Houmannalvarado4158
Hydrogen production through water electrolysis is a promising method to utilize renewable energy in the context of urgent need to phase out fossil fuels. Nickel-molybdenum (NiMo) electrodes are among the best performing non-noble metal-based electrodes for hydrogen evolution reaction in alkaline media (alkaline HER). Albeit exhibiting stable performance in electrolysis at a constant power supply (i.e., constant electrolysis), NiMo electrodes suffer from performance degradation in electrolysis at an intermittent power supply (i.e., intermittent electrolysis), which is emblematic of electrolysis powered directly by renewable energy (such as wind and solar power sources). Here we reveal that NiMo electrodes were oxidized by dissolved oxygen during power interruption, leading to vanishing of metallic Ni active sites and loss of conductivity in MoOx substrate. Based on the understanding of the degradation mechanism, chromium (Cr) coating was successfully applied as a protective layer to inhibit oxygen reduction reaction (ORR) and significantly enhance the stability of NiMo electrodes in intermittent electrolysis. Further, combining experimental and Molecular Dynamics (MD) simulations, we demonstrate that the Cr coating served as a physical barrier inhibiting diffusion of oxygen, while still allowing other species to pass through. Our work offers insights into electrode behavior in intermittent electrolysis, as well as provides Cr coating as a valid method and corresponding deep understanding of the factors for stability enhancement, paving the way for the successful application of lab-scale electrodes in industrial electrolysis powered directly by renewable energy.
This study examined the utilization and characteristics of lymph node evaluation at hysterectomy for carcinoma in situ of the uterine cervix.
This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample, evaluating 7395 patients with cervical carcinoma in situ who underwent hysterectomy from 2016 to 2019. A multivariable binary logistic regression model was fitted to identify independent characteristics related to lymph node evaluation. A classification-tree was constructed with recursive partitioning analysis to examine utilization patterns of lymph node evaluation.
Lymph node evaluation at hysterectomy was performed in 4.6%. In amultivariable analysis, older age, higher income, use of robotic-assisted hysterectomy, and surgery at large bed capacity or urban teaching centers in the northeast US region were associated with increased likelihood of lymph node evaluation (all, p < 0.05). Of those independent factors, robotic-assisted surgery exhibited the largest effect size (adjusted odds ratio 3.23, 95% confidence interval 2.54-4.10). Utilization pattern analysis identified nine unique characteristics, of which robotic-assisted surgery was the primary indicator for cohort allocation (12.4% vs. 3.2%, p < 0.001). The difference between the lowest-highest patterns was 33.3% (range, 0%-33.3%).
Lymph node evaluation was rarely performed for cervical carcinoma in situ overall and robotic surgery was associated with increased utilization of lymph node evaluation.
Lymph node evaluation was rarely performed for cervical carcinoma in situ overall and robotic surgery was associated with increased utilization of lymph node evaluation.The COVID-19 pandemic changed daily practice in a number of ways. In a recent article it was shown that mortality in multitrauma patients with mild to moderate head injury, was higher compared to pre-COVID-19 mortality. The authors describe possible mechanisms for this higher mortality, for instance scarcity of IC beds and changes in Intensive care unit admissions. However, the study only showed mortality data, not the complete range of possible outcomes. In multitrauma patients, mere survival is not necessarily a good outcome. It would be very interesting to know whether the increased mortality is a accompanied by a lower proportion of patients who need daily care. If that is the case, then the conclusion of the authors that the COVID-19 pandemic leads to worse outcomes needs to be nuanced.Procedural skills training in a developing country is challenging, but can improve the quality of care for patients with an important regional health problem. A structured, brief, teach-the-teacher-based training course supports physicians in developing countries to acquire skills needed to perform a complex procedure independently. A case of a patient diagnosed with esophageal cancer is presented and 10 tips are given for training procedural skills in a developing country.
1) To get an insight into the experience of aging with traumatic brain injury (TBI), and 2) explore intervention avenues perceived as promising for the social participation of this population.
Through an exploratory descriptive study, in-depth semi-structured interviews were conducted with aging TBI survivors recruited in a nonprofit community organization whose mission is to support the social participation of people living with TBI. Thematic analysis was done on qualitative data, using a hybrid approach of deductive and inductive analysis.
Ten aging TBI survivors with an average age of 64.9years were interviewed. Participants expressed the perception of declining faster and with greater limitations than their fellow seniors unchallenged by TBI but also of having social participation opportunities due to their condition. A list of ten facilitators (e.g., doing activities in synch with life story) and five barriers (e.g., unequal levels of disability) to their social participation emerged.
Social participation is crucial to TBI-affected individuals' healthy aging. Nonprofit community organizations should offer opportunities for participation, mobilize environmental resources, foster self-confidence, and support the achievement of meaningful personal projects to enable the social participation of people aging with TBI.
Social participation is crucial to TBI-affected individuals' healthy aging. Nonprofit community organizations should offer opportunities for participation, mobilize environmental resources, foster self-confidence, and support the achievement of meaningful personal projects to enable the social participation of people aging with TBI.Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this updated educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies. We propose a strategy to assess dyspnoea in clinical practice. Key points are determining the severity of the problem, forming a differential diagnosis, thinking about the mechanism of dyspnoea and intervening in a timely manner. We conclude that the assessment and treatment of dyspnoea often requires a multidisciplinary approach.Vaccination or recent exposure to infection with SARS-CoV-2 currently grants the vast majority of the population considerable immunity and thereby protection against severe disease. Eltanexor research buy It is yet unknow how long this protection lasts. Continuous changes of the viral genotype and phenotype herein play an important role, in particular the variant-specific alterations of the spike protein. Protection by T-cell immunity seems to be more preserved in the event of changes in the virus as compared to antibody-mediated host defences. Furthermore, the continuous succession of virus variants also directly and indirectly affects the effectiveness of medical treatment. Regarding immune-modulating as well as anti-viral therapy, the viral characteristics of the circulating SARS-CoV-2 variant in combination with the level of host immunity will determine whether their use makes sense, and for which patients. The number of patients needed to treat to prevent a clinically negative outcome herein represents an important figure.General practitioners (GP's) are confronted with patients with complex psychosocial problems that run the risk of having unintended and unwanted pregnancies. This raises two questions 1) to what extend do GP's have the right to enter the private sphere of patients in order to discuss whether they should have children? And 2) how can such a conversation be successful? Based on a case, in this contribution we argue that GP's can play an important role in sustaining the autonomy of patients with complex problems and we provide suggestions on how to start a conversation about this topic. The contribution ends by sketching how GP's can get support in situations like this by a governmental national program Nu Niet Zwanger (Not Pregnant Now), that supports health care professionals in sustaining the autonomy of vulnerable groups in choices around pregnancy and contraception.
The aim of this study was to evaluate the quality-of-life (QoL) status in keratoconus severity subgroups using the Keratoconus Outcomes Research Questionnaire (KORQ) and to determine the relationship between the QoL scores and the standard clinical variables.
A cross-sectional study was conducted using prospective, web-based Save Sight Keratoconus Registry data. Rasch analysis was conducted on the KORQ data using the Andrich Rating Scale Model. Comparative analysis included Welch t test and 1-way ANOVA. Associations between visual acuity, corneal curvature, and minimum corneal thickness with KORQ scores were evaluated with Pearson correlation and multiple regression adjusted for age and sex.
The KORQ was completed by 542 patients with keratoconus (male, 67.7%; mean age, 31.6 years). Keratoconus severity, based on Kmax, was mild [<48 diopter (D)], moderate (48-55 D), and severe (>55 D) in 26.3%, 45.0%, and 28.7% of patients, respectively. Activity limitation (AL) and symptoms (SY) scales of the KOR, and higher disease severity were associated with worse AL and SY scores in keratoconus. Although the correlations between clinical and QoL scores were statistically significant, the low magnitudes suggested a complex relationship between clinical parameters and patient-reported outcomes.A 43-year-old man presented with a painful itching penile lesion. Examination revealed multiple fistulas with protruding hairs and surrounding induration. The urologist identified them as pilonidal sinuses and surgically performed debridement. Penile pilonidal sinus is a very rare differential diagnosis of balanoposthitis, epidermal cyst and penile carcinoma.Work-related asthma is an underestimated problem. More awareness is needed for early identification of work-related lung diseases to prevent permanent damage in patients with lung diseases. Work-related asthma can lead to an increase in the burden of disease, the number of exacerbations and hospital admissions. Therefore, exposure to substances with irritating and/or sensitizing properties should be regarded as an additional treatable trait in asthma treatment. The number of occupations where such exposures plays a role is large and diverse. Inquiring about the profession, activities or future career choice of the (asthma) patient during the first consultation is of great importance for the correct diagnosis and treatment. Cooperation between pulmonologist, lung nurse, ENT specialist, dermatologist, company doctor and occupational hygienist can contribute to this. A regional organization with a 'multidisciplinary consultation' for occupational lung diseases is important to guarantee optimal care and advice. The clinical case series demonstrate work-related asthma in clinical practice.
