Acute-on-chronic Liver Failure: MELD Score 30-day Mortality Predictability and Etiology in a Pakistani Population

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability. Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p≤0.05). Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001). Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF

The Influence of Motivation to the Performance of Honorary Religious Counselor of Semarang

The aim of this research is to know and analyze the influence of motivation to the performance of honorary religious counselor of Semarang. This research is conducted to all of honorary religious counselor of Semarang 2013. Research method used is descriptive method by using simple regression analysis. Sample of research is 132 of 200 honorary religious counselor of Semarang by using simple random sampling. Variable of research consists of independent variable motivation (X) and dependent variable performance (Y). The result shows motivation has positive and significance influence to the performance of honorary religious counselor of Semarang with 90,4%. Based on that result, it suggested: 1) all of honorary religious counselor is suggested to keep their motivation, 2) ministry of religious affairs to give treatment to increase the motivation of honorary religious counselor of semarang, 3) other researcher is suggested to develop the research about motivation or performance by other factors or variables.***Penelitian ini bertujuan mengetahui dan menganalisis pengaruh motivasi terhadap kinerja penyuluh agama honorer kota Semarang. Penelitian ini dilakukan terhadap penyuluh agama honorer kota Semarang yang berada di bawah naungan kementerian agama kota Semarang tahun 2013. Metode penelitian yang digunakan adalah metode deskriptif dengan pendekatan analisis regresi sedehana. Pengambilan sampel dalam penelitian ini adalah dengan teknik sampling sederhana, yaitu dengan mengambil sebagian populasi sebanyak 132 dari 200 jumlah keselurahan penyuluh agama honorer. Adapun variable dalam penelitian ini adalah variabel bebas, yaitu variabel motivasi (X), dan variabel terikat, yakni variabel kinerja (Y). Hasil penelitian ditemukan bahwa motivasi memiliki pengaruh positif dan signifikan terhadap kinerja penyuluh agama honorer kota Semarang dengan pengaruh sebesar 90,4 %. Berdasarkan hasil tersebut, maka direkomendasi-kan: 1) kepada penyuluh agama honorer agar selalu mempertahankan motivasi dalam melaksanakan tugas-tugasnya, 2) kepada kementerian agama agar meningkatkan motivasi para penyuluh agama honorer dalam melayani masyarakat, 3) kepada para peneliti yang tertarik melakukan penelitian mengenai motivasi dan kinerja agar mengembangkan dengan faktor-faktor atau variabel lainnya

Similarity Solutions for Hydromagnetic Free Convective Heat and Mass Transfer Flow along a Semi-Infinite Permeable Inclined Flat Plate with Heat Generation and Thermophoresis

The problem of steady, two-dimensional, laminar, hydromagnetic flow with heat and mass transfer over a semi-infinite, permeable inclined flat plate in the presence of thermophoresis and heat generation is studied numerically. A similarity transformation is used to reduce the governing non-linear partial differential equations into ordinary ones. The obtained locally similar equations are then solved numerically by applying Nachtsheim-Swigert shooting iteration technique with sixth-order Runge-Kutta integration scheme. Comparisons with previously published work are performed and the results are found to be in very good agreement. Numerical results for the dimensionless velocity, temperature and concentration profiles as well as for the skin-friction coefficient, wall heat transfer and particle deposition rate are obtained and reported graphically for various values of the parameters entering into the problem

Transient Magnetohydrodynamic Free Convective Heat and Mass Transfer Flow with Thermophoresis past a Radiate Inclined Permeable Plate in the Presence of Variable Chemical Reaction and Temperature Dependent Viscosity

In the present study, an analysis is carried out to investigate the effects of variable chemical reaction, thermophoresis, temperature-dependent viscosity and thermal radiation on an unsteady MHD free convective heat and mass transfer flow of a viscous, incompressible, electrically conducting fluid past an impulsively started infinite inclined porous plate. The governing nonlinear partial differential equations are transformed into a system of ordinary differential equations, which are solved numerically using a sixth-order Runge-Kutta integration scheme with Nachtsheim-Swigert shooting method. Numerical results for the non-dimensional velocity, temperature and concentration profiles as well as the local skin-friction coefficient, the local Nusselt number and the local Stanton number are presented for different physical parameters. The results show that variable viscosity significantly increases viscous drag and rate of heat transfer. The results also show that higher order chemical reaction induces the concentration of the particles for a destructive reaction and reduces for a generative reaction

Maternal thyroid function and child educational attainment: prospective cohort study

Objective: To determine if first trimester maternal thyroid dysfunction is a critical determinant of child scholastic performance and overall educational attainment. Design: Prospective cohort study. Setting: Avon Longitudinal Study of Parents and Children cohort in the UK. Participants: 4615 mother-child pairs with an available first trimester sample (median 10 weeks gestation, interquartile range 8-12). Exposures: Free thyroxine, thyroid stimulating hormone, and thyroid peroxidase antibodies assessed as continuous measures and the seven clinical categories of maternal thyroid function. Main outcome measures: Five age-specific national curriculum assessments in 3580 children at entry stage assessment at 54 months, increasing up to 4461 children at their final school assessment at age 15. Results: No strong evidence of clinically meaningful associations of first trimester free thyroxine and thyroid stimulating hormone levels with entry stage assessment score or Standard Assessment Test scores at any of the key stages was found. Associations of maternal free thyroxine or thyroid stimulating hormone with the total number of General Certificates of Secondary Education (GCSEs) passed (range 0-16) were all close to the null: free thyroxine, rate ratio per pmol/L 1.00 (95% confidence interval 1.00 to 1.01); and thyroid stimulating hormone, rate ratio 0.98 (0.94 to 1.02). No important relationship was observed when more detailed capped scores of GCSEs allowing for both the number and grade of pass or when language, mathematics, and science performance were examined individually or when all educational assessments undertaken by an individual from school entry to leaving were considered. 200 (4.3%) mothers were newly identified as having hypothyroidism or subclinical hypothyroidism and 97 (2.1%) subclinical hyperthyroidism or hyperthyroidism. Children of mothers with thyroid dysfunction attained an equivalent number of GCSEs and equivalent grades as children of mothers with euthyroidism. Conclusions: Maternal thyroid dysfunction in early pregnancy does not have a clinically important association with impaired child performance at school or educational achievement

Automated inspection system for NDT of steel plates

The aim of the research project is to automate NDT data acquisition and analysis on large steel plates with an ultrasonic inspection technique that is implemented with robotics instrumentation. The project researches NDT sensor deployment, ultrasonic data acquisition and analysis and intelligent flaw detection. A robotic system has been developed for the inspection of internal imperfections in flat steel plates and produces a map of defective areas. It is a magnetic vehicle with a self-navigating system that carries 16 transducers for ultrasonic testing. The software that has been developed controls the scan trajectory of the vehicle and locates and plots position of the ultrasonic sensors and the presence of any defects at these positions. Internal imperfections in the steel plate are detected by monitoring the backwall echo or the echo associated with an imperfection during the scanning. The system has easy mobility to carry out inspection from site to site and a display and image processing system to analyse and show results of the ultrasonic inspection

Integration and management of solar energy for electric vehicle charging station

A rise of electric vehicles and consequent increase of charging stations in the UK has widely been acknowledged due to its negligible carbon emissions leading to the transformation of low-carbon economy. A dynamic increase in the wind and solar power systems installation and grid-integration to the charging stations of electric vehicles has led uncertainty issues in the power distribution grid e.g voltage fluctuations, transients/harmonics. This paper addresses the uncertainty scenario aiming to contribute and propose a potential model focusing on the design of the route in which solar electric power is delivered to the electric vehicle charging station. A specialised system containing an electrical control system is proposed using MATLAB and SIMULINK. A system was designed for improving the interaction among electric-vehicle charging points and battery storage system in which electrical control system assists in developing the correct duty cycle in order to stabilise and regulate the voltage at the DC/DC power conversion station. The proposed system is very effective and significant contribution in understanding and reducing the load on the converter untimely enabling reduction of charging time for electric vehicles. The implemented electrical control system manages the electric power on the grid such as during the peak times it draws power from the batteries and then charges up the batteries in the off-peak times. A constant voltage is achieved on the micro grid irrespective of fluctuations in solar energy generation and in the load

Analysing integrated renewable energy and smart-grid systems to improve voltage quality and harmonic distortion losses at electric-vehicle charging stations

Increasing the use of Electric-Vehicles (EV) is regarded as a step in the right direction to reduce air-pollution and carbon emissions. However, a dramatic increase of EV and charging stations has raised voltage quality and harmonic distortion issues that affect the performance of integrated renewable power sources (wind and solar) and smart-grid electrical transmission networks. This paper models an integrated electric-vehicle charging and battery storage system operating in the presence of unpredictable wind and solar power sources. The aim is to enable the design of an electrical control system that develops the correct duty cycle to stabilise and regulate the voltage at the DC/DC power conversion station. Simulations are performed to evaluate energy management by the proposed control system. The proposed system effectively manages the electric power on the grid by drawing power from the batteries at peak times and then charging them in off-peak times, reducing the load on the converter and enabling the reduction of charging time for electric vehicles. A constant voltage is achieved on the grid irrespective of fluctuations in renewable energy generation and in the load

Hyperglycemia Has a Greater Impact on Left Ventricle Function in South Asians Than in Europeans

OBJECTIVE Diabetes is associated with left ventricular (LV) diastolic and systolic dysfunction. South Asians may be at particular risk of developing LV dysfunction owing to a high prevalence of diabetes. We investigated the role of diabetes and hyperglycemia in LV dysfunction in a community-based cohort of older South Asians and white Europeans. RESEARCH DESIGN AND METHODS Conventional and Doppler echocardiography was performed in 999 participants (542 Europeans and 457 South Asians aged 58–86 years) in a population-based study. Anthropometry, fasting bloods, coronary artery calcification scoring, blood pressure, and renal function were measured. RESULTS Diabetes and hyperglycemia across the spectrum of HbA1c had a greater adverse effect on LV function in South Asians than Europeans (N-terminal-probrain natriuretic peptide β ± SE 0.09 ± 0.04, P = 0.01, vs. −0.04 ± 0.05, P = 0.4, P for HbA1c/ethnicity interaction 0.02), diastolic function (E/e′ 0.69 ± 0.12, P < 0.0001, vs. 0.09 ± 0.2, P = 0.6, P for interaction 0.005), and systolic function (s′ −0.11 ± 0.06, P = 0.04, vs. 0.14 ± 0.09, P = 0.1, P for interaction 0.2). Multivariable adjustment for hypertension, microvascular disease, LV mass, coronary disease, and dyslipidemia only partially accounted for the ethnic differences. Adverse LV function in diabetic South Asians could not be accounted for by poorer glycemic control or longer diabetes duration. CONCLUSIONS Diabetes and hyperglycemia have a greater adverse effect on LV function in South Asians than Europeans, incompletely explained by adverse risk factors. South Asians may require earlier and more aggressive treatment of their cardiometabolic risk factors to reduce risks of LV dysfunction

Gram - positive and gram - negative subcellular localization using rotation forest and physicochemical-based features

The functioning of a protein relies on its location in the cell. Therefore, predicting protein subcellular localization is an important step towards protein function prediction. Recent studies have shown that relying on Gene Ontology (GO) for feature extraction can improve the prediction performance. However, for newly sequenced proteins, the GO is not available. Therefore, for these cases, the prediction performance of GO based methods degrade significantly. Results: In this study, we develop a method to effectively employ physicochemical and evolutionary-based information in the protein sequence. To do this, we propose segmentation based feature extraction method to explore potential discriminatory information based on physicochemical properties of the amino acids to tackle Gram-positive and Gram-negative subcellular localization. We explore our proposed feature extraction techniques using 10 attributes that have been experimentally selected among a wide range of physicochemical attributes. Finally by applying the Rotation Forest classification technique to our extracted features, we enhance Gram-positive and Gram-negative subcellular localization accuracies up to 3.4% better than previous studies which used GO for feature extraction. Conclusion: By proposing segmentation based feature extraction method to explore potential discriminatory information based on physicochemical properties of the amino acids as well as using Rotation Forest classification technique, we are able to enhance the Gram-positive and Gram-negative subcellular localization prediction accuracies, significantly