Analysis of Distributed Systems Dynamics with Erlang Performance Lab

Modern, highly concurrent and large-scale systems require new methods for design, testing and monitoring. Their dynamics and scale require real-time tools, providing a holistic view of the whole system and the ability of showing a more detailed view when needed. Such tools can help identifying the causes of unwanted states, which is hardly possible with static analysis or metrics-based approach. In this paper a new tool for analysis of distributed systems in Erlang is presented. It provides real-time monitoring of system dynamics on different levels of abstraction. The tool has been used for analyzing a large-scale urban traffic simulation system running on a cluster of 20 computing nodes

Does smog affect the incidence of exacerbations of chronic laryngitis? : analysis based on the inhabitantsof Lesser Poland Voivodeship

Introduction: Due to dynamic industrialisation smog became a frequent phenomenon in most developing cities. According to the last WHO report from Global Urban Ambient Air Pollution Database, Krakow has been classified in the 11th place among the most polluted cities in Europe. It seems to be an urgent issue because of the influence of air pollution on the condition of upper respiratory tract. Materials & Methods: In December 2015 there were 141 patients aged 17-91 years with upper respiratory tract diseases admitted to the phoniatric outpatient clinic in the University Hospital in Cracow. They suffered from cough, hoarseness and periodic aphonia. On the basis of the results of videolaryngostroboscopy 60 patients with exacerbation of the chronic laryngitis were selected into two numerically equal groups: from Cracow and from other places at least 60 km away. The groups were equal to each other also in three categories: sex, age and voice usage. The patients were referred to the Pedagogical University in Cracow for laryngography to evaluate the movement of the vocal folds and to trace a voice profile. Finally, there were two possible types of treatment – conventional pharmacotherapy or subterraneotherapy in the underground Health Resort in the "Wieliczka" Salt Mine. Results: Pearson correlation coefficient between the distance from the place of residence to Cracow and the scale of exacerbation of inflammation of upper respiratory tract presenting as vocal fold dysfunction was observed (r= 0,617; p<0,05). Conclusion: The place of residence (in or out of the industrial area) and exacerbations of chronic laryngitis are highly correlated. Air pollution seems to be the main factor influencing on the condition of upper respiratory tract. In our local conditions of Lesser Poland Voivodeship subterraneotherapy may be an interesting, non-invasive method preventing from exacerbations of upper respiratory tract diseases

Impact of COVID-19 pandemic on emergency medical service response to emergency calls — a retrospective analysis of data from Emergency Medical Service station in Bydgoszcz

Introduction: Emergency medical systems, as the first line of management of infectious patients, were affected by the 2019 coronavirus acute respiratory disease (COVID-19) pandemic. The aim of the study was to analyze the impact of the COVID-19 pandemic on the Emergency Medical Service (EMS) with emphasis on response time. Material and methods: Retrospective analysis of dispatch card from EMS in Bydgoszcz between January 2018 and December 2020. The differences regarding the EMS response were analyzed between the pre-pandemic (2018–2019) and the pandemic (2020) period in three time-points: from call to Emergency Medical Team (EMT) departure (T1), from departure to arrival at the scene (T2), and from arrival to reaching the emergency department (T3). Results: There were 47783 EMT departures in 2018, 47113 in 2019 and 40835 in 2020. In 2020 mean (SD) monthly number of interventions was significantly lower [3403 (349) vs. 3954 (182), p &lt; 0.001) compared to the 2018–2019 period. During the pandemic period the mean T1 [0.9 (1.49) vs. 0.63 (1.12) min, p &lt; 0.001], T2 [9.91 (6.33) vs. 8.25 (5.07) min, p &lt; 0.001], and T3 interval [40.45 (19.84) vs. 36.56 (14.63) min, p &lt; 0.001] were prolonged in comparison to the pre-pandemic period. The differences in response time were the largest in October–December. Conclusions: During the first year of the pandemic, the number of EMT interventions decreased and the response time was prolonged compared to the pre-pandemic period. The largest differences were observed at the end of the year, which overlapped with the peak of the second wave of COVID-19 infections in Poland

Monitoring of tacrolimus concentration after kidney or heart transplantation - the importance of intra-subject variability parameters

Background. Properly managed immunosuppression in post-transplant therapy is a necessary for minimizing the risk of organ rejection. Aim of the study. Steady-state tacrolimus (TAC) trough concentration (Cssmin) analysis in the first month following heart or kidney transplantation. The intra-individual coefficient of variation (CV) was calculated, correlations with biochemical parameters were searched and recommendations/current guidelines for optimizing TAC dosing based on evidence-based medical databases (EBM) were presented. Material and methods. 24 patients aged 24-79 years (mean 47,1±13,9 years) were selected for retrospective analysis; 12 after heart transplant and 12 after kidney transplant. TAC dosing was the same in the patient groups and did not change during the analysis (first month); in heart recipients it was 2 mg/day and 1 mg/day in kidney recipients. Whole blood Cssmin TAC (steady state) was measured four times in all patients; the first in the 15th day of treatment, the second in 16-18, the third in 17-19, the fourth in 18-21. The QMS Tacrolimus immunoassay was used to analyze TAC concentration using the Indiko Plus automated chemistry analyzer. Results. The median Cssmin TAC value was 6,9-15,6 ng/mL after heart transplant and 8,7-16,0 ng/mL after kidney transplant. The CV range of patients after heart transplantation was 4-60%, while after kidney transplantation it was 8-40%. CV>30% (a higher risk of acute rejection) after heart transplant concerned 25% of patients and 15% after kidney transplant. The analysis of organ survival in heart and kidney recipients showed 83% and 100%, respectively, at an average of 2,7±0,5 and 3,25±2,5 years after transplantation. There were no significant correlations (p>0,05) between CV and selected biochemical parameters. Conclusion. CV>30% may indicate a large variability in the pharmacokinetics of TAC and thus, the need to optimize the dosage/physiological parameters affecting its concentration values. It seems necessary to improve the personalization of immunosuppressive therapy with TAC, taking into account individual parameters of extra- and intra-individual variability, in order to obtain better therapeutic results and avoid acute/chronic rejection, accelerated in time of organ transplant loss and/or the occurrence of additional side effects of TAC

Treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams: Focus on antiplatelet therapies. Updated experts’ standpoint

A group of Polish experts in cardiology and emergency medicine, encouraged by the European Society of Cardiology (ESC) guidelines, have recently published common recommendations for medical emergency teams regarding the pre-hospital management of patients with acute coronary syndrome. Due to the recent publication of the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation and 2017 focused update on dual antiplatelet therapy in coronary artery disease the current panel of experts decided to update the previous standpoint. Moreover, new data coming from studies presented after the previous document was issued were also taken into consideration

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe