In the interworking between a cellular network and wireless local area networks (WLANs), a two-tier overlaying structure exists in the WLAN-covered areas. Due to the heterogeneous underlying ...quality-of-service (QoS) support, the admission of traffic in these areas has a significant impact on QoS satisfaction and overall resource utilization, especially when multiple services are considered. In this paper, we analyze the performance of a simple admission strategy, referred to as WLAN-first scheme, in which incoming voice and data service requests always first try to get admission to the WLAN whenever it is available. It is observed that the overall resource utilization can be maximized when the admission regions for voice and data services in a cell and a WLAN are properly configured
In this work, we perform first-principles calculations, coupled with synchrotron small-angle x-ray scattering (SAXS) to investigate electronic origins of the chemical short-range ordering (CSRO) and ...to reveal the relationship between CSROs and mechanical properties in a typical bcc (body-centered-cubic) TiZrHfNb high-entropy alloys (HEAs). It was found that existence of an appropriate degree of CSROs not only stabilizes the HEA lattice structure, but also enhances the hardness, elastic modulus, and ideal strength. Comprehensive electronic structure analyses uncover that the reduction of d electrons at the Fermi level due to the development of (Ti, Zr)-based CSROs stabilizes the bcc HEA, and the CSRO-induced strengthening is attributed to the local lattice distortion and the d-electron transfer from high-energy to low-energy states under applied strains. This finding not only gives insight into understanding the nature of CSRO strengthening in bcc HEAs, but also provides a paradigm for achieving desired mechanical properties via tailoring CSROs in HEAs.
Itch in patients with chronic kidney disease (CKD) is common, often very distressing and associated with depression, reduced quality of life, and increased death. The most common first-line treatment ...has been the use of antihistamines despite the lack of substantial evidence for its use for uraemic itch. Few recommendations and guidelines exist for treatment.
We aimed to determine: 1) the benefits and harms (both absolute and relative) of all topical and systemic interventions for the treatment of uraemic itch, either alone or in combination, when compared with placebo or standard care; and, 2) the dose strength or frequency, stage of kidney disease or method of dialysis used (where applicable) in cases where the effects of these interventions vary depending on co-interventions.
We searched the Cochrane Kidney and Transplant Register of Studies up to 17 December 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
Randomised controlled trials (RCTs) in adults with CKD stages 4 or 5 comparing treatments (pharmacological, topical, exposure, dialysis modality) for CKD associated itch to either placebo or other established treatments.
Two authors independently abstracted study data and assessed study quality. Data were analysed using a random effects meta-analysis design estimating the relative effects of treatment versus placebo. Estimates of the relative effects between treatments are included where possible. For continuous measures of severity of itch up to three months, mean difference (MD) or standardised mean difference (SMD) were used. When reported, adverse effects were tabulated. The certainty of the evidence was estimated using GRADE.
Ninety-two RCTs, randomising 4466 participants were included. Fifty-eight studies (3285 participants) provided sufficient data to be meta-analysed. Of these, 30 compared an intervention to a placebo or control. The 10 cm Visual Analogue Scale (VAS) was the dominant instrument utilized for itch reporting and the Duo score was used in a minority of studies. GABA analogues including, gabapentin and pregabalin, reduce itch in patients with CKD (5 studies, 297 participants: 4.95 cm reduction, 95% CI 5.46 to 4.44 lower in VAS compared to placebo; high certainty evidence). Kappa opioid agonists, including nalfurafine also reduced itch in this population (6 studies, 661 participants: 1.05 cm reduction, 95% CI 1.40 to 0.71 lower in VAS compared to placebo; high certainty evidence). Ondansetron had little or no effect on itch scores (3 studies, 183 participants: 0.38 cm reduction, 95% CI 1.04 lower to 0.29 higher in VAS compared to placebo; high certainty evidence). Reduction in the severity of itch was reported with oral montelukast, turmeric, zinc sulfate and topical capsaicin. For all other interventions, the certainty of the evidence was low to moderate, and the interventions had uncertain effects on uraemic pruritus. Six studies have disclosed significant financial support from their respective manufacturers, six were affected by lack of blinding, and 11 studies have 15 participants or less. Older, smaller RCTs often failed to follow intention-to-treat protocols with unexplained dropouts after randomisation. Adverse effects were generally poorly and inconsistently reported across all RCTs. No severe adverse events were reported for any intervention.
The RCTs of this meta-analysis contain a large array of interventions with a diverse set of comparators. For many interventions, trials are sparse. This served to make informative meta-analysis challenging. Of all treatments for uraemic pruritus, gabapentinoids (gabapentin and pregabalin) were the most studied and show the greatest reduction in itch scores. Further RCTs, even of the scale of the largest trials included in this review, are unlikely to significantly change this finding. Kappa-opioid agonists (mainly nalfurafine) also may reduce itch, but indirect comparison suggests a much more modest effect in comparison to GABA analogues. Evidence for oral montelukast, turmeric, zinc sulfate, and topical capsaicin also showed an itch score reduction. However, these reductions were reported in small studies, and warrant further investigation. Ondansetron did not reduce itch. It is somewhat unlikely that a further study of ondansetron will change this result.
The regulatory function of histone acetylation in the expression of genes encoding heat shock proteins (Hsps) has been documented in Drosophila melanogaster; however, knowledge of the role of ...acetylation in modulating Hsps in other insect pests is limited. In this study, two full‐length cDNAs encoding inducible Hsp70 (designated TcHsp70) and heat shock cognate 70 (TcHsc70) were isolated and characterized in the red flour beetle, Tribolium castaneum. TcHsp70 and TcHsc70 cDNAs were 2256 and 2132 bp and encoded 1941‐ and 1893‐bp open reading frames, respectively. The deduced TcHsp70 and TcHsc70 proteins contained 646 and 630 amino acids, respectively, and contained sequences typical of the Hsp70 family, including the EEVD motif for cytoplasmic localization. Expression patterns after heat shock indicated that TcHsp70 was strongly heat‐inducible, whereas the expression level of TcHsc70 remained unchanged under heat shock. RNA interference‐mediated knock‐down of three genes encoding class I histone deacetylases differentially influenced both basal and heat shock inducible expression of TcHsp70 and TcHsc70, suggesting the involvement of histone acetylation in epigenetic regulation of Hsp70 transcription in T. castaneum.
Two full‐length cDNAs encoding heat shock protein 70 (TcHsp70) and heat shock cognate 70 (TcHsc70) were isolated and characterized in Tribolium castaneum.
TcHsp70 was strongly heat‐inducible, whereas the expression level of TcHsc70 remained unchanged under heat shock.
RNA interference‐mediated knock‐down of three genes encoding class I histone deacetylases differentially influenced both basal and heat shock inducible expression of TcHsp70 and TcHsc70.
We report the first beam-target double-polarization asymmetries in the γ+n(p)→π^{-}+p(p) reaction spanning the nucleon resonance region from invariant mass W=1500 to 2300 MeV. Circularly polarized ...photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN^{*} resonance photocouplings.
Measuring Mortality Performance Jiang, H. Joanna; Reiter, Kristin L.; Wang, Jia
Medical care,
07/2016, Volume:
54, Issue:
7
Journal Article
Peer reviewed
BACKGROUND:Safety-net hospitals (SNHs) tend to be weaker in financial condition than other hospitals, leading to a concern about how the quality of care at these hospitals would compare to other ...hospitals.
OBJECTIVES:To assess mortality performance of SNHs using all-payer databases and measures for a broad range of conditions and procedures.
DESIGN:Longitudinal analysis of hospitals from 2006 through 2011 with data from the Healthcare Cost and Utilization Project State Inpatient Databases, the American Hospital Association Annual Survey, and the Area Health Resources File.
SUBJECTS:A total of 1891 urban, nonfederal, general acute hospitals from 31 states.
METHODS:SNHs were identified by the percentage of Medicaid and uninsured patients. Hospital mortality performance was measured by 2 composites covering 6 common medical conditions and 4 surgical procedures with risk adjustment for patient characteristics. Differences in each composite between SNHs and non-SNHs were estimated through generalized estimating equations to control for hospital factors and community resources.
RESULTS:Inpatient mortality rates declined over time for all hospitals. Small differences in risk-adjusted mortality rates between SNHs and non-SNHs were found only among teaching hospitals. After controlling for hospital factors, these differences were substantially reduced and remained significant only for surgical mortality rates. The small gap in surgical mortality rates diminished in later years.
CONCLUSIONS:SNHs appeared to perform equally well as other hospitals in medical and surgical mortality measures. Policymakers should continue to monitor the quality of care at SNHs and ensure that it would not decline under the current value-based purchasing program.
Zinc phosphate coating was formed on AZ91D magnesium alloy through a phosphating bath where H
3PO
4, ZnO, Zn(NO
3)
2 and NaF were applied. Chlorate (NaClO
3) was used as an accelerator of ...phosphatization to replace nitrite. The coating compositions were hopeite (Zn
3(PO
4)
2·4H
2O) and Zn. The growth process of the phosphate film on the magnesium alloy substrate was investigated by SEM observation and XRD analysis. In the early stage (0–60 s) of phosphatization, both hopeite and metallic zinc nucleated and grew together on the substrate to form flower structure. A great number and uniform nucleation of hopeite and metallic zinc implied that they formed on the β and α phases of the AZ91D magnesium alloy simultaneously. Afterwards, because magnesium alloy substrate was almost fully covered, only hopeite deposited continuously to form slab-like structure. The formed zinc phosphate coatings exhibited high corrosion resistance in 5% NaCl solution as shown by polarization measurement.
Background and Purpose
Nitidine chloride (NC), a benzophenanthridine alkaloid, has various biological properties including anticancer and analgesic activities. The aim of the present study was to ...evaluate the role of organic cation transporter 2 (OCT2) and multidrug and toxin extrusion 1 (MATE1) in the renal disposition and nephrotoxicity of NC.
Experimental Approach
MDCK cells stably expressing human OCT2 and/or hMATE1 were used to investigate the OCT2‐ and MATE1‐mediated transport of NC. In addition, the accumulation of NC and its potential toxicity were studied in rat primary‐cultured proximal tubular (rPCPT) cells and in rats in vivo.
Key Results
NC was found to be a high‐affinity substrate of both OCT2 and MATE1 with high cytotoxicity in MDCK‐hOCT2/hMATE1 and MDCK‐hOCT2 compared to mock cells. The OCT2 inhibitors, cimetidine and (+)‐tetrahydropalmatine ((+)‐THP), significantly reduced NC accumulation and cytotoxicity in MDCK‐hOCT2, MDCK‐hOCT2/hMATE1 and rPCPT cells. Severe kidney damage with high levels of blood urea nitrogen and lactate dehydrogenase (LDH), reduced levels of alkaline phosphatase (ALP) and pathological changes were found in rats after 20 days of successive i.v. doses of NC (5 mg·kg−1·day−1). Concomitantly, the concentration of NC in the kidney reached similar high levels at 2 h after the last dose of the 20 day treatment as those observed at 0.5 h after a single i.v. dose of 5 mg·kg−1.
Conclusions and Implications
Our data indicate that NC‐induced nephrotoxicity might be mainly attributed to OCT2‐mediated extensive renal uptake and weak tubular secretion by MATE1.
Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been ...proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.
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