Effects of Agitation and Storage Temperature on Measurements of Hydration Status.

PubMed

Adams, Heather M; Eberman, Lindsey E; Yeargin, Susan W; Niemann, Andrew J; Mata, Heather L; Dziedzicki, David J

2015-12-01

Hypohydration can have significant implications on normal physiological functions of the body. This study aimed to determine the impact of agitation, storage temperature, and storage time on urine osmolality compared to the criterion control. We used a descriptive diagnostic validity test design. To investigate agitation, we recruited 75 healthy individuals (males = 41, females = 34; mean age = 22 ± 5 years; mean self-reported height = 172 ± 23 cm and mass = 77 ± 17 kg) who provided one or more samples (total = 81). The independent variables were agitation (vortex, hand shaken, no agitation) and temperature (room temperature, freezer, and refrigerator) type. Participants completed informed consent, a health questionnaire and were asked to provide a urine sample, which was split and labeled according to agitation type or storage temperature. Urine osmolality was used to determine hydration status at two time points (within 2 hours [control], 48 hours). We used t-tests to determine the difference between each condition and the control and calculated percent error for each condition. No significant differences for no agitation (t79 = -0.079, P = 0.937), hand shaken (t79 = 1.395, P = 0.167) or vortex mixed (t79 = -0.753, P = 0.453) were identified when compared to the criterion control. No significant differences for room temperature (t82 = -0.720, P = 0.474), refrigerator (t82 = -2.697, P = 0.008) or freezer (t82 = 2.576, P = 0.012) were identified when compared to the criterion control. Our findings suggest agitation of urine specimen is not necessary and samples do not require refrigeration or freezing if assessed within 48 hours. Analysis within two hours of collection is not necessary and samples can be stored for up to 48 hours without impacting the hydration status of the sample.

Risk factors for agitation in critically ill patients

PubMed Central

de Almeida, Thiago Miranda Lopes; de Azevedo, Luciano Cesar Pontes; Nosé, Paulo Maurício Garcia; de Freitas, Flavio Geraldo Resende; Machado, Flávia Ribeiro

2016-01-01

Objective To evaluate the incidence of agitation in the first 7 days after intensive care unit admission, its risk factors and its associations with clinical outcomes. Methods This single-center prospective cohort study included all patients older than 18 years with a predicted stay > 48 hours within the first 24 hours of intensive care unit admission. Agitation was defined as a Richmond Agitation Sedation Scale score ≥ +2, an episode of agitation or the use of a specific medication recorded in patient charts. Results Agitation occurred in 31.8% of the 113 patients. Multivariate analysis showed that delirium [OR = 24.14; CI95% 5.15 - 113.14; p < 0.001], moderate or severe pain [OR = 5.74; CI95% 1.73 - 19.10; p = 0.004], mechanical ventilation [OR = 10.14; CI95% 2.93 - 35.10; p < 0.001], and smoking habits [OR = 4.49; CI95% 1.33 - 15.17; p = 0.015] were independent factors for agitation, while hyperlactatemia was associated with a lower risk [OR = 0.169; CI95% 0.04 - 0.77; p = 0.021]. Agitated patients had fewer mechanical ventilation-free days at day 7 (p = 0.003). Conclusion The incidence of agitation in the first 7 days after admission to the intensive care unit was high. Delirium, moderate/severe pain, mechanical ventilation, and smoking habits were independent risk factors. Agitated patients had fewer ventilator-free days in the first 7 days. PMID:28099638

Longitudinal relationships between Alzheimer disease progression and psychosis, depressed mood, and agitation/aggression.

PubMed

Zahodne, Laura B; Ornstein, Katherine; Cosentino, Stephanie; Devanand, D P; Stern, Yaakov

2015-02-01

Behavioral and psychological symptoms of dementia (BPSD) are prevalent in Alzheimer disease (AD) and are related to poor outcomes such as nursing home placement. No study has examined the impact of individual BPSD on dependence, a clinically important feature that reflects changing patient needs and their effect on caregivers. The current study characterized independent cross-sectional and longitudinal relationships between three BPSD (psychosis, depressed mood, and agitation/aggression), cognition, and dependence to better understand the interplay between these symptoms over time. The Predictors Study measured changes in BPSD, cognition, and dependence every 6 months in patients with AD. Cross-sectional and longitudinal relationships between individual BPSD, cognition, and dependence over 6 years were characterized by using multivariate latent growth curve modeling. This approach characterizes independent changes in multiple outcome measures over time. Four memory clinics in the United States and Europe. A total of 517 patients with probable AD. Columbia University Scale for Psychopathology, modified Mini-Mental State Examination, and Dependence Scale. Both psychosis and depressed mood at study entry were associated with worse subsequent cognitive decline. Independent of cognitive decline, initial psychosis was associated with worse subsequent increases in dependence. Rates of increase in agitation/aggression separately correlated with rates of declines in both cognition and independence. Although purely observational, our findings support the poor prognosis associated with psychosis and depression in AD. Results also show that agitation/aggression tracks declines in cognition and independence independently over time. Targeted intervention for individual BPSD, particularly psychosis, could have broad effects not only on patient well-being but also on care costs and family burden. Copyright © 2015 American Association for Geriatric Psychiatry. Published by

Probable reasons for expressed agitation in persons with dementia.

PubMed

Ragneskog, H; Gerdner, L A; Josefsson, K; Kihlgren, M

1998-05-01

Nursing home patients with dementia were videotaped in three previous studies. Sixty sequences of nine patients exhibiting agitated behaviors were examined to identify the most probable antecedents to agitation. Probable reasons were interpreted and applied to the Progressively Lowered Stress Threshold model, which suggests that agitation is stress related. Analysis suggests that agitation often serves as a form of communication. Two underlying reasons seem to be that the patient had loss of control over the situation and deficient autonomy. The most common causes for expressed agitation were interpreted as discomfort, a wish to be served immediately, conflict between patients or with nursing staff, reactions to environmental noises or sound, and invasion of personal space. It is recommended that nursing staff promote autonomy and independency for this group of patients whenever possible. By evaluating probable reasons for expressed agitation, the nursing staff can take steps to prevent or alleviate agitation.

Managing Agitation Associated with Schizophrenia and Bipolar Disorder in the Emergency Setting.

PubMed

Zeller, Scott L; Citrome, Leslie

2016-03-01

Patient agitation represents a significant challenge in the emergency department (ED), a setting in which medical staff are working under pressure dealing with a diverse range of medical emergencies. The potential for escalation into aggressive behavior, putting patients, staff, and others at risk, makes it imperative to address agitated behavior rapidly and efficiently. Time constraints and limited access to specialist psychiatric support have in the past led to the strategy of "restrain and sedate," which was believed to represent the optimal approach; however, it is increasingly recognized that more patient-centered approaches result in improved outcomes. The objective of this review is to raise awareness of best practices for the management of agitation in the ED and to consider the role of new pharmacologic interventions in this setting. The Best practices in Evaluation and Treatment of Agitation (BETA) guidelines address the complete management of agitation, including triage, diagnosis, interpersonal calming skills, and medicine choices. Since their publication in 2012, there have been further developments in pharmacologic approaches for dealing with agitation, including both new agents and new modes of delivery, which increase the options available for both patients and physicians. Newer modes of delivery that could be useful in rapidly managing agitation include inhaled, buccal/sublingual and intranasal formulations. To date, the only formulation administered via a non-intramuscular route with a specific indication for agitation associated with bipolar or schizophrenia is inhaled loxapine. Non-invasive formulations, although requiring cooperation from patients, have the potential to improve overall patient experience, thereby improving future cooperation between patients and healthcare providers. Management of agitation in the ED should encompass a patient-centered approach, incorporating non-pharmacologic approaches if feasible. Where pharmacologic

Hypokalemia and agitation in acute psychotic patients.

PubMed

Hatta, K; Takahashi, T; Nakamura, H; Yamashiro, H; Asukai, N; Yonezawa, Y

1999-04-19

Hypokalemia is caused partly by intensive exercise. Some evidence suggests that psychological distress may cause hypokalemia. The relationship between the decline of serum potassium concentration and the level of symptoms of acute agitation, which was defined as a total score on a subset of six categories on the 18-item Brief Psychiatric Rating Scale (anxiety, tension, mannerism and posturing, hostility, uncooperativeness, psychomotor excitement), was examined in 313 schizophrenic men, admitted on an emergency basis during a 24-month period. In addition, change in serum potassium concentration after sedation was investigated. Serum potassium concentration in the severely agitated group was lower than that in the mild group. There was a significant correlation between serum potassium concentration and the level of symptoms of acute agitation (r = -0.30, P < 0.0001). Although the decline of serum potassium concentration in the patients who were sufficiently sedated improved within 8 h, that in the patients showing high scores on the acute agitation subset even 8 h after emergency admission was prolonged. Results indicate that sedation improves acute agitation-induced hypokalemia. rights

Therapeutic touch and agitation in individuals with Alzheimer's disease.

PubMed

Hawranik, Pamela; Johnston, Pat; Deatrich, Judith

2008-06-01

Limited effective strategies exist to alleviate or treat disruptive behaviors in people with Alzheimer's disease. Fifty-one residents of a long-term care facility with Alzheimer's disease were randomly assigned to one of three intervention groups. A multiple time series, blinded, experimental design was used to compare the effectiveness of therapeutic touch, simulated therapeutic touch, and usual care on disruptive behavior. Three forms of disruptive behavior comprised the dependent variables: physical aggression, physical nonaggression, and verbal agitation. Physical nonaggressive behaviors decreased significantly in those residents who received therapeutic touch compared with those who received the simulated version and the usual care. No significant differences in physically aggressive and verbally agitated behaviors were observed across the three study groups. The study provided preliminary evidence for the potential for therapeutic touch in dealing with agitated behaviors by people with dementia. Researchers and practitioners must consider a broad array of strategies to deal with these behaviors.

Treating agitation with dexmedetomidine in the ICU.

PubMed

Boyer, Jeanne

2009-01-01

Patients in the intensive care unit frequently experience delirium, anxiety, and agitation, with a variety of treatments used. This article discusses the role of an alpha-adrenoceptor agonist, dexmedetomidine, and its clinical relevance and advantages for the agitated patient.

Effect of agitation on methanogenesis stage of two-stage anaerobic digestion of palm oil mill effluent (POME) into biogas

NASA Astrophysics Data System (ADS)

Trisakti, Bambang; Irvan, Zahara, Intan; Taslim, Turmuzi, Muhammad

2017-05-01

This study is an assessment of the effect of agitation on biogas production on methanogenesis stage. Methanogenesis is the second stage of two-stage anaerobic digestion of palm oil effluent (POME) into biogas. The purpose of this study is to get the effect of agitation on growth of microorganisms, degradation of organic substances, and biogas production and composition. Initially, the suitable loading up was determined by varying the HRT at 100, 40, 6, and 4 days in the continuous stirred tank reactor (CSTR) with agitation rate 100 rpm, pH 6.7-7.5, at room temperature. Next, effect of agitation on the process was determined by varying agitation rate at 50, 100, 150, and 200 rpm. The substrate used was the effluent of the acidogenesis stage that fed to the CSTR four times a day. Analysis of total solids (TS), volatile solids (VS), total suspended solids (TSS), volatile suspended solids (VSS), and chemical oxygen demand (COD) were conducted in order to study the growth of microorganisms and their abilities in converting organic compound to produce biogas. Production and composition of biogas were also determined by measuring the volume of biogas and content of H2S and CO2. The result showed that the pH and alkalinity it was still within the range of methanogenesis process. The growth of microorganisms were increased with the increasing of agitation rate. However, the best degradation of organic substances, biogas production, and biogas composition were achieved at 100 rpm. The VS decomposition, COD removal, biogas production, CO2 content, and CH4 content at 100 rpm were 67.44 ± 3.59%, 81.00%, 58.87 ± 6.27 L/kg-ΔVS, 23.36%, and 76.64%, respectively.

Discontinuing the Use of PRN Intramuscular Medication for Agitation in an Acute Psychiatric Hospital.

PubMed

Hayes, Ariel; Russ, Mark J

2016-03-01

This study examined the impact of eliminating intramuscular PRN medication for agitation on patient and staff safety in an acute psychiatric inpatient setting. The current retrospective chart review investigated the use of PRN medications (oral and intramuscular) to treat acute agitation, including aggression, and related outcomes before and after a mandated change in PRN practice that required real time physician input before administration of intramuscular medications. The use of both oral and intramuscular PRN medications dramatically decreased following implementation of the mandated change in practice. In particular, the use of intramuscular PRNs for agitation decreased by about half. Despite this decrease, the assault rate in the hospital was unchanged, and the utilization of restraint and seclusion continued to decrease. It is possible to reduce the utilization of PRN medications for agitation without broadly compromising safety on acute care psychiatric inpatient units.

Poststroke agitation and aggression and social quality of life: a case control study.

PubMed

Lau, Chieh Grace; Tang, Wai Kwong; Liu, Xiang Xin; Liang, Hua Jun; Liang, Yan; Wong, Adrian; Mok, Vincent; Ungvari, Gabor S; Wong, Ka Sing; Kim, Jong S; Paradiso, Sergio

2017-03-01

Aggression and agitation are common after a stroke. The association between agitation/aggression following stroke and Health-Related Quality of Life (HRQoL) in stroke survivors is unknown. This study aimed to examine the association between agitation/aggression and HRQoL in Chinese stroke survivors. Three hundred and twenty-four stroke patients entered this cross-sectional study. Agitation/aggression was assessed using the Chinese version of Neuropsychiatric Inventory (CNPI). HRQoL was measured with the Stroke Specific Quality of Life (SSQoL). Three months after the index stroke, agitation/aggression was found in 60 (18.5%) patients. In the agitation/aggression group, 44 patients (73.3%) showed passive agitation/aggression, whereas 16 (26.7%) displayed passive and active agitation/aggression. No patients showed only active agitation/aggression. Patients with agitation/aggression were more likely to have history of diabetes and greater severity of depression, as well as lower SSQoL total score and Personality Changes and Social Role scores. Controlling for diabetes and depression severity did not alter the above results. The Energy and Thinking scores of the SSQoL were significantly lower in the passive/active agitation/aggression group relative to the passive agitation/aggression group (adjusted for CNPI aggression/agitation score). In this study sample, agitation/aggression was preponderantly of the passive type and was associated with poorer HRQoL independently from depression or medical conditions. Patients with both passive and active agitation/aggression had lower Quality of Life (QoL) than patients with only passive agitation/aggression. The causality of the association between low QoL and agitation/aggression needs to be explored in future studies.

Amlodipine and the Successful Management of Post-Electroconvulsive Therapy Agitation.

PubMed

Shahriari, Ali; Khooshideh, Maryam; Sheikh, Mahdi

2016-01-01

Electroconvulsive therapy (ECT) is a highly effective nonpharmacologic treatment for the management of depression and some other psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness, irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to serious and severe forms requiring prompt medical intervention to protect the patient and the medical staff. In severe agitation medical management may be necessary which consists of using sedative agents, either benzodiazepines or propofol. The side-effects of these sedative agents, especially in the elderly population, necessitate finding ways that could help the prevention of the occurrence of agitation after ECT treatments. We report a 68-year-old female with major depression who was referred for ECT. She experienced severe post-ECT agitation requiring medical intervention after all ECT treatments. Administering of oral amlodipine (5 mg) one hour before ECT treatment successfully prevented the occurrence of post-ECT agitation in this patient. We briefly discuss the possible underlying mechanisms and pathophysiology of amlodipine in the prevention of post-ECT agitation.

Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy

PubMed Central

Ijaopo, E O

2017-01-01

Unsurprisingly, the subject of dementia has been a rising matter of public health concerns as people now live longer. World Alzheimer Report 2015, estimate that about 46.8 million people worldwide have dementia. These numbers are projected to almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050. The modality for treating agitation and other behavioral symptoms in dementia patients has been a challenge. Many years on, there has been no FDA-approved pharmacotherapy in treating dementia-related agitation. This review discusses the current knowledge of non-pharmacological interventions, and analyzes the risks and benefits of pharmacotherapy in the management of dementia-related agitation, as well as providing an anecdotal of the author's clinical experience. This article aims to provide opportunity for increase awareness for clinicians, particularly those with no specialty training in geriatrics medicine but see dementia patients with agitation and other behavioral symptoms from time to time. Likewise, it hopefully will benefit the readers of medical journals to update their existing knowledge on matters relating to the management of dementia-related agitation. PMID:29087372

Anterior Ethmoidal Nerve Block in Prevention of Postoperative Agitation

ClinicalTrials.gov

2018-02-08

Postoperative Agitation: Impaired Awareness, Abnormal Cognitive Function, Confusion, and Verbal and Physical Agitation During Recovery From General Anesthesia; Deviated Nasal Septum; Chronic Rhinosinusitis (Diagnosis); Nasal Polyps

Unlocking Chain Exchange in Highly Amphiphilic Block Polymer Micellar Systems: Influence of Agitation.

PubMed

Murphy, Ryan P; Kelley, Elizabeth G; Rogers, Simon A; Sullivan, Millicent O; Epps, Thomas H

2014-11-18

Chain exchange between block polymer micelles in highly selective solvents, such as water, is well-known to be arrested under quiescent conditions, yet this work demonstrates that simple agitation methods can induce rapid chain exchange in these solvents. Aqueous solutions containing either pure poly(butadiene- b -ethylene oxide) or pure poly(butadiene- b -ethylene oxide- d 4 ) micelles were combined and then subjected to agitation by vortex mixing, concentric cylinder Couette flow, or nitrogen gas sparging. Subsequently, the extent of chain exchange between micelles was quantified using small angle neutron scattering. Rapid vortex mixing induced chain exchange within minutes, as evidenced by a monotonic decrease in scattered intensity, whereas Couette flow and sparging did not lead to measurable chain exchange over the examined time scale of hours. The linear kinetics with respect to agitation time suggested a surface-limited exchange process at the air-water interface. These findings demonstrate the strong influence of processing conditions on block polymer solution assemblies.

Energy consumption of agitators in activated sludge tanks - actual state and optimization potential.

PubMed

Füreder, K; Svardal, K; Frey, W; Kroiss, H; Krampe, J

2018-02-01

Depending on design capacity, agitators consume about 5 to 20% of the total energy consumption of a wastewater treatment plant. Based on inhabitant-specific energy consumption (kWh PE 120 -1 a -1 ; PE 120 is population equivalent, assuming 120 g chemical oxygen demand per PE per day), power density (W m -3 ) and volume-specific energy consumption (Wh m -3 d -1 ) as evaluation indicators, this paper provides a sound contribution to understanding energy consumption and energy optimization potentials of agitators. Basically, there are two ways to optimize agitator operation: the reduction of the power density and the reduction of the daily operating time. Energy saving options range from continuous mixing with low power densities of 1 W m -3 to mixing by means of short, intense energy pulses (impulse aeration, impulse stirring). However, the following correlation applies: the shorter the duration of energy input, the higher the power density on the respective volume-specific energy consumption isoline. Under favourable conditions with respect to tank volume, tank geometry, aeration and agitator position, mixing energy can be reduced to 24 Wh m -3 d -1 and below. Additionally, it could be verified that power density of agitators stands in inverse relation to tank volume.

State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study.

PubMed

San, Luis; Marksteiner, Josef; Zwanzger, Peter; Figuero, María Aragüés; Romero, Francisco Toledo; Kyropoulos, Grigorios; Peixoto, Alberto Bessa; Chirita, Roxana; Boldeanu, Anca

2016-01-01

Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed. A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%). The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.

Hydrodynamic effects on cell growth in agitated microcarrier bioreactors

NASA Technical Reports Server (NTRS)

Cherry, Robert S.; Papoutsakis, E. Terry

1988-01-01

The net growth rate of bovine embryonic kidney cells in microcarrier bioreactor is the result of a variable death rate imposed on a cell culture trying to grow at a constant intrinsic growth rate. The death rate is a function of the agitation conditions in the system, and increases at higher agitation because of increasingly energetic interactions of the cell covered microcarriers with turbulent eddies in the fluid. At very low agitation rates bead-bead bridging becomes important; the large clumps formed by bridging can interact with larger eddies than single beads, leading to a higher death rate at low agitation. The growth and death rate were correlated with a dimensionless eddy number which compares eddy forces to the buoyant force on the bead.

Implementation of the Agitated Behavior Scale in the Electronic Health Record.

PubMed

Wilson, Helen John; Dasgupta, Kritis; Michael, Kathleen

The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital. A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants using convenience sampling. The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale. The Agitated Behavior Scale was found to be usable, and there was 92.2% compliance with the use of the electronic Electronic Agitated Behavior Scale. The Agitated Behavior Scale was effectively implemented in the electronic health record and was found to be usable in the assessment of agitation. Utilization of the scale through the electronic health record on a daily basis will allow for an early identification of agitation in patients with traumatic brain injury and enable prompt interventions to manage agitation.

The Effects of Cannabis on Inpatient Agitation, Aggression, and Length of Stay.

PubMed

Johnson, Joseph M; Wu, Chris Y; Winder, Gerald Scott; Casher, Michael I; Marshall, Vincent D; Bostwick, Jolene R

2016-01-01

This study examines the association between cannabis use and the hospital course of patients admitted to the psychiatric inpatient unit with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder. Many confounding variables potentially contribute to the clinical presentation of hospitalized patients in the psychiatric unit. Illicit drug use, in particular, has been associated with acute agitation, and questions can be raised as to what lasting effects drug use prior to admission may have throughout a patient's hospital stay. Subjects with a discharge diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or psychosis not otherwise specified (N = 201) were retrospectively identified, and those with positive results of urine drug screen for cannabis on admission were compared to negative counterparts. Agitation and aggression were measured using an adaptation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). These markers were also quantified by comparing charted episodes of restraint and seclusion and administration of as needed medications, such as benzodiazepines and antipsychotics. Positive urine drug screen results for cannabis was correlated with young (p = .001) males (p = .003) with bipolar disorder (p = .009) exhibiting active manic symptoms (p = .003) at the time of admission. Cannabis use was further associated with a shorter length of stay (p = .008), agitation triggering adapted PANSS-EC nursing assessments (p = .029), and oral medications as needed (p = .002) for agitation. Cannabis use, as defined by positive urine drug screen results, was more common in patients with bipolar disorder and was accompanied by a higher incidence of inpatient agitation. Although these patients also had short hospital lengths of stay, there was no clear relationship between level of agitation and length of stay across all patient groups. One possible explanation for patients with bipolar disorder

Simulation studies of phase inversion in agitated vessels using a Monte Carlo technique.

PubMed

Yeo, Leslie Y; Matar, Omar K; Perez de Ortiz, E Susana; Hewitt, Geoffrey F

2002-04-15

A speculative study on the conditions under which phase inversion occurs in agitated liquid-liquid dispersions is conducted using a Monte Carlo technique. The simulation is based on a stochastic model, which accounts for fundamental physical processes such as drop deformation, breakup, and coalescence, and utilizes the minimization of interfacial energy as a criterion for phase inversion. Profiles of the interfacial energy indicate that a steady-state equilibrium is reached after a sufficiently large number of random moves and that predictions are insensitive to initial drop conditions. The calculated phase inversion holdup is observed to increase with increasing density and viscosity ratio, and to decrease with increasing agitation speed for a fixed viscosity ratio. It is also observed that, for a fixed viscosity ratio, the phase inversion holdup remains constant for large enough agitation speeds. The proposed model is therefore capable of achieving reasonable qualitative agreement with general experimental trends and of reproducing key features observed experimentally. The results of this investigation indicate that this simple stochastic method could be the basis upon which more advanced models for predicting phase inversion behavior can be developed.

The relationship between agitation and impairments of orientation and memory during the PTA period after traumatic brain injury.

PubMed

McKay, Adam; Love, Jasmine; Trevena-Peters, Jessica; Gracey, Jacinta; Ponsford, Jennie

2018-06-03

Agitation is common during the post-traumatic amnesia (PTA) period after traumatic brain injury (TBI), although our knowledge of what causes or predicts agitation is limited. The current study aimed to examine the association of agitation in PTA with the concurrent impairments in orientation and memory while controlling for covariates of agitation. Participants were 125 patients in PTA following moderate to extremely severe TBI recruited from an inpatient brain injury rehabilitation service who were assessed throughout PTA on the Agitated Behavior Scale (ABS) and the Westmead PTA Scale (WPTAS). Agitation was observed in 42.4% of participants (ABS score > 21), with disinhibited behaviours (e.g., distractibility and impulsivity) most common. Multilevel modelling found daily ABS scores to be associated with daily scores on the WPTAS but in a non-linear pattern. Analysis of covariates found that shorter time post-admission, younger age, presence of infection and higher antipsychotic doses were associated with higher ABS scores. These results support a relationship between agitation and the concurrent cognitive impairment during PTA. While a causal link cannot yet be inferred, management strategies that can potentially interfere with cognition (e.g., sedating medications, environmental changes) should be used cautiously in case they exacerbate agitation.

Nurse education regarding agitated patients and its effects on clinical practice.

PubMed

Ozdemir, Leyla; Karabulut, Erdem

This study identified the impact of an education program on nurses' practices for agitated patients and documented the changes in practice after completion of the training. Eighteen cardiac intensive care nurses were included to the study. Prior to nurses' participation in an education program, a pre-test indicating nurses' current practices for 40 agitated patients was evaluated with the 'Nurse Practice Form'. After the pre-test data collection period was completed, the 2-day training program on caring for agitated patients was conducted. The last step of the study was evaluation of post-test nurses' practices for 40 agitated patients using the 'Nurse Practice Form'. The findings indicated that instead of pre-test nurses' use of physical restraints for controlling agitated patients without a physician order, none of post-test nurses applied them. The training program provided nurses the knowledge and skills needed to evaluate and to manage the causes of agitation.

Spontaneous knotting of an agitated string.

PubMed

Raymer, Dorian M; Smith, Douglas E

2007-10-16

It is well known that a jostled string tends to become knotted; yet the factors governing the "spontaneous" formation of various knots are unclear. We performed experiments in which a string was tumbled inside a box and found that complex knots often form within seconds. We used mathematical knot theory to analyze the knots. Above a critical string length, the probability P of knotting at first increased sharply with length but then saturated below 100%. This behavior differs from that of mathematical self-avoiding random walks, where P has been proven to approach 100%. Finite agitation time and jamming of the string due to its stiffness result in lower probability, but P approaches 100% with long, flexible strings. We analyzed the knots by calculating their Jones polynomials via computer analysis of digital photos of the string. Remarkably, almost all were identified as prime knots: 120 different types, having minimum crossing numbers up to 11, were observed in 3,415 trials. All prime knots with up to seven crossings were observed. The relative probability of forming a knot decreased exponentially with minimum crossing number and Möbius energy, mathematical measures of knot complexity. Based on the observation that long, stiff strings tend to form a coiled structure when confined, we propose a simple model to describe the knot formation based on random "braid moves" of the string end. Our model can qualitatively account for the observed distribution of knots and dependence on agitation time and string length.

Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions.

PubMed

Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

2016-01-01

Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

[Management of agitated, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem].

PubMed

Jiménez Busselo, M T; Aragó Domingo, J; Nuño Ballesteros, A; Loño Capote, J; Ochando Perales, G

2005-12-01

Patients with extreme agitation, delirium, violent behavior or acute psychosis are frequently evaluated in the emergency departments of general hospitals. However, the traditional infrequency of this type of situation in pediatric emergency services can lead to a certain lack of foresight and efficiency in the initial management of these patients. Because of the current known increase of psychosocial disorders in pediatric emergencies, new pharmacological treatments for juvenile psychotic processes, and particularly the lack of compliance with these treatments, as well as the earlier consumption of ever more varied illicit drugs among young people, the frequency and diversity of this kind of disorder is on the increase. The treatment of agitation, aggression and violence begins with successful management of the acute episode, followed by strategies designed to reduce the intensity and frequency of subsequent episodes. The key to safety is early intervention to prevent progression from agitation to aggression and violence. Consequently, urgent measures designed to inhibit agitation should be adopted without delay by the staff initially dealing with the patient, usually in the emergency unit. Patients with psychomotor agitation disorder (PMAD) may require emergency physical and/or chemical restraints for their own safety and that of the healthcare provider in order to prevent harmful clinical sequelae and to expedite medical evaluation to determine the cause. However, the risks of restraint measures must be weighed against the benefits in each case. This review aims to present the emergency measures to be taken in children with PMAD. The distinct etiological situations and criteria for the choice of drugs for chemical restraint in each situation, as well as the complications associated with certain drugs, are discussed. It is advisable, therefore, that health professionals become familiar with the distinct pharmacological options.

Agitation, Mixing, and Transfers Induced by Bubbles

NASA Astrophysics Data System (ADS)

Risso, Frédéric

2018-01-01

Bubbly flows involve bubbles randomly distributed within a liquid. At large Reynolds number, they experience an agitation that can combine shear-induced turbulence (SIT), large-scale buoyancy-driven flows, and bubble-induced agitation (BIA). The properties of BIA strongly differ from those of SIT. They have been determined from studies of homogeneous swarms of rising bubbles. Regarding the bubbles, agitation is mainly caused by the wake-induced path instability. Regarding the liquid, two contributions must be distinguished. The first one corresponds to the anisotropic flow disturbances generated near the bubbles, principally in the vertical direction. The second one is the almost isotropic turbulence induced by the flow instability through a population of bubbles, which turns out to be the main cause of horizontal fluctuations. Both contributions generate a k-3 spectral subrange and exponential probability density functions. The subsequent issue will be to understand how BIA interacts with SIT.

Advancements in the treatment of agitation in Alzheimer's disease.

PubMed

Antonsdottir, Inga M; Smith, Jessica; Keltz, Melanie; Porsteinsson, Anton P

2015-01-01

Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are associated with significant negative outcomes for patients and their caregivers. Agitation, one of the most distressing NPS, lacks well-established long-term interventions that are both effective and safe. While non-pharmacological interventions are the suggested first-line treatment, it isn't effective in managing symptoms for every patient. In such cases, clinicians turn to the use of pharmacological interventions. Traditionally, these interventions consist of off-label use of antipsychotics, sedative/hypnotics, anxiolytics, acetylcholinesterase inhibitors, memantine and antidepressants, where the efficacy doesn't necessarily outweigh the associated risks. Gains made in understanding the neurobiological mechanisms underlying agitation have fueled several recent clinical trials. A comprehensive literature search for published articles evaluating pharmacologic interventions for agitation in AD was done. A review of some of these clinical trials was completed: dextromethorphan/quinidine, scyllo-inositol, brexpiprazole, prazosin, cannabinoids, dronabinol and citalopram show promise in treating agitation. Neurobiological findings and enhanced trial designs have re-ignited the area of pharmacological treatment of NPS. Although further research is needed to fully determine the safety, tolerability and efficacy of these treatments, the mission to finding effective treatments for NPS such as agitation in patients with dementia is well underway.

Effect of calcium oxide (CaO) and sawdust on adhesion and cohesion characteristics of sewage sludge under agitated and non-agitated drying conditions.

PubMed

Deng, Wen-Yi; Yuan, Min-Hao; Mei, Jing; Liu, Ya-Jun; Su, Ya-Xin

2017-03-01

Stickiness phenomenon is widely observed in sewage sludge drying practices. This paper is aimed at demonstrating and comparing the sticky properties of sewage sludge through non-agitated and agitated drying tests specially designed for sewage sludge. Special attentions were paid to the effects of additives, i.e. CaO, fine sawdust (FSD) and coarse sawdust (CSD), on the adhesive and cohesive characteristics of sewage sludge. The results indicated that the sticky properties of the sludge were markedly different under the different testing methods, and was also greatly influenced by CaO or sawdust addition. For instance, in the non-agitated drying tests, CaO can significantly enhance the maximum adhesive and cohesive stresses of the sludge, whereas in the agitated drying tests, the torque of agitation, which strongly correlated with the cohesive stress of the sludge, was lowered by CaO addition. During agitated drying process, sludge lump with CaO addition started to break up at higher moisture content than that of original sludge. On the other hand, sawdust also affected the sticky properties of sludge in a way that was totally different with CaO. After sawdust addition (at 5-10%WS (wet sludge basis)), the cohesive stress of the sludge was markedly increased due to strengthening of mechanical interlocking inside the sludge, whereas the adhesiveness of the sludge was lowered by sawdust addition. The influencing mechanisms of CaO and sawdust under the different testing methods were detailedly discussed in the paper. Copyright © 2016 Elsevier Ltd. All rights reserved.

Characterizing the experience of agitation in patients with bipolar disorder and schizophrenia.

PubMed

Roberts, Jenna; Gracia Canales, Alfredo; Blanthorn-Hazell, Sophee; Craciun Boldeanu, Anca; Judge, Davneet

2018-04-16

Agitation is a common manifestation of bipolar disorder and schizophrenia which includes symptoms ranging from inner tension and unease to violence and aggression. Much of the existing literature has focused on agitation in the acute setting, with the patient experience poorly defined. Thus, the aim of this study was to characterize agitation and its management from a patient perspective, with the focus on those who reside in the community. Surveys were completed across Germany, Spain and the UK by 583 community dwelling patients with schizophrenia or bipolar disorder who experienced episodes of agitation. Patients were recruited via either their physician or through patient support groups. The survey captured information on demographics, disease characteristics, frequency of agitation episodes and different pre-defined severity levels ranging from mild to severe, symptoms experienced during an episode, awareness of agitation and coping strategies employed by the patient. Statistics were descriptive in nature. The most commonly reported symptoms during an episode of agitation were feeling uneasy (n = 373, 64%), restless (n = 368, 63%) or nervous (n = 368, 63%). Patients experienced an average of 22.4 (SD 57.2) mild, 15.4 (SD 61.2) moderate, 6.8 (SD 63.3) moderate-intense and 2.9 (SD 24.4) severe episodes within the last 12 months; on average 2.7 (SD 6.8) required hospital attendance. Half of patients (n = 313) had attended hospital due to agitation. In total, 71% of patients (n = 412) were aware they were becoming agitated either always or sometimes and 61% of patients (n = 347) were aware of agitation triggers either always or sometimes. The majority of patients reported being able to sometimes control their agitation (56%, n = 329) but 16% (n = 94) stated that there is typically nothing they can do. To cope with episodes 55% (n = 125) of schizophrenia patients and 66% (n = 234) of bipolar disorder patients reported taking

Dexmedetomidine use in the ED for control of methamphetamine-induced agitation.

PubMed

Lam, Rex Pui Kin; Yip, Wai Lam; Wan, Chi Keung; Tsui, Matthew Sik Hon

2017-04-01

Chemical restraint is often required to control agitation induced by methamphetamine. Dexmedetomidine is an α-2 adrenergic receptor agonist with sedative, analgesic, and sympatholytic properties. Its use in the emergency department (ED) to control methamphetamine-induced agitation has not been reported. To report two cases of methamphetamine-induced agitation successfully sedated with dexmedetomidine in the ED. The first case was a 42-year-old man with unstable emotion and violent behaviours after smoking methamphetamine. His agitation did not respond to a large cumulative dose of benzodiazepines (10mg of diazepam and 332mg of midazolam) administered over 48h and sedation was achieved with dexmedetomidine. The second case was a 38-year-old methamphetamine user with unstable emotion and recurrent episodes of agitation despite repeated doses of benzodiazepines, whose agitation was controlled with dexmedetomidine infusion. In both cases, dexmedetomidine apparently reduced the dose of benzodiazepines needed to achieve adequate sedation. Transient falls in blood pressure and slowing of the heart rate were noted, which resolved either spontaneously or after reducing the infusion rate without requiring drug treatment. Dexmedetomidine can be considered as an adjunct for chemical restraint when standard treatment fails to control the agitation induced by methamphetamine, but patient's hemodynamic state should be monitored closely during administration. Its efficacy and safety in the ED warrant further evaluation with prospective controlled trials. Copyright © 2016 Elsevier Inc. All rights reserved.

A controlled trial of aromatherapy for agitation in nursing home patients with dementia.

PubMed

Snow, Lynn A; Hovanec, Linda; Brandt, Jason

2004-06-01

Two controlled trials of aromatherapy to decrease agitation in persons with dementia have recently produced promising results. However, both studies combined the use of essential oils with massage. Thus, it is unclear if the effect of the aromatherapy intervention was the result of smelling or the cutaneous absorption of the oils. The purpose of this study was to determine whether smelling lavender oil decreases the frequency of agitated behaviors in patients with dementia. The study design was within-subjects ABCBA (A = lavender oil, B = thyme oil, C = unscented grapeseed oil): 4 weeks of baseline measurement, 2 weeks for each of the five treatment conditions (10-week total intervention time), and 2 weeks of postintervention measurement. Oil was placed every 3 hours on an absorbent fabric sachet pinned near the collarbone of each participant's shirt. A long-term care facility specifically for persons with dementia. Seven agitated nursing home residents with advanced dementia. Agitation was assessed every 2 days using a modified Cohen-Mansfield Agitation Inventory. Olfactory functioning was assessed with structured olfactory identification and discrimination tasks, and with qualitative behavioral observation during those tasks. Split-middle analyses conducted separately for each patient revealed no treatment effects specific to lavender, no treatment effects nonspecific to pleasant smelling substances, and no treatment effects dependent on order of treatment administration. There were no differences between participants with more and less intact olfactory abilities. There is significant evidence in the neurologic and neuropsychologic literature that persons with dementia have impaired olfactory abilities. Concordant with this literature, this study found no support for the use of a purely olfactory form of aromatherapy to decrease agitation in severely demented patients. Cutaneous application of the essential oil may be necessary to achieve the effects reported in

An investigation of the interactive effects of the capability for suicide and acute agitation on suicidality in a military sample.

PubMed

Ribeiro, Jessica D; Bender, Theodore W; Buchman, Jennifer M; Nock, Matthew K; Rudd, M David; Bryan, Craig J; Lim, Ingrid C; Baker, Monty T; Knight, Chadwick; Gutierrez, Peter M; Joiner, Thomas E

2015-01-01

According to the interpersonal theory of suicide (1, 2), the difficulties inherently associated with death by suicide deter many individuals from engaging in suicidal behavior. Consistent with the notion that suicide is fearsome, acute states of heightened arousal are commonly observed in individuals immediately prior to lethal and near-lethal suicidal behavior. We suggest that among individuals who possess elevated levels of the capability for suicide, the heightened state of arousal experienced during periods of acute agitation may facilitate suicidal behavior in part because it would provide the necessary energy to approach a potentially lethal stimulus. Among individuals who are low on capability, the arousal experienced during agitation may result in further avoidance. In the present project we examine how acute agitation may interact with the capability for suicide to predict suicidality in a large military sample (n = 1,208) using hierarchical multiple regression. Results were in line with a priori hypotheses: among individuals high on capability, as agitation increases, suicidality increases whereas as agitation increases among individuals low on capability, suicidality decreases. Results held beyond the effects of thwarted belongingness, perceived burdensomeness, and suicidal cognitions. Beyond further substantiating the link between agitation and suicide, findings of the present study provide evidence for the construct validity of the acquired capability as well as offer initial evidence for moderating role of capability on the effect of agitation on suicide. Limitations of the current study highlight a need for future research that improves upon the techniques used in the present study. Implications for science and practice are discussed. © 2014 Wiley Periodicals, Inc.

Citalopram for the Treatment of Agitation in Alzheimer Dementia: Genetic Influences.

PubMed

Peters, Matthew E; Vaidya, Vijay; Drye, Lea T; Devanand, Davangere P; Mintzer, Jacobo E; Pollock, Bruce G; Porsteinsson, Anton P; Rosenberg, Paul B; Schneider, Lon S; Shade, David M; Weintraub, Daniel; Yesavage, Jerome; Lyketsos, Constantine G; Avramopoulos, Dimitri

2016-03-01

To assess potential genetic influences on citalopram treatment efficacy for agitation in individuals with Alzheimer dementia (AD). Six functional genetic variants were studied in the following genes: serotonin receptor 2A (HTR2A-T102C), serotonin receptor 2C (HTR2C-Cys23Ser), serotonin transporter (5HTT-LPR), brain-derived neurotropic factor (BDNF-Val66Met), apolipoprotein E (ε2, ε3, ε4 variants), and cytochrome P450 (CYP2C19). Treatment response by genotype was measured by (1) the agitation domain of the Neurobehavioral Rating Scale, (2) the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change scale (mADCS-CGIC), (3) the agitation domain of the Neuropsychiatric Inventory (NPI), and (4) the Cohen-Mansfield Agitation Inventory. We utilized data from the Citalopram for Agitation in Alzheimer's Disease (CitAD) database. CitAD was a 9-week randomized, double-blind, placebo-controlled multicenter clinical trial showing significant improvement in agitation and caregiver distress in patients treated with citalopram. Proportional odds logistic regression and mixed effects models were used to examine the above-mentioned outcome measures. Significant interactions were noted on the NPI agitation domain for HTR2A (likelihood ratio [LR] = 6.19, df = 2, P = .04) and the mADCS-CGIC for HTR2C (LR = 4.33, df = 2, P = .02) over 9 weeks. Treatment outcomes in CitAD showed modest, although statistically significant, influence of genetic variation at HTR2A and HTR2C loci. Future studies should continue to examine the interaction of known genetic variants with antidepressant treatment in patients with AD having agitation. © The Author(s) 2015.

Identifying and treating agitated behaviors in the long-term care setting.

PubMed

Hastings, S N; Thompson-Heisterman, A; Farrell, S P

1999-01-01

This article provides information on identification, assessment, and intervention techniques for agitated behaviors in the long-term care setting. Although the emphasis is on prevention and management of agitation, the article offers suggestions to assist health care providers in differentiating between delirium, psychosis, depression, anxiety, and dementia, which may place a resident at risk for agitation. Basic treatment approaches for each of these disorders is also reviewed.

Perioperative prediction of agitated (hyperactive) delirium after cardiac surgery in adults - The development of a practical scorecard.

PubMed

Mufti, Hani N; Hirsch, Gregory M

2017-12-01

Delirium is a temporary mental disorder that occurs frequently among hospitalized patients. In this study we sought to develop a user-friendly scorecard based on perioperative features to identify patients at risk of developing agitated delirium after cardiac surgery. Retrospective analysis was performed on adult patients undergoing cardiac surgery in a single center. A parsimonious predictive model was created, with subsequent internal validation. Then a simple scorecard was developed that can be used to predict the probability of agitated delirium. Among the 5584 patients who met the study criteria, 614 (11.4%) developed postoperative agitated delirium. Independent predictors of postoperative agitated delirium were age, male gender, history of cerebrovascular disease, procedure other than isolated Coronary Arteries Bypass Surgery, transfusion of blood products within the first 48h, mechanical ventilation for >24h, length of stay in the Intensive Care Unit. The scorecard stratified patients into 4 categories at risk of postoperative agitated delirium ranging from <5% to >30%. Using a large cohort of adult patient's undergoing cardiac surgery, a user-friendly scorecard was developed and validated, which will facilitate the implementation of timely interventions to mitigate adverse effects of agitated delirium in this high risk population. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions

PubMed Central

Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

2016-01-01

Many patients with Alzheimer’s disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer’s disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement. PMID:26955265

Correlates Among Nocturnal Agitation, Sleep, and Urinary Incontinence in Dementia

PubMed Central

Rose, Karen; Specht, Janet; Forch, Windy

2016-01-01

Family caregivers of elders with dementia often face the challenging behaviors of nighttime agitation, sleep disturbances, and urinary incontinence. To date, no study has examined the interrelationships of these behaviors in community-dwelling persons. This single group, descriptive study employs wireless body sensors to objectively collect data on nighttime agitation, sleep, and urinary incontinence in patients with dementia in their homes over a 5- to 7-day period. The aims are to (1) examine the feasibility and acceptability of the use of body sensors in community-dwelling persons with dementia; (2) describe patterns of nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence; and (3) examine the relationships among nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence. Data collection is in early stages and is still in progress. Challenges and advantages from preliminary data collection are reported. PMID:24670931

Agitation apparatus. [Patent application

DOEpatents

Beets, A.L.; Lewis, B.E. Jr.

1982-03-12

Agitation apparatus includes a tank with a cylindrical upper portion, a frustoconical intermediate portion, and a cylindrical lower portion, a lift tube extending from the upper portion of the tank to a point near an end cap attached to the lower portion of the tank, the lift tube being concentric with the lower portion of the tank to provide a flow passage there between, and a plurality of air supply conduits extending along the lift tube and spaced apart around its perimeter, these air supply conduits terminating adjacent the lower end of the lift tube. Air discharged from the lower ends of the air supply conduits causes liquid in the tank to flow upwardly through the lift tube and out of apertures in the upper portion thereof. Due to the unique properties of nuclear fuel dissolver solutions and the constraint placed on the amount of air that can be injected therein by conventional apparatus, there has been a need for a more effective means for agitating liquid in nuclear fuel digester tanks.

Individual music therapy for agitation in dementia: an exploratory randomized controlled trial.

PubMed

Ridder, Hanne Mette O; Stige, Brynjulf; Qvale, Liv Gunnhild; Gold, Christian

2013-01-01

Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at -6.77 (95% CI (confidence interval): -12.71, -0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample.

Detecting agitation and aggression in people with dementia using sensors-A systematic review.

PubMed

Khan, Shehroz S; Ye, Bing; Taati, Babak; Mihailidis, Alex

2018-06-01

Agitation and aggression are among the most challenging symptoms of dementia. Agitated persons with dementia can harm themselves, their caregivers, or other patients in a care facility. Automatic detection of agitation would be useful to alert caregivers so that appropriate interventions can be performed. The building blocks in the automatic detection of agitation and aggression are appropriate sensing platforms and generalized predictive models. In this article, we perform a systematic review of studies that use different types of sensors to detect agitation and aggression in persons with dementia. We conclude that actigraphy shows some evidence of correlation with incidences of agitation and aggression; however, multimodal sensing has not been fully evaluated for this purpose. Based on this systematic review, we provide guidelines and recommendations for future research directions in this field. Copyright © 2018 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Individual music therapy for agitation in dementia: an exploratory randomized controlled trial

PubMed Central

Stige, Brynjulf; Qvale, Liv Gunnhild; Gold, Christian

2013-01-01

Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. Method: In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Results: Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at −6.77 (95% CI (confidence interval): −12.71, −0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). Conclusion: This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample. PMID:23621805

System for agitating the acid in a lead-acid battery

DOEpatents

Weintraub, Alvin; MacCormack, Robert S.

1987-01-01

A system and method for agitating the acid in a large lead-sulfuric acid storage battery of the calcium type. An air-lift is utilized to provide the agitation. The air fed to the air-lift is humidified prior to being delivered to the air-lift.

Waiting room crowding and agitation in a dedicated psychiatric emergency service.

PubMed

El-Mallakh, Rif S; Whiteley, Amanda; Wozniak, Tanya; Ashby, McCray; Brown, Shawn; Colbert-Trowel, Danya; Pennington, Tammy; Thompson, Michael; Tasnin, Rokeya; Terrell, Christina L

2012-05-01

Emergency department crowding is a growing problem that impacts patient care and safety. The effect of crowding has not been examined in emergency psychiatric services. The association between patient census and use of restraints, seclusion, and anti-agitation medications as needed was examined for 1 month. A total of 689 patients were seen in 31 days. The average hourly census was 6.8 ± 2.8 (range 0 to 18). There were 33 incidences of seclusion or restraint and an additional 15 instances of medications administered for agitation. The use of seclusion, restraint, or medication for agitation was significantly associated with census (r2 = 0.3, F = 5.47, P = .036). Crowding in emergency psychiatric waiting rooms may increase the need for seclusion, restraint, or medications for agitation.

Effect of processing conditions on quality of green beans subjected to reciprocating agitation thermal processing.

PubMed

Singh, Anika; Singh, Anubhav Pratap; Ramaswamy, Hosahalli S

2015-12-01

The effect of reciprocating agitation thermal processing (RA-TP) on quality of canned beans was evaluated in a lab-scale reciprocating retort. Green beans were selected due to their soft texture and sensitive color. Green beans (2.5cm length×0.8cm diameter) were filled into 307×409 cans with carboxylmethylcellulose (0-2%) solutions and processed at different temperatures (110-130°C) and reciprocation frequency (1-3Hz) for predetermined heating times to achieve a process lethality (F o ) of 10min. Products processed at higher temperatures and higher reciprocation frequencies resulted in better retention of chlorophyll and antioxidant activity. However, high reciprocation frequency also resulted in texture losses, with higher breakage of beans, increased turbidity and higher leaching. There was total loss of product quality at the highest agitation speed, especially with low viscosity covering solutions. Results suggest that reciprocating agitation frequency needs to be adequately moderated to get the best quality. For getting best quality, particularly for canned liquid particulate foods with soft particulates and those susceptible to high impact agitation, a gentle reciprocating motion (~1Hz) would be a good compromise. Copyright © 2015 Elsevier Ltd. All rights reserved.

Enhancing antibacterial effect of sodium hypochlorite by low electric current-assisted sonic agitation

PubMed Central

Maden, Murat; Ertuğrul, İhsan Furkan; Erik, Cevat Emre; Yetiş, Ceylan Çağıl; Tuncer, Yasin; Kahriman, Mesud

2017-01-01

Background This research focused on the effects of low electric current (μE)-assisted sonic agitation of sodium hypochlorite on Enterococcus faecalis infected human root dentin. Methods Extracted human canine roots were instrumented, sterilized, and experimentally contaminated with E. faecalis. After incubation for 21 days, the presence of the biofilm was confirmed by scanning electron microscopy (n = 3). Roots were randomly divided into seven groups according to decontamination procedures: G1: no treatment; G2: sterile saline; G3: 5.25% sodium hypochlorite; G4: passive ultrasonic irrigation; G5: EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK) agitation (EA); G6: μE agitation; and G7: μE-assisted sonic agitation. Fixed μE amperage and intensities were applied in G6 and G7. Following microbial sampling, bacterial colonies were counted using the direct plating method. Results Biofilm was not eradicated in any sample. The μE-assisted sonic agitation of sodium hypochlorite revealed the lowest cfu values (p<0.05), whereas there were no significant differences among the passive ultrasonic irrigation, EndoActivator and μE agitation alone (p>0.05). Conclusions Based on available evidence, the following conclusions were drawn: The μE-assisted sonic agitation increased the antibiofilm efficiency of sodium hypochlorite than passive ultrasonic irrigation and EndoActivator. The μE-assisted sonic agitation on 5.25% sodium hypochlorite is not capable to eradicate biofilms at 10mA energy level in 60s. PMID:28854274

Enhancing antibacterial effect of sodium hypochlorite by low electric current-assisted sonic agitation.

PubMed

Maden, Murat; Ertuğrul, İhsan Furkan; Orhan, Ekim Onur; Erik, Cevat Emre; Yetiş, Ceylan Çağıl; Tuncer, Yasin; Kahriman, Mesud

2017-01-01

This research focused on the effects of low electric current (μE)-assisted sonic agitation of sodium hypochlorite on Enterococcus faecalis infected human root dentin. Extracted human canine roots were instrumented, sterilized, and experimentally contaminated with E. faecalis. After incubation for 21 days, the presence of the biofilm was confirmed by scanning electron microscopy (n = 3). Roots were randomly divided into seven groups according to decontamination procedures: G1: no treatment; G2: sterile saline; G3: 5.25% sodium hypochlorite; G4: passive ultrasonic irrigation; G5: EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK) agitation (EA); G6: μE agitation; and G7: μE-assisted sonic agitation. Fixed μE amperage and intensities were applied in G6 and G7. Following microbial sampling, bacterial colonies were counted using the direct plating method. Biofilm was not eradicated in any sample. The μE-assisted sonic agitation of sodium hypochlorite revealed the lowest cfu values (p<0.05), whereas there were no significant differences among the passive ultrasonic irrigation, EndoActivator and μE agitation alone (p>0.05). Based on available evidence, the following conclusions were drawn: The μE-assisted sonic agitation increased the antibiofilm efficiency of sodium hypochlorite than passive ultrasonic irrigation and EndoActivator. The μE-assisted sonic agitation on 5.25% sodium hypochlorite is not capable to eradicate biofilms at 10mA energy level in 60s.

Coal storage hopper with vibrating screen agitator

DOEpatents

Daw, Charles S.; Lackey, Mack E.; Sy, Ronald L.

1984-01-01

The present invention is directed to a vibrating screen agitator in a coal storage hopper for assuring the uniform feed of coal having sufficient moisture content to effect agglomeration and bridging thereof in the coal hopper from the latter onto a conveyor mechanism. The vibrating screen agitator is provided by a plurality of transversely oriented and vertically spaced apart screens in the storage hopper with a plurality of vertically oriented rods attached to the screens. The rods are vibrated to effect the vibration of the screens and the breaking up of agglomerates in the coal which might impede the uniform flow of the coal from the hopper onto a conveyer.

Coal storage hopper with vibrating-screen agitator

DOEpatents

Daw, C.S.; Lackey, M.E.; Sy, R.L.

1982-04-27

The present invention is directed to a vibrating screen agitator in a coal storage hopper for assuring the uniform feed of coal having sufficient moisture content to effect agglomeration and bridging thereof in the coal hopper from the latter onto a conveyer mechanism. The vibrating scrren agitator is provided by a plurality of transversely oriented and vertically spaced apart screens in the storage hopper with a plurality of vertically oriented rods attached to the screens. The rods are vibrated to effect the vibration of the screens and the breaking up of agglomerates in the coal which might impede the uniform flow of the coal from the hopper onto a conveyer.

Effect of Agitation on Acidogenesis Stage of Two-Stage Anaerobic Digestion of Palm Oil Mill Effluent (POME) into Biogas

NASA Astrophysics Data System (ADS)

Trisakti, B.; Irvan; Adipasah, H.; Taslim; Turmuzi, M.

2017-03-01

The acidogenesis stage in two-stage anaerobic digestion of palm oil mill effluent (POME) was studied in a continuous stirred tank reactor (CSTR). This research investigated the effect of agitation rate on the growth of microorganisms, the degradation of organic substances, and volatile fatty acids (VFA) production and composition. Initially, the suitable loading up was determined by varying the HRT 6.7, 5.0, and 4.0 days in a 2 L CSTR with agitation rate 50 rpm, pH 6.0 ± 0.2, at room temperature. Next, effect of agitation on the process was determined by varying agitation rate at 25, 50, 100, and 200 rpm. Analysis of total solids (TS), volatile solids (VS), total suspended solids (TSS), volatile suspended solids (VSS), chemical oxygen demand (COD), and volatile fatty acids (VFA) were conducted in order to study the growth of microorganisms and their abilities in converting organic compound to produce VFA. The highest growth of microorganisms was achieved at HRT 4.0 day with microorganism concentration was 20.62 mg VSS/L and COD reduction was 15.7%. The highest production of total VFA achieved was 5,766.61 mg/L mg/L at agitation rate 200 rpm, with concentration of acetic acid, propionic acid and butyric acid were 1,889.23; 1,161.43; and 2,725.95 mg/L, respectively. While degradation VS and COD were 16.61 and 38.79%.

Electroconvulsive therapy (ECT) for treating agitation in dementia (major neurocognitive disorder) - a promising option.

PubMed

Glass, Oliver M; Forester, Brent P; Hermida, Adriana P

2017-05-01

Agitation in patients with dementia increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with dementia have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of ECT for the treatment of agitation in patients with dementia (major neurocognitive disorder). We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning ECT for treating agitation in dementia using the title search terms "ECT agitation dementia;" "ECT aggression dementia;" "ECT Behavior and Psychological Symptoms of Dementia;" and "ECT BPSD." The term "dementia" was also interchanged with "Major Neurocognitive Disorder." No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients. Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, ECT has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT. Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome

Non-biodegradable landfill leachate treatment by combined process of agitation, coagulation, SBR and filtration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abood, Alkhafaji R.; Thi Qar University, Nasiriyah; Bao, Jianguo, E-mail: bjianguo888@126.com

2014-02-15

Highlights: • A novel method of stripping (agitation) was investigated for NH{sub 3}-N removal. • PFS coagulation followed agitation process enhanced the leachate biodegradation. • Nitrification–denitrification achieved by changing operation process in SBR treatment. • A dual filter of carbon-sand is suitable as a polishing treatment of leachate. • Combined treatment success for the complete treatment of non-biodegradable leachate. - Abstract: This study describes the complete treatment of non-biodegradable landfill leachate by combined treatment processes. The processes consist of agitation as a novel stripping method used to overcome the ammonia toxicity regarding aerobic microorganisms. The NH{sub 3}-N removal ratio wasmore » 93.9% obtained at pH 11.5 and a gradient velocity (G) 150 s{sup −1} within a five-hour agitation time. By poly ferric sulphate (PFS) coagulation followed the agitation process; chemical oxygen demand (COD) and biological oxygen demand (BOD{sub 5}) were removed at 70.6% and 49.4%, respectively at an optimum dose of 1200 mg L{sup −1} at pH 5.0. The biodegradable ratio BOD{sub 5}/COD was improved from 0.18 to 0.31 during pretreatment step by agitation and PFS coagulation. Thereafter, the effluent was diluted with sewage at a different ratio before it was subjected to sequencing batch reactor (SBR) treatment. Up to 93.3% BOD{sub 5}, 95.5% COD and 98.1% NH{sub 3}-N removal were achieved by SBR operated under anoxic–aerobic–anoxic conditions. The filtration process was carried out using sand and carbon as a dual filter media as polishing process. The final effluent concentration of COD, BOD{sub 5}, suspended solid (SS), NH{sub 3}-N and total organic carbon (TOC) were 72.4 mg L{sup −1}, 22.8 mg L{sup −1}, 24.2 mg L{sup −1}, 18.4 mg L{sup −1} and 50.8 mg L{sup −1} respectively, which met the discharge standard. The results indicated that a combined process of agitation-coagulation-SBR and filtration effectively

Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia.

PubMed

Acharya, Deepa; Harper, David G; Achtyes, Eric D; Seiner, Stephen J; Mahdasian, Jack A; Nykamp, Louis J; Adkison, Lesley; Van der Schuur White, Lori; McClintock, Shawn M; Ujkaj, Manjola; Davidoff, Donald A; Forester, Brent P

2015-03-01

Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge. Twenty-three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen-Mansfield Agitation Inventory-Short Form, Neuropsychiatric Inventory-Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course. Regression analyses revealed a significant decrease from baseline to discharge on the Cohen-Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p < 0.001). There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of "markedly agitated/aggressive" at baseline to "borderline agitated/aggressive" at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events. Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. Copyright © 2014 John Wiley & Sons, Ltd.

Electroconvulsive Therapy for Agitation and Aggression in Dementia: A Systematic Review.

PubMed

van den Berg, Julia F; Kruithof, Henk C; Kok, Rob M; Verwijk, Esmée; Spaans, Harm-Pieter

2018-04-01

Many patients with dementia develop agitation or aggression in the course of their disease. In some severe cases, behavioral, environmental, and pharmacological interventions are not sufficient to alleviate these potentially life-threatening symptoms. It has been suggested that in those cases, electroconvulsive therapy (ECT) could be an option. This review summarizes the scientific literature on ECT for agitation and aggression in dementia. We performed a systematic review in accordance with PRISMA guidelines. A search was conducted in Ovid MEDLINE, EMBASE, and PsycINFO. Two reviewers extracted the following data from the retrieved articles: number of patients and their age, gender, diagnoses, types of problem behavior, treatments tried before ECT, specifications of the ECT treatment, use of rating scales, treatment results, follow-up data, and adverse effects. The initial search yielded 264 articles, 17 of which fulfilled the inclusion criteria. Of these studies, one was a prospective cohort study, one was a case-control study, and the others were retrospective chart reviews, case series, or case reports. Clinically significant improvement was observed in the majority (88%) of the 122 patients described, often early in the treatment course. Adverse effects were most commonly mild, transient, or not reported. The reviewed articles suggest that ECT could be an effective treatment for severe and treatment-refractory agitation and aggression in dementia, with few adverse consequences. Nevertheless, because of the substantial risk of selection bias, the designs of the studies reviewed, and their small number, further prospective studies are needed to substantiate these preliminary positive results. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Computational fluid dynamics (CFD) insights into agitation stress methods in biopharmaceutical development.

PubMed

Bai, Ge; Bee, Jared S; Biddlecombe, James G; Chen, Quanmin; Leach, W Thomas

2012-02-28

Agitation of small amounts of liquid is performed routinely in biopharmaceutical process, formulation, and packaging development. Protein degradation commonly results from agitation, but the specific stress responsible or degradation mechanism is usually not well understood. Characterization of the agitation stress methods is critical to identifying protein degradation mechanisms or specific sensitivities. In this study, computational fluid dynamics (CFD) was used to model agitation of 1 mL of fluid by four types of common laboratory agitation instruments, including a rotator, orbital shaker, magnetic stirrer and vortex mixer. Fluid stresses in the bulk liquid and near interfaces were identified, quantified and compared. The vortex mixer provides the most intense stresses overall, while the stir bar system presented locally intense shear proximal to the hydrophobic stir bar surface. The rotator provides gentler fluid stresses, but the air-water interfacial area and surface stresses are relatively high given its low rotational frequency. The orbital shaker provides intermediate-level stresses but with the advantage of a large stable platform for consistent vial-to-vial homogeneity. Selection of experimental agitation methods with targeted types and intensities of stresses can facilitate better understanding of protein degradation mechanisms and predictability for "real world" applications. Copyright © 2011 Elsevier B.V. All rights reserved.

Does psychomotor agitation in major depressive episodes indicate bipolarity? Evidence from the Zurich Study.

PubMed

Angst, Jules; Gamma, Alex; Benazzi, Franco; Ajdacic, Vladeta; Rössler, Wulf

2009-02-01

Kraepelin's partial interpretation of agitated depression as a mixed state of "manic-depressive insanity" (including the current concept of bipolar disorder) has recently been the focus of much research. This paper tested whether, how, and to what extent both psychomotor symptoms, agitation and retardation in depression are related to bipolarity and anxiety. The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N = 591) (aged 20 at first interview) by six interviews over 20 years (1979-1999). Psychomotor symptoms of agitation and retardation were assessed by professional interviewers from age 22 to 40 (five interviews) on the basis of the observed and reported behaviour within the interview section on depression. Psychiatric diagnoses were strictly operationalised and, in the case of bipolar-II disorder, were broader than proposed by DSM-IV-TR and ICD-10. As indicators of bipolarity, the association with bipolar disorder, a family history of mania/hypomania/cyclothymia, together with hypomanic and cyclothymic temperament as assessed by the general behavior inventory (GBI) [15], and mood lability (an element of cyclothymic temperament) were used. Agitated and retarded depressive states were equally associated with the indicators of bipolarity and with anxiety. Longitudinally, agitation and retardation were significantly associated with each other (OR = 1.8, 95% CI = 1.0-3.2), and this combined group of major depressives showed stronger associations with bipolarity, with both hypomanic/cyclothymic and depressive temperamental traits, and with anxiety. Among agitated, non-retarded depressives, unipolar mood disorder was even twice as common as bipolar mood disorder. Combined agitated and retarded major depressive states are more often bipolar than unipolar, but, in general, agitated depression (with or without retardation) is not more frequently bipolar than retarded depression (with or without agitation), and

Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study.

PubMed

Livingston, Gill; Barber, Julie; Marston, Louise; Rapaport, Penny; Livingston, Deborah; Cousins, Sian; Robertson, Sarah; La Frenais, Francesca; Cooper, Claudia

2017-07-01

Agitation is reportedly the most common neuropsychiatric symptom in care home residents with dementia. To report, in a large care home survey, prevalence and determinants of agitation in residents with dementia. We interviewed staff from 86 care homes between 13 January 2014 and 12 November 2015 about residents with dementia with respect to agitation (Cohen-Mansfield Agitation Inventory (CMAI)), quality of life (DEMQOL-proxy) and dementia severity (Clinical Dementia Rating). We also interviewed residents and their relatives. We used random effects models adjusted for resident age, gender, dementia severity and care home type with CMAI as a continuous score. Out of 3053 (86.2%) residents who had dementia, 1489 (52.7%) eligible residents participated. Fifteen per cent of residents with very mild dementia had clinically significant agitation compared with 33% with mild (odds ratios (ORs)=4.49 95% confidence interval (CI)=2.30) and 45% with moderate or severe dementia (OR=6.95 95% CI=3.63, 13.31 and OR=6.23 95% CI=3.25, 11.94, respectively). More agitation was associated with lower quality of life (regression coefficient (rc)=-0.53; 95% CI=-0.61, -0.46) but not with staffing or resident ratio (rc=0.03; 95% CI=-0.04, 0.11), level of residents' engagement in home activities (rc=3.21; 95% CI=-0.82, 7.21) or family visit numbers (rc=-0.03; 95% CI=-0.15, 0.08). It was correlated with antipsychotic use (rc=6.45; 95% CI=3.98, 8.91). Care home residents with dementia and agitation have lower quality of life. More staffing time and activities as currently provided are not associated with lower agitation levels. New approaches to develop staff skills in understanding and responding to the underlying reasons for individual resident's agitation require development and testing. None. © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Non-biodegradable landfill leachate treatment by combined process of agitation, coagulation, SBR and filtration.

PubMed

Abood, Alkhafaji R; Bao, Jianguo; Du, Jiangkun; Zheng, Dan; Luo, Ye

2014-02-01

This study describes the complete treatment of non-biodegradable landfill leachate by combined treatment processes. The processes consist of agitation as a novel stripping method used to overcome the ammonia toxicity regarding aerobic microorganisms. The NH3-N removal ratio was 93.9% obtained at pH 11.5 and a gradient velocity (G) 150 s(-1) within a five-hour agitation time. By poly ferric sulphate (PFS) coagulation followed the agitation process; chemical oxygen demand (COD) and biological oxygen demand (BOD5) were removed at 70.6% and 49.4%, respectively at an optimum dose of 1200 mg L(-1) at pH 5.0. The biodegradable ratio BOD5/COD was improved from 0.18 to 0.31 during pretreatment step by agitation and PFS coagulation. Thereafter, the effluent was diluted with sewage at a different ratio before it was subjected to sequencing batch reactor (SBR) treatment. Up to 93.3% BOD5, 95.5% COD and 98.1% NH3-N removal were achieved by SBR operated under anoxic-aerobic-anoxic conditions. The filtration process was carried out using sand and carbon as a dual filter media as polishing process. The final effluent concentration of COD, BOD5, suspended solid (SS), NH3-N and total organic carbon (TOC) were 72.4 mg L(-1), 22.8 mg L(-1), 24.2 mg L(-1), 18.4 mg L(-1) and 50.8 mg L(-1) respectively, which met the discharge standard. The results indicated that a combined process of agitation-coagulation-SBR and filtration effectively eliminated pollutant loading from landfill leachate. Copyright © 2013 Elsevier Ltd. All rights reserved.

SAFETY AND UTILITY OF ACUTE ELECTROCONVULSIVE THERAPY FOR AGITATION AND AGGRESSION IN DEMENTIA

PubMed Central

Acharya, Deepa; Harper, David G.; Achtyes, Eric D.; Seiner, Stephen J.; Mahdasian, Jack A.; Nykamp, Louis J.; Adkison, Lesley; Van der Schuur White, Lori; McClintock, Shawn M.; Ujkaj, Manjola; Davidoff, Donald A.; Forester, Brent P.

2015-01-01

Objective Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge. Methods Twenty-three participants admitted to McLean Hospital (Belmont, MA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen-Mansfield Agitation Inventory (CMAI)-short form, Neuropsychiatric Inventory (NPI)-Nursing Home Version, Cornell Scale for Depression in Dementia (CSDD), and the Clinical Global Impression Scale (CGI) at baseline, during, and after the ECT course. Results Regression analyses revealed a significant decrease from baseline to discharge on the CMAI (F(4, 8) =13.3; p=0.006) and NPI (F(4, 31)= 14.6; p<0.001). There was no statistically significant change in scores on the CSDD. The CGI scores on average changed from a rating of “markedly agitated/aggressive” at baseline to “borderline agitated/aggressive” at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants due to recurrence of agitation and for three participants due to adverse events. Conclusions ECT may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. PMID:24838521

[Application of music therapy for managing agitated behavior in older people with dementia].

PubMed

Sung, Huei-Chuan; Chang, Anne M; Abbey, Jennifer

2006-10-01

Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia.

Effect of agitation rate on ethanol production from sugar maple hemicellulosic hydrolysate by Pichia stipitis.

PubMed

Shupe, Alan M; Liu, Shijie

2012-09-01

Concentrated dilute acid hydrolysate was obtained from hot water extracts of Acer saccharum (sugar maple) and was fermented to ethanol by Pichia stipitis in a 1.3-L-benchtop bioreactor. The conditions under which the highest ethanol yield was achieved were when the air flow rate was set to 100 cm(3) and the agitation rate was set to 150 rpm resulting in an overall mass transfer coefficient (K(L)a) of 0.108 min(-1). A maximum ethanol concentration of 29.7 g/L was achieved after 120 h of fermentation; however, after 90 h of fermentation, the ethanol concentration was only slightly lower at 29.1 g/L with a yield of 0.39 g ethanol per gram of sugar consumed. Using the same air flow rate and adjusting the agitation rate resulted in lower ethanol yields of 0.25 g/g at 50 rpm and 0.30 g/g at 300 rpm. The time it takes to reach the maximum ethanol concentration was also affected by the agitation rate. The ethanol concentration continued to increase even after 130 h of fermentation when the agitation rate was set at 50 rpm, whereas the maximum ethanol concentration was reached after only 68.5 h at 300 rpm.

Effectiveness and safety of oral olanzapine treatment transitioned from rapid-acting intramuscular olanzapine for agitation associated with schizophrenia.

PubMed

Katagiri, Hideaki; Taketsuna, Masanori; Kondo, Shinpei; Kajimoto, Kenta; Aoi, Etsuko; Tanji, Yuka

2018-01-01

To assess the effectiveness and safety of oral olanzapine treatment transitioned from rapid-acting intramuscular olanzapine (RAIM) in patients with acute agitation associated with schizophrenia in a real-world clinical setting. The postmarketing surveillance study with a 3-day observational period after the last RAIM administration was conducted (original study). Following this, an extended study was added for patients who received oral olanzapine after RAIM administration during the original study period, in order to additionally observe them for 7 days after initial RAIM administration. Effectiveness and safety from initial RAIM administration were evaluated using the Positive and Negative Syndrome Scale-Excited Component score and treatment-emergent adverse events (TEAEs), respectively. The effectiveness and safety analysis set included a total of 521 and 522 patients, respectively. A majority of patients received 10 mg of RAIM (475/522 patients, 91.0%). The mean ± SD total Positive and Negative Syndrome Scale-Excited Component score was 23.6±6.2 (n=318) at baseline (before initial RAIM administration), 17.4±6.8 (n=280) at 2 hours after initial administration, 16.2±6.8 (n=246) 2 days after final administration, 14.9±6.2 (n=248) 3 days after final administration, 13.8±5.9 (n=242) 4 days after final administration, 13.2±5.8 (n=221) 7 days after initial administration, and 13.4±6.2 (n=351) at final observation (with the last observation carried forward approach), showing that reduction in agitation seen with RAIM was sustained with oral dose of olanzapine. The most common TEAEs were dyslalia and somnolence (each event occurred in four patients), and abnormal hepatic function and constipation (occurred in three patients). One serious adverse event of sudden cardiac death occurred after transitioned to oral olanzapine with many other antipsychotic drugs. In the treatment of acute agitation associated with schizophrenia, RAIM could be generally transitioned to

Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes.

PubMed

Reznik, Michael E; Schmidt, J Michael; Mahta, Ali; Agarwal, Sachin; Roh, David J; Park, Soojin; Frey, Hans Peter; Claassen, Jan

2017-06-01

Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study. We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton IADL (Instrumental Activities of Daily Living) scores. Independent predictors were identified using logistic regression. From 309 SAH patients admitted between January 2011 and December 2015, 52 (17 %) developed agitation, frequently in the first 72 h (50 %) and in patients with Hunt-Hess grades 3-4 (12 % of grades 1-2, 28 % of grades 3-4, 8 % of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications; and in half of these patients, complications were diagnosed within 24 h of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95 % CI, 1.1-6.8) in non-comatose patients (Hunt-Hess 1-4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors. Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications and may have an independent impact on long-term outcomes.

Agitation after subarachnoid hemorrhage: a frequent omen of hospital complications associated with worse outcomes

PubMed Central

Reznik, Michael E.; Schmidt, J. Michael; Mahta, Ali; Agarwal, Sachin; Roh, David J.; Park, Soojin; Frey, Hans Peter; Claassen, Jan

2017-01-01

Purpose Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study. Methods We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton-IADL (Instrumental Activities of Daily Living) score. Independent predictors were identified using logistic regression. Results From 309 SAH patients admitted between 1/2011 and 12/2015, 52 (17%) developed agitation, frequently in the first 72 hours (50%) and in patients with Hunt-Hess grades 3–4 (12% of grades 1–2, 28% of grades 3–4, 8% of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications, and in half of these patients complications were diagnosed within 24 hours of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95% CI 1.1–6.8) in non-comatose patients (Hunt-Hess 1–4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors. Conclusion Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications, and may have an independent impact on long-term outcomes. PMID:28008563

Behavioral interventions for agitation in older adults with dementia: an evaluative review.

PubMed

Spira, Adam P; Edelstein, Barry A

2006-06-01

Older adults with dementia commonly exhibit agitated behavior that puts them at risk of injury and institutionalization and is associated with caregiver stress. A range of theoretical approaches has produced numerous interventions to manage these behavior problems. This paper critically reviews the empirical literature on behavioral interventions to reduce agitation in older adults with dementia. A literature search yielded 23 articles that met inclusion criteria. These articles described interventions that targeted wandering, disruptive vocalization, physical aggression, other agitated behaviors and a combination of these behaviors. Studies are summarized individually and then evaluated. Behavioral interventions targeting agitated behavior exhibited by older adults with dementia show considerable promise. A number of methodological issues must be addressed to advance this research area. Problem areas include inconsistent use of functional assessment techniques, failure to report quantitative findings and inadequate demonstrations of experimental control. The reviewed studies collectively provide evidence that warrants optimism regarding the application of behavioral principles to the management of agitation among older adults with dementia. Although the results of some studies were mixed and several studies revealed methodological shortcomings, many of them offered innovations that can be used in future, more rigorously designed, intervention studies.

Silicone Oil- and Agitation-Induced Aggregation of a Monoclonal Antibody in Aqueous Solution

PubMed Central

Thirumangalathu, Renuka; Krishnan, Sampathkumar; Ricci, Margaret Speed; Brems, David N.; Randolph, Theodore W.; Carpenter, John F.

2009-01-01

Silicone oil, which is used as a lubricant or coating in devices such as syringes, needles and pharmaceutical containers, has been implicated in aggregation and particulation of proteins and antibodies. Aggregation of therapeutic protein products induced by silicone oil can pose a challenge to their development and commercialization. To systematically characterize the role of silicone oil on protein aggregation, the effects of agitation, temperature, pH and ionic strength on silicone oil-induced loss of monomeric anti-streptavidin IgG 1 antibody were examined. Additionally, the influences of excipients polysorbate20 and sucrose on protein aggregation were investigated. In the absence of agitation, protein absorbed to silicone oil with approximately monolayer coverage, however silicone oil did not stimulate aggregation during isothermal incubation unless samples were also agitated. A synergistic stimulation of aggregation by a combination of agitation and silicone oil was observed. Solution conditions which reduced colloidal stability of the antibody, as assessed by determination of osmotic second virial coefficients, accelerated aggregation during agitation with silicone oil. Polysorbate20 completely inhibited silicone oil-induced monomer loss during agitation. A formulation strategy optimizing colloidal stability of the antibody as well as incorporation of surfactants such as polysorbate20 is proposed to reduce silicone oil-induced aggregation of therapeutic protein products. PMID:19360857

40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid service...

Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study

PubMed Central

Barber, Julie; Marston, Louise; Rapaport, Penny; Livingston, Deborah; Cousins, Sian; Robertson, Sarah; La Frenais, Francesca; Cooper, Claudia

2017-01-01

Background Agitation is reportedly the most common neuropsychiatric symptom in care home residents with dementia. Aims To report, in a large care home survey, prevalence and determinants of agitation in residents with dementia. Method We interviewed staff from 86 care homes between 13 January 2014 and 12 November 2015 about residents with dementia with respect to agitation (Cohen-Mansfield Agitation Inventory (CMAI)), quality of life (DEMQOL-proxy) and dementia severity (Clinical Dementia Rating). We also interviewed residents and their relatives. We used random effects models adjusted for resident age, gender, dementia severity and care home type with CMAI as a continuous score. Results Out of 3053 (86.2%) residents who had dementia, 1489 (52.7%) eligible residents participated. Fifteen per cent of residents with very mild dementia had clinically significant agitation compared with 33% with mild (odds ratios (ORs)=4.49 95% confidence interval (CI)=2.30) and 45% with moderate or severe dementia (OR=6.95 95% CI=3.63, 13.31 and OR=6.23 95% CI=3.25, 11.94, respectively). More agitation was associated with lower quality of life (regression coefficient (rc)=−0.53; 95% CI=−0.61, −0.46) but not with staffing or resident ratio (rc=0.03; 95% CI=−0.04, 0.11), level of residents’ engagement in home activities (rc=3.21; 95% CI=−0.82, 7.21) or family visit numbers (rc=−0.03; 95% CI=−0.15, 0.08). It was correlated with antipsychotic use (rc=6.45; 95% CI=3.98, 8.91). Conclusions Care home residents with dementia and agitation have lower quality of life. More staffing time and activities as currently provided are not associated with lower agitation levels. New approaches to develop staff skills in understanding and responding to the underlying reasons for individual resident’s agitation require development and testing. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the

Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition.

PubMed

Cummings, Jeffrey; Mintzer, Jacobo; Brodaty, Henry; Sano, Mary; Banerjee, Sube; Devanand, D P; Gauthier, Serge; Howard, Robert; Lanctôt, Krista; Lyketsos, Constantine G; Peskind, Elaine; Porsteinsson, Anton P; Reich, Edgardo; Sampaio, Cristina; Steffens, David; Wortmann, Marc; Zhong, Kate

2015-01-01

Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs. The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process. Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as "strongly agree" or "somewhat agree" (68-88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications. A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.

Actigraphy in the critically ill: correlation with activity, agitation, and sedation.

PubMed

Grap, Mary Jo; Borchers, C Todd; Munro, Cindy L; Elswick, R K; Sessler, Curtis N

2005-01-01

To determine the feasibility of continuous measurement of limb movement via wrist and ankle actigraphy (an activity measure) in critically ill patients and to compare actigraphy measurements with observed activity, subjective scores on sedation-agitation scales, and heart rate and blood pressure of patients. In a prospective, descriptive, correlational study, all activity of 20 adult patients in medical and coronary care units in a university medical center were observed for 2 hours and documented. Wrist and ankle actigraphy, heart rate, and systolic and diastolic blood pressure data were collected every minute. The Comfort Scale and the Richmond Agitation-Sedation Scale were completed at the beginning of the observation period and 1 and 2 hours later. Wrist actigraphy data correlated with scores on the Richmond Agitation-Sedation Scale (r = 0.58) and the Comfort Scale (r = 0.62) and with observed stimulation and activity events of patients (r = 0.45). Correlations with systolic, diastolic, and mean arterial pressures were weaker. Wrist and ankle actigraphy data were significantly correlated (r = 0.69; P < .001); however, their mean values (wrist, 418; ankle, 147) were significantly different (t = 5.77; P < .001). Actigraphy provides a continuous recording of patients' limb movement. Actigraphy measurements correlate well with patients' observed activity and with subjective scores on agitation and sedation scales. Actigraphy may become particularly important as a continuous measurement of activity for use in behavioral research and may enhance early recognition and management of the excessive activity that characterizes agitation.

In-patient costs of agitation and containment in a mental health catchment area.

PubMed

Serrano-Blanco, Antoni; Rubio-Valera, Maria; Aznar-Lou, Ignacio; Baladón Higuera, Luisa; Gibert, Karina; Gracia Canales, Alfredo; Kaskens, Lisette; Ortiz, José Miguel; Salvador-Carulla, Luis

2017-06-06

There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.

Role of citalopram in the treatment of agitation in Alzheimer’s disease

PubMed Central

Porsteinsson, Anton P; Keltz, Melanie A; Smith, Jessica S

2014-01-01

SUMMARY Neuropsychiatric symptoms (NPS) are common among individuals with Alzheimer’s disease (AD), associated with excess morbidity and mortality, greater healthcare use, earlier institutionalization, and caregiver burden. Agitation presents as emotional distress, excessive psychomotor activity, aggressive behaviors, disruptive irritability and dishibition. There is an unmet need to find pharmacologic treatment for agitation in patients with AD that can be safely and effectively used as a concurrent treatment alongside psychosocial interventions. A recent, multicenter, randomized, placebo-controlled trial explored the efficacy of a 30-mg daily dose of citalopram for agitation in patients with AD and showed a significant decrease in agitation for citalopram compared with placebo. Both QTc prolongation and cognitive worsening, as measured by the Mini Mental State Examination, were observed in the citalopram group and present a concern to clinicians. Citalopram at a 20-mg daily dose should be considered as a possible first-line treatment in addition to psychosocial intervention. PMID:25405648

An Agitation Experiment with Multiple Aspects

ERIC Educational Resources Information Center

Spencer, Jordan L.

2006-01-01

This paper describes a multifaceted agitation and mixing experiment. The relatively inexpensive apparatus includes a variable-speed stirrer motor, two polycarbonate tanks, and an instrumented torque table. Students measure torque as a function of stirrer speed, and use conductive tracer data to estimate two parameters of a flow model. The effect…

Low-dose divalproex in agitated patients with Alzheimer's disease.

PubMed

Dolder, Christian; McKinsey, Jonathan

2010-01-01

Adequate treatment of behavioral disturbances in Alzheimer's disease is both important and difficult. This report describes a case series that examined the effectiveness and safety of low-dose divalproex in the treatment of agitated patients with Alzheimer's disease who were admitted to an inpatient geriatric psychiatry unit over a 1-year period. All patients had agitation due to probable Alzheimer's disease or mixed dementia and were prescribed divalproex monotherapy at low and completely flexible doses. Patients and nursing staff were blind to study enrollment. Clinical global impression scale scores, divalproex serum levels, and a variety of medical chart data were collected. Twenty patients met selection criteria and were included in the study. Of those, 13 patients (65%) were considered responders, while 4 patients (20%) required augmentation with other psychotropic medications; divalproex was discontinued in 1 patient. Adverse events occurred in 25% of patients. This case series suggests that low-dose divalproex may offer behavioral improvement and a reduced risk of side effects for some patients with agitation in Alzheimer's disease.

A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

ERIC Educational Resources Information Center

Burgio, Louis D.; Park, Nan Sook; Hardin, J. Michael; Sun, Fei

2007-01-01

Purpose: Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. Design and Methods: The study included participants (N =…

Propofol-Based Palliative Sedation to Treat Antipsychotic-Resistant Agitated Delirium.

PubMed

Covarrubias-Gómez, Alfredo; López Collada-Estrada, Maria

Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness. Propofol is a sedative that has a short duration of action and a very rapid onset. These characteristics make it relatively easy to titrate. Reported doses range from 50 to 70 mg per hour. The authors present a case of antipsychotic-resistant agitated delirium treated with a propofol intravenous infusion.

40 CFR 65.110 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., and agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and..., valves, connectors, and agitators in heavy liquid service; pressure relief devices in light liquid or...

40 CFR 65.110 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., and agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and..., valves, connectors, and agitators in heavy liquid service; pressure relief devices in light liquid or...

40 CFR 65.110 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., and agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and..., valves, connectors, and agitators in heavy liquid service; pressure relief devices in light liquid or...

40 CFR 65.110 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., and agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and..., valves, connectors, and agitators in heavy liquid service; pressure relief devices in light liquid or...

40 CFR 65.110 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and..., valves, connectors, and agitators in heavy liquid service; pressure relief devices in light liquid or...

Animal-assisted therapy and agitation and depression in nursing home residents with dementia: a matched case-control trial.

PubMed

Majić, Tomislav; Gutzmann, Hans; Heinz, Andreas; Lang, Undine E; Rapp, Michael A

2013-11-01

To investigate the efficacy of animal-assisted therapy (AAT) on symptoms of agitation/aggression and depression in nursing home residents with dementia in a randomized controlled trial. Previous studies have indicated that AAT has beneficial effects on neuropsychiatric symptoms in various psychiatric disorders but few studies have investigated the efficacy of AAT in patients suffering from dementia. Of 65 nursing home residents with dementia (mean [standard deviation] age: 81.8 [9.2] years; mean Mini-Mental State Examination score: 7.1 [0.7]), 27 matched pairs (N = 54) were randomly assigned to either treatment as usual or treatment as usual combined with AAT, administered over 10 weekly sessions. Blinded raters assessed cognitive impairment with the Mini-Mental State Examination, presence of agitation/aggression with the Cohen-Mansfield Agitation Inventory, and depression with the Dementia Mood Assessment Scale at baseline and during a period of 4 weeks after AAT intervention. In the control group, symptoms of agitation/aggression and depression significantly increased over 10 weeks; in the intervention group, patients receiving combined treatment displayed constant frequency and severity of symptoms of agitation/aggression (F1,48 = 6.43; p <0.05) and depression (F1,48 = 26.54; p <0.001). Symptom amelioration did not occur in either group. AAT is a promising option for the treatment of agitation/aggression and depression in patients with dementia. Our results suggest that AAT may delay progression of neuropsychiatric symptoms in demented nursing home residents. Further research is needed to determine its long-time effects. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Prevention of Emergence Agitation with Ketamine in Rhinoplasty.

PubMed

Demir, Canser Yilmaz; Yuzkat, Nureddin

2018-06-01

Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20 min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty. Totally 140 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were equally and randomly divided into two groups: saline group (control group) (n = 70) and ketamine group (n = 70). Twenty minutes before surgery completion, 1 ml saline was administered via the intravenous (i.v.) route to the saline group, while 0.5 mg/kg ketamine was administered via i.v. patients in the ketamine group. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). For postoperative pain evaluation, the Numerical Rating Scale (NRS) was scored (from 0 to 10) every 10 min until the patients were discharged from PACU. EA incidence in the control group was as high as 54.3%, while in the ketamine group it was 8.6% just after extubation (p < 0.001). In the PACU, EA incidence was 28.6% in the control group, while none of the patients had EA in the PACU in the ketamine group (p < 0.001). Male gender, severe pain (NRS ≥ 5), and smoking were defined as significant risk factors for EA both after extubation and during follow-ups in the PACU (p < 0.001). Emergence agitation after rhinoplasty is a common complication, likely disturbing operative outcomes in adults. Ketamine at sub-anesthetic doses is highly effective in preventing EA. Further, larger-scale prospective studies are

Tissue dissolution by sodium hypochlorite: effect of concentration, temperature, agitation, and surfactant.

PubMed

Stojicic, Sonja; Zivkovic, Slavoljub; Qian, Wei; Zhang, Hui; Haapasalo, Markus

2010-09-01

Sodium hypochlorite is the most commonly used endodontic irrigant because of its antimicrobial and tissue-dissolving activity. The aim of this study was to evaluate and compare the effects of concentration, temperature, and agitation on the tissue-dissolving ability of sodium hypochlorite. In addition, a hypochlorite product with added surface active agent was compared with conventional hypochlorite solutions. Three sodium hypochlorite solutions from two different manufacturers in concentrations of 1%, 2%, 4%, and 5.8% were tested at room temperature, 37 degrees C, and 45 degrees C with and without agitation by ultrasonic and sonic energy and pipetting. Distilled and sterilized tap water was used as controls. Pieces of bovine muscle tissue (68 +/- 3 mg) were placed in 10 mL of each solution for five minutes. In selected samples, agitation was performed for one, two, or four 15-second periods per each minute. The tissue specimens were weighed before and after treatment, and the percentage of weight loss was calculated. The contact angle on dentin of the three solutions at concentrations of 1% and 5.8% was measured. Weight loss (dissolution) of the tissue increased almost linearly with the concentration of sodium hypochlorite. Higher temperatures and agitation considerably enhanced the efficacy of sodium hypochlorite. The effect of agitation on tissue dissolution was greater than that of temperature; continuous agitation resulted in the fastest tissue dissolution. Hypochlorite with added surface active agent had the lowest contact angle on dentin and was most effective in tissue dissolution in all experimental situations. Optimizing the concentration, temperature, flow, and surface tension can improve the tissue-dissolving effectiveness of hypochlorite even 50-fold. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Duration of Agitation, Fluctuations of Consciousness, and Associations with Outcome in Patients with Subarachnoid Hemorrhage.

PubMed

Reznik, Michael E; Mahta, Ali; Schmidt, J Michael; Frey, Hans-Peter; Park, Soojin; Roh, David J; Agarwal, Sachin; Claassen, Jan

2018-01-08

Agitation is common after subarachnoid hemorrhage (SAH) and may be independently associated with outcomes. We sought to determine whether the duration of agitation and fluctuating consciousness were also associated with outcomes in patients with SAH. We identified all patients with positive Richmond Agitation Sedation Scale (RASS) scores from a prospective observational cohort of patients with SAH from 2011 to 2015. Total duration of agitation was extrapolated for each patient using available RASS scores, and 24-h mean and standard deviation (SD) of RASS scores were calculated for each patient. We also calculated each patient's duration of substantial fluctuation of consciousness, defined as the number of days with 24-h RASS SD > 1. Patients were stratified by 3-month outcome using the modified Rankin scale, and associations with outcome were assessed via logistic regression. There were 98 patients with at least one positive RASS score, with median total duration of agitation 8 h (interquartile range [IQR] 4-18), and median duration of substantially fluctuating consciousness 2 days (IQR 1-3). Unfavorable 3-month outcome was significantly associated with a longer duration of fluctuating consciousness (odds ratio [OR] per day, 1.51; 95% confidence interval [CI], 1.04-2.20; p = 0.031), but a briefer duration of agitation (OR per hour, 0.94; 95% CI, 0.89-0.99; p = 0.031). Though a longer duration of fluctuating consciousness was associated with worse outcomes in our cohort, total duration of agitation was not, and may have had the opposite effect. Our findings should therefore challenge the intensity with which agitation is often treated in SAH patients.

Influence of Concentration and Agitation of Sodium Hypochlorite and Peracetic Acid Solutions on Tissue Dissolution.

PubMed

Tanomaru-Filho, Mário; Silveira, Bruna Ramos Franco; Martelo, Roberta Bosso; Guerreiro-Tanomaru, Juliane Maria

2015-11-01

To evaluated the tissue dissolution of sodium hypochlorite (NaOCl) and peracetic acid (PA) solutions at different concentrations, with or without ultrasonic agitation. The following solutions were analyzed: 2.5% NaOCl, 0.5, 1 and 2% PA, 1% PA associated with 6.5% hydrogen peroxide (HP) and saline. Fragments of bovine pulp tissue with 25 ± 2g mg were immersed into test tubes containing 4 mL of the solutions for 10 minutes. In the groups with agitation, pulp tissues were submitted to 2 cycles of 1 minute of ultrasonic agitation. The specimens were weighed after the removal from the solutions. The percentage of mass loss was calculated according to the difference of mass before and after exposure to solutions. Data were submitted to ANOVA and Tukey tests (p < 0.05). A total of 2.5% NaOCl with or without agitation showed the higher tissue dissolution (between 64.5 and 67% of mass reduction) (p < 0.005). By comparing the PA solutions, the concentrations of 1 and 2% with or without agitation and the concentration of 0.5% with agitation showed similar dissolution activity (between 35.4 and 44% of mass reduction). The use of the ultrasonic agitation promoted an increase of the dissolution ability only for 0.5% PA. Peracetic acid solution has pulp tissue dissolution. However, this ability is lower than 2.5% NaOCl solution. The sodium hypochlorite solution shows higher ability to dissolve tissue than PA.

The Effects of White Noise on Agitated Behaviors, Mental Status, and Activities of Daily Living in Older Adults With Dementia.

PubMed

Lin, Li-Wei; Weng, Shu-Chuan; Wu, Hua-Shan; Tsai, Lu-Jen; Lin, Ya-Ling; Yeh, Shu-Hui

2018-02-01

The aging of society is a global trend, and care of older adults with dementia is an urgent challenge. As dementia progresses, patients exhibit negative emotions, memory disorders, sleep disorders, and agitated behavior. Agitated behavior is one of the most difficult problems for family caregivers and healthcare providers to handle when caring for older adults with dementia. The aim of this study was to investigate the effectiveness of white noise in improving agitated behavior, mental status, and activities of daily living in older adults with dementia. An experimental research design was used to study elderly participants two times (pretest and posttest). Six dementia care centers in central and southern Taiwan were targeted to recruit participants. There were 63 participants: 28 were in the experimental group, and 35 were in the comparison group. Experimental group participants received 20 minutes of white noise consisting of ocean, rain, wind, and running water sounds between 4 and 5 P.M. daily over a period of 4 weeks. The comparison group received routine care. Questionnaires were completed, and observations of agitated behaviors were collected before and after the intervention. Agitated behavior in the experimental group improved significantly between pretest and posttest. Furthermore, posttest scores on the Mini-Mental Status Examination and Barthel Index were slightly better for this group than at pretest. However, the experimental group registered no significant difference in mental status or activities of daily living at posttest. For the comparison group, agitated behavior was unchanged between pretest and posttest. The results of this study support white noise as a simple, convenient, and noninvasive intervention that improves agitated behavior in older adults with dementia. These results may provide a reference for related healthcare providers, educators, and administrators who care for older adults with dementia.

Sequential drug treatment algorithm for agitation and aggression in Alzheimer's and mixed dementia.

PubMed

Davies, Simon Jc; Burhan, Amer M; Kim, Donna; Gerretsen, Philip; Graff-Guerrero, Ariel; Woo, Vincent L; Kumar, Sanjeev; Colman, Sarah; Pollock, Bruce G; Mulsant, Benoit H; Rajji, Tarek K

2018-05-01

Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer's and mixed Alzheimer's/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer's/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.

[Drug management of agitation in emergency departments: theoretical recommendations and studies of practices].

PubMed

Horn, Mathilde; Vaiva, Guillaume; Dumais, Alexandre

2015-01-01

Management of agitation is a frequent problematic of emergency departments that often leads to feelings of insecurity among clinicians. There are various practices regarding the drugs to be used in the management of agitations. Guidelines have been proposed by different groups of experts concerning the antipsychotic drugs that should be used for agitations in psychiatric conditions. Nevertheless, there is no clear-cut procedure referring to the utilization of intramuscular drugs in this situation. Moreover, there is no comparison available between the commonly used medications and other drugs, both in terms of superiority of efficacy and tolerance. In order to accurately assess these practices, evaluation protocols must minimize the interference with the service organization and the routine care. Further studies are required in order to develop guidelines about medications that have to be used to handle agitations, which must be based on robust evidence and applicable to emergency services. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Effect of nature-based sound therapy on agitation and anxiety in coronary artery bypass graft patients during the weaning of mechanical ventilation: A randomised clinical trial.

PubMed

Aghaie, Bahman; Rejeh, Nahid; Heravi-Karimooi, Majideh; Ebadi, Abbas; Moradian, Seyed Tayeb; Vaismoradi, Mojtaba; Jasper, Melanie

2014-04-01

Weaning from mechanical ventilation is a frequent nursing activity in critical care. Nature-based sound as a non-pharmacological and nursing intervention effective in other contexts may be an efficient approach to alleviating anxiety, agitation and adverse effects of sedative medication in patients undergoing weaning from mechanical ventilation. This study identified the effect of nature-based sound therapy on agitation and anxiety on coronary artery bypass graft patients during weaning from mechanical ventilation. A randomised clinical trial design was used. 120 coronary artery bypass graft patients aged 45-65 years undergoing weaning from mechanical ventilation were randomly assigned to intervention and control groups. Patients in the intervention group listened to nature-based sounds through headphones; the control group had headphones with no sound. Haemodynamic variables, anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively. Patients in both groups had vital signs recorded after the first trigger, at 20 min intervals throughout the procedure, immediately after the procedure, 20 min after extubation, and 30 min after extubation. Data were collected over 5 months from December 2012 to April 2013. The intervention group had significantly lower anxiety and agitation levels than the control group. Regarding haemodynamic variables, a significant time trend and interaction was reported between time and group (p<0.001). A significant difference was also found between the anxiety (p<0.002) and agitation (p<0.001) scores in two groups. Nature-based sound can provide an effective method of decreasing potential adverse haemodynamic responses arising from anxiety and agitation in weaning from mechanical ventilation in coronary artery bypass graft patients. Nurses can incorporate this intervention as a non-pharmacological intervention into the daily care of patients undergoing weaning from mechanical

Evaluating the Role of the Air-Solution Interface on the Mechanism of Subvisible Particle Formation Caused by Mechanical Agitation for an IgG1 mAb.

PubMed

Ghazvini, Saba; Kalonia, Cavan; Volkin, David B; Dhar, Prajnaparamita

2016-05-01

Mechanical agitation of monoclonal antibody (mAb) solutions often leads to protein particle formation. In this study, various formulations of an immunoglobulin G (IgG) 1 mAb were subjected to different controlled interfacial stresses using a Langmuir trough, and protein particles formed at the interface and measured in bulk solution were characterized using atomic force microscopy and flow digital imaging. Results were compared to mAb solutions agitated in glass vials and unstressed controls. At lower pH, mAb solutions exhibited larger hysteresis in their surface pressure versus area isotherms and increased number of particles in bulk solution, when subjected to interfacial stresses. mAb samples subjected to 750-1000 interfacial compression-expansion cycles in 6 h contained high particle numbers in bulk solution, and displayed similar particulation trends when agitated in vials. At compression rates of 50 cycles in 6 h, however, particle levels in mAb solutions were comparable to unstressed controls, despite protein aggregates being present at the air-solution interface. These results suggest that while the air-solution interface serves as a nucleation site for initiating protein aggregation, the number of protein particles measured in bulk mAb solutions depends on the total number of compression cycles that proteins at the air-solution interface are subjected to within a fixed time. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Lean Methodology Reduces Inappropriate Use of Antipsychotics for Agitation at a Psychiatric Hospital.

PubMed

Goga, Joshana K; Depaolo, Antonio; Khushalani, Sunil; Walters, J Ken; Roca, Robert; Zisselman, Marc; Borleis, Christopher

2017-01-01

To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. Historically Controlled Study. Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit. All Patients Admitted on the Dementia Unit Were 65 Years of Age and Older with a Primary Diagnosis of Dementia. our Multidisciplinary Team Used Lean Methodology to Identify the Root Causes and Interventions Necessary to Reduce Inappropriate Antipsychotic Use. The Primary Outcome Was Rate of Inappropriately Indicating Agitation as the Rationale When Prescribing Antipsychotic Medications. There Was a 90% (P < 0.001) Reduction in Rate Of Antipsychotic Prescribing with an Indication of Agitation. The Lean Methodology Interventions Led To A 90% (P < 0.001) Reduction in the Rate of Antipsychotic Prescribing with an Indication of Agitation and a 10% Rate Reduction in Overall Antipsychotic Prescribing. Key Words: Agitation Alzheimer's Antipsychotics Behavioral and Psychological Symptoms of Dementia Centers For Medicare & Medicaid Services Dementia Root-cause Analysis. BPSD = Behavioral and Psychological Symptoms of Dementia CATIE-AD = Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease EMR = Electronic Medical Records GAO = Government Accountability Office GNCIS = Geriatric Neuropsychiatric Clinical Indicator Scale.

The Effects of a Single Session of Music Therapy on the Agitated Behaviors of Patients Receiving Hospice Care.

PubMed

Cadwalader, Alyssa; Orellano, Shashanna; Tanguay, Carla; Roshan, Ramesh

2016-08-01

Research suggests that agitation is a common symptom for hospice patients, but while studies have examined the outcomes of music therapy on the agitated behaviors of patients in other settings, none have addressed this symptom in patients with terminal illnesses. The study objective was to determine whether a single session of music therapy provided by a board certified music therapist and using the entrainment principle would decrease agitation in hospice patients. This pilot study was a single-blind, pretest/posttest design. Music therapists used the principle of entrainment with live music during the treatment session. Subjects included in the study were 77 patients at a large hospice in south Florida with documented agitation. Agitation was measured using the Overt Agitation Severity Scale (OASS) for 5 minutes prior to and 5 minutes following a 20 minute music therapy intervention. Results from 73 participants were analyzed with a mean difference of -5.77 points from pretest to posttest. Results indicating a decrease in agitation were statistically significant (p < 0.001) for the entire sample. Age, gender, location, and diagnosis were found to have no significant effects on the results. Results indicate that a single session of music therapy using the entrainment principle may be an effective treatment for hospice patients experiencing agitation.

Effects of agitation on particle-size distribution and enzymatic hydrolysis of pretreated spruce and giant reed.

PubMed

Kadić, Adnan; Palmqvist, Benny; Lidén, Gunnar

2014-01-01

Mixing is an energy demanding process which has been previously shown to affect enzymatic hydrolysis. Concentrated biomass slurries are associated with high and non-Newtonian viscosities and mixing in these systems is a complex task. Poor mixing can lead to mass and/or heat transfer problems as well as inhomogeneous enzyme distribution, both of which can cause possible yield reduction. Furthermore the stirring energy dissipation may impact the particle size which in turn may affect the enzymatic hydrolysis. The objective of the current work was to specifically quantify the effects of mixing on particle-size distribution (PSD) and relate this to changes in the enzymatic hydrolysis. Two rather different materials were investigated, namely pretreated Norway spruce and giant reed. Changes in glucan hydrolysis and PSD were measured as a function of agitation during enzymatic hydrolysis at fiber loadings of 7 or 13% water-insoluble solids (WIS). Enzymatic conversion of pretreated spruce was strongly affected by agitation rates at the higher WIS content. However, at low WIS content the agitation had almost no effect on hydrolysis. There was some effect of agitation on the hydrolysis of giant reed at high WIS loading, but it was smaller than that for spruce, and there was no measurable effect at low WIS loading. In the case of spruce, intense agitation clearly affected the PSD and resulted in a reduced mean particle size, whereas for giant reed the decrease in particle size was mainly driven by enzymatic action. However, the rate of enzymatic hydrolysis was not increased after size reduction by agitation. The impact of agitation on the enzymatic hydrolysis clearly depends not only on feedstock but also on the solids loading. Agitation was found to affect the PSD differently for the examined pretreated materials spruce and giant reed. The fact that the reduced mean particle diameter could not explain the enhanced hydrolysis rates found for spruce at an elevated agitation

Synergistic effect of microbubble emulsion and sonic or ultrasonic agitation on endodontic biofilm in vitro.

PubMed

Halford, Andrew; Ohl, Claus-Dieter; Azarpazhooh, Amir; Basrani, Bettina; Friedman, Shimon; Kishen, Anil

2012-11-01

Irrigation dynamics and antibacterial activity determine the efficacy of root canal disinfection. Sonic or ultrasonic agitation of irrigants is expected to improve irrigation dynamics. This study examined the effects of microbubble emulsion (ME) combined with sonic or ultrasonic agitation on irrigation dynamics and reduction of biofilm bacteria within root canal models. Two experiments were conducted. First, high-speed imaging was used to characterize the bubble dynamics generated in ME by sonic or ultrasonic agitation within canals of polymer tooth models. Second, 5.25% NaOCl irrigation or ME was sonically or ultrasonically agitated in canals of extracted teeth with 7-day-grown Enterococcus faecalis biofilms. Dentinal shavings from canal walls were sampled at 1 mm and 3 mm from the apical terminus, and colony-forming units (CFUs) were enumerated. Mean log CFU/mL values were analyzed with analysis of variance and post hoc tests. High-speed imaging demonstrated strongly oscillating and vaporizing bubbles generated within ME during ultrasonic but not sonic agitation. Compared with CFU counts in controls, NaOCl-sonic and NaOCl-ultrasonic yielded significantly lower counts (P < .05) at both measurement levels. ME-sonic yielded significantly lower counts (P = .002) at 3 mm, whereas ME-ultrasonic yielded highly significantly lower counts (P = .000) at both measurement levels. At 3 mm, ME-ultrasonic yielded significantly lower CFU counts (P = .000) than ME-sonic, NaOCl-sonic, and NaOCl-ultrasonic. Enhanced bubble dynamics and reduced E. faecalis biofilm bacteria beyond the level achieved by sonic or ultrasonic agitation of NaOCl suggested a synergistic effect of ME combined with ultrasonic agitation. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study

PubMed Central

Chen, Lu; Xu, Ming; Li, Gui-Yun; Cai, Wei-Xin; Zhou, Jian-Xin

2014-01-01

Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P = 0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, P<0.001). In conclusion, emergence agitation was a frequent complication in patients after elective craniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy. Trial Registration ClinicalTrials.gov NCT00590499. PMID:25493435

Swelling and erosion properties of hydroxypropylmethylcellulose (Hypromellose) matrices--influence of agitation rate and dissolution medium composition.

PubMed

Kavanagh, Nicole; Corrigan, Owen I

2004-07-26

The effect of dissolution medium variables, such as medium composition, ionic strength and agitation rate, on the swelling and erosion of Hypromellose (hydroxypropylmethylcellulose, HPMC) matrices of different molecular weights was examined. Swelling and erosion of HPMC polymers was determined by measuring the wet and subsequent dry weights of matrices. It was possible to describe the rate of dissolution medium uptake in terms of a square root relationship and the erosion of the polymer in terms of the cube root law. The extent of swelling increased with increasing molecular weight, and decreased with increasing agitation rate. The erosion rate was seen to increase with decrease in polymer molecular weight, with a decrease in ionic strength and with increasing agitation rate. The sensitivity of polymer erosion to the degree of agitation may influence the ability of these polymers to give reproducible, agitation-independent release, compared to more rigid non-eroding matrix materials, in the complex hydrodynamic environment of the gastrointestinal tract.

Long term care staff beliefs about evidence based practices for the management of dementia and agitation.

PubMed

Ayalon, Liat; Arean, Patricia; Bornfeld, Heather; Beard, Renee

2009-02-01

Despite a growing literature on effective interventions for Alzheimer's disease (AD) and agitation, the management of these conditions in long term care (LTC) often is inadequate. The goals of the present study were: (a) to evaluate existing beliefs about evidence based practices (EBP) for the management of Alzheimer's disease and agitation among LTC staff; and (b) to evaluate the contribution of demographic and attitudinal variables to LTC staff beliefs about these EBP. A cross sectional study of 371 LTC staff members completed an EBP questionnaire, a short demographic questionnaire, and an attitudinal questionnaire about AD and agitation. Paraprofessional caregivers, those of lower educational level, and ethnic minorities were more likely to be in disagreement with the EBP views examined in this study. Those in disagreement with the EBP views also reported a preference towards not working with residents with AD and agitation and a sense of helplessness associated with such work. Disagreement with EBP views was associated with both normalization and stigmatization of AD and agitation. Paraprofessional caregivers, ethnic minorities, and people of lower educational level are most at need for educational activities about AD and neuropsychiatric symptoms. Educational efforts geared towards changing the belief system of LTC staff should target not only EBP but also information about AD and agitation as conditions that are deviant from the normal aging process, yet non-stigmatizing. It is expected that following EBP will empower staff and improve staff motivation to work with residents with AD and agitation. (c) 2008 John Wiley & Sons, Ltd.

Comparison and Agreement Between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in Evaluating Patients’ Eligibility for Delirium Assessment in the ICU

PubMed Central

Guzman, Oscar; Campbell, Noll L.; Walroth, Todd; Tricker, Jason L.; Hui, Siu L.; Perkins, Anthony; Zawahiri, Mohammed; Buckley, John D.; Farber, Mark O.; Ely, E. Wesley; Boustani, Malaz A.

2012-01-01

Background: Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU (CAM-ICU). Methods: We performed a prospective cohort study in the adult medical, surgical, and progressive (step-down) ICUs of a tertiary care, university-affiliated, urban hospital in Indianapolis, Indiana. The cohort included 975 admissions to the ICU between January and October 2009. Results: The outcome measures of interest were the correlation and agreement between RASS and SAS measurements. In 2,469 RASS and SAS paired screens, the rank correlation using the Spearman correlation coefficient was 0.91, and the agreement between the two screening tools for assessing CAM-ICU eligibility as estimated by the κ coefficient was 0.93. Analysis showed that 70.1% of screens were eligible for CAM-ICU assessment using RASS (7.1% sedated [RASS −3 to −1]; 62.6% calm [0]; and 0.4% restless, agitated [+1 to +3]), compared with 72.1% using SAS (5% sedated [SAS 3]; 66.5% calm [4]; and 0.6% anxious, agitated [5, 6]). In the mechanically ventilated subgroup, RASS identified 19.1% CAM-ICU eligible patients compared with 24.6% by SAS. The correlation coefficient in this subgroup was 0.70 and the agreement was 0.81. Conclusion: Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU. PMID:22539644

Does Cognitive Impairment and Agitation in Dementia Influence Intervention Effectiveness? Findings From a Cluster-RCT With the Therapeutic Robot, PARO.

PubMed

Jones, Cindy; Moyle, Wendy; Murfield, Jenny; Draper, Brian; Shum, David; Beattie, Elizabeth; Thalib, Lukman

2018-04-13

To explore whether severity of cognitive impairment and agitation of older people with dementia predict outcomes in engagement, mood states, and agitation after a 10-week intervention with the robotic seal, PARO. Data from the PARO intervention-arm of a cluster-randomized controlled trial was used, which involved individual, nonfacilitated, 15-minute sessions with PARO 3 afternoons per week for 10 weeks. One hundred thirty-eight residents-aged ≥60 years, with dementia-from 9 long-term care facilities. A series of stepwise multiple linear regressions were conducted. Dependent variables were participants' levels of engagement, mood states, and agitation at week 10 [assessed by video observation and Cohen Mansfield Agitation Inventory-Short Form (CMAI-SF)]. Predictor variables were baseline levels of cognitive impairment [assessed by Rowland Universal Dementia Assessment Scale (RUDAS)] and agitation (CMAI-SF). Five models were produced. The strongest finding was that participants with more severe agitation at baseline had higher levels of agitation at week 10 (R 2  = .82, P < .001). Predictors of positive response were less significant. Low levels of agitation at baseline predicted greater positive behavioral engagement with PARO (R 2  = .054, P = .009) and fewer observed instances of agitation (R 2  = .033, P = .045) at week 10, whereas greater visual engagement was predicted by both lower levels of agitation and cognitive impairment (R 2  = .082, P = .006). Less severe cognitive impairment predicted greater pleasure at week 10 (R 2  = .067, P = .004). Participants with severe agitation had poor response to PARO. Lower levels of agitation and higher cognitive functioning were associated with better responses. In clinical practice, we recommend PARO should be restricted to people with low-moderate severity of agitation. Further research is needed to determine the optimal participant characteristics for response to PARO. Copyright © 2018 AMDA �

Risperidone for psychosis-induced aggression or agitation (rapid tranquillisation).

PubMed

Ostinelli, Edoardo G; Hussein, Mohsin; Ahmed, Uzair; Rehman, Faiz-Ur; Miramontes, Krista; Adams, Clive E

2018-04-10

Aggressive, agitated or violent behaviour due to psychosis constitutes an emergency psychiatric treatment where fast-acting interventions are required. Risperidone is a widely accessible antipsychotic that can be used to manage psychosis-induced aggression or agitation. To examine whether oral risperidone alone is an effective treatment for psychosis-induced aggression or agitation. We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (up to April 2017); this register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records into the register. Randomised controlled trials (RCTs) comparing rapid use of risperidone and other drugs, combinations of drugs or placebo for people exhibiting aggression or agitation (or both) thought to be due to psychosis. We independently inspected all citations from searches, identified relevant abstracts, and independently extracted data from all included studies. For binary data we calculated risk ratio (RR) and for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CI) and used a fixed-effect model. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' tables. The review now contains data from nine trials (total n = 582) reporting on five comparisons. Due to risk of bias, small size of trials, indirectness of outcome measures and a paucity of investigated and reported 'pragmatic' outcomes, evidence was graded as very-low quality. None of the included studies provided useable data on our primary outcome 'tranquillisation or asleep' by 30 minutes, repeated need for tranquillisation or any economic outcomes. Data were available for our

The Relationship between Agitated Behavior and Cognitive Functioning in Nursing Home Residents: Preliminary Results.

ERIC Educational Resources Information Center

Cohen-Mansfield, Jiska

Agitation is a significant problem for nursing home residents, their families, and their caretakers. Agitation is defined as inappropriate verbal, vocal, or motor activity which is not explained by needs or confusion per se. It includes behaviors such as aimless wandering, pacing, cursing, screaming, biting, and fighting. The inappropriate nature…

Maximization of beta-galactosidase production: a simultaneous investigation of agitation and aeration effects.

PubMed

Alves, Fernanda Germano; Filho, Francisco Maugeri; de Medeiros Burkert, Janaína Fernandes; Kalil, Susana Juliano

2010-03-01

In this work, the agitation and aeration effects in the maximization of the beta-galactosidase production from Kluyveromyces marxianus CCT 7082 were investigated simultaneously, in relation to the volumetric enzyme activity and the productivity, as well as the analysis of the lactose consumption and production of glucose, and galactose of this process. Agitation and aeration effects were studied in a 2 L batch stirred reactor. A central composite design (2(2) trials plus three central points) was carried out. Agitation speed varied from 200 to 500 rpm and aeration rate from 0.5 to 1.5 vvm. It has been shown in this study that the volumetric enzyme production was strongly influenced by mixing conditions, while aeration was shown to be less significant. Linear models for activity and productivity due to agitation and aeration were obtained. The favorable condition was 500 rpm and 1.5 vvm, which lead to the best production of 17 U mL(-1) for enzymatic activity, 1.2 U mL(-1) h(-1) for productivity in 14 h of process, a cellular concentration of 11 mg mL(-1), and a 167.2 h(-1) volumetric oxygen transfer coefficient.

Effects of processing parameters on immersion vacuum cooling time and physico-chemical properties of pork hams.

PubMed

Feng, Chao-Hui; Drummond, Liana; Zhang, Zhi-Hang; Sun, Da-Wen

2013-10-01

The effects of agitation (1002 rpm), different pressure reduction rates (60 and 100 mbar/min), as well as employing cold water with different initial temperatures (IWT: 7 and 20°C) on immersion vacuum cooling (IVC) of cooked pork hams were experimentally investigated. Final pork ham core temperature, cooling time, cooling loss, texture properties, colour and chemical composition were evaluated. The application for the first time of agitation during IVC substantially reduced the cooling time (47.39%) to 4.6°C, compared to IVC without agitation. For the different pressure drop rates, there was a trend that shorter IVC cooling times were achieved with lower cooling rate, although results were not statistically significant (P>0.05). For both IWTs tested, the same trend was observed: shorter cooling time and lower cooling loss were obtained under lower linear pressure drop rate of 60 mbar/min (not statistically significant, P>0.05). Compared to the reference cooling method (air blast cooling), IVC achieved higher cooling rates and better meat quality. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia.

PubMed

Richeson, Nancy E

2003-01-01

The effects of a therapeutic recreation intervention using animal-assisted therapy (AAT) on the agitated behaviors and social interactions of older adults with dementia were examined using the Cohen-Mansfield Agitation Inventory and the Animal-Assisted Therapy Flow Sheet. In a pilot study, 15 nursing home residents with dementia participated in a daily AAT intervention for three weeks. Results showed statistically significant decreases in agitated behaviors and a statistically significant increase in social interaction pretest to post-test.

Development of Process Control Methodology for Tracking the Quality and Safety of Pain, Agitation, and Sedation Management in Critical Care Units.

PubMed

Walsh, Timothy S; Kydonaki, Kalliopi; Lee, Robert J; Everingham, Kirsty; Antonelli, Jean; Harkness, Ronald T; Cole, Stephen; Quasim, Tara; Ruddy, James; McDougall, Marcia; Davidson, Alan; Rutherford, John; Richards, Jonathan; Weir, Christopher J

2016-03-01

To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Eight Scottish ICUs over a 12-month period. Mechanically ventilated patients. None. The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman ρ = 0.75) and were reliable in clinician-clinician (weighted kappa; κ = 0.66) and clinician-researcher (κ = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale (ρ = 0.24) and was reliable in clinician-clinician (κ = 0.58) and clinician-researcher (κ = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale (ρ = 0.54), and reliability in clinician-clinician (κ = 0.29) and clinician-researcher (κ = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655

Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial.

PubMed

Porsteinsson, Anton P; Drye, Lea T; Pollock, Bruce G; Devanand, D P; Frangakis, Constantine; Ismail, Zahinoor; Marano, Christopher; Meinert, Curtis L; Mintzer, Jacobo E; Munro, Cynthia A; Pelton, Gregory; Rabins, Peter V; Rosenberg, Paul B; Schneider, Lon S; Shade, David M; Weintraub, Daniel; Yesavage, Jerome; Lyketsos, Constantine G

2014-02-19

Agitation is common, persistent, and associated with adverse consequences for patients with Alzheimer disease. Pharmacological treatment options, including antipsychotics are not satisfactory. The primary objective was to evaluate the efficacy of citalopram for agitation in patients with Alzheimer disease. Key secondary objectives examined effects of citalopram on function, caregiver distress, safety, cognitive safety, and tolerability. The Citalopram for Agitation in Alzheimer Disease Study (CitAD) was a randomized, placebo-controlled, double-blind, parallel group trial that enrolled 186 patients with probable Alzheimer disease and clinically significant agitation from 8 academic centers in the United States and Canada from August 2009 to January 2013. Participants (n = 186) were randomized to receive a psychosocial intervention plus either citalopram (n = 94) or placebo (n = 92) for 9 weeks. Dosage began at 10 mg per day with planned titration to 30 mg per day over 3 weeks based on response and tolerability. Primary outcome measures were based on scores from the 18-point Neurobehavioral Rating Scale agitation subscale (NBRS-A) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC). Other outcomes were based on scores from the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI), ability to complete activities of daily living (ADLs), caregiver distress, cognitive safety (based on scores from the 30-point Mini Mental State Examination [MMSE]), and adverse events. Participants who received citalopram showed significant improvement compared with those who received placebo on both primary outcome measures. The NBRS-A estimated treatment difference at week 9 (citalopram minus placebo) was -0.93 (95% CI, -1.80 to -0.06), P = .04. Results from the mADCS-CGIC showed 40% of citalopram participants having moderate or marked improvement from baseline compared with 26% of placebo

Pumping Characteristics of a Helical Screw Agitator with a Draught Tube

NASA Astrophysics Data System (ADS)

Hwang, Jung-Hoon; Kim, Youn-Jea

In the use of helical type agitator, the mixing process is usually restricted to the laminar flow regime. Common examples of laminar mixing are found where the fluid has a very high viscosity, i.e., pseudoplastic fluids. It can be indicated that a helical type agitator is sufficiently suited to the creeping flow mixing. The pumping characteristic of a Helical Screw Agitator with a draught tube (HSA) is required to evaluate its capacity for the optimal configuration of the mixing chamber. It could be executed by changing some parameters such as the number of helix, the angular velocity and the rotating direction and so on. In this study, the numerical simulation was carried out with the Eulerian multiphase mixture model and the moving mesh approximation. Some of the optimum design parameters have been developed with the aid of numerical data from the Computational Fluid Dynamics (CFD) analysis. Using the commercial code, Fluent, the pumping characteristics in the HSA are investigated from the rheological properties, and the results are graphically depicted.

40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure..., pressure relief devices in light liquid or heavy liquid service, and instrumentation systems shall be...

40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure..., pressure relief devices in light liquid or heavy liquid service, and instrumentation systems shall be...

40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure..., pressure relief devices in light liquid or heavy liquid service, and instrumentation systems shall be...

40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure..., pressure relief devices in light liquid or heavy liquid service, and instrumentation systems shall be...

Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey.

PubMed

Mi, Weifeng; Zhang, Suzhen; Liu, Qi; Yang, Fude; Wang, Yong; Li, Tao; Mei, Qiyi; He, Hongbo; Chen, Zhiyu; Su, Zhonghua; Liu, Tiebang; Xie, Shiping; Tan, Qingrong; Zhang, Jinbei; Zhang, Congpei; Sang, Hong; Chen, Wenhao; Shi, Le; Li, Lingzhi; Shi, Ying; Guo, Lihua; Zhang, Hongyan; Lu, Lin

2017-07-01

This multi-center observational study investigated the prevalence of agitation in newly hospitalized schizophrenia patients in China and its potential risk factors. It was performed in 2014 and covered 14 hospitals. Newly hospitalized patients with schizophrenia or suspected schizophrenia who met the diagnostic criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were recruited. Agitation and related risk factors were evaluated by a questionnaire designed for the survey. General demographic data, disease characteristics, scores on schizophrenia rating scales and agitation rating scales (e.g., Positive and Negative Syndrome Scale-Excited Component [PANSS-EC] and Behavioral Activity Rating Scale [BARS]) were collected. Among the 1512 patients screened in the study, 1400 (92.59%) were eligible. According to the PANSS-EC and BARS, the prevalence of agitation was 60.92% (853 of 1400) and 59.00% (826 of 1400), respectively. The overall prevalence of agitation was 47.50% (665 of 1400). The most important risk factor of agitation was being aggressive at baseline (Modified Overt Aggression Scale score ≥4, odds ratio=6.54; 95% confidence interval=4.93-8.69). Other risk factors included a history of aggressive behavior, northern region of residence, involuntary hospitalization, disease severity, low level of education, living alone, being unemployed or retired. Copyright © 2017. Published by Elsevier B.V.

Influence of agitation speed on tannase production and morphology of Aspergillus niger FETL FT3 in submerged fermentation.

PubMed

Darah, I; Sumathi, G; Jain, K; Lim, S H

2011-12-01

Agitation speed was found to influence the tannase production and fungal growth of Aspergillus niger FETL FT3. The optimal agitation speed was at 200 rpm which produced 1.41 U/ml tannase and 3.75 g/l of fungal growth. Lower or higher agitation speeds than 200 rpm produced lower enzyme production and fungal growth. Based on the SEM and TEM micrograph observation, there was a significant correlation between agitation speed and the morphology of the fungal mycelia. The results revealed an increase of the enzyme production with the change of the fungal growth morphology from filamentous to pelleted growth forms. However, the exposure to higher shear stress with an increasing agitation speed of the shaker also resulted in lower biomass yields as well as enzyme production.

Comparison of Haloperidol Alone and in Combination with Midazolam for the Treatment of Acute Agitation in an Inpatient Palliative Care Service.

PubMed

Ferraz Gonçalves, José António; Almeida, Ana; Costa, Isabel; Silva, Paula; Carneiro, Rui

2016-12-01

Agitation is a very distressing problem that must be controlled as quickly as possible, but using a safe method. The authors conducted a comparison of two protocols: a combination of haloperidol and midazolam and haloperidol alone. The combination drug protocol controlled 101 out of 121 (84%) episodes of agitation with only the first dose, whereas the haloperidol alone protocol controlled 47 out of 74 (64%) episodes. This difference is statistically significant (P =.002), with a post hoc analyzed power of 0.88. The median time from the first dose to the control of agitation was 15 minutes (range: 5-210) with the combination and 60 minutes (range: 10-430) with the other protocol, P <.001. There were no complications other than some transient somnolence, mainly with the combination protocol. The authors conclude that the combination of haloperidol and midazolam is effective and safe for the control of agitation in palliative care and it is more effective than haloperidol alone. Therefore, the combination should be adopted as the preferred protocol. It would be helpful if the usefulness of this protocol is confirmed by others.

Wernicke encephalopathy without delirium that appeared as agitation in a patient with lung cancer.

PubMed

Onishi, Hideki; Ishida, Mayumi; Takahashi, Takao; Taji, Yoshitada; Ikebuchi, Kenji; Furuya, Daisuke; Uchida, Nozomu; Akechi, Tatsuo

2018-05-11

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency, and is sometimes overlooked because of the diversity of clinical symptoms. From a series of WE patients with cancer, we report a lung cancer patient who developed WE, the main symptom of which was agitation.ResultA 50-year-old woman with lung cancer was referred to our psycho-oncology clinic because of agitation lasting for three days. No laboratory findings or drugs explaining her agitation were identified. Although the patient did not develop delirium, ophthalmoplegia, or ataxia, WE was suspected because she experienced a loss of appetite loss lasting 5 weeks. This diagnosis was supported by abnormal serum thiamine and disappearance of agitation one hour after intravenous thiamine administration.Significance of resultsThis report emphasizes the clinical diversity of WE and indicates the limits of the ability to diagnose WE from typical clinical symptoms. The presence of a loss of appetite for more than two weeks may be the key to the accurate diagnosis of WE.

Impact of fluidic agitation on human pluripotent stem cells in stirred suspension culture.

PubMed

Nampe, Daniel; Joshi, Ronak; Keller, Kevin; Zur Nieden, Nicole I; Tsutsui, Hideaki

2017-09-01

The success of human pluripotent stem cells (hPSCs) as a source of future cell therapies hinges, in part, on the availability of a robust and scalable culture system that can readily produce a clinically relevant number of cells and their derivatives. Stirred suspension culture has been identified as one such promising platform due to its ease of use, scalability, and widespread use in the pharmaceutical industry (e.g., CHO cell-based production of therapeutic proteins) among others. However, culture of undifferentiated hPSCs in stirred suspension is a relatively new development within the past several years, and little is known beyond empirically optimized culture parameters. In particular, detailed characterizations of different agitation rates and their influence on the propagation of hPSCs are often not reported in the literature. In the current study, we systematically investigated various agitation rates to characterize their impact on cell yield, viability, and the maintenance of pluripotency. Additionally, we closely examined the distribution of cell aggregates and how the observed culture outcomes are attributed to their size distribution. Overall, our results showed that moderate agitation maximized the propagation of hPSCs to approximately 38-fold over 7 days by keeping the cell aggregates below the critical size, beyond which the cells are impacted by the diffusion limit, while limiting cell death caused by excessive fluidic forces. Furthermore, we observed that fluidic agitation could regulate not only cell aggregation, but also expression of some key signaling proteins in hPSCs. This indicates a new possibility to guide stem cell fate determination by fluidic agitation in stirred suspension cultures. Biotechnol. Bioeng. 2017;114: 2109-2120. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

40 CFR 65.109 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Standards: Agitators in gas/vapor service and in light liquid service. (a) Compliance schedule. The owner or... 40 Protection of Environment 16 2012-07-01 2012-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 65.109 Section 65.109 Protection of Environment ENVIRONMENTAL...

40 CFR 65.109 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Standards: Agitators in gas/vapor service and in light liquid service. (a) Compliance schedule. The owner or... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 65.109 Section 65.109 Protection of Environment ENVIRONMENTAL...

40 CFR 65.109 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Standards: Agitators in gas/vapor service and in light liquid service. (a) Compliance schedule. The owner or... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 65.109 Section 65.109 Protection of Environment ENVIRONMENTAL...

40 CFR 65.109 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Standards: Agitators in gas/vapor service and in light liquid service. (a) Compliance schedule. The owner or... 40 Protection of Environment 16 2013-07-01 2013-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 65.109 Section 65.109 Protection of Environment ENVIRONMENTAL...

40 CFR 65.109 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Standards: Agitators in gas/vapor service and in light liquid service. (a) Compliance schedule. The owner or... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 65.109 Section 65.109 Protection of Environment ENVIRONMENTAL...

40 CFR 63.173 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Equipment Leaks § 63.173 Standards: Agitators in gas/vapor service and in light liquid service. (a)(1) Each... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 63.173 Section 63.173 Protection of Environment ENVIRONMENTAL...

40 CFR 63.173 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Equipment Leaks § 63.173 Standards: Agitators in gas/vapor service and in light liquid service. (a)(1) Each... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 63.173 Section 63.173 Protection of Environment ENVIRONMENTAL...

40 CFR 63.173 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Equipment Leaks § 63.173 Standards: Agitators in gas/vapor service and in light liquid service. (a)(1) Each... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 63.173 Section 63.173 Protection of Environment ENVIRONMENTAL...

40 CFR 63.173 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Equipment Leaks § 63.173 Standards: Agitators in gas/vapor service and in light liquid service. (a)(1) Each... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 63.173 Section 63.173 Protection of Environment ENVIRONMENTAL...

40 CFR 63.173 - Standards: Agitators in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Equipment Leaks § 63.173 Standards: Agitators in gas/vapor service and in light liquid service. (a)(1) Each... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Standards: Agitators in gas/vapor service and in light liquid service. 63.173 Section 63.173 Protection of Environment ENVIRONMENTAL...

Emergence agitation during recovery from intracranial surgery under general anaesthesia: a protocol and statistical analysis plan for a prospective multicentre cohort study.

PubMed

Yan, Li-Mei; Chen, Han; Yu, Rong-Guo; Wang, Zhu-Heng; Zhou, Guan-Hua; Wang, Yong-Jin; Zhang, Xia; Xu, Ming; Chen, Lu; Zhou, Jian-Xin

2015-04-21

Emergence agitation after intracranial surgery is an important clinical issue during anaesthesia recovery. The aim of this multicentre cohort study is to investigate the incidence of emergence agitation, identify the risk factors and determine clinical outcomes in adult patients after intracranial surgery under general anaesthesia. Additionally, we will deliberately clarify the relationship between postoperative pneumocephalus and agitation. The present study is a prospective multicentre cohort study. Five intensive care units (ICUs) in China will participate in the study. Consecutive adult patients admitted to the ICUs after intracranial surgery will be enrolled. Sedation-Agitation Scale (SAS) or Richmond Agitation-Sedation Scale (RASS) will be used to evaluate the patients 12 h after the enrolment. Agitation is defined as an SAS score of 5-7, or an RASS score of +2 to +4. According to the maximal SAS and RASS score, patients will be divided into two cohorts: the agitation group and the non-agitation group. Factors potentially related to emergence agitation will be collected at study entry, during anaesthesia and operation, during postoperative care. Univariate analyses between the agitation and the non-agitation groups will be performed. The stepwise backward logistic regression will be carried out to identify the independent predictors of agitation. Patients will be followed up for 72 h after the operation. Accidental self-extubation of the endotracheal tube and removal of other catheters will be documented. The use of sedatives and analgesics will be collected. Ethics approval has been obtained from each of five participating hospitals. Study findings will be disseminated through peer-reviewed publications and conference presentations. NCT02318199. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case.

PubMed

Nanda, U; Eisen, S; Zadeh, R S; Owen, D

2011-06-01

There is a growing body of evidence on the impact of the environment on health and well-being. This study focuses on the impact of visual artworks on the well-being of psychiatric patients in a multi-purpose lounge of an acute care psychiatric unit. Well-being was measured by the rate of pro re nata (PRN) medication issued by nurses in response to visible signs of patient anxiety and agitation. Nurses were interviewed to get qualitative feedback on the patient response. Findings revealed that the ratio of PRN/patient census was significantly lower on the days when a realistic nature photograph was displayed, compared to the control condition (no art) and abstract art. Nurses reported that some patients displayed agitated behaviour in response to the abstract image. This study makes a case for the impact of visual art on mental well-being. The research findings were also translated into the time and money invested on PRN incidents, and annual cost savings of almost $US30,000 a year was projected. This research makes a case that simple environmental interventions like visual art can save the hospital costs of medication, and staff and pharmacy time, by providing a visual distraction that can alleviate anxiety and agitation in patients. © 2010 Blackwell Publishing.

Characterization of a continuous agitated cell reactor for oxygen dependent biocatalysis.

PubMed

Toftgaard Pedersen, Asbjørn; de Carvalho, Teresa Melo; Sutherland, Euan; Rehn, Gustav; Ashe, Robert; Woodley, John M

2017-06-01

Biocatalytic oxidation reactions employing molecular oxygen as the electron acceptor are difficult to conduct in a continuous flow reactor because of the requirement for high oxygen transfer rates. In this paper, the oxidation of glucose to glucono-1,5-lactone by glucose oxidase was used as a model reaction to study a novel continuous agitated cell reactor (ACR). The ACR consists of ten cells interconnected by small channels. An agitator is placed in each cell, which mixes the content of the cell when the reactor body is shaken by lateral movement. Based on tracer experiments, a hydrodynamic model for the ACR was developed. The model consisted of ten tanks-in-series with back-mixing occurring within and between each cell. The back-mixing was a necessary addition to the model in order to explain the observed phenomenon that the ACR behaved as two continuous stirred tank reactors (CSTRs) at low flow rates, while it at high flow rates behaved as the expected ten CSTRs in series. The performance of the ACR was evaluated by comparing the steady state conversion at varying residence times with the conversion observed in a stirred batch reactor of comparable size. It was found that the ACR could more than double the overall reaction rate, which was solely due to an increased oxygen transfer rate in the ACR caused by the intense mixing as a result of the spring agitators. The volumetric oxygen transfer coefficient, k L a, was estimated to be 344 h -1 in the 100 mL ACR, opposed to only 104 h -1 in a batch reactor of comparable working volume. Interestingly, the large deviation from plug flow behavior seen in the tracer experiments was found to have little influence on the conversion in the ACR, since both a plug flow reactor (PFR) model and the backflow cell model described the data sufficiently well. Biotechnol. Bioeng. 2017;114: 1222-1230. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Effects of rivastigmine on actigraphically monitored motor activity in severe agitation related to Alzheimer's disease: a placebo-controlled pilot study.

PubMed

Mahlberg, Richard; Walther, Sebastian; Eichmann, Uta; Tracik, Ferenc; Kunz, Dieter

2007-01-01

Acetylcholinesterase inhibitors (AChEIs) are effective in the treatment of cognitive symptoms in Alzheimer's disease (AD). Because the behavioral and psychological symptoms of dementia (BPSD) have also been attributed to central cholinergic deficits, we examined whether the AChEI rivastigmine can reduce motor activity as measured in a rater-independent manner by wrist actigraphy in agitated AD patients. A total of 20 consecutive AD inpatients (13 females, 7 males, 80.4+/-9.1 years, S.D.) were included from our geriatric psychiatry unit, all of whom were exhibiting agitated behavior not attributable to delirium. Patients were assigned randomly and in a single-blinded fashion to rivastigmine 3mg or placebo for 14 days. Motor activity levels were monitored using an actigraph worn continuously on the wrist of the non-dominant hand. At the beginning and end of the study, patients were assessed using the Neuropsychiatric Inventory (NPI) and Nurses' Observation Scale for Geriatric Patients (NOSGER). Patients in the rivastigmine group exhibited less agitation than placebo recipients on the NPI-agitation subscale, but not on NOSGER. Actigraphic measurements showed a tendency towards reduced motor activity in the rivastigmine group. Because rivastigmine usually exerts its main effects after a longer period of time, the short-term effects seen in our study justify further controlled clinical trials examining the use of rivastigmine in BPSD by means of actigraphy.

Protocol for the management of psychiatric patients with psychomotor agitation.

PubMed

Vieta, Eduard; Garriga, Marina; Cardete, Laura; Bernardo, Miquel; Lombraña, María; Blanch, Jordi; Catalán, Rosa; Vázquez, Mireia; Soler, Victòria; Ortuño, Noélia; Martínez-Arán, Anabel

2017-09-08

Psychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode. Spanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement. The protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in

Effect of dissolved oxygen tension and agitation rates on sulfur-utilizing autotrophic denitrification: batch tests.

PubMed

Qambrani, Naveed Ahmed; Oh, Sang-Eun

2013-01-01

The effect of dissolved oxygen (DO) and agitation rate in open and closed reactors was examined for sulfur-utilizing autotrophic denitrification. The reaction rate constants were determined based on a half-order kinetic model. Declining denitrification rate constants obtained for open reactors those of 8.46, 8.03, and 2.18 for 50 mg NO(3) (-)-N/L, while 11.12, 9.14, and 0.12 mg(1/2)/L(1/2) h were for 100 mg NO(3) (-)-N/L at agitation speeds of 0, 100, and 200 rpm. In closed reactors, the ever-increasing denitrification rates were 10.13, 22.56, and 37.03, whereas for the same nitrate concentrations and speeds the rates were 13.17, 15.63, and 26.67 mg(1/2)/L(1/2) h. The rate constants correlated well (r ( 2 ) = 0.89-0.99) with a half-order kinetic model. In open reactors, high SO(4) (2-)/N ratios (8.02-75.10) while in closed reactors comparatively low SO(4) (2-)/N ratios (6.10-13.39) were obtained. Sulfur oxidation occurred continuously in the presence of DO, resulting in mixed cultures acclimated to sulfur and nitrate. SO(4) (2-) was produced as an end product, which reduced alkalinity and lowered pH over time. Furthermore, DO inhibited sulfur denitrification in open reactors, while agitation in closed reactors increased the rate of denitrification.

Management of acute agitation in Hong Kong and comparisons with Australasia.

PubMed

Chan, Esther Wai Yin; Tang, Cedric; Lao, Kim Shi Jian; Ling Pong, Leung; Tsui, Matthew Sik Hon; Ho, Hiu Fai; Wong, Gordon Chi Keung; Kong, David Chee Ming; McD Taylor, David; Knott, Jonathan C; Wong, Ian Chi Kei

2015-12-01

Little is known about the use of sedation drugs for the management of acute agitation in Hong Kong's Accident and Emergency Departments (AEDs) and how it compares with Australasian practice. The aim of this study was to determine drug preferences, clinicians' perceived confidence in management, barriers/gaps in training and perceived usefulness of existing clinical practice guidelines (CPGs) in Hong Kong. A validated questionnaire was used, with case vignettes typical of patients presenting to AEDs with acute agitation. The questionnaire was distributed by hand to all trainees and fellows of the Hong Kong College of Emergency Medicine (HKCEM). Two reminders were sent. Of 483 HKCEM members, 280 (58.0% [95% CI 53.5-62.3]) responded. For monotherapy, 46.8% (95% CI 41.0-52.6) of respondents chose haloperidol to manage the undifferentiated patient, followed by midazolam (33.9%, 95% CI 28.6-39.7) and diazepam (13.9%, 95% CI 10.4-18.5). Most respondents (83.6%, 95% CI 78.8-87.5) would not administer combination therapy. Respondents were confident in managing agitation overall. The lack of local/institutional CPGs (55.7%, 95% CI 49.9-61.4) was perceived as an important barrier. Institutional guidelines were considered the most useful CPGs (66.4%, 95% CI 60.7-71.7). Most respondents (72.9%, 95% CI 67.4-77.7) perceived a HKCEM endorsed CPG would be useful. Haloperidol and benzodiazepines are frequently used as monotherapy for the management of acute agitation in Hong Kong's AEDs. Management in Hong Kong differs from Australasian practice in that combination therapy is less common and clinicians' choice of sedation drugs are less variable overall. Results suggest that future work on CPG development and training regarding the safe use of combination therapy would be well received. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature.

PubMed

Sung, Huei-Chuan; Chang, Anne M

2005-10-01

This paper reviews study findings of preferred music on agitated behaviours for older people with dementia and provides implications for future research and practice. Music has been suggested as a feasible and less costly intervention to manage agitated behaviours in older people with dementia. However, no review of the literature focusing on study findings of preferred music on agitated behaviours in older people with dementia had been reported. A review was undertaken using electronic databases with specified search terms for the period of 1993-2005. The references listed in the publications selected were also searched for additional studies. Eight research-based articles met the inclusion criteria and were included in the review. The preferred music intervention demonstrated positive outcomes in reducing the occurrence of some types of agitated behaviours in older people with dementia. The findings from these studies were relatively consistent in finding improvement in agitated behaviours although the findings in one study did not reach statistical significance. The small sample sizes and some variations in the application of the preferred music intervention mean that caution is needed in drawing conclusions from these studies. This review highlights that preferred music has positive effects on decreasing agitated behaviours in older people with dementia; however, the methodological limitations indicate the need for further research. Findings from the review highlight the beneficial outcomes of preferred music in reducing agitated behaviours for older people with dementia. The incorporation of preferred music has the potential to provide a therapeutic approach to the care of older people with dementia.

Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation.

PubMed

Yang, Man-Hua; Lin, Li-Chan; Wu, Shiao-Chi; Chiu, Jen-Hwey; Wang, Pei-Ning; Lin, Jaung-Geng

2015-03-29

One of the most common symptoms observed in patients with dementia is agitation, and several non-pharmacological treatments have been used to control this symptom. However, because of limitations in research design, the benefit of non-pharmacological treatments has only been demonstrated in certain cases. The purpose of this study was to compare aroma-acupressure and aromatherapy with respect to their effects on agitation in patients with dementia. In this experimental study, the participants were randomly assigned to three groups: 56 patients were included in the aroma-acupressure group, 73 patients in the aromatherapy group, and 57 patients in the control group who received daily routine as usual without intervention. The Cohen-Mansfield Agitation Inventory (CMAI) scale and the heart rate variability (HRV) index were used to assess differences in agitation. The CMAI was used in the pre-test, post-test and post-three-week test, and the HRV was used in the pre-test, the post-test and the post-three-week test as well as every week during the four-week interventions. The CMAI scores were significantly lower in the aroma-acupressure and aromatherapy groups compared with the control group in the post-test and post-three-week assessments. Sympathetic nervous activity was significantly lower in the fourth week in the aroma-acupressure group and in the second week in the aromatherapy group, whereas parasympathetic nervous activity increased from the second week to the fourth week in the aroma-acupressure group and in the fourth week in the aromatherapy group. Aroma-acupressure had a greater effect than aromatherapy on agitation in patients with dementia. However, agitation was improved in both of the groups, which allowed the patients with dementia to become more relaxed. Future studies should continue to assess the benefits of aroma-acupressure and aromatherapy for the treatment of agitation in dementia patients. ChiCTR-TRC-14004810; Date of registration: 2014/6/12.

Timing of Initiation of Maintenance Dialysis

PubMed Central

Wong, Susan P. Y.; Vig, Elizabeth K.; Taylor, Janelle S.; Burrows, Nilka R.; Liu, Chuan-Fen; Williams, Desmond E.; Hebert, Paul L.; O’Hare, Ann M.

2016-01-01

IMPORTANCE There is often considerable uncertainty about the optimal time to initiate maintenance dialysis in individual patients and little medical evidence to guide this decision. OBJECTIVE To gain a better understanding of the factors influencing the timing of initiation of dialysis in clinical practice. DESIGN, SETTING, AND PARTICIPANTS A qualitative analysis was conducted using the electronic medical records from the Department of Veterans Affairs (VA) of a national random sample of 1691 patients for whom the decision to initiate maintenance dialysis occurred in the VA between January 1, 2000, and December 31, 2009. Data analysis took place from June 1 to November 30, 2014. MAIN OUTCOMES AND MEASURES Central themes related to the timing of initiation of dialysis as documented in patients’ electronic medical records. RESULTS Of the 1691 patients, 1264 (74.7%) initiated dialysis as inpatients and 1228 (72.6%) initiated dialysis with a hemodialysis catheter. Cohort members met with a nephrologist during an outpatient clinic visit a median of 3 times (interquartile range, 0–6) in the year prior to initiation of dialysis. The mean (SD) estimated glomerular filtration rate at the time of initiation for cohort members was 10.4 (5.7) mL/min/1.73m2. The timing of initiation of dialysis reflected the complex interplay of at least 3 interrelated and dynamic processes. The first was physician practices, which ranged from practices intended to prepare patients for dialysis to those intended to forestall the need for dialysis by managing the signs and symptoms of uremia with medical interventions. The second process was sources of momentum. Initiation of dialysis was often precipitated by clinical events involving acute illness or medical procedures. In these settings, the imperative to treat often seemed to override patient choice. The third process was patient-physician dynamics. Interactions between patients and physicians were sometimes adversarial, and physician

Phonological studies of the new gas-induced agitated reactor using computational fluid dynamics.

PubMed

Yang, T C; Hsu, Y C; Wang, S F

2001-06-01

An ozone-induced agitated reactor has been found to be very effective in degrading industrial wastewater. However, the cost of the ozone generation as well as its short residence time in reactors has restricted its application in a commercial scale. An innovated gas-induced draft tube installed inside a conventional agitated reactor was proved to effectively retain the ozone in a reactor. The setup was demonstrated to significantly promote the ozone utilization rate up to 96% from the conventional rate of 60% above the onset speed. This work investigates the mixing mechanism of an innovated gas-induced reactor for the future scale-up design by using the technique of computational fluid dynamics. A three-dimensional flow model was proposed to compute the liquid-gas free surface as well as the flow patterns inside the reactor. The turbulent effects generated by two 45 degrees pitch-blade turbines were considered and the two phases mixing phenomena were also manipulated by the Eulerian-Eulerian techniques. The consistency of the free surface profiles and the fluid flow patterns proved a good agreement between computational results and the experimental observation.

The Richmond Agitation-Sedation Scale modified for palliative care inpatients (RASS-PAL): a pilot study exploring validity and feasibility in clinical practice

PubMed Central

2014-01-01

Background The Richmond Agitation-Sedation Scale (RASS), which assesses level of sedation and agitation, is a simple observational instrument which was developed and validated for the intensive care setting. Although used and recommended in palliative care settings, further validation is required in this patient population. The aim of this study was to explore the validity and feasibility of a version of the RASS modified for palliative care populations (RASS-PAL). Methods A prospective study, using a mixed methods approach, was conducted. Thirteen health care professionals (physicians and nurses) working in an acute palliative care unit assessed ten consecutive patients with an agitated delirium or receiving palliative sedation. Patients were assessed at five designated time points using the RASS-PAL. Health care professionals completed a short survey and data from semi-structured interviews was analyzed using thematic analysis. Results The inter-rater intraclass correlation coefficient range of the RASS-PAL was 0.84 to 0.98 for the five time points. Professionals agreed that the tool was useful for assessing sedation and was easy to use. Its role in monitoring delirium however was deemed problematic. Professionals felt that it may assist interprofessional communication. The need for formal education on why and how to use the instrument was highlighted. Conclusion This study provides preliminary validity evidence for the use of the RASS-PAL by physicians and nurses working in a palliative care unit, specifically for assessing sedation and agitation levels in the management of palliative sedation. Further validity evidence should be sought, particularly in the context of assessing delirium. PMID:24684942

The Richmond Agitation-Sedation Scale modified for palliative care inpatients (RASS-PAL): a pilot study exploring validity and feasibility in clinical practice.

PubMed

Bush, Shirley H; Grassau, Pamela A; Yarmo, Michelle N; Zhang, Tinghua; Zinkie, Samantha J; Pereira, José L

2014-03-31

The Richmond Agitation-Sedation Scale (RASS), which assesses level of sedation and agitation, is a simple observational instrument which was developed and validated for the intensive care setting. Although used and recommended in palliative care settings, further validation is required in this patient population. The aim of this study was to explore the validity and feasibility of a version of the RASS modified for palliative care populations (RASS-PAL). A prospective study, using a mixed methods approach, was conducted. Thirteen health care professionals (physicians and nurses) working in an acute palliative care unit assessed ten consecutive patients with an agitated delirium or receiving palliative sedation. Patients were assessed at five designated time points using the RASS-PAL. Health care professionals completed a short survey and data from semi-structured interviews was analyzed using thematic analysis. The inter-rater intraclass correlation coefficient range of the RASS-PAL was 0.84 to 0.98 for the five time points. Professionals agreed that the tool was useful for assessing sedation and was easy to use. Its role in monitoring delirium however was deemed problematic. Professionals felt that it may assist interprofessional communication. The need for formal education on why and how to use the instrument was highlighted. This study provides preliminary validity evidence for the use of the RASS-PAL by physicians and nurses working in a palliative care unit, specifically for assessing sedation and agitation levels in the management of palliative sedation. Further validity evidence should be sought, particularly in the context of assessing delirium.

40 CFR 63.1028 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Standards § 63.1028 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 11 2013-07-01 2013-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1028 Section 63.1028 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1028 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Standards § 63.1028 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 11 2014-07-01 2014-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1028 Section 63.1028 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1028 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Standards § 63.1028 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 10 2011-07-01 2011-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1028 Section 63.1028 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1009 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... § 63.1009 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 11 2014-07-01 2014-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1009 Section 63.1009 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1009 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 63.1009 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 10 2011-07-01 2011-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1009 Section 63.1009 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1028 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Standards § 63.1028 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 11 2012-07-01 2012-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1028 Section 63.1028 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1009 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 63.1009 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1009 Section 63.1009 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1009 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2012 CFR

2012-07-01

... § 63.1009 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 11 2012-07-01 2012-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1009 Section 63.1009 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1028 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Standards § 63.1028 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1028 Section 63.1028 Protection of Environment ENVIRONMENTAL...

40 CFR 63.1009 - Agitators in gas and vapor service and in light liquid service standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 63.1009 Agitators in gas and vapor service and in light liquid service standards. (a) Compliance... 40 Protection of Environment 11 2013-07-01 2013-07-01 false Agitators in gas and vapor service and in light liquid service standards. 63.1009 Section 63.1009 Protection of Environment ENVIRONMENTAL...

Improving Crotalidae polyvalent immune Fab reconstitution times.

PubMed

Quan, Asia N; Quan, Dan; Curry, Steven C

2010-06-01

Crotalidae polyvalent immune Fab (CroFab) is used to treat rattlesnake envenomations in the United States. Time to infusion may be a critical factor in the treatment of these bites. Per manufacturer's instructions, 10 mL of sterile water for injection (SWI) and hand swirling are recommended for reconstitution. We wondered whether completely filling vials with 25 mL of SWI would result in shorter reconstitution times than using 10-mL volumes and how hand mixing compared to mechanical agitation of vials or leaving vials undisturbed. Six sets of 5 vials were filled with either 10 mL or 25 mL. Three mixing techniques were used as follows: undisturbed; agitation with a mechanical agitator; and continuous hand rolling and inverting of vials. Dissolution was determined by observation and time to complete dissolution for each vial. Nonparametric 2-tailed P values were calculated. Filling vials completely with 25 mL resulted in quicker dissolution than using 10-mL volumes, regardless of mixing method (2-tailed P = .024). Mixing by hand was shorter than other methods (P < .001). Reconstitution with 25 mL and hand mixing resulted in the shortest dissolution times (median, 1.1 minutes; range, 0.9-1.3 minutes). This appeared clinically important because dissolution times using 10 mL and mechanical rocking of vials (median, 26.4 minutes) or leaving vials undisturbed (median, 33.6 minutes) was several-fold longer. Hand mixing after filling vials completely with 25 mL results in shorter dissolution times than using 10 mL or other methods of mixing and is recommended, especially when preparing initial doses of CroFab. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Effects on Symptoms of Agitation and Depression in Persons With Dementia Participating in Robot-Assisted Activity: A Cluster-Randomized Controlled Trial.

PubMed

Jøranson, Nina; Pedersen, Ingeborg; Rokstad, Anne Marie Mork; Ihlebæk, Camilla

2015-10-01

To examine effects on symptoms of agitation and depression in nursing home residents with moderate to severe dementia participating in a robot-assisted group activity with the robot seal Paro. A cluster-randomized controlled trial. Ten nursing home units were randomized to either robot-assisted intervention or a control group with treatment as usual during 3 intervention periods from 2013 to 2014. Ten adapted units in nursing homes in 3 counties in eastern Norway. Sixty residents (67% women, age range 62-95 years) in adapted nursing home units with a dementia diagnosis or cognitive impairment (Mini-Mental State Examination score lower than 25/30). Group sessions with Paro took place in a separate room at nursing homes for 30 minutes twice a week over the course of 12 weeks. Local nurses were trained to conduct the intervention. Participants were scored on baseline measures (T0) assessing cognitive status, regular medication, agitation (BARS), and depression (CSDD). The data collection was repeated at end of intervention (T1) and at follow-up (3 months after end of intervention) (T2). Mixed models were used to test treatment and time effects. Statistically significant differences in changes were found on agitation and depression between groups from T0 to T2. Although the symptoms of the intervention group declined, the control group's symptoms developed in the opposite direction. Agitation showed an effect estimate of -5.51, CI 0.06-10.97, P = .048, and depression -3.88, CI 0.43-7.33, P = .028. There were no significant differences in changes on either agitation or depression between groups from T0 to T1. This study found a long-term effect on depression and agitation by using Paro in activity groups for elderly with dementia in nursing homes. Paro might be a suitable nonpharmacological treatment for neuropsychiatric symptoms and should be considered as a useful tool in clinical practice. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care

6. VIEW OF BRINING TANK Older, redwood model. Paddles agitated ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. VIEW OF BRINING TANK Older, redwood model. Paddles agitated the skins while they soaked in brine. The skins were then hung to dry. - Sealing Plant, St. George Island, Pribilof Islands, Saint George, Aleutians West Census Area, AK

40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2014 CFR

2014-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2011 CFR

2011-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2012 CFR

2012-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2013 CFR

2013-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2012 CFR

2012-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2014 CFR

2014-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2013 CFR

2013-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2010 CFR

2010-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

Code of Federal Regulations, 2010 CFR

2010-07-01

... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service; and...

Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia: A Randomized Clinical Trial.

PubMed

Cummings, Jeffrey L; Lyketsos, Constantine G; Peskind, Elaine R; Porsteinsson, Anton P; Mintzer, Jacobo E; Scharre, Douglas W; De La Gandara, Jose E; Agronin, Marc; Davis, Charles S; Nguyen, Uyen; Shin, Paul; Tariot, Pierre N; Siffert, João

Agitation is common among patients with Alzheimer disease; safe, effective treatments are lacking. To assess the efficacy, safety, and tolerability of dextromethorphan hydrobromide-quinidine sulfate for Alzheimer disease-related agitation. Phase 2 randomized, multicenter, double-blind, placebo-controlled trial using a sequential parallel comparison design with 2 consecutive 5-week treatment stages conducted August 2012-August 2014. Patients with probable Alzheimer disease, clinically significant agitation (Clinical Global Impressions-Severity agitation score ≥4), and a Mini-Mental State Examination score of 8 to 28 participated at 42 US study sites. Stable dosages of antidepressants, antipsychotics, hypnotics, and antidementia medications were allowed. In stage 1, 220 patients were randomized in a 3:4 ratio to receive dextromethorphan-quinidine (n = 93) or placebo (n = 127). In stage 2, patients receiving dextromethorphan-quinidine continued; those receiving placebo were stratified by response and rerandomized in a 1:1 ratio to dextromethorphan-quinidine (n = 59) or placebo (n = 60). The primary end point was change from baseline on the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (scale range, 0 [absence of symptoms] to 12 [symptoms occur daily and with marked severity]). A total of 194 patients (88.2%) completed the study. With the sequential parallel comparison design, 152 patients received dextromethorphan-quinidine and 127 received placebo during the study. Analysis combining stages 1 (all patients) and 2 (rerandomized placebo nonresponders) showed significantly reduced NPI Agitation/Aggression scores for dextromethorphan-quinidine vs placebo (ordinary least squares z statistic, -3.95; P < .001). In stage 1, mean NPI Agitation/Aggression scores were reduced from 7.1 to 3.8 with dextromethorphan-quinidine and from 7.0 to 5.3 with placebo. Between-group treatment differences were significant in stage 1 (least squares mean

Ketamine for the Acute Management of Excited Delirium and Agitation in the Prehospital Setting.

PubMed

Linder, Lauren M; Ross, Clint A; Weant, Kyle A

2018-01-01

Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting. A literature review was conducted to identify articles utilizing ketamine in the prehospital setting. The review was limited to English-language articles identified in Embase (1988-June 2017) and the U.S. National Library of Medicine (1970-June 2017). References of all pertinent articles were also reviewed. Ten articles were identified including 418 patients receiving ketamine for agitation. The most commonly utilized route for administration was intramuscular (IM), with five of the seven IM administration studies using a ketamine dose of 5 mg/kg. Ketamine administered in this fashion was efficacious to achieve proper sedation during transport and did not require repeat dosing. Three studies applied a ketamine protocol to outline dosing and the management of ketamine adverse events. The most common adverse events identified were respiratory-related events and hypersalivation. Ketamine has a role for agitation management in the prehospital setting; however, emergency personnel education and ketamine protocols should be utilized to aid in safe and effective pharmacotherapy and provide guidance on the management of adverse events. Future prospective comparative studies, with protocolized standard ketamine regimens, are needed to further delineate the role of ketamine in agitation management and identify accurate adverse event incidence rates. © 2017 Pharmacotherapy Publications, Inc.

Lithium Treatment for Agitation in Alzheimer's disease (Lit-AD): Clinical rationale and study design.

PubMed

Devanand, D P; Strickler, Jesse G; Huey, Edward D; Crocco, Elizabeth; Forester, Brent P; Husain, Mustafa M; Vahia, Ipsit V; Andrews, Howard; Wall, Melanie M; Pelton, Gregory H

2018-05-31

Symptoms of agitation, aggression, and psychosis frequently occur in patients with Alzheimer's disease (AD). These symptoms are distressing to patients and caregivers, often lead to institutionalization, are associated with increased mortality, and are very difficult to treat. Lithium is an established treatment for bipolar and other psychotic disorders in which agitation can occur. The Lit-AD study is the first randomized, double-blind, placebo-controlled trial to assess the efficacy of lithium treatment for symptoms of agitation or aggression, with or without psychosis, in older adults diagnosed with AD. Patients are randomly assigned to low dose (150-600 mg) lithium or placebo, targeting a blood level of 0.2-0.6 mmol/L, stratified by the presence/absence of psychotic symptoms. The study duration for each patient is 12 weeks. The primary study outcome is change in the agitation/aggression domain score on the Neuropsychiatric Inventory (NPI) over the study period. The secondary outcome is improvement in neuropsychiatric symptoms defined as a 30% decrease in a NPI core score that combines agitation/aggression and psychosis domain scores. The Treatment Emergent Symptom Scale (TESS) is used to assess somatic side effects. Other exploratory analyses examine the associations between improvement on lithium and indices shown to be associated with response to lithium in bipolar disorder: serum brain-derived neurotrophic factor (BDNF) levels, a SNP in intron 1 of the ACCN1 gene, and variation at the 7q11.2 gene locus. If lithium demonstrates efficacy in this Phase II pilot trial, a Phase III study will be developed to establish its clinical utility in these patients. ClinicalTrials.gov Identifier NCT02129348. Copyright © 2018. Published by Elsevier Inc.

Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey

PubMed Central

Rapaport, P.; Robertson, S.; Marston, L.; Barber, J.; Manela, M.; Livingston, G.

2017-01-01

Objective As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. Methods We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014–2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. Results Seventy‐one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen‐Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. Conclusions Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia‐friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes. PMID:28971511

Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey.

PubMed

Cooper, C; Rapaport, P; Robertson, S; Marston, L; Barber, J; Manela, M; Livingston, G

2018-03-01

As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014-2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. Seventy-one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen-Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia-friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes. © 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

Measuring information processing in a client with extreme agitation following traumatic brain injury using the Perceive, Recall, Plan and Perform System of Task Analysis.

PubMed

Nott, Melissa T; Chapparo, Christine

2008-09-01

Agitation following traumatic brain injury is characterised by a heightened state of activity with disorganised information processing that interferes with learning and achieving functional goals. This study aimed to identify information processing problems during task performance of a severely agitated adult using the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis. Second, this study aimed to examine the sensitivity of the PRPP System to changes in task performance over a short period of rehabilitation, and third, to evaluate the guidance provided by the PRPP in directing intervention. A case study research design was employed. The PRPP System of Task Analysis was used to assess changes in task embedded information processing capacity during occupational therapy intervention with a severely agitated adult in a rehabilitation context. Performance is assessed on three selected tasks over a one-month period. Information processing difficulties during task performance can be clearly identified when observing a severely agitated adult following a traumatic brain injury. Processing skills involving attention, sensory processing and planning were most affected at this stage of rehabilitation. These processing difficulties are linked to established descriptions of agitated behaviour. Fluctuations in performance across three tasks of differing processing complexity were evident, leading to hypothesised relationships between task complexity, environment and novelty with information processing errors. Changes in specific information processing capacity over time were evident based on repeated measures using the PRPP System of Task Analysis. This lends preliminary support for its utility as an outcome measure, and raises hypotheses about the type of therapy required to enhance information processing in people with severe agitation. The PRPP System is sensitive to information processing changes in severely agitated adults when used to reassess performance

Effect of dexmedetomidine on preventing agitation and delirium after microvascular free flap surgery: a randomized, double-blind, control study.

PubMed

Yang, Xudong; Li, Zhenzhen; Gao, Chunyan; Liu, Ruichang

2015-06-01

To determine whether dexmedetomidine sedation in the postanesthesia care unit (PACU) could decrease agitation and delirium after free flap surgery. Eighty patients were randomly divided into 2 groups. In the experimental group, dexmedetomidine was given at an hourly infusion rate of 0.5 μg/kg for 1 hour before the operation was completed and continued in the PACU at 0.2 to 0.7 μg/kg continuously until the next morning. In the control group, normal saline was given during the same periods. Patients in the 2 groups received sufentanil and midazolam for sedation and pain relief when necessary. Agitation was monitored with the Riker Sedation-Agitation Scale in the PACU and delirium was monitored with the Confusion Assessment Method for the Intensive Care Unit for 5 days postoperatively. The overall incidence of agitation was similar between the 2 groups. However, when the influence of patient shifting was excluded, the incidence of agitation in the dexmedetomidine group was apparently lower than that in the control group (10.3 vs 30%; P = .029). No difference was found in the occurrence of delirium between the experimental and control groups (5.1 vs 12.5%; P = .432). Dexmedetomidine does not change the overall incidence of agitation after free flap surgery; however, it does decrease agitation after PACU admission. It does not prevent delirium within 5 days postoperatively. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial.

PubMed

Lin, Li-Chan; Yang, Man-Hua; Kao, Chieh-Chun; Wu, Shiao-Chi; Tang, Sai-Hung; Lin, Jaung-Geng

2009-06-01

To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia. A double-blinded, randomized (two treatments and one control; three time periods) cross-over design was used. Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study. One hundred thirty-three institutionalized residents with dementia. Subjects were randomized into three treatment sequences: acupressure-presence-Montessori methods, Montessori methods-acupressure-presence and presence-Montessori methods-acupressure. All treatments were done once a day, 6 days per week, for a 4-week period. The Cohen-Mansfield Agitation Inventory, Ease-of-Care, and the Apparent Affect Rating Scale. After receiving the intervention, the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors, aggressive behaviors, and physically nonaggressive behaviors than the presence group. Additionally, the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group. In terms of apparent affect, positive affect in the Montessori-based-activities group was significantly better than in the presence group. This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for patients

Comparing the Effects of Cognitive Stimulation, Reminiscence, and Aroma-Massage on Agitation and Depressive Mood in People With Dementia.

PubMed

Yang, Ya-Ping; Lee, Feng-Ping; Chao, Hui-Chen; Hsu, Fang-Yu; Wang, Jing-Jy

2016-08-01

Cognitive stimulation therapy (CST), reminiscence therapy (RT), and aroma-massage therapy (AT) are believed to be beneficial for people with dementia (PwD). However, the comparing effects of these interventions have not been reported in previous studies. The purpose of this research was thus to compare the effects of these 3 interventions on alleviating agitation and depressive mood in PwD. A cohort study with pre- and post-tests was conducted. A total of 102 PwD from 10 long-term care facilities were allocated to RT (n = 43), CST (n = 29), or AT (n = 29) groups. The participants received the interventions once a week for 8 to 10 consecutive weeks. The participants were evaluated using the Chinese version of the Cohen-Mansfield Agitation Inventory and the Cornell Scale for Depression in Dementia before and shortly after the intervention. One-way ANOVA and ANCOVA were used to analyze the data. Significant differences in the effects on agitation and depressive symptoms in PwD were found among the 3 interventions (P = .013 and P < .001, respectively). Post hoc analysis showed that AT was more effective than RT and CST in improving agitated behaviors (P = .006 and P < .001, respectively), and was also more effective than CST and RT in alleviating depressive symptoms (both P < .001). Our findings indicate that among the 3 alternative remedies, AT can be a more effective intervention than CST and RT with regard to alleviating the agitated behavior and depressive symptoms of PwD. Given that agitated behavior and depressive mood are common among institutionalized PwD, and staff working in long-term care facilities often lack knowledge and time to manage such behaviors, the findings of this study can contribute to future clinical practice in long-term care facilities. In addition, aroma-massage has the advantage of being an easy-to-learn intervention for staff working with PwD. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Exploring the effect of foot massage on agitated behaviours in older people with dementia: a pilot study.

PubMed

Moyle, Wendy; Johnston, Amy Nicole Burne; O'Dwyer, Siobhan Therese

2011-09-01

To explore the effects of foot massage on agitated behaviours in older people with dementia living in long-term care. Seventeen men and 5 women (mean age 84.7 years), with a diagnosis of dementia and a history of clinically significant agitation, received a 10-minute foot massage each day for 14 days. The short form of the Cohen-Mansfield Agitation Inventory (CMAI-SF) and the Revised Memory and Behavior Problems Checklist (RMBPC) were completed at baseline, post-test and 2-weeks follow up. CMAI-SF and RMBPC scores were significantly reduced at post-test and remained significantly lower than baseline at follow up. This study provides preliminary evidence suggesting that limited short-duration foot massage reduces agitation and related behavioural problems in people with dementia, and that these behaviour changes are maintained after the massage ceases. A randomised controlled trial is required to confirm these findings. © 2011 The Authors. Australasian Journal on Ageing © 2011 ACOTA.

Foot massage versus quiet presence on agitation and mood in people with dementia: a randomised controlled trial.

PubMed

Moyle, Wendy; Cooke, Marie Louise; Beattie, Elizabeth; Shum, David H K; O'Dwyer, Siobhan T; Barrett, Sue

2014-06-01

There is increasing interest in using complementary and alternative treatments to manage behavioural and psychological symptoms of dementia such as agitation, aggression and depressed mood. To compare the effect of foot massage (intervention) and quiet presence (control) on agitation and mood in people with dementia. A randomised controlled trial using a within-subjects, crossover design. Five long-term care facilities in Brisbane, Australia. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) and the secondary outcome was the Observed Emotion Rating Scale (OERS). The screening and data collection research assistants, families, and care staff were blinded to participant allocation. Participants of the study were 55 long-term care residents aged 74-103 years (mean age 86.5), with moderate to severe dementia and a history of agitated behaviour according to the Pittsburgh Agitation Scale. A computer-program randomised participants to 10-min foot massage (intervention) or quiet presence (control), every weekday for 3 weeks. A carry-over effect was identified in the data, and so the data was treated as a parallel groups RCT. The mean total CMAI increased in both groups (reflecting an increase in agitation) with this increase greater in the quiet presence group than the foot massage group (p=0.03). There was a trend towards a difference on OERS General Alertness, with a positive change in alertness for participants in the foot massage group (indicating reduced alertness) and a negative change for participants in the quiet presence group (indicating increased alertness) (F(1,51)=3.88, p=0.05, partial ή(2)=0.07). The findings highlight the need for further research on the specific conditions under which massage might promote relaxation and improve mood for people with dementia. The unfamiliar research assistants and variations in usual activity may have contributed to the increase in agitation and this needs further research. ACTRN12612000658819

[Pharmacological Treatment for Adult Diagnosed With Schizophrenia With Agitation or Violent Behavior].

PubMed

Gómez-Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Ávila, Mauricio J; Jaramillo González, Luis Eduardo; Vélez Fernández, Carolina; Vélez Traslaviña, Ángela; García Valencia, Jenny; Pinzón-Amado, Alexander

2014-01-01

To determine the most effective pharmacological intervention and to bring recommendations for decision-making in the management of adults with schizophrenia with violent behavior or agitation. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. It is recommended the use of parenteral drugs in all agitated patient who does not respond to the measures of persuasion. The drugs with better evidence on effectiveness (control of violent behavior) are haloperidol and benzodiazepines, administered jointly or individually. Olanzapine is also an option considering that should only be used in institutions where a psychiatrist is available 24hours. Ziprasidone can be considered as a second-line drug. The information about the side effects associated with these drugs is insufficient and has low quality. Violent behavior in adults with schizophrenia represents a risk for themselves and for those around them, so the opportune implementation of interventions aimed to calm the patient, in order to prevent potential negative outcomes is necessary. It is recommended to initiate these interventions with measures of verbal persuasion, and if these measures are not effective, appropriate use of parenteral drugs: haloperidol and benzodiazepines as first-line and olanzapine and ziprasidone as second choices. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis.

PubMed

Levy, Ilana; Attias, Samuel; Ben-Arye, Eran; Bloch, Boaz; Schiff, Elad

2017-05-01

Agitation and delirium frequently occur in cognitively impaired older people. We conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions. Following preliminary search, we included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. We subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between studies, and assessment of synthesis robustness. Forty articles that met the inclusion criteria were analyzed. Sixteen of these were randomized controlled trials. One article specifically addressed CAM treatment of delirium in patients without dementia, and the remaining 39 articles described treatments of agitated older persons with dementia. Thirty-five of the 40 included studies suggested that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported. Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. We suggest that promising CAM modalities should be further explored through large-scale randomized controlled trials in different clinical settings. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Deriving a Framework for a Systems Approach to Agitated Patient Care in the Emergency Department.

PubMed

Wong, Ambrose H; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-05-01

The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network. Participants consisted of resident and attending physicians, physician assistants/nurse practitioners, nurses, technicians, and security officers. After a simulated agitated patient encounter to prime participants, uniprofessional and interprofessional focus groups were conducted, followed by a structured thematic analysis using a grounded theory approach. Quantitative data consisted of surveys of violence exposure and attitudes toward patient aggression and management. Data saturation was reached with 57 participants. Violence exposure was higher for technicians, nurses, and officers. Conflicting priorities and management challenges occurred due to four main interconnected elements: perceived complex patient motivations; a patient care paradox between professional duty and personal safety; discordant interprofessional dynamics mitigated by respect and trust; and logistical challenges impeding care delivery and long-term outcomes. Using a systems approach, five interconnected levels of ED agitated patient care delivery were identified: patient, staff, team, ED microsystem, and health care macrosystem. These care dimensions were synthesized to form a novel patient safety-based framework that can help guide future research, practice, and policy. Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Bathyphotometer bioluminescence potential measurements: A framework for characterizing flow agitators and predicting flow-stimulated bioluminescence intensity

NASA Astrophysics Data System (ADS)

Latz, Michael I.; Rohr, Jim

2013-07-01

Bathyphotometer measurements of bioluminescence are used as a proxy for the abundance of luminescent organisms for studying population dynamics; the interaction of luminescent organisms with physical, chemical, and biological oceanographic processes; and spatial complexity especially in coastal areas. However, the usefulness of bioluminescence measurements has been limited by the inability to compare results from different bathyphotometer designs, or even the same bathyphotometer operating at different volume flow rates. The primary objective of this study was to compare measurements of stimulated bioluminescence of four species of cultured dinoflagellates, the most common source of bioluminescence in coastal waters, using two different bathyphotometer flow agitators as a function of bathyphotometer volume flow rate and dinoflagellate concentration. For both the NOSC and BIOLITE flow agitators and each species of dinoflagellate tested, there was a critical volume flow rate, above which average bioluminescence intensity, designated as bathyphotometer bioluminescence potential (BBP), remained relatively constant and scaled directly with dinoflagellate cell concentration. At supra-critical volume flow rates, the ratio of BIOLITE to NOSC BBP was nearly constant for the same species studied, but varied between species. The spatial pattern and residence time of flash trajectories within the NOSC flow agitator indicated the presence of dominant secondary recirculating flows, where most of the bioluminescence was detected. A secondary objective (appearing in the Appendix) was to study the feasibility of using NOSC BBP to scale flow-stimulated bioluminescence intensity across similar flow fields, where the contributing composition of luminescent species remained the same. Fully developed turbulent pipe flow was chosen because it is hydrodynamically well characterized. Average bioluminescence intensity in a 2.54-cm i.d. pipe was highly correlated with wall shear stress and

Experiments in randomly agitated granular assemblies close to the jamming transition

NASA Astrophysics Data System (ADS)

Caballero, Gabriel; Lindner, Anke; Ovarlez, Guillaume; Reydellet, Guillaume; Lanuza, José; Clément, Eric

2004-11-01

We present the results obtained for two experiments on randomly agitated granular assemblies using a novel way of shaking. First we discuss the transport properties of a 2D model system undergoing classical shaking that show the importance of large scale dynamics for this type of agitation and offer a local view of the microscopic motions of a grain. We then develop a new way of vibrating the system allowing for random accelerations smaller than gravity. Using this method we study the evolution of the free surface as well as results from a light scattering method for a 3D model system. The final aim of these experiments is to investigate the ideas of effective temperature on the one hand as a function of inherent states and on the other hand using fluctuation dissipation relations.

Experiments in randomly agitated granular assemblies close to the jamming transition

NASA Astrophysics Data System (ADS)

Caballero, Gabriel; Lindner, Anke; Ovarlez, Guillaume; Reydellet, Guillaume; Lanuza, José; Clément, Eric

2004-03-01

We present the results obtained for two experiments on randomly agitated granular assemblies using a novel way of shaking. First we discuss the transport properties of a 2D model system undergoing classical shaking that show the importance of large scale dynamics for this type of agitation and offer a local view of the microscopic motions of a grain. We then develop a new way of vibrating the system allowing for random accelerations smaller than gravity. Using this method we study the evolution of the free surface as well as results from a light scattering method for a 3D model system. The final aim of these experiments is to investigate the ideas of effective temperature on the one hand as a function of inherent states and on the other hand using fluctuation dissipation relations.

Knowledge and Attitude Towards Pharmacological Management of Acute Agitation: A Survey of Psychiatrists, Psychiatry Residents, and Psychiatric Nurses.

PubMed

Tangu, KeumbÔh; Ifeanyi, Adaora; Velusamy, Mayurapriya; Dar, Sara; Shah, Nurun; Ezeobele, Ifeoma E; Okusaga, Olaoluwa O

2017-06-01

The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital. Where possible, Fisher's exact test was used to compare responses to questions based on designation. Of the 250 questionnaires distributed, 112 were returned (response rate of 44.8%), of which 64 (57.1%) were psychiatric nurses, 27 (24.1%) were attending psychiatrists, and 21 (18.8%) were psychiatry residents. A significantly higher percentage of attending psychiatrists and psychiatric nurses compared to psychiatry residents thought that newer second- generation antipsychotics (SGAs) are not as effective as older first-generation antipsychotics (FGAs) for managing acute agitation (55.6, 48.4, and 9.5% respectively, p = 0.008). The combination of intramuscular haloperidol, lorazepam, and diphenhydramine was the most preferred option chosen by all designations for the psychopharmacological management of severe agitation. Furthermore, a larger percentage of the psychiatric nurses, in comparison to attending psychiatrists, also chose the combination of intramuscular chlorpromazine, lorazepam, and diphenhydramine as an option for managing severe agitation; no psychiatry resident chose this option. Knowledge of evidence-based psychopharmacological management of agitation differs among attending psychiatrists, psychiatry residents and psychiatric nurses. Although the management of agitation should be individualized and context specific, monotherapy should be considered first where applicable.

Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence.

PubMed

Rubio-Valera, Maria; Luciano, Juan V; Ortiz, José Miguel; Salvador-Carulla, Luis; Gracia, Alfredo; Serrano-Blanco, Antoni

2015-03-04

Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.

R- and S-citalopram concentrations have differential effects on neuropsychiatric scores in elders with dementia and agitation.

PubMed

Ho, Thang; Pollock, Bruce G; Mulsant, Benoit H; Schantz, Oliver; Devanand, Devangere P; Mintzer, Jacobo E; Porsteinsson, Anton P; Schneider, Lon S; Weintraub, Daniel; Yesavage, Jerome; Drye, Lea T; Munro, Cynthia A; Shade, David M; Lyketsos, Constantine; Bies, Robert

2016-09-01

The aim was to determine the relationship between (R) and (S)-citalopram enantiomer exposure (AUC(0,24 h)) and therapeutic response in agitated individuals greater than 60 years old with Alzheimer's dementia (AD). Citalopram enantiomer exposures (AUC(0,24 h)) derived from an established population pharmacokinetic analysis were utilized to explore the relationship between (R)- and (S)-citalopram area under the curve (AUC(0,24 )) and Mini-Mental State Examination (MMSE), Neurobehavioural Rating Scale-Agitation Subscale (NBRS-A), modified Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC) and Neuropsychiatric Inventory Agitation subscale (NPIA) scores. Time dependent changes in these scores (disease progression) were accounted for prior to exploring the exposure effect relationship for each enantiomer. These relationships were evaluated using a non-linear-mixed effects modelling approach as implemented in nonmem v7.3. (S)-AUC(0,24 h) and (R)-AUC(0,24 h) each contributed to improvement in NBRS-A scores (k3(R) -0.502; k4(S) -0.712) as did time in treatment. However, increasing (R)-AUC(0,24 h) decreased the probability of patient response (maximum Δ -0.182%/AUC(0,24 h)) based on the CGIC while (S)-AUC(0,24 h) improved the probability of response (maximum Δ 0.112%/AUC(0,24 h)). (R)-AUC(0,24 h) was also associated with worsening in MMSE scores (-0.5 points). Our results suggest that citalopram enantiomers contributed differentially to treatment outcomes. (R)-citalopram accounted for a greater proportion of the adverse consequences associated with racemic citalopram treatment in patients with AD including a decreased probability of treatment response as measured by the CGIC and a reduction in MMSE scores. The S-enantiomer was associated with increased probability of response based on the CGIC. © 2016 The British Pharmacological Society.

Electroless deposition of nickel-boron coatings using low frequency ultrasonic agitation: Effect of ultrasonic frequency on the coatings.

PubMed

Bonin, L; Bains, N; Vitry, V; Cobley, A J

2017-05-01

The effect of ultrasound on the properties of Nickel-Boron (NiB) coatings was investigated. NiB coatings were fabricated by electroless deposition using either ultrasonic or mechanical agitation. The deposition of Ni occurred in an aqueous bath containing a reducible metal salt (nickel chloride), reducing agent (sodium borohydride), complexing agent (ethylenediamine) and stabilizer (lead tungstate). Due to the instability of the borohydride in acidic, neutral and slightly alkaline media, pH was controlled at pH 12±1 in order to avoid destabilizing the bath. Deposition was performed in three different configurations: one with a classical mechanical agitation at 300rpm and the other two employing ultrasound at a frequency of either 20 or 35kHz. The microstructures of the electroless coatings were characterized by a combination of optical Microscopy and Scanning Electron Microscope (SEM). The chemistry of the coatings was determined by ICP-AES (Inductively Coupled Plasma - Atomic Emission Spectrometry) after dissolution in aqua regia. The mechanical properties of the coatings were established by a combination of roughness measurements, Vickers microhardness and pin-on-disk tribology tests. Lastly, the corrosion properties were analysed by potentiodynamic polarization. The results showed that low frequency ultrasonic agitation could be used to produce coatings from an alkaline NiB bath and that the thickness of coatings obtained could be increased by over 50% compared to those produced using mechanical agitation. Although ultrasonic agitation produced a smoother coating and some alteration of the deposit morphology was observed, the mechanical and corrosion properties were very similar to those found when using mechanical agitation. Copyright © 2017 Elsevier B.V. All rights reserved.

Local velocity scaling in an impeller discharge flow in T400 vessel agitated by tooth impeller in a fully turbulent region

NASA Astrophysics Data System (ADS)

Šulc, Radek; Ditl, Pavel; Fořt, Ivan; Jašíkova, Darina; Kotek, Michal; Kopecký, Václav; Kysela, Bohuš

2018-06-01

Hydrodynamics and flow field were measured in an agitated vessel using 2-D Time Resolved Particle Image Velocimetry (2-D TR PIV). The experiments were carried out in a fully baffled cylindrical flat bottom vessel 400 mm in inner diameter agitated by a tooth impeller 133 mm in diameter. The velocity fields were measured in the impeller discharge flow for impeller rotation speeds from 300 rpm to 700 rpm and three liquids of different viscosities (i.e. (i) distilled water, ii) a 28% vol. aqueous solution of glycol, and iii) a 43% vol. aqueous solution of glycol), corresponding to the impeller Reynolds number in the range 68 000 < Re < 221 000. This Re range secures the fully-developed turbulent flow of agitated liquid. In accordance with the theory of mixing, the dimensionless mean and fluctuation velocities in the measured directions were found to be constant and independent of the impeller Reynolds number. On the basis of the test results the spatial distributions of dimensionless velocities were calculated. The radial turbulence intensity was found to be in the majority in the range from 0.3 to 0.9, which corresponds to the high level of this quantity.

Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

PubMed

Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-06-01

Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in

Efficacy and safety of valproic acid versus haloperidol in patients with acute agitation: results of a randomized, double-blind, parallel-group trial.

PubMed

Asadollahi, Shadi; Heidari, Kamran; Hatamabadi, Hamidreza; Vafaee, Reza; Yunesian, Somayeh; Azadbakht, Alireza; Mirmohseni, Ladan

2015-05-01

The objective of this study was to compare the efficacy of valproate versus haloperidol in decreasing the agitation level in affected patients in the emergency department. We assigned 80 acutely agitated patients to receive either intravenous sodium valproate (20 mg/kg) or intramuscular haloperidol (5 mg/1 ml). Agitation was measured at baseline and 30 min after the first injection using the Agitation-Calmness Evaluation Scale (ACES), the Positive and Negative Syndrome Scale-Excited Component subscale, and the Agitated Behavior Scale. For 80 patients treated with sodium valproate, the mean ± SD dosage was 1541.5 ± 286 mg (range 940-2400). The mean postintervention ACES scores from baseline to 30 min after drug injection were 4.73 (SD = 1.93) for the valproate group and 5.45 (SD = 2.09) for the haloperidol group (P = 0.028). No significant differences were observed in terms of the mean changes 30 min after the intervention for two additional agitation scales. A larger proportion of patients in the haloperidol group experienced intense sedation (36.2%, P < 0.001) and extrapyramidal symptoms (8.7%, P = 0.007) compared with the valproate group (2.5% for intense sedation, no patient for extrapyramidal symptoms). The findings suggest that in the clinical practice setting of emergency psychiatry, intravenous valproate is as effective as haloperidol in reducing agitation, with a better safety profile.

Electroconvulsive Therapy for Agitation in Schizophrenia: Metaanalysis of Randomized Controlled Trials.

PubMed

Gu, Xiaojing; Zheng, Wei; Guo, Tong; Ungvari, Gabor S; Chiu, Helen F K; Cao, Xiaolan; D'Arcy, Carl; Meng, Xiangfei; Ning, Yuping; Xiang, Yutao

2017-02-25

Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I 2 =0%, p =0.004) and its excitement sub-score (WMD=-1.97, p <0.0001) as well as the PANSS total score at 14 days (WMD=-7.13, I 2 =0%, p =0.004) and its excitement sub-score at 7 and 14 days (WMD=-1.97 to -1.92, p =0.002 to 0.0001) after ECT. The ECT-APs combination was superior to APs monotherapy with respect to the PANSS total score at treatment endpoint (WMD=-10.40, p=0.03) and 7 days

Risk Factors and Pathological Substrates Associated with Agitation/Aggression in Alzheimer's Disease: A Preliminary Study using NACC Data.

PubMed

Sennik, Simrin; Schweizer, Tom A; Fischer, Corinne E; Munoz, David G

2017-01-01

Neuropsychiatric symptoms are common manifestations of Alzheimer's disease (AD). A number of studies have targeted psychosis, i.e., hallucinations and delusions in AD, but few have assessed agitation/aggression in AD. To investigate the risk factors and pathological substrates associated with presence [A(+)] and absence [A(-)] of agitation/aggression (A) in autopsy-confirmed AD. Data was collected from the UDS data as of 2015 on the NACC database. Patients were stratified as intermediate (IAD) or high (HAD) pathological load of AD. Clinical diagnoses were not considered; additional pathological diagnoses were treated as variables. Analysis of data did not include a control group or corrections for multiple comparisons. 1,716 patients met the eligibility criteria; 31.2% of the IAD and 47.8% of the HAD patients were A(+), indicating an association with severity of pathology (p = 0.001). Risk factors for A(+) included: age at initial visit, age at death, years of education, smoking (in females), recent cardiac events (in males), and clinical history of traumatic brain injury (TBI) (in males). A history of hypertension was not related to A(+). In terms of comorbidity, clinical diagnosis of Lewy body dementia syndrome was associated with A(+) but the association was not confirmed when pathological diagnosis based on demonstration of Lewy bodies was used as the criterion. The additional presence of phosphorylated TDP-43, but not tau pathologies, was associated with A(+)HAD. Vascular lesions, including lacunes, large arterial infarcts, and severity of atherosclerosis were negatively associated with A(+). Associated symptoms included delusions, hallucinations, and depression, but not irritability, aberrant motor behavior, sleep and night time behavioral changes, or changes in appetite and eating habits. Smoking, TBI, and phosphorylated TDP-43 are associated with A(+)AD in specific groups, respectively. A(+) is directly associated with AD pathology load and inversely

Tailored lighting intervention improves measures of sleep, depression, and agitation in persons with Alzheimer’s disease and related dementia living in long-term care facilities

PubMed Central

Figueiro, Mariana G; Plitnick, Barbara A; Lok, Anna; Jones, Geoffrey E; Higgins, Patricia; Hornick, Thomas R; Rea, Mark S

2014-01-01

Background Light therapy has shown great promise as a nonpharmacological method to improve symptoms associated with Alzheimer’s disease and related dementias (ADRD), with preliminary studies demonstrating that appropriately timed light exposure can improve nighttime sleep efficiency, reduce nocturnal wandering, and alleviate evening agitation. Since the human circadian system is maximally sensitive to short-wavelength (blue) light, lower, more targeted lighting interventions for therapeutic purposes, can be used. Methods The present study investigated the effectiveness of a tailored lighting intervention for individuals with ADRD living in nursing homes. Low-level “bluish-white” lighting designed to deliver high circadian stimulation during the daytime was installed in 14 nursing home resident rooms for a period of 4 weeks. Light–dark and rest–activity patterns were collected using a Daysimeter. Sleep time and sleep efficiency measures were obtained using the rest–activity data. Measures of sleep quality, depression, and agitation were collected using standardized questionnaires, at baseline, at the end of the 4-week lighting intervention, and 4 weeks after the lighting intervention was removed. Results The lighting intervention significantly (P<0.05) decreased global sleep scores from the Pittsburgh Sleep Quality Index, and increased total sleep time and sleep efficiency. The lighting intervention also increased phasor magnitude, a measure of the 24-hour resonance between light–dark and rest–activity patterns, suggesting an increase in circadian entrainment. The lighting intervention significantly (P<0.05) reduced depression scores from the Cornell Scale for Depression in Dementia and agitation scores from the Cohen–Mansfield Agitation Inventory. Conclusion A lighting intervention, tailored to increase daytime circadian stimulation, can be used to increase sleep quality and improve behavior in patients with ADRD. The present field study, while

Testing social learning of anti-predator responses in juvenile jackdaws: the importance of accounting for levels of agitation

PubMed Central

Lee, Victoria E.; Thornton, Alex

2018-01-01

Social learning is often assumed to help young animals respond appropriately to potential threats in the environment. We brought wild, juvenile jackdaws briefly into captivity to test whether short exposures to conspecific vocalizations are sufficient to promote anti-predator learning. Individuals were presented with one of two models—a stuffed fox representing a genuine threat, or a toy elephant simulating a novel predator. Following an initial baseline presentation, juveniles were trained by pairing models with either adult mobbing calls, indicating danger, or contact calls suggesting no danger. In a final test phase with no playbacks, birds appeared to have habituated to the elephant, regardless of training, but responses to the fox remained high throughout, suggesting juveniles already recognized it as a predator before the experiment began. Training with mobbing calls did seem to generate elevated escape responses, but this was likely to be a carry-over effect of the playback in the previous trial. Overall, we found little evidence for social learning. Instead, individuals' responses were mainly driven by their level of agitation immediately preceding each presentation. These results highlight the importance of accounting for agitation in studies of anti-predator learning, and whenever animals are held in captivity for short periods. PMID:29410861

Testing social learning of anti-predator responses in juvenile jackdaws: the importance of accounting for levels of agitation.

PubMed

McIvor, Guillam E; Lee, Victoria E; Thornton, Alex

2018-01-01

Social learning is often assumed to help young animals respond appropriately to potential threats in the environment. We brought wild, juvenile jackdaws briefly into captivity to test whether short exposures to conspecific vocalizations are sufficient to promote anti-predator learning. Individuals were presented with one of two models-a stuffed fox representing a genuine threat, or a toy elephant simulating a novel predator. Following an initial baseline presentation, juveniles were trained by pairing models with either adult mobbing calls, indicating danger, or contact calls suggesting no danger. In a final test phase with no playbacks, birds appeared to have habituated to the elephant, regardless of training, but responses to the fox remained high throughout, suggesting juveniles already recognized it as a predator before the experiment began. Training with mobbing calls did seem to generate elevated escape responses, but this was likely to be a carry-over effect of the playback in the previous trial. Overall, we found little evidence for social learning. Instead, individuals' responses were mainly driven by their level of agitation immediately preceding each presentation. These results highlight the importance of accounting for agitation in studies of anti-predator learning, and whenever animals are held in captivity for short periods.

Mechanisms of cell damage in agitated microcarrier tissue culture reactors

NASA Technical Reports Server (NTRS)

Cherry, Robert S.; Papoutsakis, E. Terry

1986-01-01

Cells growing on microcarriers may be damaged by collisions of the microcarrier against another microcarrier or the reactor agitator. Bead-bead collisions are caused by small-scale turbulence, which can also cause high local shear stress on the cells. The cells are also exposed to 10-20 Hz cyclic shear stress by bead rotation.

Adjunctive treatment of manic agitation with lorazepam versus haloperidol: a double-blind study.

PubMed

Lenox, R H; Newhouse, P A; Creelman, W L; Whitaker, T M

1992-02-01

While lithium is effective in treating the majority of bipolar patients during a manic episode, the addition of neuroleptic during the early phase of treatment has been common clinical practice in inpatient settings. In an earlier open study, we demonstrated the utility of the short-acting benzodiazepine lorazepam as an adjunct to lithium for the clinical management of manic agitation. We now present data from a randomized, double-blind clinical study of lorazepam versus haloperidol in 20 hospitalized patients with a DSM-III-R diagnosis of bipolar disorder who were being treated concomitantly with lithium. Patients were rated using the Mania Rating Scale, Brief Psychiatric Rating Scale, Physician Global Impression Scale, and side effects scales. Data were analyzed using standard group comparisons and survival analysis. There was no evidence for a significant difference between the two treatment groups in the magnitude of or time to response (5.0 +/- .82 days for haloperidol; 6.5 +/- .93 days for lorazepam). Of the patients who were terminated from the protocol early, nonresponse was the primary reason in the lorazepam group while side effects were the reason in the haloperidol group. Lorazepam may offer an efficacious and safe alternative to haloperidol as an adjunctive treatment to lithium in the clinical management of the early phase of manic agitation in a subgroup of bipolar patients.

Anxiety or agitation in mood disorder with mixed features: A review with a focus on validity as a dimensional criterion.

PubMed

Shim, In Hee; Bae, Dong Sik; Bahk, Won-Myong

2016-08-01

The diagnostic validity of mixed features, excluding anxiety or psychomotor agitation in mood disorders, has not yet been fully examined. PubMed and relevant English-language literature (regardless of year) were searched. Keywords were mixed or mixed state or mixed features or mixed episode and anxious or anxiety or agitation and bipolar disorder or depressive disorder or mood disorder or affective disorder. Most studies on anxiety or psychomotor agitation have included a significant correlation relevant to the "with mixed features" specifier, although it is common in both poles of mood episodes regardless of the predominant polarity. There is some confusion between the characteristic of classical mixed states and the definition of the mixed features specifier with the newly added anxious distress specifier in DSM-5, specifically, whether to include anxiety and agitation as significant characteristics. This change is of concern because a large proportion of patients with mixed features are now unspecified, and this may influence treatment planning and prognosis. The findings of our review suggest that anxiety and psychomotor agitation can be core symptoms in mood episodes with mixed features and important clinical clues for prediction of treatment effects and disease course.

Hyperactivity with Agitative-Like Behavior in a Mouse Tauopathy Model.

PubMed

Jul, Pia; Volbracht, Christiane; de Jong, Inge E M; Helboe, Lone; Elvang, Anders Brandt; Pedersen, Jan Torleif

2016-01-01

Tauopathies, such as Alzheimer's disease (AD) and frontotemporal dementia (FTD), are characterized by formation of neurofibrillary tangles consisting of hyperphosphorylated tau. In addition to memory loss, patients experience behavioral symptoms such as agitation, aggression, depression, and insomnia. We explored the behavioral phenotype of a mouse model (rTg4510) carrying the human tau P301L mutation found in a familial form of FTD. We tested these mice in locomotor activity assays as well as in the Morris water maze to access spatial memory. In addition to cognitive impairments, rTg4510 mice exhibited a hyperactivity phenotype which correlated with progression of tau pathology and was dependent on P301L tau transgene expression. The hyperactive phenotype was characterized by significantly increased locomotor activity in a novel and in a simulated home cage environment together with a disturbed day/night cycle. The P301L-tau-dependent hyperactivity and agitative-like phenotype suggests that these mice may form a correlate to some of the behavioral disturbances observed in advanced AD and FTD.

Insights into Kinetics of Agitation-Induced Aggregation of Hen Lysozyme under Heat and Acidic Conditions from Various Spectroscopic Methods

PubMed Central

Chaari, Ali; Fahy, Christine; Chevillot-Biraud, Alexandre; Rholam, Mohamed

2015-01-01

Protein misfolding and amyloid formation are an underlying pathological hallmark in a number of prevalent diseases of protein aggregation ranging from Alzheimer’s and Parkinson’s diseases to systemic lysozyme amyloidosis. In this context, we have used complementary spectroscopic methods to undertake a systematic study of the self-assembly of hen egg-white lysozyme under agitation during a prolonged heating in acidic pH. The kinetics of lysozyme aggregation, monitored by Thioflavin T fluorescence, dynamic light scattering and the quenching of tryptophan fluorescence by acrylamide, is described by a sigmoid curve typical of a nucleation-dependent polymerization process. Nevertheless, we observe significant differences between the values deduced for the kinetic parameters (lag time and aggregation rate). The fibrillation process of lysozyme, as assessed by the attenuated total reflection-Fourier transform infrared spectroscopy, is accompanied by an increase in the β-sheet conformation at the expense of the α-helical conformation but the time-dependent variation of the content of these secondary structures does not evolve as a gradual transition. Moreover, the tryptophan fluorescence-monitored kinetics of lysozyme aggregation is described by three phases in which the temporal decrease of the tryptophan fluorescence quantum yield is of quasilinear nature. Finally, the generated lysozyme fibrils exhibit a typical amyloid morphology with various lengths (observed by atomic force microscopy) and contain exclusively the full-length protein (analyzed by highly performance liquid chromatography). Compared to the data obtained by other groups for the formation of lysozyme fibrils in acidic pH without agitation, this work provides new insights into the structural changes (local, secondary, oligomeric/fibrillar structures) undergone by the lysozyme during the agitation-induced formation of fibrils. PMID:26571264

Improvement of oxygen transfer coefficient during Penicillium canescens culture. Influence of turbine design, agitation speed, and air flow rate on xylanase production.

PubMed

Gaspar, A; Strodiot, L; Thonart, P

1998-01-01

To improve xylanase productivity from Penicillium canescens 10-10c culture, an optimization of oxygen supply is required. Because the strain is sensitive to shear forces, leading to lower xylanase productivity as to morphological alteration, vigorous mixing is not desired. The influence of turbine design, agitation speed, and air flow rate on K1a (global mass transfer coefficient, h(-1)) and enzyme production is discussed. K1a values increased with agitation speed and air flow rate, whatever the impeller, in our assay conditions. Agitation had more influence on K1a values than air flow, when a disk-mounted blade's impeller (DT) is used; an opposite result was obtained with a hub-mounted pitched blade's impeller (PBT). Xylanase production appeared as a function of specific power (W/m3), and an optimum was found in 20 and 100 L STRs fitted with DT impellers. On the other hand, the use of a hub-mounted pitched blade impeller (PBT8), instead of a disk-mounted blade impeller (DT4), reduced the lag time of hemicellulase production and increased xylanase productivity 1.3-fold.

1064-nm Nd:YAG and 980-nm Diode Laser EDTA Agitation on the Retention of an Epoxy-Based Sealer to Root Dentin.

PubMed

Macedo, Helena Suleiman de; Messias, Danielle Cristine Furtado; Rached-Júnior, Fuad Jacob; Oliveira, Ligia Teixeira de; Silva-Sousa, Yara Teresinha Correa; Raucci-Neto, Walter

2016-01-01

Root canal irrigants are used to minimize the negative effects of smear layer on endodontic sealer retention. The aim of this study was to evaluate the efficacy of agitation of 17% ethylenediaminetetraacetic acid (EDTA) with ultrasonic, 1064-nm Nd:YAG and 980-nm diode laser on the retention of an epoxy-based sealer to the root canal walls. Forty single-rooted bovine teeth were instrumented with ProTaper rotary system and divided into four groups according to the final irrigation protocol (n = 10): (1) 17% EDTA (control); (2) 17% EDTA with 50-s ultrasonic agitation; (3) 17% EDTA with 50-s diode laser (2-W) agitation; and (4) 17% EDTA with 50-s Nd:YAG (1.5-W) laser agitation. After endodontic filling with gutta-percha F5 master cone and Sealer 26, the roots were sectioned at the cervical, middle, and apical root thirds to obtain 1.5-mm slices. Push-out tests were performed using a universal testing machine at a 1 mm/min crosshead speed. Data were analyzed using two-way ANOVA and Tukey's tests (α=0.05). Apical root thirds had significant higher retention values than cervical and middle thirds (p < 0.05). EDTA with 1064-nm Nd:YAG or 980-nm diode laser presented the highest retention values and was significantly different from EDTA with ultrasonic agitation and EDTA only (p < 0.05). Adhesive failures were predominant to EDTA only group. Mixed failures were predominant to all agitation groups. 1064-nm Nd:YAG and 980-nm diode laser EDTA agitation enhanced the retention of the epoxy-based sealer to the root canal walls compared with that due to EDTA only or EDTA with ultrasonic agitation.

The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review.

PubMed

de Berardis, Domenico; Fornaro, Michele; Orsolini, Laura; Iasevoli, Felice; Tomasetti, Carmine; de Bartolomeis, Andrea; Serroni, Nicola; Valchera, Alessandro; Carano, Alessandro; Vellante, Federica; Marini, Stefano; Piersanti, Monica; Perna, Giampaolo; Martinotti, Giovanni; Di Giannantonio, Massimo

2017-02-08

Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.

A novel enhanced diffusion sampler for collecting gaseous pollutants without air agitation.

PubMed

Pan, Xuelian; Zhuo, Shaojie; Zhong, Qirui; Chen, Yuanchen; Du, Wei; Cheng, Hefa; Wang, Xilong; Zeng, Eddy Y; Xing, Baoshan; Tao, Shu

2018-03-06

A novel enhanced diffusion sampler for collecting gaseous phase polycyclic aromatic hydrocarbons (PAHs) without air agitation is proposed. The diffusion of target compounds into a sampling chamber is facilitated by continuously purging through a closed-loop flow to create a large concentration difference between the ambient air and the air in the sampling chamber. A glass-fiber filter-based prototype was developed. It was demonstrated that the device could collect gaseous PAHs at a much higher rate (1.6 ± 1.4 L/min) than regular passive samplers, while the ambient air is not agitated. The prototype was also tested in both the laboratory and field for characterizing the concentration gradients over a short distance from the soil surface. The sampler has potential to be applied in other similar situations to characterize the concentration profiles of other chemicals.

Statistical distribution of time to crack initiation and initial crack size using service data

NASA Technical Reports Server (NTRS)

Heller, R. A.; Yang, J. N.

1977-01-01

Crack growth inspection data gathered during the service life of the C-130 Hercules airplane were used in conjunction with a crack propagation rule to estimate the distribution of crack initiation times and of initial crack sizes. A Bayesian statistical approach was used to calculate the fraction of undetected initiation times as a function of the inspection time and the reliability of the inspection procedure used.

This is Not a History Lesson; This is Agitation: A Call for a Methodology of Diffraction in US-Based Community Psychology.

PubMed

Langhout, Regina Day

2016-12-01

Agitation, as deployed by the Industrial Areas Foundation (IAF), occurs when imaginations and curiosities are piqued, and self-interest is made visible. In this framework, agitation is a step in creating change. In this paper, I outline two agitations within US-based community psychology. I then describe a third agitation that is underway; I add my voice and call for a methodology of diffraction as a contribution to critical reflexivity practices within US-based community psychology. Consistent with the IAF framework, I do not provide solutions. I write this paper as a provocation to help us think imaginatively and creatively about our actions and future, so that we can consider the paradigm shifts needed to move into critical ways of understanding connection, responsibility, accountability, and creating change-of interest during Swampscott and today. © Society for Community Research and Action 2016.

Safety of Risperidone for Acute Agitation and Alcohol Intoxication in Emergency Department Patients.

PubMed

Pepa, Patricia A; Lee, Kelly C; Huynh, Hien E; Wilson, Michael P

2017-10-01

Acute agitation in the setting of alcohol intoxication is commonly encountered in the Emergency Department (ED). In this setting, expert consensus guidelines recommend haloperidol over second-generation antipsychotics due to their limited safety data in alcohol intoxication. The primary objective was to compare vital sign changes prior to and after risperidone administration between ED patients presenting with alcohol intoxication [ETOH (+)] and without alcohol intoxication [ETOH (-)]. The secondary objective was to assess the effect of benzodiazepine co-administration with risperidone on vital signs. This was a retrospective chart review of patients who received oral risperidone for acute agitation at two university EDs between January 1, 2012 and December 31, 2015. Vital signs (oxygen saturation, systolic and diastolic blood pressure, heart rate, and respiratory rate) were compared in patients who had ingested alcohol with those who had not. There were 785 patients without evidence of alcohol intoxication who received risperidone in the ED, and 52 patients with alcohol intoxication who received risperidone. Overall, risperidone with and without alcohol intoxication and benzodiazepine administration had no statistically significant effect on vital signs (p = ns for all comparisons). This study suggests that oral risperidone may be a safe option for acute agitation in patients presenting to the ED with alcohol intoxication. Copyright © 2017 Elsevier Inc. All rights reserved.

Pharmacological treatments for alleviating agitation in dementia: a systematic review and network meta-analysis.

PubMed

Kongpakwattana, Khachen; Sawangjit, Ratree; Tawankanjanachot, Itthipol; Bell, J Simon; Hilmer, Sarah N; Chaiyakunapruk, Nathorn

2018-04-10

To determine the most efficacious and acceptable treatments of agitation in dementia. MEDLINE, EMBASE, PsycINFO, CENTRAL and clinicaltrials.gov were searched up to 7 February 2017. Two independent reviewers selected randomized controlled trials (RCTs) of treatments to alleviate agitation in people with all-types dementia. Data were extracted using standardized forms and study quality was assessed using the revised Cochrane Risk of Bias Tool for RCTs. Data were pooled using meta-analysis. The primary outcome, efficacy, was 8-week response rates defined as a 50% reduction in baseline agitation score. The secondary outcome was treatment acceptability defined as treatment continuation for 8 weeks. Thirty-six RCTs comprising 5585 participants (30.9% male; mean ± standard deviation age, 81.8 ± 4.9 years) were included. Dextromethorphan/quinidine [odds ratio (OR) 3.04; 95% confidence interval (CI), 1.63-5.66], risperidone (OR 1.96; 95% CI, 1.49-2.59) and selective serotonin reuptake inhibitors as a class (OR 1.61; 95% CI, 1.02-2.53) were found to be significantly more efficacious than placebo. Haloperidol appeared less efficacious than nearly all comparators. Most treatments had noninferior treatment continuation compared to placebo, except oxcarbazepine, which was inferior. Findings were supported by subgroup and sensitivity analyses. Risperidone, serotonin reuptake inhibitors as a class and dextromethorphan/quinidine demonstrated evidence of efficacy for agitation in dementia, although findings for dextromethorphan/quinidine were based on a single RCT. Our findings do not support prescribing haloperidol due to lack of efficacy, or oxcarbazepine due to lack of acceptability. The decision to prescribe should be based on comprehensive consideration of the benefits and risks, including those not evaluated in this meta-analysis. © 2018 The British Pharmacological Society.

Sparging and agitation-induced injury of cultured animals cells: Do cell-to-bubble interactions in the bulk liquid injure cells?

PubMed

Michaels, J D; Mallik, A K; Papoutsakis, E T

1996-08-20

It has been established that the forces resulting from bubbles rupturing at the free air (gas)/liquid surface injure animal cells in agitated and/or sparged bioreactors. Although it has been suggested that bubble coalescence and breakup within agitated and sparged bioreactors (i.e., away from the free liquid surface) can be a source of cell injury as well, the evidence has been indirect. We have carried out experiments to examine this issue. The free air/liquid surface in a sparged and agitated bioractor was eliminated by completely filling the 2-L reactor and allowing sparged bubbles to escape through an outlet tube. Two identical bioreactors were run in parallel to make comparisons between cultures that were oxygenated via direct air sparging and the control culture in which silicone tubing was used for bubble-free oxygenation. Thus, cell damage from cell-to-bubble interactions due to processes (bubble coalescence and breakup) occurring in the bulk liquid could be isolated by eliminating damage due to bubbles rupturing at the free air/liquid surface of the bioreactor. We found that Chinese hamster ovary (CHO) cells grown in medium that does not contain shear-protecting additives can be agitated at rates up to 600 rpm without being damaged extensively by cell-to bubble interactions in the bulk of the bioreactor. We verified this using both batch and high-density perfusion cultures. We tested two impeller designs (pitched blade and Rushton) and found them not to affect cell damage under similar operational conditions. Sparger location (above vs. below the impeller) had no effect on cell damage at higher agitation rates but may affect the injury process at lower agitation intensities (here, below 250 rpm). In the absence of a headspace, we found less cell damage at higher agitation intensities (400 and 600 rpm), and we suggest that this nonintuitive finding derives from the important effect of bubble size and foam stability on the cell damage process. (c) 1996 John

Aripiprazole (intramuscular) for psychosis-induced aggression or agitation (rapid tranquillisation).

PubMed

Ostinelli, Edoardo G; Jajawi, Salwan; Spyridi, Styliani; Sayal, Kamlaj; Jayaram, Mahesh B

2018-01-08

People experiencing psychosis may become aggressive. Antipsychotics, such as aripiprazole in intramuscular form, can be used in such situations. To evaluate the effects of intramuscular aripiprazole in the treatment of psychosis-induced aggression or agitation (rapid tranquillisation). On 11 December 2014 and 11 April 2017, we searched the Cochrane Schizophrenia Group's Study-based Register of Trials which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. All randomised controlled trials (RCTs) that randomised people with psychosis-induced aggression or agitation to receive either intramuscular aripiprazole or another intramuscular intervention. We independently inspected citations and, where possible, abstracts, ordered papers and re-inspected and quality assessed these. We included studies that met our selection criteria. At least two review authors independently extracted data from the included studies. We chose a fixed-effect model. We analysed dichotomous data using risk ratio (RR) and the 95% confidence intervals (CI). We analysed continuous data using mean differences (MD) and their CIs. We assessed risk of bias for included studies and used GRADE to create 'Summary of findings' tables. Searching found 63 records referring to 21 possible trials. We could only include three studies, all completed over the last decade, with 885 participants, of which 707 were included for quantitative analyses in this systematic review. Due to limited comparisons, small size of trials and a paucity of investigated and reported 'pragmatic' outcomes, evidence was mostly graded as low or very low quality. No trials reported useful data for one of our primary outcomes of tranquil or asleep by 30 minutes. Economic outcomes were also not reported in the trials.When compared with placebo, fewer people in the aripiprazole group needed additional injections compared to the placebo group (2 RCTs, n = 382, RR 0

Women, Scientists, Agitators: Magazine Portrayal of Rachel Carson and Theo Colborn.

ERIC Educational Resources Information Center

Corbett, Julia B.

2001-01-01

Utilizes a theoretical framework of the media's role in reporting conflict and uncertain science, and feminism and science in a thematic analysis of magazine coverage given Rachel Carson and "the Rachel Carson of '90s," Theo Colborn. Notes that Carson and Colborn's identities as women, scientists, and agitators led critics to charge that…

Variation law of gas holdup in an autoclave during the pressure leaching process by using a mixed-flow agitator

NASA Astrophysics Data System (ADS)

Tian, Lei; Liu, Yan; Tang, Jun-jie; Lü, Guo-zhi; Zhang, Ting-an

2017-08-01

The multiphase reaction process of pressure leaching is mainly carried out in the liquid phase. Therefore, gas holdup is essential for the gas-liquid-solid phase reaction and the extraction rate of valuable metals. In this paper, a transparent quartz autoclave, a six blades disc turbine-type agitator, and a high-speed camera were used to investigate the gas holdup of the pressure leaching process. Furthermore, experiments determining the effects of agitation rate, temperature, and oxygen partial pressure on gas holdup were carried out. The results showed that when the agitation rate increased from 350 to 600 r/min, the gas holdup increased from 0.10% to 0.64%. When the temperature increased from 363 to 423 K, the gas holdup increased from 0.14% to 0.20%. When the oxygen partial pressure increased from 0.1 to 0.8 MPa, the gas holdup increased from 0.13% to 0.19%. A similar criteria relationship was established by Homogeneous Principle and Buckingham's theorem. Comprehensively, empirical equation of gas holdup was deduced on the basis of experimental data and the similarity theory, where the criterion equation was determined as ɛ = 4.54 × 10-11 n 3.65 T 2.08 P g 0.18. It can be seen from the formula that agitation rate made the most important impact on gas holdup in the pressure leaching process using the mixed-flow agitator.

Removal of copper powder from aqueous solution by cementation using an agitated vessel.

PubMed

Amin, N K; El-Ashtouky, E-S Z; Abdelwahab, O

2014-01-01

The present study is concerned with the removal of copper powder from aqueous solution by cementation on a stationary disc placed inside an agitated vessel. The influence of several parameters on the rate of cementation, such as initial copper sulphate concentration, impeller rotational speed, presence of surfactant (Triton X-100), distance between the disc and the impeller, type of blade turbine and presence of baffles, has been investigated. The rate of cementation was found to increase with increasing impeller rotational speed and initial copper sulphate concentration. On the other hand, the rate decreases with increasing distance between the disc and the impeller. The rate of cementation was inhibited in solutions containing Triton X-100. Performance of a four-blade 90 degree turbine with regard to the rate of copper cementation was superior to the performance of a four-blade 45 degree pitched turbine. The present data can be correlated in terms of mass transfer coefficient of cementation as Sh = 0.905 Sc0.33 Re0.89 (d/l)0.41 (four-blade 90 degree turbine); Sh = 0.815 Sc0.33Re0.79 (d/l)0.47 (four-blade 45 degree pitched turbine), for the conditions 2035 < Sc < 2810 and 35,000 < Re < 179,000.

Co-Occurrence and Predictors of Three Commonly Occurring Behavioral Symptoms in Dementia: Agitation, Aggression, and Rejection of Care.

PubMed

Choi, Scott Seung W; Budhathoki, Chakra; Gitlin, Laura N

2017-05-01

To investigate co-occurrences of agitation, aggression, and rejection of care in community-dwelling families living with dementia. Cross-sectional, secondary analysis from a randomized controlled trial testing a nonpharmacological intervention to reduce behavioral symptoms. We examined frequency of occurrence of presenting behaviors at baseline and their combination. Omnibus tests compared those exhibiting combinations of behaviors on contributory factors. Multinomial logistic regression analyses examined relationships of contributory factors to combinations of behaviors. Of 272 persons with dementia (PwDs), 41 (15%) had agitation alone (Agi), 3 (1%) had aggression alone, 5 (2%) had rejection of care alone. For behavioral combinations, 65 (24%) had agitation and aggression (Agi+Aggr), 35 (13%) had agitation and rejection (Agi+Rej), 1 (0%) had aggression and rejection, and 106 (39%) had all three behaviors (All). Four behavioral subgroups (Agi, Agi+Aggr, Agi+Rej, and All) were examined. Kruskal-Wallis tests showed that there were significant group differences in PwD cognition, functional dependence, and caregiver frustration. PwDs in Agi+Rej and All were more cognitively impaired than those in Agi and Agi+Aggr. Also, caregivers in All were more frustrated than those in Agi. In logistic regression analyses, compared with Agi, greater cognitive impairment was a significant predictor of Agi+Rej and All, but not Agi+Aggr. In contrast, greater caregiver frustration was a significant predictor of Agi+Aggr and All, but not Agi+Rej. We found that agitation, aggression, and rejection are common but distinct behaviors. Combinations of these behaviors have different relationships with contributory factors, suggesting the need for targeting treatment approaches to clusters. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan.

PubMed

Hsu, Wen-Yu; Huang, Si-Sheng; Lee, Bo-Shyan; Chiu, Nan-Ying

2010-06-01

The purpose of this study was to compare efficacy and safety among intramuscular olanzapine, intramuscular haloperidol, orally disintegrating olanzapine tablets, and oral risperidone solution for agitated patients with psychosis during the first 24 hours of treatment in an acute care psychiatric ward. Forty-two inpatients from an acute care psychiatric ward of a medical center in central Taiwan were enrolled. They were randomly assigned to 1 of the 4 treatment groups (10-mg intramuscular olanzapine, 10-mg olanzapine oral disintegrating tablet, 3-mg oral risperidone solution, or 7.5-mg intramuscular haloperidol). Agitation was measured by using the excited component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale, and the Clinical Global Impression--Severity Scale during the first 24 hours. There were significant differences in the PANSS-EC total scores for the 4 intervention groups at 15, 30, 45, 60, 75, and 90 minutes after the initiation of treatment. More significant differences were found early in the treatment. In the post hoc analysis, the patients who received intramuscular olanzapine or orally disintegrating olanzapine tablets showed significantly greater improvement in PANSS-EC scores than did patients who received intramuscular haloperidol at points 15, 30, 45, 60, 75, and 90 minutes after injection. These findings suggest that intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution are as effective treatments as intramuscular haloperidol for patients with acute agitation. Intramuscular olanzapine and disintegrating olanzapine tablets are more effective than intramuscular haloperidol in the early phase of the intervention. There is no significant difference in effectiveness among intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution.

[Aconite in homeopathic relief of post-operative pain and agitation in children].

PubMed

Alibeu, J P; Jobert, J

1990-01-01

Despite the use of modern analgesic methods and an improved use of narcotics, the combination pain-agitation sometimes persists in the recovery-room. Aconit seems to be an appropriate homeopathic treatment in this case. To prescribe it, the following conditions must be combined: violence and suddeness of the stress bringing about intense and anguish. The study included 50 children with such symptoms; it was carried out double-blind, the children being given either placebo or Aconit. Aconit proved to be effective for children's postoperative agitation with 95% good results. It is usually stated in such studies that the placebo effect is high and may reach rates higher than 30%. Aconit is an amazing cure when well prescribed, as much for the speediness of its action as for its efficiency. This remedy has a place in the recovery-room and should be in every physician's emergency case. The fundamental research could specify how the remedy works and may be discover other molecules effective for stress.

Free flowing and cohesive powders agitation in a cylindrical convective blender- kinetics experiments and Markov chain modelling

NASA Astrophysics Data System (ADS)

Legoix, Léonard; Milhé, Mathieu; Gatumel, Cendrine; Berthiaux, Henri

2017-06-01

An original methodology for studying powder flow in a cylindrical convective blender has been developed. A free-flowing and a cohesive powder were studied, at a fixed stirring speed, in rolling regime. For both powders, three apparent flow mechanisms were evidenced: convection in the volume swept by the blades, diffusion/shearing between the agitated zone and the stagnant one, as well as in the stagnant zone itself, and avalanches at the powder bed surface between agitated and stagnant zones. After defining six zones in the blender, tracing experiments were carried out by placing appropriate tracers in different starting zones and sampling the whole bed at different stirring times, which lead to mixing kinetics of the powders into themselves. A Markov chains model of the blender allowed the quantification of the three mechanisms respective magnitude by fitting the experimental data. This simple model has a good agreement with the free-flowing powder data, but is not able to represent well the observations for the cohesive powder. Bed consolidation should probably be taken into account for this kind of powders and thus a linear Markov model is not sufficient.

The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial.

PubMed

Vink, A C; Zuidersma, M; Boersma, F; de Jonge, P; Zuidema, S U; Slaets, J P J

2013-10-01

This study aimed to compare the effects of music therapy with general recreational day activities in reducing agitation in people with dementia, residing in nursing home facilities. In a randomised controlled design, residents with dementia (n = 94) were allocated to either music therapy or recreational activities. Both music therapy and general activities were offered twice weekly for 4 months. Changes in agitation were measured with a modified Cohen-Mansfield Agitation Inventory (CMAI) at four intervals on each intervention day. A mixed model analysis was used to evaluate the effectiveness of music therapy, compared with general activities, on CMAI scores at 4 h after the intervention, controlled for CMAI scores at 1 h before the session and session number. Data were analysed for 77 residents (43 randomised to music therapy and 34 to general activities). In both groups, the intervention resulted in a decrease in agitated behaviours from 1 h before to 4 h after each session. This decrease was somewhat greater in the music therapy group than in the general activities group, but this difference was statistically not significant (F = 2.885, p = 0.090) and disappeared completely after adjustment for Global Deterioration Scale stage (F = 1.500; p = 0.222). Both music therapy and recreational activities lead to a short-term decrease in agitation, but there was no additional beneficial effect of music therapy over general activities. More research is required to provide insight in the effects of music therapy in reducing agitation in demented older people. Copyright © 2012 John Wiley & Sons, Ltd.

Intramuscular olanzapine versus intramuscular haloperidol plus lorazepam for the treatment of acute schizophrenia with agitation: An open-label, randomized controlled trial.

PubMed

Huang, Charles Lung-Cheng; Hwang, Tzung-Jeng; Chen, Yi-Hsing; Huang, Guan-Hua; Hsieh, Ming H; Chen, Hsiu-Hsi; Hwu, Hai-Gwo

2015-05-01

To compare the efficacy and safety profile between intramuscular (IM) olanzapine and IM haloperidol plus IM lorazepam in acute schizophrenic patients with moderate to severe agitation. This was a prospective, randomized, open-label study. Acutely agitated patients with schizophrenia or schizoaffective disorder (n = 67) were randomized to receive 10 mg IM olanzapine (n = 37) or 5 mg IM haloperidol plus 2 mg IM lorazepam (n = 30). Agitation was measured with Positive and Negative Syndrome Scale Excited Component (PANSS-EC) and Agitation-Calmness Evaluation Scale (ACES) during the first 2 hours and at 24 hours after the first injection. Safety was assessed using the Simpson-Angus Scale and Barnes Akathisia Rating Scale and by recording adverse events at 24 hours following the first injection. The Clinical Global Impression-Severity scale was also rated. The PANSS-EC scores decreased significantly at 2 hours after the first injection in both groups (olanzapine: -10.2, p < 0.001; haloperidol + lorazepam: -9.9, p < 0.001). Haloperidol plus lorazepam was not inferior to olanzapine in reducing agitation at 2 hours. There were no significant differences in PANSS-EC or ACES scores between the two groups within 2 hours following the first injection. The frequencies of adverse events and changes in Clinical Global Impression-Severity, Simpson-Angus Scale, and Barnes Akathisia Rating Scale scores from baseline to 24 hours showed no significant differences between the groups. The findings suggest that IM haloperidol (5 mg) plus lorazepam (2 mg) is not inferior to IM olanzapine (10 mg) in the treatment of acute schizophrenic patients with moderate to severe agitation (ClinialTrials.gov identifier number NCT00797277). Copyright © 2015. Published by Elsevier B.V.

Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care

PubMed Central

Hui, David; Frisbee-Hume, Susan; Wilson, Annie; Dibaj, Seyedeh S.; Nguyen, Thuc; De La Cruz, Maxine; Walker, Paul; Zhukovsky, Donna S.; Delgado-Guay, Marvin; Vidal, Marieberta; Epner, Daniel; Reddy, Akhila; Tanco, Kimerson; Williams, Janet; Hall, Stacy; Liu, Diane; Hess, Kenneth; Amin, Sapna; Breitbart, William; Bruera, Eduardo

2017-01-01

IMPORTANCE The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. OBJECTIVE To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. DESIGN, SETTING, AND PARTICIPANTS Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. INTERVENTIONS Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. MAIN OUTCOMES AND MEASURES The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, −5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival. RESULTS Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (−4.1 points) than placebo + haloperidol (−2.3 points) (mean difference, −1.9 points [95% CI, −2.8 to −0.9]; P < .001). The lorazepam + haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, −1.0 mg [95% CI, −2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol

Elderly Patients with Dementia-Related Symptoms of Severe Agitation and Aggression: Consensus Statement on Treatment Options, Clinical Trials Methodology, and Policy

PubMed Central

Salzman, C; Jeste, D; Meyer, RE; Cohen-Mansfield, J; Cummings, J; Grossberg, G; Jarvik, L; Kraemer, H; Lebowitz, B; Maslow, K; Pollock, B; Raskind, M; Schultz, S; Wang, P; Zito, JM; Zubenko, GS

2009-01-01

Atypical antipsychotic drugs have been used off-label in clinical practice for treatment of serious dementia-associated agitation and aggression. Following reports of cerebrovascular adverse events associated with the use of atypical antipsychotic in elderly patients with dementia, the FDA issued black box warnings for several atypical antipsychotics, titled “Cerebrovascular Adverse Events, including Stroke, in Elderly Patients with Dementia.” Subsequently, the FDA initiated a meta-analysis of safety data from 17 registration trials across six antipsychotic drugs (five atypical antipsychotics and haloperidol). In 2005, the Agency issued a black box warning regarding increased risk of mortality associated with the use of atypical antipsychotic drugs in this patient population. Geriatric mental health experts participating in a 2006 consensus conference reviewed evidence on the safety and efficacy of antipsychotics, as well as nonpharmacologic approaches, in treating dementia-related symptoms of agitation and aggression. They concluded that, while problems in clinical trials design may have been one of the contributors to the failure to find a signal of drug efficacy, the findings related to drug safety should be taken seriously by clinicians in assessing the potential risks and benefits of treatment in a frail population, and in advising families about treatment. Information provided to patients and family members should be documented in the patient’s chart. Drugs should be used only when non-pharmacologic approaches have failed to adequately control behavioral disruption. Participants also agreed that that there is a need for an FDA-approved medication for the treatment of severe, persistent or recurrent dementia-related symptoms of agitation and aggression (even in the absence of psychosis), that are unresponsive to nonpharmacologic intervention. The authors have outlined methodological enhancements to better evaluate treatment approaches in future

Particulate contamination removal from wafers using plasmas and mechanical agitation

DOEpatents

Selwyn, G.S.

1998-12-15

Particulate contamination removal from wafers is disclosed using plasmas and mechanical agitation. The present invention includes the use of plasmas with mechanical agitation for removing particulate matter from the surface of a wafer. The apparatus hereof comprises a mechanical activator, at least one conducting contact pin for transferring the vibration from the activator to the wafer, clamp fingers that maintain the wafer`s position, and means for generating a plasma in the vicinity of the surface of the wafer, all parts of the cleaning apparatus except the mechanical activator and part of the contact pin being contained inside the processing chamber. By exposing a wafer to a plasma and providing motion thereto in a direction perpendicular to its surface, the bonding between the particulate matter and the surface may be overcome. Once free of the wafer surface, the particulates become charged by electrons from the plasma and are drawn into the plasma by attractive forces which keep them from redepositing. The introduction of a flowing gas through the plasma sweeps the particulates away from the wafer and out of the plasma. The entire surface is cleaned during one cleaning step. The use of an rf plasma to accomplish the particulate removal was found to remove more than 90% of the particulates. 4 figs.

Particulate contamination removal from wafers using plasmas and mechanical agitation

DOEpatents

Selwyn, Gary S.

1998-01-01

Particulate contamination removal from wafers using plasmas and mechanical agitation. The present invention includes the use of plasmas with mechanical agitation for removing particulate matter from the surface of a wafer. The apparatus hereof comprises a mechanical activator, at least one conducting contact pin for transferring the vibration from the activator to the wafer, clamp fingers that maintain the wafer's position, and means for generating a plasma in the vicinity of the surface of the wafer, all parts of the cleaning apparatus except the mechanical activator and part of the contact pin being contained inside the processing chamber. By exposing a wafer to a plasma and providing motion thereto in a direction perpendicular to its surface, the bonding between the particulate matter and the surface may be overcome. Once free of the wafer surface, the particulates become charged by electrons from the plasma and are drawn into the plasma by attractive forces which keep them from redepositing. The introduction of a flowing gas through the plasma sweeps the particulates away from the wafer and out of the plasma. The entire surface is cleaned during one cleaning step. The use of an rf plasma to accomplish the particulate removal was found to remove more than 90% of the particulates.

A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia.

PubMed

Sung, Huei-chuan; Lee, Wen-li; Li, Tzai-li; Watson, Roger

2012-06-01

This experimental study aimed to evaluate the effects of a group music intervention on anxiety and agitation of institutionalized older adults with dementia. A total of 60 participants were randomly assigned to an experimental or a control group. The experimental group received a 30-min music intervention using percussion instruments with familiar music in a group setting in mid afternoon twice weekly for 6 weeks, whereas the control group received usual care with no music intervention. The Rating of Anxiety in Dementia scale was used to assess anxiety, and Cohen-Mansfield Agitation Inventory was used to assess agitation at baseline, week 4 and week 6. Repeated measures analysis of covariance indicated that older adults who received a group music intervention had a significantly lower anxiety score than those in the control group while controlling for pre-test score and cognitive level (F = 8.98, p = 0.004). However, the reduction of agitation between two groups was not significantly different. Anxiety and agitation are common in older adults with dementia and have been reported by caregivers as challenging care problems. An innovative group music intervention using percussion instruments with familiar music as a cost-effective approach has the potential to reduce anxiety and improve psychological well-being of those with dementia. Copyright © 2011 John Wiley & Sons, Ltd.

A randomized, controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care.

PubMed

Lyketsos, C G; Lindell Veiel, L; Baker, A; Steele, C

1999-07-01

Agitated behaviors are common in dementia patients residing in chronic care settings. Their occurrence may be associated with lack of adequate exposure to sunlight and with circadian rhythm disturbances. Prior research has suggested that bright light therapy (BLT) may reduce agitated behaviors in dementia patients. The aim of this study was to test the efficacy of BLT in a randomized, controlled, crossover clinical trial. Fifteen patients with dementia and agitated behaviors residing in a chronic care facility were randomized in a crossover design to morning BLT for 1 hour per day or to a control condition with dim light exposure. Patients were treated in either condition for 4 weeks, followed by 1 week on no treatment, prior to being crossed over to the other condition. Eight out of 15 patients completed the entire study. The rest completed at least 2 weeks of study. Patients randomized to the BLT condition exhibited a statistically significant improvement in nocturnal sleep from a mean of 6.4 hours/night to 8.1 hours/night 4 weeks later (p<0.05). The sleep of patients in the control condition did not improve significantly. There were no other significant differences between baseline and follow-up, nor between BLT and control treated patients on the other outcome measures, which included the Behavioral Pathology in Alzheimer Disease scale (Behave-AD) and the Cornell Scale for Depression in Dementia. Patients with dementia in chronic care who exhibit agitated behaviors sleep more hours at night when administered morning BLT. However, BLT does not lead to improvements in agitated behaviors in institutionalized patients with dementia with non-disturbed sleep-wake cycles. Copyright 1999 John Wiley & Sons, Ltd.

Incidence and risk factors of emergence agitation in pediatric patients after general anesthesia.

PubMed

Saringcarinkul, Ananchanok; Manchupong, Sithapan; Punjasawadwong, Yodying

2008-08-01

To study the incidence and evaluate factors associated with emergence agitation (EA) in pediatrics after general anesthesia. A prospective observational study was conducted in 250 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in Maharaj Nakorn Chiang Mai Hospital between October 2006 and September 2007. The incidence of EA was assessed Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. One hundred and eight children (43.2%) had EA, with an average duration of 9.6 +/- 6.8 minutes. EA associated with adverse events occurred in 32 agitated children (29.6%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2-5 years), and general anesthesia with sevoflurane. However; difficult parental-separation behavior; and preschool age were the only factors significantly associated with EA in the multiple logistic regression analysis with OR = 3.021 (95% CI = 1.680, 5.431, p < 0.001) and OR = 1.857 (95% CI = 1.075, 3.206, p = 0.026), respectively. The present study indicated that the incidence of EA was high in PACU. Preschool children and difficult parental-separation behavior were the predictive factors of agitation on emergence. Therefore, anesthesia personnel responsible for pediatric anesthesia should have essential skills and knowledge to effectively care for children before, during, and after an operation, including implementing the methods that minimize incidence of EA.

[Agitation in people with dementia : Scoping review and putting the phenomenon into perspective using the comfort theory and the concept of attachment].

PubMed

Schaub, Corinne; Morin, Diane; von Gunten, Armin

2016-06-01

Agitation in hospitalized demented patients is troublesome and disruptive for both patients and caregivers. The literature indicates that agitation is strongly related to physical or psychological discomfort and its recent definition includes the additional relation to emotional distress. Hospitalization associated with major cognitive difficulties further activates the need for attachment and security to which caregivers must pay attention. This synthesis review first deals with the evidence related to agitation in people with dementia and its relationship with discomfort. A description of the difficulties with which caregivers must cope follows. The need to primarily use nonpharmacological approaches during agitation to meet the underlying needs causing discomfort is then developed. Recommended approaches generally involve a relational contact, even if facing the risk of mobilizing frequently unsecured and anxious attachment patterns in this population. A conceptual positioning supported by the Kolcaba comfort theory will position this knowledge. A particular point of this theory, based on previous experiences of patients, will be analyzed based on attachment characteristics of people with dementia.

Maintenance of platelet in vitro properties during 7-day storage in M-sol with a 30-hour interruption of agitation.

PubMed

Wagner, Stephen J; Myrup, Andrew; Awatefe, Helen; Thompson-Montgomery, Dedeene; Hirayama, Junichi; Skripchenko, Andrey

2008-12-01

Extensive periods without agitation can occasionally occur during platelet (PLT) shipment and can affect PLT quality during 5- to 7-day storage. The use of buffer-containing PLT additive solutions (ASs) may better preserve PLT quality during storage by maintaining PLT pH and other in vitro variables. A newly described bicarbonate-containing AS, M-sol, was compared to plasma for preservation of whole blood-derived PLT concentrates in which a 30-hour interruption of agitation was included. ABO-identical PLT-rich plasma intermediate products were pooled in sets of four, split, and centrifuged with subsequent plasma expression (n = 12). Two units were resuspended with M-sol AS to produce a 70 percent solution/30 percent plasma PLT concentrate; 2 units were resuspended in 100 percent plasma. One M-sol resuspended unit and 1 plasma unit were held on a laboratory bench in a standard shipping box for 30 hours between Day 2 and Day 3, while the other M-sol and plasma unit were continuously agitated. Standard in vitro testing for PLT quality variables on each set of 4 units was performed during storage (n = 12). Interrupting agitation of PLTs suspended in M-sol resulted in less of a pH decrement during storage than that of PLTs suspended in 100 percent plasma. On Days 5 and 7, the pH differences between M-sol and plasma units were 0.56 and 0.75 pH units, respectively (p < 0.0003). In addition, PLTs suspended in M-sol and subjected to an interruption of agitation had lesser Day 7 CD62+ cells, glucose utilization, and lactate production and greater hypotonic stress response, morphology, swirling, and aggregation response than those suspended in plasma (p agitation are better maintained during 7-day storage than those of matched units suspended in plasma.

Individualized music played for agitated patients with dementia: analysis of video-recorded sessions.

PubMed

Ragneskog, H; Asplund, K; Kihlgren, M; Norberg, A

2001-06-01

Many nursing home patients with dementia suffer from symptoms of agitation (e.g. anxiety, shouting, irritability). This study investigated whether individualized music could be used as a nursing intervention to reduce such symptoms in four patients with severe dementia. The patients were video-recorded during four sessions in four periods, including a control period without music, two periods where individualized music was played, and one period where classical music was played. The recordings were analysed by systematic observations and the Facial Action Coding System. Two patients became calmer during some of the individualized music sessions; one patient remained sitting in her armchair longer, and the other patient stopped shouting. For the two patients who were most affected by dementia, the noticeable effect of music was minimal. If the nursing staff succeed in discovering the music preferences of an individual, individualized music may be an effective nursing intervention to mitigate anxiety and agitation for some patients.

Effect of reciprocating agitation thermal processing (RA-TP) on quality of canned tomato (Solanum lycopersicum) puree.

PubMed

Pratap Singh, Anubhav; Singh, Anika; Ramaswamy, Hosahalli S

2017-06-01

Reciprocating agitation thermal processing (RA-TP) is a recent innovation in the field of canning for obtaining high-quality canned food. The objective of this study was to compare RA-TP processing with conventional non-agitated (still) processing with respect to the impact on quality (color, antioxidant capacity, total phenols, carotenoid and lycopene contents) of canned tomato (Solanum lycopersicum) puree. Owing to a 63-81% reduction in process times as compared with still processing, tomato puree with a brighter red color (closer to fresh) was obtained during RA-TP. At 3 Hz reciprocation frequency, the loss of antioxidant, lycopene and carotenoid contents could be reduced to 34, 8 and 8% respectively as compared with 96, 41 and 52% respectively during still processing. In fact, the phenolic content for RA-TP at 3 Hz was 5% higher than in fresh puree. Quality retention generally increased with an increase in frequency, although the differences were less significant at higher reciprocation frequencies (between 2 and 3 Hz). Research findings indicate that RA-TP can be effective to obtain thermally processed foods with high-quality attribute retention. It can also be concluded that a very high reciprocation frequency (>3 Hz) is not necessarily needed and significant quality improvement can be obtained at lower frequencies (∼2 Hz). © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Control of psychomotor agitation and aggressive behavior in patients with autistic disorder: a retrospective chart review.

PubMed

Novaes, Camila Marinho; Pondé, Milena Pereira; Freire, Antonio Carlos Cruz

2008-09-01

To evaluate the efficacy of pharmacotherapy on the symptoms of psychomotor agitation and aggressive behavior in a sample of patients with autistic spectrum disorder. The charts of all patients with a diagnosis of autistic spectrum disorder, receiving care for psychomotor agitation and/or aggressive behavior in two psychiatric outpatient departments between 2001 and 2006, were reviewed. The Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I) were applied to the data retrieved from the charts. The majority of the 26 patients included were treated with second-generation antipsychotics. A positive, statistically significant correlation was found between the implementation of pharmacotherapy and a reduction in CGI-S scores (p<0.05). Treatment response in patients with no mental retardation was better than in those mentally retarded (p<0.05). The majority of patients in whom clinical improvement was found following implementation of treatment had participated in at least one form of intervention therapy in addition to the principal treatment (p<0.05). Second-generation antipsychotics seem to reduce psychomotor agitation and aggressive behavior in patients with autistic spectrum disorder; however, further studies are required to evaluate the side effects of these drugs in relation to their beneficial effects.

Influence of agitation on the removal of nonylphenol by the white-rot fungi Trametes versicolor and Bjerkandera sp. BOL 13.

PubMed

Soares, Ana; Guieysse, Benoit; Mattiasson, Bo

2006-02-01

Bjerkandera sp. BOL 13 removed 95% of nonylphenol (at 9.7 mg nonylphenol L(-1) day(-1)) from aqueous medium after 5 days of incubation in agitated cultures. This removal rate decreased 2.5-fold in static cultures. By comparison, Trametes versicolor removed nonylphenol at 2.8 mg L(-1) day(-1) under conditions of static incubation, probably due to the action of laccase, but no growth was recorded in the agitated bottles.

Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: A pilot study.

PubMed

Turten Kaymaz, Tugce; Ozdemir, Leyla

We examined the effects of aromatherapy on agitation in patients with dementia and evaluated related caregiver burden. Patients and their caregivers from two hospitals in Turkey were selected and divided into an intervention group (n = 14) and a control group (n = 14). Patients were stratified according to their dementia phase and intake of antipsychotic medication. The intervention group received aromatherapy via massage and inhalation at home for 4 weeks. The control group received no intervention. Data were collected using the Neuropsychiatric Inventory (NPI), the Cohen-Mansfield Agitation Inventory (CMAI) and the Zarit Burden Interview (ZBI). At 2 and 4 weeks, the NPI scores were significantly lower in the intervention group (p < 0.05). At 4 weeks, the CMAI and ZBI scores were significantly lower in the intervention group (p < 0.05). In conclusion, after aromatherapy, agitation, neuropsychiatric symptoms, and caregiver distress significantly reduced, and aromatherapy prevented caregiver burden increase. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient preferences for medicine administration for acute agitation: results from an internet-based survey of patients diagnosed with bipolar disorder or schizophrenia in two Nordic countries.

PubMed

Jørgensen, Tine Rikke; Emborg, Charlotte; Dahlen, Karianne; Bøgelund, Mette; Carlborg, Andreas

2018-01-01

The objective was to elicit patient preferences for medicine administration method in the management of acute agitation episodes among patients diagnosed with bipolar disorder or schizophrenia. The patients' experiences of acute agitation episodes and their management of episodes were also explored. Data were collected via an anonymous, internet-based survey of residents in Denmark or Sweden with schizophrenia or bipolar disorder (October 2014 to December 2014). Inclusion criteria were having a diagnosis of schizophrenia or bipolar disorder, and being above 18 years of age. The questionnaire included questions about preferences for medication attributes, experiences with pharmacological treatment for agitation and involvement in treatment plans. A total of 237 diagnosed patients (61 with schizophrenia; 176 with bipolar disorder) completed the questionnaire. Agitation episodes were experienced by 90% of the respondents. In total, 83% of the respondents reported having received treatment with tablets. When patients were presented with the attributes of an inhalation method, respondents stated that the fast onset of action, low risk of adverse reactions and least invasive form of drug delivery were positive attributes of treatment with inhalation. Inhalation is a new delivery route for treatment of acute agitation in patients diagnosed with bipolar disorder or schizophrenia. Inhalation is the preferred treatment method for acute agitation among Danish and Swedish patients with bipolar disorder or schizophrenia.

A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia.

PubMed

Livingston, Gill; Kelly, Lynsey; Lewis-Holmes, Elanor; Baio, Gianluca; Morris, Stephen; Patel, Nishma; Omar, Rumana Z; Katona, Cornelius; Cooper, Claudia

2014-06-01

Agitation is common, persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful, but the evidence regarding non-pharmacological interventions is unclear. We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia, considering dementia severity, the setting, the person with whom the intervention is implemented, whether the effects are immediate or longer term, and cost-effectiveness. We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia, included papers' references, and contacted authors about 'missed' studies. We included quantitative studies, evaluating non-pharmacological interventions for agitation in dementia, in all settings. We rated quality, prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy, we present a qualitative evidence synthesis. In addition, we calculated standardised effect sizes (SESs) with available data, to compare heterogeneous interventions. In the health economic analysis, we reviewed economic studies, calculated the cost of effective interventions from the effectiveness review, calculated the incremental cost per unit improvement in agitation, used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality

42 CFR 405.922 - Time frame for processing initial determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Time frame for processing initial determinations. 405.922 Section 405.922 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... § 405.922 Time frame for processing initial determinations. The contractor issues initial determinations...

A randomized, controlled cross-over trial of dermally-applied lavender (Lavandula angustifolia) oil as a treatment of agitated behaviour in dementia.

PubMed

O'Connor, Daniel W; Eppingstall, Barbara; Taffe, John; van der Ploeg, Eva S

2013-11-13

Lavender essential oil shows evidence of sedative properties in neurophysiological and animal studies but clinical trials of its effectiveness as a treatment of agitation in people with dementia have shown mixed results. Study methods have varied widely, however, making comparisons hazardous. To help remedy previous methodological shortcomings, we delivered high grade lavender oil in specified amounts to nursing home residents whose agitated behaviours were recorded objectively. 64 nursing home residents with frequent physically agitated behaviours were entered into a randomized, single-blind cross-over trial of dermally-applied, neurophysiologically active, high purity 30% lavender oil versus an inactive control oil. A blinded observer counted the presence or absence of target behaviours and rated participants' predominant affect during each minute for 30 minutes prior to exposure and for 60 minutes afterwards. Lavender oil did not prove superior to the control oil in reducing the frequency of physically agitated behaviours or in improving participants' affect. Studies of essential oils are constrained by their variable formulations and uncertain pharmacokinetics and so optimal dosing and delivery regimens remain speculative. Notwithstanding this, topically delivered, high strength, pure lavender oil had no discernible effect on affect and behaviour in a well-defined clinical sample. Australian and New Zealand Clinical Trials Registry (ACTRN 12609000569202).

The effect of magnesium sulphate infusion on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia.

PubMed

Abdulatif, M; Ahmed, A; Mukhtar, A; Badawy, S

2013-10-01

This randomised, controlled, double-blind study investigated the effects of intra-operative magnesium sulphate administration on the incidence of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia. Seventy children were randomly allocated to receive a 30 mg.kg(-1) bolus of intravenous magnesium sulphate after induction of anaesthesia followed by a continuous infusion of 10 mg.kg(-1).h(-1) or an equal volume of saline 0.9%. All children received titrated sevoflurane anaesthesia adjusted to maintain haemodynamic stability. The Pediatric Anesthesia Emergence Delirium scale and the Children's Hospital of Eastern Ontario Score were used for the assessment of postoperative emergence agitation and pain, respectively. Emergence agitation was more common in the control group than in the magnesium group (23 (72%) and 12 (36%), respectively (p = 0.004)), with a relative risk of 0.51 (95% CI 0.31-0.84), an absolute risk reduction of 0.35 (95% CI 0.10-0.54), and number needed to treat of 3 (95% CI 2-9). Postoperative pain scores were comparable in the two groups. Magnesium sulphate reduces the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia and is not associated with increased postoperative side-effects or delayed recovery. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

German version, inter- and intrarater reliability and internal consistency of the "Agitated Behavior Scale" (ABS-G) in patients with moderate to severe traumatic brain injury.

PubMed

Hellweg, Stephanie; Schuster-Amft, Corina

2016-07-19

Agitation is frequently observed during early recovery after traumatic brain injury (TBI). Agitated behaviour often interferes with a goal-orientated rehabilitation and can be a substantial hindrance to therapy. Despite the relatively high occurance of agitation in TBI population there is no objective assessement in German (G) available. An existing scale with excellent psychometric properties is the "Agitated Behavior Scale (ABS)" developed by Corrigan in 1989. The aim of the study was to translate the Agitated Behavior Scale (ABS) into German (ABS-G) and investigate the inter- and intrarater reliability and internal consistency in patients with moderate to severe TBI. A formal nine-step translation and cross-cultural adaptation procedure (TCCA) was applied. Subsequently a prospective observational patient study was conducted. To examine the interrater reliability and internal consistency, two therapists rated 20 patients independently after a therapy session. This procedure was repeated twice on a weekly basis. The intrarater reliability was assessed through video recordings from three patients. Nine raters scored the demonstrated behaviour on the videotape with the ABS-G independently twice within one month. The inter- and intrarater reliability were evaluated with the Spearman rank correlation coefficient and the quadratic weighted kappa. The internal consistency was tested with Cronbach's alpha. Behaviour of 20 patients (18 males; mean age 41 ± 20.7; mean Functional Independence Measure (FIM) cognitive score on admission 7.1 ± 4.04; mean ABS-G score at first observation 17.3 ± 2.83) was assessed threefold. Interrater reliability yielded a correlation coefficient for ABS-G total score of all 60 paired observations of r s 0.845 and a weighted Kappa of 0.738. Intrarater reliability for ABS-G total score ranged between r s 0.719 and 0.953 and showed a weighted Kappa between 0.871 and 0.953. Cronbach's alpha indicated moderate internal consistency

[A prospective cohort study of the risk factors of emergence agitation in pediatric after general anesthesia].

PubMed

Fan, Hao; Tao, Fan; Wan, Hai-fang; Luo, Hong

2012-05-08

To evaluate risk factors associated with emergence agitation (EA) in pediatrics after general anesthesia. A prospective cohort study was conducted in 268 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in our hospital between January 2008 and October 2011. The incidence of EA was assessed. Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded. Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. One hundred and sixteen children (43.3%) had EA, with an average duration of 9.1 ± 6.6 minutes. EA associated with adverse events occurred in 35 agitated children (30.2%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2 - 5 years), and general anesthesia with sevoflurane. However, difficult parental-separation behavior, and preschool age were the only factors significantly associated with EA in the multiple Logistic regression analysis with OR = 3.091 (95%CI: 1.688, 5.465, P < 0.01) and OR = 1.965 (95%CI: 1.112, 3.318, P = 0.024), respectively. The present study indicated that the incidence of EA was high in PACU. Preschool children and difficult parental-separation behavior were the predictive factors of emergence agitation.

Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial.

PubMed

Hui, David; Frisbee-Hume, Susan; Wilson, Annie; Dibaj, Seyedeh S; Nguyen, Thuc; De La Cruz, Maxine; Walker, Paul; Zhukovsky, Donna S; Delgado-Guay, Marvin; Vidal, Marieberta; Epner, Daniel; Reddy, Akhila; Tanco, Kimerson; Williams, Janet; Hall, Stacy; Liu, Diane; Hess, Kenneth; Amin, Sapna; Breitbart, William; Bruera, Eduardo

2017-09-19

The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, -5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival. Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (-4.1 points) than placebo + haloperidol (-2.3 points) (mean difference, -1.9 points [95% CI, -2.8 to -0.9]; P < .001). The lorazepam + haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, -1.0 mg [95% CI, -2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol group; mean difference, 47% [95% CI, 14% to 73%], P = .007; nurses: 77% for

Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy.

PubMed

Patel, Anuradha; Davidson, Melissa; Tran, Minh C J; Quraishi, Huma; Schoenberg, Catherine; Sant, Manasee; Lin, Albert; Sun, Xiuru

2010-10-01

Dexmedetomidine, a specific α(2) agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease emergence agitation in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy (T&A). One hundred twenty-two patients with obstructive sleep apnea syndrome undergoing T&A, ages 2 to 10 years, completed this prospective, randomized, U.S. Food and Drug Administration-approved study. After mask induction with sevoflurane, group D received IV dexmedetomidine 2 μg · kg(-1) over 10 minutes, followed by 0.7 μg · kg(-1) · h(-1), and group F received IV fentanyl bolus 1 μg · kg(-1). Anesthesia was maintained with sevoflurane, oxygen, and nitrous oxide. Fentanyl 0.5 to 1 μg · kg(-1) was given to subjects in both groups for an increase in heart rate or systolic blood pressure 30% above preincision values that continued for 5 minutes. Observers in the postanesthesia care unit (PACU) were blinded to treatment groups. Pain was evaluated using the objective pain score in the PACU on arrival, at 5 minutes, at 15 minutes, then every 15 minutes for 120 minutes. Emergence agitation was evaluated at the same intervals by 2 scales: the Pediatric Anesthesia Emergence Delirium scale and a 5-point scale described by Cole. Morphine (0.05 to 0.1 mg · kg(-1)) was given for pain (score >4) or severe agitation (score 4 or 5) lasting more than 5 minutes. In group D, 9.8% patients needed intraoperative rescue fentanyl in comparison with 36% in group F (P = 0.001). Mean systolic blood pressure and heart rate were significantly lower in group D (P < 0.05). Minimum alveolar concentration values were significantly different between the 2 groups (P = 0.015). The median objective pain score was 3 for group D and 5 for group F (P = 0.001). In group D, 10 (16.3%) patients required rescue morphine, in comparison with 29 (47.5%) in group F (P = 0

The Effect of Final Rinse Agitation with Ultrasonic or 808 nm Diode Laser on Coronal Microleakage of Root-canal Treated Teeth.

PubMed

Ramazani, Mohsen; Asnaashari, Mohammad; Ahmadi, Roghayyeh; Zarenejad, Nafiseh; Rafie, Alireza; Yazadani Charati, Jamshid

2018-01-01

This in vitro study aimed at comparing the effect of agitating the final irrigant solutions of root canal by ultrasonic or using 808 nm Diode laser on the apical seal of canal. A total of 90 extracted human maxillary central incisors were prepared up to size #45 and were randomly assigned to 4 experimental groups ( n =20) and two control groups ( n =5) respectively, as follows: I ): 3 mL of 5.25% NaOCl was agitated as final irrigant solution with ultrasonic for 30 sec. The ultrasonic tip was 1 mm shorter than the working length, II ): 3 mL of 5.25% NaOCl was agitated as final irrigant with 808 nm Diode laser for 30 sec. Fiber tip, placed in 1 mm shorter from working length was spirally moved coronally, III ): 3 mL of 17% EDTA was agitated as final irrigant with 808 nm Diode laser for 30 sec and was applied similar to group II, IV ): 3 mL of 17% EDTA was stimulated as final irrigant with ultrasonic for 30 sec and was applied similar to I. Apical seal was assessed by Dual Chamber technique using Bovine Serum Albumin protein. Kruskal-Wallis and Mann Whitney tests were used with significance level lower than 0.05% for statistical analysis. The average leakage in the negative control, positive control, and groups I, II, III, IV were: 0.00, 13.5±5.1, 1.72±2.9, 5.12±5.6, 3.36±3.7, 2.4±4.2, respectively. Statistical analysis showed significant difference between groups ( P <0.05). There was a significant difference between groups 1 and 2 in terms of protein leakage . Agitating 5.25% sodium hypochlorite solution as the final irrigant with ultrasonic is more effective in apical leakage reduction compared to other groups.

Intramuscular olanzapine versus intramuscular aripiprazole for the treatment of agitation in patients with schizophrenia: A pragmatic double-blind randomized trial.

PubMed

Kittipeerachon, Mantana; Chaichan, Warawat

2016-10-01

To evaluate and compare the effectiveness and adverse effects of intramuscular (IM) olanzapine and IM aripiprazole for the treatment of agitated patients with schizophrenia in clinical practice. A 24-hour randomized double-blind study carried out at a psychiatric hospital in Thailand enrolled adult patients (18-65years old) with schizophrenia experiencing agitation. Patients received one dose of IM olanzapine or IM aripiprazole followed by routine oral psychotropic medications. Efficacy was primarily measured using the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). A total of 80 patients with a PANSS-EC score range of 22-35 entered the study, of whom 13% had a medical comorbidity and 40% a history of active substance abuse. The 40 patients receiving IM olanzapine showed greater improvement than the 40 patients receiving IM aripiprazole in PANSS-EC scores at 2h after the injection (p=0.002) but not at 24h. The two treatments were well tolerated. Patients receiving IM olanzapine experienced greater somnolence than those receiving IM aripiprazole. There were no clinically relevant changes in vital signs in either group. The results indicate that IM olanzapine and aripiprazole are similarly effective and well tolerated in the real-world treatment of agitation associated with schizophrenia over the first 24h. However, in the early hours, IM olanzapine may produce more sedation and reductions in agitation. Copyright © 2016 Elsevier B.V. All rights reserved.

Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial).

PubMed

Ballard, Clive; Brown, Richard; Fossey, Jane; Douglas, Simon; Bradley, Paul; Hancock, Judith; James, Ian A; Juszczak, Edmund; Bentham, Peter; Burns, Alistair; Lindesay, James; Jacoby, Robin; O'Brien, John; Bullock, Roger; Johnson, Tony; Holmes, Clive; Howard, Robert

2009-09-01

Good practice guidelines state that a psychological intervention should usually precede pharmacotherapy, but there are no data evaluating the feasibility of psychological interventions used in this way. At the first stage of a randomized blinded placebo-controlled trial, 318 patients with Alzheimer disease (AD) with clinically significant agitated behavior were treated in an open design with a psychological intervention (brief psychosocial therapy [BPST]) for 4 weeks, preceding randomization to pharmacotherapy. The therapy involved social interaction, personalized music, or removal of environmental triggers. Overall, 318 patients with AD completed BPST with an improvement of 5.6 points on the total Cohen-Mansfield Agitation Inventory (CMAI; mean [SD], 63.3 [16.0] to 57.7 [18.4], t = 4.8, df = 317, p < 0.0001). Therapy worksheets were completed in six of the eight centers, with the key elements of the intervention delivered according to the manual for >95% of patients. More detailed evaluation of outcome was completed for the 198 patients with AD from these centers, who experienced a mean improvement of 6.6 points on the total CMAI (mean [SD], 62.2 [14.3] to 55.6 [15.8], t = 6.5, df = 197, p < 0.0001). Overall, 43% of participants achieved a 30% improvement in their level of agitation. The specific attributable benefits of BPST cannot be determined from an open trial. However, the BPST therapy was feasible and was successfully delivered according to an operationalized manual. The encouraging outcome indicates the need for a randomized controlled trial of BPST.

A randomized, controlled cross-over trial of dermally-applied lavender (Lavandula angustifolia) oil as a treatment of agitated behaviour in dementia

PubMed Central

2013-01-01

Background Lavender essential oil shows evidence of sedative properties in neurophysiological and animal studies but clinical trials of its effectiveness as a treatment of agitation in people with dementia have shown mixed results. Study methods have varied widely, however, making comparisons hazardous. To help remedy previous methodological shortcomings, we delivered high grade lavender oil in specified amounts to nursing home residents whose agitated behaviours were recorded objectively. Methods 64 nursing home residents with frequent physically agitated behaviours were entered into a randomized, single-blind cross-over trial of dermally-applied, neurophysiologically active, high purity 30% lavender oil versus an inactive control oil. A blinded observer counted the presence or absence of target behaviours and rated participants’ predominant affect during each minute for 30 minutes prior to exposure and for 60 minutes afterwards. Results Lavender oil did not prove superior to the control oil in reducing the frequency of physically agitated behaviours or in improving participants’ affect. Conclusions Studies of essential oils are constrained by their variable formulations and uncertain pharmacokinetics and so optimal dosing and delivery regimens remain speculative. Notwithstanding this, topically delivered, high strength, pure lavender oil had no discernible effect on affect and behaviour in a well-defined clinical sample. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN 12609000569202) PMID:24219098

Acute Psychosis after Recent Isoniazid Initiation

PubMed Central

Sukhija, Gagandeep; Singh, Harpreet

2015-01-01

Isoniazid as part of Directly Observed Treatment-Short course (DOTS) regimen is universally used. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset of symptoms remains highly variable. We describe a case of 54-year-old female on anti-tubercular therapy with onset of psychosis within three days of Isoniazid initiation characterised by agitation, loosening of association, echolalia with spontaneous remission after drug stoppage. This case highlights the importance of remaining vigilant and considering isoniazid as possible causative agent for psychosis even within days of its intiation and avoiding delay in management. PMID:26266198

Helically agitated mixing in dry dilute acid pretreatment enhances the bioconversion of corn stover into ethanol

PubMed Central

2014-01-01

Background Dry dilute acid pretreatment at extremely high solids loading of lignocellulose materials demonstrated promising advantages of no waste water generation, less sugar loss, and low steam consumption while maintaining high hydrolysis yield. However, the routine pretreatment reactor without mixing apparatus was found not suitable for dry pretreatment operation because of poor mixing and mass transfer. In this study, helically agitated mixing was introduced into the dry dilute acid pretreatment of corn stover and its effect on pretreatment efficiency, inhibitor generation, sugar production, and bioconversion efficiency through simultaneous saccharification and ethanol fermentation (SSF) were evaluated. Results The overall cellulose conversion taking account of cellulose loss in pretreatment was used to evaluate the efficiency of pretreatment. The two-phase computational fluid dynamics (CFD) model on dry pretreatment was established and applied to analyze the mixing mechanism. The results showed that the pretreatment efficiency was significantly improved and the inhibitor generation was reduced by the helically agitated mixing, compared to the dry pretreatment without mixing: the ethanol titer and yield from cellulose in the SSF reached 56.20 g/L and 69.43% at the 30% solids loading and 15 FPU/DM cellulase dosage, respectively, corresponding to a 26.5% increase in ethanol titer and 17.2% increase in ethanol yield at the same fermentation conditions. Conclusions The advantage of helically agitated mixing may provide a prototype of dry dilute acid pretreatment processing for future commercial-scale production of cellulosic ethanol. PMID:24387051

Using Simulation to Train Junior Psychiatry Residents to Work with Agitated Patients: A Pilot Study

ERIC Educational Resources Information Center

Zigman, Daniel; Young, Meredith; Chalk, Colin

2013-01-01

Objective: This article examines the benefit and feasibility of introducing a new, simulation-based learning intervention for junior psychiatry residents. Method: Junior psychiatry residents were invited to participate in a new simulation-based learning intervention focusing on agitated patients. Questionnaires were used to explore the success of…

Power consumption for an agitated vessel equipped with pitched blade turbine and short baffles.

PubMed

Major-Godlewska, Marta; Karcz, Joanna

2018-01-01

Power characteristics for an agitated vessel equipped with planar short baffles of length L and pitched blade turbine of pitch β are presented in the paper. The studies were carried out in the vessel of inner diameter D  = 0.6 m, where the baffles were located in the distance p from the vessel bottom ( p  +  L  =  H ). Torque was measured using strain gauge method within the turbulent regime of the flow of Newtonian liquid in the agitated vessel. The effects of the pitch β and geometrical parameter p / H on the power number Ne were determined mathematically. The results showed that, for the assumed value of the angle β , the function Ne  =  f ( L / H ) decreases with the decrease in the baffle length L (i.e. with the increase in the parameter p ). Moreover, for the assumed value of the baffle length L , the function Ne  =  f ( β ) increases with the increase in the angle β of the inclination of the impeller blade.

Dependence of mycelial morphology on impeller type and agitation intensity.

PubMed

Jüsten, P; Paul, G C; Nienow, A W; Thomas, C R

1996-12-20

The influence of the agitation conditions on the morphology of Penicillium chrysogenum (freely dispersed and aggregated forms) was examined using radial (Rushton turbines and paddles), axial (pitched blades, propeller, and Prochem Maxflow T), and counterflow impellers (Intermig). Culture broth was taken from a continuous fermentation at steady state and was agitated for 30 min in an ungassed vessel of 1.4-L working volume. The power inputs per unit volume of liquid in the tank, P/V(L), ranged from 0.6 to 6 kW/m(3). Image analysis was used to measure mycelial morphology. To characterize the intensity of the damage caused by different impellers, the mean total hyphal length (freely dispersed form) and the mean projected area (all dispersed types, i.e., also including aggregates) were used. [In this study, breakage of aggregates was taken into account quantitatively for the first time.]At 1.4-L scale and a given P/V(L), changes in the morphology depended significantly on the impeller geometry. However, the morphological data (obtained with different geometries and various P/V(L)) could be correlated on the basis of equal tip speed and two other, less simple, mixing parameters. One is based on the specific energy dissipation rate in the impeller region, which is simply related to P/V(L) and particular impeller geometrical parameters. The other which is developed in this study is based on a combination of the specific energy dissipation rate in the impeller swept volume and the frequency of mycelial circulation through that volume. For convenience, the function arising from this concept is called the "energy dissipation/circulation" function.To test the broader validity of these correlations, scale-up experiments were carried out in mixing tanks of 1.4, 20, and 180 L using a Rushton turbine and broth from a fed-batch fermentation. The energy dissipation/circulation function was a reasonable correlating parameter for hyphal damage over this range of scales, whereas tip

An innate immune system-mimicking, real-time biosensing of infectious bacteria.

PubMed

Seo, Sung-Min; Jeon, Jin-Woo; Kim, Tae-Yong; Paek, Se-Hwan

2015-09-07

An animal cell-based biosensor was investigated to monitor bacterial contamination in an unattended manner by mimicking the innate immune response. The cells (RAW 264.7 cell line) were first attached onto the solid surfaces of a 96-well microtiter plate and co-incubated in the culture medium with a sample that might contain bacterial contaminants. As Toll-like receptors were present on the cell membrane surfaces, they acted as a sentinel by binding to pathogen-associated molecular patterns (PAMPs) of any contaminant. Such biological recognition initiates signal transmission along various pathways to produce different proinflammatory mediators, one of which, tumor necrosis factor-α (TNF-α) was measured using an immunosensor. To demonstrate automated bacterium monitoring, a capture antibody specific for TNF-α was immobilized on an optical fiber sensor tip and then used to measure complex formation in a label-free sensor system (e.g., Octet Red). The sensor response time depended significantly on the degree of agitation of the culture medium, controlling the biological recognition and further autocrine/paracrine signaling by cytokines. The response, particularly under non-agitated conditions, was also influenced by the medium volume, revealing a local gradient change of the cytokine concentration and also acidity, caused by bacterial growth near the bottom surfaces. A biosensor system retaining 50 μL medium and not employing agitation could be used for the early detection of bacterial contamination. This novel biosensing model was applied to the real-time monitoring of different bacteria, Shigella sonnei, Staphylococcus aureus, and Listeria monocytogenes. They (<100 CFU mL(-1)) could be detected automatically within the working time. Such analysis was carried out without any manual handling regardless of the bacterial species, suggesting the concept of non-targeted bacterial real-time monitoring. This technique was further applied to real sample testing (e

Time required to initiate outbreak and pandemic observational research.

PubMed

Rishu, Asgar H; Marinoff, Nicole; Julien, Lisa; Dumitrascu, Mariana; Marten, Nicole; Eggertson, Shauna; Willems, Su; Ruddell, Stacy; Lane, Dan; Light, Bruce; Stelfox, Henry T; Jouvet, Philippe; Hall, Richard; Reynolds, Steven; Daneman, Nick; Fowler, Robert A

2017-08-01

Observational research focused upon emerging infectious diseases such as Ebola virus, Middle East respiratory syndrome, and Zika virus has been challenging to quickly initiate. We aimed to determine the duration of start-up procedures and barriers encountered for an observational study focused upon such infectious outbreaks. At 1 pediatric and 5 adult intensive care units, we measured durations from protocol receipt to a variety of outbreak research milestones, including research ethics board (REB) approval, data sharing agreement (DSA) execution, and patient study screening initiation. The median (interquartile range) time from site receipt of the protocol to REB submission was 73 (30-126) days; to REB approval, 158 (42-188) days; to DSA completion, 276 (186-312) days; and to study screening initiation, 293 (269-391) days. The median time from REB submission to REB approval was 43 (13-85) days. The median time for all start-up procedures was 335 (188-335) days. There is a lengthy start-up period required for outbreak-focused research. Completing DSAs was the most time-consuming step. A reactive approach to newly emerging threats such as Ebola virus, Middle East respiratory syndrome, and Zika virus will likely not allow sufficient time to initiate research before most outbreaks are advanced. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Effects of heat, pH, antioxidant, agitation and light on betacyanin stability using red-fleshed dragon fruit (Hylocereus polyrhizus) juice and concentrate as models.

PubMed

Wong, Yen-Ming; Siow, Lee-Fong

2015-05-01

Red-fleshed dragon fruit (Hylocereus polyrhizus) is rich in antioxidants. The aim of this study was to determine the effects of heat pasteurization, pH adjustment, ascorbic acid addition as well as storage under agitation and light or dark condition on betacyanin content in red-fleshed dragon fruit (Hylocereus polyrhizus) juice and concentrate. The concentrate was produced by concentrating clarified red-fleshed dragon fruit juice in a rotary evaporator at 40 °C. UV-Visible spectrophotometer was used for analyzing betacyanin content. Addition of 0.25 % ascorbic acid, pH 4.0, and pasteurization at 65 °C for 30 min were selected as the best processing conditions to retain betacyanin content in red-fleshed dragon fruit juice. Storage at the agitation speed of 220 rpm showed that the concentrated samples had higher betacyanin stability compared to juice, while both juice and concentrate had almost similar betacyanin stability when tested for storage in the presence of light. In summary, ascorbic acid stabilized betacyanin in both juice and concentrate at agitated or non-agitated conditions. In contrast, light degraded betacyanin in both juice and concentrate models.

Appropriate anesthesia regimen to control sevoflurane-induced emergence agitation in children; propofol-lidocaine and thiopental sodium-lidocaine: a randomized controlled trial.

PubMed

Rahimzadeh, Poupak; Faiz, Seyed Hamid Reza; Alebouyeh, Mahmood Reza; Dasian, Azadeh; Sayarifard, Azadeh

2014-07-01

Emergence Agitation (EA) is a common problem in pediatric anesthesia. The current study evaluated the effect of intravenous lidocaine combined with propofol or thiopental sodium to control EA by sevoflurane in children. The current study aimed to compare the effectiveness of two anesthesia regimen propofol-lidocaine and thiopental sodium lidocaine to control sevoflurane-induced emergence agitation in children. The study enrolled 120 children aged 12 to 36 months with retinoblastoma who underwent induction of anesthesia with sevoflurane for Eye Examination Under Anesthesia (EUA). Sampling was done at Rasoul-Akram Hospital in Tehran, Iran. The subjects were randomly assigned into four groups including: group one (thiopental sodium-lidocaine [TL]), group two (thiopental sodium-saline [TS]), group three (propofol-lidocaine [PL]), and group four (propofol-saline [PS]). Emergence agitation was assessed by using a five-point scoring scale, every 10 minutes during the first 30 minutes after admission to the recovery room. EA occurred in 24 cases (20%) of children. Incidence of EA in the TS, TL, PS, and PL groups were 21 (70%), 2 (6.7%), 1 (3.3%), and 0 (0%), respectively (P < 0.001). Nausea and vomiting after anesthesia did not occur in any of the patients. After removal of the endotracheal tube, laryngospasm complication occurrence in the TS group (10 cases) was higher than the other groups and no statistically significant difference was observed (P = 0.1). Propofol-lidocaine anesthesia regimen was more effective to control the pediatric emergence agitation than the other combinations.

Effects on agitation with rivastigmine patch monotherapy and combination therapy with memantine in mild to moderate Alzheimer's disease: a multicenter 24-week prospective randomized open-label study (the Korean EXelon Patch and combination with mEmantine Comparative Trial study).

PubMed

Yoon, Soo J; Choi, Seong H; Na, Hae R; Park, Kyung-Won; Kim, Eun-Joo; Han, Hyun J; Lee, Jae-Hong; Shim, Young S; Na, Duk L

2017-03-01

Memantine is known to be effective in the treatment of the behavioral symptoms of dementia, especially agitation in moderate to severe Alzheimer's disease (AD). However, memantine and rivastigmine patch combination therapy has not been well studied in determining treatment effectiveness with mild to moderate AD patients. This was a multicenter, 24-week, prospective, randomized, open-label study design. A total 147 AD patients with Mini-Mental State Examination scores from 10 to 20 were randomly assigned to rivastigmine patch monotherapy and combination therapy with memantine groups. Agitation symptoms, using the Korean Version of the Cohen Mansfield Agitation Inventory were evaluated at baseline and at study end. Suppression and emergence of agitation symptoms were also evaluated. We carried out factor analyses to evaluate the interrelationship of agitation symptoms and to investigate treatment response in these symptoms. Factor analyses showed two symptom clusters: factor A - aggressive agitated behaviors - versus factor B - non-aggressive agitated behaviors. The rivastigmine patch monotherapy group showed significantly decreased factor B scores and had a tendency of decreased Korean Version of the Cohen Mansfield Agitation Inventory total scores and factor A scores. Conversely, the combination therapy group showed significantly increased Korean Version of the Cohen Mansfield Agitation Inventory total scores and factor B scores. Neither monotherapy nor combination therapy reduced the emergence of new agitation symptoms. In this trial of mild to moderate AD patients, the rivastigmine patch monotherapy group experienced a reduction of non-aggressive agitated behaviors. However, combination therapy with memantine did not show any benefit on the agitation associated with mild to moderate AD. Geriatr Gerontol Int 2017; 17: 494-499. © 2016 Japan Geriatrics Society.

Progress in Treatment Development for Neuropsychiatric Symptoms in Alzheimer’s Disease: Focus on Agitation and Aggression. A Report from the EU/US/CTAD Task Force

PubMed Central

Soto, M.; Abushakra, S.; Cummings, J.; Siffert, J.; Robert, P.; Vellas, B.; Lyketsos, C.G.

2015-01-01

BACKGROUND The management of neuropsychiatric symptoms (NPS) such as agitation and aggression is a major priority in caring for people with Alzheimer’s disease (AD). Agitation and aggression (A/A) are among the most disruptive symptoms, and given their impact, they are increasingly an important target for development of effective treatments. Considerable progress has been made in the last years with a growing number of randomized controlled trials (RCTs) of drugs for NPS. The limited benefits reported in some RCTs may be accounted for by the absence of a biological link of the tested molecule to NPS and also by key methodological issues. In recent RCTs of A/A, a great heterogeneity design was found. Designing trials for dementia populations with NPS presents many challenges, including identification of appropriate participants for such trials, engagement and compliance of patients and caregivers in the trials and the choice of optimal outcome measures to demonstrate treatment effectiveness. The EU/US -CTAD Task Force, an international collaboration of investigators from academia, industry, non-profit foundations, and regulatory agencies met in Philadelphia on November 19, 2014 to address some of these challenges. Despite potential heterogeneity in clinical manifestations and neurobiology, agitation and aggression seems to be accepted as an entity for drug development. The field appears to be reaching a consensus in using both agitation and aggression (or other NPS)-specific quantitative measures plus a global rating of change for agitation outcomes based on clinician judgment as the main outcomes. PMID:26413494

Shear and mixing effects on cells in agitated microcarrier tissue culture reactors

NASA Technical Reports Server (NTRS)

Cherry, Robert S.; Papoutsakis, E. Terry

1987-01-01

Tissue cells are known to be sensitive to mechanical stresses imposed on them by agitation in bioreactors. The amount of agitation provided in a microcarrier or suspension bioreactor should be only enough to provide effective homogeneity. Three distinct flow regions can be identified in the reactor: bulk turbulent flow, bulk laminar flow and boundary-layer flows. Possible mechanisms of cell damage are examined by analyzing the motion of microcarriers or free cells relative to the surrounding fluid, to each other and to moving or stationary solid surfaces. The primary mechanisms of cell damage appear to result from: (1) direct interaction between microcarriers and turbulent eddies; (2) collisions between microcarriers in turbulent flow; and (3) collisions against the impeller or other stationary surfaces. If the smallest eddies of turbulent flow are of the same size as the microcarrier beads, they may cause high shear stresses on the cells. Eddies the size of the average interbead spacing may cause bead-bead collisions which damage cells. The severity of the collisions increases when the eddies are also of the same size as the beads. Impeller collisions occur when beads cannot avoid the impeller leading edge as it advances through the liquid. The implications of the results of this analysis on the design and operation of tissue culture reactors are discussed.

Hydrodynamic effects on cells in agitated tissue culture reactors

NASA Technical Reports Server (NTRS)

Cherry, R. S.; Papoutsakis, E. T.

1986-01-01

The mechanisms by which hydrodynamic forces can affect cells grown on microcarrier beads in agitated cell culture reactors were investigated by analyzing the motion of microcarriers relative to the surrounding fluid, to each other, and to moving or stationary solid surfaces. It was found that harmful effects on cell cultures that have been previously attributed to shear can be better explained as the effects of turbulence (of a size scale comparable to the microcarriers or the spacing between them) or collisions. The primary mechanisms of cell damage involve direct interaction between microcarriers and turbulent eddies, collisions between microcarriers in turbulent flow, and collisions against the impeller or other solid surfaces. The implications of these analytical results for the design of tissue culture reactors are discussed.

Effect of nature-based sounds' intervention on agitation, anxiety, and stress in patients under mechanical ventilator support: a randomised controlled trial.

PubMed

Saadatmand, Vahid; Rejeh, Nahid; Heravi-Karimooi, Majideh; Tadrisi, Sayed Davood; Zayeri, Farid; Vaismoradi, Mojtaba; Jasper, Melanie

2013-07-01

Few studies have been conducted to investigate the effect of nature-based sounds (N-BS) on agitation, anxiety level and physiological signs of stress in patients under mechanical ventilator support. Non-pharmacological nursing interventions such as N-BS can be less expensive and efficient ways to alleviate anxiety and adverse effects of sedative medications in patients under mechanical ventilator support. This study was conducted to identify the effect of the nature-based sounds' intervention on agitation, anxiety level and physiological stress responses in patients under mechanical ventilation support. A randomized placebo-controlled trial design was used to conduct this study. A total of 60 patients aged 18-65 years under mechanical ventilation support in an intensive care unit were randomly assigned to the control and experimental groups. The patients in the intervention group received 90 min of N-BS. Pleasant nature sounds were played to the patients using media players and headphones. Patients' physiological signs were taken immediately before the intervention and at the 30th, 60th, 90th minutes and 30 min after the procedure had finished. The physiological signs of stress assessed were heart rate, respiratory rate, and blood pressure. Data were collected over eight months from Oct 2011 to June 2012. Anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively. The experimental group had significantly lower systolic blood pressure, diastolic blood pressure, anxiety and agitation levels than the control group. These reductions increased progressively in the 30th, 60th, 90th minutes, and 30 min after the procedure had finished indicating a cumulative dose effect. N-BS can provide an effective method of decreasing potentially harmful physiological responses arising from anxiety in mechanically ventilated patients. Nurses can incorporate N-BS intervention as a non-pharmacologic intervention into the

A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia.

PubMed

van der Ploeg, Eva S; Eppingstall, Barbara; Camp, Cameron J; Runci, Susannah J; Taffe, John; O'Connor, Daniel W

2013-04-01

Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors that accompany dementia. The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation, affect, and engagement more than a relevant control condition. We conducted a randomized crossover trial in nine residential facilities in metropolitan Melbourne, Australia (n = 44). Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction. Participants were observed 30 minutes before, during, and after the sessions. The presence or absence of a selected physically non-aggressive behavior was noted in every minute, together with the predominant type of affect and engagement. Behavior counts fell considerably during both the Montessori and control sessions relative to beforehand. During Montessori activities, the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well. Participants with no fluency in English (all from non-English speaking backgrounds) showed a significantly larger reduction in agitation during the Montessori than control sessions. Our results show that even non-personalized social contact can assist in settling agitated residents. Tailoring activities to residents' needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility. Future studies could explore implementation by family members and volunteers to avoid demands on facilities' resources. Australian New Zealand Clinical Trials Registry - ACTRN12609000564257.

Modeling enzyme production with Aspergillus oryzae in pilot scale vessels with different agitation, aeration, and agitator types.

PubMed

Albaek, Mads O; Gernaey, Krist V; Hansen, Morten S; Stocks, Stuart M

2011-08-01

The purpose of this article is to demonstrate how a model can be constructed such that the progress of a submerged fed-batch fermentation of a filamentous fungus can be predicted with acceptable accuracy. The studied process was enzyme production with Aspergillus oryzae in 550 L pilot plant stirred tank reactors. Different conditions of agitation and aeration were employed as well as two different impeller geometries. The limiting factor for the productivity was oxygen supply to the fermentation broth, and the carbon substrate feed flow rate was controlled by the dissolved oxygen tension. In order to predict the available oxygen transfer in the system, the stoichiometry of the reaction equation including maintenance substrate consumption was first determined. Mainly based on the biomass concentration a viscosity prediction model was constructed, because rising viscosity of the fermentation broth due to hyphal growth of the fungus leads to significant lower mass transfer towards the end of the fermentation process. Each compartment of the model was shown to predict the experimental results well. The overall model can be used to predict key process parameters at varying fermentation conditions. Copyright © 2011 Wiley Periodicals, Inc.

Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

2013-01-01

We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

Time-dependent importance sampling in semiclassical initial value representation calculations for time correlation functions.

PubMed

Tao, Guohua; Miller, William H

2011-07-14

An efficient time-dependent importance sampling method is developed for the Monte Carlo calculation of time correlation functions via the initial value representation (IVR) of semiclassical (SC) theory. A prefactor-free time-dependent sampling function weights the importance of a trajectory based on the magnitude of its contribution to the time correlation function, and global trial moves are used to facilitate the efficient sampling the phase space of initial conditions. The method can be generally applied to sampling rare events efficiently while avoiding being trapped in a local region of the phase space. Results presented in the paper for two system-bath models demonstrate the efficiency of this new importance sampling method for full SC-IVR calculations.

Effects of asenapine on agitation and hostility in adults with acute manic or mixed episodes associated with bipolar I disorder.

PubMed

Citrome, Leslie; Landbloom, Ronald; Chang, Cheng-Tao; Earley, Willie

2017-01-01

Bipolar disorder is associated with an increased risk of aggression. However, effective management of hostility and/or agitation symptoms may prevent patients from becoming violent. This analysis investigated the efficacy of the antipsychotic asenapine on hostility and agitation in patients with bipolar I disorder. Data were pooled from three randomized, double-blind, placebo-controlled, Phase III trials of asenapine in adults with manic or mixed episodes of bipolar I disorder (NCT00159744, NCT00159796, and NCT00764478). Post hoc analyses assessed the changes from baseline to day 21 on the Young Mania Rating Scale (YMRS) and the Positive and Negative Syndrome Scale (PANSS) hostility-related item scores in asenapine- or placebo-treated patients with at least minimal or mild symptom severity and on the PANSS-excited component (PANSS-EC) total score in agitated patients. Changes were adjusted for improvements in overall mania symptoms to investigate direct effects on hostility. Significantly greater changes in favor of asenapine versus placebo were observed in YMRS hostility-related item scores (irritability: least squares mean difference [95% confidence interval] =-0.5 [-0.87, -0.22], P =0.001; disruptive-aggressive behavior: -0.7 [-0.99, -0.37], P <0.0001), PANSS hostility item score (-0.2 [-0.44, -0.04]; P =0.0181), and PANSS-EC total score (-1.4 [-2.4, -0.4]; P =0.0055). Changes in the YMRS disruptive-aggressive behavior score and the sum of the hostility-related items remained significant after adjusting for improvements in other YMRS item scores. Asenapine significantly reduced hostility and agitation in patients with bipolar I disorder; improvement was at least partially independent of overall improvement on mania symptoms.

The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial.

PubMed

Testad, Ingelin; Ballard, Clive; Brønnick, Kolbjørn; Aarsland, Dag

2010-01-01

Agitation is common in dementia and is associated with use of restraints and use of psychotropic drugs. The aim of this study was to determine whether an education and supervision intervention could reduce agitation and the use of restraints and antipsychotic drugs in nursing homes. Four Norwegian nursing homes were randomly allocated to receive either treatment as usual or an intervention consisting of a 2-day educational seminar and monthly group guidance for 6 months. One hundred forty-five residents with dementia (based on medical records and corroborated with a Functional Assessment Staging score >or= 4) completed baseline and 6-month intervention assessments and were included in the analyses. The co-primary outcome measures were the proportion of residents subject to interactional restraint and the severity of agitation using the Cohen-Mansfield Agitation Inventory (CMAI). Patients were assessed at baseline, immediately after completion of the intervention at 6 months, and 12 months after baseline. Comparison of change in the 2 groups was made using repeated-measures analysis of variance (CMAI) and Mann-Whitney test (restraints). The study was conducted from 2003 to 2004. The proportion of residents starting new restraint was lower in the intervention than in the control group at 6-month evaluation (P = .02), but no statistically significant differences were found at 12-month assessment (P = .57). The total CMAI score declined from baseline to 6 and 12 months' follow-up in the intervention homes compared to a small increase in the control homes (F2,176 = 3.46, P = .034). There were no statistically significant differences in use of antipsychotic drugs. A brief 2-day staff education program followed by continued monthly guidance was able both to improve quality of care by reducing the frequency of interactional restraints and to reduce severity of agitation. ©Copyright 2010 Physicians Postgraduate Press, Inc.

Comparison of the Effect of Thiopental Sodium with Midazolam-ketamine on Post-tonsillectomy Agitation in Children.

PubMed

Toliyat, Maryam; Zangoee, Maliheh; Ahrari, Shahnaz; Zangoee, Reza

2015-10-01

The aim of this study was to determine the effect of thiopental sodium with that of midazolam-ketamine on relieving agitation after tonsillectomy in children. In a clinical trial, 50 children aged 5-10 years, candidates for tonsillectomy, were randomly divided into two 25-member groups. In the first group, thiopental sodium 5mg/kg/IV, and in the second group combination of midazolam 0.01 mg/kg/IV and ketamine 1 mg/kg/IV were used to induce anesthesia. The level of sedation was assessed after surgery with the Ramsay scale. There were no significant differences between the two groups in terms of heart rate, arterial oxygen pressure (PO2), and duration of anesthesia. The Ramsay sedation score was significantly higher in the thiopental sodium group than in the midazolam-ketamine group (P=0.01). Thiopental sodium can be more effective than the combination of midazolam-ketamine for controlling agitation after tonsillectomy in children.

Influence of thermal agitation on the electric field induced precessional magnetization reversal with perpendicular easy axis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, Hongguang, E-mail: chenghg7932@gmail.com; Deng, Ning

2013-12-15

We investigated the influence of thermal agitation on the electric field induced precessional magnetization switching probability with perpendicular easy axis by solving the Fokker-Planck equation numerically with finite difference method. The calculated results show that the thermal agitation during the reversal process crucially influences the switching probability. The switching probability can be achieved is only determined by the thermal stability factor Δ of the free layer, it is independent on the device dimension, which is important for the high density device application. Ultra-low error rate down to the order of 10{sup −9} can be achieved for the device of thermalmore » stability factor Δ of 40. Low damping factor α material should be used for the free layer for high reliability device applications. These results exhibit potential of electric field induced precessional magnetization switching with perpendicular easy axis for ultra-low power, high speed and high density magnetic random access memory (MRAM) applications.« less

34 CFR 5.81 - Time for initiation of request for review.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PUBLIC PURSUANT TO PUB. L. 90-23 (Eff. until 7-14-10) Administrative Review § 5.81 Time for initiation of request for review. A person whose request has been denied may initiate a review by filing a request for... 34 Education 1 2010-07-01 2010-07-01 false Time for initiation of request for review. 5.81 Section...

Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia.

PubMed

Viscogliosi, Giovanni; Chiriac, Iulia Maria; Ettorre, Evaristo

2017-09-01

To assess efficacy and safety of citalopram compared to quetiapine and olanzapine for the treatment of agitation in patients with Alzheimer disease (AD). Longitudinal, 6-month study. Nursing home (NH). 75 NH residents with AD and agitation, randomized to citalopram (n = 25), quetiapine (n = 25), or olanzapine (n = 25). Changes in Neuropsychiatric Inventory (NPI) agitation subscale score and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC) were used to assess treatment efficacy. Participants were surveilled for adverse health outcomes. Citalopram treatment (30±5.8 mg/d) resulted in similar 6-month efficacy compared to both quetiapine (94.0±40.4 mg/d) and olanzapine (5.2±1.6 mg/d), lower occurrence of falls than olanzapine [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.68-0.97, P = .012], lower incidence of orthostatic hypotension than both quetiapine (OR = 0.80, 95% CI = 0.66-0.95, P = .032) and olanzapine (OR = 0.75, 95% CI = 0.69-0.91, P = .02), and less all-cause hospitalizations than both quetiapine (OR = 0.92, 95% CI = 0.88-0.95, P = .016) and olanzapine (OR = 0.78, 95% CI = 0.64-0.92, P = .004), after multiple adjustment for potentially confounding variables. No differences were observed for cognitive and functional decline, QTc prolongation, and infections. Citalopram resulted in similar efficacy and less adverse outcomes when compared to 2 atypical antipsychotics for treatment of agitation in NH residents with AD. Replication of these findings and assessment of long-term efficacy and safety of citalopram for treatment of neuropsychiatric symptoms in dementia are needed. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Micro acoustic resonant chambers for heating/agitating/mixing (MARCHAM)

NASA Astrophysics Data System (ADS)

Sherrit, Stewart; Noell, Aaron C.; Fisher, Anita M.; Takano, Nobuyuki; Grunthaner, Frank

2016-04-01

A variety of applications require the mixing and/or heating of a slurry made from a powder/fluid mixture. One of these applications, Sub Critical Water Extraction (SCWE), is a process where water and an environmental powder sample (sieved soil, drill cuttings, etc.) are heated in a sealed chamber to temperatures greater than 200 degrees Celsius by allowing the pressure to increase, but without reaching the critical point of water. At these temperatures, the ability of water to extract organics from solid particulate increases drastically. This paper describes the modeling and experimentation on the use of an acoustic resonant chamber which is part of an amino acid detection instrument called Astrobionibbler [Noell et al. 2014, 2015]. In this instrument we use acoustics to excite a fluid- solid fines mixture in different frequency/amplitude regimes to accomplish a variety of sample processing tasks. Driving the acoustic resonant chamber at lower frequencies can create circulation patterns in the fluid and mixes the liquid and fines, while driving the chamber at higher frequencies one can agitate the fluid and powder and create a suspension. If one then drives the chamber at high amplitude at resonance heating of the slurry occurs. In the mixing and agitating cell the particle levitation force depends on the relative densities and compressibility's of the particulate and fluid and on the kinetic and potential energy densities associated with the velocity and pressure fields [Glynne-Jones, Boltryk and Hill 2012] in the cell. When heating, the piezoelectric transducer and chamber is driven at high power in resonance where the solid/fines region is modelled as an acoustic transmission line with a large loss component. In this regime, heat is pumped into the solution/fines mixture and rapidly heats the sample. We have modeled the piezoelectric transducer/chamber/ sample using Mason's equivalent circuit. In order to assess the validity of the model we have built and

Simple and Reproducible Two-Stage Agitation Speed Control Strategy for Enhanced Triterpene Production by Lingzhi or Reishi Medicinal Mushrooms, Ganoderma lucidum ACCC G0119 (Higher Basidiomycetes) Based on Submerged Liquid Fermentation.

PubMed

Feng, Jie; Feng, Na; Yang, Yan; Liu, Fang; Zhang, Jingsong; Jia, Wei; Lin, Chi-Chung

2015-01-01

Triterpenes are important anticancer agents produced by batch submerged liquid fermentation, with the medicinal mushroom Ganoderma lucidum ACCC G0119, which was investigated under various dissolved oxygen levels by varying agitation speeds. Three kinetic parameters were analyzed: specific mycelial growth rate (μsmg), specific glucose consumption rate (qsgc), and specific triterpene production rate (qstp). High concentration, yield, and productivity of triterpenes were achieved by developing a simple and reproducible two-stage agitation speed control strategy. At the first 40 h, agitation speed was controlled at 150 rpm to obtain the quickest peak qstp for triterpene production, subsequently agitation speed was controlled at 100 rpm to maintain high qstp for high triterpene accumulation. The maximum concentration of triterpenes reached 0.086 g/l with the yield of 6.072 g/kg and the productivity of 6.532 × 10-4 g/(l·h), which were 39.61%, 36.48%, and 49.22%, respectively, better than the best results controlled by fixed agitation speeds. Conceivably, such a triterpene fermentation production strategy would be useful for industrial large-scale production of triterpenes with G. lucidum.

[Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

PubMed

Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

2017-12-01

To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups. As an anesthetic used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable

The effects of nutrient concentration, addition of thickeners, and agitation speed on liquid fermentation of Steinernema feltiae

USDA-ARS?s Scientific Manuscript database

Therefore, this study was aimed at developing a more suitable liquid media for mass production of Steinernema feltiae, by assessing the effects of nutrient concentration, media viscosity, and agitation speed on infective juvenile (IJ) yield. For all the experiments, the base medium contained yeast ...

Evidence for an agitated-aggressive syndrome in early-onset psychosis correlated with antisocial personality disorder, forensic history, and substance use disorder.

PubMed

Huber, Christian G; Hochstrasser, Lisa; Meister, Klara; Schimmelmann, Benno G; Lambert, Martin

2016-08-01

Agitation, aggression, and violence are increased in psychotic disorders. Additionally, an earlier age at onset may be associated with aggressive behavior. However, the relationship of age at onset, an agitated-aggressive syndrome as measured with the Positive And Negative Syndrome Scale for Schizophrenia - Excited Component (PANSS-EC), and its potential correlates in first-episode psychosis (FEP) has not been studied. This study assessed the association between age at onset, an agitated-aggressive syndrome, and its potential correlates in a prospective sample of 52 FEP patients with early-onset and adult-onset followed up for 12months. Twenty-six patients conformed to the criteria of early-onset psychosis. Early age at onset was associated with antisocial personality disorder (p=0.004; φc=0.39), a history of legal involvement (p=0.005; φc=0.39), and higher rates of lifetime substance use disorder (SUD; p=0.002; φc=0.42). Early-onset patients had significantly higher PANSS-EC scores over the course of observation (F(1,44.4)=5.39; p=0.025; d=0.656), but no significant group differences emerged for the remaining PANSS subscores. PANSS-EC scores were correlated positively with antisocial personality disorder and forensic history at 6weeks, 3months, 6months, and 12months, and with lifetime substance use disorder at 3months and 6months. Patients with early onset psychosis may have increased levels of agitation/aggressiveness, and, more likely, antisocial personality disorder, forensic history, and lifetime substance use disorder. These variables were linked to suicidality, aggressiveness, and involuntary treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

The Cost-Effectiveness of Using PARO, a Therapeutic Robotic Seal, to Reduce Agitation and Medication Use in Dementia: Findings from a Cluster-Randomized Controlled Trial.

PubMed

Mervin, Merehau C; Moyle, Wendy; Jones, Cindy; Murfield, Jenny; Draper, Brian; Beattie, Elizabeth; Shum, David H K; O'Dwyer, Siobhan; Thalib, Lukman

2018-01-09

To examine the within-trial costs and cost-effectiveness of using PARO, compared with a plush toy and usual care, for reducing agitation and medication use in people with dementia in long-term care. An economic evaluation, nested within a cluster-randomized controlled trial. Twenty-eight facilities in South-East Queensland, Australia. A total of 415 residents, all aged 60 years or older, with documented diagnoses of dementia. Facilities were randomized to 1 of 3 groups: PARO (individual, nonfacilitated 15-minute sessions, 3 afternoons per week for 10 weeks); plush toy (as per PARO but with artificial intelligence disabled); and usual care. The incremental cost per Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF) point averted from a provider's perspective. Australian New Zealand Clinical Trials Registry (BLINDED FOR REVIEW). For the within-trial costs, the PARO group was $50.47 more expensive per resident compared with usual care, whereas the plush toy group was $37.26 more expensive than usual care. There were no statistically significant between-group differences in agitation levels after the 10-week intervention. The point estimates of the incremental cost-effectiveness ratios were $13.01 for PARO and $12.85 for plush toy per CMAI-SF point averted relative to usual care. The plush toy used in this study offered marginally greater value for money than PARO in improving agitation. However, these costs are much lower than values estimated for psychosocial group activities and sensory interventions, suggesting that both a plush toy and the PARO are cost-effective psychosocial treatment options for agitation. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Pharmacological profile of essential oils derived from Lavandula angustifolia and Melissa officinalis with anti-agitation properties: focus on ligand-gated channels.

PubMed

Huang, Liping; Abuhamdah, Sawsan; Howes, Melanie-Jayne R; Dixon, Christine L; Elliot, Mark S J; Ballard, Clive; Holmes, Clive; Burns, Alistair; Perry, Elaine K; Francis, Paul T; Lees, George; Chazot, Paul L

2008-11-01

Both Melissa officinalis (Mo) and Lavandula angustifolia (La) essential oils have putative anti-agitation properties in humans, indicating common components with a depressant action in the central nervous system. A dual radioligand binding and electrophysiological study, focusing on a range of ligand-gated ion channels, was performed with a chemically validated essential oil derived from La, which has shown clinical benefit in treating agitation. La inhibited [35S] TBPS binding to the rat forebrain gamma aminobutyric acid (GABA)(A) receptor channel (apparent IC50 = 0.040 +/- 0.001 mg mL(-1)), but had no effect on N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) or nicotinic acetylcholine receptors. A 50:50 mixture of Mo and La essential oils inhibited [3H] flunitrazepam binding, whereas the individual oils had no significant effect. Electrophysiological analyses with rat cortical primary cultures demonstrated that La reversibly inhibited GABA-induced currents in a concentration-dependent manner (0.01-1 mg mL(-1)), whereas no inhibition of NMDA- or AMPA-induced currents was noted. La elicited a significant dose-dependent reduction in both inhibitory and excitatory transmission, with a net depressant effect on neurotransmission (in contrast to the classic GABA(A) antagonist picrotoxin which evoked profound epileptiform burst firing in these cells). These properties are similar to those recently reported for Mo. The anti-agitation effects in patients and the depressant effects of La we report in neural membranes in-vitro are unlikely to reflect a sedative interaction with any of the ionotropic receptors examined here. These data suggest that components common to the two oils are worthy of focus to identify the actives underlying the neuronal depressant and anti-agitation activities reported.

Use of Orally Disintegrating Olanzapine During Electroconvulsive Therapy for Prevention of Postictal Agitation.

PubMed

Hermida, Adriana P; Janjua, A Umair; Tang, Yilang; Syre, Sharyn R; Job, Gregory; McDonald, William M

2016-11-01

A major medical problem for patients undergoing electroconvulsive therapy (ECT) is the occurrence of postictal agitation (PIA). This phenomenon is associated with confusion and disorientation that can have severe clinical implications for the safety of the patient and health care professionals. Many different pharmacological strategies have been used to prevent PIA. We present data on 40 patients who suffered from PIA after a course of ECT and evaluate the prophylactic use of orally disintegrating olanzapine in the prevention of PIA in subsequent ECT treatments.

Methods for determining enzymatic activity comprising heating and agitation of closed volumes

DOEpatents

Thompson, David Neil; Henriksen, Emily DeCrescenzo; Reed, David William; Jensen, Jill Renee

2016-03-15

Methods for determining thermophilic enzymatic activity include heating a substrate solution in a plurality of closed volumes to a predetermined reaction temperature. Without opening the closed volumes, at least one enzyme is added, substantially simultaneously, to the closed volumes. At the predetermined reaction temperature, the closed volumes are agitated and then the activity of the at least one enzyme is determined. The methods are conducive for characterizing enzymes of high-temperature reactions, with insoluble substrates, with substrates and enzymes that do not readily intermix, and with low volumes of substrate and enzyme. Systems for characterizing the enzymes are also disclosed.

Variation in the management of hypothetical cases of acute agitation in Australasian emergency departments.

PubMed

Chan, Esther W; Taylor, David McD; Knott, Jonathan C; Kong, David C M

2011-02-01

To describe the prescribing practice of emergency medicine clinicians in the management of highly agitated patients and to identify perceived barriers to management and the gaps in training. We undertook an anonymous cross-sectional mail survey of the Australasian College for Emergency Medicine (ACEM) members (fellows and advanced trainees) between June and September 2009. A questionnaire including a case vignette of a hypothetical patient and three clinical scenarios was employed to ascertain prescribing practice and assess perceived barriers to management, confidence and the perceived usefulness of existing and future Clinical Practice Guidelines (CPGs). All 2052 ACEM members were surveyed. However, seven had incorrect postal addresses and could not be reached. Of the remaining 2045, 786/2052 (38.3%, 95% CI 36.2-40.5) responses were received. Of the 786 respondents, 783 were practicing clinicians. If monotherapy was chosen, 622/783 (79.4%, 95% CI 76.4-82.2) of respondents preferred midazolam to manage the common scenario where no history was available, followed by haloperidol 45/783 (5.8%, 95% CI 4.3-7.7) and olanzapine 38/783 (4.9%, 95% CI 3.5-6.7). Most respondents 500/783 (63.9%, 95% CI 60.4-67.2) would also administer another sedative (combination therapy). Important perceived barriers to agitation management included lack of both training (352/783 [45.0%, 95% CI 41.4-48.5]) and a national CPG (313/783 [40.0%, 95% CI 36.5-43.5]). Respondents were generally confident in all aspects of management, although relatively fewer trainees were confident in determining dosing. Institutional CPGs were considered most useful for 415/783 (53.0%, 95% CI 49.4-56.5) respondents. If an ACEM-endorsed CPG were to be developed in the future, 634/783 (81.0%, 95% CI 78.0-83.6) respondents would consider this useful. There is considerable variation in the management of hypothetical cases of acute agitation in Australasian EDs. Benzodiazepines and antipsychotics, either alone or in

A naturalistic comparison of the efficacy and safety of intramuscular olanzapine and intramuscular haloperidol in agitated elderly patients with schizophrenia

PubMed Central

Gen, Keishi; Takahashi, Yuki

2013-01-01

Objective: This study was a comparative investigation of the clinical efficacy and safety of intramuscular (IM) olanzapine and IM haloperidol in agitated elderly patients with schizophrenia at 2 hours postdose. Methods: The subjects were 23 inpatients who had been diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Their clinical symptoms were assessed using Positive and Negative Syndrome Scale Excited Component (PANSS-EC), PANSS and Agitation Calmness Evaluation Scale (ACES), and their safety were assessed using the Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) and laboratory tests. Results: The mean reduction from baseline on the PANSS-EC total score, the PANSS total score and the ACES score were significantly greater in the IM olanzapine injection group than in the IM haloperidol injection group. The mean changes from baseline on the AIMS score, the BARS score and the DIEPSS total score were significantly better in the IM olanzapine injection group than in the IM haloperidol injection group. No serious adverse events such as paralytic ileus, diabetic ketoacidosis, neuroleptic malignant syndrome or tardive dyskinesia occurred between the two groups. Conclusion: The results of this study suggest the possibility that agitated elderly patients may result in superior efficacy and safety after IM olanzapine without serious adverse events in comparison with IM haloperidol. PMID:24294484

Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations.

PubMed

Luauté, Jacques; Plantier, David; Wiart, Laurent; Tell, Laurence

2016-02-01

The agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis. The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and

Phytochemicals for taming agitated immune-endocrine-neural axis.

PubMed

Patel, Seema

2017-07-01

Homeostasis of immune-endocrine-neural axis is paramount for human health. If this axis gets agitated due to age, genetic variations, environmental exposures or lifestyle assaults, a cascade of adverse reactions occurs in human body. Cytokines, hormones and neurotransmitters, the effector molecules of this axis behave erratically, leading to a gamut of neural, endocrine, autoimmune, and metabolic diseases. Current panel of drugs can tackle some of them but not in a sustainable, benign way as a myriad of side effects, causal of them have been documented. In this context, phytochemicals, the secondary metabolites of plants seem beneficial. These bioactive constituents encompassing polyphenols, alkaloids, flavonoids, terpenoids, tannins, lignans, stilbenoids (resveratrol), saponins, polysaccharides, glycosides, and lectins etc. have been proven to exert antioxidant, anti-inflammatory, hypolipidemic, hypotensive, antidiabetic, anticancer, immunomodulatory, anti-allergic, analgesic, hepatoprotective, neuroprotective, dermatoprotective, and antimicrobial properties, among a litany of other biological effects. This review presents a holistic perspective of common afflictions resultant of immune-endocrine-neural axis disruption, and the phytochemicals capable of restoring their normalcy and mitigating the ailments. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Vaginal and Oral Sex Initiation Timing: A Focus on Gender and Race/Ethnicity.

PubMed

Holway, Giuseppina Valle

2015-07-01

Most previous studies on sexual initiation timing have examined its effects on a variety of subsequent outcomes without first examining the correlates and predictors of these timing categories. Studies that do exist often do not utilize samples through young adulthood, leading to a misclassified set of sexual timing categories. In addition, the literature does not adequately address the issues of oral sex timing. Therefore, the objectives of this study were 1) to explore age-cutoffs that mark the "normative" and "non-normative" entry into vaginal and oral sex among young women and men in the U.S., creating sexual four sexual initiation timing categories - "early," "normative," "late," and "inexperienced," and; 2) to examine the association between race/ethnicity and sexual initiation timing by gender. The National Longitudinal Study of Adolescent to Adult Health (Add Health) was used in both descriptive and multivariate contexts to determine the net association of gender and race/ethnicity with vaginal and oral sex initiation timing. Age-cutoffs for vaginal sex timing were similar for women and men, yet differed by gender for oral sex timing. Women were more likely than men to initiate vaginal sex (20% vs. 18%) and oral sex (19% vs. 16%) at an early age and less likely than men to initiate these behaviors at a late age (18% vs. 19% for vaginal sex, and 15% vs. 16% for oral sex). Although most respondents initiated these two behaviors by young adulthood, a considerable proportion remained inexperienced, with men more likely than women to report inexperience with vaginal sex (7% vs. 5%), and women more likely than men to report abstaining from oral sex (8% vs. 6%). Race/ethnic differences in sexual initiation timing remained robust in the face of controls for both women and men. Understanding the timing at which adolescents and young adults transition to first vaginal and first oral sex is critical for sex education curriculum and policy makers.

Analysis of compaction initiation in human embryos by using time-lapse cinematography.

PubMed

Iwata, Kyoko; Yumoto, Keitaro; Sugishima, Minako; Mizoguchi, Chizuru; Kai, Yoshiteru; Iba, Yumiko; Mio, Yasuyuki

2014-04-01

To analyze the initiation of compaction in human embryos in vitro by using time-lapse cinematography (TLC), with the goal of determining the precise timing of compaction and clarifying the morphological changes underlying the compaction process. One hundred and fifteen embryos donated by couples with no further need for embryo-transfer were used in this study. Donated embryos were thawed and processed, and then their morphological behavior during the initiation of compaction was dynamically observed via time-lapse cinematography (TLC) for 5 days. Although the initiation of compaction occurred throughout the period from the 4-cell to 16-cell stage, 99 (86.1 %) embryos initiated compaction at the 8-cell stage or later, with initiation at the 8-cell stage being most frequent (22.6 %). Of these 99 embryos, 49.5 % developed into good-quality blastocysts. In contrast, of the 16 (13.9 %) embryos that initiated compaction prior to the 8-cell stage, only 18.8 % developed into good-quality blastocysts. Embryos that initiated compaction before the 8-cell stage showed significantly higher numbers of multinucleated blastomeres, due to asynchronism in nuclear division at the third mitotic division resulting from cytokinetic failure. The initiation of compaction primarily occurs at the third mitotic division or later in human embryos. Embryos that initiate compaction before the 8-cell stage are usually associated with aberrant embryonic development (i.e., cytokinetic failure accompanied by karyokinesis).

Rationale and design of the PLACID study: a randomised trial comparing the efficacy and safety of inhaled loxapine versus IM aripiprazole in acutely agitated patients with schizophrenia or bipolar disorder.

PubMed

San, L; Estrada, G; Oudovenko, N; Vieta, E

2017-04-04

The management of acute agitation manifesting in patients with schizophrenia or bipolar disorder requires swift pharmacological intervention to provide rapid symptomatic relief and prevent escalation to aggression and violence. Antipsychotic medications are widely used in this setting and the availability of an inhaled formulation with deep lung absorption of the antipsychotic loxapine has the potential to deliver a faster onset of therapeutic effect than the available intramuscular formulations of antipsychotics. The efficacy of inhaled loxapine and the alternative antipsychotic aripiprazole delivered via intramuscular (IM) injection will be compared in the Phase IIIb PLACID study. Adults (18-65 years) with a confirmed diagnosis of schizophrenia or bipolar I disorder presenting with acute agitation will be randomly assigned to open-label treatment in a 1:1 ratio. Clinical evaluation will be conducted by raters blinded to treatment assignment. The primary efficacy endpoint is time to response (defined as a Clinical Global Impression of Improvement [CGI-I] score of 1 [very much improved] or 2 [much improved]). Secondary endpoints will include the percentage of responders at different time points after dosing; the proportion of patients who receive 1 or 2 doses of study drug; time to second dose; time to rescue medication; satisfaction with study drug (evaluated using Item 14 of the Treatment Satisfaction Questionnaire for Medication); and safety and tolerability. Approximately 360 patients will be recruited with an interim analysis conducted once 180 patients have completed the study to decide whether to stop for futility or continue with or without an increase in the sample size up to additional 288 patients. The PLACID trial will assess the efficacy and safety of inhaled loxapine with deep lung absorption compared with the IM antipsychotic, aripiprazole, in acutely agitated patients with schizophrenia or bipolar disorder. In the event that the median time to

The potential of volunteers to implement non-pharmacological interventions to reduce agitation associated with dementia in nursing home residents.

PubMed

van der Ploeg, Eva S; Mbakile, Tapiwa; Genovesi, Sandra; O'Connor, Daniel W

2012-11-01

Advanced dementia may be accompanied by behavioral and psychological symptoms of dementia (BPSD). BPSD stemming from pain, depression, or psychosis benefit from treatment with drugs, but in other cases, medications have limited efficacy and may elicit adverse effects. Therefore, more attention has been paid to non-pharmacological interventions, which have fewer risks and can be successful in reducing agitation and negative mood. However, these interventions are frequently not implemented in nursing homes due to staffing constraints. This study explores the potential of volunteers to further assist staff. We interviewed 18 staff members and 39 volunteers in 17 aged care facilities in southeast Melbourne, Australia. Three-quarters of the facilities in this region worked with at least one regular volunteer. Both self-interest and altruistic reasons were identified as motives for volunteering. Volunteers were perceived by facility representatives as helpful to residents through provision of stimulation and company. However, they were discouraged from engaging with individuals with prominent BPSD. A majority of facility representatives and volunteers had experienced some difficulties in negotiating working relationships but most were easily resolved. A large majority of volunteers expressed an interest in learning new methods of interacting with residents. Despite their beneficial effects for agitated residents, non-pharmacological interventions are often not implemented in aged care facilities. Staff members often lack time but current volunteers in the sector are available, experienced, and interested in learning new methods of interacting. Volunteers therefore potentially are a valuable resource to assist with the application of new treatments.

A case of acute agitation with a negative urine drug screen: a new wave of "legal" drugs of abuse.

PubMed

Kadaria, Dipen; Sinclair, Scott E

2012-10-01

Substance abuse is reportedly the most common cause of patients presenting with severe agitation in the emergency department. With increased access to information, people are now trying different substances for recreational use. Clinicians dealing with these patients have an increased responsibility to be aware of these new substances being abused and their management. We report a case of a 36-year-old male who was brought to the ED with severe agitation. His laboratory results, including urine drug screen, failed to suggest any substance abuse, infection or encephalopathy. Later he was found to have ingested "bath salts," which are available for purchase in gas stations and convenience stores. The patient was treated and discharged home in stable condition. We aim to raise awareness among public and medical personnel, especially physicians, about this new substance of abuse as it is not illegal yet in many states.

High-quality fiber fabrication in buffered hydrofluoric acid solution with ultrasonic agitation.

PubMed

Zhong, Nianbing; Liao, Qiang; Zhu, Xun; Wang, Yongzhong; Chen, Rong

2013-03-01

An etching method for preparing high-quality fiber-optic sensors using a buffered etchant with ultrasonic agitation is proposed. The effects of etching conditions on the etch rate and surface morphology of the etched fibers are investigated. The effect of surface roughness is discussed on the fibers' optical properties. Linear etching behavior and a smooth fiber surface can be repeatedly obtained by adjusting the ultrasonic power and etchant pH. The fibers' spectral quality is improved as the ratio of the pit depth to size decreases, and the fibers with smooth surfaces are more sensitive to a bacterial suspension than those with rough surfaces.

Using the knowledge-to-action framework to guide the timing of dialysis initiation.

PubMed

Sood, Manish M; Manns, Braden; Nesrallah, Gihad

2014-05-01

The optimal time at which to initiate chronic dialysis remains unknown. Using a contemporary knowledge translation approach (the knowledge-to-action framework), a pan-Canadian collaboration (CANN-NET) set out to study the scope of the problem, then develop and disseminate evidence-based guidelines addressing the timing of dialysis initiation. The purpose of this review is to summarize the key findings and describe the planned Canadian knowledge translation strategy for improving knowledge and practices pertaining to the timing dialysis initiation. New research has provided considerable insights regarding the initiation of dialysis. A Canadian cohort study identified significant variation in the estimated glomerular filtration rate level at dialysis initiation, and a survey of providers identified related knowledge gaps that might be amenable to knowledge translation interventions. A recent knowledge synthesis/guideline concluded that early dialysis initiation is costly, and provides no measureable clinical benefits. A systematic knowledge translation intervention including a multifaceted approach may aid in reducing variation in practice and improving the quality of care. Utilizing the knowledge-to-action framework, we identified practice variation and key barriers to the optimal timing for dialysis initiation that may be amenable to knowledge translation strategies.

Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

PubMed Central

Geng, Wujun; Hong, Wandong; Wang, Junlu; Dai, Qinxue; Mo, Yunchang; Shi, Kejian; Sun, Jiehao; Qin, Jinling; Li, Mei; Tang, Hongli

2015-01-01

Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery. PMID:26273138

Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery.

PubMed

Geng, Wujun; Hong, Wandong; Wang, Junlu; Dai, Qinxue; Mo, Yunchang; Shi, Kejian; Sun, Jiehao; Qin, Jinling; Li, Mei; Tang, Hongli

2015-01-01

Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.

Timing of the initiation of parenteral nutrition in critically ill children.

PubMed

Jimenez, Lissette; Mehta, Nilesh M; Duggan, Christopher P

2017-05-01

To review the current literature evaluating clinical outcomes of early and delayed parenteral nutrition initiation among critically ill children. Nutritional management remains an important aspect of care among the critically ill, with enteral nutrition generally preferred. However, inability to advance enteral feeds to caloric goals and contraindications to enteral nutrition often leads to reliance on parenteral nutrition. The timing of parenteral nutrition initiation is varied among critically ill children, and derives from an assessment of nutritional status, energy requirements, and physiologic differences between adults and children, including higher nutrient needs and lower body reserves. A recent randomized control study among critically ill children suggests improved clinical outcomes with avoiding initiation of parenteral nutrition on day 1 of admission to the pediatric ICU. Although there is no consensus on the optimal timing of parenteral nutrition initiation among critically ill children, recent literature does not support the immediate initiation of parenteral nutrition on pediatric ICU admission. A common theme in the reviewed literature highlights the importance of accurate assessment of nutritional status and energy expenditure in deciding when to initiate parenteral nutrition. As with all medical interventions, the initiation of parenteral nutrition should be considered in light of the known benefits of judiciously provided nutritional support with the known risks of artificial, parenteral feeding.

Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).

PubMed

Ely, E Wesley; Truman, Brenda; Shintani, Ayumi; Thomason, Jason W W; Wheeler, Arthur P; Gordon, Sharon; Francis, Joseph; Speroff, Theodore; Gautam, Shiva; Margolin, Richard; Sessler, Curtis N; Dittus, Robert S; Bernard, Gordon R

2003-06-11

Goal-directed delivery of sedative and analgesic medications is recommended as standard care in intensive care units (ICUs) because of the impact these medications have on ventilator weaning and ICU length of stay, but few of the available sedation scales have been appropriately tested for reliability and validity. To test the reliability and validity of the Richmond Agitation-Sedation Scale (RASS). Prospective cohort study. Adult medical and coronary ICUs of a university-based medical center. Thirty-eight medical ICU patients enrolled for reliability testing (46% receiving mechanical ventilation) from July 21, 1999, to September 7, 1999, and an independent cohort of 275 patients receiving mechanical ventilation were enrolled for validity testing from February 1, 2000, to May 3, 2001. Interrater reliability of the RASS, Glasgow Coma Scale (GCS), and Ramsay Scale (RS); validity of the RASS correlated with reference standard ratings, assessments of content of consciousness, GCS scores, doses of sedatives and analgesics, and bispectral electroencephalography. In 290-paired observations by nurses, results of both the RASS and RS demonstrated excellent interrater reliability (weighted kappa, 0.91 and 0.94, respectively), which were both superior to the GCS (weighted kappa, 0.64; P<.001 for both comparisons). Criterion validity was tested in 411-paired observations in the first 96 patients of the validation cohort, in whom the RASS showed significant differences between levels of consciousness (P<.001 for all) and correctly identified fluctuations within patients over time (P<.001). In addition, 5 methods were used to test the construct validity of the RASS, including correlation with an attention screening examination (r = 0.78, P<.001), GCS scores (r = 0.91, P<.001), quantity of different psychoactive medication dosages 8 hours prior to assessment (eg, lorazepam: r = - 0.31, P<.001), successful extubation (P =.07), and bispectral electroencephalography (r = 0.63, P

Meteorological factors and timing of the initiating event of human parturition

NASA Astrophysics Data System (ADS)

Hirsch, Emmet; Lim, Courtney; Dobrez, Deborah; Adams, Marci G.; Noble, William

2011-03-01

The aim of this study was to determine whether meteorological factors are associated with the timing of either onset of labor with intact membranes or rupture of membranes prior to labor—together referred to as `the initiating event' of parturition. All patients delivering at Evanston Hospital after spontaneous labor or rupture of membranes at ≥20 weeks of gestation over a 6-month period were studied. Logistic regression models of the initiating event of parturition using clinical variables (maternal age, gestational age, parity, multiple gestation and intrauterine infection) with and without the addition of meteorological variables (barometric pressure, temperature and humidity) were compared. A total of 1,088 patients met the inclusion criteria. Gestational age, multiple gestation and chorioamnionitis were associated with timing of initiation of parturition ( P < 0.01). The addition of meteorological to clinical variables generated a statistically significant improvement in prediction of the initiating event; however, the magnitude of this improvement was small (less than 2% difference in receiver-operating characteristic score). These observations held regardless of parity, fetal number and gestational age. Meteorological factors are associated with the timing of parturition, but the magnitude of this association is small.

The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit.

PubMed

Staal, Jason A; Sacks, Amanda; Matheis, Robert; Collier, Lesley; Calia, Tina; Hanif, Henry; Kofman, Eugene S

2007-01-01

A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone.

Timing of the initiation of parenteral nutrition in critically ill children

PubMed Central

Jimenez, Lissette; Mehta, Nilesh M.; Duggan, Christopher

2018-01-01

Purpose of Review To review the current literature evaluating clinical outcomes of early and delayed parenteral nutrition initiation among critically ill children. Recent Findings Nutritional management remains an important aspect of care among the critically ill, with enteral nutrition (EN) generally preferred. However, inability to advance enteral feeds to caloric goals and contraindications to EN often leads to reliance on parenteral nutrition (PN). The timing of PN initiation is varied among critically ill children, and derives from an assessment of nutritional status, energy requirements, and physiologic differences between adults and children, including higher nutrient needs and lower body reserves. A recent randomized control study among critically ill children suggests improved clinical outcomes with postponing initiation of PN to 1 week after admission to the pediatric intensive care unit (PICU). Summary Although there is no consensus on the optimal timing of PN initiation among critically ill children, recent literature does not support the immediate initiation of PN on PICU admission. A common theme in the reviewed literature highlights the importance of accurate assessment of nutritional status and energy expenditure in deciding when to initiate PN. As with all medical interventions, the initiation of PN should be considered in light of the known benefits of judiciously provided nutritional support with the known risks of artificial, parenteral feeding. PMID:28376054

Time-invariant discord: high temperature limit and initial environmental correlations

NASA Astrophysics Data System (ADS)

Tabesh, F. T.; Karpat, G.; Maniscalco, S.; Salimi, S.; Khorashad, A. S.

2018-04-01

We present a thorough investigation of the phenomena of frozen and time-invariant quantum discord for two-qubit systems independently interacting with local reservoirs. Our work takes into account several significant effects present in decoherence models, which have not been yet explored in the context of time-invariant quantum discord, but which in fact must be typically considered in almost all realistic models. Firstly, we study the combined influence of dephasing, dissipation and heating reservoirs at finite temperature. Contrarily to previous claims in the literature, we show the existence of time-invariant discord at high temperature limit in the weak coupling regime and also examine the effect of thermal photons on the dynamical behavior of frozen discord. Secondly, we explore the consequences of having initial correlations between the dephasing reservoirs. We demonstrate in detail how the time-invariant discord is modified depending on the relevant system parameters such as the strength of the initial amount of entanglement between the reservoirs.

Reducing fischer-tropsch catalyst attrition losses in high agitation reaction systems

DOEpatents

Singleton, Alan H.; Oukaci, Rachid; Goodwin, James G.

2001-01-01

A method for reducing catalyst attrition losses in hydrocarbon synthesis processes conducted in high agitation reaction systems; a method of producing an attrition-resistant catalyst; a catalyst produced by such method; a method of producing an attrition-resistant catalyst support; and a catalyst support produced by such method. The inventive method of reducing catalyst attrition losses comprises the step of reacting a synthesis gas in a high agitation reaction system in the presence of a catalyst. In one aspect, the catalyst preferably comprises a .gamma.-alumina support including an amount of titanium effective for increasing the attrition resistance of the catalyst. In another aspect, the catalyst preferably comprises a .gamma.-alumina support which has been treated, after calcination, with an acidic, aqueous solution. The acidic aqueous solution preferably has a pH of not more than about 5. In another aspect, the catalyst preferably comprises cobalt on a .gamma.-alumina support wherein the cobalt has been applied to the .gamma.-alumina support by totally aqueous, incipient wetness-type impregnation. In another aspect, the catalyst preferably comprises cobalt on a .gamma.-alumina support with an amount of a lanthana promoter effective for increasing the attrition resistance of the catalyst. In another aspect, the catalyst preferably comprises a .gamma.-alumina support produced from boehmite having a crystallite size, in the 021 plane, in the range of from about 30 to about 55 .ANG.ngstrons. In another aspect, the inventive method of producing an attrition-resistant catalyst comprises the step of treating a .gamma.-alumina support, after calcination of and before adding catalytic material to the support, with an acidic solution effective for increasing the attrition resistance of the catalyst. In another aspect, the inventive method of producing an attrition-resistant catalyst support comprises the step of treating calcined .gamma.-alumina with an acidic, aqueous

75 FR 31763 - Enhanced Examination Timing Control Initiative; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

...] Enhanced Examination Timing Control Initiative; Notice of Public Meeting AGENCY: United States Patent and...: This notice announces a public meeting to solicit public opinions on an initiative being considered by.... Under the initiative, for applications filed in the USPTO that are not based on a prior foreign- filed...

Experimental study on agitated drying characteristics of sewage sludge under the effects of different additive agents.

PubMed

Deng, Wenyi; Su, Yaxin

2014-07-01

Drying experiments of dewatered sewage sludge (DSS) were conducted on a agitated paddle dryer, and the effects of additive agents, i.e., CaO, pulverized coal (PC), heavy oil (HO), and dried sludge ("DS" through back mixing) on the agitated drying characteristics of DSS were investigated. The results indicated that CaO can significantly increase the drying rate of DSS. The drying rate at CaO/DSS (mass ratio)=1/100 was 135% higher than that of CaO/DSS=0. Pulverized coal has no obvious effect on drying rate, but the increase of PC/DSS can promote breaking up of sludge lump. Heavy oil was found to be slightly effective in improving the drying rate of DSS in the examined experimental range of HO/DSS=0-1/20. It is also found that HO can reduce the torque of the dryer shaft, due to its lubrication effect. Back mixing of DS was found to be effective in alleviating the unfavorable effect of the lumpy phase by improving the mixing effect of the paddle dryer. There was a marked increase of drying rate with an increase of the DS/DSS in the experimental range of DS/DSS=0-1/3. Copyright © 2014. Published by Elsevier B.V.

Mesoscale Simulation Data for Initializing Fast-Time Wake Transport and Decay Models

NASA Technical Reports Server (NTRS)

Ahmad, Nashat N.; Proctor, Fred H.; Vanvalkenburg, Randal L.; Pruis, Mathew J.; LimonDuparcmeur, Fanny M.

2012-01-01

The fast-time wake transport and decay models require vertical profiles of crosswinds, potential temperature and the eddy dissipation rate as initial conditions. These inputs are normally obtained from various field sensors. In case of data-denied scenarios or operational use, these initial conditions can be provided by mesoscale model simulations. In this study, the vertical profiles of potential temperature from a mesoscale model were used as initial conditions for the fast-time wake models. The mesoscale model simulations were compared against available observations and the wake model predictions were compared with the Lidar measurements from three wake vortex field experiments.

The Cost of Increasing In-School Time: Evidence from the Massachusetts Expanded Learning Time Initiative

ERIC Educational Resources Information Center

Kolbe, Tammy; O'Reilly, Fran

2017-01-01

A growing number of public schools have adopted reforms that increase the amount of time students spend in school. However, the potential costs of such reforms are not well understood. In this article, we report findings from a resource-cost study conducted in four schools that participated in the Massachusetts Expanded Learning Time Initiative.…

Massachusetts Expanded Learning Time (ELT) Initiative. Case Studies 2010-2011

ERIC Educational Resources Information Center

Caven, Meghan; Checkoway, Amy; Fisman, Lianne; Gamse, Beth; Fountain, Alyssa Rulf

2012-01-01

The Massachusetts Expanded Learning Time (ELT) initiative was launched in 2005, and it provides grants to selected schools across multiple districts to increase instructional time by at least 300 hours per academic year. Participating schools receive an additional $1,300 per student to lengthen the day and/or year. Schools are expected to use the…

Alzheimer's Caregiver Support Online: lessons learned, initial findings and future directions.

PubMed

Glueckauf, Robert L; Loomis, Jeffrey S

2003-01-01

Family caregivers of older adults with progressive dementia (e.g., Alzheimer's disease) are faced with a variety of emotional and behavioral difficulties, such as dealing with persistent, repetitive questions, managing agitation and depression, and monitoring hygiene and self-care activities. Although professional and governmental organizations have called for the creation of community-based education and support programs, most dementia caregivers continue to receive little or no formal instruction in responding effectively to these challenges. The current paper describes the development and implementation of Alzheimer's Caregiver Support Online, a Web- and telephone-based education and support network for caregivers of individuals with progressive dementia. Lessons learned from the first two years of this state-supported initiative are discussed, followed by the findings of a Robert Wood Johnson Foundation-funded strategic marketing initiative and an initial program evaluation of AlzOnline's Positive Caregiving classes. Finally, clinical implications and future directions for program development and evaluation research are proposed.

Barriers and Facilitators to Initiating and Completing Time-Limited Trials in Critical Care.

PubMed

Bruce, Courtenay R; Liang, Cecilia; Blumenthal-Barby, Jennifer S; Zimmerman, Janice; Downey, Andrea; Pham, Linda; Theriot, Lisette; Delgado, Estevan D; White, Douglas

2015-12-01

A time-limited trial is an agreement between clinicians and patients or surrogate decision makers to use medical therapies over a defined period of time to see if the patient improves or deteriorates according to agreed-upon clinical milestones. Although time-limited trials are broadly advocated, there is little empirical evidence of the benefits and risks of time-limited trials, when they are initiated, when and why they succeed or fail, and what facilitates completion of them. Our study objectives were to 1) identify the purposes for which clinicians use time-limited trials and 2) identify barriers and facilitators to initiating and completing time-limited trials. Semistructured interviews: We analyzed interviews using qualitative description with constant comparative techniques. Nine hundred-bed, academic, tertiary hospital in Houston, Texas. Interviewees were from open medical, surgical, neurosurgical, and cardiovascular ICUs. Thirty healthcare professionals were interviewed (nine surgeons, 16 intensivists, three nurse practitioners, and two "other" clinicians). None. Interviewees reported initiating time-limited trials for three different purposes: to prepare surrogates and clinicians for discussion and possible shifts toward comfort-care only therapies, build consensus, and refine prognostic information. The main barriers to initiating time-limited trials involve clinicians' or surrogate decision makers' disagreement on setting a time limit. Barriers to completing time-limited trials include 1) requesting more time; 2) communication breakdowns because of rotating call schedules; and 3) changes in clinical course. Finally, facilitators to completing time-limited trials include 1) having defined goals about what could be achieved during an ICU stay, either framed in narrow, numeric terms or broad goals focusing on achievable activities of daily living; 2) applying time-limited trials in certain types of cases; and 3) taking ownership to ensure completion of the

An in vitro evaluation of passive ultrasonic agitation of different irrigants on smear layer removal after post space preparation: a scanning electron microscopic study.

PubMed

Srirekha, A; Rashmi, K; Hegde, Jayshree; Lekha, S; Rupali, K; Reshmi, George

2013-09-01

This study evaluated the removal of debris and smear layer after post space preparation using different irrigations and passive ultrasonic agitation. Sixty human premolars were decoronated and post space prepared after endodontic therapy. The samples were then randomly divided into three experimental groups (Groups A, B, C) and one control group (Group D) with fifteen samples in each group. Groups A and B samples were treated with 10 % citric acid and 17 % ethylenediamintetraacetic acid (EDTA), respectively and passive ultrasonic agitation was done, rinsed with sodium hypochlorite and finally flushed with saline. Group C samples were conditioned with 36 % phosphoric acid and then rinsed with saline. The control group was treated with 3 % sodium hypochlorite, passive ultrasonic agitation done and flushed with saline. The samples were sectioned and evaluated for debris and smear layer removal under scanning electron microscope. 10 % citric acid showed the best removal of smear layer when compared with 17 % EDTA and 36 % phosphoric acid, but was not statistically significant (p > 0.05). The difference in scoring for debris and smear layer removal in the coronal, middle and apical third of post space of experimental groups in comparison with control group was statistically significant (p < 0.001).

Time-dependent importance sampling in semiclassical initial value representation calculations for time correlation functions. II. A simplified implementation.

PubMed

Tao, Guohua; Miller, William H

2012-09-28

An efficient time-dependent (TD) Monte Carlo (MC) importance sampling method has recently been developed [G. Tao and W. H. Miller, J. Chem. Phys. 135, 024104 (2011)] for the evaluation of time correlation functions using the semiclassical (SC) initial value representation (IVR) methodology. In this TD-SC-IVR method, the MC sampling uses information from both time-evolved phase points as well as their initial values, and only the "important" trajectories are sampled frequently. Even though the TD-SC-IVR was shown in some benchmark examples to be much more efficient than the traditional time-independent sampling method (which uses only initial conditions), the calculation of the SC prefactor-which is computationally expensive, especially for large systems-is still required for accepted trajectories. In the present work, we present an approximate implementation of the TD-SC-IVR method that is completely prefactor-free; it gives the time correlation function as a classical-like magnitude function multiplied by a phase function. Application of this approach to flux-flux correlation functions (which yield reaction rate constants) for the benchmark H + H(2) system shows very good agreement with exact quantum results. Limitations of the approximate approach are also discussed.

Turbulent flow in a vessel agitated by side entering inclined blade turbine with different diameter using CFD simulation

NASA Astrophysics Data System (ADS)

Fathonah, N. N.; Nurtono, T.; Kusdianto; Winardi, S.

2018-03-01

Single phase turbulent flow in a vessel agitated by side entering inclined blade turbine has simulated using CFD. The aim of this work is to identify the hydrodynamic characteristics of a model vessel, which geometrical configuration is adopted at industrial scale. The laboratory scale model vessel is a flat bottomed cylindrical tank agitated by side entering 4-blade inclined blade turbine with impeller rotational speed N=100-400 rpm. The effect of the impeller diameter on fluid flow pattern has been investigated. The fluid flow patterns in a vessel is essentially characterized by the phenomena of macro-instabilities, i.e. the flow patterns change with large scale in space and low frequency. The intensity of fluid flow in the tank increase with the increase of impeller rotational speed from 100, 200, 300, and 400 rpm. It was accompanied by shifting the position of the core of circulation flow away from impeller discharge stream and approached the front of the tank wall. The intensity of fluid flow in the vessel increase with the increase of the impeller diameter from d=3 cm to d=4 cm.

Using TANF to Finance Out-of-School Time Initiatives

ERIC Educational Resources Information Center

Relave, Nanette; Flynn-Khan, Margaret

2007-01-01

This report addresses how the Temporary Assistance for Needy Families (TANF) program can be an important source of funding for maintaining, improving, and expanding out-of-school time initiatives. The report is designed to help policymakers and program developers understand the opportunities and challenges of effectively using TANF funding to…

Effect of ultrasonic agitation on push-out bond strength and adaptation of root-end filling materials

PubMed Central

2018-01-01

Objectives This study evaluated the effect of ultrasonic agitation of mineral trioxide aggregate (MTA), calcium silicate-based cement (CSC), and Sealer 26 (S26) on adaptation at the cement/dentin interface and push-out bond strength. Materials and Methods Sixty maxillary canines were divided into 6 groups (n = 10): MTA, S26, and CSC, with or without ultrasonic activation (US). After obturation, the apical portions of the teeth were sectioned, and retrograde cavities were prepared and filled with cement by hand condensation. In the US groups, the cement was activated for 60 seconds: 30 seconds in the mesio-distal direction and 30 seconds in the buccal-lingual direction, using a mini Irrisonic insert coupled with the ultrasound transducer. After the materials set, 1.5-mm thick sections were obtained from the apexes. The presence of gaps and the bond between cement and dentin were analyzed using low-vacuum scanning electron microscopy. Push-out bond strength was measured using a universal testing machine. Results Ultrasonic agitation increased the interfacial adaptation of the cements. The S26 US group showed a higher adaptation value than MTA (p < 0.05). US improved the push-out bond strength for all the cements (p < 0.05). Conclusions The US of retrograde filling cements enhanced the bond to the dentin wall of the root-end filling materials tested. PMID:29765903

Effect of ultrasonic agitation on push-out bond strength and adaptation of root-end filling materials.

PubMed

Alcalde, Murilo Priori; Vivan, Rodrigo Ricci; Marciano, Marina Angélica; Duque, Jussaro Alves; Fernandes, Samuel Lucas; Rosseto, Mariana Bailo; Duarte, Marco Antonio Hungaro

2018-05-01

This study evaluated the effect of ultrasonic agitation of mineral trioxide aggregate (MTA), calcium silicate-based cement (CSC), and Sealer 26 (S26) on adaptation at the cement/dentin interface and push-out bond strength. Sixty maxillary canines were divided into 6 groups ( n = 10): MTA, S26, and CSC, with or without ultrasonic activation (US). After obturation, the apical portions of the teeth were sectioned, and retrograde cavities were prepared and filled with cement by hand condensation. In the US groups, the cement was activated for 60 seconds: 30 seconds in the mesio-distal direction and 30 seconds in the buccal-lingual direction, using a mini Irrisonic insert coupled with the ultrasound transducer. After the materials set, 1.5-mm thick sections were obtained from the apexes. The presence of gaps and the bond between cement and dentin were analyzed using low-vacuum scanning electron microscopy. Push-out bond strength was measured using a universal testing machine. Ultrasonic agitation increased the interfacial adaptation of the cements. The S26 US group showed a higher adaptation value than MTA ( p < 0.05). US improved the push-out bond strength for all the cements ( p < 0.05). The US of retrograde filling cements enhanced the bond to the dentin wall of the root-end filling materials tested.

Anxiety, irritability, and agitation as indicators of bipolar mania with depressive symptoms: a post hoc analysis of two clinical trials.

PubMed

Suppes, Trisha; Eberhard, Jonas; Lemming, Ole; Young, Allan H; McIntyre, Roger S

2017-11-06

Symptoms of anxiety, irritability, and agitation (AIA) are prevalent among patients with bipolar I disorder (BD-I) mania with depressive symptoms, and could potentially be used to aid physicians in the identification of this more severe form of BD-I. Using data from two clinical trials, the aims of this post hoc analysis were to describe the phenomenology of bipolar mania in terms of AIA and depressive symptoms, and to evaluate the influence of these symptoms on the likelihood of remission during treatment. Patients with a BD-I manic or mixed episode (Diagnostic and Statistical Manual of Mental Disorders IV criteria) were randomised to 3 weeks of double-blind treatment with asenapine, placebo, or olanzapine (active comparator). Anxiety was defined as a score of ≥3 on the Positive and Negative Syndrome Scale 'anxiety' item, irritability as a score of ≥4 on the Young Mania Rating Scale (YMRS) 'irritability' item, and agitation as a score of ≥3 on the YMRS 'increased motor activity-energy' item. Depressive symptoms were defined as a score of ≥1 on three or more individual Montgomery-Åsberg Depression Rating Scale (MADRS) items, or a MADRS Total score of ≥20. A total of 960 patients with BD-I were analysed, 665 with a manic episode and 295 with a mixed episode. At baseline, 61.4% had anxiety, 62.4% had irritability, 76.4% had agitation, and 34.0% had all three AIA symptoms ('severe AIA'); 47.3% had three or more depressive symptoms, and 13.5% had a MADRS total score of ≥20. Anxiety, irritability, and severe AIA (but not agitation) were statistically significantly more common in patients with depressive symptoms. Patients with anxiety or severe AIA at baseline were statistically significantly less likely to achieve remission (YMRS total <12). In general, remission rates were higher with asenapine and olanzapine than with placebo, irrespective of baseline AIA or depressive symptoms. Assessment of AIA symptoms in bipolar mania could enable physicians to

Changes in the timing of sexual initiation among young Muslim and Christian women in Nigeria.

PubMed

Agha, Sohail

2009-12-01

Sexual initiation during adolescence has important demographic and health consequences for a population, yet no systematic analysis of changes in the timing of sexual initiation has been conducted in Nigeria. Two rounds of national surveys conducted in 1990 and 2003 were used to examine changes in the timing of sexual initiation among female adolescents in Nigeria. Multivariate survival analysis using Cox proportional hazards models was used to assess changes in the risk of sexual initiation and to identify the correlates of first sex. Contrary to what has been reported in several Nigerian studies, there was no decline in age at first sex among Christian adolescents. Age at first sex did not change significantly for Christian adolescents, although premarital sex appears to have increased-primarily due to an increase in the age at marriage. Age at first sex did increase among Muslim women. Premarital sex remained low among Muslim women. A number of socioeconomic variables were associated with the timing of sexual initiation. Weekly exposure to the mass media was associated with earlier sexual initiation. The degree to which an environment was liberal or restrictive was a key determinant of the timing of sexual initiation in Nigeria. The findings also illustrate the important role of socioeconomic factors in determining the timing of sexual initiation in Nigeria. As secondary education increases in Northern Nigeria, additional increases in the age at sexual debut are likely among Muslim women. The study raises concerns about the influence of the mass media on the timing of first sex in Nigeria. The evidence of an absence of changes in the timing of sexual initiation among Christian women in more than a decade implies that programs which aim to delay the timing of sexual initiation in Southern Nigeria may have limited success. With age at marriage already high among Christian women, programs that focus on abstinence until marriage may also be pursuing an approach with

Effects of physical agitation on yield of greenhouse-grown soybean

NASA Technical Reports Server (NTRS)

Jones, R. S.; Mitchell, C. A.

1992-01-01

Agronomic and horticultural crop species experience reductions in growth and harvestable yield after exposure to physical agitation (also known as mechanical stress), as by wind or rain. A greenhouse study was conducted to test the influence of mechanical stress on soybean yield and to determine if exposure to mechanical stress during discrete growth periods has differential effects on seed yield. A modified rotatory shaker was used to apply seismic (i.e., shaking) stress. Brief, periodic episodes of seismic stress reduced stem length, total seed dry weight, and seed number of soybean [Glycine max (L.) Merr.]. Lodging resistance was greater for plants stressed during vegetative growth or throughout vegetative and reproductive growth than during reproductive growth only. Seed dry weight yield was reduced regardless of the timing or duration of stress application, but was lowest when applied during reproductive development. Seismic stress applied during reproductive growth stages R1 to R2 (Days 3 to 4) was as detrimental to seed dry weight accumulation as was stress applied during growth stages R1 to R6 (Days 39 to 42). Seed dry weight per plant was highly correlated with seed number per plant, and seed number was correlated with the seed number of two- and three-seeded pods. Dry weight per 100 seeds was unaffected by seismic-stress treatment. Growth and yield reductions resulting from treatments applied only during the vegetative stage imply that long-term mechanical effects were induced, from which the plants did not fully recover. It is unclear which yield-controlling physiological processes were affected by mechanical stress. Both transient and long-term effects on yield-controlling processes remain to be elucidated.

The influence of agitation on oil substrate dispersion and oxygen transfer in Pseudomonas aeruginosa USM-AR2 fermentation producing rhamnolipid in a stirred tank bioreactor.

PubMed

Nur Asshifa, M N; Zambry, Nor Syafirah; Salwa, M S; Yahya, Ahmad R M

2017-07-01

Water-immiscible substrate, diesel, was supplied as the main substrate in the fermentation of Pseudomonas aeruginosa USM-AR2 producing rhamnolipid biosurfactant, in a stirred tank bioreactor. In addition to the typical gas-aqueous system, this system includes gas-hydrocarbon-aqueous phases and the presence of surfactant (rhamnolipid) in the fermentation broth. The effect of diesel dispersion on volumetric oxygen transfer coefficient, k L a, and thus oxygen transfer, was evaluated at different agitations of 400, 500 and 600 rpm. The oxygen transfer in this oil-water-surfactant system was shown to be affected by different oil dispersion at those agitation rates. The highest diesel dispersion was obtained at 500 rpm or impeller tip speed of 1.31 m/s, compared to 400 and 600 rpm, which led to the highest k L a, growth and rhamnolipid production by P. aeruginosa USM-AR2. This showed the highest substrate mixing and homogenization at this agitation speed that led to the efficient substrate utilization by the cells. The oxygen uptake rate of P. aeruginosa USM-AR2 was 5.55 mmol/L/h, which showed that even the lowest k L a (48.21 h -1 ) and hence OTR (57.71 mmol/L/h) obtained at 400 rpm was sufficient to fulfill the oxygen demand of the cells. The effect of rhamnolipid concentration on k L a showed that k L a increased as rhamnolipid concentration increased to 0.6 g/L before reaching a plateau. This trend was similar for all agitation rates of 400, 500 and 600 rpm, which might be due to the increase in the resistance to oxygen transfer (k L decrease) and the increase in the specific interfacial area (a).

Drying process optimization for an API solvate using heat transfer model of an agitated filter dryer.

PubMed

Nere, Nandkishor K; Allen, Kimberley C; Marek, James C; Bordawekar, Shailendra V

2012-10-01

Drying an early stage active pharmaceutical ingredient candidate required excessively long cycle times in a pilot plant agitated filter dryer. The key to faster drying is to ensure sufficient heat transfer and minimize mass transfer limitations. Designing the right mixing protocol is of utmost importance to achieve efficient heat transfer. To this order, a composite model was developed for the removal of bound solvent that incorporates models for heat transfer and desolvation kinetics. The proposed heat transfer model differs from previously reported models in two respects: it accounts for the effects of a gas gap between the vessel wall and solids on the overall heat transfer coefficient, and headspace pressure on the mean free path length of the inert gas and thereby on the heat transfer between the vessel wall and the first layer of solids. A computational methodology was developed incorporating the effects of mixing and headspace pressure to simulate the drying profile using a modified model framework within the Dynochem software. A dryer operational protocol was designed based on the desolvation kinetics, thermal stability studies of wet and dry cake, and the understanding gained through model simulations, resulting in a multifold reduction in drying time. Copyright © 2012 Wiley-Liss, Inc.

77 FR 71200 - Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-29

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Initial Certification of Full-Time School...) 3206-0099, Initial Certification of Full-Time School Attendance. As required by the Paperwork Reduction... or faxed to (202) 395-6974. SUPPLEMENTARY INFORMATION: RI 25-41, Initial Certification of Full-Time...

77 FR 33007 - Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-04

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Initial Certification of Full-Time School...) 3206-0099, Initial Certification of Full-Time School Attendance. As required by the Paperwork Reduction..., Initial Certification of Full-Time School Attendance, is used to determine whether a child is unmarried...

Fermentative and growth performances of Dekkera bruxellensis in different batch systems and the effect of initial low cell counts in co-cultures with Saccharomyces cerevisiae.

PubMed

Meneghin, Maria Cristina; Bassi, Ana Paula Guarnieri; Codato, Carolina Brito; Reis, Vanda Renata; Ceccato-Antonini, Sandra Regina

2013-08-01

Dekkera bruxellensis is a multifaceted yeast present in the fermentative processes used for alcoholic beverage and fuel alcohol production - in the latter, normally regarded as a contaminant. We evaluated the fermentation and growth performance of a strain isolated from water in an alcohol-producing unit, in batch systems with/without cell recycling in pure and co-cultures with Saccharomyces cerevisiae. The ethanol resistance and aeration dependence for ethanol/acid production were verified. Ethanol had an effect on the growth of D. bruxellensis in that it lowered or inhibited growth depending on the concentration. Acid production was verified in agitated cultures either with glucose or sucrose, but more ethanol was produced with glucose in agitated cultures. Regardless of the batch system, low sugar consumption and alcohol production and expressive growth were found with D. bruxellensis. Despite a similar ethanol yield compared to S. cerevisiae in the batch system without cell recycling, ethanol productivity was approximately four times lower. However, with cell recycling, ethanol yield was almost half that of S. cerevisiae. At initial low cell counts of D. bruxellensis (10 and 1000 cells/ml) in co-cultures with S. cerevisiae, a decrease in fermentative efficiency and a substantial growth throughout the fermentative cycles were displayed by D. bruxellensis. Due to the peculiarity of cell repitching in Brazilian fermentation processes, D. bruxellensis is able to establish itself in the process, even when present in low numbers initially, substantially impairing bioethanol production due to the low ethanol productivity, in spite of comparable ethanol yields. Copyright © 2013 John Wiley & Sons, Ltd.

Co-state initialization for the minimum-time low-thrust trajectory optimization

NASA Astrophysics Data System (ADS)

Taheri, Ehsan; Li, Nan I.; Kolmanovsky, Ilya

2017-05-01

This paper presents an approach for co-state initialization which is a critical step in solving minimum-time low-thrust trajectory optimization problems using indirect optimal control numerical methods. Indirect methods used in determining the optimal space trajectories typically result in two-point boundary-value problems and are solved by single- or multiple-shooting numerical methods. Accurate initialization of the co-state variables facilitates the numerical convergence of iterative boundary value problem solvers. In this paper, we propose a method which exploits the trajectory generated by the so-called pseudo-equinoctial and three-dimensional finite Fourier series shape-based methods to estimate the initial values of the co-states. The performance of the approach for two interplanetary rendezvous missions from Earth to Mars and from Earth to asteroid Dionysus is compared against three other approaches which, respectively, exploit random initialization of co-states, adjoint-control transformation and a standard genetic algorithm. The results indicate that by using our proposed approach the percent of the converged cases is higher for trajectories with higher number of revolutions while the computation time is lower. These features are advantageous for broad trajectory search in the preliminary phase of mission designs.

Self-similar space-time evolution of an initial density discontinuity

NASA Astrophysics Data System (ADS)

Rekaa, V. L.; Pécseli, H. L.; Trulsen, J. K.

2013-07-01

The space-time evolution of an initial step-like plasma density variation is studied. We give particular attention to formulate the problem in a way that opens for the possibility of realizing the conditions experimentally. After a short transient time interval of the order of the electron plasma period, the solution is self-similar as illustrated by a video where the space-time evolution is reduced to be a function of the ratio x/t. Solutions of this form are usually found for problems without characteristic length and time scales, in our case the quasi-neutral limit. By introducing ion collisions with neutrals into the numerical analysis, we introduce a length scale, the collisional mean free path. We study the breakdown of the self-similarity of the solution as the mean free path is made shorter than the system length. Analytical results are presented for charge exchange collisions, demonstrating a short time collisionless evolution with an ensuing long time diffusive relaxation of the initial perturbation. For large times, we find a diffusion equation as the limiting analytical form for a charge-exchange collisional plasma, with a diffusion coefficient defined as the square of the ion sound speed divided by the (constant) ion collision frequency. The ion-neutral collision frequency acts as a parameter that allows a collisionless result to be obtained in one limit, while the solution of a diffusion equation is recovered in the opposite limit of large collision frequencies.

A novel bioreactor system for simultaneous mutli-metal leaching from industrial pyrite ash: Effect of agitation and sulphur dosage.

PubMed

Panda, Sandeep; Akcil, Ata; Mishra, Srabani; Erust, Ceren

2018-01-15

Simultaneous multi-metal leaching from industrial pyrite ash is reported for the first time using a novel bioreactor system that allows natural diffusion of atmospheric O 2 and CO 2 along with the required temperature maintenance. The waste containing economically important metals (Cu, Co, Zn & As) was leached using an adapted consortium of meso-acidophilic Fe 2+ and S oxidising bacteria. The unique property of the sample supported adequate growth and activity of the acidophiles, thereby, driving the (bio) chemical reactions. Oxido-reductive potentials were seen to improve with time and the system's pH lowered as a result of active S oxidation. Increase in sulphur dosage (>1g/L) and agitation speed (>150rpm) did not bear any significant effect on metal dissolution. The consortium was able to leach 94.01% Cu (11.75% dissolution/d), 98.54% Co (12.3% dissolution/d), 75.95% Zn (9.49% dissolution/d) and 60.80% As (7.6% dissolution/d) at 150rpm, 1g/L sulphur, 30°C in 8days. Copyright © 2017 Elsevier B.V. All rights reserved.

How to Radicalize Graduate Students: Take These Simple Steps to Intimidate, Alienate, and Agitate Your Own Flock of Graduate Students

ERIC Educational Resources Information Center

Steffen, Heather

2011-01-01

As the recession, budget cuts, endowment losses, and Republican governors gut university funding, campuses across the country have become host to occupations, union actions, and demonstrations. One can take steps to intimidate, alienate, and agitate a flock of graduate students. The author discusses steps that offer simple ways to rile up and…

A novel experimental approach to investigate the effect of different agitation methods using sodium hypochlorite as an irrigant on the rate of bacterial biofilm removal from the wall of a simulated root canal model.

PubMed

Mohmmed, Saif Alarab; Vianna, Morgana E; Penny, Matthew R; Hilton, Stephen T; Mordan, Nicola; Knowles, Jonathan C

2016-10-01

Root canal irrigation is an important adjunct to control microbial infection. This study aimed primarily to develop a transparent root canal model to study in situ Enterococcus faecalis biofilm removal rate and remaining attached biofilm using passive or active irrigation solution for 90s. The change in available chlorine and pH of the outflow irrigant were assessed. A total of forty root canal models (n=10 per group) were manufactured using 3D printing. Each model consisted of two longitudinal halves of an 18mm length simulated root canal with size 30 and taper 0.06. E. faecalis biofilms were grown on the apical 3mm of the models for 10days in Brain Heart Infusion broth. Biofilms were stained using crystal violet for visualization. The model halves were reassembled, attached to an apparatus and observed under a fluorescence microscope. Following 60s of 9mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic and ultrasonic methods for 30s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analyzed using Kruskal-Wallis test and generalized linear mixed model. The highest level of biofilm removal was with ultrasonic agitation (90.13%) followed by sonic (88.72%), gutta-percha (80.59%), and passive irrigation group (control) (43.67%) respectively. All agitation groups reduced the available chlorine and pH of NaOCl more than that in the passive irrigation group. The 3D printing method provided a novel model to create a root canal simulation for studying and understanding a real-time biofilm removal under microscopy. Ultrasonic agitation of NaOCl left the least amount of residual biofilm in comparison to sonic and gutta-percha agitation methods. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Evolutionary cost analysis of valsartan initiation among patients with hypertension: a time series approach.

PubMed

Sun, Peter; Chang, Joanne; Zhang, Jie; Kahler, Kristijan H

2012-01-01

This study examines the evolutionary impact of valsartan initiation on medical costs. A retrospective time series study design was used with a large, US national commercial claims database for the period of 2004-2008. Hypertensive patients who initiated valsartan between the ages of 18 and 63, and had continuous enrollment for 24-month pre-initiation period and 24-month post-initiation period were selected. Patients' monthly medical costs were calculated based on individual claims. A novel time series model was devised with monthly medical costs as its dependent variables, autoregressive integrated moving average (ARIMA) as its stochastic components, and four indicative variables as its decomposed interventional components. The number of post-initiation months before a cost-offset point was also assessed. Patients (n = 18,269) had mean age of 53 at the initiation date, and 53% of them were female. The most common co-morbid conditions were dyslipidemia (52%), diabetes (24%), and hypertensive complications (17%). The time series model suggests that medical costs were increasing by approximately $10 per month (p < 0.01) before the initiation, and decreasing by approximately $6 per month (p < 0.01) after the initiation. After the 4th post-initiation month, medical costs for patients with the initiation were statistically significantly lower (p < 0.01) than forecasted medical costs for the same patients without the initiation. The study has its limitations in data representativeness, ability to collect unrecorded clinical conditions, treatments, and costs, as well as its generalizability to patients with different characteristics. Commercially insured hypertensive patients experienced monthly medical cost increase before valsartan initiation. Based on our model, the evolutionary impact of the initiation on medical costs included a temporary cost surge, a gradual, consistent, and statistically significant cost decrease, and a cost-offset point around the

Computing arrival times of firefighting resources for initial attack

Treesearch

Romain M. Mees

1978-01-01

Dispatching of firefighting resources requires instantaneous or precalculated decisions. A FORTRAN computer program has been developed that can provide a list of resources in order of computed arrival time for initial attack on a fire. The program requires an accurate description of the existing road system and a list of all resources available on a planning unit....

Intravenous midazolam-droperidol combination, droperidol or olanzapine monotherapy for methamphetamine-related acute agitation: subgroup analysis of a randomized controlled trial.

PubMed

Yap, Celene Y L; Taylor, David McD; Knott, Jonathan C; Taylor, Simone E; Phillips, Georgina A; Karro, Jonathan; Chan, Esther W; Kong, David C M; Castle, David J

2017-07-01

To examine the efficacy and safety of (1) midazolam-droperidol versus droperidol and (2) midazolam-droperidol versus olanzapine for methamphetamine-related acute agitation. A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-droperidol 5 mg combined, droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg or olanzapine 5 mg, respectively. The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-droperidol, droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. A midazolam-droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than droperidol or olanzapine alone. © 2017 Society for the Study of Addiction.

How is agitation and restlessness managed in the last 24 h of life in patients whose care is supported by the Liverpool care pathway for the dying patient?

PubMed

Gambles, M; McGlinchey, T; Latten, R; Dickman, A; Lowe, D; Ellershaw, J E

2011-12-01

Guidance regarding the patient centred management of agitation and restlessness reinforces the importance of considering underlying causes, non-pharmacological approaches to treatment and judicious use of medications titrated to patient need. In contrast, recent reports in the literature suggest that the practice of continuous deep sedation until death is prevalent in the UK. To use data from the National Care of the Dying Audit-Hospitals (NCDAH) to explore the administration of medication for management of agitation and restlessness in the last 24 h of life. Hospitals submitted data from up to 30 consecutive adult patients whose care in the final hours/days of life was supported by the Liverpool Care Pathway for the Dying Patient (LCP). Data on the total dose received in the last 24 h of life PRN and the last dose prescribed for administration via continuous subcutaneous infusion (CSCI) for agitation and restlessness were submitted. 155 hospitals provided data from 3893 patients. Median total doses in the last 24 h for midazolam, haloperidol and levomepromazine, respectively, were: PRN only, 2.5, 1.5 and 6.25 mg; CSCI only, 10, 3 and 6.25 mg; PRN+CSCI, 15, 3 and 12.5 mg. Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no 'blanket' policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

Evaluating time dynamics of topographic threshold relations for gully initiation

NASA Astrophysics Data System (ADS)

Hayas, Antonio; Vanwalleghem, Tom; Poesen, Jean

2016-04-01

Gully erosion is one of the most important soil degradation processes at global scale. However, modelling of gully erosion is still difficult. Despite advances in the modelling of gully headcut rates and incision rates, it remains difficult to predict the location of gully initiation points and trajectories. In different studies it has been demonstrated that a good method of predicting gully initiation is by using a slope (S) - area (A) threshold. Such an S-A relation is a simple way of estimating the critical discharges needed to generate a critical shear stress that can incise a particular soil and initiate a gully. As such, the simple S-A threshold will vary if the rainfall-runoff behaviour of the soil changes or if the soil's erodibility changes. Over the past decades, important agronomic changes have produced significant changes in the soil use and soil management in SW Spain. It is the objective of this research to evaluate how S-A relations for gully initiation have changed over time and for two different land uses, cereal and olive. Data was collected for a gully network in the Cordoba Province, SW Spain. From photo-interpretation of historical air photos between 1956 and 2013, the gully network and initiation points were derived. In total 10 different time steps are available (1956; 1977; 1984; 1998; 2001; 2004; 2006; 2008; 2010; 2013). Topographical thresholds were extracted by combining the digitized gully network with the DEM. Due to small differences in the alignment of ortophotos and DEM, an optimization technique was developed in GIS to extract the correct S-A value for each point. With the S-A values for each year, their dynamics was evaluated as a function of land use (olive or cereal) and in function of the following variables in each of the periods considered: • soil management • soil cover by weeds, where weed growth was modeled from the daily soil water balance • rainfall intensity • root cohesion, , where root growth was modeled from

Estimation of Initial and Response Times of Laser Dew-Point Hygrometer by Measurement Simulation

NASA Astrophysics Data System (ADS)

Matsumoto, Sigeaki; Toyooka, Satoru

1995-10-01

The initial and the response times of the laser dew-point hygrometer were evaluated by measurement simulation. The simulation was based on loop computations of the surface temperature of a plate with dew deposition, the quantity of dew deposited and the intensity of scattered light from the surface at each short interval of measurement. The initial time was defined as the time necessary for the hygrometer to reach a temperature within ±0.5° C of the measured dew point from the start time of measurement, and the response time was also defined for stepwise dew-point changes of +5° C and -5° C. The simulation results are in approximate agreement with the recorded temperature and intensity of scattered light of the hygrometer. The evaluated initial time ranged from 0.3 min to 5 min in the temperature range from 0° C to 60° C, and the response time was also evaluated to be from 0.2 min to 3 min.

Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial.

PubMed

Olsen, Christine; Pedersen, Ingeborg; Bergland, Astrid; Enders-Slegers, Marie-José; Patil, Grete; Ihlebaek, Camilla

2016-12-01

The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL). A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used. A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found. Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.

PubMed

Maust, Donovan T; Kales, Helen C; McCammon, Ryan J; Blow, Frederic C; Leggett, Amanda; Langa, Kenneth M

2017-10-01

Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care. Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old. BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity. Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02). A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia. Copyright © 2017 American Association for Geriatric Psychiatry. All rights reserved.

Parent-Child Communication and Marijuana Initiation: Evidence Using Discrete-Time Survival Analysis

PubMed Central

Nonnemaker, James M.; Silber-Ashley, Olivia; Farrelly, Matthew C.; Dench, Daniel

2012-01-01

This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or—in the case of youth reports of communication—potentially harmful (leading to increased likelihood of marijuana initiation). PMID:22958867

Effect of closed-loop order processing on the time to initial antimicrobial therapy.

PubMed

Panosh, Nicole; Rew, Richardd; Sharpe, Michelle

2012-08-15

The results of a study comparing the average time to initiation of i.v. antimicrobial therapy with closed-versus open-loop order entry and processing are reported. A retrospective cohort study was performed to compare order-to-administration times for initial doses of i.v. antimicrobials before and after a closed-loop order-processing system including computerized prescriber order entry (CPOE) was implemented at a large medical center. A total of 741 i.v. antimicrobial administrations to adult patients during designated five-month preimplementation and postimplementation study periods were assessed. Drug-use reports generated by the pharmacy database were used to identify order-entry times, and medication administration records were reviewed to determine times of i.v. antimicrobial administration. The mean ± S.D. order-to-administration times before and after the implementation of the CPOE system and closed-loop order processing were 3.18 ± 2.60 and 2.00 ± 1.89 hours, respectively, a reduction of 1.18 hours (p < 0.0001). Closed-loop order processing was associated with significant reductions in the average time to initiation of i.v. therapy in all patient care areas evaluated (cardiology, general medicine, and oncology). The study results suggest that CPOE-based closed-loop order processing can play an important role in achieving compliance with current practice guidelines calling for increased efforts to ensure the prompt initiation of i.v. antimicrobials for severe infections (e.g., sepsis, meningitis). Implementation of a closed-loop order-processing system resulted in a significant decrease in order-to-administration times for i.v. antimicrobial therapy.

The glass is not yet half empty: agitation but not Varroa treatment causes cognitive bias in honey bees.

PubMed

Schlüns, Helge; Welling, Helena; Federici, Julian René; Lewejohann, Lars

2017-03-01

Honey bees (Apis mellifera) are prone to judge an ambiguous stimulus negatively if they had been agitated through shaking which simulates a predator attack. Such a cognitive bias has been suggested to reflect an internal emotional state analogous to humans who judge more pessimistically when they do not feel well. In order to test cognitive bias experimentally, an animal is conditioned to respond to two different stimuli, where one is punished while the other is rewarded. Subsequently a third, ambiguous stimulus is presented and it is measured whether the subject responds as if it expects a reward or a punishment. Generally, it is assumed that negative experiences lower future expectations, rendering the animals more pessimistic. Here we tested whether a most likely negatively experienced formic acid treatment against the parasitic mite Varroa destructor also affects future expectations of honey bees. We applied an olfactory learning paradigm (i.e., conditioned proboscis extension response) using two odorants and blends of these odorants as the ambiguous stimuli. Unlike agitating honey bees, exposure to formic acid did not significantly change the response to the ambiguous stimuli in comparison with untreated bees. Overall evidence suggests that the commonest treatment against one of the most harmful bee pests has no detrimental effects on cognitive bias in honey bees.

Errors in Postural Preparation Lead to Increased Choice Reaction Times for Step Initiation in Older Adults

PubMed Central

Nutt, John G.; Horak, Fay B.

2011-01-01

Background. This study asked whether older adults were more likely than younger adults to err in the initial direction of their anticipatory postural adjustment (APA) prior to a step (indicating a motor program error), whether initial motor program errors accounted for reaction time differences for step initiation, and whether initial motor program errors were linked to inhibitory failure. Methods. In a stepping task with choice reaction time and simple reaction time conditions, we measured forces under the feet to quantify APA onset and step latency and we used body kinematics to quantify forward movement of center of mass and length of first step. Results. Trials with APA errors were almost three times as common for older adults as for younger adults, and they were nine times more likely in choice reaction time trials than in simple reaction time trials. In trials with APA errors, step latency was delayed, correlation between APA onset and step latency was diminished, and forward motion of the center of mass prior to the step was increased. Participants with more APA errors tended to have worse Stroop interference scores, regardless of age. Conclusions. The results support the hypothesis that findings of slow choice reaction time step initiation in older adults are attributable to inclusion of trials with incorrect initial motor preparation and that these errors are caused by deficits in response inhibition. By extension, the results also suggest that mixing of trials with correct and incorrect initial motor preparation might explain apparent choice reaction time slowing with age in upper limb tasks. PMID:21498431

Parent-child communication and marijuana initiation: evidence using discrete-time survival analysis.

PubMed

Nonnemaker, James M; Silber-Ashley, Olivia; Farrelly, Matthew C; Dench, Daniel

2012-12-01

This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or - in the case of youth reports of communication - potentially harmful (leading to increased likelihood of marijuana initiation). Copyright © 2012 Elsevier Ltd. All rights reserved.

Beyond the Golden Hours: Caring for Septic Patients After the Initial Resuscitation.

PubMed

Gelinas, Jean P; Walley, Keith R

2016-06-01

Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload. Substantial evidence now supports a lower hemoglobin transfusion threshold of 7 g/dL. A rush to initiate enteral or parenteral feeds is not clearly supported by the current evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementing real-time GNSS monitoring to investigate continental rift initiation processes

NASA Astrophysics Data System (ADS)

Jones, J. R.; Stamps, D. S.; Wauthier, C.; Daniels, M. D.; Saria, E.; Ji, K. H.; Mencin, D.; Ntambila, D.

2017-12-01

Continental rift initiation remains an elusive, yet fundamental, process in the context of plate tectonic theory. Our early work in the Natron Rift, Tanzania, the Earth's archetype continental rift initiation setting, indicates feedback between volcanic deformation and fault slip play a key role in the rift initiation process. We found evidence that fault slip on the Natron border fault during active volcanism at Ol Doniyo Lengai in 2008 required only 0.01 MPa of Coulomb stress change. This previous study was limited by GPS constraints 18 km from the volcano, rather than immediately adjacent on the rift shoulder. We hypothesize that fault slip adjacent to the volcano creeps, and without the need for active eruption. We also hypothesize silent slip events may occur over time-scales less than 1 day. To test our hypotheses we designed a GNSS network with 4 sites on the flanks of Ol Doinyo Lengai and 1 site on the adjacent Natron border fault with the capability to calculate 1 second, 3-5 cm precision positions. Data is transmitted to UNAVCO in real-time with remote satellite internet, which we automatically import to the EarthCube building block CHORDS (Cloud Hosted Real-time Data Services for the Geosciences) using our newly developed method. We use CHORDS to monitor and evaluate the health of our network while visualizing the GNSS data in real-time. In addition to our import method we have also developed user-friendly capabilities to export GNSS positions (longitude, latitude, height) with CHORDS assuming the data are available at UNAVCO in NMEA standardized format through the Networked Transport of RTCM via Internet Protocol (NTRIP). The ability to access the GNSS data that continuously monitors volcanic deformation, tectonics, and their interactions on and around Ol Doinyo Lengai is a crucial component in our investigation of continental rift initiation in the Natron Rift, Tanzania. Our new user-friendly methods developed to access and post-process real-time GNSS

Effects of viewing a preferred nature image and hearing preferred music on engagement, agitation, and mental status in persons with dementia

PubMed Central

Eggert, Julia; Vincent, Ellen; Parker, Veronica; Daily, Shaundra B; Pham, Hiep; Watson, Alison Turner; Summey, Hollie; Roy, Tania

2015-01-01

Background: The purpose of the described exploratory study was to test proactive strategies for enhancing engagement and cognitive ability while diminishing dementia-related disordered behaviors of those diagnosed with Alzheimer’s disease and other dementias. Study participants resided in an Memory Care unit of an assisted living community. Method: The researchers measured the effects of exposure to music and nature images on engagement using the Individualized Dementia Engagement and Activities Scale tool, on cognitive ability using the Montreal Cognitive Assessment, and on agitation using the Cohen-Mansfield Agitation Inventory. Result: The within-subject study design revealed that use of both music and nature images hold promise for reducing undesirable behaviors and improving engagement of residents. Conclusion: The authors suggest caregivers for those with Alzheimer’s disease and other dementias can effectively use nature images and music to improve engagement and reduce disordered behaviors, thus potentially enhancing quality of life for the care recipient as well as the caregiver while possibly reducing the costs of medications used to control dementia-related undesirable behaviors. PMID:26770801

Development of a new type of high pressure calorimetric cell, mechanically agitated and equipped with a dynamic pressure control system: Application to the characterization of gas hydrates

NASA Astrophysics Data System (ADS)

Plantier, F.; Marlin, L.; Missima, D.; Torré, J.-P.

2013-12-01

A novel prototype of calorimetric cell has been developed allowing experiments under pressure with an in situ agitation system and a dynamic control of the pressure inside the cell. The use of such a system opens a wide range of potential practical applications for determining properties of complex fluids in both pressurized and agitated conditions. The technical details of this prototype and its calibration procedure are described, and an application devoted to the determination of phase equilibrium and phase change enthalpy of gas hydrates is presented. Our results, obtained with a good precision and reproducibility, were found in fairly good agreement with those found in literature, illustrate the various interests to use this novel apparatus.

Irrigation initiation timing in soybean grown on sandy soils in Northeast Arkansas

USDA-ARS?s Scientific Manuscript database

Irrigation initiation timing was evaluated in furrow-irrigated soybean field with sandy soils in Mississippi County, AR. A major objective of this 2015 study was to validate and expand irrigation timing recommendations that pair plant growth measures with weather cues including use of local weather ...

A Modern-Day Fight Club? The Stabilization and Management of Acutely Agitated Patients in the Emergency Department.

PubMed

New, Andrew; Tucci, Veronica Theresa; Rios, Juan

2017-09-01

This article is an overview of the treatment and management of acutely agitated patients as they present in the emergency department or emergency psychiatric facility. This article focuses on how a patient encounter may unfold and what issues need to be considered along the way. Verbal de-escalation is emphasized as a standard of care, including the offering of environmental changes and medications when indicated. Approved medications are reviewed as well as the proper use of restraints. Copyright © 2017 Elsevier Inc. All rights reserved.

Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation).

PubMed

Ostinelli, Edoardo G; Brooke-Powney, Melanie J; Li, Xue; Adams, Clive E

2017-07-31

Haloperidol used alone is recommended to help calm situations of aggression or agitation for people with psychosis. It is widely accessible and may be the only antipsychotic medication available in limited-resource areas. To examine whether haloperidol alone is an effective treatment for psychosis-induced aggression or agitation, wherein clinicians are required to intervene to prevent harm to self and others. We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (26th May 2016). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. Randomised controlled trials (RCTs) involving people exhibiting aggression and/or agitation thought to be due to psychosis, allocated rapid use of haloperidol alone (by any route), compared with any other treatment. Outcomes of interest included tranquillisation or asleep by 30 minutes, repeated need for rapid tranquillisation within 24 hours, specific behaviours (threat or injury to others/self), adverse effects. We included trials meeting our selection criteria and providing useable data. We independently inspected all citations from searches, identified relevant abstracts, and independently extracted data from all included studies. For binary data we calculated risk ratio (RR), for continuous data we calculated mean difference (MD), and for cognitive outcomes we derived standardised mean difference (SMD) effect sizes, all with 95% confidence intervals (CI) and using a fixed-effect model. We assessed risk of bias for the included studies and used the GRADE approach to produce 'Summary of findings' tables which included our pre-specified main outcomes of interest. We found nine new RCTs from the

Kinetics of insulin aggregation in aqueous solutions upon agitation in the presence of hydrophobic surfaces.

PubMed Central

Sluzky, V; Tamada, J A; Klibanov, A M; Langer, R

1991-01-01

The stability of protein-based pharmaceuticals (e.g., insulin) is important for their production, storage, and delivery. To gain an understanding of insulin's aggregation mechanism in aqueous solutions, the effects of agitation rate, interfacial interactions, and insulin concentration on the overall aggregation rate were examined. Ultraviolet absorption spectroscopy, high-performance liquid chromatography, and quasielastic light scattering analyses were used to monitor the aggregation reaction and identify intermediate species. The reaction proceeded in two stages; insulin stability was enhanced at higher concentration. Mathematical modeling of proposed kinetic schemes was employed to identify possible reaction pathways and to explain greater stability at higher insulin concentration. Images PMID:1946348

Optimal time for initiating extracorporeal membrane oxygenation.

PubMed

Haile, Dawit T; Schears, Gregory J

2009-09-01

The technical evolution of extracorporeal membrane oxygenation (ECMO) coincides with the vast improvement in intensive care medicine of the past 4 decades. Extracorporeal circulatory technology substitutes for acutely failed cardiac or pulmonary function until these organs regain sustainable function through goal-oriented intensive care practice. The technology has been validated to improve survival in select patients who would otherwise have 100% mortality. This is by far the most complex life-sustaining technology employed and thus can contribute significant risks such that the decision to institute ECMO requires prompt risk and benefit analysis. Delaying the institution of ECMO may cause irreversible pulmonary and cardiac injuries in addition to other organs. Therefore, the optimal time of initiating ECMO support is crucial to the survival of a critically ill patient.

Evaluation of the Massachusetts Expanded Learning Time (ELT) Initiative: Final Study Findings

ERIC Educational Resources Information Center

Checkoway, Amy; Gamse, Beth; Velez, Melissa; Linkow, Tamara

2013-01-01

The Massachusetts Expanded Learning Time (ELT) initiative provides grants to selected schools to redesign their schedules by adding 300-plus instructional hours to the school year to improve outcomes, broaden enrichment opportunities, and provide teachers with more planning and professional development time. The Massachusetts Department of…

Macro-level age norms for the timing of sexual initiation and adolescents' early sexual initiation in 17 European countries.

PubMed

Madkour, Aubrey Spriggs; de Looze, Margaretha; Ma, Ping; Halpern, Carolyn Tucker; Farhat, Tilda; Ter Bogt, Tom F M; Ehlinger, Virginie; Nic Gabhainn, Saoirse; Currie, Candace; Godeau, Emmanuelle

2014-07-01

To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. Nationally representative data from 17 countries that participated in the 2006/2007 European Social Survey (ESS-3, n = 33,092) and the 2005/2006 Health Behaviour in School-Aged Children Study (HBSC, n = 27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16 years) self-reported age at sexual initiation, which we defined as early (<15 years) or not early (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR .60, 95% CI .45-.79); associations with ESI were stronger for parent cohort (ages 31-65 years) norms (AOR .37, 95% CI .23-.58) than for peer cohort (ages 15-20 years) norms (AOR .60, 95% CI .49-.74). For boys, overall norms were also significantly negatively associated with ESI (AOR .68, 95% CI .46-.99), as were parent cohort norms (AOR .66, 95% CI .45-.96). Peer cohort norms were not significantly related to boys' ESI. Macrolevel cultural norms may impact adolescents' sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Macro-level Age Norms for the Timing of Sexual Initiation and Adolescents’ Early Sexual Initiation in 17 European Countries

PubMed Central

Madkour, Aubrey Spriggs; de Looze, Margaretha; Ma, Ping; Halpern, Carolyn Tucker; Farhat, Tilda; ter Bogt, Tom F. M.; Ehlinger, Virginie; Nic Gabhainn, Saoirse; Currie, Candace; Godeau, Emmanuelle

2014-01-01

Purpose To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. Methods Nationally-representative data from 17 countries that participated in the 2006/07 European Social Survey (ESS-3, n=33,092) and the 2005/06 Health Behaviour in School-Aged Children Study (HBSC, n=27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16) self-reported age at sexual initiation which we defined as early (<15 years) or not (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. Results In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR 0.60, 95% CI 0.45-0.79); associations with ESI were stronger for parent cohort (ages 31-65) norms (AOR 0.37, 95% CI 0.23-0.58) than for peer cohort (ages 15-20) norms (AOR 0.60, 95% CI 0.49-0.74). For boys, overall norms were also significantly negatively associated with ESI (AOR 0.68, 95% CI 0.46-0.99), as were parent cohort norms (AOR 0.66, 95% CI 0.45-0.96). Peer cohort norms were not significantly related to boys’ ESI. Conclusion Macro-level cultural norms may impact adolescents’ sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted. PMID:24508092

Aggregation and Particle Formation of Therapeutic Proteins in Contact With a Novel Fluoropolymer Surface Versus Siliconized Surfaces: Effects of Agitation in Vials and in Prefilled Syringes.

PubMed

Teska, Brandon M; Brake, Jeffrey M; Tronto, Gregory S; Carpenter, John F

2016-07-01

We examined the effects of an accelerated agitation protocol on 2 protein therapeutics, intravenous immunoglobulin (IVIG) and Avastin (bevacizumab), in contact with a novel fluoropolymer surface and more typical siliconized surfaces. The fluoropolymer surface provides "solid-phase" lubrication for the syringe plunger-obviating the need for silicone oil lubrication in prefilled syringes. We tested the 2 surfaces in a vial system and in prefilled glass syringes. We also examined the effects of 2 buffers, phosphate-buffered saline (PBS) and 0.2-M glycine, with and without the addition of polysorbate 20, on agitation-induced aggregation of IVIG. Aggregation was monitored by measuring subvisible particle formation and soluble protein loss. In both vials and syringes, protein particle formation was much lower during agitation with the fluoropolymer surface than with the siliconized surface. Also, particle formation was greater in PBS than in glycine buffer, an effect attributed to lower colloidal stability of IVIG in PBS. Polysorbate 20 in the formulation greatly inhibited protein particle formation. Overall, the fluoropolymer plunger surface in an unsiliconized glass barrel was demonstrated to be a viable solution for eliminating silicone oil droplets from prefilled syringe formulations and providing a consistent system for rationale formulation development and simplified particle analysis. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Dissolvable layered double hydroxide as an efficient nanosorbent for centrifugeless air-agitated dispersive solid-phase extraction of potentially toxic metal ions from bio-fluid samples.

PubMed

Rajabi, Maryam; Arghavani-Beydokhti, Somayeh; Barfi, Behruz; Asghari, Alireza

2017-03-08

In the present work, a novel nanosorbent namely layered double hydroxides with 4-amino-5-hydroxyl-2,7-naphthalendisulfonic acid monosodium salt interlayer anion (Mg-Al-AHNDA-LDH) was synthesized and applied as a dissolvable nanosorbent in a centrifugeless ultrasound-enhanced air-agitated dispersive solid-phase extraction (USE-AA-D-SPE) method. This method was used for the separation and preconcentration of some metal ions including Cd 2+ , Cr 6+ , Pb 2+ , Co 2+ , and Ni 2+ prior to their determination using the micro-sampling flame atomic absorption spectrometry (MS-FAAS) technique. The most interesting aspect of this nanosorbent is its immediate dissolvability at pH values lower than 4. This capability drastically eliminates the elution step, leading to a great improvement in the extraction efficiency and a decrease in the extraction time. Also in this method, the use of a syringe nanofilter eliminates the need for the centrifugation step, which is time-consuming and essentially causes the analysis to be off-line. Several effective parameters governing the extraction efficiency including the sample solution pH, amount of nanosorbent, eluent condition, number of air-agitation cycles, and sonication time were investigated and optimized. Under the optimized conditions, the good linear dynamic ranges of 2-70, 6-360, 7-725, 7-370, and 8-450 ng mL -1 for the Cd 2+ , Cr 6+ , Pb 2+ , Co 2+ and Ni 2+ ions, respectively, with the correlation of determinations (R 2 s) higher than 0.997 were obtained. The limits of detection (LODs) were found to be 0.6, 1.7, 2.0, 2.1, and 2.4 for the Cd 2+ , Cr 6+ , Pb 2+ , Co 2+ , and Ni 2+ ions, respectively. The intra-day and inter-day precisions (percent relative standard deviations (%RSDs) (n = 5)) were below 7.8%. The proposed method was also successfully applied for the extraction and determination of the target ions in different biological fluid and tap water samples. Copyright © 2017 Elsevier B.V. All rights reserved.

Appropriateness and reliability testing of the modified Richmond Agitation-Sedation Scale in Spanish patients with advanced cancer.

PubMed

Benítez-Rosario, Miguel Angel; Castillo-Padrós, Manuel; Garrido-Bernet, Belen; González-Guillermo, Toribio; Martínez-Castillo, Luis Pedro; González, Aceysele

2013-06-01

A tool to quantify agitation severity and sedation level in patients with advanced cancer is needed. To test the appropriateness and reliability of the Richmond Agitation-Sedation Scale (RASS) in Spanish patients with advanced cancer. The original RASS was translated into Spanish according to the standard guidelines. Face validity was assessed by members of the palliative care team, and interrater reliability was assessed, using a weighted kappa, from observations of patients admitted to the palliative care unit. The association between scores of the RASS, Ramsay Sedation Scale, and Glasgow Coma Scale was evaluated using Spearman's ρ. Three hundred twenty-two observations were performed in 156 patients: 116 observations were performed for delirious patients, 76 observations for sedated patients, and 130 observations for patients admitted for other symptom control. The weighted kappa values were practically equal to or greater than 0.90 between nurses and nurses and physicians. The agreement level between observers for each RASS score was roughly 90%. The correlation between the RASS and the Ramsay and Glasgow Scale values was analyzed for 196 observations recorded in 80 patients. The sedation scale of the RASS had a strong correlation with both the Ramsay (Spearman's ρ, -0.89; P < 0.001) and the Glasgow Coma Scales (Spearman's ρ, 0.85; P < 0.001). These data support the use of the RASS in Spanish patients with advanced cancer. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Contextual and Developmental Predictors of Sexual Initiation Timing among Mexican-Origin Girls

ERIC Educational Resources Information Center

Bámaca-Colbert, Mayra Y.; Greene, Kaylin M.; Killoren, Sarah E.; Noah, Aggie J.

2014-01-01

Using data from a longitudinal study of Mexican-origin girls (ages 11-17 at Time 1), we examined sociocultural (i.e., family structure, nativity, and acculturation), interpersonal (i.e., supportive parenting and conflict), and developmental (i.e., menarche timing and autonomy expectations) predictors of sexual initiation. Using Cox proportional…

The surgical waiting time initiative: A review of the Nigerian situation

PubMed Central

Abdulkareem, Imran Haruna

2014-01-01

SUMMARY The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24

The surgical waiting time initiative: A review of the Nigerian situation.

PubMed

Abdulkareem, Imran Haruna

2014-11-01

The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24

5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1005 Time limits for OPM to initiate...

[Just-in-time initiation of optimal dialysis].

PubMed

Cornelis, Tom; Kooman, Jeroen P; van der Sande, Frank M

2010-01-01

The IDEAL trial shows that the decision to start renal replacement treatment should not depend on GFR alone, but should be taken on the basis of clinical parameters. Quality of Life (QoL) questionnaires and bio-impedance analysis are potential tools for detecting subtle changes in the predialysis clinic. Too early an initiation of dialysis may be deleterious for the patient and the healthcare system. We are convinced that ESRD patients should be informed about intensive haemodialysis (HD), especially nocturnal (home) HD, as the best available dialysis modality. There is substantial evidence which shows that intensive HD improves clinical, biochemical and biological parameters, and may even prolong survival. We believe that 'just-in-time delivery of intensive haemodialysis' may result in optimised QoL and reduced economic burden.

Breast-feeding initiation time and neonatal mortality risk among newborns in South India.

PubMed

Garcia, C R; Mullany, L C; Rahmathullah, L; Katz, J; Thulasiraj, R D; Sheeladevi, S; Coles, C; Tielsch, J M

2011-06-01

To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region. Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h. Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 1  h after birth. Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.

Effect of timely initiation of breastfeeding on child health in Ghana.

PubMed

Fosu-Brefo, Rita; Arthur, Eric

2015-01-01

Early initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana. Cross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey. The results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child's health. Additionally, factors such as the wealth of the household, mother's education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana. The findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.

Combined effects of agitation and aeration on the chitinolytic enzymes production by the Antarctic fungus Lecanicillium muscarium CCFEE 5003

PubMed Central

2012-01-01

Background The Antarctic fungus Lecanicillium muscarium CCFEE 5003 is one of the most powerful chitinolytic organisms. It can produce high level of chitinolytic enzymes in a wide range of temperatures (5-30°C). Chitinolytic enzymes have lot of applications but their industrial production is still rather limited and no cold-active enzymes are produced. In view of massive production of L. muscarium chitinolytic enzymes, its cultivation in bioreactors is mandatory. Microbial cultivation and/or their metabolite production in bioreactors are sometime not possible and must be verified and optimized for possible exploitation. Agitation and aeration are the most important parameters in order to allow process up-scaling to the industrial level. Results In this study, submerged cultures of L. muscarium CCFEE 5003 were carried out in a 2-L bench-top CSTR bioreactor in order to optimise the production of chitinolytic enzymes. The effect of stirrer speed (range 200-500 rpm) and aeration rate (range 0.5-1.5 vvm) combination was studied, by Response Surface Methodology (RSM), in a medium containing 1.0% yeast nitrogen base and 1% colloidal chitin. Optimization was carried out, within a "quadratic D-optimal" model, using quantitative and quantitative-multilevel factors for aeration and agitation, respectively. The model showed very good correlation parameters (R2, 0.931; Q2, 0.869) and the maximum of activity (373.0 U/L) was predicted at ca. 327 rpm and 1.1 vvm. However, the experimental data showed that highest activity (383.7 ± 7.8 U/L) was recorded at 1 vvm and 300 rpm. Evident shear effect caused by stirrer speed and, partially, by high aeration rates were observed. Under optimized conditions in bioreactor the fungus was able to produce a higher number of chitinolytic enzymes than those released in shaken flasks. In addition, production was 23% higher. Conclusions This work demonstrated the attitude of L. muscarium CCFEE 5003 to grow in bench-top bioreactor; outlined the

The modern role of antipsychotics for the treatment of agitation and psychosis in Alzheimer's disease.

PubMed

Creese, Byron; Da Silva, Miguel Vasconcelos; Johar, Iskandar; Ballard, Clive

2018-05-21

Antipsychotics have long been the mainstay of treatment for agitation and psychosis in Alzheimer's disease. Despite their current use successive studies have shown that they only confer a modest benefit which must be balanced against their well-established serious side effects (extrapyramidal symptoms, stroke, accelerated cognitive decline and mortality). Areas covered: This review outlines the current guidance on antipsychotic usage and the evidence of their continued usage against a backdrop of emerging pharmacological treatments and an increasing emphasis on the importance of non-pharmacological interventions. Expert commentary: The current justification for antipsychotic use in the context of the changing landscape of prescribing and provide a view on the most promising alternative candidates to this class of drug are appraised.

The effect of impeller type on silica sol formation in laboratory scale agitated tank

NASA Astrophysics Data System (ADS)

Nurtono, Tantular; Suprana, Yayang Ade; Latif, Abdul; Dewa, Restu Mulya; Machmudah, Siti; Widiyastuti, Winardi, Sugeng

2016-02-01

The multiphase polymerization reaction of the silica sol formation produced from silicic acid and potassium hydroxide solutions in laboratory scale agitated tank was studied. The reactor is equipped with four segmental baffle and top entering impeller. The inside diameter of reactor is 9 cm, the baffle width is 0.9 cm, and the impeller position is 3 cm from tank bottom. The diameter of standard six blades Rushton and three blades marine propeller impellers are 5 cm. The silicic acid solution was made from 0.2 volume fraction of water glass (sodium silicate) solution in which the sodium ion was exchanged by hydrogen ion from cation resin. The reactor initially filled with 286 ml silicic acid solution was operated in semi batch mode and the temperature was kept constant in 60 °C. The 3 ml/minute of 1 M potassium hydroxide solution was added into stirred tank and the solution was stirred. The impeller rotational speed was varied from 100 until 700 rpm. This titration was stopped if the solution in stirred tank had reached the pH of 10-The morphology of the silica particles in the silica sol product was analyzed by Scanning Electron Microscope (SEM). The size of silica particles in silica sol was measured based on the SEM image. The silica particle obtained in this research was amorphous particle and the shape was roughly cylinder. The flow field generated by different impeller gave significant effect on particle size and shape. The smallest geometric mean of length and diameter of particle (4.92 µm and 2.42 µm, respectively) was generated in reactor with marine propeller at 600 rpm. The reactor with Rushton impeller produced particle which the geometric mean of length and diameter of particle was 4.85 µm and 2.36 µm, respectively, at 150 rpm.

Married Thai Working Mothers: Coping with Initial Part-Time Doctoral Study

ERIC Educational Resources Information Center

Thinnam, Thanit

2011-01-01

Advanced educational attainment can "grow" a career. But acquiring a doctoral qualification adds study to existing work and family responsibilities, especially for women. This phenomenological research explores the experiences of eight Thai working mothers enrolled in the initial stage of part-time doctoral programs in Thailand. A…

Public views on a wait time management initiative: a matter of communication.

PubMed

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2010-08-05

Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative--the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.

Timely initiation of breastfeeding is associated with the practice of exclusive breastfeeding in Indonesia.

PubMed

Paramashanti, Bunga Astria; Hadi, Hamam; Gunawan, I Made Alit

2016-12-01

Exclusive breastfeeding has been proven to be essential for optimal health, and for reducing infections and mortality in children. However, exclusive breastfeeding coverage both in Indonesia and in globalremains low. This study evaluated the relationship between the timely initiation of breastfeeding and the practice of exclusive breastfeeding in Indonesia. This cross-sectional study used Riskesdas 2013 data. Participants were 7,667 mothers whose children were aged 6-23 months in Indonesia, and were selected based on the completeness of the variables. The data were analysed using descriptive statistics, chisquare tests, and a multiple logistic regression that considered the sampling weight. STATA 13.0 was used for the analyses, and the significance level was set at p<0.05. Timely initiation of breastfeeding within 1 hour of parturition (OR=3.66, 95% CI: 2.14-3.64), timely initiation of breastfeeding at or after 1 hour following parturition (OR=2.79, 95% CI: 3.00-4.46), and neonatal illness (OR=0.69, 95% CI: 0.53-0.91) were significantly associated with an exclusive breastfeeding history among children aged 6-23 months. Other factors, such as the mother's age, mother's educational level, child's birth weight, household economic status, and residential area were not associated with an exclusive breastfeeding history. Timely initiation of breastfeeding and the prevention of neonatal illness should be the main interventions to improve exclusive breastfeeding coverage in Indonesia.

Data on the agitation of a viscous Newtonian fluid by radial impellers in a cylindrical tank.

PubMed

Ameur, Houari; Kamla, Youcef; Sahel, Djamel

2017-12-01

In this paper, the data assembled concerning the agitation of a Newtonian fluid in a cylindrical vessel is disclosed. The stirred vessel is not provided with baffles and has a flat-bottom. The data presents some information on the characteristics of two impellers: a six-blade Rushton turbine and a six-blade paddle impeller. The flow patterns generated by both impellers are depicted and compared. Also, the power required when changing the impeller rotational speed is given. The data summarized here via three-dimensional calculations of velocities and viscous dissipation in the whole volume of the tank provides additional knowledge for the best choice of impellers for each industrial process.

Impact of varying analytical methodologies on grain particle size determination.

PubMed

Kalivoda, J R; Jones, C K; Stark, C R

2017-01-01

The determination of particle size is an important quality control measurement for feed manufacturers, nutritionists, and producers. The current approved method for determining the geometric mean diameter by weight (d) and geometric standard deviation (S) of grains is standard ANSI/ASAE S319.4. This method controls many variables, including the suggested quantity of initial material and the type, number, and size of sieves. However, the method allows for variations in sieving time, sieve agitators, and the use of a dispersion agent. The objective of this experiment was to determine which method of particle size analysis best estimated the particle size of various cereal grain types. Eighteen samples of either corn, sorghum, or wheat were ground and analyzed using different variations of the approved method. Treatments were arranged in a 5 × 3 factorial arrangement with 5 sieving methods: 1) 10-min sieving time with sieve agitators and no dispersion agent, 2) 10-min sieving time with sieve agitators and dispersion agent, 3) 15-min sieving time with no sieve agitators or dispersion agent, 4) 15-min sieving time with sieve agitators and no dispersion agent, and 5) 15-min sieving time with sieve agitators and dispersion agent conducted in 3 grain types (ground corn, sorghum, and wheat) with 4 replicates per treatment. The analytical method that resulted in the lowest d and greatest S was considered desirable because it was presumably representative of increased movement of particles to their appropriate sieve. Analytical method affected d and S ( ≤ 0.05) measured by both standards. Inclusion of sieve agitators and dispersion agent in the sieve stack resulted in the lowest d, regardless of sieving time. Inclusion of dispersion agent reduced d ( ≤ 0.05) by 32 and 36 µm when shaken for 10 and 15 min, respectively, compared to the same sample analyzed without dispersion agent. The addition of the dispersion agent also increased S. The dispersion agent increased the

[Scoping review on the concepts of touch and massage and their effects on agitation and stress in aged hospitalized patients suffering from dementia

PubMed

Schaub, Corinne; von Gunten, Armin; Morin, Diane

2016-09-01

This scoping review examines the effects of touch/massage on agitation and stress in aged hospitalized patients suffering from dementia. This intervention is multidimensional, at the edges of medical neurosciences, nursing sciences, and social sciences. This review is primarily supported by a biological model of social relations, describing the interconnection between cognition, affect, and endocrine aspects of attachment modes. It is also guided by nursing sciences conceptualizations which anchors touch/massage in the heart of nursing practice. The importance of touch/massage and its emotional regulation capacity is discussed in the light of these conceptualizations. The needs for that kind of contact in aged demented inpatients appears to be related to sensory loss and to a lack of emotional and social contacts. Evidence of the benefits of touch/massage is synthesized and indicate that this intervention is sometimes difficult to provide for agitated patients. Finally, proposals are made to develop a scientific agenda in clinical settings in order to continue the development of evidence and thus contribute to better inform nursing practice.

Modeling and optimization of poly(3hydroxybutyrate-co-3hydroxyvalerate) production from cane molasses by Azohydromonas lata MTCC 2311 in a stirred-tank reactor: effect of agitation and aeration regimes.

PubMed

Zafar, Mohd; Kumar, Shashi; Kumar, Surendra; Dhiman, Amit K

2012-07-01

The effects of agitation and aeration rates on copolymer poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [P(3HB-co-3HV)] production by Azohydromonas lata MTCC 2311 using cane molasses supplemented with propionic acid in a bioreactor were investigated. The experiments were conducted in a three-level factorial design by varying the impeller (150-500 rev min(-1)) and aeration (0.5-1.5 vvm) rates. Further, the data were fitted to mathematical models [quadratic polynomial equation and artificial neural network (ANN)] and process variables were optimized by genetic algorithm-coupled models. ANN and hybrid ANN-GA were found superior for modeling and optimization of process variables, respectively. The maximum copolymer concentration of 7.45 g l(-1) with 21.50 mol% of 3HV was predicted at process variables: agitation speed, 287 rev min(-1); and aeration rate, 0.85 vvm, which upon validation gave 7.20 g l(-1) of P(3HB-co-3HV) with 21 mol% of 3HV with the prediction error (%) of 3.38 and 2.32, respectively. Agitation speed established a relative high importance of 72.19% than of aeration rate (27.80%) for copolymer accumulation. The volumetric gas-liquid mass transfer coefficient (k (L) a) was strongly affected by agitation and aeration rates. The highest P(3HB-co-3HV) productivity of 0.163 g l(-1) h(-1) was achieved at 0.17 s(-1) of k (L) a value. During the early phase of copolymer production process, 3HB monomers were accumulated, which were shifted to 3HV units (9-21%) during the cultivation period of 24-42 h. The enhancement of 7.5 and 34% were reported for P(3HB-co-3HV) production and 3HV content, respectively, by hybrid ANN-GA paradigm, which revealed the significant utilization of cane molasses for improved copolymer production.

Determinants of timely initiation of breastfeeding among mothers in Goba Woreda, South East Ethiopia: A cross sectional study

PubMed Central

2011-01-01

Background Although breastfeeding is universal in Ethiopia, ranges of regional differences in timely initiation of breastfeeding have been documented. Initiation of breastfeeding is highly bound to cultural factors that may either enhance or inhibit the optimal practices. The government of Ethiopia developed National Infant and Young Child Feeding Guideline in 2004 and behavior change communications on breast feeding have been going on since then. However, there is a little information on the practice of timely initiation of breast feeding and factors that predict these practices after the implementation of the national guideline. The objective of this study is to determine the prevalence and determinant factors of timely initiation of breastfeeding among mothers in Bale Goba District, South East Ethiopia. Methods A community based cross sectional study was carried out from February to March 2010 using both quantitative and qualitative methods of data collection. A total of 608 mother infant pairs were selected using simple random sampling method and key informants for the in-depth interview were selected conveniently. Descriptive statistics, bivariate analysis and multivariable logistic regression analyses were employed to identify factors associated with timely initiation of breast feeding. Results The prevalence of timely initiation of breastfeeding was 52.4%. Bivariate analysis showed that attendance of formal education, being urban resident, institutional delivery and postnatal counseling on breast feeding were significantly associated with timely initiation of breastfeeding (P < 0.05). After adjust sting for other factors on the multivariable logistic model, being in the urban area [AOR: 4.1 (95%C.I: 2.31-7.30)] and getting postnatal counseling [AOR: 2.7(1.86-3.94)] were independent predictors of timely initiation of breastfeeding. Conclusions The practice of timely initiation of breast feeding is low as nearly half the mothers did not start breastfeeding

Timing of dialysis initiation in transplant-naive and failed transplant patients

PubMed Central

Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

2017-01-01

Over the past two decades, most guidelines have advocated early dialysis initiation on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m2, from 20% in 1996 to 52% in 2008. During this period, patients starting dialysis with an eGFR ≥15 ml/min/1.73 m2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes in patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Dialysis reinitiation in patients with a failing renal allograft encounters similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients. In this Review, we will discuss studies of dialysis initiation and compare risks and benefits of early versus late dialysis therapy. PMID:22371250

Public views on a wait time management initiative: a matter of communication

PubMed Central

2010-01-01

Background Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative - the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Methods Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Results Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Conclusions Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management. PMID:20687952

Effect of Pore Clogging on Kinetics of Lead Uptake by Clinoptilolite.

PubMed

Inglezakis; Diamandis; Loizidou; Grigoropoulou

1999-07-01

The kinetics of lead-sodium ion exchange using pretreated natural clinoptilolite are investigated, more specifically the influence of agitation (0, 210, and 650 rpm) on the limiting step of the overall process, for particle sizes of 0.63-0.8 and 0.8-1 mm at ambient temperature and initial lead solutions of 500 mg l-1 without pH adjustment. The isotopic exchange model is found to fit the ion exchange process. Particle diffusion is shown to be the controlling step for both particle sizes under agitation, while in the absence of agitation film diffusion is shown to control. The ion exchange process effective diffusion coefficients are calculated and found to depend strongly on particle size in the case of agitation at 210 rpm and only slightly on particle size at 650 rpm. Lead uptake rates are higher for smaller particles only at rigorous agitation, while at mild agitation the results are reversed. These facts are due to partial clogging of the pores of the mineral during the grinding process. This is verified through comparison of lead uptake rates for two samples of the same particle size, one of which is rigorously washed for a certain time before being exposed to the ion exchange. Copyright 1999 Academic Press.

Nonthermal microwave effects revisited: on the importance of internal temperature monitoring and agitation in microwave chemistry.

PubMed

Herrero, M Antonia; Kremsner, Jennifer M; Kappe, C Oliver

2008-01-04

The concept of nonthermal microwave effects has received considerable attention in recent years and is the subject of intense debate in the scientific community. Nonthermal microwave effects have been postulated to result from a direct stabilizing interaction of the electric field with specific (polar) molecules in the reaction medium that is not related to a macroscopic temperature effect. In order to probe the existence of nonthermal microwave effects, four synthetic transformations (Diels-Alder cycloaddition, alkylation of triphenylphosphine and 1,2,4-triazole, direct amide bond formation) were reevaluated under both microwave dielectric heating and conventional thermal heating. In all four cases, previous studies have claimed the existence of nonthermal microwave effects in these reactions. Experimentally, significant differences in conversion and/or product distribution comparing the conventionally and microwave-heated experiments performed at the same measured reaction temperature were found. The current reevaluation of these reactions was performed in a dedicated reactor setup that allowed accurate internal reaction temperature measurements using a multiple fiber-optic probe system. Using this technology, the importance of efficient stirring and internal temperature measurement in microwave-heated reactions was made evident. Inefficient agitation leads to temperature gradients within the reaction mixture due to field inhomogeneities in the microwave cavity. Using external infrared temperature sensors in some cases results in significant inaccuracies in the temperature measurement. Applying the fiber-optic probe temperature monitoring device, a critical reevaluation of all four reactions has provided no evidence for the existence of nonthermal microwave effects. Ensuring efficient agitation of the reaction mixture via magnetic stirring, no significant differences in terms of conversion and selectivity between experiments performed under microwave or oil bath

The effect of the medicine administration route on health-related quality of life: Results from a time trade-off survey in patients with bipolar disorder or schizophrenia in 2 Nordic countries.

PubMed

Jørgensen, Tine Rikke; Emborg, Charlotte; Dahlen, Karianne; Bøgelund, Mette; Carlborg, Andreas

2016-07-16

Agitation episodes are common among patients with schizophrenia or bipolar disorder. Oral and intramuscular administration methods are commonly used in pharmacological treatment of acute agitation. Recently, an innovative inhalation product with loxapine(Adasuve®)has become available for treatment of acute agitation episodes associated with bipolar disorder or schizophrenia. The objective for the present study was to investigate the impact of the pharmacological treatment's administration methods on the health-related quality of life (HRQoL) in patients with bipolar disorder or schizophrenia in Denmark and Sweden using a time trade-off (TTO) approach. The TTO methodology was used to examine the HRQoL impact of administration method of pharmacological treatment of acute agitation. Data were collected via an internet-based survey, using an existing panel of respondents with schizophrenia or bipolar disorder. Respondents considered living with schizophrenia/ bipolar disorder, having one yearly agitation episode treated with inhaler better than living with the same conditions and receiving treatment with tablet or injection. The utility value was 0.762 for inhalable treatment, 0.707 for injection and 0.734 for tablet treatment. Patients' preference for treatment delivery options showed that inhalation was associated with a significant utility gain when compared to injection or tablets. Inhalable loxapine may be a new tool for control of agitation episodes for strengthening the patient provider alliance when taking patient's preference for delivery method into consideration.

Effect of agitation time on nutrient distribution in full-scale CSTR biogas digesters.

PubMed

Kress, Philipp; Nägele, Hans-Joachim; Oechsner, Hans; Ruile, Stephan

2018-01-01

The aim of this work was to study the impact of reduced mixing time in a full-scale CSTR biogas reactor from 10 to 5 and to 2min in half an hour on the distribution of DM, acetic acid and FOS/TAC as a measure to cut electricity consumption. The parameters in the digestate were unevenly distributed with the highest concentration measured at the point of feeding. By reducing mixing time, the FOS/TAC value increases by 16.6%. A reduced mixing time of 2min lead to an accumulation of 15% biogas in the digestate. Copyright © 2017 Elsevier Ltd. All rights reserved.

5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... debarments. 890.1005 Section 890.1005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1005 Time limits for OPM to initiate...

5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... debarments. 890.1005 Section 890.1005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1005 Time limits for OPM to initiate...

5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... debarments. 890.1005 Section 890.1005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1005 Time limits for OPM to initiate...

Evolution of Degenerate Space-Time from Non-Degenerate Initial Value in Ashtekar's Formalism

NASA Astrophysics Data System (ADS)

Ma, Yongge; Liang, Canbin

1998-09-01

The possibility of evolving a degenerate space-time from non-degenerate initial value in Ashtekar's formalism is considered in a constructed example. It is found that this possibility could be realized in the time evolution given by Ashtekar's equations, but the topology change of space makes it fail to be a Cauchy evolution.

Cationic Surface Charge Combined with Either Vitronectin or Laminin Dictates the Evolution of Human Embryonic Stem Cells/Microcarrier Aggregates and Cell Growth in Agitated Cultures

PubMed Central

Lam, Alan Tin-Lun; Li, Jian; Chen, Allen Kuan-Liang; Reuveny, Shaul

2014-01-01

The expansion of human pluripotent stem cells (hPSC) for biomedical applications generally compels a defined, reliable, and scalable platform. Bioreactors offer a three-dimensional culture environment that relies on the implementation of microcarriers (MC), as supports for cell anchorage and their subsequent growth. Polystyrene microspheres/MC coated with adhesion-promoting extracellular matrix (ECM) protein, vitronectin (VN), or laminin (LN) have been shown to support hPSC expansion in a static environment. However, they are insufficient to promote human embryonic stem cells (hESC) seeding and their expansion in an agitated environment. The present study describes an innovative technology, consisting of a cationic charge that underlies the ECM coatings. By combining poly-L-lysine (PLL) with a coating of ECM protein, cell attachment efficiency and cell spreading are improved, thus enabling seeding under agitation in a serum-free medium. This coating combination also critically enables the subsequent formation and evolution of hPSC/MC aggregates, which ensure cell viability and generate high yields. Aggregate dimensions of at least 300 μm during early cell growth give rise to ≈15-fold expansion at 7 days' culture. Increasing aggregate numbers at a quasi-constant size of ≈300 μm indicates hESC growth within a self-regulating microenvironment. PLL+LN enables cell seeding and aggregate evolution under constant agitation, whereas PLL+VN requires an intermediate 2-day static pause to attain comparable aggregate sizes and correspondingly high expansion yields. The cells' highly reproducible bioresponse to these defined and characterized MC surface properties is universal across multiple cell lines, thus confirming the robustness of this scalable expansion process in a defined environment. PMID:24641164

Determinants of timely initiation of breastfeeding among mothers in Goba Woreda, South East Ethiopia: a cross sectional study.

PubMed

Setegn, Tesfaye; Gerbaba, Mulusew; Belachew, Tefera

2011-04-08

Although breastfeeding is universal in Ethiopia, ranges of regional differences in timely initiation of breastfeeding have been documented. Initiation of breastfeeding is highly bound to cultural factors that may either enhance or inhibit the optimal practices. The government of Ethiopia developed National Infant and Young Child Feeding Guideline in 2004 and behavior change communications on breast feeding have been going on since then. However, there is a little information on the practice of timely initiation of breast feeding and factors that predict these practices after the implementation of the national guideline. The objective of this study is to determine the prevalence and determinant factors of timely initiation of breastfeeding among mothers in Bale Goba District, South East Ethiopia. A community based cross sectional study was carried out from February to March 2010 using both quantitative and qualitative methods of data collection. A total of 608 mother infant pairs were selected using simple random sampling method and key informants for the in-depth interview were selected conveniently. Descriptive statistics, bivariate analysis and multivariable logistic regression analyses were employed to identify factors associated with timely initiation of breast feeding. The prevalence of timely initiation of breastfeeding was 52.4%. Bivariate analysis showed that attendance of formal education, being urban resident, institutional delivery and postnatal counseling on breast feeding were significantly associated with timely initiation of breastfeeding (P < 0.05). After adjust sting for other factors on the multivariable logistic model, being in the urban area [AOR: 4.1 (95%C.I: 2.31-7.30)] and getting postnatal counseling [AOR: 2.7(1.86-3.94)] were independent predictors of timely initiation of breastfeeding. The practice of timely initiation of breast feeding is low as nearly half the mothers did not start breastfeeding with one hour after delivery. The results

Time to Initiation of Antiretroviral Therapy Among Patients Who Are ART Eligible in Rwanda: Improvement Over Time

PubMed Central

Teasdale, Chloe A.; Wang, Chunhui; Francois, Uwinkindi; d’Amour Ndahimana, Jean; Vincent, Mutabazi; Sahabo, Ruben; El-Sadr, Wafaa M.; Abrams, Elaine J.

2016-01-01

Background Delayed initiation of antiretroviral therapy (ART) in eligible patients is a concern in resource-limited countries. Methods We analyzed data on HIV-positive patients ≥15 years enrolled at 41 ICAP-supported health care facilities in Rwanda, 2005–2010, to determine time to ART initiation among patients eligible at enrollment compared with those ineligible or of indeterminate eligibility who become eligible during follow-up. ART eligibility was based on CD4+ cell count (CD4+) and WHO staging; patients lacking CD4+ and WHO stage were considered indeterminate. Cumulative incidence of reaching ART eligibility and to ART initiation after eligibility was generated using competing risk estimators. Results A total of 31,033 ART-naive adults were enrolled; 64.2% were female. At enrollment, 10,158 (32.7%) patients were ART eligible, 13,372 (43.1%) were ineligible for ART, and 7503 (24.2%) patients were indeterminate. Among patients retained in care pre-ART eligibility, 17.9% [95% confidence interval (CI): 17.2 to 18.6] of ineligible and 22.8% (95% CI: 21.7 to 23.8) of indeterminate patients at enrollment reached ART eligibility within 12 months. Cumulative incidence of ART initiation within 3 months for patients eligible at enrollment was 77.2% (95% CI: 76.4 to 78.0) compared with 67.9% (95% CI: 66.4 to 69.3) for ineligible and 63.8% (95% CI: 61.9 to 65.8) for patients with indeterminate eligibility at enrollment (P < 0.05). Over the study period, there was more rapid ART initiation for patients who became ART eligible. Conclusions We found higher rates of ART initiation within 3 months among patients who were ART eligible at enrollment compared with those who reached eligibility during follow-up. From 2006 to 2011, earlier initiation of ART after eligibility was observed likely reflecting improved program quality. PMID:25415291

Incidence and timing of cancer in HIV-infected individuals following initiation of combination antiretroviral therapy.

PubMed

Yanik, Elizabeth L; Napravnik, Sonia; Cole, Stephen R; Achenbach, Chad J; Gopal, Satish; Olshan, Andrew; Dittmer, Dirk P; Kitahata, Mari M; Mugavero, Michael J; Saag, Michael; Moore, Richard D; Mayer, Kenneth; Mathews, W Christopher; Hunt, Peter W; Rodriguez, Benigno; Eron, Joseph J

2013-09-01

Cancer is an important cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), but patterns of cancer incidence after combination antiretroviral therapy (ART) initiation remain poorly characterized. We evaluated the incidence and timing of cancer diagnoses among patients initiating ART between 1996 and 2011 in a collaboration of 8 US clinical HIV cohorts. Poisson regression was used to estimate incidence rates. Cox regression was used to identify demographic and clinical characteristics associated with cancer incidence after ART initiation. At initiation of first combination ART among 11 485 patients, median year was 2004 (interquartile range [IQR], 2000-2007) and median CD4 count was 202 cells/mm(3) (IQR, 61-338). Incidence rates for Kaposi sarcoma (KS) and lymphomas were highest in the first 6 months after ART initiation (P < .001) and plateaued thereafter, while incidence rates for all other cancers combined increased from 416 to 615 cases per 100 000 person-years from 1 to 10 years after ART initiation (average 7% increase per year; 95% confidence interval, 2%-13%). Lower CD4 count at ART initiation was associated with greater risk of KS, lymphoma, and human papillomavirus-related cancer. Calendar year of ART initiation was not associated with cancer incidence. KS and lymphoma rates were highest immediately following ART initiation, particularly among patients with low CD4 cell counts, whereas other cancers increased with time on ART, likely reflecting increased cancer risk with aging. Our results underscore recommendations for earlier HIV diagnosis followed by prompt ART initiation along with ongoing aggressive cancer screening and prevention efforts throughout the course of HIV care.

Initial operation of the NSTX-Upgrade real-time velocity diagnostic

DOE PAGES

Podestà, M.; Bell, R. E.

2016-11-03

A real-time velocity (RTV) diagnostic based on active charge-exchange recombination spectroscopy is now operational on the National Spherical Torus Experiment-Upgrade (NSTX-U) spherical torus (Menard et al 2012 Nucl. Fusion 52 083015). We designed the system in order to supply plasma velocity data in real time to the NSTX-U plasma control system, as required for the implementation of toroidal rotation control. Our measurements are available from four radii at a maximum sampling frequency of 5 kHz. Post-discharge analysis of RTV data provides additional information on ion temperature, toroidal velocity and density of carbon impurities. Furthermore, examples of physics studies enabled bymore » RTV measurements from initial operations of NSTX-U are discussed.« less

Wavepacket propagation using time-sliced semiclassical initial value methods

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wallace, Brett B.; Reimers, Jeffrey R.; School of Chemistry, University of Sydney, Sydney NSW 2006

2004-12-22

A new semiclassical initial value representation (SC-IVR) propagator and a SC-IVR propagator originally introduced by Kay [J. Chem. Phys. 100, 4432 (1994)], are investigated for use in the split-operator method for solving the time-dependent Schroedinger equation. It is shown that the SC-IVR propagators can be derived from a procedure involving modified Filinov filtering of the Van Vleck expression for the semiclassical propagator. The two SC-IVR propagators have been selected for investigation because they avoid the need to perform a coherent state basis set expansion that is necessary in other time-slicing propagation schemes. An efficient scheme for solving the propagators ismore » introduced and can be considered to be a semiclassical form of the effective propagators of Makri [Chem. Phys. Lett. 159, 489 (1989)]. Results from applications to a one-dimensional, two-dimensional, and three-dimensional Hamiltonian for a double-well potential are presented.« less

18 CFR 701.205 - Time limit for requester to appeal an initial adverse determination.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Time limit for requester to appeal an initial adverse determination. 701.205 Section 701.205 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.205 Time...

18 CFR 701.205 - Time limit for requester to appeal an initial adverse determination.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Time limit for requester to appeal an initial adverse determination. 701.205 Section 701.205 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.205 Time...

18 CFR 701.205 - Time limit for requester to appeal an initial adverse determination.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Time limit for requester to appeal an initial adverse determination. 701.205 Section 701.205 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.205 Time...

18 CFR 701.205 - Time limit for requester to appeal an initial adverse determination.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Time limit for requester to appeal an initial adverse determination. 701.205 Section 701.205 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.205 Time...

Breast-feeding patterns, time to initiation, and mortality risk among newborns in southern Nepal.

PubMed

Mullany, Luke C; Katz, Joanne; Li, Yue M; Khatry, Subarna K; LeClerq, Steven C; Darmstadt, Gary L; Tielsch, James M

2008-03-01

Initiation of breast-feeding within 1 h after birth has been associated with reduced neonatal mortality in a rural Ghanaian population. In South Asia, however, breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified. Data were collected during a community-based randomized trial of the impact of topical chlorhexidine antisepsis interventions on neonatal mortality and morbidity in southern Nepal. In-home visits were conducted on d 1-4, 6, 8, 10, 12, 14, 21, and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding. Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time. Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth, 3.4% of infants were breast-fed and 56.6% were breast-fed within 24 h of birth. Partially breast-fed infants (72.6%) were at higher mortality risk [relative risk (RR) = 1.77; 95% CI = 1.32-2.39] than those exclusively breast-fed. There was a trend (P = 0.03) toward higher mortality with increasing delay in breast-feeding initiation. Mortality was higher among late (> or = 24 h) compared with early (< 24 h) initiators (RR = 1.41; 95% CI = 1.08-1.86) after adjustment for low birth weight, preterm birth, and other covariates. Improvements in breast-feeding practices in this setting may reduce neonatal mortality substantially. Approximately 7.7 and 19.1% of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life, respectively. Community-based breast-feeding promotion programs should remain a priority, with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding.

The effect of impeller type on silica sol formation in laboratory scale agitated tank

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nurtono, Tantular; Suprana, Yayang Ade; Latif, Abdul

2016-02-08

The multiphase polymerization reaction of the silica sol formation produced from silicic acid and potassium hydroxide solutions in laboratory scale agitated tank was studied. The reactor is equipped with four segmental baffle and top entering impeller. The inside diameter of reactor is 9 cm, the baffle width is 0.9 cm, and the impeller position is 3 cm from tank bottom. The diameter of standard six blades Rushton and three blades marine propeller impellers are 5 cm. The silicic acid solution was made from 0.2 volume fraction of water glass (sodium silicate) solution in which the sodium ion was exchanged by hydrogen ion from cationmore » resin. The reactor initially filled with 286 ml silicic acid solution was operated in semi batch mode and the temperature was kept constant in 60 °C. The 3 ml/minute of 1 M potassium hydroxide solution was added into stirred tank and the solution was stirred. The impeller rotational speed was varied from 100 until 700 rpm. This titration was stopped if the solution in stirred tank had reached the pH of 10-The morphology of the silica particles in the silica sol product was analyzed by Scanning Electron Microscope (SEM). The size of silica particles in silica sol was measured based on the SEM image. The silica particle obtained in this research was amorphous particle and the shape was roughly cylinder. The flow field generated by different impeller gave significant effect on particle size and shape. The smallest geometric mean of length and diameter of particle (4.92 µm and 2.42 µm, respectively) was generated in reactor with marine propeller at 600 rpm. The reactor with Rushton impeller produced particle which the geometric mean of length and diameter of particle was 4.85 µm and 2.36 µm, respectively, at 150 rpm.« less

18 CFR 701.205 - Time limit for requester to appeal an initial adverse determination.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Time limit for requester to appeal an initial adverse determination. 701.205 Section 701.205 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.205 Time limit for...

Time correlation between mononucleosis and initial symptoms of MS

PubMed Central

Endriz, John; Ho, Peggy P.

2017-01-01

Objective: To determine the average age of MS onset vs the age at which Epstein-Barr infection has previously occurred and stratify this analysis by sex and the blood level of Epstein-Barr nuclear antigen 1 (EBNA1) antibody. Methods: Using infectious mononucleosis (IM) as a temporal marker in data from the Swedish epidemiologic investigation of MS, 259 adult IM/MS cases were identified and then augmented to account for “missing” childhood data so that the average age of MS onset could be determined for cases binned by age of IM (as stratified by sex and EBNA1 titer level). Results: Mean age of IM vs mean age of MS reveals a positive time correlation for all IM ages (from ∼5 to ∼30 years), with IM-to-MS delay decreasing with increased age. When bifurcated by sex or EBNA1 blood titer levels, males and high-titer subpopulations show even stronger positive time correlation, while females and low-titer populations show negative time correlation in early childhood (long IM/MS delay). The correlation becomes positive in females beyond puberty. Conclusions: IM/MS time correlation implies causality if IM is time random. Alternative confounding models seem implausible, in light of constraints imposed by time-invariant delay observed here. Childhood infection with Epstein-Barr virus (EBV) in females and/or those genetically prone to low EBNA1 blood titers will develop MS slowly. Males and/or high EBNA1-prone develop MS more rapidly following IM infection at all ages. For all, postpubescent EBV infection is critical for the initiation and rapid development of MS. PMID:28271078

Impact of Simulation Training on Time to Initiation of Cardiopulmonary Resuscitation for First-Year Pediatrics Residents

PubMed Central

Ross, Joshua C.; Trainor, Jennifer L.; Eppich, Walter J.; Adler, Mark D.

2013-01-01

Background Pediatrics residents have few opportunities to perform cardiopulmonary resuscitation (CPR). Enhancing the quality of CPR is a key factor to improving outcomes for cardiopulmonary arrest in children and requires effective training strategies. Objective To evaluate the effectiveness of a simulation-based intervention to reduce first-year pediatrics residents' time for 3 critical actions in CPR: (1) call for help, (2) initiate bag-mask ventilation, and (3) initiate chest compressions. Methods A prospective study involving 31 first-year pediatrics residents at a children's hospital assigned to an early or late (control) intervention group. Residents underwent baseline assessment followed by repeat evaluations at 3 and 6 months. Time to critical actions was scored by video review. A 90-minute educational intervention focused on skill practice was conducted following baseline evaluation for the early-intervention group and following 3-month evaluation for the late-intervention group. Primary outcome was change in time to initiating the 3 critical actions. Change in time was analyzed by comparison of Kaplan-Meier curves, using the log-rank test. A 10% sample was timed by a second rater. Agreement was assessed using intraclass correlation (ICC). Results There was a statistically significant reduction in time for all 3 critical actions between baseline and 3-month evaluation in the early intervention group; this was not observed in the late (control) group. Rater agreement was excellent (ICC ≥ 0.99). Conclusions A simulation-based educational intervention significantly reduced time to initiation of CPR for first-year pediatrics residents. Simulation training facilitated acquisition of critical CPR skills that have the potential to impact patient outcome. PMID:24455010

Effects of Fentanyl on Emergence Agitation in Children under Sevoflurane Anesthesia: Meta-Analysis of Randomized Controlled Trials

PubMed Central

Xiong, Wei; Zhou, Qin; Yang, Peng; Huang, Xiongqing

2015-01-01

Background and Objectives The goal of this meta-analysis study was to assess the effects of fentanyl on emergence agitation (EA) under sevoflurane anesthesia in children. Subjects and Methods We searched electronic databases (PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials) for articles published until December 2014. Randomized controlled trials (RCTs) that assessed the effects of fentanyl and placebo on EA under sevoflurane anesthesia in children that the outcome were the incidence of EA, postoperative pain, emergence time or adverse effects were included in this meta-analysis. Results A total of 16 studies, including 1362 patients (737 patients for the fentanyl group and 625 for the placebo group), were evaluated in final analysis. We found that administration of fentanyl decreased the incidences of EA (RR = 0.37, 95% CI 0.27~0.49, P<0.00001) and postoperative pain (RR = 0.59, 95% CI 0.41~0.85, P = 0.004) but increased the incidence of postoperative nausea and vomiting (PONV) (RR = 2.23, 95% CI 1.33~3.77, P = 0.003). The extubation time (WMD = 0.71 min, 95% CI 0.12~1.3, P = 0.02), emergence time (WMD = 4.90 min, 95% CI 2.49~7.30, P<0.0001), and time in the postanesthesia care unit (PACU) (WMD = 2.65 min, 95% CI 0.76~4.53, P = 0.006) were slightly increased. There were no significant differences in the time to discharge of day patients (WMD = 3.72 min, 95% CI -2.80~10.24, P = 0.26). Conclusion Our meta-analysis suggests that fentanyl decreases the incidence of EA under sevoflurane anesthesia in children and postoperative pain, but has a higher incidence of PONV. Considering the inherent limitations of the included studies, more RCTs with extensive follow-up should be performed to validate our findings in the future. PMID:26275039

[Consensus document: a model of integrated management of patients with psycomotor agitation].

PubMed

2016-01-01

Psychomotor agitation (PMA) is a heterogeneous clinical syndrome associated with a widenumber of pathological conditions. The currently available recommendations and guidelines on PMA correct assessment and management are significantly dishomogeneous and suffer from a lack of standardization, especially regarding pharmacological interventions. Based on this deficiency, and on multidisciplinary nature of PMA, that includes factors shared by different health professionals other than pharmacoeconomic and risk management aspects, we started a project aimed to elaborate a shared model of integrated management for PMA patients. The model, developed by a scientific board and a multidisciplinary panel using the consensus Delphi-RAND method, aims to give indications of good clinical practice for the management of these patients. The present document reports the results of this consensus process, whose main principles are the centrality of the patient, as an active and collaborating subject, the importance of prompt and not coercive interventions able to block the escalation to violence and to allow a correct diagnostic and therapeutic workup, the appropriate use of pharmacological interventions based on the severity of symptoms and the importance of an integrated and harmonized approach by the different professionals involved in PMA management.

Process viscometry in flows of non-Newtonian fluids using an anchor agitator

NASA Astrophysics Data System (ADS)

Jo, Hae Jin; Jang, Hye Kyeong; Kim, Young Ju; Hwang, Wook Ryol

2017-11-01

In this work, we present a viscosity measurement technique for inelastic non-Newtonian fluids directly in flows of anchor agitators that are commonly used in highly viscous fluid mixing particularly with yield stress. A two-blade anchor impeller is chosen as a model flow system and Carbopol 940 solutions and Xanthan gum solutions with various concentrations are investigated as test materials. Following the Metzner-Otto correlation, the effective shear rate constant and the energy dissipation rate constant have been estimated experimentally by establishing (i) the relationship between the power number and the Reynolds number using a reference Newtonian fluid and (ii) the proportionality between the effective shear rate and the impeller speed with a reference non-Newtonian fluid. The effective viscosity that reproduces the same amount of the energy dissipation rate, corresponding to that of Newtonian fluid, has been obtained by measuring torques for various impeller speeds and the accuracy in the viscosity prediction as a function of the shear rate has been compared with the rheological measurement. We report that the process viscometry with the anchor impeller yields viscosity estimation within the relative error of 20% with highly shear-thinning fluids.

Successful child psychotherapy of attention deficit/hyperactive disorder: an agitated depression explanation.

PubMed

Seitler, Burton Norman

2008-09-01

Science tries to explain phenomena in ways that are demonstrable and replicable to develop logical, coherent, parsimonious, and predictive theoretical systems. Yet hyperactive children are given stimulants to "calm" them down, despite the fact that science would predict stimulants would increase hyperactivity. Bradley (1937, 1950) observed that half of the behavior-problem children to whom he administered a stimulant for one week became subdued. He called this finding paradoxical, speculating that inhibitory centers of the central nervous system were stimulated. While Bradley's assertion of a paradoxical reverse effect in children may be an empirical observation, it is not an explanation. The Attention Deficit/Hyperactive Disorder (ADHD) is inferred to exist from hyperactive behavior, which in turn, is inferred to be neurological in origin, a circular argument. An inevitable consequence of the belief in the hypothetical neurological etiology of ADHD is that children are typically given stimulants. Using the case of a seven-year old child, described as experiencing ADHD, who was treated successfully without medication as an illustration, the author provides an alternative, more parsimonious explanation of the etiology, suggesting that ADHD is related to agitated depression.

Timing of vasopressor initiation and mortality in septic shock: a cohort study

PubMed Central

2014-01-01

Introduction Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation of key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce the mortality in this condition. This study examined whether early initiation of vasopressor therapy is associated with improved survival in fluid therapy-refractory septic shock. Methods Utilizing a well-established database, relevant information including duration of time to vasopressor administration following the initial documentation of recurrent/persistent hypotension associated with septic shock was assessed in 8,670 adult patients from 28 ICUs in Canada, the United States of America, and Saudi Arabia. The primary endpoint was survival to hospital discharge. Secondary endpoints were length of ICU and hospital stay as well as duration of ventilator support and vasopressor dependence. Analysis involved multivariate linear and logistic regression analysis. Results In total, 8,640 patients met the definition of septic shock with time of vasopressor/inotropic initiation documented. Of these, 6,514 were suitable for analysis. The overall unadjusted hospital mortality rate was 53%. Independent mortality correlates included liver failure (odds ratio (OR) 3.46, 95% confidence interval (CI), 2.67 to 4.48), metastatic cancer (OR 1.63, CI, 1.32 to 2.01), AIDS (OR 1.91, CI, 1.29 to 2.49), hematologic malignancy (OR 1.88, CI, 1.46 to 2.41), neutropenia (OR 1.78, CI, 1.27 to 2.49) and chronic hypertension (OR 0.62 CI, 0.52 to 0.73). Delay of initiation of appropriate antimicrobial therapy (OR 1.07/hr, CI, 1.06 to 1.08), age (OR 1.03/yr, CI, 1.02 to 1.03), and Acute Physiology and Chronic Health Evaluation (APACHE) II Score (OR 1.11/point, CI, 1.10 to 1.12) were also found to be significant independent correlates of mortality. After adjustment, only a weak correlation between vasopressor delay and hospital mortality was found (adjusted OR 1.02/hr, 95% CI

Comparative evaluation of cyanide removal by adsorption, biodegradation, and simultaneous adsorption and biodegradation (SAB) process using Bacillus cereus and almond shell.

PubMed

Dwivedi, Naveen; Balomajumder, Chandrajit; Mondal, Prasenji

2016-07-01

The present study aimed to investigate the removal efficiency of cyanide from contaminated water by adsorption, biodegradation and simultaneous adsorption and biodegradation (SAB) process individually in a batch reactor. Adsorption was achieved by using almond shell granules and biodegradation was conducted with suspended cultures of Bacillus cereus, whereas SAB process was carried out using Bacillus cereus and almond shell in a batch reactor. The effect of agitation time, pH, and initial cyanide concentration on the % removal of cyanide has been discussed. Under experimental conditions, optimum removal was obtained at pH 7 with agitation time of 48 hrs and temperature of 35 degrees C. Cyanide was utilized by bacteria as sole source of nitrogen for growth. The removal efficiencies of cyanide by adsorption, biodegradation, and SAB were found to be 91.38%, 95.87%, and 99.63%, respectively, at initial cyanide concentration of 100 mg l(-1). The removal efficiency of SAB was found to be better as compared to that of biodegradation and adsorption alone.

How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania

PubMed Central

2013-01-01

Background Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Methods Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation. Results Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10–2.58) and 2.00 (95% CI 1.05–3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41–5.59) and 4.10 (95% CI 1.68–10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Conclusion Late ANC initiation is a significant maternal and

How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania.

PubMed

Exavery, Amon; Kanté, Almamy Malick; Hingora, Ahmed; Mbaruku, Godfrey; Pemba, Senga; Phillips, James F

2013-02-06

Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation. Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10-2.58) and 2.00 (95% CI 1.05-3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41-5.59) and 4.10 (95% CI 1.68-10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Late ANC initiation is a significant maternal and child health consequence of mistimed and

Decolorization of distillery spent wash effluent by electro oxidation (EC and EF) and Fenton processes: A comparative study.

PubMed

David, Charles; Arivazhagan, M; Tuvakara, Fazaludeen

2015-11-01

In this study, laboratory scale experiments were performed to degrade highly concentrated organic matter in the form of color in the distillery spent wash through batch oxidative methods such as electrocoagulation (EC), electrofenton (EF) and Fenton process. The effect of corresponding operating parameters, namely initial pH: 2-10; current intensity: 1-5A; electrolysis time: 0.5-4h; agitation speed: 100-500rpm; inter-electrode distance: 0.5-4cm and Fenton's reagent dosage: 5-40mg/L was employed for optimizing the process of spent wash color removal. The performance of all the three processes was compared and assessed in terms of percentage color removal. For EC, 79% color removal was achieved using iron electrodes arranged with 0.5cm of inter-electrode space and at optimum conditions of pH 7, 5A current intensity, 300rpm agitation speed and in 2h of electrolysis time. In EF, 44% spent wash decolorization was observed using carbon (graphite) electrodes with an optimum conditions of 0.5cm inter-electrode distance, pH 3, 4A current intensity, 20mg/L FeSO4 and agitation speed of 400rpm for 3h of electrolysis time. By Fenton process, 66% decolorization was attained by Fenton process at optimized conditions of pH 3, 40mg/L of Fenton's reagent and at 500rpm of agitation speed for 4h of treatment time. Copyright © 2015 Elsevier Inc. All rights reserved.

Time to and factors associated with insulin initiation in patients with type 2 diabetes mellitus.

PubMed

Machado-Alba, Jorge Enrique; Machado-Duque, Manuel Enrique; Moreno-Gutierrez, Paula Andrea

2015-03-01

Determine the time between the start of oral antidiabetic therapy (OAD) and the initiation of insulin therapy and to establish factors associated with insulin prescription among patients with type 2 diabetes mellitus (T2DM) in Colombia. Cohort, retrospective, population-based study. We identify patients with T2DM who started OAD therapy between 1 January 2007 and 31 December 2008, and a 5-year follow-up was performed. Kaplan-Meier survival analysis for time to start insulin therapy was generated and factors associated with insulin initiation were determined using logistic regression. A total of 1042 patients (52.4% women), mean age 63.4 years at the start of pharmacological treatment. After 5 years, 272 patients (26.1%) initiated insulin therapy. Using combination therapy of metformin and glibenclamide was associated with greater risk of insulin initiation (OR: 1.64, 95% CI: 1.12-2.40, p=0.010), while being a male over 45 years of age (OR: 0.59, 95% CI: 0.37-0.96, p=0.034) and initiating OAD therapy with metformin (OR: 0.30, 95% CI: 0.20-0.46, p<0.001) reduced the risk of insulin use. After 5 years of OAD treatment, 26.1% of people with T2DM started insulin therapy. Age, sex and type of initial OAD affected the probability of switching to insulin in these patients in Colombia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Online support and education for dementia caregivers: overview, utilization, and initial program evaluation.

PubMed

Glueckauf, Robert L; Ketterson, Timothy U; Loomis, Jeffrey S; Dages, Pat

2004-01-01

Family caregivers of older adults with progressive dementia (e.g., Alzheimer's disease) are confronted with a variety of challenges in providing assistance to their loved ones, such as dealing with persistent, repetitive questions, managing episodes of agitation and aggressive responding, as well as monitoring hygiene and self-care activities. Although professional and governmental organizations have called for the creation of community-based education and support programs, a significant proportion of dementia caregivers in the United States continue to receive little or no formal instruction in responding effectively to these anxiety-provoking situations. This paper describes the development and implementation of Alzheimer's Caregiver Support Online (also known as AlzOnline), an Internet- and telephone-based education and support network for caregivers of individuals with progressive dementia. An outcome analysis of a Robert Wood Johnson Foundation-funded strategic marketing initiative to promote the use of AlzOnline is reviewed, followed by a presentation of the findings of an initial program evaluation. Finally, future directions for online caregiver evaluation research are proposed.

Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing

PubMed Central

Ridderstråle, Martin

2017-01-01

Background: Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. Methods: Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. Results: GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. Conclusions: We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point. PMID:28366085

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

PubMed

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2007-11-16

As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

PubMed Central

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2007-01-01

Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy

Age at the time of sulfonylurea initiation influences treatment outcomes in KCNJ11-related neonatal diabetes.

PubMed

Thurber, Brian W; Carmody, David; Tadie, Elizabeth C; Pastore, Ashley N; Dickens, Jazzmyne T; Wroblewski, Kristen E; Naylor, Rochelle N; Philipson, Louis H; Greeley, Siri Atma W

2015-07-01

Individuals with heterozygous activating mutations of the KCNJ11 gene encoding a subunit of the ATP-sensitive potassium channel (KATP) can usually be treated with oral sulfonylurea (SU) pills in lieu of insulin injections. The aim of this study was to test our hypothesis that younger age at the time of initiation of SU therapy is correlated with lower required doses of SU therapy, shorter transition time and decreased likelihood of requiring additional diabetes medications. We performed a retrospective cohort study using data on 58 individuals with neonatal diabetes due to KCNJ11 mutations identified through the University of Chicago Monogenic Diabetes Registry ( http://monogenicdiabetes.uchicago.edu/registry ). We assessed the influence of age at initiation of SU therapy on treatment outcomes. HbA1c fell from an average of 8.5% (69 mmol/mol) before transition to 6.2% (44 mmol/mol) after SU therapy (p < 0.001). Age of initiation of SU correlated with the dose (mg kg(-1) day(-1)) of SU required at follow-up (r = 0.80, p < 0.001). Similar associations were observed across mutation subtypes. Ten participants required additional glucose-lowering medications and all had initiated SU at age 13 years or older. No serious adverse events were reported. Earlier age at initiation of SU treatment is associated with improved response to SU therapy. Declining sensitivity to SU may be due to loss of beta cell mass over time in those treated with insulin. Our data support the need for early genetic diagnosis and appropriate personalised treatment in all cases of neonatal diabetes.

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial.

PubMed

Ballard, Clive; Corbett, Anne; Orrell, Martin; Williams, Gareth; Moniz-Cook, Esme; Romeo, Renee; Woods, Bob; Garrod, Lucy; Testad, Ingelin; Woodward-Carlton, Barbara; Wenborn, Jennifer; Knapp, Martin; Fossey, Jane

2018-02-01

Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial

PubMed Central

Orrell, Martin; Williams, Gareth; Garrod, Lucy; Testad, Ingelin; Woodward-Carlton, Barbara; Wenborn, Jennifer; Knapp, Martin

2018-01-01

Background Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. Methods and findings This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory–Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4

A simple method to calculate first-passage time densities with arbitrary initial conditions

NASA Astrophysics Data System (ADS)

Nyberg, Markus; Ambjörnsson, Tobias; Lizana, Ludvig

2016-06-01

Numerous applications all the way from biology and physics to economics depend on the density of first crossings over a boundary. Motivated by the lack of general purpose analytical tools for computing first-passage time densities (FPTDs) for complex problems, we propose a new simple method based on the independent interval approximation (IIA). We generalise previous formulations of the IIA to include arbitrary initial conditions as well as to deal with discrete time and non-smooth continuous time processes. We derive a closed form expression for the FPTD in z and Laplace-transform space to a boundary in one dimension. Two classes of problems are analysed in detail: discrete time symmetric random walks (Markovian) and continuous time Gaussian stationary processes (Markovian and non-Markovian). Our results are in good agreement with Langevin dynamics simulations.

Predictive modeling in Clostridium acetobutylicum fermentations employing Raman spectroscopy and multivariate data analysis for real-time culture monitoring

NASA Astrophysics Data System (ADS)

Zu, Theresah N. K.; Liu, Sanchao; Germane, Katherine L.; Servinsky, Matthew D.; Gerlach, Elliot S.; Mackie, David M.; Sund, Christian J.

2016-05-01

The coupling of optical fibers with Raman instrumentation has proven to be effective for real-time monitoring of chemical reactions and fermentations when combined with multivariate statistical data analysis. Raman spectroscopy is relatively fast, with little interference from the water peak present in fermentation media. Medical research has explored this technique for analysis of mammalian cultures for potential diagnosis of some cancers. Other organisms studied via this route include Escherichia coli, Saccharomyces cerevisiae, and some Bacillus sp., though very little work has been performed on Clostridium acetobutylicum cultures. C. acetobutylicum is a gram-positive anaerobic bacterium, which is highly sought after due to its ability to use a broad spectrum of substrates and produce useful byproducts through the well-known Acetone-Butanol-Ethanol (ABE) fermentation. In this work, real-time Raman data was acquired from C. acetobutylicum cultures grown on glucose. Samples were collected concurrently for comparative off-line product analysis. Partial-least squares (PLS) models were built both for agitated cultures and for static cultures from both datasets. Media components and metabolites monitored include glucose, butyric acid, acetic acid, and butanol. Models were cross-validated with independent datasets. Experiments with agitation were more favorable for modeling with goodness of fit (QY) values of 0.99 and goodness of prediction (Q2Y) values of 0.98. Static experiments did not model as well as agitated experiments. Raman results showed the static experiments were chaotic, especially during and shortly after manual sampling.

41 CFR 302-11.23 - When must I request to have my initial time period extended?

Code of Federal Regulations, 2010 CFR

2010-07-01

... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time Limitations...

41 CFR 302-11.23 - When must I request to have my initial time period extended?

Code of Federal Regulations, 2014 CFR

2014-07-01

... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time Limitations...

41 CFR 302-11.23 - When must I request to have my initial time period extended?

Code of Federal Regulations, 2013 CFR

2013-07-01

... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time Limitations...

41 CFR 302-11.23 - When must I request to have my initial time period extended?

Code of Federal Regulations, 2011 CFR

2011-07-01

... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time Limitations...

41 CFR 302-11.23 - When must I request to have my initial time period extended?

Code of Federal Regulations, 2012 CFR

2012-07-01

... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time Limitations...

Factors associated with breastfeeding initiation time in a baby-friendly hospital in Istanbul.

PubMed

İnal, Sevil; Aydin, Yasemin; Canbulat, Nejla

2016-11-01

To investigate perinatal factors that affect breastfeeding of newborns delivered at a baby-friendly public hospital in Turkey, including the time of the first physical examination by a pediatrician, the first union with their mothers, and the first breastfeeding time after delivery. The research was conducted from May 2nd through June 30th, 2011, in a baby-friendly public hospital in Istanbul. The sample consisted of 194 mothers and their full-term newborns. The data were collected via an observation form developed by the researchers. In analyzing the data, the average, standard deviation, minimum, maximum values, Chi-square, and percentages were used. The results revealed that the first physical examinations of the newborns were performed approximately 53.02±39min (range, 1-180 min) after birth. The newborns were given to their mothers approximately 69.75±41min (range, 3-190 min) after birth. Consequently, the first initiated breastfeeding took place approximately 78.58±44min following birth, and active sucking was initiated after approximately 85.90±54min. A large percentage of the newborns (64.4%) were not examined by a specialist pediatrician within half an hour of birth, and 74.7% were not united with their mothers within the same period. Also, the newborns who initiated breastfeeding within the first half hour had significantly earlier success with active sucking and required significantly less assistance to achieve successful breastfeeding. The newborns in our study met with their mothers late in the birth ward because examinations of the newborns were delayed. The newborns began initial sucking later, and this chain reaction negatively impacted the breastfeeding success of the newborns. Copyright © 2016 Elsevier Inc. All rights reserved.

Timing of First Antenatal Care (ANC) and Inequalities in Early Initiation of ANC in Nepal.

PubMed

Paudel, Yuba Raj; Jha, Trishna; Mehata, Suresh

2017-01-01

The provision and uptake of quality and timely antenatal care (ANC) is an essential element of efforts to improve health outcomes for women and newborn babies. Antenatal consultations assist in early identification and treatment of complications during pregnancy. This study aimed to provide an information on distribution and inequalities in early initiation of ANC in Nepal. The distribution and inequalities in the early initiation of ANC were examined using Nepal Demographic and Health Surveys 2011. Bivariate and multivariate logistic regression was used to assess inequalities. Overall, 70% of the women had started their first ANC at 4 month or earlier. Among participants who had never attended school, just more than half (52%) received first ANC at 4 months or earlier, while majority of participants (97%) who had received higher education received first ANC at recommended time. Similarly, 89% of those from richest quintile and 48% of those from poorest quintile received first ANC at recommended time. In adjusted analysis, women from richest wealth quintile were significantly more likely to initiate ANC early (AOR: 3.74, 95% CI: 2.31-6.05) compared to the poorest. Similarly, women with higher level education were significantly more likely (AOR: 11.40, 95% CI: 5.05-25.73) to initiate ANC early compared to women who had never attended school. A significantly lower odds of early ANC take up was observed among madhesi other caste (AOR: 0.56, 95% CI: 0.35-0.90) compared to brahmin/chhetri women. Women whose pregnancy was unwanted were significantly less likely to attend first ANC at 4 months or early (AOR: 0.73, 95% CI: 0.58-0.93) in comparison to women whose pregnancy was wanted. The differences in the recommended timing of initiation of ANC were evident among women with different educational, economic levels, and caste/ethnic groups. Rural women were less likely to have checkups as per guidelines. The findings suggest to a need of interventions to raise female

GROUT HOPPER MODELING STUDY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, S.

2011-08-30

The Saltstone facility has a grout hopper tank to provide agitator stirring of the Saltstone feed materials. The tank has about 300 gallon capacity to provide a larger working volume for the grout slurry to be held in case of a process upset, and it is equipped with a mechanical agitator, which is intended to keep the grout in motion and agitated so that it won't start to set up. The dry feeds and the salt solution are already mixed in the mixer prior to being transferred to the hopper tank. The hopper modeling study through this work will focusmore » on fluid stirring and agitation, instead of traditional mixing in the literature, in order to keep the tank contents in motion during their residence time so that they will not be upset or solidified prior to transferring the grout to the Saltstone disposal facility. The primary objective of the work is to evaluate the flow performance for mechanical agitators to prevent vortex pull-through for an adequate stirring of the feed materials and to estimate an agitator speed which provides acceptable flow performance with a 45{sup o} pitched four-blade agitator. In addition, the power consumption required for the agitator operation was estimated. The modeling calculations were performed by taking two steps of the Computational Fluid Dynamics (CFD) modeling approach. As a first step, a simple single-stage agitator model with 45{sup o} pitched propeller blades was developed for the initial scoping analysis of the flow pattern behaviors for a range of different operating conditions. Based on the initial phase-1 results, the phase-2 model with a two-stage agitator was developed for the final performance evaluations. A series of sensitivity calculations for different designs of agitators and operating conditions have been performed to investigate the impact of key parameters on the grout hydraulic performance in a 300-gallon hopper tank. For the analysis, viscous shear was modeled by using the Bingham plastic approximation

The Influence of Race and Comorbidity on the Timely Initiation of Antiretroviral Therapy Among Older Persons Living With HIV/AIDS

PubMed Central

Smith, Lerissa; Zhang, Shun; Fairchild, Amanda J.; Heiman, Harry J.; Rust, George

2014-01-01

Objectives. We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). Methods. We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005–2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). Results. Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. Conclusions. Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA. PMID:25211735

Impact of real-time notification of Clostridium difficile test results and early initiation of effective antimicrobial therapy.

PubMed

Polen, Christian B; Judd, William R; Ratliff, Patrick D; King, Gregory S

2018-05-01

Clostridium difficile is a prominent nosocomial pathogen and is the most common causative organism of health care-associated diarrhea. To our knowledge, no studies have investigated the impact of real-time notification of culture results with rapid antimicrobial stewardship program (ASP) intervention in the setting of C difficile infection (CDI). The purpose of this study was to assess the impact of real-time notification of detection of toxigenic C difficile by DNA amplification results in patients with confirmed CDI. This is a single-center, retrospective cohort study at a 433-bed tertiary medical center in central Kentucky. The study consisted of 2 arms: patients treated for CDI prior to implementation of real-time provider notification and patients postimplementation. The primary outcome was time to initiation of effective antimicrobial therapy. The median time to initiation of effective antimicrobial therapy decreased from 5.75 hours in the preimplementation cohort to 2.05 hours in the postimplementation cohort (P = .001). ASP intervention also resulted in a shorter time from detection of CDI to order entry of effective antimicrobial therapy in the patient's electronic medical record (3.0 vs 0.6 hours; P = .001). The implementation of a real-time notification system to alert a pharmacist-led ASP of toxigenic CDI resulted in statistically significant shorter times to order entry and subsequent initiation of effective antimicrobial therapy and contact precautions. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Estimation of the Arrival Time and Duration of a Radio Signal with Unknown Amplitude and Initial Phase

NASA Astrophysics Data System (ADS)

Trifonov, A. P.; Korchagin, Yu. E.; Korol'kov, S. V.

2018-05-01

We synthesize the quasi-likelihood, maximum-likelihood, and quasioptimal algorithms for estimating the arrival time and duration of a radio signal with unknown amplitude and initial phase. The discrepancies between the hardware and software realizations of the estimation algorithm are shown. The characteristics of the synthesized-algorithm operation efficiency are obtained. Asymptotic expressions for the biases, variances, and the correlation coefficient of the arrival-time and duration estimates, which hold true for large signal-to-noise ratios, are derived. The accuracy losses of the estimates of the radio-signal arrival time and duration because of the a priori ignorance of the amplitude and initial phase are determined.

Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia.

PubMed

Best, Janie T; Frith, Karen; Anderson, Faye; Rapp, Carla Gene; Rioux, Lisa; Ciccarello, Christina

2011-11-01

To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. Practice change. The oncology unit of an urban hospital in the south-eastern United States. Adult patients with cancer and febrile neutropenia admitted six months prior to (n = 30) or during the three months following (n = 23) implementation of the order set. Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Time intervals were analyzed using SPSS® software, version 18. Initial antibiotic times, order-set use, and length of stay. An overall reduction in time intervals for initiation of antibiotic therapy was observed for presentation (t = 2.25; degrees of freedom [df] = 37; p = 0.031) and order (t = 2.67; df = 40.17; p = 0.012) to antibiotic administration, with an order-set usage of 31% in the inpatient unit and 71% in the emergency department. Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit-based medication dispensing machines helped reduce time intervals for initial antibiotic therapy. The use of an evidence-based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence-based practice changes.

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Real-time observation of the initiation of RNA polymerase II transcription.

PubMed

Fazal, Furqan M; Meng, Cong A; Murakami, Kenji; Kornberg, Roger D; Block, Steven M

2015-09-10

Biochemical and structural studies have shown that the initiation of RNA polymerase II transcription proceeds in the following stages: assembly of the polymerase with general transcription factors and promoter DNA in a 'closed' preinitiation complex (PIC); unwinding of about 15 base pairs of the promoter DNA to form an 'open' complex; scanning downstream to a transcription start site; synthesis of a short transcript, thought to be about 10 nucleotides long; and promoter escape. Here we have assembled a 32-protein, 1.5-megadalton PIC derived from Saccharomyces cerevisiae, and observe subsequent initiation processes in real time with optical tweezers. Contrary to expectation, scanning driven by the transcription factor IIH involved the rapid opening of an extended transcription bubble, averaging 85 base pairs, accompanied by the synthesis of a transcript up to the entire length of the extended bubble, followed by promoter escape. PICs that failed to achieve promoter escape nevertheless formed open complexes and extended bubbles, which collapsed back to closed or open complexes, resulting in repeated futile scanning.

Effect of Agitation in Alkalization Process on the Characteristics of Sodium Carboxymethyl Sago and Cassava Starches

NASA Astrophysics Data System (ADS)

Titi, C. S.; Fachrudin, R.; Ruriani, E.; Yuliasih, I.

2018-05-01

Sodium carboxymethyl starch (Sodium CMS) is a modified starch prepared by two successive processes, alkalization and etherification. Alkalization will change the activated hydroxyl group of starch to more reactive alkoxide (St-O-), and then carboxymethyl group will substitute the hydroxyl group into sodium CMS. This research investigated the effect of agitation (1000 rpm of stirring and 4000 rpm of homogenization) in alkalization process to the modification of native starch into sodium CMS. Cassava and sago starches were mixed with sodium hydroxide (1.8 and 1.9 moles per mole anhydrous glucose units). The combination of NaOH and homogenizing gave the highest degrees of substitution for cassava (DS 0.73) and sago (DS 0.55) starches. The sodium CMS characteristics (paste clarity, water and oil absorption capacities, solubility, swelling power) were a function of mixing method but not on the amount of NaOH used.

Trajectory-Based Takeoff Time Predictions Applied to Tactical Departure Scheduling: Concept Description, System Design, and Initial Observations

NASA Technical Reports Server (NTRS)

Engelland, Shawn A.; Capps, Alan

2011-01-01

Current aircraft departure release times are based on manual estimates of aircraft takeoff times. Uncertainty in takeoff time estimates may result in missed opportunities to merge into constrained en route streams and lead to lost throughput. However, technology exists to improve takeoff time estimates by using the aircraft surface trajectory predictions that enable air traffic control tower (ATCT) decision support tools. NASA s Precision Departure Release Capability (PDRC) is designed to use automated surface trajectory-based takeoff time estimates to improve en route tactical departure scheduling. This is accomplished by integrating an ATCT decision support tool with an en route tactical departure scheduling decision support tool. The PDRC concept and prototype software have been developed, and an initial test was completed at air traffic control facilities in Dallas/Fort Worth. This paper describes the PDRC operational concept, system design, and initial observations.

Effects of sentence-structure complexity on speech initiation time and disfluency.

PubMed

Tsiamtsiouris, Jim; Cairns, Helen Smith

2013-03-01

There is general agreement that stuttering is caused by a variety of factors, and language formulation and speech motor control are two important factors that have been implicated in previous research, yet the exact nature of their effects is still not well understood. Our goal was to test the hypothesis that sentences of high structural complexity would incur greater processing costs than sentences of low structural complexity and these costs would be higher for adults who stutter than for adults who do not stutter. Fluent adults and adults who stutter participated in an experiment that required memorization of a sentence classified as low or high structural complexity followed by production of that sentence upon a visual cue. Both groups of speakers initiated most sentences significantly faster in the low structural complexity condition than in the high structural complexity condition. Adults who stutter were over-all slower in speech initiation than were fluent speakers, but there were no significant interactions between complexity and group. However, adults who stutter produced significantly more disfluencies in sentences of high structural complexity than in those of low complexity. After reading this article, the learner will be able to: (a) identify integral parts of all well-known models of adult sentence production; (b) summarize the way that sentence structure might negatively influence the speech production processes; (c) discuss whether sentence structure influences speech initiation time and disfluencies. Copyright © 2012 Elsevier Inc. All rights reserved.

Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study.

PubMed

Bedirli, Nurdan; Akçabay, Mehmet; Emik, Ulku

2017-03-11

This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia. Seventy-seven patient, aged 2-12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded. Dexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D. Both tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration. Retrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016.

Optimization and modeling of laccase production by Trametes versicolor in a bioreactor using statistical experimental design.

PubMed

Tavares, A P M; Coelho, M A Z; Agapito, M S M; Coutinho, J A P; Xavier, A M R B

2006-09-01

Experimental design and response surface methodologies were applied to optimize laccase production by Trametes versicolor in a bioreactor. The effects of three factors, initial glucose concentration (0 and 9 g/L), agitation (100 and 180 rpm), and pH (3.0 and 5.0), were evaluated to identify the significant effects and its interactions in the laccase production. The pH of the medium was found to be the most important factor, followed by initial glucose concentration and the interaction of both factors. Agitation did not seem to play an important role in laccase production, nor did the interaction agitation x medium pH and agitation x initial glucose concentration. Response surface analysis showed that an initial glucose concentration of 11 g/L and pH controlled at 5.2 were the optimal conditions for laccase production by T. versicolor. Under these conditions, the predicted value for laccase activity was >10,000 U/L, which is in good agreement with the laccase activity obtained experimentally (11,403 U/L). In addition, a mathematical model for the bioprocess was developed. It is shown that it provides a good description of the experimental profile observed, and that it is capable of predicting biomass growth based on secondary process variables.

Shock timing experiments on the National Ignition Facility: Initial results and comparison with simulation

NASA Astrophysics Data System (ADS)

Robey, H. F.; Boehly, T. R.; Celliers, P. M.; Eggert, J. H.; Hicks, D.; Smith, R. F.; Collins, R.; Bowers, M. W.; Krauter, K. G.; Datte, P. S.; Munro, D. H.; Milovich, J. L.; Jones, O. S.; Michel, P. A.; Thomas, C. A.; Olson, R. E.; Pollaine, S.; Town, R. P. J.; Haan, S.; Callahan, D.; Clark, D.; Edwards, J.; Kline, J. L.; Dixit, S.; Schneider, M. B.; Dewald, E. L.; Widmann, K.; Moody, J. D.; Döppner, T.; Radousky, H. B.; Throop, A.; Kalantar, D.; DiNicola, P.; Nikroo, A.; Kroll, J. J.; Hamza, A. V.; Horner, J. B.; Bhandarkar, S. D.; Dzenitis, E.; Alger, E.; Giraldez, E.; Castro, C.; Moreno, K.; Haynam, C.; LaFortune, K. N.; Widmayer, C.; Shaw, M.; Jancaitis, K.; Parham, T.; Holunga, D. M.; Walters, C. F.; Haid, B.; Mapoles, E. R.; Sater, J.; Gibson, C. R.; Malsbury, T.; Fair, J.; Trummer, D.; Coffee, K. R.; Burr, B.; Berzins, L. V.; Choate, C.; Brereton, S. J.; Azevedo, S.; Chandrasekaran, H.; Eder, D. C.; Masters, N. D.; Fisher, A. C.; Sterne, P. A.; Young, B. K.; Landen, O. L.; Van Wonterghem, B. M.; MacGowan, B. J.; Atherton, J.; Lindl, J. D.; Meyerhofer, D. D.; Moses, E.

2012-04-01

Capsule implosions on the National Ignition Facility (NIF) [Lindl et al., Phys. Plasmas 11, 339 (2004)] are underway with the goal of compressing deuterium-tritium (DT) fuel to a sufficiently high areal density (ρR) to sustain a self-propagating burn wave required for fusion power gain greater than unity. These implosions are driven with a carefully tailored sequence of four shock waves that must be timed to very high precision in order to keep the DT fuel on a low adiabat. Initial experiments to measure the strength and relative timing of these shocks have been conducted on NIF in a specially designed surrogate target platform known as the keyhole target. This target geometry and the associated diagnostics are described in detail. The initial data are presented and compared with numerical simulations. As the primary goal of these experiments is to assess and minimize the adiabat in related DT implosions, a methodology is described for quantifying the adiabat from the shock velocity measurements. Results are contrasted between early experiments that exhibited very poor shock timing and subsequent experiments where a modified target geometry demonstrated significant improvement.

Time dependency of the prediction skill for the North Atlantic subpolar gyre in initialized decadal hindcasts

NASA Astrophysics Data System (ADS)

Brune, Sebastian; Düsterhus, André; Pohlmann, Holger; Müller, Wolfgang A.; Baehr, Johanna

2017-11-01

We analyze the time dependency of decadal hindcast skill in the North Atlantic subpolar gyre within the time period 1961-2013. We compare anomaly correlation coefficients and temporal interquartile ranges of total upper ocean heat content and sea surface temperature for three differently initialized sets of hindcast simulations with the global coupled model MPI-ESM. All initializations use weakly coupled assimilation with the same full value nudging in the atmospheric component and different assimilation techniques for oceanic temperature and salinity: (1) ensemble Kalman filter assimilating EN4 observations and HadISST data, (2) nudging of anomalies to ORAS4 reanalysis, (3) nudging of full values to ORAS4 reanalysis. We find that hindcast skill depends strongly on the evaluation time period, with higher hindcast skill during strong multiyear trends, especially during the warming in the 1990s and lower hindcast skill in the absence of such trends. Differences between the prediction systems are more pronounced when investigating any 20-year subperiod within the entire hindcast period. In the ensemble Kalman filter initialized hindcasts, we find significant correlation skill for up to 5-8 lead years, albeit along with an overestimation of the temporal interquartile range. In the hindcasts initialized by anomaly nudging, significant correlation skill for lead years greater than two is only found in the 1980s and 1990s. In the hindcasts initialized by full value nudging, correlation skill is consistently lower than in the hindcasts initialized by anomaly nudging in the first lead years with re-emerging skill thereafter. The Atlantic meridional overturning circulation reacts on the density changes introduced by oceanic nudging, this limits the predictability in the subpolar gyre in the first lead years. Overall, we find that a model-consistent assimilation technique can improve hindcast skill. Further, the evaluation of 20 year subperiods within the full hindcast period

18 CFR 701.204 - Time limits for WRC initial determinations regarding requests for information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Time limits for WRC initial determinations regarding requests for information. 701.204 Section 701.204 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.204...

18 CFR 701.204 - Time limits for WRC initial determinations regarding requests for information.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Time limits for WRC initial determinations regarding requests for information. 701.204 Section 701.204 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.204...

18 CFR 701.204 - Time limits for WRC initial determinations regarding requests for information.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Time limits for WRC initial determinations regarding requests for information. 701.204 Section 701.204 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.204...

18 CFR 701.204 - Time limits for WRC initial determinations regarding requests for information.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Time limits for WRC initial determinations regarding requests for information. 701.204 Section 701.204 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.204...

18 CFR 701.204 - Time limits for WRC initial determinations regarding requests for information.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Time limits for WRC initial determinations regarding requests for information. 701.204 Section 701.204 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.204...

Evidence of Program Quality and Youth Outcomes in the DYCD Out-of-School Time Initiative: Report on the Initiative's First Three Years

ERIC Educational Resources Information Center

Russell, Christina A.; Mielke, Monica B.; Reisner, Elizabeth R.

2009-01-01

In September 2005, the New York City Department of Youth and Community Development (DYCD) launched the Out-of-School Time Programs for Youth (OST) initiative to provide young people throughout New York City with access to high-quality programming after school, on holidays, and during the summer at no cost to their families. Working closely with…

Adsorption of malachite green from aqueous solution by using novel chitosan ionic liquid beads.

PubMed

Naseeruteen, Faizah; Hamid, Nur Shahirah Abdul; Suah, Faiz Bukhari Mohd; Ngah, Wan Saime Wan; Mehamod, Faizatul Shimal

2018-02-01

Chitosan ionic liquid beads were prepared from chitosan and 1-butyl-3-methylimidazolium based ionic liquids to remove Malachite Green (MG) from aqueous solutions. Batch adsorption experiments were carried out as a function of initial pH, adsorbent dosage, agitation time and initial MG concentration. The optimum conditions were obtained at pH 4.0, 0.008g of adsorbent dosage and 20min of agitation time were utilized in the kinetic and isotherm studies. Three kinetic models were applied to analyze the kinetic data and pseudo-second order was found to be the best fitted model with R 2 >0.999. In order to determine the adsorption capacity, the sorption data were analyzed using the linear form of Langmuir, Freundlich and Temkin equations. The isotherm was best fitted by Langmuir isotherm model. The maximum adsorption capacity (q max ) obtained from Langmuir isotherm for two chitosan beads 1-butyl-3-methylimidazolium acetate A and 1-butyl-3-methylimidazolium B are 8.07mgg -1 and 0.24mgg -1 respectively. Copyright © 2017 Elsevier B.V. All rights reserved.

18 CFR 701.207 - Extension of time limits for WRC initial and final determinations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Extension of time limits for WRC initial and final determinations. 701.207 Section 701.207 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Availability of Information § 701.207 Extension of...