A review on the historical evolution of seismic hazard maps in Turkey is followed by summarizing the important aspects of the updated national probabilistic seismic hazard maps. Comparisons with the ...predecessor probabilistic seismic hazard maps as well as the implications on the national design codes conclude the paper.
Introduction
Desamino D‐arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues ...regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored.
Aim
The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWD patients.
Methods
We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWD patients.
Results
DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWD patients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use.
Conclusions
DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWD patients.
Introduction
The bleeding propensity in von Willebrand disease (VWD) is usually moderate or mild and patients with VWD do not need continuous treatment, but do require extra increased haemostatic ...cover when undergoing dental or surgical procedures. Desmopressin can be effective in certain patient groups and this has been considered in a previous publication.
Aim
This paper now seeks to evaluate current knowledge and practice in the use of factor concentrate in the management of VWD patients undergoing invasive procedures.
Methods
A literature search was performed on the use of factor concentrates to cover invasive procedures and a survey of current practice in a number of specialist haematology centres across Europe represented by the European Haemophilia Strategy Board was conducted.
Results
Our review of the literature and the results of the survey showed considerable heterogeneity in treatment regimens, and a lack of consistency in reporting of the variables that determine factor concentrate dosing and monitoring.
Conclusion
By analysing the literature, examining guidelines and using consensus deliberation, this survey allowed the group to develop recommendations for management of VWD patients undergoing invasive procedures.
Early collaboration is crucial if the final design is to be clash-free, and automation processes through Building Information Modelling (BIM) have the capacity to reduce clashes through 3D design ...coordination. Yet, current design practices are still dependent on clash detection and contemporary literature presents several reasons for this. This paper investigates the root causes of clashes with respect to achieving “clash avoidance” as proposed in PAS 1192-2 design phase specifications for BIM in the UK. Empirical data from BIM coordinators around the world was collected and analyzed using explanatory sequential mixed-methods. It was found that: (i) isolated working was the prime cause of high occurrences of clashes linked to mechanical, electrical and plumbing (MEP) 3D BIM systems; (ii) there is a link between non-BIM specific training (or the professional qualifications) of design practitioners with the high incidence of clashes; and (iii) the current structure of cloud-based common data environments (CDEs) does not facilitate clash avoidance and in fact, encourages isolated working in the early design stage by creating “digital information silos”. A conceptual framework for an open work in progress (OWIP) has been proposed to address this problem. These findings point to the need for more transparency during collaboration through CDE where designers from multidisciplinary backgrounds can engage in concurrent co-creation. This transparent and inclusive process could have consequences on how future architectural, engineering and construction (AEC) professionals are trained.
In treating brain diseases, such as canine cognitive dysfunction (CCD), most currently available potent drugs have weak therapeutic efficacy. One of the causes is the inability of the substance to ...reach the brain in therapeutic quantities. These pharmaceuticals lacked targeted mechanisms for drug delivery, coming about in an elevated drug concentration in imperative organs, which drove to drug harmfulness. In recent years, cell-free treatment (conditioned medium) determined from animal and human stem cells has provided new promise for treating brain diseases, as CM can stimulate the regeneration of neurons and prevent the inflammation and apoptotic of neurons caused by pathology or aging. On the other hand, it is well known that chitosan-hydrogel (CH) is a polymer derived from natural sources. It has been authorized for use in biomedical use because of its uncommon biodegradability, biocompatibility, and mucoadhesive properties. CH modification has been utilized to generate nanoparticles (NPs) for intranasal and intravenous brain targeting. NPs shown upgraded drug take-up to the brain with decreased side impacts due to their drawn out contact time with the nasal mucosa, surface charge, nanosize, and capacity to extend the tight intersections inside the mucosa. Due to the aforementioned distinctive characteristics, developing Chitosan Hydrogel Nanoparticles load with bovine umbilical mesenchymal stem cell conditioned medium is crucial as a new therapeutic strategy for CCD.
Abstract
Artificial dyes such as methylene blue are commonly detected in textile industry wastewater. Clay is commonly used as an economical and effective adsorbent for methylene blue in textile ...waste treatment. The addition of surfactants into the system is usually done to increase the adsorption capacity of the clay. In this study, we used a molecular dynamics simulation method to study the effect of tetrabutylammonium organic surfactant on the adsorption process of methylene blue on the clay surface. The modelled clays are pyrophyllite and montmorillonite which are hydrophobic and negatively charged, respectively. The simulation results show that the addition of tetrabutylammonium surfactant causes a 12 % and 40% decrease in the binding of methylene blue to the surfaces of pyrophyllite and montmorillonite, respectively. This is due to the occurrence of competitive adsorption in both systems. Therefore, the addition of tetrabutylammonium surfactant was considered ineffective in increasing the adsorption capacity of pyrophyllite and montmorillonite.
Introduction: Unanticipated difficult airway is still a cause of morbidity and mortality. Various parameters are used to predict difficult airways. Recent studies have found that measuring the ...Sternomental Displacement (SMDD) can help establish a difficult airway. Aim: To find whether the Ratio of Height to Sternomental Displacement (RHSMDD) could be used as a predictor for Difficult Laryngoscopy (DL) and intubation. Secondary objectives included comparing RHSMDD with routine assessment parameters like Modified Mallampati Score (MMT), SMD, Thyromental Distance (TMD), and Inter Incisor Distance (IID). Materials and Methods: A prospective observational study was conducted at Malabar Medical College, Calicut, Kerala, India among 120 adult patients undergoing elective surgeries under general anaesthesia. Airway parameters like MMT, IID, TMD, SMD, Sternomental Displacement (SMDD), RHSMDD, Ratio of Height to Sternomental Distance (RHSMD), and Ratio of Height to Thyromental Distance (RHTMD) were measured preoperatively and associated with Cormack Lehane’s laryngoscopic grading and Intubation Difficulty Scale (IDS) value. A comparison of airway parameters with laryngoscopy and intubation was done by the Mann-Whitney U test. Receiver Operating Characteristics (ROC) curves were constructed, and optimal cut-off values for significant quantitative indices were calculated. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were also calculated and compared. Results: The incidence of DL was 27.5%, and Difficult Intubation (DI) was 10.8%. Age (p-value=0.013), weight (p-value=<0.001), and height (p-value=0.019) showed a significant association with DL. It was found that only RHTMD was statistically significantly higher in the DI group (p=0.044). All other parameters did not show statistical significance in either group. The calculated cutoff value for RHTMD was ≥18.45 cm. The highest specificity (96.3%) and NPV (90.43%) were observed for Body Mass Index (BMI) alone as a predictor of DI. The highest sensitivity (93.75%) was observed for TMD alone in predicting DL. The combination of MMT+RHSMD yielded the highest sensitivity and NPV for DI. Conclusion: RHTMD showed significance in DI and remains a better predictor. RHSMDD cannot be used as a predictor for a difficult airway. The combination of parameters demonstrated high sensitivity and NPV, suggesting they can be combined with modern ultrasound airway measurement for more accuracy
Despite decades of research, glioblastoma (GBM) remains invariably fatal among all forms of cancers. The high level of inter‐ and intratumoral heterogeneity along with its biological location, the ...brain, are major barriers against effective treatment. Molecular and single cell analysis identifies different molecular subtypes with varying prognosis, while multiple subtypes can reside in the same tumor. Cellular plasticity among different subtypes in response to therapies or during recurrence adds another hurdle in the treatment of GBM. This phenotypic shift is induced and sustained by activation of several pathways within the tumor itself, or microenvironmental factors. In this review, the dynamic nature of cellular shifts in GBM and how the tumor (immune) microenvironment shapes this process leading to therapeutic resistance, while highlighting emerging tools and approaches to study this dynamic double‐edged sword are discussed.
This review summarizes the dynamic nature of cellular shift in glioblastoma and how the tumor (immune) microenvironment shapes this process leading to therapeutic resistance, while highlighting emerging tools and approaches to study this dynamic double‐edged sword.
High-speed trains are one of the most preferred ways of transportation. The fact that it is fast and safe, cost effective and not being effected by weather conditions provides many advantages for ...passengers but there are also many disadvantages for the buildings close to the train track and the people who reside in these buildings. In this study, a series of site tests were performed to obtain the acceleration recordings of the vibrations existing in free field of the soil and building foundation. The average shear wave velocity of soil was considered as 200m/s and the velocity of the high-speed train was taken as 250km/h. In this study, it is aimed to reveal the kinematic interaction between the free field motion and foundation vibration of the building while high-speed train passed. Furthermore, vibrations occurring under the current soil conditions of the study area were evaluated according to the key parameters defined in regulations of the Federal Transit Administration Report (FTA) and Human Exposure to Vibration in Buildings/Effects of Vibration on Structures (DIN 4150-2/3). It is seen that the compliance with the limit values specified in the regulations changes according to the purpose of use. The results showed that rigid foundations significantly modify the wave propagation and vibration level due to kinematic interaction effects.
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