Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice

Background: Macrocytic anaemia (MCV \xe2\x89\xa5 100 fL) is a relatively common finding in general practice. However, literature on the prevalence of the different causes in this population is limited. The prevalence of macrocytic anaemia and its underlying aetiology were analysed in a general practice population. The potential effect of the different aetiology on survival was also evaluated. Methods: Between the 1st of February 2007 and the 1st of February 2015, patients aged 50 years or older and presenting to their general practitioner with a newly diagnosed anaemia, were included in the study. Anaemia was defined as haemoglobin level below 13.7 g/dL in men and below 12.1 g/dL in women. A broad range of laboratory tests was performed for each patient. The causes of anaemia were consequently determined by two independent observers based on the laboratory results. Results: Of the 3324 included patients, 249 (7.5 %) displayed a macrocytic anaemia and were subsequently analysed. An underlying explanation could be established in 204 patients (81.9 %) with 27 patients (13.2 %) displaying multiple causes. Classic aetiology (i.e. alcohol abuse, vitamin B12/folic acid deficiency, haemolysis and possible bone marrow disease) was found in 115 patients. Alternative causes (i.e. anaemia of chronic disease, iron deficiency, renal anaemia and other causes) were encountered in 101 patients. In addition, a notable finding was the median gamma GT of 277 U/L in patients diagnosed with alcohol abuse (N = 24, IQR 118.0-925.5) and 23 U/L in the remaining cohort (N = 138, IQR 14.0-61.0). The distribution of gamma GT values was statistically different (P < 0.001). Five year survival rates were determined for six categories of causes, ranging from 39.9 % (95 % CI 12.9-66.9) for renal anaemia to 76.2 % (95 % CI 49.4-103.0) for the category multiple causes. Conclusion: In addition to classic explanations for macrocytosis, alternative causes are frequently encountered in patients with macrocytic anaemia in general practice

Electronic and thermal sequential transport in metallic and superconducting two-junction arrays

The description of transport phenomena in devices consisting of arrays of tunnel junctions, and the experimental confirmation of these predictions is one of the great successes of mesoscopic physics. The aim of this paper is to give a self-consistent review of sequential transport processes in such devices, based on the so-called "orthodox" model. We calculate numerically the current-voltage (I-V) curves, the conductance versus bias voltage (G-V) curves, and the associated thermal transport in symmetric and asymmetric two-junction arrays such as Coulomb-blockade thermometers (CBTs), superconducting-insulator-normal-insulator-superconducting (SINIS) structures, and superconducting single-electron transistors (SETs). We investigate the behavior of these systems at the singularity-matching bias points, the dependence of microrefrigeration effects on the charging energy of the island, and the effect of a finite superconducting gap on Coulomb-blockade thermometry.Comment: 23 pages, 12 figures; Berlin (ISBN: 978-3-642-12069-5

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: A retrospective cohort study

Objectives To describe all iron deficiency anaemia (IDA)-related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival. Design and setting Retrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands. Participants Men and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously). Method From February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was u

СумДУ на сторінках преси : поточний інформаційний список, липень-серпень 2018 р.

Поточний інформаційний список містить перелік статей про Сумський державний університет з періодичних видань, які надійшли до бібліотеки за липень-серпень

Dynamic process management for engineering environments

The research presented in this paper proposes a concept for dynamic process management as part of an integrated approach to engineering process support. The theory of information management is the starting point for the development of a process management system based on evolution of information content. The use of an ontology enables the formalization of information content. Based on this ontology, transition relations and task definitions can be instantiated. A methodology for the generation of task networks is presented. From these networks, process models can be derived in the form of task chains

Workflow management based on Information Management

In manufacturing processes, the role of the underlying information is of the utmost importance. Based on three different types of integration (function, information and control), as well as the theory of information management and the accompanying information structures, the entire product creation process can be formulated in terms of the information requirements of distinct processes. So-called task chains can establish the correlation between processes. Using formal representations of the information content (ontologies), a flexible resolution of process-steps is achieved. Based on this, an improved method for workflow management comes within reach

Anterior Open-Bite Diagnosis And Treatment

BACKGROUND: The opening wedge approach to high tibial osteotomy (HTO) is perceived to have some advantages relative to the closing wedge approach but it may be associated with delayed and nonunions. Because nonunions evolve over months, it would be advantageous to be able to identify risk factors for and early predictors of nonunion after medial opening wedge HTO. QUESTIONS/PURPOSES: We sought to determine whether (1) preoperatively identifiable patient factors, including tobacco use, body mass index > 30 kg/m(2), and degree of correction, are associated with nonunion, and (2) a modified Radiographic Union Score for Tibial Fractures (RUST) score, taken at 6 weeks and 3 months, would be predictive for delayed or nonunion after medial opening wedge HTO. METHODS: The medical records and radiographs of 185 patients, 21 bilateral cases, treated with a medial open wedge HTO using the TomoFix((R)) device were retrospectively evaluated. For all patients, demographic data regarding risk factors were collected from their records. Diagnosis for delayed or nonunion was already done earlier for standard medical care by the orthopaedic surgeon based on clinical and radiographic grounds. For the retrospective radiographic evaluation, a modified RUST score was used in which each tibial cortex is scored by one observer. Logistic regression analysis was used to identify preoperative and postoperative predictive factors for developing delayed or nonunion. In the series, a total of 19 patients (9.2%) developed clinically delayed/nonunion of whom 10 patients (4.9%) developed a nonunion. RESULTS: Smoking was identified as a risk factor for developing delayed/nonunion (19% for smokers versus 5.4% for nonsmokers; p = 0.005; odds ratio, 4.1; 95% confidence interval, 1.5-10.7). By contrast, body mass index, lateral cortical hinge fracture, age, infection, and degree of correction were not risk factors. Patients with delayed/nonunion had lower RUST scores at all time points when a radiograph was taken compared with the total study group. CONCLUSIONS: The RUST score at 6 weeks and 3 months after surgery and the use of tobacco were identified as predictive factors for development of delayed union and nonunion after open wedge HTO. Based on these results, we now actively try to stop patients from smoking and these data are helpful in doing that. The RUST score may be of use to identify which patients are at risk for developing a delayed union so that interventions may be offered earlier in the course of care. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Smart energy facade for building comfort to optimize interaction with the smart grid

An Intelligent Electrical Energy supply Grid, a Smart Grid, is being developed to cope with fluctuations in energy generation from the different renewable energy sources. Energy demand and energy need to be better balanced to achieve improved overall efficiency. The process control of the energy flows in the buildings in relation to the outside environment and the user behavior also needs to become smart, intelligent and capable of adaptation to changing conditions. Otherwise you get the combination of a smart infrastructure but a dumb client, which is not good for the business of the client. Especially is it of great importance to take in account the goal of the energy use: human comfort. There is need for dynamic individual local comfort control instead of only process control at room level. Especially with these new process control possibilities, the interaction becomes essential of the outdoor active and passive energy processes with indoor through the façade. The façade is as such passive and active energy source on the one hand and a critical factor in relation to the perceived thermal comfort. The façade can be seen as an energy interface that should be optimized to perceived comfort of the occupants and their energy consumption