The Veracity of Troponin Test Requests for Patients Presenting to the Emergency Department with Chest Pain; A Clinical Audit

Introduction: Troponin test is one of the methods for diagnosing acute coronary syndrome, but the overuse and misuse of this test has increased the costs imposed on the health system and the patients. Objective: The present study was conducted to investigate the veracity of troponin test requests for patients presenting to an emergency department with chest pain and examine the effectiveness of training emergency medicine assistants in reducing unnecessary and inappropriate requests in emergency departments. Methods: This clinical audit was conducted in the emergency department of Imam Hossein Hospital, Tehran, Iran, in 2014. Sampling was carried out using the census method and all the cases presenting to the emergency department for whom a troponin test was requested by the emergency medical assistants were included in the research. First, the veracity of the current troponin test requests was assessed; then, training was given to the personnel, and the veracity of the troponin test requests was once again verified after the training was completed. The rate of veracious troponin requests for the patients was measured based on two factors, including the interval between the patients’ admission and the troponin test request, and the interval between the onset of pain and the troponin test request. The veracity of the troponin test request was compared before and after training using the Phi test and Cramer’s V test in IBM SPSS-21. Results: This study examined a total of 500 patients (250 before training and 250 after), who had a mean age of 57.65±18.15 years, including 51.6% men. Significant differences were observed between the mean time of the patients’ admission and the overall and post-training troponin test results (P=0.000), and also between the mean time of the onset of pain and the overall and post-training troponin test results (P=0.000). The number of positive troponin test results did not differ significantly between the patients in either of the two stages (P=0.39). Conclusion: Unnecessary troponin test requests reduced significantly after this clinical audit in the examined emergency department

Effect of Different pH Values on the Compressive Strength of Calcium-Enriched Mixture Cement

Introduction: The aim of this study was to evaluate the compressive strength of calcium-enriched mixture (CEM) cement in contact with acidic, neutral and alkaline pH values. Methods and Materials: The cement was mixed according to the manufacturer’s instructions, it was then condensed into fourteen split molds with five 4×6 mm holes. The specimens were randomly divided into 7 groups (n=10) and were then exposed to environments with pH values of 4.4, 5.4, 6.4, 7.4, 8.4, 9.4 and 10.4 in an incubator at 37° C for 4 days. After removing the samples from the molds, cement pellets were compressed in a universal testing machine. The exact forces required for breaking of the samples were recorded. The data were analyzed with the Kruskal-Wallis and Dunn tests for individual and pairwise comparisons, respectively. The level of significance was set at 0.05. Results: The greatest (48.59±10.36) and the lowest (9.67±3.16) mean compressive strength values were observed after exposure to pH value of 9.4 and 7.4, respectively. Alkaline environment significantly increased the compressive strength of CEM cement compared to the control group. There was no significant difference between the pH values of 9.4 and 10.4 but significant differences were found between pH values of 9.4, 8.4 and 7.4. The acidic environment showed better results than the neutral environment, although the difference was not significant for the pH value of 6.4. Alkaline pH also showed significantly better results than acidic and neutral pH. Conclusion: The compressive strength of CEM cement improved in the presence of acidic and alkaline environments but alkaline environment showed the best results

The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas

Introduction: In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Methods: Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT) scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. Results: 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4), 58.5% (95% CI: 51.2-65.5), 56% (95% CI: 48.5-63.3), 79.6% (95% CI: 71.8-85.7), 1.27% (95% CI: 1.30-1.57), and 0.25% (95% CI: 0.18-0.36), respectively. Conclusion: The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging

Time-Discontinuous Finite Element Analysis of Two-Dimensional Elastodynamic Problems using Complex Fourier Shape Functions

This paper reformulates a time-discontinuous finite element method (TD-FEM) based on a new class of shape functions, called complex Fourier hereafter, for solving two-dimensional elastodynamic problems. These shape functions, which are derived from their corresponding radial basis functions, have some advantages such as the satisfaction of exponential and trigonometric function fields in complex space as well as the polynomial ones simultaneously, that make them a better choice than classic Lagrange shape functions, which only can satisfy polynomial function field. To investigate the validity and accuracy of the proposed method, three numerical examples are provided and the results obtained from the present method (complex Fourier-based TD-FEM) and the classic Lagrange-based TD-FEM are compared with the exact analytical solutions. According to them, using complex Fourier functions in TD-FEM leads to more accurate and stable solutions rather than those obtained from the classic TD-FEM

Pro-BNP versus MEDS Score in Determining the Prognosis of Sepsis Patients; a Diagnostic Accuracy Study

Introduction: Pro-brain natriuretic peptide (Pro-BNP) can act as an independent predictor of mortality in septic patients. This study aimed to compare the diagnostic accuracy of pro-BNP and Mortality in Emergency Department Sepsis (MEDS) score in this regard.Method: This cross-sectional study was conducted on > 14 years old sepsis patients of an emergency department (ED), during 2 years. The level of Pro-BNP and MEDS score were measured for all eligible patients and considering one-month mortality as reference, screening performance characteristics of the two tests were compared using SPSS 21 and STATS 11.Results: 121 patients with the mean age of 75.87±11.82 years were studied (55.4% male). 85 (70.25%) patients had moderate to high probability of mortality according to MEDS score. The mean Pro-BNP levels of survivor and non-survivor patients were 489.69 ± 327.47 and 3954.98 ± 2717.85 pg/ml, respectively (p < 0.0001). Sensitivity and specificity of Pro-BNP (in 1000 pg/ml cut off) and MEDS score (in level 3) in prediction of 1-month mortality were 93.6 (83.7-97.9), 94.8 (84.7-98.6), 65.0 (51.9-76.3), and 98.2 (89.5-99.9), respectively. Area under the ROC curve of the two tests were 97.36 (95% CI: 92.92-94.48) and 92.31 (95% CI: 86.35-96.53), respectively (p = 0.0543).Conclusion: Pro-BNP and MEDS score both have excellent diagnostic accuracy in predicting 1-month mortality of sepsis patients. However, considering the higher sensitivity as well as availability and ease of calculation, it seems that Pro-BNP can be considered an appropriate tool for screening patients with high risk of mortality following sepsis in ED.

Evaluations of the effect of sodium metabisulfite on the stability and dissolution rates of various model drugs from the extended release polyethylene oxide matrices

Purpose: This study examines the effect of sodium metabisulfite (SMB) as an antioxidant on the stability and release of various model drugs namely propranolol HCl, theophylline and zonisamide from the polyethylene oxide (PEO) tablets. The antioxidant was used to minimise degradation and instability of the manufactured tablets when stored at 40°C (55±5 % RH) over 8 weeks. Method: Multiple batches of tablets weighing 240 mg (50% w/w) with a ratio of 1:1 drug: polymer and 1% (w/w) sodium metabisulfite containing different model drugs and various molecular weights of PEO 750 and 303 were produced. Results: The results indicated that the use of sodium metabisulfite marginally assisted in reducing drug release and degradation via oxidation in propranolol HCl tablets containing both PEO 750 and 303. In the case of poorly and semi-soluble drugs (zonisamide and theophylline) the formulations with both PEO showed entirely superimposable phenomenon and different release profiles compared to control samples (matrices without SMB). DSC study demonstrated the modifications of the polymer due to degradation and observed the effect of SMB on the thermal degradation of the PEO matrices. Conclusion: The use of antioxidant has assisted in retaining the stability of the manufactured tablets with different model drugs especially those with the highly soluble drug that are susceptible to rapid degradation. This has been reflected by an extended release profile of various drugs used at various stages of the storage time up to 8 weeks

The principle of annual nature of budget and perennial budgeting

The Legal nature of budgetary laws and the competence of Parliament and Government in budgeting process are major topics that researchers in public finance study in each country. What binds these subjects together are legal principles governing the budget acts and budgeting processes which are aimed at establishing the budgetary authority of the Executive and the Legislative. The importance of these legal imperatives lies in the historic campaign that led to their creation on the one hand, and their effectiveness on the other. Obviously, all these principles are subject to exceptions or have changed over time. In this paper, firstly we study the legal notion and nature of these rules briefly. Then, the emergence and transformation of annual and perennial nature of budget especially in Iranian context (1906 to 2016) will be examined. It is deduced that annual principle is politically still important but, economically its dysfunction has contributed to the emergence of perennial budgeting principle

On the hydrodynamics of liquid-liquid Taylor flows within mini and micro capillaries

This thesis presents an experimental investigation of the hydrodynamics of liquid-liquid Taylor flows in mini and micro channels, with the objectives of bridging gaps and extending previously conducted research on the subject. Taylor flows have emerged as a highly active research area due to the increasing demand for microscale devices and miniaturized components in order to reduce production costs and improve mobility. The utilization of two-phase flows in microdevices enables the dissipation of remarkably high heat fluxes within a confined space while maintaining minimal temperature variations. In addition, such flows also offer a promising platform for chemical and biomedical processes due to their well-defined high specific interfacial area and enhanced safety resulting from their extremely small dimensions. However, despite this research, the fluid mechanics of Taylor flows are still yet to be fully-determined and understanding the influence of all parameters is a big challenge, which calls for further investigation.The context of this thesis is divided into three main aspects: the development of a precise measurement technique for slug flow characterization within microchannels; an experimental investigation on the mobility of droplets in liquid-liquid Taylor flows within circular capillaries; and experimentally investigating the pressure drop of liquid-liquid Taylor flows over varying viscosity ratios.The first aspect introduces a novel technique to easily and reliably measure slug length and velocity. This automated, non-intrusive measurement technique allows for in-line high-frequency droplet/bubble detection and related physical properties based on changes in the light intensity caused by phase shifting in liquid-liquid or liquid-gas flows. This measurement methodology will aid in the determination and analysis of two-phase flow configurations in transparent microchannels, allowing for a better comprehension of the experimental data.The velocity of individual droplets in liquid-liquid Taylor flow is then investigated experimentally over a wide range of Capillary number (2 × 10−4 to 3.7 × 10−2 ), Bond number (0.05 to 3.2) and carrier to dispersed phase viscosity ratio (0.059 to 23.2) while also varying droplet length. This study provides a greater insight into droplet flows through an analysis of parameters affecting droplet mobility. The results indicate a complex dependency of droplet velocity on various parameters including droplet length, viscosity ratio, Reynolds and Bond number. In all cases, as droplet length exceeds a threshold value, droplet velocity becomes independent of length and is shown to scale with ~ Ca0.5 . Finally, a new expression has been developed to better estimate the velocity of elongated droplets, which has been found to correlate as a function of Capillary, Bond and Reynolds numbers.Finally, pressure drop in liquid-liquid Taylor flow regimes is empirically explored by means of a reliable experimental set up that ensured high measurement accuracy and repeatability. The experiments were conducted using five different combinations of liquids in a capillary of 800 µm diameter. The strengths and weaknesses of existing models are identified and a more fundamental understanding of predicting pressure drop in Taylor flow regimes is developed. A new expression is presented that more accurately estimates the interfacial pressure drop in liquid-liquid Taylor flows. This correlation fits the experimental data within ±20% by assuming an annular velocity profile across the capillary in the presence of the second phase while accounting for inertial and viscosity ratio effects.Overall, this study seeks to provide an improved understanding of liquid-liquid Taylor flow hydrodynamics as well as significant insights to facilitate microfluidic device optimisation.</p

The role of fillers and sodium metabisulfite on drug release from aged polyox tablets

Polyethylene oxides (PEOs) are extensively used to control the release rate of drugs from matrices. Unfortunately, polyox polymers are prone to oxidation under high temperature and relative humidity. The aim of this study was to investigate the effect of sodium metabisulfite as an antioxidant to overcome the drug release changes from polyox matrices (PEO 301 and 303) when stored at 40°C. The effect of different types of fillers (lactose, mannitol and dicalcium phosphate dihydrate) on stability of diltiazem HCl release profiles was also investigated. Generally, the presence of sodium metabisulfite stabilized the release of drug from PEO matrices stored at 40°C for 8 weeks. Whilst the absence of metabisulfite caused an increase in drug release from polyox matrices when stored at 40°C. The results indicate that all three concentrations (0.25, 0.5 and 1% w/w) of sodium metabisulfite were able to overcome structural changes of polyox samples hence stabilizing the drug release. The results also showed that the incorporation of fillers in polyox matrices reduced the sensitivity of drug release when stored at elevated temperature. This indicates that when these excipients were used there was no need to incorporate additional antioxidant. DSC results showed that there was no difference in the melting points of fresh polyox samples and aged polyox samples containing sodium metabisulfite, whereas the melting point of aged polyox samples without sodium metabisulfite were lower than fresh polyox samples. This indicates that the presence of metabisulfite is essential to stabilize polyox samples