Poor Control Research Articles

Multi-objective optimization of HESS control for optimal frequency regulation in a power system with RE penetration

Concerns over fossil fuel emissions and their hazardous effects have led to a shift away from conventional power plants and focus more on the expansion of renewable energy sources. This shift has resulted in reduced inertia and resulted in poor frequency control within electrical power systems. Hybrid Energy Storage Systems (HESS) have been proposed as an effective solution to enhance frequency stability and address the reduced inertia issue. This research evaluates three distinct control models for HESS, Incorporating Supercapacitor Energy Storage (SCES) and Battery Energy Storage Systems (BESS). To optimize the control parameters with the best objectives, all possible sets of objectives with four different optimization algorithms are studied. The three control models considered for the HESS incorporate Virtual Synchronous Generator (VSG) or Virtual Inertia (VI) control with independent or simultaneous optimization of control parameters. The performances of the three control models are evaluated based on three test scenarios incorporating uncertainties, reduced inertia, and uniform and random load disturbances. The findings indicate that the Independently Optimized Virtual Synchronous Generator HESS (IO VSG-HESS) achieves the best settling time post-contingency but offers the least improvement in frequency nadir with an average of 0.31 %. Conversely, the Simultaneously Optimized Virtual Inertia And Virtual Synchronous Generator Controlled HESS (SO VI-VSG-HESS) excel in mitigating small frequency fluctuations with an average improvement in frequency standard deviation of 87.65 %. The Simultaneously Optimized Virtual Synchronous Generator Controlled HESS (SO VSG-HESS) provides the best frequency nadir, with an average improvement of 0.63 %, but with a slight increase in settling time.

Risk factors for poor prognosis in patients with zoster-associated neuralgia who underwent interventional pain management.

Zoster-associated neuralgia (ZAN) is recognized as a challenging neuralgia that often leads to poor prognosis in patients receiving interventional pain management. Identifying risk factors early can enable clinicians to develop personalized treatment plans; however, research in this area is limited. We retrospectively screened all patients with ZAN who received interventional therapy in the Pain Department of Soochow University First Affiliated Hospital from January 1, 2022 to August 31, 2023. Data on patient demographics, medical history, neutrophil-to-lymphocyte ratio (NLR), clinical scoring, and treatment methods were collected. Interventional therapy included short-term nerve electrical stimulation (st-NES), pulsed radiofrequency (PRF) and radiofrequency thermocoagulation (RF-TC). Patients were categorized into poor prognosis and control groups based on outcomes 3 months post-discharge. Multivariate logistic regression was used to identify risk factors for poor prognosis. The final analysis included 282 patients. The rate of poor prognosis was 32.6% (92/282). Multivariate logistic regression analysis revealed that age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; p = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; p < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; p = 0.001), use of immunosuppressants (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; p = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; p < 0.001), PRF (st-NES as reference) (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; p = 0.024) and RF-TC (st-NES as reference) (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; p < 0.001) were found to be independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management. Age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; p = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; p < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; p = 0.001), immunosuppressants use (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; p = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; p < 0.001), PRF (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; p = 0.024) and RF-TC (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; p < 0.001) were identified as independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management.

Degraded oculomotor function and its implications on balance in pediatric strabismus

BackgroundChildren with visual impairment often exhibit poor postural control. However, the effects of strabismus on oculomotor system components and its impact on balance in children are not yet fully understood. This study aims to determine the potential effects of oculomotor functions on balance skills in children with strabismus.MethodsA total of 30 children aged between 6 and 10 years participated in this study. Fifteen children diagnosed with strabismus were included in the strabismus group (8.07 ± 1.33 years), and 15 healthy children without any vision problems were included in the control group (8.03 ± 1.49 years). All children underwent a comprehensive hearing evaluation, bedside neurological and balance examinations, the Pediatric Balance Scale (PBS) assessment to assess balance function, and Videonystagmography (VNG) tests to measure oculomotor function.ResultsIn the saccade test, no significant differences were found between the groups in terms of latency, accuracy, and speed (p > 0.05). The strabismus group showed significantly lower pursuit test gains (except the left eye at 0.4 Hz) (p < 0.05) and significantly higher asymmetries (except the right eye at 0.4 Hz) (p < 0.05). No significant difference was observed between the groups in optokinetic test gains (p > 0.05). The strabismus group had significantly lower scores on the 360-degree rotation task (10th item) (p = 0.027) and total PBS scores (p = 0.029). Correlation analysis revealed statistically significant negative correlations between strabismus angle and optokinetic test gains, pursuit test gains, and PBS total scores, with varying correlation strengths (p < 0.05 and − 0.639 < r < − 0.338).ConclusionsStrabismus adversely affects the optokinetic and pursuit systems, as well as balance in children. Furthermore, an increase in the strabismus angle is associated with greater adverse effects on these functions. The lower scores obtained in the PBS scores of the strabismus group indicate that strabismus may negatively affect balance skills in activities of daily living. Early intervention and targeted therapies should be considered to mitigate these effects and support the development of balance skills in children with strabismus.

Prevalence of Adhesive Capsulitis in Patients With Type 2 Diabetes Mellitus: A Single-Center Cross-Sectional Study From Pakistan.

Background An inflammatory condition leading to stiffness and pain in the shoulder joint, adhesive capsulitis is associated with conditions such as diabetes mellitus, cervical spondylosis, thyroid dysfunction, autoimmune rheumatic diseases, and shoulder injury due to trauma, fracture, rotator cuff tear, surgery, or immobilization. Adhesive capsulitis may affect a notable proportion of the diabetic population. There are numerous studies that show that patients with type 2 diabetes mellitus are not only at higher risk of developing adhesive capsulitis but also suffer poor outcomes despite treatment, especially in patients with long-standing diabetes mellitus. Furthermore, there is significant variation in data regarding the prevalence of adhesive capsulitis in Pakistani patients with type 2 diabetes mellitus. Objective To determine the prevalence of adhesive capsulitis among patients with type 2 diabetes mellitus presenting to a tertiary care hospital in Bahawalpur, Pakistan. Methods The present observational cross-sectional study was carried out at the Department of Medicine, Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from February 2024 to August 2024. Type 2 diabetes mellitus was labeled by HbA1c of more than 7.0%, or two random blood glucose levels of 200 mg/dL or more, or an existing diagnosis of diabetes mellitus, and/or use of anti-hyperglycemic therapy. Adhesive capsulitis was diagnosed clinically on the basis of history (gradual onset shoulder pain with limitation of movements) and examination (reduction in active and passive range of motion (ROM) of the shoulder, especially abduction, internal rotation, and external rotation) in the absence of significant abnormalities on shoulder X-ray. After ethical approval and obtaining informed consent, 430 patients with type 2 diabetes mellitus were included in the study using a non-probability consecutive sampling technique. Demographic information, diabetes control, and HbA1c levels were noted, and the patients were assessed for adhesive capsulitis. All the data was recorded and entered into IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA), for analysis. Results Having a female preponderance (266, or 61.9%), the mean age of the participants was 54.0 ± 13.1 years. With regard to occupational status, 126 (29.3%) had a sedentary occupation, 45 (10.5%) were unemployed, and 259 (60.2%) had a non-sedentary occupation. The mean diabetes duration was 6.4 ± 5.3 years, and the majority of patients had poor diabetes control (322, or 74.9%). Adhesive capsulitis was present in 61 (14.2%) patients with type 2 diabetes mellitus. On stratification, no significant statistical association of adhesive capsulitis was seen with gender (p-value: 0.075), age (p-value: 0.465), occupation (p-value: 0.056), diabetes duration (p-value: 0.118), or diabetes control (p-value: 0.090). Conclusion Adhesive capsulitis was not an uncommon finding in our study, reported in almost one-fifth of the 430 patients enrolled. We recommend that treating physicians screen diabetic patients for adhesive capsulitis so that proper pain relief, physiotherapy, and rehabilitation may be provided timely and efficiently, thereby reducing morbidity and improving the quality of life for such patients.

Progressive T1 high-intensity plaques in carotid stenosis: Comparative MRI analyses in asymptomatic and symptomatic phases of low-grade stenosis

Background and PurposeCarotid artery stenosis, particularly the progression from asymptomatic to symptomatic lesions, is a key factor in cerebrovascular events. This study identifies predictors of symptom development in low-grade carotid stenosis (<50%), focusing on intraplaque hemorrhage (IPH) and dynamic plaque changes. Materials and MethodsWe conducted a retrospective study analyzing 30 cases of symptomatic low-grade carotid stenosis, using carotid MRI before and after symptom onset. Key measures included relative plaque signal intensity (rSI) and high-intensity plaque (HI plaque) volume. Stepwise regression analysis examined the influence of these factors on Symptomatic rSI, Symptomatic plaque volume, and NIHSS scores. ResultsSignificant increases were observed in rSI (1.32 ± 0.32 to 1.69 ± 0.25, p < 0.001) and HI plaque volume (296.4 ± 362.7 mm³ to 717.5 ± 554.9 mm³, p < 0.001) from asymptomatic to symptomatic phases. Past smoking (p = 0.008) and statin use (p = 0.04) were associated with higher Symptomatic rSI, while poor risk factor control (p = 0.03) was negatively associated. Female sex (p = 0.007) and current smoking (p = 0.009) were linked to smaller Symptomatic plaque volumes, while ischemic heart disease (p = 0.0002) and poor risk factor control (p = 0.002) predicted larger plaque volumes. Larger plaques were correlated with higher NIHSS scores (p = 0.002). ConclusionsIPH and plaque volume are key markers of progression in low-grade carotid stenosis. Poor control of cardiovascular risk factors and a history of ischemic heart disease contribute to plaque burden and stroke severity. Continuous monitoring and strict risk management are essential in reducing stroke severity in these patients.

Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study.

Although depression is a frequently occurring mental disorder in patients with hypertension, little is known about the symptoms of depression among Afghan hypertensive patients. This study aimed to analyze the prevalence and predictors of depression symptoms among Afghan hypertensive patients. This was a secondary analysis of a multi-center cross-sectional study conducted between August and December 2022 across three major provinces in Afghanistan. Socio-demographic and clinical characteristics of the eligible participants were used in the analysis. A score of ≥ 5 on the PHQ-9 (Patient Health Questionnaire) was considered the cut-off point for labeling hypertensive patients as screening positive for depressive symptoms. We performed binary logistic regression to determine the predictors of depression symptoms among hypertensive patients. Out of 853hypertensive patients, 51.8% (95% CI: 48.4-55.2%) had depressive symptoms. Binary logistic regression revealed that low monthly household income [AOR=1.42, 95% CI (1.01-1.97), low education level [2.41 (1.57-3.71)], physical inactivity [1.81 (1.22-2.71)], poor blood pressure control [2.41 (1.57-3.71)], and the presence of medical comorbidity [1.59 (1.15-2.19)] were the predictors of depression symptoms. This study showed a high prevalence of depressive symptoms among Afghan hypertensive patients. Moreover, we found that low monthly household income, physical inactivity, low education level, poor blood pressure control, and the presence of medical comorbidity were the predictors of depression symptoms. Our findings suggest that hypertensive patients should be screened for mental health symptoms, and those most at risk for depression should seek supportive counseling.

Vitamin K Antagonist Anticoagulation in Antiphospholipid Syndrome: Time in Therapeutic Range and Clinical Outcomes

BackgroundThrombosis in antiphospholipid syndrome is still frequently treated with vitamin K antagonists, with a target international normalized ratio of 2-3. Time in therapeutic range of international normalized ratio of ≥ 70% is considered optimal. Time in therapeutic range among antiphospholipid syndrome patients is not well documented and the clinical consequences of poor international normalized ratio control are uncertain. This study aimed to determine the proportion of vitamin K antagonist-treated antiphospholipid syndrome patients achieving time in therapeutic range ≥ 70%, to define the features associated with poor control and to determine its association with thrombotic and bleeding events. MethodsThis medical records review included antiphospholipid syndrome patients treated with vitamin K antagonists, between 2012-2023. The proportion of patients achieving a time in therapeutic range ≥ 70% was determined, and thrombotic and bleeding events were compared between patients with time in therapeutic range ​​≥ 70% vs < 70%. ResultsSixty seven antiphospholipid syndrome patients were studied. It was observed that 29.9% achieved time in therapeutic range ≥ 70% and 9.1% of patients with 3 or more comorbidities achieved time in therapeutic range values ≥ 70% compared with 40% of patients with less than 3 comorbidities. Fewer recurrent arterial and overall thrombotic events occurred with time in therapeutic range ​​≥ 70%. ConclusionsA minority of antiphospholipid syndrome patients treated with vitamin K antagonists achieve optimal anticoagulation and are at risk for recurrent thrombotic events, particularly arterial. Presence of multiple comorbidities is associated with poor international normalized ratio control. Careful monitoring of this patient population is warranted.

Glycated hemoglobin, type 2 diabetes, and poor diabetes control are positively associated with impulsivity changes in aged individuals with overweight or obesity and metabolic syndrome.

Impulsivity has been proposed to have an impact on glycemic dysregulation. However, it remains uncertain whether an unfavorable glycemic status could also contribute to an increase in impulsivity levels. This study aims to analyze associations of baseline and time-varying glycemic status with 3-year time-varying impulsivity in older adults at high risk of cardiovascular disease. A 3-year prospective cohort design was conducted within the PREDIMED-Plus-Cognition substudy. The total population includes 487 participants (mean age = 65.2 years; female = 50.5%) with overweight or obesity and metabolic syndrome. Insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), presence of type 2 diabetes mellitus, and type 2 diabetes control were evaluated. Impulsivity was measured using the Impulsive Behavior Scale questionnaire and various cognitive measurements. Impulsivity z-scores were generated to obtain Global, Trait, and Behavioral Impulsivity domains. Linear mixed models were used to study the longitudinal associations across baseline, 1-year, and 3-year follow-up visits. HOMA-IR was not significantly related to impulsivity. Participants with higher HbA1c levels, type 2 diabetes, and poor control of diabetes showed positive associations with the Global Impulsivity domain over time, and those with higher HbA1c levels were further related to increases in the Trait and Behavioral Impulsivity domains over the follow-up visits. These results suggest a potential positive feedback loop between impulsivity and glycemic-related dysregulation.

Research and Practice of Sand Control Completion Technology Optimization in Western H Oilfield

Abstract In view of the problems of poor reservoir physical properties, high clay content, loose cementation, shallow burial, low compaction degree, low temperature in the middle and deep oil layers during the development process of unconsolidated sandstone reservoirs in the western H oilfield, the original sand control technology has poor adaptability and short sand control validity period., this paper carried out research on the optimization of sand control completion technology. In the study, a series of optimization studies were conducted, including analysis of acoustic time difference in sand producing layers, simulation of sand control formation compaction, optimization of gravel filling particle size, and sand control tools. A high-strength artificial wellbore and cyclic gravel filling sand control completion process suitable for different sand producing well conditions were developed and applied in practice. The research results and on-site practice indicate that the high-strength artificial wellbore sand control completion technology has good adaptability in low-temperature and long wellbore sand production wells; The cyclic gravel filling sand control completion technology has the advantages of simple construction, low cost, and low probability of major repairs in conventional shallow sand producing wells; The complementary advantages of the two processes effectively solve the problem of sand damage in H oilfield. Since 2021, the optimized sand control completion technology has been applied 46 times in H oilfield, with an average recovery oil production of 3.4t per well and an average effective period of over 500 days for sand control. The overall input-output ratio is 1:2.8, achieving good benefits and having high promotion and application value.

The Supraglottic Index: An indicator of response to laryngopharyngeal reflux therapy in asthma

BackgroundLaryngopharyngeal reflux (LPR) is associated with gastroesophageal reflux and is known to cause poor asthma control. Moreover, LPR and asthma frequently coexist in the same individual. Controlling LPR could be associated with improved asthma control. The Supraglottic Index (SGI) is a clinically applied visual scale, which correlates with the presence of LPR. The role of SGI in monitoring LPR therapy in individuals with asthma is not known. ObjectiveTo determine whether the SGI can be used over time to assess the presence of LPR in patients with asthma, and whether the SGI improves with LPR treatment. MethodsThis is a pilot study in 15 participants with asthma. Those without evidence of LPR by SGI measurement were assigned to the observation arm. Those with LPR were assigned to the treatment arm and were treated with either standard-of-care LPR treatment (antacids and behavioral management) or a novel therapy (upper esophageal assist device). ResultsThe SGI remained stable in individuals with asthma who underwent observation over 8 weeks. The SGI improved in participants with asthma treated for LPR (P = .024). ConclusionThe SGI is a readily available clinical tool to assess the presence of LPR and monitor its therapy in asthma.

Evolución del programa de recuperación rápida a cirugía ambulatoria en artroplastia total de cadera

IntroductionThe implementation of enhanced recovery programs has transformed total hip arthroplasty (THA) surgery. Outpatient prosthetic surgery is a safe and beneficial technique. Few centers in our country perform outpatient total hip arthroplasty (OTHA). We present the preliminary results of our experience. Material and methodThis is a prospective observational study conducted in 2023 with a sample of 30 patients proposed for THA following an outpatient surgery protocol by the orthopedic surgery and traumatology service. ResultsIn 2023, we performed 132 THAs in our center. Thirty patients, 27 men and 3 women with an average age of 55.7 years were included for an outpatient surgery circuit. Three patients did not meet the inclusion criteria identified by the Anesthesiology Department. Of the 27 patients included in the program, 25 were discharged on the same day. Two patients were admitted: one due to an intraoperative fracture and the other due to poor pain control and dizziness. No secondary complications related to the program were observed after discharge. All patients except one would recommend the outpatient protocol. ConclusionsOTHA programs should evolve from rapid recovery programs. Their implementation depends on an experienced multidisciplinary team. In this study, inclusion criteria were defined, achieving high satisfaction without increased complications. Outpatient surgery is a good option, and the implementation of this circuit is a safe, effective, and a satisfactory practice for selected patients.

A Study of Psychological Features in Patients With Type 2 Diabetes Mellitus.

There is a lack of multidisciplinary studies examining the link between psychological factors and glycemic control in individuals with chronic illnesses. The aim of this study is to investigate the relationship between psychological factors such as resilience, perceived stress, emotional regulation, aggressiveness, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes. Additionally, the study seeks to determine the predictive value of perceived stress and resilience on HbA1c levels and to explore the role of anger expression and emotion regulation strategies in glycemic control, comparing diabetic patients to healthy controls. The study was conducted between November 2021 and November 2023 at the Clinic of Endocrinology and Metabolic Diseases at the St. George University Hospital, Bulgaria, and the Department of Science and Research at the Medical University of Plovdiv, Bulgaria. Of these 84 individuals were diagnosed with type 2 diabetes, divided into two groups of 42 individuals each, who had poor and fair glycated hemoglobin. The third group was a healthy control consisting of 42 individuals in the same age group who had no established chronic diseases. When comparing the study groups on HbA1c and individual psychological characteristics, there were statistically significant differences in resilience, perceived stress, emotion regulation suppression, and anger expression. When comparing the mean values of mental resilience with glycated hemoglobin levels, we find that there are statistically significantly higher mean values between the poor HbA1c control and the healthy group. From the regression analysis, we conclude that the psychological characteristics positively associated with perceived stress (β=0.502; p<0.001) and inversely associated with mental resilience (β=-0.359; p<0.001) are the most predictive. Less influential was the straight correlation with emotion regulation-expressive inhibition (β=0.226; p<0.05), the positive correlation with anger (β=0.170; p<0.001), and general aggressiveness (β=0.151; p<0.05). From the present study, we note that glycated hemoglobin level is strongly influenced by two psychological predictors, namely subjective perception of stressful situations and resilience level.

An efficient polyaluminum lanthanum silicate coagulant for phosphorus removal and algal bloom control

Due to the advantages of convenient operation and low cost, the use of coagulants is considered a promising method for algae bloom harvesting. However, large dosages, poor algal bloom control rates, and limited phosphorus removal efficiency restrict the usage of most coagulants. In this study, a novel polyaluminum lanthanum silicate (PALS) coagulant was used to remove phosphorus and control algal bloom. The results of isotherm study showed that phosphorus adsorption on PALS fitted Freundlich model, indicating chemisorption and heterogeneous multilayer adsorption were the mechanisms of phosphorus adsorption by PALS. The maximum phosphorus adsorption capacity of PALS by Langmuir model was 485.30mg/g. According to the algal bloom control experiments, the removal of algae and phosphorus was slight at low dosages of PALS (2mg/L and 5mg/L). Short-term control of the algal bloom was observed within 2 days in PALS-10 group, but the bloom recovered afterward, while phosphorus and algae were almost completely removed in PALS-15 and PALS-20. When the dosage of PALS was ≤ 10mg/L, PALS coated the algal cell surfaces and induced mild oxidative stress, showing a little damage to cell integrity. However, the PALS dose over 15mg/L could effectively capture algal cells through charge neutralization, cause severe oxidative stress, strongly upregulate the expression of selected five genes, significantly damage cell integrity, and lead to algae lysis. These findings demonstrated that PALS is a promising coagulant for phosphorus removal and algal bloom control in eutrophic waters, and the minimum threshold of its usage was 15mg/L.

Uncovering Factors Contributing to Poor Asthma Control among Asthmatic Patients in Erbil City - Kurdistan Region

الكشف عن العوامل التي تساهم في ضعف السيطرة على الربو: مجموعة مستقبلية خلاصة الخلفية: الربو هو مرض غير متجانس، ويتميز عادة بالتهاب مجرى الهواء المزمن وتقييد تدفق الهواء الزفير المتغير الهدف: كان الهدف من هذه الدراسة هو الكشف عن العوامل التي تساهم في ضعف السيطرة على الربو في مدينة أربيل في العراق. طُرق: تم إجراء هذه الدراسة الرصدية المقطعية على 200 مريض مصاب بالربو في الفترة من 1 يونيو 2023 إلى 31 ديسمبر 2023 لتقييم السيطرة على الربو في مدينة أربيل. الخصائص الديموغرافية والسريرية والمحفزات والأمراض المصاحبة ومشاكل الاستنشاق وأسباب الزيارة وحالة السيطرة على الربو باستخدام استبيان أداة تقييم .GINA 2023 ينقسم مستوى التحكم في الربو إلى ثلاثة مستويات يمكن التحكم فيها، ومستوى يمكن التحكم فيه جزئيًا، وغير يمكن التحكم فيه. نتائج: تمت في هذه الدراسة دراسة 200 مريض مصاب بالربو (108 إناث و 92 ذكر(كان متوسط العمر ± SD للمرضى 35.61 ± 17.182 سنة (يتراوح من 15 إلى 81 سنة)، ونسبة الإناث إلى الذكور هي 1.17:1. السيطرة على الربو سيئة للغاية وتم التحكم في 24 مريضًا فقط (12٪.( ليس للجنس ولا للفئة العمرية علاقة ذات دلالة إحصائية مع السيطرة على الربو. تشمل العوامل ذات الأهمية الإحصائية المرتبطة بالسيطرة على الربو تقنية الاستنشاق غير الصحيحة (45.5%)، والخوف من الإدمان (29%)، ووصفات الاستنشاق غير الصحيحة (27.5%)، والساحل (23%)، ونوع الجهاز (22.5%)، والالتهابات (21 ( % ، والتعرض الداخلي والخارجي (18%)، ودخان التبغ (17%)، والتهاب الأنف التحسسي ((%28.5)، والارتجاع المعدي المريئي (21.5(% علاج SABA وحده 104 (52%)، في حين أن العوامل الأخرى المرتبطة بالسيطرة على الربو ولكنها ليست ذات دلالة إحصائية مثل الإجهاد العاطفي (9.5%) وحساسية الطعام (8.5%)، والسمنة (15%)، والتهاب الجلد التأتبي (6(% ، انقطاع التنفس الانسدادي أثناء النوم (15%)، والحمل (5.5 .(% خاتمة: من العوامل ذات الأهمية الإحصائية المرتبطة بسوء التحكم في الربو هي أن الربو الذي يتم التحكم فيه بشكل سيئ مرتبط بأجهزة الاستنشاق (تقنية الاستنشاق غير المناسبة، وصفة الاستنشاق غير المناسبة، وعدم الالتزام بجهاز الاستنشاق) والمحفزات (العدوى، والحساسية، والدخان، والتلوث) والأمراض المصاحبة (التهاب الجيوب الأنفية، والارتجاع المعدي المريئي.( الكلمات المفتاحية: ، المثيرات الربو، السيطرة، الاستنشاق ، الأمراض المصاحبة.

The effect of femoral strapping on hip internal rotation and pain response in females with patellofemoral pain

BackgroundHip internal rotation has been reported to affect patellofemoral joint mechanics and contribute to patellofemoral pain (PFP). The SERF (Stability through External Rotation of the Femur) strap was designed to provide hip stability by pulling the thigh into external rotation during weight-bearing activities. Research questionWhat are the effects of the SERF strap on hip internal rotation and pain response in females with PFP who present with hip internal rotation during weight-bearing activities? MethodsNineteen females between the ages of 18 and 45 with a diagnosis of PFP participated. Lower extremity kinematics were obtained during three tasks (drop-jump, unilateral step-down, over-ground running) under strap and no-strap conditions. A 10-cm visual analog scale (VAS) was used to assess pain response during each task and strap condition. Participants who exhibited at least 5 degrees of hip internal rotation during at least one of the 3 tasks were included in the final analysis. Peak hip internal rotation and mean VAS score were compared separately between strap conditions across tasks using 2 ×3 (strap condition x task) repeated-measures ANOVAs. ResultsEighteen of the 19 females with PFP met the criteria for the presence of hip internal rotation. There was a significant reduction in peak hip internal rotation across tasks when wearing the SERF strap (mean ± sd = 7.4 ± 2.3, p<0.001). Additionally, the change in mean VAS pain score was significantly lower across tasks when wearing the SERF strap (1.0 ± 1.0, p=0.03). SignificanceThe SERF strap was effective in reducing hip internal rotation and PFP during dynamic weight-bearing activities in symptomatic females. The SERF strap may be a useful treatment adjunct for persons with PFP who present with poor transverse plane control of the hip.

Racial and Ethnic Disparities in Pediatric Atopic Dermatitis.

Atopic dermatitis (AD) is one of the most common chronic childhood conditions. Disparities in treatment and access to care can result in poor disease control and decreased quality of life. The aim of this study was to determine whether race and ethnicity affect treatment and healthcare utilization for pediatric atopic dermatitis in central Florida. This study of 4008 children with AD compared healthcare utilization and management using the numbers of AD-related healthcare visits, prescriptions, testing, and subspecialty referrals. Multivariable models were used to compare racial and ethnic groups (Black, Hispanic, Asian, and Other) with the reference group of non-Hispanic White, while adjusting for common confounders. The mean number of urgent care visits for the Hispanic group was 1.61 times that of the non-Hispanic White group, and the mean number of emergency department visits was 3.71 (P < 0.001) times the reference group. Black or African American patients had a mean number of emergency department visits that was 1.52 times that of non-Hispanic White patients (P = 0.021). The mean count of primary care visits was lower among Hispanic patients and higher among Asian patients (P = 0.012). Visits to subspecialty clinics and hospitalizations did not differ significantly. There were no consistent patterns in differences of AD-related prescriptions, testing, or subspecialty referrals. This study indicates that racial and ethnic disparities exist in healthcare utilization in pediatric AD. The underlying factors contributing to these disparities need to be further studied and addressed to reach health equity within pediatric AD.

Demographic and clinical characteristics of New York City Health + Hospitals HIV Heart Failure (NYC4H cohort): cohort profile.

Studies have elucidated that heart failure (HF) in people living with HIV manifests differently when compared with HF cases in the general population. This cohort aimed to examine the mortality risk factors, including biological and social factors, as well as suitable medical interventions to prevent death in this population. The New York City Health+Hospitals HIV Heart Failure (NYC4H) cohort encompassed records from 11 major hospital sites. Adult individuals with confirmed HIV and HF were recruited from either inpatient or clinic hospital visits between July 2017 and June 2022. The first follow-up period began on the date of the first clinical encounter until June 2023, and the second follow-up period extended between July 2022 and October 2023. In total, 1044 patients were enrolled in the study. The cohort comprised 657 (62.9%) males and 387 (37.1%) females. The average age was 61.6 years at baseline and the average follow-up time was 3.8 years. Overall, a total of 259 (24.8%) deaths were identified, of which 193 occurred in the first follow-up period (enrolling date to June 2022) and 66 during the second follow-up period (June 2022 to October 2023). The most common comorbidities within this population were hypertension (75.3%), chronic obstructive pulmonary disease (39.2%), type II diabetes mellitus (40%) and hyperlipidaemia (35.7%). The most common social adversities were polysubstance use (31.13%), mental health-related issues (20.7%) and lack of family support (14.5%). 601 (57.6%) patients had encountered at least one and more than one social adversity in their lifetime. Currently, nutritional notes from licensed dietitians and right and left heart catheterisation reports are under review. We are scheduled to complete the data collection for the comprehensive third follow-up period, which includes follow-up psychosocial evaluations, by the end of 2025. In addition, we intend to conduct annual follow-ups for specific high-risk groups, such as individuals with pulmonary hypertension, those facing higher social adversities and participants with poor HIV control.

Does Adopting Western Low-density Lipoprotein Cholesterol Targets Expose Indians to a Higher Risk of Cardiovascular Events? Expert Opinion From the Lipid Association of India.

Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below. In the US, mean low-density lipoprotein cholesterol (LDL-C) levels have markedly declined over the last 2 decades, correlating with a proportional reduction in CV events. Conversely, poor risk factor control and dyslipidemia management have led to increased CV and coronary artery disease (CAD) mortality rates in India. The population-attributable risk of dyslipidemia is about 50% for myocardial infarction, signifying its major role in CV events. In addition, the pattern of dyslipidemia in Indians differs considerably from that in Western populations, requiring unique strategies for lipid management in Indians and modified treatment targets. The Lipid Association of India (LAI) recognized the need for tailored LDL-C targets for Indians and recommended lower targets compared to Western guidelines. For individuals with established ASCVD or diabetes with additional risk factors, an LDL-C target of <50 mg/dL was recommended, with an optional target of ≤30 mg/dL for individuals at extremely high risk. There are several reasons that necessitate these lower targets. In Indian subjects, CAD develops 10 years earlier than in Western populations and is more malignant. Additionally, Indians experience higher CAD mortality despite having lower basal LDL-C levels, requiring greater LDL-C reduction to achieve a comparable CV event reduction. The Indian Council for Medical Research-India Diabetes study described a high prevalence of dyslipidemia among Indians, characterized by relatively lower LDL-C levels, higher triglyceride levels, and lower high-density lipoprotein cholesterol (HDL-C) levels compared to Western populations. About 30% of Indians have hypertriglyceridemia, aggravating ASCVD risk and complicating dyslipidemia management. The levels of atherogenic triglyceride-rich lipoproteins, including remnant lipoproteins, are increased in hypertriglyceridemia and are predictive of CV events. Hypertriglyceridemia is also associated with higher levels of small, dense LDL particles, which are more atherogenic, and higher levels of apolipoprotein B (Apo B), reflecting a higher burden of circulating atherogenic lipoprotein particles. A high prevalence of low HDL-C, which is often dysfunctional, and elevated lipoprotein(a) [Lp(a)] levels further contribute to the heightened atherogenicity and premature CAD in Indians. Considering the unique characteristics of atherogenic dyslipidemia in Indians, lower LDL-C, non-HDL-C, and Apo B goals compared to Western guidelines are required for effective control of ASCVD risk in Indians. South Asian ancestry is identified as a risk enhancer in the American lipid management guidelines, highlighting the elevated ASCVD risk of Indian and other South Asian individuals, suggesting a need for more aggressive LDL-C lowering in such individuals. Hence, the LDL-C goals recommended by the Western guidelines may be excessively high for Indians and could result in significant residual ASCVD risk attributable to inadequate LDL-C lowering. Further, the results of Mendelian randomization studies have shown that lowering LDL-C by 5-10 mg/dL reduces CV risk by 8-18%. The lower LDL-C targets proposed by LAI can yield these incremental benefits. In conclusion, Western LDL-C targets may not be suitable for Indian subjects, given the earlier presentation of ASCVD at lower LDL-C levels. They may result in greater CV events that could otherwise be prevented with lower LDL-C targets. The atherogenic dyslipidemia in Indian individuals necessitates more aggressive LDL-C and non-HDL-C lowering, as recommended by the LAI, in order to stem the epidemic of ASCVD in India.

Antihypertensive Treatment Patterns in CKD Stages 3 and 4: The CKD-REIN Cohort Study

Rationale & ObjectiveBlood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP (SBP). Study DesignProspective observational cohort study Setting & Population2755 hypertensive patients with CKD stages 3–4, receiving care from a nephrologist, from the French CKD-REIN cohort study ExposurePatient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary-care physician and specialist encounters. OutcomesChanges in antihypertensive drug class prescription during follow-up: add-on, or withdrawal. Analytical ApproachHierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level, and linear mixed models to describe Systolic BP trajectory. ResultsAt baseline, median age was 69, mean eGFR, 33 ml/min/1.73m2; 66% of patients were men, 81% had BP ≥130/80 mmHg and 75% were prescribed ≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons and 25 per 100 for withdrawals. After adjusting for risk factors, Systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on, 1.35 (95% confidence interval, 1.01-1.80), while a shorter education level was associated with increased HR for withdrawal, 1.23 (1.02-1.49) for 9-11 years versus ≥12 years. More frequent nephrologist visits (≥4 versus none) were associated with higher HRs of add-on and withdrawal (1.52; 95% CI 1.06-2.18 and 1.57; 1.12-2.19, respectively), while associations with visit frequency to other physicians varied with their specialty. Mean Systolic BPdecreased by 4 mmHg following drug add-on but tended to rise thereafter. LimitationsLack of information on prescriber, and drug dosing. Conclusions: In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in Systolic BPafter add-on of a drug class is infrequently achieved.

Adaptive sliding mode control of petrochemical flare combustion process based on radial basis function network

Steam-assisted combustion elevated flares are currently the most widely used type of petrochemical flares. Due to the complex and variable composition of the waste gas they handle, the combustion environment is severely affected by meteorological conditions. Key process parameters such as intake composition, flow rate, and real-time data of post-combustion residues are difficult to measure or exhibit lag in data availability. As a result, the control methods for these flares are limited, leading to poor control effectiveness. To address this issue, this paper proposes an adaptive sliding mode control method based on the Radial Basis Function (RBF) network. Firstly, the operational characteristics of the petrochemical flare combustion process are analyzed, and a control model for the combustion process is established based on carbon dioxide detection. Secondly, an RBF neural network-based unknown function approximator is designed to identify the nonlinear part of the actual operating system. Finally, by combining the control model of the petrochemical flare combustion and designing the RBF sliding mode controller with its adaptive control law, fast and stable control of the flare combustion state is achieved. Simulation results demonstrate that the designed control strategy can achieve tracking control of the petrochemical flare combustion state, and the adaptive law also accomplishes system identification.