Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Adherence to Physical Measures during the SARS-COV2 Pandemic by Haemodialysis Patients in a Burkina Faso Tertiary Hospital: A Cross-Sectional Survey

Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures against SARS-Cov2 in haemodialysis patients. Methods and Material: From 13 to 19 July 2021, we administered the questionnaire to haemodialysis patients during or immediately after the dialysis session. The dependent variables were adherence to wearing masks, hand washing outside the dialysis centre, social distancing of at least 1.5 meters, and cough and sneeze hygiene. Statistical Analysis Used: Data were analyzed using Epi info software;descriptive statistics were presented as mean, headcount, and percentage;related factors were determined by multi-logistic regression. The significance level was 5%. The Health Research Ethics Committee approved the research protocol. Results: 142 patients were included (mean age: 42.5 ± 14 years). Wearing masks, hand-washing, social distancing, and coughing and sneezing hygiene were observed by 88%, 75%, 47%, and 60% of patients, respectively. Conclusion: Wearing masks was the most respected physical measure, while social distancing was the least respected.

Clinical Evaluation of Two Interferon-Gamma Release Assays for Diagnostic Tests of Tuberculosis Infection in a Tertiary Hospital: Clinical Evaluation of Two IGRAs for TB Infection

Background: The aim of this study was to evaluate the usefulness of two interferon-gamma release assays (IGRAs) (QuantiFERON-TB Plus (QFT-plus) and T-SPOT.TB assay) for patients suspected of having tuberculosis (TB) infection as supportive methods for diagnosing TB. Patients and Methods: The subjects consisted of 45 patients who required clinical differentiation of TB disease from June 2019 to August 2023. The final clinical diagnoses were: 14 patients with active TB disease, 4 with latent TB infection (LTBI), 17 with old (cured) TB disease, and 10 with pulmonary nontuberculous mycobacterial (NTM) disease. We used the two IGRAs for these patients and evaluated the data according to the manufacturer’s guidelines for interpretation or FDA-approved cutoffs. Results: Among the total of 14 patients with active TB disease (mean age: 64 years old, male: 9, and female: 5), a positive response was noted in 10 patients (71%) on QFT-plus and 9 (64%) on T-SPOT.TB. Four patients with a negative response on QFT-plus and T-SPOT.TB were elderly or cancer patients with lymphocytopenia or hypoalbuminemia. All four patients with LTBI showed a positive response (100%) on both QFT-plus and T-SPOT.TB. Among the seventeen patients with old (cured) TB disease, a positive response was noted in 8 patients (47%) on QFT-plus and 9 (53%) on T-SPOT.TB. All patients with pulmonary NTM disease showed a negative response on both QFT-plus and T-SPOT.TB. Conclusions: A false-negative response on QFT-plus as well as T-SPOT.TB was recognized in elderly patients and patients with an immunosuppressed condition, and half of patients with old (cured) TB showed no negative conversion after the completion of treatment through this study. Although it was recently reported that the positive response rate on QFT-plus of patients with active TB disease was high, we consider it necessary to be careful in diagnosing TB infection using IGRAs for patients with severe underlying diseases in a tertiary hospital based on the results.

System Assimilation of E-Skills in Tertiary Institutions to Empower Graduates in South Africa

The value of system assimilation is to improve working relationships between tutors and learners while increasing workflow efficiency among tertiary institutions with low operational costs. E-skills could be described as electronic education development, to assist ICT professionals to reach their future career goals and aim to help users boost their ICT skills. In a society that is expanding, it is also a crucial issue to take into account. Researchers have turned their attention to this topic because of its significance and contribution to the empowerment of graduates in digital education. Many scholars have proposed many methods for integrating e-skills into society with impressive results, but the rising rate of graduate unemployment in South Africa is gradually becoming a big worry in our society. A model based on Activity Theory (AT) and e-skills will be developed in our tertiary institution to equip graduates with skills that will increase their employability and provide more individualized work opportunities as part of this study’s effort to solve this issue. With the use of the Statistical Package for the Social Sciences (SPSS) and Cronbach’s Alpha for validity and reliability testing, the study will create an experimental performance to assess the approach taken to measure e-skills in tertiary institutions to empower graduates in South Africa. The study established that system development and e-skilled models for tertiary institutions are growing gradually, especially in South African institutions, that empower graduates with profitable employability with experiences to improve work operation in the industries. In conclusion, system development and e-skills are very demanding but important to empower graduate employability to determine competency in the professional workforce.

Is“Intelligence”More Capable of Promoting the Development of the Tertiary Industry?-Analysis of the Impact of Artificial Intelligence on Different Categories of Industries

In the new scientific and technological revolution round,artificial intelligence(AI)technology has become a key leading force for industrial change.Research shows that AI not only promoted technical transformation and industry upgrades but also played a significant role in the rapid development of emerging industries.Based on the installed number of industrial robots and the industrial data by the National Bureau of Statistics,this study establishes a theoretical framework with the econometric model and compares the impact of AI on different categories of industries through empirical analysis.Our results show that AI not only promotes economic growth but also plays a key role in promoting the tertiary industry.Hence,optimization of industrial structure and economic upgrade can be induced.

Dynamics simulation of tertiary amines adsorbing on kaolinite(001) plane

The collecting power of tertiary amines（DRN,DEN and DPN） on kaolinite follows the order of DENDPNDRN.After reacting with DRN,DEN and DPN,the surface potentials of kaolinite increase remarkably,and the recruitments caused by collectors also follow the order of DENDPNDRN.The results of dynamics simulation show that the geometries of substituent groups bonding to N are deflected and twisted,and some of bond angles are changed when tertiary amines cations adsorb on kaolinite（001） surface.Based on the results of dynamics simulations and quantum chemistry calculations,the electrostatic forces between three tertiary amines cations and 4×4×3（001） plane of kaolinite are 1.38×10？7 N（DRN12H＋）,1.44×10-6 N（DEN12H＋）,1.383×10-6 N（DPN12H＋）,respectively.

Isolation and Identification of Eleven Tertiary Alkaloidsin Corydalis decumbens

Eleven tertiarv alkaloids were isolated from Corvdalis decumbens rhizome Their structures were identified as protopine(Ⅶ),allocryptopine(Ⅷ),cryptopine (Ⅸ),muramine(ⅩⅦ);(+)-tetrahydropalmatine(Ⅲ),(+)-kikemanine (Ⅳ),(一)-scoulerine (ⅩⅧ),(十)-bulbo- capnine (ⅩⅨ),and(一)一capnoidine(Ⅰ),(一)一bicuculline(Ⅴ),(+) coriumidine(ⅩⅣ), respecti vely。 Among these,cryptopine,muramine,(+)-kikemanine,(-)-scoulerine,(一)capnoidine,(一)一bicuculline were isolated for the first time from this plant

CRETACEOUS-TERTIARY DESERTS IN SOUTHWESTERN CHINA AND DESERT SEDIMENTOLOGY

The special issue deals with the Cretaceous-Tertiary deserts in southwestern China and relevant sedimentological problems about deserts. The study area is located between 101°10＇- 107°00＇E and 28°00＇-30°40′ N. The ancient desert study is so little in China that there has not been a systematic report about it up to now. Based on the study in many ways on Cretaceous-Tertiary deserts in southwestern China, plentiful data have been obtained. Though it is still a bit rough, the study is a good beginning of the ancient desert study in China. The main ideas and conclusions are summarized as follows.

A Comparative Study of Chinese and Western Conceptions of Effective Teaching in Tertiary Education

Effective teaching has always been a goal pursued by teachers as a part of education both from the western and eastern society,for it to some extend is considered an effective way to improve society.In this essay,both Chinese and western conceptions of teaching and learning will be discussed.In doing so,their differences and similarities can be seen clearly,which will help the cross-cultural educators to understand their teaching environment and learning styles.

Quantitative Modelling of Multiphase Lithospheric Stretching and Deep Thermal History of Some Tertiary Rift Basins in Eastern China

The stretching process of some Tertiary rift basins in eastern China is characterized by multiphase rifting. A multiple instantaneous uniform stretching model is proposed in this paper to simulate the formation of the basins as the rifting process cannot be accurately described by a simple (one episode) stretching model. The study shows that the multiphase stretching model, combined with the back-stripping technique, can be used to reconstruct the subsidence history and the stretching process of the lithosphere, and to evaluate the depth to the top of the asthenosphere and the deep thermal evolution of the basins. The calculated results obtained by applying the quantitative model to the episodic rifting process of the Tertiary Qiongdongnan and Yinggehai basins in the South China Sea are in agreement with geophysical data and geological observations. This provides a new method for quantitative evaluation of the geodynamic process of multiphase rifting occurring during the Tertiary in eastern China.

Indicators of fatal outcome in severe Plasmodium falciparum malaria:a study in a tertiary-care hospital in Thailand

Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.

Formation and evolution of the tertiary carbonate reefs in the Madura Strait Basin of Indonesia

Analysis of 2 D seismic data over 4 500 km in length from the Madura Strait Basin in the East Java Sea reveals seismic re?ection characteristics of reefs and associated sedimentary bodies, including asymmetrical or symmetrical dome re?ections, slope progradational re?ections, chaotic re?ections and discontinuous strong re?ections inside the reef, which onlap the ?ank of the reef. It is concluded that the developmental paleo-environment of most reefs is mainly conducive to shallow marine carbonate platform facies and platform margin facies, based on well core data, variations in seismic facies and strata thickness.The formation and evolution of all reefs are primarily in?uenced by the tectonic framework of the Madura Strait Basin. Platform margin reefs are principally controlled by two types of structures: one is a series of E-W trending Paleogene normal faults, and the other is an E-W trending Neogene inversion structures. In addition, wave actions, tidal currents and other ocean currents play an accelerated role in sorting, rounding and redeposition for the accumulation and evolution of reefs. Tertiary reefs in the MSB can be divided into four types: 1) an open platform coral reef of Late Oligocene to Early Miocene, 2) a platform margin coral reef controlled by normal faults in Late Oligocene to Early Miocene, 3) a platform margin Globigerina moundreef controlled by a "hidden" inversion structure in Early Pliocene, and 4) a platform margin Globigerina mound-reef controlled by thrust faults in the early Pliocene. Patterns of the formation and evolution of reefs are also suggested.

CRETACEOUS AND TERTIARY BOUNDARY IN THE TINGRI REGION OF SOUTHERN TIBET

Marine uppermost Cretaceous to lowermost Tertiary sequence occurs in the Gamba and Tingri regions of southern Tibet. In previous work, the sequences in both regions were divided into the Zongshan, Jidula and Zhepure Formations (Wan, 1985; Hao and Wan, 1985; Xu, Wan, et al. 1990). The K/T boundary in Gamba was studied by Wan Xiaoqiao (1988). This paper deals with the boundary in the Tingri region. Willems (1993) discussed the Cretaceous to Tertiary sequence in the Tingri region. In his work, the Upper Cretaceous to Lower Tertiary passage beds involved the Zongshan, Zhepure Shanpo, Jidula and Zhepure Shan Formations. The lithologies in the Tingri and Gamba regions are generally comparable, and we describe the boundary sequence in the Tingri region as follows:1\ Zongshan Formation (Campanian—Middle Maastrichtian) Hao and Wan (1985) first described this formation in Tingri. It consists of limestones equivalent to the strata in Gamba. The nomination of the Zongshan formation has been used in both regions. The Formation in Gamba ranges from Campanian to Late Maastrichtian age. In Tingri, however, the upper beds were referred to the Zhepure Shanpo Formation because they are clastic sediments (Willems, 1993). Planktonic foraminifera are abundant, such as Globotruncana spp. and Omphalocyclus sp.

Contrast ultrasound in hepatocellular carcinoma at a tertiary liver center: First Indian experience

AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. METHODS: Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. RESULTS: About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemoembolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2(4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2(4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc.CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions. CONCLUSION: CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.

Depositional Model and Tectonic Evolution of Tertiary Transform-Extensional Basins in Northeast China: Case Study on Yitong and Damintun Grabens

? The formation and evolution of the Tertiary transformextensional basins in Northeast China are controlled by extensional and strikeslidding combinational processes because the giant strikeslip fault system, TanchengLujiang fault, cut through the basement or margin. Two kinds of structural styles have been identified in Northeast China: Yitong and Damintun styles. The former shows a clear asymmetry, in which sediments came mainly from two lateral sides and thick filling sediments were adjacent to the main strikeslip fault. The latter shows symmetry filling, in which sediments came from the long axial ends in addition to from two lateral sides. The tectonic evolution of Tertiary transformextensional basins in Northeast China underwent three stages: Eocene extensional, Oligocene transformextensional and Neogene transpressional stages.

Tertiary Sea Level Changes and Sequence Stratigraphic Framework in East China Sea Shelf Basin

The East China Sea shelf basin is a key area for setting up the sea level changes of Cenozoic in the West Pacific. Based upon the characteristics of seismic reflection, the analysis of sequence stratigraphy and depositional system, the high resolution chronostratigraphic framework has been set up by using the data of micropaleontologic biozone fossils. The relative sea level change curve has been set up by combining analysis of paleoecology, genetic facies, specific sedimentary structures and on lap recognized from the seismic profiles with study of geochemical characteristics. There are 4 2nd order basin cycles showing the long term sea level changes, and 22 3rd order cycles showing short term ones with relative changing ranges of 0-150 m. Transgression and regression showing long term sea level changes bear asymmetric feature, which indicates that the speed of transgression is faster than that of regression. There are a lot of differences when compared with Haq ’s curve. The sequence stratigraphic framework has also been set up and 3 tectonic sequences, 7 supersequences and 19 sequences have been subdivided for Tertiary in the East China Sea shelf basin. On the basis of detailed analysis of genetic facies and log facies, 9 sedimentary systems, 20 depositional assemblages and many genetic facies have also been recognized and investigated. Based on the studies mentioned above, the favorable source and reservoir facies of gas and petroleum are indicated.

Application of Tertiary Amine Cationic Polyacrylamide with High Cationic Degree in Salt-free Dyeing of Reactive Dyes

Tertiary amine cationic polyacrylamide with high cationization degree was used as a new cationic agent to pretreat cotton with dip-pad-bake method. The obtained cationic cotton was dyed with reactive dyes in the ab-sence of electrolyte. The effects of the characteristics of the cationic agent and the pretreatment conditions on dye-ability of reactive dye were investigated. The results showed that the fixation and K/S values of the reactive dyes on the cationic cotton were improved compared with those on the untreated one in the presence of salt. Tests on fast-ness properties of the dyed cotton and fabric quality of the pretreated cotton were carried out and the results showed that wash and rub fastness of the salt-free dyeing were both satisfactory. And anti-crease property,tensile and tear strength,and handling of the cationic cotton were also good compared with that of the untreated one.

Tuning Metallic Co0.85Se Quantum Dots/Carbon Hollow Polyhedrons with Tertiary Hierarchical Structure for High-Performance Potassium Ion Batteries

Potassium-ion batteries(KIBs)are a potential candidate to lithium-ion batteries(LIBs)but possess unsatisfactory capacity and rate properties.Herein,the metallic cobalt selenide quantum dots(Co0.85Se-QDs)encapsulated in mesoporous carbon matrix were designed via a direct hydrothermal method.Specifically,the cobalt selenide/carbon composite(Co0.85Se-QDs/C)possesses tertiary hierarchical structure,which is the primary quantum dots,the secondary petals flake,and the tertiary hollow micropolyhedron framework.Co0.85Se-QDs are homogenously embedded into the carbon petals flake,which constitute the hollow polyhedral framework.This unique structure can take the advantages of both nanoscale and microscale features:Co0.85Se-QDs can expand in a multidimensional and ductile carbon matrix and reduce the K-intercalation stress in particle dimensions;the micropetals can restrain the agglomeration of active materials and promote the transportation of potassium ion and electron.In addition,the hollow carbon framework buffers volume expansion,maintains the structural integrity,and increases the electronic conductivity.Benefiting from this tertiary hierarchical structure,outstanding K-storage performance(402 mAh g?1 after 100 cycles at 50 mA g?1)is obtained when Co0.85Se-QDs/C is used as KIBs anode.More importantly,the selenization process in this work is newly reported and can be generally extended to prepare other quantum dots encapsulated in edge-limited frameworks for excellent energy storage.

TECTONO-SEDIMENTARY EVOLUTION OF THE TERTIARY BASINS IN EASTERN TIBET: CONSTRAINING THE RAISING OF TIBETAN PLATEAU

The Tertiary basins are distributed in the eastern margin of the Tibetan Plateau along the large\|scale arc\|shaped strike\|slip belt of the Qiangtang—Hengduan Shan—Jinshajiang—Red River belt. Most of basins were controlled by regional northwest\| and south\|north treading faults, and a few basins were constrained by northwest\| or north\|north\|east\|treading local faults.The detailed field mapping and sedimentologic observations for 6 typical Tertiary basins in eastern Tibet show that their types include depressive basins, rifting basins, pull\|apart and extensional basins related to strike\|slip faulting, and erosion\|residual basins. Recently, most of them are controlled by compression\| or thrust\|related margin faults in single side or double laterals of these basins. Not\|well\|developed strata in the Tertiary basins were deformed to form various tight folds and thrusts. High\|K magma intruded widely into the basins. The tectono\|sedimentary evolution of the Tertiary basins appears tempo\|spatially inhomogeneous. The preliminary model to interpret the Tertiary basin evolution is described as below.

THE TERTIARY STRATIGRAPHIC SEQUENCE OF YANYUAN BASIN IN THE SOUTHEASTERN MARGIN OF THE QINGHAI—TIBET PLATEAU

The Cenozoic Yanyuan basin is located in the huge Longmenshan—Jinpingshan nappetectonic belt along the eastern margin of the Qinghai—Tibet plateau. The basin is the largest and the best\|preserved intraorogenic basin above 2300m ASL.The basin has deposited different kinds of sediments with 1600m in depth. The early Tertiary strata were first named as Lijiang formation in 1961, and later named as Hongyanzi formation. The later Tertiary strata, the lignite\|bearing strata, were once named as Xigeda formation. Li Yougheng(1978) found some mammal fossils in the strata, so they named it Yanyuan formation. The Hongyanzi Formation which thickness is 1022m can be divided into five members according to the lithologic characters. The first one is mainly made of purplish\|red coarse conglomerates. The composition of gravel mainly consists of limestone and purplish\|red sandstone and marl. The second one consists of sandstone interbedded with conglomerate. The member has three cyclic sequences from conglomerate to sandstone. The composition of gravel of this member is mainly limestone. From bottom to top the degree of sorting and roundness tends to be well. In sandstones or sand lenticules the oblique bedding and trough cross\|bedding can be seen. The third one is the member of sandstone and mudstone. The sandstone is light purple while the mudstone is purplish red. Ripple marks can be seen in the sandstone. The forth one consists of conglomerate interbedded with mudstone, The conglomerate and the sandstone assume three cyclic sequences. The composition of the gravel is chiefly limestone. The fifth one is a member of light purple massive conglomerate. The composition of the gravel is limestone. The imbricate structure can be seen in the conglomerate. The strata belong to later Eocene epoch in accordance with the fossils of mammals, plants and ostracoda in it.