Educating renal nurses - inferior vena caval ultrasound for intravascular volume assessment

Aim: Volume status of haemodialysis patients can be evaluated by trained doctors using ultrasound (US) of the inferior vena cava (IVC). To date, renal nurses have not been taught this skill. As part of a larger study exploring the use of US by renal nurses we developed an educational program to ensure that renal nurses received adequate US training to attain competence in IVC ultrasound (IVC-US). Methods: The educational program was divided into four parts. Initially a clinical US expert delivered the necessary theoretical and then practical components of the program. After this the nurse undertook a period of self-directed US practice (100 scans). During this period three formative reviews of the recorded scan clips with feedback occurred. Specific feedback covered US technique, image optimisation and acquisition and image interpretation. Finally, as a summative assessment the nurse performed and interpreted 60 scans on 10 dialysis patients. These scans were independently assessed for quality and the nurse interpretations reviewed for accuracy, prior to deeming the candidate competent to independently perform IVC-US. Findings: Ultrasound education involves knowledge and skill acquisition. Initial theoretical and practical education must be translated into competence through task repetition and targeted feedback. A staged educational program that involves these components is likely to be successful. The rate for US skill acquisition varies and a summative assessment ensuring competence prior to independent scanning is important. Conclusions: This four-step program demonstrated that it is feasible to educate a renal nurse in IVC-US for intravascular volume assessment

Attitudes toward Precision Treatment of Smoking in the Southern Community Cohort Study

Background: Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease. Methods: We surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. Seven items assessed attitudes toward aspects of precision smoking treatment, from undergoing tests to acting on results. Items were dichotomized as favorable (5 = strongly agree/4 = agree) versus less favorable (1 = strongly disagree/2 = disagree/3 = neutral); a summary score reflecting generalized attitudes was also computed. Multivariable logistic regression tested independent associations of motivation (precontemplation, contemplation, and preparation) and confidence in quitting (low, medium, and high) with generalized attitudes, controlling for sociodemographic factors and nicotine dependence. Results: More than 70% of respondents endorsed favorable generalized attitudes toward precision medicine, with individual item favorability ranging from 64% to 83%. Smokers holding favorable generalized attitudes reported higher income and education (P \u3c 0.05). Predicted probabilities of favorable generalized attitudes ranged from 63% to 75% across motivation levels [contemplation vs. precontemplation: adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI), 1.36–3.25, P = 0.001; preparation vs. precontemplation: AOR = 1.83, 95% CI, 1.20–2.78, P = 0.005; contemplation vs. preparation: AOR = 1.15, 95% CI, 0.75–1.77, P = 0.52] and from 59% to 78% across confidence (medium vs. low: AOR = 1.91, 95% CI, 1.19–3.07, P = 0.007; high vs. low: AOR = 2.62, 95% CI, 1.68–4.10, P \u3c 0.001; medium vs. high: AOR = 0.73, 95% CI, 0.48–1.11, P = 0.14). Conclusions: Among disproportionately burdened community smokers, most hold favorable attitudes toward precision smoking treatment. Individuals with lower motivation and confidence to quit may benefit from additional intervention to engage with precision smoking treatment. Impact: Predominantly favorable attitudes toward precision smoking treatment suggest promise for future research testing their effectiveness and implementation

Disruption of medical care among individuals in the southeastern United States during the COVID-19 pandemic

Background: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences. Design and Methods: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled low-income individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data. Results: Among 4,463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare.  Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; p-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare. Conclusions: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access

The challenge of simulating the star cluster population of dwarf galaxies with resolved interstellar medium

We present results on the star cluster properties from a series of high resolution smoothed particles hydrodynamics (SPH) simulations of isolated dwarf galaxies as part of the griffin project. The simulations at sub-parsec spatial resolution and a minimum particle mass of 4 M⊙ incorporate non-equilibrium heating, cooling, and chemistry processes, and realize individual massive stars. The simulations follow feedback channels of massive stars that include the interstellar-radiation field variable in space and time, the radiation input by photo-ionization and supernova explosions. Varying the star formation efficiency per free-fall time in the range ϵff = 0.2–50 per cent neither changes the star formation rates nor the outflow rates. While the environmental densities at star formation change significantly with ϵff, the ambient densities of supernovae are independent of ϵff indicating a decoupling of the two processes. At low ϵff, gas is allowed to collapse more before star formation, resulting in more massive, and increasingly more bound star clusters are formed, which are typically not destroyed. With increasing ϵff, there is a trend for shallower cluster mass functions and the cluster formation efficiency Γ for young bound clusters decreases from 50 per cent to ∼1 per cent showing evidence for cluster disruption. However, none of our simulations form low mass (3 M⊙) clusters with structural properties in perfect agreement with observations. Traditional star formation models used in galaxy formation simulations based on local free-fall times might therefore be unable to capture star cluster properties without significant fine tuning

Untersuchungen zur Erweiterung des Einsatzbereiches der katalytischen NO_X-Minderung im Hinblick auf Sauerstoffpartialdruck, Temperatur und Katalysatorgifte Abschlussbericht

Available from TIB Hannover: FR 5339 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Untersuchungen zur Erweiterung des Einsatzbereiches der katalytischen Kohlenwasserstoff-Emissionsminderung bei industriellen und gewerblichen Prozessen Schlussbericht

The project considered catalytical reduction technologies applicable to emission of hydrocarbons and chlorine hydrocarbons from industrial processes. Heterogenous catalytical procedures as well as homogenous catalytical processes initialized in gas phase by radicals were widely investigated. The following points were essentially treated: - Extension/adjustment of two laboratory plants for the investigations of catalytical oxidation of hydrocarbons and chlorine hydrocarbons. - Development of catalysts for the oxidation of short chain hydrocarbons on basis of precious metal exchanged zeolites. - Development of catalysts for the oxidation of short chain chlorine hydrocarbons on basis of metal exchanged zeolites. - Investigation of the applicability of reduction processes using excited atoms. (orig.)Das Projekt zielte insbesondere auf katalytische Minderungstechnologien, die fuer Prozessemissionen von Kohlenwasserstoffen und Chlorkohlenwasserstoffen aus Industrie und Gewerbe einsetzbar sind. Hierbei wurden sowohl heterogen-katalytische Verfahren als auch radikalinitierte, quasi-homogen katalysierte Gasphasenprozesse eingehend untersucht und weiterentwickelt. Im wesentlichen wurden folgende Punkte bearbeitet: - Erweiterung/Anpassung zweier Laborreaktoranlagen zur Untersuchung der Wirksamkeit von Katalysatoren fuer die Kohlenstoff- und fuer die Chlorkohlenwasserstoffoxidation. - Entwicklung von Oxidationskatalysatoren fuer kurzkettige Kohlenwasserstoffe auf der Basis edelmetallausgetauschter Zeolithe. - Entwicklung von Oxidationskatalysatoren fuer kurzkettige Chlorkohlenwasserstoffe auf der Basis metallausgetauschter Zeolithe. - Untersuchung der Anwendungsmoeglichkeit plasmaunterstuetzter Minderungsprozesse. (orig.)SIGLEAvailable from TIB Hannover: F93B930 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Plasmareinigung fuer den mobilen Einsatz. Teilvorhaben: Mikrowelleninduzierte Plasmen zur Schadstoffminderung in Abgasen von Verbrennungsmotoren Abschlussbericht

Exhaust gases of Diesel engines usually contain some percent of oxygen. Therefore, the application of common catalysts is not possible. The development of new technologies, especially for the reduction of nitric oxide in such exhaust gases, is important. The potential of a plasmachemical procedure for the aftertreatment of Diesel exhausts was investigated. By absorption of microwave energy a plasma was induced in a nitrogen gas stream. This plasma was expanded through a nozzle and injected as a plasmajet into synthetic gas mixtures containing NO as pollutant. The amount of gas in the plasmajet was about 10% of the synthetic exhaust gas stream. The microwave source was a 2.45 GHz Magnetron. This way we succeeded in producing plasmas at atmospheric pressure without electrodes and expanding them into the exhaust gas mixtures. The operating time during the experiments was not limited. In mixtures of N_2/NO we found a removal of NO of 95%. In presence of oxygen in the range of 0% to 10%, we could show reduction rates of 95% to about 40% with the N_2-plasma jet. The reduced NO was completely converted into the elements. The system was modified for experiments with water and hydrocarbon as gaseous components in the exhaust gas. First experiments show the reduction of hydrocarbons in presence of water in the range of some 10%. First investigations show the reduction of hydrocarbons in presence of water in the range of some 10%. Former investigations of the method seem promising and now experiments with real exhaust gases are planned. (orig.)Im Abgas von Dieselmotoren liegt nebst den ueblichen Verbrennungsprodukten und Schadstoffen noch Sauerstoff in Konzentrationen von einigen Prozent vor. Aus diesem Grund ist der heute gaengige Dreiwege-Katalysator nicht einsetzbar. Die Einhaltung kuenftiger Grenzwerte fuer Schadstoffe - speziell der notwendige Abbau der Stickoxide im Abgas - stellt ein bislang noch nicht zufriedenstellend geloestes Problem dar, die Entwicklung neuer Technologien ist erforderlich. Untersucht wurde ein Verfahren, in dem ein mikrowelleninduziertes Plasma zur Schadstoffminderung in Abgasen eingesetzt werden soll. Dabei wird in einem Gasstrom aus Stickstoff, der bezogen auf den eigentlichen Abgashauptstrom relativ klein ist (ca. 10% oder weniger), durch Einkopplung von Mikrowellenstrahlung ein Plasma erzeugt. Dieses wird durch eine Duese als Plasmajet in den eigentlichen Abgashauptstrom eingespeist und loest dort selektive chemsiche Reaktionen aus, die zum Abbau der Schadstoffe fuehren. Ziel der Arbeiten war es das Potential des Verfahrens fuer den mobilen Einsatz zu untersuchen. Es wurde ein Magnetron der Frequenz von 2,45 Ghz eingesetzt. Die elektrodenlose Erzeugung und der Dauerbetrieb des Plasmas bei Atmosphaerendruck mit anschliessender Expansion in ein synthetisch gemischtes 'Abgas' ist realisiert. In Gasgemischen aus N_2/NO wurden mit einem N_2-Plasmajet 95% NO-Minderung erzielt. In Gemischen mit einem Sauerstoffanteil von 0%-10% wurden so zwischen 95% und ca. 40% NO-Minderung nachgewiesen, wobei das NO selektiv zu N_2 und O_2 reduziert wird. Die fuer diese Experimente entwickelte Laboranlage wurde fuer Versuche mit H_2O und Kohlenwasserstoffen ausgebaut. Erste Experimente mit Kohlenwasserstoffen zeigen auch fuer diese Komponente in Gegenwart von H_2O Abbauraten von einigen 10%. Die weitere Untersuchung des Verfahrens wird angesichts der vorliegenden Ergebnisse als aussichtsreich bewertet. Der Uebergang auf reale Abgase ist nunmehr wichtig. (orig.)SIGLEAvailable from TIB Hannover: F98B985+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population

The purpose of this study was to examine differences in risk factors associated with hepatocellular carcinoma (HCC) among White and African Americans from low socioeconomic backgrounds in the Southern Community Cohort Study (SCCS). The SCCS is a prospective cohort study with participants from the southeastern US. HCC incidence rates were calculated. Multivariable Cox regression was used to calculate HCC-adjusted hazard ratios (aHR) associated with known baseline HCC risk factors for White and African Americans, separately. There were 294 incident HCC. The incidence rate ratio for HCC was higher (IRR = 1.4, 95%CI: 1.1–1.9) in African Americans compared to White Americans. White Americans saw a stronger association between self-reported hepatitis C virus (aHR = 19.24, 95%CI: 10.58–35.00) and diabetes (aHR = 3.55, 95%CI: 1.96–6.43) for the development of HCC compared to African Americans (aHR = 7.73, 95%CI: 5.71–10.47 and aHR = 1.48, 95%CI: 1.06–2.06, respectively) even though the prevalence of these risk factors was similar between races. Smoking (aHR = 2.91, 95%CI: 1.87–4.52) and heavy alcohol consumption (aHR = 1.59, 95%CI: 1.19–2.11) were significantly associated with HCC risk among African Americans only. In this large prospective cohort, we observed racial differences in HCC incidence and risk factors associated with HCC among White and African Americans

Laserdiagnostische und plasmatechnologische Grundlagen zur Verminderung von Emissionen und Kraftstoffverbrauch von DI-Verbrennungsmotoren. Teilvorhaben: Mikrowelleninduzierte Plasmen fuer die Reinigung motorischer Abgase Abschlussbericht

Exhaust gases of modern DI-combustion engines contain some percent of oxygen. Therefore, the application of common catalysts is not possible. The development of new technologies is important. The potential of a plasmachemical procedure for the aftertreatment of exhaust gases was investigated. By absorption of microwave energy a plasma was induced in N_2 and N_2/O_2 gas streams. This plasma was expanded through a nozzle and injected as a plasmajet into synthetic gas mixtures containing NO as pollutant. The amount of gas in the plasmajet was about 10% of the synthetic exhaust gas stream. The microwave source was a 2.45 GHz magnetron. This way we succeeded in producing plasmas at atmospheric pressure without electrodes and expanding them into the exhaust gas mixtures. The operating time during the experiments was not limited. The operation principle was demonstrated in previous experiments with N_2-plasmajets. NO-reduction rates up to nearly 100% were achieved. In automobiles pure nitrogen is not available. The use of air or exhaust gas itself are conceivable. Therefore, gas mixtures with low oxygen contents were used as plasma gases in experiments with synthetic exhaust gas mixtures. At low oxygen concentrations (up to 3%) reduction rates of 50% to 85% were achieved in oxygen containing exhaust gases. Engine test bench investigations were also carried out with pure nitrogen jets. Reduction rates of about 40% of NO_x and 60% CH_x were achieved. (orig.)Abgase von modernen DI-Verbrennungsmotoren koennen je nach Betriebspunkt Sauerstoff in Konzentrationen von 10% und mehr enthalten. Dies macht den Einsatz gaengiger Dreiwege - Katalysatoren unmoeglich. Die Erreichung zukuenftiger Abgasnormen ist ein bislang noch nicht zufriedenstellend geloestes Problem. Es wurde ein Verfahren untersucht, in dem ein mikrowelleninduziertes Plasma zur Schadstoffminderung in Abgasen eingesetzt werden soll. Dabei wird in einem Gasstrom aus Stickstoff, der bezogen auf den eigentlichen Abgashauptstrom relativ klein ist (10% und weniger), durch elektrodenlose Einkopplung von Mikrowellenstrahlung ein Plasma erzeugt. Dieses wird durch eine Duese als Plasmajet in das Abgas eingespeist und loest dort selektive chemische Reaktonen aus, die zum Abbau der Schadstoffe fuehren. Ziel der Arbeiten war es, das Potential des Verfahrens fuer den mobilen Einsatz im Fahrzeug zu untersuchen. In vorangegengenen Arbeiten war das Verfahrensprinzip mit reinem Stickstoff als Plasmagas mit NO-Abbauraten nahe 100% erfolgreich demonstriert worden, auch in sauerstoffhaltigen synthetischen Abgasgemischen wurde NO zu N_2 und O_2 reduziert. An Bord von Fahrzeugen steht unter heutigen Randbedingungen reiner Stickstoff zum Betrieb des Plasmas nicht zur Verfuegung, die Verwendung von Luft oder Abgas ist ohne Weiteres moeglich, sauerstoffabgereicherte Gemische theoretisch denkbar. Es wurden daher sauerstoffhaltige Gasmischungen im Plasma untersucht. Bei niedrigen Sauerstoffanteilen von einigen Prozent im Plasma wurden NO-Abbauraten zwischen 50% und 85% in synthetischen Abgasmischungen erzielt. Am Motorenpruefstand wurden mit reinen Stickstoffjets NO_x-Abbauraten um 40% und ein Abbau von Kohlenwasserstoffen um 60% erzielt. (orig.)SIGLEAvailable from TIB Hannover: F02B270+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung und Forschung, Berlin (Germany)DEGerman

Rauchgasreinigung zur simultanen Entfernung von SO_2 und NO_x durch Oxidation und Kondensation Abschlussbericht

With 16 refs., 5 tabs., 27 figs.SIGLEAvailable from TIB Hannover: FR 6169 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman