Thermodynamic properties of interstitial elements in the refractory metals Semiannual report, 1 Dec. 1967 - 31 May 1968

Thermodynamic behavior of interstitial elements in Mo, W, Nb, and T

Knowledge, Attitude and Practice in Managing Chronic Kidney Disease with SGLT2 Inhibitors

Background and objective: Chronic kidney disease (CKD), and its increasing global burden, is associated with significant morbidity and mortality. This survey-based study aims to capture the knowledge, attitude and practices (KAP) amongst practicing physicians in considering sodium-glucose co-transporter 2 inhibitors (SGLT2i) for the prevention and progression of CKD in diabetic or nondiabeticindividuals. Methodology: An online questionnaire-based survey was conducted among 262 health care practitioners (HCPs) who manage people with CKD with or without diabetes. The survey was prepared as a Google form and circulated through email to different HCPs. The survey consisted of 6 knowledge-based questions, 4 attitude-based questions and 4 practice-based questions. The forms were filled up voluntarily by the participants and the authors had no control over the response provided. All the responses wereconsolidated using Microsoft Excel and analyzed. Results: A total of 262 HCPs from different regions of the country participated in the survey. About 87% to 94% of the participants were aware that SGLT2i, specifically dapagliflozin, is approved for use in CKD patients with or without diabetes. About threefourths of the HCPs accepted that an initial drop in estimated glomerular filtration rate (eGFR) occursupon initiation of dapagliflozin treatment. Almost 90% of them acknowledged the importance of screening for CKD in diabetic patients, and the majority were aware of the renal benefits of SGLT2i. Almost 96% of HCPs consider that dapagliflozin could be used in all patients with CKD irrespective of their diabetes status. Major determining factors with respect to a setback in practice are fear of side effects (54%) and hesitation in switching to newer medications when older medications work fine (34%). Conclusion:SGLT2i have demonstrated significant clinical benefits in patients with CKD with or without diabetes. This survey has shown good awareness among clinicians of the beneficial role of SGLT2i in CKD.&nbsp

Spontaneous intramural jejunal haematoma: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Solid-State Diffusion Welding of Wrought AISI 304 Stainless Steel to Nimonic AP-1 Superalloy Powder by Hot Isostatic Pressing Dissimilar materials like stainless steels and powder metallurgy superalloys can be joined by diffusion welding using hot isostat

ABSTRACT. The diffusion welding characteristics of wrought AISI 304 stainless steel to a superalloy powder Nimonic AP-1 were examined in this study. After encapsulation, evacuation and degassing, the welds were hot isostatically pressed (HIPed) in two different cycles, i.e., 1200°C (2192°F)/3 h/147 MPa and 1270°C (2318°F)/3 h/121 MPa. A variation in surface condition of stainless steel was also studied for its influence on properties of the joints. These diffusionwelded joints were characterized for diffusion of alloying elements, microstructural features and tensile properties. Most specimens showed good weld strength for both the hot isostatic pressing (HIP) cycles, except specimens with sand blasted surfaces, which gave negligible ductility because of the presence of sand particles embedded on the surface. In general, the tensile properties of the diffusion welded specimens were limited by the mechanical properties of stainless steel and not the joint interface. The microstructural examination of a HIP welded joint showed a thin weld zone of 30-40 ~m. While the stainless steel region of the welded specimen showed a relatively clean structure, the Nimonic AP-1 region showed precipitation of dark particles near the interface extending over 20-60 pm. Electron microprobe analysis of the diffusion welded zone revealed enrichment of titanium-rich particles along prior particle boundaries (PPBs) near the interface. Electron microprobe analysis further revealed extensive diffusion of Ni, Co and AI elements into stainless steel and that of Fe into Nimonic AP-1 superalloy indicating complex composition of the weld interlayer. M. C. SOMANI and N. C. BIRLA, Scientists, are with Defence Metallurgical Research Laboratory, Hyderabad, India, and A. TEKIN is with th

Using nutritional geometry to define the fundamental macronutrient niche of the widespread invasive ant <i>Monomorium pharaonis</i>

The emerging field of nutritional geometry (NG) provides powerful new approaches to test whether and how organisms prioritize specific nutritional blends when consuming chemically complex foods. NG approaches can thus help move beyond food-level estimates of diet breadth to predict invasive success, for instance by revealing narrow nutritional niches if broad diets are actually composed of nutritionally similar foods. We used two NG paradigms to provide different, but complementary insights into nutrient regulation strategies and test a hypothesis of extreme nutritional generalism in colony propagules of the globally distributed invasive ant Monomorium pharaonis. First, in two dimensions (protein:carbohydrates; P:C), M. pharaonis colonies consistently defended a slightly carbohydrate-biased intake target, while using a generalist equal-distance strategy of collectively overharvesting both protein and carbohydrates to reach this target when confined to imbalanced P:C diets. Second, a recently developed right-angled mixture triangle method enabled us to define the fundamental niche breadth in three dimensions (protein:carbohydrates:lipid, P:C:L). We found that colonies navigated the P:C:L landscape, in part, to mediate a tradeoff between worker survival (maximized on high-carbohydrate diets) and brood production (maximized on high-protein diets). Colonies further appeared unable to avoid this tradeoff by consuming extra lipids when the other nutrients were limiting. Colonies also did not rely on nutrient regulation inside their nests, as they did not hoard or scatter fractions of harvested diets to adjust the nutritional blends they consumed. These complementary NG approaches highlight that even the most successful invasive species with broad fundamental macronutrient niches must navigate complex multidimensional nutritional landscapes to acquire limiting macronutrients and overcome developmental constraints as small propagules

Caecal metastasis from breast cancer presenting as intestinal obstruction

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal metastsasis from the breast cancer are rare. We report a patient who presented with intestinal obstruction due to solitary caecal metastasis from infiltrating ductal carcinoma of breast. We also review the available literature briefly.</p> <p>Case presentation</p> <p>A 72 year old lady with past history of breast cancer presented with intestinal obstruction due to a caecal mass. She underwent an emergency right hemicolectomy. The histological examination of the right hemicolectomy specimen revealed an adenocarcinoma in caecum staining positive for Cytokeratin 7 and Carcinoembryonic antigen and negative for Cytokeratin 20, CDX2 and Estrogen receptor. Eight out of 11 mesenteric nodes showed tumour deposits. A histological diagnosis of metastatic breast carcinoma was given.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first case report of solitary metastasis to caecum from infiltrating ductal carcinoma of breast. Awareness of this possibility will aid in appropriate management of such patients.</p

Effect of mineral-enriched diet and medicinal herbs on Fe, Mn, Zn, and Cu uptake in chicken

<p>Abstract</p> <p>Background</p> <p>The goal of our study was to evaluate the effects of different medicinal herbs rich in polyphenol (Lemon balm, Sage, St. John's wort and Small-flowered Willowherb) used as dietary supplements on bioaccumulation of some essential metals (Fe, Mn, Zn and Cu) in different chicken meats (liver, legs and breast).</p> <p>Results</p> <p>In different type of chicken meats (liver, legs and breast) from chickens fed with diets enriched in minerals and medicinal herbs, beneficial metals (Fe, Mn, Zn and Cu) were analysed by flame atomic absorption spectrometry. Fe is the predominant metal in liver and Zn is the predominant metal in legs and breast chicken meats. The addition of metal salts in the feed influences the accumulations of all metals in the liver, legs and breast chicken meat with specific difference to the type of metal and meat. The greatest influences were observed in legs meat for Fe and Mn. Under the influence of polyphenol-rich medicinal herbs, accumulation of metals in the liver, legs and breast chicken meat presents specific differences for each medicinal herb, to the control group that received a diet supplemented with metal salts only. Great influence on all metal accumulation factors was observed in diet enriched with sage, which had significantly positive effect for all type of chicken meats.</p> <p>Conclusions</p> <p>Under the influence of medicinal herbs rich in different type of polyphenol, accumulation of metals in the liver, legs and breast chicken meat presents significant differences from the group that received a diet supplemented only with metal salts. Each medicinal herb from diet had a specific influence on the accumulation of metals and generally moderate or poor correlations were observed between total phenols and accumulation of metals. This may be due to antagonism between metal ions and presence of other chelating agents (amino acids and protein) from feeding diets which can act as competitor for complexation of metals and influence accumulation of metals in chicken meat.</p> <p><b>Graphical abstract</b></p

Validation of the care transition measure in multi-ethnic South-East Asia in Singapore

10.1186/1472-6963-12-256BMC Health Services Research121

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery