Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-volume Extracorporeal Membrane Oxygenation Center.

Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging approach to cardiac arrest. We present two contrasting cases from a high-volume extracorporeal membrane oxygenation (ECMO) center (defined as greater than 30 ECMO cases per year) without a 24/7 ECPR program to highlight how to establish an ECPR program with a focus on patient selection and outcome optimization. In one case, a patient presented with cardiac arrest during initial triage for chest pain within the emergency department, and in the other case, a patient experienced an out-of-hospital cardiac arrest with prolonged no-flow and low-flow time. Despite the lack of a 24/7 ECPR program at the presenting center, both patients received an ECPR evaluation, as both patients presented while all services necessary for ECMO cannulation were available. The in-hospital cardiac arrest patient was successfully cannulated for ECMO during cardiopulmonary resuscitation and survived with few complications. The out-of-hospital cardiac arrest patient was deemed a poor candidate for ECPR and expired soon after presentation. These two cases highlight the complex decision-making in ECPR and further illustrate how to create ECPR protocols at a high-volume ECMO center before resources are available for a 24/7 ECPR program.

Cardiovascular disease associated with methamphetamine use: a review.

Methamphetamine abuse is a global epidemic associated with a wide-ranging array of adverse effects on the cardiovascular system including dilated cardiomyopathy, malignant and benign arrhythmias, coronary vasospasm, and atherosclerotic coronary artery disease. While the acute behavioral manifestations of amphetamine abuse are the most easily clinically identified, cardiovascular toxicity is common in this patient population and should be considered in this setting due to its high morbidity and mortality. The specific mechanisms for amphetamine cardiotoxicity have not been fully established, but new research implicates activation of several cellular targets including Sigma-1 receptors and trace amine-associated receptor 1 (TAAR1) leading to a myriad of negative downstream effects including increased reactive oxygenating species (ROS), mitochondrial dysfunction, and modulations of intracellular calcium. Additional pathologic effects are mediated by increased circulating catecholamines, which when chronically activated have well-established adverse effects on the cardiovascular system. In this article, we present a case report followed by a current review of the epidemiology, pathophysiology, diagnosis, and treatment modalities of amphetamine-induced cardiovascular disease.

Subcutaneous furosemide for the treatment of heart failure: a state-of-the art review.

The prevalence of heart failure (HF) is on the rise. By 2030, over eight million Americans (46% increase from current prevalence) will have heart failure. In the USA, approximately 30 billion dollars is spent annually on heart failure and this number will likely double in 2030. Thus, HF represents a significant economic burden. Acute decompensated heart failure (ADHF) is a clinical spectrum, which refers to increasing symptoms and signs of heart failure prompting an emergency room visit or hospitalization. In ADHF, inpatient administration of intravenous diuretic is the standard of care due to the variability in the absorption of oral diuretics. Within 30 days, 25-30% of these patients are readmitted with recurrent ADHF. Recent efforts have focused in reducing HF readmission, and thereby decreasing costs; hence, innovative outpatient treatment options have emerged. Subcutaneous furosemide use will potentially overcome the need to place intravenous lines, reduce associated expenses, and enable management of ADHF at home. This review presents data on the pharmacodynamics and pharmacokinetics of subcutaneous furosemide, scientific evidence on the use of this therapy in the palliative and hospice population, and its experimental use as an outpatient therapy and/or as a bridge from inpatient to home.

Implantable devices for heart failure monitoring and therapy.

Heart failure (HF), the cardiovascular epidemic of the twenty-first century, is associated with significant comorbidities and high mortality. The prevalence of HF is estimated around 6.5 million people and is expected to increase to 8 million by the year 2030. The associated costs to care for these patients continue to increase. Despite the advancement of pharmacologic therapy with significant improvement in morbidity and mortality, the 5-year survival for heart failure still stands at 61%. The challenges faced by HF patients include difficulty with lifestyle modifications, nonadherence to complex medical regimens, financial limitations, lack of access to medical care, and unfavorable side effects. The sickest HF patients, who are ACC/AHA stage D, have advanced therapeutic options such as left ventricular assist devices and orthotopic heart transplant; however, the majority of patients are ACC/AHA stage C and/or not candidates for such advanced care. With constraints placed on hospitals by Medicare on HF readmissions as well as the multiple comorbidities imposed by this disease, intense interest is focused on the development of implantable devices as add-on therapy. This review discusses the innovative devices under varying stages of investigation or approved for monitoring and treatment of HF.

The prevalence of musculoskeletal symptoms in the construction industry: a systematic review and meta-analysis.

PURPOSE: Although individual studies have reported high prevalence of musculoskeletal symptoms (MSS) among construction workers, no systematic review has summarized their prevalence rates. Accordingly, this systematic review/meta-analysis aimed to synthesize MSS prevalence in different construction trades, gender and age groups, which may help develop specific ergonomic interventions. METHODS: Nine databases were searched for articles related to the research objective. Two reviewers independently screened citations, extracted information and conducted quality assessment of the included studies. Meta-analyses were conducted on clinical and statistical homogenous data. RESULTS: Thirty-five out of 1130 potential citations were included reporting diverse types of period prevalence and case definitions. Only the 1-year prevalence rates of MSS (defined as at least one episode of pain/MSS in the last year) at nine anatomical regions had sufficient homogeneous data for meta-analysis. Specifically, the 1-year prevalence of MSS was 51.1% for lower back, 37.2% for knee, 32.4% for shoulder, 30.4% for wrist, 24.4% for neck, 24.0% for ankle/foot, 20.3% for elbow, 19.8% for upper back, and 15.1% for hip/thigh. Female workers demonstrated a higher prevalence of MSS while there was insufficient information on the prevalence of trade-specific or age-related MSS. The quality assessments revealed that many included studies estimated prevalence solely based on self-reported data, and did not report non-respondents' characteristics. CONCLUSIONS: Lumbar, knee, shoulder, and wrist MSS are the most common symptoms among construction workers. Future studies should standardize the reporting of period prevalence of MSS in different construction trades to allow meta-analyses and to develop relevant MSS prevention program.

Evaluation of sweat-based biomarkers using wearable biosensors for monitoring stress and fatigue: a systematic review.

Objectives. This systematic review aims to report the evaluation of wearable biosensors for the real-time measurement of stress and fatigue using sweat biomarkers. Methods. A thorough search of the literature was carried out in databases such as PubMed, Web of Science and IEEE. A three-step approach for selecting research articles was developed and implemented. Results. Based on a systematic search, a total of 17 articles were included in this review. Lactate, cortisol, glucose and electrolytes were identified as sweat biomarkers. Sweat-based biomarkers are frequently monitored in real time using potentiometric and amperometric biosensors. Wearable biosensors such as an epidermal patch or a sweatband have been widely validated in scientific literature. Conclusions. Sweat is an important biofluid for monitoring general health, including stress and fatigue. It is becoming increasingly common to use biosensors that can measure a wide range of sweat biomarkers to detect fatigue during high-intensity work. Even though wearable biosensors have been validated for monitoring various sweat biomarkers, such biomarkers can only be used to assess stress and fatigue indirectly. In general, this study may serve as a driving force for academics and practitioners to broaden the use of wearable biosensors for the real-time assessment of stress and fatigue.

Non-invasive detection of mental fatigue in construction equipment operators through geometric measurements of facial features.

INTRODUCTION: Prolonged operation of construction equipment could lead to mental fatigue, which can increase the chances of human error-related accidents as well as operators' ill-health. The objective detection of operators' mental fatigue is crucial for reducing accident risk and ensuring operator health. Electroencephalography, photoplethysmography, electrodermal activity, and eye-tracking technology have been used to mitigate this issue. These technologies are invasive and wearable sensors that can cause irritation and discomfort. Geometric measurements of facial features can serve as a noninvasive alternative approach. Its application in detecting mental fatigue of construction equipment operators has not been reported in the literature. Although the application of facial features has been widespread in other domains, such as drivers and other occupation scenarios, their ecological validity for construction excavator operators remains a knowledge gap. METHOD: This study proposed employing geometric measurements of facial features to detect mental fatigue in construction equipment operators' facial features. In this study, seventeen operators performed excavation operations. Mental fatigue was labeled subjectively and objectively using NASA-TLX scores and EDA values. Based on geometric measurements, facial features (eyebrow, mouth outer, mouth corners, head motion, eye area, and face area) were extracted. RESULTS: The results showed that there was significant difference in the measured metrics for high fatigue compared to low fatigue. Specifically, the most noteworthy variation was for the eye and face area metrics, with mean differences of 45.88% and 26.9%, respectively. CONCLUSIONS: The findings showed that geometrical measurements of facial features are a useful, noninvasive approach for detecting the mental fatigue of construction equipment operators.

A science mapping-based review of work-related musculoskeletal disorders among construction workers.

INTRODUCTION: Work-related musculoskeletal disorders (WMSDs) are recognized as a leading cause of nonfatal injuries in construction, but no review of existing studies has systematically analyzed and visualized the trends of WMSDs among construction workers. The current science mapping-based review summarized research published between 2000 and 2021 related to WMSDs among construction workers through co-word, co-author, and citation analysis. METHOD: A total of 63 bibliographic records retrieved from the Scopus database were analyzed. RESULTS: The results identified influential authors with high impacts in this research domain. Moreover, the results indicated that MSDs, ergonomics, and construction not only had the highest occurrence of been studied, but also the highest impact in terms of total link strength. In addition, the most significant contributions to research relating to WMSDs among construction workers have originated primarily from the United States, Hong Kong, and Canada. Furthermore, a follow-up in-depth qualitative discussion was conducted to focus on summarizing mainstream research topics, identifying existing research gaps, and proposing directions for future studies. CONCLUSIONS: This review provides an in-depth understanding of related research on WMSDs among construction workers and proposes the emerging trends in this research field.

The use of mobile health technology in the management of osteoarthritis: A scoping review with scientometric analyses.

INTRODUCTION: Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively review the scope of mHealth technology in managing hip/knee OA. This scoping review and scientometric analyses aimed to summarize the current state of research on the use of mHealth technology (mobile applications/web-based interventions) for self-management/education of adults with hip/knee OA, identify key research activities, and provide future directions on the development/usage of mHealth technology. METHODS: The Arksey and O'Malley methodological framework was employed, augmented with scientometric analyses. Six databases were searched from inception to 31 May 2021. Findings were reported according to the PRISMA extension for scoping review. Co-word, co-author, and co-citation scientometric analyses were conducted to examine the social and intellectual connections of the research field (e.g., research hotspots and researcher collaborations). RESULTS: Twenty mHealth programs for promoting self-management of hip/knee OA were identified. The programs mainly included exercises or directives on performance of exercises. Compared to no interventions, mHealth technology was usable and might be more effective in improving pain, physical function, and quality of life in individuals with OA. The scientometric analyses identified multiple co-occurring keywords that reflected conceptual properties of this research domain. Although some intellectual connections among authors, research articles, and journals were noted, there were insufficient international collaborations in this field. DISCUSSION: While individual small-scale studies highlighted promising short-term effects of mHealth technology in self-managing hip/knee OA, many mHealth technologies were developed without clinicians' and/or patients' contributions. Future mHealth programs should be developed based on a strong theoretical background and professional inputs. The long-term benefits and cost-effectiveness of mHealth technologies, user experience, as well as cross-cultural adaptation of these technologies should be evaluated.

Myocarditis Following Immune Checkpoint Inhibition With Pembrolizumab: Management in a Context of Steroid Intolerance.

Immune checkpoint inhibitors (ICIs) are a major advance in oncology and have become first- or second-line therapy for over 50% of oncology patients. ICI-associated myocarditis is a complication that, although rare, has a high mortality rate. We present a case of ICI-associated myocarditis presenting as complete heart block. Traditional treatment with high-dose steroids was abandoned in this case, owing to steroid-induced psychosis. Alternative treatment with immunomodulators was initiated with a good response. This case highlights the variable presentation of ICI-associated myocarditis. As use of ICIs continues to expand, an understanding of their adverse reactions and best treatments will be needed.

Les inhibiteurs des points de contrôle immunitaire (IPCI) constituent un progrès majeur dans le domaine de l'oncologie, et sont maintenant utilisés comme traitement de première ou de deuxième intention pour plus de 50 % des patients en oncologie. La myocardite associée aux IPCI est une complication rare, mais dont le taux de mortalité est élevé. Nous présentons ici un cas de myocardite associée aux IPCI caractérisé par un bloc cardiaque complet. Le traitement classique par doses élevées de stéroïdes a dû être abandonné en raison d'une psychose provoquée par les stéroïdes. Un autre traitement par des immunomodulateurs a été amorcé et a produit une réponse satisfaisante. Ce cas permet de souligner la variété des tableaux cliniques des myocardites associées aux IPCI. Alors que l'utilisation des IPCI continue d'augmenter, une meilleure compréhension des réactions indésirables et des options pour leur prise en charge seront nécessaires.

Safety Risk Estimation of Construction Project Based on Energy Transfer Model and System Dynamics: A Case Study of Collapse Accident in China.

Analyzing and understanding the occurrence and evolution mechanisms of construction accidents are important for construction safety management. This study proposed a hybrid approach of integrating the energy transfer model (ETM) and system dynamics (SD) theory to delineate the entire evolution stage of the construction accident. Specifically, the Fengcheng Power Plant construction platform collapse accident (FPCA) was taken as a practical case study. First, the ETM is applied to demonstrate the evolving nature of the accident. Then, the network of the accident-causing factors is constructed using the SD theory to analyze the dynamic change characteristics. The results indicate that the accident was caused by risk factors with complex interactions at the management level. An energy constraint failure occurred when the transfer of dangerous energy transpired at the physical entity level, inducing the event. The proposed approach can provide a useful reference for safety risk estimation and management in future major construction projects.

Visualizing and Understanding Shrinking Cities and Towns (SCT) Research: A Network Analysis.

The world is undergoing an unprecedented trend of fast urbanization, which causes a range of socio-environmental consequences, one of which is shrinking cities and towns (SCT). SCT refer to the cities or towns that are experiencing population decline and economic downturn. In the existing literature, there have been numerous studies on SCT; however, there is a lack of study which investigates its knowledge domains. Therefore, this paper aims to conduct a scientometric analysis to achieve an outline of the SCT research status. Through the procedures of literature search and screening, a total of 716 SCT-related studies were extracted from the Scopus. The VOSviewer software system program was then utilized to visualize the present SCT-related studies. The visualization results revealed that the journal of Sustainability made significant contributions to the SCT research in terms of relevant publications. In addition, Haase, Annegret received the most co-citations, and was also the most productive author in this field. Furthermore, it was identified that current SCT research is mainly conducted in developed countries. Through the analysis of keywords, the emerging research topics were revealed. Discussions were further made from the perspectives of prevailing research methods, evaluation criteria, and solutions for SCT problems.

Exploring Key Factors for Contractors in Opening Prefabrication Factories: A Chinese Case Study.

Adoption of prefabrication is essential for improving the urban built environment. However, the existing prefabrication market in China is far from mature. As the stakeholder who conducts construction activities, the contractor is facing a dilemma of lacking steady prefabricated components supply. In this circumstance, a potential solution is that contractors open their own prefabrication factories to guarantee stable component supply. The aim of this research is exploring the key factors for contractors to open prefabrication factories. Firstly, a total of 28 influencing factors were identified from literature. Then, the identified factors were divided into four categories: policy environment, market environment, technological environment, and enterprise internal environment. Through interviews with experienced professionals, a total of 19 factors were selected for future analysis. Based on the 19 factors, a questionnaire was designed and distributed to the experts to rate the degree of mutual influences. The collected data were analyzed using Ucinet6.0 software, and the adjacency matrix and the visual models were established. Finally, through the analysis of node centrality, betweenness centrality, and closeness centrality, the four key influencing factors were determined including mandatory implementation policy, precast concrete component's price, market demand, and contractor's strategic objectives. The results of this study could assist contractors in making decisions of opening their own prefabrication factories toward more sustainable environment.

Chronic myocardial and coronary arterial effects of intracoronary supersaturated oxygen therapy in swine with normal and ischemic-reperfused myocardium.

The study assessed chronic myocardial, coronary and systemic effects of intracoronary supersaturated oxygen (SSO2) therapy. Left anterior descending coronary arteries of 40 swine were stented and randomized to 90-min selective intracoronary infusion of SSO2 (pO2 760-1000 mmHg) or normoxemic saline. In 20 out of 40 animals, SSO2 delivery followed a 60-min balloon occlusion to induce myocardial infarction (MI). In both normal and MI models, intracoronary treatment with hyperoxemic SSO2 therapy showed no evidence of coronary thrombosis. There were no biologically relevant differences between treatments at either time point in regard to coronary intervention site healing and neointimal growth. No signs of any myocardial or systemic toxicity were observed after 7 or 30 days. A trend was observed toward reduced incidence of microscopic MI scars and reduced infarct size in histopathology, as well as toward better recovery of echocardiographically evaluated global and regional contractility at 30 days. No treatment related infarcts or thromboemboli were observed in the downstream organs.

Beyond the stethoscope: managing ambulatory heart failure during the COVID-19 pandemic.

There have been nearly 70 million cases of COVID-19 worldwide, with over 1.5 million deaths at the time of this publication. This global pandemic has mandated dramatic changes in healthcare delivery with a particular focus on social distancing in order to reduce viral transmission. Heart failure patients are among the highest utilizers of health care and are at increased risk for COVID-related vulnerabilities. Effectively managing this complex and resource-intensive patient population from a distance presents new and unique challenges. Here, we review relevant data on telemedicine and remote monitoring strategies for heart failure patients and provide a framework to help providers treat this population during the COVID-19 pandemic. This includes (i) dedicated pre-visit contact and planning (i.e. confirm clinical appropriateness, presence of compatible technology, and patient comfort); (ii) utilization of virtual clinic visits (use of telehealth platforms, a video-assisted exam, self-reported vital signs, and weights); and (iii) use of existing remote heart failure monitoring sensors when applicable (CardioMEMS, Optivol, and HeartLogic). While telemedicine and remote monitoring strategies are not new, these technologies are emerging as an important tool for the effective management of heart failure patients during the COVID-19 pandemic. In general, these strategies appear to be safe; however, additional data will be needed to determine their effectiveness with respect to both process and outcomes measures.

An Analysis on Promoting Prefabrication Implementation in Construction Industry towards Sustainability.

As a game-changing technology with significant environmental, economic, and social benefits, prefabricated technology has attracted attention and has been increasingly adopted in the construction industry. Although multitudinous studies have investigated various aspects of prefabrication in construction, a thorough review of its current development state that synthesized environmental, economic, and social sustainability dimensions remains overdue. Therefore, this study aims to fill this research gap by constructing a systematic framework, analyzing the research status quos, and providing recommendations for future research. This study first conducted a holistic review of 768 references with NVivo. A research foci framework that represented the body of knowledge in prefabrication in construction was developed with five levels, which were advantages, hindrances, stakeholders, promotion policies, and strategy spectrum. Following the framework, the in-depth analyses from the perspectives of environmental, economic, social sustainability, technologies development, and promotion strategies were performed. The current research domains were further linked with potential research directions for promoting prefabricated construction towards sustainability. The study is of value in both offering references for policy formulation and stakeholder practice and providing recommendations for future research.

Key Factors of Opening Gated Community in Urban Area: A Case Study of China.

Gated communities are the most popular residential pattern in the urban areas of China. However, along with the increasing population density in urban areas, this pattern may have negative influences on people's daily lives, such as traffic jams. To avoid the negative influences, the government has encouraged residents to open their gated communities; however, few positive actions have been taken. With this background, this study aims to explore the key factors in residents' willingness to open their gated communities. To start with, a total of 26 potential factors were identified based on a comprehensive literature review. Then, a questionnaire was designed and distributed to collect empirical data. Furthermore, logistic regression was employed to analyze the collected data. Based on the derived results, it was revealed that concerns are different between male and female residents. Male residents regarded "community safety" and "property management" as having a significant impact on their decision to open a gated community, while female residents paid more attention to the factor of "proprietary equity". The results of this study could provide valuable references that enable the government to better understand residents' underlying concerns and to make relevant policy decisions.

Myocarditis in the Setting of Recent COVID-19 Vaccination.

We report three patients who presented with chest pain after receiving either the BNT162b2 Pfizer/BioNTech or mRNA-1273 Moderna/NIH vaccine. Clinical presentation, biomarker, and cardiac MRI supported myocarditis. It is imperative that potential side effects of COVID-19 vaccine are reported to improve our knowledge about COVID-19 and mRNA vaccines.

Evaluation of Sleep Habits, Generalized Anxiety, Perceived Stress, and Research Outputs Among Postgraduate Research Students in Hong Kong During the Coronavirus (COVID-19) Pandemic.

PURPOSE: The current study aimed to evaluate the impact of coronavirus (COVID-19) pandemic on sleep hygiene, anxiety levels, perceived stress, and research output among postgraduate research students in Hong Kong. METHODS: An online survey was developed and distributed to Hong Kong postgraduate research students. The sleep hygiene, anxiety levels, and perceived stress during the outbreak of COVID-19 were assessed. Questions about COVID-19's impact on research outputs were asked. RESULTS: A total of 108 (response rate, 72%) full-time postgraduate students (PhD, 64%; M Phil, 8%; and Masters, 28%) participated. Approximately 83% of students reported poor sleep hygiene. Similarly, nearly 76% of students reported mild to severe levels of self-perceived anxiety levels. Most of the respondents (89%) expressed a moderate level of perceived stress. Sleep hygiene scores were moderately associated with anxiety levels (r = 0.384, p < 0.01) and perceived stress scores (r = 0.423, p < 0.01). Perceived stress was strongly correlated with anxiety levels (r = 0.601, p < 0.01). A hierarchical regression analysis revealed a significant association between respondents' ethnicity (B = -0.923, p = 0.003), past medical history (such as hypertension, diabetes, and musculoskeletal disorders) (B = 1.112, p = 0.005), or poor sleep hygiene (B = 0.259, p = 0.000) and high levels of perceived stress. Additionally, prior medical history (such as hypertension, diabetes, and musculoskeletal disorders) (B = 1.957, p = 0.001) and poor sleep hygiene (B = 0.312, p = 0.000) were found to be strongly related to anxiety levels among postgraduate research students. CONCLUSION: This is the first study that highlights poor sleep hygiene, moderate-to-severe levels of anxiety, and perceived stress during the COVID-19 pandemic in postgraduate research students in Hong Kong. These findings will help educators to prepare strategies to alleviate the stress and psychological problems in postgraduate students.

Critical Success Factors of Safety Program Implementation in Construction Projects in Iraq.

The construction sector is recognized as one of the most dangerous industries in the world. The situation is worsening in Iraq, as a result of a lack of attention to safety in the building industry and the poor implementation of safety programs. This research aims to identify the critical safety factors (CSFs) of safety program implementation in the Iraqi construction industry. The CSFs were first identified from a review of literature before being verified by construction practitioners, using semi-structured interviews. A questionnaire, based on the verified CSFs, was distributed to construction practitioners in Iraq. Exploratory factor analysis (EFA) was used to analyze the quantitative data, and the results show that the CSFs can be categorized into four constructs: worker involvement, safety prevention and control system, safety arrangement, and management commitment. Following that, partial least square structural equation modelling (PLS-SEM) was executed to establish the connection between safety program implementation and overall project success. The result confirms that safety program implementation has a significant, positive impact on project success. This article contributes to knowledge and practice by identifying the CSFs for implementing safety programs in the Iraqi construction industry. The successful implementation of a safety program not only improves safety performance, but also helps to meet other project goals.