Early graft survival after renal transplantation, single center experience

Aim: The best treatment for patient with end stage kidney disease is kidney transplantation which improve their quality of life and survival rate. The aim of our study is to determine the factors that affect the results of early outcomes of graft function. Method: Twenty-eight adult patients who underwent renal transplantation from 2016 to 2017 were included in our university. Results: The median age of the recipients was 38.5 (range: 19-65) and 68% (19 patients) were male. Acute rejection was detected in 8 patients. Patients who developed rejection were found to have higher panel reactive antibody positivity and higher parathyroid hormone levels. Panel reactive antibody positivity was found to be 25% in patients who developed rejection and 0% in patients who did not develop rejection (p = 0.02). The parathyroid hormone level was calculated as 963.2 ± 587 in the rejection group and 378 ± 227 in the rejection group (p = 0.003). It was observed that 37.5% of DM patients had rejection and 10% in non-diabetic patients. The difference was statistically significant (p = 0.08). Conclusion: Panel reactive antibody positivity and parathyroid hormone levels increased the likelihood of rejection. The effect of the presence of diabetes mellitus in the patient on the development of rejection was observed to be limited. Our findings were consistent with the literature. Because of the number of patients and the short follow-up period, further studies are needed

An Empirical Study on the Benefit of Split Loads with the Pickup and Delivery Problem

Splitting loads such that the delivery of certain loads is completed in multiple trips rather than one trip has show to have benefit for both the classic Vehicle Routing Problem and the Pickup and Delivery Problem. However, the magnitude of the benefit may be affected by various problem characteristics. In this paper, we characterize those real world environments in which split loads are most likely to be beneficial. Based on practitioner interest, we determine how the benefit is affected by the mean load size and variance, number of origins relative to the number of destinations, the percentage of origin-destination pairs with a load requiring service and the clustering of origin and destination locations. We find that the magnitude of benefit: is greatest for load sizes just over one half vehicle capacity as these loads can not be combined without splitting, while they are the easiest to combine on a vehicle with splitting; increases as the number of loads sharing an origin or destination increases because there are more potential load combinations to split at each stop; and increases as the average distance from an origin to a destination increases because splitting loads reduces the trips from origins to destinations

Synthesis of mesoporous MCM-41 materials with low power microwave heating

Crystalline, high surface area, hexagonal mesoporous MCM-41 having uniform pore sizes and good thermal stability was successfully synthesized at 90-120oC in 30 minutes using low power microwave irradiation. This appears to be the first comprehensive and quantitative investigation of the comparatively rapid synthesis of mesoporous MCM-41 using low power microwave heating of 80W (90oC) and 120W (120oC). The influence of reaction temperature and the duration of heating were carefully investigated and the calcined MCM-41 materials were characterized by XRD, SEM, TEM, nitrogen adsorption, TGA and FTIR. The mesoporous MCM-41 product synthesized in 30 minutes at 120W and calcined at 550oC had a very high surface area of 1438 m2/g and was highly ordered, contained uniform pores with diameters in the range of 3.5-4.5 nm. The wall thickness of the materials highly depended on the power of the microwave energy used during the synthesis. Synthesis of the mesoporous MCM-41 products at 120oC resulted with a structure having thinner walls. The mesoporous MCM-41 materials synthesized in the present work had good thermal stability

An optimization‐based decision‐support tool for post‐disaster debris operations

Debris generated by disasters can hinder relief efforts and result in devastating economic, environmental, and health problems. In this study, we present a decision‐support tool employing analytical models to assist disaster and waste management officials with decisions regarding collection, transportation, reduction, recycling, and disposal of debris. The tool enables optimizing and balancing the financial and environmental costs, duration of the collection and disposal operations, landfill usage, and the amount of recycled materials. In addition to post‐disaster operational decisions, the tool can also support the challenging task of developing strategic plans for disaster preparedness. We illustrate the applicability and effectiveness of the tool with a disaster scenario based on Hurricane Andrew

Effects of trust-based decision making in disrupted supply chains

The United States has experienced prolonged severe shortages of vital medications over the past two decades. The causes underlying the severity and prolongation of these shortages are complex, in part due to the complexity of the underlying supply chain networks, which involve supplier-buyer interactions across multiple entities with competitive and cooperative goals. This leads to interesting challenges in maintaining consistent interactions and trust among the entities. Furthermore, disruptions in supply chains influence trust by inducing over-reactive behaviors across the network, thereby impacting the ability to consistently meet the resulting fluctuating demand. To explore these issues, we model a pharmaceutical supply chain with boundedly rational artificial decision makers capable of reasoning about the motivations and behaviors of others. We use multiagent simulations where each agent represents a key decision maker in a pharmaceutical supply chain. The agents possess a Theory-of-Mind capability to reason about the beliefs, and past and future behaviors of other agents, which allows them to assess other agents’ trustworthiness. Further, each agent has beliefs about others’ perceptions of its own trustworthiness that, in turn, impact its behavior. Our experiments reveal several counter-intuitive results showing how small, local disruptions can have cascading global consequences that persist over time. For example, a buyer, to protect itself from disruptions, may dynamically shift to ordering from suppliers with a higher perceived trustworthiness, while the supplier may prefer buyers with more stable ordering behavior. This asymmetry can put the trust-sensitive buyer at a disadvantage during shortages. Further, we demonstrate how the timing and scale of disruptions interact with a buyer’s sensitivity to trustworthiness. This interaction can engender different behaviors and impact the overall supply chain performance, either prolonging and exacerbating even small local disruptions, or mitigating a disruption’s effects. Additionally, we discuss the implications of these results for supply chain operations

Template synthesis of boron nitride nanotubes over iron impregnated mesoporous silica MCM-41 by chemical vapor deposition technique

BN nanotubes were successfully grown over iron impregnated MCM-41 at a relatively low temperature of 750oC for 1 hour by CVD technique. BN nanotubes were obtained after the purification procedure including HCl and HNO3 treatments to remove impurities. SEM image showed the formation of nano-fibrous network BN structures in the diameter range of 20 nm to 40 nm. Both XRD and FTIR characterization results supported the formation of h-BN and c-BN nanostructures. Oxidative TGA results indicated that the synthesized BN nanostructures were thermally stable at temperatures higher than 550oC. Hydrogen storage measurements via IGA showed that BNNTs could adsorb 0.85 wt% hydrogen which was two times larger than for commercial CNTs

Point-of-Care Emergency Ultrasonography in Non-Traumatic Cardiac Arrest and Near-Arrest Emergency Patients; A Pilot Trial

Background: In this study, we evaluated the applicability and interpretation of point-of-care emergency ultrasound (POCEUS) performed by an emergency physician (EP) in non-traumatic adult cardiac arrest and near-arrest patients at presentation to the Emergency Department (ED).   Methods: POCEUS was performed in 5 steps on 73 adults to assess; 1. Qualitative global cardiac function, cardiac chambers and presence of pericardial effusion; 2. Presence of pleural sliding, B-lines, A-lines or consolidation on anterior-superior; 3. Presence of an abdominal aorta aneurysm and pelvic free fluid; 4. Presence of pleural effusion, consolidation, free fluid on lateral-inferior; 5. Qualitative width and collapsibility of the inferior vena cava. A fulfilled checklist and real-time images of ultrasonography were sent by WhatsApp to the head of the study to generate the evidence and collect the data. The process of patient care, in-hospital diagnosis and survival were retrieved from digital hospital records. This prospective multicenter sample study was conducted from November 16, 2015, to January 5, 2016.   Results: The most common findings of POCEUS were performed and interpreted to have a first prediction of patients’ acute clinic problem by EPs were compatible with global systolic dysfunction (n = 16, 22.9%), pulmonary edema (n = 17, 23.3%), pulmonary embolus (n = 6, 8.2%), distributive/hypovolemic shock (n = 12, 16.4%), cardiac tamponade or pericardial effusion (n = 5, 6.8%), and pneumonia (n = 31, 42.5%) at presentation. The kappa correlation coefficient value of the POCEUS at presentation versus the final, traditional clinical diagnosis of the admitted ward, was 0.773 (95% CI, 0.747–0.892; p = 0.064, McNemar).   Conclusions: POCEUS performed by an EP at presentation had a good agreement between in qualitative prediction of the first differential diagnosis in life-threatened patients and the last diagnosis obtained during hospitalization. Furthermore, this study showed the requirement of evidence in comparison of measurements to the qualitative manner and new descriptive processes in POCEUS for unexplained situations and questions