Uncontrolled Cases Research Articles

Clinical Impact of a Digital Dose Counter Pressurized Metered-Dose Inhaler on Uncontrolled Asthma: Cross-Sectional, Observational, Surveillance Study.

BackgroundIn India, control of asthma with persistent symptoms remains a clinical enigma with likely incriminating factors including non- and pseudoadherence to the inhaled corticosteroids and long-acting beta2-agonists. The United States Food and Drug Administration guidance recommends the use of dose counter pressurized metered-dose inhalers (pMDIs) with further mechanisms to track adherence and pseudoadherence in real-world settings.ObjectiveDigital dose counter pMDIs (dpMDIs) offer simplified, reliable tracking of individual “actuated” dosages with “END” display at completion of the labelled therapeutic aerosol spray. The translational impact on symptom persistence with likely unwarranted exposure to the “Step up” strategy is often prevented if not treated, as in the cases of “pseudo” severe asthma. To further assess the real-world acceptance and clinical impact of dpMDIs in bronchial asthma including poorly controlled or uncontrolled bronchial asthma cases, a noninterventional observational study was performed.MethodsThis cross-sectional, retrospective, case cohort, observational study—the Drug Utilization Surveillance—of dpMDIs in bronchial asthma was conducted in September 2016 in an outpatient setting in India. The retrospective analysis was initiated and conducted as per the International Conference on Harmonization Good Clinical Practice principles and Declaration of Helsinki, following approval from the local ethics committee and registration in the Clinical Trial Registry of India.ResultsConsecutive cases of moderate-to-severe asthma with poor control (n=4575), diagnosed as per the Global Initiative for Asthma symptom scale at baseline and follow-up, were included. Patients under treatment using dpMDIs were enrolled from 500 centers across India and assessed by respiratory care specialists. Baseline asthma control was assessed as partly controlled (n=4575) or poorly controlled (n=2942). Per protocol analyses showed that asthma was well controlled with dpMDIs at 8 weeks in 92.7% of the cases (2727/2942, P<.001). Adverse events (n=106, 2%) of mild-to-moderate intensity were reported. Nebulization was required in two patients with episodic breathlessness who were discharged with no consequent sequelae. Post hoc analyses for patients with baseline poorly controlled asthma who “switched” exclusively to dpMDI monotherapy or a combination with xanthines or long-acting beta2-agonists showed a “well controlled” asthma status in 85.9% (500/582, P=.04), 95.4% (395/414, P=.048), and 80.3% (106/132, P=.28) of the cases, respectively. The patient acceptability criteria for an “empty” canister was well correlated with the clinical strategy to identify and avoid pseudoadherence in poorly controlled or difficult-to-treat asthma cases, especially in patients who “switched” exclusively to dpMDIs (n=582) and demonstrated responses of “Use till twenty dose display” (65/156, 41.6%), “Use till END display” (83/156, 53.2%), and “Use till LAST spray” (8/156, 5.1%).ConclusionsdpMDIs offer simple, accurate, and reliable tracking of non- and pseudoadherence while highlighting incremental asthma-control rates in severe and pseudosevere asthma cases before risk assessment for further “add-on” therapyTrial RegistrationClinical Trials Registry - India CTRI/2018/06/014595; http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php? trialid=24583

Sensitivity and Specificity of Alzheimer Type II Astrocytes in Hepatic Encephalopathy.

Hepatic encephalopathy (HE) is associated with presence of type II astrocytes in the brain on the basis of observations made in single uncontrolled cases. This finding was subsequently demonstrated by in vitro studies with replication of microenvironment of HE by increase in ammonia levels. However, no human studies have been done correlating HE with type II astrocytes. To determine the sensitivity and specificity of type II astrocytes in HE. This is a retrospective cohort study in which cases and controls were included. A database search was conducted to identify potential cases of hepatic encephalopathy during a 3-year period, as well as concomitant cases with altered mental status from other causes, liver disease, both, and neither. The presence of HE was determined according to standard clinical criteria, and a coronal section of basal ganglia was selected for examination from each case. Type II astrocytes were enumerated over 20 random high-power fields (HPFs). Twenty-one patients with HE were identified, with 35 patient controls (18 females, 38 males). Among the patients with HE there was a mean of 19.8 type II astrocytes in 20 HPFs. Patients with altered mental status without HE had an average of 7.2 type II astrocytes per 20 HPFs, and for those without altered mental status, the average was 2.8. For patients with hepatic insufficiency without HE, the average was 11, while for patients with normal hepatic function, the average was 4.1. Overall, for those without HE, the average was 5.4 type II astrocytes per 20 HPFs. At a cutoff of 5 or more type II astrocytes per 20 HPFs, sensitivity for HE was 85.7% and specificity was 68.6%. Alzheimer type II astrocytes were present in all cases of HE but were also present in a wide variety of patients without HE.

Precision Medicine in Rhinosinusitis.

Our scope is the presentation of research and clinical progresses in relation to precision medicine that are expected to alter our clinical practice in relation to chronic rhinosinusitis (CRS). Current knowledge on phenotypes and endotypes, biomarkers, and clinical markers for diagnosis, medical and surgical therapy, and prognosis is presented as well as the role of precision medicine in United Airway Disease and SCUAD (severe-uncontrolled chronic upper airway inflammation). Current technological progresses, mostly in relation to molecular biology and information technology, have permitted more detailed pathophysiological assessments and multidimensional approaches in airways diseases. Based on the concept of united airways diseases, new classification schemes, called endotypes, have been proposed for CRS. In addition, novel biological treatments that have been introduced for the treatment of asthma show great promise as well for severe uncontrolled cases of CRS with nasal polyps. Central to this approach are new biomarkers that are being examined in relation to complex bio-clinical traits of CRS. As this narrative review of the aforementioned precision medicine initiatives in relation to CRS advances, a modification of current practice is expected not only for severe chronic upper airways diseases in tertiary centers but also for milder and more common cases that are being encountered in the community.

Handling severe asthma exacerbations: current guidelines and techniques

Background: Asthma affects approximately 300 million people globally, with a significant prevalence of uncontrolled cases contributing to rising hospitalizations and healthcare costs. In Saudi Arabia, 64% of asthma patients experience uncontrolled symptoms. Effective management of severe asthma exacerbations is critical, yet many patients remain inadequately controlled even in advanced care settings. Aim: This review aims to synthesize current guidelines and techniques for handling and management of severe asthma exacerbations, focusing on optimizing therapeutic strategies and improving patient outcomes via pharmacists and Emergency medical services. Methods: The review systematically examines existing guidelines, including the Saudi Initiative for Asthma (SINA) and other international protocols. It evaluates various treatments such as inhaled bronchodilators, systemic steroids, anticholinergic agents, and newer therapies like magnesium sulfate and heliox. The review also considers the effectiveness of different diagnostic and monitoring tools. Results: Effective management of severe asthma exacerbations involves a multi-faceted approach. Key strategies include the use of inhaled bronchodilators (MDIs preferred over nebulizers), systemic steroids for moderate to severe cases, and oxygen therapy to address hypoxemia. Anticholinergic agents and magnesium sulfate may be used for severe exacerbations, though their benefits vary.

Handling severe asthma exacerbations: Current guidelines and techniques

Background: Asthma affects approximately 300 million people globally, with a significant prevalence of uncontrolled cases contributing to rising hospitalizations and healthcare costs. In Saudi Arabia, 64% of asthma patients experience uncontrolled symptoms. Effective management of severe asthma exacerbations is critical, yet many patients remain inadequately controlled even in advanced care settings. Aim: This review aims to synthesize current guidelines and techniques for handling and management of severe asthma exacerbations, focusing on optimizing therapeutic strategies and improving patient outcomes via pharmacists and Emergency medical services. Methods: The review systematically examines existing guidelines, including the Saudi Initiative for Asthma (SINA) and other international protocols. It evaluates various treatments such as inhaled bronchodilators, systemic steroids, anticholinergic agents, and newer therapies like magnesium sulfate and heliox. The review also considers the effectiveness of different diagnostic and monitoring tools. Results: Effective management of severe asthma exacerbations involves a multi-faceted approach. Key strategies include the use of inhaled bronchodilators (MDIs preferred over nebulizers), systemic steroids for moderate to severe cases, and oxygen therapy to address hypoxemia. Anticholinergic agents and magnesium sulfate may be used for severe exacerbations, though their benefits vary.

Assessment of neutrophil/lymphocyte percentage in bronchial asthma

Background Neutrophil/lymphocyte percentage is a helpful test for evaluation of systemic inflammation. This study aimed to investigate neutrophil/lymphocyte percentage as an evidence of control status in bronchial asthma. Patients and methods The study included 45 (20 males and 25 females) patients and 45 apparently healthy subjects. Full clinical evaluation, complete blood count (CBC) with differential white blood cell count, Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total IgE measurement were done for participants. Results Neutrophil/lymphocyte percentage and CRP were higher in asthmatics than controls (statistically significant difference), and they were significantly increased with uncontrolled asthma. Neutrophil/lymphocyte percentage could predict uncontrolled asthma with a sensitivity of 66.7%, specificity of 75.6%, positive predictive value of 73.2%, negative predictive value of 69.4% and accuracy of 71.1%. Neutrophil/lymphocyte percentage increased in asthmatics with asthma control test (ACT) less than 20 versus patients with ACT of at least 20 (statistically significant difference), whereas neutrophil/lymphocyte percentage did not differ significantly among the patients with asthma regarding sex and smoking. Neutrophil/lymphocyte percentage had direct proportional relation with CRP and ACT, whereas the relations between neutrophil/lymphocyte percentage and age, eosinophils, IgE, Forced expiratory volume in first second (FEV1%), duration of the disease, or number of attacks per year were nonsignificant. No significant correlation was found between controlled and uncontrolled cases regarding total leukocyte count (TLC), duration, and onset of the disease. The number of attacks was significantly higher in uncontrolled cases than controlled ones. Conclusion Neutrophil/lymphocyte percentage could predict uncontrolled asthma with high sensitivity and specificity. Neutrophil/lymphocyte percentage is a rapid, inexpensive method with routine CBC analysis and could be a useful predictor of asthma control.

Study of CD14+ and CD16+ peripheral blood monocytes in asthmatic patients

Objective This study aimed to investigate the enhanced frequencies of CD14++ CD16 + peripheral blood monocytes in asthmatic patients. Background CD16 + monocytes are increased in inflammatory conditions. It was reported that CD16 + monocytes can be divided into two subsets with different potential of modulating inflammatory responses: CD14++ CD16 + and CD14 + CD16 + monocytes. CD14++ CD16 + and CD14 + CD16 + monocyte subsets are quantified in asthmatic patients regarding severity of disease and glucocorticoids treatment options. Patients and methods CD14++ CD16 + was examined in 20 cases of completely controlled asthma, 20 cases of partly controlled asthma, 20 cases of uncontrolled asthma, and 25 healthy controls using flow cytometry. Results The results showed highly significant difference among the controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups regarding pulmonary function tests and also showed highly significant difference among controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups regarding percentage of CD14++ CD16 + cells. Moreover, the results showed highly significant correlation between CD14++ CD16 + cells and percentage of forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, C-reactive protein, erythrocyte sedimentation rate, immunoglobulin E, neutrophils, and eosinophils (laboratory investigations) of controlled asthma, partly controlled asthma, uncontrolled asthma, and control groups. Conclusion CD14++ CD16 + monocytes showed the highest levels of expression in uncontrolled asthmatic cases as compared with other monocyte subsets. CD14++ CD16 + monocytes showed higher levels of expression in uncontrolled asthma cases than other asthmatic cases.

Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism.

BackgroundImpairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.MethodsTwenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.ResultsAfter PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.ConclusionSubtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Level of Control of Type 2 Diabetic Patients Attending Primary Health Care Centers in Jeddah, Saudi Arabia

Background: Diabetes mellitus is one of the most prevalent chronic diseases, its proper management is important for better prognosis. poor control is not uncommon and factors associated with uncontrolled state vary between communities. No previous published researches focused on estimating uncontrolled cases in Jeddah, nor exploring its associated factors. Objectives of the study: To estimate prevalence of uncontrolled type 2 diabetic cases and explore its associated factors in patients attending primary heal care centers, Jeddah, KSA. Subjects and methods: Through a cross section study, with nested case control design, 400 diabetic patients were selected randomly from primary health care centers in Jeddah. They responded to a predesigned valid questionnaire enclosing information about glycemic level, and demographic and clinical variables possibly associated with poor glycemic control. Chi square test and Odds ratio were used to identify factors significantly associated and predicting uncontrolled diabetes. Results: Out of all patients (n=400), more than one half (54%) aged 60 years or older, with marked dominance of females (65.5%). almost three quarters (72.5%) were considered as being “uncontrolled cases”. The most significant factors associated with poor glycemic control included being a female (OR=1.456, 95% CI: 1.065-2.706)), older patients as it reached up to 80.4% in patients aged 60-79 years, widowed (87.1%), obese patients (73.6%) and hypertensive patients (OR=3.126, 95% CI:1.867-5.233). Poor control was less frequentr in those who had positive history of hyperglycemic crisis (OR=0.578, 95% CI:0.497-0.673) and those who had positive family history of diabetes mellitus (OR=0.822, 95% CI:0.728-0.928) p<0.05. Conclusion and recommendations: Poor glycemic control is markedly prevalent among diabetic patients attending PHC in Jeddah. Associated factors included being female, old age, obesity, hypertension and positive family history of diabetes. Tailored care should be planned for diabetic patients with the predictors of poor glycemic explored in the current study.

Robust feedrate control for high-efficiency machining using quantitative feedback theory

ABSTRACTThis study used quantitative feedback theory (QFT) to design a robust controller suitable for various cutting conditions. First, servo dynamics and milling process models were identified. The nominal plant was defined for milling process conditions of 20-mm cutting depth, 500-rpm spindle speed, and 1-mm cutting width, and the workpiece material was aluminum. Different milling conditions can result in different milling process models, which are regarded as perturbed plants. The differences between nominal and perturbed plants were treated as system uncertainties and were applied in designing the QFT controller to ensure that robust performance could be guaranteed under various milling conditions. Instead of using force measured by a dynamometer, the robust controller adjusted feedrate according to the spindle current, which was easy to measure online. The experimental results illustrated that the cutting force could be maintained at a constant level at different cutting depths, and machining time could be reduced by over 20% compared with uncontrolled cases. The proposed controller’s robustness was validated by testing different tools, workpiece materials, and cutting parameters in different experiments.

Passive flow control of a stalled airfoil using a microcylinder

The effect of passive flow control using a microcylinder near the leading edge of a stalled airfoil (NACA 0012) at a Reynolds number of 6 × 106 is investigated through a computational study. Detailed parametric analyses for the microcylinder are carried out based on Reynolds averaged Navier-Stokes (RANS) calculations in order to determine the optimal control parameters. Computations using delayed detached eddy simulation (DDES) for the controlled and uncontrolled cases are supplemented to capture the transient vortical structures in the massive separation region and further verify the numerical results from RANS. It is found that the total aerodynamic forces of the entire system are highly sensitive to the spacing between the surfaces of the airfoil and the microcylinder. When a superior set of control parameters is adopted, significant enhancement of lift coefficient and lift-to-drag ratio can be achieved after stall, accompanying a pronounced decrease of drag coefficient. Both RANS and DDES results indicate that the heavy stall can be effectively delayed and the extent of large separation region on the airfoil suction surface can also be diminished by such a little control device. A physical analysis of the flow fields is performed to illustrate the mechanisms of flow control for the improvement of airfoil aerodynamic performance.

English

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality world-wide. Although declining globally, maternal mortality is on the rise in the United States. Since uterine balloon tamponade (UBT) has been shown to be safe as well as highly effective in arresting PPH and halting shock progression, this study sought to clarify the practice and perceptions of UBT use among midwives and family physicians in the United States. A cross-sectional 12-item survey on the practice, experiences and perceptions of uterine balloon tamponade utilization for PPH management was conducted among midwives and family physicians that perform deliveries in the United States. The survey settings were one family medicine and two midwifery national conferences in the United States. One hundred and ninety-seven midwives (164; 83.2%) and family physicians (33; 16.8%) completed the surveys. The 197 providers had previously cared for a mean of 6.0 (SD= 18.8) uncontrolled PPH cases each, over the course of their career till date. Eighty (40.6%) of the 197 respondents had been involved with at least one hemorrhaging woman in which a UBT was placed, but only 13 (7.9%) of the 164 midwives and 6 (18.2%) of the 33 family physicians had ever placed a UBT device themselves. One hundred and thirty-one (73.6%) of 178 providers desired training on use of UBT. Midwives and family physicians in the United States care for women with uncontrolled PPH, however, infrequently place a UBT device. Most midwives and family physicians would like training on uterine balloon tamponade. Key words: Uterine balloon tamponade, post-partum hemorrhage, maternal hemorrhage, emergency obstetric care.

Quality of life in children with bronchial asthma

Introduction: Bronchial asthma is one of the most common childhood diseases. It imposes significant burden on children’s health related quality of life despite the availability of effective and safe treatment. So, this study was conducted to assess the quality of life (QOL) in children with bronchial asthma and to study the impact of various clinical and socio-demographic factors on their QOL. Methods: Observational, hospital based study conducted in Pediatric chest clinic of a tertiary care teaching Hospital on children between 7-17 years of age, newly or previously diagnosed with bronchial asthma over a period of one year. Using the Pediatric Asthma Quality of Life Questionnaire (Standardized), (PAQLQ(S)) the quality of life was assessed in relation to clinical and socio-demographic data among newly diagnosed and follow-up cases of asthma. Results: Of the 90 children enrolled, 20 were newly diagnosed and 70 were follow up cases with male female ratio of 2.1: 1. Children reported more impairment in PAQLQ(S) scores if the onset of symptoms was before one year of age, in those with frequent exacerbations, poor treatment compliance, poorly controlled symptoms and Children with history of school absenteeism. The mean PAQLQ(S) score was lowest in emotional function among newly diagnosed and follow up cases. Statistically significant difference was observed between PAQLQ(S) scores of controlled, partly controlled and uncontrolled cases of asthma. Conclusion: Although children improved clinically with treatment, asthma had a significant impact on emotional status of the children.

Self-Tuning Fuzzy Control for Seismic Protection of Smart Base-Isolated Buildings Subjected to Pulse-Type Near-Fault Earthquakes

Pulse-type near-fault earthquakes have obvious long-duration pulses, so they can cause large deformation in a base-isolated system in contrast to non-pulse-type near-fault and far-field earthquakes. This paper proposes a novel self-tuning fuzzy logic control strategy for seismic protection of a base-isolated system, which can operate the control force of the piezoelectric friction damper against different types of earthquakes. This control strategy employs a hierarchic control algorithm, in which a higher-level supervisory fuzzy controller is implemented to adjust the input normalization factors and output scaling factor, while a sub-level fuzzy controller effectively determines the command voltage of the piezoelectric friction damper according to current level of earthquakes. The efficiency of the proposed control strategy is also compared with uncontrolled and maximum passive cases. Numerical results reveal that the novel fuzzy logic control strategy can effectively reduce the isolation system deformations without the loss of potential advantages of base-isolated system.

Cholesterol levels of Japanese dyslipidaemic patients with various comorbidities: BioBank Japan.

BackgroundControlling serum cholesterol is critical to prevent cardiovascular disease in patients with dyslipidaemia. Guidelines emphasise the need to select treatment for dyslipidaemia based on specific patient profiles; however, there is little information about the serum cholesterol levels of patients in each profile in Japan. Therefore, we aimed to describe the serum cholesterol levels and prevalence of uncontrolled cases in Japanese patients with dyslipidaemia.MethodsWe included data for patients with dyslipidaemia between 2003 and 2007 from the BioBank Japan Project (66 hospitals). Then, we reported their serum cholesterol levels by age, body mass index, glycaemic control (glycated haemoglobin A1c), blood pressure, smoking, drinking, comorbidity and medication profiles.ResultsWe included 22,189 male and 21,545 female patients. The mean serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) and non-HDL-C levels in males were 117.4 mg/dL, 51.0 mg/dL, 187.6 mg/dL and 153.6 mg/dL, respectively; the corresponding levels in females were 129.5 mg/dL, 60.5 mg/dL, 144.9 mg/dL and 157.9 mg/dL, respectively. In both males and females, the LDL-C levels were the highest in the following profiles: age 19–44 years, body mass index 18.5–22 kg/m2, glycated haemoglobin A1c <6.0%, never smoker, chronic respiratory disease as a comorbidity and no medication use.ConclusionsThese data provide details of serum cholesterol levels by risk-factor profile in patients with dyslipidaemia and could add evidence of treatment decisions.

LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED?

To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Comparative Study of Smart Base-Isolation Using Fuzzy Control and Neural Network

The paper presents seismic response of a five story building equipped with smart base-isolation system using Lead rubber bearing (N-Z) and MR-damper placed in between foundation and base of the building. Five types of building viz. fixed base building, base isolated building without MR damper, base isolated building with MR damper in passive off/on mode, and base isolated building with MR damper driven by Fuzzy logic controller, base isolated building with MR damper driven by Neural network are studied. The peak base displacement and top floor absolute acceleration for controlled and uncontrolled cases are evaluated for past four earthquake ground motion history. The result of the study shows that the ANN is found to be effective in reducing mean peak isolator displacement relative to the FLC and FLC is found to be effective in reducing normalized mean peak top floor absolute acceleration relative to the ANN.

Microbial Etiology of Bacteremia in Controlled and Uncontrolled Type-2 Diabetes in Eastern Part of India

Bacteremia in Type 2 Diabetes (T2D) is the most serious public health issue. Very limited information is available in this aspect with reference to complications. We hypothesized that abnormal increase in blood sugar levels may result in different bacterial infection associated with different categories of complications. Therefore, the aim of the present study was to evaluate and investigate the possible causes of bacteremia in T2D patients and its related complications in eastern region of the country where the data is unavailable to the best of our knowledge. The study included a total of 244 established T2D patients and 20 healthy controls in and around Bhubaneswar region, Odisha. Staging of T2D was done as per standard criteria into controlled and uncontrolled T2D. Blood samples were collected from all subjects including healthy controls and culture was done for bacterial isolation, identification. Prevalence of bacteremia was more among the uncontrolled cases (70.1%) than the controlled ones (29.8%) compared to healthy controls with p<0.0001. Occurrence of both gram positive and gram negative bacteria were found which comprised of Staphylococcus sp., Streptococcus, Bacilli, E. coli, Klebsiella. These groups of bacteria were thought as the causes of T2D complications. Eastern region of India being called as sweet region have a great affinity towards food and entertainment. So, we expect a higher intensity of sugar level in their blood and culture which often remains undiagnosed and develop to complications. Therefore, in our results we evaluated a strong connection of hyperglycemia with bacteremia providing a key for good empiric treatment in such high risk population.

Registry Study for Type 2 Diabetes Mellitus in a Diabetic Center in Saudi Arabia with Comparative Analysis for Controlled Versus Uncontrolled Cases

Registry Study for Type 2 Diabetes Mellitus in a Diabetic Center in Saudi Arabia with Comparative Analysis for Controlled Versus Uncontrolled Cases

Mitigation of the seismic response of multi-span bridges using MR dampers: Experimental study of a new SMC-based controller

Pounding between adjacent structures has been a concern in multi-span bridges in recent earthquakes. In this paper, a pounding mitigation strategy using magnetorheological dampers is proposed, and its performance is tested for a three-span bridge using a series of shake-table experiments. A new semi-active control algorithm called SMC-OPC is developed that is based on a clipped sliding mode control (SMC) with sliding surfaces designed using an optimal polynomial control (OPC) approach. The control design uses a stochastically linearized model of the nonlinear bridge with passive components of the magnetorheological dampers embedded to achieve a more representative system characterization. Optimal weighting matrices for the optimal polynomial control are found through a genetic algorithm. The proposed method along with uncontrolled, passive-off, and passive-on cases are tested on shake-tables for several scaled near-field Kobe ground motion records. Although no pounding is observed in all control cases for small earthquakes, significant pounding occurs in the uncontrolled and passive-off systems under large earthquakes. For these ground motions, the performance of the semi-active controller converges to that of the passive-on case but with noticeably reduced power consumption. The study shows that the use of magnetorheological dampers between adjacent spans is very effective in mitigating critical bridge responses especially under large earthquakes. In addition, the proposed SMC-OPC semi-active control strategy enables achieving balance among multiple performance objectives with significantly reduced power consumption as compared to passive-on case.