Summary Osteoarthritis (OA) is a heterogeneous disorder. The goals of this review are (1) To stimulate use of standardized nomenclature for OA that could serve as building blocks for describing OA ...and defining OA phenotypes, in short to provide unifying disease concepts for a heterogeneous disorder; and (2) To stimulate establishment of ROAD (Risk of OA Development) and ROAP (Risk of OA Progression) tools analogous to the FRAX™ instrument for predicting risk of fracture in osteoporosis; and (3) To stimulate formulation of tools for identifying disease in its early preradiographic and/or molecular stages – REDI (Reliable Early Disease Identification). Consensus around more sensitive and specific diagnostic criteria for OA could spur development of disease modifying therapies for this entity that has proved so recalcitrant to date. We fully acknowledge that as we move forward, we expect to develop more sophisticated definitions, terminology and tools.
To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and ...Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data.
We sought evidence for 60 unique interventions. A systematic search of all relevant databases was conducted from inception through July 2018. After abstract and full-text screening by two independent reviewers, eligible studies were matched to PICO questions. Data were extracted and meta-analyses were conducted using RevMan software. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence Profiles were compiled using the GRADEpro web application. Voting for Core Treatments took place first. Four subsequent voting sessions took place via anonymous online survey, during which Panel members were tasked with voting to produce recommendations for all joint locations and comorbidity classes. We designated non-Core treatments to Level 1A, 1B, 2, 3, 4A, 4B, or 5, based on the percentage of votes in favor, in addition to the strength of the recommendation.
Core Treatments for Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management. Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were strongly recommended for individuals with Knee OA (Level 1A). For individuals with gastrointestinal comorbidities, COX-2 inhibitors were Level 1B and NSAIDs with proton pump inhibitors Level 2. For individuals with cardiovascular comorbidities or frailty, use of any oral NSAID was not recommended. Intra-articular (IA) corticosteroids, IA hyaluronic acid, and aquatic exercise were Level 1B/Level 2 treatments for Knee OA, dependent upon comorbidity status, but were not recommended for individuals with Hip or Polyarticular OA. The use of Acetaminophen/Paracetamol (APAP) was conditionally not recommended (Level 4A and 4B), and the use of oral and transdermal opioids was strongly not recommended (Level 5). A treatment algorithm was constructed in order to guide clinical decision-making for a variety of patient profiles, using recommended treatments as input for each decision node.
These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA.
Steam methane reforming (SMR) is one of the most promising processes for hydrogen production. Several studies have demonstrated its advantages from the economic viewpoint. Nowadays process ...development is based on technical and economical aspects; however, in the near future, the environmental impact will play a significant role in the design of such processes. In this paper, an SMR process is studied from the viewpoint of overall environmental impact, using an exergoenvironmental analysis. This analysis presents the combination of exergy analysis and life cycle assessment. Components where chemical reactions occur are the most important plant components from the exergoenvironmental point of view, because, in general, there is a high environmental impact associated with these components. This is mainly caused by the exergy destruction within the components, and this in turn is mainly due to the chemical reactions. The obtained results show that the largest potential for reducing the overall environmental impact is associated with the combustion reactor, the steam reformer, the hydrogen separation unit and the major heat exchangers. The environmental impact in these components can mainly be reduced by improving their exergetic efficiency. A sensitivity analysis for some important exergoenvironmental variables is also presented in the paper.
We make use of the Quantum Theory of Atoms in Molecules (QTAM) to partition the total energy of a many-electron system into intra- and interatomic terms, by explicitly computing both the one- and ...two-electron contributions. While the general scheme is formally equivalent to that by Bader et al., we focus on the separation and computation of the atomic self-energies and all the interaction terms. The partition is ultimately performed within the density matrices, in analogy with McWeeny's Theory of Electronic Separability, and then carried onto the energy. It is intimately linked with the atomistic picture of the chemical bond, not only allowing the separation of different two-body contributions (point-charge-like, multipolar, total Coulomb, exchange, correlation, ...) to the interaction between a pair of atoms but also including an effective many-body contribution to the binding (self-energy, formally one-body) due to the deformation of the atoms within the many-electron system as compared to the free atoms. Many qualitative ideas about the chemical bond can be quantified using this scheme.
•Integration of site utility and steam power plant.•Application of new targeting procedure for integrated plant.•Exergoeconomic and exergoenvironmental evaluation.
The purpose of a steam power plant ...usually is electrical power generation; however, it can work as dual purpose plant producing steam and power simultaneously. In this paper we seek the optimum integration of a steam power plant as a source and a site utility system as a sink of steam and power. Estimating the cogeneration potential prior to the design of a central utility system for site utility systems is important for setting targets for site fuel demand as well as heat and power production. In this regard, an accurate cogeneration targeting procedure is used for the coupling of a steam power plant and a site utility consisting of a process plant. Exergoeconomic and exergoenvironmental evaluations are performed. In the exergoenvironmental analysis, the environmental impacts obtained by life cycle assessment (LCA) are apportioned to the exergy streams, identifying the main system components with the highest environmental impacts and possible improvements associated with these components. Moreover, exergoenvironmental variables are calculated, and an exergoenvironmental evaluation is carried out. In addition, the cogeneration targeting method has been applied.
A gas fired steam power plant and a process site utility are considered as a case study, with the integration of steam levels of the steam power plant and the site utility system carried out using the new procedure presented in this paper.
Given the energy of a solid (
E) as a function of the molecular volume (
V), the
gibbs program uses a quasi-harmonic Debye model to generate the Debye temperature
Θ(
V), obtains the non-equilibrium ...Gibbs function
G
★(
V;
p,
T), and minimizes
G
★ to derive the thermal equation of state (EOS)
V(
p,
T) and the chemical potential
G(
p,
T) of the corresponding phase. Other macroscopic properties are also derived as a function of
p and
T from standard thermodynamic relations. The program focuses in obtaining as much thermodynamical information as possible from a minimum set of (
E,
V) data, making it suitable to analyse the output of costly electronic structure calculations, adding thermal effects at a low computational cost. Any of three analytical EOS widely used in the literature can be fitted to the
p−
V(
p,
T) data, giving an alternative set of isothermal bulk moduli and their pressure derivatives that can be fed to the Debye model machinery.
Title of the program:
gibbs
Catalogue number: ADSY
Program summary URL:
http://cpc.cs.qub.ac.uk/summaries/ADSY
Program obtainable from: CPC Program Library, Queen's University of Belfast, N. Ireland
Licensing provisions: Persons requesting the program must sign the standard CPC non-profit use license
Computers on which the program has been tested: Intel Pentium, Alpha, Sun Sparc/Ultra/Blade
Operating system under which the program has been tested: Unix, GNU/Linux
Programming language used: Fortran 77
Memory required to execute with typical data: 700 KB
No. of bits in a word: 32
No. of processors used: 1
No. of bytes in distributed program, including test data, etc.: 277
497
No. of lines in distributed program, including test data, etc.: 7390
Distribution format: tar gzip file
Keywords: Quasi-harmonic Debye model, equation of state
Nature of physical problem: Derivation of the static and thermal equation of state, chemical potential, and thermodynamic properties of a crystal from energy-volume data only.
Method of solution: A quasi-harmonic Debye model is used to obtain the vibrational Helmholtz free energy as a function of temperature at the molecular volumes of input. The non-equilibrium Gibbs energy is then minimized at any temperature
T and pressure
p to obtain the EOS and the chemical potential. Several standard EOS parameters can be derived by fitting analytical forms to the pressure-volume data. Finally, some thermodynamic properties are computed for each (
p,
T).
Restrictions on the complexity of the problem: Thermal effects are assumed to be well represented by a quasi-harmonic Debye model, in which the temperature dependence of the internal parameters is embedded into the temperature dependence of the volume.
Typical running time: less than 1 s (Pentium III, 800 MHz) for 25 (
E,
V) pairs, 10 pressure and 10 temperature values.
In this study, an optimal design and analysis of an integrated internal reforming Solid Oxide fuel cell (IRSOFC) - Gas Turbine (GT) – Organic Rankine Cycle (ORC) system are investigated. R407C and ...R404A as ORC working fluids are used to produce the additional power based on the recovery of the flue gases in the ORC. A thermodynamic simulation of the integrated system has been performed to evaluate the performance of the proposed cycle. In this regard, exergetic, exergoeconomic and exergoenvironmental analyses have been done for a better understanding of the interaction between the components and the overall system. In order to carry out the exergoenvironmental analysis, the environmental impacts obtained by Life Cycle Assessment (LCA) are apportioned to the exergy streams. The analysis of this integrated system has been carried out by using computer code in MATLAB. A Multi-Objective Water Cycle Algorithm based on the maximization of overall exergy efficiency and minimization of total exergetic cost rate and total exergetic environmental impacts was performed to find optimum design variables for the proposed system. The results show that R407C has the best thermodynamic performance and with this organic fluid the overall energy and exergy efficiencies for the proposed optimum system are 49.42% and 46.83% respectively. Furthermore, the exergoeconomic and exergoenvironmental main optimum parameters are comprised and evaluated.
Proteasome inhibitors (PIs), namely bortezomib, have become a cornerstone therapy for multiple myeloma (MM), potently reducing tumor burden and inhibiting pathologic bone destruction. In clinical ...trials, carfilzomib, a next generation epoxyketone-based irreversible PI, has exhibited potent anti-myeloma efficacy and decreased side effects compared with bortezomib. Carfilzomib and its orally bioavailable analog oprozomib, effectively decreased MM cell viability following continual or transient treatment mimicking in vivo pharmacokinetics. Interactions between myeloma cells and the bone marrow (BM) microenvironment augment the number and activity of bone-resorbing osteoclasts (OCs) while inhibiting bone-forming osteoblasts (OBs), resulting in increased tumor growth and osteolytic lesions. At clinically relevant concentrations, carfilzomib and oprozomib directly inhibited OC formation and bone resorption in vitro, while enhancing osteogenic differentiation and matrix mineralization. Accordingly, carfilzomib and oprozomib increased trabecular bone volume, decreased bone resorption and enhanced bone formation in non-tumor bearing mice. Finally, in mouse models of disseminated MM, the epoxyketone-based PIs decreased murine 5TGM1 and human RPMI-8226 tumor burden and prevented bone loss. These data demonstrate that, in addition to anti-myeloma properties, carfilzomib and oprozomib effectively shift the bone microenvironment from a catabolic to an anabolic state and, similar to bortezomib, may decrease skeletal complications of MM.
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