Renal function, electrolytes, and congestion monitoring in heart failure.

Congestion, renal function, and electrolyte imbalance (particularly potassium) are common problems in the management of the complex multi-morbid patient with heart failure (HF). Poor control of these fundamental clinical features is associated with adverse outcomes. Close monitoring of serum potassium and renal function is recommended by most current guidelines during the management of an episode of acute decompensated HF, yet the recommendations remain poorly implemented. Physicians are advised to treat a state of euvolaemia after an admission with decompensated HF and residual congestion is a marker of worse outcome, yet control of congestion is poorly assessed and managed in real-world practice. This document reflects the key points discussed by a panel of experts during a Heart Failure Association meeting on physiological monitoring of the complex multi-morbid HF patient, and here, we present to aspects related to renal function, electrolyte, and congestion monitoring

The self-consistent quantum-electrostatic problem in strongly non-linear regime

The self-consistent quantum-electrostatic (also known as Poisson-Schr\"odinger) problem is notoriously difficult in situations where the density of states varies rapidly with energy. At low temperatures, these fluctuations make the problem highly non-linear which renders iterative schemes deeply unstable. We present a stable algorithm that provides a solution to this problem with controlled accuracy. The technique is intrinsically convergent including in highly non-linear regimes. We illustrate our approach with (i) a calculation of the compressible and incompressible stripes in the integer quantum Hall regime and (ii) a calculation of the differential conductance of a quantum point contact geometry. Our technique provides a viable route for the predictive modeling of the transport properties of quantum nanoelectronics devices.Comment: 28 pages. 14 figures. Added solution to a potential failure mode of the algorith

Impact of Hyperkalemia and Worsening Renal Function on the Use of Renin Angiotensin Aldosterone System Inhibitors in Chronic Heart Failure With Reduced Ejection Fraction

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138255/1/cpt746.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138255/2/cpt746_am.pd

Toward model-based engineering for space embedded systems and software

International audienceEmbedded systems development suffers from difficulties to reach cost, delay and safety requirements. The continuous increase of system complexity requires a corresponding increase in the capability of design fault-free systems. Model-based engineering aims to make complexity management easier with the construction of a virtual representation of systems enabling early prediction of behaviour and performance. In this context, Space industry has specific needs to deal with remote systems that can not be maintained on ground. In such systems, fault management includes complex detection, localisation and recovery automatic procedures that can not be performed without confidence on safety. In this way, only simulation and formal proofs can support the validation of all the possible configurations. Thus, formal description of both functional and non-functional properties with temporal logic formulae is expected to analyse and to early predict system characteristics at execution. This paper is based on various studies and experiences that are carried out in space domain on the support provided by model-based engineering in terms of: • support to needs capture and requirements analysis, • support to design, • support to early verification and validation, • down to automatic generation of code

HYDROBIA ULVAE: A DEPOSIT-FEEDER FOR CLEANING LIVING HARD-SHELLED FORAMINIFERA

International audienceThis study proposes a new method for fast and inexpensive extraction of a large number of living foraminifera for laboratory cultures. The method is a significant improvement over current extraction methods, which are highly time-consuming. Several treatments were designed to test the method. Sediment bearing foraminifera from Brouage Mudflat (Atlantic coast of France) was washed through a 50-µm sieve and distributed in glass Petri dishes with 20, 40 and 80 specimens of Hydrobia ulvae, a common gastropod from European intertidal mudflats. As a control experiment, one dish was treated similarly but maintained without Hydrobia. After two days, most of the sediment in the Hydrobia treatments was compacted into small cylindrical gastropod feces and the tests of living benthic foraminifera (Ammonia tepida and Haynesina germanica) were clean and easily visible. Additional experiments showed that the foraminifera were not ingested by Hydrobia ulvae, and could be picked quickly and easily

Design of InAs/GaSb superlattice infrared barrier detectors

Design of InAs/GaSb type-II superlattice (T2SL) infrared barrier detectors is theoretically investigated. Each part of the barrier structures is studied in order to achieve optimal device operation at 150 K and 77 K, in the midwave and longwave infrared domain, respectively. Whatever the spectral domain, nBp structure with a p-type absorbing zone and an n-type contact layer is found to be the most favourable detector architecture allowing a reduction of the dark-current associated with generation-recombination processes. The nBp structures are then compared to pin photodiodes. The MWIR nBp detector with 5 μm cut-off wavelength can operate up to 120 K, resulting in an improvement of 20 K on the operating temperature compared to the pin device. The dark-current density of the LWIR nBp device at 77 K is expected to be as low as 3.5 × 10−4 A/cm2 at 50 mV reverse bias, more than one decade lower than the usual T2SL photodiode. This result, for a device having cut-off wavelength at 12 μm, is at the state of the art compared to the well-known MCT ‘rule 07’

Influence de l'adsorption d'alginates sur les propriétés de membranes organiques d'ultra et de microfiltration

Les applications potentielles des cultures de microalgues et cyanobactéries en dépollution d'effluents dans des photobioréacteurs à membrane souffrent de performances limitées par un colmatage de l'élément filtrant dû en grande partie aux exopolysaccharides sécrétés par ces micro-organismes. Cette étude du laboratoire quantifie les effets de l'adsorption de ces polysaccharides sur des membranes organiques d'ultra et microfiltration tangentielle de matériaux et charges de surface différents. L'alginate de sodium est utilisé comme adsorbat modèle. Les membranes propres sont d'abord testées par une mesure de flux à l'eau pure, puis mises en contact avec une solution d'alginate durant un temps choisi. Le flux à l'eau pure des membranes après adsorption est ensuite à nouveau mesuré.La réduction relative du rayon de pore (ZEMAN, 1983) met en évidence l'effet de la mouillabilité et des charges superficielles. L'étude comparée de membranes d'ultra et microfiltration montre que cette réduction relative du rayon de pore augmente avec le seuil de coupure ou le diamètre de pore. L'effet de la concentration révèle aussi que la résistance hydraulique d'adsorption (MATTHIASSON, 1983) à l'équilibre évolue selon l'isotherme de LANGMUIR. Le modèle cinétique traduisant l'évolution de la résistance d'une membrane d'ultrafiltration proposé par BAKLOUTI et al.(1984), amélioré par AIMAR et al. (1988) puis discuté par RUIZ-BEVIÁ et al. (1997), est complété par un nouvel exposant agissant sur le facteur temps.La comparaison des résistances à l'écoulement de membranes de microfiltration avec celle d'une membrane d'ultrafiltration hydrophile neutre permet de dégager des critères de choix pour l'optimisation du fonctionnement d'un photobioréacteur à membrane utilisable en dépollution d'effluents.Potential applications of microalgae and cyanobacteria for treatment of wastewater effluents using membrane-photobioreactors suffer from limited performance due to fouling effects, mainly attributable to exocellular polysaccharides secreted by these micro-organisms. A membrane photobioreactor is defined as a process associating the culture of photosynthetic micro-organisms with a continuous separation by membrane filtration of the biomass and the water treated. The goal of the present laboratory-scale study was to quantify polysaccharide adsorption effects on organic membranes (ultra and microfiltration) characterised by different materials and surface charges. Sodium alginate was used as the "model adsorbate".Seven plane organic membranes were tested. The influence of membrane cut-off (or of pore diameters) as well as that of the material polyethersuphone (PES), polyacrylonitrile (PAN), polyvinilidene fluoride (PVDF) and of its properties (hydrophobicity, surface charges, …) were assessed. The study consisted of two parts :1. the first part was concerned with the kinetics of alginate adsorption and the influence contact time and solute concentrations on the reduction of pore diameter (ZEMAN, 1983) or on the increase of hydraulic resistance (MATTHIASSON, 1983);2. the second part dealt with adsorption equilibrium (formulations of LANGMUIR and FREUNDLICH).The study constituted the first step of a research program aimed at developing membrane photobioreactors for the treatment of specific industrial effluents. The fluid used to test the membranes was quality II pure water (ISO 3696 norm). Tangential velocities were set to 2.5 m.s-1, corresponding to a Reynolds number of 2500. To represent exopolysaccharides, we used alginic acid at concentrations of 1, 10 and 50 g, neutralised with sodium hydroxide at pH 9. New (or clean) membranes were first characterised through pure water flux measurements. J0, the flux of pure water for a new membrane, was obtained (flowrate / unit of surface area), and then the membrane was kept in contact, for a definite duration, with the alginate solution. After adsorption and rinsing, the pure water flux was measured again. Ja, the pure water flux, was measured through the membrane after adsorption.Adsorption model at equilibrium:The effect of adsorption is quantified under the form of the relative pore size reduction as described by ZEMAN (1983) and included in the relation : ∆r / r=1 - (Ja / Jo)1/4. A variation of this quantification is that of the MATTHIASSON model (1983) applied to the pure water flux, based on DARCY's law expressing the relative value of the hydraulic resistance of the adsorbed layer Ra in relation to the intrinsic resistance of the membrane Rm : Ra / Rm=(Jo / Ja) - 1.To express adsorption phenomena at the solid/liquid interface of membranes, we used LANGMUIR's law together with MATTHIASSON's experimental observation (1983): the relative resistance Ra / Rm due to adsorbed compounds is proportional to the mass "x" of solute adsorbed per unit of membrane surface area, x=Kx.Ra. If one assumes that the mass m of a homogeneous plane membrane per unit of membrane surface area is proportional to its adsorbing surface area Ω per unit of membrane surface area (m=Km.Ω), and if one combines the flux equations expressed by DARCY's and POISEUILLE's laws, then the result is m=K'm.Rm in a homogeneous membrane. Substituting x and m in LANGMUIR's law results in the equilibrium model Rae / Rm=(Jo / Ja) - 1=a.c / (1 + bc) in which c=concentration of adsorbing solute; a and b are coefficients; and Rae is the resistance due to compounds adsorbed at equilibrium. Kinetic model: To show the evolution of membrane resistance with time, we suggest the introduction of an empirical exponent j over the time parameter in the AIMAR et al. model (1988).Results: The effect of changing the alginate concentration reveals that the hydraulic resistance of adsorption, at equilibrium, (MATTHIASSON, 1983) evolves according to LANGMUIR's isotherm. The relative decrease of pore radius ∆r / r in the presence of l g.l-1 of sodium alginate shows that a quasi-plateau is obtained after two hours using the most hydrophobic membrane. The curves ∆r / r=f (t) for five membranes made of different materials, monitored during the transition phase before the plateau with common 1 g.l-1 concentrations, reveal similar adsorption behaviour, characterised by the limiting common value ∆r / r=0.06 ± 0.005. However, the uncharged hydrophilic membrane PAN 3038 stands out owing to a much lower ∆r / r value of 0.09. This peculiar behaviour can also be observed in the influence of the alginate concentration: hydrophobic and charged hydrophilic membranes display a saturation effect with ∆r / r little affected by the increase of alginate concentration, whereas the uncharged hydrophilic membrane PAN 3038 displays a ∆r / r value three to six times lower with great sensitivity to concentration effects at concentrations below 10 g.l-1. The model Rae / Rm=(Jo / Ja) - 1=a.c / (1 + bc) is in agreement with the experimental results obtained with hydrophobic and hydrophilic membranes. The proposed kinetic model shows that time dependence of R (t) does not seem to be linked to the nature of membranes. However, compared with concentration, R (c) is very sensitive to the nature of membranes. A comparative study of ultra and microfiltration membranes shows that the reduction in ∆r / r values increases with molecular weight cut-off (or pore diameter).Criteria for the choice of membranes: A comparative study of three polyacrylonitrile membranes reveals that membrane 3038 PAN (neutral) displays a very interesting, peculiar behaviour: its adsorption, expressed by ∆r / r or Rae/(Rae+Rm) is four to six times weaker than that of the other two. The surface charge of membranes seems to influence the intensity of adsorption in a significant way. Wetability also has a strong influence on adsorption. The sum of resistances Rae + Rm of ultrafiltration membrane 3038 PAN is only four times as great as those of hydrophobic microfiltration membranes. Experimentation already showed that, in the presence of microparticles, interactions between the layer of adsorbed alginate and microparticles will increase the likelihood of fouling of microfiltration membranes, decreasing their resistance down to the level of very little adsorbing ultrafiltration membrane IRIS 3038 (ROSSIGNOL et al., 1999).A culture system of marine microalgae in a membrane photobioreactor using ultrafiltration membrane IRIS 3038 PAN displayed a stable permeation flux during 6 weeks and easy regeneration, which meant adsorption was almost nil. The ability of some microalgae to assimilate ammonia nitrogen, nitrates and phosphates contained in waste water with excellent efficiencies (e.g., Phormidium bohneri: SYLVESTRE et al., 1996) allows one to consider using membrane photobioreactors in the treatment of home or industrial effluents. Other microalgae such as Chlorella salina (GARNHAM et al., 1992) are capable of fixing large amounts of heavy metals (Co, Mn, Zn, etc…); grown in membrane photobioreactors, they could depollute industrial effluents

Diffuse small bowel thickening in aids patient - a case report

<p>Abstract</p> <p>Background</p> <p>Diarrhea is common in HIV/AIDS patients, caused by both classic enteric pathogens and different opportunistic agents. <it>Infection with these different pathogens may lead to similar radiological findings, thus causing diagnostic confusion</it>.</p> <p>Case presentation</p> <p>A 30-yr-old female with AIDS presented with chronic diarrhea of 4 months duration. She had diffuse small bowel thickening present on CT scan of her abdomen, with stool examination showing no parasites. She was erroneously diagnosed as abdominal tuberculosis and given antituberculosis drugs with which she showed no improvement. Repeat stool examination later at a specialized laboratory revealed <it>Cryptosporidium parvum </it>infection.</p> <p>The patient was given an extended course of nitazoxanide treatment, as her stool examination was positive for <it>Cryptosporidium parvum </it>even after 2 weeks of drug consumption. Parasite clearance was documented after 10 weeks of treatment. Interestingly, the bowel thickening reversed with parasitological clearance.</p> <p>Conclusions</p> <p><it>Cryptosporidium parvum </it>may lead to small bowel thickening in AIDS patients. This small bowel thickening may reverse following parasitological clearance.</p