the Comparisons of Their Characteristics at the Walferdange Underground Laboratory for Geodynamics, Luxembourg

In December 2019, the latest generation transportable superconducting gravimeter (SG) iGrav-043 purchased by the University of Bonn was installed in the Walferdange Underground Laboratory for Geodynamics (WULG) in the Grand Duchy of Luxembourg. In this paper, we estimate the calibration factor of the iGrav-043, which is essential for long-term gravity monitoring. We used simultaneously collected gravity data from the un-calibrated iGrav-043 and the calibrated Observatory superconducting gravimeter OSG-CT040 that operates continuously at WULG since 2002. The tidal analysis provides a simple way to transfer the calibration factor of one SG to the other. We then assess and compare tidal analyses, instrumental drifts and high frequency noises. After 20 years of continuous operation, the instrumental drift of the OSG-CT040 is almost zero. From 533 days of joint operation, we found that the instrumental drift of iGrav-043 exhibits a composite behavior: just after the setup and for two months a fast exponential decrease of 171 nm s−2, then a linear with a rate of 66 nm s−2 ± 10 nm s−2 per year. We suggest that a period of 3 months is sufficient for calibrating the iGrav. Accidental electrical power cuts triggered slight differences in the reaction and recovery of the OSG-CT040 and iGrav-043. However, it has been found that the long-term linear behavior of the drift was not affected

PATHOPHYSIOLOGY, INVESTIGATIONS, AND MANAGEMENT OF VENTRICULAR SEPTAL DEFECT

Background: Ventricular septal defects (VSDs) are still one of the most prevalent surgical indications in newborns and children with congenital heart disease. With advances in echocardiography, cardiac catheterization is no longer necessary in the treatment of these individuals. Although perioperative mortality and morbidity for isolated defects are still low, unique scenarios such as surgical care of numerous VSDs and decision-making in patients with pulmonary hypertension remain difficult. This chapter examines both classic and recent evidence that has shaped the management of this condition, as well as the facts underlying developing interventional methods utilized in both the catheterization lab and the operating room. Conclusion: VSD is the most common congenital abnormality at birth. Small flaws should close on their own within the first year of life; however, larger faults can cause serious difficulties. The major interventions for big problems are surgical VSD closure and device closure