The influence of hydrodynamics and particle size on the rejection properties of ultrafiltration membranes

A mathematical model based on the flow hydrodynamics is developed to calculate the treatment efficiency of ultrafiltration process. This model relates the treatment efficiency with the consideration of both fixed parameters and variable parameters. The fixed parameters are function of the intrinsic rejection coefficient, diffusion coefficient, and viscosity whereas the variable parameters can be related to the fluid velocity, volume flux, and cartridge dimensions. The model has been examined by solutions with solutes that have different molecular weights. The experimental data fits the proposed mathematical model very closely suggesting its suitability to evaluate the rejection efficiency in ultrafiltration. As such the mathematical model can be used to evaluate the intrinsic rejection coefficient that can be used to determine the solvent flux in Kedem Katchalisky model. The role of the particle size is investigated by using a log -log plot of the intrinsic rejection coefficient and the solute molecular weight. Results shows that modeling of the intrinsic rejection coefficient as log normal probability distribution function is possible. Fluid velocity on the membrane cartridge as an important parameter in the design of ultrafiltration systems

Validity of the Shahin Mixed Depression Scale: A Self-Rated Instrument Designed to Measure the Non-DSM Mixed Features in Depression

Background: The DSM5-defined mixed features in depression do not include psychomotor agitation, irritability or distractibility because they are considered overlapping symptoms. A growing number of modern psychiatrists have expressed dissatisfaction with this and proposed alternative sets of mixed symptoms that are much more common and clinically relevant. Among such alternative criteria were those proposed by Koukopoulos. He utilized the research diagnostic criteria of agitated depression (RDC-A) as a mixed depression subtype, and validated another form of mixed depression, the Koukopoulos criteria for mixed depression (K-DMX). Purpose: This study provides psychometric validation for the first self-rated scale designed to measure the most common mixed symptoms in depression as proposed by Koukopoulos. Patients and methods: We conducted a multicenter cross-sectional study of 170 patients with unipolar depression. They completed the Shahin Mixed Depression Scale (SMDS) and underwent expert interviews as a gold standard reference. SMDS' psychometric properties were assessed, including Cronbach's alpha, factor analysis, sensitivity, specificity, predictive value and accuracy. Results: We found significant association and agreement between mixity according to SMDS and the gold standard (K-DMX and RDC-A according to expert interview) with good internal consistency (Cronbach's alpha=0.87), high sensitivity (=91.4%), specificity (=98.0%), positive predictive value (=96.9%), negative predictive value (= 94.2%) and accuracy (=95.2%). Factor analysis identified one factor for psychomotor agitation and another for mixity without psychomotor agitation. Conclusion: SMDS was a reliable and valid instrument for assessing the frequently encountered and clinically relevant mixed features in depression

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Overall elemental dry deposition velocities measured around Lake Michigan

Overall dry deposition velocities of several elements were determined by dividing measured fluxes by measured airborne concentrations in different particle size ranges. The dry deposition measurements were made with a smooth surrogate surface on an automated dry deposition sampler (Eagle II) and the ambient particle concentrations were measured with a dichotomous sampler. These long-term measurements were made in Chicago, IL, South Haven, MI, and Sleeping Bear Dunes, MI, from December 1993 through October 1995 as part of the Lake Michigan Mass Balance Study. In general, the dry deposition fluxes of elements were highly correlated with coarse particle concentrations, slightly less well correlated with total particle concentrations, and least well correlated with fine particle concentrations. The calculated overall dry deposition velocities obtained using coarse particle concentrations varied from approximately 12 cm s−1 for Mg in Chicago to 0.2 cm s−1 for some primarily anthropogenic metals at the more remote sites. The velocities calculated using total particle concentrations were slightly lower. The crustal elements (Mg, Al, and Mn) had higher deposition velocities than anthropogenic elements (V, Cr, Cu, Zn, Mo, Ba and Pb). For crustal elements, overall dry deposition velocities were higher in Chicago than at the other sites