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

Telehealth: acceptability, clinical interventions and quality of life in peritoneal dialysis

Introduction: Telehealth technologies are being widely adopted across the globe for management of long-term conditions. There are limited data on its use, effectiveness and patient experience in end-stage renal disease. The aim of this pilot project was to explore patient acceptability of technology and evaluate its effect on clinical interventions and quality of life in patients undergoing peritoneal dialysis. Methods: Peritoneal dialysis patients were provided with computer tablets (PODs). PODs contained a knowledge database with treatment- and symptom-based questionnaires that generated alerts for the clinical team. Alerts were reviewed daily and followed up by a telephone call or clinic visit. Interventions were at the discretion of clinicians. Data were recorded prospectively and quality of life and Quebec User Evaluation of Satisfaction with assistive Technology questionnaires evaluated at the start and end of the programme. Results: In all, 22 patients have participated over 15 months. The mean age was 61.6 years and PODs were utilised for an average of 341.9 days with 59.1% choosing to continue beyond the study period. We received a total of 1195 alerts with an average of 2.6 alerts per day. A total of 36 admissions were avoided and patients supported to self-manage on 154 occasions. Quebec User Evaluation of Satisfaction with assistive Technology scores remained high throughout the programme although no improvement in quality of life was seen. Discussion: Telehealth is useful to monitor patients with renal failure on peritoneal dialysis. It is acceptable across age groups and provides an additional resource for patients to self-manage. Satisfaction scores and retention rates suggest a high level of acceptability

Numerical Investigation of Installed Jet Noise Sensitivity to Lift and Wing/Engine Positioning

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.As the turbofan engines of modern transport aircraft have increasingly larger bypass ratios, by necessity to avoid longer undercarriage, the engine must be installed closer to the wing. This then has the potential of interaction between the jet flow and a deployed flap. This interaction can be an important noise source when the high-lift systems are deployed, as at approach and take-off. Investigating the parameters that have a strong influence on the installation noise penalty can help in identifying noise reduction measures. In this paper Wall-Modelled Large Eddy Simulations (WMLES), combined with the FfowcsWilliams and Hawkings (FW-H) sound extrapolation method, are performed to reproduce three experimental cases, with the aim of isolating the different contributions of flap angle and trailing-edge/jet-axis distance h. The first case (DOAK), consisting of a single jet installed near a horizontal flat plate, confirms the fundamental mechanisms of jet-surface interaction and jet-surface reflection in the absence of lift. The second case (DLR-F16), with a coaxial jet installed under a high-lift wing, reveals the trailing-edge/jet-axis distance h as the dominant parameter, with a possible influence of the flap angle at low frequencies. The third case (SYMPHONY) is used to study the interaction of a coaxial jet with a full aircraft geometry using Fourier decomposition of the pressure near-field to analyse the effects on sound sources and radiation

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

The Artificial Production of Mutants

n/

Effect of continuous gamma-ray exposure on performance of learned tasks and effect of subsequent fractionated exposures on blood-forming tissue

Sixteen monkeys trained to perform continuous and discrete-avoidance and fixed-ratio tasks with visual and auditory cues were performance-tested before, during, and after 10-day gamma-ray exposures totaling 0, 500, 750, and 1000 rads. Approximately 14 months after the performance-test exposures, surviving animals were exposed to 100-rad gamma-ray fractions at 56-day intervals to observe injury and recovery patterns of blood-forming tissues. The fixed-ratio, food-reward task performance showed a transient decline in all dose groups within 24 hours of the start of gamma-ray exposure, followed by recovery to normal food-consumption levels within 48 to 72 hours. Avoidance tasks were performed successfully by all groups during the 10-day exposure, but reaction times of the two higher dose-rate groups in which animals received 3 and 4 rads per hour or total doses of 750 and 1000 rads, respectively, were somewhat slower

Lessons as a prevention intern: Eliminating sexual violence through school-based programs

Every 73 seconds another person in America is sexually assaulted. For my senior practicum, I worked at Sexual Assault Resource Center, which provides advocacy and support services, including crisis intervention and counseling, for survivors of sexual violence. My goals for my time with SARC included developing knowledge and skills related to being a trauma therapist, learning about how a nonprofit operates, and gaining an understanding of sex education and sexual violence prevention programs. As a Sexual Assault Advocate and Education and Prevention Intern at SARC, my primary responsibilities involved engaging in community outreach events, delivering educational workshops, and presenting prevention curriculum in schools. As a result of my participation, I became interested in researching school-based prevention strategies and programs aimed at reducing sexual violence, as well as their focus areas, strengths, and limitations. My research and practicum experience reframed the way I viewed prevention work, provided insight into effective prevention strategies, and reminded me of why I believe so strongly in early prevention education to reduce sexual violence

How Will The Politics And Government Of Hong Kong Change In 2047 When The “One Country, Two Systems” Policy Has Expired.

Since the official transfer of sovereignty over Hong Kong from Great Britain to China in 1997, Hong Kong has been governed under a special set of laws dubbed “One Country, Two Systems”. Though Hong Kong and the mainland are one country, the People’s Republic of China, they are governed under two different systems with regards to economic and political policy. This two-system agreement has been seen as a guarantor of Hong Kong’s Western-style democracy and political freedoms, especially as compared to the rest of the People’s Republic. However, the system was set to be in place for only fifty years and is due to expire in 2047. The upcoming expiration of the One Country, Two Systems style of governance has led to speculation as to whether or not 2047 will spell the end of Hong Kong’s way of life. Through data gathered from research into other studies of the same topic, as well as interviews with experts from Hong Kong, these fears seem unfounded. Because of Hong Kong’s significant economic importance to China, as well as the presence of Western interests and nationals in Hong Kong, the expiration of the One Country, Two Systems law is not expected to affect any sort of significant change for Hong Kong. Though the Chinese government is likely to continue suppression of independence movements, and immigration to the island is expected to increase, the general projection for Hong Kong after the expiration of the Two Systems law will continue into the future in a very similar way since cost and gains do not seem to be equitable for mainland China