Estimated GFR reporting is associated with decreased nonsteroidal anti-inflammatory drug prescribing and increased renal function

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used; however, they are also nephrotoxic with both acute and chronic effects on kidney function. Here we determined NSAID prescribing before and after estimated GFR (eGFR) reporting and evaluate renal function in patients who used NSAIDs but stopped these after their first eGFR report. A population-based longitudinal analysis using a record-linkage database was conducted with the GFR estimated using the four-variable equation from the MDRD study and analyzed by trend test, paired t-test, and logistic regression modeling. Prescriptions for NSAIDs significantly decreased from 39,459 to 35,415 after implementation of eGFR reporting from the second quarter of 2005 compared with the first quarter of 2007. Reporting eGFR was associated with reduced NSAID prescriptions (adjusted odds ratio, 0.78). NSAID prescription rates in the 6 months before April 2006 were 18.8, 15.4, and 7.0% in patients with CKD stages 3, 4, and 5 and 15.5, 10.7, and 6.3%, respectively, after eGFR reporting commenced. In patients who stopped NSAID treatment, eGFR significantly increased from 45.9 to 46.9, 23.9 to 27.1, and 12.4 to 26.4 ml/min per 1.73 m(2) in 1340 stage 3 patients, 162 stage 4 patients, and 9 stage 5 patients, respectively. Thus, NSAID prescribing decreased after the implementation of eGFR reporting, and there were significant improvements in estimated renal function in patients who stopped taking NSAIDs. Hence, eGFR reporting may result in safer prescribing

Digitally-Driven Hybrid Manufacture of Ceramic Thick-Film Substrates

Ceramic substrates are commonly used in the electronics industry across a range of applications such as automotive, aerospace, industrial monitoring, power electronics and electromagnetic devices due to their ability to withstand high temperatures, pressures, radiation and mechanical shock. This paper will present the development of a new digitally-driven hybrid manufacturing process which overcomes many of the current limitations of stand-alone Additive Manufacturing for the production of precision engineered ceramic substrates and packages. This is achieved by interleaving ceramic paste extrusion with sacrificial support printing and micro-machining to produce a three-dimensional ceramic green-state part. A number of substrates were fabricated using a high viscosity, non-Newtonian paste consisting of 96wt% alumina. Thermally processing the substrate at temperatures in excess of 1400 °C yields a monolithic ceramic substrate with resultant shrinkages of ∼18% and part densities of ∼99.8%. The 3D ceramic part is then processed using computer-controlled equipment to selectively dispense a conformal circuit using silver thick film conductor paste, followed by solder dispensing and pick and place surface mount assembly of components. This fully digitally driven approach enables new design freedoms and customization currently not possible with conventional template driven manufacturing methods of ceramic electronic packages

Extreme environment interconnects and packaging for power electronics

This paper presents the combination of an innovative assembly and packaging process utilising solid liquid inter diffusion (SLID) Cu-Sn interconnects within bespoke ceramic substrates that have been produced using additive manufacturing (AM). The resultant process chain supports the integration and packaging of power electronics for harsh environment applications. Here, the authors explore how the bond strength and composition of Cu-Sn SLID interconnects vary during exposure to thermal-mechanical load profiles. Samples of Cu-Sn are exposed to thermal loading up to 300°C and integrated mechanical loading via high random frequency vibrations (1 and 2000 Hz). In parallel, micro-extrusion printing methods in which high-viscosity ceramic pastes are dispensed through cylindrical fine nozzles (2–250 µm) using CNC-controlled motion has enabled complex 3D geometries to be fabricated. Additional secondary conductor deposition after firing the ceramic substrate enables the electronic circuitry to be generated without dedicated tooling, masks, or templates. This work presents the first fully 3D-printed ceramic-based electronic substrates. To demonstrate the applications of this printing method, a 555 timer circuit with flashing LED has been printed and the components surface mount assembled. The resultant ceramic substrates are dense, mechanically robust, and the reflowed circuit functions exactly as intended

Characterization of Cu-Sn SLID interconnects for harsh environment applications

This paper reports on the results obtained from performing 'shake and bake' testing on demonstrator vehicles bonded using Cu-Sn SLID technique. The demonstrator vehicles were exposed concurrently to vibration and thermal loadings similar to those seen in aerospace and downhole applications. This work demonstrates that Cu-Sn SLID bonding process is ideal for packaging sensors and electronics to be used within harsh environments, especially those encountered in the aerospace and oil & gas industries

Minimising losses to predation during microalgae cultivation

We explore approaches to minimise impacts of zooplanktonic pests upon commercial microalgal crops using system dynamics models to describe algal growth controlled by light and nutrient availability and zooplankton growth controlled by crop abundance and nutritional quality. Losses of microalgal crops are minimised when their growth is fastest and, in contrast, also when growing slowly under conditions of nutrient exhaustion. In many culture systems, however, dwindling light availability due to self-shading in dense suspensions favours slow growth under nutrient sufficiency. Such a situation improves microalgal quality as prey, enhancing zooplankton growth, and leads to rapid crop collapse. Timing of pest entry is important; crop losses are least likely in established, nutrient-exhausted microalgal communities grown for high C-content (e.g. for biofuels). A potentially useful approach is to promote a low level of P-stress that does not adversely affect microalgal growth but which produces a crop that is suboptimal for zooplankton growth

Autotrophic and heterotrophic acquisition of carbon and nitrogen by a mixotrophic chrysophyte established through stable isotope analysis

Collectively, phagotrophic algae (mixotrophs) form a functional continuum of nutritional modes between autotrophy and heterotrophy, but the specific physiological benefits of mixotrophic nutrition differ among taxa. Ochromonas spp. are ubiquitous chrysophytes that exhibit high nutritional flexibility, although most species generally fall towards the heterotrophic end of the mixotrophy spectrum. We assessed the sources of carbon and nitrogen in Ochromonas sp. strain BG-1 growing mixotrophically via short-term stable isotope probing. An axenic culture was grown in the presence of either heat-killed bacteria enriched with ^(15)N and ^(13)C, or unlabeled heat-killed bacteria and labeled inorganic substrates (^(13)C-bicarbonate and ^(15)N-ammonium). The alga exhibited high growth rates (up to 2 divisions per day) only until heat-killed bacteria were depleted. NanoSIMS and bulk IRMS isotope analyses revealed that Ochromonas obtained 84–99% of its carbon and 88–95% of its nitrogen from consumed bacteria. The chrysophyte assimilated inorganic ^(13)C-carbon and ^(15)N-nitrogen when bacterial abundances were very low, but autotrophic (photosynthetic) activity was insufficient to support net population growth of the alga. Our use of nanoSIMS represents its first application towards the study of a mixotrophic alga, enabling a better understanding and quantitative assessment of carbon and nutrient acquisition by this species

The effect of changes to GOLD severity stage on long term morbidity and mortality in COPD

Abstract Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV1). This allows patients to change to less severe COPD stages, a novel aspect of assessment not previously evaluated. We aimed to investigate the association between temporal changes in GOLD severity stage and outcomes in COPD patients. Methods This was a record-linkage study using patients registered with a Scottish regional COPD network 2000–2015. Annual spirometry & symptoms were recorded and linked to healthcare records to identify exacerbations, hospitalisations and mortality. Spirometry, modified Medical Research Council (mMRC) dyspnoea scale and acute exacerbations over the previous year were used to assign GOLD severity at each visit. A time-dependent Cox model was used to model time to death. Secondary outcomes were respiratory specific mortality and hospitalisations. Effect sizes are expressed as Hazard Ratios HR (95%CI). Results Four thousand, eight hundred and eighty-five patients (mean age 67.3 years; 51.3% female) with 21,348 visits were included. During a median 6.6 years follow-up there were 1530 deaths. For the secondary outcomes there were 712 respiratory deaths and 1629 first hospitalisations. Across 16,463 visit-pairs, improvement in COPD severity was seen in 2308 (14%), no change in 11,010 (66.9%) and worsening in 3145 (19.1). Compared to patients staying in GOLD stage A, those worsening had a stepwise increased mortality and hospitalisations. Conclusions Improving COPD severity classification was associated with reduced mortality and worsening COPD severity was associated with increased mortality and hospitalisations. Change in GOLD group has potential as monitoring tool and outcome measure in clinical trials