The broad objective of this research was to improve current surface mining practices and reduce negative environmental impact of overburden removal in West Virginia(WV).The specific objectives were to(i)compare conven...The broad objective of this research was to improve current surface mining practices and reduce negative environmental impact of overburden removal in West Virginia(WV).The specific objectives were to(i)compare conventional surface mining method(drilling,blasting,digging,and loading)to a surface miner(SM)method,and(ii)apply the analytical hierarchy process(AHP)to help select the optimal mining method based on production,cost and environmental criteria.The design and the procedures used in this research involve five interrelated modules:(i)rock properties of overburden in WV,(ii)drilling and blasting,(iii)digging and loading,(iv)SM method,and(v)comparative analysis and selection of the optimal mining method by AHP.Results of this research indicate that application of SM method would yield higher cost of overburden removal than conventional mining methods in rocks with a high unconfined compressive strength and abrasivity.A significant advantage of SM method,where applicable,is the elimination of the negative environmental impacts associated with blasting.展开更多
Farming is still an important sector in rural economic development of West Virginia where 44% of the population lives in rural areas and 24% of the land is used for farming. While income earnings, education and employ...Farming is still an important sector in rural economic development of West Virginia where 44% of the population lives in rural areas and 24% of the land is used for farming. While income earnings, education and employment rates are low in rural areas, poverty rates and unemployment are high compared to the urban areas. Thus, in the context of rural development farming is a potential major economic sector where 42% of the people's primary occupation is reported as farming. The objective of this study is to identify and estimate the potential impacts of farm employment in rural economic growth of West Virginia. Data from U.S. Bureau of Labor Statistics and U.S Census Bureau for the period of 1993 to 2008 are used for the empirical analysis. A model derived from the three simultaneous equations of Duncan is used for analysis. Three-Stage Least Squares (3SLS) method using the statistical package of STATA is used for estimation. The results concerning simultaneous relationships with population density growth, per capita income growth, and farm employment growth reveal significant importance of farming in rural economic development of West Virginia. Furthermore, the results indicate the positive impacts of population density, number of people with farming as principal occupation, and crop production on rural farming sector.展开更多
Subalpine dark coniferous forests in the western Sichuan Province of China play an important role in the hydrological processes in the upper reaches of the Yangtze River. Second-growth forests, with different stand su...Subalpine dark coniferous forests in the western Sichuan Province of China play an important role in the hydrological processes in the upper reaches of the Yangtze River. Second-growth forests, with different stand successional stages, have developed as a result of logging over the past 50 years. Forest cover and stand structure changed greatly with concomitant degradation of forest ecosystem functions. To understand how the stand structures of the second-growth forests change during the stand succession process, we analyzed stand structure characteristics and an old-growth state index of the bamboo and moss-forest types. We found that stand structure at the young successional stage featured one-third of the structure characteristics of the old-growth dark coniferous forests,while the structure of the medium-aged stage had reached half the structure of the old-growth state. The two forest types were similar in the rate of development at the young successional stage but differed at the medium-aged stage;the moss-forest type had more advanced development than the bamboo-forest type at the medium-aged successional stage.展开更多
Hypertension is a major public health problem that adversely affects the health status of individuals, families and communities. L-arginine levels of a total of 90 consecutively-recruited hypertensive subjects and 50 ...Hypertension is a major public health problem that adversely affects the health status of individuals, families and communities. L-arginine levels of a total of 90 consecutively-recruited hypertensive subjects and 50 age-matched non-hypertensive controls were studied. Plasma from subjects and control participants were analyzed for L-arginine. The mean values of L-arginine level were significantly lower among the hypertensive subjects which are (174.33 ± 78.31 μmol/L) compared to those of the 50 non-hypertensive controls (237.82 ± 261.16 μmol/L) (p = 0.04). There was no statistically significant difference in the L-arginine levels of hypertensive subjects based on gender, age and ethnici-ty (p = 0.87, 0.23 and 0.57) respectively. The L-arginine level was significantly higher among married hypertensive subjects (181.71 ± 78.17 μmol/L) compared to single or unmarried subjects (130.62 ± 65.99 μmol/L) (p = 0.03). The mean value of L-arginine level was significantly higher among hypertensive subjects with mild blood pressure (187.63 ± 77.93 μmol/L) compared to those with high blood pressure (156.93 ± 76.31 μmol/L). The difference however was not statistically significant (p = 0.05). The findings from this study confirm that the level of L-arginine is lower among hypertensive subjects compared to non-hypertensive controls. Age, gender and ethnicity did not have a significant effect on the L-arginine levels of hypertensive subjects. L-arginine level was significantly lower among single hypertensive patients and those with markedly raised blood pressure. It is recommended the L-arginine supplement be prescribed to hypertensive patient as a prophylactic measure. There is a need to enlighten hypertensive patients in the area on the need to maintain a balanced diet containing sufficient level of L-arginine.展开更多
Building energy performance is a function of numerous building parameters.In this study,sensitivity analysis on twenty parameters is performed to determine the top three parameters that have the most significant impac...Building energy performance is a function of numerous building parameters.In this study,sensitivity analysis on twenty parameters is performed to determine the top three parameters that have the most significant impact on the energy performance of buildings.Actual data from two fully operational commercial buildings were collected and used to develop a building energy model in the Quick Energy Simulation Tool(eQUEST).The model is calibrated using the Normalized Mean Bias Error(NMBE)and Coefficient of Variation of Root Mean Square Error(CV(RMSE))method.The model satisfies the NMBE and CV(RMSE)criteria set by the American Society of Heating,Refrigeration,and Air-Conditioning(ASHRAE)Guideline 14,Federal Energy Management Program(FEMP),and International Performance Measurement and Verification Protocol(IPMVP)for building energy model calibration.The values of the parameters are varied in two levels,and then the percentage change in output is calculated.Fractional factorial analysis on eight parameters with the highest percentage change in energy performance is performed at two levels in a statistical software JMP.For building A,the top 3 parameters from the percentage change method are:Heating setpoint,cooling setpoint and server room.From fractional factorial design,the top 3 parameters are:heating setpoint(p-value=0.00129),cooling setpoint(p-value=0.00133),and setback control(p-value=0.00317).For building B,the top 3 parameters from both methods are:Server room(pvalue=0.0000),heating setpoint(p-value=0.00014),and cooling setpoint(p-value=0.00035).If the best values for all top three parameters are taken simultaneously,energy efficiency improves by 29%for building A and 35%for building B.展开更多
Pavement infrastructure is vital in providing services and links between various sectors of society. Therefore, thepreservation and maintenance of these roads are critical to attaining a pavement network in good condi...Pavement infrastructure is vital in providing services and links between various sectors of society. Therefore, thepreservation and maintenance of these roads are critical to attaining a pavement network in good conditionthroughout its service life. Various performance indicators like the international roughness index (IRI), pavementcondition index (PCI), and present serviceability rating (PSR) have been used by the state department of transportation (DOT) and highway agencies for evaluating pavement surface conditions and planning future maintenance strategies. Limited data availability, multiple distresses depending on region, lack of correlation of thesecondition indices to maintenance strategies, and data collection limitations pose a challenge for applying theseindices to local conditions. This paper compares condition indices of different states for rigid pavements. Further,using a specific condition index for local conditions is also highlighted. For this purpose, five states and theircorresponding condition indices were evaluated and compared to the Michigan DOT distress index (DI). Thesestates include Virginia, Minnesota, North Dakota, Louisiana, and Oregon. The corresponding distresses of eachcondition index were converted to make them compatible with the MDOT DI. This study used the MDOT'spavement management system (PMS) database to evaluate each condition index for 433 rigid pavement sections.Each distress index was plotted against MDOT DI and compared using a paired t-test. Results show that thecondition indices of Virginia and Minnesota are comparable to DI in terms of the Spearman correlation value. Thet-test results show that except for Virgina, condition indices from other states statistically differ from DI.Therefore, one can't use those directly for local conditions in Michigan. This paper presents the evaluation anddata requirements for each condition index and its impact on selecting a maintenance treatment.展开更多
As government agencies continue to tighten emissions regulations due to the continued increase in greenhouse gas production, automotive industries are seeking to produce increasingly efficient vehicle technology. Hybr...As government agencies continue to tighten emissions regulations due to the continued increase in greenhouse gas production, automotive industries are seeking to produce increasingly efficient vehicle technology. Hybrid electric vehicles (HEVs) have been introduced to mitigate problems while improving fuel economy. HEVs have led to the demand of creating more advanced controls software to consider multiple components for propulsive power in a vehicle. A large section in the software development process is the implementation of an optimal energy management strategy meant to improve the overall fuel efficiency of the vehicle. Optimal strategies can be implemented when driving conditions are known a prior. The Equivalent Consumption Minimization Strategy (ECMS) is an optimal control strategy that uses an equivalence factor to equate electrical to mechanical power when performing torque split determination between the internal combustion engine and electric motor for propulsive and regenerative torque. This equivalence factor is determined from offline vehicle simulations using a sensitivity analysis to provide optimal fuel economy results while maintaining predetermined high voltage battery state of charge (SOC) constraints. When the control hierarchy is modified or different driving styles are applied, the analysis must be redone to update the equivalence factor. The goal of this work is to implement a fuzzy logic controller that dynamically updates the equivalence factor to improve fuel economy, maintain a strict charge sustaining window of operation for the high voltage battery, and reduce computational time required during algorithm development. The adaptive algorithm is validated against global optimum fuel economy and charge sustaining results from a sensitivity analysis performed for multiple drive cycles. Results show a maximum fuel economy improvement of 9.82% when using a mild driving style and a 95% success rate when maintaining an ending SOC within 5% of the desired SOC regardless of starting SOC.展开更多
BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and imp...BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.展开更多
This work explores the axiology of consciousness in Mocombe’s consciousness field in the material world.The paper critically assesses Mocombe’s consciousness field theory(CFT)within the larger body of contemporary o...This work explores the axiology of consciousness in Mocombe’s consciousness field in the material world.The paper critically assesses Mocombe’s consciousness field theory(CFT)within the larger body of contemporary ontological debates regarding the nature,origin,and constitution of consciousness in the universe.The work goes on to highlight the manifestation of Mocombe’s consciousness field in the material resource framework that is the earth,and the nature and origins of ethics and values.展开更多
This work argues that Denmark Vesey,Nat Turner,Gabriel Prosser,David Walker,Henry Highland Garnet,amongst a few others were the reactionary(dialectical)exceptions to the black church,not the norm,an(ideological)instit...This work argues that Denmark Vesey,Nat Turner,Gabriel Prosser,David Walker,Henry Highland Garnet,amongst a few others were the reactionary(dialectical)exceptions to the black church,not the norm,an(ideological)institution established to interpellate and indoctrinate blacks to accept their conditions in slavery.In other words,the aforementioned were the enslaved who used Christian dogma to(negative dialectically)respond to the barbarity of slavery by violently convicting white Christian society for not living up to its values,ideas,and ideals given the treatment of African people by so-called Christians.In the latter sense it was reactionary;in the former,it was an ideological apparatus of domination and control for the institution of slavery.The contemporary attempt to racially vindicate the black church as a sui generis revolutionary institution overflowing with Africanisms is ahistorical and ideological reaped in pseudoscientific propositions stemming from postmodern and post-structural theories.展开更多
Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing ...Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing cells lead to increased cell turnover which exceeds the kidneys’ ability to adequately filtrate by-products of cellular breakdown (i.e., phosphate, potassium, anduric acid), leading to end organ damage. It has been reported in the past that kidney failure is a sequelae of Tumor Lysis Syndrome (TLS), but there have been no reports that demonstrate acute kidney injury (AKI) preceding TLS. The case presented here demonstrates TLS in a patient with no formal cancer diagnosis, who had received no chemotherapy or radiation that was precipitated by an iatrogenic AKI with chlorthalidone and ibuprofen. This unusual pattern of AKI preceding STLS may provide insight into the pathophysiology of the condition and could possibly lead to greater understanding of this phenomenon.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warranted to investigate and mitigate modifiable risk factors.展开更多
基金The research work in this paper is financially supported by the West Virginia Coal and Energy Research Bureau(CERB).
文摘The broad objective of this research was to improve current surface mining practices and reduce negative environmental impact of overburden removal in West Virginia(WV).The specific objectives were to(i)compare conventional surface mining method(drilling,blasting,digging,and loading)to a surface miner(SM)method,and(ii)apply the analytical hierarchy process(AHP)to help select the optimal mining method based on production,cost and environmental criteria.The design and the procedures used in this research involve five interrelated modules:(i)rock properties of overburden in WV,(ii)drilling and blasting,(iii)digging and loading,(iv)SM method,and(v)comparative analysis and selection of the optimal mining method by AHP.Results of this research indicate that application of SM method would yield higher cost of overburden removal than conventional mining methods in rocks with a high unconfined compressive strength and abrasivity.A significant advantage of SM method,where applicable,is the elimination of the negative environmental impacts associated with blasting.
文摘Farming is still an important sector in rural economic development of West Virginia where 44% of the population lives in rural areas and 24% of the land is used for farming. While income earnings, education and employment rates are low in rural areas, poverty rates and unemployment are high compared to the urban areas. Thus, in the context of rural development farming is a potential major economic sector where 42% of the people's primary occupation is reported as farming. The objective of this study is to identify and estimate the potential impacts of farm employment in rural economic growth of West Virginia. Data from U.S. Bureau of Labor Statistics and U.S Census Bureau for the period of 1993 to 2008 are used for the empirical analysis. A model derived from the three simultaneous equations of Duncan is used for analysis. Three-Stage Least Squares (3SLS) method using the statistical package of STATA is used for estimation. The results concerning simultaneous relationships with population density growth, per capita income growth, and farm employment growth reveal significant importance of farming in rural economic development of West Virginia. Furthermore, the results indicate the positive impacts of population density, number of people with farming as principal occupation, and crop production on rural farming sector.
基金supported by the grants from the Chinese National Natural Science Foundation(31160156)the Ministry of Science and Technology(2006BAD03A042012BAD22B01)
文摘Subalpine dark coniferous forests in the western Sichuan Province of China play an important role in the hydrological processes in the upper reaches of the Yangtze River. Second-growth forests, with different stand successional stages, have developed as a result of logging over the past 50 years. Forest cover and stand structure changed greatly with concomitant degradation of forest ecosystem functions. To understand how the stand structures of the second-growth forests change during the stand succession process, we analyzed stand structure characteristics and an old-growth state index of the bamboo and moss-forest types. We found that stand structure at the young successional stage featured one-third of the structure characteristics of the old-growth dark coniferous forests,while the structure of the medium-aged stage had reached half the structure of the old-growth state. The two forest types were similar in the rate of development at the young successional stage but differed at the medium-aged stage;the moss-forest type had more advanced development than the bamboo-forest type at the medium-aged successional stage.
文摘Hypertension is a major public health problem that adversely affects the health status of individuals, families and communities. L-arginine levels of a total of 90 consecutively-recruited hypertensive subjects and 50 age-matched non-hypertensive controls were studied. Plasma from subjects and control participants were analyzed for L-arginine. The mean values of L-arginine level were significantly lower among the hypertensive subjects which are (174.33 ± 78.31 μmol/L) compared to those of the 50 non-hypertensive controls (237.82 ± 261.16 μmol/L) (p = 0.04). There was no statistically significant difference in the L-arginine levels of hypertensive subjects based on gender, age and ethnici-ty (p = 0.87, 0.23 and 0.57) respectively. The L-arginine level was significantly higher among married hypertensive subjects (181.71 ± 78.17 μmol/L) compared to single or unmarried subjects (130.62 ± 65.99 μmol/L) (p = 0.03). The mean value of L-arginine level was significantly higher among hypertensive subjects with mild blood pressure (187.63 ± 77.93 μmol/L) compared to those with high blood pressure (156.93 ± 76.31 μmol/L). The difference however was not statistically significant (p = 0.05). The findings from this study confirm that the level of L-arginine is lower among hypertensive subjects compared to non-hypertensive controls. Age, gender and ethnicity did not have a significant effect on the L-arginine levels of hypertensive subjects. L-arginine level was significantly lower among single hypertensive patients and those with markedly raised blood pressure. It is recommended the L-arginine supplement be prescribed to hypertensive patient as a prophylactic measure. There is a need to enlighten hypertensive patients in the area on the need to maintain a balanced diet containing sufficient level of L-arginine.
基金supported by the National Institutes of Health[Grant Number:3R15NR018547]Praboromrajachanok Institute for Health Workforce Development,Ministry of Public Health,Thailand[Grant number 2/2561]。
基金funded in part by the Industrial Assessment Center Projectsupported by grants fromthe US Department of Energy and by the West Virginia Development Office.
文摘Building energy performance is a function of numerous building parameters.In this study,sensitivity analysis on twenty parameters is performed to determine the top three parameters that have the most significant impact on the energy performance of buildings.Actual data from two fully operational commercial buildings were collected and used to develop a building energy model in the Quick Energy Simulation Tool(eQUEST).The model is calibrated using the Normalized Mean Bias Error(NMBE)and Coefficient of Variation of Root Mean Square Error(CV(RMSE))method.The model satisfies the NMBE and CV(RMSE)criteria set by the American Society of Heating,Refrigeration,and Air-Conditioning(ASHRAE)Guideline 14,Federal Energy Management Program(FEMP),and International Performance Measurement and Verification Protocol(IPMVP)for building energy model calibration.The values of the parameters are varied in two levels,and then the percentage change in output is calculated.Fractional factorial analysis on eight parameters with the highest percentage change in energy performance is performed at two levels in a statistical software JMP.For building A,the top 3 parameters from the percentage change method are:Heating setpoint,cooling setpoint and server room.From fractional factorial design,the top 3 parameters are:heating setpoint(p-value=0.00129),cooling setpoint(p-value=0.00133),and setback control(p-value=0.00317).For building B,the top 3 parameters from both methods are:Server room(pvalue=0.0000),heating setpoint(p-value=0.00014),and cooling setpoint(p-value=0.00035).If the best values for all top three parameters are taken simultaneously,energy efficiency improves by 29%for building A and 35%for building B.
文摘Pavement infrastructure is vital in providing services and links between various sectors of society. Therefore, thepreservation and maintenance of these roads are critical to attaining a pavement network in good conditionthroughout its service life. Various performance indicators like the international roughness index (IRI), pavementcondition index (PCI), and present serviceability rating (PSR) have been used by the state department of transportation (DOT) and highway agencies for evaluating pavement surface conditions and planning future maintenance strategies. Limited data availability, multiple distresses depending on region, lack of correlation of thesecondition indices to maintenance strategies, and data collection limitations pose a challenge for applying theseindices to local conditions. This paper compares condition indices of different states for rigid pavements. Further,using a specific condition index for local conditions is also highlighted. For this purpose, five states and theircorresponding condition indices were evaluated and compared to the Michigan DOT distress index (DI). Thesestates include Virginia, Minnesota, North Dakota, Louisiana, and Oregon. The corresponding distresses of eachcondition index were converted to make them compatible with the MDOT DI. This study used the MDOT'spavement management system (PMS) database to evaluate each condition index for 433 rigid pavement sections.Each distress index was plotted against MDOT DI and compared using a paired t-test. Results show that thecondition indices of Virginia and Minnesota are comparable to DI in terms of the Spearman correlation value. Thet-test results show that except for Virgina, condition indices from other states statistically differ from DI.Therefore, one can't use those directly for local conditions in Michigan. This paper presents the evaluation anddata requirements for each condition index and its impact on selecting a maintenance treatment.
文摘As government agencies continue to tighten emissions regulations due to the continued increase in greenhouse gas production, automotive industries are seeking to produce increasingly efficient vehicle technology. Hybrid electric vehicles (HEVs) have been introduced to mitigate problems while improving fuel economy. HEVs have led to the demand of creating more advanced controls software to consider multiple components for propulsive power in a vehicle. A large section in the software development process is the implementation of an optimal energy management strategy meant to improve the overall fuel efficiency of the vehicle. Optimal strategies can be implemented when driving conditions are known a prior. The Equivalent Consumption Minimization Strategy (ECMS) is an optimal control strategy that uses an equivalence factor to equate electrical to mechanical power when performing torque split determination between the internal combustion engine and electric motor for propulsive and regenerative torque. This equivalence factor is determined from offline vehicle simulations using a sensitivity analysis to provide optimal fuel economy results while maintaining predetermined high voltage battery state of charge (SOC) constraints. When the control hierarchy is modified or different driving styles are applied, the analysis must be redone to update the equivalence factor. The goal of this work is to implement a fuzzy logic controller that dynamically updates the equivalence factor to improve fuel economy, maintain a strict charge sustaining window of operation for the high voltage battery, and reduce computational time required during algorithm development. The adaptive algorithm is validated against global optimum fuel economy and charge sustaining results from a sensitivity analysis performed for multiple drive cycles. Results show a maximum fuel economy improvement of 9.82% when using a mild driving style and a 95% success rate when maintaining an ending SOC within 5% of the desired SOC regardless of starting SOC.
文摘BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.
文摘This work explores the axiology of consciousness in Mocombe’s consciousness field in the material world.The paper critically assesses Mocombe’s consciousness field theory(CFT)within the larger body of contemporary ontological debates regarding the nature,origin,and constitution of consciousness in the universe.The work goes on to highlight the manifestation of Mocombe’s consciousness field in the material resource framework that is the earth,and the nature and origins of ethics and values.
文摘This work argues that Denmark Vesey,Nat Turner,Gabriel Prosser,David Walker,Henry Highland Garnet,amongst a few others were the reactionary(dialectical)exceptions to the black church,not the norm,an(ideological)institution established to interpellate and indoctrinate blacks to accept their conditions in slavery.In other words,the aforementioned were the enslaved who used Christian dogma to(negative dialectically)respond to the barbarity of slavery by violently convicting white Christian society for not living up to its values,ideas,and ideals given the treatment of African people by so-called Christians.In the latter sense it was reactionary;in the former,it was an ideological apparatus of domination and control for the institution of slavery.The contemporary attempt to racially vindicate the black church as a sui generis revolutionary institution overflowing with Africanisms is ahistorical and ideological reaped in pseudoscientific propositions stemming from postmodern and post-structural theories.
文摘Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing cells lead to increased cell turnover which exceeds the kidneys’ ability to adequately filtrate by-products of cellular breakdown (i.e., phosphate, potassium, anduric acid), leading to end organ damage. It has been reported in the past that kidney failure is a sequelae of Tumor Lysis Syndrome (TLS), but there have been no reports that demonstrate acute kidney injury (AKI) preceding TLS. The case presented here demonstrates TLS in a patient with no formal cancer diagnosis, who had received no chemotherapy or radiation that was precipitated by an iatrogenic AKI with chlorthalidone and ibuprofen. This unusual pattern of AKI preceding STLS may provide insight into the pathophysiology of the condition and could possibly lead to greater understanding of this phenomenon.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warranted to investigate and mitigate modifiable risk factors.