Cannabis-induced Acute Coronary Syndrome: A Coincidence or Not?

Marijuana, derived from the Cannabis sativa plant, is the most commonly abused illicit drug in the United States. Now, more than ever, due to changing regulations, marijuana is more readily available and is known to be habitually used by millions. The neuropsychiatric effects of marijuana are well-known which include chronic fatigue syndrome and polyphagia. However, marijuana is also known to exert cardiac effects, such as tachycardia, hypotension, and hypertension. Marijuana has also been described in association with atrial fibrillation, ventricular tachycardia, and cardiac arrest. However, acute coronary syndromes, such as myocardial infarction in the setting of marijuana use, is rare. Herein, we present the case of a non-ST-elevation myocardial infarction (NSTEMI) in the setting of marijuana use in a 42-yearold African American male with no significant past medical history who presented with chest pain at rest one hour after smoking marijuana

A Case of Pneumomediastinum and Pneumoperitoneum with Concurrent Massive Subcutaneous Emphysema due to Repositioning of a Tracheostomy Tube.

Tracheostomy is a common procedure seen in critically ill patients that require long term ventilatory support. As with all airway access procedures, tracheotomy with prolonged tracheal tube placement comes with possible risks such as tracheal scarring, tracheal rupture, pneumothorax, tracheoesophageal fistula among others. Another possible complication, though rare, is escape of free air into the surrounding tissue, as well as pneumomediastinum (PM). This may occur due to various reasons, some of them being tracheal rupture, barotrauma or tracheal tube mispositioning. Pneumomediastinum may present with concurrent free air in other body cavities such as the peritoneum, thorax or subcutaneous tissue. Though often not life-threatening it may require treatment including high flow oxygen, ventilator management or occasionally, surgical intervention. Herein we describe a rare case of PM with communicating pneumoperitoneum and massive subcutaneous emphysema due to tracheal tube mispositioning along with a review of the literature

Effect of Device Warm-Up Time on Load-Voltage Relationship in S-Type Load Cells

Warm up time may have an effect on voltage readings taken from s-type load cells, making prior load- voltage calibration equations inaccurate. PURPOSE: To evaluate the effect of warm up time on load- voltage relationship in s-type load cells. METHODS: Dead weight calibrations were performed on two load cells using 200kg after 15 minutes, 1 hour, and 2 hours of warm up time. A linear model was created to estimate the influence of warm up time on the load-voltage relationship (i.e. voltage = β0 + β1•load + β2•power.source(plug) + β3•time + β4•load • time.) RESULTS: Time did not affect voltage in one testedload cell (i.e. no main (p=0.2396) or interaction effect for load x time (p=0.7492)). In the second load cell, there was a significant interaction effect of load x time (p=0.0079). At 200kg (i.e. the maximum tested load), each minute of additional warm up time would change measured voltage by about -0.00005 volts on average. CONCLUSION: Although time did affect voltage and the load-voltage relationship, the size of the effect may be practically irrelevant

Effect of Primary Power Source on the Load Voltage Relationship in Load Cells from an Instrumented Scrum Machine

To measure force generated by rugby union players during the scrum, we instrumented a scrum machine using S-type load cells for voltage force data collection. Data collection may take place in a variety of settings with varying access to primary power. The voltage outputs from electronic equipment may change when using battery versus AC power. Purpose: To compare the load-voltage relationship in S-type load cells between wall outlet AC power and a lithium ion battery pack and inverter. Methods: Dead weight calibrations of two load cells under two power supply conditions were performed up to 200kg. Voltage data was obtained using 1) outlet power from the lab, and 2) using a lithium ion battery pack and inverter (Yeti 1500x Goal Zero, South Bluffdale, UT). A linear model was created to estimate the influence of power source (battery vs wall plug) on the load-voltage relationship (i.e. voltage = β0 + β1•load + β2•load.cell(7) + β3•power.source(plug) + β4•time + β5•load • power.source(plug)). Results: The linear model indicated a main effect of the power source was present (p = 0.003) but not a load x power source interaction effect (p = 0.085). On average, voltage values from the load cell were about 0.001 volts greater than when using the battery. Conclusion: The lithium ion battery pack reliably produces voltage outputs greater than wall AC outlet power. Thus field data collection using the lithium ion battery pack is permitted, providing the volt difference is accounted for when analyzing data

Uso de artículos de investigación en la construcción de pruebas en ecuaciones diferenciales

El objetivo de esta investigación fue analizar cómo el uso artículos de investigación puede ser una estrategia pedagógica de aprendizaje activo por indagación que ayude a los estudiantes de matemáticas en la construcción de pruebas. El estudio se realizó bajo un paradigma cualitativo con enfoque interpretativo. Los datos se recopilaron durante un curso de modelación matemática de un programa de formación de matemáticos en una universidad pública del sureste de México. Nueve estudiantes participaron en este estudio y el profesor del curso. Los datos fueron analizados con base en la codificación de los razonamientos y estrategias seguidos por los estudiantes en su proceso de construcción de pruebas en relación con las cinco componentes que estructuran una competencia matemática y el ciclo de los cuatro modos de aprendizaje experiencial.  El uso de artículos de investigación tuvo un rol esencial en el razonamiento adaptativo, la generación de argumentos e integración de conocimientos de los estudiantes durante la construcción de sus pruebas matemáticas sobre la positividad de las soluciones de un sistema de ecuaciones diferenciales e incluso, ayudó a superar dificultades tales como la comprensión de algunos teoremas implicados en las pruebas.  

Exploring Attitudes Toward “Sugar Relationships” Across 87 Countries: A Global Perspective on Exchanges of Resources for Sex and Companionship

The current study investigates attitudes toward one form of sex for resources: the so-called sugar relationships, which often involve exchanges of resources for sex and/or companionship. The present study examined associations among attitudes toward sugar relationships and relevant variables (e.g., sex, sociosexuality, gender inequality, parasitic exposure) in 69,924 participants across 87 countries. Two self-report measures of Acceptance of Sugar Relationships (ASR) developed for younger companion providers (ASR-YWMS) and older resource providers (ASR-OMWS) were translated into 37 languages. We tested cross-sex and cross-linguistic construct equivalence, cross-cultural invariance in sex differences, and the importance of the hypothetical predictors of ASR. Both measures showed adequate psychometric properties in all languages (except the Persian version of ASR-YWMS). Results partially supported our hypotheses and were consistent with previous theoretical considerations and empirical evidence on human mating. For example, at the individual level, sociosexual orientation, traditional gender roles, and pathogen prevalence were significant predictors of both ASR-YWMS and ASR-OMWS. At the country level, gender inequality and parasite stress positively predicted the ASR-YWMS. However, being a woman negatively predicted the ASR-OMWS, but positively predicted the ASR-YWMS. At country-level, ingroup favoritism and parasite stress positively predicted the ASR-OMWS. Furthermore, significant cross-subregional differences were found in the openness to sugar relationships (both ASR-YWMS and ASR-OMWS scores) across subregions. Finally, significant differences were found between ASR-YWMS and ASR-OMWS when compared in each subregion. The ASR-YWMS was significantly higher than the ASR-OMWS in all subregions, except for Northern Africa and Western Asia

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049