Clinical outcomes in the management of iron deficiency anemia in patients with inflammatory bowel disease

INTRODUCTION: Anemia is a frequent complication in patients with inflammatory bowel disease (IBD). The inflammation observed in IBD negatively impact absorption of iron. This could lead to increased hospitalizations, affect growth and development, and decrease overall quality of life. This is especially pronounced in the pediatric population. The screening and treatment of iron deficiency anemia (IDA) varies between centers, and as a result, roughly 40-60% of pediatric IBD patients are iron deficient. OBJECTIVES: The objective of this study is to assess the efficacy and safety profile of intravenous and enteral iron therapy in a population of iron deficient patients with IBD. The secondary aim of this study is to determine if oral or intravenous iron therapy can improve hematologic and iron parameters. We will also examine the longitudinal changes in gastrointestinal (GI) symptoms and quality of life in patients receiving oral and intravenous iron supplementation. METHODS: We conducted a prospective cohort study in pediatric patients with IBD admitted to the inpatient GI service at Boston Children’s Hospital from 09/05/2017 to 03/05/2018. Forty-six IBD patients were screened, and twenty-nine (63%) were identified as iron deficient and were consented for data collection through chart review and administration of the IMPACT-III quality of life questionnaire. RESULTS: Out of the twenty-nine IBD patients, eighteen (62%) received intravenous iron, seven (24%) received oral iron, and four (14%) were untreated and served as controls. The mean change in hemoglobin in patients receiving parenteral, oral, or no iron therapy was 1.6g/dl±0.5, 1.1g/dl±0.4, and 0.2g/dl±0.5, respectively. The change in hemoglobin was significant between the parenteral and oral iron group (P<0.05). The mean change in health-related quality of life scores in patients receiving parenteral or oral iron therapy was 11.6±11.4 and 3.8l±7.5, respectively. CONCLUSION: Our study demonstrates that intravenous iron therapy was more efficacious than oral iron in improving hematologic and iron parameters in IBD patients. This improvement was concomitant with higher scores on the IMPACT-III quality of life questionnaire, suggesting that iron supplementation improves health-related quality of life in IBD patients with iron deficiency anemia

Effectiveness of Implementing the Citizen’s Charter at a Regional Health Services Directorate in Sri Lanka

Introduction - Unacceptable delays in providing services by the Regional Director of Health Services’ Office, Kurunegala and subsequent re-visits had created customer dissatisfaction. A citizen’s charter and supplementary interventions were developed and implemented to improve providing services. The objective of this study is to assess effectiveness of implementing citizen’s charter and supplementary interventions at Establishment Branch of Regional Director of Health Services’ Office, Kurunegala.Methods - Methods involve developing process and outcome indicators to assess the effectiveness of charter and supplementary interventions, pre and post-assessments of developed indicators following implementing interventions for three months, and comparison of pre and post results for statistical significance to assess the effectiveness of implementations.Results - Following implementations, compliance of personal files with service standards significantly increased (p<0.001) from 40% to 94% while average number of visits per service to Establishment Branch had a significant reduction (p<0.001) from 2.40 to 1.09. Nursing officers’ overall satisfaction on receiving services improved significantly (p<0.001) from 11.5% to 75% as their satisfaction on all service attributes showed statistically significant improvements. Three attributes namely, awareness of place of formats, availability of contact details of responsible officer for services and courtesy exceeded expectations although the remainder showed expectation-perception gaps.Conclusion - Charter and supplementary interventions proved to be effective in improving service provision at Establishment Branch of Regional Director of Health Services’ Office, Kurunegala. It is recommended that Regional Director of Health Services’ offices implement charters and supplementary interventions at Establishment Branches in a stepwise manner to improve service provision.

Impact of Cable-deck Interaction on the Efficiency of External Damper in Controlling Stay Cable Vibration on Cable-Stayed Bridges

External dampers are widely used to control vibrations of stay cables on cable-stayed bridges. In general, the estimation of the damping of a stay cable in a cable-damper system is done based on the assumption that the bridge stay cable has fixed supports at both ends and the damper has a fixed support on the deck. But long-span bridges experience frequent bridge-girder vibrations under dynamic loadings due to long span length, light weight and flexible nature. Therefore, the assumptions of..

Media Sosial dan Perpustakaan Menurut Islam

Arus kemodenan ini memberi impak tertentu dalam kehidupan kita seperti komunikasi efektif bersama keluarga dan banyak lagi. Begitu juga dengan perpustakaan yang turut menerima impak yang tertentu akibat kewujudan media sosial. Dalam hal ini, masyarakat haruslah memahami dan peka terhadap kebaikan dan keburukan yang dibawa oleh media sosial terutamanya kepada institusi perpustakaan. Kertas kerja ini mengutarakan beberapa kesan dan keburukan yang timbul akibat media sosial dan ingin menekankan tentang pentingnya membaca dan mencari ilmu di perpustakaan. Objektifnya adalah untuk menanam kepentingan perpustakaan dalam jiwa pembaca. Melalui kajian ini, didapati bahawa terdapat banyak isu yang boleh dikaitkan antara media sosial dan perpustakaan. Secara umumnya, kedua-dua platform tersebut mempunyai banyak ilmu yang boleh ditimba. Namun demikian, isu kesahihan maklumat juga perlu diberi perhatian dalam membincangkan isu media sosial dan perpustakaan ini. Terdapat juga impak tertentu terhadap masyarakat yang berkait dengan media sosial dan perpustakaan

The Yield of Fever, Inflammatory Markers and Ultrasound in the Diagnosis of Acute Cholecystitis: A Validation of the 2013 Tokyo Guidelines

Each year, 1–4 % of people with known gallstones become symptomatic, either presenting with biliary colic or as acute cholecystitis. The distinction between both diagnoses remains challenging. To aid the proper diagnosis, the revised 2013 Tokyo Guidelines (TG 2013) were proposed with a self-acclaimed diagnostic accuracy of over 90 %. However, this accuracy has not been verified by others so far. Objective: To determine the accuracy of the TG 2013 guidelines in the diagnosis of acute cholecystitis both in its single components of fever, inflammatory markers and US features and of the combined application of the TG 2013 guidelines as a whole. Methods: A 5-year retrospective analysis equal to the TG 2013 validation process of all emergency cholecystectomies for acute cholecystitis or persistent biliary pain with an ultrasound performed during the same admission. Acute cholecystitis at histology was the golden standard. Results: Inclusion criteria were met by 169 patients with a prevalence of acute cholecystitis of 52.7 %. The individual features of fever, gallbladder wall thickening and probe tenderness were not significant in univariate analysis. In multivariate analysis only, neutrophil count was an independent predictor. The combined application of the TG 2013 guidelines led to a better sensitivity of 83.1 % at the cost a reduced specificity of 37.5 % compared to neutrophil count alone. The accuracy was therefore only 60.3 %, which was well below the TG 2013 report. Conclusion: The 2013 Tokyo Guidelines were slightly better in predicting acute cholecystitis but over diagnosed two-thirds of normal gallbladders compared to neutrophil count alone

NMF-based GPU accelerated coronagraphy pipeline

We present a generalized Non-negative factorization (NMF)-based data reduction pipeline for circumstellar disk and exoplanet detection. By using an adaptable pre-processing routine that applies algorithmic masks and corrections to improper data, we are able to easily offload the computationally-intensive NMF algorithm to a graphics processing unit (GPU), significantly increasing computational efficiency. NMF has been shown to better preserve disk structural features compared to other post-processing approaches and has demonstrated improvements in the analysis of archival data. The adaptive pre-processing routine of this pipeline, which automatically aligns and applies image corrections to the raw data, is shown to significantly improve chromatic halo suppression. Utilizing HST-STIS and JWST-MIRI coronagraphic datasets, we demonstrate a factor of five increase in real-time computational efficiency by using GPUs to perform NMF compared to using CPUs. Additionally, we demonstrate the usefulness of higher numbers of NMF components with SNR and contrast improvements, which necessitates the use of a more computationally efficient approach for data reduction

SRI LANKA OXYGEN READINESS AND STRATEGIES ADAPTED FOR COVID-19 PATIENTS’ MANAGEMENT

Background: Shortly after the Covid-19 oxygen crisis in India, the Sri Lanka Ministry of Health started investigating and analyzing gaps in oxygen production, supplies and demands. Aims: This study aimed to evaluate the preparedness in Covid-19 cases management and recommend strategies to prevent oxygen crisis in healthcare facilities. Methods: This study used information on oxygen source redundancy and delivery methods to assess whether a healthcare facility is prepared to provide the necessary oxygen demand for patients in need and to estimate the number of patients that can be treated with the currently available oxygen supplies. The predicted oxygen supplies and demands were assessed with a panel of experts using qualitative and quantitative methods. Data were collected using the Health Information Update System. Results: Sri Lanka had 39,529 designated hospital beds including Intensive Care Unit and High Dependency Unit beds for Covid-19 patients. Even though an average number of patients were reaching 30,000, the actual oxygen demands were around 1,200 which were easily manageable with the current capacity of 80 tons per day. Conclusions: Sri Lanka has made progress to increase access to oxygen by using novel methods to procure and increase oxygen availability, storing, and carrying capacity

Approaches to lowering the cost of large space telescopes

New development approaches, including launch vehicles and advances in sensors, computing, and software, have lowered the cost of entry into space, and have enabled a revolution in low-cost, high-risk Small Satellite (SmallSat) missions. To bring about a similar transformation in larger space telescopes, it is necessary to reconsider the full paradigm of space observatories. Here we will review the history of space telescope development and cost drivers, and describe an example conceptual design for a low cost 6.5 m optical telescope to enable new science when operated in space at room temperature. It uses a monolithic primary mirror of borosilicate glass, drawing on lessons and tools from decades of experience with ground-based observatories and instruments, as well as flagship space missions. It takes advantage, as do large launch vehicles, of increased computing power and space-worthy commercial electronics in low-cost active predictive control systems to maintain stability. We will describe an approach that incorporates science and trade study results that address driving requirements such as integration and testing costs, reliability, spacecraft jitter, and wavefront stability in this new risk-tolerant "LargeSat" context.Comment: Presented at SPIE, Optics+Photonics 2023, Astronomical Optics: Design, Manufacture, and Test of Space and Ground Systems IV in San Diego, CA, US