Telemedicine Management of Diabetics in an Underserved Community

Information technology via telemedicine offers the potential for cost-effective and active management of type 2 diabetes mellitus for people in high-risk underserved communities such as Harlem, NY and the Bronx, NY. Telemedicine is the use of telecommunications technology for medical diagnostic, monitor- ing, and therapeutic purposes to communicate information instantaneously from one location to another, such as from a patients’ home to a hospital. We compared the baseline Hemoglobin A1C levels to the levels recorded after the patient was enrolled in the Housecalls telemedicine program for at least 3 months. The initial results indicate that the Housecalls program is effective in improving compliance and management of diabetes. The initial success of the program is encouraging and demonstrates a great po- tential for the use of telemedicine in monitoring chronic disease

Fatigue monitoring in offshore energy operations: Research to Practice gaps

PresentationThe oil and gas extraction (OGE) industry continues to experience an elevated fatality rate; from 2010-2014 fatality the rate in this industry was nearly seven times higher than that for all U.S. workers. OGE workers are exposed to intensive shift patterns and long work durations inherent in the OGE environment, which can lead to fatigue, thereby increasing risks of accidents and injuries. Fatigue, often defined as a physiological state of reduced mental or physical performance capability resulting from sleep loss, circadian phase, and workload, has been implicated as a critical risk in both offshore and onshore OGE operations. The aims of this study were to explore the effect of offshore shiftwork on physiological and subjective fatigue outcomes. 10 male workers (age: 31.3 (6.1) years; stature: 1.72 (0.1) m; weight: 85.24 (9.8) kg) were monitored throughout their daily shifts for six days using intrinsically safer physiological sensors (EQ02 LifeMonitor, EquivitalTM, Cambridge, UK) that recorded various physiological parameters at 250Hz and subjective fatigue scales were employed to obtain perceptions of fatigue. Results indicate that overall average ambulatory heart rate (an indicator of fatigue) were elevated for all participants and was highest and raised the most for those who started and ended their hitch on the day shift. The same measure was lowest and did not change for those who started on the day shift and swung to the night shift. The ambulation rates (a measure of movement) were higher later in the participants’ hitch and this effect was seen primarily for those who started their hitch in the day shift. Participants’ reports of fatigue were relatively high for acute fatigue and intershift recovery as well as for lack of effort and sleepiness; however, the physiological measures were not consistently or predictably correlated with the self-report measures of fatigue or activity. The study outcomes identified a critical gap in fatigue assessment in OGE operations; existing fatigue surveys for the general (or other) working populations are not comprehensive of OGE operations and are thus not applicable for OGE workers, nor are they validated against physiological fatigue outcomes in OGE workers

Drug resistance among extrapulmonary TB patients: Six years experience from a supranational reference laboratory.

BACKGROUND & OBJECTIVES There is limited information available about the drug resistance patterns in extrapulmonary tuberculosis (EPTB), especially from high burden countries. This may be due to difficulty in obtaining extrapulmonary specimens and limited facilities for drug susceptibility testing. This study was undertaken to review and report the first and second-line anti-TB drug susceptibility patterns in extrapulmonary specimens received at the National Institute for Research in Tuberculosis (NIRT), Chennai, India, between 2005 and 2012. METHODS Extrapulmonary specimens received from referring hospitals were decontaminated and cultured using standard procedures. Drug susceptibility testing (DST) for Mycobacterium tuberculosis was done by absolute concentration or resistance ratio methods for the first and the second line anti-TB drugs. RESULTS Between 2005 and 2012, of the 1295 extrapulmonary specimens, 189 grew M. tuberculosis, 37 (19%) cases were multidrug resistant (MDR) while one was extensively drug resistant (XDR). Specimen-wise MDR prevalence was found to be: CSF-10 per cent, urine-6 per cent, fluids and aspirates-27 per cent, pus-23 per cent, lymph nodes-19 per cent. Resistance to isoniazid and ethionamide was found to be high (31 and 38%, respectively). INTERPRETATION & CONCLUSIONS Drug resistance including MDR-TB was observed in a significant proportion of extrapulmonary specimens referred for DST. Access to culture and DST for extrapulmonary specimens should be expanded. Guidelines for MDR-TB management should have explicit sections on extra-pulmonary tuberculosis and training on laboratory techniques is urgently required

The Impact of Preoperative Antithrombotic Therapy on the Risks for Thrombo-ischemic Events and Bleeding among Patients Undergoing Elective Spine Surgery

Study Design Retrospective matched analysis. Purpose To evaluate the effect of antithrombotic drug therapy on the rates of thrombo-ischemic or bleeding events 90 days following elective spine surgery. Overview of Literature Thrombo-ischemic and bleeding complications in patients undergoing spine surgery are major causes of morbidity. Many patients who pursue elective spine surgery are concurrently receiving antithrombotic therapy for unrelated conditions; however, at this time, the effects of preoperative antithrombotic use on postoperative bleeding and thrombosis are unclear. Methods Using an all-payer claims database, patients who underwent elective cervical and lumbar spine interventions between January 1, 2010, and June 30, 2018, were identified. Individuals were categorized into groups taking and not taking antithrombotics. A 1:1 analysis was constructed based on comorbidities found to be independently associated with bleeding or ischemic complications using logistic regression models. The primary outcomes were the rates of thrombo-ischemic events and bleeding complications. Results A total of 660,866 patients were eligible for inclusion. Following the matching procedure, 56,476 patient records were analyzed, with 28,238 in each group. The antithrombotic agent group had significantly greater odds of developing any 90-day thrombo-ischemic event after surgery: deep vein thrombosis (odds ratio [OR], 3.61; 95% confidence interval [CI], 3.06–4.25), pulmonary embolism (OR, 3.93; 95% CI, 3.34–4.62), myocardial infarction (OR, 6.20; 95% CI, 5.69–6.76), and ischemic stroke (OR, 3.76; 95% CI, 3.31–4.27). In addition, the antithrombotic agent group had an increased likelihood of experiencing hematoma (OR, 1.54; 95% CI, 1.35–1.76) and need for transfusion (OR, 2.61; 95% CI, 2.29–2.96). Conclusions Patients taking antithrombotic medications before elective surgery of the cervical and lumbar spine had increased risks of both ischemic and bleeding events. Spine surgeons should carefully consider these implications when appraising patients for surgery, given the lack of guidelines on perioperative management of antithrombotic agents

VISCOSITY INDUCED CELLULAR ADAPTATIONS FOR INCREASED CELL MOTILITY

Cancer, a disease with significant dependence on genetic predisposition, is caused when an epithelial cell undergoes mutation and multiplies clonally in a direction away from the vascular supply to form a tumor. Cancer-related deaths, nearly 90%, are caused by cells detaching from the primary tumor and spreading through the body to form multiple secondary tumors through a process called metastasis. In order to understand the process of metastasis, it is crucial to study the process and mechanism by which cells migrate throughout the body, and although cell migration is an extensively studied field, there exist several distinct mechanisms that are not yet well understood. Confined cells, for example, use mechanisms that vary vastly from migration on 2D surfaces, increasing the difficulty of preventing metastasis. During migration, cancer cells experience a variety of physicochemical microenvironments, from hypoxic and acidic conditions inside tumors to detaching from their primary tumors and circulating in the blood. These varying environments also play a vital role in the metastatic cascade, and though many factors in this cascade have been studied and well documented, the role of hydraulic resistance or viscosity is not well understood. Advances in intravital imaging have illustrated that cancer cells migrate through pre-existing tunnel-like tracks in the tumor microenvironment and get exposed to external physical forces. The pre-existing tissue tracks can be as narrow as 3μm and force cellular adaptations in order to allow migration through them. When combined with the elevated hydraulic resistance that cells face in multiple stages of the metastatic cascade, studying confined migration at elevated viscosities becomes essential to understanding the underlying mechanisms that affect or cause metastasis. In this study, we have observed that viscosity causes the cells to migrate faster and display a more aggressive phenotype in polydimethylsiloxane (PDMS) devices and 16kPa hydrogel de- vices. These increases in speeds have been observed in conjunction with phenotypic changes that suggest a change in the underlying mechanism of migration. In this study, we explain the cellular adaptations that cause the upregulation in cell motility and how they affect the cell

A comparative study to evaluate use of apache ii and sofa score in sepsis patients in intensive care unit of a tertiary level hospital in western Maharashtra

Background: Intensive care units (ICU) in most settings consume very high cost and sophisticated devices but mortality rates are still very high. There is no specific literature comparing APACHE II score and SOFA score in sepsis patient and this research topic will help to identify the score more appropriate to predict the seriousness, outcome and mortality of patients suffering from sepsis, which has been evaluated in our study. Methodology: This was a single centre hospital based cross sectional, observational, descriptive study conducted in patients in ICUs of our institute. 100 patients over age 16 years old admitted in intensive care unit who have fulfilled the criteria for sepsis were included in our study. Their clinical profile, APACHE II and SOFA scores were evaluated and compared with respect to patients’ outcome in the form of survival. Results: The mean age was 56.71 ± 16.77 years. Majority of patients were males (69%). 52 of patients were survivors (52%) and non-survivor were 48%. The mean SOFA score of survived patients was 3.54 ± 2.57 lower than non-survivor patients of 6.02 ± 3.17

Heterogeneous catalysis in esterification reactions: preparation of phenethyl acetate and cyclohexyl acetate by using a variety of solid acidic catalysts

Esterification is an important class of reactions in the preparation of perfumery and flavor chemicals, wherein homogeneous acid catalysts are normally used. The application of solid acidic and superacidic catalysts can prove to be very effective from the viewpoint of activity, selectivity, reusability, and economy in the manufacture of perfumery esters, and thus, this paper delineates such studies in the preparation of phenethyl acetate and cyclohexyl acetate with a variety of solid acids including a complete theoretical and experimental analysis. The list of catalysts employed for this study is Filtrol-24, Amberlyst-15, sulfated zirconia, heteropolyacids (supported on silica and carbon and also unsupported), and concentrated sulfuric acid