Timing of diuretic administration effects on urine volume in hospitalized patients.

Importance: Some medications have effects that depend on the time of day they are given. Current knowledge of the time-of-day effects of specific medications in hospitalized patients with cardiovascular disease is very limited. In hospitalized patients, increased medication efficiency might reduce dose (and associated side effects) and/or the length of time in the Intensive Care Unit (ICU) or hospital-potentially improving patient outcomes and patient and family quality of life and reducing financial costs. We studied whether the time of day or night patients in Cardiac or Intensive Care Units receive a diuretic affects urine volume. Methods: In this observational study, data were collected from 7,685 patients (63% male, 18 to 98 years old) admitted to one hospital's Acute Care Cardiac units, Cardiac ICUs, Cardiac Surgery ICUs, and/or Non-cardiac ICUs who received intravenous furosemide (a diuretic), had measurements of urine volume, were hospitalized for ≥3 days between January 2016 to July 2021 and were older than 18 years. The outcomes of interest were urine volume normalized by the most recent (not older than 24 h) weight or body mass index (BMI), (i) in the hour after the time of diuretic administration, and (ii) when no diuretics were administered for the previous 3 h. Results: We identified diuretic medication administration time 23:00-04:59 as a predictor of higher urine volume response. For patients without recent diuretic medication, higher urine volume was predicted 11:00-16:59 and 17:00-22:59. Other factors that affected urine volume response to the diuretic were sex, age, medication dose, creatinine concentration, diagnoses, and hospital unit. Discussion: Time-of-day of medication administration may be a factor associated with increased medication efficiency. Randomized controlled trials should be conducted to quantify the relative effect of modifiable factors, such as time of medication administration, that may affect short- and longer-term outcomes.

Identifying Modifiable Predictors of COVID-19 Vaccine Side Effects: A Machine Learning Approach.

Side effects of COVID-19 or other vaccinations may affect an individual's safety, ability to work or care for self or others, and/or willingness to be vaccinated. Identifying modifiable factors that influence these side effects may increase the number of people vaccinated. In this observational study, data were from individuals who received an mRNA COVID-19 vaccine between December 2020 and April 2021 and responded to at least one post-vaccination symptoms survey that was sent daily for three days after each vaccination. We excluded those with a COVID-19 diagnosis or positive SARS-CoV2 test within one week after their vaccination because of the overlap of symptoms. We used machine learning techniques to analyze the data after the first vaccination. Data from 50,484 individuals (73% female, 18 to 95 years old) were included in the primary analysis. Demographics, history of an epinephrine autoinjector prescription, allergy history category (e.g., food, vaccine, medication, insect sting, seasonal), prior COVID-19 diagnosis or positive test, and vaccine manufacturer were identified as factors associated with allergic and non-allergic side effects; vaccination time 6:00-10:59 was associated with more non-allergic side effects. Randomized controlled trials should be conducted to quantify the relative effect of modifiable factors, such as time of vaccination.

Real-Time and Offline Evaluation of Myoelectric Pattern Recognition for the Decoding of Hand Movements.

Pattern recognition algorithms have been widely used to map surface electromyographic signals to target movements as a source for prosthetic control. However, most investigations have been conducted offline by performing the analysis on pre-recorded datasets. While real-time data analysis (i.e., classification when new data becomes available, with limits on latency under 200-300 milliseconds) plays an important role in the control of prosthetics, less knowledge has been gained with respect to real-time performance. Recent literature has underscored the differences between offline classification accuracy, the most common performance metric, and the usability of upper limb prostheses. Therefore, a comparative offline and real-time performance analysis between common algorithms had yet to be performed. In this study, we investigated the offline and real-time performance of nine different classification algorithms, decoding ten individual hand and wrist movements. Surface myoelectric signals were recorded from fifteen able-bodied subjects while performing the ten movements. The offline decoding demonstrated that linear discriminant analysis (LDA) and maximum likelihood estimation (MLE) significantly (p < 0.05) outperformed other classifiers, with an average classification accuracy of above 97%. On the other hand, the real-time investigation revealed that, in addition to the LDA and MLE, multilayer perceptron also outperformed the other algorithms and achieved a classification accuracy and completion rate of above 68% and 69%, respectively.

Evaluation of surface EMG-based recognition algorithms for decoding hand movements.

Myoelectric pattern recognition (MPR) to decode limb movements is an important advancement regarding the control of powered prostheses. However, this technology is not yet in wide clinical use. Improvements in MPR could potentially increase the functionality of powered prostheses. To this purpose, offline accuracy and processing time were measured over 44 features using six classifiers with the aim of determining new configurations of features and classifiers to improve the accuracy and response time of prosthetics control. An efficient feature set (FS: waveform length, correlation coefficient, Hjorth Parameters) was found to improve the motion recognition accuracy. Using the proposed FS significantly increased the performance of linear discriminant analysis, K-nearest neighbor, maximum likelihood estimation (MLE), and support vector machine by 5.5%, 5.7%, 6.3%, and 6.2%, respectively, when compared with the Hudgins' set. Using the FS with MLE provided the largest improvement in offline accuracy over the Hudgins feature set, with minimal effect on the processing time. Among the 44 features tested, logarithmic root mean square and normalized logarithmic energy yielded the highest recognition rates (above 95%). We anticipate that this work will contribute to the development of more accurate surface EMG-based motor decoding systems for the control prosthetic hands.

A novel approach for removing ECG interferences from surface EMG signals using a combined ANFIS and wavelet.

In recent years, the removal of electrocardiogram (ECG) interferences from electromyogram (EMG) signals has been given large consideration. Where the quality of EMG signal is of interest, it is important to remove ECG interferences from EMG signals. In this paper, an efficient method based on a combination of adaptive neuro-fuzzy inference system (ANFIS) and wavelet transform is proposed to effectively eliminate ECG interferences from surface EMG signals. The proposed approach is compared with other common methods such as high-pass filter, artificial neural network, adaptive noise canceller, wavelet transform, subtraction method and ANFIS. It is found that the performance of the proposed ANFIS-wavelet method is superior to the other methods with the signal to noise ratio and relative error of 14.97dB and 0.02 respectively and a significantly higher correlation coefficient (p<0.05).

ECG Artifact Removal from Surface EMG Signal Using an Automated Method Based on Wavelet-ICA.

This study aims at proposing an efficient method for automated electrocardiography (ECG) artifact removal from surface electromyography (EMG) signals recorded from upper trunk muscles. Wavelet transform is applied to the simulated data set of corrupted surface EMG signals to create multidimensional signal. Afterward, independent component analysis (ICA) is used to separate ECG artifact components from the original EMG signal. Components that correspond to the ECG artifact are then identified by an automated detection algorithm and are subsequently removed using a conventional high pass filter. Finally, the results of the proposed method are compared with wavelet transform, ICA, adaptive filter and empirical mode decomposition-ICA methods. The automated artifact removal method proposed in this study successfully removes the ECG artifacts from EMG signals with a signal to noise ratio value of 9.38 while keeping the distortion of original EMG to a minimum.

A combination method for electrocardiogram rejection from surface electromyogram.

The electrocardiogram signal which represents the electrical activity of the heart provides interference in the recording of the electromyogram signal, when the electromyogram signal is recorded from muscles close to the heart. Therefore, due to impurities, electromyogram signals recorded from this area cannot be used. In this paper, a new method was developed using a combination of artificial neural network and wavelet transform approaches, to eliminate the electrocardiogram artifact from electromyogram signals and improve results. For this purpose, contaminated signal is initially cleaned using the neural network. With this process, a large amount of noise can be removed. However, low-frequency noise components remain in the signal that can be removed using wavelet. Finally, the result of the proposed method is compared with other methods that were used in different papers to remove electrocardiogram from electromyogram. In this paper in order to compare methods, qualitative and quantitative criteria such as signal to noise ratio, relative error, power spectrum density and coherence have been investigated for evaluation and comparison. The results of signal to noise ratio and relative error are equal to 15.6015 and 0.0139, respectively.

Synthesis, characterization, and in vitro evaluation of new Ibuprofen polymeric prodrugs based on 2-hydroxypropyl methacrylate.

The present research work describes the synthesis and evaluation of new acrylic-type polymeric systems having degradable ester bonds linked to ibuprofen as materials for drug delivery. Ibuprofen was linked to 2-hydroxy-propyl methacrylate by an activated ester methodology in a one-pot procedure with a high yield. The resulting material was copolymerized with either 2-hydroxyethyl methacrylate or methyl methacrylate (in 1:3 mole ratios) by the free radical polymerization method, utilizing azoisobutyronitrile at 65-70 °C. The characterization of the resulting products by FTIR, (1)H NMR, (13)C NMR, DSC, and elemental analysis confirmed their synthesis successfully. Ibuprofen release from the obtained polymers was preliminarily evaluated at different buffered solutions (pH 1, 7.4, and 10) into dialysis bags to show the capacity of prodrugs to release the drug under hydrolytic conditions. Detection of hydrolysis by UV spectroscopy at selected intervals showed that the drug can be released by selective hydrolysis of the ester bond at the side of the drug moiety. The release profiles indicated that the hydrolytic behavior of polymers is strongly based on the polymer hydrophilicity and the pH value of the hydrolysis solution. The results suggest that these polymers could be useful in controlled release systems.