Blueprint for a european calciphylaxis registry initiative. the european calciphylaxis network (eucalnet)

Calcific uraemic arteriolopathy (CUA) is a rare disease and continues to be a clinical challenge. The typical course of CUA is characterized by painful skin discolouration and induration evolving to necrotic ulcerations. Medial calcification of cutaneous arterioles and extensive extracellular matrix remodelling are the hallmarks of CUA. The epidemiology and risk factors associated with this disease are still not fully understood. Moreover, CUA treatment strategies vary significantly among centres and expert recommendations are heterogeneous. Registries may provide important insights and information to increase our knowledge about epidemiology and clinical aspects of CUA and may help to optimize its therapeutic management. In 2006, we established an internet-based registry in Germany (www.calciphylaxie.de) to allow online notification of patients with established or suspected CUA. The registry includes a comprehensive database with questions covering >70 parameters and items regarding patient-related and laboratory data, clinical background and presentation as well as therapeutic strategies. The next phase will be to allow international patient registration via www.calciphylaxis.net as part of the multinational EuCalNet (European Calciphylaxis Network) initiative, which is supported by the ERA-EDTA scientific working group 'CKD-MBD'. Based on the valuable experience with the previous German CUA registry, EuCalNet will be a useful tool to collect data on the rare disease CUA and may become a basis for prospective controlled trials in the near future

Magnetic fields in the early universe in the string approach to MHD

There is a reformulation of magnetohydrodynamics in which the fundamental dynamical quantities are the positions and velocities of the lines of magnetic flux in the plasma, which turn out to obey equations of motion very much like ideal strings. We use this approach to study the evolution of a primordial magnetic field generated during the radiation-dominated era in the early Universe. Causality dictates that the field lines form a tangled random network, and the string-like equations of motion, plus the assumption of perfect reconnection, inevitably lead to a self-similar solution for the magnetic field power spectrum. We present the predicted form of the power spectrum, and discuss insights gained from the string approximation, in particular the implications for the existence or not of an inverse cascade.Comment: 12 pages, 2 figure

Hypophosphatemia after high-dose iron repletion with ferric carboxymaltose and ferric derisomaltose-the randomized controlled HOMe aFers study

Background In patients with iron deficiency anemia, ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) allow high-dose iron repletion. While FCM is reported to induce hypophosphatemia, the frequency of hypophosphatemia after an equivalent dosage of FDI had not been assessed prospectively. Methods In the prospective, single-center, double-blind HOMe aFers study, 26 women with iron deficiency anemia (hemoglobin < 12 g/dL plus either plasma ferritin ≤ 100 ng/mL or a plasma ferritin ≤ 300 ng/mL and transferrin saturation (TSAT) ≤ 30%) were randomized to a single intravenous infusion of 20 mg/kg body weight (up to a maximum of 1000 mg) FCM or FDI. The primary endpoint was the incidence of hypophosphatemia (plasma phosphorus levels < 2.0 mg/dL at day 1, day 7 ± 2, and/or day 35 ± 2 after the infusion). In order to investigate potential skeletal and cardiovascular implications, we assessed changes in other components of mineral and bone metabolism, left ventricular function, and arrhythmias. Results Hypophosphatemia occurred more frequently in women treated with FCM (9 out of 12 [75%]) than in those treated with FDI (1 out of 13 [8%]; p = 0.001). Within 24 h after iron supplementation, women in the FCM group had significant higher plasma intact FGF23 (p < 0.001) and lower plasma 1.25-dihydroxyvitamin D (p < 0.001). As an indicator of urinary phosphorus losses, urinary fractional phosphorus excretion was higher in the FCM group (p = 0.021 at day 7 ± 2 after iron supplementation). We did not observe differences in skeletal and cardiovascular markers, potentially because of the limited number of participants. Conclusions While both FCM and FDI provide efficient iron repletion in participants with iron deficiency anemia, FCM induced hypophosphatemia more often than FDI. Trial registration Clinical Trials.gov NCT02905539. Registered on 8 September 2016. 2015-004808-36 (EudraCT Number) U1111-1176-4563 (WHO Universal Trial Number) DRKS00010766 (Deutsches Register Klinischer Studien

Оптимизация продвижения производственно-сервисного предприятия в Интернет-среде

Актуальность работы связана с прогрессирующей популярностью социальных медиа как площадки для продвижения бизнеса, что в свою очередь обусловлено ростом пользователей социальных сетей и их большим маркетинговым потенциалом. Объект исследования – продвижение в интернет-среде. Предмет исследования - SMM как один из элементов комплекса интернет-маркетинга. Цель ВКР – разработка проектных рекомендаций по продвижению торгово-монтажной компании в социальных сетях. Новизна и практическая значимость работы: разработанные проектные рекомендации могут быть реализованы на практике, что позволит оптимизировать продвижение компании в интернет-среде, повысить количество лидов, расширить аудиторию компании и увеличить ее лояльность.The relevance of the work is associated with the progressive popularity of social media as a platform for promoting business, which in turn is due to the growth of users of social networks and their great marketing potential. The object of research is promotion in the Internet environment. The subject of research is SMM as one of the elements of the Internet marketing complex. The purpose of WRC – development of project recommendations for the promotion of trade and installation company in social networks

Нейтронно-физический расчет ядерного реактора типа УГР

Объектом исследования является ядерный реактор мощностью 1550МВт с топливом UO2 и обогащением 2,5 % и с теплоносителем углекислый газ. Цель работы – реализация нейтронно-физического расчёта реактора, состоящего в физическом обосновании конструкции и определении совокупности физических параметров, удовлетворяющих поставленным требованиям. В процессе исследования проводились расчеты нейтронно-физических характеристик реактора, на основании которых были получены таблицы и построены графики, а так же начерчен чертеж; произведен расчет финансовой составляющей работы, описаны внешние факторы, влиявшие на выполнение работы. В результате исследования произведён нейтронно-физический расчет данного реактора, в частности оценены размеры активной зоны, рассчитаны коэффициенты размножения «холодного» и «горячего» реакторов, произведен расчет реактора на конец кампании.The object of research is nuclear reactor power 1550МВт fuel and UO2 enriched to 2.5 % with the coolant carbon dioxide. Purpose – implementation of neutron-physical calculation of the reactor consisting in a physical rationale for the design and definition of a set of physical parameters that meet the requirements. In the process of investigation the calculations of neutron-physical characteristics of the reactor on the basis of which was obtained tables and graphs, and blueprint drawing. the calculation of the financial component of the operation described external factors affecting performance of the work. The study produced neutron-physical calculation of the reactor, in particular the estimated size of the active zone, coefficients were calculated propagation "cold" and "hot" reactors, calculation of reactor at the end of the campaign

GWAS meta-analysis followed by Mendelian randomization revealed potential control mechanisms for circulating alpha-Klotho levels

The protein alpha-Klotho acts as transmembrane co-receptor for fibroblast growth factor 23 (FGF23) and is a key regulator of phosphate homeostasis. However, alpha-Klotho also exists in a circulating form, with pleiotropic, but incompletely understood functions and regulation. Therefore, we undertook a genome-wide association study (GWAS) meta-analysis followed by Mendelian randomization (MR) of circulating alpha-Klotho levels. Plasma alpha-Klotho levels were measured by enzyme-linked immunosorbent assay (ELISA) in the Ludwigshafen Risk and Cardiovascular Health and Avon Longitudinal Study of Parents and Children (mothers) cohorts, followed by a GWAS meta-analysis in 4376 individuals across the two cohorts. Six signals at five loci were associated with circulating alpha-Klotho levels at genome-wide significance (P 9% of the variation in circulating alpha-Klotho levels. MR analyses revealed no causal relationships between alpha-Klotho and renal function, FGF23-dependent factors such as vitamin D and phosphate levels, or bone mineral density. The screening for genetic correlations with other phenotypes followed by targeted MR suggested causal effects of liability of Crohn's disease risk [Inverse variance weighted (IVW) beta = 0.059 (95% confidence interval 0.026, 0.093)] and low-density lipoprotein cholesterol levels [-0.198 (-0.332, -0.063)] on alpha-Klotho. Our GWAS findings suggest that two enzymes involved in post-translational modification, B4GALNT3 and CHST9, contribute to genetic influences on alpha-Klotho levels, presumably by affecting protein turnover and stability. Subsequent evidence from MR analyses on alpha-Klotho levels suggest regulation by mechanisms besides phosphate-homeostasis and raise the possibility of cross-talk with FGF19- and FGF21-dependent pathways, respectively. Significance statement: alpha-Klotho as a transmembrane protein is well investigated along the endocrine FGF23-alpha-Klotho pathway. However, the role of the circulating form of alpha-Klotho, which is generated by cleavage of transmembrane alpha-Klotho, remains incompletely understood. Genetic analyses might help to elucidate novel regulatory and functional mechanisms. The identification of genetic factors related to circulating alpha-Klotho further enables MR to examine causal relationships with other factors. The findings from the first GWAS meta-analysis of circulating alpha-Klotho levels identified six genome-wide significant signals across five genes. Given the function of two of the genes identified, B4GALNT3 and CHST9, it is tempting to speculate that post-translational modification significantly contributes to genetic influences on alpha-Klotho levels, presumably by affecting protein turnover and stability

Pion interaction with the trinucleon up to the eta production threshold

Pion elastic, charge exchange scattering and induced eta production on the trinucleon systems are investigated in a coupled-channels approach in momentum space with Fadeev wave functions. The channel $\pi N \rightarrow \eta N$ is included using an isobar model with S-, P-, and D-wave resonances. While the coherent reactions like $^3$He($\pi,\pi)^3$He can be reasonably well reproduced up to $T_{\pi}$=500 MeV, large discrepancies appear for the incoherent processes, $^3$He($\pi^-,\pi^0)^3$H and $^3$He($\pi^-,\eta)^3$H at backward angles and energies above $\Delta$-resonance. In the forward direction the $(\pi,\eta)$ calculations underestimate the experimental measurements very close to threshold but agreement with the data improves with increasing pion energy. Predictions are made for the asymmetries of the various reactions on polarized $^3$He.Comment: 40 pages, 12 figures (available from the authors), Mainz preprint MKPH-T-92-1

Validation of commercially available ELISAs for the detection of circulating sclerostin in hemodialysis patients

ABSTRACT BACKGROUND: Sclerostin is an endocrine regulator in chronic kidney disease -mineral and bone disorder (CKD-MBD). Validation of assay comparability and pre-analytical handling is mandatory for establishment of sclerostin as a biomarker

Palliative care in context: an ethnographic account of the journey from diagnosis to the end of life.

This thesis provides an ethnographic account of the journey from diagnosis with a life-limiting illness to the end of life. It tracks the lives and eventual deaths of eight people and 83 family members for a period of three and a half years in total. Culture is located as a central element or lens by which to view this journey. The role, function and issues for social work as a profession are discussed in various chapters. The theoretical underpinnings of the thesis are informed by the ecological perspective combined with psychosocial theories of loss and grief. Drawing on a broad social systems theory, in conjunction with an ethnographic methodology and grounded theory analysis, contributes to the development of research which firmly takes culture into account. Four primary topic areas are presented: a narrative exploration of diagnosis, the changing landscape that participants encounter, the embodiment of new places and spaces, and finally, the journey’s end. The themes from the four topic areas contribute to the development of the two core categories “time and place” and “preparedness for death”. A schematic representation of the paths participants took is provided in the discussion of the core categories. Lastly, the New Zealand Palliative Care Strategy (Ministry of Health, 2001) is drawn on to aid the discussion of issues arising from the research and the implications for practice in this field