Maintenance intravenous fluid therapy in infants with sepsis and hyponatremia: a clinical trial.

BACKGROUND: This study aimed to compare the effect of two methods of maintenance intravenous fluid therapy on hyponatremia in hospitalized infants with sepsis. METHODS: In a double-blinded randomized clinical trial, 60 term infants with sepsis were enrolled. Blood samples were taken to determine sodium, potassium, Creatinine, and BUN levels before the initiation of treatment. Urine samples were taken to assess specific gravity and urinary output. Infants in the intervention group received half saline in 10% dextrose and infants in the control group were assigned to receive the conventional solution as maintenance. The above indicators were re-evaluated 24 and 48 h after the initiation of treatment. Two groups were compared concerning the incidence of hyponatremia, and other criteria such as urinary output and urinary specific gravity, blood urea nitrogen (BUN), and creatinine levels. RESULTS: Hyponatremia was more common in the control group. Sodium levels were significantly higher in half saline recipients 24 h (137.83 ± 2.86 vs. 134.37 ± 1.91 mmol/L), and 48 h (138.10 ± 2.41 vs. 133.66 ± 1.98 mmol/L) after treatment (P < 0.001). Although BUN in the intervention group was significantly higher in comparison to the control group, the difference in urinary output, urine specific gravity, potassium, and Creatinine levels were not significant in the two groups. CONCLUSIONS: The use of a half-saline solution as maintenance fluid reduces the risk of hyponatremia after 48 h when compared to 0.18%NaCl. TRIAL REGISTRATION: This has been registered at Iranian Registry of Clinical Trials (Retrospectively registered, Registration date: 2017-10-12, identifier: IRCT2017053034223N1, https://irct.behdasht.gov.ir/trial/26204 ).

Safety and Efficacy of 2.5 mg and 1.25 mg Nebulized Salbutamol Compared with Placebo on Transient Tachypnea of the Newborns: A Triple-Blind Phase II/III Parallel Randomized Controlled Trial.

Background: To evaluate the safety and efficacy of 2.5 and 1.25 mg nebulized salbutamol on Transient Tachypnea of the Newborn (TTN) compared with placebo. Methods: We conducted a triple-blind, phase II/III parallel randomized controlled trial in two university-affiliated hospitals with neonatal intensive care units. Newborns with a confirmed diagnosis of TTN, with gestational age >35 weeks and gestational weight >2 kg were included. Cases of asphyxia, meconium aspiration syndrome, and persistent pulmonary hypertension were excluded. Ninety eligible patients were randomly allocated in three intervention groups (2.5 mg salbutamol, 1.25 mg salbutamol, and placebo), and a single-dose nebulized product was prescribed 6 hours after the birth. Safety outcomes included postintervention tachycardia, hyperglycemia, hypokalemia, and changes in blood pressure. To evaluate the efficacy, the duration of postintervention tachypnea, TTN clinical score, and clinical and paraclinical respiratory indices were assessed. Parents, Outcome assessors, and data analyzer were blind to the intervention. Results: There was no adverse reaction, including tachycardia, hypokalemia, and jitteriness. Both groups of salbutamol recipients showed significant improvement regarding respiratory rate, TTN clinical score, and oxygenation indices compared with the placebo (p-values <0.001). Nonstatistically significant higher hospital stay was observed in the placebo group. Single 2.5 mg salbutamol nebulization showed a little better outcome than the dose of 1.25 mg, although we could not find statistical superiority. Conclusion: The newly applied single high dose of 2.5 mg nebulized salbutamol is safe in treating TTN and leads to notable faster improvement of respiratory status without any considerable adverse reaction. Registry code: IRCT20190328043133N1.

Comparison of prematurity-related outcomes and complications in very low birth weight (VLBW) neonates fed with mother`s own milk versus donor milk: a comparative study.

BACKGROUND: When mother`s own milk (MOM) is unavailable or insufficient, donor milk (DM) from a human milk bank serves as an alternative feeding option. Our study sought to investigate and compare the outcomes and complications of very low birth weight (VLBW) preterm infants who receive MOM versus DM. METHODS: In this retrospective cohort study conducted between 2018 and 2022, we compared 70 VLBW preterm infants exclusively fed with DM to 70 randomly selected counterparts fed with MOM. Both groups began enteral feeding within 72 hours of birth. Various clinical outcomes were investigated during a three-month follow-up. The clinical outcomes were compared via independent t-tests, Mann-Whitney U, and Fisher`s exact test. RESULTS: The mean gestational age of the infants who were included was 29.6 ± 1.6 weeks, 84 (60%) were males, and the average birth weight was 1217 ± 151 grams. Both groups had similar baseline characteristics. The results of the study demonstrated no statistically significant differences between the groups in terms of hospital length of stay (37±16.3 days in MOM vs 40.3±16.9 days in DM group, P= 0.17), growth rate (13±4 gram/day in MOM vs 13±4 gram/day in DM group, P=0.51), growth velocity (9.8±3.0g/kg/d in MOM vs 9.5±3.2 g/kg/d in DM group), infants with in-hospital vomiting (51 cases in MOM vs 59 cases in DM group, P=0.15),vomiting frequency (1.3±1.1 times in MOM vs 1.5±1.0 times in DM group), incidence of retinopathy of prematurity (ROP) (4 cases in MOM vs 5 cases in DM group, P > 0.999) and incidence of bronchopulmonary dysplasia (BPD) (7 cases in MOM vs 6 cases in DM group, P > 0.999). CONCLUSION: Our study findings indicate that the utilization of DM didn`t have a substantial negative impact on infants` outcomes nor any complications in comparison with MOM.

The Effect of Birth Hour on Neonatal Morbidity and Mortality in Very-Low Birth Weight Infants in a Teaching Hospital.

OBJECTIVE: With the increase in the preterm birth rate, the factors influencing mortality and morbidity in very-low-birth weight neonates have gained importance in recent years. The results of available studies on the influence of birth hour on the mortality and morbidity rates of preterm infants are contradictory. Moreover, no study on this topic has been conducted in our region. MATERIALS AND METHODS: This retrospective cohort study was conducted on 127 very-low-birth weight newborns based on birth hour. The newborns were divided into 2 groups, the first born during working hours (7:00 am to 11:59 pm) and the second born during after-hours care (12-6:59 am). Mortality and major diseases were compared using Statistical Package for the Social Sciences by Fisher's exact tests, Pearson's chi-squared test, and independent t-tests. The statistical significance level for all analyses was set at P < .05 and the CI at 95%. RESULTS: Based on the results of this study in terms of neonatal mortality and major morbidities such as intraventricular hemorrhage and the need for prolonged mechanical ventilation, no significant difference was found between the 2 groups, but the difference in appearance, pulse, grimace, activity, respiration (APGAR) score at the fifth minute was statistically significant and was lower at the working hours. CONCLUSION: The results of the study may be due to appropriate allocation of resources, assignment of tasks, and professionalism of care in our study area. Further study is needed to determine the differences in clinical care processes that cause these results.

Efficacy of ozone therapy on visual evoked potentials in diabetic patients.

BACKGROUND: The involvement of the central nervous system is a frequent yet underestimated complication of diabetes mellitus. Visual evoked potentials (VEP) are a simple, sensitive, and noninvasive method for detecting early alterations in central optic pathways. The objective of this paralleled randomized controlled trial was to evaluate the impact of ozone therapy on visual pathways in diabetic patients. METHODS: Sixty patients with type 2 diabetes visiting clinics of Baqiyatallah university in Tehran (Iran) hospital were randomly assigned to two experimental groups: Group 1 (N = 30) undergoing a cycle of 20 sessions of systemic oxygen-ozone therapy in addition to standard therapy for metabolic control; Group 2 (N = 30)-serving as control-receiving only standard therapy against diabetes. The primary study endpoints were two VEP parameters; P100 wave latency and P100 amplitude at 3 months. Moreover, HbA1c levels were measured before the start of treatment and three months later as secondary study endpoint. RESULTS: All 60 patients completed the clinical trial. P100 latency significantly reduced at 3 months since baseline. No correlation was found between repeated measures of P100 wave latency and HbA1c (Pearson's r = 0.169, p = 0.291). There was no significant difference between baseline values and repeated measures of P100 wave amplitude over time in either group. No adverse effects were recorded. CONCLUSIONS: Ozone therapy improved the conduction of impulses in optic pathways of diabetic patients. The improved glycemic control following ozone therpay may not fully explain the reduction of P100 wave latency though; other mechanistic effects of ozone may be involved.

Comparison of the efficacy of inhaled versus infused milrinone in the management of persistent pulmonary hypertension of the newborn in resource-limited settings: A randomized clinical trial.

BACKGROUND: The standard treatment for persistent pulmonary hypertension of the newborn (PPHN) is inhaled nitric oxide (iNO), which is not available in Iran. Consequently, other drugs, such as milrinone, are prescribed. So far, no study has investigated the effectiveness of inhaled milrinone in the management of PPHN. The present study aimed to improve the management of PPHN in the absence of iNO. METHODS: In this randomized clinical trial, neonates with PPHN, admitted to the neonatal intensive care unit of Hazrat Ali-Asghar and Akbar-Abadi hospitals, were treated with intravenous dopamine infusion and randomly divided into two groups, receiving milrinone through inhalation or infusion rout. The neonates were evaluated by Doppler echocardiography, clinical examinations, and oxygen demand test. The neonates were also evaluated for the clinical symptoms and mortality in the follow-up. RESULTS: A total of 31 infants, with a median age of 2 days (interquartile range = 4), were included in this study. There was a significant decrease in the peak systolic and mean pulmonary arterial pressure in both inhalation and infusion groups following milrinone administration, with no significant difference between the groups (p = 0.584 and p = 0.147, respectively). There was no significant difference between the two groups regarding the mean systolic blood pressure before and after treatment. Additionally, diastolic blood pressure was significantly lower in the infusion group after treatment (p = 0.020); however, the amount of reduction was not significantly different between the groups (p = 0.928). Overall, 83.9% of the participants achieved full recovery, 75% of whom were in the infusion group and 93.3% in the inhalation group (p = 0.186). CONCLUSION: Milrinone inhalation can have similar effects to milrinone infusion as an adjunct treatment in the management of PPHN. Also, infusion and inhalation of milrinone showed similar safety.

Design of a new method for one-pot synthesis of 2-amino thiazoles using trichloroisocyanuric acid in the presence of a novel multi-functional and magnetically catalytic nanosystem: Ca/4-MePy-IL@ZY-Fe3O4.

In this study, an effective approach was developed to synthesize a novel, multifunctional ionic liquid nanocatalyst based on zeolite-Y with 4-methylpyridinium chloride (4-MePy-Cl) and calcium ions (Ca/4-MePy-IL@ZY). Then, Fe3O4 nanoparticles were produced inside the zeolite pores with the use of ultrasonic waves. XRD, FESEM, FT-IR, EDX-Map, TGA-DTA, VSM, BET, and atomic absorption techniques were used to identify the structure of the magnetic nanocomposite. Then, its catalytic activity in the one-pot synthesis of 2-aminothiazoles using trichloroisocyanuric acid (TCCA) as a green supplier of halogen ions for intermediates was studied. To provide ideal conditions for the preparation of pure products, first, the one-pot reaction of acetophenone and thiourea in various solvents, different temperatures, and the presence of different amounts of nanocatalysts and the molar amount of TCCA was used. Next, the reaction was investigated in the one-pot preparation of 2-aminothiazole derivatives under optimal conditions. This method replaces iodine (I2), a toxic reagent, for the first time with TCCA, a safe and sustainable source of halogen. The use of non-toxic solvent and a cheap, safe, recyclable nanocatalyst, quick reaction times, high efficiency, and ease of nanocatalyst separation with the aid of a magnet are additional benefits of this method. This has led to this procedure being classified as "green chemistry".

The relationship between ratings of perceived exertion (RPE) and relative strength for a fatiguing dynamic upper extremity task: A consideration of multiple cycles and conditions.

The goal of this study was to evaluate the relationship between ratings of perceived exertion (RPE) and relative strength with respect to baseline for a fatiguing free dynamic task targeting the upper extremity, namely simulated order picking, and determine whether the relationship remains the same for different conditions (i.e., pace and weight) and with fatigue. Fourteen participants (seven males, seven females) performed four sessions that included two 45-min work periods separated by 15 min of rest. The work periods involved picking weighted bottles from shoulder height and packaging them at waist height for four combinations of bottle mass and picking rate: 2.5 kg-15 bottles per minute (bpm), 2.5 kg-10 bpm, 2.5 kg-5 bpm, and 1.5 kg-15 bpm. Participants reported their RPEs every 5 min and performed a maximum isometric shoulder flexion exertion every 9 min. Pearson product-moment correlation was used to evaluate the linear relationship between RPE and relative strength for each subject and work period. Then, the effects of condition and work period on the average relationship were assessed using a repeated-measures analysis of variance (ANOVA). For the first 45-min period, there were no significantly different correlations between RPE and relative strength across conditions (average r = -0.62 (standard deviation = 0.38); p = 0.57). There was a significant decrease in average correlation for the second work period (r = -0.39 (0.53)). These results suggest that individual subjective responses consistently increase while relative strength declines when starting from a non-fatigued state. However, correlations are weaker when re-engaging in work following incomplete recovery. Thus, starting fatigue levels should be accounted for when considering the expected relationship between RPE and relative strength.

Functional ANOVA for Upper Extremity Fatigue Analysis during Dynamic Order Picking.

OCCUPATIONAL APPLICATIONSMusculoskeletal disorders are prevalent among warehouse workers who engage in repetitive and dynamic tasks. To prevent such injuries, it is vital to identify the factors that influence fatigue in the upper extremities during these repetitive activities. Our study reveals that task factors, namely the bottle mass and picking rate, significantly influence upper extremity fatigue. In most cases, the fatigue indicator is a functional variable, meaning that the fatigue score or measurement is a curve captured over time, which could be modeled as a function. In this study, we demonstrate that functional data analysis tools, such as functional analysis of variance (FANOVA), prove more effective than traditional methods in specifying how task factors contribute to the development of fatigue in the upper extremities. Furthermore, since there are inherent differences among workers that could affect their fatigue development process, the data heterogeneity could be tackled by employing clustering methods.

Background: Preventing musculoskeletal disorders is a paramount safety concern for industries, with order pickers in warehouses being particularly vulnerable due to their repetitive and dynamic tasks. Understanding the factors contributing to upper-extremity fatigue in such settings is crucial. Purpose: This paper investigates the impact of task-related factors on two upper-extremity fatigue indicators: ratings of perceived fatigue and relative muscle strength. Several statistical approaches were used and compared in terms of their capability in eliciting these effects. Methods: Simulated over-shoulder, order-picking lab experiments were conducted under different combinations of two bottle loads and three picking paces. Fourteen participants, evenly distributed between genders, completed the experiment. A FANOVA was executed as the principal analytical approach, considering the functional nature of the two fatigue indicators measured over the work period. To underscore the benefits of considering the whole functional curve instead of discrete variables, we also conducted repeated-measures and two-way ANOVA as benchmark analyses. Results: FANOVA outcomes affirmed that both task factors (load and pace) significantly influenced both fatigue indicators. The FANOVA method identified larger effect sizes (0.11< ηp2 < 0.19) for both task factors compared to the conventional methods (0< ηp2 < 0.11), supporting the efficacy of FANOVA in identifying the importance of these factors. Conclusions: The FANOVA approach proved effective in detecting the impact of task factors on fatigue indicators, yielding superior results compared to conventional benchmark methods. To address participant heterogeneity, functional clustering and gender-based clustering were introduced into the FANOVA framework, both effectively mitigating this challenge. Notably, FANOVA with functional clusters had superior performance compared to the one with gender clustering, suggesting functional clustering as a more suitable method in overcoming participant heterogeneity.

Correlation between Alkaline Phosphatase and Neonatal Jaundice.

Background: Hyperbilirubinemia is one of the most common neonatal disorders and one of the risk factors of neurological complications. So this study was conducted to evaluate the correlation between alkaline phosphatase (ALP) and pathological jaundice. Methods: A case-control was performed on term neonates with and without pathological jaundice who were referred to the Hazrat-e-Ali Asghar Hospital in 2017. In both groups, cases (neonates with pathological jaundice, n=153) and control (neonates with and without pathological jaundice, n=153) levels of alkaline-phosphatase and serum total bilirubin were evaluated with biochemical tests. Moreover, other data were also recorded from their history and clinical examinations. In addition, the severity of jaundice, duration of hospitalization, type of required treatment, and probable complications after the treatment were considered in follow-up. Data were collected by checklist and entered to SPSS v.20. ALP level and its relationship with serum total bilirubin compared between two groups. Results: Mean level of ALP was 411.3 ± 134.2 U/L in the case group and 338 ± 131.4 U/L in the control group. Serum total bilirubin level was 11.9 mg/dl in the case group and 6.2 mg/dl in the control group. ALP levels in the case group were significantly more than the control group (p=0.001). There was no correlation between ALP and serum total bilirubin level in neonates in the case group (p=0.532). There was no statistically significant relationship between alkaline phosphatase level and gender of neonates, but the relationship of ALP level with types of delivery was statistically significant (p=0.002). There was not a significant relationship between ALP level with hospitalization duration (p=0.371). Conclusion: The result of this study showed that there is no correlation between ALP levels and pathological jaundice in patients, although this issue needs to be approved by the other studies.

Modified Ondra's Formula to Predict Post-Op SVA after Lumbar PSO: A Preliminary Report Verified by Simulated Post-op Images Via Surgimap Software.

AIM: This study aimed to introduce a new mathematical formula to predict sagittal vertical axis (SVA) changes after lumbar pedicle subtraction osteotomy (PSO). MATERIAL AND METHODS: This cross-sectional study included 43 patients. Lateral full spinal radiographs were exported from Picture Archiving and Communicating Systemand imported to Surgimap (NemarisInc,New York, NY, version 2.3.1.1) software for PSO simulation. Regression analysis was done on the first 16 cases to find a constant variable (K) in the proposed formula. PSOs of 15°, 20°,25°, 30°, and 35°were simulated at L3,L4, and L5 for each patient, and the simulated postoperative SVAs were compared to predict postoperative SVA. Paired T-Test, Spearman test, and analysis of variance were applied to analyze the results. The Statistical Package for the Social Sciences software (Version 24.0) was used for the statistical analysis. RESULTS: Postoperative SVA was different in terms of PSO level and degree, with a mean of 74.87±37.88, 66.12±38.33, and 56.95±38.53 at 15°; 61.76±36.68, 50.13±37.32, and 43.03±36.67 at 20°; 48.61±35.60, 39.13±35.35, and 43.18±31.56 at 25°; and 37.73±33.78, 42.38±28.76, and 44.81±16.85 at 30° for L3, L4, and L5, respectively (P 0.05). The mean difference between the predicted SVA using the formula and the SVA simulated using Surgimap software was 2.37, 2.09, and 0.47 mm atL3, L4, andL5 levels, respectively. The mathematical formula was highly predictive for postoperative simulated SVA values in all three vertebral levels (L3-L5) (P 0.05). Additionally, a strong relationship was found between the vertebral level and the amount of SVA correction (Spearman correlation: 0.7-0.9). CONCLUSION: The mathematical formula is an accurate predictor of postoperative SVA and is helpful in PSO surgical planning. However, future studies are recommended to verify its accuracy in a clinical setting.

Chewing Gums as a Drug Delivery Approach for Oral Health.

Background: Drug delivery approaches with the shortest therapeutic period and the lowest side effects have always been considered a sublime target in the medical sciences. Among many delivery methods, chewing gum could be perceived as a promising drug carrier that can carry several types of drugs for oral health. These drug carriers could represent optimal therapeutic time and lower side effects due to their sustained release capability and lower required thresholds for the drug compared with other delivery approaches. The convenient use in the oral cavity's local environment and the ability to locally carry multiple drugs are considered the main advantages of this delivery approach. Aim: This review aimed to explore chewing gum as a promising drug carrier that can carry several types of drugs for oral health. Materials and Methods: Articles were searched for on PubMed, ISI, SCOPUS, Google Patents, the Royal Society of Chemistry website, and electronic databases using MESH terms and the following keywords: ("Gum" OR "Chewing gum") and ("Drug delivery OR Drug delivery systems") in the English language. No time limit was applied, and all documents as of August 30th, 2020 were retrieved. Results: Gum-drug interactions, mechanisms of release, and formulations of the drugs might all play a role in this versatile delivery method. Accordingly, chewing gum-based carriers may be presented as a plausible candidate for drug delivery in oral diseases. Conclusion: Gum-driven drugs could be introduced as promising candidates for treating oral diseases due to their ability to deliver the proper local dosages of active ingredients, short contact time, biocompatibility, and biodegradable chemical structures.

Perceived Discomfort, Neck Kinematics, and Muscular Activity During Smartphone Usage: A Comparative Study.

OBJECTIVE: The present study aims to evaluate the effects of posture, task, and handgrip style on discomfort, neck kinematics, and concomitant muscular activity when using a smartphone (SP). BACKGROUND: Along with the popularity of smartphones, musculoskeletal disorders have become prevalent among smartphone users. However, comprehensive aspects of discomfort, kinematics, and electromyographic responses across various conditions remain to be investigated. METHOD: Twenty-four young smartphone users performed typing, video watching, and reading tasks while holding the smartphone both with one hand and with two hands while either sitting or standing. Neck kinematics and muscular activities were simultaneously recorded. RESULTS: Working with SPs led to higher discomfort in the neck (p = 0.01), lower back (p = 0.01), and shoulder (p = 0.04) while sitting as compared to standing. Sitting was associated with greater neck flexion and more minor lateral bending for all tasks and grip styles (p < 0.05). Electromyographic analysis indicated significant differences between sitting and standing, with alterations being dependent on the test condition. Moreover, neck kinematics and muscular activities significantly differed based on the task nature, handgrip, and interactions. CONCLUSION: This study highlights the risk of using smartphones in increased neck angle flexion and muscular activities fatigue. Thus, posture and handgrip should be considered while using SPs. As each test condition affects a specific dependent variable, a holistic approach is required to evaluate the responses of SP users' musculoskeletal systems. APPLICATION: Results can be applied to develop guidelines for musculoskeletal disorders/discomfort prevention among SP users, especially with the rise of smartphone use during the COVID-19 pandemic.

Efficacy of adding dexmedetomidine to lidocaine to enhance inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis: double-blind randomized clinical trial.

OBJECTIVES: This randomized, double-blind study was to determine whether dexmedetomidine (DEX) helped to improve the inferior alveolar nerve block's (IANB) success in patients with asymptomatic irreversible pulpitis (AIP). We hypothesized that adding DEX to lidocaine enhances the anesthetic effect of lidocaine to a satisfactory level by localizing anesthesia in a safer way. MATERIALS AND METHODS: Fifty adult volunteers with AIP in a first or second mandibular molar were randomly assigned to two groups to either receive 1.4 ml 2% plain lidocaine or 1.4 ml 2% lidocaine + 0.4 ml (40 µg) DEX, for standard IANB injection. Access cavity preparation initiated 10-15 min postinjection when the patient reported lower lip numbness and had two negative electric pulp tests (EPTs) with 5-min intervals. Heft-Parker visual analog scale (VAS) was used to report pain in three steps: during caries and dentin removal, access cavity preparation, and canal working-length determinations; EPT and VAS were analyzed by Friedman test; and success rates were analyzed by Mann-Whitney and Fisher's exact test using SPSS software version 20. RESULTS: Successful anesthesia (defined as no or mild pain during any of steps and no need for additional injection) is obtained in 12% of patients in the lidocaine group, while DEX-lidocaine group increased the success rate of IANB to 72% (p-value = 0.0001). CONCLUSIONS: DEX significantly increases the anesthetic effect of lidocaine in IANB injection in patients with AIP. CLINICAL RELEVANCE: DEX would be a safe adjunct to lidocaine to increase the success rate in IANB and could be a suitable alternative for conventional vasoconstrictors in sensitive groups.

The Effect of High Glucose Intake on Weight Gain in Very Low Birth Weight Neonates: A Randomized Controlled Trial.

This study aims at evaluating the effect of high glucose intake as a component of total parenteral nutrition on birth weight (BW) regain in very low birth weight neonates. Ninety newborns with BW <1500 g were randomized to control or experimental groups. Both groups received the same total parenteral nutrition regimens except glucose intake provided by dextrose water (DW) serum: 7 to 15 g/kg/d (10% DW) in the former versus 8.75 to 18.75 g/kg/d (12.5% DW) in the latter. Body weight as the primary outcome was monitored until the BW was regained. Results revealed that neonates who received 12.5% DW regained BW significantly faster (10.98 ± 2.46 vs 13.24 ± 4.03 days, P = .024) and needed lesser duration of respiratory support (5.34 ± 2.11 vs 7.17 ± 3.19 days, P = .003). As the proposed intervention can reduce neonatal intensive care unit admission duration, it mitigates risks of health care-associated infections, while favorably affecting the health economy.

Automatic Breast Tumor Diagnosis in MRI Based on a Hybrid CNN and Feature-Based Method Using Improved Deer Hunting Optimization Algorithm.

Breast cancer is an unusual mass of the breast texture. It begins with an abnormal change in cell structure. This disease may increase uncontrollably and affects neighboring textures. Early diagnosis of this cancer (abnormal cell changes) can help definitively treat it. Also, prevention of this cancer can help to decrease the high cost of medical caring for breast cancer patients. In recent years, the computer-aided technique is an important active field for automatic cancer detection. In this study, an automatic breast tumor diagnosis system is introduced. An improved Deer Hunting Optimization Algorithm (DHOA) is used as the optimization algorithm. The presented method utilized a hybrid feature-based technique and a new optimized convolutional neural network (CNN). Simulations are applied to the DCE-MRI dataset based on some performance indexes. The novel contribution of this paper is to apply the preprocessing stage to simplifying the classification. Besides, we used a new metaheuristic algorithm. Also, the feature extraction by Haralick texture and local binary pattern (LBP) is recommended. Due to the obtained results, the accuracy of this method is 98.89%, which represents the high potential and efficiency of this method.

Head forward flexion, lateral bending and viewing distance in smartphone users: A comparison between sitting and standing postures.

BACKGROUND: Smartphones (SPs) are widely used by people of all age groups and genders. Users spend many hours per day on the SPs for different purposes, which imposes significant stress on their musculoskeletal system. OBJECTIVES: This study explored head forward flexion, lateral bending angle, and viewing distance while working with a SP in sitting/standing postures and one-handed/two-handed grips. The users' performance as well as pain development were also investigated. METHODS: Participants answered a questionnaire on pain experience before and after SP usage. Neck kinematics of 20 SP users were monitored by a motion analysis system while doing three tasks (typing, video watching, and reading) in sitting and standing postures. Performance was evaluated by number of typed words, amount of errors in typing, and total read words. RESULTS: The results indicated a significant increase in pain complaints in neck and upper limbs after test completion. Working with SPs in sitting and standing postures were, respectively, associated with greater head forward flexion for watching and viewing distance for two-handed typing tasks. Higher left lateral bending values were measured for one-handed watching and reading tasks in standing posture. The performance measures were superior for two-handed grips in all conditions. CONCLUSIONS: Overall, using SPs in sitting posture creates greater head forward flexion and lower lateral bending angles in all tasks and grip types. The findings of this study can be used to provide recommendations for SP users.

Design and ergonomic assessment of an infusion set connector tool used in nursing work.

Nursing is a physically demanding job characterized by a high prevalence of fatigue and musculoskeletal disorders. One of the high-exertion and repetitive nursing tasks is the manual connection of an infusion set to a medical fluid bottle. Such physical work can be eased by the design of new hand tools. Correspondingly, this study designed and ergonomically assessed an infusion set connector tool (ISCT) and compared it with that of manual connection. First, a prototype of ISCT was designed to perform infusion set connecting task in the mechanical form. Subsequently, 12 nurses were asked to connect an infusion set to medical bottle in the form of manual and mechanical tasks and these tasks were evaluated using ergonomic indices including muscular activity level, force, posture, and subjective (Borg scale CR10) measures. Results showed that the activity levels (root mean square) of the extensor digitorum communis, flexor carpi radialis, biceps, triceps, and deltoid muscles remarkably decreased when the nurses used the ISCT. The postures of the wrist, arm, and shoulder regions were corrected from Rapid Upper Limb Assessment action level 3 to 2 when the designed tool was used. Additionally, the subjective perception of exertion was significantly lower with the use of the prototype.