Prothrombin deficiency with recurrent subretinal hemorrhage.

Ocular hemorrhage has been recorded in congenital factor deficiencies like hemophilia A, but it has never been documented in prothrombin deficiency. Here, we describe an unusual case of sudden vision loss in the right eye caused by subretinal hemorrhage following a coughing episode in a 67-year-old woman. Notably, the patient underwent left eye enucleation 12 years previously under similar circumstances due to subretinal hemorrhage. During the interview, it was discovered that the patient had a history of prothrombin deficiency, which was subsequently confirmed through laboratory testing. Aside from recurrent ocular bleeding and 1 instance of bleeding following dental extraction in childhood, there is no other history of bleeding. Subsequent molecular studies revealed a homozygous missense mutation at G1499A (Arg500Gln), a variant previously identified as R457Q. Although the likelihood of prothrombin deficiency initiating subretinal hemorrhage is low, it is likely to worsen retinal hemorrhage and contribute to difficulty in controlling bleeding. A comprehensive coagulation workup is essential in patients with ocular hemorrhage. Determining factor II activity should be included in individuals exhibiting variably prolonged prothrombin time and activated partial thromboplastin time with correction in mixing studies. Additional investigations, such as genetic sequencing and family studies, are advised for those with isolated low prothrombin levels.

Engagement and partnership with consumers and communities in the co-design and conduct of Research: Lessons from the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial.

BACKGROUND: Engagement and partnership with consumers and communities throughout research processes produces high quality research meeting community needs and promoting translation of research into improved policy and practice. Partnership is critical in research involving Aboriginal and/or Torres Strait Islander people (First Nations Peoples) to ensure cultural safety. We present lessons from the design, implementation and progress of the National Health and Medical Research Council funded INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on hemodialysis (INFERR) clinical trial. MAIN BODY: The trial was designed to understand the benefits and harms of iron therapy in First Nations Australians on haemodialysis with anaemia and hyperferritinaemia. The lack of evidence for treatment was discussed with patients who were potential participants. A key element ensuring safe conduct of the INFERR trial was the establishment of the Indigenous Reference Groups (IRGs) comprising of dialysis patients based in the Top End of Australia and Central Australia. Two IRGs were needed based on advice from First Nations communities and researchers/academics on the project regarding local cultural differences and approaches to trial conduct. The IRGs underpin culturally safe trial conduct by providing input into study materials and translating study findings into effective messages and policies for First Nations dialysis patients. Throughout the trial conduct, the IRGs' role has developed to provide key mechanisms for advice and guidance regarding research conduct both in this study and more broadly. Support provided to the IRGs by trial First Nations Research Officers and independent First Nations researchers/academics who simplify research concepts is critical. The IRGs have developed feedback documents and processes to participants, stakeholders, and the renal units. They guarantee culturally safe advice for embedding findings from the trial into clinical practice guidelines ensuring evidence-based approaches in managing anaemia in haemodialysis patients with hyperferritinaemia. CONCLUSION: Active consumer and community partnership is critical in research conduct to ensure research impact. Strong partnership with consumers in the INFERR clinical trial has demonstrated that First Nations Consumers will engage in research they understand, that addresses health priorities for them and where they feel respected, listened to, and empowered to achieve change.

In this paper, we present the importance of actively involving consumers in the planning, implementation and conduct of research using the example of a clinical trial among Aboriginal and/or Torres Strait Australians (First Nations Australians) who have kidney disease and are currently receiving haemodialysis. The study assesses how safe and effective it is for people on dialysis to receive iron given through the vein during dialysis when they have anaemia and high levels of a blood test called ferritin, a test used routinely to measure iron levels. Two consumer reference groups of First Nations patients on dialysis, one based in the Top End of Australia and the other based in Central Australia, are supported by First Nations Research Officers and Research Academics to make sure that the research is performed in a way that involves, respects and values First Nations participation, culture, and knowledge. Active consumer and community partnership in this study has supported robust research governance processes which we believe are crucial for knowledge translation to have a positive impact for patients.

Fluoroscopically-assisted closed reduction and percutaneous fixation of sacroiliac luxations in cats using 2.4 mm headless cannulated compression screws: Description, evaluation and clinical outcome.

OBJECTIVE: To describe fluoroscopically-assisted closed reduction and percutaneous fixation of sacroiliac-luxation (SIL) in cats and report radiographic results and long-term functional outcomes. STUDY DESIGN: Retrospective clinical study. ANIMALS: Eleven cats. METHODS: Percutaneous fixation of 17 SILs in 11 cats was performed with 2.4 mm headless cannulated compression screws under fluoroscopic guidance. Luxation-reduction, screw placement and purchase within the sacral body, pelvic canal diameter ratio (PCDR) and hemipelvic canal width ratio (HCWR) were assessed on pre- and postoperative radiographs. Radiographic follow-up was performed to assess the same parameters when available. Long-term clinical outcome was evaluated with an owner questionnaire. Wilcoxon paired-test was performed for comparison. RESULTS: Mean age and bodyweight of the cats were 3.3 ± 2.6 years and 4.0 ± 0.82 kg, respectively. Nine cats presented with concurrent pelvic injuries. Median luxation-reduction was 94.1% (IQR = 13.9) and median screw-purchase within the sacral body was 73.3% (IQR = 17.0) immediately postoperatively. One screw exited the sacral body caudally. Upon 7-week radiographic follow-up, luxation-reduction (88.3%, IQR = 20.1) and screw-purchase (70.7%, IQR = 12.8) had decreased compared to immediately postoperatively (p = .008 and p = .013 respectively). Screw migration was not observed. PCDR and HCWR measured on postoperative radiographs indicated successful restoration of the pelvic canal width. Owners reported an excellent long-term functional outcome (mean postoperative time: 19 ± 5 months). CONCLUSION: Fluoroscopically-assisted closed reduction and fixation of feline SIL using 2.4 mm headless cannulated compression screws allowed good reduction and optimal screw purchase within the sacral body. An excellent functional outcome was reported. CLINICAL SIGNIFICANCE: Minimally invasive reduction and fixation with headless compression screws should be considered in cats with SIL.

Comparison of two ferritin assay platforms to assess their level of agreement in measuring serum and plasma ferritin levels in patients with chronic kidney disease.

BACKGROUND: Ferritin levels are used to make decisions on therapy of iron deficiency in patients with chronic kidney disease (CKD). Hyperferritinaemia, common among patients with CKD from the Northern Territory (NT) of Australia, makes use of ferritin levels as per clinical guidelines challenging. No gold standard assay exists for measuring ferritin levels. Significant variability between results from different assays creates challenges for clinical decision-making regarding iron therapy. In the NT, different laboratories use different methods. In 2018, Territory Pathology changed the assay from Abbott ARCHITECT i1000 (AA) to Ortho-Clinical Diagnostics Vitros 7600 (OCD). This was during the planning of the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial. The trial design was based on AA assay ferritin levels. We compared the two assays' level of agreement in measuring ferritin levels in CKD patients. METHODS: Samples from INFERR clinical trial participants were analysed. Other samples from patients whose testing were completed the same day on OCD analyzers and run within 24 h on AA analyzers were added to ensure wide range of ferritin levels, adding statistical strength to the comparison. Ferritin levels from both assays were compared using Pearson's correlation, Bland-Altman, Deming and Passing-Bablok regression analyses. Differences between sample types, plasma and serum were assessed. RESULTS: Sixty-eight and 111 (179) samples from different patients from Central Australia and Top End of Australia, respectively, were analyzed separately and in combination. The ferritin levels ranged from 3.1 µg/L to 3354 µg/L and 3 µg/L to 2170 µg/L for AA and OCD assays respectively. Using Bland-Altman, Deming and Passing-Bablok regression methods for comparison, ferritin results were consistently 36% to 44% higher with AA than OCD assays. The bias was up to 49%. AA ferritin results were the same in serum and plasma. However, OCD ferritin results were 5% higher in serum than plasma. CONCLUSIONS: When making clinical decisions, using ferritin results from the same assay in patients with CKD is critical. If the assay is changed, it is essential to assess agreement between results from the new and old assays. Further studies to harmonize ferritin assays are required.

A green method for the authentication of sugarcane spirit and prediction of density and alcohol content based on near infrared spectroscopy and chemometric tools.

Cachaça is a Brazilian beverage obtained from the fermentation of sugarcane juice (sugarcane spirit) and is considered one of the most consumed alcoholic beverages in the world with a strong economic impact on the northeastern Brazil, more specifically in the Brejo. This microregion produces sugarcane spirits with high quality associated to edaphoclimatic conditions. In this sense, analysis for sample authentication and quality control that uses solvent-free, environmentally friendly, rapid and non-destructive methods is advantageous for cachaça producers and production chain. Thus, in this work commercial cachaça samples using near-infrared spectroscopy (NIRS) were classified based on geographical origin using one-class classification Data-Driven in Soft Independent Modelling of Class Analogy (DD-SIMCA) and One-Class Partial Least Squares (OCPLS) and predicted quality parameters of alcohol content and density based on different chemometric algorithms. A total of 150 sugarcane spirits samples were purchased from the Brazilian retail market being 100 from Brejo and 50 from other regions of Brazil. The one-class chemometric classification model was obtained with DD-SIMCA using the Savitzky-Golay derivative with first derivative, 9-point window and 1st degree polynomial as preprocessing algorithm and sensibility was 96.70 % and specificity 100 % in the spectral range 7,290-11,726 cm-1. Satisfactory results were obtained in the model constructs for density and the chemometric model, iSPA-PLS algorithm with baseline offset as preprocessing, obtained root mean square errors of prediction (RMSEP) of 0.0011 mg/L and Relative Error of Prediction (REP) of 0.12 %. The chemometric model for alcohol content prediction used the iSPA-PLS algorithm with Savitzky-Golay derivative with first derivative, 9-point window and 1st degree polynomial as algorithm as preprocessing obtaining RMSEP and REP of 0.69 and 1.81 % (v/v), respectively. Both models used the spectral range from 7,290-11,726 cm-1. The results reflected the potential of vibrational spectroscopy coupled with chemometrics to build reliable models for identifying the geographical origin of cachaça samples for predicting quality parameters in cachaça samples.

Tea authentication and determination of chemical constituents using digital image-based fingerprint signatures and chemometrics.

Tea (Camellia sinensis) fraud has been frequently identified and involves tampering with the labelling of inferior products or without geographical origin certification and even mixing them with superior quality teas to mask an adulteration. Consequently, economic losses and health damage to consumers are observed. Thus, a Chemometrics-assisted Color Histogram-based Analytical System (CACHAS) was employed a simple, cost-effective, reliable, and green analytical tool to screen the quality of teas. Data-Driven Soft Independent Modeling of Class Analogy was used to authenticate their geographical origin and category simultaneously, recognizing correctly all Argentinean and Sri Lankan black teas and Argentinean green teas. For the determination of moisture, total polyphenols, and caffeine, Partial Least Squares obtained satisfactory predictive abilities, with values of root mean squared error of prediction (RMSEP) of 0.50, 0.788, and 0.25 mg kg-1, rpred of 0.81, 0.902, and 0.81, and relative error of prediction (REP) of 6.38, 9.031, and 14.58%., respectively. CACHAS proved to be a good alternative tool for environmentally-friendly non-destructive chemical analysis.

A video processing and machine vision-based automatic analyzer to determine sequentially total suspended and settleable solids in wastewater.

The monitoring of total suspended (TSS) and settleable (SetS) solids in wastewater is essential to maintain the quality parameters for aquatic biota because they can transport pollutants and block light penetration. Determining them by their respective reference methods, however, is laborious, expensive, and time consuming. To overcome this, we developed a new analytical instrument called Solids in Wastewater's Machine Vision-based Automatic Analyzer (SWAMVA), which is equiped with an automatic sampler and a software for real-time digital movie capture to quantify sequentially the TSS and SetS contents in wastewater samples. The machine vision algorithm (MVA) coupled with the Red color plane (derived from color histograms in the Red-Green-Blue (RGB) system) showed the best prediction results with R2 of 0.988 and 0.964, and relative error of prediction (REP) of 6.133 and 9.115% for TSS and SetS, respectively. The constructed models were validated by Analysis of Variance (ANOVA), and the accuracy and precision of the predictions by the t- and F-tests, respectively, at a 0.05 significance level. The elliptical joint confidence region (EJCR) test confirmed the accuracy, while the coefficient of variation (CV) of 6.529 and 10.908% confirmed the good precisions, respectively. Compared with the reference method (Standard Methods For the Examination of Water and Wastewater), the proposed method reduced the analysis volume from 1.5 L to just 15 mL and the analysis time from 12 h to 24 s per sample. Therefore, SWAMVA can be considered an important alternative to the determination of TSS and SetS in wastewater as an automatic, fast, and low-cost analytical tool, following the principles of Green Chemistry and exploiting Industry 4.0 features such as intelligent processing, miniaturization, and machine vision.

Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety.

BACKGROUND: MRI-guided laser interstitial thermal therapy (MRgLITT) is a promising alternative to open surgery for treatment of drug-resistant epilepsy, offering significant advantages over traditional approaches for candidate patients, including minimally invasive approach, shorter hospitalization, and decreased patient post-operative discomfort. LITT uses a stereotactically placed fiber optic laser probe to ablate tissue under real-time MR thermometry. METHODS: Retrospective chart review of intraoperative and perioperative characteristics was performed for 28 cases of MRgLITT in 25 pediatric patients, ages 4-21 years old, at our institution between 2019 and 2021. MRgLITT ablation of the mesial temporal lobe was performed in 8 cases, extratemporal epileptogenic foci in 9 cases, and for corpus callosotomy in 11 cases. RESULTS: At 1 year of follow-up, 53% of all patients experienced improvement in seizure frequency (Engel I or II) (class I: 38%, class II: 15%, class III: 17%, class IV: 31%), including 37% of MTL ablations and 80% extratemporal SOZ ablations. After MRgLITT corpus callosotomy, 71% of patients were free from atonic seizures at most recent follow-up. Median length of hospitalization was 2 days (1-3), including a median ICU stay of 1 day (1-2). CONCLUSION: This series demonstrates the safety of MRgLITT as an approach for seizure control in drug-resistant epilepsy. We provide additional evidence that MRgLITT is an effective procedure that is well-tolerated by pediatric patients and is accompanied by an acceptable rate of complications and relatively short hospital stay.

Nonreciprocal and Non-Hermitian Material Response Inspired by Semiconductor Transistors.

Here, inspired by the operation of conventional semiconductor transistors, we introduce a novel class of bulk materials with nonreciprocal and non-Hermitian electromagnetic response. Our analysis shows that material nonlinearities combined with a static electric bias may lead to a linearized permittivity tensor that lacks the Hermitian and transpose symmetries. Remarkably, the material can either dissipate or generate energy, depending on the relative phase of the electric field components. We introduce a simple design for an electromagnetic isolator based on an idealized "MOSFET-metamaterial" and show that its performance can in principle surpass conventional Faraday isolators due to the material gain. Furthermore, it is suggested that analogous material responses may be engineered in natural media in nonequilibrium situations. Our solution determines an entirely novel paradigm to break the electromagnetic reciprocity in a bulk nonlinear material using a static electric bias.

Feasibility study on quantification and authentication of the cassava starch content in wheat flour for bread-making using NIR spectroscopy and digital images.

This works proposed a feasibility study on NIR spectroscopy and chemometrics-assisted color histogram-based analytical systems (CACHAS) to determine and authenticate the cassava starch content in wheat flour. Prediction results of partial least squares (PLS) achieved coefficient of correlation (rpred) of 0.977 and root mean square error of prediction (RMSEP) of 1.826 mg kg-1 for the certified additive-free wheat flour, while rpred of 0.995 and RMSEP of 1.004 mg kg-1 were obtained for the commercial wheat flour containing chemical additives. Additionally, Data-Driven Soft Independent Modelling of Class Analogy (dd-SIMCA) presented similar predictive ability using NIR and CACHAS for the certified wheat flour, authenticating all target samples, besides correctly recognizing samples that could represent a fraud. No satisfactory results were obtained for the commercial wheat flour. Therefore, NIR spectroscopy is more useful to offer definitive quantitative and qualitative analysis, while CACHAS can only provide an alternative preliminary analysis.

Variable selection in the chemometric treatment of food data: A tutorial review.

Food analysis covers aspects of quality and detection of possible frauds to ensure the integrity of the food. The arsenal of analytical instruments available for food analysis is broad and allows the generation of a large volume of information per sample. But this instrumental information may not yet give the desired answer; it must be processed to provide a final answer for decision making. The possibility of discarding non-informative and/or redundant signals can lead to models of better accuracy, robustness, and chemical interpretability, in line with the principle of parsimony. Thus, in this tutorial review, we cover aspects of variable selection in food analysis, including definitions, theoretical aspects of variable selection, and case studies showing the advantages of variable selection-based models concerning the use of a wide range of non-informative and redundant instrumental information in the analysis of food matrices.

Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia.

BACKGROUND: Indigenous Australians are disproportionately affected by end stage kidney disease. Despite this, they face significant delays being assessed and waitlisted for kidney transplant. AIMS: To examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous Australians and non-Indigenous patients, and identify major sources of delay. METHODS: We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between-group differences were used to compare the time between commencement of dialysis and completion of each component of assessment. Patients who had more than 1 year between commencement of dialysis and waitlisting were further analysed for major sources of delay. RESULTS: Twenty-five patients were included (20 Indigenous Australians and 5 non-Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 vs 264 days, P = 0.032). Indigenous Australian patients waited longer before commencing the transplant assessment process and before completing dental assessment, tissue typing and review by the transplant nephrologist and surgeon. Five patients (two Indigenous Australians, three non-Indigenous) were waitlisted within 1 year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay. CONCLUSION: Indigenous Australian patients face significant delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve equity of access to kidney transplantation.

INFERR-Iron infusion in haemodialysis study: INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis-a protocol for a prospective open-label blinded endpoint randomised controlled trial.

BACKGROUND: The effectiveness of erythropoiesis-stimulating agents, which are the main stay of managing anaemia of chronic kidney disease (CKD), is largely dependent on adequate body iron stores. The iron stores are determined by the levels of serum ferritin concentration and transferrin saturation. These two surrogate markers of iron stores are used to guide iron replacement therapy. Most Aboriginal and/or Torres Islander Australians of the Northern Territory (herein respectfully referred to as First Nations Australians) with end-stage kidney disease have ferritin levels higher than current guideline recommendations for iron therapy. There is no clear evidence to guide safe and effective treatment with iron in these patients. We aim to assess the impact of intravenous iron treatment on all-cause death and hospitalisation with a principal diagnosis of all-cause infection in First Nations patients on haemodialysis with anaemia, high ferritin levels and low transferrin saturation METHODS: In a prospective open-label blinded endpoint randomised controlled trial, a total of 576 participants on maintenance haemodialysis with high ferritin (> 700 µg/L and ≤ 2000 µg/L) and low transferrin saturation (< 40%) from all the 7 renal units across the Northern Territory of Australia will be randomised 1:1 to receive intravenous iron polymaltose 400 mg once monthly (200 mg during 2 consecutive haemodialysis sessions) (Arm A) or no IV iron treatment (standard treatment) (Arm B). Rescue therapy will be administered when the ferritin levels fall below 700 µg/L or when clinically indicated. The primary outcome will be the differences between the two study arms in the risk of hospitalisation with all-cause infection or death. An economic analysis and several secondary and tertiary outcomes analyses will also be performed. DISCUSSION: The INFERR clinical trial will address significant uncertainty on the safety and efficacy of iron therapy in First Nations Australians with CKD with hyperferritinaemia and evidence of iron deficiency. This will hopefully lead to the development of evidence-based guidelines. It will also provide the opportunity to explore the causes of hyperferritinaemia in First Nations Australians from the Northern Territory. TRIAL REGISTRATION: This trial is registered with The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000705987 . Registered 29 June 2020.

Honey authentication in terms of its adulteration with sugar syrups using UV-Vis spectroscopy and one-class classifiers.

This work proposes the use of UV-Vis spectroscopy and one-class classifiers to authenticate honey in terms of their individual and simultaneous adulterations with corn syrup, agave syrup, and sugarcane molasses. Then, spectra of aqueous authentic (n = 73) and adulterated (n = 162) honey samples were recorded. Before the construction of OC-PLS and DD-SIMCA models, different pre-processing techniques were used to removed baseline shifts. The best result obtained by DD-SIMCA using offset correction, correctly classifying all the samples in the test set. Therefore, the proposed methodology can be used as a promising tool to authenticate honey and prevent fraudulent labeling, affording security to consumers and providing an alternative to regulatory agencies. Moreover, it avoids laborious sample preparation and additional operational costs, since the analytical information is acquired using a routine instrumental technique, without the need for any sample preparation step, other than dilution of the samples in water alone.

Are UX Evaluation Methods Providing the Same Big Picture?

The success of a software application is related to users' willingness to keep using it. In this sense, evaluating User eXperience (UX) became an important part of the software development process. Researchers have been carrying out studies by employing various methods to evaluate the UX of software products. Some studies reported varied and even contradictory results when applying different UX evaluation methods, making it difficult for practitioners to identify which results to rely upon. However, these works did not evaluate the developers' perspectives and their impacts on the decision process. Moreover, such studies focused on one-shot evaluations, which cannot assess whether the methods provide the same big picture of the experience (i.e., deteriorating, improving, or stable). This paper presents a longitudinal study in which 68 students evaluated the UX of an online judge system by employing AttrakDiff, UEQ, and Sentence Completion methods at three moments along a semester. This study reveals contrasting results between the methods, which affected developers' decisions and interpretations. With this work, we intend to draw the HCI community's attention to the contrast between different UX evaluation methods and the impact of their outcomes in the software development process.

Scores selection via Fisher's discriminant power in PCA-LDA to improve the classification of food data.

This paper proposes an adaptation of the Fisher's discriminability criterion (named here as discriminant power, DP) for choosing principal components (obtained from Principal Component Analysis, PCA), which will be used to construct supervised Linear Discriminant Analysis (LDA) models for solving classification problems of food data. The proposed PCA-DP-LDA algorithm was then applied to (i) simulated data, (ii) classify soybean oils with respect to expiration date, and (iii) identify cachaça adulteration with wood extracts that simulated aging. For comparison, PCA-DP-LDA was evaluated against conventional PCA-LDA (based on explained variance) and Partial Least Squares-Discriminant Analysis (PLS-DA). Among them, PCA-DP-LDA achieved the most parsimonious and interpretable results, with similar or better classification performance. Therefore, the new algorithm can be considered a good alternative to the already well-established discriminant methods, being potentially applied where the discriminability of the principal components may not follow the same behavior of the explained variance.

Non-destructive authentication of Gourmet ground roasted coffees using NIR spectroscopy and digital images.

The growing demand for excellent-quality coffees allied with their symbolic aestheticization that add value to the products favor the adulteration practices and consequently economic losses. So, this work proposes the suitability of NIR spectroscopy and Digital Images (from CACHAS) coupled with one-class classification methods for the non-destructive authentication of Gourmet ground roasted coffees. For this, Gourmet coffees (n = 44) were discriminated from Traditional (n = 36) and Superior (n = 10) by directly analyzing their powder without any sample preparation. Then, OC-PLS and dd-SIMCA were used to construct the models. dd-SIMCA using offset correction for NIR and RGB histogram for CACHAS achieved the best results, correctly recognizing all the 90 samples in both the training and test sets. Therefore, the proposed methodologies can be useful for both the consumers and regulatory agencies because it confirms the elevated standards of excellence of Brazilian specialty coffees, preventing fraudulent labeling, besides following the Principles of Green Analytical Chemistry.

The utility of routine head CT for hemorrhage surveillance in post-craniotomy patients undergoing anticoagulation for venous thromboembolism.

Anticoagulation for postoperative venous thromboembolism (VTE) may infer a higher risk of intracranial hemorrhage. We treat patients with VTE using slowly titrating intravenous heparin drip without bolus. When PTT is greater than 60 s, a head CT is obtained to monitor for the development of a intracranial hemorrhage before transition to oral anticoagulation. We evaluated the utility of routine surveillance head CT to monitor for intracranial hemorrhage during anticoagulation. This is a case series of neurosurgical patients in an academic quaternary hospital who developed a VTE after cranial procedures between 2007 and 2017. Over 11,000 patients were screened for the study. Patients' demographics data, surgical indication, PTT at the time of surveillance CT head, surveillance CT head findings, and patient's clinical course were reviewed. A total of 83 patients were included. Three patients (3.6%) developed a new subclinical hemorrhage on CT head imaging while on heparin drip. Interval CT head showed stable hemorrhage in all patients. Heparin drip was stopped in two patients and they both progressed from DVT to pulmonary embolism: one patient died due to cardiac arrest, the other patient was transitioned to oral anticoagulation. In the third patient heparin drip was continued uneventfully and transitioned to oral anticoagulation with no further clinical sequalae. Surveillance CT while on heparin drip for VTE management detected subclinical intracranial hemorrhage in a small subset of patients. Patients whose anticoagulation was stopped had progression of VTE. Undertreatment of VTE in the presence of subclinical hemorrhage may lead to significant morbidity and mortality.

Venturi: dispositivo de cavitação hidrodinâmica para acelerar a síntese de biodiesel / Venturi: hydrodynamic cavitation device to accelerate biodiesel synthesis

RESUMO O objetivo deste trabalho foi avaliar o potencial do Venturi para a síntese de biodiesel a partir de óleo comestível residual em rota metílica. Para tanto, foi construído em escala de laboratório um aparato experimental constituído de um tanque de 5,2 L e um dispositivo Venturi projetado para produzir o fenômeno de cavitação. A produção de biodiesel foi avaliada em três diferentes pressões de entrada do Venturi: 4,4; 2,9; e 1,4 bar. Os teores de ésteres metílicos foram determinados por cromatografia gasosa. O tempo de síntese de 5,2 L de biodiesel, com o Venturi, foi de 23,2 segundos (ou 4,5 segundos por litro de biodiesel produzido), o que equivale a um único ciclo de passagem pelo sistema a pressão máxima (4,4 bar). Nessa condição, o rendimento dos teores de ésteres foi superior a 98%. Não há na literatura outro caso de síntese tão rápida como a encontrada neste trabalho. A caracterização do biodiesel mostrou que os parâmetros viscosidade cinemática, índice de acidez, ponto de entupimento a frio e massa específica estão dentro dos limites estabelecidos pela Agência Nacional de Petróleo. A comparação com outros estudos da literatura mostrou que o Venturi é superior às placas de orifício na síntese de biodiesel.

Abstract The objective of this work was to evaluate the potential of Venturi in the synthesis of biodiesel from residual edible oil in a methyl route. For this purpose, an experimental apparatus consisting of a 5.2 L tank and a Venturi device designed to produce the cavitation phenomenon was constructed in laboratory scale. Biodiesel production was evaluated at three different Venturi inlet pressures: 4.4; 2.9; and 1.4 bar. Methyl esters contents were determined by gas chromatography. Biodiesel synthesis time with the Venturi device was 23.2 seconds (or 4.5 seconds per liter of biodiesel produced), which is equivalent to a single cycle of the system at maximum pressure (4.4 bar). In this condition, the yield of the ester contents was greater than 98%. There is no other case of synthesis as fast as that found in this work. The biodiesel characterization showed that the parameters kinematic viscosity, acidity index, cold clogging point, and specific mass are within the limits established by National Agency of Petroleum Natural Gas and Biofuels (Agência Nacional de Petróleo). The use of Venturi, as a cavitation device, was shown to be more efficient in biodiesel synthesis than other devices, such as orifice plates.

Barriers and challenges of returning patients back to community after renal transplantation in Central Australia.

BACKGROUND: The majority of patients living in remote communities of Central Australia must relocate to Alice Springs for their dialysis treatments. There is limited information available about the challenges and barriers that Aboriginal patients encounter in the process of returning back to their communities after renal transplantation. AIM: To determine the length of stay of patients in Alice Springs and challenges faced subsequent to renal transplantation, before they could safely return to their remote communities. METHODS: All transplant recipients from 2012 who are aged 18 years were analysed retrospectively. RESULTS: Thirty-six patients received renal transplantation from Central Australia. Of them, 25 were from very remote communities of whom 24 were Aboriginal. Average length of stay in Alice Springs post-transplantation prior to returning to community was 17.2 weeks (121 days). The most common challenge faced prior to returning to community was the need for monitoring and titration of immunosuppressive medication (100%) followed by infections (90%) and admissions to hospital (85%). The other common barrier was optimising glycaemic control (80%). Less common barriers included proficiency with self-monitoring of blood sugar levels (50%), social factors (40%), blood pressure control (25%), leukopenia (25%), safe housing (20%) and rejection episodes (15%). CONCLUSIONS: Multiple challenges are faced during post-transplantation period in Alice Springs that prolong the time before recipients from remote communities can return home. Some barriers such as titration of immunosuppression are inherent in the transplant journey. However, some factors might be modifiable prior to transplantation.