Comparison of V̇O2-Kinetic Parameters for the Management of Heart Failure

Objective: The aim of this study was to analyze whether V̇O2-kinetics during cardiopulmonary exercise testing (CPET) is a useful marker for the diagnosis of heart failure (HF) and to determine which V̇O2-kinetic parameter distinguishes healthy participants and patients with HF.Methods: A total of 526 healthy participants and 79 patients with HF between 20 and 90 years of age performed a CPET. The CPET was preceded by a 3-min low-intensity warm-up and followed by a 3-min recovery bout. V̇O2-kinetics was calculated from the rest to exercise transition of the warm-up bout (on-kinetics), from the exercise to recovery transition following ramp test termination (off-kinetics) and from the initial delay of V̇O2 during the warm-up to ramp test transition (ramp-kinetics).Results: V̇O2 off-kinetics showed the highest z-score differences between healthy participants and patients with HF. Furthermore, off-kinetics was strongly associated with V̇O2peak. In contrast, ramp-kinetics and on-kinetics showed only minimal z-score differences between healthy participants and patients with HF. The best on- and off-kinetic parameters significantly improved a model to predict the disease severity. However, there was no relevant additional value of V̇O2-kinetics when V̇O2peak was part of the model.Conclusion: V̇O2 off-kinetics appears to be superior for distinguishing patients with HF and healthy participants compared with V̇O2 on-kinetics and ramp-kinetics. If V̇O2peak cannot be determined, V̇O2 off-kinetics provides an acceptable substitute. However, the additional value beyond that of V̇O2peak cannot be provided by V̇O2-kinetics.

Appraisal of China's Response to the Outbreak of COVID-19 in Comparison With SARS

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019 and has since become a pandemic. The COVID-19 containment measures were comparable to those used with severe acute respiratory syndrome (SARS), although these were stricter and more organized, and were initiated earlier and on a larger scale. Based on the lessons learned from SARS, the Chinese government acted aggressively in response to COVID-19, through a unified and effective commanding system, using law-based and science-driven strategies, and coordinated deployment of medical resources. Additionally, the application of high-tech measures, traditional Chinese medicine, and hierarchical medical systems also played an important role in control measures. Despite the remarkable performance, the initial delay in response suggests that the coordination between public health and medical services, reserve and coordination of emergency materials, and capacity for disease control and prevention need to be strengthened.

Rotatory subluxation of the proximal interphalangeal joint: an easily missed diagnosis

We present a case of volar rotatory subluxation of index finger proximal interphalangeal joint (PIPJ) following a skiing accident. The injury was initially perceived to be a central slip rupture and treatment was directed as such. After the initial delay in the diagnosis, the patient underwent surgery during which his radial collateral ligament was found to be avulsed from the proximal origin, the radial lateral band palmarly subluxed and was interposed in the joint space. This structure was also adhered to the uninjured volar plate.PIPJ volar rotatory subluxation could be readily missed in the acute setting. Without surgery, the functional outcome could be mediocre and to the patient’s detriment.

Anopheles coluzzii infection by the microsporidian, Vavraia culicis: the effect of host age

Host age at infection has important implications for disease development. In mosquitoes, infections with microsporidia and later concurrent infections with malaria parasites, leads to a suppression in the development of malaria parasites. Host age at infection with microsporidia could have implications for disease outcomes when infection occurs subsequently with malaria parasites. Mosquito larvae can take between five to seven days or more depending on the temperature to reach the adult stage, giving the microsporidian Vavraia culicis, a theoretical head start in establishing and developing within larvae and possibly resulting in different levels of infection in emergent adult mosquitoes. To determine the effects of early or late infection with V. culicis, equal numbers of Anopheles coluzzii larvae were infected individually with a high or low dose of V. culicis, at different ages post hatching.Significantly fewer spores were produced from mosquitoes infected later, than ones infected earlier with microsporidia and there was an initial delay in the production of spores from later infected mosquitoes. In early infected larvae, there was no such initial delay and spore production took off unchecked. The infectious dose of V. culicis did not affect the total spore count per mosquito. Male mosquitoes produced fewer spores than females. Daily mosquito longevity and pupation was not affected significantly by infection, the infectious dose of V. culicis given or by the sex of the mosquito. Considering hourly deaths, early infected hosts died 17 to 18 hours earlier than later infected larvae. The number of V. culicis spores rose with increasing duration of infection. When equal duration of infection was considered, the findings remained the same. Host age at infection influences disease outcomes and virulence.

Output Feedback of Uncertain Multi-Input Systems

This chapter evaluates output feedback of uncertain multi-input systems. Similar to the case of single-input delay, the result of multi-input delays obtained in the chapter is not global, as it does not believe the problem where the actuator state is not measurable and the delay value is unknown at the same time is solvable globally, since the problem is not linearly parameterized. In a practical sense, the stability result proven in the chapter is not a highly satisfactory result since it is local both in the initial state and in the initial parameter error. This means that the initial delay estimate needs to be sufficiently close to the true delay. Under such an assumption, one might as well use a linear controller and rely on robustness of the feedback law to small errors in the assumed delay value. Nevertheless, the chapter presents the local result here as it highlights quite clearly why a global result is not obtainable when both the delay value and the delay state are unavailable.

Strengthened Formulations and Valid Inequalities for Single Delay Management in Public Transportation

The delay management problem arises in public transportation networks, often characterized by the necessity of connections between different vehicles. The attractiveness of public transportation networks is strongly related to the reliability of connections, which can be missed when delays or other unpredictable events occur. Given a single initial delay at one node of the network, the delay management problem is to determine which vehicles have to wait for the delayed ones, with the aim of minimizing the dissatisfaction of the passengers. In this paper, we present strengthened mixed integer linear programming formulations and new families of valid inequalities. The implementation of branch-and-cut methods and tests on a benchmark of instances taken from real networks show the potential of the proposed formulations and cuts.