In Vitro Evaluation oF Aerosol Drug Delivery With And Without High Flow Nasal Cannula Using Pressurized Metered Dose Inhaler And Jet Nebulizer in Pediatrics

Background: HFNC system is a novel device used with aerosol therapy and seems to be rapidly accepted. Although there are some studies conducted on HFNC and vibrating mesh nebulizer, the effect of HFNC on aerosol delivery using jet nebulizer or pressurized metered-dose inhaler (pMDI) has not been reported. In an effort to examine the effect of HFNC on aerosol deposition, this study was conducted to quantify aerosol drug delivery with or without a HFNC using either pMDI or jet nebulizer. Methodology: The SAINT model, attached to an absolute filter (Respirgard II, Vital Signs Colorado Inc., Englewood, CO, USA) for aerosol collection, was connected to a pediatric breathing simulator (Harvard Apparatus, Model 613, South Natick, MA, USA). To keep the filter and the SAINT model in upright position to collect aerosolized drug, an elbow adapter was connected between the absolute filter and the breathing simulator. An infant HFNC (Optiflow, Fisher & Paykel Healthcare LTD., Auckland, New Zealand) ran at 3 l/min O2 was attached to the nares of the SAINT model. Breathing parameters used in this study were Vt of 100 mL, RR of 30 breaths/min, and I:E ratio of 1: 1.4. Aerosol drug was administered using: 1) Misty-neb jet nebulizer (Allegiance Healthcare, McGaw Park, Illinois, USA) powered by air at 8 l/min using pediatric aerosol facemask (B&F Medical, Allied Healthcare Products, Saint Louis, MO, USA) to deliver albuterol sulfate (2.5 mg/3 mL NS), and 2) Four actuations of Ventolin HFA pMDI (90 μg/puff) (GlaxoSmithKline, Research Triangle Park, NC, USA) combined with VHC (AeroChamber plus with Flow-Vu, Monaghan Medical, Plattsburgh, NY, USA). Aerosol was administered to the model with and without the HFNC and another without (n=3). Drug was collected on an absolute filter, eluted and measured using spectrophotometry. Independent t tests were performed for data analysis. Statistical significance was determined with a p value of \u3c0.05. Results: The mean inhaled mass percent was greatest for pMDI with (p = 0.0001) or without HFNC (p = 0.003). Removing HFNC from the nares before aerosol treatment trended to increase drug delivery with the jet nebulizer (p = 0.024), and increased drug delivery by 6 fold with pMDI (p = 0.003). Conclusions: Aerosol drug may be administered in pediatrics receiving HFNC therapy using either jet nebulizer or pMDI. However, using pMDI, either with or without HFNC, is the best option. When delivering medical aerosol by mask, whether by jet nebulizer or pMDI, removing HFNC led to an increase in inhaled mass percent. However, the benefit of increased aerosol delivery must be weighed against the risk of lung derecruitment when nasal prongs are removed

A Holistic Framework to Evaluate E-government Systems

Evaluation of e-government systems is difficult duty since it involves many perspectives that complicate enumerating itsbenefits. Although the literature has reported several e-government evaluation frameworks, several shortcomings still exist inthe previous work. The objective of this paper is to propose a formative and holistic framework to remedy the currentresearch gaps. The formative position of the evaluation framework ensures the objectives achievement and the holistic sideensures completeness and continuity of the evaluation process. The framework can be used as a template for researchers andpractitioners to assess e-government projects. We demonstrate the applicability and practicability of the framework byapplying it to the Korean Government-for-Citizen (G4C) project

Decision Support Capabilities of Enterprise Content Management Systems: An Empirical Investigation

Enterprise content management (ECM) systems help organizations cope with the increasing complexity and volume of data and information. Despite the growing popularity of ECM, published literature indicates that organizations primarily use ECM for operational benefits, while the strategic decision making capabilities are rarely considered. Thus, the most significant rewards of ECM implementation may be largely forgone. This study investigates the potential of ECM technology for decision support. A research model is proposed and validated via an empirical investigation. The results show that ECM positively influences problem identification and definition, decision making speed and analysis, decision quality, and decision makers’ satisfaction

An Innovative Approach Based on Machine Learning to Evaluate the Risk Factors Importance in Diagnosing Keratoconus

Background and objective: Keratoconus is a non-inflammatory corneal condition affecting both eyes and is present in one out of every 2,000 people worldwide. The cornea deforms into a conical shape and thins, resulting in high-order aberrations and gradual vision loss. Risk factor analysis in the degradation of keratoconus is under-researched. Methods: This research work investigates and uses effective machine learning models to gain insight into how much the risk factors of a patient contribute towards the progressive stages of keratoconus, as well as how significant these factors are in the creation of an accurate prediction model. This research demonstrates the value of machine learning approaches on a clinical dataset. This research paper employs several machine learning algorithms to classify the patients' stage of keratoconus using clinical information, such as measurements of the cornea's topography, elevation, and pachymetry taken using pentacam equipment at Sydney's Vision Eye Institute Chatswood. Results: Eight different machine learning techniques were investigated over three variations of a dataset and achieved an average accuracy of 68, 80, and 90% for the risk factor, pentacam, and cumulative datasets, respectively. The results show a significant increase in accuracy and a 97% increase in AUC upon addition of risk factor data compared to the models trained on pentacam data alone. The machine learning methods shown in this paper outperform those in current research. Conclusions: This research highlights the importance of machine learning methods and risk factor data in the diagnosis of keratoconus and highlights the patient's primary optical aid as the strongest risk factor. The goal of this research is to support the work of the ophthalmologists in diagnosing keratoconus and provide better care for the patient

Variance Ranking for Multi-Classed Imbalanced Datasets: A Case Study of One-Versus-All

Imbalanced classes in multi-classed datasets is one of the most salient hindrances to the accuracy and dependable results of predictive modeling. In predictions, there are always majority and minority classes, and in most cases it is difficult to capture the members of item belonging to the minority classes. This anomaly is traceable to the designs of the predictive algorithms because most algorithms do not factor in the unequal numbers of classes into their designs and implementations. The accuracy of most modeling processes is subjective to the ever-present consequences of the imbalanced classes. This paper employs the variance ranking technique to deal with the real-world class imbalance problem. We augmented this technique using one-versus-all re-coding of the multi-classed datasets. The proof-of-concept experimentation shows that our technique performs better when compared with the previous work done on capturing small class members in multi-classed datasets

A retrospective epidemiological study of the incidence and risk factors of salmonellosis in bahrain in children during 2012–2016

Salmonellosis is one of the major public health concerns in Bahrain as it has increased rapidly during the past few years. This study aims to determine the prevalence of salmonellosis in children and the possible risk factors such as age, geographical area, nationality, gender, unsafe drinking water, infant born weight and gastrointestinal disease. The cases of salmonellosis in children reported by the Ministry of Health of Bahrain ranged from 21 to 26 per 100,000 population during the period 2012–2016. Salmonellosis cases were geographically concentrated in the capital and northern regions. Statistical analysis showed a significant difference in the number of salmonellosis cases between Bahrainis and non-Bahrainis based on region, and gender (p < 0.001). In the Bahraini cohort, there was an association between the increase of cases and the number of gastrointestinal disease-related deaths (p < 0.05). In addition, unsafe water (over the level of 2.14%) and low-birth weight (<3.100 g) were associated, but not statistically significant (p = 0.086 and p = 0.126, respectively) with the increase of salmonellosis cases. Despite the decline in the number of cases, the results of this study contribute to the understanding of the epidemiology of Salmonella in humans and this, in turn, will help develop and implement preventative measures

Rice germ macro- and micronutrients: a new opportunity for the nutraceutics

The aim of this study is to characterise the rice germ from the nutritional point of view. The latest laboratory methods for evaluation of macronutrients and micronutrients have been used. Rice germ has a high protein content (18 g per 100 g of edible product) with considerable amounts of essential amino acids (mainly lysine, histidine and valine), fatty acids (mainly monounsaturated and polyunsaturated fatty acids), and fibre (7 g per 100 g). Regarding water-soluble vitamins, rice germ has high amounts of thiamine (B1) and vitamin B6, while vitamin E is the main fat-soluble vitamin present. Iron (77% of RDA) and magnesium (108% of RDA) are the two main minerals found in rice germ. Given its great nutritional value, it will be of interest in future studies to explore ways for rice germ to be incorporated into dietary supplements aimed at increasing nutrition intake for a specific population

Novel insights on intake of fish and prevention of sarcopenia: All reasons for an adequate consumption

Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is diagnosed by measurements of muscle mass, muscle strength, and physical performance. Sarcopenia affects quality of life and is associated with several adverse health effects. Muscle decline is aggravated by a sedentary lifestyle and can be prevented through proper nutrition, together with adequate physical activity. Fish contains biologically active compounds, such as omega-3 polyunsaturated fatty acids, proteins, vitamin D, magnesium, and carnitine, which are able to intervene positively on muscle metabolism. This narrative literature review was performed to evaluate evidence regarding the actual benefit of fish consumption in the prevention of sarcopenia and the positive action on the muscle mass of the biological compounds present in fish. The results demonstrated that fish consumption has a protective and anti-inflammatory function on skeletal muscle and that its biologically active compounds help to maintain good muscle performance, preventing sarcopenia. Considering the nutritional and health benefits, elderly with sarcopenia should consume at least three servings per week of fish in order to have a minimum intake of 4–4.59 g daily of omega 3, and reaching the 50% RDA in Vitamin E and D. High biological value of proteins in 150 g of fish and its high available magnesium (20% of RDA in 150 g of fish) are an added value that could suggest fish as a “functional food” in order to prevent and treat sarcopenia

An overview of the features of chatbots in mental health: A scoping review

Background: Chatbots are systems that are able to converse and interact with human users using spoken, written, and visual languages. Chatbots have the potential to be useful tools for individuals with mental disorders, especially those who are reluctant to seek mental health advice due to stigmatization. While numerous studies have been conducted about using chatbots for mental health, there is a need to systematically bring this evidence together in order to inform mental health providers and potential users about the main features of chatbots and their potential uses, and to inform future research about the main gaps of the previous literature. Objective: We aimed to provide an overview of the features of chatbots used by individuals for their mental health as reported in the empirical literature. Methods: Seven bibliographic databases (Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, IEEE Xplore, ACM Digital Library, and Google Scholar) were used in our search. In addition, backward and forward reference list checking of the included studies and relevant reviews was conducted. Study selection and data extraction were carried out by two reviewers independently. Extracted data were synthesised using a narrative approach. Chatbots were classified according to their purposes, platforms, response generation, dialogue initiative, input and output modalities, embodiment, and targeted disorders. Results: Of 1039 citations retrieved, 53 unique studies were included in this review. Those studies assessed 41 different chatbots. Common uses of chatbots were: therapy (n = 17), training (n = 12), and screening (n = 10). Chatbots in most studies were rule-based (n = 49) and implemented in stand-alone software (n = 37). In 46 studies, chatbots controlled and led the conversations. While the most frequently used input modality was writing language only (n = 26), the most frequently used output modality was a combination of written, spoken and visual languages (n = 28). In the majority of studies, chatbots included virtual representations (n = 44). The most common focus of chatbots was depression (n = 16) or autism (n = 10). Conclusion: Research regarding chatbots in mental health is nascent. There are numerous chatbots that are used for various mental disorders and purposes. Healthcare providers should compare chatbots found in this review to help guide potential users to the most appropriate chatbot to support their mental health needs. More reviews are needed to summarise the evidence regarding the effectiveness and acceptability of chatbots in mental health

Effects of daily low-dose date consumption on glycemic control, lipid profile, and quality of life in adults with pre-and type 2 diabetes: A randomized controlled trial

Dates have a low glycemic index and are a source of antioxidants but, nevertheless, contain more than 70% sugar. This study aims to assess the effects of date consumption (three dates daily) on glycemic profile (HbA1c), body mass index (BMI), quality of life, and lipid profile, including total cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) in terms of safety for type 2 diabetic mellitus (T2DM) subjects. A randomized controlled trial was conducted with a sample of 100 T2DM subjects (39 male and 61 female) randomly assigned in two groups. The first group received three dates daily for 16 weeks, and the control group avoided date consumption. After a 16-week follow-up period, the study results showed an improvement of lipid profile with a statistically significant decrease in total cholesterol of ∆ = −0.209 mmol/L (confidence interval (CI) 95% −0.358, −0.059; p < 0.05) and in LDL of ∆ = −0.171 mmol/L (CI 95% −0.358, 0.016) in the group receiving three dates daily. Intra-group mean differences of BMI were not statistically different in both groups after 16 weeks of date consumption. Even HbA1c did not change, both within and between groups after date consumption (∆ = 0.087%; CI 95% −0.086, 0.261). Between groups, mean difference changes (intervention minus control) showed a statistically significant improvement of quality of life index of ∆ = ± 30.66 points (CI 95% 12.45, 48.23) due to the consequent improvement in mental health. Although the definitive effect of dose/intake response of date consumption on Hb1Ac, lipid profile, and BMI in T2DM subjects is still to be established, the study suggests that dates could potentially have a beneficial effect on lipid profile, especially in reducing total cholesterol and elevating HDL, because of its high polyphenolic content. In addition, a low–moderate consumption of dates did not impact glucose levels because of dates’ low glycemic index