Thermal Behavior in the Lens Process

Direct laser metal deposition processing is a promising manufacturing technology which could significantly impact the length oftime between initial concept and finished part. For adoption ofthis technology in the manufacturing environment, further understanding is required to ensure robust components with appropriate properties are routinelyfabricated. This requires a complete understanding ofthe thermal history.during part fabrication and control ofthis behavior. This paper will describe our research to understand the thermal behavior for the Laser Engineered Net Shaping (LENS) process!, where a component is fabricated by focusing a laser beam onto a substrate to create a molten pool in which powder particles are simultaneously injected to build each layer. The substrate is moved beneath the l~ser beam to deposit a thin cross section, thereby creating the desired geometry for each layer. After deposition of each layer, the powder delivery nozzle and focusing lens assembly is incremented in the positive Z-direction, thereby building a three dimensional component layer additively. It is important to control the thermal behavior to reproducibly fabricate parts. The ultimate intent is to monitor the thermal signatures and to incorporate sensors and feedback algorithms to control part fabrication. With appropriate control, the geometric properties (accuracy, surface finish, low warpage) as well as the materials' properties (e.g. strength, ductility) of a component can be dialed into the part through the fabrication parameters. Thermal monitoring techniques will be described, and their particular benefits highlighted. Preliminary details in correlating thermal behavior with processing results will be discussed.Mechanical Engineerin

Incidence of angioedema after initiation of angiotensin-converting enzyme inhibitors in adults with heart failure

Background: Angioedema, a potentially life-threatening adverse event associated with angiotensin-converting enzyme inhibitor (ACEI) use, occurs more often among Black patients than non-Black patients. Specific angioedema incidence rates (IRs) among heart failure (HF) patients initiating an ACEI are limited. Objectives: To provide estimates of angioedema incidence among HF patients initiating an ACEI, particularly among Black patients. Methods: We conducted a retrospective cohort study among adult (≥18 years) patients with HF who initiated ACEI use at 5 health care delivery systems within the Cardiovascular Research Network between July 2015 and May 2019. We required patients to have ≥12 months of continuous medical and prescription drug coverage and no ACEI dispensings in the 1 year before treatment initiation. Our primary outcome was serious angioedema, defined as a primary or secondary diagnosis of ICD-9 code 995.1 (‘Angioneurotic edema not elsewhere classified’) or ICD-10 codes in the T78.3 series (‘Angioneurotic edema’) during hospitalization. Our secondary out-come was ‘any angioedema’, which included serious angioedema and non-serious angioedema that was diagnosed in the outpatient setting. We followed patients from ACEI initiation until first angioedema diagnosis or a censoring event (treatment discontinuation, initiation of another renin-angiotensin-aldosterone system blocking agent, disenrollment, death, or end of 365-day follow-up or study). We calculated crude IRs and exact 95% confidence intervals (CI) for angioedema among HF patients initiating an ACEI. Results: We identified 14 ,241 ACEI users, of which 6,156 (43 .2%)were women and 2,105 (15%) were self-reported Black. Mean age was 70 ± 14 years. We observed 6 serious angioedema events overall (IR: 0.8/1,000 person-years (PYs), 95% CI: 0.3-1.7), with 2 events occurring among Black patients (IR: 1.8/1,000 PYs, 95%CI: 0.2-6.5) and 4 events among non-Black patients (IR: 0.6/1,000PYs, 95% CI: 0.2-1.5). We observed 43 angioedema events overall (IR: 5.4/1,000 PYs, 95% CI: 3.9-7.3), with 21 events occurring among Black patients (IR: 19/1,000 PYs, 95% CI: 11.8-29.1) and 22 events among non-Black patients (IR: 3.2/1,000 PYs, 95%CI: 2.0-4.9). Conclusions: Our estimate of angioedema incidence among HF patients who initiated an ACEI (5.4 events/1,000 PYs) is slightly higher than a previously published estimate (3.3/1,000 PYs) among a similarly-defined population identified through administrative claims data. Similar to prior reports, we found a higher incidence of angioedema, both serious and non-serious, among Black ACEI users than among non-black ACEI users

Information security: Listening to the perspective of organisational insiders

Aligned with the strategy-as-practice research tradition, this article investigates how organisational insiders understand and perceive their surrounding information security practices, how they interpret them, and how they turn such interpretations into strategic actions. The study takes a qualitative case study approach, and participants are employees at the Research & Development department of a multinational original brand manufacturer. The article makes an important contribution to organisational information security management. It addresses the behaviour of organisational insiders – a group whose role in the prevention, response and mitigation of information security incidents is critical. The article identifies a set of organisational insiders’ perceived components of effective information security practices (organisational mission statement; common understanding of information security; awareness of threats; knowledge of information security incidents, routines and policy; relationships between employees; circulation of stories; role of punishment provisions; and training), based on which more successful information security strategies can be developed

Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries

One-sentence summary for table of contents: These countries should consider using inexpensive generic agents to confront the next pandemic

Етнологія релігії – актуальна сфера українського релігієзнавства

Background: Inhaled long-acting beta-2-adrenoceptor agonists (LABA) are frequently used in patients suffering from asthma and chronic obstructive pulmonary disease (COPD). For evaluation of real-life data, drug consumption studies are needed but results might be widely influenced due to methodological differences in particular regarding inter-country comparisons. Objectives: This study aims to compare the LABA prescribing in the general population and specifically in patients suffering from asthma and/or COPD in five European countries. Methods: Crude and age- and sex-standardized (European 2008 reference population) annual period prevalence rates per 10,000 persons were calculated for the period 2002-2009 based on seven European electronic health record databases (Denmark, Germany, Spain, the Netherlands (2), and the United Kingdom (2)). Stratification by sex, age, and indication were performed for the annual period prevalence rates. Results: In all databases, we observed an increase in LABA prescriptions during the study period for the general population and for patients suffering from asthma and/or COPD. In 2008, the highest standardized period prevalence was observed in the Dutch Mondriaan-AHC and the Spanish BIFAP database (443.3 and 395.5 per 10,000 persons), and the lowest in the German Bavarian Claims and Dutch Mondriaan- NPRCD database (278.7 and 290.6 per 10,000 persons). Prevalence rates for LABA increased with age and were highest in patients over 70 years. Patients with a combined diagnosis of asthma and COPD had higher prevalence rates of LABA compared to patients with a single diagnosis of asthma or COPD. The proportion of patients with one inhaled LABA prescription only ranged from 14% (UK databases) to 35% (Spanish BIFAP database) in 2008 in the general population. Conclusions: By using a standardized protocol, we demonstrated inter- and intra-country differences in LABA prescriptions. A general increase of LABA prescriptions during the study period was observed in all databases

Experience of safety monitoring in the context of a prospective observational study of artemether-lumefantrine in rural Tanzania: lessons learned for pharmacovigilance reporting

<p>Abstract</p> <p>Objectives</p> <p>To identify and implement strategies that help meet safety monitoring requirements in the context of an observational study for artemether-lumefantrine (AL) administered as first-line treatment for uncomplicated malaria in rural Tanzania.</p> <p>Methods</p> <p>Pharmacovigilance procedures were developed through collaboration between the investigating bodies, the relevant regulatory authority and the manufacturer of AL. Training and refresher sessions on the pharmacovigilance system were provided for healthcare workers from local health facilities and field recorders of the Ifakara Health Demographic Surveillance System (IHDSS). Three distinct channels for identification of adverse events (AEs) and serious adverse events (SAEs) were identified and implemented. Passive reporting took place through IHDSS and health care facilities, starting in October 2007. The third channel was through solicited reporting that was included in the context of a survey on AL as part of the ALIVE (<b>A</b>rtemether-<b>L</b>umefantrine <b>I</b>n <b>V</b>ulnerable patients: <b>E</b>xploring health impact) study (conducted only in March-April 2008).</p> <p>Results</p> <p>Training was provided for 40 healthcare providers (with refresher training 18 months later) and for six field recorders. During the period 1^stSeptember 2007 to 31^stMarch 2010, 67 AEs were reported including 52 under AL, five under sulphadoxine-pyrimethamine, one under metakelfin, two after antibiotics; the remaining seven were due to anti-pyretic or anti-parasite medications. Twenty patients experienced SAEs; in 16 cases, a relation to AL was suspected. Six of the 20 cases were reported within 24 hours of occurrence.</p> <p>Discussion</p> <p>Safety monitoring and reporting is possible even in settings with weak health infrastructure. Reporting can be enhanced by regular and appropriate training of healthcare providers. SMS text alerts provide a practical solution to communication challenges.</p> <p>Conclusion</p> <p>Experience gained in this setting could help to improve spontaneous reporting of AEs and SAEs to health authorities or marketing authorization holders.</p

Second malignant neoplasms after a first cancer in childhood: temporal pattern of risk according to type of treatment

The variation in the risk of solid second malignant neoplasms (SMN) with time since first cancer during childhood has been previously reported. However, no study has been performed that controls for the distribution of radiation dose and the aggressiveness of past chemotherapy, which could be responsible for the observed temporal variation of the risk. The purpose of this study was to investigate the influence of the treatment on the long-term pattern of the incidence of solid SMN after a first cancer in childhood. We studied a cohort of 4400 patients from eight centres in France and the UK. Patients had to be alive 3 years or more after a first cancer treated before the age of 17 years and before the end of 1985. For each patient in the cohort, the complete clinical, chemotherapy and radiotherapy history was recorded. For each patient who had received external radiotherapy, the dose of radiation received by 151 sites of the body were estimated. After a mean follow-up of 15 years, 113 children developed a solid SMN, compared to 12.3 expected from general population rates. A similar distribution pattern was observed among the 1045 patients treated with radiotherapy alone and the 2064 patients treated with radiotherapy plus chemotherapy; the relative risk, but not the excess absolute risk, of solid SMN decreased with time after first treatment; the excess absolute risk increased during a period of at least 30 years after the first cancer. This pattern remained after controlling for chemotherapy and for the average dose of radiation to the major sites of SMN. It also remained when excluding patients with a first cancer type or an associated syndrome known to predispose to SMN. When compared with radiotherapy alone, the addition of chemotherapy increases the risk of solid SMN after a first cancer in childhood, but does not significantly modify the variation of this risk during the time after the first cancer. © 1999 Cancer Research Campaig

Rationale, design and methodology of a double-blind, randomized, placebo-controlled study of escitalopram in prevention of Depression in Acute Coronary Syndrome (DECARD)

<p>Abstract</p> <p>Background</p> <p>The prevalence of depression in patients with acute coronary syndrome, i.e. myocardial infarction and unstable angina, is higher than in the general population. The prevalence of anxiety is higher as well. Both depression and anxiety are associated with poor cardiac outcomes and higher mortality. Comorbid depression in patients with acute coronary syndrome often goes undiagnosed, and it is therefore a challenging task to prevent this risk factor. The study of DEpression in Coronary ARtery Disease (DECARD) is designed to examine if it is possible to prevent depression in patients with acute coronary syndrome.</p> <p>Methods</p> <p>Two hundred forty non-depressed patients with acute coronary syndrome are randomized to treatment with either escitalopram or placebo for 1 year. Psychiatric and cardiac assessment of patients is performed to evaluate the possibility of preventing depression. Diagnosis of depression and Hamilton Depression Scale are the primary outcome measures.</p> <p>Discussion</p> <p>This is the first study of prevention of depression in patients after acute coronary syndrome with a selective serotonin reuptake inhibitor.</p> <p>Trial Registration</p> <p><url>http://www.ClinicalTrials.gov.</url> Identifier: NCT00140257</p