Chronic opioid analgesic usage post‐kidney transplantation and clinical outcomes

Chronic opioid usage ( COU ) is common among patients with end‐stage renal disease ( ESRD ) qualified for kidney transplantation and associated with inferior post‐transplant outcomes. The magnitude of COU after kidney transplantation and its impact on transplant outcomes remain unknown. We performed a single‐center retrospective study aimed to describe the prevalence of COU during the first year, to identify the predictors of COU and to determine the impact of COU on post‐transplant outcomes including the rates of hospitalization and acute rejection during the first year, as well as long‐term patient and graft survival. Among 1045 kidney transplant patients, 119 (11.4%) had required continued outpatient prescription of opioid analgesics during the first year after kidney transplantation, mostly for non‐surgery‐related pain (85%). A positive history of COU prior to transplantation was the strongest predictor of COU in the first year post‐transplantation (adjusted odds ratio [ AOR ] 4.31, p < 0.001). Patients with COU had more often hospital admission during the first year ( AOR 2.48, p = 0.001, for 1 or 2 admissions, and AOR 6.03, p < 0.001 for ≥3 admissions), but similar rate of acute rejection (19.3% vs. 15.7%, p = 0.31). During long‐term follow‐up, however, the patient and/or death‐censored kidney survival was not different. COU early post‐kidney transplantation, when clinically indicated and properly supervised, does not appear to affect the risk of death and death‐censored graft failure.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108587/1/ctr12414.pd

Optimization of orbital assignment and specification of service areas in satellite communications

The mathematical nature of the orbital and frequency assignment problem for communications satellites is explored, and it is shown that choosing the correct permutations of the orbit locations and frequency assignments is an important step in arriving at values which satisfy the signal-quality requirements. Two methods are proposed to achieve better spectrum/orbit utilization. The first, called the delta S concept, leads to orbital assignment solutions via either mixed-integer or restricted basis entry linear programming techniques; the method guarantees good single-entry carrier-to-interference ratio results. In the second, a basis for specifying service areas is proposed for the Fixed Satellite Service. It is suggested that service areas should be specified according to the communications-demand density in conjunction with the delta S concept in order to enable the system planner to specify more satellites and provide more communications supply

Calificaciones, pruebas objetivas y aprendizaje significativo en Química y Física de COU

Herein are studied the relations between Chemistry and Physics school marks in COU and in the first university year, and the score obtained at an objective test designed on the COU curriculum. The output of correlations is low and the analysis of the regression shows that the predictive ability of the variables of the objective test with respect to the marks is small; paradoxically, it is bigger for the marks at university than for those in COU, whose curriculum was the base for the test. Besides, predictive results are higher for Chemistry than for Physics. Non-significant learning could explain both, low results and the differences observed

Estudio llevado a cabo sobre representaciones de la respiración celular en los alumnos de Bachillerato y COU

This paper reports on an experiment involving students of the Natural Sciences and Biology subjects in first and third year BUP and COU. The experiment involved investigating the students' alternative ideas of cellular breathing and determining whether they evolve throughout the students' secondary education (BUP and COU)

Comparison of a private midwife obstetric unit and a private consultant obstetric unit

Background: The role of Midwife Obstetric Units (MOUs) as lead caregivers for low risk pregnancies has been a topic of much debate in recent years. It has been suggested that MOUs are more cost effective, and have a less interventionist approach to low risk pregnancies, when compared to Consultant Obstetric Units (COUs). Objectives: The primary objective of this study was to compare intrapartum delivery procedures, methods of delivery, and maternal and neonatal wellbeing for low risk pregnancies between a MOU and a COU. The second objective was to investigate the predictors of key outcomes such as caesarean sections and perineal tears. The research was carried out at a private obstetric unit in Gauteng from January 2005-June 2006. Materials and Methods: The study design was a retrospective cohort study, by means of a record review of routinely collected data. 808 subjects (212 COU and 596 MOU patients) satisfied the criteria for a low risk pregnancy during the defined period and were included in the analysis. Results: Overall the MOU had fewer interventions than the COU, but had very similar maternal and neonatal outcomes. MOU patients were less likely to have an epidural than COU patients (p<0.001), and more likely to utilise a bath for pain relief (p<0.001). The MOU was also less likely to induce a patient than the COU (p=0.002). Primiparous patients accounted for more than 95% of the caesarean section (C/S) rate (p<0.001), with the COU performing 2.2 times more C/S on primiparous patients than the MOU. Vaginal birth in the MOU was 2.6 times more likely to be an underwater birth (UWB) than the COU (p<0.001). Positive predictors for C/S were COU care, primiparous status and induction of labour. UWB was a positive predictor for grade 1 and 2 perineal tears. There were no maternal or neonatal deaths, in either unit, during the study period. There were no significant differences between the MOU and COU for maternal morbidity indicators (tears, postpartum haemorrhage, and retained placenta) or neonatal morbidity indicators (Apgar < 7 at 5 minutes and neonatal ICU admission). Conclusion: The MOU had fewer intrapartum interventions (epidurals and induction of labour) and lower C/S rates than the COU for low risk pregnancies, yet maternal and neonatal outcomes were similar. This study suggests that the MOU can function just as effectively as the COU for low risk pregnancies. Therefore the establishment of more MOUs would have immense resource implications for both the public and private health sectors in South Africa

Delocalization of weakly interacting bosons in a 1D quasiperiodic potential

We consider weakly interacting bosons in a 1D quasiperiodic potential (Aubry-Azbel-Harper model) in the regime where all single-particle states are localized. We show that the interparticle interaction may lead to the many-body delocalization and we obtain the finite-temperature phase diagram. Counterintuitively, in a wide range of parameters the delocalization requires stronger cou- pling as the temperature increases. This means that the system of bosons can undergo a transition from a fluid to insulator (glass) state under heating

Generation of SST anomalies in the midlatitudes

Analyses of monthly mean sea surface temperatures (SST) from a hierarchy of global cou- pled ocean-atmosphere models have been carried out with the focus on the midlatitudes (20N-45N). The spectra of the simulated SSTs have been tested against the null hypothe- sis of Hasselmann's stochastic climate model, which assumes an AR(1)-process for the SST variability. It has been found that the spectra of the SST variability in CGCl\/ls with fully dynamical ocean models are significantly different from the AR(1)-process, while the SST variability in an AGCM coupled to a slab ocean is consistent with an AR(1)-process. The deviation of the SST variability in CGCl\/ls with fully dynamical ocean models from the AR(1)-process are not characterized by spectral peaks but are due to a different shape of the spectra. This can be attributed to local air-sea interactions which can be simulated with an AGCM coupled to a slab ocean with dynamical varying mixed layer depth

Actitudes hacia la ciencia a lo largo de BUP y COU : un estudio longitudinal

We have performed a longitudinal study among BUP and COU students, from fourteen to eighteen years old, and their attitudes to Science. This attitude becomes neither linear nor more negative through successive years. On the contrary, we have observed a «saw tooth» profile