Association of Frailty Status on the Causes and Outcomes of Patients Admitted With Cardiovascular Disease.

Data are limited about the contemporary association between frailty and the causes and outcomes of patients admitted with cardiovascular diseases (CVD). Using the US National Inpatient Sample, CVD admissions of interest (acute myocardial infarction, ischemic stroke, atrial fibrillation (AF), heart failure, pulmonary embolism, cardiac arrest, and hemorrhagic stroke) were stratified by Hospital Frailty Risk Score (HFRS). Logistic regression was used to determine adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of in-hospital mortality among different groups with frailty. The study included 9,317,398 hospitalizations. Of these, 5,573,033 (59.8%) had a low HFRS (15). Ischemic stroke was the most common admission for the groups with high risk (75.4%), whereas acute myocardial infarction was the most common admission for the group with low risk (36.9%). Compared with the group with low risk, patients with high risk had increased mortality across the most CVD admissions, except in patients admitted for cardiac arrest and hemorrhagic stroke (p <0.001). The strongest association with all-cause mortality was shown among patients with high risk admitted for AF (aOR 6.75, 95% CI 6.51 to 7.00, and aOR 17.69, 95% CI 16.08 to 19.45) compared with their counterparts with low risk. In conclusion, patients with CVD admissions have varying frailty risk according to cardiovascular cause of admission, with ischemic stroke being the most common among groups with frailty and high risk. Increased frailty is associated with all-cause mortality in patients with most CVD admissions, except for cardiac arrest and hemorrhagic stroke, with the strongest association seen in patients admitted with AF

Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia

The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

Experimental investigation of heat transfer and exergy loss in heat exchanger with air bubble injection technique

The main aim of this study is to evaluate thermal performance and exergy analysis of a shell-and-tube heat exchanger with a new technique called air bubble injection. The study has been carried out with different parameters such as flow rate, fluid inlet temperature, and different air injection techniques. The air has been injected at different locations such as the inlet of pipe, throughout the pipe, and in the outer pipe of the heat exchanger. Based on the results, the performance of the heat exchanger enhances with an increase in the flow rate and the fluid inlet temperature. The exergy loss and dimensionless exergy loss increase with a rise in the flow rate. The maximum and dimensionless exergy losses are obtained at a maximum flow rate of 3.5 l min−1. With the air bubble injection in the heat exchanger, it has been observed that the temperature difference increases, which leads to an increase in the exergy loss. The injecting air bubbles throughout the tube section shows that minimum dimensionless exergy is 27.49% concerning no air injection.http://link.springer.com/journal/109732021-08-28am2020Mechanical and Aeronautical Engineerin