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Port-a-caths are implanted intravascular chest ports that enable venous access. With more port placements performed by interventional radiologists, it is important to discern differences in infection and complication rates between double- and single-lumen ports.
Methods:
We retrospectively reviewed 1,385 port placements over 2 years at the University of Miami. Patients were grouped by single- or double-lumen ports. Data on duration of catheter stay, bloodstream infections, malfunctions, and other complications (fibrin sheath, thrombosis, catheter malposition) were collected. Multivariate Cox regression was performed to identify variables predicting port infection.
Results:
The mean patient age was 58.8 years; the mean BMI was 26.9 kg/m2; and 61.5% of these patients were female. Our search revealed 791 double-lumen ports (57.1%) and 594 single-lumen ports (42.9%). The median follow-up was 668 days (range, 2–1,297). Double-lumen ports were associated with significantly higher rates of bacteremia (2.78% vs 0.84%; P = .02), port malfunction (8.3% vs 2.0%; P < .001), fibrin sheath formation (2.2% vs 0.5%; P < .02), catheter tip malposition (1.0% vs 0; P = .01), and catheter-associated thrombosis (1.4% vs 0; P = .003). Multivariate Cox regression analysis, after adjusting for other variables, showed that double-lumen chest ports had 2.98 times (95% confidence interval, 1.12–7.94) the hazard rate of single-lumen ports for developing bloodstream infection (P = .029).
Conclusions:
Double-lumen chest ports are associated with increased risk for bloodstream infection, malfunction, fibrin sheath formation, catheter tip malposition, and catheter-associated thrombosis. Interventional radiologists may consider placing single-lumen ports if clinically feasible; however, future studies are needed to determine clinical significance. The study limitations included the retrospective study design and the potential loss of patient follow-up.
A variety of machines are currently being used for mechanical excavation in mining and civil industries. A series of research works have been conducted at McGill University in the past decade to study the effects of microwave (MW) irradiation on rock mechanical properties. The idea is to enhance the excavation performance by improving the rate of penetration and decreasing the wear rate on the cutting tools. These two effects would eventually translate into economic benefits for mine operators. The effectiveness of MW on weakening rocks is proven, however the most efficient method to employ MW in mines is still under investigation. This article presents some experimental results on the effects of cooling- rate on rock strength. Brazilian Tensile Strength (BTS) of microwave treated samples were compared in natural air-cooled and water rapid-cooled conditions.
Galen's highly influential treatise On the Affected Parts (Περὶ τῶν πεπονθότων τόπων, often referred to by its Latin title De locis affectis, hereafter indicated with the abbreviation De loc. aff.) is currently being critically edited by the Corpus Medicorum Graecorum at the Berlin-Brandenburg Academy of Sciences. Over the last decade, a team of scholars, including the present authors as well as the late and lamented Aḥmad ʿEtmān, have worked on producing a critical edition of the Arabic translation of this text, and their efforts are now drawing to a close. Here we present new insights into how this Arabic translation relates to the Greek textual tradition.
Anemia (and especially mild forms) is a frequent laboratory finding in the elderly and is usually regarded in our everyday practice in psychiatry as an incidental innocent finding.
However, the growing body of literature proves otherwise.
Recent literature shows that anemia in the elderly has serious negative impact on mortality, morbidity and quality of life in this age group.
Despite the importance of this topic in mental health care, there is paucity or even lack of studies aiming to examine the magnitude of this problem in psychiatric hospitals and to suggest potential solutions for it.
In this small study, we aim to examine the prevalence of anemia in an inpatient psychiatric hospital, the types of anemia found, the investigations done and if any treatment was given.
Design and methods
Inpatient case notes were examined retrospectively for patients admitted to the Julian hospital from June 2010 to December 2010.
Anemia was defined according to the WHO criteria1 as a hemoglobin concentration lower than 12 g/dL in women and 13 g/dL in men.
Results
Based on WHO criteria, most of our elderly patients were found to be anemic, with a significantly higher frequency in men than in women. The prevalence of anemia increased with increasing age, both in men and in women.
Conclusions
Anemia in elderly is a frequent, underappreciated and potentially morbid condition accounting for significant morbidity and mortality in this population.
As mental health professionals, we must work with our colleagues in medicine to translate awareness into action.
Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.
Method
From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.
Results
All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.
Conclusion
In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.
To investigate the expression of basic fibroblast growth factor in the matrix of human acquired cholesteatoma compared to the deep meatal skin. This topic does not appear to have been fully investigated before.
Methods
An immunochemical study was conducted. Cholesteatoma tissues from adult patients were collected during surgery (n = 19). Control specimens were taken from the deep meatal skin (n = 8) and compared.
Results
A highly significant difference in basic fibroblast growth factor expression was identified between cholesteatoma and skin (mean ± standard error = 58.53 ± 3.6 per cent in cholesteatoma vs 40.6 ± 3.5 per cent in skin; p = 0.005). Both basal and parabasal keratinocytes were stained positive with basic fibroblast growth factor. Additionally, there was specific staining in the basal columnar middle-ear epithelium and mast cell membrane.
Conclusion
Basic fibroblast growth factor plays an active role in proliferative activity of cholesteatoma through its overexpression in basal and parabasal layers of cholesteatoma matrix. Moreover, its expression in the mast cell membrane supports its role in bone resorption activity.
Sol–gel spin coating is applied to fabricate the pure and different concentrations of aluminum (Al)-doped ZnO films on high-quality silicon substrates. All films are showing high crystallinity in X-ray diffraction study, and lattice constants were obtained using PowderX software. The value of crystallite size was found in range of 20–40 nm. EDX/SEM mapping was performed for 2 wt% Al-doped ZnO film, which shows the presence of Al and its homogeneous distribution in the film. SEM investigation shows nanorods morphology all over the surface of films, and the dimension of nanorods is found to increase with Al doping. The E(g)dire. values were estimate in range of 3.25–3.29 eV for all films. Linear refractive index was found in range of 1.5–2.75. The χ1 value is found in range of 0.13–1.4 for all films. The χ3 values are found in range of 0.0053 × 10−10 to 6.24 × 10−10 esu for pure and doped films. The n2 values were also estimated. These studies clearly showed that the properties of ZnO have been enriched by Al doping, and hence doped films are more appropriate for optoelectronic applications.
The vortical structures and turbulence statistics in the near wake of rectangular, trapezoidal, triangular and ellipsoidal tabs were experimentally studied in a refractive-index-matching channel. The tabs share the same bulk dimensions, including a 17 mm height, a 28 mm base width and a $24.5^{\circ }$ inclination angle. Measurements were performed at two Reynolds numbers based on the tab height, $Re_{h}\simeq 2000$ (laminar incoming flow) and 13 000 (turbulent incoming flow). Three-dimensional, three-component particle image velocimetry (PIV) was used to study the mean flow distribution and dominant large-scale vortices, while complementary high-spatial-resolution planar PIV measurements were used to quantify high-order statistics. Instantaneous three-dimensional fields revealed the coexistence of a coherent counter-rotating vortex pair (CVP) and hairpin structures. The CVP and hairpin vortices (the primary structures) exhibit distinctive characteristics and strength across $Re_{h}$ and tab geometries. The CVP is coherently present in the mean flow field and grows in strength over a significantly longer distance at the low $Re_{h}$ due to the lower turbulence levels and the delayed shedding of the hairpin vortices. These features at the low $Re_{h}$ are associated with the presence of Kelvin–Helmholtz instability that develops over three tab heights downstream of the trailing edge. Moreover, a secondary CVP with an opposite sense of rotation resides below the primary one for the four tabs at the low $Re_{h}$. The interaction between the hairpin structures and the primary CVP is experimentally measured in three dimensions and shows complex coexistence. Although the CVP undergoes deformation and splitting at times, it maintains its presence and leads to significant mean spanwise and wall-normal flows.
Olive jift is a solid by-product of olive (Olea europea) oil processing. Greenhouse experiments were conducted to evaluate olive jift effect on broomrape (Orobanche spp.) infections on three crops. Soil—jift mixtures were used as potting medium in ratios of 1:0, 1:1, and 3:1 soil to jift. Broomrape seeds were evenly incorporated in the potting media at 0, 150, 300, 450, 600, 750, and 900 seeds/kg. Pots planted with faba bean or pea were inoculated with seeds of O. crenata Forsk., whereas pots planted with tomato were inoculated with seeds of O. lavandulacea Reichenb. Jift in soil reduced broomrape germination and infection on all three hosts regardless of inoculation densities. Pea was not infected with broomrape in jift-containing media at any inoculation density, whereas only sporadic broomrape infections were observed in faba bean and tomato grown in jift-mixed soils. Fresh and dry weights of all crops were not adversely affected by mixing jift with soil. These results suggest a possible use of jift as an inexpensive organic material for broomrape control.
Thirteen soil-incorporated herbicides, mainly of the dinitroaniline and carbamate groups, were evaluated in the greenhouse for selective control of hemp broomrape (Orobanche ramosa L.) in tomato (Lycopersicon esculentum Mill. ‘Rutgers’). Hemp broomrape readily parasitized tomato roots and competed vigorously with the host. Shoots of the parasite emerged within 6 weeks after inoculation. Herbicides at 0.1 to 10.0 ppmw, with one exception, significantly reduced shoot dry weight of tomato measured at 10 weeks after treatment, in comparison with untreated, noninoculated controls. Generally, the degree of inhibition of establishment of the parasite was correlated with herbicidal injury to tomato. None of the treatments prevented the establishment of the parasite without causing severe crop injury. However, N-n-propyl-N-tetrahydrofurfuryl-4-trifluoromethyl-2,6-dinitroaniline (CGA-14397, ER-9063) at 3.3 and 6.6 ppmw exhibited some degree of selectivity as indicated by relative shoot dry weights of the host and parasite. Activated charcoal applied as a root dip on tomato or in soil admixtures prior to transplanting had no effect on parasitism and growth of hemp broomrape.
The flow development above and within homogeneous and heterogeneous canopies was experimentally studied using particle image velocimetry in a refractive-index-matching channel. The experiments were designed to gain insight into the effect of height heterogeneity on the structure and spatial distribution of the turbulence. The homogeneous model (base case) is constituted of elements of height $h$ arranged in a staggered configuration; whereas the heterogeneous canopy resembled a row canopy and consisted of elements of two heights $h_{1}=h+(1/3)h$ and $h_{2}=h-(1/3)h$ alternated every two rows. Both canopies had the same density, element geometry and mean height. The flow was studied under three submergences $H/h=2$, 3 and 4, where $H$ denotes the flow depth. The experiments were performed at Reynolds number $Re_{H}\simeq 6500$, 11 300 and 12 300 and nearly constant Froude number $Fr\simeq 0.1$. Turbulence statistics complemented with quadrant analysis and proper orthogonal decomposition reveal richer flow dynamics induced by height heterogeneity. Topography-induced spatially periodic mean flows are observed for the heterogeneous canopy. Furthermore, and in contrast to the homogeneous case, non-vanishing vertical velocity is maintained across the entire length of the heterogeneous canopy with increased levels at lower submergence depths. Further alternations were induced in the magnitude and distribution of the turbulent kinetic energy, Reynolds shear stress and characteristics of the canopy mixing layer, evidencing enhanced mixing and turbulent transport for the heterogeneous canopy especially at lower submergence depths. Overall, the results indicate that heterogeneous canopies exhibit greater vertical turbulent exchange at the canopy interface, suggesting a potential for greater scalar exchange and a greater impact on channel hydraulic resistance than a homogeneous canopy of similar roughness density.
A laboratory investigation was performed to study distinctive features of the laminar-to-turbulent transition over distributed roughness characterized by two-dimensional (2D) and three-dimensional (3D) periodic, low-order topographies at roughness Reynolds number $Re_{k}\approx 300$. Systematic experiments were performed using high-spatial-resolution planar particle image velocimetry (PIV) in a refractive-index-matching (RIM) channel, where the roughness covered the entire length of the test section. The results show that the flow over the 2D roughness becomes turbulent much sooner than its 3D counterpart ($Re_{x}=50\,000$ versus 120 000). This is attributed to the presence of a velocity inflection point resulting from flow separation within the troughs of the 2D roughness. In the transitional region, unsteady disturbances above the two roughnesses appear upstream of near-roughness disturbances. The above-roughness disturbances are associated with the inflection point in the vertically displaced boundary layer for the 2D case, and with the mean velocity deficit resulting from the interaction of the wakes of upstream elements for the 3D case. The near-roughness fluctuations are associated with the shear layer present behind the crests of both roughnesses. The transitional region is characterized by the interaction between above- and near-roughness disturbances, which merge, leading to a rapid vertical growth of the turbulent fluctuations.
Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of chemoprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the post-injury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were: studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers based on levels of evidence. Results: A total of 408 studies were screened. Forty-five studies were reviewed in-entirety and 21 were included in the systematic review. There were 2 prospective randomized trials and 19 comparative studies. Eighteen total studies demonstrated that VTEp post injury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration specifically 24–72 hours post injury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive ICH. Conclusions: Literature suggests that administering VTEp 48 hours post-injury may be safe for patients with low-hemorrhagic risk TBIs and stable injury on repeat imaging.
A fully two-dimensional theoretical study of the electromagnetic wave propagation through Metal–Liquid Crystal–Metal (M–LC–M) waveguide structure is presented. Dispersion relations corresponding to both symmetric and antisymmetric-coupled surface plasmons polaritons modes in M–LC–M structure are derived and numerically solved. The effects of LC tilt angles on the effective refractive index and propagation length are proposed. The analytical method is in good agreement with those obtained from finite-difference time-domain simulation. The obtained analytic formula can be used as an efficient element in designing tunable ultrahigh nanoscale integrated plasmonic devices.
Combined petrographic and geochemical methods are utilized to investigate the provenance, tectonic setting, palaeo-weathering and climatic conditions of the Cambrian Araba clastic sediments of NE Egypt. The ~ 60 m thick Araba Formation consists predominantly of sandstone and mudstone interbedded with conglomerate. Petrographically the Araba sandstones are mostly sub-mature and classified as subarkoses with an average framework composition of Q80F14L6. The framework components are dominated by monocrystalline quartz with subordinate K-feldspar, together with volcanic and granitic rock fragments. XRD analysis demonstrated that clay minerals comprise mixed-layer illite/smectite (I/S), illite and smectite, with minor kaolinite. Diagenetic features of the sandstone include mechanical infiltration of clay, mechanical and chemical compaction, cementation, dissolution and replacement of feldspars by carbonate cements and clays. The modal composition and geochemical parameters (e.g. Cr/V, Y/Ni, Th/Co and Cr/Th ratios) of the sandstones and mudstones indicate that they were derived from felsic source rocks, probably from the crystalline basement of the northern fringe of the Arabian–Nubian Shield. The study reveals a collisional tectonic setting for the sediments of the Araba Formation. Palaeo-weathering indices such as the chemical index of alteration (CIA), chemical index of weathering (CIW) and plagioclase index of alteration (PIA) of the clastic sediments suggest that the source area was moderately chemically weathered. On the northern margin of Gondwana, early Palaeozoic weathering occurred under fluctuating climatic conditions.
Religious laws do not usually forbid the use of psychotropic medication, but many do forbid the consumption of animal-based derivatives of bovine and/or porcine origin (e.g. gelatin and stearic acid) such as are found in many medications. Demonstrating awareness of this, combined with a genuine concern about how it affects the patient, may strengthen the doctor—patient relationship and avoid non-adherence. In this article, we outline dietary requirements of key religions and belief systems that may have a bearing when prescribing medication containing animal-based ingredients. We identify common psychotropics that contain animal-based derivatives and suggest alternative prescribing options and approaches to dealing with sensitive ethical issues.
In this paper, a method of processing argon plasma images, obtained from the DC pseudo glow discharge technique, using two- and multiple-beam interference is suggested. This method is based on measuring the image fringe shift from the background interference fringes. Hence, this mapping of intensity shift is related to the electron density distribution of the argon plasma. Also, the refractive index of the plasma is computed from the electron density values. The contrast of the interferometer images in presence of plasma shift is investigated in both cases of two- and multiple-beam interference.
In the Kingdom of Saudi Arabia (KSA), Old World cutaneous leishmaniasis (CL) is mainly caused by Leishmania major and Leishmania tropica parasites. Diagnosis of CL is predominately made by clinicians, who at times fail to detect the disease and are unable to identify parasite species. Here, we report the development of a chemiluminescent enzyme-linked immunosorbent assay (CL-ELISA) to measure the levels of anti-α-galactosyl antibodies in human sera. Using this assay, we have found that individuals infected with either Leishmania spp. had significantly elevated levels (up to 9-fold higher) of anti-α-Gal IgG compared to healthy control individuals. The assay sensitivity was 96% for L. major (95% CI; 94–98%) and 91% for L. tropica (95% CI; 86–98%) infections and therefore equivalent to restriction fragment length polymorphism-polymerase chain reaction analysis of parasite ITS1 gene. In addition, the assay had higher sensitivity than microscopy analysis, which only detected 68 and 45% of the L. major and L. tropica infections, respectively. Interestingly, up to 2 years following confirmed CL cure individuals had 28-fold higher levels of anti-α-Gal IgG compared to healthy volunteers. Monitoring levels of anti-α-Gal antibodies can be exploited as both a diagnostic tool and as a biomarker of cure of Old World CL in disease elimination settings.
In this paper, a model-based exponential stabilization of a quadruped robot is studied in bounding motion. The dynamics of the five-link planar underactuated mechanical model of the quadruped robot with four actuated joints system is derived. It is shown that the dynamical equation of the proposed simplified model belongs to a class of second-order nonholonomic mechanical systems which cannot be stabilized by any smooth time-invariant state feedback. Utilizing a coordinate transformation based on the so-called normalized momentum, a robust backstepping control method is presented for the quadruped robot. Both theoretical analysis and numerical simulations show that the robust backstepping controller can stabilize the underactuated quadruped robot so that it could balance on its rear legs and track a desired trajectory. Despite the model parameter uncertainties, the robustness of the controller is maintained. The simulation results show the effectiveness of the proposed method.