Methadone and Corrected QT Prolongation in Pain and Palliative Care Patients: A Case–Control Study

Background: Methadone (ME) is commonly used in pain and palliative care (PPC) patients with refractory pain or intolerable opioid adverse effects (AEs). A unique ME AE is its corrected QT (QTc) interval prolongation risk, but most evidence exists in methadone maintenance therapy patients. Objective: Our goal was to identify QTc interval prolongation risk factors in PPC patients receiving ME and other medications known to prolong the QTc interval and develop a risk stratification tool. Design: We performed a case–control study of adult inpatients receiving ME for pain management. Settings/Subjects: Adult inpatients receiving ME with a QTc \u3e470 msec (males) and \u3e480 msec (females) were matched 1:2 according to age, history of QTc prolongation, and gender with ME patients who did not have a prolonged QTc interval. QTc prolongation risk factors were collected for both groups. Covariates were analyzed using conditional logistic regression. Classification and regression tree analysis was used to identify the ME dose associated with QTc prolongation. Results: Predictors of QTc prolongation included congestive heart failure (CHF) (OR: 11.9; 95% CI: 3.7–38.2; p \u3c 0.00), peptic ulcer disease (PUD) (odds ratio [OR]: 8.3; 95% confidence interval [95% CI]: 2.4–28.9; p \u3c 0.00), hypokalemia (OR: 6.5; 95% CI: 1.5–28.2; p \u3c 0.01), rheumatologic diseases (OR: 4.7; 95% CI: 1.6–13.9; p \u3c 0.00), taking medications with a known torsades de pointes (TdP) risk (OR: 4.4; 95% CI: 1.8–10.7; p \u3c 0.01), malignancy (OR: 3.3; 95% CI: 1.2–9.3; p \u3c 0.03), hypocalcemia (OR: 2.1; 95% CI: 0.9–4.8; p \u3c 0.07), and ME doses \u3e45 mg per day (OR: 1.9; 95% CI: 0.8–4.8; p \u3c 0.16). Mild liver disease was protective against QTc prolongation (OR: 0.05; 95% CI: 0.0–0.46; p \u3c 0.01). Conclusions: Predictors of QTc prolongation in our multivariate conditional logistic regression model included CHF, PUD, hypokalemia, rheumatologic disorders, use of medications with a known TdP risk, malignancy, hypocalcemia, and ME doses \u3e45 mg per day

Epidemiology of Poisoning in Northeast of Iran (2004-2013)

Background: Poisoning is a major concern, especially in developing countries. We aimed to focus on poisoning trends based on registry data for the recent 10 years.Methods: This cross-sectional study was performed on registry database of Imam Reza Hospital in Mashhad, Iran. All cases of toxic exposure or poisoning during 2004 to 2013 were included (49189 patients). Data from two national censuses were used for calculating rates. SPSS 11.5 was used for data analysis. P<0.05 was considered statistically significant.Results: There were 49189 admissions during the 10-year period with a mean age of 26.21±14.97 years out of which 50.3% were female. The prevalence rate had increased three times in women and four times in men. Pharmaceutical toxins (63.5%) had the highest proportional mortality ratio, which mostly occurred in winters. The mean age of admission began to decline again in recent years.Conclusion: Analyzing data on secular trends can always enlighten the healthcare decision makers for real health problems. Designing the proper population-based interventions can be one of the many uses of these findings

The determinants of internationalization in the portuguese metalworking industry

A considerable attention has been devoted by the literature to the determinants of internationalization. This research aims to explore the relation between internationalization and the following determinants: Size, innovation, productivity, international trade fairs, management influence and government assistance. Using a sample of 48 firms in the Portuguese metalworking industry for a period of two years, we have found the following results after controlling for firm‐specific unobserved characteristics. Productivity has a positive impact on internationalization. Size has no significant impact suggesting that size is not a barrier for internationalization and small and medium firms can success in internationalization as well as large firms. Innovation was insignificant suggesting that innovation is not important determinant for internationalization. Also none of international trade fairs, management influence and government assistance determinates has significant effect. Furthermore, our findings indicate that there are unobserved characteristics captured by firm fixed effects, that have significant impact and they are important in explaining firm’s internationalization. Further studies are suggested for future research to investigate these unobserved characteristics. The sample size is the main limitation of the research.Uma atenção considerável tem sido dada aos determinantes da internacionalização. O presente trabalho tem como objetivo explorar a relação ente a internacionalização e os seguintes determinantes: dimensão, inovação, produtividade, presença em feiras internacionais, influência da gestão e assistência/apoio do governo. Utilizando uma amostra caracterizada por 48 empresas da indústria metalúrgica Portuguesa ao longo de um período de 2 anos, foi possível concluir os seguintes resultados, controlando para as características não observáveis especificas das empresas: A produtividade tem um impacto positivo na internacionalização. A dimensão da organização não tem um impacto significativo na capacidade de internacionalização, sugerindo assimque tanto uma PME pode ter tanto sucesso na internacionalização, como uma grande empresa. A inovação não foi uma variável significativa neste estudo, sugerindo assim, que esta não é determinante para a internacionalização. Variáveis como feiras internacionais, a influência da gestão e a assistência/apoio do governo não revelaram um efeito significativo. Contudo, os resultados obtidos indicam que existem características não observáveis, capturadas por efeitos fixos, que são importantes para a explicação da internacionalização das organizações. Para estudar estas características não observáveis são sugeridas pesquisas futuras. A dimensão da amostra é a principal limitação desta pesquisa

Phonological Working Memory and FOXP2

The discovery and description of the affected members of the KE family (aKE) initiated research on how genes enable the unique human trait of speech and language. Many aspects of this genetic influence on speech-related cognitive mechanisms are still elusive, e.g. if and how cognitive processes not directly involved in speech production are affected. In the current study we investigated the effect of the FOXP2 mutation on Working Memory (WM). Half the members of the multigenerational KE family have an inherited speech-language disorder, characterised as a verbal and orofacial dyspraxia caused by a mutation of the FOXP2 gene. The core phenotype of the affected KE members (aKE) is a deficiency in repeating words, especially complex non-words, and in coordinating oromotor sequences generally. Execution of oromotor sequences and repetition of phonological sequences both require WM, but to date the aKE's memory ability in this domain has not been examined in detail. To do so we used a test series based on the Baddeley and Hitch model, which posits that the central executive (CE), important for planning and manipulating information, works in conjunction with two modality-specific components: The phonological loop (PL), specialized for processing speech-based information; and the visuospatial sketchpad (VSSP), dedicated to processing visual and spatial information. We compared WM performance related to CE, PL, and VSSP function in five aKE and 15 healthy controls (including three unaffected members of the KE family who do not have the FOXP2 mutation). The aKE scored significantly below this control group on the PL component, but not on the VSSP or CE components. Further, the aKE were impaired relative to the controls not only in motor (i.e. articulatory) output but also on the recognition-based PL subtest (word-list matching), which does not require speech production. These results suggest that the aKE's impaired phonological WM may be due to a defect in subvocal rehearsal of speech-based material, and that this defect may be due in turn to compromised speech-based representations

Measuring supply chain complexity based on multi-criteria decision approach

This study identified twenty-two drivers that cause the complexity in supply chain. The level of such complexity is quantified by using hybrid AHP and GRA method. A case company is studied in order to demonstrate the applicability of the proposed method. The results from the case company were analyzed and it is seen that the level of supply chain complexity of the case company is 0.44, which is signifying that there is a considerable scope of improvement in terms of minimizing complexity in its supply chain. From the study outcomes, it is realized that the case company mainly needs substantial improvement on the issues of “government regulation,” “internal communication and information sharing,” and “company culture” in order to minimize the level of accompanied complexity in its supply chain.©2020 IEOM Society.fi=vertaisarvioitu|en=peerReviewed

Studying effects of gold nanoparticle on dose enhancement in megavoltage radiation

Background: Gold nanoparticles are emerging as promising agents for cancer therapy and are being investigated as drug carriers, photothermal agents, contrast agents and radiosensitisers. Objective: The aim of this study is to understand characteristics of secondary electrons generated from interaction of gold nanoparticles GNPs with x-rays as a function of nanoparticle size and beam energy and thereby further understanding of GNPenhanced radiotherapy. Methods: Effective range, defection angle, dose deposition, energy, and interaction processes of electrons produced from the interaction of x-rays with a GNP were calculated by Monte Carlo simulations. The MCNPX code was used to simulate and track electrons generated from 30 and 50 nm diameter GNP when it is irradiated with a cobalt-60 and 6MV photon and electron beam in water. Results: When a GNP was present, depending on beam types used, secondary electron production increased by 10- to 2000-fold compared to absence of a GNP. Conclusion: GNPs with larger diameters also contributed to more doses. © 2015, Shiraz University of Medical Sciences. All rights reserved

Semi-Automated Needle Steering in Biological Tissue Using an Ultrasound-Based Deflection Predictor

The performance of needle-based interventions depends on the accuracy of needle tip positioning. Here, a novel needle steering strategy is proposed that enhances accuracy of needle steering. In our approach the surgeon is in charge of needle insertion to ensure the safety of operation, while the needle tip bevel location is robotically controlled to minimize the targeting error. The system has two main components: (1) a real-time predictor for estimating future needle deflection as it is steered inside soft tissue, and (2) an online motion planner that calculates control decisions and steers the needle toward the target by iterative optimization of the needle deflection predictions. The predictor uses the ultrasound-based curvature information to estimate the needle deflection. Given the specification of anatomical obstacles and a target from preoperative images, the motion planner uses the deflection predictions to estimate control actions, i.e., the depth(s) at which the needle should be rotated to reach the target. Ex-vivo needle insertions are performed with and without obstacle to validate our approach. The results demonstrate the needle steering strategy guides the needle to the targets with a maximum error of 1.22 mm