Effect of Diabetes on Nitric Oxide Metabolism During Cardiac Surgery

The metabolism of nitric oxide (NO) during cardiac surgery is unclear. We studied the effect of diabetes on NO metabolism during cardiac surgery in 40 subjects (20 with diabetes and 20 without diabetes). The patients were randomized to receive an infusion of physiological saline or nitroglycerin (GTN) at 1 g kg–1 min–1 starting 10 min before the initiation of cardiopulmonary bypass and then continuing for a period of 4 h. Blood and urine samples were collected at several time points for up to 8 h. NO metabolites were determined by the measurement of nitrate/nitrite (NOx, mol/mmol creatinine) and cyclic guanosine monophosphate (cGMP, nmol/mmol creatinine) in plasma and urine. Plasma insulin levels were also determined at selected time points. Plasma NOx levels before surgery were significantly elevated in the group with diabetes compared with the group without diabetes (P < 0.001), and values were further increased during surgery in the former (P 0.005) but not in the latter (P 0.8). The greater plasma NOx values in patients with diabetes were matched by commensurate elevations in plasma cGMP levels (P 0.01). Interestingly, infusion of GTN, an NO donor, significantly reduced plasma NOx (P < 0.001) and its urine elimination (P < 0.001) in patients with diabetes without reducing plasma cGMP levels (P 0.89). Cardiac surgery increased plasma insulin in patients with and without diabetes; this increase was delayed by the infusion of GTN, but it was not related to the changes in NO production. In conclusion, NO production during cardiac surgery is increased in patients with diabetes, and this elevation can be blunted by the infusion of GTN in a rapid and reversible manner

Evaluating the Performance of Cooperative Merging Assistance System for Aging Drivers

Freeway merging maneuvers demand considerable attention by drivers and are among the more complex operations drivers must perform on freeways. Aging drivers, a growing population in the United States, face added challenges when merging. This study utilized Vissim models created in a previous study that modeled the behavior of aging drivers during freeway merging. An algorithm for Cooperative Merging Assistance System (CMAS) that utilizes Connected Vehicle (CV) technology was developed in this study. The Vissim models were created for two interchanges on I-75 in Fort Myers, Florida, each with different geometric characteristics. Acceleration lane lengths of 1000ft and 1500ft were analyzed in this study, and the CV environment was created in Vissim through the Component Object Model (COM) Interface. A sensitivity analysis was conducted by varying CV penetration rates, composition of aging on-ramp drivers, and mainline and on-ramp traffic flows to analyze the effects of CV technology under different levels of service (LOSs). Merging location, merging speed and vehicle interaction states (braking for lane change, emergency stop and cooperative braking) together with deceleration rate were the measures of effectiveness (MOEs) considered. Findings showed the number of aging drivers merging late onto the freeway can be decreased by up to 60.0% when CMAS was employed, while there was no significant change in merging speed at 95% confidence level when CMAS was employed. Furthermore, the results showed that CMAS reduced the percentages of aging drivers braking for lane change or emergency stop and also hard braking by up to 100% for low traffic conditions (LOS A and B). A maximum reduction of 82.2% was observed for cooperative braking of mainline vehicles when CMAS was employed. The reductions in interaction states were significant at 95% confidence level according to Mann-Kendall trend test

Effects of Strategic Alliances on Organizational Performance: Supermarkets and Their Alliances in Kenya

This study sought to examine the effect of strategic alliances on performances. .The objectives of the study were: to establish the effects of technological, production and marketing strategic alliances on the performance of supermarkets and their alliances in Kenya. The study employed a correlational research design. The sample of the study entailed a study of all the five big supermarkets (Nakumatt, Ukwala, Naivas, Tuskys and Uchumi) and 95 of their strategic alliances. Data for this study was collected from the head offices of the firms by use of a questionnaire. The data was analyzed using a multiple regression model in order to test the effect of the independent variables relating to strategic alliances and the dependent variable performance. Independent one-way ANOVA test and independent t-test (one tailed) were used to determine the level of significance. Data was presented using figures, and tables. The empirical results of the study indicated that there was a strong, negative correlation between technological strategic alliances and performance. However, there was no statistical significant relationship between technological strategic alliances and performances among supermarkets and their alliances in Nairobi CBD. Correlation results indicated that there was a weak, negative effect between production strategic alliances and performance, for the supermarkets while for supermarket alliances there was a large, positive effect between the two variables. There was a strong, positive effect between marketing strategic alliances and performance for the supermarkets while for supermarket alliances there was a medium, positive correlation between marketing strategic alliances and performance. However, 2 tailed tests indicated that there was a statistically insignificant relationship between the variables. The results from the multiple regression analysis indicated that strategic alliances had a strong relationship with supermarket performance which suggests that strategic alliance contributes positively towards supermarkets performance. On the other hand supermarket alliances regression analysis showed a weak relationship between strategic alliances and performance suggesting that other factors account for the performance in these alliances. The ANOVA test indicated that the relationship between strategic alliances and performance was not statistically significant for the supermarket alliances but significant for the supermarkets. The t- test analysis indicates that the relationship between strategic alliances and performance was statistically significant among the supermarkets and their alliances suggesting that strategic alliances positively increase performance. Keywords: strategic alliances, supermarkets, supermarket alliances, performanc

Meeting Report on the International Conference of ECMO-Life Support for Pakistan in 21st Century held May 11-12, 2017, Lahore

Extracorporeal membrane oxygenation support (ECMO) is indicated in severe heart or lung failure with 80 percent or more risk of mortality. In experienced centers, overall survival to discharge ranges from 40 percent in cardiac arrest with extracorporeal cardiopulmonary resuscitation (ECPR) to 70 percent for respiratory failure in adults. Overall survival in children is about 80 percent and newborns with severe lung injury can recover to normal function following prolonged ECMO support, thus, re-defining irreversible lung injury. In the future, ECMO will be automatically controlled with care out of the Intensive care units (ICU) or at home. The International Conference of ECMO-Life Support for Pakistan in 21st Century which was recently held in Lahore, Pakistan on May 11 - 12, 2017. It was to bring together the best of cardiothoracic and vascular surgeons, heart failure cardiologist, adult and pediatric intensivists, pulmonologists, anaesthetists, cardiovascular nurses, postgraduate trainees, para-medical staff, perfusionists, ambulance cardiac first responders and cardiovascular scientists for thought provoking evidence based discussions on the direction and flow of ECMO technology for Pakistan and the Developing World in the next decade. The aim of this conference was to share knowledge on ECMO technologies, advancements and their impact on the health capacity building

Assessment of Water Quality in Kalundu Stream and Kalundu dam in Kitui County, Kenya

This study aimed to assess levels of selected physico-chemical and bacteriological loads of Kalundu stream and Kalundu dam. Sampling was conducted from February to April 2019 in three selected sampling sites. Surface water samples were collected and analyzed for fifteen physico-chemical parameters. Water temperature, pH, turbidity and electrical conductivity were measured on site. Biological oxygen demand (BOD), Chemical Oxygen Demand (COD), total hardness and alkalinity, selected major anions and cations were analyzed at a Water Resources Authority laboratory using standard procedures. Data analysis was carried out using one-way analysis of variance and significant differences accepted at p≤0.05. Results showed that pH, fluoride, sulphates, total hardness and alkalinity were within WHO set standards for drinking water. However, turbidity, EC, Fe, Ca, Mg, Nitrites and Chlorides were above the WHO recommended levels for drinking water. Both total coliforms and E. coli were exceedingly high and ranged from 385±188.9 to 337,133±124,970 MPN/100ml and 70.70±46.50 to 3941183±2771080 MPN/100ml respectively. The findings revealed that water quality of Kalundu stream and Kalundu dam is highly polluted with pathogenic microorganisms and a potential risk to human health. Therefore, measures to curb microbial pollution should be taken by the relevant municipality authorities of Kitui County government. Keywords: Assessment, Water quality, Bacteriology, Kalundu dam, Kitui County DOI: 10.7176/JEES/11-1-05 Publication date: January 31st 202

A Cross-sectional Survey of the Determinants of Maternal Health Services Utilization among Women with Disability in Mbale District, Uganda.

Background: The study aimed to evaluate the determinants of maternal health services utilization among women with disability (WWD) in the Mbale district in Uganda. Methodology: The study approach was a mixed qualitative and quantitative cross-sectional design. The selection of study participants was by snowballing for the quantitative tool and purposively sampling for the Key Informants. A sample size of 189 women with disabilities was used in the study and 8 key informants were interviewed. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 22, and qualitative data were subjected to thematic analysis. Findings: The proportion of WWD utilizing MHS was found to be low in the Mbale district with only 17.7% attending four or more antenatal visits. Fear of stigma was the main barrier to the utilization of maternal health services. Health education influenced the utilization of maternal health services. Utilization of maternal health services (MHS) among women with disabilities was associated with socio-economic determinants (secondary level education, spousal support, and monthly income). Finally, there was a significant association between accessibility and the utilization of MHS. Conclusion:   This study revealed that external factors form the main barriers to the utilization of maternal health services among women with disability.   Recommendations:   Training and equipping health facility staff to be more sensitive to and attend to the unique needs of WWD could improve the experiences of WWD seeking MHS at the health facility. This may reduce their fear of stigmatization thus improving service utilization.

Evaluating integrated participatory planning in a decentralised governance system: the case of Yei River County, Southern Sudan

Local government is an important level of participatory democracy, where communities play an active role not only as the electorate, but also as end-users and consumers, and thereby holding their municipal councils accountable for their actions. Given the above statement, the interim Constitution of the Republic of South Sudan 2011, entrusts local government with the provision of services to communities in a sustainable manner. It also provides for the promotion of social and economic development and the promotion of a safe and healthy environment. This also entails the need for a commitment to service delivery hence, public representatives and public officials must take seriously their obligation to render services to the people that could be in the form of ensuring that refuse gets collected, electricity being supplied and other services rendered which better the general welfare of citizens. There are several definitions of public participation, but it can be defined as a process of empowering citizens by involving them in making decisions on all issues that concern them, which can be political, social or economic. The main aim of this study was to, investigate and identify the nature and extent of integrated participatory planning in Yei River County and the extent to which opportunities for public participation are accessible to the communities. The study sought to investigate: How different stakeholders in the community in Yei River County make use of public participation opportunities during the integrated participatory planning process? As such, the main objectives of the study were to; to assess the existing integrated participatory planning practices in Yei River County, to examine and evaluate how the existing integrated participatory planning practices influence service delivery in Yei River County and lastly to identify the barriers to effective integrated participatory planning in YRC and advance recommendations for improvement. Purposive and snowball sampling methods were used and data was collected from a sample of two hundred and twenty-six (226) public officials, comprising of Local Government officials, County councillors and members of the public. Results from the data collected using open and close-ended questionnaires, showed that public participation is very important in local government planning as it leads to incorporation of public suggestions and interests in the development strategies. The results further showed that public meetings and workshops were the only public participation mechanisms being used by Yei River County. The study therefore recommended among other things that, Yei River County should strengthen public participation in integrated participatory planning by providing adequate skilled human resources and establishing structures, as well as public participation mechanisms at the Payam and Boma levels. It was also recommended that the communities needed to utilise all available mechanisms of participation to ensure maximum participation during the integrated participatory planning processes