The Canadian Mobile Servicing System for Space Station Servicing

The Mobile Servicing System (MSS) concept is being developed as the Canadian contribution to the Space Station Program. The MSS is a major element of the servicing architecture in the Space Station Program and complements the role of U.S. developed Servicing Facility on the Station. This paper describes the servicing functions performed by MSS. These functions include servicing of attached payloads as well as assembly and maintenance of the Station. Robotic servicing requirements have also been addressed. The architecture and concepts of MSS and its constituent systems are described

Severe Hypercalcemia and Acute Renal Failure: An Unusual Presentation of Sarcoidosis

Although hypercalcemia is a known metabolic complication of sarcoidosis, it is rarely a presenting manifestation. Long-standing hypercalcemia and hypercalciuria can cause nephrocalcinosis and chronic renal failure. Acute renal failure, although described, is also a rare presentation of patients with sarcoidosis. We describe two patients with sarcoidosis, who presented with severe hypercalcemia and worsening renal function. Parathyroid hormone levels were appropriately suppressed. This led to an extensive search for the cause of hypercalcemia. Finally, after a lymph node biopsy in both cases, a diagnosis of sarcoidosis was established, hypercalcemia resolved, and renal function improved in both cases after administration of prednisone

Comparison of the Adherence to the American Diabetes Association Guidelines of Diabetes Care in Primary Care and Subspecialty Clinics

Abstract Background Diabetes mellitus is a major public health problem with significant morbidity and mortality. Evidence based guidelines have been proposed to reduce the micro and macrovascular complications, but studies have shown that these goals are not being met. We sought to compare the adherence to the American Diabetes Association guidelines for measurement and control of glycohemoglobin (A1c), blood pressure (BP), lipids (LDL) and microalbuminuria (MA) by subspecialty and primary care clinics in an academic medical center. Methods 390 random charts of patients with diabetes from Family Practice (FP), Internal Medicine (IM) and Diabetes (DM) clinics at Michigan State University were reviewed. Results We reviewed 131, 134 and 125 charts from the FP, IM and DM clinics, respectively. DM clinic had a higher percentage of patients with type 1 diabetes 43/125 (34.4%) compared with 7/131 (5.3%) in FP and 7/134 (5.2%) in IM clinics. A1c was measured in 99%, 97.8% and 100% subjects in FP, IM and DM clinics respectively. B.P. was measured in all subjects in all three clinics. Lipids were checked in 97.7%, 95.5% and 92% patients in FP, IM and DM clinics respectively. MA was measured at least once during the year preceding the office visit in 85.5%, 82.8% and 76.8% patients in FP, IM and DM clinics respectively. A1C was controlled (<7%) in 38.9, 43.3, 28.8% of patients in the FP, IM and DM clinics, respectively (p = 0.034). LDL was controlled (<100 mg/dl or 2.586 mmol/l) in 71.8, 64.9, 64% of patients in the FP, IM and DM clinics, respectively. MA was controlled (<30 mg/gm creatinine) in 60.3%, 51.5% and 60% patients in FP, IM and DM clinics respectively (P = 0.032). BP was controlled (<130/80) in 59.5, 67.2 and 52.8% patients in the FP, IM and DM clinics, respectively. Conclusion Testing rates for A1C, LDL, and MA were high, in both subspecialty and primary care clinics. However, the degree of control was not optimal. Significantly fewer patients in the DM clinic had A1c <7%, the cause of which may be multifactorial.http://deepblue.lib.umich.edu/bitstream/2027.42/111055/1/40200_2015_Article_158.pd

How do hospital professionals involved in a randomised controlled trial perceive the value of genotyping vs. PCR-ribotyping for control of hospital acquired C. difficile infections?

Background: Despite scientific advances in typing of C. difficile strains very little is known about how hospital staff use typing results during periods of increased incidence (PIIs). This qualitative study, undertaken alongside a randomised controlled trial (RCT), explored this issue. The trial compared ribotyping versus more rapid genotyping (MLVA or multilocus variable repeat analysis) and found no significant difference in post 48 hour cases (C difficile transmissions). Methods: In-depth qualitative interviews with senior staff in 11/16 hospital trusts in the trial (5 MLVA and 6 Ribotyping). Semi-structured interviews were conducted at end of the trial period. Transcripts were content analysed using framework analysis supported by NVivo-8 software. Common sub-themes were extracted by two researchers independently. These were compared and organised into over-arching categories or ‘super-ordinate themes’. Results: The trial recorded that 45% of typing tests had some impact on infection control (IC) activities. Interviews indicated that tests had little impact on initial IC decisions. These were driven by hospital protocols and automatically triggered when a PII was identified. To influence decision-making, a laboratory turnaround time < 3 days (ideally 24 hours) was suggested; MLVA turnaround time was 5.3 days. Typing results were predominantly used to modify initiated IC activities such as ward cleaning, audits of practice or staff training; major decisions (e.g. ward closure) were unaffected. Organisational factors could limit utilisation of MLVA results. Results were twice as likely to be reported as ‘aiding management’ (indirect benefit) than impacting on IC activities (direct effect). Some interviewees considered test results provided reassurance about earlier IC decisions; others identified secondary benefits on organisational culture. An underlying benefit of improved discrimination provided by MLVA typing was the ability to explore epidemiology associated with CDI cases in a hospital more thoroughly. Conclusions: Ribotyping and MLVA are both valued by users. MLVA had little additional direct impact on initial infection control decisions. This would require reduced turnaround time. The major impact is adjustments to earlier IC measures and retrospective reassurance. For this, turnaround time is less important than discriminatory power. The potential remains for wider use of genotyping to examine transmission routes

Cost estimation of establishing a veterinary clinic in the Republic of Croatia

Veterinarska klinika tip je veterinarske organizacije koja klijentima i njihovim životinjama nudi široku paletu usluga na vrlo visokoj razini. U planiranju osnivanja veterinarske klinike treba voditi računa ne samo o našim željama i mogućnostima nego i o uvjetima propisanima Zakonom o veterinarstvu i Pravilnikom o uvjetima kojima moraju udovoljavati veterinarske organizacije, veterinarska praksa i veterinarska služba u sustavu provedbe veterinarske djelatnosti, koji izravno utječu na troškove osnivanja klinke. Minimalna je preporučena veličina veterinarske klinike 186 m2 (93 m2 po jednoj prostoriji za pregled i liječenje životinja, a prema Pravilniku u klinici moraju postojati dvije). U skladu s tim trošak mjesečnog najma prostora procijenjen je na 16.740 HRK (2.232 €), trošak adaptacije prostora na 158.100 HRK (21.080 €), trošak opremanja prostora na 2.704.299 HRK (360.573 €), trošak zaliha medicinskog materijala i lijekova na 30.000 HRK (4.000 €), trošak bruto mjesečnih plaća veterinarskih djelatnika na 41.157 HRK (5.488 €), trošak marketinga na 6.750 HRK (900 €), trošak računalne opreme i programa na 40.000 HRK (5.333 €) te trošak osnivanja poduzeća i knjigovodstvenih usluga na 5.000 HRK (667 €). Ukupni prosječni trošak osnivanja veterinarske klinike procijenjen je na oko 3.000.000 HRK (400.000 €). Razlike između prosječnih i minimalnih troškova najveće su kod stavke Trošak opremanja prostora, gdje bi potencijalni investitori pažljivim odabirom mogli ostvariti uštedu do čak 55 % od ukupnog troška osnivanja. S druge strane, procijenjeni Trošak adaptacije prostora bi, ovisno o zatečenom stanju uređenja odabranog prostora, mogao biti i veći od navedenoga, što bi u manjoj mjeri moglo smanjiti uštede ostvarene smanjenjem troškova opremanja prostora. Procijenjeni mjesečni trošak klinike mogao bi se kretati između 60.000 i 90.000 HRK (između 8.000 i 12.000 €) (uvećan za troškove održavanja), ovisno o utrošku zaliha materijala i lijekova, a uključivao bi trošak najma, trošak održavanja zaliha materijala i lijekova, trošak plaća i trošak knjigovodstvenih usluga.A veterinary clinic is a type of veterinary organization that offers clients and their animals a wide range of services at a very high level. During the planning of the future veterinary clinic, we must take into account not only our wishes and possibilities, but also the conditions prescribed by the Veterinary Law and the Ordinance on the conditions that veterinary organizations, veterinary practices and veterinary service must meet in the system of implementation of veterinary activities, which directly affect the clinic establishment costs. The assumed minimum recommended size of a veterinary clinic is 186 m2 (93 m2 per one room for examination and treatment of animals, and according to the Ordinance there must be two in the clinic). In accordance with this, the cost of monthly rent of the space is estimated at HRK 16,740 (€2,232), the cost of adapting the space at HRK 158,100 (€21,080), the cost of equipping the space at HRK 2,704,299 (€360,573), the cost of medical supplies and medicines at 30,000 HRK (€4,000), the cost of gross monthly salaries of veterinary workers at HRK 41,157 (€5,488), marketing costs at HRK 6,750 (€900), the cost of computer equipment and software at HRK 40,000 (€5,333), and the cost of establishing a company and accounting services at HRK 5,000 (€667). The total average cost of establishing a veterinary clinic is estimated at around HRK 3 million (€400 thousand). The differences between the average and minimum costs are the largest in the item Equipment cost, where, by careful selection, potential investors could achieve savings of up to 55% of the Total establishment cost. On the other hand, the estimated Adaptation cost could, depending on the condition of the selected property, be higher than the above, which could, to a lesser extent, reduce the savings achieved by reducing the Equipment cost. The estimated monthly operating cost of the clinic could be between 60 and 90 thousand HRK (between 8 and 12 thousand €) (increased for maintenance costs) depending on the consumption of supplies of materials and medicines, and would include the cost of rent, the cost of maintaining supplies of materials and medicines, the cost of salaries and the cost of bookkeeping services

A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS)

<p>Abstract</p> <p>Background</p> <p>MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients.</p> <p>Methods/Design</p> <p>The study is a prospective two-period cross-over study set in 7 surgical wards covering different surgical specialities. A total of 10,000 patients > 18 years will be tested over 16 months. The only difference between the two study periods is the method used for the detection of MRSA in each ward (rapid v conventional culture), with all other infection control practices remaining consistent between the arms. The study has been designed to complement routine practice in the NHS. Outcomes are MRSA cross-infection rates (primary outcome) and need for antibiotic therapy and MRSA-related morbidity. Parallel economic and modelling studies are being conducted to aid in the interpretation of the results and to evaluate the cost-effectiveness of the rapid PCR screening strategy.</p> <p>Discussion</p> <p>This paper highlights the design, methods and operational aspects of a study evaluating rapid MRSA screening in the surgical ward setting.</p

A Multirate MAC Protocol for Reliable Multicast in Multihop Wireless Networks

Many multicast applications, such as audio/video streaming, file sharing or emergency reporting, are becoming quite common in wireless mobile environment, through the widespread deployment of 802.11-based wirelessnetworks. However, despite the growing interest in the above applications, the current IEEE 802.11 standard does not offer any medium access control (MAC) layer support to the efficient and reliable provision of multicast services. It does not provide any MAC-layer recovery mechanism for unsuccessful multicast transmissions. Consequently, lost frames cannot be detected, hence retransmitted, causing a significant quality of service degradation. In addition, 802.11 multicast traffic is sent at the basic data rate, often resulting in severe throughput reduction. In this work, we address these issues by presenting areliablemulticastMACprotocol for wirelessmultihopnetworks, which is coupled with a lightweight rate adaptation scheme. Simulation results show that our schemes provide high packet delivery ratio and when compared with other state-of-the-art solutions, they also provide reduced control overhead and data delivery dela

Autosufficienza nella produzione di carni suine nella Repubblica di Croazia

U novonastaloj gospodarskoj situaciji koja je proizašla iz ekonomskih učinaka pandemije bolesti COVID 19 i rata u Ukrajini te svjetske gospodarske krize od 2008. godine, samodostatnost nacionalnih gospodarstava u proizvodnji hrane postaje vrlo važna tema. Obzirom na izrazitu nestabilnost međunarodnih lanaca opskrbe, proizvodnja hrane postaje, osim ekonomskog, i važno političko pitanje. U strahu od moguće nove pandemije i eskalacije sukoba u Ukrajini vlade država u okruženju suočene su s izazovom brze prilagodbe s ciljem osiguranja prehrambene i energetske samodostatnosti, a time i društveno-političke stabilnosti svojih zemalja. Samodostatnost u proizvodnji svinjskog mesa samo je jedan dio prehrambene samodostatnosti koja bitno utječe na zaposlenost stanovništva te posredno i na ekonomski položaj pripadnika veterinarske struke koji sudjeluju u toj proizvodnji. Ukupna potrošnja svinjskog mesa u Republici Hrvatskoj (RH) bila je u razdoblju od 2012. do 2021. godine pokrivena domaćom proizvodnjom prosječno oko 65 %. To znači da je oko 35 % potrošene količine svinjskog mesa u RH porijeklom iz uvoza. Dostizanje samodostatnosti u proizvodnji svinjskog mesa u Hrvatskoj bilo bi moguće postići povećanjem svinjogojske proizvodnje za oko 50 %. Takvo povećanje predstavljalo bi značajan potencijal za zapošljavanje i mobilizaciju neiskorištenih prirodnih resursa te veliki izazov svim dionicima u proizvodnji i prodaji svinjskog mesa. Iskustva nekih EU zemalja poput Poljske i Mađarske pokazuju da je to moguće postići, a istraživanja sugeriraju da samodostatnost može stabilizirati domaću proizvodnju i zaštititi je od fluktuacija cijena na međunarodnom tržištu.In the newly emerging economic situation resulting from the economic effects of the COVID 19 pandemic, the war in Ukraine and the global economic crisis of 2008, the self-sufficiency of national economies in food production is becoming a very important issue. Given the enhanced instability of international supply chains, food production is becoming, in addition to economic, an important political issue. Fearing a possible new pandemic and escalating conflict in Ukraine, the governments of the surrounding countries face the challenge of rapid adjustment to ensure food and energy self-sufficiency and thus the socio-political stability of their countries. Self-sufficiency in pork production is only one part of the food self-sufficiency that significantly affects the employment of the population and indirectly the economic position of veterinary professionals involved in this production. The total consumption of pork in the Republic of Croatia in the period from 2012 to 2020 was covered by domestic production on average about 65%. This means that about 35% of pork consumed in Croatia came from imports. Achieving full self-sufficiency in pork production would mean that it would be necessary to increase pork production in Croatia by at least about 50%, which represents a significant potential for employment and mobilization of unused natural resources and a great challenge to all stakeholders in pork production and sales. The experience of some EU countries such as Poland and Hungary shows that this can be achieved and research suggests that self-sufficiency can stabilize domestic production and protect it from price fluctuations in the international market.In der neu entstandenen wirtschaftlichen Situation, die sich aus den wirtschaftlichen Auswirkungen der COVID 19-Pandemie, dem Krieg in der Ukraine und der globalen Wirtschaftskrise von 2008 ergibt, wird die Selbstversorgung der Volkswirtschaften mit Lebensmitteln zu einem sehr wichtigen Thema. Angesichts der zunehmenden Instabilität der internationalen Versorgungsketten wird die Nahrungsmittelproduktion nicht nur zu einem wirtschaftlichen, sondern auch zu einem wichtigen politischen Thema. Aus Angst vor einer möglichen neuen Pandemie und einem eskalierenden Konflikt in der Ukraine stehen die Regierungen der umliegenden Länder vor der Herausforderung einer raschen Anpassung, um die Selbstversorgung mit Nahrungsmitteln und Energie und damit die sozio-politische Stabilität ihrer Länder zu gewährleisten. Die Selbstversorgung mit Schweinefleisch ist nur ein Teil der Selbstversorgung mit Nahrungsmitteln, die sich in erheblichem Maße auf die Beschäftigung der Bevölkerung und indirekt auch auf die wirtschaftliche Lage der mit dieser Produktion befassten Veterinärmediziner auswirkt. Der Gesamtverbrauch von Schweinefleisch in der Republik Kroatien wurde im Zeitraum von 2012 bis 2020 zu durchschnittlich 65 % durch die heimische Produktion gedeckt. Das bedeutet, dass etwa 35 % des in Kroatien verbrauchten Schweinefleischs aus Importen stammt. Um eine vollständige Selbstversorgung mit Schweinefleisch zu erreichen, müsste die Schweinefleischproduktion in Kroatien um mindestens 50 % gesteigert werden, was ein erhebliches Potenzial für die Beschäftigung und die Mobilisierung ungenutzter natürlicher Ressourcen darstellt und eine große Herausforderung für alle an der Schweinefleischproduktion und -vermarktung Beteiligten ist. Die Erfahrungen einiger EU-Länder wie Polen und Ungarn zeigen, dass dies möglich ist, und Untersuchungen legen nahe, dass die Selbstversorgung die heimische Produktion stabilisieren und vor Preisschwankungen auf dem internationalen Markt schützen kann.En la situación económica emergente resultante de los efectos económicos de la pandemia de COVID 19, la guerra en Ucrania y la crisis económica mundial desde 2008, la autosuficiencia de las economías nacionales en la producción de alimentos se está convirtiendo en un tema muy importante. Dada la mayor inestabilidad de las cadenas de suministro internacionales, la producción de alimentos se está convirtiendo, además de económica, en un tema político importante. Ante el temor de una posible nueva pandemia y la escalada del conflicto en Ucrania, los gobiernos de los países vecinos se enfrentan al reto de un ajuste rápido para garantizar la autosuficiencia alimentaria y energética y, por tanto, la estabilidad sociopolítica de sus países. La autosuficiencia en la producción de carne de cerdo es solo una parte de la autosuficiencia alimentaria que afecta significativamente el empleo de la población e indirectamente la posición económica de los profesionales veterinarios involucrados en esta producción. El consumo total de carne de cerdo en la República de Croacia en el período de 2012 a 2020 estuvo cubierto por la producción nacional en un promedio de alrededor del 65 %. Esto significa que alrededor del 35% de la carne de cerdo consumida en Croacia provino de importaciones. Para alcanzar la autosuficiencia total en la producción de carne de cerdo sería necesario aumentar la producción de carne de cerdo en Croacia por al menos un 50%, lo que representa un potencial significativo para el empleo y la movilización de recursos naturales no utilizados y un gran desafío para todas las partes interesadas en la producción y la venta de carne de cerdo. La experiencia de algunos países de la UE, como Polonia y Hungría, muestra que esto se puede lograr y la investigación sugiere que la autosuficiencia puede estabilizar la producción nacional y protegerla de las fluctuaciones de precios en el mercado internacional.Nella nuova situazione economica derivante dagli effetti economici causati dalla pandemia da COVID 19, dalla guerra in Ucraina e dalla crisi economica globale del 2008, l’autosufficienza delle economie nazionali nella produzione alimentare è diventato un argomento molto importante. Data l’estrema instabilità delle filiere internazionali, la produzione alimentare è diventata un’importante questione non solo economica ma anche politica. Nel timore di una possibile nuova pandemia e dell’escalation del conflitto in Ucraina, i governi degli stati circostanti sono chiamati a confrontarsi con la sfida dell’adattamento rapido alle nuove circostanze, con l’obiettivo di garantire l’autosufficienza alimentare ed energetica e, quindi, la stabilità socio-politica del loro Paesi. L’autosufficienza nella produzione di carne suina è soltanto un aspetto dell’autosufficienza alimentare, che incide in modo significativo sull’occupazione della popolazione e, indirettamente, sulla posizione economica degli addetti alla professione veterinaria che partecipano a questa produzione. Il consumo totale di carne suina nella Repubblica di Croazia (RH) nel periodo dal 2012 al 2021 è stato coperto dalla produzione interna in media intorno al 65%. Ciò significa che circa il 35% della carne suina consumata nella Repubblica di Croazia nel periodo di riferimento è stata importata. L’obiettivo dell’autosufficienza nella produzione di carne suina in Croazia potrebbe essere raggiunto aumentando la produzione di carne suina di circa il 50%. Un tale aumento rappresenterebbe un potenziale significativo per l’occupazione e la mobilitazione delle risorse naturali inutilizzate e una grande sfida per tutte le parti coinvolte nella produzione e nella vendita di carni suine. Le esperienze di alcuni paesi appartenenti all’UE, come la Polonia e l’Ungheria, dimostrano che è possibile raggiungere questo obiettivo, mentre alcuni studi suggeriscono che l’autosufficienza può stabilizzare la produzione interna e proteggerla dalle fluttuazioni dei prezzi sul mercato internazional

Cost-effectiveness comparison between palpation- and ultrasound-guided thyroid fine-needle aspiration biopsies

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to perform a cost-effectiveness comparison between palpation-guided thyroid fine-needle aspiration biopsies (P-FNA) and ultrasound-guided thyroid FNA biopsies (USG-FNA).</p> <p>Methods</p> <p>Each nodule was considered as a case. Diagnostic steps were history and physical examination, TSH measurement, Tc^99mthyroid scintigraphy for nodules with a low TSH level, initial P-FNA versus initial USG-FNA, repeat USG-FNA for nodules with initial inadequate P-FNA or USG-FNA, hemithyroidectomy for inadequate repeat USG-FNA. American Thyroid Association thyroid nodule management guidelines were simulated in estimating the cost of P-FNA strategy. American Association of Clinical Endocrinologists guidelines were simulated for USG-FNA strategy. Total costs were estimated by adding the cost of each diagnostic step to reach a diagnosis for 100 nodules. Strategy cost was found by dividing the total cost to 100. Incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between strategy cost of USG-FNA and P-FNA to the difference between accuracy of USG-FNA and P-FNA. A positive ICER indicates more and a negative ICER indicates less expense to achieve one more additional accurate diagnosis of thyroid cancer for USG-FNA.</p> <p>Results</p> <p>Seventy-eight P-FNAs and 190 USG-FNAs were performed between April 2003 and May 2008. There were no differences in age, gender, thyroid function, frequency of multinodular goiter, nodule location and diameter (median nodule diameter: 18.4 mm in P-FNA and 17.0 mm in USG-FNA) between groups. Cytology results in P-FNA versus USG-FNA groups were as follows: benign 49% versus 62% (p = 0.04), inadequate 42% versus 29% (p = 0.03), malignant 3% (p = 1.00) and indeterminate 6% (p = 0.78) for both. Eleven nodules from P-FNA and 18 from USG-FNA group underwent surgery. The accuracy of P-FNA was 0.64 and USG-FNA 0.72. Unit cost of P-FNA was 148 Euros and USG-FNA 226 Euros. The cost of P-FNA strategy was 534 Euros and USG-FNA strategy 523 Euros. Strategy cost includes the expense of repeat USG-FNA for initial inadequate FNAs and surgery for repeat inadequate USG-FNAs. ICER was -138 Euros.</p> <p>Conclusion</p> <p>Universal application of USG-FNA for all thyroid nodules is cost-effective and saves 138 Euros per additional accurate diagnosis of benign versus malignant thyroid nodular disease.</p> <p>Trial registration</p> <p>ClinicalTrials.gov, NCT00571090</p