Plastic cannulae versus metal needle cannulation in haemodialysis: Results of an international survey from the nurse perspective

Background: In haemodialysis is key to successfully obtaining cannulation of the arteriovenous fistula (AVF). The literature agrees that cannulation, failing in the initial maturation period, can lead to delayed dialysis, haematoma, scarring, needle phobia and loss of confidence in the cannulator. The introduction of plastic cannulae for haemodialysis has changed cannulation practice positively, preventing frequent complications such as infiltration or trauma. Despite that, most countries have continued to use metal cannulation, in particular in Europe. This study investigates the common use of plastic cannulae versus metal needles for cannulation in dialysis units and explores the implications of focusing on the side effects of cannulation. Methods: The study is a cross-sectional survey. A questionnaire was created by a team of experts from the European Dialysis Transplant Nurse Association/European Renal Care Association (EDTNA/ERCA) to address the study's aims and sent online to nurse members. Results: Data collected suggested a strong resistance towards using plastic cannulae, with few respondents claiming to use these cannulas. Most of the respondents were female (74%), Europeans, working in nephrology for more than 10 years and most worked in the public sector. There was a strong correlation between the use of plastic cannulae and fewer adverse events in elbow located AVF and newly created or fragile AVF. Conclusions: The results are in line with the current literature. Possible resistance to the use of the plastic device includes the difference in cost between the two devices in favour of metal needles. However, it should be considered that the lower number of adverse events, in particular infiltration and haematoma caused by the metal needle, involves a considerable saving both in money and in terms of time and distress for the patient.

Rheumatic Diseases and Biosimilars: Evidence about Switch from Originators to Biosimilars in the Real Life

Biosimilars are broadly available for the treatment of several diseases including inflammatory arthritis. Thanks to biosimilars it has been possible to treat a greater number of rheumatic patients who previously were undertreated due to the high cost of originators, in several countries. There are a lot of data from double blind, randomized, controlled clinical trials, especially on TNF inhibitors (TNFi), concerning the maintenance of clinical efficacy after switching from originators to biosimilars; therefore, such a transition is increasingly encouraged both in the US and Europe mainly for economic reasons. However, despite the considerable saving, such shifts to biosimilar drugs are still being debated, principally over their ethical implications. Since the drugs are similar but not identical, the main issues are related to the possibility to compare the adverse events and/or the lack of efficacy and, to date, the variability in effectiveness for a single patient remains an unpredictable datum before effecting the switch. Despite encouraging data about the maintenance of efficacy and safety after the switch, there are many reports of discontinuation due both lack of efficacy or and adverse events. In this chapter we aim at showing the disease activity trend and the safety after the transition to TNF-i biosimilars in patients with rheumatic diseases in real life..

Word-Based Systolic Processor for Field Multiplication and Squaring Suitable for Cryptographic Processors in Resource-Constrained IoT Systems

Internet of things (IoT) technology provides practical solutions for a wide range of applications, including but not limited to, smart homes, smart cities, intelligent grid, intelligent transportation, and healthcare. Security and privacy issues in IoT are considered significant challenges that prohibit its utilization in most of these applications, especially relative to healthcare applications. Cryptographic protocols should be applied at the different layers of IoT framework, especially edge devices, to solve all security concerns. Finite-field arithmetic, particularly field multiplication and squaring, represents the core of most cryptographic protocols and their implementation primarily affects protocol performance. In this paper, we present a compact and combined two-dimensional word-based serial-in/serial-out systolic processor for field multiplication and squaring over GF(2m). The proposed structure features design flexibility to manage hardware utilization, execution time, and consumed energy. Application Specific Integrated Circuit (ASIC) Implementation results of the proposed word-serial design and the competitive ones at different embedded word-sizes show that the proposed structure realizes considerable saving in the area and consumed energy, up to 93.7% and 98.2%, respectively. The obtained results enable the implementation of restricted cryptographic primitives in resource-constrained IoT edge devices such as wearable and implantable medical devices, smart cards, and wireless sensor nodes.

Analysis of shear stress on marine piles using shear friction theory

The current research investigation is focused on estimating the theoretical capacity of a rehabilitated steel marine pile. The old steel pile can be rehabilitated by installing new concrete encasement (jacket). The new concrete jacket can be easily connected to the old steel pile using shear friction between old pile and new concrete jacket or additional mechanical or welded connection. The under-water welding process is a very expensive task and considerable saving can be realized by eliminating this process. A previous experimental investigation was conducted to evaluate the behaviour of the rehabilitated steel pile. The maximum load and the load-slip deformation data were recorded for all of the tested specimens. The test results indicated that the marine pile can be efficiently rehabilitated by installing a concrete jacket using shear friction principles or the bolted connection to avoid the expense of welding under-water. The theoretical study included the investigation of surface friction, shear friction mechanism and cohesion on the bond capacity. The effect of the bolted anchor on increasing the effective cross section of the rehabilitated pile is examined. After investigating the predicted values of various equations developed by various researchers, the shear friction mechanical model developed by CSA 1994 is recommended to be used as the most effective formula that can provide an accurate prediction for the rehabilitated pile capacity.

Analysis of shear stress on marine piles using shear friction theory

The current research investigation is focused on estimating the theoretical capacity of a rehabilitated steel marine pile. The old steel pile can be rehabilitated by installing new concrete encasement (jacket). The new concrete jacket can be easily connected to the old steel pile using shear friction between old pile and new concrete jacket or additional mechanical or welded connection. The under-water welding process is a very expensive task and considerable saving can be realized by eliminating this process. A previous experimental investigation was conducted to evaluate the behaviour of the rehabilitated steel pile. The maximum load and the load-slip deformation data were recorded for all of the tested specimens. The test results indicated that the marine pile can be efficiently rehabilitated by installing a concrete jacket using shear friction principles or the bolted connection to avoid the expense of welding under-water. The theoretical study included the investigation of surface friction, shear friction mechanism and cohesion on the bond capacity. The effect of the bolted anchor on increasing the effective cross section of the rehabilitated pile is examined. After investigating the predicted values of various equations developed by various researchers, the shear friction mechanical model developed by CSA 1994 is recommended to be used as the most effective formula that can provide an accurate prediction for the rehabilitated pile capacity.

Enhancement of Food Waste Management and Its Environmental Consequences

This paper assesses the potential environmental effects of the optimization of the kitchen waste management in Opole. The separate collection of kitchen waste is improved by distribution of separate collection kits consisting of an in-home bin and 10 L biodegradable bags. The surplus of collected kitchen waste is diverted from treatment in a mechanical-biological pretreatment (MBP) along with the residual waste to anaerobic digestion (AD) with the biowaste. This has positive effects on European and Polish goals, ambitions, and targets, such as (i) increasing the level of renewables in the primary energy supply, (ii) decreasing the level of greenhouse gas (GHG) emissions, (iii) increasing the level of preparation for reuse and recycling of municipal waste. The environmental effects of 1 ton additionally separately collected and treated kitchen waste are determined by using life cycle assessment. It was shown that in all selected impact categories (global warming potential, marine eutrophication potential, acidification potential, and ozone depletion potential) a clear environmental benefit can be achieved. These benefits are mainly caused by the avoided emissions of electricity and heat from the Polish production mix, which are substituted by energy generation from biogas combustion. Optimization of the waste management system by diversion of kitchen waste from mechanical-biological pretreatment to anaerobic digestion can lead to considerable saving of 448 kg CO2-eq/t of waste diverted. With an estimated optimization potential for the demonstration site of 40 kg/inh·year for the city of Opole, this would lead to 680,000 t CO2-eq savings per year for the whole of Poland. The sensitivity analysis showed that with a choice for cleaner energy sources the results would, albeit lower, show a significant savings potential.

Addressing the standardisation of internal standards and preservative used in human bio fluids for NMR analysis: a method optimization

Objectives A database comprising multivariate data in developing a model from nuclear magnetic resonance (NMR) analysis using human bio fluids are necessary to have reproducibility and reliability of the data. To achieve reproducibility of the data, standardised experiments, including internal standard and preservative used should be attained, especially for samples such as human bio fluids to hinder the variation among samples. The aim of the study was to optimise in commonly used human bio fluids (serum and urine) for a suitable internal standard and preservative used in extended storage samples for NMR analysis. Methods Serum and urine samples were collected from healthy human subjects. The experiment was divided into two parts, part one to evaluate 2,2,2,2-tetradeutero-4,4-dimethyl-4-silapentanoic acid (TSP) and 4,4-dimethyl-4-silapentane-1-ammonium trifluoroacetate (DSA) as the optimal internal standard for the serum and urine samples. The second part investigated the effects of preservatives in the serum and urine samples on extended storage. Results Overall, TSP and DSA are suitable to be used as an internal standard in human urine samples. However, DSA is a superior internal standard in serum samples for NMR analysis. For the effect of preservative, the results indicated that human serum and urine samples could be stored without addition of preservative in −80 °C, as no changes in NMR fingerprinting have been observed during storage in the absence or presence of the preservative. Conclusions The findings suggest the use of DSA and TSP as an internal standard in serum and urine samples, respectively. Storage of serum and urine samples without any addition of preservative for an extended period has no effect on the metabolites changes. By having a standardised method, it will offer a considerable saving in both operator and spectrometer time and most importantly produce reproducible and reliable data.

Addressing the standardisation of internal standards and preservative used in human bio fluids for NMR analysis: a method optimization

Objectives A database comprising multivariate data in developing a model from nuclear magnetic resonance (NMR) analysis using human bio fluids are necessary to have reproducibility and reliability of the data. To achieve reproducibility of the data, standardised experiments, including internal standard and preservative used should be attained, especially for samples such as human bio fluids to hinder the variation among samples. The aim of the study was to optimise in commonly used human bio fluids (serum and urine) for a suitable internal standard and preservative used in extended storage samples for NMR analysis. Methods Serum and urine samples were collected from healthy human subjects. The experiment was divided into two parts, part one to evaluate 2,2,2,2-tetradeutero-4,4-dimethyl-4-silapentanoic acid (TSP) and 4,4-dimethyl-4-silapentane-1-ammonium trifluoroacetate (DSA) as the optimal internal standard for the serum and urine samples. The second part investigated the effects of preservatives in the serum and urine samples on extended storage. Results Overall, TSP and DSA are suitable to be used as an internal standard in human urine samples. However, DSA is a superior internal standard in serum samples for NMR analysis. For the effect of preservative, the results indicated that human serum and urine samples could be stored without addition of preservative in −80 °C, as no changes in NMR fingerprinting have been observed during storage in the absence or presence of the preservative. Conclusions The findings suggest the use of DSA and TSP as an internal standard in serum and urine samples, respectively. Storage of serum and urine samples without any addition of preservative for an extended period has no effect on the metabolites changes. By having a standardised method, it will offer a considerable saving in both operator and spectrometer time and most importantly produce reproducible and reliable data.

Irrigation Scheduling through Drip/Surface Method: A Review on Growth, Yield, Nutrient Uptake and Water Productivity of Wheat

Water is one of the most essential natural resource, which is often costly and limiting input particularly in arid and Semi-arid. Since water is the life line for accruing desired yield levels, its time of application, method of application and quantity applied levels besides saving water. Further, there is a need for judicious use of water to reap the maximum benefit from this limiting resource. Off late, amongst irrigation methods, drip irrigation plays a vital role in economizing irrigation water, higher water use efficiency and enhancing crop yield in water scarce areas. Many research findings also confirm considerable saving in irrigation water through adoption of precise irrigation method like drip irrigation. The response of wheat to surface check basin and drip irrigation is reviewed.

On the Validity of Scaling Transient Conjugate Heat Transfer Characteristics

Accurate prediction of unsteady thermal loads is of paramount importance in several engineering disciplines and applications. Performing time-accurate unsteady conjugate heat transfer (CHT) simulations presents considerable challenges due to the markedly different time scales between the solid and fluid domains. Two methods have been recently proposed, aimed at addressing this issue: multiscale modeling (MSM) and equalized time-scales (ET). The former is based on the separation of the disparate short and long temporal scales of the solution and subsequent averaging of the flow/energy equations. In the latter, the equalization of the time scales is achieved through manipulation of the solid's thermal properties. Both methods are very appealing due to the possibility of being easily implemented on an existing solver. It becomes, thus, relevant to assess their performance and/or limitations. This paper work presents a comparative study of the two methods for the prediction of transient thermal load, first using a simplified case of a solid body with uniform temperature, then through the investigation of the prewarming phase of a steam turbine. Both methods are then compared against a reference baseline fully coupled (FC) CHT solution. The results show how the MSM allows greater accuracy and robustness with considerable saving in computational cost with respect to the baseline solution.