Identification Of Failure Research Articles

Association of Serum Creatinine and Electrolyte Abnormalities in Preterm Low Birth Weight Neonates

Introduction: Being born prematurely is a threat to survival and the subsequent quality of life ICDDR,B Health and Science Bulletin published in March 2006 reported that prematurity and low birth weight contributes to 27.8% of neonatal deaths in rural areas of Bangladesh Premature infant are at increased risk of developing dehydration or over hydration. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. The investigation of renal function in pretenn neonate is complicated because of continuing renal development, rise in creatinine is transient and may not be clinically significcmt. Serum creatinine is most widely used marker of renal function in adults and children but its validity as a marker of GFR/ renal function is doubtful a few studies have been conducted on assessment of renal function and electrolytes in the context of prematurity in Bangladesh. But it seems to be essential for immediate management for planning appropriate fluid and electrolyte therapy and thereby for improved outcome. Information was collected who gave consent and participated in the study willingly. The sample size was 50. Duration of data collection was approximately 6 (Six) months.Patients admitted to the Holy Family Red Crescent Medical College and hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the sample patients. Total 50 pretenn LBW neonates fulfilling the inclusion criteria were studied during this study period. Mean creatinine level was .82 mmoKrange was 0.40-1.90 mg/d1. Abnormal electrolytes were documented in 20(40%) pretenn LBW neonates of which hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7 (14.0%), hypokalemia in 3 (6.0%) and hypernatremia 2 (4.0%). In the present study 20 of preterm LBW babies have electrolyte abnormalities. Hyperkalemia was found in 8(16.0%) babies in this study from above findings it is evident that prematurity causes transient renal impairment, in preterm neonates which is inversely related to gestational age. Renal impairment should be suspected if the serum creatinine rises or fails to show normal post-natal fall. It was observed that electrolyte abnormalities are common in preterm LBW neonates and transient renal failure also occurs in a large number of preterm LBW babies. So, identification of renal failure and associated electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients. Objective: The aim at this study was to assess the prevalence of HIV/AIDS treatment failure and its determinants factors of patients on first line HAART at Felegehiwot Referral Hospital. Methods: Cross sectional study was conducted on 421 participants who had started first line HAART during August 2016 to September 2016. Data were collected from patients’ chart starting from ART commencement and face to face interview using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were enter in to EPI info version 3.5.1 and transfer to and analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, positive and negative predictive values, life table, receiver operating characteristics curves, bi-variate and multiple logistic regression were used to analysis. Independent associations were considered with p<0.05. Result: Among the 421 participants enrolled, 292 (69.4%) were adult and 129 (30.6%) were children. More than half 243 (57.7%) of the participants were females. The adult median age at ART initiation was 38.0 years with inter quartile rage (IQR) 10 and for children 9.8 years with IQR 4.The median duration of treatment failure from initiation of treatment was 87 months (IQR 110-65 months). A total of 45 (10.7%) participants were found to have treatment failure. The median CD4 T-cells at initiation of Anti retroviral therapy were 147 cells/μl (IQR 226-84.5). The median time to detect virological failure was 47 months. Sensitivity of immunologic failure of predicting virological failure was 62.2%. Clinical stage II 374 (88.8%) was the predominant clinical stage. Conclusion: The prevalence of treatment failure in this study was 10.7%. Long duration on treatment, conducting faith healing, immunologic failure, high medication dosage, and ambulatory functional status at baseline and not feeling privacy during consultation and counseling were found to be significant predictors of treatment failure.Therefore early identification of associated factors and monitoring treatment failure has to be strengthened to benefit patients from prevent further complication.

Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care

ABSTRACT Background: Early identification of virological failure (VF) limits occurrence and spread of drug-resistant viruses in patients receiving antiretroviral treatment (ART). Viral load (VL) monitoring is therefore recommended, but capacities to comply with this are insufficient in many low-income countries. Clinical algorithms might identify persons at higher likelihood of VF to allocate VL resources. Objectives: We aimed to construct a VF algorithm (the Viral Load Testing Criteria; VLTC) and compare its performance to the 2013 WHO treatment failure criteria. Methods: Subjects with VL results available 1 year after ART start (n = 494) were identified from a cohort of ART-naïve adults (n = 812), prospectively recruited and followed 2011–2015 at Ethiopian health centres. VF was defined as VL≥1000 copies/mL. Variables recorded at the time of sampling, with potential association with VF, were used to construct the algorithm based on multivariate logistic regression. Results: Fifty-seven individuals (12%) had VF, which was independently associated with CD4 count <350 cells/mm3, previous ART interruption, and short mid-upper arm circumference (<24cm and <23cm, for men and women, respectively). These variables were included in the VLTC. In derivation, the VLTC identified 52/57 with VF; sensitivity 91%, specificity 43%, positive predictive value (PPV) 17%, negative predictive value (NPV) 97%. In comparison, the WHO criteria identified 38/57 with VF (sensitivity 67%, specificity 74%, PPV 25%, NPV 94%). Conclusions: The VLTC identified subjects at greater likelihood of VF, with higher sensitivity and NPV than the WHO criteria. If external validation confirms this performance, these criteria could be used to allocate limited VL resources. Due to its limited specificity, it cannot be used to determine treatment failure in the absence of a confirmatory viral load.

Shifting from disorientation to orientation: Reading student discourses of success

Academic success in higher education is generally evaluated by means of concrete and measurable criteria that function as an institutional discourse of success. However, a parallel discourse of success that is far less evident is the languaging and identification of success or failure that students hold and circulate. This paper investigates as success from students' perspectives using a critical lens informed by Stuart Hall's discursive analysis and James Gee's inclusive articulation of discourse. We argue that students tend to describe and evaluate their success in a consistent way, making it more than a highly individualised set of statements. Being well versed in terms of what counts for the institution, we consider what counts for the students: do they endorse, contest or negotiate as markers of success? We subsequently tease out the similarities and distinctions in these two discourses that function in parallel and read the recurring themes and nuances of (dis)orientation that come through in the interviews as markers for an alternative discourse of success or failure that stands alongside of (and occasionally in opposition to) the institutional discourse.

Short Communication: Impact of Viral Load Use on Treatment Switch in Perinatally HIV-Infected Children in Asia.

We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.

Failure analysis of bolted joint for the column of an aerial platform

This paper focuses on the identification of failure causes of a bolted joint used for the bedding of a primary column of an aerial platform. The tests conducted to determine chemical composition and mechanical properties have confirmed the 12.9 grade of the bolts. Also, mechanical properties tests and metallographic examination did not indicate any hidden defects caused by heat treatment (e.g. decarburisation etc.). On the other hand, visual and metallographic examination of cross-section as well as electron microscope scanning confirmed fatigue fracture of the bolts. Therefore, further analyses were done to check the dimensioning and the installation of the bolts. The effects on stress states in the bolts are presented from the standpoint of rated operating regimes, stiffness of joined elements, lubrication conditions of thread surfaces and temperature incompatibility between the bolts and elements being joined. Pre-tightening torque value incompatible with lubrication conditions was found to be the main factor that led to high stress values that initiated and later intensified the fatigue process which ended in fatigue failure of the bolts.

RETRACTED ARTICLE: Application of empirical mode decomposition (EMD) for automated identification of congestive heart failure using heart rate signals

Electrocardiogram is widely used to diagnose the congestive heart failure (CHF). It is the primary noninvasive diagnostic tool that can guide in the management and follow-up of patients with CHF. Heart rate variability (HRV) signals which are nonlinear in nature possess the hidden signatures of various cardiac diseases. Therefore, this paper proposes a nonlinear methodology, empirical mode decomposition (EMD), for an automated identification and classification of normal and CHF using HRV signals. In this work, HRV signals are subjected to EMD to obtain intrinsic mode functions (IMFs). From these IMFs, thirteen nonlinear features such as approximate entropy $$ (E_{\text{ap}}^{x} ) $$(Eapx), sample entropy $$ (E_{\text{s}}^{x} ) $$(Esx), Tsallis entropy $$ (E_{\text{ts}}^{x} ) $$(Etsx), fuzzy entropy $$ (E_{\text{f}}^{x} ) $$(Efx), Kolmogorov Sinai entropy $$ (E_{\text{ks}}^{x} ) $$(Eksx), modified multiscale entropy $$ (E_{{{\text{mms}}_{y} }}^{x} ) $$(Emmsyx), permutation entropy $$ (E_{\text{p}}^{x} ) $$(Epx), Renyi entropy $$ (E_{\text{r}}^{x} ) $$(Erx), Shannon entropy $$ (E_{\text{sh}}^{x} ) $$(Eshx), wavelet entropy $$ (E_{\text{w}}^{x} ) $$(Ewx), signal activity $$ (S_{\text{a}}^{x} ) $$(Sax), Hjorth mobility $$ (H_{\text{m}}^{x} ) $$(Hmx), and Hjorth complexity $$ (H_{\text{c}}^{x} ) $$(Hcx) are extracted. Then, different ranking methods are used to rank these extracted features, and later, probabilistic neural network and support vector machine are used for differentiating the highly ranked nonlinear features into normal and CHF classes. We have obtained an accuracy, sensitivity, and specificity of 97.64, 97.01, and 98.24 %, respectively, in identifying the CHF. The proposed automated technique is able to identify the person having CHF alarming (alerting) the clinicians to respond quickly with proper treatment action. Thus, this method may act as a valuable tool for increasing the survival rate of many cardiac patients.

Validation of the Intensive Care Unit Early Warning Dashboard: Quality Improvement Utilizing a Retrospective Case-Control Evaluation.

Risk stratification with the Modified Early Warning System (MEWS) or electronic cardiac arrest trigger (eCART) has been utilized with ward patients to preemptively identify high-risk patients who might benefit from enhanced monitoring, including early intensive care unit (ICU) transfer. In-hospital mortality from cardiac arrest is ∼80%, making preventative interventions an important focus area. ICUs have lower patient to nurse ratios than wards, resulting in less emphasis on the development of ICU early warning systems. Our institution developed an early warning dashboard (EWD) identifying patients who may benefit from earlier interventions. Using the adverse outcomes of cardiac arrest, ICU mortality, and ICU readmissions, a retrospective case-control study was performed using three demographic items (age, diabetes, and morbid obesity) and 24 EWD measured items, including vital signs, laboratory values, ventilator information, and other clinical information, to validate the EWD. Ten statistically significant areas were identified for cardiac arrest and 13 for ICU death. Identified items included heart rate, dialysis, leukocytosis, and lactate. The ICU readmission outcome was compared to controls from both ICU patients and ward patients, and statistical significance was identified for respiratory rate >30. With several statistically significant data elements, the EWD parameters have been incorporated into advanced clinical decision algorithms to identify at-risk ICU patients. Earlier identification and treatment of organ failure in the ICU improve outcomes and the EWD can serve as a safety measure for both at-risk in-house patients and also extend critical care expertise through telemedicine to smaller hospitals.

Usefulness of oblique coronal magnetic resonance images of the knee after posterior cruciate ligament reconstruction.

To know the usefulness of the oblique coronal view of the posterior cruciate ligament (PCL) in the evaluation of the graft normal anatomy and the diagnostic accuracy of combining the PCL view with orthogonal views for the evaluation of PCL graft failure or impingement after reconstruction procedures. This retrospective study included 54 patients who underwent PCL-view MRI after PCL reconstruction surgery. Anatomic identification of graft failure and impingement was scored by two radiologists. The ability to diagnose PCL graft failure with the PCL view, orthogonal view or combined PCL/orthogonal views was evaluated by calculating the sensitivity, specificity and accuracy. The entire width discrimination scores and margin sharpness scores for the PCL view were significantly higher than those for the orthogonal view for both readers. The specificities and accuracies for the PCL view and the combined PCL/orthogonal views were higher than those for the orthogonal view alone, but these differences were not statistically significant. The PCL view provided a better anatomic evaluation than the orthogonal view with regard to the entire width evaluation and margin sharpness evaluation of the PCL graft. The combined view of orthogonal and PCL views was slightly more sensitive and accurate, but not significantly so, in the diagnoses of graft failure and impingement. The PCL view provided a better anatomic evaluation than the orthogonal view with regard to the entire width evaluation and margin sharpness evaluation of the PCL graft. The PCL view was slightly more sensitive and accurate, but not significantly so, in the diagnoses of graft failure and impingement.

Whole genome sequencing as a tool for phylogenetic analysis of clinical strains of Mitis group streptococci.

Identification of Mitis group streptococci (MGS) to the species level is challenging for routine microbiology laboratories. Correct identification is crucial for the diagnosis of infective endocarditis, identification of treatment failure, and/or infection relapse. Eighty MGS from Danish patients with infective endocarditis were whole genome sequenced. We compared the phylogenetic analyses based on single genes (recA, sodA, gdh), multigene (MLSA), SNPs, and core-genome sequences. The six phylogenetic analyses generally showed a similar pattern of six monophyletic clusters, though a few differences were observed in single gene analyses. Species identification based on single gene analysis showed their limitations when more strains were included. In contrast, analyses incorporating more sequence data, like MLSA, SNPs and core-genome analyses, provided more distinct clustering. The core-genome tree showed the most distinct clustering.

Identifying fatigue failure in asphalt binder time sweep tests

Identification of fatigue failure of asphalt binder in time sweep test results remains a question crucial to asphalt binder fatigue performance evaluation and prediction. This paper presents a comparison of different analysis approaches for defining the occurrence of fatigue failure during time sweep fatigue tests conducted in both control-displacement and control-stress loading modes. The candidate failure definitions evaluated include the traditional 50% reduction in stiffness parameter (S0.5), dissipated energy indicators including the dissipated energy ratio (DER) and the ratio of dissipated energy change (RDEC), as well as two phenomenological parameters corresponding to the peak in S×N and peak in phase angle. Both phenomenological parameters and dissipated energy based indicators were found to be effective in defining fatigue failure. Statistical analysis results further indicate that maximum S×N, maximum phase angle and RDEC approach provide equivalent fatigue life results, however, peak in S×N is strongly recommended for detecting fatigue failure of asphalt binder in time sweep tests because it is easy to calculate and well defined.

Identification of acute brain failure using electronic medical records

PurposeUp to 80% of critically ill patients have acute neurologic dysfunction syndromes. We evaluated interrater reliability between the examination by the investigator and the charted assessment by the nurse because the accuracy and reliability of detailed data sets extracted from the electronic medical records represents a keystone for creating EMR-based definitions. Materials and methodsWe conducted a prospective observational study of intensive care unit (ICU) patients to assess the reliability of charted Confusion Assessment Method for the ICU, Glasgow Coma Scale (GSC), Full Outline of Unresponsiveness, and Richmond Agitation Sedation Scale (RASS) scores, and a composite measure of ABF defined as new-onset coma or delirium. Trained investigator blinded to nursing assessments performed the neurologic evaluations that were compared with nursing documentation. ResultsA total of 202 observations were performed in 55 ICU patients. Excellent correlation was noted for GCS and Full Outline of Unresponsiveness scores on Bland-Altman plots (Pearson correlation 0.87 and 0.92, respectively). Correlation for Confusion Assessment Method for the ICU was also high (κ= 0.86; 95% confidence interval [CI], 0.70-1.01). Richmond Agitation Sedation Scale had good agreement when scores were dichotomized as oversedated (less than −2) vs not oversedated, with κ= 0.76 (95% CI, 0.54-0.98). Investigator assessment and nurse charting were highly concordant (κ= 0.84; 95% CI, 0.71-0.99). ConclusionNeurologic assessments documented on the EMR are reliable.

Exhaled Breath Analysis for Monitoring Response to Treatment in Advanced Lung Cancer

IntroductionThe Response Evaluation Criteria in Solid Tumors (RECIST) serve as the accepted standard to monitor treatment efficacy in lung cancer. However, the time intervals between consecutive computerized tomography scans might be too long to allow early identification of treatment failure. This study examines the use of breath sampling to monitor responses to anticancer treatments in patients with advanced lung cancer. MethodsA total of 143 breath samples were collected from 39 patients with advanced lung cancer. The exhaled breath signature, determined by gas chromatography/mass spectrometry and a nanomaterial-based array of sensors, was correlated with the response to therapy assessed by RECIST: complete response, partial response, stable disease, or progressive disease. ResultsGas chromatography/mass spectrometry analysis identified three volatile organic compounds as significantly indicating disease control (PR/stable disease), with one of them also significantly discriminating PR/stable disease from progressive disease. The nanoarray had the ability to monitor changes in tumor response across therapy, also indicating any lack of further response to therapy. When one-sensor analysis was used, 59% of the follow-up samples were identified correctly. There was 85% success in monitoring disease control (stable disease/partial response). ConclusionBreath analysis, using mainly the nanoarray, may serve as a surrogate marker for the response to systemic therapy in lung cancer. As a monitoring tool, it can provide the oncologist with a quick bedside method of identifying a lack of response to an anticancer treatment. This may allow quicker recognition than does the current RECIST analysis. Early recognition of treatment failure could improve patient care.

The Pitfalls of Companion Diagnostics: Evaluation of Discordant EGFR Mutation Results from a Clinical Laboratory and a Central Laboratory

Accurate identification of somatic mutations in formalin-fixed, paraffin-embedded tumor tissue is required for enrollment into clinical trials for many novel targeted therapeutics, including trials requiring EGFR mutation status in non-small-cell lung carcinomas. Central clinical trial laboratories contracted to perform this analysis typically rely on US Food and Drug Administration-approved targeted assays to identify these mutations. We present two cases in which central laboratories inaccurately reported EGFR mutation status because of improper identification and isolation of tumor material and failure to accurately report assay limitations, resulting in enrollment denial. Such cases highlight the need for increased awareness by clinical trials of the limitation of these US Food and Drug Administration-approved assays and the necessity for a mechanism to reevaluate discordant results by alternative laboratory-developed procedures, including clinical next-generation sequencing.

Post-prostatectomy salvage radiation therapy in prostate cancer upon identification of biochemical failure.

127 Background: Prostate Specific Antigen (PSA) values post-prostatectomy are used as an indication for salvage radiation therapy. It has been suggested that initiation of therapy at lower PSA values lead to better outcomes. This study investigates outcomes of salvage radiation therapy at specific PSA thresholds. Methods: One hundred two prostate cancer patients were treated with salvage radiotherapy at our institution with curative intent, 19 of whom had Gleason score ≤6, 52 of whom had Gleason 7, and 31 with Gleason ≥8. Median follow-up after radiotherapy was 51 months. The median PSA prior to salvage radiotherapy was 0.33 ng/mL, and the median time from prostatectomy to radiotherapy was 24.6 months. Positive margins were identified in 52 patients, and perineural invasion was positive in 83. The median dose delivered was 64.8 Gy. Results: The 5-year actuarial freedom from biochemical failure rates for NCCN low, intermediate, and high risk groups were 100%, 77%, and 62%, p=0.2449. The 5-year actuarial freedom from biochemical failure rates for Gleason score ≤6, Gleason 7, and Gleason ≥8 patients were 87%, 72%, and 49%, p=0.0187. Patients with pre-radiotherapy PSA ≤0.5 ng/mL had better 5-year biochemical control relative to patients with higher pre-radiotherapy PSA, 76% versus 51%, p=0.0211. The pathological margin status did not predict for biochemical control after salvage radiation across the different Gleason grades. Very few interval biochemical failures are observed after the 5-year point of follow-up. The 5-year overall survival for the entire cohort is 92%, with prostate cancer specific survival of 96%. Conclusions: Salvage radiotherapy demonstrated favorable efficacy with durable PSA control and few failures 5 years post radiation. Initiation of salvage radiotherapy for PSA ≤0.5 ng/mL demonstrated improved biochemical control, supporting the adoption of early referral to radiation oncology once post-prostatectomy biochemical failure is identified. [Table: see text]

Levels of N-terminal-pro Brain Natriuretic Peptide (NT-pro-BNP) and associated risk factors in systolic heart failure consequential to ischaemic heart disease

Background Early identification of heart failure as a post-myocardial infarction is very important in a clinical setting. A study was planned to determine the levels of N-terminal NT-pro- Brain Natriuretic Peptide BNP in systolic heart failure consequential to ischaemic heart disease and to find out the risk factors in those patients.Material and methods The levels of NT-pro-BNP was determined in 100 patients admitted to Basaveshwar Teaching and General Hospital Kalaburagi with a diagnosis of systolic heart failure having an ejection fractionlt40 subsequent to ischaemic heart disease.Results The levels of NT-pro-BNP ranged between 358 pgml and 3000 pgml with a mean value of 2049 pgml and a median value of 1886 pgml. Conclusions NT-pro-BNP level had a good predictive value for heart failure p-0.03nbsp

Multi Sensor Signal Processing for Catastrophic Tool Failure Detection in Turning

This paper presents a methodology aimed at the identification of a catastrophic tool failure (CTF) in turning processes based on multiple sensor monitoring. Experimental turning tests were carried out under various cutting conditions (cutting speed, feed, depth of cut) using a multi-sensor monitoring system consisting of a triaxial force sensor to acquire the three components of the cutting force and an acoustic emission sensor. Signals analysis, interpretation and processing was performed on the multi-sensor signals acquired during the turning process and relevant statistical features were extracted and used to develop a methodology for the automatic CTF detection during turning.

Bivariate dependent rate analyses for fault identification in transformer windings during impulse test

Identification of winding insulation failure during lightning impulse testing of transformer has been an important issue over a long period of time. It requires a significant human expertise and knowledge for proper judgment of transformer insulation. In this paper, the bivariate dependent rate analyses are proposed to identify the failure in transformer windings. The proposed analyses enable the calculation of winding response due to any impulse voltage excitation of full wave (FW) and chopped wave impulse (CW) for typical transformers. Initially, the line of best-fit on the scatter diagram is utilized to visualize the similarities between the measured winding responses and also to identify the type of relationship with potential outliers. Further, ellipse analysis is utilized to calculate the diversification (size, shape and orientation) between the responses. The actual interdependency between winding responses is established through nonlinear interpretation coefficients. To prove the feasibility of the analyses, 66.7 MVA, 90 MVA, 150 MVA, 250 MVA transformers, 80 MVAr reactor and 22 kV interleaved winding are used.

Optimal QT interval correction formula in sinus tachycardia for identifying cardiovascular and mortality risk: Findings from the Penn Atrial Fibrillation Free study

The QT interval measures cardiac repolarization, and prolongation is associated with adverse cardiovascular outcomes and death. The exponential Bazett correction formula overestimates the QT interval during tachycardia. We evaluated 4 formulas of QT interval correction in individuals with sinus tachycardia for the identification of coronary artery disease, heart failure, and mortality. The Penn Atrial Fibrillation Free study is a large cohort study of patients without atrial fibrillation. The present study examined 6723 Penn Atrial Fibrillation Free study patients without a history of heart failure and with baseline sinus rate ≥100 beats/min. Medical records were queried for index clinical parameters, incident cardiovascular events, and all-cause mortality. The QT interval was corrected by using Bazett (QT/RR(0.5)), Fridericia (QT/RR(0.33)), Framingham [QT + 0.154 * (1000 - RR)], and Hodges (QT + 105 * (1/RR - 1)) formulas. In 6723 patients with a median follow-up of 4.5 years (interquartile range 1.9-6.4 years), the annualized cardiovascular event rate was 2.3% and the annualized mortality rate was 2.2%. QT prolongation was diagnosed in 39% of the cohort using the Bazett formula, 6.2% using the Fridericia formula, 3.7% using the Framingham formula, and 8.7% using the Hodges formula. Only the Hodges formula was an independent risk marker for death across the range of QT values (highest tertile: hazard ratio 1.26; 95% confidence interval 1.03-1.55). Although all correction formulas demonstrated an association between QTc values and cardiovascular events, only the Hodges formula identified one-third of individuals with tachycardia that are at higher risk of all-cause mortality. Furthermore, the Bazett correction formula overestimates the number of patients with a prolonged QT interval and was not associated with mortality. Future work may validate these findings and result in changes to automated algorithms for QT interval assessment.

The Need to Uplift Quality Control and Quality Assurance for Specialized Concrete Crack Repair in the South African Construction Industry

Concrete patch repair is becoming an important facet of the civil construction industry when considering the large quantity of exposed concrete surfaces requiring maintenance and rehabilitation during its design life cycle. Patch repairs are more often than not done with a specialized polymer-modified mortar which requires adequate quality control and quality assurance during application and curing to ensure long-term success. Unfortunately, there have been many patch repair projects where there has been poor performance of the patch repairs resulting in debonding, cracking and discolouration. In this paper, poor or inadequate quality control during the patch repair process is investigated as one of the possible reasons for poor performance and premature failure . It is postulated that because of the lack of adequate knowledge and understanding of the repair material and the repair process by the various stakeholders (applicator, supplier, consultant and client), deficiencies in the quality control and quality assurance before, during and after the repair project often exists. In many patch repair projects, the responsibility for the successful completion of the patch repair work and the assessment of long term performance of patch repairs is not fully embraced by all of the parties involved.This postulation has led to the research, by using questionnaires designed specifically for the four different stakeholder categories of the concrete repair industry. The results indicate that there is very little discussion amongst the stakeholders regarding quality control and acceptance criteria when performing concrete patch repairs, neither for the identification of patch repair failure directly after the completion of the patch repair, nor for long term performance of the patch repairs.