A rare case of multiple thromboembolic events following valve replacement in pregnant women with rheumatic heart disease

Pregnancy is a hypercoagulable state. Women with mechanical valve replacement done falls under WHO 3 risk. Effective anticoagulation therapy is mandatory. Oral anticoagulants offer the best maternal protection against thrombosis, but associated with risk of fetal malformations and pregnancy loss. Oral anticoagulants offer the best maternal protection against thrombosis, but associated with risk of fetal malformations and pregnancy loss. A 26 years old primigravida, known case of rheumatic heart disease (RHD) since 11 years, post mechanical mitral valve replacement for severe mitral stenosis, referred with left upper limb ischemia, at 9 weeks gestation and managed accordingly

ADEPOS: Anomaly Detection based Power Saving for Predictive Maintenance using Edge Computing

In industry 4.0, predictive maintenance(PM) is one of the most important applications pertaining to the Internet of Things(IoT). Machine learning is used to predict the possible failure of a machine before the actual event occurs. However, the main challenges in PM are (a) lack of enough data from failing machines, and (b) paucity of power and bandwidth to transmit sensor data to cloud throughout the lifetime of the machine. Alternatively, edge computing approaches reduce data transmission and consume low energy. In this paper, we propose Anomaly Detection based Power Saving(ADEPOS) scheme using approximate computing through the lifetime of the machine. In the beginning of the machines life, low accuracy computations are used when the machine is healthy. However, on the detection of anomalies, as time progresses, the system is switched to higher accuracy modes. We show using the NASA bearing dataset that using ADEPOS, we need 8.8X less neurons on average and based on post-layout results, the resultant energy savings are 6.4 to 6.65XComment: Submitted to ASP-DAC 2019, Japa

Cells exhibiting strong p16INK4a promoter activation in vivo display features of senescence

The activation of cellular senescence throughout the lifespan promotes tumor suppression, whereas the persistence of senescent cells contributes to aspects of aging. This theory has been limited, however, by an inability to identify and isolate individual senescent cells within an intact organism. Toward that end, we generated a murine reporter strain by “knocking-in” a fluorochrome, tandem-dimer Tomato (tdTom), into exon 1α of the p16 INK4a locus. We used this allele (p16 tdTom ) for the enumeration, isolation, and characterization of individual p16 INK4a -expressing cells (tdTom + ). The half-life of the knocked-in transcript was shorter than that of the endogenous p16 INK4a mRNA, and therefore reporter expression better correlated with p16 INK4a promoter activation than p16 INK4a transcript abundance. The frequency of tdTom + cells increased with serial passage in cultured murine embryo fibroblasts from p16 tdTom/+ mice. In adult mice, tdTom + cells could be readily detected at low frequency in many tissues, and the frequency of these cells increased with aging. Using an in vivo model of peritoneal inflammation, we compared the phenotype of cells with or without activation of p16 INK4a and found that tdTom + macrophages exhibited some features of senescence, including reduced proliferation, senescence-associated β-galactosidase (SA-β-gal) activation, and increased mRNA expression of a subset of transcripts encoding factors involved in SA-secretory phenotype (SASP). These results indicate that cells harboring activation of the p16 INK4a promoter accumulate with aging and inflammation in vivo, and display characteristics of senescence

Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD

This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a "spike"and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs

Incidence of respiratory infections and its correlation with smoke exposure among infants from an urban field practice area in Tamil Nadu

Background: Children’s acute lower respiratory infections are most prevalent among new-born. Clinical evaluation and symptoms help to establish the connection between smoke exposure and acute respiratory tract infection (ARTI). Furthermore, there is proof that exposing children to coal smoke considerably increases their risk of developing ARTI. Aims and Objectives: This study was designed to estimate the incidence of respiratory tract infection (RTI) among selected cohort of infants in urban field practice area of Tamil Nadu and to correlate the incidence of RTIs with smoke practices. Materials and Methods: In Tamil Nadu’s urban field practice area, a cohort study of infants was done. A house-to-house survey was conducted and information was gathered among 150 newborns who were tracked after being selected as a period sample based on inclusion criteria at a 15* visit. Numerous data on ARI episodes, housing circumstances, and smoke exposure were gathered and correlated. Software such as Epi info and SPSS version 22 were used to analye data. Results: The incidence of TI was calculated to be 1.7 episodes per 100 person days and 4.7 on average among the 150 newborns chosen. Nearly 48% of people lived in huts, 84% had indoor kitchens, and 75% cooked with gas. Infants who appeared to regularly be exposed to passive smoking have a little increase in the incidence of mean RTI bouts. Conclusion: The additional hospital admissions, which are entirely preventable, place a heavy load on the public health system. It is evident that new initiatives are required to stop infants from being exposed to passive smoke during and after pregnancy. Improving international Electrotechnical commission activities play an active role is reducing incidence of RTIs among infants. Intensified educational interventions on ill effects of indoor and outdoor smoke, passive smoking helps in addressing the issue

Reference Distorted Prices

I show that when consumers (mis)perceive prices relative to reference prices, budgets turn out to be soft, prices tend to be lower and the average quality of goods sold decreases. These observations provide explanations for decentralized purchase decisions, for people being happy with a purchase even when they have paid their evaluation, and for why trade might affect high quality local firms 'unfairly'

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)

Managing Product Returns Within the Customer Value Framework

Customers can create value to the firm by purchasing products, not returning these products, recommending products to other potential customers, influencing other customers, and providing feedback to the company. In this chapter, we first discuss how product returns and engagement behaviors can be included in the customer value framework. Second, we discuss the antecedents of a customer’s product return decision, namely, return policies, information at the moment of purchase, and customer and product characteristics. Third, we focus on the consequences of product returns: the effects on future purchase and product return behavior, as well as on customer engagement behaviors. Thus, this chapter provides a comprehensive synthesis of current knowledge on antecedents and consequences of product returns and how this relates to measuring and managing customer value

Information Disclosure Strategies for Green Industries

Environmental information disclosure strategies, which involve corporate attempts to increase the availability of information on pollution and emissions, can become a basis for a new wave of environmental protection policy that follows and has the potential to complement traditional command and control and market-based approaches. Although a growing body of literature and operational programs suggest that publicly disclosing the information can motivate improved corporate environmental performance, this phenomenon remains poorly understood. This paper reviews the economic and legitimacy theory behind information disclosure and analyzes the current practice and programs adopted in industrialized and industrializing countries. Admittedly few in number, the cases studied reveal the advantages of such voluntary approaches, when the countries of developing Asia must deal with weak institutions, growing markets, and strong communities. Factors that contributed to widespread success of selected programs in the People's Republic of China, India, Indonesia, the Philippines, and the United States are information quality, the dissemination mechanisms, provision of incentives for good performers, and public and private pressure