The Effect of Tramadol on Decreasing Postoperative Shivering

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Temporal evolution of anxiety and depression in chronic heart failure and its association with clinical outcome

Background: Although anxiety and depression have been associated with adverse outcomes in chronic heart failure (HF), data on temporal evolution of these symptoms are scarce. We aimed to investigate the association between repeatedly measured depression and anxiety symptoms and clinical outcome in chronic HF patients. Methods: In this prospective observational study, outpatients with chronic HF were included and followed-up for a maximum of 2.5 years. The hospital anxiety and depression scale (HADS) questionnaire was conducted every six months. The primary endpoint was a composite of HF hospitalization, cardiovascular death, heart transplantation and left ventricular assist device (LVAD) implantation. Cox and joint models were used to investigate the association between the HADS score and the endpoint. Results: A total of 362 patients filled out a median (25th–75th percentile) of 3 [2–4] questionnaires each. Mean ± SD age was 63 ± 13 years, 72% were men. Anxiety scores remained relatively stable leading up to the endpoint, while depression scores increased. Higher baseline depression scores were significantly associated with the endpoint (hazard ratio [HR] 1.68 and 95% confidence interval [CI] 1.19–2.36 per log(score+1), p = 0.003), while higher baseline anxiety scores did not reach statistical significance (HR [95% CI] 1.34 [0.99–1.83], p = 0.061). When repeatedly measured, both higher anxiety (HR [95% CI] 1.57[1.07–2.30], p = 0.022) and depression (HR [95% CI] 2.04 [1.39–3.06], p &lt; 0.001) scores were significantly associated with the endpoint. Conclusion: Serial measurements of depression and anxiety symptoms identify chronic HF patients with increased risk of adverse clinical outcomes. Screening for both disorders should be considered in clinical practice.</p

Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction

Background: We investigated whether repeatedly measured left atrial reservoir strain (LASr) in heart failure with reduced ejection fraction (HFrEF) patients provides incremental prognostic value over a single baseline LASr value, and whether temporal patterns of LASr provide incremental prognostic value over temporal patterns of other echocardiographic markers and NT-proBNP. Methods: In this prospective observational study, 153 patients underwent 6-monthly echocardiography, during a median follow-up of 2.5 years. Speckle tracking echocardiography was used to measure LASr. Hazard ratios (HRs) were calculated for LASr from Cox models (baseline) and joint models (repeated measurements). The primary endpoint (PEP) comprised HF hospitalization, left ventricular assist device, heart transplantation, and cardiovascular death. Results: Mean age was 58 ± 11 years, 76% were men, 82% were in NYHA class I/II, mean LASr was 20.9% ± 11.3%, and mean LVEF was 29% ± 10%. PEP was reached by 50 patients. Baseline and repeated measurements of LASr (HR per SD change (95% CI) 0.20 (0.10–0.41) and (0.13 (0.10–0.29), respectively) were both significantly associated with the PEP, independent of both baseline and repeated measurements of other echo-parameters and NT-proBNP. Although LASr was persistently lower over time in patients with PEP, temporal trajectories did not diverge in patients with versus without the PEP as the PEP approached. Conclusion: LASr was associated with adverse events in HFrEF patients, independent of baseline and repeated other echo-parameters and NT-proBNP. Temporal trajectories of LASr showed decreased but stable values in patients with the PEP, and do not provide incremental prognostic value for clinical practice compared to single measurements of LASr. Graphical abstract: [Figure not available: see fulltext.].</p

Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure

BACKGROUND: We investigated whether repeatedly measured global longitudinal strain (GLS) has incremental prognostic value over repeatedly measured left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP), and a single “baseline” GLS value, in chronic heart failure (HF) patients. METHODS: In this prospective observational study, echocardiography was performed in 173 clinically stable chronic HF patients every six months during follow up. During a median follow-up of 2.7 years, a median of 3 (25th–75th percentile:2–4) echocardiograms were obtained per patient. The endpoint was a composite of HF hospitalization, left ventricular assist device, heart transplantation, cardiovascular death. We compared hazard ratios (HRs) for the endpoint from Cox models (used to analyze the first available GLS measurements) with HRs from joint models (which links repeated measurements to the time-to-event data). RESULTS: Mean age was 58 ± 11 years, 76% were men, 81% were in New York Heart Association functional class I/II, and all had LVEF < 50% (mean ± SD: 27 ± 9%). The endpoint was reached by 53 patients. GLS was persistently decreased over time in patients with the endpoint. However, temporal GLS trajectories did not further diverge in patients with versus without the endpoint and remained stable during follow-up. Both single measurements and temporal trajectories of GLS were significantly associated with the endpoint [HR per SD change (95%CI): 2.15(1.34–3.46), 3.54 (2.01–6.20)]. In a multivariable model, repeatedly measured GLS maintained its prognostic value while repeatedly measured LVEF did not [HR per SD change (95%CI): GLS:4.38 (1.49–14.70), LVEF:1.14 (0.41–3.23)]. The association disappeared when correcting for repeatedly measured NT-proBNP. CONCLUSION: Temporal evolution of GLS was associated with adverse events, independent of LVEF but not independent of NT-proBNP. Since GLS showed decreased but stable values in patients with adverse prognosis, single measurements of GLS provide sufficient information for determining prognosis in clinical practice compared to repeated measurements, and temporal GLS patterns do not add prognostic information to NT-proBNP

Experimental and theoretical analysis of energy efficiency in a flat plate solar collector using monolayer graphene nanofluids

Flat‐plate solar collectors are one of the cleanest and most efficient heating systems available. Studies on the presence of covalently functionalized graphene (Gr) suspended in distilled water as operating fluids inside an indoor flat‐plate solar collector (FPSC) were experimentally and theoretically performed. These examinations were conducted under different testing conditions namely 0.025%‐wt., 0.05%‐wt., 0.075%‐wt., and 0.1%‐wt., 0.5, 1, and 1.5 kg/min, 30, 40, and 50 °C, and 500, 750, and 1000 W/m2. Various techniques were used to characterize the functionalized nanofluids’ stability and morphological properties namely UV/Vis spectrophotometry, EDX analysis with a Scanning Electron Microscope (SEM), zeta potential, and nanoparticle size. The results showed that the collected heat improved as the percentage of GrNPs and the fluid mass flow rates increased, although it decreased as the reduced temperature coefficient increased, whereas the maximum increase in collector efficiency at higher concentration was 13% and 12.5% compared with distilled water at 0.025 kg/s. Finally, a new correlation was developed for the base fluid and nanofluids’ thermal efficiency as a function of dropped temperature parameter and weight concentration with 2.758% and 4.232% maximum deviations

Reforming Fiscal Institutions in Resource-Rich Arab Economies: Policy Proposals

This paper traces the evolution of fiscal institutions of Resource Rich Arab Economies (RRAEs) over time since their pre-oil days, through the discovery of oil to their build-up of oil exports. It then identifies challenges faced by RRAEs and variations in their severity among the different countries over time. Finally, it articulates specific policy reforms, which, if implemented successfully, could help to overcome these challenges. In some cases, however, these policy proposals may give rise to important trade-offs that will have to be evaluated carefully in individual cases

Patterns of fatigue in adolescents receiving chemotherapy

Abstract: Purpose/Objectives: To describe patterns of fatigue in adolescents and the impact of fatigue during one month of chemotherapy, to explore variables that affect fatigue, and to explore the feasibility of collecting daily selfreport data in this population. Design: Longitudinal, descriptive. Setting: Two pediatric oncology centers in central Virginia. Sample: 20 adolescents with a variety of cancer diagnoses receiving chemotherapy. Methods: Adolescents described daily fatigue for one month using rating scales and qualitative diaries Main Research Variables: Fatigue severity. Finding: Adolescents commonly reported a peak in fatigue in the days immediately following chemotherapy administration. The most common pattern for adolescents who received chemotherapy on a schedule every three to four weeks was a &quot;declining rollercoaster&quot; pattern, with fatigue severity alternating on a daily basis but gradually declining until chemotherapy was scheduled again. Adolescents who received chemotherapy weekly showed more frequent peaks and troughs (the &quot;yo-yo&quot; pattern) that did not diminish in severity over the weeks of the study. Adolescents associated fatigue with other symptoms, particularly sleep-wake disturbances, pain, and nausea, and frequently reported that fatigue interfered with daily activities. Conclusions: Fatigue commonly bothers adolescents receiving chemotherapy, particularly in the days following chemotherapy administration and when other symptoms are present. Although fatigue interfered with the adolescents&apos; abilities to maintain their usual lifestyles, many still participated in the typical activities of adolescence. Implications for Nursing: Fatigue is a complex and dynamic symptom. Oncology clinicians and researchers should frequently assess fatigue in adolescents receiving chemotherapy and apply timely and tailored interventions to match the factors that contribute to fatigue and influence fatigue severity. Management of fatigue during treatment will help adolescents stay involved in age-related activities and meet developmental milestones. Article: Adolescents diagnosed with cancer represent a group of patients with a unique cancer epidemiology, development profile, and research needs. The population&apos;s most common cancers include lymphoma, leukemia, central nervous system cancers, endocrine and germ cell tumors, and sarcomas--a spectrum of cancers different than that seen in adults or in younger childre