Investigation of Magnetic Pulse Deformation of Powder Parts

Current article covers basics of powder compaction by electromagnetic impulse field and research results of sintered Fe powder part deformation process. This work is a joint research carried out by Riga Technical University (Latvia) and the Westsächsische Hochschule Zwickau (Germany)

THE ACHIEVABILITY OF TARGET CONVECTION VOLUMES IN ON-LINE HEMODIAFILTRATION

Aim. To evaluate the achievability of recommended convection volumes in hemodiafiltration (HDF) and impeding factors. Materials and methods. In short interventional one-center study among 67 stable prevalent dialysis patients we succeeded in achieving convection volume of more than 24 l/session in 60 patients (90%). Results. Substitution volume rose in the whole group from 21.1 ± 1.6 to 23.8 ± 1.2 l/session (p < 0.01). 12 patients, who didn`t achieve target volume had similar age, duration of renal replacement therapy and ultrafiltration rate as those who did. They differed from 55 patients who achieved target volume by substitution volume at first session in evaluation period (22.2 ± 1.7 vs. 23.6 ± 1.5 liters, р = 0.004), by transmembrane pressure (170 ± 40 vs. 146 ± 24 mmHg, р = 0.009) and by session duration (248 ± 15 vs. 262 ± 17 min, р = 0.0017). Blood flow rate also differed at the start of the study between the achievers and non-achievers: 353 ± 21 vs. 339 ± 19 ml/min, р = 0.035. The pressure in venous segment was lower in the achievers (154 ± 25 vs. 176 ± 36, р = 0.02) as well as transmembrane pressure (144 ± 24 vs. 164 ± 36, р = 0.014) which has been rising session by session in nonachievers. In non-achievers the membrane surface area was lower: 1.75 ± 0.2 vs. 1.91 ± 0.2 m2 (p = 0.02). In the multiple binary logistic regression model the session duration and membrane surface area were positive factors while the transmembrane pressure was negative one. Session prolonged by 15 min was associated with increase in relative chance to achieve target volume by 39% (95% CI 5–82%; р = 0.02). The membrane surface area enlarged by 0.1 m2 was linked with increase of chance by 4.2% (95% CI 0.2–8.4%; р = 0.04). The transmembrane pressure increased by 10 mmHg was associated with decreased chance to achieve target volume by 17% (95% CI 0–70%; р = 0.05). Conclusion. To achieve convection volume of 24 l/session one needs to afford effective blood flow rate, to increase the session duration and membrane surface area, avoiding high transmembrane pressure; severe comorbidity can hamper achieving target volume. Accumulating data of different studies are rather divergent in conclusions with regard to required target volume and ways to ensure its achievability, so study continuation is mandatory

Hybrid Syntactic Foams of Metal - Fly Ash Cenosphere - Clay

This paper addresses an innovative composite material (CM)- syntactic foam prodecued out of metal powder (Fe), fly ash cenospheres (CS) and clay. Due to the low density of CS (were used as space holder, CS bulk density-0,38 g/cm3), the average density of these foams is about 2,6-2,9 g/cm3. It was found that CS undergoes phase transformation during thermal treatment at a temperature of 1200 C. Microstructural observations reveal a uniform distribution of CS and Fe particles in the composite. Compressive strength and friction coefficient of obtained Fe/CS CM are in the range between 149-344 MPa and 0,15-1,1, respectively. Dependence of compressive strength on firing temperature is demonstrated exhibiting the maximum at 344 MPa. Dependence of coefficient of friction on a material properties, obtained at different firing temperature exhibits the minimum value of 0,15 at the firing temperature of 1150 C. The obtained syntactic form was shown to be a candidate for wear resistant applications

Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey

OBJECTIVES: The Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide. SETTING: A cross-sectional global survey. PARTICIPANTS: Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included. PRIMARY OUTCOMES: Primary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries. RESULTS: 160 countries (covering 98% of the world's population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries. CONCLUSION: Significant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries

Increasing access to integrated ESKD care as part of universal health coverage

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide