Outcomes In Terms Of Loss Research Articles

Assessing the discrete and systemic response of the Built Environment to an earthquake

• Discrete and Systemic Built Environment Vulnerability Index. • Systemic dependencies between the elements of Vulnerability. • Analysis at Mid-scale level of Urban area. • Identification of possible isolated street networks. • Rapid Visual Screening of Buildings. The built environment is an outcome of the land development process that expresses the community's relation to its surroundings. In the context of earthquakes, the built environment directly relates to a disaster's outcome in terms of loss of life and property. Hence it becomes imperative to assess the built environment and minimize the seismic impact comprehensively. The currently available literature focuses on the individual elements of the built environment operating as independent domains of research. However, this article emphasizes the need to understand the built environment from an ecosystem perspective where each element interacts to produce a comprehensive disaster effect. Utilizing urban planning as a seismic risk reduction tool, this paper identifies the elemental composition of the urban environment and proposes a framework to assess the Built Environment Vulnerability (BEV). The study functions at the mid-scale resolution and introduces two new concepts, Discrete and Systemic Vulnerabilities. A total of 1107 buildings and 134 kilometers of road have been surveyed, and object-oriented analysis is carried out in six neighborhoods of Siliguri Municipal Corporation, India. The results are the differential BEV pre and post-earthquake across the six neighborhoods corresponding to their different built characteristics.

RIFLE serum creatinine and urine output criteria combined is superior to RIFLE serum creatinine criterion alone in predicting Acute Kidney Injury (AKI) in critically ill patients: A prospective observational study

Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF) is largely replaced by acute kidney injury (AKI), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality.
 Objectives: We designed this study to diagnose even mild renal dysfunction earlier than usual time frame with the combined effect of both serum creatinine and urine output criteria, when compared with serum creatinine criterion alone. To establish this objective we used RIFLE serum creatinine and urine output (UO) criteria combined (Scr+UO) and compared with RIFLE serum creatinine (Scr) alone to diagnose AKI early (in days).
 Design: Prospective observational cohort study. Duration of the study was one year (01 year), from January 2014 to December 2014
 Method: All adult patients admitted into department of critical care medicine, BIRDEM General Hospital, DHAKA who received treatment for 48 hours and fulfilled the inclusion and exclusion criteria was included in the study. Representative serum creatinine value was obtained either from the day of admission in hospital, day of admission into or transfer to ICU or any document within last six months. The lesser of pre-ICU admission serum creatinine (SCr) and ICU admission SCr would serve as baseline renal function. Weight in kilogram, representative serum urea/BUN, co-morbidities and reason for ICU admission were incorporated in it. Patient’s daily data entry of renal replacement therapy, daily creatinine value, urinary output over 6 hours, 12 hours, and 24 hours, episode of anuria over 12 hours, if present were documented. Data collected on renal replacement therapy at the time of discharge, if any and outcome in terms of loss and ESRD status were collected. APACHE II data and SAPS II data were calculated and analyzed.
 Result: Total 236 adult patients were enrolled in the study to assess their renal function status using RIFLE (Risk, Injury, Failure, Loss, End Stage Renal Disease). Serum creatinine was estimated daily for seven days. Those patients who fulfilled the creatinine criteria for RIFLE were categorized into RIFLE serum creatinine (Scr) group. Those patients who met both the criteria for urine output and serum creatinine according to RIFLE was designated as RIFLE serum creatinine and urine output criteria Combined (Scr+ UO) group. In our study, mean of number of days needed for diagnosis of AKI using RIFLE creatinine (Scr) was 3.25 (±1.24) and using RIFLE combined (Scr+uo) criteria was 2.84(±1.03).
 Conclusion: The present study concludes that RIFLE serum creatinine criterion (Scr) alone delays the diagnosis of AKI in comparison to RIFLE serum creatinine and urine output criteria combined (Scr+UO). AKI should be graded using both the criteria of RIFLE serum creatinine and urine output criteria combined (Scr+UO). Urine output should not be underestimated in AKI diagnosis in ICU patients.
 Bangladesh Crit Care J March 2020; 8(1): 17-23

Potential Impact of Risk and Loss Aversion on the Process of Accepting Kidneys for Transplantation.

Behavioral economic theory suggests that people make decisions based on maximizing perceived value; however, this may be influenced more by the risk of loss rather than of potential gain. Additionally, individuals may seek certainty over uncertainty. These are termed loss aversion and risk aversion, respectively. Loss aversion is particularly sensitive to how the decision is "framed." Thus, labeling a kidney as high Kidney Donor Profile Index results in higher discard rates because this creates a nonlinearity in perceived risk. There is also evidence that the perceived loss due to regulatory sanction results in increased organ discard rates. This may be due to the overuse of terminology that stresses regulatory sanctions and thus perpetuates fear of loss through a form of nudging. Our goal is to point out how these concepts of behavioral economics may negatively influence the decision process to accept these suboptimal organs. We hope to make the community more aware of these powerful psychological influences and thus potentially increase the utilization of these suboptimal organs. Further, we would urge regulatory bodies to avoid utilizing strategies that frame outcomes in terms of loss due to flagging and build models that are less prone to uncertain expected versus observed outcomes.

Medio-lateral entry pin versus lateral entry pin for displaced pediatric supracondylar fractures: A comparative, prospective study

Background & Objectives: Supracondylar fracture is one of the commonest fractures in children. Although the technique of pinning is controversial, percutaneous medio-lateral entry pinning is theoretically considered more stable biomechanical construct. The drawback of this method is injury to ulnar nerve which is not encountered in only lateral entry pinning.Materials & Methods: This was a prospective, comparative and observational study done in 60 patients which was alternately divided into two groups. The first group (A) underwent medio-lateral entry pinning and the second group (B) underwent lateral entry pinning. They were followed for 24 weeks and the outcome was assessed using Flynn’s criteria.Results: At twenty-four weeks, the mean loss of range of motion of elbow in medio-lateral pinning group was 3.70 degrees (SD±1.93) and that in lateral pinning group was 4.23 degrees (SD ±1.38). The mean loss in carrying angle at twenty-four weeks in medio-lateral group was 2.93 degrees (SD±2.19) and that in lateral group was 4.17 (SD±2.24). There were 2 (6.67%) cases of iatrogenic ulnar nerve injury in medio-lateral pinning group. Out of thirty patients, in medio-lateral pinning group, 25 had excellent results, 5 had good results and none had fair or poor results. While out of 30 patients in lateral pinning group, 23 had excellent results, 7 had good results and none had fair or poor results.Conclusion: There is no significant difference in outcome in terms of loss of carrying angle and range of motion between the medio-lateral pinning group and the lateral pinning group at the end of 6 months.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 28-31

Management of Pediatric Displaced Distal Metaphyseal Forearm Fracture: Comparison between Cast Immobilization and Percutaneous Kirschner Wire Fixation

Background: Distal metaphyseal forearm fracture is one of the common injuries in children. Closed reduction and above elbow cast is the standard method of treatment but reported to be associated with redisplacement rate of 7-25%. Closed reduction and fixation with percutaneous Kirschner wire is an alternative treatment option to prevent redisplacement. Methods: Thirty five children (group I) of age between 6 to 13 yrs with displaced ( more than 50% of cortical diameter) or angulated (more than 20°) distal metaphyseal forearm fracture managed with closed reduction and above elbow cast were compared with 21 children (group II) managed with closed reduction and percutaneous crossed Kirschner fixation. Clinical outcomes and complications were compared in both groups after 12 weeks of follow up. Results: Preoperative variables in both the groups were comparable. Mean loss of elbow flexion and extension (12° vs. 4°, p =0.08), wrist dorsflexion and palmerflexion (27° vs. 14°, p=0.12) and forearm supination and pronation (27° vs. 15°, p= 0.143) were more in group I but were statistically not significant. Complications rate (28.4% vs. 19.04%, p= 0.04) was higher in group I (such as fracture redisplacement and swelling) than in group II (pin tract infection). Conclusions: Grossly displaced or angulated distal metaphyseal forearm both bone fracture in children treated with either closed reduction and above elbow cast or closed reduction with crossed Kirschner wire fixation have no statistically significant clinical outcomes in terms of loss of movement of elbow, wrist and forearm but complication rate is higher in cast group. Percutaneous Kirschner wire fixation prevents redisplacement. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8133 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 1-6

Sarcopenia: etiology, clinical consequences, intervention, and assessment

The aging process is associated with loss of muscle mass and strength and decline in physical functioning. The term sarcopenia is primarily defined as low level of muscle mass resulting from age-related muscle loss, but its definition is often broadened to include the underlying cellular processes involved in skeletal muscle loss as well as their clinical manifestations. The underlying cellular changes involve weakening of factors promoting muscle anabolism and increased expression of inflammatory factors and other agents which contribute to skeletal muscle catabolism. At the cellular level, these molecular processes are manifested in a loss of muscle fiber cross-sectional area, loss of innervation, and adaptive changes in the proportions of slow and fast motor units in muscle tissue. Ultimately, these alterations translate to bulk changes in muscle mass, strength, and function which lead to reduced physical performance, disability, increased risk of fall-related injury, and, often, frailty. In this review, we summarize current understanding of the mechanisms underlying sarcopenia and age-related changes in muscle tissue morphology and function. We also discuss the resulting long-term outcomes in terms of loss of function, which causes increased risk of musculoskeletal injuries and other morbidities, leading to frailty and loss of independence.

A Benefit-Risk Assessment of Sibutramine in the Management of Obesity

Obesity is a multifactorial, chronic disorder that has reached epidemic proportions in most industrialised countries and is threatening to become a global epidemic. Clinical management of obese patients is complex and serious doubts have arisen with regard to safety and efficacy of drug therapy. Following the withdrawal of fenfluramine and dexfenfluramine in 1997, interest has focused on novel anti-obesity drugs. Pharmacological approaches to the management of obesity can, in broad terms, use different distinct strategies: firstly, to reduce energy intake; secondly, to increase energy expenditure; and thirdly, to alter the partitioning of nutrients between fat and lean tissue. Sibutramine is a serotonin-noradrenaline (norepinephrine) reuptake inhibitor indicated for the management of obesity in conjunction with a reduced calorie diet. The pharmacological mechanisms by which sibutramine exerts its weight loss effect are likely due to a combination of reduced appetite, feelings of satiety and possibly the induction of thermogenesis. The efficacy of sibutramine for inducing initial weight loss and the subsequent maintenance of weight loss is well proven in short- and long-term clinical trials of up to 2 years' duration. Most individual placebo-controlled trials and pooled estimates found that the drug produced statistically significant greater weight loss than placebo at all observed endpoints (weighted mean difference for weight change at 8 weeks: -3.4 kg; mean difference range for weight change at 6 months: -4.0 to -9.1 kg; and at 1 year: -4.1 to -4.8 kg). The most frequent dosage regimen in these trials was 10-20 mg daily. Findings suggested a dose-effect relationship in terms of weight loss. Sibutramine was also associated with better weight maintenance relative to placebo (statistically significant difference). Results from mainly small trials showed that sibutramine produced more favourable outcomes in terms of loss of fat mass, reduction in body mass index and loss of > or = 5-10% of initial bodyweight. The most commonly reported adverse effects of sibutramine are headache, constipation and nausea. Certain adverse events associated with the nervous system, including dizziness, dry mouth and insomnia, are reported by > 5% of patients receiving sibutramine. Increases in blood pressure and heart rate were possible adverse effects that require regular monitoring especially in obese hypertensive patients. Neither left-sided cardiac valve disease nor primary pulmonary hypertension was associated with the use of sibutramine. The assessment of the benefit-risk profile of sibutramine remained positive, although the product must be kept under regular review.