The relationship between risk factors for falling and the quality of life in older adults

BACKGROUND: Falls are one of the major health problems that effect the quality of life among older adults. The aim of this study was to explore the relationship between quality of life (Short Form-12) and the risk factors of falls (balance, functional mobility, proprioception, muscle strength, flexibility and fear of falling) in older adults. METHODS: One hundred sixteen people aged 65 or older and living in the T.C. Emekli Sandigi Narlidere nursing home participated in the study. Balance (Berg Balance test), functional mobility (Timed Up and Go), proprioception (joint position sense), muscle strength (back/leg dynamometer), flexibility (sit and reach) and fear of falling (Visual Analogue Scale) were assessed as risk factors for falls. The quality of life was measured by Short Form-12 (SF-12). RESULTS: A strong positive correlation was observed between Physical Health Component Summary of SF-12, General Health Perception and balance, muscle strength. Proprioception and flexibility did not correlated with SF-12 (p > 0.05). There was negative correlation between Physical Health Component Summary of SF-12, General Health Perception and fear of falling, functional mobility (p < 0.05). CONCLUSION: We concluded that the risk factors for falls (balance, functional mobility, muscle strength, fear of falling) in older adults are associated with quality of life while flexibility and proprioception are not

Can Non-lytic CD8+T Cells Drive HIV-1 Escape?

The CD8+ T cell effector mechanisms that mediate control of HIV-1 and SIV infections remain poorly understood. Recent work suggests that the mechanism may be primarily non-lytic. This is in apparent conflict with the observation that SIV and HIV-1 variants that escape CD8+ T cell surveillance are frequently selected. Whilst it is clear that a variant that has escaped a lytic response can have a fitness advantage compared to the wild-type, it is less obvious that this holds in the face of non-lytic control where both wild-type and variant infected cells would be affected by soluble factors. In particular, the high motility of T cells in lymphoid tissue would be expected to rapidly destroy local effects making selection of escape variants by non-lytic responses unlikely. The observation of frequent HIV-1 and SIV escape poses a number of questions. Most importantly, is the consistent observation of viral escape proof that HIV-1- and SIV-specific CD8+ T cells lyse infected cells or can this also be the result of non-lytic control? Additionally, the rate at which a variant strain escapes a lytic CD8+ T cell response is related to the strength of the response. Is the same relationship true for a non-lytic response? Finally, the potential anti-viral control mediated by non-lytic mechanisms compared to lytic mechanisms is unknown. These questions cannot be addressed with current experimental techniques nor with the standard mathematical models. Instead we have developed a 3D cellular automaton model of HIV-1 which captures spatial and temporal dynamics. The model reproduces in vivo HIV-1 dynamics at the cellular and population level. Using this model we demonstrate that non-lytic effector mechanisms can select for escape variants but that outgrowth of the variant is slower and less frequent than from a lytic response so that non-lytic responses can potentially offer more durable control

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Simulation of stability and dynamics of multistage flash desalination

gPROMS software was used to study the dynamics of a multistage flash desalination brine circulation system (MSF-BR) as a function of major operating parameters. Most of the previous studies focused on MSF-BR dynamic model development however; it gave very little information on dynamic response of the system to the most significant process independent parameters. The present model was first validated against available industrial data of different plants. System dynamics were obtained upon increasing/decreasing several of the operating parameters over a range of \ub1 15%. Results show that increase/decrease of the cooling seawater flow rate have limited effect on the system dynamics. Increasing/decreasing the brine recycle flow had more sizeable effects on the system performance. Therefore, it was not possible to operate the system below 7% decrease of the design value. The most sensitive system response was obtained as function of the heating steam temperature. As a result, increase/decrease of this parameter was limited to 2% and 3%, respectively. The system seizes to operate because of the following: increase in the brine level above the design limits (approximately 0.5. m below the demister), decrease in brine level below gate height (blow through phenomena), decrease in the production capacity below the minimum design value. \ua9 2011 Elsevier B.V

Eulerian-lagrangian modeling and computational fluid dynamics simulation of wire mesh demisters in MSF plants

This study focuses on computational fluid dynamics model (CFD) for simulation of demisters in multistage flash desalination (MSF). The Eulerian-Lagrangian model (steady-state and two-dimensional) was developed to simulate the demister. The model was used to simulate the flow of water vapor and brine droplets in the demister. The computational domain includes the following three zones: the vapor space above the demister, the vapor space below the demister, and the demister. The demister zone was modeled as tube banks. A sensitivity analysis of the model revealed that vapor velocity is the main parameter that affects demister performance. Additionally, the analysis indicated that vapor temperature had no effect on the pressure drop across the demister. The developed model was validated using data from both the literature and real MSF plants. Analysis indicated that model predictions and experimental data were consistent. This work gives extensive details for CFD modeling of the MSF demister. The work is based on a previous study by Al-Fulaij et al. (2014). This work is part of a group effort to develop a comprehensive CFD simulation for the entire flashing stage of the MSF process, which would provide an extremely efficient and inexpensive design and simulation tool to the desalination community