Thrice weekly nocturnal in-centre haemodiafiltration: a 2-year experience

Background: Adequate control of plasma phosphate without phosphate binders is difficult to achieve on a thrice-weekly haemodialysis schedule. The use of quotidian nocturnal dialysis is effective but not practical in the in-centre setting. This quality improvement project was set up as an exercise allowing the evaluation of small-solute clearance by combining convection with extended-hour dialysis in a thrice-weekly hospital setting. Methods: A single-centred, prospective analysis of patients' electronic records was performed from August 2012 to July 2014. The duration of haemodiafiltration was increased from a median of 4.5 to 8 h. Dialysis adequacy, biochemical parameters and medications were reviewed on a monthly basis. A reduction in plasma phosphate was anticipated, so all phosphate binders were stopped. Results: Since inception, 14 patients have participated with over 2,000 sessions of dialysis. The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.4 to 1.06 ± 0.1 mmol/l (p < 0.05). The average binder intake of 3.26 ± 2.6 tablets was eliminated. A normal plasma phosphate range has been maintained with increased dietary phosphate intake and no requirement for intradialytic phosphate supplementation. Conclusion: Phosphate control can be achieved without the need for binders or supplementation on a thrice-weekly in-centre haemodiafiltration program

Mechanical Evidence of the Orbital Angular Momentum to Energy Ratio of Vortex Beams

We measure, in a single experiment, both the radiation pressure and the torque due to a wide variety of propagating acoustic vortex beams. The results validate, for the first time directly, the theoretically predicted ratio of the orbital angular momentum to linear momentum in a propagating beam. We experimentally determine this ratio using simultaneous measurements of both the levitation force and the torque on an acoustic absorber exerted by a broad range of helical ultrasonic beams produced by a 1000-element matrix transducer array. In general, beams with helical phase fronts have been shown to contain orbital angular momentum as the result of the azimuthal component of the Poynting vector around the propagation axis. Theory predicts that for both optical and acoustic helical beams the ratio of the angular momentum current of the beam to the power should be given by the ratio of the beam’s topological charge to its angular frequency. This direct experimental observation that the ratio of the torque to power does convincingly match the expected value (given by the topological charge to angular frequency ratio of the beam) is a fundamental result

Multidimensional collaboration; reflections on action research in a clinical context

This paper reflects on the challenges and benefits of multidimensional collaboration in an action research study to evaluate and improve preoperative education for patients awaiting colorectal surgery. Three cycles of planning, acting,observing and reflecting were designed to evaluate practice and implement change in this interactive setting, calling for specific and distinct collaborations. Data collection includes: observing educational interactions; administering patient evaluation questionnaires; interviewing healthcare staff, patients and carers; patient and carer focus groups; and examining written and audiovisual educational materials. The study revolves around and depends on multi-dimensional collaborations. Reflecting on these collaborations highlights the diversity of perspectives held by all those engaged in the study and enhances the action research lessons. Successfully maintaining the collaborations recognises the need for negotiation, inclusivity, comprehension, brokerage,and problem-solving. Managing the potential tensions is crucial to the successful implementation of changes introduced to practice and thus has important implications for patients’ well-being. This paper describes the experiences from an action research project involving new and specific collaborations, focusing on a particular healthcare setting. It exemplifies the challenges of the collaborative action research process and examines how both researchers and practitioners might reflect on the translation of theory into educational practices within a hospital colorectal department. Despite its context-specific features, the reflections on the types of challenges faced and lessons learned provide implications for action researchers in diverse healthcare settings across the world

High Spatial Resolution Thermal-Infrared Spectroscopy with ALES: Resolved Spectra of the Benchmark Brown Dwarf Binary HD 130948BC

We present 2.9-4.1 micron integral field spectroscopy of the L4+L4 brown dwarf binary HD 130948BC, obtained with the Arizona Lenslets for Exoplanet Spectroscopy (ALES) mode of the Large Binocular Telescope Interferometer (LBTI). The HD 130948 system is a hierarchical triple system, in which the G2V primary is joined by two co-orbiting brown dwarfs. By combining the age of the system with the dynamical masses and luminosities of the substellar companions, we can test evolutionary models of cool brown dwarfs and extra-solar giant planets. Previous near-infrared studies suggest a disagreement between HD 130948BC luminosities and those derived from evolutionary models. We obtained spatially-resolved, low-resolution (R~20) L-band spectra of HD 130948B and C to extend the wavelength coverage into the thermal infrared. Jointly using JHK photometry and ALES L-band spectra for HD 130948BC, we derive atmospheric parameters that are consistent with parameters derived from evolutionary models. We leverage the consistency of these atmospheric quantities to favor a younger age (0.50 \pm 0.07 Gyr) of the system compared to the older age (0.79 \pm 0.22 Gyr) determined with gyrochronology in order to address the luminosity discrepancy.Comment: 17 pages, 9 figures, Accepted to Ap

Simultaneous Water Vapor and Dry Air Optical Path Length Measurements and Compensation with the Large Binocular Telescope Interferometer

The Large Binocular Telescope Interferometer uses a near-infrared camera to measure the optical path length variations between the two AO-corrected apertures and provide high-angular resolution observations for all its science channels (1.5-13 $\mu$m). There is however a wavelength dependent component to the atmospheric turbulence, which can introduce optical path length errors when observing at a wavelength different from that of the fringe sensing camera. Water vapor in particular is highly dispersive and its effect must be taken into account for high-precision infrared interferometric observations as described previously for VLTI/MIDI or the Keck Interferometer Nuller. In this paper, we describe the new sensing approach that has been developed at the LBT to measure and monitor the optical path length fluctuations due to dry air and water vapor separately. After reviewing the current performance of the system for dry air seeing compensation, we present simultaneous H-, K-, and N-band observations that illustrate the feasibility of our feedforward approach to stabilize the path length fluctuations seen by the LBTI nuller.Comment: SPIE conference proceeding

Exoplanet science with the LBTI: instrument status and plans

The Large Binocular Telescope Interferometer (LBTI) is a strategic instrument of the LBT designed for high-sensitivity, high-contrast, and high-resolution infrared (1.5-13 $\mu$m) imaging of nearby planetary systems. To carry out a wide range of high-spatial resolution observations, it can combine the two AO-corrected 8.4-m apertures of the LBT in various ways including direct (non-interferometric) imaging, coronagraphy (APP and AGPM), Fizeau imaging, non-redundant aperture masking, and nulling interferometry. It also has broadband, narrowband, and spectrally dispersed capabilities. In this paper, we review the performance of these modes in terms of exoplanet science capabilities and describe recent instrumental milestones such as first-light Fizeau images (with the angular resolution of an equivalent 22.8-m telescope) and deep interferometric nulling observations.Comment: 12 pages, 6 figures, Proc. SPI

Cortical bony thickening of the lateral intercondylar wall : the functional attachment of the anterior cruciate ligament

Background: The anatomy of the anterior cruciate ligament (ACL) has become the subject of much debate. There has been extensive study into attachment points of the native ligament, especially regarding the femoral attachment. Some of these studies have suggested that fibers in the ACL are of differing functional importance. Fibers with higher functional importance would be expected to exert larger mechanical stress on the bone. According to Wolff’s law, cortical thickening would be expected in these areas. Purpose: To examine cortical thickening in the region of the ACL footprint (ie, the functional footprint of the ACL). Study Design: Descriptive laboratory study. Methods: Using micro–computed tomography with resolutions ranging from 71 to 91 μm, the cortical thickness of the lateral wall of the intercondylar notch in 17 cadaveric knees was examined, along with surface topography. After image processing, the relationship between the cortical thickening and surface topology was visually compared. Results: A pattern of cortical thickening consistent with the functional footprint of the ACL was found. On average, this area was 3 times thicker than the surrounding bone and significantly thicker than the remaining lateral wall (P < .0001). This thickening was roughly elliptical in shape (with a mean centroid at 23.5 h:31 t on a Bernard and Hertel grid) and had areas higher on the wall where greater thickness was present. The relationship to previously reported osseous landmarks was variable, although the patterns were broadly consistent with those reported in previous studies describing direct and indirect fibers of the ACL. Conclusion: The findings of this study are consistent with those of recent studies describing fibers in the ACL of differing functional importance. The area in which the thickening was found has been defined and is likely to represent the functional footprint of the ACL

Exploring Nonlinearity in the Association Between Birth Defect Rates and Agrichemicals in Groundwater in an Agricultural State

Background: Agricultural practices over the last 70 years have led to increased agrichemical contamination in some drinking water supplies. Studies report an elevated risk of birth defects associated with exposure to nitrate or atrazine, but little is known about effects of co-exposure. This ecological study evaluated the relationship between the concomitant presence of nitrate and atrazine in Nebraska drinking water supplies and risk for birth defects. Methods: County birth data were combined with water chemistry data retrieved from a state-sponsored agrichemical contaminant database. Segmented linear regression was used to examine associations between percentage of wells with nitrate and atrazine (separately and as a mixture), and the risk of birth defects. Results: When modeled for wells with nitrate-N concentrations \u3e 2 mg/L, the slope of the first regression segment was positive, increasing to 58% positive wells. After 58% positivity, the slope showed a negative association with birth defect rates. Adding atrazine to the model moved the changepoints to a lower percentage of wells positive for these agrichemicals in the association to birth defect rates. Models consistently showed this pattern of association with and without other nitrosatable compounds present. Conclusions: The results support an effect of nitrate and nitrosatable compounds on fetal development and suggest the relationship may be nonlinear. Exposure to nitrate and nitrosatable compounds as a mixture may have separate biological effects on reproductive outcomes when compared to the single compounds.https://digitalcommons.unmc.edu/chri_forum/1059/thumbnail.jp

Structure of turbulent sonic underexpanded free jets

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76109/1/AIAA-10145-898.pd

The HOSTS Survey for Exozodiacal Dust: Preliminary results and future prospects

[abridged] The presence of large amounts of dust in the habitable zones of nearby stars is a significant obstacle for future exo-Earth imaging missions. We executed an N band nulling interferometric survey to determine the typical amount of such exozodiacal dust around a sample of nearby main sequence stars. The majority of our data have been analyzed and we present here an update of our ongoing work. We find seven new N band excesses in addition to the high confidence confirmation of three that were previously known. We find the first detections around Sun-like stars and around stars without previously known circumstellar dust. Our overall detection rate is 23%. The inferred occurrence rate is comparable for early type and Sun-like stars, but decreases from 71% [+11%/-20%] for stars with previously detected mid- to far-infrared excess to 11% [+9%/-4%] for stars without such excess, confirming earlier results at high confidence. For completed observations on individual stars, our sensitivity is five to ten times better than previous results. Assuming a lognormal luminosity function of the dust, we find upper limits on the median dust level around all stars without previously known mid to far infrared excess of 11.5 zodis at 95% confidence level. The corresponding upper limit for Sun-like stars is 16 zodis. An LBTI vetted target list of Sun-like stars for exo-Earth imaging would have a corresponding limit of 7.5 zodis. We provide important new insights into the occurrence rate and typical levels of habitable zone dust around main sequence stars. Exploiting the full range of capabilities of the LBTI provides a critical opportunity for the detailed characterization of a sample of exozodiacal dust disks to understand the origin, distribution, and properties of the dust.Comment: To appear in SPIE Astronomical Telescopes + Instrumentation 2018 proceedings. Some typos fixed, one reference adde