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В статье представлены клинические результаты применения нового концептуального подхода и новых технологий, которые манифестируют определение свойств и возможностей поддержания биологической целостности организма в периоперационном периоде. Установлено, что применение энергопротективных технологий для обеспечения безопасности периоперационной медицины должно быть ориентировано на удовлетворение энергоструктурных потребностей пациента в энергосубстратах, что является гарантией исключения нарушений жизнедеятельности пациентов., У статті наведено клінічні результати застосування нового концептуального підходу та нових технологій, що маніфестують визначення властивостей і можливостей підтримки біологічної цілісності організму в періопераційному періоді. Встановлено, що застосування енергопротективних технологій для забезпечення безпеки періопераційної медицини повинно бути орієнтованим на задоволення енергоструктурних потреб пацієнта в енергосубстратах, що є гарантією виключення порушень життєдіяльності пацієнтів., The article presents the clinical results of the application of the new conceptual approach and new technologies that manifest the determination of the properties and capabilities of maintaining the body’s biological integrity during the perioperative period. It has been found that the use of energy-protective technologies to ensure the safety of perioperative medicine should be oriented towards the satisfaction of the energy-structural needs of the patient in the energy substrates, which is a guarantee of the exclusion of patients’ life impairments.

This Special Issue addresses the concept of sustainability in pension systems from a wide range of perspectives. It examines the central questions raised about sustainable, socially responsible investments and other associated concepts by opening up a comprehensive discussion with an interdisciplinary approach. Normative trends and international cases are analysed in some detail concerning the situation of specific European Member States. Also, the concept of sustainability in European occupational pension schemes is questioned as an efficient vehicle able to assure adequate pension entitlements to all workers to avoid old-age poverty.

Aim: The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained with 22-Gauge and 27-Gauge needles.Materials and Methods: From January 2019 to December 2019, 860 patients with thyroid nodules who underwent ultrasound-guided fine-needle biopsies were included in this retrospective study. The results of the samples taken were classified cytologically according to the Bethesda 2017classification. Sample adequacy rates were calculated for each group and compared using chi-square tests.Results: Our cytological results were reported as 157 (18,3%) inadequate materials (Bethesda1). There were no statistically significant differences among the adequacy rates achieved with 22- and 27-gauge needles (80.4% and 83.2%, respectively; P>0.05). There was no significant or permanent complication.Conclusion: There was no difference between 22 and 27-Gauge needle sizes in diagnostic adequate sample. Prospective randomized controlled studies are needed to examine the relationships between nodule, needle, and patient dependent variables., Amaç: Bu çalışmanın amacı 22 ve 27-Gauge boyutlu iğneler ile yapılan tiroid biyopsilerinde alınan sitolojik örneklerin patolojik olarak tanı verme yeterliliğini karşılaştırmaktır.Gereç ve Yöntem: Bu retrospektif çalışmaya Ocak 2019-Aralık 2019 tarihleri arasında 860 hastaya ultrason kılavuzluğunda yapılan tiroid ince iğne biyopsileri dahil edilmiştir. Alınan örneklerin sonuçları sitolojik olarak Bethesda 2017 sınıflamasına göre sınıflandırılmıştır. Örneklerin tanı yeterlilikleri her grup için ki-kare testi ile analiz edilmiştir.Bulgular: Toplam tanısal olmayan patoloji sonucu oranı %18,3 olarak bulundu (Bethesda 1). Araştırmamızda 22 ve 27-Gauge boyutlu iğneler ile elde edilen örneklerin tanısal yetersizlik oranları arasında istatistiksel olarak anlamlı bir farklılık yoktu (sırasıyla; %19,6 ve %16,8, P>0,05). Kalıcı veya ciddi bir komplikasyon görülmedi.Sonuç: İnce iğne biyopsisinin yeterli numune vermesi açısından 22 ve 27 Gauge iğne boyutları arasında fark görülmemektedir. İğneye, nodülün özelliğine ve hastaya bağlı değişkenler arasındaki ilişkileri incelemek için prospektif randomize kontrollü çalışmalara ihtiyaç vardır.

BACKGROUND: Prior studies evaluating thyroid fine needle aspiration biopsies (FNABs) have limited the calculation of risk of malignancy (ROM) to cytologic specimens with corresponding histologic specimens, and clinical follow-up for those patients who do not undergo immediate surgery has been largely disregarded. Moreover, there is marked variability in how researchers have approached thyroid FNAB statistical analyses. This study addresses the urgent need for information from a large cohort of patients with long-term clinical follow-up to more accurately determine the performance of thyroid FNAB and ROM for each diagnostic category. METHODS: A retrospective review of the University of California, San Francisco (UCSF), pathology database for thyroid FNABs from January 1, 1997, to December 31, 2004, was performed. Diagnoses were coded using the 2017 The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and patients were matched to both the UCSF cancer registry and California Cancer Registry. Data were analyzed using the Kaplan–Meier method, and stratified by TBSRTC diagnostic category. Kaplan–Meier curves were used to estimate incidence rates of malignancy, stratified by FNAB category. Cox proportional hazards models were used to determine the instantaneous ROM. RESULTS: Initial FNABs from 2207 patients were included. Median follow-up period after the first thyroid FNAB was 13.9 years (range: 10.5–18.4 years). During follow-up, there were 279 confirmed diagnoses of thyroid malignancy. Estimates derived from Kaplan–Meier curves demonstrated that the risk of having a thyroid malignancy was low for nondiagnostic and benign categories, intermediate for atypia of undetermined significance (AUS), follicular lesion of undetermined significance (FLUS), AUS/FLUS combined, and follicular neoplasm, and high for suspicious and malignant categories. A total of 52/1575 false-negative cases (3.2%) were identified. Excluding papillary microcarcinomas, the false-negative rate was 1.5% (23/1575). No patients with a false-negative diagnosis died of thyroid cancer during the follow-up period. CONCLUSIONS: Asymptomatic patients with low-risk clinical and radiologic features and initially benign or unsatisfactory biopsy are unlikely to develop thyroid malignancy and highly unlikely to die of thyroid cancer. FNAB is highly accurate in detecting malignancy. Additional studies evaluating similar large data sets after the adoption of TBSRTC and the integration of molecular testing are needed.

Background: Intra-dialytic hypotension (IDH) and pruritus are frequent and distressing complications during hemodialysis; moreover, they are associated with adverse outcomes. The aim of the work: The current work aimed to investigate the effect of applying individualized cool dialysate (ICD) on IDH, dialysis adequacy, pruritus and its acceptance by both patient and nephrologists. Patients and Methods: This is a non-randomized single center study that was conducted at Al-Azher nephrology and dialysis unit. The study was carried out over a period of fvie weeks. Core body temperature (CBT) and dialysis adequacy (by Kt/v) were measured. Patients who fulfilled the inclusion and exclusion criteria underwent hemodialysis for six consecutive sessions at dialysate temperature of 37°C, followed by another six consecutive sessions at ICD temperature (0.5 oC below CBT). Blood pressure (BP) measurements, episodes of hypotension, pruritus score, patients and nephrologist questionnaire were collected during both standard and cool phases. Results: The study included 50 patients, the mean age 51.10±11.57 years, and males constituted 64% . The implementation of ICD has been associated with a significant reduction in IDH episodes (p

Since May 2018, the European Commission (Commission) has the exclusive competence not only to assess third countries for an adequacy decision authorizing the international transfer of personal data to third countries or international organizations in relation to the General Data Protection Regulation (GDPR) but also for law enforcement purposes under the Law Enforcement Directive (LED). So far, no LED adequacy decision has been adopted. The complexity and the fragmentation of data protection within a law enforcement context complicate the task of the Commission to adopt a LED adequacy decision. Moreover, in light of the fact that due to existing international law enforcement cooperation mechanisms mainly based on international agreements such as ‘Mutual Legal Assistance Treaties’ (MLATs), international data flows for law enforcement appear to continue ‘as usual’, the Commission seems to feel no urgency to adopt them. This poses the question why LED adequacy decisions were introduced in the first place and if the existing framework suffices for the protection of fundamental rights in a manner essentially equivalent to the EU as mandated for data transfers by the Court of Justice of the European Union (CJEU) since Schrems. My systematic analysis of these questions based on EU fundamental rights law shows that LED adequacy decisions are crucial within the EU data protection system for law enforcement both from a fundamental rights perspective and from a systematic and practical viewpoint and that their absence seriously undermines the protection of EU fundamental rights.

Introduction. Conducting an experiment when conducting research on electroplating coatings requires a lot of time and energy. To reduce the number of experiments performed, it is necessary to conduct mathematical modeling of the experiment to reduce the number of experiments performed and reduce it to a specific algorithm to obtain reliable and accurate data. The obtained reliable data will allow to get good results in studies of obtaining chrome coatings, with maximum performance, including current output.Materials and methods. To conduct the research, the necessary equipment for obtaining electroplating coatings, developed a new electrolyte composition for obtaining high-quality high-performance chrome precipitation, as well as the Statistica 13.0 program, which allowed us to reduce the time for calculations and building the necessary graphs, was used.Results. The analysis of methods and methods of mathematical analysis of the results obtained in order to process them and build a model showed that with a confidence regression coefficient of 0.95, it is most preferable to study the effect of the composition of the chromating electrolyte on the current output, in the range of current density values from 125 ... 250 A / dm2 , the amount of hydrofluoric acid 0.6...1.2 g / l and the operating temperature of the electrolyte 16 ... 27 o C.Discussion and conclusion. As a result of the obtained mathematical model, it can be argued that studies of the influence of the electrolyte composition on the current density will allow to obtain reliable data with the least number of experiments. At the same time, it can also be argued that it is possible to obtain an even greater current output if additional research is carried out with a change in factors up or down. However, it is not known how the quality of the coating and the adhesion to the base of the part will change, which is an important factor in obtaining wearresistant electroplating.

Inadequate diets have adverse effects on maternal, fetal, and, possibly, childhood health. This cross-sectional study aimed to examine daily food group intake of pregnant Jordanian women during the three pregnancy trimesters and to compare these to the recommended servings of the five food groups reported by The United States Department of Agriculture and My Plate Plan. A total of 283 pregnant Jordanian women were recruited during their antenatal visits. Data were obtained by interviewer-administered structured questionnaires. Our results showed that 1.1% of participants consumed the recommended number of servings for all five food groups during pregnancy and 10.2% did not consume the minimum number of servings of the five food groups. Nearly half of the participants in the first trimester met the recommended daily servings for three food groups but only approximately two-third of participants met the minimum recommended daily servings for one or two food groups in the second and third trimesters. Consumption of grains and sweets was significantly higher in the third trimester compared with the first and second trimesters. Overall, the majority of pregnant Jordanian women in this study did not consume the recommended number of servings for all five food groups during pregnancy.

Conceptual constructions of management quality and adequacy for the mathematical model of an object within management are correlated. Deterministic, stochastic and uncertain situations are localized in the estimation of adequacy. The article exposes the expediency of model adequacy optimization. It identifies the most essential features of the models and objects for the adequacy estimations. We offered a typology of problems for adequacy estimation involved in mathematical models with the formalization, which examines the most problematic issues of adequacy estimating in the considered area.

Highlights • This study was conducted in two tertiary health institutions in Anambra state of southeastern Nigeria. • It compared the adequacy of Pap smears obtained with two sampling devices- the wooden Ayre’s spatula and the Papcone®. • The adequacy of smears obtained with Papcone® was significantly better than those of wooden Ayre’s spatula. • Papcone® should always be preferred, especially in developing countries where liquid-based cytology is not yet routine., This is a comparative study on the adequacy of cervical smears obtained using the Papcone® sampling device or wooden Ayre’s spatula conducted from two tertiary health facilities –– Nnamdi Azikiwe University Teaching Hospital Nnewi and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, in Anambra State, Nigeria. Slides from smears obtained using both devices were read by a cytopathologist blinded for the study. The primary outcome was the proportion of smears with an adequate endocervical component. Significantly higher adequate cervical smears were obtained in 177/192 (92.2%) women using the Papcone® sampling device, compared to 152/192 (79.2%) using wooden Ayre’s spatula (p

Resumen La hemodialisis domiciliaria (HDD) con monitores de bajo flujo de liquido de dialisis ha ganado popularidad en los ultimos anos gracias a su sencillez de diseno, portabilidad y capacidad de desplazamiento. No obstante, existen dudas respecto a la adecuacion que este tipo de tecnica ofrece, pues utiliza monitores con bano a flujos bajos y lactato. El objetivo de este estudio fue demostrar los beneficios clinicos de la HDD con el monitor NxStage System One® introducido recientemente en Espana. Presentamos los resultados de un estudio observacional, retrospectivo que incluyo de manera no seleccionada a los primeros pacientes con HDD corta mediante este monitor en 12 centros en Espana. Se analizo la evolucion clinica de 86 pacientes a 0, 6 y 12 meses, incluyendo datos relacionados con la prescripcion, evolucion de parametros analiticos de dosis de dialisis, anemia, metabolismo oseo-mineral, evolucion de la diuresis residual, utilizacion de farmacos y datos relacionados con permanencia en la tecnica, y causas de salida a lo largo del seguimiento. Pudimos demostrar que este monitor proporciono una adecuada dosis de dialisis, con tasa optima de ultrafiltracion, con mejoria de los principales marcadores bioquimicos de adecuacion en dialisis. El uso de esta tecnica se asocio con una disminucion de antihipertensivos, captores del fosforo y agentes eritropoyeticos, observandose, ademas, muy buenos resultados de supervivencia tanto del paciente como de la tecnica. La sencillez de este monitor unida a sus buenos resultados clinicos deberia facilitar el crecimiento y utilizacion de la HDD, tanto en pacientes incidentes como prevalentes.

The intake of fiber‐rich foods during pregnancy has several health benefits to the pregnant woman including lowering the risks of diabetes, preeclampsia, and constipation. However, little is known about the content, daily intake levels, and adequacy of fiber among pregnant women in many low‐income settings. We aimed to identify common food items and determine adequacy of dietary fiber intake levels among pregnant women in rural Ethiopia. Dietary data were collected from a subsample (n = 55) of pregnant women enrolled to a larger prospective cohort study (n = 414). Dietary intake level was measured using repeated 24‐hr dietary recall method and weighing the total amount of daily food. Fiber content was determined using the Weende method supplemented by other sources.The mean [±SD] dietary fiber intake level was 25.89 [±5.09 mg/g] per day, which declined across pregnancy trimester from 26.01 [±9.18 mg/g] to 22.67 [±9.01 mg/g] and 24.56 [±9.98 mg/g] during the first, to second and third pregnancy trimesters, respectively. Boiled cereals and coffee contributed to nearly two‐thirds (63.2%) of the daily fiber intake, while the major bulk of daily food, enjera, contributed to less than a quarter (24.3%) of the fiber intake. Though dietary patterns favor diversified intake for fiber, the mean intake levels below the recommended levels and proportion of women getting adequate to the physiologic stages of pregnancy were inadequate compared to the standard. Mothers, in such community, could benefit from increasing overall intake of existing food to satisfy their fiber needs during pregnancy.

Purpose To investigate the symptoms and delays in the clinical pathway of bladder cancer (BC). Methods This is a substudy of a prospective, randomized, multicenter phase III study (FinnBladder 9, NCT01675219) where the efficacy of photodynamic diagnosis and 6 weekly optimized mitomycin C instillations are studied in pTa bladder cancer with high risk for recurrence. The data of presenting symptoms and critical time points were prospectively collected, and the effect of factors on delays was analyzed. Results At the time of analysis, 245 patients were randomized. Analysis included 131 patients with primary bladder cancer and their complete data. Sixty-nine percent had smoking history and 67% presented with macroscopic hematuria. Median patient delay (from symptoms to health-care contact) was 7 days. The median general practice delay (from health-care contact to urology referral) was 8 days. Median time from urology referral to cystoscopy was 23 days and from cystoscopy to TUR-BT 21 days. Total time used in the clinical pathway (from symptom to TUR-BT) was 78 days. Current and former smokers had non-significantly shorter patient-related and general practice delays compared to never smokers. TUR-BT delay was significantly shorter in patients with malignant cytology (16 days) compared to patients with benign cytology (21 days, p = 0.03). Conclusions Patient-derived delay was short and most of the delay occurred in the referral centers. The majority had macroscopic hematuria as the initial symptom. Surprisingly, current and past smokers were more prone to contact the health-care system compared to never smokers.

Background The COVID-19 pandemic has been a challenge for nutrition monitoring and delivery. This study evaluates clinical and nutritional characteristics of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and investigates the relationship between nutrition delivery and clinical outcomes. Methods Prospective observational study of adults admitted for >24 hrs to a tertiary-care hospital during a period of 2months. Data was collected on disease severity, energy, protein delivery and adequacy, use of mechanical ventilation (MV), hospital length of stay (LOS). Multivariate logistic regression models were used to determine the associations with mortality as the primary outcome. Results 1083 patients: 69% male (n = 747), 31% females (n = 336), mean age 58.2 ± 12.8 with 26.6 ± 4.32 BMI were analysed. 1021 patients survived and 62 deaths occurred, with 183 and 900 patients in the ICU and ward, respectively. Inadequate calorie and protein delivery had significantly higher mortality than those with adequate provision (p

Background Prenatal care is an important component for the continuum of care in maternal and child health services. Despite increased attention on prenatal care service coverage, the adequacy of service provision has not been well addressed in Ethiopia. Therefore, this study aimed to describe the status of the adequacy of prenatal care and its associated factors in Southern Ethiopia. Method A longitudinal study done by the Performance care Monitoring and Accountability (PMA2020) project was used. The study was conducted from August 2016 to January 2017 in Southern Ethiopia. A multistage stratified cluster design in which all enumeration areas were randomly selected using probability proportional to size and all households were screened to identify 324 pregnant women of six or more months. Questions regarding early attendance of prenatal care, enough visits, and sufficient services were asked to measure the adequacy of prenatal care. Finally, an ordered logistic regression analysis was employed to assess factors associated with the adequacy of prenatal care services. Results Of the total pregnant women 44.21 % attended enough visits, 84.10 % had early visits, and 42.03 % received sufficient services. The women residing in urban areas had 2.35 odds of having adequate prenatal care in reference to rural areas (adjusted odds ratio (aOR) 2.35 [95 % CI 1.05–5.31]). Women who attended primary and secondary education had 2.42(aOR 2.42 [95 % C.I. 1.04, 5.65]), and 4.18 (aOR 4.18 [95 % CI 1.32, 13.29]) odds of adequate prenatal care in reference with those who never attended education respectively. The women participating in one to five networks have 2.18 odds of adequate prenatal care in reference to their counterparts (aOR 2.78 [95 % CI 1.01, 7.71]). Conclusions The adequacy of prenatal care services in Southern Ethiopia is very low. The Ethiopian health care system should strengthen one to five networks to discuss on family health issues. Further research, should validate the tools and measure the adequacy of the services in different contexts of Ethiopia using a mixed method study for an in-depth understanding of the problem.

International audience; Decentralized electricity systems based on variable renewable energy (VRE) sources such as wind power can provide affordable, dependable, and modern energy in a manner consistent with the Paris Agreement. Such sources are, however, sensitive to extreme values of climatic factors—an issue that may jeopardize power system reliability. As a resource-rich region with a high proportion of rural population without access to electricity, Africa has been of wide interest in studies on VRE-based electricity generation. Nevertheless, there is still a major gap in our continent-scale understanding of the wind power potential and its variability at different time scales, as well as the influence of low-wind-resource periods in Africa. Using ERA5 hourly estimates of wind speed, the present study investigated the adequacy and temporal variability of local wind power potential across Africa over the 2000–2017 period. The results indicated that design requirements of wind power systems are, on average, fulfilled in regions in the North, South, and Horn of Africa at different time scales. However, low-resource periods were shown to have a significant impact on the reliability of wind power potential in the majority of the continent. Demand flexibility can reduce the severity of these periods and help to achieve design requirements.

Many countries around the world are resorting to mandatory funded components in their multi-pillar pension systems with the purpose of catering for the financial pressure from ageing. This paper aims at analysing the possible replacement rates for such a scheme, by choosing different assumptions and setting the best combined area for the expected result. Then, an approach for analysing the potential for the implementation of such a scheme in Greece is presented along with the actuarially projected expected benefit expenditure and respective accrued capital. A result of the introduction of such a component is expected to be the elevated replacement rate at retirement with a concurrent alleviation of the fiscal burden for the state. The projected scale of savings will also provide domestic financing for investments generating growth.

Background:Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT >2hours. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis.Methods:We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: 4 hours. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT >2 hours) in reference to a change to a shorter DRT (decrease below DRT 4 hours). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (>365-to-≤545 days FDD) and second prevalent (>730-to-≤910 days FDD) years.Results:Among 98616 incident HD patients (age 62.6±14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR=0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR=1.008; 95%CI 1.001-to-1.015) and 1.6% (OR=1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time.Conclusions:Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

Objective Fine needle aspiration cytology (FNAC) is a well-established diagnostic procedure for head and neck masses not clearly originating from mucosal or cutaneous surfaces. We analysed head and neck masses evaluated over a 2-year period, to assess the reliability of FNAC for the evaluation of malignancy. Methods We enrolled all patients undergoing FNAC, from April 2013 to July 2015, in a single service of a large Italian university hospital. Relevant clinical data and ultrasonographic parameters of the lesions were recorded. We performed both conventional and thin-prep smears. Clinical presentation, ultrasonographic features and final cytology diagnoses were analysed and correlated with histology. Results The series included 301 lesions in 285 patients, with a single (94.4%) or two (5.6%) lesions. Only eight samples were considered non-diagnostic/inadequate (2.6%). Among the cases, 139 FNAC (46.1%) underwent surgery. Cytological-histological correspondence was found in 89% of the cases. Concerning malignancy, we documented less than 4% false positives and less than 2.5% false negatives, with 92.7% sensitivity and 94.6% specificity. Conclusion FNAC diagnosis can be highly specific. Most importantly, it is highly reliable in assessing malignancy, thus defining the priority and guiding the management procedures.

Background Hemodialysis (HD) dose targets and ultrafiltration rate (UFR) limits for pediatric patients on chronic HD are not known and are derived from adults (spKt/V>1.4 and Methods Retrospective analysis on a cohort of patients 1.6 (Kaplan–Meier analysis), (II) secondary analyses: UFR and alternative dialysis adequacy measures [eKt/V, body-surface normalized Kt/BSA] on continuous scale (Weibull regression model). Results A total of 1780 patients were included (age at the start of HD: 0–12y: n=321, >12–18y: n=1459; median spKt/V=1.55, eKt/V=1.31, Kt/BSA=31.2 L/m2, UFR=10.6 mL/kg/h). (I) spKt/V1.4–1.6 (P1.6 (PP18 mL/kg/h. Associations did not alter significantly following adjustment for demographic characteristics (age, etiology of kidney disease, and ethnicity). Conclusions Our results suggest usefulness of targeting Kt/BSA>30 L/m2 for best long-term outcomes, corresponding to spKt/V>1.4 (>12 years) and >1.6 (

BackgroundPercutaneous renal biopsy (PRB) is the primary biopsy technique and it was used by 16G needles or 18G needles in China, but there is controversy about the effect and safety of the two different diameters. The study aims to compare the adequacy, complication rate and pathological classification when using 18G vs. 16G needles to perform renal biopsy with ultrasound-guidedance on native kidneys in Chinese individuals.MethodsWe retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients with the use of 18G or 16G needles from January 2011 to May 2017 and verified whether the needle gauge affected the disease diagnosis.ResultsA total of 270 kidney biopsies were performed. Among them,72 were performed with 18G needles, and 198 were performed with 16G needles. There was no difference in the number of glomeruli under light microscope using 18G relative to 16G needles (24 ± 11 vs. 25 ± 11,p = 0.265), whereas more glomeruli were found in the 16G group than in the 16G group using immunofluorescence microscopy (3 ± 2 vs. 5 ± 3,p p = 0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs. 7.07%,p = 0.57), gross hematuria (4.17% vs. 3.54%,p = 0.729), and perinephric hematoma without symptoms (4.17% vs. 1.52%,p = 0.195), were not significantly different between the 18G and 16G groups. In the 16G group, 2 cases of serious complications occurred: severe gross hematuria requiring blood transfusion and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, although there was no significant difference in serious complications rates between the 18G and 16G groups (0% vs. 1.02%,p = 1).ConclusionThere was no significant difference in the number of glomeruli, adequate sample rates, or complication rates when using 18G or 16G needles to perform renal biopsy, and the use of an 18G needle with a smaller diameter did not affect the pathological diagnosis or classification of IgA nephropathy and lupus nephritis.

The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.

BackgroundOver the last decade, a trend towards high utilisation of primary maternity care was observed in high-income countries. There is limited research with contradictory results regarding frequent attendance (FA) and perinatal outcomes in midwifery care. Therefore, this study examined possible associations between FA in midwifery care and obstetric interventions and perinatal outcomes.MethodsA retrospective cohort study was performed in a medium-sized midwifery-led care practice in an urban region in the Netherlands. Frequent attenders (FAs) were categorised using the Kotelchuck-Index Revised. Regression analyses were executed to examine the relationship between FAs and perinatal outcomes, stratified by antenatal referral to an obstetrician. Main outcomes of interest were Apgar score ≤ 7 and perinatal death, birth weight, mode of delivery, haemorrhage, place of birth, transfer during labour, and a requirement for pain relief.ResultsThe study included 1015 women, 239 (24%) FAs and 776 (76%) non-FAs, 538 (53%) were not referred and 447 (47%) were referred to an obstetrician. In the non-referred group, FA was significantly associated with a requirement for pain relief (OR 1.98, 95% CI 1.24–3.17) and duration of dilatation (OR 1.20, 95% CI 1.04–1.38). In the referred group, FA was significantly associated with induction of labour (OR 1.86, 95% CI 1.17–2.95), ruptured perineum (OR 0.50, 95% CI 0.27–0.95) and episiotomy (OR 0.48, 95% CI 0.24–0.95). In the non-referred and the referred group, FA was not associated with the other obstetric and neonatal outcomes. Due to small numbers, we could not measure possible associations of FA with an Apgar score ≤ 7 and perinatal death.ConclusionIn our study, perinatal outcomes differed by FA and antenatal referral to an obstetrician. In the non-referred group, FA was significantly associated with medical pain relief and duration of dilatation. In the referred group, FA was significantly associated with induction of labour, ruptured perineum, and episiotomy. Further research with a larger study population is needed to look for a possible association between FA and primary adverse birth outcomes such as perinatal mortality.

Renewable energy resources are becoming the dominating element in power systems. Along with de-carbonization, they transform power systems into a more distributed, autonomous, bottom-up style one. We speak of Smart Grid and Microgrid when distributed energy resources take over. While being a means to improve technical and financial efficiency, planning, operations, and carbon footprint, it is these new technologies that also introduce new challenges. Reliability is one of them, deserving a new way of describing and assessing system and component reliability. This paper introduces a new reliability framework that covers these new elements in modern power systems. It can be seen that reliability assessment of modern power systems also requires introducing local reliability concepts as well as incorporating different electro-magnetic/mechanical stability issues.

Hyperleptinemia is often observed in peritoneal dialysis (PD) patients. But, there are few studies on the relationship between blood leptin level and PD survival, and, some of them contradict each other. The present study aimed to investigate the impact of PD initiation on the serum leptin concentrations and its association with PD adequacy. Method. A total of 23 patients with end-stage renal disease (ESRD), who started the treatment with continuous ambulatory peritoneal dialysis (CAPD), were included in this prospective single-center observational longitudinal study. Among the patients, there were 15 men and 8 women; the average age of the patient population was 52.4 ± 12.3 years. The treatment with CAPD was performed using Dianeal PD 4 with glucose concentration of 1.36% and 2.27%. The patients were screened before PD initiation and after 3- and 12- month PD treatment. Leptin levels were determined in all patients using ELISA-method. Results. The median serum leptin concentration at study entry was 10.6 [5.6-21.9] ng/mL. Leptin level and its dynamics during the year after PD treatment initiation were dependent on body mass index (BMI). The overweight or obese patients had ever-increasing leptin levels after 3- and 12- month PD treatment. Whereas in the PD patients with normal weight, we observed a significant decrease of leptin levels after 12-month PD treatment. Serum leptin concentration in the women was significantly higher compared with the men (46.4 [1.1-95] vs 9.8 [3.2-14.5] ng/mL; p = 0.02). Blood cholesterol levels had a positive correlation with serum leptin concentrations after 3- and 12- month PD treatment: r = 0.53, p = 0.01 and r = 0.56, p = 0.008, respectively. However, we did not find a statistically significant association of leptin with PD adequacy parameters after 3- and 12- month PD treatment of the patients. In the Cox proportional hazard model adjusted for gender, serum leptin level demonstrated itself as the effective factor in PD adequacy survival: HR 5.3 (95% CI 1.7; 16.3). PD adequacy survival was better in the patients with leptin concentrations above the median (≥10.6 ng/mL) compared with the patients who had serum leptin levels below the median (log rank test, χ2= 8.2; p = 0.0042). Conclusions. Our study have demonstrated markedly elevated serum leptin level in the overweight PD patients and its strong decrease during 12 months in the patients with normal weight. Low serum leptin level before PD initiation is associated with inadequate PD.

The article presents the results of the study on the formation of an independent opinion of the reliability of financial accounting, which is reflected in the auditor’s report and is based on his intermediate conclusions. It has been established that determining the sufficiency of evidence presents a problem that consists in the auditor’s decision on the extent to which they are sufficient to prove the accuracy of his opinion as to the reliability of financial accounting. The study of methodological approaches to assessing the adequacy of audit evidence in the process of performing the audit task was conducted in order to provide evidence of the audit opinion regarding the reliability of the statements of management personnel, contained in the financial report indicators. The article presents the results of the research of scientific approaches concerning the qualitative and quantitative characteristics of audit evidence. Based on the analysis of the provisions of the International Standards on Quality Control, Audit, Inspection, Other Assurance and Related Services (ISA) and literary sources, the main criteria for evaluating audit evidence were identified, their content and terms of security were determined. The relationship between audit procedures and qualitative aspects of financial reporting was considered. Taking into account the requirements of the rules for assessing the reliability of the evidence, provided by the ISA 500 “Audit Evidence”, division of evidence into more and less reliable was made; generalized factors for the consideration in the process of assessing the reliability of evidence were generated. The process of assessing evidence at the stages of the audit task was considered and a conceptual model for assessing the adequacy of audit evidence was constructed. On the basis of the conducted research, it was concluded that the evidence of the auditor’s judgment regarding the chosen form of the audit opinion depends directly on the results of the integrated assessment of the collected audit evidence at all stages of the audit task. The results of the study provide an opportunity to adequately elaborate the process of planning the audit procedures, for the purpose of obtaining relevant audit evidence, their assessment of compliance with the established criteria, the auditor’s making well-grounded decisions, which will reduce the risks of errors in the auditor’s judgment.

Over the years, since the beginning of the national and infrastructural project of Development and Renovation of Paddy Fields of Iranian Northern provinces, it has been essential to evaluate water distribution and delivery Performance of the project to get its feedback in the pursuit of the desired goals. However, the results of the evaluation of a system can reliable when they are based on quantitative indicators, not on personal opinions and empirical judgment. So, in this study, Total Error (TE) of performance of water delivery system, a statistical indicator, and its component including adequacy, water management capability and equity errors were calculated and compared for two concrete and earthen irrigation canals. This analysis was done based on calculating water demand and measuring the volume of delivered water between outlets during the irrigation season in the paddy fields of Esmaelkola of Joybar city, in 2015. According to the results, although the concrete channel (0.28) had less error than the earthen channel (0.43) and in the concrete channel, as compared to the earthen channel, the share of the components of adequacy and water management capability from the total error was dropped from 47% to less than 10%, but the error in the water delivery of the concrete channel was still high due to the error in the equity of distribution, whose value was 0.25 (90% of the total error). Therefore, in order to reduce the performance error, after channel lining, it would be necessary to make fundamental changes in the intake and flow control structure in addition to the training of irrigators regarding water delivery based on water demand.

Caffeine is an adenosine receptor antagonist and a possible cause of inadequate stress perfusion. Splenic switch-off (SSO) and splenic rest-stress T1-mapping have been proposed as indicators of stress adequacy during perfusion cardiac magnetic resonance (CMR). We compared myocardial rest-stress T1-mapping with SSO and splenic rest-stress T1-mapping in patients with and without recent coffee intake. We analyzed 344 consecutive patients suspected of myocardial ischemia with adenosine perfusion CMR. All 146 normal CMR studies with a normal T1-rest of the myocardium, used as standard of reference, were included and divided in two groups. 22 patients accidentally ingested coffee

Introduction: the methods of content integration of higher education play an important role during intensification of integration processes in the post-industrial society. Universal methodology and methods of content integration of higher education are underdeveloped and coupled with insufficient level of preparedness of graduates of higher educational institutions to solve complex professional tasks. This challenge determines the timeliness of this study. The aim of the article is to substantiate the general methodology and principles of integrating the content of higher education in the context o f a competence-based approach. Materials and Methods: integration, cognitive, hermeneutical and competence-based approaches, analytical- synthetic methods, comparative analysis and sociological methods were used during the study. In addition, the author used recitation, written testing and the original method of self-diagnostics of students’ cultural assets. Results: in summary, a knowledge integrator and a cognition integrator are defined; the structure of integrated rational content of integrated knowledge in education is revealed; universal hermeneutic methodological standard of integration knowledge in education is substantiated and introduced in practice; principles of adequacy of the integration of the content of education are formulated, new requirements to the structure of competencies of a graduate in integrated educational content are identified. Discussions and Conclusions: the scientific novelty and theoretical significance of the article lies in the author’s substantiation of the hermeneutic concept of integrating the content of higher education, as well as in integrating the hermeneutic approach with cognitive and competence-based approaches to the content of higher education. The author concluded that the condition for the successful integration of educational content is the hermeneutical methodology: the principles and methodology for its implementation. The practical significance of the article is the development and experimental verification of the hermeneutic methodology for integrating the content of higher education to develop the readiness of future specialists in information protection to solve integrated professional problems. The article can be useful for higher institution teaching staff who are working on solving similar problems in other educational areas. The presented research can be developed by revealing the specifics of a justified concept in different educational sectors and at different levels of education.

Objective: To prospectively investigate the value of rapid on-site evaluation (ROSE) in transthoracic fine needle aspiration cytology (FNAC) of patients with pulmonary nodules. Computed tomography (CT)-guided FNA is commonly employed for the diagnosis of lung lesions and the most common reason for not being able to provide a diagnosis in FNA is inadequacy of samples. Materials and Methods: This was a prospective study conducted in the departments of pathology and radiology of our cancer centre. This study had approval from the institutional review board and ethical committee of our institute. Fifty consecutive cases undergoing CT-guided transthoracic FNAC in our centre were included in the study. The smear submitted for ROSE was stained using toluidine blue stain. The specimen adequacy and diagnosis in ROSE was compared with that of the final cytology report, and the concordance regarding adequacy and diagnosis were noted. Results: Smears were adequate in 34 cases (68%) and inadequate in 16 cases (32%) Out of the 16 inadequate cases, 5 (31%) were converted to adequate due to the application of ROSE, thus increasing the adequate number of cases to 39 (78%). A diagnosis of malignancy was made in all 39 adequate cases. Sensitivity of ROSE in determining adequacy was 92% and specificity was 100%. The most common malignancy was adenocarcinoma in 26 cases. Pnemothorax occurred in 2 cases. No significant complications occurred in other cases. Conclusion: CT-guided FNA with ROSE is a safe and useful tool in the diagnostic work-up of lung cancer patients. A multidisciplinary approach along with onsite evaluation of adequacy will increase the diagnostic utility of cytology in lung lesions.

Context: Dengue fever (DF) altogether with its severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome, has become public health concerns. Indonesia belongs to category A of endemicity for DF/DHF. One of the several efforts to control dengue virus infection in Indonesia is a passive surveillance called “Dengue Case Surveillance.” Timeliness report defined as a report sent within 24 h after the clinical diagnosis is needed to have a proper surveillance. The study on the evaluation of dengue case report in terms of accuracy, adequacy, and timeliness in Indonesia is still limited. Aims: The aim of this study was to identify the accuracy, adequacy, and timeliness from the reports of dengue viral infection (DVI) cases admitted from January 1 to December 31, 2015 to 7 major hospitals in Bandung, West Java, Indonesia. Settings and Design: This was a retrospective analysis study. Materials and Methods: To evaluate the accuracy, all medical records of DVI patients were reviewed epidemiologically, clinically, and laboratory using a standardized questionnaire. To evaluate the adequacy, hospital data were compared with reported data in Bandung Municipality Health Authority. To evaluate the timeliness of report, interview to the person in charge for dengue reporting cases in each hospital and in Bandung Municipality Health Authority were performed. Statistical Analysis Used: Univariate analysis was used for statistical analysis. Results: A total of 4096 (72%) of 5712 hospitalized DVI cases lived in Bandung Municipality. The accuracy of the clinical diagnosis was 3397 out of 4096 cases (82.9%). The adequacy of the accurate cases was 1553 out of 3397 cases (45.7%). Conclusions: The timeliness of report was varied, ranging from days to month. The accuracy of dengue cases was good, but the adequacy and timely reporting should be strengthened.

Significance and deep psychologism of one of Emily Bronte’s most famous poems “Remembrance” is considered. Attention is paid to the analysis of translations of this poem into Russian. The results of comparative analysis of two translations of this poem made by T. Gutina, famous translator of E. Bronte’s poetry, and Sh. Fenn, translator under the pseudonym, are presented. The question of relevance of the study of Emily Bronte’s poetry from the standpoint of psychoanalysis is raised. Special attention is paid to equivalence and adequacy in the translation of poetry. The key positions of the analysis of the translations of the poem by E. Bronte necessary for the transmission of the meaning of her poetry are determined. The novelty of the research lies in the fact that Emily Bronte, the author of the novel “Wuthering Heights,” well-known to Russian readers, is completely unknown for her poetry, which is rightfully worthy of attention of readers. The relevance of the research is due to the need to determine the basic key positions of the poetry translation, namely: preservation of the logical content, rhythmic and melodic pattern, stylistic expression when translating. The facts are given, urging that to pass the rhythm of a funeral march is fundamental for the poem “Remembrance”, and it was implemented in translators in full. The author focuses on the analysis of the system of images, as well as those formal characteristics of the poem, which contribute to the understanding of its deep meaning.

ResumenObjetivoAnalizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada.MétodoEstudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos.ResultadosDe 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p

Background For peritoneal dialysis patients, the likelihood of conception is low and the probability of getting through the pregnancy successfully is even lower. Almost 60 years after the first reported case of a successful pregnancy in a dialysis patient, many issues concerning pregnancy in dialysis patients remain unresolved. Our patient’s pregnancy is considered high risk as she has end stage renal failure and falls in the category of advance maternal age for pregnancy. We describe here the course of her uneventful pregnancy which we hope will contribute to the overall knowledge and management of pregnancy in elderly patients receiving peritoneal dialysis. Case presentation We report a successful elderly multigravid pregnancy, in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). Her pregnancy was detected early and she was closely managed by the nephrologist and obstetrician. She tolerated the same PD prescription throughout 36 weeks of pregnancy with daily ultrafiltration of 500-1500mls. Her blood pressure remained well controlled without the need of any antihypertensive medication. Her total Kt/V ranged from 1.93 to 2.73. Her blood parameters remained stable and she was electively admitted at 36 weeks for a trans-peritoneal lower segment caesarian section and bilateral tubal ligation. Conclusions At the age of 42, our case is the oldest reported successful pregnancy in a patient on peritoneal dialysis. With careful counselling and meticulous follow up, we have shown that woman in the early stage of end stage renal failure can successfully deliver a full term baby without any complications. Therefore, these women should not be discourage from conceiving even if they are in advanced maternal age for pregnancy.

Introduction: Increased oxidative stress is suggested as one of the possible mechanisms of structural and functional damage to the peritoneal membrane in peritoneal dialysis patients. But there are few available data on the association of oxidative stress with peritoneal dialysis adequacy and technique survival. The present study was undertaken to investigate the association of oxidative stress biomarkers with the peritoneal dialysis adequacy and technique survival. Methods: This prospective single‑center observational study was conducted between January 2010 and May 2015. Adequacy of dialysis, malondialdehyde levels in the serum and erythrocytes (as an indicator of lipid peroxidation), the concentration of ceruloplasmin, transferrin, and sulfhydryl groups in the blood, and total peroxidase activity in erythrocyte (as indicators of antioxidant system) were determined in 44 stable ambulatory non‑diabetic peritoneal dialysis patients. Results: The follow‑up period was 3 years. We identified a negative correlation between the serum level of malondialdehyde in the patients and total weekly Kt/V. Peritoneal weekly CrCl was positively correlated with the levels of transferrin, total peroxidase activity, and SH– groups. Daily peritoneal ultrafiltration had a positive correlation with the total peroxidase activity and the serum transferrin levels. The results of the Kaplan–Meier analysis and the log‑rank test also demonstrated a significant difference in the cumulative technique survival rate between the patients with ceruloplasmin level ≤0.19 g/l and ≥0.2 g/l. Conclusions: The results mentioned above could be considered as one of the ways to explain better technique survival in PD patients.

This study examines the impact of court-ordered finance reform in New York State resulting from Campaign for Fiscal Equity v. State of New York on equity of inputs using synthetic controls. The findings herein indicate court mandated education finance reform in New York had little to no impact on equity of educational inputs despite an overhauled education finance system intending to distribute more state funding based on student need. In the period during and following the Great Recession, the State of New York chose to cut districts’ foundation aid, a form of aid designed to be distributed progressively, halting any improvement in equity. Had funding been distributed to districts according to the foundation formula that was specified by the education finance reform legislation passed in 2007, high poverty districts would have received more funding and disparities in funding across districts with similar characteristics would have been reduced. I also show that other forms of aid, which are regressively distributed, could have been cut instead of foundation aid, allowing for more funding to flow to high poverty districts in a time of fiscal constraint.

Introduction:In post-dilution online hemodiafiltration, a very thin balance subsists in preventingcoagulation of the extracorporeal circuit (ECC) during treatment and bleeding in the patient, con-cerning dialyzer status and anticoagulation dose.The aim of this study was to assess whether there are clinical outcome differences between thevisual aspect of the dialyzer’s status in terms of clottedfibers at end of dialysis treatments, single-pool urea kinetic modeling (spKt/V) and substitution volume (SubsVol).Methods:It is a multicenter, descriptive-correlational study, involving 2829 patients during April2016. Previous training was given to the Nursing staff to evaluate and classify both the dialyzer’sand the venous chamber’s appearance of the ECC venous line. Registration was performed at bed-side immediately after the patient disconnection.Findings and discussion:Mean age was 68.96 years (SD= 13.75), 60.8% were men. The averagehematocrit was 33.91% (SD= 3.45%). The average dry weight was 68.53 kg (SD= 13.27 kg). Meanunfractioned heparin (UFH) dose was 58.13 IU/kg. Only 32.4% of the patients had a clean dialyzerat the end of treatment. 19.4% of patientsfinished the treatment with more than 10% of clottedfibers. Patients with no residual blood (clean, 32.4%) presented a higher UFH dose (66.32 IU/kg)compared to overall average dose. UFH dose had a significant effect on dialyzer status. There weresignificant differences in average ofspKt/V and SubsVol between the category clean and the othercategories of dialyzer’s status.Evaluating the dialyzer status represents an excellent opportunity to help the physicians to estab-lish an ideal heparin dose. Only the categorycleanis significant to achieve the target. The nursingstaff, by classifying the ECC appearance at patient’s bedside and recording it in a centralized database, can be a major contributor to achieve an individualized and optimal UFH dose and subsequently better patient outcomes. info:eu-repo/semantics/publishedVersion

The objectiveof the research was to determine the types, patterns of uterine cervical lesions and specific age distributions in which they occur. Methods.The data for this study were obtained from the records of patients seen in consultations in the Department of Histopathology, Central Hospital Warri during the 10-year periodfrom2007 to 2016. Relevant clinical information was extracted from the available histopathology records and permission for this study was conformed with the provision of the Declaration of Helsinki in 1995. Results.The study revealed that the peak age range for malignant neoplasm was between 40-49 years (27.52%) with the general age range between (20-80 years) mean age 52.39±13.69. Non-keratinizing squamous cell carcinoma constituted majority of squamous cell tumours (55.05%), while the keratinising variety was the second most common (26.61%) one. The study further revealed that ectocervical fibroepithelial polyps were more common than endocervical tumours especially in the reproductive years (30-50 years) with only one case of atrophic polyp recorded in a woman in the sixth decade. The study documented that 58 (22.48%) of the cervical biopsies were inflammatory with most cases occurring in the ectocervix (94.80%). Most cases of inflammation of the cervix (cervicitis) were disposed between 30 and 59 years with the peak age group occurring in the 4thage group (30-39 years). Conclusions.This audit of uterine cervical biopsies established that malignant tumours were the most common neoplasms. Squamous cell carcinomas accounted for most carcinomas. Similarly, leiomyoma was demonstrated as predominant stromal tumour. &nbsp

Background Assessment of adequacy of intermittent hemodialysis (IHD) is conventionally based upon urea kinetic models for calculation of single pool Kt/Vurea (Kt/V), with 1.2 accepted as minimum adequate clearance for thrice weekly IHD. In the Acute Renal Failure Trial Network (ATN) Study, adequacy of IHD in patients with acute kidney injury (AKI) was assessed using Kt/V. However, equations for Kt/V require volume of distribution of urea, which is highly variable in AKI. Therefore, simpler methods are needed to assess adequacy of IHD in AKI. We assessed correlation of urea reduction ratio (URR) with Kt/V and determined URR thresholds corresponding to Kt/V values to determine if URR could be a simpler means to assess the delivered dose of IHD. Methods Using patients who received IHD for 2.5–6 h and with pre-dialysis BUN ≥20 mg/dL, we plotted URR against Kt/V. We determined URR thresholds (0.60 to 0.75) corresponding to Kt/V ≥ 1.2, 1.3, and 1.4. We generated receiver operating characteristic (ROC) curves for increasing URR values for each level of Kt/V to identify the corresponding thresholds of URR. Results There was strong correlation between URR and Kt/V. ROC curves comparing URR with Kt/V ≥ 1.2, 1.3, and 1.4 had area under the curves (AUC) of 0.99. Sensitivity and specificity of URR ≥0.67 for corresponding values of Kt/V ≥ 1.2 were 0.769 (95% CI: 0.745 to 0.793) and 0.999 (95% CI: 0.997 to 1.000), respectively and the sensitivity and specificity of URR ≥0.67 for corresponding values of Kt/V ≥ 1.4 were 0.998 (95% CI: 0.995 to 1.000) and 0.791 (95% CI: 0.771 to 0.811), respectively. Conclusions Targeting a URR ≥0.67 provides a simplified means of assessing adequacy of IHD in patients with AKI. Use of URR will enhance ability to assess delivery of small solute clearance and improve adherence with clinical practice guidelines in AKI.

The article considers the theory and practice of rental group vehicles in the transportation of commercial cargo on the pendulum route with reverse not loaded mileage in the cities. Transportation is carried out by vehicles of the same capacity and same brand, a method of accomplishment of handling works– manually. Dependence of the cost of rental group vehicles from the change of transportation distance is established. Check installed dependencies on the adequacy to process of costs forming is executed.

Background: Hemodialysis is one of renal replacement therapy for patients with chronic renal failure (CRF). The quality of hemodialysis is largely determined by the recommended dose of hemodialysis. Biological and psychological changes are often faced by patients undergoing hemodialysis, which can affect their quality of life. Family support is an important factor that serves as a support system for the patients to face the health problems. This study aimed to determine the association between hemodialysis adequacy, family support, and quality of life in chronic renal failure patients. Subjects and Method: This was an analitic observational study with cross sectional design. It was conducted at Kasih Ibu Hospital, Surakarta, Central Java. A total sample of 102 patients with chronic renal failure who underwent hemodialysis were selected for this study using random sampling. The dependent variable was quality of life. The independent variables were hemodialysis adequacy and family support. The quality of life was assessed using the WHOQoL questionnaire. The hemodialysis adequacy was measured by Ureum Reduction Rate (URR) formula. Family support was measured by family support questionnaire. The data were analyzed using Chi Square test, Mann Whitney test, and logistic regression Results: Patients with chronic renal failure had better quality of life if they underwent adequate hemodialysis (OR= 5.34 95% CI= 2.20 to 12.98 p= 0.001) and received strong family support (OR= 7.74; 95% CI= 3.13 to 19.13 p= 0.001). Conclusion: Quality of life of the patients with chronic renal failure is determined by hemodialysis adequacy and family support. Keywords: chronic renal failure, hemodialysis, adequacy, family support, quality of life Corespondence: Leo Chandra Wisnu Pandu Winata. Masters Programs in Family Medicine, Sebelas Maret University, Jl. Ir Sutami 36A, Surakarta. Email: leochandrawisnupw@gmail.com Indonesian Journal of Medicine (2017), 2(1): 63-72 https://doi.org/10.26911/theijmed.2017.02.01.07

Target dialysis dose to ensure the best patient outcome is still a matter of debate. Traditional models have a number of limitations and do not comprehensively reflect all factors involved. In this study we present a new complex model of dialysis adequacy, the hemodialysis adequacy score (HAS), and evaluate its prognostic value, as well as its relationship with the malnutrition-inflammation score (MIS). The components of HAS included paradigms of the 6 major factors known to influence the outcome of hemodialysis (HD) patients: the modified Karnofsky index (KI), the Charlson comorbidity index (CCI), Kt/V and URR measures of dialysis dose, body mass index (BMI) and serum albumin level, serum levels of hemoglobin and ferritin, intact parathyroid hormone (iPTH) and calcium-phosphorus solubility product. The score was evaluated in a 24-month prospective study on 147 HD patients. Odds ratio analysis showed that hospitalized patients had twice the chance to have HAS >13 compared to those who were not hospitalized during the study period (OR=2.152, CI 95% (1.0024-4.619). Mortality rate was significantly higher in patients with a HAS >13 at the 12-month follow-up (χ2=16.416, p 13 had significantly higher probability of death (log-rank Cox-Mantel=17.920, df=1, p