Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support ...the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care.
Recently, non-data aided synchronizers for QAM with a feedforward structure have been significantly improved by incorporating the prefllter originally proposed by Franks to mitigate the self-noise in ...analog clock regenerators. Prior to this, D'Andrea proposed a synchronizer with a feedback structure that used Franks' prefllter. Although not reported in the literature, the earlier D'Andrea's synchronizer outperforms the more recent feedforward synchronizers, and consequently is believed by the authors to be the optimum non-data aided synchronizer for QAM. An all digital version of D'Andrea's synchronizer is presented in this paper. The steady state timing jitter is thoroughly analyzed by deriving a closed form expression for the noise power spectrum, as well as a simple expression to estimate the variance of the jitter. Performance comparisons are made.
Controlling the frequency response of an engineering component or structure is important in the aerospace and automotive sectors and is a key consideration when seeking a new and more efficient ...design for a given component. In this contribution, the standard truss layout optimization procedure is modified to incorporate semidefinite constraints to limit the minimum value of the first natural frequency. Since this increases the computational expense and reduces the scale of the problem that can be solved, a bespoke algorithm incorporating an adaptive 'member adding' procedure is proposed and applied to a number of benchmark example problems. It is demonstrated that this allows problems to be solved with relatively fine numerical discretization, allowing modified structures with an acceptable minimum first natural frequency response to be successfully identified.
Worldwide refugees numbered nearly 25.9 million in 2018 and, according to the United Nations High Commissioner for Refugees, the crisis grows each year. Research reports that refugees have a high ...prevalence of mental health conditions and are at increased risk for emotional and mental distress during resettlement. Furthermore, interpreters have been shown to be at increased risk for secondary re‐traumatisation, a condition similar to Post Traumatic Stress Disorder, where client trauma shares commonalities with trauma experienced by the interpreter. The purpose of this study was to explore the experiences of resettled refugee interpreters. Based on previous data from this community, the research team determined that a qualitative methodology was best practice to explore the experiences of resettled refugee interpreters. In May of 2019, seven participants were recruited from a pool of resettled refugee interpreters who worked at a refugee health clinic in a large multicultural city in Texas. One‐on‐one interviews were conducted, and the data were analysed using content analysis. Five themes emerged that represented the experiences of these participants: speaking for others, developing interpretation strategies, advocating for the community, receiving social support and overcoming challenges specific to the healthcare setting. The findings from this study add to the current body of literature that addresses the experiences of resettled refugee interpreters. Furthermore, these data may be used to create additional resources for refugee interpreters who work at health clinics, such as training on medical terminology, access to mental health services and site‐specific incentives.
Most current research on food-relevant Pickering emulsions has been conducted using inorganic or food-compatible organic particles as emulsifiers. A key challenge is maintaining a favourable ...structure while being able to resist displacement or destabilisation by surfactants and controlling transport of substrates during digestion. Liposome stabilised emulsions have demonstrated some potential for being smart, responsive delivery systems for poorly available bioactives and drugs. We developed a liposome-stabilized oil-in-water Pickering emulsion utilising macromolecular crowding- with polyethylene glycol (PEG). They were pH-controllable and had surfactant-dependent deformability whilst displaying dual delivery routes from both the liposome and oil phases. Dynamic light scattering, confocal microscopy and emulsion stability measurements indicated the liposomes containing 10% PEG at neutral pH remained intact at the interface for extended time. Various degrees of interfacial coverage still existed in the presence of PEG, under acidic environment and with added bile salts. Emulsions with added PEG maintained a more integrated structure after in vitro oral-gastric digestion, and showed greater lipolysis with more free fatty acids (14.7 ± 0.5% for with PEG vs. 12.7 ± 0.1% for without PEG) released during in vitro intestinal digestion. These Pickering emulsions could provide a flexible approach to controlled release under a broad range of conditions.
In this study, we determined whether vaccination with Duramune DAPPi+LC containing canine parvovirus (CPV) type 2b protects against challenge with virulent CPV antigenic type 2c. Seven healthy dogs, ...seronegative for CPV2, were enrolled into two treatment groups; five were vaccinated twice, 21 days apart, with minimum titre vaccine, and two were given saline. Dogs were challenged with CPV 2c three weeks later. Clinical observations, body weight and rectal temperature measurements, blood samples for serology and white blood cell counts and faecal samples for virus excretion were collected. Control dogs remained seronegative until challenge; vaccinated dogs seroconverted and were positive for antibodies to CPV2 from day 21. Four days after challenge, clinical signs associated with parvovirus infection (vomiting, paroxysmal shivering, depression, loose stools) were observed in the control dogs. Both animals were withdrawn from the study for welfare reasons one day later. On day 47, leucopenia was observed in controls, with white blood cell counts less than 50 per cent prechallenge values. No specific clinical sign of parvovirus infection were observed in the vaccinated dogs, nor was (detectable) challenge virus shed in faeces suggesting that antibodies generated contributed sterilising immunity. We conclude that vaccination of dogs with Duramune DAPPi+LC protects against challenge with a virulent field strain of CPV 2c.
The ATLAS EventIndex has been running in production since mid-2015, reliably collecting information worldwide about all produced events and storing them in a central Hadoop infrastructure at CERN. A ...subset of this information is copied to an Oracle relational database for fast dataset discovery, event-picking, crosschecks with other ATLAS systems and checks for event duplication. The system design and its optimization is serving event picking from requests of a few events up to scales of tens of thousand of events, and in addition, data consistency checks are performed for large production campaigns. Detecting duplicate events with a scope of physics collections has recently arisen as an important use case. This paper describes the general architecture of the project and the data flow and operation issues, which are addressed by recent developments to improve the throughput of the overall system. In this direction, the data collection system is reducing the usage of the messaging infrastructure to overcome the performance shortcomings detected during production peaks; an object storage approach is instead used to convey the event index information, and messages to signal their location and status. Recent changes in the Producer/Consumer architecture are also presented in detail, as well as the monitoring infrastructure.
Seven classes of persistent mistake are identified and described, based on the author's 20 years' experience of making mistakes in simulation modelling. The errors identified are trifle-worship, ...belief in answers, connectionism, the black box mistake, methodolatry, the dead fish fallacy, and the Jehovah problem. Each is discussed in turn. It is expected that fellow practitioners will recognize many of these mistakes, and hoped that this paper will help to avoid repeating them.
The bacterial pathogen Campylobacter jejuni is primarily transmitted via the consumption of contaminated foodstuffs, especially poultry meat. In food processing environments, C. jejuni is required to ...survive a multitude of stresses and requires the use of specific survival mechanisms, such as biofilms. An initial step in biofilm formation is bacterial attachment to a surface. Here, we investigated the effects of a chicken meat exudate (chicken juice) on C. jejuni surface attachment and biofilm formation. Supplementation of brucella broth with ≥5% chicken juice resulted in increased biofilm formation on glass, polystyrene, and stainless steel surfaces with four C. jejuni isolates and one C. coli isolate in both microaerobic and aerobic conditions. When incubated with chicken juice, C. jejuni was both able to grow and form biofilms in static cultures in aerobic conditions. Electron microscopy showed that C. jejuni cells were associated with chicken juice particulates attached to the abiotic surface rather than the surface itself. This suggests that chicken juice contributes to C. jejuni biofilm formation by covering and conditioning the abiotic surface and is a source of nutrients. Chicken juice was able to complement the reduction in biofilm formation of an aflagellated mutant of C. jejuni, indicating that chicken juice may support food chain transmission of isolates with lowered motility. We provide here a useful model for studying the interaction of C. jejuni biofilms in food chain-relevant conditions and also show a possible mechanism for C. jejuni cell attachment and biofilm initiation on abiotic surfaces within the food chain.
The ability of several emergency FMD vaccine formulations to elicit early protective immunity in sheep was examined. All vaccine formulations were shown to protect sheep against airborne challenge ...with homologous FMDV within 4 days of vaccination. Protection was associated in part with the induction of serum antibody responses but was also demonstrated in the absence of any detectable antibody response at the time of challenge. Aqueous Al(OH)
3/saponin vaccine formulations and oil emulsion vaccines based on Montanide ISA 206 adjuvant reduced virus replication and the numbers of animals subclinically infected up to 28 days post-challenge, when compared with non-vaccinated animals, consequently limiting transmission of the disease or infection to in-contact susceptible animals.
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