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Dengue is an acute arboviral infection common in tropical and subtropical countries. Dengue has been highlighted as a public health concern in the last five decades, affecting almost 50% of the population in developing nations. Dengue infection results in a complex symptomatic disease that ranges from headache, fever, and skin rash to extreme hemorrhage fever and liver dysfunction. The diagnosis of the disease is essential for effective treatment. The early onset of the infection can be detected through viral structural peptides that act as markers for detection, including Pre-Membrane (Pre-M) protein. In the currently proposed research, the structural gene obtained from local isolates was targeted for studies. For this purpose, recombinant structural protein Pre-M was amplified, cloned, and expressed in the bacterial expression system. The expression of the structural protein (Pre-M) was scrutinized by Sodium Dodecyl Sulphate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) and validated by western blot and dot blot, and afterwards, the antigen was purified. The purified Pre-M protein carries the potential for the development of in-house diagnostic assay as well as for vaccine production. This study aimed to develop a highly specific, sensitive, and cost-effective in-house enzyme-linked immunoassay (ELISA) for the detection of antibodies of Pakistani most prevalent dengue virus serotype 2 (DENV-2). The success of this research would also pave the way toward developing novel vaccines for the future prevention of dengue infection.

Background Earlier studies have shown disparate cardiovascular care in homeless patients. Limited data exist on burden of infective endocarditis (IE) in homeless patients and in this study, we aimed to analyze it using a nationally representative United States population sample. Methods Data were extracted from National Inpatient Sample database from January 2000 to December 2017. Patients with endocarditis were sampled using International Classification of Diseases, 9th Revision, Clinical Modification codes of 421.0, 421.1 or 421.9 and International Classification of Diseases, 10th Revision, Clinical Modification codes of I33.0 or I33.9. Homeless patients were identified using codes of V60 and Z59. Linear regression was used for trend analysis and logistic regression was utilized to identify predictors of mortality. 1:1 propensity score (PS) matching was also done to balance confounders and outcomes were assessed in both unmatched and matched cohorts. Results We found an increase in proportion of homeless patients admitted with endocarditis from 0.2% in year 2000 to 2.4% in year 2017. Mortality was not statistically significant in PS matched homeless and non-homeless cohorts (4.7% vs 6.6%, p = 0.072). There was a trend towards increased mortality in homeless endocarditis patients over our study years with lower utilization of valvular surgeries. Advanced age, alcohol abuse and admission to large hospitals were independently associated with mortality in homeless endocarditis patients. Conclusion Homeless patients have rising trend of IE and IE related mortality and also found to have low utilization of life saving valvular surgeries when compared to general population.

Background Adherence to ADHD medication is a complex phenomenon as the decision to adhere is influenced by a range of factors. To design tailored interventions to promote adherence, it is important to understand the factors that influence adherence in the context of its three phases: initiation, implementation and discontinuation. Objective The objective of this study was to explore the phase‐specific factors that influence adherence to medication in adults who have a diagnosis of ADHD. Methods Three focus groups (FGs) were conducted with twenty adults with ADHD in different metropolitan areas of Sydney, Australia. FGs were transcribed verbatim and thematically analysed. Results Participants’ decision to initiate medication (the initiation phase) was influenced by their perceived needs (desire to improve academic and social functioning) and concerns (fear of side‐effects) about medication following a similar process as defined by the Necessity‐Concerns Framework (NCF). The balance between benefits of medication (needs) and side‐effects (concerns) continued to determine participants’ daily medication‐taking (the implementation phase) and persistence (or discontinuation) with their medication. Forgetfulness and stigma were reported as concerns negatively impacting the implementation phase, while medication cost and dependence influenced the discontinuation phase of adherence. Conclusions Adults’ decision to initiate, continue or discontinue medication is influenced by a range of factors; some are unique to each phase while some are common across the phases. Participants balanced the needs for the medication against their concerns in determining whether to adhere to medication at each phase. It appears that the NCF has applicability when decision making about medication is explored at the three phases of adherence.

Purpose: End stage renal disease (ESRD) is a well-recognized risk factor for development of sudden cardiac arrest (SCA). There is limited data on baseline characteristics and outcomes after an in-hospital SCA event in ESRD patients. Methods: For the purpose of this study, data were obtained from National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using International Classification of Disease, 9th Revision, Clinical Modification and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63 and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Baseline characteristics and outcomes were compared among ESRD and non-ESRD patients in crude and propensity matched (PS) cohorts. Predictors of mortality in ESRD patients after an in-hospital SCA event were analyzed using a multivariate logistic regression model. Results: A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS matched cohort (70.4% vs. 70.7%, p = 0.45) with an overall downward trend over our study years. Advanced age, Black race and key co-morbidities independently predicted increased mortality while prior implantable defibrillator was associated with decreased mortality in ESRD patients after an in-hospital SCA event. Conclusion: In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients.

The social restrictions amid coronavirus disease 2019 (COVID-19) pandemic have posed a serious threat to mental health and have implications in the use of medications for mental health including antidepressants (ADs). This study investigated the trends in prescriptions and costs of various ADs in England during COVID-19 pandemic. National prescribing rates and net ingredient costs (NIC) of all ADs prescriptions during 2016 to 2020 were analyed. The total number of ADs prescriptions dispensed during COVID-19 pandemic (January to December 2020) were 78 million, 4 million more than in 2019 that costed NHS England £ 139 million more than in 2019. Sertraline, an SSRI antidepressant drug, alone accounted for an extra £113 million during 2020 than in 2019. The peak dispensing for ADs was observed in March 2020 while the total costs for AD drugs peaked in April 2020. The rising prescription costs for ADs during COVID-19 pandemic is a potential cause of concern, in particular the increasing use in adolescents and younger adults needs attention, who are at a higher risk of life-threatening adverse drug reactions. Supplementary Information The online version contains supplementary material available at 10.1007/s40199-021-00390-z.

Objective: We investigated the prescription trends and adverse drug reactions (ADRs) of ADHD drugs in primary care, England between 2010 and 2019. Methods: The Prescription Cost Analysis database presenting the primary care prescriptions data and the Interactive Drug Analysis Profiles presenting all suspected ADRs reported for each drug were screened. The data were analyzed using linear regression analysis to examine the annual average change per year. Results: The prescription items dispensed for ADHD showed an average 11.07% (95% CI 10.54–11.60, p = .001) increase per year and there was a mean 11.54% (95% CI 11.03–12.06, p = .001) increase per year in the costs. The overall reporting of serious and fatal ADR was reduced by 1.79% per year for ADHD drugs. Guanfacine showed a 40% mean increase per year. Conclusion: The increasing use of ADHD drugs within primary care in England could be a result of multiple factors such as growing ADHD prevalence.

In bone tissue engineering, multifunctional composite materials are very challenging. Bone tissue engineering is an innovative technique to develop biocompatible scaffolds with suitable orthopedic applications with enhanced antibacterial and mechanical properties. This research introduces a polymeric nanocomposite scaffold based on arabinoxylan-co-acrylic acid, nano-hydroxyapatite (nHAp), nano-aluminum oxide (nAl2O3), and graphene oxide (GO) by free-radical polymerization for the development of porous scaffolds using the freeze-drying technique. These polymeric nanocomposite scaffolds were coated with silver (Ag) nanoparticles to improve antibacterial activities. Together, nHAp, nAl2O3, and GO enhance the multifunctional properties of materials, which regulate their physicochemical and biomechanical properties. Results revealed that the Ag-coated polymeric nanocomposite scaffolds had excellent antibacterial properties and better microstructural properties. Regulated morphological properties and maximal antibacterial inhibition zones were found in the porous scaffolds with the increasing amount of GO. Moreover, the nanosystem and the polymeric matrix have improved the compressive strength (18.89 MPa) and Young's modulus (198.61 MPa) of scaffolds upon increasing the amount of GO. The biological activities of the scaffolds were investigated against the mouse preosteoblast cell lines (MC3T3-E1) and increasing the quantities of GO helps cell adherence and proliferation. Therefore, our findings showed that these silver-coated polymeric nanocomposite scaffolds have the potential for engineering bone tissue.

BackgroundCardiovascular disease is the major cause of mortality in end stage renal disease (ESRD) patients on dialysis and myocardial infarction constitutes almost 20% of such deaths. We assessed the trends, characteristics and in-hospital outcomes in patients with ESRD.MethodsWe used national inpatient sample (NIS) to identify patients with ESRD presenting with ST-segment elevation myocardial infarction (STEMI) for calendar years 2012-2016. Multiple logistic regression analysis and propensity matched data was used to compare outcomes for the purpose of our study.ResultsPatients on dialysis who presented with STEMI were less likely to be treated with emergent reperfusion therapies including percutaneous coronary intervention, bypass graft surgery and thrombolytics with in first 24h. In propensity-matched cohort, the mortality was nearly double in patients who have ESRD compared to patients without ESRD (29.7% vs. 15.9%, p&nbsp

Background The safety and efficacy of aspirin for the primary prevention of cardiovascular disease in patients with diabetes mellitus remains controversial. Design A meta-analysis to investigate the effects of aspirin for the prevention of cardiovascular disease in diabetes mellitus. Methods Ten randomized controlled trials were selected using MEDLINE, EMBASE and CENTRAL databases until 27 September 2018. Risk ratios (RRs) with 95% confidence intervals (CIs) and risk differences (RDs) reported as incident events per 1000 person-years were calculated. Results In 33,679 patients, aspirin did not significantly reduce the risk of major adverse cardiovascular outcomes (RR 0.93, 95% CI 0.87–1.00, P = 0.06; RD −0.68 incident cases per 1000 person-years (95% CI −1.54, 0.17)), cardiovascular mortality (RR 0.95, 95% CI 0.83–1.09, P = 0.49; RD 0.11 incident cases per 1000 person-years (95% CI −0.80, 1.02)), myocardial infarction (RR 0.91, 95% CI 0.75–1.11, P = 0.36; RD −0.66 incident cases per 1000 person-years (95% CI −2.07, 0.75)), or stroke (RR 0.91, 95% C, 0.76–1.10, P = 0.33; RD −0.55 incident cases per 1000 person-years (95% CI −1.57, 0.47)). There was a significantly higher risk of total bleeding associated with aspirin (RR 1.29, 95% CI 1.07–1.55, P = 0.01; RD 1.49 incident cases per 1000 person-years (95% CI 0.36, 2.61)). Conclusion The use of aspirin for primary prevention of cardiovascular disease in patients with diabetes mellitus increases the risk of total bleeding without reducing the risk of major adverse cardiovascular outcomes.

Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents remains uncertain. We compared short-term (12-month) DAPT after percutaneous coronary intervention with drug-eluting stents. Methods: Twenty-four randomized, controlled trials were selected using Medline, Embase, Cochrane library, and online databases through September 2019. The coprimary end points were myocardial infarction and major bleeding, which constituted the net clinical benefit. A frequentist network meta-analysis was conducted with a random-effects model. Results: In 79 073 patients, at a median follow-up of 18 months, extended-term DAPT was associated with a reduced risk of myocardial infarction in comparison with 12-month DAPT (absolute risk difference, –3.8 incident cases per 1000 person-years; relative risk, 0.68 [95% CI, 0.54–0.87]), midterm DAPT (absolute risk difference, –4.6 incident cases per 1000 person-years; relative risk, 0.61 [0.45–0.83]), and short-term DAPT followed by aspirin monotherapy (absolute risk difference, –6.1 incident cases per 1000 person-years; relative risk, 0.55 [0.37–0.83]), or P2Y12 inhibitor monotherapy (absolute risk difference, –3.7 incident cases per 1000 person-years; relative risk, 0.69 [0.51–0.95]). Conversely, extended-term DAPT was associated with a higher risk of major bleeding than all other DAPT groups. In comparison with 12-month DAPT, no significant differences in the risks of ischemic end points or major bleeding were observed with midterm or short-term DAPT followed by aspirin monotherapy, with the exception that short-term DAPT followed by P2Y12 inhibitor monotherapy was associated with a reduced risk of major bleeding. There were no significant differences with respect to mortality between the different DAPT strategies. In acute coronary syndrome, extended-term in comparison with 12-month DAPT was associated with a reduced risk of myocardial infarction without a significant increase in the risk of major bleeding. Conclusions: The present network meta-analysis suggests that, in comparison with 12-month DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy reduces major bleeding after percutaneous coronary intervention with drug-eluting stents, whereas extended-term DAPT reduces myocardial infarction at the expense of more bleeding events.

Theory can play an important role in providing the framework, and underpinning the design and implementation of interventions to improve medication adherence. Interventions that are grounded in a theory are relatively more effective in improving medication adherence than interventions which do not have a theoretical support. However, a large body of adherence research does not appear to be linked to any theory or model, which therefore may have resulted in interventions that are either ineffective or not sustainable. Interventions that are based on theory have mainly employed socio-behavioural models to explain, and design interventions to address, the complex phenomenon of adherence. Yet, the effectiveness of these interventions is inconclusive, supporting the argument that socio-behavioural models alone have limited applicability in explaining behaviour associated with medication-taking. An important reason for this limitation may be the complex and dynamic nature of adherence. There is a need to include a wide variety of factors in a model and examine adherence in the context of its three phases (initiation, implementation, and discontinuation). One possible way forward is to also examine medication-taking behaviour from an economic perspective, for example, by using a discrete choice experiment (DCE), which provides a different approach to understanding human behaviour about medication-taking and the complexities of decision-making in adhering to medication. DCEs can help in understanding how patients decide to initiate, continue or discontinue taking medication, factors that influence their decision, and the relative importance of those factors, which can assist researchers to prioritise interventions to improve medication adherence. Integration of multiple theories is needed to examine adherence from multiple perspectives and design interventions that are effective and sustainable. This commentary focusses on the pros and cons of some of the commonly used socio-behavioural models in adherence research and suggests a way forward by incorporating DCEs in adherence research.

OBJECTIVE To assess contemporary national trends of comorbidities, outcomes, and health care resource utilization in patients with aortic stenosis (AS) and end-stage renal disease (ESRD) undergoing transcatheter and surgical aortic valve replacement (TAVR and SAVR). METHODS AND RESULTS The National-Inpatient-Sample was used to study trends in patients with AS and ESRD undergoing TAVR and SAVR between January 2012 and December 2017. Of 12,550 patients, 5,735 underwent TAVR and 6,815 underwent SAVR. Over the years, the utilization of SAVR declined (from 82.0 to 37.7%); and increased for TAVR (from 18.0 to 62.3%; p

INTRODUCTION: Retrospective studies have shown conflicting benefit of utilizing targeted temperature management (TTM) in cardiac arrest (CA) patients with a non-shockable rhythm and presently there is only one randomized trial in this realm. We sought to determine trends and outcomes of TTM utilization in these patients from a large nationally representative United States population database. METHODS AND RESULTS: Data were derived from National Inpatient Sample (NIS) from January 2006 to December 2013. All patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Patients with evidence of shockable rhythm (ventricular tachycardia, ventricular flutter and ventricular fibrillation) were excluded. Trends in TTM utilization and mortality were assessed over our study period. Various outcomes were measured in patients receiving TTM and no TTM in unmatched and propensity matched cohorts. Logistic regression analysis was done to determine predictors of mortality. A total of 1,185,479 CA patients were identified in whom cause of arrest was a non-shockable rhythm. Overall, there was a steady increase in TTM utilization over our study period. In propensity-matched groups, mortality was higher in patients in whom TTM was utilized compared to non-TTM group (72.9% vs 68.7%, P < .01). In adjusted analysis, TTM remains an independent predictor of increased mortality in our group. Mortality remained high with TTM utilization regardless of location of CA. CONCLUSIONS: TTM utilization was associated with increased mortality in CA patients with a non-shockable rhythm. These findings merit further confirmation in a large randomized trial before application into clinical practice.

Arabinoxylan (AX) is a natural biological macromolecule with several potential biomedical applications. In this research, AX, nano-hydroxyapatite (n-HAp) and titanium dioxide (TiO2) based polymeric nanocomposite scaffolds were fabricated by the freeze-drying method. The physicochemical characterizations of these polymeric nanocomposite scaffolds were performed for surface morphology, porosity, swelling, biodegradability, mechanical, and biological properties. The scaffolds exhibited good porosity and rough surface morphology, which were efficiently controlled by TiO2 concentrations. MC3T3-E1 cells were employed to conduct the biocompatibility of these scaffolds. Scaffolds showed unique biocompatibility in vitro and was favorable for cell attachment and growth. PNS3 proved more biocompatible, showed interconnected porosity and substantial mechanical strength compared to PNS1, PNS2 and PNS4. Furthermore, it has also showed more affinity to cells and cell growth. The results illustrated that the bioactive nanocomposite scaffold has the potential to find applications in the tissue engineering field.

Introduction: In patient undergoing transcatheter aortic valve implantation (TAVI), stroke remains a potentially devastating complication associated with significant morbidity and mortality. Hypothesis: To reduce the risk of stroke, cerebral protection devices (CPD) were developed to prevent debris from embolizing to the brain during TAVI.The data on the safety and efficacy of cerebral protection devices (CPD) remains limited. Methods: We performed a systemic review and meta-analysis to determine the safety and efficacy of CPD in TAVI. The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with various combinations of medical subject headings to identify relevant articles. Statistical analysis was performed using a random-effects model to calculate unadjusted odds ratio (OR). Results: Using a pooled analysis, CPD was associated with a significant reduction in major adverse cardiovascular events (MACE) (OR 0.69, 95% CI 0.50-0.96, p=0.03) and stroke (OR 0.61, 95% CI 0.42-0.90, p=0.08) in patients undergoing TAVI. Similarly, on MRI volume per lesion were lower for patients with CPD use (SMD -0.79 [-1.30,-0.28], p Conclusions: In conclusion, CPD device use in TAVI is associated with a reduction of MACE and stroke compared with patients undergoing TAVI without CPD.

Introduction: Contemporary data on the outcomes after Transcatheter Aortic Valve Implantation (TAVI) in patients with a baseline right bundle branch block (RBBB) remains limited. Methods: We analyzed National Inpatient Sample (NIS) data from the year 2011 to 2018. Results: Of the patients who underwent TAVI, 3472 (1.6%) had baseline right bundle branch block and 212467 (98.4%) did not. The patients who had baseline RBBB were older at 83 years [Interquartile range (IQR), 77-87] vs 82 [75-87]) and had higher male gender representation (66.7 % vs 52.2%) (p Conclusions: In conclusion we report that RBBB is associated with increased pacemaker implantation after TAVI. Factors like age greater than 75, male gender, coronary artery disease, diabetes, hypertension, obesity, and renal failure are associated with higher incidence of PPM implantation.

Introduction: Data on outcomes of transcatheter mitral valve repair (TMVR) in patients with acute kidney injury (AKI) remains limited. Hypothesis: AKI is associated with worse outcomes in patients undergoing TMVR Methods: We utilized the United States National Inpatient Sample database from the year 2015 to 2018 to evaluate outcomes of TMVR in AKI. Results: A total of 21,505 weighted hospitalizations were included in the analysis. Of the patients who underwent TMVR 3350 (15.6%) developed acute kidney injury. The mean age of patients undergoing TMVR was higher for patients with AKI compared to patients who did not develop AKI was 77 and 76 years respectively. A logistic regression model adjusted for age, gender and baseline comorbidities was developed for predictors of AKI. On adjusted comparison liver disease (OR 2.4 95% CI, 2-2.9), peripheral vascular disease (1.35, 95% CI 1.2-1.53), congestive heart failure (2.76 95% CI, 2.34-3.26) and history of weight loss (1.92 95% CI 1.64-2.25) were significant predictors of AKI. In-hospital mortality was higher for patients with AKI versus no AKI (10.1% vs. 0.7%, p Conclusions: AKI is associated with increased in hospital mortality and increased health care resource utilization in patients undergoing TMVR.

Introduction: Data on outcomes and predictors of gastrointestinal (GI) bleeding in patients undergoing percutaneous mitral valve repair (PMVR) remains limited. Hypothesis: GI bleed is associated with worse outcomes in patients undergoing PMVR Methods: We utilized the national inpatient sample data from the year 2015 to 2018 to evaluate outcomes and predictors of GI bleed in patients undergoing PMVR. Results: A total of 21,505 weighted hospitalizations were included in the analysis. Of the patients who underwent PMVR, 285 (1.3%) developed GI bleed whereas 21220 (98.7%) did not have in-hospital GI bleed event. The mean age of patient with and without GI bleed was 77 and 76 years respectively (P Conclusions: In conclusion we report that GI bleed is associated with higher in-hospital mortality and resource utilization in patients undergoing PMVR.

BackgroundOutcomes data on the use of cerebral embolic protection devices (CPDs) with transcatheter aortic valve replacement (TAVR) remain limited. Previous randomized trials were underpowered for primary outcomes of stroke prevention and mortality.MethodsThe National Inpatient Sample and Nationwide Readmissions Database were queried from 2017 to 2018 to study utilization and inpatient mortality, neurological complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack), procedural complications, resource utilization, and 30-day readmissions with and without use of CPD. A 1:3 ratio propensity score matched model was created.ResultsAmong 108,315 weighted encounters, CPD was used in 4380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs. 0.5%, p

This work presents a new technique for enhancing the performance of a multiple-input multiple-output (MIMO) antenna by improving its correlation coefficient ρ. A broadband dielectric structure is designed using the transformation electromagnetics (TE) concept to decorrelate the fields of closely placed radiating elements of an MIMO antenna, thereby decreasing ρ and mutual coupling. The desired properties of the broadband dielectric wave tilting structure (DWTS) are determined by using quasi-conformal transformation electromagnetics (QCTE). Next, the permittivity profile of the DWTS is realized by employing air-hole technology, which is based on the effective medium theory, and the DWTS is fabricated using the additive manufacturing (3D printing) technique. The effectiveness of the proposed technique is verified by designing two-element patch-based MIMO antenna prototypes operating at 3 GHz, 5 GHz, and 7 GHz, respectively. The proposed technique helped to reduce the correlation coefficient ρ in the range of 37% to 99% in the respective operating bandwidth of each MIMO antenna, thereby, in each case, improving the isolation between antenna elements by better than 3 dB, which is an excellent performance.

Background The decision to initiate medication is complex and is influenced by a variety of factors. There is limited information on the relative importance of factors that influence the initiation of ADHD medication. Aims To investigate the factors, and their relative importance, that influence the decision to initiate medication in adults, and parents of children, with ADHD. Methods A discrete choice experiment was conducted using eight choice tasks made up of five attributes that described the outcomes of initiating medication. A mixed multinomial logit model was used to estimate preferences for medication. Results Respondents' overall preferences for initiating medication were negative (Mean (β)= -0.72705, p Conclusions Important differences in preferences of patients and parents were identified, highlighting that the decision to initiate medication is influenced differently in different individuals and groups.

Background Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy. Methods We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p Results Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value Conclusion Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated. Funding Acknowledgement Type of funding sources: None.

The treatment of successive skin wounds necessitates meticulous medical procedures. In the care and treatment of skin wounds, hydrogels produced from natural polymers with controlled drug release play a crucial role. Arabinoxylan is a well-known and widely available biological macromolecule. We produced various formulations of blended composite hydrogels (BCHs) from arabinoxylan (ARX), carrageenan (CG), and reduced graphene oxide (rGO) using and cross-linked them with an optimal amount of tetraethyl orthosilicate (TEOS). The structural, morphological, and mechanical behavior of the BCHs samples were determined using Fourier-transform infrared spectroscopy (FT-IR), Scanning electron microscope (SEM), mechanical testing, and wetting, respectively. The swelling and degradation assays were performed in phosphate-buffered saline (PBS) solution and aqueous media. Maximum swelling was observed at pH 7 and the least swelling in basic pH regions. All composite hydrogels were found to be hemocompatible. In vitro, silver sulfadiazine release profile in PBS solution was analyzed via the Franz diffusion method, and maximum drug release (87.9%) was observed in 48 h. The drug release kinetics was studied against different mathematical models (zero-order, first-order, Higuchi, Hixson–Crowell, Korsmeyer–Peppas, and Baker–Lonsdale models) and compared their regression coefficient (R2) values. It was observed that drug release follows the Baker–Lonsdale model, as it has the highest value (0.989) of R2. Hence, the obtained results indicated that, due to optimized swelling, wetting, and degradation, the blended composite hydrogel BCH-3 could be an essential wound dressing biomaterial for sustained drug release for skin wound care and treatment.

The classical printed monopole antenna exhibits wideband operation with low gain and an omnidirectional radiation pattern. In order to boost the gain of the antenna at two frequency bands, a novel ...

In this work, a 2-layer frequency reconfigurable Yagi-like multiple-input–multiple-output (MIMO) antenna system is proposed based on a closed pentagonal slot-loop excitation. The MIMO system consists of 4 identical active antenna elements reactively loaded with varactor diodes to achieve frequency reconfigurability over a band from 1.5 to 2.1 GHz. The distinguishing feature of the proposed work is achieving Yagi-like directional characteristics over a very wide frequency band. The conventional omni-directional pattern of a slot antenna is made directional by using a parasitic metallic reflector layer below the substrate. By using the reflector element, the back-lobe radiation is highly suppressed and a front-to-back ratio of 5–13 dB is achieved within the entire frequency band of operation. The proposed design is compact with an overall size of 100 × 100 × 20 mm 3 , and a reflector size of 110 × 110 mm 2 . A single element has a maximum peak gain of 4 dBi and total measured radiation efficiency of 76%. The antenna system also shows good MIMO performance with high port isolation of 11.3 dB and very low envelope correlation coefficient values within the operational band.

Background Adherence to prescribed medication is a dynamic process that changes over time. Whilst several measures have been used to examine adherence in patients with ADHD, it is not clear how these measures have been used to measure adherence in the context of its three phases (initiation, implementation, discontinuation). Objective To examine measures used to assess medication adherence at its three phases in people with ADHD. Methods The PRISMA guidelines were followed for this review. Six databases (Medline, PubMed, IPA, CINAHL, Embase, and PsycINFO) were systematically searched in October 2018, without any limitations on the start dates. Keywords reflecting three broad concepts (adherence, ADHD and measures) were used as part of the search strategy. Studies that assessed medication adherence in people with ADHD and described methods used to assess adherence were selected for this review. Results Forty-nine studies were included. Most (69.3%) examined adherence at the implementation phase. Claims databases, self-reported questionnaires, and prescription-refill records were used to measure adherence at the initiation, implementation, and discontinuation phase, respectively. Overall, self-reported questionnaires were the most frequently used measure at the implementation phase, but the psychometric properties were not reported in almost half of the studies that used these measures. Conclusions Initiation and discontinuation phases of adherence have been relatively less examined in people with ADHD. Although self-reported questionnaires were the commonly used measures, the validity and reliability of these measures are of concern in guiding evidence-based practice. Measures with improved psychometric properties are needed that can examine adherence across its three phases.

The impact of body mass index (BMI) on cardiovascular outcomes in patients receiving intensive low-density lipoprotein cholesterol (LDL-C) lowering therapy is uncertain. We performed meta-analysis of 29 randomized controlled trials using PubMed, Embase, and CENTRAL through April 2019. Therapies were grouped as more intensive LDL-C lowering therapy (statins, ezetimibe + statin or PCSK9 inhibitors) and less intensive LDL-C lowering therapy (less potent active control or placebo). Random effects meta-regressions and meta-analyses were performed to evaluate association of BMI with cardiovascular endpoints. In 265,766 patients, for every 1 kg/m(2) increase in BMI, more intensive therapy compared with less intensive therapy was associated with hazard ratio (HR) of 1.07 for cardiovascular mortality (95% confidence interval 1.02 to 1.13); HR of 1.03 for all-cause mortality (0.99 to 1.06) HR of 1.06 for myocardial infarction (1.02 to 1.09), HR of 1.08 (1.03 to 1.12) for revascularization and HR of 1.04 for MACE (1.01 to 1.07). Meta-analysis showed that patients with BMI