Search results for: renal failure

Authors: Ali Kassem, Sharf Eldeen-Shazly, Alshemaa Lotfy

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Introduction: Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired renal failure. Patients with cardiac diseases are particularly at risk especially with repeated injections of contrast media. CIN is generally defined as an increase in serum creatinine concentration of > 0.5 mg/dL or 25% above baseline within 48 hours after contrast administration. Aim of work: To examine the frequency of CIN for patients undergoing cardiac catheterization at Sohag University Hospital (Upper Egypt) and to identify possible risk factors for CIN in these patients. Material and methods: The study included 104 patients with mean age 56.11 ±10.03, 64(61.5%) are males while 40(38.5%) are females. 44(42.3%) patients are diabetics, 43(41%) patients are hypertensive, 6(5.7%) patients have congestive heart failure, 69(66.3%) patients on statins, 74 (71.2 %) are on ACEIs or ARBs, 19(15.4%) are on metformin, 6 (5.8%) are on NSAIDs, 30(28.8%) are on diuretics. RESULTS: Patients were classified at the end of the study into two groups: Group A: Included 91 patients who did not develop CIN. Group B: Included 13 patients who developed CIN, of which serum creatinine raised > 0.5mg/dl in 6 patients and raised > 25% from the baseline after the procedure in 13 patients. The overall incidence of CIN was 12.5%. CIN increased with older age. There was an increase in the incidence of CIN in diabetic versus non-diabetic patients (20.5% and 6.7%) respectively. (p< 0.03). There was a highly significant increase in the incidence of CIN in patients with CHF versus those without CHF (100% and 71%) respectively, (P<0001). Patients on diuretics showed a significant increase in the incidence of CIN representing 61.5% of all patients who developed CIN. Conclusion: Older patients, diabetic patients, patients with CHF and patients on diuretics have higher risk of developing CIN during coronary catheterization and should receive reno-protective measures before contrast exposure.

Keywords: cardiac diseases, contrast-induced nephropathy, coronary catheterization, CIN

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Authors: Adjal Yassine, Semmani Amar

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During the last decades, The risk of collision has been increased, especially in high maritime traffic. As the consequence, the demand is required for safety at sea and environmental protection. For this purpose, the consequences prediction of ship collisions is recommended in order to minimize structural failure. additionally, at the design stage of the ship, damage generated during the collision event must be taken into consideration. This structural failure, in some cases, can develop into the progressive collapse of other structural elements and generate catastrophic consequences. The present study investigates the progressive collapse of ships damaged by collisions using the Non -linear finite element method. The failure criteria are taken into account. The impacted area has a refined mesh in order to have more reliable results. Finally, a parametric study was conducted in this study to highlight the effect of the ship's speed, as well as the different impacted areas of double-bottom ships.

Keywords: collsion, strucural failure, ship, finite element analysis

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Authors: Binjuan Xu, Qian Zhao, Ping Jiang, Bo Guo, Zhijun Cheng, Xiaoyue Wu

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Astronautical valves are key units in engine systems of astronautical products; their reliability will influence results of rocket or missile launching, even lead to damage to staff and devices on the ground. Besides failure in engine system may influence the hitting accuracy and flight shot of missiles. Therefore high reliability is quite essential to astronautical products. There are quite a few literature doing research based on few failure test data to estimate valves’ reliability, thus this paper proposed a new method to estimate valves’ reliability, according to the corresponding tests of different failure modes, this paper takes advantage of tests data which acquired from temperature, vibration, and action tests to estimate reliability in every failure modes, then this paper has regarded these three kinds of tests as three stages in products’ process to integrate these results to acquire valves’ reliability. Through the comparison of results achieving from tests data and simulated data, the results have illustrated how to obtain valves’ reliability based on the few failure data with failure modes and prove that the results are effective and rational.

Keywords: censored data, temperature tests, valves, vibration tests

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Authors: H. J. Kim, G. C. Park, K. C. Kim, J. H. Shin

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Cavities are frequently found beneath conduits on pile foundations in old embankments. Cavity reduces seepage length significantly and consequently causes piping failure of embankments. Case studies of embankment failures indicate that the relative settlement between ground and pile supported-concrete conduit was the main reason of the cavity. In this paper, an attempt to simulate the cavity-induced piping failure mechanism was made using finite element numerical method. Piping potential is examined by carrying out parametric study for influencing factors such as cavity length, water level, and flow conditions. The concentration of hydraulic gradient adjacent to cavity was found. It is found that the hydraulic gradient close to the cavity exceeds considerably the critical hydraulic gradient causing piping. Piping failure potential due to the existence of cavity is evaluated and contour map for the potential risk of an embankment for piping failure is proposed.

Keywords: cavity, hydraulic gradient, levee, piping

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Authors: Clara Luwe, Oliver Harness, Helena Meally, Kim Martin, Alexandra Harrington

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Background: The role of ‘Renal Specialist Podiatrist’ originated in 2022 due to prevailing evidence of patients with diabetes and end-stage renal disease (ESRD) on haemodialysis (HD) and active ulcerations that were at higher risk of rapid deterioration, foot-related hospital admissions, and lower limb amputations. This role started in April 2022 with the aim of screening all patients on haemodialysis and instigating preventative measures to reduce serious foot related complications. Methods: A comprehensive neurovascular foot assessment was completed to establish baseline vascular status and identify those with peripheral arterial disease (PAD) for all patients on HD. Individual’s foot risk was stratified, advice and education tailored and issued. Identifying all diabetes patients on HD as high-risk for diabetic foot complications. Major Findings: All patients screened revealed over half of the caseload had diabetes, and more than half had a clinical presentation of PAD. All those presenting with ulcerations had a diagnosis of diabetes. Of the presenting ulcerations, the majority of these ulcers predated the renal specialist post and were classified as severe >3 SINBAD Score. Since April’22, complications have been identified quicker, reducing the severity (SINBAD<3 or below), and have improved healing times, in line with the national average. During the eight months of the role being in place, we have seen a reduction in minor amputations and no major amputations. Conclusion: By screening all patients on haemodialysis and focusing on education, early recognition of complications, appropriate treatment, and timely onward referral, we can reduce the risk of foot Diabetic foot ulcerations and lower limb amputations. Having regular podiatry input to stratify and facilitate high-risk, active wound patients across different services has helped to keep these patients stable, prevent amputations, and reduce foot-related hospital admissions and mortality from foot-related disease. By improving the accessibility to a specialist podiatrist, patients felt able to raise concerns sooner. This has helped to implement treatment at the earliest possible opportunity, enabling the identification and healing of ulcers at an earlier and less complex stage (SINBAD <3), thus, preventing potential limb-threatening complications.

Keywords: renal, podiatry, haemodialysis, prevention, early detection

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Authors: Magdalena Barbara Kaziuk, Waldemar Kosiba

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Introduction: Despite the development of technologies and improvements in the interior of dialysis stations, dialysis remains an unpleasant procedure, difficult to accept by the patients (who undergo it 2 to 3 times a week, a single treatment lasting several hours). Haemodialysis is one of the renal replacement therapies, in Poland most commonly used in patients with chronic or acute kidney failure. Purpose: An attempt was made to evaluate the quality of life in haemodialysed patients using the WHOQOL-BREF questionnaire. Material and methods: The study covered 422 patients (200 women and 222 men, aged 60.5 ± 12.9 years) undergoing dialysis at three selected stations in Poland. The patients were divided into 2 groups, depending on the duration of their dialysis treatment. The evaluation was conducted with the WHOQOL-BREF questionnaire containing 26 questions analysing 4 areas of life, as well as the perception of the quality of life and health self-assessment. A 5-point scale is used to answer them. The maximum score in each area is 20 points. The results in individual areas have a positive direction. Results: In patients undergoing dialysis for more than 3 years, a reduction in the quality of life was found in the physical area and in their environment versus a group of patients undergoing dialysis for less than 3 years, where a reduced quality of life was found in the areas of social relations and mental well-being (p < 0.05). A significant correlation (p < 0.01) between the two groups was found in self-perceived general health, while no significant differences were observed in the general perception of the quality of life (p > 0.05). Conclusions: The study confirmed that in patients undergoing dialysis for more than three years, the quality of life is especially reduced in their environment (access to and quality of healthcare, financial resources, and mental and physical safety). The assessment of the quality of life should form a part of the therapeutic process, in which the role of the patient in chronic renal care should be emphasised, reflected in the quality of services provided by dialysis stations.

Keywords: haemodialysis, perception of quality of life, quality of services provided, dialysis station

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Authors: Ali Nour El Hajj

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Background: The perennial deficiencies of the failure models in the materials field have profoundly and significantly impacted all associated technical fields that depend on accurate failure predictions. Many preeminent and well-known scientists from an earlier era of groundbreaking discoveries attempted to solve the issue of material failure. However, a thorough understanding of material failure has been frustratingly elusive. Objective: The heart of this study is the presentation of a methodology that identifies a newly derived one-parameter criterion as the only general failure theory for noncompressible, homogeneous, and isotropic materials subjected to multiaxial states of stress and various boundary conditions, providing the solution to this longstanding problem. This theory is the counterpart and companion piece to the theory of elasticity and is in a formalism that is suitable for broad application. Methods: Utilizing advanced finite-element analysis, the maximum internal breaking stress corresponding to the maximum applied external force is identified as a unified and universal material failure criterion for determining the structural capacity of any system, regardless of its geometry or architecture. Results: A comparison between the proposed criterion and methodology against design codes reveals that current provisions may underestimate the structural capacity by 2.17 times or overestimate the capacity by 2.096 times. It also shows that existing standards may underestimate the structural capacity by 1.4 times or overestimate the capacity by 2.49 times. Conclusion: The proposed failure criterion and methodology will pave the way for a new era in designing unconventional structural systems composed of unconventional materials.

Keywords: failure criteria, strength theory, failure mechanics, materials mechanics, rock mechanics, concrete strength, finite-element analysis, mechanical engineering, aeronautical engineering, civil engineering

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Authors: Yu Chen

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This paper investigates the influence of flaw on failure process of rock-like material under uniaxial compression. In laboratory, the uniaxial compression tests of intact specimens and a series of specimens within single flaw were conducted. The inclination angle of flaws includes 0°, 15°, 30°, 45°, 60°, 75° and 90°. Based on the laboratory tests, the corresponding models of numerical simulation were built and loaded in PFC2D. After analysing the crack initiation and failure modes, deformation field, and energy mechanism for both laboratory tests and numerical simulation, it can be concluded that the influence of flaws on the failure process is determined by its inclination. The characteristic stresses increase as flaw angle rising basically. The tensile cracks develop from gentle flaws (α ≤ 30°) and the shear cracks develop from other flaws. The propagation of cracks changes during failure process and the failure mode of a specimen corresponds to the orientation of the flaw. A flaw has significant influence on the transverse deformation field at the middle of the specimen, except the 75° and 90° flaw sample. The input energy, strain energy and dissipation energy of specimens show approximate increase trends with flaw angle rising and it presents large difference on the energy distribution.

Keywords: failure pattern, particle deformation field, energy mechanism, PFC

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Authors: Itsuo Yokoyama, Rikako Kikuti, Naoko Watabe, Tosinori Asai, Sarai Tsuyoshi

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Introduction: Chronic kidney disease presents significant changes in mineral and bone metabolism, referred to as CKD-MBD. These changes lead to decreased bone mass, heightened bone fragility, fractures, and increased vascular and valvular calcification, ultimately impacting cardiovascular outcomes. Key contributors to these complications in dialysis patients include calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and the vitamin D hormonal system. Methods: In our outpatient dialysis clinic, we monitor the long-term effects of vascular calcifications by calculating the volume of calcified areas in the abdominal aorta based on CT scan data. The results revealed a progressive nature of vascular calcification. To extend our study, we measured the volume of calcification in bones (vertebrae and femur) corresponding to Hounsfield units of 200 and 300. The study aims to investigate changes in osteoporosis during a 5-year follow-up period and its relationship with extraosseous calcification. Results and Considerations: While extraosseous calcification demonstrated a generally progressive nature, often resistant to medical treatment, the degree of osteoporotic change varied among patients. The majority exhibited continuous osteoporotic changes, while some showed improvement or minimal changes in bone calcification. Variations in the distribution and magnitude of osteoporotic changes were observed between groups based on the timing of hemodialysis initiation during the study. The former group tended to display more osteoporotic changes, possibly attributed to differences in medication between the groups. Other contributing factors may include the patient's age, duration of dialysis, or causes of renal disease. In conclusion, we emphasize the importance of carefully monitoring calcium and phosphate levels and maintaining adequate dialysis therapy to prevent osteoporosis in dialysis patients.

Keywords: CKD-MBD, dialysis, calcification, kidney

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Authors: Abderafi Charki, David Bigaud

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The aim of this oral speach is to present the PVMODREL© (PhotoVoltaic MODule RELiability) new software developed in the University of Angers. This new tool permits us to evaluate the lifetime and reliability of a PV module whatever its geographical location and environmental conditions. The electrical power output of a PV module decreases with time mainly as a result of the effects of corrosion, encapsulation discoloration, and solder bond failure. The failure of a PV module is defined as the point where the electrical power degradation reaches a given threshold value. Accelerated life tests (ALTs) are commonly used to assess the reliability of a PV module. However, ALTs provide limited data on the failure of a module and these tests are expensive to carry out. One possible solution is to conduct accelerated degradation tests. The Wiener process in conjunction with the accelerated failure time model makes it possible to carry out numerous simulations and thus to determine the failure time distribution based on the aforementioned threshold value. By this means, the failure time distribution and the lifetime (mean and uncertainty) can be evaluated. An example using the damp heat test is shown to demonstrate the usefulness PVMODREL.

Keywords: lifetime, reliability, PV Module, accelerated life testing, accelerated degradation testing

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Authors: Lalit Kishore, Randhir Singh

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Diabetic nephropathy (DN) is the major cause of morbidity among diabetic patients. In this study, the effect of Bacopa monnieri Linn. (Brahmi, BM), was studied in a Streptozotocin (STZ)-induced experimental rat model of DN. Diabetic nephropathy was induced in Male Wistar rats (body weight- 300± 10 gms) by single intra-peritoneal injection of STZ (45mg/kg, i.p.) after 15 min of Nicotinamide (230 mg/kg) administration. Different doses of alcoholic extract i.e. 100, 200 and 400 mg/kg was given for 45 days by oral gavage after induction of DN. Blood glucose level, serum insulin, glycosylated haemoglobin, renal parameters (serum urea, uric acid, creatinine and BUN) and lipid profile (total cholesterol, triglycerides, HDL, LDL and VLDL levels) were measured. Concentration of thiobarbituric acid reactive species (TBARS) and levels of antioxidant enzymes of reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were evaluated in the kidney, liver and pancreas. At the end of treatment period the alcoholic extract of BM reduced the elevated level of blood glucose, serum insulin, renal parameters, lipid levels, TBARS, AGE’s in kidney and significantly increased body weight, HDL and antioxidant enzymes in dose dependent manner as compared to diabetic control animals. These results suggested the BM possesses significant renoprotective activity.

Keywords: AGE's, lipid profile, oxidative stress, renal parameters

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Authors: A. Falsafi, M. Dadkhah, S. Shahidi

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The destruction and defeat of drill pipes and drill rigs in oil wells often combined with a combination of shear modulus II and III. In such a situation, the strength and load bearing capacity of the drill are evaluated based on the principles of fracture mechanics and crack growth criteria. In this paper, using the three-dimensional stress equations around the Turkish frontier, the relations of the tense-tense criterion (MTS) are extracted for the loading of the combined II and III modulus. It is shown that in crisp deflection under loading of combination II and III, the level of fracture is characterized by two different angles: the longitudinal angle of deflection θ and the angle of the deflection of the alpha. Based on the relationships obtained from the MTS criterion, the failure criteria, the longitudinal angle of the theta failure and the lateral angle of the failure of the alpha are presented. Also, the role of Poisson's coefficient on these parameters is investigated in these graphs.

Keywords: most tangential tension criterion, longitudinal angle of failure, side angle of fracture, drills crack

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Authors: Alex Hughes

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Patients with advanced heart failure develop specific palliative care needs due to the progressive symptom burden and unpredictable disease trajectory. NICE guidance advises that palliative care should be provided to patients with both cancer and non-cancer conditions as and when required. However, there is some way to go before this guidance is consistently and effectively implemented nationwide in conditions such as heart failure. The Ambitions for Palliative and End of Life Care: A national framework for local action in England provides a set of foundations and ambitions which outline a vision for what high-quality palliative and end-of-life care look like in England. This poster aims to critically consider how to improve access to palliative care for heart failure patients in England by analysing the foundations taken from this framework to generate specific recommendations using Soft Systems Methodology (SSM). The eight foundations analysed are: ‘Personalised care planning’, ‘Shared records’, ‘Evidence and information’, ‘Involving, supporting and caring for those important to the dying Person’, ‘Education and training’, ‘24/7 access’, ‘Co-design’ and ‘Leadership.’ A number of specific recommendations have been generated which highlight a need to close the evidence-policy gap and implement policy with sufficient evidence. These recommendations, alongside the creation of an evidence-based national strategy for palliative care and heart failure, should improve access to palliative care for heart failure patients in England. Once implemented, it will be necessary to evaluate the effect of these proposals to understand if access to palliative care for heart failure patients actually improves.

Keywords: access, health systems, heart failure, palliative care

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Authors: M. S. Meon, M. N. Rao, K-U. Schröder

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Mechanical fasteners especially bolting is commonly used in joining carbon-fiber reinforced polymer (CFRP) composite structures due to their good joinability and easy for maintenance characteristics. Since this approach involves with notching, a proper progressive damage model (PDM) need to be implemented and verified to capture existence of damages in the structure. A three dimensional (3D) failure criteria of Puck is established to predict the ultimate bearing failure of such joint. The failure criteria incorporated with degradation scheme are coded based on user subroutine executed in Abaqus. Single lap joint (SLJ) of composite bolted joint is used as target configuration. The results revealed that the PDM adopted here could sufficiently predict the behaviour of composite bolted joint up to ultimate bearing failure. In addition, mesh refinement near holes increased the accuracy of predicted strength as well as computational effort.

Keywords: bearing strength, bolted joint, degradation scheme, progressive damage model

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Authors: Fidelis E. Uwumiro, Chimaobi O. Nwevo, Favour O. Osemwota, Victory O. Okpujie, Emeka S. Obi, Omamuyovbi F. Nwoagbe, Ejiroghene Tejere, Joycelyn Adjei-Mensah, Christopher N. Ekeh, Charles T. Ogbodo

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Several risk factors associated with cardiovascular events have been identified as specific to Chronic Kidney Disease (CKD). This study endeavors to validate these CKD-specific risk factors using up-to-date national-level data, thereby highlighting the crucial significance of confirming the validity and generalizability of findings obtained from previous studies conducted on smaller patient populations. The study utilized the nationwide inpatient sample database to identify adult hospitalizations for CKD from 2016 to 2020, employing validated ICD-10-CM/PCS codes. A comprehensive literature review was conducted to identify both traditional and CKD-specific risk factors associated with cardiovascular events. Risk factors and cardiovascular events were defined using a combination of ICD-10-CM/PCS codes and statistical commands. Only risk factors with specific ICD-10 codes and hospitalizations with complete data were included in the study. Cardiovascular events of interest included cardiac arrhythmias, sudden cardiac death, acute heart failure, and acute coronary syndromes. Univariate and multivariate regression models were employed to evaluate the association between chronic kidney disease-specific risk factors and cardiovascular events while adjusting for the impact of traditional CV risk factors such as old age, hypertension, diabetes, hypercholesterolemia, inactivity, and smoking. A total of 690,375 hospitalizations for CKD were included in the analysis. The study population was predominantly male (375,564, 54.4%) and primarily received care at urban teaching hospitals (512,258, 74.2%). The mean age of the study population was 61 years (SD 0.1), and 86.7% (598,555) had a CCI of 3 or more. At least one traditional risk factor for CV events was present in 84.1% of all hospitalizations (580,605), while 65.4% (451,505) included at least one CKD-specific risk factor for CV events. The incidence of CV events in the study was as follows: acute coronary syndromes (41,422; 6%), sudden cardiac death (13,807; 2%), heart failure (404,560; 58.6%), and cardiac arrhythmias (124,267; 18%). 91.7% (113,912) of all cardiac arrhythmias were atrial fibrillations. Significant odds of cardiovascular events on multivariate analyses included: malnutrition (aOR: 1.09; 95% CI: 1.06–1.13; p<0.001), post-dialytic hypotension (aOR: 1.34; 95% CI: 1.26–1.42; p<0.001), thrombophilia (aOR: 1.46; 95% CI: 1.29–1.65; p<0.001), sleep disorder (aOR: 1.17; 95% CI: 1.09–1.25; p<0.001), and post-renal transplant immunosuppressive therapy (aOR: 1.39; 95% CI: 1.26–1.53; p<0.001). The study validated malnutrition, post-dialytic hypotension, thrombophilia, sleep disorders, and post-renal transplant immunosuppressive therapy, highlighting their association with increased risk for cardiovascular events in CKD patients. No significant association was observed between uremic syndrome, hyperhomocysteinemia, hyperuricemia, hypertriglyceridemia, leptin levels, carnitine deficiency, anemia, and the odds of experiencing cardiovascular events.

Keywords: cardiovascular events, cardiovascular risk factors in CKD, chronic kidney disease, nationwide inpatient sample

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Authors: Saleh N. Maodaa

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Perinatal exposure to nicotine imbalances the redox status in newborns. This study investigated the effect of Anethum graveolens (dill) extract on oxidative stress and tissue injury in the liver and kidney of mice newborns exposed to nicotine perinatally. Pregnant mice received nicotine (0.25 mg/kg) on gestational day 12 to day 5 after birth and/or A. graveolens extract on a gestational day 1 to day 15 after birth. Newborn mice exposed to nicotine showed multiple histopathological alterations in the kidney and liver, including inflammatory cell infiltration and degenerative changes. Nicotine exposure increased hepatic and renal reactive oxygen species (ROS), lipid peroxidation, tumor necrosis factor (TNF-_), interleukin-6 (IL-6), and inducible nitric oxide synthase (iNOS) (p < 0.001), and decreased antioxidant defenses (p < 0.001). A. graveolens supplementation significantly prevented liver and kidney injury, suppressed ROS generation (p < 0.001), lipid peroxidation (p < 0.001), and inflammatory response (p < 0.001), and enhanced antioxidant defenses. In addition, A. graveolens upregulated hepatic and renal Nrf2 and HO-1 mRNA and increased HO-1 activity in normal and nicotine-exposed mice. In conclusion, A. graveolens protects against perinatal nicotine-induced oxidative stress, inflammation, and tissue injury in the liver and kidney of newborn mice. A. graveolens upregulated hepatic and renal Nrf2/HO-1 signaling and enhanced antioxidant defenses in mice.

Keywords: dill, oxidative stress, cytokines, nicotine

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Authors: Luthfi Assholam Solamat

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Nowadays many people do not know the soil failure pattern as an important part in planning the under structure caused by the loading occurs. This is because the soil is located under the foundation, so it cannot be seen directly. Based on this study, the idea occurs to do a study for testing the soil failure pattern, especially the type of sand soil under the foundation. The necessity of doing this to the design of building structures on the land which is the initial part of the foundation structure that met with waves/vibrations during an earthquake. If the underground structure is not strong it is feared the building thereon more vulnerable to the risk of building damage. This research focuses on the search of soil failure pattern, which the most applicable in the field with the loading periodic re-testing of a particular time with the help of the integrated video visual observations performed. The results could be useful for planning under the structure in an effort to try the upper structure is minimal risk of the earthquake.

Keywords: soil failure pattern, earthquake, under structure, sand soil testing method

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Authors: Vijay Vir Singh

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In this paper, we focus on the reliability and performance analysis of Computer Centre (CC) at Yobe State University, Damaturu, Nigeria. The CC consists of three servers: one database mail server, one redundant and one for sharing with the client computers in the CC (called as local server). Observing the different possibilities of functioning of the CC, analysis has been done to evaluate the various reliability characteristics of the system. The system can completely fail due to failure of router, redundant server before repairing the mail server, and switch failure. The system can also partially fail when local server fails. The system can also fail completely due to a cooling failure, electricity failure or some natural calamity like earthquake, fire etc. All the failure rates are assumed to be constant while repair follows two types of distributions: general and Gumbel-Hougaard family copula.

Keywords: reliability, availability Gumbel-Hougaard family copula, MTTF, internet data centre

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Authors: Babu Shersad, Partha Banerjee

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Reduction in haemoglobin levels has been implicated to be a cause for reduced exercise tolerance and cardiovascular complications of chronic renal diseases. Trends of hemoglobin levels in patients on haemodialysis could be an indicator of efficacy of hemodialysis and an indicator of quality of life in haemodialysis patients. In the UAE, the rate of growth (of patients on dialysis) is 10 to 15 per cent per year. The primary mode of haemodialysis in the region is based on in-patient hospital-based hemodialysis units. The increase in risk of cardiovascular and cerebrovascular morbidity as well as mortality in pre-dialysis Chronic Renal Disease has been reported. However, data on the health burden on haemodialysis in standalone dialysis facilities is very scarce. This is mainly due to the paucity of ambulatory centres for haemodialysis in the region. AMSA is the first center to offer standalone dialysis in the UAE and a study over a one year period was performed. Patient data was analyzed using a questionnaire for 45 patients with an average of 2.5 dialysis sessions per week. All patients were on chronic haemodialysis as outpatients. The trends of haemoglobin levels as an independent variable were evaluated. These trends were interpreted in comparison with other parameters of renal function (creatinine, uric acid, blood pressure and ferritin). Trends indicate an increase in hemoglobin levels with increased supplementation of iron and erythropoietin over time. The adequacy of hemodialysis shows improvement concomitantly. This, in turn, correlates with better patient outcomes and has a direct impact on morbidity and mortality. This study is a pilot study and further studies are indicated so that objective parameters can be studied and validated for hemodialysis in the region.

Keywords: haemodialysis, haemoglobin in haemodialysis, haemodialysis parameters, erythropoietic agents in haemodialysis

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Authors: Stephen J Futter, Michael I Okereke

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This paper presents an investigation of the premature in-service failure of the engine mounting towers that form part of the bedframe commonly used for industrial power generation applications. The client during a routine in-service assessment of the generator set observed that the engine mounting towers had cracked. Thus, this study has investigated in detail the origin of the crack and proffered solutions to prevent a re-occurrence. Seven step problem solving methodology was followed during this paper. The study used both experimental and numerical approaches to understand, monitor and evaluate the cause and evolution of the premature failure. Findings from this study indicated that the failure resulted from a combination of varied processes from procurement of material parts, material selection, welding processes and inaptly designed load-bearing mechanics of the generating set and its mounting arrangement. These in-field observations and experimental simulations provided insights to design and validate a numerical finite element sub-model of the cracked bedframe considering thermal cycling: designed as part of these investigations. Resulting findings led to a recommendation of several procedural changes that should be adopted by the manufacturer, in order to prevent the re-occurrence of such pre-mature failure in future industrial applications.

Keywords: Engine, Premature Failure, Failure Analysis, Finite Element Model

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Authors: Stijn Horck

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Background: The value of lessons learned from failure increases when these insights can be put to use by those who did not experience the failure. While learning from others has mostly been researched between individuals or teams within the same environment, transferring knowledge from the person who experienced the failure to an outsider comes with extra challenges. As sense-making of failure is an individual process leading to different learning experiences, the potential of lessons learned from failure is highly variable depending on who is transferring the lessons learned. Using an integrated framework of linguistic aspects related to attributional egotism, this study aims to offer a complete explanation of the challenges in transferring lessons learned from failures that are experienced by others. Method: A case study of a failed foundation established to address the information needs for GPs in times of COVID-19 has been used. An overview of failure causes and lessons learned were made through a preliminary analysis of data collected in two phases with metaphoric examples of failure types. This was followed up by individual narrative interviews with the board members who have all experienced the same events to analyse the individual variance of lessons learned through discourse analysis. This research design uses the researcher-as-instrument approach since the recipient of these lessons learned is the author himself. Results: Thirteen causes were given why the foundation has failed, and nine lessons were formulated. Based on the individually emphasized events, the explanation of the failure events mentioned by all or three respondents consisted of more linguistic aspects related to attributional egotism than failure events mentioned by only one or two. Moreover, the learning events mentioned by all or three respondents involved lessons learned that are based on changed insight, while the lessons expressed by only one or two are more based on direct value. Retrospectively, the lessons expressed as a group in the first data collection phase seem to have captured some but not all of the direct value lessons. Conclusion: Individual variance in expressing lessons learned to outsiders can be reduced using metaphoric or analogical explanations from a third party. In line with the attributional egotism theory, individuals separated from a group that has experienced the same failure are more likely to refer to failure causes of which the chances to be contradicted are the smallest. Lastly, this study contributes to the academic literature by demonstrating that the use of linguistic analysis is suitable for investigating the knowledge transfer from lessons learned after failure.

Keywords: failure, discourse analysis, knowledge transfer, attributional egotism

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Authors: V. V. Singh, Yusuf Ibrahim Gwanda, Rajesh Prasad

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In this paper, we focus on the reliability and performance analysis of Computer Centre (CC) at Yobe State University, Damaturu, Nigeria. The CC consists of three servers: one database mail server, one redundant and one for sharing with the client computers in the CC (called as a local server). Observing the different possibilities of the functioning of the CC, the analysis has been done to evaluate the various popular measures of reliability such as availability, reliability, mean time to failure (MTTF), profit analysis due to the operation of the system. The system can ultimately fail due to the failure of router, redundant server before repairing the mail server and switch failure. The system can also partially fail when a local server fails. The failed devices have restored according to Least Recently Used (LRU) techniques. The system can also fail entirely due to a cooling failure of the server, electricity failure or some natural calamity like earthquake, fire tsunami, etc. All the failure rates are assumed to be constant and follow exponential time distribution, while the repair follows two types of distributions: i.e. general and Gumbel-Hougaard family copula distribution.

Keywords: reliability, availability Gumbel-Hougaard family copula, MTTF, internet data centre

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Authors: Mohammad Javad Esmaeili

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Background: Coagulopathy is one of the complications with end stage renal disease with high prevalence in the world. Thromboelastogram is adynamic test for evaluation of coagulopathy and we have compared our patient's coagulation profiles with the results of TEG. Material and methods: In this study 50 patients with ESRD who were on regular hemodialysis for at least 6 months was selected with simple sampling and their coagulation profile was done with blood sampling and also TEG was done for every patient. Data were analyzed with SPSS and P<0.05 consider significant. Results: Protein s, Protein c and Antithrombin III deficiency was detected in 32%, 16% and 20% of patients and activated protein c resistance was abnormal in 2% of patients. In TEG, R time in 49% and K in 22/5% of patients was lower than normal and a-angle in 26% and maximum amplitude in 36% of patients was upper than normal (Hypercoagulable state). PS with R and ATIII with K have correlation. Conclusion: R time and K in TEG can be a suitable screening test in patients with suspicious to PS and ATIII deficiency.

Keywords: thromboelastography, chronic kidney disease, Coagulating disorder, hemodialysis

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Authors: Oussama Derdous, Lakhdar Djemili, Hamza Bouchahed

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The consequences of a dam breach can be devastating; both in terms of lives lost and damaged infrastructure and property. Hydraulic modeling provides a clear picture of the possible consequences of partial or complete failure of a dam, which is the key to carry out emergency planning and conduct reliable risk assessments. In this paper, the MIKE11 model developed by the Danish Hydrologic Institute (DHI) was used to simulate the flood wave propagation associated with a potential failure analysis failure of Zardezas dam located in the city of Skikda in the North East of Algeria. MIKE11 results including inundation maps and the representative channel/valley cross-sections depicting flow depth and maximal flow velocities showed that Zardezas reservoir presents a significant risk to downstream areas in the event of a dam failure. These results can be used as the basis of the development of an Emergency Action Plan (EAP).The main objective of this plan is to predict the appropriate steps to avoid or at least decrease the consequences of unexpected failure of Zardezas dam.

Keywords: MIKE11, dam break, inundation maps, emergency action plan

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Authors: Shiva Naidoo, Kristena Yossef, Grimm Jimm, Mirza Wasique, Eric Kemmerer, Joshua Obuch, Anand Mahadevan

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Background: Fiducial markers effectively enhance tumor target visibility prior to Stereotactic Body Radiation Therapy or Proton therapy. To streamline clinical practice, fiducial placement guidelines from a robotic radiosurgery vendor were examined with the goals of optimizing and standardizing feasible geometries for each treatment indication. Clinical examples of prostate, renal, and pancreatic cases are presented. Methods: Vendor guidelines (Accuray, Sunnyvale, Ca) suggest implantation of 4–6 fiducials at least 20 mm apart, with at least a 15-degree angular difference between fiducials, within 50 mm or less from the target centroid, to ensure that any potential fiducial motion (e.g., from respiration or abdominal/pelvic pressures) will mimic target motion. Also recommended is that all fiducials can be seen in 45-degree oblique views with no overlap to coincide with the robotic radiosurgery imaging planes. For the prostate, a standardized geometry that meets all these objectives is a 2 cm-by-2 cm square in the coronal plane. The transperineal implant of two pairs of preloaded tandem fiducials makes the 2 cm-by-2 cm square geometry clinically feasible. This technique may be applied for renal cancer, except repositioned in a sagittal plane, with the retroperitoneal placement of the fiducials into the tumor. Pancreatic fiducial placement via endoscopic ultrasound (EUS) is technically more challenging, as fiducial placement is operator-dependent, and lesion access may be limited by adjacent vasculature, tumor location, or restricted mobility of the EUS probe in the duodenum. Fluoroscopically assisted fiducial placement during EUS can help ensure fiducial markers are deployed with optimal geometry and visualization. Results: Among the first 22 fiducial cases on a newly installed robotic radiosurgery system, live x-ray images for all nine prostatic cases had excellent fiducial visualization at the treatment console. Renal and pancreatic fiducials were not as clearly visible due to difficult target access and smaller caliber insertion needle/fiducial usage. The geometry of the first prostate case was used to ensure accurate geometric marker placement for the remaining 8 cases. Initially, some of the renal and pancreatic fiducials were closer than the 20 mm recommendation, and interactive feedback with the proceduralists led to subsequent fiducials being too far to the edge of the tumor. Further feedback and discussion of all cases are being used to help guide standardized geometries and achieve ideal fiducial placement. Conclusion: The ideal tradeoffs of fiducial visibility versus the thinnest possible gauge needle to avoid complications needs to be systematically optimized among all patients, particularly in regards to body habitus. Multidisciplinary collaboration among proceduralists and radiation oncologists can lead to improved outcomes.

Keywords: fiducial, prostate cancer, renal cancer, pancreatic cancer, radiotherapy

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Authors: S. Sreeja, Radhakrishnan R. Nair, Noble Gracious, Sreeja S. Nair, M. Radhakrishna Pillai

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Background: Tacrolimus is a potent immunosuppressant clinically used for the long term treatment of antirejection of transplanted organs in liver and kidney transplant recipients though dose optimization is poorly managed. However, So far no study has been carried out on the South Indian kidney transplant patients. The objective of this study is to evaluate the potential influence of a functional polymorphism in CYP3A5*3 gene on tacrolimus physiological availability/dose ratio in South Indian renal transplant patients. Materials and Methods: Twenty five renal transplant recipients receiving tacrolimus were enrolled in this study. Their body weight, drug dosage, and therapeutic concentration of Tacrolimus were observed. All patients were on standard immunosuppressive regime of Tacrolimus-Mycophenolate mofetil along with steroids on a starting dose of Tac 0.1 mg/kg/day. CYP3A5 genotyping was performed by PCR followed with RFLP. Conformation of RFLP analysis and variation in the nucleotide sequence of CYP3A5*3 gene were determined by direct sequencing using a validated automated generic analyzer. Results: A significant association was found between tacrolimus per dose/kg/d and CYP3A5 gene (A6986G) polymorphism in the study population. The CYP3A5 *1/*1, *1/*3 and *3/*3 genotypes were detected in 5 (20 %), 5 (20 %) and 15 (60 %) of the 25 graft recipients, respectively. CYP3A5*3 genotypes were found to be a good predictor of tacrolimus Concentration/Dose ratio in kidney transplant recipients. Significantly higher L/D was observed among non-expressors 9.483 ng/mL(4.5- 14.1) as compared with the expressors 5.154 ng/mL (4.42-6.5 ) of CYP3A5. Acute rejection episodes were significantly higher for CYP3A5*1 homozygotes compared to patients with CYP3A5*1/*3 and CYP3A5*3/*3 genotypes (40 % versus 20 % and 13 %, respectively ). The dose normalized TAC concentration (ng/ml/mg/kg) was significantly lower in patients having CYP3A5*1/*3 polymorphism. Conclusion: This is the first study to extensively determine the effect of CYP3A5*3 genetic polymorphism on tacrolimus pharmacokinetics in South Indian renal transplant recipients and also shows that majority of our patients carry mutant allele A6986G in CYP3A5*3 gene. Identification of CYP3A5 polymorphism prior to transplantation could contribute to evaluate the appropriate initial dosage of tacrolimus for each patient.

Keywords: kidney transplant patients, CYP3A5 genotype, tacrolimus, RFLP

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Authors: Akram Khaleghei Ghosheh Balagh, Viliam Makis, Leila Jafari

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In this paper, we present a new maintenance model for a partially observable system subject to two failure modes, namely a catastrophic failure and a failure due to the system degradation. The system is subject to condition monitoring and the degradation process is described by a hidden Markov model. A cost-optimal Bayesian control policy is developed for maintaining the system. The control problem is formulated in the semi-Markov decision process framework. An effective computational algorithm is developed and illustrated by a numerical example.

Keywords: partially observable system, hidden Markov model, competing risks, multivariate Bayesian control

Procedia PDF Downloads 426

Authors: Gerard Bray, Derek Mao, Arya Bahadori, Sachinka Ranasinghe

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The EAU currently recommends partial nephrectomy as the preferred management for localised cT1 renal tumours, irrespective of surgical approach. With the advent of robotic assisted partial nephrectomy, there is growing evidence that warm ischaemia time may be reduced compared to the traditional laparoscopic approach. There is still no clear differences between the two approaches with regards to other peri-operative and oncological outcomes. Current limitations in the field denote the lack of single surgeon series to compare the two approaches as other studies often include multiple operators of different experience levels. To the best of our knowledge, this study is the first single surgeon series comparing peri-operative outcomes of robotic assisted and laparoscopic PN. The current study aims to reduce intra-operator bias while maintaining an adequate sample size to assess the differences in outcomes between the two approaches. We retrospectively compared patient demographics, peri-operative outcomes, and renal function derangements of all partial nephrectomies undertaken by a single surgeon with experience in both laparoscopic and robotic surgery. Warm ischaemia time, length of stay, and acute renal function deterioration were all significantly reduced with robotic partial nephrectomy, compared to laparoscopic nephrectomy. This study highlights the benefits of robotic partial nephrectomy. Further prospective studies with larger sample sizes would be valuable additions to the current literature.

Keywords: partial nephrectomy, robotic assisted partial nephrectomy, warm ischaemia time, peri-operative outcomes

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Authors: Rima Al Garni, Emad Al Shdaifat, Sahar Elmetwalli, Mohammad Alzaid, Abdulrahman Alghothayyan, Sara Al Abd Al Hai, Seham Al Rashidi

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Aim: To investigate the prevalence of non-adherence of patients on haemodialysis and explore their perception of the importance of adherence to the therapeutic regime and estimate the predictors for adherence to the therapeutic regime. Background: End-stage renal disease is commonly treated by haemodialysis. Haemodialysis treatment alone is not effective in replacing kidney function. Diet and fluid restrictions, along with supplementary medications, are mandatory for the survival and well-being of patients. Hence, adherence to this therapeutic regimen is essential. However, non-adherence to diet and fluid restrictions, medications, and dialysis is common among patients on haemodialysis. Design: Descriptive cross-sectional method was applied to investigate the prevalence of non-adherence to treatment, including adherence to diet and fluid restrictions, medications, and dialysis sessions. Methods: Structured interviews were conducted using the Arabic version of the End-Stage Renal Disease Adherence Questionnaire. The sample included 230 patients undergoing haemodialysis in the Eastern Region of Saudi Arabia. Data were analysed using descriptive statistics and multiple regressions. Results/Findings: Most patients had good adherence (71.3%), and only 3.9% had poor adherence. The divorced or widowed patient had higher adherence compared with single (P=0.011) and married participants (P=0.045) through using the post hoc test. Patients above 60 years had higher adherence compared to patients below 40 years old (P=0.016) using the post hoc test. For the perception of the importance of adherence to the therapeutic regime subscale, two-thirds of the patients had lower scores (<=11). Conclusion: Adherence to therapeutic regime is high for three fourth of patients undergoing haemodialysis in the Eastern Region of Saudi Arabia; this finding is similar to results abstracted from the local literature. This result would help us highlight the needs of patients who are not compliant with their treatment plans and investigate the consequences of non-adherence on their well-being and general health. Hence, plan individualised therapeutic programmes that could raise their awareness and influence their adherence to therapeutic regimes.

Keywords: adherence to treatment, haemodialysis, end stage renal disease, diet and fluid restrictions

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Authors: Baby Tabassum, Priya Bajaj

Abstract:

Cadmium is the second most hazardous heavy metal occurring in both elemental as well as compound forms. It is a highly toxic metal with a very high bio-concentration factor (BCF>100). WHO permitted groundwater cadmium concentration is 0.005 mg/L only, but reality is far away from this limit. A number of natural and anthropogenic industrial activities contribute to the spread of cadmium into the environment. The present study had been designated to find out the renal changes at functional level after cadmium intoxication and protection against these changes offered by Mentha piperata. For the purpose, albino rats were selected as the model organism. Cadmium significantly increases the serum level of serum proteins and nitrogenous wastes showing reduced filtration rate of kidneys. Pretreatment with Mentha piperata leaf extract causes significant retention of these levels to normalcy. These findings conclude that Cadmium exposure affects renal functioning but Mentha could prevent it, proving its nephro-protective potential against heavy metal toxicity.

Keywords: albino rat, cadmium, Mentha piperata, nephrotoxicity

Procedia PDF Downloads 363