Success Rate and Complications of Internal Jugular Vein Catheterization With and Without Ultrasonography Guide

Background: Central venous catheterization (CVC) is an important procedure in emergency departments (EDs). Despite existence of ultrasonography (US) devices in every ED, CVC is done using anatomical landmarks in many EDs in Iran. Objectives: This study aimed to compare the traditional landmark method vs. US-guided method of CVC placement in terms of complications and success rate. Patients and Methods: In this randomized controlled trial, patients who were candidate for internal jugular vein catheterization, and referred to Baqiyatallah Hospital ED were randomly allocated into US-guided CVC and anatomical landmarks guided CVC groups. Central vein access time, number of attempts, success rate, and complications in each group were evaluated. Mann-Whitney U, chi-square and Fisher exact tests along with Pearson and Spearman correlation coefficients were used to analyze the data. Results: Out of 100 patients, 56 were male and 44 were female. No significant differences were found between the US-guided and traditional landmark methods of CVC insertion in terms of age, gender, BMI, and site of catheter insertion. The mean access time was significantly lower in the US-guided group (37.12 ± 17.33 s vs. 63.42 ± 35.19 s, P < 0.001). The mean number of attempts was also significantly lower in the US-guided group (1.12 ± 0.3 vs. 1.58 ± 0.64 times, P < 0.001). Eighty-eight percent of patients in the US-guided group were catheterized in the first attempt, while 50% of patients in the traditional landmark group were catheterized in the second or more attempts (P < 0.001). The success rate was 100% in the US-guided group, while it was 88% in the landmark group (P = 0.013). Moreover, the rate of complications was significantly lower in the US-guided group (4% vs. 24%, P = 0.004). Conclusions: The US-guided method for CVC placement was superior to the traditional landmark method in terms of access time, number of attempts, success rate, and fewer complications

AZ ÉLELMISZERGAZDASÁG KÜLKERESKEDELME 2016. év I–X. hónap

A mezőgazdasági és élelmiszeripari termékek kivitele 6607 millió eurót, behozatala 4216 millió eurót tett ki 2016 első tíz hónapjában. Az agrár-külkereskedelmi forgalom 2391 millió euró aktívumot eredményezett. A kivitel értéke 1,4 százalékkal, a behozatalé 4,8 százalékkal emelkedett, az aktívum 4,1 százalékkal, 103 millió euróval elmaradt a 2015. január–októberi értéktől. A mezőgazdasági és élelmiszeripari termékek részesedése a teljes nemzetgazdasági exportból 2016 októberében 8,9 százalék, 2016 január–októberi időszakában 8,5 százalék, az importból 2016 októberében 6,3 százalék, 2016 január–októberi időszakában 6,1 százalék volt. Az agrárexport aránya 2016 január–októberi időszakában 0,1 százalékponttal alacsonyabb, míg az import aránya 0,2 százalékponttal magasabb volt, mint 2015 első tíz hónapjában

Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

Influence of case definition on incidence and outcome of acute coronary syndromes

© 2016, BMJ Publishing Group. All rights reserved. Objective: Acute coronary syndromes (ACS) are common, but their incidence and outcome might depend greatly on how data are collected. We compared case ascertainment rates for ACS and myocardial infarction (MI) in a single institution using several different strategies. Methods: The Hull and East Yorkshire Hospitals serve a population of ∼560 000. Patients admitted with ACS to cardiology or general medical wards were identified prospectively by trained nurses during 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and, independently, from Myocardial Infarction National Audit Project (MINAP) records. The hospital laboratory identified all patients with an elevated serum troponin-T (TnT) by contemporary criteria ( > 0.03 μg/L in 2005). Results: The prospective survey identified 1731 admissions (1439 patients) with ACS, including 764 admissions (704 patients) with MIs. The hospital information department reported only 552 admissions (544 patients) with MI and only 206 admissions (203 patients) were reported to the MINAP. Using all 3 strategies, 934 admissions (873 patients) for MI were identified, for which TnT was > 1 μg/L in 443, 0.04-1.0 μg/L in 435, =0.03 μg/L in 19 and not recorded in 37. A further 823 patients had TnT > 0.03 μg/L, but did not have ACS ascertained by any survey method. Of the 873 patients with MI, 146 (16.7%) died during admission and 218 (25.0%) by 1 year, but ranging from 9% for patients enrolled in the MINAP to 27% for those identified by the hospital information department. Conclusions: MINAP and hospital statistics grossly underestimated the incidence of MI managed by our hospital. The 1-year mortality was highly dependent on the method of ascertainment

Herding model and 1/f noise

We provide evidence that for some values of the parameters a simple agent based model, describing herding behavior, yields signals with 1/f power spectral density. We derive a non-linear stochastic differential equation for the ratio of number of agents and show, that it has the form proposed earlier for modeling of 1/f^beta noise with different exponents beta. The non-linear terms in the transition probabilities, quantifying the herding behavior, are crucial to the appearance of 1/f noise. Thus, the herding dynamics can be seen as a microscopic explanation of the proposed non-linear stochastic differential equations generating signals with 1/f^beta spectrum. We also consider the possible feedback of macroscopic state on microscopic transition probabilities strengthening the non-linearity of equations and providing more opportunities in the modeling of processes exhibiting power-law statistics

Review of Modeling Approaches to Groundwater Flow in Deformed Carbonate Aquifers

We discuss techniques to represent groundwater flow in carbonate aquifers using the three existing modeling approaches: equivalent porous medium, conduit network, and discrete fracture network. Fractures in faulted stratigraphic successions are characterized by dominant sets of sub-vertical joints. Grid rotation is recommended using the equivalent porous medium to match higher hydraulic conductivity with the dominant orientation of the joints. Modeling carbonate faults with throws greater than approximately 100 m is more challenging. Such faults are characterized by combined conduit-barrier behavior. The barrier behavior can be modeled using the Horizontal Flow Barrier Package with a low-permeability vertical barrier inserted to represent the impediment of horizontal flow in faults characterized by sharp drops of the piezometric surface. Cavities can occur parallel to the strike of normal faults generating channels for the groundwater. In this case, flow models need to account for turbulence using a conduit network approach. Channels need to be embedded in an equivalent porous medium due to cavities a few centimeters large, which are present in carbonate aquifers even in areas characterized by low hydraulic gradients. Discrete fracture network modeling enables representation of individual rock discontinuities in three dimensions. This approach is used in non-heavily karstified aquifers at industrial sites and was recently combined with the equivalent porous medium to simulate diffusivity in the matrix. Following this review, we recommend that the future research combines three practiced modeling approaches: equivalent porous medium, discrete fracture network, and conduit network, in order to capture structural and flow aspects in the modeling of groundwater in carbonate rocks

A Parallelizable Heuristic for Solving the Generic Materials and Operations Planning in a Supply Chain Network: A Case Study from the Automotive Industry

[EN] A trend in up-to date developments in multi-site operations planning models is to consider in details the different ways to produce, buy or transport products and the distributed decision-making process for operations planning. One of the most generic approaches to support global optimization in those supply chain networks by considering all the different operations alternatives and product structures is the Generic Materials & Operations Planning Problem. This problem can be modelled by a Mixed Integer Linear Programming model capable of considering production, transportation, procurement tasks and their alternatives and other relevant issues such as packaging. The aim of this paper is to introduce the implementation of a parallelizable heuristic method for materials and operations planning and its application to a case of a Supply Chain Network of the automotive industry. The approach uses variants of the GMOP model to overcome traditional MRP systems' limitations.Maheut ., JP.; García Sabater, JP. (2013). A Parallelizable Heuristic for Solving the Generic Materials and Operations Planning in a Supply Chain Network: A Case Study from the Automotive Industry. IFIP Advances in Information and Communication Technology. 397:151-157. doi:10.1007/978-3-642-40352-1_20S151157397Maheut, J., Garcia-Sabater, J.P.: La Matriz de Operaciones y Materiales y la Matriz de Operaciones y Recursos, un nuevo enfoque para resolver el problema GMOP basado en el concepto del Stroke. Dirección y Organización 45, 46–57 (2011)Garcia-Sabater, J.P., Maheut, J., Marin-Garcia, J.A.: A new formulation technique to model Materials and Operations Planning: the Generic Materials and Operations Planning (GMOP) Problem. European J. Industrial Engineering 7, 119–147 (2013)Mula, J., Maheut, J., Garcia-Sabater, J.P.: Supply Chain Network Design. Journal of Marketing and Operations Management Research 1, 378–383 (2012)Dudek, G., Stadtler, H.: Negotiation-based collaborative planning between supply chains partners. European Journal of Operational Research 163, 668–687 (2005)Torabi, S.A., Hassini, E.: Multi-site production planning integrating procurement and distribution plans in multi-echelon supply chains: an interactive fuzzy goal programming approach. International Journal of Production Research 47, 5475–5499 (2009)Kanyalkar, A.P., Adil, G.K.: Aggregate and detailed production planning integrating procurement and distribution plans in a multi-site environment. International Journal of Production Research 45, 5329–5353 (2007)de Kok, T.G., Fransoo, J.C.: Planning Supply Chain Operations: Definition and Comparison of Planning Concepts. In: Graves, S.C. (ed.) Handbooks in Operations Research and Management Science Supply Chain Management: Design, Coordination and Operation, vol. 11, pp. 597–675. Elsevier (2003)Buschkühl, L., Sahling, F., Helber, S., Tempelmeier, H.: Dynamic capacitated lot-sizing problems: a classification and review of solution approaches. OR Spectrum (2009)Maheut, J., Garcia-Sabater, J.P., Mula, J.: A supply Chain Operations Lot-Sizing and Scheduling Model with Alternative Operations. In: Sethi, S.P., Bogataj, M., Ros-McDonnell, L. (eds.) Proceedings of the Industrial Engineering: Innovative Networks, 5th International Conference on Industrial Engineering and Industrial Management "CIO 2011", Cartagena, Spain, pp. 309–316. Springer, London (2012)Garcia-Sabater, J.P., Maheut, J., Garcia-Sabater, J.J.: A two-stage sequential planning scheme for integrated operations planning and scheduling system using MILP: the case of an engine assembler. Flexible Services and Manufacturing Journal 24, 171–209 (2012)Pinto, J.M., Chen, P., Papageorgiou, L.G.: A discrete/continuous time MILP model for medium term planning of single stage multiproduct plants, pp. 1–6. Elsevier, B.V. (2007)Scheer, A.W.: Business Process Engineering - Reference Models for Industrial Enterprises. Springer (1994)Lin, J.T., Chen, T.L., Lin, Y.T.: Critical material planning for TFT-LCD production industry. International Journal of Production Economics 122, 639–655 (2009)Escudero, L.F.: CMIT, capacitated multi-level implosion tool. European Journal of Operational Research 76, 511–528 (1994)Maheut, J., Garcia-Sabater, J.P., Valero-Herrero, M.: MILP model for solving the supply chain operations scheduling problem with alternative operations considering delay penalization: a case study of a mass customization company. In: Proceedings of the 41st International Conference on Computers & Industrial Engineering, pp. 289–294 (2011

Reframing policy responses to population aging in Iran

Iran is aging rapidly and is expected to see negative population growth rates later this century. This change is generating significant concern for policymakers, whose response is to seek ‘demographic solutions’ to these issues: raise the fertility rate, decrease the divorce rate, and promote marriage among young people. Part of these policies has entailed curtailing access to free family planning services. This ‘call and response’ approach is unlikely to succeed in its stated aim, as it over-simplifies the real challenges of population aging as well as the multiple dimensions of population change. Such policies derive from simple representations of demographic change, most notably using the old-age dependency ratio. Using a microsimulation model, this paper suggests that increasing Iran’s currently low female labor force participation and translating educational gains into rising productivity is a more effective means of responding to the challenges of population aging, even under low fertility conditions. The advancement on previous such microsimulation exercises lies in the fact that this study explicitly considers the comparison between raising fertility and increasing female economic empowerment to offset population aging in a setting characterized by an overt pronatalist policy system. In tandem with reforming stressed institutional systems (such as the pension system), releasing the full potential of Iran’s existing (and future) human capital—especially of its women—is a far more effective policy direction than fertility-promoting policies