General practitioners\u27 knowledge and approach to chronic kidney disease in Karachi, Pakistan

Due to lack of adequate number of formally trained nephrologists, many patients with chronic kidney disease (CKD) are seen by general practitioners (GPs). This study was designed to assess the knowledge of the GPs regarding identification of CKD and its risk factors, and evaluation and management of risk factors as well as complications of CKD. We conducted a cross-sectional survey of 232 randomly selected GPs from Karachi during 2011. Data were collected on a structured questionnaire based on the kidney disease outcomes and quality initiative recommendations on screening, diagnosis, and management of CKD. A total of 235 GPs were approached, and 232 consented to participate. Mean age was 38.5 ± 11.26 years; 56.5% were men. Most of the GPs knew the traditional risk factors for CKD, i.e., diabetes (88.4%) and hypertension (80%), but were less aware of other risk factors. Only 38% GPs were aware of estimated glomerular filtration rate in evaluation of patients with CKD. Only 61.6% GPs recognized CKD as a risk factor for cardiovascular disease. About 40% and 29% GPs knew the correct goal systolic and diastolic blood pressure, respectively. In all, 41% GPs did not know when to refer the patient to a nephrologist. Our survey identified specific gaps in knowledge and approach of GPs regarding diagnosis and management of CKD. Educational efforts are needed to increase awareness of clinical practice guidelines and recommendations for patients with CKD among GPs, which may improve management and clinical outcomes of this population

Risk factors associated with Helicobacter pylori infection treatment failure in a high prevalence area

Triple therapy is commonly used for the treatment of Helicobacter pylori infection. We determined risk factors associated with its failure in compliant Patients focusing on H. pylori density, virulence marker and 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance. H. pylori infection was diagnosed by (14)C urea breath test ((14)C UBT) and rapid urease test or histology. Triple therapy with esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. was prescribed for 10 days. 14C UBT was repeated 4 weeks after treatment. In total, 111 Patients [69 (62%) males] with a mean age of 46 +/- 16 years were enrolled. The mean age of treatment failure was 39 +/- 14 years compared to 48 +/- 16 years with eradication (P=0.002). Treatment failure was associated with younger mean age, point mutations in the 23S rRNA gene of H. pylori and vacA s1a and m1 when associated with cagA negativity

Giant onsite electronic entropy enhances the performance of ceria for water splitting

AbstractPrevious studies have shown that a large solid-state entropy of reduction increases the thermodynamic efficiency of metal oxides, such as ceria, for two-step thermochemical water splitting cycles. In this context, the configurational entropy arising from oxygen off-stoichiometry in the oxide, has been the focus of most previous work. Here we report a different source of entropy, the onsite electronic configurational entropy, arising from coupling between orbital and spin angular momenta in lanthanide f orbitals. We find that onsite electronic configurational entropy is sizable in all lanthanides, and reaches a maximum value of ≈4.7 kB per oxygen vacancy for Ce4+/Ce3+ reduction. This unique and large positive entropy source in ceria explains its excellent performance for high-temperature catalytic redox reactions such as water splitting. Our calculations also show that terbium dioxide has a high electronic entropy and thus could also be a potential candidate for solar thermochemical reactions.</jats:p

Mechanisms of airfoil noise near stall conditions

The focus of this paper is on investigating the noise produced by an airfoil at high angles of attack over a range of Reynolds number Re≈2×10⁵–4×10⁵. The objective is not modeling this source of noise but rather understanding the mechanisms of generation for surface pressure fluctuations, due to a separated boundary layer, that are then scattered by the trailing edge. To this aim, we use simultaneous noise and surface pressure measurement in addition to velocimetric measurements by means of hot wire anemometry and time-resolved particle image velocimetry. Three possible mechanisms for the so-called “separation-stall noise” have been identified in addition to a clear link between far-field noise, surface pressure, and velocity fields in the noise generation

Perceived risk factors for severe Covid-19 symptoms and their association with health behaviours: Findings from the HEBECO study

Background: There remains uncertainty about Covid-19 risk factors. We examined UK adults’ risk perceptions for severe Covid-19 symptoms and whether engaging in concurrent health behaviours is associated with risk perceptions. / Methods: Cross-sectional analysis of data from the HEBECO study where 2206 UK adults classified potential factors (age 70+, ethnic minority, medical comorbidities, vaping, smoking cigarettes, alcohol drinking, regular physical activity, being overweight, eating unhealthy foods, using nicotine replacement therapy – NRT, lower income, poor housing, being a keyworker) as either increasing, decreasing, or having no impact on severe Covid-19 symptoms. Logistic regressions examined whether engaging in health behaviours was associated with risk perceptions after adjusting for socio-demographic characteristics, health conditions and other behaviours. / Results: The great majority (89-99%) of adults classified age 70+, having comorbidities, being a key worker, overweight, and from an ethnic minority as increasing the risk. People were less sure about alcohol drinking, vaping, and nicotine replacement therapy use (17.4-29.5% responding ‘don’t know’). Relative to those who did not, those who smoked tobacco, vaped and consumed alcohol had significantly (all p<0.015) higher odds (aORs=1.58 to 5.80) for classifying these behaviours as ‘no impact’ or ‘decreasing risk’, and lower odds (aORs=.25 to .72) for classifying as ‘increasing risk’. Similarly, eating more fruit and vegetables was associated with classifying unhealthy diet as ‘increasing risk’ (aOR=1.37,1.12-1.69), and exercising more with classifying regular physical activity as ‘decreasing risk’ (aOR=2.42,1.75-3.34). / Conclusions: Risk perceptions for severe Covid-19 symptoms were lower for adults’ own health behaviours, evidencing optimism bias. / Implications: These risk perceptions may form barriers to changing one’s own unhealthy behaviours or make one less responsive to interventions that refer to the risk of Covid-19 as a motivating factor. Thus, in some cases risk perceptions could help sustain unhealthy behaviours and exacerbate inequalities in health behaviours and outcomes

Corn Stover Availability and Collection Efficiency Using Typical Hay Equipment

Corn stover has been identified as a potential feedstock for the production of fermentable sugars and thermochemical processes. The availability and efficiency of typical hay equipment for collecting corn stover has not been well quantified. Corn stover was collected for two years on a central Kentucky farm near Louisville. Six different harvesting treatments, using traditional hay equipment, were used to harvest corn stover. A rotary mower, rotary scythe (flail-type mower with windrow-forming shields), parallel bar rake, and a round baler were utilized. The average stover moisture content prior to grain harvest was above 40%, and field drying was required before baling. All treatments were analyzed for collection efficiency and corn stover yield. The stover collection yields varied from 1.93 to 5.34 dry t/ha, with collection efficiencies (ratio of stover collected to the total above-ground stover excluding grain) between 32.1% and 94.5%. The most promising collection strategy was disengaging the straw chopper and spreader to produce a windrow behind the combine. This windrow could then be baled in a separate operation that resulted in a collection efficiency of 74.1%

Dark Energy and Neutrino Masses from Future Measurements of the Expansion History and Growth of Structure

We forecast the expected cosmological constraints from a combination of probes of both the universal expansion rate and matter perturbation growth, in the form of weak lensing tomography, galaxy tomography, supernovae, and the cosmic microwave background incorporating all cross-correlations between the observables for an extensive cosmological parameter set. We allow for non-zero curvature and parameterize our ignorance of the early universe by allowing for a non-negligible fraction of dark energy (DE) at high redshifts. We find that early DE density can be constrained to 0.2% of the critical density of the universe with Planck combined with a ground-based LSST-like survey, while curvature can be constrained to 0.06%. However, these additional degrees of freedom degrade our ability to measure late-time dark energy and the sum of neutrino masses. We find that the combination of cosmological probes can break degeneracies and constrain the sum of neutrino masses to 0.04 eV, present DE density also to 0.2% of the critical density, and the equation of state to 0.01 - roughly a factor of two degradation in the constraints overall compared to the case without allowing for early DE. The constraints for a space-based mission are similar. Even a modest 1% dark energy fraction of the critical density at high redshift, if not accounted for in future analyses, biases the cosmological parameters by up to 2 sigma. Our analysis suggests that throwing out nonlinear scales (multipoles > 1000) may not result in significant degradation in future parameter measurements when multiple cosmological probes are combined. We find that including cross-correlations between the different probes can result in improved constraints by up to a factor of 2 for the sum of neutrino masses and early dark energy density.Comment: 25 pages, 12 figures. Added new figure, discussion of intrinsic alignments, and references. Matches version accepted for publication in PR

Smoker Identity and Its Potential Role in Young Adults' Smoking Behavior: A Meta-ethnography

OBJECTIVE: Identity is an important influence on behavior. To identify potential targets for smoking cessation interventions in young adults, we synthesized findings from qualitative studies on smoker identity and potential influences on smoking and smoking cessation. METHODS: A systematic search of 4 electronic databases up to September 19, 2013, was conducted to identify qualitative studies on smoker identity in smokers and ex-smokers aged 16-34. Key concepts were extracted from individual studies and synthesized into higher-order interpretations by following the principles of meta-ethnography. RESULTS: Seventeen relevant papers were identified. At the highest level of interpretation, we identified 4 types of findings: (a) contributory factors to identity, (b) identity in relation to smoking, (c) contextual and temporal patterning, and (d) behavior in relation to smoking. Contributory factors included the desire to establish aspirational individual and social identities, enact a smoker identity appropriate to the momentary social context, and alter personal nonsmoking rules when consuming alcohol. Smoker identity was multifaceted and incorporated individuals' defensive rationalizations, and both positive and negative feelings attached to it. Smoker identities took time to develop, were subject to change, and were context dependent. Identity was found to play a role in quit attempts. CONCLUSIONS: Qualitative research into the identity of young adult smokers has established it as a multifaceted phenomenon serving important functions but also involving conflict and defensive rationalizations. It develops over time and contextual factors influence its expression. The nature of a smoker's identity can play an important role in smoking cessation