Single‐center Experience of Outcomes of Tracheostomy in Children with Congenital Heart Disease

Objective A subset of children with repaired congenital heart disease ( CHD ) may require tracheostomy for ongoing ventilatory support. Data on outcomes of children with CHD and tracheostomy are scarce. Our objectives were to describe indications for tracheostomy and outcomes, including readmission data in this population. Methods This is a retrospective chart review of children (<18 years old) with CHD who underwent tracheostomy at a single center over a 12‐year period. Exclusion criteria were prematurity with isolated patent ductus arteriosus ligation. Outcomes until discharge and data on all readmissions after the initial discharge were reviewed. Results A total of 21 subjects with CHD underwent tracheostomy at a median (range) age of 4 (1–84) months and mean (standard deviation) weight of 7.2 (5.9) kg. The most common indication for tracheostomy was tracheomalacia with ventilator‐dependent respiratory failure (14/21 subjects), followed by subglottic stenosis (5) and vocal cord palsy (2). Genetic syndromes were present in 13 (62%) subjects. The mean (standard deviation) post‐tracheostomy length of stay was 55 (35) days. All subjects survived to discharge; 17 (81%) required home ventilation. A total of 11 (52%) subjects died during follow‐up, all of whom were mechanically ventilated while three (14%) children underwent successful decannulation. The mean number of nonelective readmissions decreased from 2.4/patient‐year in the first year to 1.4/patient‐year in the second year, respectively. The commonest reasons for readmission were respiratory deterioration, infections, and mechanical tracheostomy‐related problems. Conclusions The majority of children with CHD who underwent tracheostomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102228/1/chd12048.pd

Zika Virus NS5 Protein novel Inhibitors from Limonium sinense phytochemicals using Glide: In silico Approach

Zika virus infection causes significant congenital disabilities, in addition to microcephaly while an excited mother is infected during pregnancy. Mosquito vectors are the main spreaders of the zika virus which includes Aedes albopictus and Aedes aegypti. presently clear-cut and definite treatment for the zika virus is not yet available. engrossing in silico approach present study determines the active fighter constituents from aboriginal antiviral herbs to regulate the zika virus. The Lipinski rule filter was used for the Phytoconstituents to determine their molecular interactions and pharmacokinetic studies. NS5 polymerase protein (PDB ID; 5U04) and ligand interactions were determined using Schrodinger Maestro software version 12.7. The outcome displayed that Quercetin, Moupinamide, Epigallocatechin gallate, and Myricetin have sharpened synergism with the asparte active site of NS5 RdRps with docking score (-6.087, -5.838, -5.812, -5.418 Kcal/mol). Analysing the pharmacokinetic study hydrogen bonds with 2.5 Å for target Aspartate amino acid have prime activity. the present study propounds that Quercetin can be used as an inhibitor of the Zika virus

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Modeling and Simulation Assessment of Solar Photovoltaic/Thermal Hybrid Liquid System Using TRNSYS

The PV/T hybrid system is a combined system consisting of PV panel behind which heat exchanger with fins are embedded. The PV/T system consists of PV panels with a battery bank, inverter etc., and the thermal system consists of a hot water storage tank, pump and differential thermostats. In the present work, the modeling and simulation of a Solar Photovoltaic/Thermal (PV/T) hybrid system is carried out for 5 kWp using TRNSYS for electrical energy and thermal energy for domestic hot water applications. The prominent parameters used for determining the electrical efficiency, thermal efficiency, overall thermal efficiency, electrical thermal efficiency and exergy efficiency are the solar radiation, voltage, current, ambient temperature, mass flow rate of water, area of the PV module etc. The simulated results of the Solar PV/T hybrid system are analyzed for the optimum water flow rate of 25 kg/hr. The electrical efficiency, thermal efficiency, overall thermal efficiency, equivalent thermal efficiency, exergy efficiency are found to be 10%, 34%, 60%, 35% and 13% respectively. The average tank temperature is found to be 50°C

Carbon-Efficient Virtual Machine Placement Based on Dynamic Voltage Frequency Scaling in Geo-Distributed Cloud Data Centers

The tremendous growth of big data analysis and IoT (Internet of Things) has made cloud computing an integral part of society. The prominent problem associated with data centers is the growing energy consumption, which results in environmental pollution. Data centers can reduce their carbon emissions through efficient management of server power consumption for a given workload. Dynamic voltage frequency scaling (DVFS) can be applied to control the operating frequencies of the servers based on the workloads assigned to them, as this approach has a cubic increment relationship with power consumption. This research work proposes two DVFS-enabled host selection algorithms for virtual machine (VM) placement with a cluster selection strategy, namely the carbon and power-efficient optimal frequency (C-PEF) algorithm and the carbon-aware first-fit optimal frequency (C-FFF) algorithm.The main aims of the proposed algorithms are to balance the load among the servers and dynamically tune the cooling load based on the current workload. The cluster selection strategy is based on static and dynamic power usage effectiveness (PUE) values and the carbon footprint rate (CFR). The cluster selection is also extended to non-DVFS host selection policies, namely the carbon- and power-efficient (C-PE) algorithm, carbon-aware first-fit (C-FF) algorithm, and carbon-aware first-fit least-empty (C-FFLE) algorithm. The results show that C-FFF achieves 2% more power reduction than C-PEF and C-PE, and demonstrates itself as a power-efficient algorithm for CO2 reduction, retaining the same quality of service (QoS) as its counterparts with lower computational overheads

Mixed ligand triphenylphosphine/arsine Schiff base complexes of ruthenium(II) and their catalytic activities towards oxidation of alcohols

90-93Mixed ligand ruthenium(II) complexes [Ru(CO)(Y)(L)], where Y = PPh3, AsPh3, pyridine (py) or piperidine (pip) and H2L = Schiff bases derived from the condensation of o-aminophenol, o-aminothiophenol and anthranillic acid with acetyl acetone in 2:1 molar ratio, obtained from the reactions of [RuHX(CO)(EPh3)2(Y)] (X = H or Cl ; E = P or As) with H2L, have been found to show catalytic activity in the oxidation of alcohols to aldehydes