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Background Kidney transplant recipients (KTRs) are routinely excluded from direct oral anticoagulant (DOAC) trials. Given the lack of safety and efficacy data in this population, we examined real-world prescribing practices of DOACs in KTRs. Methods We conducted a retrospective cohort study using linked administrative data sets in Ontario, Canada. All adult KTRs (n = 5580) from June 23, 2009, to March 31, 2017, were included. The primary outcomes were the first prescription for a DOAC or warfarin. Patients were censored on graft failure, death, or end of follow-up. Results The mean age was 55 (SD, 14) years; 63% were male, and 65% had received a deceased donor kidney. Over a median follow-up of 5.5 and 4.7 years, 224 KTRs (4.0%) and 824 KTRs (14.8%) were prescribed DOACs and warfarin, respectively. The rates of DOAC and warfarin prescriptions were 8.1 and 32.6 per 1000 person-years, respectively. Older age, receipt of a kidney transplant in more recent years, and higher baseline estimated glomerular filtration rate were associated with DOAC prescription compared with warfarin. Patients with multiple comorbidities and a history of deep venous thromboembolism had a lower risk of DOAC prescription compared with warfarin. When examined by era, the incidence rate of both DOAC and warfarin prescriptions increased significantly over time. Conclusions Despite limited safety and efficacy data, DOACs are prescribed to KTRs. However, warfarin still remains more commonly prescribed in this selected patient population. Anticoagulant prescriptions overall are on the rise in KTRs. Further study is needed to determine the safety and efficacy of DOACs in KTRs.

A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; at years 1, 2, and 3; and at final follow-up (average of 3.4 years). Both bisphosphonate and denosumab treatments increased lumbar spine bone density; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Denosumab treatment increased femoral neck BMD, whereas bisphosphonate treatment had a mean decrease in femoral neck BMD at final follow-up. Thus, our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant.To compare the clinical effectiveness and safety between the use of denosumab and bisphosphonates on bone density and incidence of adverse events in renal transplant patients.A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; years 1, 2, and 3; and at final follow-up (average of 3.4 years).Absolute change in lumbar spine and femoral neck BMD over the treatment period was 0.029 ± 0.075 g/cmBoth treatments increased lumbar spine BMD; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant.

Grassland birds are among the most globally threatened bird groups due to substantial degradation of native grassland habitats. However, the current network of grassland conservation areas may not be adequate for halting population declines and biodiversity loss. Here, we evaluate a network of grassland conservation areas within Wisconsin, U.S.A., that includes both large Focal Landscapes and smaller targeted conservation areas (e.g., Grassland Bird Conservation Areas, GBCAs) established within them. To date, this conservation network has lacked baseline information to assess whether the current placement of these conservation areas aligns with population hot spots of grassland‐dependent taxa. To do so, we fitted data from thousands of avian point‐count surveys collected by citizen scientists as part of Wisconsin's Breeding Bird Atlas II with multinomial N‐mixture models to estimate habitat–abundance relationships, develop spatially explicit predictions of abundance, and establish ecological baselines within priority conservation areas for a suite of obligate grassland songbirds. Next, we developed spatial randomization tests to evaluate the placement of this conservation network relative to randomly placed conservation networks. Overall, less than 20% of species statewide populations were found within the current grassland conservation network. Spatial tests demonstrated a high representation of this bird assemblage within the entire conservation network, but with a bias toward birds associated with moderately tallgrasses relative to those associated with shortgrasses or tallgrasses. We also found that GBCAs had higher representation at Focal Landscape rather than statewide scales. Here, we demonstrated how combining citizen science data with hierarchical modeling is a powerful tool for estimating ecological baselines and conducting large‐scale evaluations of an existing conservation network for multiple grassland birds. Our flexible spatial randomization approach offers the potential to be applied to other protected area networks and serves as a complementary tool for conservation planning efforts globally., Grassland birds are rapidly declining globally and therefore are of conservation concern. Here, we integrated citizen science data, hierarchical occupancy models, and novel spatial simulations to evaluate the spatial configuration of an existing conservation network for the conservation of 9 obligate grassland birds. We found representation of grassland birds within the conservation network to be high for species that specialize in moderately tall grassland habitats but not shortgrass or tallgrass specialists.

BACKGROUND Novel oral anticoagulants (NOACs) were developed as alternatives to vitamin K antagonists, primarily warfarin, as they do not require routine monitoring and have limited drug-drug and drug-food interactions. However, the efficacy and safety of these agents in kidney transplantation are not well studied. AIM To assess the profile and safety of NOACs for patients who had kidney transplantation, and to provide recommendations and guidelines on therapeutic strategies in these patients. METHODS This was a retrospective study carried out among adult patients who were actively on the following NOACs (apixaban, rivaroxaban or dabigatran) in our renal transplantation program from December 2015 to December 2016. The patients were identified primarily through electronic medical record system (patient data linkage). Data on the clinical and laboratory profile of the patients were retrieved and analyzed with SPSS 22.0. RESULTS Complete data on 42 renal transplant patients were retrieved: 59.5% males, 90.5% were whites and 66.7% were older than 60 years old. The mean duration since renal transplantation of the patients was 8.8 ± 7.4 years. The most common risk factors for the development of end-stage renal disease in the subjects were hypertension (19.0%), polycystic kidney disease (19.0%), followed by diabetic nephropathy (16.7%) and chronic glomerulonephritis (16.7%). The main indications for NOACs use in the cohort were atrial fibrillation in 25 patients (59.5%) and venous thromboembolism in 10 patients (23.8%). Overall, 29 patients (69%) were treated with apixaban, 10 patients (23.8%) with rivaroxaban and 3 patients (7.14%) with dabigatran. No (0%) thromboembolic events were observed during the one-year period, but 3 (7.1%) bleeding events occurred in the cohort consisting of 1 patient treated with rivaroxaban 15 mg daily and 2 patients who received apixaban 2.5 mg twice daily. There were no significant changes in serum tacrolimus level three days after the initiation of NOACs among patients treated with tacrolimus (pre- and post-NOACs tacrolimus levels were 7.2516 and 7.8867 ng/mL, P = 0.55, respectively). Also, after one-year of treatment with NOACs there were no significant changes in the pre- and post-NOACs serum creatinine level (P = 0.772) and estimated glomerular filtration rates (P = 0.232). CONCLUSION No thromboembolic events or significant changes in renal profile were observed in our cohort of kidney transplant recipients who were treated with NOACs for at least a year. However, a few bleeding events were observed. This calls for further well-planned randomized controlled trials to assess the efficacy and safety of NOACs among renal transplant recipients.

Background and objectives With expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk kidney transplant cases. The objective of our study was to evaluate factors purported to influence the risk of 1-year graft loss in kidney transplant recipients. Design, setting, participants, & measurements We searched bibliographic databases from 2000 to 2017 and included observational studies that measured the association between donor, recipient, the transplant operation, or early postoperative complications, and 1-year death-censored graft loss. Results We identified 35 eligible primary studies, with 20 risk factors amenable to meta-analysis. Six factors were associated with graft loss, with moderate to high degree of certainty: donor age (hazard ratio [HR], 1.11 per 10-year increase; 95% confidence interval [95% CI], 1.04 to 1.18), extended criteria donors (HR, 1.35; 95% CI, 1.28 to 1.42), deceased donors (HR, 1.54; 95% CI, 1.32 to 1.82), number of HLA mismatches (HR, 1.08 per one mismatch increase; 95% CI, 1.07 to 1.09), recipient age (HR, 1.17 per 10-year increase; 95% CI, 1.09 to 1.25), and delayed graft function (HR, 1.89; 95% CI, 1.46 to 2.47) as risk factors for 1-year graft loss. Pooled analyses also excluded, with a high degree of certainty, any associations of cold ischemia time, recipient race, pretransplant body mass index, diabetes, and hypertension with 1-year graft loss. Conclusions Recipient age, donor age, standard versus extended criteria donor, living versus deceased donor, HLA mismatch, and delayed graft function all predicted 1-year graft survival. The effect of each risk factor is small.

3D printing is now widely used in aerospace, healthcare, energy, automotive and other industries. Metal printing, in particular, is the fastest growing sector, yet its development presents scientific, technological and economic challenges that must be understood and addressed.

The paper presents the most important measurements related to the vertical vibrations characterization of the bucket wheel boom (BWB) of excavator in the coal delivery system at Thermal Power Plant „Nikola Tesla"-B. The position of the BWB was measured, as well as the pressures above and below the piston on the hydraulic cylinders for his vertical movement. Based on this measurements, vibration analysis was performed and the dominant oscillation modes were detected with frequencies of 0.5 [Hz] (for the case of the BWB operating mode when is performed being coal grip) and 0.59 [Hz] (for the case with the BWB when rising in the air). Based on these values and the known speeds of raising and lowering the BWB, the vibration amplitudes were determined. Among other things, the analysis and determination of the period of damped oscillations of the BWB proved to be very important for determining his equivalent moment of inertia. Based on the obtained measurements and analysis of vibrations, all the lacks of the existing system were noticed and a new solution of the BWB electro-hydraulic drive was designed, which was at the end successfully realized. The results presented in this paper are part of the project "Reconstruction of the electro-hydraulic drive of the BWB on TPP Nikola Tesla -B", which was done in August 2017, system implementation, commissioning and exploitation testing the BWB electro-hydraulic drive were done in mid-December 2017, since when the complete system has been in use at the coal delivery system.

Algorithms for solving Rubik’s cube have been an active research area since the first appearance of the cube in 1974. The challenge posed when solving the cube is to choose an algorithm that solves the cube for the minimum number of steps. Many algorithms are already implemented in software, but not many are tested with modern hardware-software methodologies, such as hardware-software co-design. Here, the challenge is to take into consideration limiting factors of hardware and implement the most efficient solution. In this paper, the hardware/software co-design is used to solve the random configuration of Rubik’s cube. Two algorithms are used: the Basic algorithm and the Kociemba algorithm. The Basic algorithm is easy to understand and implement but requires many more steps to solve the cube than the Kociemba algorithm. The Kociemba algorithm requires some pre-processing tasks, such as depth-first search and pruning trees, but can solve the cube in about 25 moves. Both algorithms are implemented and tested on a custom-made robot with mechanical parts, actuators, grippers and Intel’s DE1-SoC for drive control and implementation of solving algorithms. The robot successfully solved a number of random configurations. Performances (running time, number of moves needed for solving the cube) of both algorithms are measured and compared.

Atypical hemolytic uremic syndrome (aHUS) is an extremely rare, heterogeneous disease of uncontrolled activation of the alternative complement pathway that is difficult to diagnose. We have evaluated the Canadian patients enrolled in the Global aHUS Registry to provide a Canadian perspective regarding the diagnosis and management of aHUS and the specific challenges faced.To evaluate Canadian patients enrolled in the Global aHUS Registry to provide a Canadian perspective regarding the diagnosis and management of aHUS and the specific challenges faced.The Global aHUS Registry is an observational, noninterventional, multicenter study that has prospectively and retrospectively collected data from patients of all ages with an investigator-made clinical diagnosis of aHUS, irrespective of treatment. Patients of all ages with a clinical diagnosis of aHUS were eligible and invited for enrollment, and those with evidence of Shiga toxin-producingA total of 37 Canadian patients were enrolled (15 pediatric and 22 adult patients) between February 2014 and May 2017; the median age at initial aHUS presentation was 25.9 (interquartile range = 6.7-51.7) years; 62.2% were female and 94.6% had no family history of aHUS. Over three-quarters of patients (78.4%) had no conclusive genetic or anti-complement factor H (CFH) antibody information available, and most patients (94%) had no reported precipitating factors prior to aHUS diagnosis. Nine patients (8 adults and 1 child) experienced ESRD prior to the study. After initial presentation, there appears to be a trend that children are less likely to experience ESRD than adults, with 5-year ESRD-free survival of 93 and 56% (This evaluation provides insight into the diagnosis and management of aHUS in Canadian patients and the challenges faced. More genetic or anti-CFH antibody testing is needed to improve the diagnosis of aHUS, and the management of children and adults needs to consider several factors such as the risk of progression to ESRD is based on age (more likely in adults), and that the location of extrarenal manifestations differs in children and adults.Le syndrome hémolytique et urémique atypique (SHUa) se caractérise par l’activation incontrôlée de la voie alternative du complément. Il s’agit d’une maladie rare, hétérogène et très difficile à diagnostiquer. Nous avons évalué les patients Canadiens inscrits au registre international du SHUa afin d’offrir une perspective canadienne sur le diagnostic et la prise en charge du SHUa, de même que sur les défis posés par la maladie.Évaluer les patients Canadiens inscrits au registre international du SHUa afin d’offrir une perspective canadienne sur le diagnostic et la prise en charge du SHUa, de même que sur les défis posés par la maladie.Le registre international du SHUa est une étude observationnelle, non interventionnelle et multicentrique ayant recueilli, de façon rétrospective et prospective, des données auprès de patients de tous âges ayant reçu un diagnostic clinique de SHUa, quel que soit le traitement. Tous ces patients étaient admissibles et ont été invités à participer à l’étude. Les patients présentant une infection diagnostiquée àAu total, 37 patients canadiens ont été inscrits (15 enfants et 22 adultes) entre février 2014 et mai 2017. L’âge médian lors de l’épisode initial était de 25,9 ans (intervalle interquartile: 6,7–51,7); 62,2 % des sujets étaient de sexe féminin et 94,6 % n’avaient pas d’antécédents familiaux de SHUa. Plus des trois quarts des patients (78,4 %) ne disposaient d’aucune information génétique ou relative aux anticorps anti-complément du facteur H concluante, et aucun facteur précipitant n’avait été rapporté avant le diagnostic pour la majorité des patients (94 %). Neuf patients (8 adultes et 1 enfant) avaient souffert d’IRT avant l’étude. Une tendance semble indiquer qu’après l’épisode initial, les enfants seraient moins susceptibles que les adultes de progresser vers l’IRT (survie sans IRT après 5 ans: 93 % et 56 % respectivement;Cette étude offre un éclairage sur le diagnostic et la prise en charge du SHUa chez les patients canadiens, de même que sur les défis posés par la maladie. Davantage de dépistage génétique et de dépistage des anticorps anti-CFH sont requis pour améliorer le diagnostic du SHUa. La prise en charge de la maladie doit tenir compte de plusieurs facteurs, notamment du risque de progression vers l’IRT qui varie selon l’âge (plus probable chez l’adulte) et du fait que le site des manifestations extrarénales diffère chez l’enfant et l’adulte.

Improving the medical care of deceased organ donors to increase transplant rates and improve allograft function requires an understanding of the current epidemiology and clinical practices of deceased donation within intensive care units (ICUs). Herein, we report the results of our investigation into the feasibility of a multicentre prospective cohort study addressing the afformentioned issues. We conducted a 12-month prospective observational cohort study in six ICUs and one coronary care unit in Hamilton, Canada. We included consecutive children and adults following consent for deceased organ donation (including neurologic determination of death [NDD] or donation after circulatory death [DCD]). Intensive care unit research staff recorded donor management data from hospital records, extending from one day prior to the consent for organ donation up to the time of organ retrieval. The provincial Organ Donation Organization (ODO) supplemented these data and, additionally, provided data on corresponding organ recipients. We identified, evaluated, and measured three potential obstacles to the feasibility of a national cohort study: obtaining authorization to implement the study with a waiver of research consent, accessibility of transplant recipient data, and the time required to complete very detailed case report forms (CRFs), with valuable lessons learned for implementation in future projects. The local Research Ethics Board and the ODO Privacy Office both authorized the recording of donor and recipient study data with a waiver of research consent. Sixty-seven consecutive consented donors were included (31 NDD and 36 DCD donors); 50 of them provided 144 organs for transplantation to 141 recipients. We identified the age and sex of the recipients as well as the location and date of transplant for all organ recipients in Ontario; however, we obtained no recipient data for six organs transported outside of Ontario. Intensive care unit research staff estimated that future CRF completion will require five to seven hours per patient. The Hamilton-DONATE pilot study supports the feasibility of a larger cohort study to describe the epidemiology and clinical practices related to deceased donor care in Canada. wwwclinicaltrials.gov (NCT02902783). Registered 16 September 2016.

Cancer & the Kidney International Network was created in 2014. The aim was to improve the management of cancer patients by developing clinical and scientific knowledge on the main topic of cancer and the kidney. Therefore, the Cancer & the Kidney International Network created a special working group: the Thrombosis, Kidney Disease, and Cancer working Group. The first step of this force was to produce a position paper on this topic by investigating the association of chronic kidney disease and venous thromboembolism in cancer patients, focusing particularly on the anticoagulant management of patients presenting these three comorbidities. The use of low-molecular-weight heparins, vitamin K agonists and oral direct anticoagulants in cancer patients with chronic kidney disease was reviewed.

Clinicians lack well-validated, non-invasive, objective tools to guide volume management in the post-resuscitative period. Bioimpedance analysis (BIA) represents a novel method for guiding fluid management. We studied the relationship of BIA vector length (VL), an indicator of volume status, to the need for mechanical ventilation in patients with sepsis. This is a multicentre prospective observational study at four Canadian ICUs. We examined adult patients admitted to the ICU within 72 hr of a sepsis diagnosis. Patients underwent daily BIA measurements for 30 days, until discharge from the ICU, or until death. Our primary outcome was the ongoing need for invasive mechanical ventilation, and we examined the association with VL using a generalized estimating equation. Our secondary analyses were targeted to determine an association between VL and other measures of volume status and acute kidney injury (AKI). We enrolled 159 patients from four centres over 27 months. The mean (standard deviation [SD]) age was 64 (15) yr with a mean (SD) APACHE (acute physiology, age, chronic health evaluation) II score of 25 (10); 57% (n = 91) were male. A 50-unit (ohm·m) increase in VL over any time period was associated with a 30% decrease in the probability of requiring invasive mechanical ventilation (P < 0.03). Volume expansion, indicated by a shorter VL, correlated with higher edema scores (r = − 0.31; P < 0.001) and higher net 24-hr fluid balance (r = − 0.27, P < 0.001). Patients with AKI had a shorter overall VL (r = − 0.23; P = 0.003). An increase in VL over time is associated with a decrease in probability of requiring invasive mechanical ventilation. Vector length correlates with other commonly used volume assessment methods in post-resuscitation patients with sepsis.

Crusted scabies is a rare disease variant associated with T-cell dysregulation. Transplant patients are at risk of developing crusted scabies as a consequence of their immunosuppressive regimens. We report a case of crusted scabies presenting with recurrent septicemia in a 65-year-old renal transplant recipient, treated with daily ivermectin for 7 days after initial failure of weekly ivermectin dosing. A literature review of crusted scabies in transplant recipients consisting of 19 cases reports was summarized. Pruritus was common, and initial misdiagnosis was frequent. Most were treated with topical therapy, with one-third receiving ivermectin. Three of seven cases presenting with a concomitant infection died. Crusted scabies is commonly misdiagnosed in transplant recipients owing to its rarity, varied appearance, and different skin distributions. It should be considered in the differential diagnosis of transplant recipients presenting with rash and pruritus, given its association with secondary infection and subsequent mortality.

Several studies have demonstrated harm associated with using erythropoiesis-stimulating agents (ESA) to achieve higher hemoglobin (Hb) levels. Subsequently, more conservative use of ESAs has changed anemia therapy in patients with chronic renal failure.The objectives were to identify transfusion rates in hemodialysis (HD) patients during the first year of therapy, to identify factors associated with the probability of transfusion, describe reasons for the transfusions, and identify the Hb values associated with each transfusion. An exploratory objective was to describe the age of red blood cell transfusions.This was a multicenter prospective observational cohort study.There were 12 study sites in 5 Canadian provinces. The study was performed from 2012 to 2014.The study patients were adult incident chronic HD patients in these centers. Patients with acute kidney injury, peritoneal dialysis, and planned transfer to satellite units were excluded. Patients had to receive at least 1 month of chronic HD to be eligible. Data for 3 months prior to HD were obtained by retrospective chart review. Prospectively, charts were reviewed monthly for 12 months for data abstraction.There were 314 patients enrolled and 79.9% completed 12 month follow-up. Ninety-four (29.9%) patients received at least 1 unit of blood. During the first 90 days, the transfusion episode rate was 148.4 per 100 patient-years compared with 62.6 per 100 patient-years post 90 days. The most frequent indication was a low Hb value (92%) with gastrointestinal bleeding, surgical blood loss, and fatigue accounting for 9.9%, 8.6%, and 4.5%, respectively. Some patients had1 indication. The mean Hb values prior to transfusion episodes ranged from 75.3 to 78.6 g/L. Cox regression analysis on time to first transfusion and time to first hospitalization/death both showed an association with inpatient initiation of HD. Some 37.5% initiated HD as an inpatient and differed from those starting as an outpatient. They had less predialysis care and laboratory data suggested more inflammation. The mean and median ages of the blood units transfused were 24.9 (SD = 10.0) and 23 days (interquartile range = 17-33).This work reported the blood transfusion rate in incident HD patients in Canada during a period associated with conservative ESA prescription. The major indication for transfusion was a low Hb rather than clinical symptoms. Initiation of HD as an inpatient was independently associated with the probability of receiving a blood transfusion. These findings require further investigation.Plusieurs études ont fait état de lésions associées à l’utilisation d’agents stimulant l’érythropoïèse (ASE) pour hausser le taux d’hémoglobine (Hb). Dès lors, une utilisation plus conservatrice des ASE a modifié le traitement de l’anémie chez les patients atteints d’insuffisance rénale chronique.L’étude visait à i) établir les taux de transfusion sanguine chez les patients hémodialysés au cours de la première année de traitement; ii) cerner les facteurs associés à la probabilité de recourir à une transfusion sanguine; iii) connaître les raisons de la transfusion; et iv) caractériser le taux d’hémoglobine au moment de l’intervention. En outre, un objectif exploratoire consistait à déterminer l’âge des érythrocytes transfusés.Il s’agit d’une étude de cohorte observationnelle prospective multicentrique.L’étude s’est tenue entre 2012 et 2014 sur douze sites répartis dans cinq provinces canadiennes.Les patients adultes hémodialysés des centres participants ont été recrutés pour l’étude. Ont été exclus les patients atteints d’insuffisance rénale aiguë, les patients traités par dialyse péritonéale et les patients à être transférés vers une unité satellite. Pour être admissible, le patient devait recevoir un traitement d’hémodialyse continu pendant au moins un mois. On a rétrospectivement tiré des dossiers médicaux les données des trois mois précédant l’hémodialyse, puis on a extrait les données des dossiers médicaux chaque mois sur un an.Un total de 314 patients a participé à l’étude et 79,9 % d’entre eux ont complété les 12 mois de suivi. Sur cette période, 94 patients (29,9 %) ont reçu au moins une transfusion sanguine. Au cours des 90 premiers jours, le taux d’épisodes transfusionnels était de 148,4 pour 100 années-patients, comparativement à 62,6 pour 100 années-patients pour le reste de l’étude. La raison la plus fréquente de recourir à une transfusion était un faible taux d’Hb (92 % des cas); les cas de saignements gastro-intestinaux, de perte de sang périchirurgicale et de fatigue comptaient quant à eux pour 9,9 %, 8,6 % et 4,5 % respectivement. Certains patients cumulant plus d’une indication. Le taux d’Hb moyen prétransfusion variait de 75,3 à 78,6 g/L. Une analyse de régression de Cox sur le temps écoulé jusqu’à la première transfusion et jusqu’à la première hospitalisation (ou le décès) du patient a montré une corrélation avec l’initiation d’un traitement d’hémodialyse chez les patients hospitalisés. Les sujets qui avaient initié leur traitement d’hémodialyse alors qu’ils étaient hospitalisés (37,5 %) ont reçu moins de soins prédialyse et présentaient davantage d’inflammation que les sujets qui avaient commencé leurs traitements d’hémodialyse en tant que patient externe. Enfin, l’âge moyen et l’âge médian des érythrocytes transfusés étaient de 24,9 jours (ÉT : 10,0) et de 23 jours (EIQ : 17 à 23).Notre étude a permis de connaître le taux de transfusions sanguines dans une population de patients hémodialysés canadiens au cours d’une période correspondant à une prescription conservatrice d’ASE. On a observé que la principale raison de transfusion était un faible taux d’Hb et non des symptômes cliniques. Enfin, une hémodialyse amorcée en cours d’hospitalisation a été associée à une probabilité accrue de transfusion sanguine. Nos constatations devraient faire l’objet d’études plus approfondies.

With this paper we presented architectural redesign of SOA (service oriented architecture) integration platform by following principles of microservices design. Presented SOA platform is currently in use for Real estate sector. Number of messages which need to be processed by platform is growing as well as number of new integrations which requires redesign of platform. Redesign should provide ability for scalability, better resource management, maintenance and deployment. To support this, it is necessary to transform integration platform to be microservices based.

Limited energy resources after the 2008 global crisis for the first time lead to positive cost-effectiveness of energy efficiency management implementation. In year 2009 EU adopted EN 16001 standard. International standard organization publish ISO 50001 in 2011. ISO 50001 is a generic management standard same as ISO 9001 and ISO 14000 and can be applied to any organization. The paper gives a chronological overview of the development of energy management standards and explains the standard implementation. The first and most important step is to secure commitment of Management then to perform energy audit according to EN 16247. Furthermore to identify key energy usage and establish energy baseline. System behavior is defined on the basis on changes in individual energy performance indicators (EnPI). Defining EnPI should be monitored in order to valorize the state of system efficiency. Energy management standards in form of ISO 50001 is still evolving. New standards are being developed to further, in more detail, define the requirements of energy management standard ; ISO 50002:2014, ISO 50003:2014, ISO 50004:2014, ISO 50006:2014, 50015:2014, ISO 50007:2017 and ISO 50008 under development.

Vibratory movements are one of the most ways for conveying and transportation of granular and particulate materials.Vibratory conveyors and feeders with electromagnetic excitation belong to a group of mechatronic devices that in an efficient wayprovides drive force and oscillations for this conveying. They have an important role in framework of the many industrial process inwhich are dominant the particulate materials: food processing, cement production, certain product line in steel industry,pharmaceutical industry, agriculture, etc. Therefore, they are representing a very important element of above mentioned technologicprocesses and production line. Especially, the vibratory conveyors and feeders that operate in the resonant mode are used in industrialapplications because of their energy efficiency increasing. The relatively small input energy of actuator drive causes intensivelyvibrations of load carry element (LCE) of vibratory conveyor. The intensity of the vibrations directly affects on gravimetric flow (massflow) and therefore on the productivity of vibratory conveyors. To ensure a reliable and energy-efficient operation of vibratoryconveyors, it is necessary to have a reliable and accurate measurement and testing of electrical and mechanical quantities. A hardwareand software implementation of the testing and measurement system of resonant vibratory conveyor with electromagnetic drive, andtheir corresponding data acquisition platform are presented in this paper. The experimental results obtained on a real laboratory setupof resonant vibratory conveyor are also shown.

Over the last decades, agricultural co-operatives grew substantially in most developed and developing countries, often reaching dominant market positions. We inquire into the economic mechanism behind this growth, by elaborating on the relation between co-operative identity and co-operative benefits. We highlight the ability of agricultural co-operatives to co-ordinate large-scale production, to monitor work contributions and product quality, and to ensure economic independence of farmer members. Following the two principal streams in the economic literature, we distinguish between the conceptions of agricultural co-operatives as units of vertical integration and as firms characterized by common governance of collective entrepreneurial action and ability to reduce transaction costs and economic risk. We describe the financial and governance limitations of agricultural co-operatives while taking account of new co-operative models presenting institutional tools introduced to overcome these limitations. We conclude by suggesting directions for enhancing the role of co-operatives in agricultural and rural development.

ObjectiveAdequate consumption of fruits and vegetables is a part of recommendations for a healthy diet. The aim of the present study was to assess acute cumulative dietary exposure to organophosphorus and carbamate pesticides via fruit and vegetable consumption by the population of schoolchildren aged 11–12 years and the level of risk for their health.DesignCumulative probabilistic risk assessment methodology with the index compound approach was applied.SettingSlovenia, primary schools.SubjectsSchoolchildren (n1145) from thirty-one primary schools in Slovenia. Children were part of the PRO GREENS study 2009/10 which assessed 11-year-olds’ consumption of fruit and vegetables in ten European countries.ResultsThe cumulative acute exposure amounted to 8·3 (95 % CI 7·7, 10·6) % of the acute reference dose (ARfD) for acephate as index compound (100 µg/kg body weight per d) at the 99·9th percentile for daily intake and to 4·5 (95 % CI 3·5, 4·7) % of the ARfD at the 99·9th percentile for intakes during school time and at lunch. Apples, bananas, oranges and lettuce contributed most to the total acute pesticides intake.ConclusionsThe estimations showed that acute dietary exposure to organophosphorus and carbamate pesticides is not a health concern for schoolchildren with the assessed dietary patterns of fruit and vegetable consumption.

Fluid resuscitation, along with the early administration of antibiotics, is the cornerstone of treatment for patients with sepsis. However, whether differences in resuscitation fluids impact on the requirements for renal replacement therapy (RRT) remains unclear. To examine this issue, we performed a network meta-analysis (NMA), including direct and indirect comparisons, that addressed the effect of different resuscitation fluids on the use of RRT in patients with sepsis. The data sources MEDLINE, EMBASE, ACPJC, CINAHL and Cochrane Central Register were searched up to March 2014. Eligible studies included randomized trials reported in any language that enrolled adult patients with sepsis or septic shock and addressed the use of RRT associated with alternative resuscitation fluids. The risk of bias for individual studies and the overall certainty of the evidence were assessed. Ten studies (6664 patients) that included a total of nine direct comparisons were assessed. NMA at the four-node level showed that an increased risk of receiving RRT was associated with fluid resuscitation with starch versus crystalloid [odds ratio (OR) 1.39, 95% credibility interval (CrI) 1.17-1.66, high certainty]. The data suggested no difference between fluid resuscitation with albumin and crystalloid (OR 1.04, 95% CrI 0.78-1.38, moderate certainty) or starch (OR 0.74, 95% CrI 0.53-1.04, low certainty). NMA at the six-node level showed a decreased risk of receiving RRT with balanced crystalloid compared to heavy starch (OR 0.50, 95% CrI 0.34-0.74, moderate certainty) or light starch (OR 0.70, 95% CrI 0.49-0.99, high certainty). There was no significant difference between balanced crystalloid and saline (OR 0.85, 95% CrI 0.56-1.30, low certainty) or albumin (OR 0.82, 95% CrI 0.49-1.37, low certainty). Of note, these trials vary in terms of case mix, fluids evaluated, duration of fluid exposure and risk of bias. Imprecise estimates contributed to low confidence in most estimates of effect. Among the patients with sepsis, fluid resuscitation with crystalloids compared to starch resulted in reduced use of RRT; the same may be true for albumin versus starch.

Summary Background The costs and laboratory workload arising from meticillin-resistant Staphylococcus aureus (MRSA) screening could be reduced markedly by processing nose, throat and skin swabs from one person in a single culture broth (specimen pooling). The purpose of this study was to evaluate the sensitivities and times for MRSA detection using a variety of approaches to processing of individual and pooled swabs. Methods Four hundred and seventeen swabs from 139 subjects with a history of MRSA colonization (three swabs per subject – nose, throat and skin) were submitted. Swabs were suspended in 200-μL sterile saline, and these suspensions were used individually and as pooled samples to inoculate two different chromogenic media [MRSA SMART (bioMėrieux, Marcy-l'Etoile, Paris, France) and CHROMagar MRSA (CHROMagar, Paris, France)] and Todd-Hewitt Broth; the latter cultures were then subcultured on to the same chromogenic media. Results MRSA was detected from at least one specimen in 75 subjects (50.4%). The diagnostic sensitivities of pooled surveillance cultures compared with single cultures were 97% and 93% for direct and enrichment cultures, respectively. Enrichment culture of either individual or pooled samples had no benefit compared with direct culture ( P >0.05). Conclusions Pooling of MRSA screening swabs for either direct culture on chromogenic agar or enrichment culture is suitable for routine use.

Renal transplant recipients (RTRs) are at significantly higher risk for morbidity and mortality compared with the general population, largely attributed to cardiovascular disease (CVD). Previous estimates of CVD events have come from health care databases and retrospective studies.The objective of this study was to prospectively determine the prevalence of risk factors and incidence of CVD events in a Canadian cohort of RTRs.Study of Cardiovascular Outcomes in Renal Transplantation (SCORe) was a prospective, longitudinal, multicenter observational study.Adult RTRs were recruited from 6 participating transplant sites in Ontario, Canada.Eligible patients were those receiving a living or deceased donor renal transplant. Patients who received simultaneous transplant of any other organ were excluded.Primary outcomes included myocardial infarction (MI) defined by American College of Cardiology (ACC-MI) criteria, and major adverse cardiac events (MACE), defined as cardiovascular (CV) death, ACC-MI, coronary revascularization, and nonhemorrhagic stroke. CV events were adjudicated by a single, independent cardiologist.CV and transplant-specific risk factors that predict MACE and ACC-MI were identified by stepwise regression analysis using the Cox proportional hazards model.A total of 1303 patients enrolled across 6 transplant centers were followed for 4.5 ± 1.6 years (mean ± SD). Incidence of MACE was 7.0%, with significant independent predictors/risk factors including age, diabetes, coronary revascularization, nonhemorrhagic stroke, and renal replacement therapy (RRT). ACC-MI incidence was 4.0%, with significant independent predictors/risk factors including age, coronary revascularization, and duration of RRT in excess of the median value (2.91 years).Patients were recruited from a single province, so may not reflect the experience of RTRs in other areas of Canada.Using a prospective design and rigorous methodology, this study found that the incidence of CV events after renal transplantation was elevated relative to the general Canadian population and was comparable with that reported in patient registries, thus helping validate the utility of retrospective analysis in this field. SCORe highlights the importance of monitoring RTRs for traditional cardiac and transplant-specific CV risk factors to help prevent CV morbidity and mortality. Further research is needed to investigate a broader range of potential risk factors and their combined effects on incident CV events.Les receveurs d’une greffe rénale présentent un risque significativement plus élevé de morbidité et de mortalité que l’ensemble de la population, ceci est en grande partie attribuable aux maladies cardiovasculaires. Les estimations antérieures du nombre d’événements cardiovasculaires proviennent des bases de données du système de santé et des résultats d’études rétrospectives.L’étude visait à mesurer de manière prospective la prévalence des facteurs de risque et l’incidence des événements cardiovasculaires dans une cohorte de patients receveurs d’une greffe rénale au Canada.L’étude SCORe consistait en une étude observationnelle longitudinale menée de façon prospective au sein de plusieurs centres hospitaliers.Les patients adultes receveurs d’une greffe rénale ont été recrutés dans six hôpitaux de la province de l’Ontario, au Canada.Les patients qui avaient reçu une greffe rénale provenant d’un donneur vivant ou décédé ont été inclus dans l’étude. Les patients qui avaient reçu une greffe simultanée de tout autre organe ont été exclus.Les principaux critères retenus incluaient un infarctus du myocarde répondant aux critères établis par l’American College of Cardiology (ACC-MI), des événements cardiaques majeurs indésirables (MACE) tels que le décès d’origine cardiovasculaire, l’ACC-MI, la revascularisation coronarienne et l’AVC non hémorragique. Ces événements cardiovasculaires ont été constatés par un cardiologue indépendant.Les facteurs de risque, cardiovasculaires ou spécifiques à la transplantation, qui permettent de prédire les MACE et l’ACC-MI ont été identifiés à l’aide du modèle de risques proportionnels de Cox pour l’analyse de régression en étapes.Les 1 303 patients recrutés au sein des six centres hospitaliers ont été suivis sur une moyenne de 1,6 an (SD ± 4,5). L’incidence de MACE était de 7,0%, avec des indicateurs prévisionnels indépendants et des facteurs de risque significatifs incluant l’âge, le diabète, la revascularisation coronarienne, l’AVC non hémorragique et la thérapie de remplacement rénale. L’incidence d’ACC-MI était de 4,0%, avec des indicateurs prévisionnels indépendants et des facteurs de risque significatifs incluant l’âge, la revascularisation coronarienne et une durée pour la thérapie de remplacement rénal excédant la valeur médiane (2,91 ans).Les patients ont été recrutés dans une seule province, les résultats sont susceptibles de ne pas être représentatifs de la situation des receveurs d’une greffe rénale ailleurs au Canada.Grâce à un plan d’étude prospectif et à une méthodologie rigoureuse, nous avons déterminé que l’incidence des événements cardiovasculaires chez les receveurs d’une greffe rénale a été plus élevée que dans la population canadienne en général. Nous avons également constaté qu’elle était comparable à l’incidence rapportée dans les registres de patients, ce qui vient confirmer l’utilité des études rétrospectives dans ce domaine. Les résultats obtenus lors de l’étude SCORe mettent en lumière l’importance de faire un suivi auprès des receveurs d’une greffe rénale afin de détecter les facteurs de risque cardiovasculaires ou spécifiques à l’intervention, et ainsi aider à prévenir la mortalité et la morbidité liées aux maladies cardiovasculaires. D’autres recherches sont nécessaires afin d’examiner un plus large éventail de facteurs de risques potentiels et leurs effets concomitants sur les événements cardiovasculaires.

Resource management agencies must be able to integrate current research into their decision-making to effectively address climate change impacts. In this study, we investigated the capacity for climate-adaptive management by surveying the community of researchers, administrators, and field managers who are responsible for wildlife conservation in the state of Wisconsin, USA. We specifically measured differences in how these sectors perceive climate change risk, communicate, and make decisions to represent barriers in how they transmit and use research. We frame these barriers within the literature on evidence-based and adaptive management and risk psychology, as principles that underlie climate change adaptation. Almost all respondents agreed that the climate is changing (223/224), but 22% of the respondents were unsure whether climate change is negative for wildlife and field managers dominated this group (68%). Field managers also reported using components of adaptive management more frequently than did other sectors, but all three questioned the importance of one specific component: predicting the consequence of management before implementation. When seeking information, researchers preferred communicating via published literature, but managers and administrators reported a preference for in-person communication. Although only 29% of the respondents were currently involved in climate change work, 77% said they would get involved without additional incentives or direction at work. These results confirm a common pattern of barriers between research and management sectors across all scales of decision-making. Overall, results suggest that in-person and problem-based communication that is focused on real decisions and that utilizes social networks are a way to enable resource management communities to effectively confront these barriers. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Objectives A P-value Study Design and Setting A review of RCTs in high-impact medical journals that reported a statistically significant result for at least one dichotomous or time-to-event outcome in the abstract. In the group with the smallest number of events, we changed the status of patients without an event to an event until the P-value exceeded 0.05. We labeled this number the Fragility Index; smaller numbers indicated a more fragile result. Results The 399 eligible trials had a median sample size of 682 patients (range: 15-112,604) and a median of 112 events (range: 8-5,142); 53% reported a P-value Conclusion The statistically significant results of many RCTs hinge on small numbers of events. The Fragility Index complements the P-value and helps identify less robust results.

ObjectiveTo examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries.DesignCross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses.SettingSchools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden.SubjectsEleven-year-old children (n 8159, response rate 72%) and their parents.ResultsIn five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents’ education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree.ConclusionsParental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.

Thrombosis and bleeding are among the most common causes of morbidity and mortality in patients with renal disease or liver disease. The pathophysiology underlying the increased risk for venous thromboembolism and bleeding in these 2 populations is distinct, as are considerations for anticoagulation. Anticoagulation in patients with kidney or liver disease increases the risk of bleeding; this risk is correlated with the degree of impairment of anticoagulant elimination by the kidneys and/or liver. Despite being in the same pharmacologic category, anticoagulant agents may have varied degrees of renal and liver metabolism. Therefore, specific anticoagulants may require dose reductions or be contraindicated in renal impairment and liver disease, whereas other drugs in the same class may not be subject to such restrictions. To minimize the risk of bleeding, while ensuring an adequate therapeutic effect, both appropriate anticoagulant drug choices and dose reductions are necessary. Renal and hepatic function may fluctuate, further complicating anticoagulation in these high-risk patient groups.

In the present paper a simple anti-reset windup solution is derived for TITO PID control based on the ideal decoupler. Difficult examples are used to demonstrate performance of the proposed anti-reset windup TITO controller. The first example is the model of a typical industrial process, with significant multivariable interactions, a non-self regulatory nature, non-minimum-phase behavior and with integral action in the decoupler. The second example is a stable process with high relative gain array RGA of 13.7 in the nominal operating regime and significant multiple dead-times. An anti-reset windup solution is proposed also for inverted decoupling. Closed-loop system responses, obtained by antiwindup implementations based on the ideal and inverted decoupling, are compared on a stable process with an RHP zero and multiple time delays.

Renal transplantation is an effective therapy with improved long-term outcomes compared with other therapies for end stage renal disease. Present methods for evaluating kidney allograft function, such as serum creatinine or allograft biopsy, are not sensitive and identify pathological changes only after any potential intervention would be effective. Thus, there is a necessity for biomarkers that would provide early prognostic information about kidney transplant outcomes. Circulating microvesicles represent an attractive source of biomarkers for different diseases including renal failure. We have studied the proteins of the circulating microvesicles from two populations of kidney transplant recipients (n = 20) with poor transplant outcomes (n = 10) or good transplant outcome (n = 10), according to their estimated glomerular filtration rate (eGFR). Microvesicles from age-matched healthy subjects (n = 10) were used as a control. Also, we performed a pilot study to assess the microvesicle protein in kidney transplant recipients before and six months after kidney transplant (n = 6), compared to healthy subjects. Proteomic analysis of microvesicles could discriminate between transplant recipients and healthy subjects, and between transplant patients based on eGFR. Our results shed light on the potential of blood microvesicles to provide a novel tool for the prediction of the outcome of kidney transplants.

Badve and colleagues' systematic review evaluated the benefits and harms of oral anticoagulant therapy in patients with stage 3 to 5 chronic kidney disease, including those receiving dialysis. The ...

In the United States, government-mandated growth in the production of crops dedicated to biofuel (agrofuels) is predicted to increase the demands on existing agricultural lands, potentially threatening the per- sistence of populations of grassland birds they support. We review recently published literature and datasets to (1) examine the ability of alternative agrofuel crops and their management regimes to provide habitat for grass- land birds, (2) determine how crop placement in agricultural landscapes and agrofuel-related land-use change will affect grassland birds, and (3) identify critical research and policy-development needs associated with agro- fuel production. We find that native perennial plants proposed as feedstock for agrofuel (switchgrass, Panicum virgatum, and mixed grass-forb prairie) have considerable potential to provide new habitat to a wide range of grassland birds, including rare and threatened species. However, industrialization of agrofuel production that maximizes biomass, homogenizes vegetation structure, and results in the cultivation of small fields within largely forested landscapes is likely to reduce species richness and/or abundance of grassland-dependent birds. Realiz- ing the potential benefits of agrofuel production for grassland birds' conservation will require the development of new policies that encourage agricultural practices specifically targeting the needs of grassland specialists. The broad array of grower-incentive programs in existence may deliver new agrofuel policies effectively but will re- quire coordination at a spatial scale broader than currently practiced, preferably within an adaptive-management framework.

Cardiovascular death remains the leading cause of mortality in kidney transplant recipients. Cardiovascular events are associated with significant morbidity. However, current trends in cardiovascular events after kidney transplantation are poorly understood.We conducted a retrospective study using healthcare databases in Ontario, Canada, to determine whether the incidence of cardiovascular events after kidney transplantation has changed from 1994 to 2009. Our primary endpoint was a 3-year composite outcome of posttransplant death or major cardiovascular event (myocardial infarction, coronary angioplasty, coronary artery bypass graft surgery, stroke).Recipients (n = 4954) were older and had more baseline comorbidity in recent years. A total of 445 recipients (9.0%) died or experienced a major cardiovascular event within 3 years of transplantation. There was no significant change in the incidence of the composite outcome or death-censored cardiovascular events over time (P = 0.41 and 0.92, respectively). After adjusting for age, sex, and comorbidities, the risk of death or major cardiovascular event steadily declined across the years of transplant (2006-2009 adjusted hazard ratio, 0.70; P = 0.009; referent 1994-1997). When recipients were matched on age, sex, and date of cohort entry to members of the general population and to the chronic kidney disease population, the risk was lowest in the general population and highest in the chronic kidney disease population.Despite transplant centers accepting recipients who are older with more comorbidities in recent years, the 3-year cumulative incidence of death or major cardiovascular event has remained stable over time.

The advent of free-electron laser (FEL) sources delivering two synchronized pulses of different wavelengths (or colours) has made available a whole range of novel pump–probe experiments. This communication describes a major step forward using a new configuration of the FERMI FEL-seeded source to deliver two pulses with different wavelengths, each tunable independently over a broad spectral range with adjustable time delay. The FEL scheme makes use of two seed laser beams of different wavelengths and of a split radiator section to generate two extreme ultraviolet pulses from distinct portions of the same electron bunch. The tunability range of this new two-colour source meets the requirements of double-resonant FEL pump/FEL probe time-resolved studies. We demonstrate its performance in a proof-of-principle magnetic scattering experiment in Fe–Ni compounds, by tuning the FEL wavelengths to the Fe and Ni 3p resonances., Two-colour X-ray free electron laser is a powerful tool for pump–probe measurements, but currently constrained by limited tunability. Here, Ferrari et al. develop a configuration that allows tuning both the pump and the probe to specific electronic excitations, providing element selectivity.

The Moquah Barrens Research Natural Area (RNA) was established by the Chequamegon National Forest and the Lakes States Forest Experiment Station in 1935 with a research objective well-suited to the needs of the Forest Service and the scientific understanding of ecosystem function prevalent at the time of establishment. The original research plan was never implemented, which led to a joint Forest-Station decision in 1956 to disestablish the RNA. However, that decision was never implemented. A series of management decisions made after 1956 led to the loss of the pine barrens ecosystem originally encompassed by the RNA. This loss is not irretrievable and the work necessary to recover the original ecosystem is possible under existing RNA management guidelines. The experience of the Moquah Barrens RNA can be used by the Forest Service to improve overall management of the entire system of research natural areas. Two main areas of opportunity are identified: 1) implement an improved approach to managing official records associated with RNAs; and 2) adopt a management framework suitable for long-term ecological projects.

Background. Bioimpedance analysis (BIA) is a novel method of assessing a patient’s volume status.Objective. We sought to determine the feasibility of using vector length (VL), derived from bioimpedance analysis (BIA), in the assessment of postresuscitation volume status in intensive care unit (ICU) patients with sepsis.Method. This was a prospective observational single-center study. Our primary outcome was feasibility. Secondary clinical outcomes included ventilator status and acute kidney injury. Proof of concept was sought by correlating baseline VL measurements with other known measures of volume status.Results. BIA was feasible to perform in the ICU. We screened 655 patients, identified 78 eligible patients, and approached 64 for consent. We enrolled 60 patients (consent rate of 93.8%) over 12 months. For each 50-unit increase in VL, there was an associated 22% increase in the probability of not requiring invasive mechanical ventilation (IMV) (p=0.13). Baseline VL correlated with other measures of volume expansion including serum pro-BNP levels, peripheral edema, and central venous pressure (CVP).Conclusion. It is feasible to use BIA to predict postresuscitation volume status and patient-important outcomes in septic ICU patients.Trial Registration. This trial is registered with clinicaltrials.govNCT01379404registered on June 7, 2011.

The vibratory conveyors with electromagnetic drive are used for performing gravimetric flow of granular materials in processing industry. By realizing free vibrations of variable intensity and frequency over a wide range through application of the electromagnetic actuator, suitable power converter, and the corresponding controller, continuous conveyance of granular materials have been provided for various operating conditions. Standard power output stages intended for control of vibratory conveyance using thyristors and triacs. Phase angle control can only accomplish tuning of amplitude oscillations, but oscillation frequency cannot be adjusted by these converters. Application of current controlled transistor converters enables accomplishing the amplitude and/or frequency control. Their use implies the excitation of a vibratory conveyor independent of the supply network frequency. In addition, the frequency control ensures operation in the region of mechanical resonance. Operation in this region is favourable from the energy point of view, since it requires minimal energy consumption. The paper presents a possible solution and advantages of the amplitude-frequency control of vibratory conveyors by means of a current controlled power converter.

Natural resource managers are tasked with assessing the impacts of climate change on conservation targets and developing adaptation strategies to meet agency goals. The complex, transboundary nature of climate change demands the collaboration of scientists, managers, and stakeholders in this effort. To share, integrate, and apply knowledge from these diverse perspectives, we must engage in social learning. In 2009, we initiated a process to engage university researchers and agency scientists and managers in collaborative learning to assess the impacts of climate change on terrestrial fauna in the state of Wisconsin, USA. We constructed conceptual Bayesian networks to depict the influence of climate change, key biotic and abiotic factors, and existing stressors on the distribution and abundance of 3 species: greater prairie-chicken (Tympanuchus cupido), wood frog (Lithobates sylvaticus), and Karner blue butterfly (Plebejus melissa samuelis). For each species, we completed a 2-stage expert review that elicited dialogue on information gaps, management opportunities, and research priorities. From our experience, collaborative network modeling proved to be a powerful tool to develop a common vision of the potential impacts of climate change on conservation targets. © 2011 The Wildlife Society.

Marine debris is a widespread and globally recognized problem. Sound information is necessary to understand the extent of the problem and to inform resource ...

An elementary derivation of fundamental properties of X-ray free-electron lasers is presented, including gain and saturation. Because of its simplicity, this approach is particularly suitable for teaching at different levels and for presentations to non-specialized audiences., It is shown that an elementary semi-quantitative approach explains essential features of the X-ray free-electron laser mechanism, in particular those of the gain and saturation lengths. Using mathematical methods and derivations simpler than complete theories, this treatment reveals the basic physics that dominates the mechanism and makes it difficult to realise free-electron lasers for short wavelengths. This approach can be specifically useful for teachers at different levels and for colleagues interested in presenting X-ray free-electron lasers to non-specialized audiences.

Syngeneic transplants provide an interesting dilemma with respect to donor selection. The risk of relapse is higher for patients with AML undergoing syngeneic transplant vs. HLA-matched sibling transplant, however, rates of graft versus host disease and transplant related mortality have historically been lower with syngeneic transplants. Thus, HLA -matched sibling donors are preferred to identical twin donors for patients undergoing transplant for malignant diseases (ie. AML) to optimize the impact of graft vs. leukemia (GvL) whereas identical twin donors are ideal for non-malignant disorders. We present a patient with AML who had both an HLA matched sibling donor as well as an identical twin. He was initially transplanted with the HLA matched sibling donor successfully however, at 6 months post transplant he developed severe neutropenia (ANC = 0). Chimerism studies revealed 95% DNA from the related donor T cells at this time. The cause of his neutropenia was autoimmune in nature and refractory to multiple immunosuppressive medications and therefore he underwent a second transplant this time using his identical twin as the donor. The patient’s neutrophils engrafted and he has undergone a complete recovery post transplant. Chimerism studies after the second transplant reveal that 85% of the DNA is from the second donor’s T cells. Typically, chimerism studies with syngeneic transplant are not helpful as the patient and donor are identical. However in this case, chimerism studies were possible to determine the engraftment of the initial related donor to the patient/twin. This case illustrates that optimal donor selection depends on disease when an identical twin and an HLA matched sibling donor are available. It also showcases the interesting results of chimerism testing in a patient who has received both an allogeneic and a syngeneic transplant.

The clinical significance of HLA-DP donor specific antibodies (DSA) detected with solid phase assays in recipients of renal transplants remains poorly defined. Recent literature has elucidated that many patients have a HLA-DP antibody pattern of reactivity against broad cross-reactive epitopes which may be more clinically significant. Typically, a DSA that reacts at a mean fluorescence intensity (MFI) of greater than 5000 results in positive crossmatch. We present two cases with pre-transplant HLA-DP DSAs at high MFI (>5000) directed against cross-reactive epitopes identified on virtual crossmatch which resulted in negative and positive flow crossmatch respectively. Case 1 is 57 yr old male who received a deceased donor renal transplant in 2015. He was known to have a HLA-DP9 DSA DED epitope reactivity pattern at 7,333 MFI detected by Luminex bead assay against his donor on peak serum. Pre-transplant crossmatch was negative and he proceeded to transplant. Current creatinine is stable at 150 μmol/L and there are no episodes of rejection. Case 2 is 67 yr old female who remains on the deceased donor list awaiting renal transplant with a cPRA of 99%. She has had 3 offers where she has had a HLA-DP1 or HLA-DP3 DSA DEAV epitope reactivity pattern at 10,000 MFI against her donors resulting in flow B-cell positive crossmatch. Crossmatch with donor cells known not to express DP DEAV epitope antigens have been negative. The current cases illustrate that HLA-DP DSAs at high MFI with epitope reactivity may not necessarily result in a positive flow crossmatch. The differential crossmatch results for these two recipients may be related to variable HLA-DPB1 antigen expression in the donor rather than MFI and/or epitope pattern reaction in the recipient. Avoidance of transplant in the context of high MFI HLA-DP DSA epitope cross-reactivity pattern may not be necessary and can be associated with acceptable clinical outcome in the context of a negative pre-transplant crossmatch. HLA-DPA DSAs that have an epitope pattern of reactivity resulting in positive crossmatch are still avoided. Adding DP DSAs to the allocation algorithm without the opportunity to perform flow crossmatch does not allow for accurate immunological risk assessment and may prevent the opportunity for successful transplant. C. Ribic: 1. Grant/Research Support; Company/Organization; Leo Pharma; Astellas. 3. Speaker’s Bureau; Company/Organization; Leo Pharma; Astellas.

In this paper, a high-performance feedback controller for an electromagnetic vibratory feeder is proposed. An electromagnetic actuator is driven by a switching circuit with pulsewidth as the control variable. The controller structure consists of a proportional-integral controller combined with a state observer. The controlled variable is the resonant frequency vibration amplitude obtained in real time from the state observer. The use of the state observer allows fast disturbance rejection and reference tracking in both directions (amplitude increase and decrease). Simulations and experimental results from the real device are presented.

Purpose Prior reports have indicated that patients with colon cancer who demonstrate high-level microsatellite instability (MSI-H) or defective DNA mismatch repair (dMMR) have improved survival and receive no benefit from fluorouracil (FU) -based adjuvant therapy compared with patients who have microsatellite-stable or proficient mismatch repair (pMMR) tumors. We examined MMR status as a predictor of adjuvant therapy benefit in patients with stages II and III colon cancer. Methods MSI assay or immunohistochemistry for MMR proteins were performed on 457 patients who were previously randomly assigned to FU-based therapy (either FU + levamisole or FU + leucovorin; n = 229) versus no postsurgical treatment (n = 228). Data were subsequently pooled with data from a previous analysis. The primary end point was disease-free survival (DFS). Results Overall, 70 (15%) of 457 patients exhibited dMMR. Adjuvant therapy significantly improved DFS (hazard ratio [HR], 0.67; 95% CI, 0.48 to 0.93; P = .02) in patients with pMMR tumors. Patients with dMMR tumors receiving FU had no improvement in DFS (HR, 1.10; 95% CI, 0.42 to 2.91; P = .85) compared with those randomly assigned to surgery alone. In the pooled data set of 1,027 patients (n = 165 with dMMR), these findings were maintained; in patients with stage II disease and with dMMR tumors, treatment was associated with reduced overall survival (HR, 2.95; 95% CI, 1.02 to 8.54; P = .04). Conclusion Patient stratification by MMR status may provide a more tailored approach to colon cancer adjuvant therapy. These data support MMR status assessment for patients being considered for FU therapy alone and consideration of MMR status in treatment decision making.

A framework for a sampling plan for monitoring marshbird populations in the contiguous 48 states is proposed here. The sampling universe is the breeding habitat (i.e. wetlands) potentially used by marshbirds. Selection protocols would be implemented within each of large geographical strata, such as Bird Conservation Regions. Site selection will be done using a two-stage cluster sample. Primary sampling units (PSUs) would be land areas, such as legal townships, and would be selected by a procedure such as systematic sampling. Secondary sampling units (SSUs) will be wetlands or portions of wetlands in the PSUs. SSUs will be selected by a randomized spatially balanced procedure. For analysis, the use of a variety of methods as a means of increasing confidence in conclusions that may be reached is encouraged. Additional effort will be required to work out details and implement the plan.

Purpose The study aimed to systematically review the effect of low-molecular-weight heparin (LMWH) thromboprophylaxis in medical-surgical critically ill patients in the intensive care unit. Methods In duplicate and independently, we searched for relevant articles using MEDLINE and EMBASE; we also contacted experts and reviewed reference lists. For included studies, we abstracted data on study and patient characteristics, LMWH use, clinical outcomes (venous thromboembolism [VTE], bleeding, and mortality), laboratory outcomes (anti-Xa levels and thrombocytopenia), and methodological quality. Results We included 8 prospective cohort studies and 1 randomized trial, with a total of 629 patients. Eight studies (n = 406 patients) reported anti-Xa levels and only 3 studies (n = 240 patients) reported on at least one clinical outcome. Low-molecular-weight heparin does not appear to bioaccumulate based on repeated measurements of trough anti-Xa levels. Thrombocytopenia occurred in 9.3% of patients receiving LMWH; heparin-induced thrombocytopenia was not reported. In studies reporting clinical outcomes, the frequency of VTE in patients receiving LMWH ranged from 5.1% to 15.5%, bleeding complications ranged from 7.2% to 23.1%, and mortality ranged from 1.4% to 7.4%. Conclusions Low-molecular-weight heparin may be effective for thromboprophylaxis in medical-surgical critically ill patients, but no trials have compared LMWH against an alternative active strategy; thus, LMWH cannot be recommended routinely. Trials testing LMWH thromboprophylaxis are required, which examine patient-important end points such as the incidence and clinical consequences of VTE, bleeding, heparin-induced thrombocytopenia, and mortality.

With the goal of relieving the Internet of things (IoT)application designers of the complexities and heterogeneity of wireless sensory networks (WSNs), devices, communication media, protocols and operating systems, the development of higher level domain specific language has been undertaken. The result is DSL-4-IoT Editor-Designer, which is based on high level visual programming language, established on the class of visual domain specific modeling languages (VDSMLs). DSL-4-IoT is using formal presentations and abstract syntax in a metamodel. The visual front-end of the Editor has been developed in JavaScript language. The runtime execution of generated IoT application configuration files is done by the open source project “OpenHAB” runtime engine. In order to demonstrate the viability and usability of the developed DSL-4-IoT visual model based language, an experimental IoT testbed including 15 heterogeneous wireless sensory devices spanning two application domain (smart home and remote patient monitoring), has been designed and deployed.

There is often a need enter data in online documents. Web based interface is popular, but sometimes there is a need to fill the data using scripting and automation. JavaScript may enable automatic data entry, but it requires that script written in JavaScript executes on the same server where the form is being processed, due to protection mechanism of “same origin policy”. If needed, some browsers support disabling this policy, or there is alternative method to bypass it. The paper describes this method and includes a sample JavaScript code for automated data confirmation.

The microtexture of 0.5–10 μm thick Cu films on polyimide substrates was characterized by automated electron backscatter diffraction (EBSD). The transition from a dominant (1 1 1) to a (1 0 0) fibre texture with increasing film thickness is clearly evident and is in agreement with X-ray diffraction measurements. For interpretation of the texture evolution, a driving force map is constructed which displays the energy balance for interfacial and elastic driving forces using experimental yield stress values. The observations follow the predictions of the texture evolution model of Thompson and Carel [Thompson CV, Carel R. MSF 1996;204–206:83; Thompson CV, Carel R. J Mech Phys Solids 1996;44:657] but add new elements: the texture does not switch abruptly as predicted by energetic considerations, but a broad transition is found. Furthermore, access to the microtexture as well as grain size statistics is given by the EBSD technique, allowing new insight into the details of texture evolution.

IntroductionResearch on the management of deceased organ donors aims to improve the number and quality of transplants and recipient outcomes. In Canada, this research is challenged by regionalisation of donation services within provinces and the geographical, clinical and administrative separation of donation from transplantation services. This study aims to build a national platform for future clinical trials in donor management. Objectives are to engage collaborators at donation hospitals and organ donation organisations (ODOs) across Canada, describe current practices, evaluate the effectiveness of donation-specific interventions and assess the feasibility of future clinical trials.Methods and analysisThis ongoing prospective observational study of the medical management of deceased organ donors will enrol more than 650 consented potential donors from adult intensive care units at 33 hospital sites across Canada, each participating for 12 months. ODOs ensure enrolment of consecutive eligible participants. Research staff record detailed data about participants, therapies, organ assessments, death declaration procedures and adverse clinical exposures from the time of donation consent to organ recovery. ODOs provide reasons that organs are declined, dates and places of transplantation, and recipient age and sex.Descriptive analyses will summarise current practices. Effectiveness analyses will examine donation-specific interventions with respect to the number of transplants, using multilevel regression models to account for clustering by donor, hospitals and ODOs. Feasibility analyses will focus on acceptance of the research consent model; participation of academic and community hospitals as well as ODOs; and accessibility of recipient data.Ethics and disseminationThis study uses a waiver of research consent. Hospitals will receive reports on local practices benchmarked to (1) national practices and (2) national donor management guidelines. We will report findings to donation and transplant collaborators (ie, clinicians, researchers, ODOs) and publish in peer-reviewed journals.Trial registration numberNCT03114436.