Lung Biopsy in ARDS: Is It Worth the Risk?

Progress in the treatment of acute respiratory distress syndrome (ARDS) has been slow, perhaps in part due to the heterogeneity in the biology underlying this syndrome. Open lung biopsy is a feasible approach to define various subcategories of underlying histology. In experienced hands, with careful selection of patients and close attention to details of critical care management, including mechanical ventilator settings, the procedure is safe even in patients with severe disease. However, further work is needed to define which patients, if any, experience a beneficial effect on outcome from this procedure. More research is needed on assessing efficacy of potential therapies within histologically defined subgroups. In the future, various biomarkers may be available to non-invasively classify ARDS patients from the standpoint of responsiveness to various therapies, such as gluco-corticoids

Effect of agro-input management practices on yield of linseed (Linum usitatissimum L.) under vertisols of Chhattisgarh, India

A field experiment was conducted to study the effect of agro-input management practices on yield of linseed (Linum usitatissimum L.) at the Instructional cum Research Farm, Indira Gandhi Krishi Vishwavidyalaya, Raipur, (C.G.) during Rabi 2015-16. Different agro input management practices had significant (P=0.05) effect on growth, yield attributes and yield of linseed. However, seed rates did not give significant influence on seed yield. Whereas, application of RDF + FYM placement in rows @ 5 t ha-1 (N3) recorded significantly (P=0.05) higher growth parameters viz. plant height (88.44 cm), primary branches plant-1 (3.83), secondary branches plant-1 (23.39), dry matter accumulation (6.76 g plant-1) and yield attributes viz. capsules plant-1 (30.86), seeds capsule-1(7.63), seeds plant-1 (235.32), seed yield (2100 kg ha-1) and stover yield (4885 kg ha-1). In case of foliar spray, application of 2 % urea at 15, 40, 65 and 90 DAS (F3) gave significantly higher growth parameters viz. plant height (88.37 cm), primary branches plant-1(3.82), secondary branches plant-1 (23.68), dry matter accumulation (6.59 g plant-1) and yield attributes viz. capsules plant-1(31.74), seeds capsule-1(7.63), seeds plant-1 (241.38), seed yield (2089 kg ha-1) and stover yield (4772 kg ha-1). Interaction among seed rate 30 kg ha-1 (S2) X RDF 60:30:30 N: P: K kg ha-1 (N1) with foliar application of 2 % urea at 15, 40, 65 and 90 DAS (F3) (S2 XN1X F3) recorded the highest benefit-cost ratio (4.39). Line placement of FYM was better than broadcasting in terms of seed yield; and foliar application of urea was economical than Nitrobenzene

A Failure Analysis and Remaining Life assessment of Boiler Water Wall tube

This paper presents failure investigation on the SA210GrC water wall tube by visual Site inspection, tube wall thickness measurements, chemical composition test, Hardness test and microstructure analysis with proper evidence collected to identify the exact cause of the failure. The water wall tube was failed with blister, bulging and creep cracks on outer surface located near to the Soot Blower. On-site wall thickness measurements were performed on some of the water wall tubes located at the same level of the ruptured tube. The tubes have significant wall thinning and erosion from outside. Mild corrosion deposition also seen in the inner side. Microscopic examinations on the failed rupture region and some distance away of the as-received tubes are also conducted in order to determine the failure mechanism and root cause. Failure mechanisms are also discussed and relevant data from few months back to the failure gathered to identify the failure reason. The failure mechanism is identified as a result of the combination of the significant wall thinning of water wall tube due to long term overheating and creep. Corrosion due to oxygen is also a cause of wall thinning. Root cause analysis identified that deaerator was not working efficient to remove dissolved gases was reason behind corrosion. Long term overheating was due to operating temperature above the design one. Finally all the parameters checked and rectified properly. Maintenance of Deaerator has been done to put it in the working condition

On Normal Fuzzy Soft Group

In this paper, we introduce the concept of normal fuzzy soft group. We also define the level subsets of a normal fuzzy soft subgroup and discussed some of its properties.   Keywords Fuzzy group, Fuzzy Soft Group, Fuzzy Normal, Normal Fuzzy Soft Group, Fuzzy normalizer

Increased risk of depression in non-depressed HIV infected men with sleep disturbance: Prospective findings from the Multicenter AIDS Cohort Study.

ObjectiveSleep disturbance is a known risk factor for depression, but it is not known whether sleep disturbance contributes to greater risk of depression in those infected with human immunodeficiency virus (HIV+) as compared to those uninfected with HIV (HIV-).MethodsUsing data from the Multicenter AIDS Cohort Study, a population-based prospective study of men who have sex with men (MSM), self-reported sleep disturbance (>2 weeks) and depressive symptoms (Clinical Epidemiologic Scale for Depression, CES-D) were assessed every 6 months over 12 years of follow-up. Adjusted mixed effects logistic regression analyses tested whether sleep disturbance predicted depression (CES-D ≥ 16) at the immediate subsequent visit, and so on over 12 years, in non-depressed HIV+(N = 1054; 9556 person-visits) and non-depressed HIV- (N = 1217; 12,680 person-visits). In HIV+ vs. HIV- MSM, linearly estimated average incidence of depression and normalized cumulative rate of depression over 12 years were compared.ResultsIn the HIV+ MSM, sleep disturbance was associated with a significant increase in depression 6 months later (OR = 1.6; 95% CI, 1.30, 1.96), which was significantly greater (P < .05) than in HIV- MSM (OR = 1.16; 95% CI, 0.94, 1.44). HIV status and sleep disturbance interacted (P < .001), such that incidence of depression and normalized cumulative rate of depression were greater in HIV+ with sleep disturbance than in HIV+ without sleep disturbance and HIV- groups (all P's < 0.001).ConclusionsHIV+ persons who report sleep disturbance represent a high risk group to be monitored for depression, and possibly targeted for insomnia treatment to prevent depression. FUND: National Institute of Allergy and Infectious Diseases

Lack of reproducibility of linkage results in serially measured blood pressure data

BACKGROUND: Using the longitudinal Framingham Heart Study data on blood pressure, we analyzed the reproducibility of linkage measures from serial cross-sectional surveys of a defined population by performing genome-wide model-free linkage analyses to systolic blood pressure (SBP) and history of hypertension (HTN) measured at five separate time points. RESULTS: The heritability of SBP was relatively stable over time, ranging from 11.6 to 23.5% (coefficient of variation = 25.7%). However, the variability in linkage results was much greater. The average correlation in LOD scores at any pair of time points was 0.46 for HTN (NPL All LOD) and 0.17 for SBP (Variance Components LOD). No evidence of reproducible linkage results was found, with a mean κ of 0.02 for linkage to HTN and -0.03 for SBP linkage. At loci with potential evidence for linkage (LOD > 1.0 at one or more time points), the correlation was even lower. The coefficient of variation at loci with potential evidence of linkage was 126% for HTN and 135% for SBP. None of 15 chromosomal regions for HTN and only one of 28 regions for SBP with potential evidence for linkage had a LOD > 1.0 at more than two of the five time points. CONCLUSION: These data suggest that, although heritability estimates at different time points are relatively robust, the reproducibility of linkage results in serial cross-sectional samples of a geographically defined population at successive time points is poor. This may explain in part the difficulty encountered in replicating linkage studies of complex phenotypes

Obstructive sleep apnea and psychomotor vigilance task performance

Background: Obstructive sleep apnea (OSA) is a highly prevalent disorder with considerable morbidity and mortality. Vigilance and attentiveness are often impaired in OSA patients. In occupational medicine settings, subjective reports of sleepiness are notoriously inaccurate, making the identification of objective measures of vigilance potentially important for risk assessments of fitness for duty. In order to evaluate the effects of OSA on attentiveness and vigilance, we conducted a cross-sectional study to examine the association between OSA and psychomotor vigilance task (PVT) performance. Methods: Patients attending sleep clinics for evaluation of possible sleep apnea were recruited. The subjects underwent either a standard overnight laboratory polysomnography or home sleep study. Subjective daytime sleepiness was assessed by Epworth sleepiness scale, and vigilance was tested using a portable device. The participants were asked to respond to the PVT signals using their dominant hand. Each PVT administration lasted 10 minutes, with stimuli signals appearing randomly at variable intervals of 2–10 seconds. Results: Mean age of the participants was 46±15 years, and mean body mass index was 34.3±9.8 kg/m2. Participants with higher Epworth scores had worse PVT performance (P<0.05). In multivariate analyses, age, body mass index, and poor sleep efficiency (measured by Pittsburgh sleep quality index score) were associated with worse PVT performance (P<0.05). In contrast, PVT performance did not differ significantly across categories of apnea hypopnea index severity. Subgroup analysis demonstrated that women had worse performance on all PVT measures (P<0.05). Conclusion: PVT performance can be utilized for risk assessments of sleepiness and may be particularly useful among populations where subjective reports are unreliable

Sleep Disturbances and Glucose Metabolism in Older Adults: The Cardiovascular Health Study.

ObjectiveWe examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia with glucose metabolism and incident type 2 diabetes in older adults.Research design and methodsBetween 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989-1994. In 1989-1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989-1990 and again in 1992-1993, 1994-1995, 1996-1997, and 1998-1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazards models. We adjusted for sociodemographics, lifestyle factors, and medical history.ResultsObserved apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19-2.86]), snoring (HR 1.27 [95% CI 0.95-1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13-2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.ConclusionsEasily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults

Genome-wide linkage analysis of longitudinal phenotypes using σ(2)(A )random effects (SSARs) fitted by Gibbs sampling

The study of change in intermediate phenotypes over time is important in genetics. In this paper we explore a new approach to phenotype definition in the genetic analysis of longitudinal phenotypes. We utilized data from the longitudinal Framingham Heart Study Family Cohort to investigate the familial aggregation and evidence for linkage to change in systolic blood pressure (SBP) over time. We used Gibbs sampling to derive sigma-squared-A-random-effects (SSARs) for the longitudinal phenotype, and then used these as a new phenotype in subsequent genome-wide linkage analyses. Additive genetic effects (σ(2)(A.time)) were estimated to account for ~9.2% of the variance in the rate of change of SBP with age, while additive genetic effects (σ(2)(A)) were estimated to account for ~43.9% of the variance in SBP at the mean age. The linkage results suggested that one or more major loci regulating change in SBP over time may localize to chromosomes 2, 3, 4, 6, 10, 11, 17, and 19. The results also suggested that one or more major loci regulating level of SBP may localize to chromosomes 3, 8, and 14. Our results support a genetic component to both SBP and change in SBP with age, and are consistent with a complex, multifactorial susceptibility to the development of hypertension. The use of SSARs derived from quantitative traits as input to a conventional linkage analysis appears to be valuable in the linkage analysis of genetically complex traits. We have now demonstrated in this paper the use of SSARs in the context of longitudinal family data