Cochrane Nursing Care Field: Human Albumin for Intra-dialytic Hypotension in Haemodialysis Patients

First paragraph: Hypotension is the most common intra-dialytic complication occurring in 20%-50% of the haemodialysis sessions (Irwin & Rippe, 2003). Despite the use of a variety of preventative measures, such as sodium profiling, sequential ultrafiltration and prescription dialysate, some patients still experience the adverse effects of a sudden drop in blood pressure (BP). The main cause of this unpleasant complication is fluid removal during the dialysis procedure, although other factors are also known to contribute, for example the components of the dialysis procedure and other patientspecific factors such as left ventricular dysfunction

Base metal losses to furnace slag during processing of platinum-bearing concentrates

The base metal distribution in, and losses to, Anglo Platinum six-in-line and slag cleaning furnace slags were characterised to coincide with various process changes at Waterval Smelter from 1999 to 2009. The base metals are presumed to be reliable indicators of PGE losses and are easier to detect and measure than these elements are. In addition, base metal and sulphur levels are used to monitor and control many smelter processes, including slag cleaning and converting. Some losses to slag are recoverable but others are not – these have been quantified during this study. Slag composition and smelting temperatures have varied substantially, and optimisation of the slag cleaning furnace – a first for the South African platinum industry – has produced a wide variation in oxidation conditions. Most of the base metal losses in the slag cleaning furnace are mechanically entrained matte particles, the largest of which should be recovered. These have been examined to establish any relationship between composition, size, and depth within the furnace so that recommendations can be made to limit these types of losses. In the six-in-line furnaces, over half of base metal losses to slag are as dissolved phases, which are not recoverable. Levels of dissolved metals have been measured and related to furnace operating conditions and slag composition. The prediction of such base metal losses is not easy, because the slag compositions are so complex. One aspect of the project has been to compare the measured distribution of the base metals with those calculated using the FactSage equilibrium model, to identify problem areas, and to recommend actions which could improve the predictions of this and similar modelling programs for base metal dissolution in slag. New electron microbeam techniques have been developed to quantify base metal distribution in slag, and novel combinations of these techniques with analytical chemistry and Mössbauer Spectroscopy have been pioneered.Dissertation (MSc)--University of Pretoria, 2009.Materials Science and Metallurgical Engineeringunrestricte

Editorial: Movement practice(s): how do we “do” social movements?

How do we “do” social movements? And how can we do them better? Do you mean the same thing by “better” that I do? When we talk about “we”, do we have the same people in mind? Do we agree that what we are doing is a social movement – and do we mean the same thing when we say that? In one way or another, questions like this are an inescapable part of organising, particularly when we set up new projects, reflect after a setback or strategize for the longer term. Whenever new people become involved or different networks and groups come together in new formations, communities, places or spaces; whenever our traditional ways of doing things aren’t working, or we endeavour to imagine taking them further; whenever new resources and opportunities open up, or new intra-movement dynamics begin to emerge, we are prompted to think about our practice as movement participants, or the various practices and aspects of activism that we engage in (Ganz 2000, Krinsky 2008). While the overall shape of social movements has remained consistent over the past few hundred years, within the larger framework there is struggle (Tilly 2008)

Women\u27s preferences for selective estrogen reuptake modulators: an investigation using the time trade off technique

PurposeSelective Estrogen Receptor Modulators (SERMs) reduce the risk of breast cancer for women at increased risk by 38%. However, uptake is extremely low and the reasons for this are not completely understood. The aims of this study were to utilize time trade-off methods to determine the degree of risk reduction required to make taking SERMs worthwhile to women, and the factors associated with requiring greater risk reduction to take SERMs. MethodsWomen at increased risk of breast cancer (N = 107) were recruited from two familial cancer clinics in Australia. Participants completed a questionnaire either online or in pen and paper format. Hierarchical multiple linear regression analysis was used to analyze the data. ResultsOverall, there was considerable heterogeneity in the degree of risk reduction required to make taking SERMs worthwhile. Women with higher perceived breast cancer risk and those with stronger intentions to undergo (or who had undergone) an oophorectomy required a smaller degree of risk reduction to consider taking SERMs worthwhile. ConclusionWomen at increased familial risk appear motivated to consider SERMs for prevention. A tailored approach to communicating about medical prevention is essential. Health professionals could usefully highlight the absolute (rather than relative) probability of side effects and take into account an individual’s perceived (rather than objective) risk of breast cancer

History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women

BACKGROUND: Few studies have reported associations between periodontitis and cardiovascular disease (CVD) risk in older women, which is the objective of the present investigation. METHODS AND RESULTS: Participants were 57 001 postmenopausal women ages 55 to 89 years (mean 68 years; \u3e 85% 60 and older) who were enrolled (1993-1998) in the Women\u27s Health Initiative Observational Study, and were without known CVD when history of periodontitis and edentulism was assessed by questionnaire at study Year-5 (1998-2003). There were 3589 incident CVD events and 3816 total deaths during a mean follow-up of 6.7 years. In multivariable analysis, periodontitis was not associated with CVD events, but was associated with higher total mortality (hazard ratio (HR)=1.12, 95% CI: 1.05-1.21). Edentulism was associated with higher age- and smoking-adjusted risks of CVD (HR=1.42, 95% CI: 1.27-1.59) and mortality (HR=1.47, 95% CI: 1.32-1.63). Further adjustment eliminated the association with CVD, but mortality remained significantly increased (HR=1.17, 95% CI: 1.02-1.33). Stratification on age, race-ethnicity, smoking, and diabetes mellitus yielded comparable results; however, edentulism was more strongly associated with CVD in women reporting \u3e /=1 dental visit (HR=1.57) compared with (HR 1.03, interaction P=0.004) annually. CONCLUSIONS: In community-dwelling older women, edentulism was associated with increased risks of CVD and total mortality, and presence of periodontitis, which is more prevalent than edentulism, was associated with 17% higher mortality rate. These findings suggest that improving periodontal condition of the general population could reduce overall mortality

Historical simulations with HadGEM3-GC3.1 for CMIP6

We describe and evaluate historical simulations which use the third Hadley Centre Global Environment Model in the Global Coupled configuration 3.1 (HadGEM3-GC3.1) model and which form part of the UK's contribution to the sixth Coupled Model Intercomparison Project, CMIP6. These simulations, run at two resolutions, respond to historically evolving forcings such as greenhouse gases, aerosols, solar irradiance, volcanic aerosols, land use, and ozone concentrations. We assess the response of the simulations to these historical forcings and compare against the observational record. This includes the evolution of global mean surface temperature, ocean heat content, sea ice extent, ice sheet mass balance, permafrost extent, snow cover, North Atlantic sea surface temperature and circulation, and decadal precipitation. We find that the simulated time evolution of global mean surface temperature broadly follows the observed record but with important quantitative differences which we find are most likely attributable to strong effective radiative forcing from anthropogenic aerosols and a weak pattern of sea surface temperature response in the low to middle latitudes to volcanic eruptions. We also find evidence that anthropogenic aerosol forcings play a role in driving the Atlantic Multidecadal Variability and the Atlantic Meridional Overturning Circulation, which are key features of the North Atlantic ocean. Overall, the model historical simulations show many features in common with the observed record over the period 1850–2014 and so provide a basis for future in-depth study of recent climate change

Preindustrial control simulations with HadGEM3-GC3.1 for CMIP6

Pre‐industrial control simulations with the HadGEM3‐GC3.1 climate model are presented at two resolutions. These are N216ORCA025, which has a horizontal resolution of 60km in the atmosphere and 0.25° in the ocean, and N96ORCA1, which has a horizontal resolution of 130km in the atmosphere and 1° in the ocean. The aim of this study is to document the climate variability in these simulations, make comparisons against present‐day observations (albeit under different forcing), and discuss differences arising due to resolution. In terms of interannual variability in the leading modes of climate variability the two resolutions behave generally very similarly. Notable differences are in the westward extent of El‐Niño and the pattern of Atlantic multidecadal variability, in which N216ORCA025 compares more favourably to observations, and in the Antarctic Circumpolar Current, which is far too weak in N216ORCA025. In the North Atlantic region, N216ORCA025 has a stronger and deeper AMOC, which compares well against observations, and reduced biases in temperature and salinity in the North Atlantic subpolar gyre (NA SPG). These simulations are being provided to the sixth Coupled Model Intercomparison Project (CMIP6) and provide a baseline against which further forced experiments may be assessed

Diagnostic importance of pulmonary interleukin-1beta and interleukin-8 in ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most commonly fatal nosocomial infection. Clinical diagnosis of VAP remains notoriously inaccurate. The hypothesis was tested that significantly augmented inflammatory markers distinguish VAP from conditions closely mimicking VAP. METHODS: A prospective, observational cohort study was carried out in two university hospital intensive care units recruiting 73 patients with clinically suspected VAP, and a semi-urban primary care practice recruiting a reference group of 21 age- and sex-matched volunteers. Growth of pathogens at >10(4) colony-forming units (cfu)/ml of bronchoalveolar lavage fluid (BALF) distinguished VAP from "non-VAP". Inflammatory mediators were quantified in BALF and serum. Mediators showing significant differences between patients with and without VAP were analysed for diagnostic utility by receiver operator characteristic (ROC) curves. RESULTS: Seventy-two patients had recoverable lavage-24% had VAP. BALF interleukin-1beta (IL-1beta), IL-8, granulocyte colony-stimulating factor and macrophage inflammatory protein-1alpha were significantly higher in the VAP group (all p<0.005). Using a cut-off of 10 pg/ml, BALF IL-1beta generated negative likelihood ratios for VAP of 0.09. In patients with BALF IL-1beta <10 pg/ml the post-test probability of VAP was 2.8%. Using a cut-off value for IL-8 of 2 ng/ml, the positive likelihood ratio was 5.03. There was no difference in cytokine levels between patients with sterile BALF and those with growth of <10(4) cfu/ml. CONCLUSIONS: BALF IL-1beta and IL-8 are amongst the strongest markers yet identified for accurately demarcating VAP within the larger population of patients with suspected VAP. These findings have potential implications for reduction in unnecessary antibiotic use but require further validation in larger populations