Mitigation of Blood Load Impact in Patients with Subarachnoid Hemorrhage by Cisternal Lavage

<b><i>Object:</i></b> The initial amount of subarachnoid and ventricular blood is an important prognostic factor for outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). In this comparative study of an unselected aSAH-population, we assess the modifiability of these factors by implementation of blood clearance by cisternal lavage. <b><i>Methods:</i></b> All patients with aSAH treated in our department between October 2011 and October 2019 (8 years, <i>n</i> = 458) were included in our study. In the first 4-year period (BEFORE, <i>n</i> = 237), patients were treated according to international guidelines. In the second 4-year period (AFTER, <i>n</i> = 221), cisternal lavage methods were available and applied in 72 high-risk patients (32.5%). The cisternal and ventricular blood load was recorded by the Hijdra score. Multivariable regression models were used to assess the prognostic significance of risk factors, including blood load, in relation to common aSAH characteristics in both study groups. <b><i>Results:</i></b> Worse neurological outcomes (mRS &#x3e; 3) occurred in the BEFORE population with 41.45% versus 30.77% in the AFTER cohort, 6 months after aSAH (HR: 1.59, 95% CI 1.08–2.34, <i>p</i> = 0.01). Admission WFNS grade, comorbidities (Charlson Comorbidity Index), herniation signs, concomitant intracerebral hemorrhage, and the development of delayed cerebral infarction were strongly associated with poor outcome in both study groups. Intraventricular and cisternal blood load and, particularly, a cast fourth ventricle (Cast 4) represented strong prognosticators of poor neurological outcome in the BEFORE cohort. This effect was lost after implementation of cisternal lavage (AFTER cohort). <b><i>Conclusion:</i></b> Cisternal and ventricular blood load – in particular: a Cast 4 – represent important prognosticators in patients with aSAH. They are, however, amenable to modification by blood clearing therapies.

Performance of 15 Years of Hydraulic Fracturing of Oil Wells in South of Oman

The first application of Hydraulic Fracturing in the South Oman started in 2000 to enhance water disposal wells. In 2004 the first oil wells were frac'ed. Although the technology was deployed many times, it never grew into a conventional practice. From 2004 to 2017 on average 5 Oil Wells were hydraulically fractured on yearly basis. In November 2017, a Hydraulic Fracturing Maturation & Expansion Workshop was conducted with the vision of growing the application by applying new frac concepts. A focused effort was initiated to drastically reduce cost, and simultaneously increase the scope by executing larger frac campaigns. The first hydraulic fracturing campaign introducing the frac new concepts, started end 2018 and a rapid growth from 5 wells per year to 45 wells per year was anticipated in the next three years. This large growth of scope relied on a steady supply of frac candidates and needed to be supported by screening and selecting processes that are fit for purpose in finding candidates. Although more than a hundred wells had already been frac'ed wells, selection of the most appropriate wells for stimulation was and remains one of the greatest challenges. A frac performance database was created for over 100 wells that had been hydraulically fracture stimulated to date. Recognizing that the frac performance depends on many variables ranging from subsurface properties to surface execution of the frac job, the size of the dataset proved to be too small to find correlations using sophisticated multivariable regression methods. Instead, the dataset was analyzed through careful investigation and evaluation of each frac job. In this paper the net oil gain will be used as the key success criteria i.e., value driver to demonstrates how effective the frac is achieving its business objective. Some 40% of the producers had been producing from the same zone before the hydraulic fracture stimulation. This provided the opportunity to understand the efficiency of the stimulation in terms of the "stimulation ratio" i.e., measuring the net oil gain. This paper will focus on investigating the suitability of frac'ing the reservoir based on the initial production variables; Gross Rate and BS&W. Also, this paper will discuss benefits and impacts of Hoist versus Coiled-Tubing clean-out on the frac delivery process and compare the frac performance. To date, the project demonstrated that hydraulic fracturing at low cost, can be applied as a viable development concept for producing oil wells, with the potential unlock additional and new reserves. Significant folds in production increase are possible from 2x to 7x.

Patient Compliance in Assessing Electronic Patient-Reported Outcome Measures after Urologic Surgery

<b><i>Introduction:</i></b> This study aimed to assess patient compliance with a newly established electronic patient-reported outcome measure (ePROM) system after urologic surgery and to identify influencing factors. <b><i>Methods:</i></b> Digital surveys were provided to patients undergoing cystectomy, radical or partial nephrectomy, or transurethral resection of bladder tumor via a newly established ePROM system. Participants received a baseline survey preoperatively and several follow-up surveys postoperatively. Multivariable regression analysis was performed to identify factors predicting compliance. <b><i>Results:</i></b> Of <i>N</i> = 435 eligible patients, <i>n</i> = 338 completed the baseline survey (78.0%). Patients who did not participate were significantly more likely male (<i>p</i> = 0.004) and older than 70 years (<i>p</i> = 0.005). Overall, 206/337 patients (61.3%) completed the survey at 1-month, 167/312 (53.5%) at 3-month, and 142/276 (51.4%) at 6-month follow-up. Lower baseline quality of life (odds ratio: 2.27; <i>p</i> = 0.004) was a significant predictor for dropout at 1-month follow-up. Low educational level was significantly associated with low compliance at 3- (OR: 1.92; <i>p</i> = 0.01) and 6-month follow-up (OR: 2.88; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Acceptable compliance rates can be achieved with ePROMs following urologic surgery. Several factors influence compliance and should be considered when setting-up ePROM surveys.

Predictors for wound healing complications and prolonged hospital stay in patients with isolated calcaneal fractures

Purpose Surgically treated calcaneal fractures have a high risk of postoperative wound healing complications and a prolonged length of hospital stay (LOS). The aim of this study was to identify predictor variables of impaired wound healing (IWH) and LOS in surgically treated patients with isolated calcaneal fractures. Methods This retrospective cohort study analyzed data on patients aged 18 years or older who were admitted to a level I trauma center with isolated calcaneal fractures between 2008 and 2018. Multivariable regression models were used to identify predictor variables. Results In total, 89 patients (age: 45.4 years; SD: 15.1) were included. In 68 of these patients, low-profile locking plate osteosynthesis was performed, and a minimally invasive approach (MIA) (percutaneous single screws/K-wire or low-profile locking plating via a sinus tarsi approach) was applied in 21 patients. Multivariable regression analysis revealed that a higher preoperative Böhler’s angle (β = − 0.16 days/degree, 95% CI [− 0.25, − 0.08], p = 0.004) and MIA (β = − 5.04 days, 95% CI [− 8.52, − 1.56], p = 0.002) reduced the LOS. A longer time-to-surgery (β = 1.04 days/days, 95% CI [0.66, 1.42] p = 0.001) and IWH increased the LOS (β = 7.80 days, 95% CI [4.48, 11.12], p = 0.008). In a subsequent multivariable regression analysis, two variables, open fractures (OR: 14.6, 95% CI [1.19, 180.2], p = 0.030) and overweight (BMI > 24) (OR: 3.65, 95% CI [1.11, 12.00], p = 0.019), increased the risk of IWH. Conclusion Advanced treatment algorithms for open fractures are needed to reduce the risk of IWH.

Individual Pharmacotherapy Management (IPM) - I: a group-matched retrospective controlled clinical study on prevention of complicating delirium in the elderly trauma patients and identification of associated factors

Background Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.

Perceived burden and family functioning among informal caregivers of individuals living with schizophrenia in Tanzania: a cross-sectional study

Background Globally, families play a critical role in providing care and support for persons living with schizophrenia. It is important to identify potentially modifiable factors that influence perceived caregiver burden in order to properly address the needs of caregivers. This is especially relevant in low-resource settings where psychiatric services are scarce and interventions could be most effective if targeted to both the individual living with schizophrenia and their caregiver. This study examines correlates of perceived burden among informal caregivers of individuals with schizophrenia in Tanzania, in particular, the association between burden and caregiver-reported family functioning. Methods This study used baseline data from an individually randomized controlled trial with 65 pairs of individuals with schizophrenia and their informal caregivers in Dar es Salaam and Mbeya, Tanzania. Caregiver burden was measured using the Burden Assessment Scale. Univariable and multivariable regression analyses were performed to determine the relationship between caregiver burden and family functioning and to explore other correlates of burden. Results Sixty-three percent of caregivers reported experiencing high burden as a result of caring for a relative with schizophrenia. Multivariable regression analyses revealed that poor family functioning and the caregiver being employed were associated with high caregiver burden, while higher levels of hopefulness in the caregiver was associated with low caregiver burden. Conclusion Caregivers who were employed, reported poor family functioning, and/or had low levels of hopefulness were more likely to perceive high caregiver burden. Future interventions aiming to reduce caregiver burden may benefit from improving family functioning and nurturing hope among caregivers of individuals living with schizophrenia. Policies and programs should be cognizant of the needs of caregivers that work in addition to providing care for a relative with schizophrenia in order to better support them.

The Functional Polymorphism of DDAH2 rs9267551 Is an Independent Determinant of Arterial Stiffness

Background: The association of circulating asymmetric dimethylarginine (ADMA) levels with cardiovascular risk and arterial stiffness has been reportedly demonstrated, although the causal involvement of ADMA in the pathogenesis of these conditions is still debated. Dimethylaminohydrolase 2 (DDAH2) is the enzyme responsible for ADMA hydrolysis in the vasculature, and carriers of the polymorphism rs9267551 C in the 5′-UTR of DDAH2 have been reported to have higher DDAH2 expression and reduced levels of serum ADMA.Approach and Results: We genotyped rs9267551 in 633 adults of European ancestry and measured their carotid–femoral pulse wave velocity (cfPWV), the gold-standard method to estimate arterial stiffness. cfPWV resulted significantly lower in rs9267551 C allele carriers (Δ = −1.12 m/s, P &lt; 0.01) after correction for age, sex and BMI, and a univariate regression showed that the presence of rs9267551 C variant was negatively associated with cfPWV (β = −0.110, P &lt; 0.01). In a multivariable regression model, subjects carrying the rs9267551 C allele manifested significantly lower cfPWV than GG carriers (β = −0.098, P = 0.01) independently from several potential confounders. We measured circulating ADMA levels in a subset of 344 subjects. A mediation analysis revealed that the effect of DDAH2 rs9267551 genotype on cfPWV was mediated by the variation in ADMA levels.Conclusions: These evidences hint that the presence of rs9267551 C allele may explain, at least in part, a reduction in vessel rigidity as measured by cfPWV, and support the attribution of a causative role to ADMA in the pathogenesis of arterial stiffness.

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.

Prosocial Behaviors Among the Vietnamese Population During the COVID-19 Pandemic: Implications for Social Education Programs

Objective: The objectives of this study were to estimate the prevalence of prosocial behaviors and to examine associated factors among the Vietnamese people during the COVID-19 pandemic. Methods: Two hundred and ninety-two Vietnamese people participated in the study through web-based respondent network sampling. Result: Findings showed that the prevalence of high prosocial behaviors was 75.3%. Conclusion: In the multivariable regression models, significant factors for prosocial behaviors were institutional trust and age. Implications for social education programs were also discussed in this study.

THEORETICAL CONSIDERATIONS ON THE OPTIMIZATION OF THE WORKING PROCESS OF VARIABLE WIDTH PLOUGHS

The paper presents theoretical research conducted for the optimization of the working process of variable width ploughs. Thus, were determined multivariable regression functions for the traction force of the plough with variable working function of the control parameters: working depth, working width and working speed. The use of these theoretical considerations of the optimal points sought lead to the opportunity of making assessments on the possibilities to conduct their experimental validation. Conditions for an experimental plan were formulated to highlight such optimal points and the theoretical results were validated through experiments.