Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement

Background There has been ongoing controversy as to whether prosthesis-patient mismatch (PPM, defined as indexed effective orifice area (EOAI) <0.85 m(2)/cm(2)) influences mortality after aortic valve replacement (AVR). In most studies, PPM is anticipated by reference tables based on mean EOAs as opposed to individual assessment. These reference values may not reflect the actual in vivo EOAI and hence, the presence or absence of PPM may be based on false assumptions. Objective To assess the impact of small prosthesis EOA on survival after aortic valve replacement AVR. Methods 645 patients had undergone an AVR between 2000 and 2007 entered the study. All patients underwent transthoracic echocardiography for determination of the actual EOAI within 6 months postoperatively. In order to predict time from surgery to death a proportional hazards model for competing risks (cardiac death vs death from other causes) was used. EOAI was entered as a continuous variable. Results PPM occurred in 40% of the patients. After a median follow-up of 2.35 years, 92.1% of the patients were alive. The final Cox regression model showed a significantly increased risk for cardiac death among patients with a smaller EOAI (HR=0.32, p=0.022). The effect of EOAI on the 2-5 year mortality risk was demonstrated by risk plots. Conclusions In contrast to previous studies these EOAI values were obtained through postoperative echocardiography, substantially improving the accuracy of measurement, and the EOAI was modelled as a continuous variable. There was a significantly improved survival for larger EOAIs following AVR. Strategies to avoid PPM should become paramount during AVR

Outdoor node localization using random neural networks for large-scale urban IoT LoRa networks

Accurate localization for wireless sensor end devices is critical, particularly for Internet of Things (IoT) location-based applications such as remote healthcare, where there is a need for quick response to emergency or maintenance services. Global Positioning Systems (GPS) are widely known for outdoor localization services; however, high-power consumption and hardware cost become a significant hindrance to dense wireless sensor networks in large-scale urban areas. Therefore, wireless technologies such as Long-Range Wide-Area Networks (LoRaWAN) are being investigated in different location-aware IoT applications due to having more advantages with low-cost, long-range, and low-power characteristics. Furthermore, various localization methods, including fingerprint localization techniques, are present in the literature but with different limitations. This study uses LoRaWAN Received Signal Strength Indicator (RSSI) values to predict the unknown X and Y position coordinates on a publicly available LoRaWAN dataset for Antwerp in Belgium using Random Neural Networks (RNN). The proposed localization system achieves an improved high-level accuracy for outdoor dense urban areas and outperforms the present conventional LoRa-based localization systems in other work, with a minimum mean localization error of 0.29 m

Hand dysfunction after transradial artery catheterization for coronary procedures

AIM To sythesize the available literature on hand dysfunction after transradial catheterization. METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized. RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction (6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included. CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel

Impact of CEOs Pay Disparity on Stability of Banks: Evidence from Pakistan

This study is carried out to investigate the nature of association between Banks’ stability and the Chief Executive Officers (CEOs) pay difference as compared to other executives for a sample of 17 Pakistani commercial banks, over the period of 9 years (2005 to 2013). The study finds that as compared to other executives, CEO pay difference has a significant but negative association with stability of banks performance, i.e., higher pay difference between CEO and other executives induced greater risk practices in banks. Hence, banks with lower stability must try to reduce the compensation gap between the CEO and his executive team, so that safe policies could be implemented

Synthesizing an Agent-Based Heterogeneous Population Model for Epidemic Surveillance

In this paper we propose a probabilistic approach to synthesize an agent-based heterogeneous population interaction model to study the spatio-temporal dynamics of an air-born epidemic, such as influenza, in a metropolitan area. The methodology is generic in nature and can generate a baseline population for cities for which detailed population summary tables are not available. The joint probabilities of population demographics are estimated using the International Public Use Microsimulation Data (IPUMS) sample data set. Agents, are assigned various activities based on several characteristics. The agent-based model for the city of Lahore, Pakistan is synthesized and a rule based disease spread model of influenza is simulated. The simulation results are visualized to analyze the spatio-temporal dynamics of the epidemic. The results show that the proposed model can be used by officials and medical experts to simulate an outbreak

An alkali catalyzed trans-esterification of rice bran, cottonseed and waste cooking oil

In this research work, biodiesel production by trans-esterification of three raw materials including virgin and used edible oil and non edible oil has been presented. A two step method following acidic and alkali catalyst was used for non edible oil due to the unsuitability of using the straight alkaline-catalyzed trans-esterification of high FFA present in rice bran oil. The acid value after processing for rice bran, cottonseed and waste cooking oil was found to be 0.95, 0.12 and 0.87 respectively. The influence of three variables on percentage yield i.e., methanol to oil molar ratio, reaction temperature and reaction time were studied at this stage. Cottonseed oil, waste cooking oil and rice bran oil showed a maximum yield of 91.7%, 84.1% and 87.1% under optimum conditions. Fuel properties of the three biodiesel satisfied standard biodiesel fuel results

Performance of a live multi-gateway LoRaWAN and interference measurement across indoor and outdoor localities

Little work has been reported on the magnitude and impact of interference with the performance of Internet of Things (IoT) applications operated by Long-Range Wide-Area Network (LoRaWAN) in the unlicensed 868 MHz Industrial, Scientific, and Medical (ISM) band. The propagation performance and signal activity measurement of such technologies can give many insights to effectively build long-range wireless communications in a Non-Line of Sight (NLOS) environment. In this paper, the performance of a live multi-gateway in indoor office site in Glasgow city was analysed in 26 days of traffic measurement. The indoor network performances were compared to similar performance measurements from outdoor LoRaWAN test traffic generated across Glasgow Central Business District (CBD) and elsewhere on the same LoRaWAN. The results revealed 99.95% packet transfer success on the first attempt in the indoor site compared to 95.7% at the external site. The analysis shows that interference is attributed to nearly 50 X greater LoRaWAN outdoor packet loss than indoor. The interference measurement results showed a 13.2&ndash;97.3% and 4.8&ndash;54% probability of interfering signals, respectively, in the mandatory Long-Range (LoRa) uplink and downlink channels, capable of limiting LoRa coverage in some areas

Can Different Salt Formulations Revert the Depressing Effect of Salinity on Maize by Modulating Plant Biochemical Attributes and Activating Stress Regulators through Improved N Supply?

Salinity is a major constraint in improving agricultural productivity due to its adverse impact on various physiological and biochemical attributes of plants, and its effect on reducing nitrogen (N) use efficiency due to ion toxicity. To understand the relationship between sodium chloride (NaCl) and increased N application rates, a pot study was performed in which the ammonical (NH4+) form of N was applied as urea to maize crops at different rates (control, 160, 186, 240, 267, 293, and 320 kg N ha−1) using two salinity levels (control and 10 dS m−1 NaCl). The results indicate that all biochemical and physiological attributes of the maize plant improved with increased concentration of N up to 293 kg ha−1, compared to those in the control treatment. Similarly, the optimal N concentration regulated the activities of antioxidant enzymes, i.e., catalase activity (CAT), peroxidase activity (POD), and superoxide dismutases (SOD), and also increased the N use efficiencies of the maize crop up to 293 kg N ha−1. Overall, our results show that the optimum level of N (293 kg ha−1) improved the salinity tolerance in the maize plant by activating stress coping physiological and biochemical mechanisms. This may have been due to the major role of N in the metabolic activity of plants and N assimilation enzymes activity such as nitrate reductase (NR) and nitrite reductase (NiR)

Effect of Gender On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmissions Database)

Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs$12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes