Haemodialysis is capable of prolonging life in patients with end stage renal disease, however this therapy comes with significant negative impact on quality of life. For patients requiring ...haemodialysis, the need for an adequately functioning vascular access (VA) is an everyday concern. The Vascular Access Questionnaire (VAQ) provides a mechanism for identifying and scoring factors in haemodialysis that impact on patients' quality of life and perception of their therapy.
Between April 2017-18 the VAQ was administered to prevalent haemodialysis patients at 10 units in the West Midlands via structured interviews.
749 of 920 potentially eligible patients completed the survey. The mean VAQ score was seen to improve significantly with age (7.7 in < 55 vs. 3.8 in 75+) and the duration of access (8.9 if less than 1 month old vs. 5.0 at a year). Better average scores were demonstrated for Arteriovenous fistulas (AVF) than other modalities (AVF 5.1 vs. AVG (arteriovenous grafts) 7.2 vs. CVC (central venous catheter) 6.6). There was no significant difference in scores between fistulas on non-dominant or dominant arms, with both having a mean of 5.2 (p = 0.341).
Overall, better satisfaction scores were seen in AVF. The presence of an AVF on the non-dominant arm was not a concern for the majority of patients and did not affect the VAQ score. A number of factors were identified that can influence VAQ satisfaction score.
•Inverse vulcanization of elemental sulfur and dially sulfide is reported.•Films exhibit tunable transparency depending on composition.•Films are flexible with low glass transition temperature and ...low Young modulus.
Flexible, freestanding polysulfide films with high sulfur content (50–90% sulfur) were prepared via inverse vulcanization technique by reacting sulfur and diallyl disulfide; a naturally occurring diene. The prepared films are partially transparent depending on the amount of sulfur loading. SEM images showed a smooth and uniform surface of the film. XRD and DSC results confirmed the conversion of crystalline sulfur into an amorphous co-polymer. Low Young modulus and high tensile extension at break confirmed the flexible and elastic nature of the films. The flexibility of the films could be due to the presence of freely rotating low aliphatic carbon chains, which leads to low glass transition temperature (Tg=−13°C to −4°C) of these films.
Abstract The Indian crested porcupine (Hystrix indica) is a vertebrate pest of agricultural lands and forest. The study was aimed to report the damage to local crops by the Indian crested porcupine ...(Hystrix indica) in the Muzaffarabad District. A survey was conducted to identify the porcupine-affected areas and assess the crop damage to the local farmers in district Muzaffarabad Azad Jammu and Kashmir (AJK) from May 2017 to October 2017. Around 19 villages were surveyed, and a sum of 191 semi-structured questionnaires was distributed among farmers. Crop damage was found highest in village Dhanni where a porcupine destroyed 175 Kg/Kanal of the crops. Regarding the total magnitude of crop loss, village Danna and Koomi kot were the most affected areas. More than half (51.8%) of the respondents in the study area suffered the economic loss within the range of 101-200$, and (29.8%) of the people suffered losses in the range of 201-300$ annually. Among all crops, maize (Zea mays) was found to be the most damaged crop ranging between 1-300 Kg annually. In the study area, porcupine also inflicted a lot of damages to some important vegetables, including spinach (Spinacia oleracea), potato (Solanum tuberosum) and onion (Allium cepa). It was estimated that, on average, 511Kg of vegetables are destroyed by porcupine every year in the agricultural land of Muzaffarabad. It was concluded that the Indian crested porcupine has a devastating effect on agriculture which is an important source of income and food for the local community. Developing an effective pest control strategy with the help of the local government and the Wildlife department could help the farmers to overcome this problem.
Resumo O porco-espinho de crista indiano (Hystrix indica) é uma praga vertebrada de terras agrícolas e florestais. No estudo atual, o dano às plantações locais pelo porco-espinho de crista indiano (Hystrix indica) foi relatado pela primeira vez no distrito de Muzaffarabad. O estudo foi projetado para investigar a perda econômica causada pelo porco-espinho de crista indiano (Hystrix indica) nos distritos de Muzaffarabad, Azad Jammu e Caxemira (AJK) de maio de 2017 a outubro de 2017. Um estudo baseado em pesquisa foi conduzido para identificar as áreas afetadas por porcos-espinhos e avaliar os danos às colheitas para os agricultores locais. Cerca de 19 aldeias foram pesquisadas e um total de 191 questionários semiestruturados foi distribuído entre os agricultores. Os danos às colheitas foram encontrados mais intensamente na aldeia Dhanni, onde um porco-espinho destruiu 175 kg / Kanal das colheitas. Em relação à magnitude total da perda de safra, as aldeias Danna e Koomi Kot foram as áreas mais afetadas. Mais da metade (51,8%) dos entrevistados na área de estudo sofreu perdas econômicas na faixa de 101-200 $, e 29,8% das pessoas sofreram perdas na faixa de 201-300 $ anualmente. Entre todas as culturas, o milho (Zea mays) foi considerado a cultura mais danificada, variando entre 1-300 kg anualmente. Na área de estudo, o porco-espinho também causou muitos danos a alguns vegetais importantes, incluindo espinafre (Spinacia oleracea), batata (Solanum tuberosum) e cebola (Allium cepa). Estimou-se que, em média, 511 kg de vegetais são destruídos pelo porco-espinho todos os anos nas terras agrícolas de Muzaffarabad. Concluiu-se que o porco-espinho de crista indiano tem um efeito devastador na agricultura, que é importante fonte de renda e alimento para a comunidade local. O desenvolvimento de uma estratégia eficaz de controle de pragas com a ajuda do governo local e do Departamento de Vida Selvagem pode ajudar os agricultores a superar esse problema.
The thermal diusion phenomena, also known as the Soret eect, is important for the study of compositional variation in hydrocarbon reservoirs. Several theoretical models have been developed over the ...years to predict the thermodiusion coefficient of an organic mixture. Firoozabadi et al. 1 developed an analytical relationship between the thermal, molecular, and pressure diusion coefficients based on the approach of Dougherty and Drickamer 2. The distinctive feature of Firoozabadi's model is its ability to be used not only for binary mixtures but also for multicomponent mixtures. The verification of Firoozabadi's model by numerical simulations was limited to binary mixtures only because of a lack of experimental data on thermodiusion coefficients in multicomponent hydrocarbon mixtures. However, Platten et al. 3 were able to measure the thermodiusion coefficients of a ternary hydrocarbon mixture experimentally by utilizing the thermogravitational column technique, hence making it possible to verify the theoretical model. This paper will compare the density, thermodiusion, and molecular diusion coefficients obtained with the Fontainebleau benchmark values for binary mixtures of n-dodecane, isobutylbenzene, and tetrahydronaphtalene. The accuracy of the numerical results from the Firoozabadi's model for ternary hydrocarbon mixtures is investigated. Results reveal a positive agreement between experimental and numerical data.
Abstract Aims Coronary artery disease (CAD) negatively affects prognosis in patients undergoing surgical aortic valve replacement, being currently evaluated in the most common used risk score. Our ...meta-analysis aims to clarify the prognostic role of CAD on mid-term survival in patients undergoing TAVI. Methods and results Studies reporting multivariate predictors of adverse outcomes in patients undergoing TAVI were systematically searched for and pooled, when appropriate, using a random-effect method. 960 citations were first screened and finally 7 studies (2472 patients) were included. Diagnosis of CAD was reported in 52%(42–65) of patients and 1169 Edwards SAPIEN and 1303 CoreValve prostheses were implanted. After a median follow up of 452 days (357–585) 24% of patients (19–33) died, and 23 (14–32) for cardiovascular death. At pooled analysis of multivariate approach, diagnosis of coronary artery disease did not increase risk of death (OR 1.0, 95% CI, confidence interval, 0.67–1.50 I2 0%). Conclusion CAD does not affect mid-term TAVI outcome: this finding should be weighted to accurately evaluate risk and strategies for patients with severe aortic stenosis.
Purpose
This systematic literature review investigated whether extended dosing intervals (EDIs) of pharmacological acromegaly treatments reduce patient burden and costs compared with standard dosing, ...while maintaining effectiveness.
Methods
MEDLINE/Embase/the Cochrane Library (2001–June 2021) and key congresses (2018–2021) were searched and identified systematic literature review bibliographies reviewed. Included publications reported on efficacy/effectiveness, safety and tolerability, health-related quality of life (HRQoL), and patient-reported and economic outcomes in longitudinal/cross-sectional studies in adults with acromegaly. Interventions included EDIs of pegvisomant, cabergoline, and somatostatin receptor ligands (SRLs): lanreotide autogel/depot (LAN), octreotide long-acting release (OCT), pasireotide long-acting release (PAS), and oral octreotide; no comparator was required.
Results
In total, 35 publications reported on 27 studies: 3 pegvisomant monotherapy, 11 pegvisomant combination therapy with SRLs, 9 LAN, and 4 OCT; no studies reported on cabergoline, PAS, or oral octreotide at EDIs. Maintenance of normal insulin-like growth factor I (IGF-I) was observed in ≥ 70% of patients with LAN (1 study), OCT (1 study), and pegvisomant monotherapy (1 study). Achievement of normal IGF-I was observed in ≥ 70% of patients with LAN (3 studies) and pegvisomant in combination with SRLs (4 studies). Safety profiles were similar across EDI and standard regimens. Patients preferred and were satisfied with EDIs. HRQoL was maintained and cost savings were provided with EDIs versus standard regimens.
Conclusions
Clinical efficacy/effectiveness, safety, and HRQoL outcomes in adults with acromegaly were similar and costs lower with EDIs versus standard regimens. Physicians may consider acromegaly treatment at EDIs, especially for patients with good disease control.
Roads constitute a significant hazard if the effects of wintertime are not
handled well. After a heavy snowfall, the most dangerous factor is a slippery
surface due to ice adhesion with the asphalt ...pavement. The ice on roads
increases the risk of road accidents and, upon melting, contributes to the
formation of Low-Temperature Cracks (LTCs) and potholes. This research
explores the physical principle that could remove the ice from concrete
roads by investigating whether road ice is susceptible to self-separation
upon loading when the road surfaces in cold regions are coated with a
polymer-based material such as polyurethane. This study conducted an
experimental and numerical analysis of ice-polyurethane and ice-concrete
separation under tensile load and calculated the Von-Mises stresses on the
surfaces. Results revealed higher Von-Mises stresses on ice when the base
material is polyurethane compared to concrete, indicating ice is more prone
to self-separation when adhered to polyurethane than concrete. These
results are important for increasing the operational life of roads in cold
regions and reducing the number of road accidents. In addition,
polyurethane is a potential material for pre-emptive road measures, such as
repairing cracks before they become potholes.
The presented work discusses the vibration behavior of an axial turbine, analyzed using the finite element method (FEM) using commercial software ANSYS®. The turbine was modeled as a 2-D plate type ...of structure discretized with 4-noded shell 63 elements to save computational time. Constraints were applied keeping in view the actual operating conditions. The turbine was modeled with more than one FE meshes. Mesh sensitivity analysis was carried out to ensure the quality and independence of the results. Modal analysis was conducted to calculate a few initial natural frequencies. Results were studied against the operating frequency of the turbine. After carrying out the modal analysis, harmonic analysis was performed to see the response of the turbine under dynamic loading. The nature and cause of the dynamic loading are also discussed in relation to dynamic behavior. It was observed that the turbine is safe in its entire range of operation as far as the phenomenon of resonance is concerned. Also, it was observed that the maximum harmonic response of the turbine on the application of dynamic loading is far lesser than its failure limit within the specified operating range.
There is a current and anticipated labor shortage of endocrinologists in the United States. Over the past decade, the number of applications to endocrinology fellowship programs has plateaued despite ...increased available positions, and interest in endocrinology has declined relative to other internal medicine subspecialty fields. The examination of driving factors for pursuit of endocrinology as a subspecialty career is needed.
A 12-question online survey was developed to identify the primary reasons for current endocrinology fellows/trainees to pursue the field. This survey was sent to 152 U.S. endocrinology fellowship program directors for completion by their fellows between July and August 2021.
A total of 176 of 629 fellows (28.0%) completed the survey. The majority (57.4%) had decided to pursue endocrinology as a career during residency, while 27.3% had decided during medical school. The endocrinology rotation during residency was ranked by 79 fellows (44.9%) as the most influential factor, followed by having positive experiences with a clinical mentor (27.3%). Endocrinology exposure during medical school was sparse, with only 2.8% noting the availability of an endocrinology student interest group, while 59.7% reported inadequate endocrinology exposure during their medical school curriculum.
The majority of current endocrinology fellows/trainees report that exposure to the field during medical school was limited, and that their endocrinology elective and mentorship experiences during residency were the most influential factors for pursuing endocrinology as a subspecialty. Improved integration of endocrinology experiences between medical school and residency may enhance career interest in endocrinology.
PDF
