The gray area between operational tolerance and overt rejection in kidney transplantation

Operational tolerance in kidney transplantation is characterized by stable serum creatinine < 1.7 mg/dL and proteinuria < 1 g/day in the absence of immunosuppression or immunodeficiency for over one year. However, simultaneous donor specific antibodies are common and serum creatinine is a poor surrogate of early lesions. Consequently, subclinical rejections will meet operational tolerance criteria if serum creatinine remains stable. We report a patient with operational tolerance criteria followed by biopsy-proven chronic active antibody mediated rejection, discussing the intricate challenges of immunosuppression management.

PHASE METHODS OF GAS GENERATORS CONTROL HYDROGEN STORAGE AND SUPPLY SYSTEMS

Methods of control of technical condition of gas generators of systems of storage and supply of hydrogen based on use of their phase-frequency characteristics are considered. Methods of control of gas generators are divided into two groups depending on the mathematical models used to describe the operation of such gas generators. It is shown that when using as such a mathematical model the transfer function of the gas generator in the form of an inertial link, it is possible to implement control algorithms both by its phase-frequency characteristics and by its time constant. In the first case, the phase-frequency characteristic is measured at an a priori set frequency. In the second case, there is no such restriction. When using as a mathematical model of the gas generator the transfer function in the form of a fractional-rational function of the second order, the implementation of algorithms for its control can be carried out directly using the phase-frequency characteristics of the gas generator. With this implementation of algorithms for monitoring the technical condition of gas generators, the measurement of the values of their phase-frequency characteristics is carried out at several frequencies. This approach to the control of gas generators can increase the reliability of its results. All methods of monitoring the technical condition of gas generators of hydrogen storage and supply systems are focused on the use of tolerance criteria. The parameters of the tolerance criteria can be both the values of the time constants of gas generators of hydrogen storage and supply systems, and fixed values of the phase-frequency characteristics of such gas generators. In the latter case, control algorithms are implemented that cover the entire operating frequency range of gas generators.

A study on the effects and visibility of low-order aberrations on laser beams with orbital angular momentum

Laguerre–Gaussian-like laser beams have been proposed for driving experiments with high-intensity lasers. They carry orbital angular momentum and exhibit a ring-shaped intensity distribution in the far field which make them particularly attractive for various applications. We show experimentally and numerically that this donut-like shape is extremely sensitive to off-axis wavefront deformations. To support our claim, we generate a Laguerre–Gaussian-like laser beam and apply a selection of common low-order wavefront aberrations. We investigate the visibility of those wavefront deformations in the far field. Under use of established tolerance criteria, we determine the thresholds for the applied aberration and compare the findings with simulations for verification.

KERAGAMAN FENOTIPE DAN PRODUKTIVITAS LABU KUNING NUSANTARA (Cucurbita moschene Dutchene) DALAM RANGKA PENGEMBANGAN VARIETAS UNGGUL

The increase of population and the depletion of productive agricultural land causes the availability of rice as the staple food as carbohidrat becomes unbalanced. Efforts to reduce dependence on rice should be made, through the diversification of alternative food crops containing high carbohydrates. Pumpkin plants (waluh) is one of the crop that have high carbohydrate content and has many types. This research aims to collect various types of yellow squash varieties as the initial material in the assembling of superior varieties, and to identify vegetative character and agronomic character of yellow squash pumpkin varieties. The research was conducted in Randuagung Village, Lumajang Regency with height of 112 asl. The materials used in are local lumajang pumpkin seeds and local poor pumpkin. The results of this study indicate that the ratio of male flowers and female flowers on both varieties of local yellow squash showed the number of male flowers more than the number of female flowers. The beta-carotene content of local lumajang is lower than the local yellow squash is seen from the color of the pumpkin the yellow is getting faded and the taste is less sweet. The resistance to the disease of both varieties of local yellow squash indicates the tolerance criteria. The male juvenile blueberry male jungle flowers are faster than the local yellow squash lumajang, but the age of the local pumpkin flower lumajang is faster than the local yellow squash.The yellow local pumpum lumajang color is relatively the same that is brown, while the varieties of local yellow pumpkin there is a difference that is brown and green.

Opioid tolerance and urine drug testing among initiates of extended-release or long-acting opioids in Food and Drug Administration's Sentinel System

Objective: A risk evaluation and mitigation strategy for extended-release and long-acting (ER/LA) opioid analgesics was approved by the Food and Drug Administration in 2012. Our objective was to assess frequency of opioid tolerance and urine drug testing for individuals initiating ER/LA opioid analgesics.Design: Retrospective cohort study.Setting: Sentinel, a distributed database with electronic healthcare data on >190 million predominantly commercially insured members.Patients, participants: Members under age 65 initiating ER/LA opioid analgesics between January 2009 and December 2013.Main outcome measure(s): We examined the proportion of opioid-tolerantonly ER/LA opioid analgesic initiates meeting tolerance criteria: receipt of ≥30 mg oxycodone equivalents per day in 7 days prior to the first opioid-tolerant-only dispensing. We separately examined the proportion of new users of extended-release oxycodone (ERO) and other ER/LA opioid analgesics with a claim for a urine drug test in the 30 days prior to, and separately for the 183 days after, dispensing.Results: We identified 79,824 ERO, 7,343 extended-release hydromorphone, and 91,778 transdermal fentanyl opioid-tolerant-only episodes. Tolerance criteria were met in 64 percent of ERO, 64 percent of extended-release hydromorphone and 40 percent of transdermal fentanyl episodes. We identified 210,581 incident ERO and 311,660 other ER/LA opioid analgesic episodes. Use of urine drug testing for ERO compared with other ER/LA opioid analgesics was: 4 percent vs 14 percent respectively in the 30 days prior to initiation and 9 percent vs 23 percent respectively in the 183 days following initiation.Conclusions: These results suggest potential areas for improving appropriate ER/LA opioid analgesic prescribing practices.

Adding another dimension to plan evaluation: visualising the dose–volume histogram band in head and neck radiotherapy and exploring its utility

BackgroundTo introduce a method to generate a ‘dose–volume histogram (DVH) band’ for plan evaluation of photon therapy and explore its various potentials.Materials and methodsIntensity-modulated radiotherapy (IMRT) plans for head and neck cancer patients were analysed, retrospectively, for setup errors noted during treatment. From the maximum observed random errors, absolute displacement was calculated using Euclidian formula. The original plan with same beam parameters and leaf sequence were used to generate six plans with shifts applied in three axes in six directions. The DVH curves from these six plans were superimposed to form the DVH band. Plans were reviewed with set tolerance criteria.ResultsMethod to generate and visualise DVH band was developed. DVH bands were created for 20 patients with head and neck cancer who underwent treatment with IMRT. It was found that seven out these 20 plans were rejected as they crossed the set tolerance criteria using DVH band as an evaluation tool.ConclusionsDVH band in photon therapy can help the clinician visualise the impact of setup errors at planning and may help select the plan with lesser influence of setup errors over another.