Essentials Clinical benefit of hospitalization vs. outpatient treatment in pulmonary embolism (PE) is unknown. We performed a propensity matched cohort study of hemodynamically stable PE patients. ...Regardless of the risk assessment, hospitalized patients had the highest rate of adverse event. If confirmed, ambulatory care of normotensive PE patients may be preferred whenever possible.
Background The decision to hospitalize or not patients with acute pulmonary embolism (PE) is controversial. Despite the advantages of close monitoring, hospitalization by itself may lead to in-hospital complications and potentially worsen the prognosis of PE patients. Objectives To determine the net clinical benefit of hospitalization vs. outpatient management of normotensive patients with acute pulmonary embolism (PE). Methods Retrospective cohort propensity score analysis (radius marching with replacement). Hemodynamically stable PE patients treated as outpatients or inpatients were matched to balance out differences for 28 patient characteristics and known risk factors for adverse events. The primary outcome was the rate of adverse events at 14 days, including recurrent venous thromboembolism, major bleeding or death. Results Among 1127 eligible patients, 1081 were included in the matched cohort, 576 treated as inpatients and 505 as outpatients. The 14-day rate of adverse events was 13.0% for inpatients and 3.3% for outpatients (adjusted OR, 5.07; 95% CI, 1.68-15.28). The 3-month rate was 21.7% for inpatients and 6.9% for outpatients (OR, 4.90; 95% CI, 2.62-9.17). In the high-risk subgroup (Pulmonary Embolism Severity Index class III-V; n = 597), the 14-day rate of adverse events was 16.5% for hospitalized patients vs. 4.5% for outpatients (OR, 4.16; 95% CI, 1.2-14.35). Conclusion Outpatient treatment of hemodynamically stable PE patients seems to be associated with a lower rate of adverse events than hospitalization and, if confirmed, may be considered as first-line management in patients not requiring specific in-hospital care, regardless of their initial risk stratification, if proper outpatient care can be provided.
Cancer is one of the most dreaded diseases of the 20th century and spreading further with continuance and increasing incidence in the 21st century. The situation is so alarming that every fourth ...person is having a lifetime risk of cancer. India registers more than 11 lakh new cases of cancer every year, whereas, this figure is above 14 million worldwide. Is cancer curable? The short answer to this question is "Yes." In fact, all cancers are curable if they are caught early enough. Cancer cells continue to grow unless one of four things occur: (1) The cancerous mass is removed surgically; (2) using chemotherapy or another type of cancer-specific medication, such as hormonal therapy; (3) using radiation therapy; or (4) the cancer cells shrink and disappear on their own.
This article presents an application of an efficient and reliable heuristic technique inspired by swarm behaviours in nature namely, gravitational search algorithm (GSA) for solution of ...multi-objective optimal power flow (OPF) problems. GSA is based on the Newton's law of gravity and mass interactions. In the proposed algorithm, the searcher agents are a collection of masses that interact with each other using laws of gravity and motion of Newton. In order to investigate the performance of the proposed scheme, multi-objective OPF problems are solved. A standard 26-bus and IEEE 118-bus systems with three different individual objectives, namely fuel cost minimisation, active power loss minimisation and voltage deviation minimisation, are considered. In multi-objective problem formulation fuel cost and loss; fuel cost and voltage deviation; fuel cost, loss and voltage deviation are minimised simultaneously. Results obtained by GSA are compared with mixed integer particle swarm optimisation, evolutionary programming, genetic algorithm and biogeography-based optimisation. The results show that the new GSA algorithm outperforms the other techniques in terms of convergence speed and global search ability.
Two weeks after the world health organization described the novel coronavirus (SARS-CoV-2) outbreak as pandemic, the Indian government implemented lockdown of industrial activities and traffic flows ...across the entire nation between March 24 and May 31, 2020. In this paper, we estimated the improvements achieved in air quality during the lockdown period (March 24, 2020 and April 20, 2020) compared to the pre-lockdown (January 1, 2020 and March 23, 2020) by analyzing PM2.5, PM10, SO2, CO, NO2 and O3 data from nine different air quality monitoring stations distributed across four different zones of the industrialized Gujarat state of western Indian. The Central Pollution Control Board (CPCB)-Air Quality Index (AQI) illustrated better air qualities during the lockdown with higher improvements in the zones 2 (Ahmedabad and Gandhinagar) and 3 (Jamnagar and Rajkot), and moderate improvements in the zones 1 (Surat, Ankleshwar and Vadodra) and 4 (Bhuj and Palanpur). The concentrations of PM2.5, PM10, and NO2 were reduced by 38–78%, 32–80% and 30–84%, respectively. Functioning of the power plants possibly led to less reduction in CO (3–55%) and the declined emission of NO helped to improve O3 (16–48%) contents. We observed an overall improvement of 58% in AQI for the first four months of 2020 compared to the same interval of previous year. This positive outcome resulted from the lockdown restrictions might help to modify the existing environmental policies of the region.
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•Reduction of 30–84% in NO2 during COVID-19 lockdown in western India.•Increasing O3 (16–58%) was mainly due to less NO emission.•Overall improvement of Air Quality Index (AQI) by 58% compared to 2019.•Populated cities with more industrial activities showed higher improvement in air quality (AQI: +60–75%).
This paper presents an analysis of regenerative Organic Rankine Cycle (ORC), based on parametric optimization using R-123 and R-134a during superheating at a constant pressure of 2.50 MPa under ...realistic conditions. The aim was to select a better working fluid on the basis of obtained system efficiency, turbine work output, irreversibility rate and second law efficiency under applied fixed and variable heat source temperature conditions. R-123 has been found a better working fluid than R-134 for converting low grade heat to power. A computer program has been developed to parametrically optimize and compare the system and second law efficiency, turbine work output, system mass flow rate, irreversibility rate and irreversibility ratio with increases in turbine inlet temperature (TIT) under different heat source temperature conditions to obtain the optimum operating conditions while using R-123 as the working fluid during superheating at various turbine inlet pressures for the utilization of the waste heat sources of temperatures above 150 °C. The calculated results reveal that an inlet pressure of 2.70 MPa gives the maximum system efficiency, turbine work output and second law efficiency with minimum irreversibility rate, irreversibility ratio and system mass flow rate up to a TIT in the range of 165 °C–250 °C.
► Analysis of regenerative ORC using R-123 during superheating at various TIP. ► Compared efficiencies, irreversibility ratio, work output etc. with increase in TIT under different heat source temperature. ► For variable heat source, the temperature of heat source is kept 15 °C above TIT. ► Obtained the optimum operating conditions for the utilization of waste heat sources above 150 °C. ► A TIP of 2.70 MPa at TIT in the range of 165 °C–250 °C is optimum for converting low grade waste heat to power.
High-intensity aerobic exercise might attenuate the symptoms of Parkinson's disease, but high-quality evidence is scarce. Moreover, long-term adherence remains challenging. We aimed to evaluate the ...effectiveness of aerobic exercise—gamified and delivered at home, to promote adherence—on relieving motor symptoms in patients with Parkinson's disease with mild disease severity who were on common treatment regimes.
In this single-centre, double-blind, randomised controlled trial (Park-in-Shape), we recruited sedentary patients with Parkinson's disease from the outpatient clinic at Radboudumc, Nijmegen, Netherlands. Patients were made aware of the study either by their treating neurologist or via information in the waiting room. Patients could also contact the study team via social media. We included patients aged 30–75 years with a Hoehn and Yahr stage of 2 or lower, who were on stable dopaminergic medication. Patients were randomly assigned (in a 1:1 ratio) to either aerobic exercise done on a stationary home-trainer (aerobic intervention group) or stretching (active control group) by means of a web-based system with minimisation for sex and medication status (treated or untreated) and permuted blocks of varying sizes of more than two (unknown to study personnel). Patients were only aware of the content of their assigned programme. Assessors were unaware of group assignments. Both interventions were home based, requiring 30–45 min training three times per week for 6 months. Both groups received a motivational app and remote supervision. Home trainers were enhanced with virtual reality software and real-life videos providing a so-called exergaming experience (ie, exercise enhanced by gamified elements). The primary outcome was the between-group difference in the Movement Disorders Society—Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor section at 6 months, tested during the off state (≥12 h after last dopaminergic medication). The analysis was done on an intention-to-treat basis in patients who completed the follow-up assessment, regardless of whether they completed the assigned intervention. Patients reported adverse events directly to their coach and also after the 6-month visit retrospectively. A between-group difference of 3·5 points or more was deemed a-priori clinically relevant. The study is concluded and registered with the Dutch Trial Registry, NTR4743.
Between Feb 2, 2015, and Oct 27, 2017, 139 patients were assessed for eligibility in person, of whom 130 were randomly assigned to either the aerobic intervention group (n=65) or the active control group (n=65). Data from 125 (96%) patients were available for the primary analysis; five patients were lost to follow-up (four in the intervention group; one in the control group). 20 patients (ten in each group) did not complete their assigned programme. The off-state MDS-UPDRS motor score revealed a between-group difference of 4·2 points (95% CI 1·6–6·9, p=0·0020) in favour of aerobic exercise (mean 1·3 points SE 1·8 in the intervention group and 5·6 points SE 1·9 for the control group). 11 patients had potentially related adverse events (seven 11% in the intervention group, four 6% in the control group) and seven had unrelated serious adverse events (three in the intervention group vestibilar disorder, vasovagal collapse, knee injury during gardening that required surgery; 6%, four in the control group supraventricular tachycardia, hip fracture, fall related injury, severe dyskinesias after suprathreshold dose levodopa in a patient with deep brain stimulation; 7%).
Aerobic exercise can be done at home by patients with Parkinson's disease with mild disease severity and it attenuates off-state motor signs. Future studies should establish long-term effectiveness and possible disease-modifying effects.
Netherlands Organization for Health Research and Development.
Abstract Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, ...some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n = 3036) or discharged early (n = 535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i.e. risk of death) as the Pulmonary Embolism Severity Criteria (PESI) or simplified PESI. In all these studies, a specific follow-up was performed for patients managed at home involving a dedicated team. The overall early (i.e. between 1 to 3 months) complication rate was low, < 2% for thromboembolic recurrences or major bleedings and < 3% for deaths with no evidence in favour of one selection strategy or another. Outpatient management appears to be feasible and safe for many patients with PE. In the coming years, outpatient treatment may be considered as the first line management for hemodynamically stable PE patients, subject to the respect of simple eligibility criteria and on the condition that a specific procedure for outpatient care is developed in advance.
During a post-encoding delay period, the ongoing consolidation of recently acquired memories can suffer interference if the delay period involves encoding of new memories, or sensory stimulation ...tasks. Interestingly, two recent independent studies suggest that (i) autobiographical thinking also interferes markedly with ongoing consolidation of recently learned wordlist material, while (ii) a 2-Back task might not interfere with ongoing consolidation, possibly due to the suppression of autobiographical thinking. In this study, we directly compare these conditions against a quiet wakeful rest baseline to test whether the promotion (via familiar sound-cues) or suppression (via a 2-Back task) of autobiographical thinking during the post-encoding delay period can affect consolidation of studied wordlists in a negative or a positive way, respectively. Our results successfully replicate previous studies and show a significant interference effect (as compared to the rest condition) when learning is followed by familiar sound-cues that promote autobiographical thinking, whereas no interference effect is observed when learning is followed by the 2-Back task. Results from a post-experimental experience-sampling questionnaire further show significant differences in the degree of autobiographical thinking reported during the three post-encoding periods: highest in the presence of sound-cues and lowest during the 2-Back task. In conclusion, our results suggest that varying levels of autobiographical thought during the post-encoding period may modulate episodic memory consolidation.
In order for textures in intrinsic antiferromagnets to be applied in proposed spintronics devices, localized and controllable writing is required. Here, the feasibility of a simple scheme for ...spin-Hall torque driven localized writing of chiral antiferromagnetic (AFM) domain wall (DW) pairs at a chosen location in AFM nano stripes is investigated. Short voltage pulses causing in-plane current-injection across transverse contacts in the heavy metal trigger a localized horizontal boundary-nucleated reverse AFM domain that propagates throughout the width to the opposite boundary, defining a locally written DW pair without affecting information in other parts of the device. The nucleation mechanism is examined, indicating exchange torque governing. A diagram of the number of DW-pairs written as a function of applied writing pulse amplitude and pulse duration is shown for a generic antiferromagnet, illustrating the degree of control required of the excitation protocol. Simulations of write and drive pulses are also presented, showing that the slight current bending around the writing contacts does not impose any significant pinning nor nucleation of unwanted textures for a typical driving amplitude. The advantages of this simple scheme are that it does not require any component for vertical spin-polarized current injection nor lasers for writing as in previous proposals.
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