Conivaptan and its role in the treatment of hyponatremia

Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is associated with increased morbidity and mortality. The recognition of the central role that arginin vasopressin plays in the pathogenesis of hyponatremia and the discovery that its actions are mediated by stimulation of V1A and V2 receptors have led to the development of a new class of drugs, the arginin vasopressin antagonists. Conivaptan is a nonselective V1A and V2 receptors antagonist that was the first of this class to be approved by the FDA for the management of euvolemic and hypervolemic hyponatremia. Its short-term safety and efficacy for the correction of hyponatremia have been established by multiple double-blind, randomized, controlled studies. Blocking the effects of arginin vasopressin on V2 receptors produces aquaresis – the electrolyte-sparing excretion of water – an ideal approach to correct hypervolemic hyponatremia. The nonselectivity of conivaptan offers a theoretical advantage for its use in heart failure that may merit further exploration

Enriching student knowledge on sustainable forest management practices by forestry professionals: a look into the generic structure potential of Malaysian forestry annual reports

Despite the establishment of numerous goals related to sustainable forest management (SFM), including the setting of Goal 15 in the 2015 United Nations' Sustainable Development Goals (SDGs), to date, its implementation is seen to be problematic. Its poor implementation is often associated with ineffective management of forests areas, which poses some challenges for students to understand better the nature of forestry professions and the expectations that come with the responsibility of sustainably managing forest reserves and lands. Analysing the practices and agendas conveyed in the forestry annual report (FAR) is indispensable, especially for forestry students who wish better to understand the forestry profession upon their study completion. This study sets out to identify the generic structure potential for the Year under the Review section of the forestry annual report and its functions in portraying forestry professionals throughout ten years (2009–2018). Document analysis following a Systemic Functional Linguistics perspective on generic structure potential is adopted in this study to identify the obligatory and optional elements included in the forestry annual report as well as the functions of each element observed in the Year under Review section of FAR. The results of the study show that eleven obligatory elements constitute the generic structure of the Year under Review section of the forestry annual report, which is directly related to the ideal SFM practices that contribute to SDG Goal 15 (Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss). The establishment of the generic structure potential for the Year under Review section of the Malaysian forestry annual report will help undergraduate forestry students understand the forestry profession's actual practices to equip them with knowledge in real-life settings

Accuracy of procalcitonin levels for diagnosis of culture-positive sepsis in critically ill trauma patients: A retrospective analysis

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.Methodology: This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.Results: A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p \u3c 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p \u3c 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p \u3c 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p \u3c 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.Conclusion: Our study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly

Investigating the acceptability of non-mesh, long-lasting insecticidal nets amongst nomadic communities in Garissa County, Kenya using a prospective, longitudinal study design and cross-sectional household surveys.

BACKGROUND: North East Kenya is an area of semi-arid terrain, prone to malaria epidemics. The distribution of long-lasting insecticidal nets (LLINs) has long been a key malaria intervention, however, for nomadic populations who live and sleep outside, in harsh climates and areas with increasing reports of exophagic behaviour of mosquitoes, traditional LLINs are often inadequate. This study investigates the acceptability of non-mesh LLINs, specifically designed to suit nomadic, outdoor sleeping communities. METHODS: In September 2011, 13,922 non-mesh LLINs were distributed to 8,511 nomadic households in Garissa County, North East Province, Kenya. A prospective, longitudinal study design was used to assess the acceptability of this novel type of LLIN. Cross-sectional household surveys, focus group discussions (FGDs), and key informant interviews (KIs) were used to collect data on attitudes and practices regarding the Dumuria nets. RESULTS: A very high level of acceptability was reported with 95.3% of respondents stating they liked the nets. Of the factors reportedly determining net use the most frequently mentioned was "vulnerability". Of those with concerns about the nets, the colour (white) was the most frequently reported. CONCLUSION: The tailoring of LLINs to specific communities and contexts leads to increased levels of acceptability. Large-scale, blanket net distribution campaigns, which are currently the standard practice, do not cater for the specific and nuanced needs of the differing communities they often serve. This non-mesh LLIN offers a highly effective and desirable malaria prevention option to a typically hard to reach and underserved nomadic population at increased risk of malaria infection

Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data

Drivers need sufficient passing sight distance (PSD) to pass slower vehicles with safety. This distance can help to improve traffic operation on two-way, two-lane highways. Existing models propose different values of PSD because of different assumptions. In only some cases were these models based on field data of passing maneuvers. This research proposed the design of a methodology to observe passing maneuvers on existing highways with the help of six video cameras installed at a fixed point next to passing sections. The use of more cameras allows complete registration of trajectories along the entire passing zone, with uniform image resolution. The methodology was applied to register a sample of 234 maneuvers on four passing zones. Trajectories of 58 maneuvers were completely described and analyzed with specific restitution software. Results were compared with those from existing PSD models. The distances traveled proposed by the AASHTO model on the left lane were (a) similar to average observed distances when the passed vehicle was one truck and (b) between 50 and 100 m higher when one passenger car was passed. Higher differences, greater than 100 m, were found between measured data and the PSD model (published previously), especially at high design speeds. The observed average speed difference between passing and impeding vehicles was significantly higher than that in any model. Variables with the strongest influence on the time and distance traveled on the opposing lane were the type and speed of the passed vehicle and the length of the passing zone. Left-lane time and distance increase with this length.Llorca Garcia, C.; García García, A. (2011). Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data. Transportation Research Record. 2262:42-51. doi:10.3141/2262-05S42512262Farah, H., Bekhor, S., & Polus, A. (2009). Risk evaluation by modeling of passing behavior on two-lane rural highways. Accident Analysis & Prevention, 41(4), 887-894. doi:10.1016/j.aap.2009.05.006Rilett, L. R., Hutchinson, B. G., & Whitney, M. (1990). Mechanics of the passing maneuver and the impact of large trucks. Transportation Research Part A: General, 24(2), 121-128. doi:10.1016/0191-2607(90)90019-3Wang, Y., & Cartmell, M. P. (1998). New Model for Passing Sight Distance on Two-Lane Highways. Journal of Transportation Engineering, 124(6), 536-545. doi:10.1061/(asce)0733-947x(1998)124:6(536)Polus, A., Livneh, M., & Frischer, B. (2000). Evaluation of the Passing Process on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 53-60. doi:10.3141/1701-07Carlson, P., Miles, J., & Johnson, P. (2006). Daytime High-Speed Passing Maneuvers Observed on Rural Two-Lane, Two-Way Highway: Findings and Implications. Transportation Research Record: Journal of the Transportation Research Board, 1961, 9-15. doi:10.3141/1961-02Harwood, D. W., Gilmore, D. K., & Richard, K. R. (2010). Criteria for Passing Sight Distance for Roadway Design and Marking. Transportation Research Record: Journal of the Transportation Research Board, 2195(1), 36-46. doi:10.3141/2195-0

Patient adherence to prescribed artemisinin-based combination therapy in Garissa County, Kenya, after three years of health care in a conflict setting.

BACKGROUND: Current day malaria cases and deaths are indicative of a lack of access to both methods of prevention, diagnosis, and treatment; an important determinant of treatment efficacy is adherence. This study is a follow up to the baseline study of adherence to artemether-lumefantrine (AL) carried out in Garissa District in 2010. The study presented evaluates any changes in adherence levels which may have occurred in the area during this period and after nearly three years of sustained use of ACT across the public health sector. METHODS: The study was carried out in Garissa County in the North Eastern Province of Kenya and included patients fitting the suspected malaria case definition and having been prescribed AL, regardless of confirmatory diagnosis. A questionnaire assessed the intake of AL via both self-reporting by the participant and observation of blister packs by the interviewer. On separate occasions exit interviews with patients and observations of prescribers were also carried out. RESULTS: Of the 218 participants enrolled, 195 were successfully followed up. 60% of participants were found to be adherent to the three-day AL regimen, this is 4.7% lower than the proportion of participants adherent in 2010; the result of a two-sided z-test was not significant (p = 0.23). The odds of the patient being adherent to AL increased by 65% with each additional correct statement regarding how to take AL that a patient could recall (between zero and four statements), this was the only variable significantly associated with patient adherence (p = 0.01). CONCLUSION: Sustaining the ACT adherence rates at the 2010 levels, through 2.5 years of insecurity in the study area is an achievement and suggests that if security can be improved barriers to improving health service quality and patient adherence to AL would be removed. This study, by looking specifically at anti-malarial adherence over a prolonged period and in a setting of severe conflict, provides a valuable and rare insight in to the challenges and barriers to ACT adherence in such settings

Prevalence of diabetes foot ulcers and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia

BackgroundDiabetes mellitus (DM) causes significant morbidity and mortality in sub-Saharan Africa (SSA), including Somalia. Among diabetic patients, diabetic foot ulcers (DFUs) constitute the largest proportion of admissions, amputations, and mortality. The aim of this study is to assess the prevalence of diabetic foot ulcers and subsequently determine factors associated with it among diabetic patients at three major hospitals in Somalia.MethodsAn institutional-based cross-sectional study was conducted among 193 diabetic patients between August and November 2022. All eligible diabetes patients who were attending De Martini Hospital, Madina General Hospital, and Deynile General Hospital during the study period were included in the study. Patients were interviewed using a structured questionnaire. We collected demographic, clinical, and behavioral variables from all participants. A bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. An odds ratio with a 95% confidence interval was computed to determine the level of significance.ResultThe mean age of the study’s participants was 50.9 ± 13.6 years. The prevalence of diabetic foot ulcer was 15%. Patients who were either overweight or obese (OR 4.63, CI: 2.08–10.30), had a lack of family support in managing diabetes (OR 3.33, CI: 1.74–6.36), and did not check their feet regularly were more likely to develop DFU (OR 1.99, CI:1.08–3.66).ConclusionIncreased body mass index, lack of family support, and not checking feet regularly were associated with DFUs. The high prevalence of DFUs and the plethora of needs of people with DFUs pose challenges for health care. A coordinated health care system is necessary to meet the needs of diabetic patients and prevent DFUs

Influence of highway 3D coordination on drivers' perception of horizontal curvature and available sight distance

"This paper is a preprint of a paper submitted to [journal] and is subject to Institution of Engineering and Technology Copyright. If accepted, the copy of record will be available at IET Digital Library"Drivers' road perception is an important human factor of comfort and safety on driving. Available sight distance of crest vertical curves superimposed on horizontal curves can be geometrically optimised by applying 3D coordination criteria. However, drivers might not perceive available sight distance improvements. Two approaches were used to investigate the effect of geometrical optimised design on perceived sharpness and visibility of isolated crest vertical curves overlapped with horizontal curves. A survey-based approach was used to evaluate subjective perception of 100 drivers. Three-dimensional renderings were displayed to subjects; who were asked to rank the curves by sharpness and sight distance. Moreover, 50 of those drivers previously participated on a driving simulation experiment involving the same curves, so objective driving data were collected too. Drivers' survey results indicate that driver's curve perception depends on the algebraic difference of grades while coordination of vertical and horizontal curves does not appear to affect this perception. On the other hand, the operating speeds on different curves were not statistically different from each other. Surprisingly, the operating speeds on a flat curve tended to be lower than on the vertical crest curves superimposed on the same horizontal curve. Likely causes are discussed in the paper.Moreno Chou, AT.; García García, A.; Camacho Torregrosa, FJ.; Llorca Garcia, C. (2013). Influence of highway 3D coordination on drivers' perception of horizontal curvature and available sight distance. IET Intelligent Transport Systems. 7(2):244-250. doi:10.1049/iet-its.2012.0146S24425072Hassan, Y., & Easa, S. M. (2000). Modeling of Required Preview Sight Distance. Journal of Transportation Engineering, 126(1), 13-20. doi:10.1061/(asce)0733-947x(2000)126:1(13)García, A. (2004). Discussion of «Optimal Vertical Alignment Analysis for Highway Design» by T. F. Fwa, W. T. Chan, and Y. P. Sim. Journal of Transportation Engineering, 130(1), 138-138. doi:10.1061/(asce)0733-947x(2004)130:1(138)Bidulka, S., Sayed, T., & Hassan, Y. (2002). Influence of Vertical Alignment on Horizontal Curve Perception: Phase I: Examining the Hypothesis. Transportation Research Record: Journal of the Transportation Research Board, 1796(1), 12-23. doi:10.3141/1796-02Hassan, Y., Sayed, T., & Bidulka, S. (2002). Influence of Vertical Alignment on Horizontal Curve Perception: Phase II: Modeling Perceived Radius. Transportation Research Record: Journal of the Transportation Research Board, 1796(1), 24-34. doi:10.3141/1796-03Hasan, M., Sayed, T., & Hassan, Y. (2005). Influence of vertical alignment on horizontal curve perception: effect of spirals and position of vertical curve. Canadian Journal of Civil Engineering, 32(1), 204-212. doi:10.1139/l04-090Wang, F., & Easa, S. M. (2009). Validation of Perspective-View Concept for Estimating Road Horizontal Curvature. Journal of Transportation Engineering, 135(2), 74-80. doi:10.1061/(asce)0733-947x(2009)135:2(74)Bella, F. (2007). Parameters for Evaluation of Speed Differential. Transportation Research Record: Journal of the Transportation Research Board, 2023(1), 37-43. doi:10.3141/2023-05Ben-Bassat, T., & Shinar, D. (2011). Effect of shoulder width, guardrail and roadway geometry on driver perception and behavior. Accident Analysis & Prevention, 43(6), 2142-2152. doi:10.1016/j.aap.2011.06.004Jia, L., Wang, J., & Lu, M. (2011). Using real-world data to calibrate a driving simulator measuring lateral driving behaviour. IET Intelligent Transport Systems, 5(1), 21-31. doi:10.1049/iet-its.2009.0094Antonson, H., Mårdh, S., Wiklund, M., & Blomqvist, G. (2009). Effect of surrounding landscape on driving behaviour: A driving simulator study. Journal of Environmental Psychology, 29(4), 493-502. doi:10.1016/j.jenvp.2009.03.005Land, M. F., & Lee, D. N. (1994). Where we look when we steer. Nature, 369(6483), 742-744. doi:10.1038/369742a0Zuriaga, A. M. P., García, A. G., Torregrosa, F. J. C., & D’Attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record: Journal of the Transportation Research Board, 2171(1), 11-20. doi:10.3141/2171-02Kweon, B.-S., Ellis, C. D., Lee, S.-W., & Rogers, G. O. (2006). Large-Scale Environmental Knowledge. Environment and Behavior, 38(1), 72-91. doi:10.1177/001391650528009

Influence of age, gender and delay on overtaking dynamics

"This paper is a preprint of a paper submitted to [journal] and is subject to Institution of Engineering and Technology Copyright. If accepted, the copy of record will be available at IET Digital Library"Overtaking is one of the most dangerous manoeuvres on two-lane rural highways. The most influential factors are related to drivers, so ITS and assistance systems are not yet common. This research is based on experimental data of overtaking manoeuvres collected using an instrumented passenger car, equipped with four cameras, laser rangefinders and a global positioning service (GPS) tracker. This vehicle was driven along four different road segments in the surroundings of Valencia (Spain) at a speed slightly slower than the operating speed of each segment. Overtaking time and speeds were measured. Unlike previous work, the influence of human factor was also considered. Age and gender of overtaking driver, as well as time spent following were used to characterise this influence. More than 200 manoeuvres were recorded and the influence of driver characteristics and delay on gap acceptance, manoeuvre duration and speed differences have been analysed. Results show differences in behaviour between age and gender groups, since young male overtaking drivers have shown a more aggressive behaviour. Overtaking times were around 1 s lower than other drivers, whereas average speed difference was 4 km/h higher. Collected data and their analysis have provided a basis to review design criteria and to develop future assistance systems.Authors would like to thank Spanish Ministry of Economy and Competitiveness that subsidizes the research project with reference code TRA2010-21736. Authors thank also Spanish General Traffic Directorate, Spanish Ministry of Public Works and Valencia Regional Governance for their collaboration during field study.Llorca García, C.; García García, A.; Moreno Chou, AT.; Pérez Zuriaga, AM. (2013). Influence of age, gender and delay on overtaking dynamics. IET Intelligent Transport Systems. 7(2):174-181. https://doi.org/10.1049/iet-its.2012.0147S17418172Farah, H. (2011). Age and Gender Differences in Overtaking Maneuvers on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 2248(1), 30-36. doi:10.3141/2248-04Hassan, Y., Easa, S. M., & El Halim, A. O. A. (1996). Passing sight distance on two-lane highways: Review and revision. Transportation Research Part A: Policy and Practice, 30(6), 453-467. doi:10.1016/0965-8564(95)00032-1Wang, Y., & Cartmell, M. P. (1998). New Model for Passing Sight Distance on Two-Lane Highways. Journal of Transportation Engineering, 124(6), 536-545. doi:10.1061/(asce)0733-947x(1998)124:6(536)Polus, A., Livneh, M., & Frischer, B. (2000). Evaluation of the Passing Process on Two-Lane Rural Highways. Transportation Research Record: Journal of the Transportation Research Board, 1701(1), 53-60. doi:10.3141/1701-07Carlson, P., Miles, J., & Johnson, P. (2006). Daytime High-Speed Passing Maneuvers Observed on Rural Two-Lane, Two-Way Highway: Findings and Implications. Transportation Research Record: Journal of the Transportation Research Board, 1961, 9-15. doi:10.3141/1961-02Hegeman, G., Tapani, A., & Hoogendoorn, S. (2009). Overtaking assistant assessment using traffic simulation. Transportation Research Part C: Emerging Technologies, 17(6), 617-630. doi:10.1016/j.trc.2009.04.010El Zarif, J., Hobeika, A., & Rakha, H. (2003). Evaluating a Detection and Warning System to Deter No-Passing Zone Violations. Journal of Transportation Engineering, 129(6), 590-599. doi:10.1061/(asce)0733-947x(2003)129:6(590)Llorca, C., & García, A. (2011). Evaluation of Passing Process on Two-Lane Rural Highways in Spain with New Methodology Based on Video Data. Transportation Research Record: Journal of the Transportation Research Board, 2262(1), 42-51. doi:10.3141/2262-0