The heterogeneity of clinical practice patterns among an international cohort of pulmonary arterial hypertension experts

Abstract The extent to which pulmonary arterial hypertension (PAH) experts share common practice patterns that are in alignment with published expert consensus recommendations is unknown. Our objective was to characterize the clinical management strategies used by an international cohort of self-identified PAH experts. A 32-item questionnaire composed mainly of rank order or Likert scale questions was distributed via the Internet (August 5, 2013, through January 20, 2014) to four international pulmonary vascular disease organizations. The survey respondents (N = 105) were field experts reporting 11.6 ± 8.7 years of PAH experience. Likert scale responses (1 = disagree, 7 = agree) were 3.0–5.0, indicating a disparity in opinions, for 78% of questions. Respondent (dis)agreement scores were 4.4 ± 2.2 for use of expert recommendations to determine catheterization timing in PAH. For PAH patients without cardiogenic shock or known vasoreactivity status, the most and least preferred first-line therapies (1 = most preferred, 5 = least preferred) were phosphodiesterase type 5 inhibitors (PDE-Vi) and subcutaneous prostacyclin analogues, respectively (1.4 ± 0.8 vs. 4.0 ± 1.1; P < 0.05). Compared with US-practicing clinicians (N = 46), non-US-practicing clinicians (N = 57) favored collaboration between cardiology and pulmonary medicine for clinical decision making (1 = disagree, 7 = agree; 3.1 ± 2.2 vs. 4.8 ± 2.2; P < 0.0001) and PDE-Vi (6.5% vs. 22.4%) as first-line therapy for PAH patients with cardiogenic shock but were less likely to perform vasoreactivity testing in patients with lung disease–induced pulmonary hypertension (4.3 ± 2.1 vs. 2.2 ± 1.6; P < 0.0001). In conclusion, practice patterns among PAH experts diverge from consensus recommendations and differ by practice location, suggesting that opportunity may exist to improve care quality for this highly morbid cardiopulmonary disease

Concrete Mix Strength and Permeability with Various Supplementary Cementitious Materials

In order to reduce the amount of cement required, improve workability, mechanical properties, and durability, and have a positive environmental impact, supplementary cementitious materials are frequently utilized as a partial replacement for cement in concrete mixes. In this experimental investigation, the effects of employing waterproof and supplemental cementitious materials such as flyash, silica fume, and nano silica along with a water reduction agent were examined to increase the effectiveness and performance of concrete. The cement employed in this investigation, sulfate-resistant Portland cement, was partially substituted by the supplemental cementing components mentioned earlier to create concrete with a w/b ratio of (0.30-0.35) and C35 compressive strength. Thirteen various concrete mixtures were designed and tested at 28 days of age for compressive strength, splitting tensile strength, water sorptivity, absorption, and penetration depth under pressure. To enhance the dependability of the outcomes, three samples were evaluated, and their mean value was recorded. According to the research, mixing the chemicals with concrete resulted in a brand new substance that may meet the rising need for construction materials. All of the materials utilized in this study, with the exception of Water Proof, also showed good resistance to water absorption and strength improvement

Establishing the First Geriatric Medicine Fellowship Program in Ghana

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151282/1/jgs16014.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151282/2/jgs16014_am.pd

Combined quay crane assignment and quay crane scheduling with crane inter-vessel movement and non-interference constraints

Integrated models of the quay crane assignment problem (QCAP) and the quay crane scheduling problem (QCSP) exist. However, they have shortcomings in that some do not allow movement of quay cranes between vessels, others do not take into account precedence relationships between tasks, and yet others do not avoid interference between quay cranes. Here, an integrated and comprehensive optimization model that combines the two distinct QCAP and QCSP problems which deals with the issues raised is put forward. The model is of the mixed-integer programming type with the objective being to minimize the difference between tardiness cost and earliness income based on finishing time and requested departure time for a vessel. Because of the extent of the model and the potential for even small problems to lead to large instances, exact methods can be prohibitive in computational time. For this reason an adapted genetic algorithm (GA) is implemented to cope with this computational burden. Experimental results obtained with branch-and-cut as implemented in CPLEX and GA for small to large-scale problem instances are presented. The paper also includes a review of the relevant literature

An evolutionary approach to a combined mixed integer programming model of seaside operations as arise in container ports

This paper puts forward an integrated optimisation model that combines three distinct problems, namely berth allocation, quay crane assignment, and quay crane scheduling that arise in container ports. Each one of these problems is difficult to solve in its own right. However, solving them individually leads almost surely to sub-optimal solutions. Hence, it is desirable to solve them in a combined form. The model is of the mixed-integer programming type with the objective being to minimize the tardiness of vessels and reduce the cost of berthing. Experimental results show that relatively small instances of the proposed model can be solved exactly using CPLEX. Large scale instances, however, can only be solved in reasonable times using heuristics. Here, an implementation of the genetic algorithm is considered. The effectiveness of this implementation is tested against CPLEX on small to medium size instances of the combined model. Larger size instances were also solved with the genetic algorithm, showing that this approach is capable of finding the optimal or near optimal solutions in realistic times

Cardiopulmonary disease as sequelae of long-term COVID-19: Current perspectives and challenges

COVID-19 infection primarily targets the lungs, which in severe cases progresses to cytokine storm, acute respiratory distress syndrome, multiorgan dysfunction, and shock. Survivors are now presenting evidence of cardiopulmonary sequelae such as persistent right ventricular dysfunction, chronic thrombosis, lung fibrosis, and pulmonary hypertension. This review will summarize the current knowledge on long-term cardiopulmonary sequelae of COVID-19 and provide a framework for approaching the diagnosis and management of these entities. We will also identify research priorities to address areas of uncertainty and improve the quality of care provided to these patients

The Impact of Online Consumption Communities on Crowdfunding Success

Crowdfunding is an emerging model of finance whereby backers gather online to fund projects, events, causes or events. Online consumption communities OCC play an important role in removing temporal and spatial boundaries by allowing consumers to convene online over a shared consumption interest. In this paper, we try to understand the impact of online consumption community membership on crowdfunding project success. We build on the online consumption community literature to structure our argumentation and develop our hypotheses. We then apply sophisticated statistical models on a rich dataset integrated from multiple data sources to test our hypotheses. Our analysis suggests that online consumption community membership is significantly associated with higher likelihood of crowdfunding project success. We argue that this impact is due to increasing the project exposure to the right set of potential backers who share the same funding interest. This can circumvent the need for pre-existing backers who are able to pledge to the project and thus lead to more success. Our study provides an important extension to the crowdfunding body of knowledge through introducing the concept of online consumption community and testing its impact on crowdfunding success. The study also provides insightful practical implications for all parties in the crowdfunding ecosystem, including project creators, backers, and platform designers

Understanding the Role of Lead Organizational Donor Types in Civic Crowdfunding

Civic crowdfunding is a subgenre of crowdfunding wherein the crowd finances civic projects of value to communities. A unique aspect of civic crowdfunding is that projects regularly attract a mix of individuals and organizations, spanning the private, public, and non-profit sectors. This diversity of stakeholders raises novel questions and challenges for platform operators and fundraisers. Here, we focus on such challenges as they relate to third-party endorsements. A lengthy literature has examined the signaling value of endorsements and prominent lead contributions, typically treating their sources as homogenous. However, the varied backgrounds, motivations, and objectives of stakeholders in civic crowdfunding suggests that endorsers’ signaling value is likely to vary. We theorize how onlookers’ (potential backers’ or donors’) perception of lead organizational donors’ motivations and fit with the project’s objectives will influence the latter’s signaling value, hypothesizing differences across lead donor types (i.e., businesses, governments, non-governmental organizations). Leveraging data on 303 projects from a leading civic crowdfunding platform, SpaceHive, we show that lead donations are significantly more beneficial when supplied by NGOs, rather than businesses or government entities. Further, based on perceptual measures reported by human coders about the more than 500 organizational lead donations in our sample, we confirm our theorized mechanisms, finding that lead donor involvement is more likely to be perceived as credible, and to lead to support for a project, when the lead’s involvement is believed to be a result of value motives (rather than strategic motives), and when the lead is a natural fit with the project (i.e., congruence). We discuss the implications of our work for both theory and practice

Concrete Mix Strength and Permeability with Various Supplementary Cementitious Materials

In order to reduce the amount of cement required, improve workability, mechanical properties, and durability, and have a positive environmental impact, supplementary cementitious materials are frequently utilized as a partial replacement for cement in concrete mixes. In this experimental investigation, the effects of employing waterproof and supplemental cementitious materials such as flyash, silica fume, and nano silica along with a water reduction agent were examined to increase the effectiveness and performance of concrete. The cement employed in this investigation, sulfate-resistant Portland cement, was partially substituted by the supplemental cementing components mentioned earlier to create concrete with a w/b ratio of (0.30-0.35) and C35 compressive strength. Thirteen various concrete mixtures were designed and tested at 28 days of age for compressive strength, splitting tensile strength, water sorptivity, absorption, and penetration depth under pressure. To enhance the dependability of the outcomes, three samples were evaluated, and their mean value was recorded. According to the research, mixing the chemicals with concrete resulted in a brand new substance that may meet the rising need for construction materials. All of the materials utilized in this study, with the exception of Water Proof, also showed good resistance to water absorption and strength improvement