Infusion of 5% human albumin (HA) and 6% hydroxyethyl starch 130/0.4 (HES) during cardiac surgery expand circulating volume to a greater extent than crystalloids and would be suitable for a ...restrictive fluid therapy regimen. However, HA and HES may affect blood coagulation and could contribute to increased transfusion requirements.
We randomly assigned 240 patients undergoing elective cardiac surgery to receive up to 50 ml kg−1 day−1 of either HA, HES, or Ringer’s lactate (RL) as the main infusion fluid perioperatively. Study solutions were supplied in identical bottles dressed in opaque covers. The primary outcome was chest tube drainage over 24 h. Blood transfusions, thromboelastometry variables, perioperative fluid balance, renal function, mortality, intensive care unit, and hospital stay were also assessed.
The median cumulative blood loss was not different between the groups (HA: 835, HES: 700, and RL: 670 ml). However, 35% of RL patients required blood products, compared with 62% (HA) and 64% (HES group; P=0.0003). Significantly, more study solution had to be administered in the RL group compared with the colloid groups. Total perioperative fluid balance was least positive in the HA group 6.2 (2.5) litre compared with the HES 7.4 (3.0) litre and RL 8.3 (2.8) litre groups (P<0.0001). Both colloids affected clot formation and clot strength and caused slight increases in serum creatinine.
Despite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.
1. Freshwater conservation has received less attention than its terrestrial or marine counterparts. Given the accelerated rate of change and intensive human use that freshwater ecosystems are ...submitted to, it is urgent to focus more attention on fresh waters. Existing conservation planning tools - such as Marxan - need to be modified to account for the special nature of these systems. Connectivity plays a key role in freshwater ecosystems. Threats are mediated along river corridors, and the condition of the entire catchment influences river biodiversity downstream. This needs to be considered in conservation planning. 2. The probabilities of occurrence of nine native freshwater fish species in a Mediterranean river basin, obtained from Multivariate Adaptive Regression Splines‐ Generalized Linear Model (MARS‐GLM) models, were used as features to develop spatial conservation priorities. The priorities accounted for complementarity and spatial design issues. 3. To deal with the connected nature of rivers, we modified Marxan's boundary length penalty, avoiding the selection of isolated planning units and forcing the inclusion of closer upstream areas. We introduced ‘virtual boundaries' between non‐headwater stream segments and added distance‐weighted penalties to the overall connectivity cost (CP) when stream segments upstream of the selected planning units are not selected. 4. This approach to prioritising connectivity is concordant with ecological theory, as it considers the natural and roughly exponential decay of upstream influences with distance. It accounts for the natural capacity of rivers to mitigate impacts when designing reserves. When connectivity was not emphasised, Marxan prioritised natural corridors for longitudinal movements. In contrast, whole sub‐basins were prioritised when connectivity was emphasised. Changing the relative emphasis on connectivity substantially changed the spatial prioritisation; our conservation investment could move from one basin to another. 5. Our novel approach to dealing with directional connectivity enables managers of freshwater systems to set ecologically meaningful spatial conservation priorities.
Background
While near surface residual stress (NSRS) from milling is a driver for distortion in aluminum parts there are few studies that directly compare available techniques for NSRS measurement.
...Objective
We report application and assessment of four different techniques for evaluating residual stress versus depth in milled aluminum parts.
Methods
The four techniques are: hole-drilling, slotting, cos(α) x-ray diffraction (XRD), and sin
2
(ψ) XRD, all including incremental material removal to produce a stress versus depth profile. The milled aluminum parts are cut from stress-relieved plate, AA7050-T7451, with a range of table and tool speeds used to mill a large flat surface in several samples. NSRS measurements are made at specified locations on each sample.
Results
Resulting data show that NSRS from three techniques are in general agreement: hole-drilling, slotting, and sin
2
(ψ) XRD. At shallow depths (< 0.03 mm), sin
2
(ψ) XRD data have the best repeatability (< 15 MPa), but at larger depths (> 0.04 mm) hole-drilling and slotting have the best repeatability (< 10 MPa). NSRS data from cos(α) XRD differ from data provided by other techniques and the data are less repeatable. NSRS data for different milling parameters show that the depth of NSRS increases with feed per tooth and is unaffected by cutting speed.
Conclusion
Hole-drilling, slotting, and sin
2
(ψ) XRD provided comparable results when assessing milling-induced near surface residual stress in aluminum. Combining a simple distortion test, comprising removal of a 1 mm thick wafer at the milled surface, with a companion stress analysis showed that NSRS data from hole-drilling are most consistent with milling-induced distortion.
The public health message around alcohol is complex, with benefits versus harms, the confusing concept of risk and drinking guidance changing over time. This provides a difficult context for alcohol ...screening in primary care, with established barriers from the practitioner perspective, but less is known about the patients' perspective. This study explores patients' views on drinking.
Eligible participants were recorded as drinking above low risk levels in primary care. Six practices in North London participated. Interviews were in-depth, semi-structured, transcribed verbatim and underwent detailed thematic analysis.
Interviews were conducted with 8 women and 12 men, aged 26-83 years, mostly educated to undergraduate level and of 'White' ethnicity. UK drinking guidance was viewed as irrelevant for reasons related to life stage, lifestyle and absence of harm. Dependence, loss of functionality and control were perceived as key features of problematic drinking. Healthy lifestyles, in terms of diet, exercise and not smoking, were thought to mitigate potential problems associated with alcohol intake.
The findings suggest that public health messages and brief advice should focus on harm experienced at different life stages, among people with different lifestyles, to challenge the ubiquitous view that 'I'm not a real boozer'.
Mankind is setting to colonize space, for which the manufacturing of habitats, tools, spare parts and other infrastructure is required. Commercial manufacturing processes are already well engineered ...under standard conditions on Earth, which means under Earth’s gravity and atmosphere. Based on the literature review, additive manufacturing under lunar and other space gravitational conditions have only been researched to a very limited extent. Especially, additive manufacturing offers many advantages, as it can produce complex structures while saving resources. The materials used do not have to be taken along on the mission, they can even be mined and processed on-site. The Einstein-Elevator offers a unique test environment for experiments under different gravitational conditions. Laser experiments on selectively melting regolith simulant are successfully conducted under lunar gravity and microgravity. The created samples are characterized in terms of their geometry, mass and porosity. These experiments are the first additive manufacturing tests under lunar gravity worldwide.
Background: The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown. Aims: To establish levels of ...alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. Method: 3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions. Results: Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment. Conclusions: IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.
Background: Animal models have limitations in cancer research, especially regarding anatomy-specific questions. An example is the exact endoscopic placement of magnetic field traps for the targeting ...of therapeutic nanoparticles. Three-dimensional-printed human replicas may be used to overcome these pitfalls. Methods: We developed a transparent method to fabricate a patient-specific replica, allowing for a broad scope of application. As an example, we then additively manufactured the relevant organs of a patient with locally advanced pancreatic ductal adenocarcinoma. We performed experimental design investigations for a magnetic field trap and explored the best fixation methods on an explanted porcine stomach wall. Results: We describe in detail the eight-step development of a 3D replica from CT data. To guide further users in their decisions, a morphologic box was created. Endoscopies were performed on the replica and the resulting magnetic field was investigated. The best fixation method to hold the magnetic field traps stably in place was the fixation of loops at the stomach wall with endoscopic single-use clips. Conclusions: Using only open access software, the developed method may be used for a variety of cancer-related research questions. A detailed description of the workflow allows one to produce a 3D replica for research or training purposes at low costs.
Linke et al thank the authors for taking the time to comment about their manuscript. Their thoughtful response reiterated the limitations of cross- sectional data and the need for intervention and ...longitudinal research to better understand the relationships among the risk factors addressed in their publication. They share this viewpoint and attempt to convey in their manuscript that these results do not indicate a definitive relationship between the risk factors as found in their results.
•We have developed a chart based on DOEs. It can be used to control the burr size for various process parameters.•Micro drills were used for drilling PCB. The study aims to optimize the drilling ...process by minimizing burr formation.•The chart has been divided into uniform burr, transient burr, preferred burr, drill breakage and critical burr region.•Taguchi method and multiple regression tests were performed for determining the variance in the burr height.•It was shown that drill diameter made a statistically significant contribution to the variance in burr height.
A drilling burr-control chart (DBCC), based on experimental results, is a tool for the prediction and control of drilling burrs for a large range of drilling parameters. A micro-drilling burr-control chart (M-DBCC) was developed for a standard double-sided copper-clad laminated (CCL) printed circuit board (PCB) with laminated fiber-reinforced plastic (FRP) substrate. This chart will assist in the selection of favorable drilling parameters for predicting and achieving preferred types of burrs. Burr classification was carried out according to the burr geometric characteristics, burr formation mechanisms, burr height, and drill bit breakage while drilling. The design of experiment (DOE) technique based on the Taguchi method was used to find the most significant drilling parameter affecting burr height. The results show that the drill diameter makes a statistically significant contribution to burr-height variation.
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