Utility of Pretest Probability and Exercise Treadmill Test in Korean Women with Suspected Coronary Artery Disease.

PubMed

Kim, Yong-Hyun; Shim, Wan-Joo; Kim, Myung-A; Hong, Kyung-Soon; Shin, Mi-Seung; Park, Seong-Mi; Cho, Kyoung Im; Kim, Mina; Kim, Sihun; Kim, Hak-Lyoung; Yoon, Hyun-Ju; Na, Jin-Oh; Kim, Sung-Eun

2016-06-01

Pretest probability (PTP) and an exercise treadmill test (ETT) are recommended for the initial evaluation of possible coronary artery disease (CAD), but the applicability of these tests in Korean women has not been evaluated. Korean women with PTP, ETT, and invasive coronary angiography results were enrolled. Across all PTP levels, PTP and ETT statistics were evaluated and independent CAD predictors obtained. Of the 335 patients (mean age 58.0 ± 10.2 years), 99 and 236 were in the low (LPTP) and intermediate PTP (IPTP) groups, respectively. The observed prevalence of CAD was significantly lower than the PTP. (7.1% vs. 9.1 ± 4.9% in LPTP, p < 0.001; 23.3% vs. 33.0 ± 15.1% in IPTP, p < 0.001) The ETT's sensitivity and positive predictive values (PPVs) appeared lower than previously reported (LPTP: 42.9% and 16.7%; IPTP: 61.8% and 37.0%), whereas the negative predictive values (NPVs) were higher (LPTP: 95.1%; IPTP: 85.4%). After multivariate adjustments, positive ETT (odds ratio 3.276, 95% confidence interval 1.643-6.532, p = 0.001) independently predicted the presence of CAD, but the PTP showed only marginal predictability (odds ratio 1.019, 95% confidence interval 0.998-1.041, p = 0.069). In Korean women, the observed prevalence of CAD was lower than the PTP, and PTP showed only marginal CAD predictability. Although a positive ETT independently predicted CAD, the ETT showed lower sensitivity and PPVs than previously reported. Despite the limited value of PTP and ETT, the high NPVs of ETT appear useful for saving patients from unnecessary further examinations.

Evaluating the effects of a 532-nm fiber-based KTP laser on transoral laser surgery supplies.

PubMed

Coughlan, Carolyn A; Verma, Sunil P

2013-11-01

The KTP laser has become commonplace in transoral head and neck surgery. The interactions of this laser with commonly used supplies in transoral surgery have not been formally examined. This study evaluates the effects of the KTP laser on surgical supplies. Experimental study. The study was conducted in an empty operating room at a university-affiliated medical center. An Aura XP 532-nm KTP laser with a 600-nm fiber was used in pulsed and continuous modes. The beam was focused at the shaft and balloon of 3 "laser-safe" endotracheal tubes (ETTs), a polyvinyl chloride (PVC) ETT, and a Codman surgical patty. Time to penetrate was recorded. Results The KTP laser beam was unable to penetrate any of the laser-resistant ETTs. It did react with the black number markings on the PVC ETT by producing sparks but was unable to penetrate the shaft of the ETT. The KTP laser was nonreactive with all ETT cuffs except in 1 of 3 trials with the outer balloon cuff of a Rusch Lasertubus ETT when the laser was used in a continuous mode. The KTP laser caused the production of a flame upon contact with the blue radiopaque strip of the surgical patty, even when the patty was wet. This study demonstrates that a number of safe ETT options may be used during transoral laser microsurgery with a KTP laser. In addition, Codman surgical patties are shown to be a significant fire risk in KTP laser surgery.

Validity of an Exercise Test Based on Habitual Gait Speed in Mobility-Limited Older Adults

PubMed Central

Li, Xin; Forman, Daniel E.; Kiely, Dan K.; LaRose, Sharon; Hirschberg, Ronald; Frontera, Walter R.; Bean, Jonathan F.

2013-01-01

Objective To evaluate whether a customized exercise tolerance testing (ETT) protocol based on an individual’s habitual gait speed (HGS) on level ground would be a valid mode of exercise testing older adults. Although ETT provides a useful means to risk-stratify adults, age-related declines in gait speed paradoxically limit the utility of standard ETT protocols for evaluating older adults. A customized ETT protocol may be a useful alternative to these standard methods, and this study hypothesized that this alternative approach would be valid. Design We performed a cross-sectional analysis of baseline data from a randomized controlled trial of older adults with observed mobility problems. Screening was performed using a treadmill-based ETT protocol customized for each individual’s HGS. We determined the content validity by assessing the results of the ETTs, and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly (PASE) and the Late Life Function and Disability Instrument (LLFDI). Setting Outpatient rehabilitation center. Participants Community-dwelling, mobility-limited older adults (N = 141). Interventions Not applicable. Main Outcome Measures Cardiac instability, ETT duration, peak heart rate, peak systolic blood pressure, PASE, and LLFDI. Results Acute cardiac instability was identified in 4 of the participants who underwent ETT. The remaining participants (n = 137, 68% female; mean age, 75.3y) were included in the subsequent analyses. Mean exercise duration was 9.39 minutes, with no significant differences in durations being observed after evaluating among tertiles by HGS status. Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/ min and 175.0mmHg, respectively. Within separate multivariate models, ETT duration in each of the 3 gait speed groups was significantly associated (P<.05) with PASE and LLFDI. Conclusions Mobility-limited older adults can complete this customized

Estimation of tracheal pressure and imposed expiratory work of breathing by the endotracheal tube, heat and moisture exchanger, and ventilator during mechanical ventilation.

PubMed

Uchiyama, Akinori; Yoshida, Takeshi; Yamanaka, Hidenori; Fujino, Yuji

2013-07-01

The resistance of the endotracheal tube (ETT), the heat and moisture exchanger (HME), and the ventilator may affect the patient's respiratory status. Although previous studies examined the inspiratory work of breathing (WOB), investigation of WOB in the expiratory phase is rare. We estimated tracheal pressure at the tip of the ETT (Ptrach) and calculated expiratory WOB imposed by the ETT, the HME, and the expiratory valve. We examined imposed expiratory WOB in patients under a continuous mandatory ventilation (CMV) mode and during spontaneous breathing trials (SBTs). We hypothesized that imposed expiratory WOB would increase with heightened ventilatory demand. We measured airway pressure (Paw) and respiratory flow (V). We estimated Ptrach using the equation Ptrach = Paw - K1 × V(K2) - 2.70 × V(L/s)(1.42). K1 and K2 were determined by the inner diameter (ID) of the ETT. Imposed expiratory WOB was calculated from the area of Ptrach above PEEP versus lung volume. We examined imposed expiratory WOB and imposed expiratory resistance in relation to mean expiratory flow. We examined 28 patients under CMV mode, and 29 during SBT. During both CMV and SBT, as mean expiratory flow increased, imposed expiratory WOB increased. The regression curves between mean expiratory flow (x) (L/s) and imposed expiratory WOB (y) (J/L) were y = 1.35x(0.83) (R(2) = 0.79) for 7 mm ID ETT under CMV, y = 1.12x(0.82) (R(2) = 0.73) for 8 mm ID ETT under CMV, y = 1.07x(1.04) (R(2) = 0.85) for 7 mm ID ETT during SBT, and y = 0.84x(0.93) (R(2) = 0.75) for 8 mm ID ETT during SBT. Levels of imposed expiratory WOB were affected by ETT diameter and ventilator mode. The reason for increasing imposed expiratory WOB was an increase in expiratory resistance imposed by the ETT and HME. Under mechanical ventilation, imposed expiratory WOB should be considered in patients with higher minute ventilation.

Evaluation of Endotracheal Tube Scraping on Airway Resistance.

PubMed

Scott, J Brady; Dubosky, Meagan N; Vines, David L; Sulaiman, Adewunmi S; Jendral, Kyle R; Singh, Gagan; Patel, Ankeet; Kaplan, Carl A; Gurka, David P; Balk, Robert A

2017-11-01

Spontaneous breathing trials (SBTs) are used to assess the readiness for discontinuation of mechanical ventilation. When airway resistance (R aw ) is elevated, the imposed work of breathing can lead to prolongation of mechanical ventilation. Biofilm and mucus build-up within the endotracheal tube (ETT) can increase R aw . Scraping the ETT can remove the biofilm build-up and decrease mechanical R aw . The primary aim of this study was to evaluate the impact of ETT scraping on R aw . The secondary aim was to determine whether decreasing R aw would impact subsequent SBT success. Intubated, mechanically ventilated subjects were enrolled if they failed an SBT and had an R aw of > 10 cm H 2 O/L/s. SBT failure was based on institutional guidelines, and R aw was calculated by subtracting the difference between the measured peak and plateau pressures using a square flow waveform with an inspiratory flow set at 60 L/min. The endOclear device was inserted into the ETT and withdrawn per manufacturer's guidelines. Scraping was repeated until the ETT was cleared. Change in R aw was compared pre- and post-ETT scraping using a paired t test. A Mann-Whitney U test evaluated the difference in percentage change in R aw between SBT groups. Twenty-nine subjects completed the study. The mean pre- and post-ETT scraping R aw values were 15.17 ± 3.83 and 12.05 ± 3.19 cm H 2 O/L/s, respectively ( P < .001). Subsequent SBT success was 48%; however, there was no difference in percentage change in R aw between subsequent passed SBT (18.61% [interquartile range 8.90-33.93%]) and failed SBT (23.88% [interquartile range 0.00-34.80%]), U = 78.5, z = -0.284, P = .78. No adverse events were noted with ETT scraping. This study demonstrated that ETT scraping can reduce R aw . The decrease in R aw post-ETT scraping did not affect subsequent SBT success. Copyright © 2017 by Daedalus Enterprises.

Main Vacuum Technical Issues of Evacuated Tube Transportation

NASA Astrophysics Data System (ADS)

Zhang, Y. P.; Li, S. S.; Wang, M. X.

In the future, Evacuated Tube Transportation (ETT) would be built and faster than jets. ETT tube with diameter 2∼4m and length over 1000 km will be the largest scale vacuum equipment on earth. This paper listed some main vacuum technical issues to be solved in ETT as follow. How to build ultra-large-scale vacuum chamber like ETT tube with low cost and high reliability? How to pump gas out off the ETT tube in short time? How to release heat or reduce temperature in the vacuum tube? Hot to avoid vacuum electricity discharge? How to manufacture vehicles with airproof shells and equip the life support system? How to detect leakage and find leakage position efficiently and fast as possible? Some relative solutions and suggestions are put up.

Pediatric Endotracheal Tube Cuff Pressures During Aeromedical Transport.

PubMed

Orsborn, Jonathan; Graham, James; Moss, Michele; Melguizo, Maria; Nick, Todd; Stroud, Michael

2016-01-01

Cuffed endotracheal tubes (ETTs) are frequently used in children, allowing fewer air leaks and helping prevent ventilator-associated pneumonia. Tracheal mucosal perfusion is compromised at an ETT cuff pressure (ETTCP) of 30 cm H2O with blood flow completely absent above 50 cm H2O. Our objective was to compare multiple pediatric-sized ETTCPs at ground level and various altitudes during aeromedical transport. Simulating the transport environment, 4 pediatric-sized mannequin heads were intubated with appropriately sized cuffed ETTs (3.0, 4.0, 5.0, 6.0) and transported by helicopter or nonpressurized fixed-wing aircraft 20 times each. The ETTCP was set to 10 cm H2O before transport, and the pressure was measured with a standard manometer at 1000-ft intervals until reaching peak altitude or CP greater than 60 cm H2O. Ground elevation ranged from 400-650 ft mean sea level (MSL) and peak altitude from 3500 to 5000 ft MSL. Increased altitude caused a significant increase in ETTCP of all ETT sizes (P < 0.001). However, there is no statistical difference in pressures between ETT sizes (P = 0.28). On average, ETTCP in 3.0, 4.0, and 6.0 ETTs surpassed 30 cm H2O at approximately 1500 ft MSL and 50 cm H2O at approximately 2800 ft MSL. In the 5.0 ETT, the CP reached 30 cm H2O at 2000 ft MSL and 50 cm H2O at 3700 ft MSL. The ETTCP in pediatric-sized ETTs regularly exceed recommended pressure limits at relatively low altitudes. There is no additional pressure increase related to ETT size. This has the potential to decrease mucosal blood flow, possibly increasing risk of subsequent tracheal stenosis, rupture, and other complications.

Severed cuff inflation tubing of endotracheal tube: A novel way to prevent cuff deflation.

PubMed

Rao, Amrut K; Chaudhuri, Souvik; Joseph, Tim T; Kamble, Deependra; Gotur, Gopal; Venkatesh, Sandeep

2014-01-01

A well-secured endotracheal tube (ETT) is essential for safe anesthesia. The ETT has to be fixed with the adhesive plasters or with tie along with adhesive plasters appropriately. It is specially required in patients having beard, in intensive care unit (ICU) patients or in oral surgeries. If re-adjustment of the ETT is necessary, we should be cautious while removal of the plasters and tie, as there may be damage to the cuff inflation system. This can be a rare cause of ETT cuff leak, thus making maintenance of adequate ventilation difficult and requiring re-intubation. In a difficult airway scenario, it can be extremely challenging to re-intubate again. We report an incidence where the ETT cuff tubing was severed while attempting to re-adjust and re-fix the ETT and the patient required re-intubation. Retrospectively, we thought of and describe a safe, reliable and novel technique to prevent cuff deflation of the severed inflation tube. The technique can also be used to monitor cuff pressure in such scenarios.

A Novel Energetic Perchlorate Amine Salt: Synthesis, Properties, and Density Functional Theory Calculation

NASA Astrophysics Data System (ADS)

Ma, Peng; Pan, Yong; Jiang, Juncheng; Zhu, Shunguan

2017-10-01

A novel explosive, ethylenediamine triethylenediamine tetraperchlorate (ETT), was synthesized by a rapid " one-pot" method. The molecular and crystal structures of ETT were determined by X-ray diffraction (XRD) and Fourier transformed infrared (FTIR) spectroscopy. The purity of the ETT was characterized by hydrogen nuclear magnetic resonance (H-NMR) spectra and elemental analysis (EA). The chemical and physical properties of the co-crystal ETT were further explored including impact sensitivity, velocity of detonation, and thermal behavior. The impact sensitivity of the ETT (h50% = 9.50 cm) is much lower than that of its components, ethylenediamine diperchlorate (ED) (h50% = 5.60 cm) and triethylenediamine diperchlorate (TD) (h50% = 2.10 cm). The measured detonation velocity is 8956 m/s (ρ = 1.873 g/cm3), which is much higher than that of TNT (6900 m/s) or RDX (8350 m/s). The co-crystal ETT shows a unique thermal behavior with a decomposition peak temperature at 365 °C. Band structure and density of states (DOS) of the ETT were confirmed by the CASTEP code. The first-principles tight-binding method within the general gradient approximation (GGA) was employed to study the electronic band structure as well as the DOS and Fermi energy. Hirshfeld surfaces were applied to analyze the intermolecular interactions in the co-crystal, and the results showed that weak interaction was dominantly mediated by H … O hydrogen bond. By analyzing the bond length at different temperatures, N-H covalent bond is the trigger bond for the ETT.

Photodynamic therapy to destroy pneumonia associated microorganisms using external irradiation source

NASA Astrophysics Data System (ADS)

Bassi, Rosane; Myakawa, Walter; Navarro, Ricardo S.; Baptista, Alessandra; Ribeiro, Martha Simões; Nunez, Silvia Cristina

2018-02-01

An endotracheal tube (ETT) is required for the management of critically ill, mechanically ventilated patients. Ventilatorassociated pneumonia (VAP) affects patients hospitalized in intensive care units; its risk of occurrence is 1% to up 3% for each day of mechanical ventilation. The polymicrobial nature of VAP is established with mixed bacterial-fungal biofilms colonizing the ETT. The microbial interaction enhances the microbial pathogenesis contributing to high indexes of morbidity/mortality. Antimicrobial Photodynamic Therapy (aPDT) could be a suitable therapy for decontamination of oral cavity and ETT at the same time, but the use of a fiber optics inside the ETT seems to not be appropriated since a cannula for secretion aspiration has to be introduced into the ETT to keep it's lumen. The aim of this study is to proof the concept that an external light source from a LED is capable of reach all areas of the ETT. We use a commercial ETT, 60μM methylene blue (MB), and a 660nm diode laser and calculated the transmission coefficient of light in different situations as only tube, tube with biofilm and biofilm+MB. The results prove that is possible to transmit light through the tube even in the presence of MB and biofilm although a high attenuation of about 60% was measured depending on the tested condition.

Tracheal palpation to assess endotracheal tube depth: an exploratory study.

PubMed

McKay, William P; Klonarakis, Jim; Pelivanov, Vladko; O'Brien, Jennifer M; Plewes, Chris

2014-03-01

Correct placement of the endotracheal tube (ETT) occurs when the distal tip is in mid-trachea. This study compares two techniques used to place the ETT at the correct depth during intubation: tracheal palpation vs placement at a fixed depth at the patient's teeth. With approval of the Research Ethics Board, we recruited American Society of Anesthesiologists physical status I-II patients scheduled for elective surgery with tracheal intubation. Clinicians performing the tracheal intubations were asked to "advance the tube slowly once the tip is through the cords". An investigator palpated the patient's trachea with three fingers spread over the trachea from the larynx to the sternal notch. When the ETT tip was felt in the sternal notch, the ETT was immobilized and its position was determined by fibreoptic bronchoscopy. The position of the ETT tip was compared with our hospital standard, which is a depth at the incisors or gums of 23 cm for men and 21 cm for women. The primary outcome was the incidence of correct placement. Correct placement of the ETT was defined as a tip > 2.5 cm from the carina and > 3.5 cm below the vocal cords. Movement of the ETT tip was readily palpable in 77 of 92 patients studied, and bronchoscopy was performed in 85 patients. Placement by tracheal palpation resulted in more correct placements (71 [77%]; 95% confidence interval [CI] 74 to 81) than hospital standard depth at the incisors or gums (57 [61%]; 95% CI 58 to 66) (P = 0.037). The mean (SD) placement of the ETT tip in palpable subjects was 4.1 (1.7) cm above the carina, 1.9 cm (1.5-2.3 cm) below the ideal mid-tracheal position. Tracheal palpation requires no special equipment, takes only a few seconds to perform, and may improve ETT placement at the correct depth. Further studies are warranted.

MR Imaging of Uterine Epithelioid Trophoblastic Tumor: A Case Report

PubMed Central

KAGEYAMA, Sakiko; KANOTO, Masafumi; SUGAI, Yukio; SUTO, Takeshi; NAGASE, Satoru; OSAKABE, Mitsumasa; HOSOYA, Takaaki

2016-01-01

Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic neoplasm of chorionic-type intermediate trophoblasts, and it is most frequently located in the lower uterine segment and endocervix. Due to the epithelial-growth pattern with geographic necrosis exhibited by the neoplastic cells, ETT is commonly confused, both clinically and pathologically, with squamous cell carcinoma. Although there have been no previous reports of ETT focusing on computed tomography (CT) or magnetic resonance imaging (MRI) findings, we report a case of uterine ETT with special attention to the MRI findings referring to the pathological findings and MR images of previous reports. A 42-year-old Japanese woman (gravid 1, para 1) presented with uterus enlargement during screening, and complained of recent-onset lower abdominal pain. The MRI showed a solid tumor throughout the entire myometrium of the lower uterine segment, with the hemorrhagic cystic portion extending to the posterior subserosal space. Following hysterectomy, the final pathological diagnosis was ETT. An ETT is essentially a solid tumor composed of intermediate trophoblasts that exhibit an epithelial-like growth pattern and contain geographic necrosis with calcification. In our case, MRI revealed a non-specific-intensity solid tumor in the lower uterine segment with massive necrosis and hemorrhage extending to the subserosa. While it is difficult to distinguish between ETT and uterine carcinomas, recognition of certain tumor shapes and necrosis could enable more accurate diagnosis before treatment. PMID:27001388

A 72-hour study to test the efficacy and safety of the "Mucus Slurper" in mechanically ventilated sheep.

PubMed

Li Bassi, Gianluigi; Curto, Francesco; Zanella, Alberto; Stylianou, Mario; Kolobow, Theodor

2007-03-01

In patients intubated with endotracheal tubes (ETTs), suctioning is routinely performed to remove mucus from within the ETT and trachea. The Mucus Slurper is a novel ETT with built-in suction ports arranged radially at its tip. We evaluated the safety and efficacy of the Mucus Slurper, compared with conventional tracheal suction, to prevent airway obstruction in sheep with the ETT and trachea oriented below horizontal. Prospective randomized animal study. Animal research facility at the National Institutes of Health. Twelve healthy sheep. Sheep were randomized to be intubated with either the Mucus Slurper (study group) or a Hi-Lo Tracheal Tube (Mallinckrodt, St. Louis, MO) (control group) and mechanically ventilated for 72 hrs. In the study group, automatic, timed tracheal aspiration lasted 0.3 secs, was repeated every 2 mins, and was synchronized with the early expiratory phase. In the control group, tracheal suction was performed every 6 hrs or as required. In the control group, tracheal secretions accumulated progressively within the ETT and the trachea. In the study group, all mucus that reached the tip of the Mucus Slurper was aspirated, keeping the lumen of the ETT, and proximal trachea, free from secretions. In the study group, expiratory water trap protein concentration, a crude index to measure mucus drainage through the ETT, was consistently less than the control group (p < .001). At autopsy, no macroscopic injury to the tracheal mucosa was found in either group. In the study group, the respiratory circuit was less colonized than in the control group. There were no statistically significant differences between the two groups in bacterial colonization of the lungs/bronchi. The Mucus Slurper, combined with orientation of the trachea below horizontal, prevents accumulation of secretions within the lumen of the ETT and trachea, without need for conventional tracheal suctioning.

The significance of early post-exercise ST segment normalization.

PubMed

Chow, Rudy; Fordyce, Christopher B; Gao, Min; Chan, Sammy; Gin, Kenneth; Bennett, Matthew

2015-01-01

The persistence of ST segment depression in recovery signifies a strongly positive exercise treadmill test (ETT). However, it is unclear if early recovery of ST segments portends a similar prognosis. We sought to determine if persistence of ST depression into recovery correlates with ischemic burden based on myocardial perfusion imaging (MPI). This was a retrospective analysis of 853 consecutive patients referred for exercise MPI at a tertiary academic center over a 24-month period. Patients were stratified into three groups based on the results of the ETT: normal (negative ETT), persistence (positive ETT with >1mm ST segment depression at 1minute in recovery) and early normalization (positive ETT with <1mm ST segment depression at 1minute in recovery). Summed stress scores (SSSs) were calculated then for each patient, while the coronary anatomy was reported for the subset of patients who received coronary angiograms. A total of 513 patients had a negative ETT, 235 patients met criteria for early normalization, while 105 patients met criteria for persistence. The persistence group had a significantly greater SSS (8.48±7.77) than both the early normalization (4.34±4.98, p<0.001) and normal (4.47±5.31, p<0.001) groups. The SSSs of the early normalization and normal groups were not statistically different and met the prespecified non-inferiority margin (mean difference 0.12, -0.66=lower 95% CI, p<0.001). Among the 87 patients who underwent an angiogram, significant three-vessel or left main disease was seen in 39.3% of the persistence group compared with 5.9% of normal and 7.4% of early normalization groups. Among patients with an electrically positive ETT, recovery of ST segment depression within 1minute was associated with a lower SSS than patients with persistence of ST depression beyond 1minute. Furthermore, early ST segment recovery conferred a similar SSS to patients with a negative ETT. These results suggest that among patients evaluated for chest pain with

Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS.

PubMed

Weisberg, Stacy N; McCall, Jonathan C; Tennyson, Joseph

2017-06-01

Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopters are not pressurized, thereby providing a good environment for studying the effects of altitude changes ETT cuff pressures. This study aims to explore the relationship between altitude and ETT cuff pressures in a helicopter air-medical transport program. ETT cuffs were initially inflated in a nonstandardized manner and then adjusted to a pressure of 25 cmH 2 O. The pressure was again measured when the helicopter reached maximum altitude. A final pressure was recorded when the helicopter landed at the receiving facility. We enrolled 60 subjects in the study. The mean for initial tube cuff pressures was 70 cmH 2 O. Maximum altitude for the program ranged from 1,000-3,000 feet above sea level, with a change in altitude from 800-2,480 feet. Mean cuff pressure at altitude was 36.52 ± 8.56 cmH 2 O. Despite the significant change in cuff pressure at maximum altitude, there was no relationship found between the maximum altitude and the cuff pressures measured. Our study failed to demonstrate the expected linear relationship between ETT cuff pressures and the maximum altitude achieved during typical air-medical transportation in our system. At altitudes less than 3,000 feet above sea level, the effect of altitude change on ETT pressure is minimal and does not require a change in practice to saline-filled cuffs.

Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport.

PubMed

Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

2016-11-01

Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH 2 O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH 2 O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90). The mean ETT cuff pressure was 70 (95% CI= [61-80]) cmH 2 O. The mean lies 40 cmH 2 O above the maximum accepted value of 30 cmH 2 O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH 2 O, the maximum pressure on the analog gauge. Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should

Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS

PubMed Central

Weisberg, Stacy N.; McCall, Jonathan C.; Tennyson, Joseph

2017-01-01

Introduction Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopters are not pressurized, thereby providing a good environment for studying the effects of altitude changes ETT cuff pressures. This study aims to explore the relationship between altitude and ETT cuff pressures in a helicopter air-medical transport program. Methods ETT cuffs were initially inflated in a nonstandardized manner and then adjusted to a pressure of 25 cmH2O. The pressure was again measured when the helicopter reached maximum altitude. A final pressure was recorded when the helicopter landed at the receiving facility. Results We enrolled 60 subjects in the study. The mean for initial tube cuff pressures was 70 cmH2O. Maximum altitude for the program ranged from 1,000–3,000 feet above sea level, with a change in altitude from 800–2,480 feet. Mean cuff pressure at altitude was 36.52 ± 8.56 cmH2O. Despite the significant change in cuff pressure at maximum altitude, there was no relationship found between the maximum altitude and the cuff pressures measured. Conclusion Our study failed to demonstrate the expected linear relationship between ETT cuff pressures and the maximum altitude achieved during typical air-medical transportation in our system. At altitudes less than 3,000 feet above sea level, the effect of altitude change on ETT pressure is minimal and does not require a change in practice to saline-filled cuffs. PMID:28611883

Neural control of ventilation prevents both over-distension and de-recruitment of experimentally injured lungs.

PubMed

Brander, Lukas; Moerer, Onnen; Hedenstierna, Göran; Beck, Jennifer; Takala, Jukka; Slutsky, Arthur S; Sinderby, Christer

2017-03-01

Endogenous pulmonary reflexes may protect the lungs during mechanical ventilation. We aimed to assess integration of continuous neurally adjusted ventilatory assist (cNAVA), delivering assist in proportion to diaphragm's electrical activity during inspiration and expiration, and Hering-Breuer inflation and deflation reflexes on lung recruitment, distension, and aeration before and after acute lung injury (ALI). In 7 anesthetised rabbits with bilateral pneumothoraces, we identified adequate cNAVA level (cNAVA AL ) at the plateau in peak ventilator pressure during titration procedures before (healthy lungs with endotracheal tube, [HL ETT ]) and after ALI (endotracheal tube [ALI ETT ] and during non-invasive ventilation [ALI NIV ]). Following titration, cNAVA AL was maintained for 5min. In 2 rabbits, procedures were repeated after vagotomy (ALI ETT+VAG ). In 3 rabbits delivery of assist was temporarily modulated to provide assist on inspiration only. Computed tomography was performed before intubation, before ALI, during cNAVA titration, and after maintenance at cNAVA AL . During ALI ETT and ALI NIV , normally aerated lung-regions doubled and poorly aerated lung-regions decreased to less than a third (p<0.05) compared to HL ETT ; no over-distension was observed. Tidal volumes were<5ml/kg throughout. Removing assist during expiration resulted in lung de-recruitment during ALI ETT , but not during ALI NIV . During ALI ETT+VAG the expiratory portion of EAdi disappeared, resulting in cyclic lung collapse and recruitment. When using cNAVA in ALI, vagally mediated reflexes regulated lung recruitment preventing both lung over-distension and atelectasis. During non-invasive cNAVA the upper airway muscles play a role in preventing atelectasis. Future studies should be performed to compare these findings with conventional lung-protective approaches. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of Tribulus terrestris on monosodium iodoacetate-induced osteoarthritis pain in rats

PubMed Central

Park, Young Jin; Cho, Young-Rak; Oh, Joa Sub; Ahn, Eun-Kyung

2017-01-01

Tribulus terrestris L. (T. terrestris) has been used as a traditional medicine for the treatment of diuretic, lithontriptic, edema and urinary infections. Previous studies have indicated that it is effective in improving inflammation by regulating tumor necrosis factor-α (TNF)-α, interleukin (IL)-6, IL-10, nitric oxide (NO) and cyclooxygenase (COX)-2. However, the effects and mechanism of action of T. terrestris on osteoarthritis (OA) remain unknown. Therefore, the present study aimed to evaluate the effects of the ethanolic extract of T. terrestris (ETT) in a monosodium iodoacetate (MIA)-induced OA animal model. OA was induced in LEW/SSNHSD rats by intra-articular injection of MIA. Morphometric changes and parameters of the tibial trabecular bone were determined using micro-computed tomography. The molecular mechanisms of ETT in OA were investigated using reverse transcription-polymerase chain reaction, western blotting and gelatin zymogram analysis. Treatment with ETT attenuated MIA-induced OA, and this effect was mediated by the downregulation of NO synthase 2, COX-2, TNF-α and IL-6. Furthermore, the ETT-mediated attenuation of OA was also dependent on the expression of matrix metalloproteinases-2 and −9. The results of the current study indicate that further evaluation of the mechanisms underlying the attenuation of MIA-induced OA by ETT are required, and may support the development of ETT as a potential therapeutic agent for the treatment of inflammatory diseases such as OA. PMID:28849084

Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

PubMed Central

Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

2016-01-01

Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow

Audit of Endotracheal Tube Suction in a Pediatric Intensive Care Unit.

PubMed

Davies, Kylie; Bulsara, Max K; Ramelet, Anne-Sylvie; Monterosso, Leanne

2017-02-01

We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes ( N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT © requires "preparation for extubation" to be added.

The minimal leak test technique for endotracheal cuff maintenance.

PubMed

Harvie, D A; Darvall, J N; Dodd, M; De La Cruz, A; Tacey, M; D'Costa, R L; Ward, D

2016-09-01

Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Both under- and over-inflation of the ETT cuff can lead to patient complications, with an ideal pressure range of 20-30 cmH 2 O defined. A range of techniques are employed to ensure adequate ETT cuff inflation, with little comparative data. We performed an observational cross-sectional study in a tertiary metropolitan ICU, assessing the relationship between the minimal leak test and cuff manometry. Forty-five mechanically ventilated patients, over a three-month period, had ETT cuff manometry performed at the same time as their routine cuff maintenance (minimal leak test). Bedside nurse measurements were compared with investigator measurements. At the endpoint of cuff inflation, 20 of 45 patients (44%) had cuff pressures between 20 and 30 cmH 2 O; 11 of 45 patients (24%) had cuff pressures <20 cmH 2 O; 14 of 45 patients (31%) had cuff pressures ≥30 cmH 2 O. Univariate analysis demonstrated an association between both patient obesity and female gender requiring less ETT cuff volume ( P =0.008 and P <0.001 respectively), though this association was lost on multivariate analysis. No association was demonstrated between any measured variables and cuff pressures. Inter-operator reliability in performing the minimal leak test showed no evidence of bias between nurse and investigators (Pearson coefficient = 0.897). We conclude the minimal leak test for maintenance of ETT cuffs leads to both over- and under-inflation, and alternative techniques, such as cuff manometry, should be employed.

Front teeth-to-carina distance in children undergoing cardiac catheterization.

PubMed

Hunyady, Agnes I; Pieters, Benjamin; Johnston, Troy A; Jonmarker, Christer

2008-06-01

Knowledge of normal front teeth-to-carina distance (FT-C) might prevent accidental bronchial intubation. The aim of the current study was to measure FT-C and to examine whether the Morgan formula for oral intubation depth, i.e., endotracheal tube (ETT) position at front teeth (cm) = 0.10 x height (cm) + 5, gives appropriate guidance when intubating children of different ages. FT-C was measured in 170 infants and children, aged 1 day to 19 yr, undergoing cardiac catheterization. FT-C was obtained as the sum of the ETT length at the upper front teeth/dental ridge and the distance from the ETT tip to the carina. The latter measure was taken from an anterior-posterior chest x-ray. There was close linear correlation between FT-C and height: FT-C (cm) = 0.12 x height (cm) + 5.2, R = 0.98. The linear correlation coefficients (R) for FT-C versus weight and age were 0.78 and 0.91, respectively. If the Morgan formula had been used for intubation, the ETT tip would have been at 90 +/- 4% of FT-C. No patient would have been bronchially intubated, but the ETT tip would have been less than 0.5 cm from the carina in 13 infants. FT-C can be well predicted from the height/length of the child. The Morgan formula provides good guidance for intubation in children but can result in a distal ETT tip position in small infants. Careful auscultation is necessary to ensure correct tube position.

The impact of hospital-wide use of a tapered-cuff endotracheal tube on the incidence of ventilator-associated pneumonia.

PubMed

Bowton, David L; Hite, R Duncan; Martin, R Shayn; Sherertz, Robert

2013-10-01

Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of ventilator-associated pneumonia (VAP). A tapered-cuff endotracheal tube (ETT) has been demonstrated to reduce aspiration around the cuff. Whether these properties are efficacious in reducing VAP is not known. This 2-period, investigator-initiated observational study was designed to assess the efficacy of a tapered-cuff ETT to reduce the VAP rate. All intubated, mechanically ventilated patients over the age of 18 were included. During the baseline period a standard, barrel-shaped-cuff ETT (Mallinckrodt Hi-Lo) was used. All ETTs throughout the hospital were then replaced with a tapered-cuff ETT (TaperGuard). The primary outcome variable was the incidence of VAP per 1,000 ventilator days. We included 2,849 subjects, encompassing 15,250 ventilator days. The mean ± SD monthly VAP rate was 3.29 ± 1.79/1,000 ventilator days in the standard-cuff group and 2.77 ± 2.00/1,000 ventilator days in the tapered-cuff group (P = .65). While adherence to the VAP prevention bundle was high throughout the study, bundle adherence was significantly higher during the standard-cuff period (96.5 ± 2.7%) than in the tapered-cuff period (90.3 ± 3.5%, P = .01). In the setting of a VAP rate very near the average of ICUs in the United States, and where there was high adherence to a VAP prevention bundle, the use of a tapered-cuff ETT was not associated with a reduction in the VAP rate.

Assessing cognitive functioning in females with Rett syndrome by eye-tracking methodology.

PubMed

Ahonniska-Assa, Jaana; Polack, Orli; Saraf, Einat; Wine, Judy; Silberg, Tamar; Nissenkorn, Andreea; Ben-Zeev, Bruria

2018-01-01

While many individuals with severe developmental impairments learn to communicate with augmentative and alternative communication (AAC) devices, a significant number of individuals show major difficulties in the effective use of AAC. Recent technological innovations, i.e., eye-tracking technology (ETT), aim to improve the transparency of communication and may also enable a more valid cognitive assessment. To investigate whether ETT in forced-choice tasks can enable children with very severe motor and speech impairments to respond consistently, allowing a more reliable evaluation of their language comprehension. Participants were 17 girls with Rett syndrome (M = 6:06 years). Their ability to respond by eye gaze was first practiced with computer games using ETT. Afterwards, their receptive vocabulary was assessed using the Peabody Picture Vocabulary Test-4 (PPVT-4). Target words were orally presented and participants responded by focusing their eyes on the preferred picture. Remarkable differences between the participants in receptive vocabulary were demonstrated using ETT. The verbal comprehension abilities of 32% of the participants ranged from low-average to mild cognitive impairment, and the other 68% of the participants showed moderate to severe impairment. Young age at the time of assessment was positively correlated with higher receptive vocabulary. The use of ETT seems to make the communicational signals of children with severe motor and communication impairments more easily understood. Early practice of ETT may improve the quality of communication and enable more reliable conclusions in learning and assessment sessions. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Effect of heat and moisture exchanger (HME) positioning on inspiratory gas humidification

PubMed Central

Inui, Daisuke; Oto, Jun; Nishimura, Masaji

2006-01-01

Background In mechanically ventilated patients, we investigated how positioning the heat and moisture exchanger (HME) at different places on the ventilator circuit affected inspiratory gas humidification. Methods Absolute humidity (AH) and temperature (TEMP) at the proximal end of endotracheal tube (ETT) were measured in ten mechanically ventilated patients. The HME was connected either directly proximal to the ETT (Site 1) or at before the circuit Y-piece (Site 2: distance from proximal end of ETT and Site 2 was about 19 cm) (Figure. 1). Two devices, Hygrobac S (Mallinckrodt Dar, Mirandola, Italy) and Thermovent HEPA (Smiths Medical International Ltd., Kent, UK) were tested. AH and TEMP were measured with a hygrometer (Moiscope, MERA Co., Ltd., Tokyo, Japan). Results Hygrobac S provided significantly higher AH and TEMP at both sites than Thermovent HEPA. Both Hygrobac S and with Thermovent HEPA provided significantly higher AH and TEMP when placed proximally to the ETT. Conclusion Although placement proximal to the ETT improved both AH and TEMP in both HMEs tested, one HME performed better in the distal position than the other HME in the proximal position. We conclude the both the type and placement of HME can make a significant difference in maintaining AH and TEMP during adult ventilation. PMID:16895607

Effect of heat and moisture exchanger (HME) positioning on inspiratory gas humidification.

PubMed

Inui, Daisuke; Oto, Jun; Nishimura, Masaji

2006-08-08

In mechanically ventilated patients, we investigated how positioning the heat and moisture exchanger (HME) at different places on the ventilator circuit affected inspiratory gas humidification. Absolute humidity (AH) and temperature (TEMP) at the proximal end of endotracheal tube (ETT) were measured in ten mechanically ventilated patients. The HME was connected either directly proximal to the ETT (Site 1) or at before the circuit Y-piece (Site 2: distance from proximal end of ETT and Site 2 was about 19 cm) (Figure. 1). Two devices, Hygrobac S (Mallinckrodt Dar, Mirandola, Italy) and Thermovent HEPA (Smiths Medical International Ltd., Kent, UK) were tested. AH and TEMP were measured with a hygrometer (Moiscope, MERA Co., Ltd., Tokyo, Japan). Hygrobac S provided significantly higher AH and TEMP at both sites than Thermovent HEPA. Both Hygrobac S and with Thermovent HEPA provided significantly higher AH and TEMP when placed proximally to the ETT. Although placement proximal to the ETT improved both AH and TEMP in both HMEs tested, one HME performed better in the distal position than the other HME in the proximal position. We conclude the both the type and placement of HME can make a significant difference in maintaining AH and TEMP during adult ventilation.

Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients.

PubMed

Marino, Poala J; Wise, Matt P; Smith, Ann; Marchesi, Julian R; Riggio, Marcello P; Lewis, Michael A O; Williams, David W

2017-06-01

Mechanically ventilated patients are at risk for developing ventilator-associated pneumonia, and it has been reported that dental plaque provides a reservoir of respiratory pathogens that may aspirate to the lungs and endotracheal tube (ETT) biofilms. For the first time, metataxonomics was used to simultaneously characterize the microbiome of dental plaque, ETTs, and non-directed bronchial lavages (NBLs) in mechanically ventilated patients to determine similarities in respective microbial communities and therefore likely associations. Bacterial 16S rRNA gene sequences from 34 samples of dental plaque, NBLs, and ETTs from 12 adult mechanically ventilated patients were analyzed. No significant differences in the microbial communities of these samples were evident. Detected bacteria were primarily oral species (e.g., Fusobacterium nucleatum, Streptococcus salivarius, Prevotella melaninogenica) with respiratory pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcuspneumoniae, and Haemophilus influenzae) also in high abundance. The high similarity between the microbiomes of dental plaque, NBLs, and ETTs suggests that the oral cavity is indeed an important site involved in microbial aspiration to the lower airway and ETT. As such, maintenance of good oral hygiene is likely to be highly important in limiting aspiration of bacteria in this vulnerable patient group. Copyright © 2017 Elsevier Inc. All rights reserved.

Access to Ophthalmologists in States Where Optometrists Have Expanded Scope of Practice.

PubMed

Stein, Joshua D; Kapoor, Kapil G; Tootoo, Joshua L; Li, Ruiyang; Wagner, Alan; Andrews, Chris; Miranda, Marie Lynn

2018-01-01

As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice. To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014. This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017. The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office. The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the

Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients.

PubMed

Ghoochani Khorasani, Ahmad; Shadnia, Shahin; Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

2016-01-01

Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients.

Auscultation versus Point-of-care Ultrasound to Determine Endotracheal versus Bronchial Intubation: A Diagnostic Accuracy Study.

PubMed

Ramsingh, Davinder; Frank, Ethan; Haughton, Robert; Schilling, John; Gimenez, Kimberly M; Banh, Esther; Rinehart, Joseph; Cannesson, Maxime

2016-05-01

Unrecognized malposition of the endotracheal tube (ETT) can lead to severe complications in patients under general anesthesia. The focus of this double-blinded randomized study was to assess the accuracy of point-of-care ultrasound in verifying the correct position of the ETT and to compare it with the accuracy of auscultation. Forty-two adult patients requiring general anesthesia with ETT were consented. Patients were randomized to right main bronchus, left main bronchus, or tracheal intubation. After randomization, the ETT was placed via fiber-optic visualization. Next, the location of the ETT was assessed using auscultation by a separate blinded anesthesiologist, followed by an ultrasound performed by a third blinded anesthesiologist. Ultrasound examination included assessment of tracheal dilation via cuff inflation with air and evaluation of pleural lung sliding. Statistical analysis included sensitivity, specificity, positive predictive value, negative predictive value, and interobserver agreement for the ultrasound examination (95% CI). In differentiating tracheal versus bronchial intubations, auscultation showed a sensitivity of 66% (0.39 to 0.87) and a specificity of 59% (0.39 to 0.77), whereas ultrasound showed a sensitivity of 93% (0.66 to 0.99) and specificity of 96% (0.79 to 1). Identification of tracheal versus bronchial intubation was 62% (26 of 42) in the auscultation group and 95% (40 of 42) in the ultrasound group (P = 0.0005) (CI for difference, 0.15 to 0.52), and the McNemar comparison showed statistically significant improvement with ultrasound (P < 0.0001). Interobserver agreement of ultrasound findings was 100%. Assessment of trachea and pleura via point-of-care ultrasound is superior to auscultation in determining the location of ETT.

Safety and tolerability of omecamtiv mecarbil during exercise in patients with ischemic cardiomyopathy and angina.

PubMed

Greenberg, Barry H; Chou, Willis; Saikali, Khalil G; Escandón, Rafael; Lee, Jacqueline H; Chen, Michael M; Treshkur, Tatyana; Megreladze, Irakli; Wasserman, Scott M; Eisenberg, Paul; Malik, Fady I; Wolff, Andrew A; Shaburishvili, Tamaz

2015-01-01

The goal of this study was to assess the safety and tolerability of omecamtiv mecarbil treatment during symptom-limited exercise in patients with ischemic cardiomyopathy and angina. These patients may have increased vulnerability to prolongation of the systolic ejection time. Omecamtiv mecarbil is a selective cardiac myosin activator that augments cardiac contractility in patients with systolic heart failure through a dose-dependent increase in systolic ejection time. In this double-blind, placebo-controlled study, patients with chronic heart failure were randomized 2:1 to receive omecamtiv mecarbil or placebo in 2 sequential cohorts of escalating doses designed to achieve plasma concentrations previously shown to increase systolic function. Patients underwent 2 symptom-limited exercise treadmill tests (ETTs) at baseline (ETT1 and ETT2) and again before the end of a 20-h infusion of omecamtiv mecarbil (ETT3). The primary pre-defined safety endpoint (i.e., the proportion of patients who stopped ETT3 because of angina at a stage earlier than baseline) was observed in 1 patient receiving placebo and none receiving omecamtiv mecarbil. No dose-dependent differences emerged in the proportion of patients stopping ETT3 for any reason or in the pattern of adverse events. Doses of omecamtiv mecarbil producing plasma concentrations previously shown to increase systolic function were well tolerated during exercise in these study patients with ischemic cardiomyopathy and angina. There was no indication that treatment increased the likelihood of myocardial ischemia in this high-risk population. (Pharmacokinetics [PK] and Tolerability of Intravenous [IV] and Oral CK-1827452 in Patients With Ischemic Cardiomyopathy and Angina; NCT00682565). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia?

PubMed

Gentile, Michael A; Siobal, Mark S

2010-02-01

Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation via an artificial airway. As with all nosocomial infections, VAP increases costs, morbidity, and mortality in the intensive care unit (ICU). VAP prevention is a multifaceted priority of the intensive care team, and can include the use of specialized artificial airways and heat-and-moisture exchangers (HME). Substantial evidence supports the use of endotracheal tubes (ETTs) that allow subglottic suctioning; silver-coated and antiseptic-impregnated ETTs; ETTs with thin-walled polyurethane cuffs; and HMEs, but these devices also can have adverse effects. Controversy still exists regarding the evidence, cost-effectiveness, and disadvantages and risks of these devices.

Bactericidal effects of silver plus titanium dioxide-coated endotracheal tubes on Pseudomonas aeruginosa and Staphylococcus aureus

PubMed Central

Tarquinio, Keiko M; Kothurkar, Nikhil K; Goswami, Dharendra Y; Sanders, Ronald C; Zaritsky, Arno L; LeVine, Ann Marie

2010-01-01

Purpose: Ventilator-associated pneumonia (VAP) is a nosocomial infection resulting in significant morbidity and mortality. Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) are pathogens associated with VAP. Silver (Ag) coating of endotracheal tubes (ETTs) reduces bacterial colonization, however titanium dioxide (TiO2) coating has not been studied. Methods: Five types of ETT coatings were applied over silica layer: Ag, solgel TiO2, solgel TiO2 with Ag, Degussa P25 TiO2 (Degussa TiO2), and Degussa TiO2 with Ag. After ETTs were incubated with P. aeruginosa or S. aureus; colonization was determined quantitatively. Results: Pseudomonas aeruginosa and S. aureus grew for 5 days on standard ETTs. Compared to standard ETTs, P. aeruginosa growth was significantly inhibited by solgel TiO2 with Ag at 24 hours, and by Degussa TiO2 with Ag at 24 and 48 hours after inoculation. No significant difference in S. aureus growth was observed between the control and any of the five coatings for 5 days. Conclusion: In vitro, solgel TiO2 with Ag and Degussa TiO2 with Ag both attenuated P. aeruginosa growth, but demonstrated no effect on S. aureus colonization. Further studies using alternative coating and incorporating UV light exposure are needed to identify their potential utility in reducing VAP. PMID:20463933

Comparison of postoperative complication between Laryngeal Mask Airway and endotracheal tube during low-flow anesthesia with controlled ventilation

PubMed Central

Peirovifar, Ali; Eydi, Mahmood; Mirinejhad, Mir Mousa; Mahmoodpoor, Ata; Mohammadi, Afsaneh; EJ Golzari, Samad

2013-01-01

Objective: To compare the postoperative complications between Laryngeal Mask Airway (LMA) and endotracheal tube (ETT) during low-flow anesthesia with controlled ventilation. Methodology: Eighty adult Patients with ASA class I or II were randomly allocated into two forty-patient groups (ETT or LMA). Cuff pressure was monitored during anesthesia. After high uptake period, fresh gas flow (FGF) was decreased to 1 lit/min and isoflurane set to 1%. Monitoring during anesthesia included non-invasive blood pressure, ECG, ETCO2 and pulse oximetry. System leakage (>100 ml/min), rebreathing and any attempt to increase FGF to overcome the leak were monitored during anesthesia. Later, patients were extubated and transferred to Post Anesthesia Care Unit (PACU). In PACU, the incidence of sore throat, cough, difficulty in swallowing and shivering was monitored for all patients. Results: Leakage was observed in two and three cases in ETT and LMA groups respectively (P>0.05). Postoperative cough, sore throat and difficulty in swallowing were significantly less in LMA than ETT group. No significant difference was observed regarding ETCo2 values between 2 groups. Conclusion: If careful measures regarding insertion techniques, correct LMA position and routine monitoring of LMA cuff pressure are taken, LMA can be used as a safe alternative with lower incidence of post operation complication compared with ETT during low-flow controlled anesthesia with modern anesthetic machines. PMID:24353586

Survey on Restoration of Endodontically Treated Anterior Teeth: A Questionnaire Based Study

PubMed Central

Ratnakar, P; Bhosgi, Rashmi; Metta, Kiran Kumar; Aggarwal, Kanika; Vinuta, S; Singh, Navneet

2014-01-01

Background: The aim of endodontic and restorative dentistry is the conservation of natural tooth structure. Endodontically treated tooth (ETT) undergoes loss of tooth structure and changes in physical characteristics. Therefore, proper selection of restoration for ETT is mandatory. The clinical approach of restoring ETT needs taking into considerations several issues. However, the best way to restore teeth after root canal treatment has long been and still a controversial subject to debate. Therefore, this study was carried out to detect the frequency of preferred methods of restoring ETT under different conditions. Materials and Methods: A questionnaire was framed and distributed among prosthodontists, endodontist and general practitioners of north India region to find out the frequency of best suitable material and method regarding restoration of ETT. 220 questionnaires were sent by electronic mail out of which 110 were received back. The questionnaire contained different methods of restoration of endodontically treated anterior teeth at different conditions (percentages) of remaining sound tooth structure. Respondents were asked to indicate their preferred method of restoration of those teeth. Results: Results showed that majority of respondents (51.82%) preferred to restore the tooth only with a tooth-color restorative material in condition A. In condition B, majority of respondents preferred to use tooth colored crown (44.55%) and prefabricated post and tooth colored restoration (24.5%). Whereas in condition C, most of the respondents preferred to use a cast post and core/crown (80.91%). Conclusion: From the findings of the present study, it can be concluded that the unrestored ETT is susceptible to fracture, which could lead to loss of tooth and that the maximum preservation of healthy tooth structure and use of restorative materials with mechanical properties similar to dental structure favor greater longevity of tooth restoration complex. PMID:25628482

Comparison of commercial and noncommercial endotracheal tube-securing devices.

PubMed

Fisher, Daniel F; Chenelle, Christopher T; Marchese, Andrew D; Kratohvil, Joseph P; Kacmarek, Robert M

2014-09-01

Tracheal intubation is used to establish a secure airway in patients who require mechanical ventilation. Unexpected extubation can have serious complications, including airway trauma and death. Various methods and devices have been developed to maintain endotracheal tube (ETT) security. Associated complications include pressure ulcers due to decreased tissue perfusion. Device consideration includes ease of use, rapid application, and low exerted pressure around the airway. Sixteen ETT holders were evaluated under a series of simulated clinical conditions. ETT security was tested by measuring distance displaced after a tug. Nine of the 16 methods could be evaluated for speed of moving the ETT to the opposite side of the mouth. Sensors located on a mannequin measured applied forces when the head was rotated vertically or horizontally. Data were analyzed using multivariate analysis of variance, with P < .05. Median displacement of the ETT by the tug test was 0 cm (interquartile range of 0.0-0.10 cm, P < .001). The mean time to move the ETT from one side of the mouth to the other ranged from 1.25 ± 0.2 s to 34.4 ± 3.4 s (P < .001). Forces applied to the face with a vertical head lift ranged from < 0.2 newtons (N) to a maximum of 3.52 N (P < .001). Forces applied to the face with a horizontal rotation ranged from < 0.2 N to 3.52 N (P < .001). Commercial devices produced greater force than noncommercial devices. Noncommercial airway holders exert less force on a patient's face than commercial devices. Airway stability is affected by the type of securing method. Many commercial holders allow for rapid but secure movement of the artificial airway from one side of the mouth to the other. Copyright © 2014 by Daedalus Enterprises.

An in vitro evaluation of aerosol delivery through tracheostomy and endotracheal tubes using different interfaces.

PubMed

Ari, Arzu; Harwood, Robert J; Sheard, Meryl M; Fink, James B

2012-07-01

Previous research reporting factors influencing aerosol delivery in intubated patients has been largely focused on the endotracheal tube (ETT) during mechanical ventilation, with little comparative analysis of effect of types of artificial airways and their interfaces on aerosol delivery during spontaneous breathing. The purpose of this study was to compare aerosol delivery via tracheostomy tube (TT) and ETT, using interfaces such as T-piece, tracheostomy collar, and manual resuscitation bag. A teaching manikin was intubated with either an ETT (8.0 mm inner diameter) and TT (8 mm inner diameter). Both bronchi were connected to a collecting filter, attached to a sinusoidal pump simulating the breathing pattern of a spontaneously breathing adult (tidal volume 450 mL, respiratory rate 20 breaths/min, inspiratory-expiratory ratio 1:2). Albuterol sulfate (2.5 mg/3 mL) was nebulized through a jet nebulizer, using each airway and interface as appropriate (n = 3). Drug on the filter was eluted and analyzed with spectrophotometry, and expressed as mean percent of loaded dose delivered. Descriptive statistics, the Student t test, and one-way analysis of variance were applied. A greater percentage of nominal dose was delivered via TT than ETT with both T-piece (13.79 ± 2.59% vs 9.05 ± 0.70%) and manual resuscitation bag (45.75 ± 1.8% vs 27.23 ± 8.98%, P = .038 and P = .025, respectively). Use of manual resuscitation bag with both TT and ETT increased lung dose more than 3-fold. Inhaled dose with tracheostomy collar was (6.92 ± 0.81%) less than T-piece with TT (P = .01). In this adult model of spontaneous ventilation, aerosol therapy through ETT was less efficient than TT, while the manual resuscitation bag was more efficient than T-piece or tracheostomy collar.

Primary Endoscopic Transnasal Transsphenoidal Surgery for Giant Pituitary Adenoma.

PubMed

Kuo, Chao-Hung; Yen, Yu-Shu; Wu, Jau-Ching; Chang, Peng-Yuan; Chang, Hsuan-Kan; Tu, Tsung-Hsi; Huang, Wen-Cheng; Cheng, Henrich

2016-07-01

Giant pituitary adenoma (>4 cm) remains challenging because the optimal surgical approach is uncertain. Consecutive patients with giant pituitary adenoma who underwent endoscopic transnasal transsphenoidal surgery (ETTS) as the first and primary treatment were retrospectively reviewed. Inclusion criteria were tumor diameter ≥4 cm in at least 1 direction, and tumor volume ≥10 cm(3). Exclusion criteria were follow-ups <2 years and diseases other than pituitary adenoma. All the clinical and radiologic outcomes were evaluated. A total of 38 patients, average age 50.8 years, were analyzed with a mean follow-up of 72.9 months. All patients underwent ETTS as the first and primary treatment, and 8 (21.1%) had complete resection without any evidence of recurrence at the latest follow-up. Overall, mean tumor volume decreased from 29.7 to 3.2 cm(3) after surgery. Residual and recurrent tumors (n = 30) were managed with 1 of the following: Gamma Knife radiosurgery (GKRS), reoperation (redo ETTS), both GKRS and ETTS, medication, conventional radiotherapy, or none. At last follow-up, most of the patients had favorable outcomes, including 8 (21.1%) who were cured and 29 (76.3%) who had a stable residual condition without progression. Only 1 (2.6%) had late recurrence at 66 months after GKRS. The overall progression-free rate was 97.4%, with few complications. In this series of giant pituitary adenoma, primary (ie, the first) ETTS yielded complete resection and cure in 21.1%. Along with adjuvant therapies, including GKRS, most patients (97.4%) were stable and free of disease progression. Therefore, primary ETTS appeared to be an effective surgical approach for giant pituitary adenoma. Copyright © 2016 Elsevier Inc. All rights reserved.

Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia.

PubMed

Fernandez, Juan F; Levine, Stephanie M; Restrepo, Marcos I

2012-07-01

Ventilator-associated pneumonia (VAP) is associated with high morbidity, mortality, and costs. Interventions to prevent VAP are a high priority in the care of critically ill patients requiring mechanical ventilation (MV). Multiple interventions are recommended by evidence-based practice guidelines to prevent VAP, but there is a growing interest in those related to the endotracheal tube (ETT) as the main target linked to VAP. Microaspiration and biofilm formation are the two most important mechanisms implicated in the colonization of the tracheal bronchial tree and the development of VAP. Microaspiration occurs when there is distal migration of microorganisms present in the secretions accumulated above the ETT cuff. Biofilm formation has been described as the development of a network of secretions and attached microorganisms that migrate along the ETT cuff polymer and inside the lumen, facilitating the transfer to the sterile bronchial tree. Therefore, our objective was to review the literature related to recent advances in ETT technologies regarding their impact on the control of microaspiration and biofilm formation in patients on MV, and the subsequent impact on VAP.

Children's Implicit Learning of Graphotactic and Morphological Regularities

ERIC Educational Resources Information Center

Pacton, Sbastien; Fayol, Michel; Perruchet, Pierre

2005-01-01

In French, the transcription of the same sound can be guided by both probabilistic graphotactic constraints (e.g., t is more often transcribed ette after -v than after -f) and morphological constraints (e.g., t is always transcribed ette when used as a diminutive suffix). Three experiments showed that pseudo-word spellings of 8-to 11-year-old…

Exaggerated blood pressure response during exercise treadmill testing: functional and hemodynamic features, and risk factors.

PubMed

de Lima, Sandro G; de Albuquerque, Maria de F P M; de Oliveira, João R M; Ayres, Constância F J; da Cunha, José E G; de Oliveira, Danyllo F; de Lemos, Roberta R; de Souza, Manuela B R; e Silva, Odwaldo B

2012-07-01

The factors which contribute to an exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) are not wholly understood. The association between the insertion/deletion polymorphisms of the angiotensin-converting enzyme (ACE) and M235T of the angiotensinogen with EBPR during ETT still remains unstudied. To identify and compare the risk factors for hypertension between normotensive subjects with EBPR and those who exhibit a normal curve of blood pressure (BP) during ETT. In a series of EBPR cases from a historical cohort of normotensive individuals, a univariate analysis was performed to estimate the association of the studied factors with BP behavior during ETT. Additionally, logistic multivariate regression was conducted to analyze the joint effects of the variables. P-values above 0.05 were considered statistically significant. From a total of 10,027 analyzed examinations, only 219 met the criteria employed to define EBPR, which resulted in a prevalence of 12.6%. For the systolic component of the BP, hyperreactive subjects displayed a mean age and body mass index (BMI) significantly higher than the others (P=0.002 and <0.001, respectively). No association was observed between the polymorphisms cited above and EBPR. An analysis of the joint effect of variables has indicated that only age (P< 0.001) and BMI (P=0.001) were specifically associated with systolic BP during exercise. Age and BMI were the only factors that independently influenced EBPR during ETT.

Effects of Tribulus terrestris on monosodium iodoacetate‑induced osteoarthritis pain in rats.

PubMed

Park, Young Jin; Cho, Young-Rak; Oh, Joa Sub; Ahn, Eun-Kyung

2017-10-01

Tribulus terrestris L. (T. terrestris) has been used as a traditional medicine for the treatment of diuretic, lithontriptic, edema and urinary infections. Previous studies have indicated that it is effective in improving inflammation by regulating tumor necrosis factor‑α (TNF)‑α, interleukin (IL)‑6, IL‑10, nitric oxide (NO) and cyclooxygenase (COX)‑2. However, the effects and mechanism of action of T. terrestris on osteoarthritis (OA) remain unknown. Therefore, the present study aimed to evaluate the effects of the ethanolic extract of T. terrestris (ETT) in a monosodium iodoacetate (MIA)‑induced OA animal model. OA was induced in LEW/SSNHSD rats by intra‑articular injection of MIA. Morphometric changes and parameters of the tibial trabecular bone were determined using micro‑computed tomography. The molecular mechanisms of ETT in OA were investigated using reverse transcription‑polymerase chain reaction, western blotting and gelatin zymogram analysis. Treatment with ETT attenuated MIA‑induced OA, and this effect was mediated by the downregulation of NO synthase 2, COX‑2, TNF‑α and IL‑6. Furthermore, the ETT‑mediated attenuation of OA was also dependent on the expression of matrix metalloproteinases‑2 and ‑9. The results of the current study indicate that further evaluation of the mechanisms underlying the attenuation of MIA‑induced OA by ETT are required, and may support the development of ETT as a potential therapeutic agent for the treatment of inflammatory diseases such as OA.

Calcium score of coronary artery stratifies the risk of obstructive coronary artery diseases.

PubMed

Ibrahim, O; Oteh, M; Anwar, I R; Che Hassan, H H; Choor, C K; Hamzaini, A H; Rahman, M M

2013-01-01

Coronary heart disease is a major health problem in Malaysia with high morbidity and mortality. Common primary screening tool of cardiovascular risk stratification is exercise treadmill test (ETT). This communication is to determine the performance of coronary artery calcium score a new method to stratify the presence of obstructive coronary artery disease (CAD) in comparison to traditional ETT in patients having coronary artery diseases. Patients between 30 to 60 years old attended the ETT to screen for ischemic heart disease were recruited for Agatston coronary artery calcium score (CACS) of multi-sliced computed tomography (MSCT). Subsequently all patients underwent a full MSCT coronary angiography. The major determinant was the state of CAD whether obstructive (50% stenosis or more) or non-obstructive (less than 50% stenosis). All patients diagnosed with obstructive CAD on MSCT coronary angiogram were subjected to invasive coronary angiogram (ICA) to confirm the findings and planned the need for revascularization. The CACS was 100% sensitivity and 97.5% specificity in detecting obstructive CAD at the optimal cut-off value of 106.5 and above. The positive predictive value (PPV) at CACS ≥ 106 was 71.4% and the negative predictive value (NPV) was consistent at 100%. Compare to ETT, the CACS discriminative value and diagnostic performance was much better (PPV 71.4% vs. 45.5%), respectively. CACS can be a good diagnostic screening tool in patients suspected of CAD, and particularly within the non-diagnostic ETT subgroup with low to moderate cardiovascular risks.

Optimization of Ultrasound Transducer Positioning for Endotracheal Tube Placement Confirmation in Cadaveric Model.

PubMed

Lonchena, Tiffany; So, Sokpoleak; Ibinson, James; Roolf, Peter; Orebaugh, Steven L

2017-02-01

Sonography has been suggested as a possible means of endotracheal tube (ETT) placement confirmation. However, optimum ultrasound transducer placement has not been established. Using a cadaveric model, ETT placement by the sonographic appearance at the thyroid cartilage, cricoid cartilage, and suprasternal notch in the upper airway was assessed to determine which ultrasound transducer placement offered the most optimal images for ETT confirmation in the airway. One provider intubated 5 cadavers, with the ultrasound transducer at each of the 3 levels, for a total of 30 intubations per specimen, while 2 providers assigned a visual score of 1 (subtle), 2 (clear), or 3 (pronounced) to each sonogram of the ETT in the airway. At the level of the thyroid cartilage, tracheal intubation was detected at a rate of 40%, with a median visualization scale of 1 (subtle movement). At the level of the cricoid cartilage, the visualization scale improved to a median of 2 (clear movement), with a 70% intubation detection rate. At the level of the suprasternal notch, 100% of the tracheal intubations were visualized on sonography, with a median score of 3 (pronounced movement). In comparing sonographic detection of ETT placement at 3 levels of the upper airway in a cadaveric model, our results clearly indicate that visualization was superior at the level of the suprasternal notch, with 100% of intubations detected with the best visualization scores. © 2017 by the American Institute of Ultrasound in Medicine.

Tolerability and performance of BIP endotracheal tubes with noble metal alloy coating--a randomized clinical evaluation study.

PubMed

Björling, Gunilla; Johansson, Dorota; Bergström, Linda; Jalal, Shah; Kohn, Ivar; Frostell, Claes; Kalman, Sigridur

2015-12-01

Hospital acquired infections worsen the outcome of patients treated in intensive care units and are costly. Coatings with silver or metal alloys may reduce or alter the formation of biofilm on invasive medical devices. An endotracheal tube (ETT) is used to connect the patient to a ventilator and coated tubes have been tested in relation to bacterial colonization and respiratory infection. In the present study, we aimed to evaluate and compare a coated and uncoated ETT for patient symptoms and local tracheal tolerability during short term clinical use. Degree of bacterial colonization was also described. A silver-palladium-gold alloy coating ('Bactiguard®'Infection Protection, BIP) has been extensively used on urinary tract catheters and lately also on central venous catheters. We performed a randomised, single-blinded, controlled, first in man, post Conformité Européenne (EC) certification and CE marking study, focused on Bactiguard® coated ETTs (BIP ETT). Thirty patients at a tertiary university hospital scheduled for upper abdominal elective surgery with an expected duration of anaesthesia of at least 3 h were randomised; BIP ETT (n = 20) or standard ETT (n = 10). The tolerability was assessed with a modified version of Quality of Life Head and Neck Module, QLQ-H&N35 and by inspection of the tracheal mucosa with a fibre-optic bronchoscope before intubation and at extubation. Adverse Events (AE) and bacterial adherence were also studied. Statistical evaluations were carried out with the Fisher's Exact Test, the Clopper-Pearson method, as well as a Proportional Odds Model. Differences between groups were identified in 2 of 8 patient related symptoms with regard to tolerability by QLQ-H&N35 (cough, p = 0.022 and dry mouth, p = 0.014 in the treatment group.). No mucosal damage was identified with bronchoscopy. A low level of bacterial colonization with normal flora, equal between groups, was seen after short-term of intubation (median 5 h). No

[Diversity analysis of biofilm bacteria on tracheal tubes removed from intubated neonates].

PubMed

Song, Chao; Yu, Jia-lin; Ai, Qing; Liu, Dong; Lu, Wei; Lu, Qi; Peng, Ning-ning

2013-08-01

The catheter-related infections caused by mechanical ventilation have become a intractable clinical problem, and it is related to the formation of bacterial biofilm (BF) on the surface of the implanted material. The majority of natural biofilms are formed by multiple bacterial species. However, there always only one or limited species were detected on tracheal tubes removed from intubated neonates by using traditional methods including bacterium culture and antigen detection. The aims of this study were to observe the bacterial communities diversity of BF on endotracheal tube (ETT), and discuss the difference between traditional bacterium culture methods and the use of molecular biology techniques on the basis of denatured gradient gel electrophoresis (DGGE), to provide new ideas for clinical prevention, diagnosis and treatment of bacterial infections. Thirty-five ETTs were obtained from 26 neonates on mechanical ventilator (from October 2012 to March 2013) in Department of Neonatology of Children's Hospital. Among the patients, 18 were boys and 8 girls, and 19 patients were < 37 weeks gestational age and 7 patients ≥ 37 weeks. DGGE profiling of 16S rDNA gene amplicons was used to assess the diversity of the bacterial population by using the software of quantity one. TA Cloning Kit and sequencing were used to investigate the distribution of bacteria and common dominant bacteria in ETT-BF. The mean bands of 35 ETTs cases were 13.8 ± 5.4 from 16S rDNA PCR-DGGE, and the mean Shanon-Wiener indexes was 2.42 ± 0.38. The 16 ETTs were collected in different stages of diseases from the 7 patients. The indwelling days of 6/7 patients' ETTs increased, the Shanon-siener indexes were decreased. Among the 6 cases from different basic illnesses, and there were different Shanon-siener indexes. The result of molecular cloning and sequencing for 24 dominant bands showed that 35 cases (100%) contained Klebsiella SP·, 28 cases (80%) had Pseudomonas SP·, 27 cases (77%) had

Energy drinks give you wings but also an abnormal exercise test.

PubMed

Choudhury, Tawfiqur R; Abdool, Muhammad A; Galasko, Gavin

2017-07-27

This is the case of a 53-year-old man with known coronary artery disease who underwent two exercise treadmill tests (ETT). The first test, which yielded an abnormal result, was undertaken shortly after he had drunk two cans of Red Bull, a popular energy drink (ED). A second ETT was undertaken 1 week later by the same team without EDs on board and the test result was normal. This case suggests that drinking EDs prior to an ETT could lead to a false positive result and should be discouraged prior to exercise testing. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Interface-Located Photothermoelectric Effect of Organic Thermoelectric Materials in Enabling NIR Detection.

PubMed

Huang, Dazhen; Zou, Ye; Jiao, Fei; Zhang, Fengjiao; Zang, Yaping; Di, Chong-an; Xu, Wei; Zhu, Daoben

2015-05-06

Organic photothermoelectric (PTE) materials are promising candidates for various photodetection applications. Herein, we report on poly[Cux(Cu-ett)]:PVDF, which is an excellent polymeric thermoelectric composite, possesses unprecedented PTE properties. The NIR light irradiation on the poly[Cu(x)(Cu-ett)]:PVDF film could induce obvious enhancement in Seebeck coefficient from 52 ± 1.5 to 79 ± 5.0 μV/K. By taking advantage of prominent photothermoelectric effect of poly[Cu(x)(Cu-ett)]:PVDF, an unprecedented voltage of 12 mV was obtained. This excellent performance enables its promising applications in electricity generation from solar energy and NIR detection to a wide range of light intensities ranging from 1.7 mW/cm(2) to 17 W/cm(2).

Effects of Mo, Cr, and V Additions on Tensile and Charpy Impact Properties of API X80 Pipeline Steels

NASA Astrophysics Data System (ADS)

Han, Seung Youb; Shin, Sang Yong; Seo, Chang-Hyo; Lee, Hakcheol; Bae, Jin-Ho; Kim, Kisoo; Lee, Sunghak; Kim, Nack J.

2009-08-01

In this study, four API X80 pipeline steels were fabricated by varying Mo, Cr, and V additions, and their microstructures and crystallographic orientations were analyzed to investigate the effects of their alloying compositions on tensile properties and Charpy impact properties. Because additions of Mo and V promoted the formation of fine acicular ferrite (AF) and granular bainite (GB) while prohibiting the formation of coarse GB, they increased the strength and upper-shelf energy (USE) and decreased the energy transition temperature (ETT). The addition of Cr promoted the formation of coarse GB and hard secondary phases, thereby leading to an increased effective grain size, ETT, and strength, and a decreased USE. The addition of V resulted in a higher strength, a higher USE, a smaller effective grain size, and a lower ETT, because it promoted the formation of fine and homogeneous of AF and GB. The steel that contains 0.3 wt pct Mo and 0.06 wt pct V without Cr had the highest USE and the lowest ETT, because its microstructure was composed of fine AF and GB while its maintained excellent tensile properties.

Changes in uncuffed endotracheal tube leak during laparoscopic inguinal herniorrhaphy in children.

PubMed

Noguchi, Akiko; Kuga, Kumiko; Tashiro, Naoki; Shimakawa, Yusuke; Shono, Takeshi; Hirakawa, Naomi; Sakaguchi, Yoshiro

2016-08-01

The present study was conducted to investigate changes in uncuffed endotracheal tube (ETT) leak during laparoscopic surgery. The study included 31 patients aged between 1 and 6 years scheduled for elective laparoscopic inguinal herniorrhaphy. Inspiratory and expiratory tidal volumes (TVi and TVe) were measured during mechanical ventilation, and ETT leak was calculated using the formula-ETT leak = (TVi - TVe)/TVi × 100 (%), assessed at the following time-points-5 min after the start of mechanical ventilation (T1, baseline), just before the start of surgery (T2), 5 min after the induction of pneumoperitoneum with 15° Trendelenburg tilt (T3), and at the end of surgery (T4). Additionally, leak pressure was assessed after successful tracheal intubation (T0, baseline) at T2, T3 and T4. Uncuffed ETT leak significantly decreased at T3 compared with T1 (baseline). Leak pressure significantly increased at T3 and T4 compared with T0 (baseline). Further studies are needed in order to determine whether the results are universal and associated with clinically significant outcomes.

Automated control of endotracheal tube cuff pressure during simulated flight.

PubMed

Blakeman, Thomas; Rodriquez, Dario; Woods, James; Cox, Daniel; Elterman, Joel; Branson, Richard

2016-11-01

Successful mechanical ventilation requires that the airway be controlled by an endotracheal tube (ETT) with an inflatable cuff to seal the airway. Aeromedical evacuation represents a unique challenge in which to manage ETT cuffs. We evaluated three methods of automatic ETT cuff pressure adjustment during changes in altitude in an altitude chamber. Size 7.5 and 8.0 mm ETTs that are currently included in the Critical Care Air Transport Team allowance standard were used for the evaluation. Three automatic cuff pressure controllers-Intellicuff, Hamilton Medical; Pyton, ARM Medical; and Cuff Sentry, Outcome Solutions-were used to manage cuff pressures. The fourth group had cuff pressure set at sea level without further adjustment. Each ETT was inserted into a tracheal model and taken to 8,000 feet and then to 16,000 feet at 2,500 ft/min. Baseline cuff pressure at sea level was approximately 25 cm H2O. Mean cuff pressure at both altitudes with both size ETTs was as follows: Control arm, 141 ± 64 cm H2O; Pyton, 25 ± 0.8 cm H2O; Cuff Sentry, 22 ± 0.3 cm H2O; and Intellicuff, 29 ± 6.6 cm H2O. The mean time that cuff pressure was >30 cm H2O using Intellicuff at both altitudes was 2.8 ± 0.8 minutes. Pressure differences from baseline in the control arm and with Intellicuff were statistically significant. Cuff pressure with the Cuff Sentry tended to be lower than indicated on the device. Mean cuff pressures were within the recommended range with all three devices. Intellicuff had difficulty regulating the cuff pressure initially with increases in altitude but was able to reduce the pressure to a safe level during the stabilization period at each altitude. The Pyton and Cuff Sentry allowed the least variation in pressure throughout the evaluation, although the Cuff Sentry set pressure was less than the actual pressure. Therapeutic study, level V.

Ventilator associated pneumonia: evolving definitions and preventive strategies.

PubMed

Mietto, Cristina; Pinciroli, Riccardo; Patel, Niti; Berra, Lorenzo

2013-06-01

Ventilator-associated pneumonia (VAP) is one of the most frequent hospital-acquired infections occurring in intubated patients. Because VAP is associated with higher mortality, morbidity, and costs, there is a need to solicit further research for effective preventive measures. VAP has been proposed as an indicator of quality of care. Clinical diagnosis has been criticized to have poor accuracy and reliability. Thus, the Centers for Disease Control and Prevention has introduced a new definition based upon objective and recordable data. Institutions are nowadays reporting a VAP zero rate in surveillance programs, which is in discrepancy with clinical data. This reduction has been highlighted in epidemiological studies, but it can only be attributed to a difference in patient selection, since no additional intervention has been taken to modify pathogenic mechanisms in these studies. The principal determinant of VAP development is the presence of the endotracheal tube (ETT). Contaminated oropharyngeal secretions pool over the ETT cuff and subsequently leak down to the lungs through a hydrostatic gradient. Impairment of mucociliary motility and cough reflex cannot counterbalance with a proper clearance of secretions. Lastly, biofilm develops on the inner ETT surface and acts as a reservoir for microorganism inoculum to the lungs. New preventive strategies are focused on the improvement of secretions drainage and prevention of bacterial colonization. The influence of gravity on mucus flow and body positioning can facilitate the clearance of distal airways, with decreased colonization of the respiratory tract. A different approach proposes ETT modifications to limit the leakage of oropharyngeal secretions: subglottic secretion drainage and cuffs innovations have been addressed to reduce VAP incidence. Moreover, coated-ETTs have been shown to prevent biofilm formation, although there is evidence that ETT clearance devices (Mucus Shaver) are required to preserve the

Comparison of the Force Required for Dislodgement Between Secured and Unsecured Airways.

PubMed

Davenport, Curtis; Martin-Gill, Christian; Wang, Henry E; Mayrose, James; Carlson, Jestin N

2018-05-01

Airway device placement and maintenance are of utmost importance when managing critically ill patients. The best method to secure airway devices is currently unknown. We sought to determine the force required to dislodge 4 types of airways with and without airway securing devices. We performed a prospective study using 4 commonly used airway devices (endotracheal tube [ETT], laryngeal mask airway [LMA], King laryngeal tube [King], and iGel) performed on 5 different mannequin models. All devices were removed twice per mannequin in random order, once unsecured and once secured as per manufacturers' recommendations; Thomas Tube Holder (Laerdal, Stavanger, Norway) for ETT, LMA, and King; custom tube holder for iGel. A digital force measuring device was attached to the exposed end of the airway device and gradually pulled vertically and perpendicular to the mannequin until the tube had been dislodged, defined as at least 4 cm of movement. Dislodgement force was reported as the maximum force recorded during dislodgement. We compared the relative difference in the secured and unsecured force for each device and between devices using a random-effects regression model accounting for variability in the manikins. The median dislodgment forces (interquartile range [IQR]) in pounds for each secured device were: ETT 13.3 (11.6, 14.1), LMA 16.6 (13.9, 18.3), King 21.7 (16.9, 25.1), and iGel 8 (6.8, 8.3). The median dislodgement forces for each unsecured device were: ETT 4.5 (4.3, 5), LMA 8.4 (6.8, 10.7), King 10.6 (8.2, 11.5), and iGel 3.9 (3.2, 4.2). The relative difference in dislodgement forces (95% confidence intervals) were higher for each device when secured: ETT 8.6 (6.2 to 11), LMA 8.8 (4.6 to 13), King 12.1 (7.2 to 16.6), iGel 4 (1.1 to 6.9). When compared to secured ETT, the King required greater dislodgement force (relative difference 8.6 [4.5-12.7]). The secured iGel required less force than the secured ETT (relative difference -4.8 [-8.9 to -0.8]). Compared with a

Protective effect of an aphrodisiac herb Tribulus terrestris Linn on cadmium-induced testicular damage

PubMed Central

Rajendar, B.; Bharavi, K.; Rao, G. S.; Kishore, P.V.S; Kumar, P. Ravi; Kumar, C.S.V Satish; Patel, T. Pankaj

2011-01-01

Aim: The aim of the present study was to investigate whether Tribulus terrestris Linn (TT) could protect the cadmium (Cd)-induced testicular tissue peroxidation in rats and to explore the underlying mechanism of the same. Materials and Methods: In vitro and in vivo studies were conducted to know the protective effect of ethanolic extract of TT (eTT) in Cd toxicity. In in vitro studies, total antioxidant and ferrous metal ion chelating activity of TT was studied. In vivo studies were conducted in rats. A total of 40 Wistar strain adult male rats were divided into four groups. Group 1 served as control, while group 2 to 4 received CdCl2 (3 mg/kg b. wt. s/c once a week). In addition to Cd, group 3 and 4 rats also received eTT (5 mg/kg b.wt. daily as oral gavage) and α-tocopherol (75 mg/kg daily by oral gavage), respectively. At the end of 6th week, all the rats were sacrificed and the separated testes were weighted and processed for estimation of tissue peroxidation markers, antioxidant markers, functional markers, and Cd concentration. The testes were also subjected to histopathological screening. Results: In in vitro studies, the percentage of metal ion chelating activity of 50 μg/ml of eTT and α-tocopherol were 2.76 and 9.39, respectively, and the antioxidant capacity of eTT was equivalent to 0.063 μg of α-tocopherol/μg of eTT. In in vivo studies, administration of Cd significantly reduced the absolute and relative testicular weight, antioxidant markers such as superoxide dismutase and glutathione, and functional markers such as LDH and ALP, along with significant increase in peroxidation markers such as malondialdehyde and protein carbonyls in testicular tissue. Testes of Cd only-treated group showed histological insults like necrotic changes in seminiferous tubules and interstitium, shrunken tubules with desquamated basal lamina, vacuolization and destruction of sertoli cells, and degenerating Leydig cells. This group also had higher Cd levels in testicular

Discordance of exercise thallium testing with coronary arteriography in patients with atypical presentations

NASA Technical Reports Server (NTRS)

Bungo, M. W.; Leland, O. S., Jr.

1983-01-01

Eighty-one patients with diagnostically difficult clinical presentations suggesting coronary artery disease underwent symptom-limited maximal-exercise treadmill testing (ETT) and exercise radionuclide scanning with thallium-201 followed by coronary angiography. Results showed that in nearly half of the patients (47%) these tests were in agreement, while either exercise thallium or ETT was positive in 94% of patients with coronary artery disease. It was found that agreement between exercise thallium and ETT tests predicted disease in 92% of the instances or excluded disease in 82% of the instances. It is concluded that despite frequent discord between these two tests in 53% of the cases, a significant gain in exclusive diagnostic capability is realized when applied to a patient population anticipated to have a disease prevalence equal to the 67% encountered in this study.

Feasibility of a Novel Optoacoustic Device to Precisely Localize Endotracheal Tube Positioning in a Cadaver Model

DTIC Science & Technology

2016-11-02

million per year to U.S. hospitals [1,2]. Current methods of assessing ETT position include chest radiography, end- tidal carbon dioxide (EtCO2...lasers to generate sound waves to determine the position of “labeled” ETTs within millimeters of accuracy. Laser optoacoustic imaging combines the merits...of optical tomography (high optical contrast) and ultrasound imaging (minimal scattering of acoustic waves ) to yield high contrast, sensitivity, and

Discovery of the ergothioneine transporter

PubMed Central

Gründemann, Dirk; Harlfinger, Stephanie; Golz, Stefan; Geerts, Andreas; Lazar, Andreas; Berkels, Reinhard; Jung, Norma; Rubbert, Andrea; Schömig, Edgar

2005-01-01

Variants of the SLC22A4 gene are associated with susceptibility to rheumatoid arthritis and Crohn's disease. SLC22A4 codes for an integral membrane protein, OCTN1, that has been presumed to carry organic cations like tetraethylammonium across the plasma membrane. Here, we show that the key substrate of this transporter is in fact ergothioneine (ET). Human OCTN1 was expressed in 293 cells. A substrate lead, stachydrine (alias proline betaine), was identified by liquid chromatography MS difference shading, a new substrate search strategy. Analysis of transport efficiency of stachydrine-related solutes, affinity, and Na+ dependence indicates that the physiological substrate is ET. Efficiency of transport of ET was as high as 195 μl per min per mg of protein. By contrast, the carnitine transporter OCTN2 from rat did not transport ET at all. Because ET is transported >100 times more efficiently than tetraethylammonium and carnitine, we propose the functional name ETT (ET transporter) instead of OCTN1. ET, all of which is absorbed from food, is an intracellular antioxidant with metal ion affinity. Its particular purpose is unresolved. Cells with expression of ETT accumulate ET to high levels and avidly retain it. By contrast, cells lacking ETT do not accumulate ET, because their plasma membrane is virtually impermeable for this compound. The real-time PCR expression profile of human ETT, with strong expression in CD71+ cells, is consistent with a pivotal function of ET in erythrocytes. Moreover, prominent expression of ETT in monocytes and SLC22A4 polymorphism associations suggest a protective role of ET in chronic inflammatory disorders. PMID:15795384

Pressure attenuation during high-frequency airway clearance therapy across different size endotracheal tubes: An in vitro study.

PubMed

Smallwood, Craig D; Bullock, Kevin J; Gouldstone, Andrew

2016-08-01

High-frequency airway clearance therapy is a positive pressure secretion clearance modality used in pediatric and adult applications. However, pressure attenuation across different size endotracheal tubes (ETT) has not been adequately described. This study quantifies attenuation in an in vitro model. The MetaNeb® System was used to deliver high-frequency pressure pulses to 3.0, 4.0, 6.0 and 8.0mm ID ETTs connected to a test lung during mechanical ventilation. The experimental setup included a 3D-printed trachea model and imbedded pressure sensors. The pressure attenuation (Patt%) was calculated: Patt%=[(Pproximal-Pdistal)/Pproximal]x100. The effect of pulse frequency on Pdistal and Pproximal was quantified. Patt% was inversely and linearly related to ETT ID and (y=-7.924x+74.36; R(2)=0.9917, P=.0042 for 4.0Hz pulse frequency and y=-7.382+9.445, R(2)=0.9964, P=.0018 for 3.0Hz pulse frequency). Patt% across the 3.0, 4.0, 6.0 and 8.0mm I.D. ETTs was 48.88±10.25%, 40.87±5.22%, 27.97±5.29%, and 9.90±1.9% respectively. Selecting the 4.0Hz frequency mode demonstrated higher Pproximal and Pdistal compared to the 3.0Hz frequency mode (P=.0049 and P=.0065). Observed Pdistal was <30cmH2O for all experiments. In an in vitro model, pressure attenuation was linearly related to the inner diameter of the endotracheal tube; with decreasing attenuation as the ETT size increased. Copyright © 2016 Elsevier Inc. All rights reserved.

Low flow anesthesia: Efficacy and outcome of laryngeal mask airway versus pressure–optimized cuffed–endotracheal tube

PubMed Central

El-Seify, Zeinab A; Khattab, Ahmed Metwally; Shaaban, Ashraf; Radojevic, Dobrila; Jankovic, Ivanka

2010-01-01

Background Low flow anesthesia can lead to reduction of anesthetic gas and vapor consumption. Laryngeal mask airway (LMA) has proved to be an effective and safe airway device. The aim of this study is to assess the feasibility of laryngeal mask airway during controlled ventilation using low fresh gas flow (1.0 L/min) as compared to endotracheal tube (ETT). Patients and Methods Fifty nine non-smoking adult patients; ASA I or II, being scheduled for elective surgical procedures, with an expected duration of anesthesia 60 minutes or more, were randomly allocated into two groups - Group I (29 patients) had been ventilated using LMA size 4 for females and 5 for males respectively; and Group II (30 patients) were intubated using ETT. After 10 minutes of high fresh gas flow, the flow was reduced to 1 L/min. Patients were monitored for airway leakage, end-tidal CO2(ETCO2), inspiratory and expiratory isoflurane and nitrous oxide fraction concentrations, and postoperative airway-related complications. Results Two patients in the LMA-group developed initial airway leakage (6.9%) versus no patient in ETT-group. Cough and sore throat were significantly higher in ETT patients. There were no evidences of differences between both groups regarding ETCO2, uptake of gases, nor difficulty in swallowing. Conclusion: The laryngeal mask airway proved to be effective and safe in establishing an airtight seal during controlled ventilation under low fresh gas flow of 1 L/min, inducing less coughing and sore throat during the immediate postoperative period than did the ETT, with continuous measurement and readjustment of the tube cuff pressure. PMID:20668559

Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport.

PubMed

Mann, Catherine; Parkinson, Neil; Bleetman, Anthony

2007-03-01

Helicopters and light (unpressurised) aircraft are used increasingly for the transport of ventilated patients. Most of these patients are ventilated through endotracheal tubes (ETTs), others through laryngeal mask airways (LMAs). The cuffs of both ETTs and LMAs inflate with increases in altitude as barometric pressure decreases (30 mbar/1000 feet). Tracheal mucosa perfusion becomes compromised at a pressure of approximately 30 cm H2O; critical perfusion pressure is 50 cm H2O. The change in dimensions of the inflated cuffs of a size 8 ETT and a size 5 LMA were measured with digital callipers at 1000 feet intervals in the unpressurised cabin of an Agusta 109 helicopter used by the Warwickshire and Northamptonshire Air Ambulance. A linear expansion in cuff dimensions as a function of altitude increase was identified. For ETTs, a formula for removal of air from the cuff with increasing altitude was calculated and is recommended for use in aeromedical transfers. This is 1/17x1.1 = 0.06 ml/1000 foot ascent/ml initial cuff inflation. The data for LMA cuff expansion failed to show significant correlation with altitude change. Further work is required to determine a similar rule of thumb for LMA cuff deflation.

Escherichia coli type III secretion system 2: a new kind of T3SS?

PubMed

Zhou, Mingxu; Guo, Zhiyan; Duan, Qiangde; Hardwidge, Philip R; Zhu, Guoqiang

2014-03-19

Type III secretion systems (T3SSs) are employed by Gram-negative bacteria to deliver effector proteins into the cytoplasm of infected host cells. Enteropathogenic Escherichia coli use a T3SS to deliver effector proteins that result in the creation of the attaching and effacing lesions. The genome sequence of the Escherichia coli pathotype O157:H7 revealed the existence of a gene cluster encoding components of a second type III secretion system, the E. coli type III secretion system 2 (ETT2). Researchers have revealed that, although ETT2 may not be a functional secretion system in most (or all) strains, it still plays an important role in bacterial virulence. This article summarizes current knowledge regarding the E. coli ETT2, including its genetic characteristics, prevalence, function, association with virulence, and prospects for future work.

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate.

PubMed

Ivanov, Vadim A

2016-02-01

The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO2 elimination in a model of the premature neonate lung. The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode. The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (VT) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and

Managing endotracheal tube cuff pressure at altitude: a comparison of four methods.

PubMed

Britton, Tyler; Blakeman, Thomas C; Eggert, John; Rodriquez, Dario; Ortiz, Heather; Branson, Richard D

2014-09-01

Ascent to altitude results in the expansion of gases in closed spaces. The management of overinflation of the endotracheal tube (ETT) cuff at altitude is critical to prevent mucosal injury. We continuously measured ETT cuff pressures during a Critical Care Air Transport Team training flight to 8,000-ft cabin pressure using four methods of cuff pressure management. ETTs were placed in a tracheal model, and mechanical ventilation was performed. In the control ETT, the cuff was inflated to 20 mm Hg to 22 mm Hg and not manipulated. The manual method used a pressure manometer to adjust pressure at cruising altitude and after landing. A PressureEasy device was connected to the pilot balloon of the third tube and set to a pressure of 20 mm Hg to 22 mm Hg. The final method filled the balloon with 10 mL of saline. Both size 8.0-mm and 7.5-mm ETT were studied during three flights. In the control tube, pressure exceeded 70 mm Hg at cruising altitude. Manual management corrected for pressure at altitude but resulted in low cuff pressures upon landing (<10 mm Hg). The PressureEasy reduced the pressure change to a maximum of 36 mm Hg, but on landing, cuff pressures were less than 15 mm Hg. Saline inflation ameliorated cuff pressure changes at altitude, but initial pressures were 40 mm Hg. None of the three methods using air inflation managed to maintain cuff pressures below those associated with tracheal damage at altitude or above pressures associated with secretion aspiration during descent. Saline inflation minimizes altitude-related alteration in cuff pressure but creates excessive pressures at sea level. New techniques need to be developed.

Endotracheal tube placement by EMT-Basics in a rural EMS system.

PubMed

Pratt, Jeffrey C; Hirshberg, Alan J

2005-01-01

To evaluate the effectiveness of an intubation-training module and special-waiver project in which Emergency Medical Technician (EMT)-Basics were trained to perform endotracheal intubations in a rural community. This was a prospective observational study over a four-year period (July 1998 through May 2002) of all intubation attempts by EMT-Basics in the field. The authors observed intubation data, training methods, and quality-assurance methods of a special-waiver project agreed to by the State Department of Public Health to train and allow EMT-Basics to intubate patients. Data were from documentation unique to the project. Project documentation evaluated the placement and complication(s) of endotracheal tube (ETT) placement after arrival to the emergency department. An intubation attempt was defined as direct laryngoscopy. A successful attempt was defined as an appropriately sized ETT placed and secured in the trachea below the vocal cords and above the carina. Confirmation of placement in the field included accepted clinical methods and the use of qualitative colorimetric end-tidal carbon dioxide detectors. The EMT-Basics were trained using a paramedic curriculum, including operating room intubations on live adult patients. All patients were in either cardiopulmonary or respiratory arrest. Thirty-two intubations were performed by EMT-Basics. Thirty attempts were successful and two were unsuccessful (94%; 95% confidence interval [CI] 80-98%). Unsuccessful ETT placements were managed with accepted basic life support airway standards. There were no unrecognized esophageal ETT placements (0%; 95% CI 0-11%). This study demonstrated that with an intensive training program using selected highly motivated providers and close monitoring, a program of EMT-Basic ETT placement in a rural setting can achieve acceptable success rates in patients in cardiac or respiratory arrest.

Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization.

PubMed

Akdogan, Ozlem; Ersoy, Yasemin; Kuzucu, Ciğdem; Gedik, Ender; Togal, Turkan; Yetkin, Funda

The effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p<005). On average, VAP occurred 17.33±21.09 days in the case group and 10.43±7.83 days in the control group (p=0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

Exercise-induced ischemia initiates the second window of protection in humans independent of collateral recruitment.

PubMed

Lambiase, Pier D; Edwards, Richard J; Cusack, Michael R; Bucknall, Clifford A; Redwood, Simon R; Marber, Michael S

2003-04-02

This study was designed to examine if exercise-induced ischemia initiated late preconditioning in humans that becomes manifest during subsequent exercise and serial balloon occlusion of the left anterior descending coronary artery (LAD). The existence of late preconditioning in humans is controversial. We therefore compared myocardial responses to exercise-induced and intracoronary balloon inflation-induced ischemia in two groups of patients subjected to different temporal patterns of ischemia. Thirty patients with stable angina secondary to single-vessel LAD disease underwent percutaneous coronary intervention (PCI) after two separate exercise tolerance test (ETT) protocols designed to investigate isolated early preconditioning (IEP) alone or the second window of protection (SWOP). The IEP subjects underwent three sequential ETTs at least two weeks before PCI. The SWOP subjects underwent five sequential ETTs commencing 24 h before PCI. During PCI there was no significant difference in intracoronary pressure-derived collateral flow index (CFI) between groups (IEP = 0.15 +/- 0.13, SWOP = 0.19 +/- 0.15). In SWOP patients, compared with the initial ETT, the ETT performed 24 h later had a 40% (p < 0.001) increase in time to 0.1-mV ST depression and a 60% (p < 0.05) decrease in ventricular ectopic frequency. During the first balloon inflation, peak ST elevation was reduced by 49% (p < 0.05) in the SWOP versus the IEP group, and the dependence on CFI observed in the IEP group was abolished (analysis of covariance, p < 0.05). The significant attenuation of ST elevation (47%, p < 0.005) seen at the time of the second inflation in the IEP patients was not seen in the SWOP patients. Exercise-induced ischemia triggers late preconditioning in humans, which becomes manifest during exercise and PCI. This is the first evidence that ischemia induced by coronary occlusion is attenuated in humans by a late preconditioning effect induced by exercise.

Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial.

PubMed

Almarakbi, Waleed A; Kaki, Abdullah M

2014-07-01

The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness. In a prospective, randomized clinical trial, 100 patients' tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001). The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications.

Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

PubMed

Li Bassi, Gianluigi; Fernandez-Barat, Laia; Saucedo, Lina; Giunta, Valeria; Marti, Joan Daniel; Tavares Ranzani, Otavio; Aguilera Xiol, Eli; Rigol, Montserrat; Roca, Ignasi; Muñoz, Laura; Luque, Nestor; Esperatti, Mariano; Saco, Maria Adela; Ramirez, Jose; Vila, Jordi; Ferrer, Miguel; Torres, Antoni

2015-02-27

Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm. Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ≥3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ≥3 log cfu/g. P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P = 0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P = 0.327). Nevertheless, VAP never developed. Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.

The unusual amino acid l-ergothioneine is a physiologic cytoprotectant

PubMed Central

Paul, BD; Snyder, SH

2010-01-01

Ergothioneine (ET) is an unusual sulfur-containing derivative of the amino acid, histidine, which is derived exclusively through the diet. Although ET was isolated a century ago, its physiologic function has not been clearly established. Recently, a highly specific transporter for ET (ETT) was identified in mammalian tissues, which explains abundant tissue levels of ET and implies a physiologic role. Using RNA interference, we depleted cells of its transporter. Cells lacking ETT are more susceptible to oxidative stress, resulting in increased mitochondrial DNA damage, protein oxidation and lipid peroxidation. ETT is concentrated in mitochondria, suggesting a specific role in protecting mitochondrial components such as DNA from oxidative damage associated with mitochondrial generation of superoxide. In combating cytotoxic effects of pyrogallol, a known superoxide generator, ET is as potent as glutathione. Because of its dietary origin and the toxicity associated with its depletion, ET may represent a new vitamin whose physiologic roles include antioxidant cytoprotection. PMID:19911007

Intonation and expressivity: a single case study of classical western singing.

PubMed

Sundberg, Johan; Lã, Filipa M B; Himonides, Evangelos

2013-05-01

Previous studies have shown that singers tend to sharpen phrase-peak tones as compared with equally tempered tuning (ETT). Here we test the hypothesis that this can serve the purpose of musical expressivity. Data were drawn from earlier recordings, where a professional baritone sang excerpts as void of musical expression as he could (Neutral) and as expressive as in a concert (Concert). Fundamental frequency averaged over tones was examined and compared with ETT. Phrase-peak tones were sharper in excited examples, particularly in the Concert versions. These tones were flattened to ETT using the Melodyne software. The manipulated and original versions were presented pairwise to a musician panel that was asked to choose the more expressive version. By and large, the original versions were perceived as more expressive, thus supporting the common claim that intonation is a means for adding expressivity to a performance. Copyright © 2013 The Voice Foundation. All rights reserved.

The effect of esophagogastroduodenoscopy probe insertion on the intracuff pressure of airway devices in children during general anesthesia.

PubMed

Balaban, Onur; Kamata, Mineto; Hakim, Mumin; Tumin, Dmitry; Tobias, Joseph D

2017-04-01

Given the size of the esophagogastroduodenoscopy (EGD) probe and the compressibility of the pediatric airway, the EGD probe may increase the intracuff pressure (IP) of an airway device. The current study evaluated IP changes during EGD examination under general anesthesia in pediatric patients. Following the induction of anesthesia, a laryngeal mask airway (LMA) or endotracheal tube (ETT) was placed without neuromuscular blockade. The IP was measured at baseline, during EGD probe insertion, while the EGD probe was in place, and after probe removal. The study cohort included 101 patients (mean age 11.3 years). The airway was secured with an LMA and an ETT in 88 and 13 patients, respectively. The IP increased from 27 ± 15 cmH 2 O at baseline to 34 ± 17 cmH 2 O during probe insertion (p < 0.001), remained at 33 ± 16 cmH 2 O while the probe was in place, and decreased to 26 ± 14 cmH 2 O after probe removal. The IP of the LMA or ETT increased during EGD probe insertion and remained elevated while the probe was in place. High IP may compromise mucosal perfusion resulting in a sore throat when using an LMA or the potential for airway damage if an ETT is used. Removal of air from the cuff and titration of the IP should be considered after EGD insertion.

Use of a Flexible Intubating Scope in Combination with a Channeled Video Laryngoscope for Managing a Difficult Airway in the Emergency Department.

PubMed

Sowers, Nicholas; Kovacs, George

2016-02-01

Difficulty with intubation is not uncommon in the emergency setting. Video laryngoscopes (VLs) are commonly used to manage the difficult airway in the emergency department (ED). Intubation using a flexible bronchoscope, while considered the gold standard for managing the anticipated difficult airway in the operating room, is not commonly used in the ED. We present a case describing VL-assisted flexible scope intubation performed in the ED as a novel feasible approach to managing the difficult airway. A 65-year-old male, post cardiac arrest, with multiple unsuccessful attempts at prehospital intubation had rapid sequence intubation (RSI) performed and, despite obtaining a view with a King Vision™ VL, the skilled operator was unable to advance the endotracheal tube (ETT). An Ambu™ aScope3 flexible intubating scope (FIS) was placed through the ETT loaded in the channel of the King Vision and advanced through the cords to a position proximal to the carina. The ETT was then advanced easily over the FIS and down the trachea. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although video laryngoscopy is commonly used in the ED, intubation can prove difficult, despite having an adequate view of the glottis. Use of an FIS, however, through a channeled VL makes navigation of the ETT easier and facilitates tube advancement, which can be difficult with VL. Channeled VL-assisted use of an FIS is a viable option for managing the difficult airway. Copyright © 2016 Elsevier Inc. All rights reserved.

Fermi surfaces and electronic topological transitions in metallic solid solutions

NASA Astrophysics Data System (ADS)

Bruno, E.; Ginatempo, B.; Guiliano, E. S.; Ruban, A. V.; Vekilov, Yu. Kh.

1994-12-01

Notwithstanding the substitutional disorder, the Fermi surface of metallic alloys can be measured and computed. We show that, from the theoretical point of view, it is defined as the locus of the peaks of the Bloch Spectral Function (BSF). Such Fermi surfaces, on varying the atomic concentrations, may undergo changes of their topology, known as Electronic Topological Transitions (ETT). Thus, for instance, pockets of electrons or holes may appear or disappear, necks may open or close. ETTs cause anomalous behaviours of thermodynamic, transport and elastic properties of metals and constitute a fascinating field in the study of Fermi liquid systems. Although ETTs could be studied on pure systems as a function of the thermodynamic variables, nevertheless such a study would often require extreme conditions, and would lead to experimental difficulties. On the other hand, it is possible to explore the variations of atomic concentration, i.e. the valence electron per atom ratio, in metallic solid solutions with a relative experimental ease. In this paper we review the theoretical techniques for the determination of Fermi surfaces in metallic solid solutions and discuss some examples of ETTs, namely LiMg, ZrNb, NbMo, MoRe, AgPd, CdMg, NiW and NiTi alloys, also in connection with experimental data as thermoelectric power, resistivity, elastic constants and electron-phonon coupling and with the determinations of the electron momentum distribution function from Compton scattering and positron annihilation experiments. We show that the ab initio calculations of the electronic structure for the quoted systems, together with a careful determination of the BSF, are able to predict quantitatively ETTs at those concentrations where physical quantities display anomalies, so confirming directly ETT theory. Although it is not the purpose of the present review to give a full account of electronic structure calculation schemes, however, we briefly discuss the

A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions

PubMed Central

Truszewski, Zenon; Krajewski, Paweł; Fudalej, Marcin; Smereka, Jacek; Frass, Michael; Robak, Oliver; Nguyen, Bianka; Ruetzler, Kurt; Szarpak, Lukasz

2016-01-01

Abstract Background: Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. Methods: ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. Results: The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5–22] sec, when compared to that of sETT at 21.5 [IQR, 20–25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5–24.5] sec (p < .001) and sETT was 27 [IQR, 24.5–31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19–25.5] sec for the ETView and 42.5 [IQR, 35–49.5] sec for sETT. Conclusions: In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were

A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial.

PubMed

Truszewski, Zenon; Krajewski, Paweł; Fudalej, Marcin; Smereka, Jacek; Frass, Michael; Robak, Oliver; Nguyen, Bianka; Ruetzler, Kurt; Szarpak, Lukasz

2016-11-01

Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5-22] sec, when compared to that of sETT at 21.5 [IQR, 20-25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5-24.5] sec (p < .001) and sETT was 27 [IQR, 24.5-31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19-25.5] sec for the ETView and 42.5 [IQR, 35-49.5] sec for sETT. In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion

Atraumatic intubation: experience using a 5.0 endotracheal tube without a stylet for laryngeal surgery.

PubMed

Moore, Jaime E; Hu, Amanda; Rutt, Amy; Green, Parmis; Hawkshaw, Mary; Sataloff, Robert T

2015-02-01

Vocal fold injury is a well-know complication of intubation, with rates reported as high as 69%. Laryngology textbooks recommend the use of a small endotracheal tube (ETT) to help avoid these complications and optimize visualization. Case reports have suggested that the rigid stylet can lead to laryngeal injury. Given the additional risks, intubation without the stylet is our preferred practice. There is limited documentation in the literature regarding this viewpoint. Our study investigated the feasibility of and potential barriers to intubation using 5.0 ETT without a stylet. Prospective study. Consecutive adult patients undergoing laryngeal surgery were recruited for intubation with a 5.0 ETT without a stylet. Demographic data, specialty and training level of the intubator, and factors that would predict a difficult intubation were recorded. Descriptive statistical analysis was performed. Findings of the participants (n = 67) included average American Society of Anesthesiologists (ASA) physical status classification (2.2), average Mallampati score (1.7), average Cormack-Lehane grade (1.5), and average body mass index (28.0). Five patients (7.4%) required intubation using a stylet, and one of these five participants was intubated initially with a stylet. Of these five participants, 80% required use of a GlideScope (P < .001), and they had significantly higher ASA classification (P = .047) and number of intubation attempts (P = .042). One patient sustained an oropharyngeal injury during intubation with a stylet. No participants had laryngeal injury. Most patients can be intubated successfully using a 5.0 ETT without a stylet. There were no cases of laryngeal trauma with this technique. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Prevention of ventilator-associated pneumonia.

PubMed

Li Bassi, Gianluigi; Senussi, Tarek; Aguilera Xiol, Eli

2017-04-01

Ventilator-associated pneumonia (VAP) is an iatrogenic disease. Here we appraise recent advancements in the development and testing of strategies to prevent VAP. We also provide recommendations on the most promising interventions that should be applied. In the last year, preventive bundles have consistently let to a reduction of VAP. A few trials on endotracheal tubes (ETTs) with novel cuffs failed to translate positive bench findings into clinical settings. In addition, meta-analyses confirmed the primary role of subglottic secretion aspiration in VAP prevention. A relatively new ETT, with an innovative cuff design, has been tested in clinical trials confirming potential value. Meta-analyses confirmed reduction of VAP with the use of chlorhexidine for oropharyngeal decontamination. However, prophylactic inhaled or oral antibiotics are ineffective. Finally, there is growing interest in orally ingested probiotics to prevent VAP. The results of ongoing studies on probiotics are much-awaited. In conclusion, in the past year, new evidence elucidated limitations of new ETT cuffs in the prevention of VAP; whereas, subglottic secretion aspiration proved consistent benefits. Modulation of oropharyngeal colonization with chlorhexidine decreases risks of VAP and should be widely implemented. Finally, preventive measures with proven preventive value should be grouped into bundles.

Relationship Between Post-exercise Heart Rate Recovery and Changing Ratio of Cardiopulmonary Exercise Capacity.

PubMed

Kim, Ji-Hyun; Choe, Yu-Ri; Song, Min-Keun; Choi, In-Sung; Han, Jae-Young

2017-12-01

To determine whether heart rate recovery (HRR) following an exercise tolerance test (ETT) is correlated with a changing ratio of peak oxygen consumption (VO 2 ) and maximal metabolic equivalents (MET max ). A total of 60 acute myocardial infarction (AMI) patients who underwent ETT at both assessment points - 3 weeks (T0) after the AMI attack and 3 months after T0 (T1) were included. After achieving a peak workload, the treadmill was stopped with a 5-minute cooldown period, and the patients recovered in a comfortable and relaxed seated position. HRR was defined as the difference between the maximal heart rate (HR max ) and the HR measured at specific time intervals - immediately after the cool down period (HRR-0) and 3 minutes after the completion of the ETT (HRR-3). HRR-0 and HRR-3 increased over time, whereas VO 2max and MET max did not show significant changes. There was a positive correlation between HRR at T0 and the exercise capacity at T0. HRR at T0 also showed a positive correlation with the exercise capacity at T1. There was no significant correlation between HRR measured at T0 and the change in the ratio of VO 2max and MET max , as calculated by subtracting VO 2max and MET max obtained at T0 from those obtained at T1, divided by VO 2max at T0 and multiplied by 100. Post-exercise HRR measured at 3 weeks after the AMI onset can reflect the exercise capacity 3 months after the first ETT. However, it may be difficult to correlate post-exercise HRR at T0 with the degree of increase in cardiopulmonary exercise capacity in patients with AMI.

Do Physicians Do What They Say?

PubMed Central

Wennberg, David E; Dickens, John D; Biener, Lois; Fowler, Floyd J; Soule, David N; Keller, Robert B

1997-01-01

OBJECTIVE Efforts to evaluate variations in cardiac procedures have focused on patient factors and differences in health care delivery systems. We wanted to assess how physicians’ inclination to test patients with coronary artery disease influences utilization patterns. SETTING AND SUBJECTS Physicians and the populations of Maine, New Hampshire, and Vermont. DESIGN We conducted a survey of 263 family practitioners, internists, and cardiologists residing in 57 hospital service areas in Maine, New Hampshire, and Vermont. Using patient scenarios, we assessed the clinicians’ inclinations to test during the evaluation of patients with coronary artery disease. Self-reported testing intensities were used to create three indices: a Catheterization Index, an Imaging Exercise Tolerance Test (ETT) Index, and a Nonimaging ETT Index. Using administrative data, age- and gender-adjusted population-based coronary angiography rates were calculated. Physicians were assigned to low (2.9/1,000), average (4.2/1,000), and high (5.8/1,000) coronary angiography rate areas, based on where they practice. Analysis of variance techniques were used to assess the relation of the index scores to the population-based coronary angiography rates and to physician specialties. RESULTS There was a positive relationship between the population-based coronary angiography rates and the self-reported scores of the Catheterization Index (p < .005) and the Imaging ETT Index (p = .01), but none was found for the Nonimaging ETT Index (p = .10). These relationships were evident in subanalyses of cardiologists and internists, but not of family practitioners. CONCLUSIONS Self-reported testing intensity by physicians is related to the population-based rates of coronary angiography. This relationship cuts across specialties, suggesting that there is a “medical signature” for the evaluation of patients with coronary artery disease.

Alternative approaches to ventilator-associated pneumonia prevention.

PubMed

Berra, L; Sampson, J; Fumagalli, J; Panigada, M; Kolobow, T

2011-03-01

Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. Ideally, the elimination of the mechanisms responsible for aspiration would decrease the incidence of VAP. Several preventive measures have been tested in clinical trials with little success.Here we present the results of our efforts to develop novel approaches for the prevention of VAP. Specifically, we found that keeping ventilated patients in a lateral position, which eliminates gravitational forces, is feasible and possibly advantageous. Additionally, several novel medical devices have been recently developed to prevent bacterial biofilm formation from the ETT and breathing tubing. These devices include coated ETTs, mucus shavers and mucus slurpers. Prevention of ETT bacterial colonization showed decreased bacterial colonization of the respiratory circuit and of the lower respiratory tract in laboratory studies and clinical trials. Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.

Electronic topological transitions in Zn under compression

NASA Astrophysics Data System (ADS)

Kechin, Vladimir V.

2001-01-01

The electronic structure of hcp Zn under pressure up to 10 GPa has been calculated self-consistently by means of the scalar relativistic tight-binding linear muffin-tin orbital method. The calculations show that three electronic topological transitions (ETT's) occur in Zn when the c/a axial ratio diminishes under compression. One transition occurs at c/a~=1.82 when the ``needles'' appear around the symmetry point K of the Brillouin zone. The other two transitions occur at c/a~=3, when the ``butterfly'' and ``cigar'' appear simultaneously both around the L point. It has been shown that these ETT's are responsible for a number of anomalies observed in Zn at compression.

The efficacy of elastic therapeutic tape variations on measures of ankle function and performance.

PubMed

Brogden, Christopher Michael; Marrin, Kelly; Page, Richard Michael; Greig, Matt

2018-04-23

To investigate the effects of different variations of elastic therapeutic taping (ETT) on tests used to screen for ankle injury risk and function. Randomized crossover. Laboratory. Twelve professional male soccer players completed three experimental trials: No tape (NT), RockTape™ (RT), and Kinesio™ Tape (KT) applied to the ankle complex. Clinical and functional ankle screening tests were used to assess the effects of ETT on measures of joint position sense, postural stability and ground reaction forces. KT (P = 0.04) and RT (P = 0.01) demonstrated significant improvements in end range joint position sense. When compared to NT, RT significantly (P = 0.02) improved mid-range joint position sense at 15°, and time to complete a drop landing task. No significant differences were observed for measures of postural stability (P ≥ 0.12) nor ground reaction force variables (P ≥ 0.33). Results advocate the use of ETT for proprioceptive and functional tasks when applied to the ankles of healthy male soccer players. However, a greater number of practical and significant differences were observed when RT only was applied, indicating that practitioners may potentially advocate the use of RT for tasks requiring proprioception and functional performance. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

A novel airway device with tactile sensing capabilities for verifying correct endotracheal tube placement.

PubMed

Goethals, Pauwel; Chaobal, Harshu; Reynaerts, Dominiek; Schaner, David

2014-04-01

We present a new device for verifying endotracheal tube (ETT) position that uses specialized sensors intended to distinguish anatomical features of the trachea and esophagus. This device has the potential to increase the safety of resuscitation, surgery, and mechanical ventilation and decrease the morbidity, mortality, and health care costs associated with esophageal intubation and unintended extubation by potentially improving the process and maintenance of endotracheal intubation. The device consists of a tactile sensor connected to the airway occlusion cuff of an ETT. It is intended to detect the presence or absence of tracheal rings immediately upon inflation of the airway occlusion cuff. The initial study detailed here verifies that a prototype device can detect contours similar to tracheal rings in a tracheal model.

Wireless remote monitoring of myocardial ischemia using reconstructed 12-lead ECGs.

PubMed

Vukcevic, Vladan; Panescu, Dorin; Bojovic, Bosko; George, Samuel; Gussak, Ihor; Giga, Vojislav; Stankovic, Ivana

2010-01-01

CardioBip (CB) is a hand-held patient-activated device for recording and wireless transmission of reconstructed 12-lead ECG (12CB) based on patient specific matrices. It has 5 contact points: 3 precordial and 2 on the device top serving as limb leads when touched by index fingers. To determine whether CB could be used to monitor coronary disease (CAD) patients, we compared 12CB to simultaneous 12-lead ECGs (12L) in patients with CAD, pre-and post-exercise treadmill testing (ETT). The study goals were to assess: (1) whether 12CB can accurately reconstruct and wirelessly transmit 12-lead ECGs in CAD patients during ETT recovery; (2) whether 12CB can be used to evaluate ST segment changes in patients with exercise-induced ischemia.

Optimizing Travel Time to Outpatient Interventional Radiology Procedures in a Multi-Site Hospital System Using a Google Maps Application.

PubMed

Mandel, Jacob E; Morel-Ovalle, Louis; Boas, Franz E; Ziv, Etay; Yarmohammadi, Hooman; Deipolyi, Amy; Mohabir, Heeralall R; Erinjeri, Joseph P

2018-02-20

The purpose of this study is to determine whether a custom Google Maps application can optimize site selection when scheduling outpatient interventional radiology (IR) procedures within a multi-site hospital system. The Google Maps for Business Application Programming Interface (API) was used to develop an internal web application that uses real-time traffic data to determine estimated travel time (ETT; minutes) and estimated travel distance (ETD; miles) from a patient's home to each a nearby IR facility in our hospital system. Hypothetical patient home addresses based on the 33 cities comprising our institution's catchment area were used to determine the optimal IR site for hypothetical patients traveling from each city based on real-time traffic conditions. For 10/33 (30%) cities, there was discordance between the optimal IR site based on ETT and the optimal IR site based on ETD at non-rush hour time or rush hour time. By choosing to travel to an IR site based on ETT rather than ETD, patients from discordant cities were predicted to save an average of 7.29 min during non-rush hour (p = 0.03), and 28.80 min during rush hour (p < 0.001). Using a custom Google Maps application to schedule outpatients for IR procedures can effectively reduce patient travel time when more than one location providing IR procedures is available within the same hospital system.

Influence of different interfaces on synchrony during pressure support ventilation in a pediatric setting: a bench study.

PubMed

Conti, Giorgio; Gregoretti, Cesare; Spinazzola, Giorgia; Festa, Olimpia; Ferrone, Giuliano; Cipriani, Flora; Rossi, Marco; Piastra, Marco; Costa, Roberta

2015-04-01

In adults and children, patient-ventilator synchrony is strongly dependent on both the ventilator settings and interface used in applying positive pressure to the airway. The aim of this bench study was to determine whether different interfaces and ventilator settings may influence patient-ventilator interaction in pediatric models of normal and mixed obstructive and restrictive respiratory conditions. A test lung, connected to a pediatric mannequin using different interfaces (endotracheal tube [ETT], face mask, and helmet), was ventilated in pressure support ventilation mode testing 2 ventilator settings (pressurization time [Timepress]50%/cycling-off flow threshold [Trexp]25%, Timepress80%/Trexp60%), randomly applied. The test lung was set to simulate one pediatric patient with a healthy respiratory system and another with a mixed obstructive and restricted respiratory condition, at different breathing frequencies (f) (30, 40, and 50 breaths/min). We measured inspiratory trigger delay, pressurization time, expiratory trigger delay, and time of synchrony. At each breathing frequency, the helmet showed the longest inspiratory trigger delay compared with the ETT and face mask. At f30, the ETT had a reduced Tpress. The helmet had the shortest Tpress in the simulated child with a mixed obstructive and restricted respiratory condition, at f40 during Timepress50%/Trexp25% and at f50 during Timepress80%/Trexp60%. In the simulated child with a normal respiratory condition, the ETT presented the shortest Tpress value at f50 during Timepress80%/Trexp60%. Concerning the expiratory trigger delay, the helmet showed the best interaction at f30, but the worst at f40 and at f50. The helmet showed the shortest time of synchrony during all ventilator settings. The choice of the interface can influence patient-ventilator synchrony in a pediatric model breathing at increased f, thus making it more difficult to set the ventilator, particularly during noninvasive ventilation. The

Aerosol Delivery Using Jet Nebulizer and Vibrating Mesh Nebulizer During High Frequency Oscillatory Ventilation: An In Vitro Comparison.

PubMed

Fang, Tien-Pei; Lin, Hui-Ling; Chiu, Shu-Hua; Wang, Szu-Hui; DiBlasi, Robert M; Tsai, Ying-Huang; Fink, James B

2016-10-01

High frequency oscillatory ventilation (HFOV) is used in critically ill patients with severe hypoxemic respiratory failure. The purpose of this in vitro study was to determine the efficiency of aerosol delivery with different lung parameters during simulated neonatal, pediatric, and adult HFOV. Sensormedics 3100A/B ventilators were used to deliver infant, pediatric, and adult HFOV. Two types of aerosol generators were chosen for testing: 1) a continuous jet nebulizer (JN) with a unit-dose of 5.0 mg/2.5 mL salbutamol sulfate diluted into 4 mL, and 2) a vibrating mesh nebulizer (VMN) with salbutamol sulfate were run to completion of aerosol generation. Both aerosol devices were placed 1) between the ventilator circuit and the endotracheal tube (ETT) (proximal position); and 2) at the inlet of the heated humidifier (distal position) (n = 5). Drug was collected on a bacterial filter placed distal to the ETT, and the drug eluted and analyzed with a UV Spectrophotometer at 276 nm. T- test and ANOVA tests were used for comparison (p < 0.05). The inhaled drug delivered by JN was 0%-0.6% of the nominal dose when placed at distal position, and 0%-3% at proximal position (p < 0.01), while the VMN was 0%-0.5% at distal and 8.6%-22.7% at proximal position (p < 0.01). Aerosol delivery during HFOV was greater with adult settings than pediatric and infant settings with VMN and JN (22.7%, 8.6%, and 17.4% respectively, p < 0.01). When the aerosol delivery device was placed at the distal position, negligible drug mass was observed (<0.5%), regardless of the nebulizer device used. During HFOV, aerosol delivery with the nebulizer placed at proximal was greater than placement distal from the ETT, with VMN delivering more drug than JN. The inhaled drug was delivery correlated positively with ETT size, MAP, and bias flow, and inversely proportional to power settings.

Prognostic Value of Exercise Treadmill Testing in Asymptomatic Chronic Nonischemic Mitral Regurgitation

PubMed Central

Supino, Phyllis G.; Borer, Jeffrey S.; Schuleri, Karlheinz; Gupta, Anuj; Hochreiter, Clare; Kligfield, Paul; Herrold, Edmund McM.; Preibisz, Jacek J.

2007-01-01

In many heart diseases, exercise treadmill testing(ETT) has useful functional correlates and/or prognostic value. However, its predictive value in mitral regurgitation(MR) is undefined. To determine whether ETT descriptors predict death or indications for mitral valve surgery among patients with MR, we prospectively followed, for 7±3 endpoint-free years, a cohort of 38 patients with chronic severe nonischemic MR who underwent modified Bruce ETT; all lacked surgical indications at study entry. Their baseline exercise descriptors also were compared with those from 46 patients with severe MR who, at entry, already had reached surgical indications. Endpoints during follow-up among the cohort included sudden death(n=1), heart failure symptoms(n=2), atrial fibrillation(n=4), LVEF<60%(n=2), LV systolic dimensions(IDs)≥45 mm(n=12) and LVIDs>40mm(n=11), LVEF<60%+LVIDs 45 mm(n=3), and heart failure+LVIDs 45mm+LVEF<60%(n=1). In univariate analysis, exercise duration(p=.004), chronotropic response(p=.007), percent predicted peak heart rate(p=.01) and heart rate recovery(p<.02) predicted events; in multivariate analysis, only exercise duration was predictive(p<.02). Average annual event risk was 5-fold lower(4.62%) with exercise duration≥15 minutes vs. <15 minutes(average annual risk=23.48%, p=.004). Relative risks among patients with and without exercise-inducible ST segment depression were comparable(≤1.3[NS]) whether defined at entry and/or during follow-up. Exercise duration, but not prevalence of exercise-inducible ST segment depression, was lower(p<.001) among patients with surgical indications at entry vs. initially endpoint-free patients. In conclusion, among asymptomatic patients with chronic severe nonischemic MR and no objective criteria for operation, progression to surgical indications generally is rapid. However, those with excellent exercise tolerance have a relatively benign course. Exercise-inducible ST segment depression has no prognostic value in this

Intraoperative Endotracheal Cuff Pressure Study: How Education and Availability of Manometers Help Guide Safer Pressures.

PubMed

Stevens, Gregory J; Warfel, Joel W; Aden, James K; Blackwell, Scott D

2018-02-13

Endotracheal intubation is a medical procedure that is often indicated in both the perioperative and critical care environments. Cuffed endotracheal tubes (ETT) allow for safer and more efficient delivery of positive pressure ventilation, as well as create a barrier to reduce the risk of micro-aspiration and anesthetic pollution in the operating room environment. Over-inflation of the endotracheal cuff can lead to serious and harmful sequelae. This study aimed to assess if departmental education paired with ready access to a manometer to assess cuff pressure would result in an improvement in the proportion of ETT cuff pressures in the goal range. A quality improvement study was conducted at the San Antonio Military Medical Center (SAMMC; Department of Defense hospital in San Antonio, TX). The initiative was divided into three key periods: pre-implementation, implementation, and post-implementation. During the pre-implementation period, ETT cuff pressures were obtained to assess the baseline state of ETT cuff pressures for patients in the operating room; the proportion of in-range (20-30 cmH2O) pressures was calculated. During the implementation phase, operating rooms were equipped with manometers and anesthesia departmental education was performed regarding the use of the manometers. Three months later, post-implementation cuff pressures were measured in the OR, and the proportion of in-range pressures was again calculated. The pre-implementation data showed an average cuff pressure of 48.92 cmH2O and a median of 38.5 cmH2O. Of the 100 pre-implementation pressures, 20 were in the goal range. Post-implementation data had an average cuff pressure of 41.96 cmH2O and a median of 30 cmH2O. A chi-squared test of pressures in the safe range from the pre-implementation versus post-implementation values yielded a highly significant p-value of 0.0003. The data from this study clearly demonstrated a statistically significant improvement in the proportion of in-range cuff

Lifshitz topological transitions, induced by doping and deformation in single-crystal bismuth wires

NASA Astrophysics Data System (ADS)

Nikolaeva, A. A.; Konopko, L. A.; Huber, T. E.; Kobylianskaya, A. K.; Para, Gh. I.

2017-02-01

The features associated with the manifestation of Lifshitz electron topological transitions (ETT) in glass-insulated bismuth wires upon qualitative changes to the topology of the Fermi surface are investigated. The variation of the energy spectrum parameters was implemented by doping Bi with an acceptor impurity Sn and using elastic strain of up to 2%, relative to the elongation in the weakly-doped p-type Bi wires. Pure and doped glass-insulated single-crystal bismuth with different diameters and (1011) orientations along the axis were prepared by the Ulitovsky liquid phase casting method. For the first time, ETT-induced anomalies are observed along the temperature dependences of the thermoemf α(T) as triple-changes of the α sign (given heavy doping of Bi wires with an acceptor impurity Sn). The concentration and energy position of the Σ-band given a high degree of bismuth doping with Sn was assessed using the Shubnikov-de Haas effect oscillations, which were detected both from L-electrons and from T-holes in magnetic fields of up to 14 T. It is shown that the Lifshitz electron-topological transitions with elastic deformation of weakly-doped p-type Bi wires are accompanied by anomalies along the deformation dependences of the thermoemf at low temperatures. The effect is interpreted in terms of the formation of a selective scattering channel of L-carriers into the T-band with a high density of states, which is in good agreement with existing theoretical ETT models.

Randomized clinical study comparing metallic and glass fiber post in restoration of endodontically treated teeth.

PubMed

Gbadebo, Olaide S; Ajayi, Deborah M; Oyekunle, Oyekunle O Dosumu; Shaba, Peter O

2014-01-01

Post-retained crowns are indicated for endodontically treated teeth (ETT) with severely damaged coronal tissue. Metallic custom and prefabricated posts have been used over the years, however, due to unacceptable color, extreme rigidity and corrosion, fiber posts, which are flexible, aesthetically pleasing and have modulus of elasticity comparable with dentin were introduced. To compare clinical performance of metallic and glass fiber posts in restoration of ETT. 40 ETT requiring post retained restorations were included. These teeth were randomly allocated into 2 groups. Twenty teeth were restored using a glass fiber-reinforced post (FRP) and 20 others received stainless steel parapost (PP), each in combination with composite core buildups. Patients were observed at 1 and 6 months after post placement and cementation of porcelain fused to metal (PFM) crown. Marginal gap consideration, post retention, post fracture, root fracture, crown fracture, crown decementation and loss of restoration were part of the data recorded. All teeth were assessed clinically and radiographically. Fisher's exact test was used for categorical values while log-rank test was used for descriptive statistical analysis. One tooth in the PP group failed, secondary to decementation of the PFM crown giving a 2.5% overall failure while none in the FRP group failed. The survival rate of FRP was thus 100% while it was 97.5% in the PP group. This however was not statistically significant (log-rank test, P = 0.32). Glass FRPs performed better than the metallic post based on short-term clinical performance.

Effect of ferrule on the fracture resistance of mandibular premolars with prefabricated posts and cores

PubMed Central

2017-01-01

PURPOSE This study evaluated fracture resistance with regard to ferrule lengths and post reinforcement on endodontically treated mandibular premolars incorporating a prefabricated post and resin core. MATERIALS AND METHODS One hundred extracted mandibular premolars were randomly divided into 5 groups (n=20): intact teeth (NR); endodontically treated teeth (ETT) without post (NP); ETT restored with a prefabricated post with ferrule lengths of either 0 mm (F0), 1 mm (F1), or 2 mm (F2). Prepared teeth were restored with metal crowns. A thermal cycling test was performed for 1,000 cycles. Loading was applied at an angle of 135 degrees to the axis of the tooth using a universal testing machine with a crosshead speed of 2.54 mm/min. Fracture loads were analyzed by one-way ANOVA and Tukey HSD test using a statistical program (α=.05). RESULTS There were statistical differences in fracture loads among groups (P<.001). The fracture load of F2 (237.7 ± 83.4) was significantly higher than those of NP (155.6 ± 74.3 N), F0 (98.8 ± 43.3 N), and F1 (152.8 ± 78.5 N) (P=.011, P<.001, and P=.008, respectively). CONCLUSION Fracture resistance of ETT depends on the length of the ferrule, as shown by the significantly increased fracture resistance in the 2 mm ferrule group (F2) compared to the groups with shorter ferrule lengths (F0, F1) and without post (NP). PMID:29142639

Measures to prevent nosocomial infections during mechanical ventilation.

PubMed

Ramirez, Paula; Bassi, Gianluigi L; Torres, Antonio

2012-02-01

Endotracheal intubation and mechanical ventilation are lifesaving measures in critically ill patients. However, these interventions increase the risk of respiratory infections, particularly ventilator-associated pneumonia (VAP). VAP constitutes a serious burden for the healthcare system and worsens the patient's outcomes; thus, several preventive strategies have been implemented. This communication reviews the current knowledge on VAP pathogenesis and the latest preventive measures. Pathogen-laden oropharyngeal secretions leak across the endotracheal tube (ETT) cuff; thus, a continuous control of the internal cuff pressure and cuffs made of polyurethane improve sealing effectiveness and associated risks of infections. Subglottic secretions aspiration prevents VAP, and the latest evidence demonstrated a reduction in the incidence of late-onset VAP. The role of ETT biofilm in the pathogenesis of VAP is not fully elucidated. Nevertheless, antimicrobial-coated ETTs have showed beneficial effects in VAP incidence. Recent experimental evidence has challenged the benefits associated with the use of the semirecumbent position; yet, these findings need to be corroborated in clinical trials. The latest results from trials testing the effects of selective digestive decontamination (SDD) showed beneficial effects on patients' outcomes, but concerns remain regarding the emergence of bacterial resistance, specifically upon digestive tract re-colonization. The use of oropharyngeal decontamination with antiseptics and the use of probiotics are potential alternatives to SDD. There is consistent evidence that strategies affecting the primary mechanisms of VAP pathogenesis efficiently reduce the occurrence of the disease. Preventive measures should be implemented grouped into bundles to improve overall efficacy.

Cuffed endotracheal tubes in children: the effect of the size of the cuffed endotracheal tube on intracuff pressure.

PubMed

Krishna, Senthil G; Hakim, Mumin; Sebastian, Roby; Dellinger, Heather L; Tumin, Dmitry; Tobias, Joseph D

2017-05-01

In children, the size of the cuffed endotracheal tube is based on various age-based formulas. However, such formulas may over or underestimate the size of the cuffed endotracheal tube. There are no data on the impact of different-sized cuffed endotracheal tubes (ETT) on the intracuff pressure in children. The current study measures intracuff pressure with different-sized cuffed ETT. The study was conducted in an in vitro and in vivo phase. For the in vitro phase, 10 cuffed ETT of size 4.0, 4.5, and 5 mm internal diameter (ID) each were randomly placed inside a 1.0 cm ID plastic tube (mimicking the trachea), which was in turn connected to a 1 l test lung. After inflation of the cuff using the air leak test at a continuous positive airway pressure of 20 cmH 2 O, the intracuff pressure was measured. The in vivo phase was conducted in 100 children (4-8 years) and were randomly divided into two groups to receive either a cuffed endotracheal tube based on the Khine formula (Group R) or a cuffed endotracheal tube that was a half-size (0.5 mm ID) smaller (Group S). Following the inflation of the cuff to seal the trachea, the intracuff pressure was measured. In the in vitro phase, the intracuff pressure was 45 ± 6, 23 ± 1, and 14 ± 6 cmH 2 O with size 4.0, 4.5, and 5 mm ID cuffed ETT, respectively (F-test P < 0.001 for difference among three groups). In the in vivo phase, the mean intracuff pressure in Group R was 25 ± 19 cmH 2 O vs 37 ± 35 cmH 2 O in Group S (95% CI of difference: 1, 23; P = 0.039). If the cuffed endotracheal tube is too small, the trachea can still be sealed by inflating the cuff with additional air. However, this transforms the cuff from the intended high-volume, low-pressure cuff to an undesirable high-volume, high-pressure cuff. © 2017 John Wiley & Sons Ltd.

Ventilator-associated pneumonia: current status and future recommendations.

PubMed

Efrati, Shai; Deutsch, Israel; Antonelli, Massimo; Hockey, Peter M; Rozenblum, Ronen; Gurman, Gabriel M

2010-04-01

Ventilator-associated pneumonia (VAP) is a common hazardous complication in ICU patients. The aim of the current review is to give an update on the current status and future recommendations for VAP prevention. This article gives an updated review of the current literature on VAP. The first part briefly reviews pathogenesis and epidemiology while the second includes an in-depth review of evidence-based practice guidelines (EBPG) and new technologies developed for prevention of VAP. VAP remains a frequent and costly complication of critical illness with a pooled relative risk of 9-27% and mortality of 25-50%. Strikingly, VAP adds an estimated cost of more than $40,000 to a typical hospital admission. An important aetiological mechanism of VAP is gross or micro-aspiration of oropharyngeal organisms around the cuff of the endotracheal tube (ETT) into the distal bronchi. Prevention of VAP is preferable. Preventative measures can be divided into two main groups: the implemen- tation of EBPGs and use of device-based technologies. EBPGs have been authored jointly by the American Thoracic Society and the Infectious Diseases Society of America. The Canadian Critical Care Trials group also published VAP Guidelines in 2008. Their recommendations are detailed in this review. The current device-based technologies include drainage of subglottic secretions, silver coated ETTs aiming to influence the internal bio-layer of the ETT, better sealing of the lower airways with ultrathin cuffs and loops for optimal cuff pressure control. EBPG consensus includes: elevation of the head of the bed, use of daily "sedation vacations" and decontamination of the oropharynx. Technological solutions should aim to use the most comprehensive combination of subglottic suction of secretions, optimization of ETT cuff pressure and ultrathin cuffs. VAP is a type of hospital-acquired pneumonia that develops more than 48 h after endotracheal intubation. Its incidence is estimated to be 9-27%, with a

Performance of the PneuX System: A Bench Study Comparison With 4 Other Endotracheal Tube Cuffs.

PubMed

Chenelle, Christopher T; Itagaki, Taiga; Fisher, Daniel F; Berra, Lorenzo; Kacmarek, Robert M

2017-01-01

Cuff design affects microaspiration, a risk factor for pneumonia. We questioned whether the PneuX low-volume fold-free cuff design would prevent cuff leakage and maintain the same tracheal wall pressure as high-volume, low-pressure (HVLP) cuffs. We evaluated 4 HVLP-cuffed endotracheal tubes (ETTs), Hi-Lo (polyvinyl chloride [PVC]), Microcuff (polyurethane [PU]), SealGuard (PU + tapered), and TaperGuard (PVC + tapered), and the PneuX with its dedicated tracheal seal monitor. In Part 1, we determined tracheal wall pressure using each cuff's capacity to support water columns across recommended intracuff pressures. In Part 2, we evaluated the tracheal seal monitor function at recommended settings. In Part 3, we compared leakage volumes of all ETTs during 30 min of simulated mechanical ventilation or during 8 h if no leak occurred. Parts 1 and 3 were performed with/without lubrication and PEEP. In Part 1, PneuX cuffs exerted an average tracheal wall pressure of 27.4 ± 2.4 cm H 2 O at the recommended intracuff pressure of approximately 80 cm H 2 O. Tracheal wall pressure did not differ among HVLP cuffs (19.6 ± 1.4 to 29.5 ± 1.4 cm H 2 O). In Part 2, preinflation intracuff pressure affected the time to obtain tracheal seal monitor pressure attainment (P < .01). The tracheal seal monitor generated average calculated tracheal wall pressure of 33.4 ± 1.2 cm H 2 O. In Part 3, PneuX ETT showed no leak across 8 h for all trials. Overall, leakage volume was lower with PU (P < .01) and PneuX (P < .01) than with PVC cuffs, regardless of shape, and lower with lubrication and/or PEEP (all P < .01). In each HVLP cuff, lubrication alone eliminated leak at an intracuff pressure of ≤30 cm H 2 O. The PneuX cuff generally exerted acceptable tracheal wall pressure, but the tracheal wall pressure monitor allowed pressures exceeding 30 cm H 2 O in some trials and was the only ETT to prevent leak in all tests. For HVLP cuffs, leak was reduced by PU and PEEP and eliminated by lubrication

Shedding light on the role of AT-hook/PPC domain protein in Arabidopsis thaliana

PubMed Central

Ng, Kian-Hong

2010-01-01

Flower reproductive development is a complex process involving well-coordinated control of transcriptional regulation cascades. AGAMOUS (AG) plays an instrumental role in the specification and differentiation of reproductive organs in Arabidopsis thaliana. We recently characterized a downstream target gene of AG, GIANT KILLER (GIK), which encodes for an AT-hook/plants and prokaryotes conserved (PPC) domain protein. We found that overexpression of GIK leads to severe reproductive defects and downregulation of genes involved in patterning and differentiation of reproductive floral organs. We showed that GIK is a matrix protein, and GIK-mediated gene regulation requires binding of GIK to matrix associated region (MAR) of the target genes. We further showed that GIK-mediated negative regulation of one of the target genes, ETTIN (ETT), is associated with changes of chromatin histone modification at ETT promoter, suggesting that GIK acts as a gene expression modulator through chromatin organization. PMID:20173412

A link among DNA replication, recombination, and gene expression revealed by genetic and genomic analysis of TEBICHI gene of Arabidopsis thaliana.

PubMed

Inagaki, Soichi; Nakamura, Kenzo; Morikami, Atsushi

2009-08-01

Spatio-temporal regulation of gene expression during development depends on many factors. Mutations in Arabidopsis thaliana TEBICHI (TEB) gene encoding putative helicase and DNA polymerase domains-containing protein result in defects in meristem maintenance and correct organ formation, as well as constitutive DNA damage response and a defect in cell cycle progression; but the molecular link between these phenotypes of teb mutants is unknown. Here, we show that mutations in the DNA replication checkpoint pathway gene, ATR, but not in ATM gene, enhance developmental phenotypes of teb mutants, although atr suppresses cell cycle defect of teb mutants. Developmental phenotypes of teb mutants are also enhanced by mutations in RAD51D and XRCC2 gene, which are involved in homologous recombination. teb and teb atr double mutants exhibit defects in adaxial-abaxial polarity of leaves, which is caused in part by the upregulation of ETTIN (ETT)/AUXIN RESPONSIVE FACTOR 3 (ARF3) and ARF4 genes. The Helitron transposon in the upstream of ETT/ARF3 gene is likely to be involved in the upregulation of ETT/ARF3 in teb. Microarray analysis indicated that teb and teb atr causes preferential upregulation of genes nearby the Helitron transposons. Furthermore, interestingly, duplicated genes, especially tandemly arrayed homologous genes, are highly upregulated in teb or teb atr. We conclude that TEB is required for normal progression of DNA replication and for correct expression of genes during development. Interplay between these two functions and possible mechanism leading to altered expression of specific genes will be discussed.

The WOMEN study: what is the optimal method for ischemia evaluation in women? A multi-center, prospective, randomized study to establish the optimal method for detection of coronary artery disease (CAD) risk in women at an intermediate-high pretest likelihood of CAD: study design.

PubMed

Mieres, Jennifer H; Shaw, Leslee J; Hendel, Robert C; Heller, Gary V

2009-01-01

Coronary artery disease remains the leading cause of morbidity and mortality in women. The optimal non-invasive test for evaluation of ischemic heart disease in women is unknown. Although current guidelines support the choice of the exercise tolerance test (ETT) as a first line test for women with a normal baseline ECG and adequate exercise capabilities, supportive data for this recommendation are controversial. The what is the optimal method for ischemia evaluation in women? (WOMEN) study was designed to determine the optimal non-invasive strategy for CAD risk detection of intermediate and high risk women presenting with chest pain or equivalent symptoms suggestive of ischemic heart disease. The study will prospectively compare the 2-year event rates in women capable of performing exercise treadmill testing or Tc-99 m tetrofosmin SPECT myocardial perfusion imaging (MPI). The study will enroll women presenting for the evaluation of chest pain or anginal equivalent symptoms who are capable of performing >5 METs of exercise while at intermediate-high pretest risk for ischemic heart disease who will be randomized to either ETT testing alone or with Tc-99 m tetrofosmin SPECT MPI. The null hypothesis for this project is that the exercise ECG has the same negative predictive value for risk detection as gated myocardial perfusion SPECT in women. The primary aim is to compare 2-year cardiac event rates in women randomized to SPECT MPI to those randomized to ETT. The WOMEN study seeks to provide objective information for guidelines for the evaluation of symptomatic women with an intermediate-high likelihood for CAD.

Do physical examination and CT-scan measures of femoral neck anteversion and tibial torsion relate to each other?

PubMed

Sangeux, Morgan; Mahy, Jessica; Graham, H Kerr

2014-01-01

Informed clinical decision making for femoral and/or tibial de-rotation osteotomies requires accurate measurement of patient function through gait analysis and anatomy through physical examination of bony torsions. Validity of gait analysis has been extensively studied; however, controversy remains regarding the accuracy of physical examination measurements of femoral and tibial torsion. Comparison between CT-scans and physical examination measurements of femoral neck anteversion (FNA) and external tibial torsion (ETT) were retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a tertiary hospital for instrumented gait analysis between 2007 and 2010. The physical examination methods studied for femoral neck anteversion were the trochanteric prominence angle test (TPAT) and the maximum hip rotation arc midpoint (Arc midpoint) and for external tibial torsion the transmalleolar axis (TMA). Results showed that all physical examination measurements statistically differed to the CT-scans (bias(standard deviation): -2(14) for TPAT, -10(12) for Arc midpoint and -16(9) for TMA). Bland and Altman plots showed that method disagreements increased with increasing bony torsions in all cases but notably for TPAT. Regression analysis showed that only TMA and CT-scan measurement of external tibial torsion demonstrated good (R(2)=57%) correlation. Correlations for both TPAT (R(2)=14%) and Arc midpoint (R(2)=39%) with CT-scan measurements of FNA were limited. We conclude that physical examination should be considered as screening techniques rather than definitive measurement methods for FNA and ETT. Further research is required to develop more accurate measurement methods to accompany instrumented gait analysis. Copyright © 2013. Published by Elsevier B.V.

Automated cuff pressure modulation: a novel device to reduce endotracheal tube injury.

PubMed

Chadha, Neil K; Gordin, Arie; Luginbuehl, Igor; Patterson, Greg; Campisi, Paolo; Taylor, Glenn; Forte, Vito

2011-01-01

To assess whether dynamically modulating endotracheal tube (ETT) cuff pressure, by decreasing it during each ventilatory cycle instead of maintaining a constant level, would reduce the extent of intubation-related laryngotracheal injury. Single-blind, randomized controlled animal study using a previously validated live porcine model of accelerated intubation-related tracheal injury. Animal research facility. Ten piglets (weight, 16-20 kg each) were anesthetized and underwent intubation using a cuffed ETT. The animals were randomized into the following 2 groups: 5 pigs had a novel device to modulate their cuff pressure from 25 cm H₂O during inspiration to 7 cm H₂O during expiration, and 5 pigs had a constant cuff pressure of 25 cm H₂O. Both groups underwent ventilation under hypoxic conditions for 4 hours. Laryngotracheal mucosal injury after blinded histopathological assessment. The modulated-pressure group showed significantly less overall laryngotracheal damage than the constant-pressure group (mean grades, 1.2 vs 2.1; P < .001). Subglottic damage and tracheal damage were significantly less severe in the modulated-pressure group (mean grades, 1.0 vs 2.2; P < .001, and 1.9 vs 3.2; P < .001, respectively). There was no significant difference in glottic or supraglottic damage between the groups (P = .06 and .27, respectively). This novel device reduces the risk of subglottic and tracheal injury by modulating ETT cuff pressure in synchronization with the ventilatory cycle. This finding could have far-reaching implications for reducing the risk of airway injury in patients undergoing long-term intubation. Further clinical study of this device is warranted.

Pilot study of dornase alfa (Pulmozyme) therapy for acquired ventilator-associated infection in preterm infants.

PubMed

Scala, Melissa; Hoy, Deborah; Bautista, Maria; Palafoutas, Judith Jones; Abubakar, Kabir

2017-06-01

Evaluate the feasibility, safety, and efficacy of adjunctive treatment with dornase alfa in preterm patients with ventilator-associated pulmonary infection (VAPI) compared to standard care. We hypothesize that therapy with dornase alfa will be safe and well tolerated in the preterm population with no worsening of symptoms, oxygen requirement, or need for respiratory support. Prospective, randomized, blinded, pilot study comparing adjunctive treatment with dornase alfa to sham therapy. In addition to standard care, infants were randomized to receive dornase alfa 2.5 mg nebulized via endotracheal tube (ETT) every 12 hr for 7 days or sham therapy. ETT secretion gram stain and culture and chest X-ray (CXR) findings were evaluated. Respiratory support data were downloaded from the ventilator. Fourteen infants developed VAPI between 2012 and 2014; 11 enrolled in the study. Six received dornase alfa and five received sham therapy. Average gestational age at birth was 25 weeks and age at study entry was 31 days. There were no differences in demographics, ETT white blood cell count (WBC), CXR, or mean airway pressure (MAP) between the two groups. There was a trend towards decreased oxygen requirement (FiO2) in the treatment group that did not reach statistical significance. No side effects were observed in the treatment group. Treatment with dornase alfa is safe and treated infants had some improvement in FiO 2 requirement but no improvement in MAP. A larger randomized trial is needed to evaluate the efficacy of this therapy. Pediatr Pulmonol. 2017; 52:787-791. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

78 FR 30243 - Airworthiness Directives; Eclipse Aerospace, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... Airworthiness Directives; Eclipse Aerospace, Inc. Airplanes AGENCY: Federal Aviation Administration (FAA), DOT... (AD) for all Eclipse Aerospace, Inc. Model EA500 airplanes equipped with Avio, Avio with ETT, or Avio... identified in this proposed AD, contact Eclipse Aerospace, Inc. 26 East Palatine Road, Wheeling, Illinois...

[Study of oculomotor disorders in spinocerebellar ataxia genotype].

PubMed

Oda, Rie; Takemoto, Tsuyoshi; Kawai, Motoharu; Yamashita, Hiroshi

2006-01-01

Spinocerebellar degeneration (SCD) exhibits a variety of spinal and cerebullar symptoms and progress. The recent advent of molecular genetics has revealed triplet repeat mutation in the gene of SCD patients. Due to the underlying genetic defects, hereditary SCD is referred to as different spinocerebellar ataxia (SCA) genotypes. We conducted vestibular functional tests in 33 SCD patients, including 3 with SCA3 and 2 with SCA6. We compared the degree of lower extremity ataxia with the degree of oculomotor disorder by using eye tracking tests (ETT) and optokinetic pattern tests (OKP). Both SCA3 and SCA6 show high ETT score and low mean slowest phase velocity in OKP. This means that SCA3 and SCA6 tend to have oculomotor disorder precedes extremity ataxia. Oculomotor examination should thus prove to be a useful, senstive indicator in screening SCD patients from early disease onset, and in evaluating the disease progression and the effectiveness of treatment.

The LoTrach system: its role in the prevention of ventilator-associated pneumonia.

PubMed

Fletcher, Andrew J W; Ruffell, Alison J; Young, Peter J

2008-01-01

To discuss the development of the LoTrach system in light of current evidence around the prevention of ventilator-associated pneumonia (VAP) and its practical application in the intensive care setting. VAP causes substantial morbidity and mortality in ventilated patients in the Intensive Care Unit (ICU), increases length of stay in ICU and is extremely costly. Strategies are needed to reduce the risk of VAP. We examine the need for an endotracheal tube (ETT) specifically designed for the critically-ill patient, the development of the LoTrach system from conception to production, and the role of the various components of the system in preventing VAP. Early issues in implementing this revolutionary equipment into ICU are explored and three case studies highlight advantages of this system. The LoTrach system has been designed to facilitate the provision of a number of evidence-based interventions that have been shown to reduce VAP. Pulmonary aspiration is ubiquitous with conventional cuffs but prevented by the cuff of the LoTrach system when held at a constant and safe pressure against the tracheal wall with a cuff pressure controller. Other aspects incorporated in the ETT are aimed at clearing the secretions from the subglottic space, preventing tube occlusion and accidental extubation, and avoiding damage to the airway. In this way the LoTrach system employs a multifactorial approach to the prevention of VAP and the cost savings from LoTrach rather than a standard ETT will be considerable because of an average 3 day reduction in ICU length of stay related to this. It thus has the potential to be a very useful tool in the ICU setting in the prevention of VAP.

Prehospital cardiac arrest survival and neurologic recovery.

PubMed

Hillis, M; Sinclair, D; Butler, G; Cain, E

1993-01-01

Many studies of prehospital defibrillation have been conducted but the effects of airway intervention are unknown and neurologic follow-up has been incomplete. A non-randomized cohort prospective study was conducted to determine the effectiveness of defibrillation in prehospital cardiac arrest. Two ambulance companies in the study area developed a defibrillation protocol and they formed the experimental group. A subgroup of these patients received airway management with an esophageal obturator airway (EOA) or endotracheal intubation (ETT). The control group was composed of patients who suffered a prehospital cardiac arrest and did not receive prehospital defibrillation. All survivors were assessed for residual deficits using the Sickness Impact Profile (SIP) and the Dementia Rating Scale (DRS). A total of 221 patients were studied over a 32-month period. Both the experimental group (N = 161) and the control group (N = 60) were comparable with respect to age, sex distribution, and ambulance response time. Survival to hospital discharge was 2/60 (3.3%) in the control group and 12/161 (6.3%) in the experimental group. This difference is not statistically significant. Survival in the experimental group by airway management technique was basic airway support (3/76 3.9%), EOA (3/67 4.5%), and ETT (6/48 12.5%). The improved effect on survival by ETT management was statistically significant. Survivors had minor differences in memory, work, and recreation as compared to ischemic heart disease patients as measured by the SIP and DRS. No effect of defibrillation was found on survival to hospital discharge. However, endotracheal intubation improved survival in defibrillated patients. Survivors had a good functional outcome.

Independent Review of Elemental Phosphorus Remediation at the Eastern Michaud Flats FMC Operable Unit near Pocatello, Idaho

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

Martino, L. E.; Jerden, J. J.; Kimmell, T. A.

2016-01-01

If, despite risks to workers and these potential impacts, stakeholders decide that P4 wastes need to be excavated and treated, the Review Team determined that a number of the ETTs examined warrant further consideration for the treatment of P4 waste that has been characterized (for example, P4 waste present in the historical ponds). Nevertheless, concerns about the health and safety of site investigation workers using then-available investigation approaches prevented the collection of subsurface samples containing P4 from large areas of the site (e.g., the railroad swale, the vadose zone beneath the Furnace Building, and the abandoned railcars), As a result,more » the contaminant CSM in those particular areas was not refined enough to allow the Review Team to draw conclusions about using some of the ETTs to treat P4 waste in those areas. The readiness of an ETT for implementation varies depending on many factors, including stakeholder input, permitting, and remedial action construction requirements. Technologies that could be ready for use in the near term (within 1 year) include the following: mechanical excavation, containment technologies, off-site incineration, and drying and mechanical mixing under a tent structure. Technologies that could be ready for use in the mid-term (1 to 2 years) include cutter suction dredging, thermal-hydraulic dredging, and underground pipeline cleaning technologies. Technologies requiring a longer lead time (2 to 5 years) include on-site incineration, a land disposal restriction waste treatment system, an Albright & Wilson batch mud still, post-treatment on-site disposal, and post-treatment off-site disposal.« less

Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease.

PubMed

Pletscher, Mark; Walker, Simon; Moschetti, Karine; Pinget, Christophe; Wasserfallen, Jean-Blaise; Greenwood, John P; Schwitter, Juerg; Girardin, François R

2016-07-01

The aim of this study was to assess the cost-effectiveness of eight common diagnostic work-up strategies for coronary heart disease (CHD) in patients with stable angina symptoms in Switzerland. A decision analytical model was used to perform a cost-effectiveness comparison of eight common multitest strategies to diagnose CHD using combinations of four diagnostic techniques: exercise treadmill test (ETT), single-photon emission computed tomography (SPECT), cardiac magnetic resonance imaging (CMR), and coronary angiography (CA). We used a Markov state transition model to extrapolate the results over a life-time horizon, from a third-party payer perspective. We used a CHD prevalence rate of 39% in patients and a base-case scenario with 60-year-old male patients with intermediate symptom severity Canadian Cardiovascular Society grading of angina pectoris 2 and at least one cardiovascular (CV) risk factor but without a history of myocardial infarction and without need for revascularization. Among the eight work-up strategies, one strategy was dominant, i.e. least costly and most effective: ETT followed by CMR if the ETT result was inconclusive and then CA if the CMR result was positive or inconclusive. The CMR features a favourable balance between false-negative diagnoses, associated with an elevated risk of CV events, and false-positive diagnoses, leading to unnecessary CA and related mortality. Key parameters guiding the diagnostic strategy are the prevalence of CHD in patients with angina symptoms and the diagnostic costs of CA and CMR. Cardiac magnetic resonance imaging appears to be a cost-effective work-up strategy compared with other regimens using SPECT or direct CA. Cardiac magnetic resonance imaging should be more widely recommended as a diagnostic procedure for patients with suspected angina symptoms.

Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia.

PubMed

Toman, Huseyin; Erbas, Mesut; Sahin, Hasan; Kiraz, Hasan Ali; Uzun, Metehan; Ovali, Mehmet Akif

2015-12-01

In this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30th minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5th minute mean arterial pressure values (p < 0.05). It was observed that QTc intervals at the 1st and 5th minute in the ET group significantly increased when compared with the other groups (p < 0.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (p < 0.05). It was also observed that QTc interval of LMA Group at the 5th minute after intubation significantly increased when compared with V-gel group (p < 0.05). It was observed that HR values of ETT group at the 1st, 5th and 15th minutes after intubation increased with regards to PLA and V-gel groups (p < 0.05). It was determined that the 30th minute hearth rate of ETT group was higher when compared to V-gel group (p < 0.05). In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.

The incidence and relevance of site-reported vs. patient-reported angina: insights from the ABSORB II randomized trial comparing Absorb everolimus-eluting bioresorbable scaffold with XIENCE everolimus-eluting metallic stent.

PubMed

Grundeken, Maik J; White, Roseann M; Hernandez, John B; Dudek, Dariusz; Cequier, Angel; Haude, Michael; van Boven, Adrianus J; Piek, Jan J; Helqvist, Steffen; Sabate, Manel; Baumbach, Andreas; Suwannasom, Pannipa; Ishibashi, Yuki; Staehr, Peter; Veldhof, Susan; Cheong, Wai-Fung; de Winter, Robbert J; Garcia-Garcia, Hector M; Wykrzykowska, Joanna J; Onuma, Yoshinobu; Serruys, Patrick W; Chevalier, Bernard

2016-04-01

In the ABSORB II trial, comparing Absorb™ bioresorbable vascular scaffold with metallic XIENCE™ everolimus-eluting stent (EES), a difference was found in site-reported new or worsening angina using adverse event (AE) reporting. However, the clinical relevance of this site-reported angina is unclear. The aim of the present study was therefore to investigate the clinical relevance of site-reported angina by evaluating its relation with cardiac endpoints, cardiovascular resource utilization (including diagnostics and treatment), positive exercise stress tolerance tests (ETTs), and Seattle Angina Questionnaire (SAQ). Site-reported new or worsening angina was captured on cardiac AE forms. There was a wide variation in the total number of days with site-reported angina (overall interquartile range 35-279 days). Patients with site-reported angina showed higher rates of cardiovascular events [including the patient-oriented composite endpoint of all deaths, all myocardial infarctions (MI), or all revascularizations (21.1 vs. 4.2%, P < 0.0001), all MIs (2.3 vs. 0%, P = 0.03), and all revascularizations (21.1 vs. 0.7%, P < 0.0001)], cardiovascular resource utilization (including stress tests, anti-anginal medication, diagnostic angiographies, and hospitalization), and positive ETTs (51.9 vs. 14.9%, P < 0.001), compared with those without site-reported angina. Furthermore, an event-based analysis of the SAQ showed that patients with ongoing angina within the recall period of 4 weeks prior to the SAQ assessment have clinically and statistically significant decrements of >14 points in SAQ scores compared with those with no reported angina. We showed that the site-reported angina through AE reporting may be clinically relevant because of their relation with cardiovascular events (mostly repeat revascularizations), cardiovascular resource utilization, ETT, and SAQ. https://clinicaltrials.gov/ct2/show/NCT01425281; Unique identifier: NCT01425281.

Comparison between Two Endotracheal Tube Cuff Inflation Methods; Just-Seal Vs. Stethoscope-Guided.

PubMed

Borhazowal, Rishiraj; Harde, Minal; Bhadade, Rakesh; Dave, Sona; Aswar, Swapnil Ganeshrao

2017-06-01

The Endotracheal Tube (ETT) cuff performs a critical function of sealing the airway during positive pressure ventilation. There is a narrow range of cuff pressure required to maintain a functionally safe seal without exceeding capillary blood pressure. We aimed to compare Just-Seal (JS) and Stethoscope-Guided (SG) method of ETT cuff inflation with respect to the volume of air required to inflate the cuff, the manometric cuff pressure achieved and also to assess for the occurrence of postoperative sore throat after extubation in both the groups. It was a prospective observational study done in a Tertiary Teaching Public Hospital over a period of 1½ years on 100 patients with 50 each in two groups; JS or SG method of cuff inflation. SPSS Version 17 was used for data analysis. Statistically significant difference (p-value of less than 0.05) was noted between the two methods based on the volume of air injected into the cuff {the mean volume injected in JS was 6.79 ml and in the SG was 4.95 ml with p=5.71E-16 (< 0.05)} and cuff pressure achieved {mean cuff pressure achieved was 38.80 cm H 2 O in the JS and 29.64 cm H 2 O in SG with p=2.29E-14 (< 0.05)}. The incidence of post extubation sore throat was 54% (27 in 50) in the JS group and only 12% (6 in 50) in the SG; p= 0.00000797. ETT cuff inflation guided by a stethoscope is an effective technique for ensuring appropriate cuff pressures thus accomplishing the objective of providing safe and superior quality care of the patient both during and after anaesthesia and reducing the likelihood of even minimal risk complications that may still have legal implications.

Correlation of rolling condition, microstructure, and low-temperature toughness of X70 pipeline steels

NASA Astrophysics Data System (ADS)

Hwang, Byoungchul; Kim, Young Min; Lee, Sunghak; Kim, Nack J.; Yoo, Jang Yong

2005-07-01

Correlation of rolling conditions, microstructure, and low-temperature toughness of high-toughness X70 pipeline steels was investigated in this study. Twelve kinds of steel specimens were fabricated by vacuum-induction melting and hot rolling, and their microstructures were varied by rolling conditions. Charpy V-notch (CVN) impact test and drop-weight tear test (DWTT) were conducted on the rolled steel specimens in order to analyze low-temperature fracture properties. Charpy impact test results indicated that the energy transition temperature (ETT) was below -100 °C when the finish cooling temperature range was 350 °C to 500 °C, showing excellent low-temperature toughness. The ETT increased because of the formation of bainitic ferrite and martensite at low finish cooling temperatures and because of the increase in effective grain size due to the formation of coarse ferrites at high finish cooling temperatures. Most of the specimens also showed excellent DWTT properties as the percent shear area well exceeded 85 pct, irrespective of finish rolling temperatures or finish cooling temperatures, although a large amount of inverse fracture occurred at some finish cooling temperatures.

Effective grain size and charpy impact properties of high-toughness X70 pipeline steels

NASA Astrophysics Data System (ADS)

Hwang, Byoungchul; Kim, Yang Gon; Lee, Sunghak; Kim, Young Min; Kim, Nack J.; Yoo, Jang Yong

2005-08-01

The correlation of microstructure and Charpy V-notch (CVN) impact properties of a high-toughness API X70 pipeline steel was investigated in this study. Six kinds of steel were fabricated by varying the hot-rolling conditions, and their microstructures, effective grain sizes, and CVN impact properties were analyzed. The CVN impact test results indicated that the steels rolled in the single-phase region had higher upper-shelf energies (USEs) and lower energy-transition temperatures (ETTs) than the steels rolled in the two-phase region because their microstructures were composed of acicular ferrite (AF) and fine polygonal ferrite (PF). The decreased ETT in the steels rolled in the single-phase region could be explained by the decrease in the overall effective grain size due to the presence of AF having a smaller effective grain size. On the other hand, the absorbed energy of the steels rolled in the two-phase region was considerably lower because a large amount of dislocations were generated inside PFs during rolling. It was further decreased when coarse martensite or cementite was formed during the cooling process.

Electronic topological transitions in the AgPd system

NASA Astrophysics Data System (ADS)

Skorodumova, N. V.; Simak, S. I.; Smirnova, E. A.; Vekilov, Yu. Kh.

1995-02-01

“First-principles” LMTO-CPA calculations of the Fermi surfaces and thermodynamic properties of AgPd random alloys are presented. We show that there are at least four electronic topological transitions (ETT) in the system. The changes of the Fermi surface topology lead to the appearance of peculiarities in the concentration dependence of the thermodynamic (ground state) properties.

European Training Thesaurus: A Multilingual Synopsis

ERIC Educational Resources Information Center

Cedefop - European Centre for the Development of Vocational Training, 2012

2012-01-01

Education and training issues are similar across Europe, but how can we ensure we mean the same things with the same terms? The new format of the European training thesaurus (ETT) is a multilingual synopsis. It is an online tool enabling those working in education, training and employment to have a common understanding of terms. It helps…

Development of Factorially Based ASVAB High School Composites

DTIC Science & Technology

1979-04-01

commercial test batteries. 2For details see Nie , N. H . , Hull , C. H . , et al . , Statistical Package for the Social Sciences (Second Edition ). New...E*ss.rdi APE, AIIM: SAVTE-t 1 USA Air Del Sets. Ft Su es, ATTN : AISA TEN I USA Ate Mobility Rids I Des Lab, Mol$ett FM, AIIM: ‘3A’JOL-AS I USA

The Operational Mentoring and Liaison Team Program as a Model for Assisting the Development of an Effective Afghan National Army

DTIC Science & Technology

2009-06-12

care has been taken to ensure the ANA is comprised of soldiers from all of Afghanistan’s major ethnic groups - Pashtun, Tajik, Uzbek , Hazara, Turkmen...Canada, Croatia, France, Germany, Italy, Netherlands, Poland , Spain, the United Kingdom (UK), and United States have contributed full OMLTs/ETTs...embedded training teams) while Canada, Croatia, Czech Republic, France, Germany, Latvia, Netherlands, Norway, Poland , Portugal, Romania, Slovenia

Numerical investigation of pulmonary drug delivery under mechanical ventilation conditions

NASA Astrophysics Data System (ADS)

Banerjee, Arindam; van Rhein, Timothy

2012-11-01

The effects of mechanical ventilation waveform on fluid flow and particle deposition were studied in a computer model of the human airways. The frequency with which aerosolized drugs are delivered to mechanically ventilated patients demonstrates the importance of understanding the effects of ventilation parameters. This study focuses specifically on the effects of mechanical ventilation waveforms using a computer model of the airways of patient undergoing mechanical ventilation treatment from the endotracheal tube to generation G7. Waveforms were modeled as those commonly used by commercial mechanical ventilators. Turbulence was modeled with LES. User defined particle force models were used to model the drag force with the Cunningham correction factor, the Saffman lift force, and Brownian motion force. The endotracheal tube (ETT) was found to be an important geometric feature, causing a fluid jet towards the right main bronchus, increased turbulence, and a recirculation zone in the right main bronchus. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by the ETT. Authors acknowledge financial support through University of Missouri Research Board Award.

Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review.

PubMed

Cornette, J; Laker, S; Jeffery, B; Lombaard, H; Alberts, A; Rizopoulos, D; Roos-Hesselink, J W; Pattinson, R C

2017-01-01

ámicos serios, debido a los cuales existe la necesidad de sistemas validados de monitorización hemodinámica para mujeres embarazadas. Aunque la cateterización de la arteria pulmonar (CAP) mediante termodilución es el patrón de referencia clínico para la medición del gasto cardíaco (GC), este método se usa con poca frecuencia debido a su naturaleza invasiva. La ecocardiografía transtorácica (ETT) permite la determinación no invasiva del GC. El objetivo de este estudio fue validar la ETT frente al CAP para determinar el GC en mujeres embarazadas gravemente enfermas. MÉTODOS: Este estudio consistió en un metaanálisis que combinó datos de un estudio prospectivo y una revisión sistemática. El estudio prospectivo se llevó a cabo en Pretoria (Sudáfrica) en 2003. Se incluyeron mujeres con complicaciones graves en el embarazo que requerían una monitorización invasiva mediante CAP según las directrices de ese momento. Se realizó una ETT en un plazo de 15 minutos de haber realizado el CAP y el investigador no tuvo acceso a las mediciones del CAP. Las mediciones comparativas se extrajeron de estudios similares obtenidos a partir de una revisión sistemática de la literatura y se añadieron a una base de datos. Se compararon las mediciones simultáneas del GC mediante ETT y CAP. La concordancia entre métodos se evaluó a través del método estadístico de Bland-Altman y de coeficientes de correlación intraclase (CCI). Se incluyeron treinta y cuatro mediciones comparativas en el metaanálisis. Los valores medios del GC obtenidos mediante CAP y ETT fueron de 7,39 l/min y 7.18 l/min, respectivamente. El sesgo fue de 0,21 l/min, siendo los límites inferior y superior de la concordancia de -1,18 l/min y 1.60 l/min; el error porcentual fue del 19,1%, y el CCI entre ambos métodos fue de 0,94. Las mediciones del GC en mujeres embarazadas mediante ETT muestran una excelente concordancia con las obtenidas mediante CAP. Dada su naturaleza no invasiva y su

Sphingosine Prevents Bacterial Adherence to Endotracheal Tubes: A Novel Mechanism to Prevent Ventilator-Associated Pneumonia

DTIC Science & Technology

2016-06-21

measurement of antibacterial activity on plastics and other non-porous surfaces, ISO 22196. Bacteria were prepared as described above to a concentration of...PVC ETTs. The antimicrobial assay we used is a variation of the international standard for measurement of antibacterial activity on plastics and... activity against both Gram-positive and Gram-negative bacteria. Additionally, sphingosine’s presence in the skin, oral mucosa, and respiratory mucosa

Information Sciences Assessment for Asia and Australasia

DTIC Science & Technology

2009-10-16

entertainment and home services - Machine Translation for international cooperation - NLU + Affective Computing for education - Intelligent Optimization for...into an emotion. ETTS, embedded Mandarin, music retrieval. Also, research in areas of computer graphics, digital media processing  Intelligent...many from outside China, 40% in phase 2 Sales volume in 2007 130 * 100 million RMB SAP (1st), CITI, AIG, EDS, Capgemini, ILOG, Infosys, HCL, Sony

Silicide Formation and Schottky Barrier of Rare-Earth Metals on SI

DTIC Science & Technology

1983-09-30

1981). 4. K. N. Tu, R. D. Thompson and B. Y. Tsaur, App]. Phys. Lett. 38, 626 (1981). 5. H. Norde, J. de Sousa Pires, F. d’Heurle, F. Pesavento , S...Phys. Lett. 38, 626 (1981). 7. H. Plarde, J. de ’’uis Pires, F. dI’Heurle, F. Pesavento , S. Petersson and P. A. Tove, ;!.Phys. L.ett. 38, 865 (1981

An Investigation of the Reacting and Non-Reacting Flow Characteristics of Solid Fuel Ramjets.

DTIC Science & Technology

1980-09-01

which was run on the IBM-360 computer at the Naval 23 Postgraduate School. Programs for Texas Instruments TI - 59 programmable calculator were utilized...Pc’ F P A e 12 = g(y+l) F + PA e-TT 2(R F (9) lil Equations 7, 8, and 9 were solved for each run by software programs written for the TI - 59 programmable calculator . The

Genetic analysis of ectopic growth suppression during planar growth of integuments mediated by the Arabidopsis AGC protein kinase UNICORN.

PubMed

Enugutti, Balaji; Schneitz, Kay

2013-01-02

The coordination of growth within a tissue layer is of critical importance for tissue morphogenesis. For example, cells within the epidermis undergo stereotypic cell divisions that are oriented along the plane of the layer (planar growth), thereby propagating the layered epidermal structure. Little is known about the developmental control that regulates such planar growth in plants. Recent evidence suggested that the Arabidopsis AGC VIII protein kinase UNICORN (UCN) maintains planar growth by suppressing the formation of ectopic multicellular protrusions in several floral tissues including integuments. In the current model UCN controls this process during integument development by directly interacting with the ABERRANT TESTA SHAPE (ATS) protein, a member of the KANADI (KAN) family of transcription factors, thereby repressing its activity. Here we report on the further characterization of the UCN mechanism. Phenotypic analysis of flowers of ucn-1 plants impaired in floral homeotic gene activity revealed that any of the four floral whorls could produce organs carrying ucn-1 protrusions. The ectopic outgrowths of ucn integuments did not accumulate detectable signals of the auxin and cytokinin reporters DR5rev::GFP and ARR5::GUS, respectively. Furthermore, wild-type and ucn-1 seedlings showed similarly strong callus formation upon in vitro culture on callus-inducing medium. We also show that ovules of ucn-1 plants carrying the dominant ats allele sk21-D exhibited more pronounced protrusion formation. Finally ovules of ucn-1 ett-1 double mutants and ucn-1 ett-1 arf4-1 triple mutants displayed an additive phenotype. These data deepen the molecular insight into the UCN-mediated control of planar growth during integument development. The presented evidence indicates that UCN downstream signaling does not involve the control of auxin or cytokinin homeostasis. The results also reveal that UCN interacts with ATS independently of an ATS/ETT complex required for integument

The function of androgen/androgen receptor and insulin growth factor‑1/insulin growth factor‑1 receptor on the effects of Tribulus terrestris extracts in rats undergoing high intensity exercise.

PubMed

Wu, Yin; Yang, Hongfang; Wang, Xiaohui

2017-09-01

Our previous study demonstrated that treatment with Tribulus terrestris (TT) extracts (120 mg/kg) promoted the muscle weight gain and performance of rats undergoing high intensity exercise. The present study was designed to explore the mechanisms underlying the effect of treatment with TT extracts and the involvement of androgens, the androgen receptor (AR), insulin growth factor‑1 (IGF‑1) and the IGF‑1 receptor (IGF‑1R). A total of 32 Sprague‑Dawley rats were randomly divided into groups as follows: Control; TT, treated with TT extracts, E, high intensity exercise; E+TT, high intensity exercise plus TT treatment. The rats of the E and E+TT groups underwent high intensity exercise with a progressively increasing load for 5 weeks, and TT extracts were intragastrically administered in the TT and E+TT rats 30 min prior to training. TT extract composition was analyzed using ultra‑high performance liquid chromatography‑quadrupole‑time of flight mass spectrometry. Testosterone and IGF‑1 plasma levels and AR, IGF‑1R and myosin heavy chain (MHC) protein levels in muscles were determined by ELISA and western blotting, respectively. The saponins tigogenin and diosgenin comprised ~71.35% of the total peak area. Compared with the E group, TT extracts increased the testosterone and IGF‑1 plasma levels, and AR, IGF‑1R and MHC protein levels in the gastrocnemius of rats undergoing high intensity exercise, accompanied with increased body weight and gastrocnemius weight. In conclusion, the effect of TT extracts on the performance of high intensity exercise rats may be attributed to increased levels of circulating testosterone and IGF‑1 and increased AR and IGF‑1R protein expression levels in the gastrocnemius, resulting in increased muscle weight and increased MHC in the gastrocnemius. The present study provided preliminary evidence supporting the use of TT extracts as a dietary supplement for the promotion of skeletal muscle mass increase and the

Acceptance and commitment therapy improves exercise tolerance in sedentary women.

PubMed

Ivanova, Elena; Jensen, Dennis; Cassoff, Jamie; Gu, Fei; Knäuper, Bärbel

2015-06-01

To test the efficacy of an acute intervention derived from acceptance and commitment therapy (ACT) for increasing high-intensity constant work rate (CWR) cycle exercise tolerance in a group of low-active women age 18-45 yr. The secondary goals were to examine whether ACT would reduce perceived effort and improve in-task affect during exercise and increase postexercise enjoyment. In a randomized controlled trial, 39 women were randomized to either the experimental (using ACT-based cognitive techniques and listening to music during the CWR exercise tests) or a control group (listening to music during the CWR exercise tests). Before (CWR-1) and after the intervention (CWR-2), participants completed a CWR cycle exercise test at 80% of maximal incremental work rate (Wmax) until volitional exhaustion. On average, ACT (n = 18) and control (n = 21) groups were matched for age, body mass index, weekly leisure activity scores, and Wmax (all P > 0.05). Exercise tolerance time (ETT) increased by 15% from CWR-1 to CWR-2 for the ACT group (392.05 ± 146.4 vs 459.39 ± 209.3 s; mean ± SD) and decreased by 8% (384.71 ± 120.1 vs 353.86 ± 127.9 s) for the control group (P = 0.008). RPE were lower (e.g., by 1.5 Borg 6-20 scale units at 55% of ETT, P ≤ 0.01) during CWR-2 in the ACT versus that in the control group. By contrast, ACT had no effect on in-task affect. Exercise enjoyment was higher after CWR-2 in the ACT group versus that in the control group (P < 0.001). An acute ACT intervention increased high-intensity ETT and postexercise enjoyment and reduced perceived effort in low-active women. Further investigations of ACT as an effective intervention for enhancing the established health benefits of high-intensity exercise need to be provided.

Use of carbonated water in reduction of adjacent gastric activity in 456 consecutive technetium-99m myocardial perfusion imaging studies.

PubMed

Thomas, Dustin M; Lee, Joshua S; Charmforoush, Anthony; Rubal, Bernard J; Rosenblatt, Stephen A; Butler, Joshua T; Clemenshaw, Michael; Cheezum, Michael K; Slim, Ahmad M

2015-12-01

Small, observational trials have suggested a reduction in adjacent gastric activity with ingestion of soda water in myocardial perfusion imaging (MPI). We report our findings prior to and after implementation of soda water in 467 consecutive MPI studies. Consecutive MPI studies performed at a high-volume facility referred for vasodilator (VD) or exercise treadmill testing (ETT) were retrospectively reviewed before and after implementation of the soda water protocol. Patients undergoing the soda water protocol received 100 ml of soda water administered 30 min prior to image acquisition and after stress. Studies were performed using a same day rest/stress protocol. Incidence of adjacent gastric activity, diaphragmatic attenuation, stress and rest perfusion defects, and major adverse cardiovascular events (MACE) outcomes defined as death, myocardial infarction, stroke, reevaluation for chest pain, and late revascularization (>90 days from MPI) were abstracted using International Classification of Diseases, Ninth Revision (ICD-9) search. Two hundred and eighteen studies were performed prior to implementation of the soda water protocol and 249 studies were performed with the use of soda water. Baseline demographic data were equal between the groups with the exception of more patients undergoing VD stress receiving soda water (p < 0.001). Soda water was not associated with a decreased incidence of adjacent gastric activity with stress (54.7% versus 61.9% with no soda water, p = 0.129) or rest (68.6% versus 69.5% with no soda water, p = 0.919) imaging. Less adjacent gastric activity was observed with patients undergoing ETT who received soda water (42.5% versus 56.9% with no soda water, p = 0.031), but no difference was observed between the groups with VD stress (69.0% versus 68.1% with no soda water, p = 1.000). The use of soda water prior to technetium-99m MPI was associated with lower rates of adjacent gastric activity only in patients undergoing ETT stress but not

Genetic analysis of ectopic growth suppression during planar growth of integuments mediated by the Arabidopsis AGC protein kinase UNICORN

PubMed Central

2013-01-01

Background The coordination of growth within a tissue layer is of critical importance for tissue morphogenesis. For example, cells within the epidermis undergo stereotypic cell divisions that are oriented along the plane of the layer (planar growth), thereby propagating the layered epidermal structure. Little is known about the developmental control that regulates such planar growth in plants. Recent evidence suggested that the Arabidopsis AGC VIII protein kinase UNICORN (UCN) maintains planar growth by suppressing the formation of ectopic multicellular protrusions in several floral tissues including integuments. In the current model UCN controls this process during integument development by directly interacting with the ABERRANT TESTA SHAPE (ATS) protein, a member of the KANADI (KAN) family of transcription factors, thereby repressing its activity. Here we report on the further characterization of the UCN mechanism. Results Phenotypic analysis of flowers of ucn-1 plants impaired in floral homeotic gene activity revealed that any of the four floral whorls could produce organs carrying ucn-1 protrusions. The ectopic outgrowths of ucn integuments did not accumulate detectable signals of the auxin and cytokinin reporters DR5rev::GFP and ARR5::GUS, respectively. Furthermore, wild-type and ucn-1 seedlings showed similarly strong callus formation upon in vitro culture on callus-inducing medium. We also show that ovules of ucn-1 plants carrying the dominant ats allele sk21-D exhibited more pronounced protrusion formation. Finally ovules of ucn-1 ett-1 double mutants and ucn-1 ett-1 arf4-1 triple mutants displayed an additive phenotype. Conclusions These data deepen the molecular insight into the UCN-mediated control of planar growth during integument development. The presented evidence indicates that UCN downstream signaling does not involve the control of auxin or cytokinin homeostasis. The results also reveal that UCN interacts with ATS independently of an ATS/ETT

Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air and Saline Filled Cuffs

DTIC Science & Technology

2017-01-31

AFRL-SA-WP-SR-2017-0004 Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air- and Saline -Filled...Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air- and Saline -Filled Cuffs 5a. CONTRACT NUMBER FA8650-14...descending from altitude. When using saline in the ETT cuff, TW pressure differences with the 7.5 high-volume, low-pressure cuff and 8.0 TaperGuard

Automated Control of Endotracheal Tube Cuff Pressure During Simulated Flight

DTIC Science & Technology

2016-06-01

ventilator, while the other two devices are stand-alone products. The fourth group of ETTs had the cuff pressure measured by the respiratory ...Maquet, Rastatt, Germany). To simulate a clinical environment, each model was ventilated using ventilator settings of respiratory rate of 12...rapidly changes with descent to below 10 cmH2O, allowing fluid above the cuff to readily move into the lower respiratory tract. As with ascent

Locking the 150-cavity open: in silico design and verification of influenza neuraminidase inhibitors.

PubMed

Han, Nanyu; Mu, Yuguang

2013-01-01

Neuraminidase (NA) of influenza is a key target for virus infection control and the recently discovered open 150-cavity in group-1 NA provides new opportunity for novel inhibitors design. In this study, we used a combination of theoretical methods including fragment docking, molecular linking and molecular dynamics simulations to design ligands that specifically target at the 150-cavity. Through in silico screening of a fragment compound library on the open 150-cavity of NA, a few best scored fragment compounds were selected to link with Zanamivir, one NA-targeting drug. The resultant new ligands may bind both the active site and the 150-cavity of NA simultaneously. Extensive molecular dynamics simulations in explicit solvent were applied to validate the binding between NA and the designed ligands. Moreover, two control systems, a positive control using Zanamivir and a negative control using a low-affinity ligand 3-(p-tolyl) allyl-Neu5Ac2en (ETT, abbreviation reported in the PDB) found in a recent experimental work, were employed to calibrate the simulation method. During the simulations, ETT was observed to detach from NA, on the contrary, both Zanamivir and our designed ligand bind NA firmly. Our study provides a prospective way to design novel inhibitors for controlling the spread of influenza virus.

Cuff leak test and laryngeal survey for predicting post-extubation stridor.

PubMed

Patel, Anit B; Ani, Chizobam; Feeney, Colin

2015-02-01

Evidence for the predictive value of the cuff leak test (CLT) for post-extubation stridor (PES) is conflicting. We evaluated the association and accuracy of CLT alone or combined with other laryngeal parameters with PES. Fifty-one mechanically ventilated adult patients in a medical-surgical intensive care unit were tested prior to extubation using; CLT, laryngeal ultrasound and indirect laryngoscopy. Biometric, laryngeal and endotracheal tube (ETT) parameters were recorded. PES incidence was 4%. CLT demonstrated 'no leak' in 20% of patients. Laryngeal oedema was present in 10% of the patients on indirect laryngoscopy, and 71% of the patients had a Grades 1-3 indirect laryngoscopic view. Mean air column width on laryngeal ultrasound was 0.66 ± 0.15 cm (cuff deflated), mean ratio of ETT to laryngeal diameter was 0.48 ± 0.07, and the calculated CLT and laryngeal survey composite was 0.86 ± 1.25 (range 0-5). CLT and the CLT and Laryngeal survey composite measure were not associated with or predict PES. Age, sex, peri-extubation steroid use, intubation duration and body mass index were not associated with PES. Even including ultrasonographic and indirect laryngoscopic examination of the airway, no single aspect of the CLT or combination with laryngeal parameters accurately predicts PES.

Endotracheal Tube Cuff Management at Altitude

DTIC Science & Technology

2014-02-05

to hypoxia and causes expansion of gas trapped in closed spaces. In the latter case, gas trapped in the body ( pneumothorax , bowel gas) or in devices... pneumothorax , bowel gas) or in devices (endotracheal tube (ETT) cuffs, pneumatic tourniquets) expands during ascent and contracts on descent. We designed a...hypoxia and causes expansion of gas trapped in closed spaces [6]. In the latter case, gas trapped in the body ( pneumothorax , bowel gas) or in

Advising the Command: Best Practices from the Special Operations Advisory Experience in Afghanistan

DTIC Science & Technology

2015-01-01

in their spare time. They looked for opportunities to have lunch with Afghans and reportedly extended offers for dinner .18 The SMW ETT cultivated...extremely close relationships with their counterparts, in part by routinely eating with colleagues in the Afghan dining facility. They initiated the...October 21 and November 21, 2013. The practice is very much akin to that of Task Force (TF) 51, where Norwegian SOF operators eat daily meals with

Visual Search in the Detection of Retinal Injury: A Feasibility Study

DTIC Science & Technology

2013-04-01

D, Heyes A. et al. Mobility of people with retinitis pigmentosa as a function of vision and psychological variables. Optometry and Vision Science...AFRL-RH-FS-TR-2013-0019 Visual Search in the Detection of Retinal Injury: A Feasibility Study Thomas Kuyk TASC, Inc. Lei Liu The...Detection of Retinal Injury: A Feasibility Study" 2013 0019 LEON N. McLIN, JR., DR-III, DAF Work Unit Manager 711 HPW/ RHDO POLHAMUS.GARR ETT.D

Daily Magnetograms for 1979 from the AFGL Network.

DTIC Science & Technology

1985-02-22

produced the edited data shown in these plots and who lost his life in October 1982 while the work was under way. Many other persons have also...S317g 42919 24 OCT 79 (LAY 79.297) UIVERSAL TlrE AFGL r’bETt’ETER NErUcwa 304 5 NO.. ’.e> FLLA jTE X CiUtFffT40i’EL.Sr 1c I’III 161127 p C

An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial.

PubMed

Almeida, Fabio A; Smith-Ray, Renae L; Dzewaltowski, David A; Glasgow, Russell E; Lee, Rebecca E; Thomas, Deborah S K; Xu, Stanley; Estabrooks, Paul A

2015-08-24

Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action. Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT). This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a "5 As"-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome. Sedentary participants (n=452; 34.7% participation rate) without a gym membership (mean age 58.57 years

Propulsion Velocity and ETT on Biomagnetic Assessment of the Human Esophagus

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

Cordova-Fraga, T.; Cano, E.; Bravo-Miranda, C.

Esophagus transit time measurement is a common clinical practical. Biomagnetic techniques and modern instrumentation can perform non invasive and functional assessments of the gastrointestinal tract. This study presents the evaluation of the esophagus transit time and propulsion velocity of a magnetic marker from the mouth to stomach using water vs. a swallow easy substance recently patented. A group of ten healthy subjects from 45 to 55 years, were evaluated in identical conditions for two times, they ingested randomly a magnetic marker in an anatomical body position of 45 deg., one times with water and the other one with a patentedmore » substance developed in order to help the subjects to swallow pills. The esophagus transit time was shorter when the subjects ingested the magnetic marker with the swallow easy substance than they ingested the magnetic marker with same quantity of water.« less

Electromagnetic Pulse/Transient Threat Testing of Protection Devices for Amateur/Military Affiliate Radio System Equipment. Volume 3. Test Data, Electromagnetic Pulse Testing of Protection Devices. Section 1. High Energy Pulse-Device Failure Test. 50 Ohms Impedance 25,000 Volts-4000 Amps, 100 Joules.

DTIC Science & Technology

1985-10-31

7 oat s LinkI . . - P Comments: ~ y V ,~o.*.-’ ,. 157q Pk: 6ETtC*6L- - ’ . */-’-..- -,.-., Oats Teet Poit c C 2 b AmplifI481OS’ dS Attenuaio 2-4D dB...Puleer Level * Data LinkI Comments: /:2- VO%’ a*1 Date/3 - Attenuaion dS HMmontai na/dIv I Vertial mnV/div I s. Horizontal g n a/div 2 Vertical IV

Friendly Extensible Transfer Tool Beta Version

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

Collins, William P.; Gutierrez, Kenneth M.; McRee, Susan R.

2016-04-15

Often data transfer software is designed to meet specific requirements or apply to specific environments. Frequently, this requires source code integration for added functionality. An extensible data transfer framework is needed to more easily incorporate new capabilities, in modular fashion. Using FrETT framework, functionality may be incorporated (in many cases without need of source code) to handle new platform capabilities: I/O methods (e.g., platform specific data access), network transport methods, data processing (e.g., data compression.).

A survey of Australian prosthodontists: The use of posts in endodontically treated teeth.

PubMed

Sambrook, Raelene; Burrow, Michael

2018-05-09

This study aimed to gain insight into common practices of Australian prosthodontists when placing a post in an endodontically treated tooth (ETT). A 17-question open- and closed- format questionnaire was sent to registered Australian prosthodontists. The response rate was 55% (n=95). The majority of respondents indicated the purpose of a post was to retain a core (n=94, 99%). The decision to place a post is affected by the quantity of remaining tooth structure (n=91, 96%) and the definitive restoration (n=68, 72%). The ideal post length is neither a short nor long post with the most frequent response (n=52, 34%) being 'as long as possible without disturbing the apical seal'. The apical seal requirements were defined as 4-5mm of Gutta Percha for 77% of respondents. The most preferred post type was a custom cast metal post (n=85, 49%). The most popular luting cement was resin composite (n=84, 39%). The results from this survey do not provide a definitive guide for restoring an ETT. However, it illustrates how Australian prosthodontists address this clinical challenge. The multiple responses received for a number of questions suggest that the material and technique employed in the Australian context is influenced by the individual clinical case. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Stress testing response in women heterozygous for familial hypercholesterolemia.

PubMed

Kolovou, Genovefa D; Damaskos, Dimitris S; Anagnostopoulou, Katherine K; Salpea, Klelia D; Dritsas, Athanasios; Giannakopoulou, Vasiliki; Vasiliadis, Ioannis K; Cokkinos, Dennis V

2007-10-31

We evaluated 62 exercise treadmill tests (ETTs) in equal numbers of heterozygous for familial hypercholesterolemia (hFH) and healthy (HLY) women, matched for age, baseline systolic and diastolic blood pressure (BP) and baseline heart rate (HR), using the Bruce protocol. Both groups had similar rate pressure product (RPP) and workload in metabolic equivalents (METs) (27,563+/-3124 vs. 29,090+/-4077, p=0.103 and 11.2+/-1.7 vs. 11.5+/-1.8, p=0.473, respectively). Women with hFH had lower delta (difference of peak to baseline) and peak exercise systolic and diastolic BP (systolic: 48+/-12 vs. 58+/-17 mmHg, p=0.010 and 167+/-19 vs. 177+/-17 mmHg, p=0.042, respectively; diastolic: 11+/-7 vs. 15+/-7 mmHg, p=0.028 and 85+/-7 vs. 91+/-7 mmHg, p<0.001, respectively). Furthermore, women with hFH had higher delta percentage (%) of HR, compared to HLY; (106+/-25 vs. 95+/-20, p=0.047). In conclusion, hFH women possibly have an inadequate rise in systolic BP during ETT. Diastolic BP increased more in the HLY than in the hFH group, but still remained within normal limits. These findings may reflect preclinical changes of atherosclerosis in hFH women, however further research should be undertaken.

Cigarette Smoking and Military Deployment: A Prospective Evaluation

DTIC Science & Technology

2007-04-10

serving in the military has also been hown to be a strong predictor for both cigarette moking and nicotine dependence.15,16 The stress of 10749-3797/08...findings have hown that an increase in ositive affect through physi- al exercise can reduce ciga- ette cravings and relapse.36 ncreased positive affect...Bray RM, Vincus AA. Psychosocial correlates of nicotine dependence among men and women in the U.S. naval services. Addict Behav 1999;24:521–36. 6. Bray

Catalogue of UBVRI photometry of T Tauri stars and analysis of the causes of their variability

NASA Astrophysics Data System (ADS)

Herbst, W.; Herbst, D. K.; Grossman, E. J.; Weinstein, D.

1994-11-01

A computer-based catalogue of UBVRI photoelectric photometry of T Tauri stars and their earlier type analogs has been compiled. It presently includes over 10 000 entries on 80 stars and will be updated on a regular basis; it is available on Internet. The catalogue is used to analyze the sometimes bizarre light variations of pre-main-sequence stars on time scales of days to months in an attempt to illuminate the nature and causes of the phenomenon. It is useful in discussing their light variations to divide the stars into three groups according to their spectra. These are: weak T Tauri stars (WTTS; spectral class later than K0 and WH-alpha less than 10 A, classical T Tauri stars (CTTS; spectral class later than K0 and WH-alpha greater than 10 A), and early type T Tauri stars (ETTS; spectral class of K0 or earlier). Three distinct types of variability are displayed by stars in the catalogue. Type I variations are periodic in VRI and undoubtedly caused by rotational modulation of a star with an asymmetric distribution of cool spots on its surface. Irregular flare activity is sometimes seen on such stars in U and B. Type I variations are easiest to see on WTTS but are clearly present on CTTS and ETTS as well. Type II variations are caused by hot 'spots' or zones and, it is argued, result from changes in the excess or 'veiling' continuum commonly attributed to an accretion boundary layer or impact zone of a magnetically channeled accretion flow. This type of variation is seen predominantly or solely in CTTS. A sub-category, designated Type IIp, consists of stars which display periodic variations caused by hot spots. Whereas cool spots may last for hundreds or thousands of rotations, hot spots appear to come and go on a much shorter time scale. This suggests that both unsteady accretion and rotation of the star contribute to Type II variations. It is shown that a third type of variation exists among ETTS, including stars as early as A type. UX Ori is a typical example

The Hereptofauna of Letterkenny Army Depot, South-Central Pennsylvania: A Starting Point to the Long-Term Monitoring and Management of Amphibians and Reptiles

DTIC Science & Technology

2010-06-01

Journal of Kansas Herpetology Number 34 (June 2010) 11 www.cnah.org/khs ARtIClES tHE HERpEtofAUNA of lEttERKENNY ARMY dEpot, SoUtH-CENtRAl...compare the herpetological commu- nity currently present at the site with that expected from prior literature (felbaum, 1995; Hulse et al., 2001; tetra...Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Journal of Kansas Herpetology Number 34 (June 2010) 12 www.cnah.org/khs agricultural and other

Computational Vision: A Critical Review

DTIC Science & Technology

1989-10-01

Optic News, 15:9-25, 1989. [8] H. B . Barlow and R. W. Levick . The mechanism of directional selectivity in the rabbit’s retina. J. Physiol., 173:477...comparison, other formulations, e.g., [64], used 16 @V A \\E(t=t2) (a) \\ E(t-tl) ( b ) Figure 7: An illustration of the aperture problem. Left: a bar E is...Ballard and C. M. Brown. Computer Vision. Prentice-Hall, Englewood Cliffs, NJ, 1982. [7] D. H. Ballard, R. C. Nelson, and B . Yamauchi. Animate vision

A User’s Manual for Electromagnetic Surface Patch (ESP) Code. Version II. Polygonal Plates and Wires.

DTIC Science & Technology

1983-09-01

to geometries not large in terms of wavelength and the lack of analytical results which can provide physical insight into the problem. The first...EPTS)*Ŗ) STPM *2. ’TP’ (CABS (ETPS)*Ŗ) STTHi2.*TP*(CARS(ETTS)*Ŗ) RETURN - 1 END 296 do APPENDIX 37 * SUBROUTINE SURFFY SUBROUTINE.SURF!? (KXl,YN1...D-Ai135 837 A USER’S MAiNUAfL FOR ELECTROMAGNETIC SURFACE PATCH (ESP) 1 /4 CODE VERSION 11 P.-(U) OHIO STATE UNIV COLUMBUS U CLAS ELECTROSCIENCE LAB E

The delivery of chlorofluorocarbon-propelled versus hydrofluoroalkane-propelled beclomethasone dipropionate aerosol to the mechanically ventilated patient: a laboratory study.

PubMed

Mitchell, Jolyon P; Nagel, Mark W; Wiersema, Kimberly J; Doyle, Cathy C; Migounov, Vladimir A

2003-11-01

We describe a laboratory investigation comparing the delivery of chlorofluorocarbon (CFC)- and hydrofluoroalkane (HFA)-formulated beclomethasone dipropionate (BDP) by metered-dose inhaler and holding chamber (AeroChamber HC MV) in a simulation of a mechanically ventilated adult patient. We equipped each HC MV (n = 5) with an 8.0 mm diameter endotracheal tube (ETT), locating the HC MV in the inspiratory limb of a breathing circuit linked to a mechanical ventilator set to simulate tidal breathing at tidal volume = 830 mL, respiratory rate = 15 breaths/min, inspiratory-expiratory ratio of 1:2.1, peak inspiratory pressure = 20 cm H(2)O. Temperature and humidity settings were 35+/-1 degrees C and 100% relative humidity (close to body conditions). We compared delivery of 5-actuations of CFC- and HFA-BDP (both 50 microg/actuation), measuring total emitted mass captured by a filter at the distal end of the ETT. In a separate study, we inserted the distal end of the ETT within the entry cone of a cascade impactor so that the aerosol particle size distribution could be determined with the circuit at similar environmental conditions as described previously. We made benchmark measurements with circuit temperature and humidity at room ambient conditions (21+/-1 degrees C and 54+/-5% RH respectively). Total emitted mass (5 measurements/device) was significantly greater for HFA-BDP (14.1+/-1.1 microg/actuation) compared with CFC-BDP (2.4+/-0.8 microg/actuation) (paired t test, p < 0.001). More HFA-BDP (2.7 +/- 0.2 microg/actuation) was lost from the delivery system during exhalation (0.9 +/- 0.4 microg/actuation for CFC-BDP) (p < 0.001). The mass median aerodynamic diameter (MMAD) increased from 1.2 microm (room ambient) to 2.8 microm (higher temperature and humidity conditions) for HFA-BDP. In contrast, MMAD for CFC-BDP remained close to 4.6 microm under either condition, but particles finer than about 4.0 microm increased in size when the circuit was saturated. Total emitted

Treatment of childhood encopresis: a randomized trial comparing three treatment protocols.

PubMed

Borowitz, Stephen M; Cox, Daniel J; Sutphen, James L; Kovatchev, Boris

2002-04-01

To compare short- and long-term effectiveness of three additive treatment protocols in children experiencing chronic encopresis. Children, 6 to 15 years of age, who experienced at least weekly fecal soiling for 6 months or longer were eligible for the study. Children were randomly assigned to a group that received intensive medical therapy (IMT), a group that received intensive medical therapy plus a behavior management program called enhanced toilet training (ETT), or a group that received intensive medical therapy with enhanced toilet training and external anal sphincter electromyographic biofeedback (BF). Data concerning toileting habits were collected for 14 consecutive days before an initial visit, and at 3, 6, and 12 months after initiation of therapy. All data were collected using a computerized voice-mail system that telephoned the families each day. At 12 months, children were classified as significantly improved (reduction in soiling, P < 0.001) or cured (ETT, and BF groups were 36, 48, and 39, respectively (not significant). The improvement rates for these three groups were 45, 78, and 54, respectively (P < 0.05). These results were very stable over time (r > 0.90, P < 0.001 in each case). Response to treatment during the first 2 weeks of therapy was highly predictive of outcome at 3, 6, and 12 months (P < 0.0001). Children in the ETT group used less laxative medication (P < 0.04) and required fewer treatment contacts (P = 0.08) than children in the IMM group. All three treatments resulted in significant increases in daily bowel movements passed in the toilet and self-initiated toileting, and resulted in decreases in average daily soiling at 3, 6, and 12 months (P < 0.05). Enhanced toilet training is somewhat

Changes in Oxygen Consumption and Heart Rate After Acute Myocardial Infarction During 6-Month Follow-up.

PubMed

Choe, Yuri; Han, Jae-Young; Choi, In-Sung; Park, Hyeng-Kyu

2018-06-01

Exercise intensity is a particularly important determinant of physiological responses to exercise training in patients with acute myocardial infarction. Heart rate (HR) is commonly used as a practical way of prescribing and monitoring exercise as specific intensities based on a linear relationship between the percentage of maximum HR (%HR max ) and the percentage of maximum oxygen consumption (%VO 2max ) regardless of age, gender, or exercise mode. To examine the change in variability in the correlation between %HR max and %VO 2max after acute myocardial infarction. Retrospective study. Regional cardio-cerebrovascular center at a tertiary hospital. A total of 66 patients were enrolled who were referred for cardiac rehabilitation (CR) after percutaneous intervention, and who had reached stage 3 of the modified Bruce Protocol (mBP) on an exercise tolerance test (ETT). There were 54 men and 12 women with an average age of 56.7 ± 9.48 years, ejection fraction (EF) of 56.4% ± 8.89%, and body mass index (BMI) of 24.73 ± 2.86 kg/m 2 . All patients participated in a 4-week outpatient CR program and underwent ETT with a gas analyzer to determine maximal heart rate and maximal oxygen consumption before CR and 1 month, 3 months, and 6 months after CR. VO 2max and HR max were defined as the highest values attained during the ETT. The HR and VO 2 values at each stage of the mBP were expressed as percentages of their maximum. %HR max and %VO 2max were calculated at each stage of the mBP. The maximum METs and VO 2max significantly improved at 1 month after CR, but not significantly at 3 and 6 months after CR. The correlation between VO 2max and HR max progressively changed in a favorable manner during CR. The relationship between %HR max and %VO 2max indicated a coefficient of variation before and 1, 3, and 6 months after of 0.800, 0.826, 0.832, and 0.880, respectively. This study showed that the %HR max correlates better with the %VO 2max in the late-stage post-AMI than in

Optimization of Endotracheal Tube Cuff Pressure by Monitoring CO2 Levels in the Subglottic Space in Mechanically Ventilated Patients: A Randomized Controlled Trial.

PubMed

Efrati, Shai; Bolotin, Gil; Levi, Leon; Zaaroor, Menashe; Guralnik, Ludmila; Weksler, Natan; Levinger, Uriel; Soroksky, Arie; Denman, William T; Gurman, Gabriel M

2017-10-01

Many of the complications of mechanical ventilation are related to inappropriate endotracheal tube (ETT) cuff pressure. The aim of the current study was to evaluate the effectiveness of automatic cuff pressure closed-loop control in patients under prolonged intubation, where presence of carbon dioxide (CO2) in the subglottic space is used as an indicator for leaks. The primary outcome of the study is leakage around the cuff quantified using the area under the curve (AUC) of CO2 leakage over time. This was a multicenter, prospective, randomized controlled, noninferiority trial including intensive care unit patients. All patients were intubated with the AnapnoGuard ETT, which has an extra lumen used to monitor CO2 levels in the subglottic space.The study group was connected to the AnapnoGuard system operating with cuff control adjusted automatically based on subglottic CO2 (automatic group). The control group was connected to the AnapnoGuard system, while cuff pressure was managed manually using a manometer 3 times/d (manual group). The system recorded around cuff CO2 leakage in both groups. Seventy-two patients were recruited and 64 included in the final analysis. The mean hourly around cuff CO2 leak (mm Hg AUC/h) was 0.22 ± 0.32 in the manual group and 0.09 ± 0.04 in the automatic group (P = .01) where the lower bound of the 1-sided 95% confidence interval was 0.05, demonstrating noninferiority (>-0.033). Additionally, the 2-sided 95% confidence interval was 0.010 to 0.196, showing superiority (>0.0) as well. Significant CO2 leakage (CO2 >2 mm Hg) was 0.027 ± 0.057 (mm Hg AUC/h) in the automatic group versus 0.296 ± 0.784 (mm Hg AUC/h) in the manual group (P = .025). In addition, cuff pressures were in the predefined safety range 97.6% of the time in the automatic group compared to 48.2% in the automatic group (P < .001). This study shows that the automatic cuff pressure group is not only noninferior but also superior compared to the manual cuff pressure group

Greenhouse Gas-ette Fall 1988, Spring, Fall 1989, Winter, Spring, Fall 1990.

ERIC Educational Resources Information Center

Greenhouse Gas-ette, 1990

1990-01-01

This newsletter is for educators interested in developing lessons related to global climate change. The newsletter contains sample lessons, news items involving global climate change on an international scale, and background information on issues related to global climate change. (CW)

Archaeology and direct imaging of exoplanets

NASA Astrophysics Data System (ADS)

Campbell, John B.

The search for extraterrestrial technology effectively began 45 years ago with Frank Drake's Project Ozma and a radioastronomy start to the search for extraterrestrial intelligence (SETI). Eventually searches began for possible interstellar probes in stable orbits in the Solar System, as well as for infrared excesses from possible Dyson spheres round Sun-like stars. Whilst the Cold War was still underway, some scientists looked for evidence of nuclear waste dumps and nuclear wars elsewhere in the Milky Way. None of this work was carried out by archaeologists, even though by their very nature archaeologists are experts in the detection of ancient technologies. The technologies being searched for would have been partly ancient in age though advanced in techniques and science. The development of ESA's Darwin and NASA's TPF for detection and imaging of Earth-like exoplanets in our galactic neighbourhood represents an opportunity for the testing of techniques for detecting signatures of technological activities. Ideally, both Darwin and TPF might be able to provide spectroscopic data on the chemistry and biochemistry of the atmospheres of Earth-like exoplanets, and thus to detect some of the signs of life. If this can be accomplished successfully, then in theory evidence for pollution and nuclear accidents and wars should be detectable. Some infrared signatures of ETT on or round exoplanets might be detectable. Direct visual imaging of ETT structures will probably not be feasible till we have extremely powerful interstellar telescopes or actually send orbital craft.

Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension.

PubMed

Lima, S G; Albuquerque, M F P M; Oliveira, J R M; Ayres, C F J; Cunha, J E G; Oliveira, D F; Lemos, R R; Souza, M B R; Barbosa e Silva, O

2013-04-01

Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension.

Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

PubMed Central

Dasgupta, Sugata; Singh, Shipti Shradha; Chaudhuri, Arunima; Bhattacharya, Dipasri; Choudhury, Sourav Das

2016-01-01

Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications. Aims: To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India. Methods: Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed. Results: The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001). Conclusions: The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs. PMID:27076709

Prediction of the mid-tracheal level using surface anatomical landmarks in adults

PubMed Central

Jang, Young-Eun; Kim, Eun-Hee; Song, In-Kyung; Lee, Ji-Hyun; Ryu, Ho-Geoul; Kim, Hee-Soo; Kim, Jin-Tae

2017-01-01

Abstract Endotracheal tube (ETT) should be placed at the optimal level to avoid single lung ventilation or accidental extubation. This study was performed to estimate the mid-tracheal level by using surface anatomical landmarks in adult patients. Neck computed tomography images of 329 adult patients between the ages of 16 and 79 years were reviewed. In the midline sagittal plane, the levels corresponding to the vocal cords, cricoid cartilage, suprasternal notch, manubriosternal junction, and carina were identified. The surface distances from the cricoid cartilage to the suprasternal notch (extCC-SSN) and that from the suprasternal notch to the manubriosternal junction (extSSN-MSJ) were measured. The relationship between mid-tracheal level and the surface distances was analyzed using Bland–Altman plot. The difference between the extCC-SSN and the mid-tracheal level was −6.6 (12.5) mm, and the difference between the extSSN-MSJ and the mid-tracheal level was −19.2 (6.1) mm. The difference between the extCC-SSN and the mid-tracheal level was smaller in females compared with males [−1.7 (11.7) mm vs −12.8 (10.7) mm; P < 0.001]. The mid-tracheal level, which is helpful in planning the insertion depth of an ETT, can be predicted by the surface distance between the cricoid cartilage and suprasternal notch in adults, especially in females. PMID:28328810

Effect of nebulized eucalyptus on contamination of microbial plaque of endotracheal tube in ventilated patients

PubMed Central

Amini, Nazanin; Rezaei, Korosh; Yazdannik, Ahmadreza

2016-01-01

Background: Formation of biofilm and bacterial colonization within the endotracheal tube (ETT) are significant sources of airway contamination and play a role in the development of ventilator-associated pneumonia (VAP). This study was conducted to examine the effect of nebulized eucalyptus (NE) on bacterial colonization of ETT biofilm. Materials and Methods: We performed a randomized clinical trial in three intensive care units (ICUs) of an educational hospital. Seventy intubated patients were selected and randomly divided into intervention (n = 35) and control (n = 35) groups. The intervention group received 4 ml (5%) of eucalyptus in 6 ml normal saline every 8 h. The placebo group received only 10 ml of normal saline in the same way. On extubation, the interior of the tube was immediately sampled using a sterile swab for standard microbiological analysis. Chi-square and Fisher's exact tests were used for statistical analysis in SPSS. P values less than 0.05 were considered statistically significant. Results: In both samples, Klebsiella pneumoniae and Acinetobacter baumannii were the most frequently isolated bacteria. In the control group, heavy colonization was greater than in the intervention group (P = 0.002). The frequency of isolation of K. pneumoniae in the intervention group was lower than in the control group (P < 0.001). However, there was no difference between the two groups in other isolated bacteria. Conclusions: NE can reduce microbial contamination of the endotracheal tube biofilm in ventilated patients. Moreover, K. pneumoniae was the most sensitive to NE. PMID:27095990

Proceedings of Image Understanding Workshop Held at Miami, Florida on 9- 10 December 1985

DTIC Science & Technology

1985-12-01

established powerful tecl’n;ques f()( adaptatiOn and change in these networks (Feldmar.. 1982). A major milc:su..ne was ac;hie~ed with Sabbah’s thesis ...guation." Ph.D. thesis , Cor.1puter Science Dept.., Unh. Rochester. r\\p.il 1985; also TR145. Comput~.:r Science Dept, Lmv. Rochester. ~ .. 1ay, 1985...i(ien.:e Maater’• Thesis , 1985. Fl«lc, Mar~arrt. "Local Rotational !’yiDmetria: ~.t~hu!~etts Institute o( Tcc:hnology Dep.~rtmeot ol Electrical

Simulation of Oil Slick Transport in Great Lakes Connecting Channels. Theory and Model Formulation

DTIC Science & Technology

1990-02-01

Cox 1979, Foda and Cox 1980). These complex mathemati- cal treatments are not suitable for real field problems. In the present study, a Lagrangian... analysis (Fischer et al. 1979), where 1 cp - 1.0x0 2 g/cm-s - 2A lb/ft-hr. 13 V"= (4ET/t)"/2 (27) where 8t is a time step. Murray (1972), using the... analysis . This is equivalent to excluding the parcels located at a radial distance greater than 2.2 r from the centroid of the slick. This was

Endotracheal Suctioning in Preterm Infants Using Four-Handed versus Routine Care

PubMed Central

Cone, Sharon; Pickler, Rita H.; Grap, Mary Jo; McGrath, Jacqueline; Wiley, Paul M.

2013-01-01

Objective To evaluate the effect of four-handed care on preterm infants’ physiologic and behavioral responses to and recovery from endotracheal suctioning versus routine endotracheal (ETT) suctioning. Design Randomized crossover design with infants as their own controls. Setting Single-family-room newborn intensive care unit in an academic health center. Participants Ten intubated infants on conventional ventilation with inline suctioning who were fewer than 37 weeks gestation at birth, and less than one week of age. Methods Each infant was observed twice on a single day. One observation involved routine ETT suctioning and one involved four-handed care. Physiologic and behavioral response data were collected. Results No differences were noted when comparing baseline heart rate (HR) or oxygen saturation (SpO2) data to those obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO2 increased from preobservation 95.49 to during observation saturation 97.75 (p = .001). Salivary cortisol levels did not differ between groups at baseline or postsuctioning. No significant difference in behavior state was observed between the two conditions. More stress and defense behaviors occurred postsuctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care. No statistical difference was found in the number of monitor call-backs postsuctioning. Conclusions Four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors. PMID:23316894

Tinian Island Nas, Mariana Islands. Revised Uniform Summary of Surface Weather Observations (RUSSWO). Parts A-F.

DTIC Science & Technology

1973-05-25

oonO. L yJab1Qps 1009100 ’A1!k 10 0ki 10.100.1( 0o l0,1, 10,110 10,1D. TOTAL NUMBER OF OBSERVATIONS ’ATA PP~i/fSS7I’% ;Ar.C; ’A ET.T CEILING VERSUS...t 52 .j 8 2@0 2 7 000 W T - 12 0 IT a? a 3 td $ 84*86 1 4? e 8 29 F2, IT~ 8612, 82 13 11. . 6 000 2* 1 Its . 0 2F 4) , 8206.~ 828~j 82.P p 2 > 5000 k

Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess.

PubMed

Thapa, Dennis B; Greene, Nathaniel H; Udani, Andrea G

2017-01-01

Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction.

What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room.

PubMed

Roy, Soham; Smith, Lee P

2011-02-01

Airway fires are a well-described and potentially devastating complication of oropharyngeal surgery. However, the actual factors required to ignite the fire have never been well-delineated in the medical literature. In this study, we used a mechanical model to assess the oxygen parameters necessary to cause an oropharyngeal fire. An electrosurgical unit (Bovie) was grounded to a whole raw chicken and a 6.0 endotracheal tube (ETT) was inserted into the cranial end of the degutted central cavity. Oxygen (O(2)) was then titrated through the ETT tube at varying concentrations, with flow rates varying from 10 to 15L/min. Electrocautery (at a setting of 15W) was performed on tissue in the central cavity of the chicken near the ETT. All trials were repeated twice to ensure accuracy. Positive test results were quantified by the time required to obtain ignition of any part of the mechanical setup and time required to produce a sustained flame. A test was considered negative if no ignition could be obtained after four minutes of direct electrocautery. At an O(2) concentration of 100% and a flow rate of 15L/min, ignition with a sustained flame was obtained between 15 and 30s after initiation of electrocautery. At 100% O(2) at 10L/min, ignition was obtained at 70s with immediate sustained flame. At an O(2) concentration of 60%, ignition occurred at 25s and sustained fire after 60s. At an O(2) concentration of 50% ignition with a sustained flame occurred between 128 and 184s. At an O(2) concentration of 45%, neither ignition nor sustained flames could be obtained in any trial. Operating room fires remain a genuine danger when performing oropharyngeal surgery where electrocautery is performed in an oxygen-enriched environment. In our study, higher O(2) flow rates with higher FiO(2) correlated with quicker ignition in the chicken cavity. A fire was easily obtained when using 100% O(2); as the O(2) concentration decreases, longer exposure to electrocautery is required for ignition

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

Oshima, M.; Port, S.C.; Ray, G.

Forty-two patients (pts) with 1VD(greater than or equal to 70% stenosis and no prior infarction) undergoing PTCA provide a model to study the efficacy with which non-invasive tests can a) detect stress induced ischemia and b) reflect the reduction in stress induced ischemia expected from arteriographically successful PTCA. The diseased coronary was the right in 12, the circumflex in 3 and the LAD in 27 pts. Pre- and post- PTCA paired data were available from treadmill (ETT), planar thallium (Qual-T1), 7 pinhole tomography and 1st pass radionuclide angiograms (RNA) in 29, 26, 31 and 25 pts. After tomographic images weremore » digitized and analyzed by a computer, the intensity (=area/range, a numerical index of the severity of a defect) served as a quantitative T1 (Quant-T1). Criteria for ischemia were: significant ST change on ETT, unequivocal stress defects on Qual-T1, Quant-T1 intensity greater than or equal to 2.0, and exercise ejection fraction (Ex EF) greater than or equal to 0.55 or a new wall motion abnormality on Ex RNA. Ex EF was .61 +- .13 pre- and .63 +- .10 post-PTCA (p=NS). Quant-T1 intensity was 9.5 +- 7.1 pre- and 4.0 +- 5.5 post-PTCA (p=.0003). T1 testing was the most sensitive for detecting ischemia pre-PTCA. However, given an ischemic response pre-PTCA, the RNA showed the greatest trend toward normalization post-PTCA. If one test must be chosen Quant-T1 seems most appropriate in the evaluation of pre- and post- PTCA pts with 1VD.« less

Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess

PubMed Central

Greene, Nathaniel H.

2017-01-01

Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction. PMID:28299222

Description and modelling of the solar-hydrogen-biogas-fuel cell system in GlashusEtt

NASA Astrophysics Data System (ADS)

Hedström, L.; Wallmark, C.; Alvfors, P.; Rissanen, M.; Stridh, B.; Ekman, J.

The need to reduce pollutant emissions and utilise the world's available energy resources more efficiently has led to increased attention towards e.g. fuel cells, but also to other alternative energy solutions. In order to further understand and evaluate the prerequisites for sustainable and energy-saving systems, ABB and Fortum have equipped an environmental information centre, located in Hammarby Sjöstad, Stockholm, Sweden, with an alternative energy system. The system is being used to demonstrate and evaluate how a system based on fuel cells and solar cells can function as a complement to existing electricity and heat production. The stationary energy system is situated on the top level of a three-floor glass building and is open to the public. The alternative energy system consists of a fuel cell system, a photovoltaic (PV) cell array, an electrolyser, hydrogen storage tanks, a biogas burner, dc/ac inverters, heat exchangers and an accumulator tank. The fuel cell system includes a reformer and a polymer electrolyte fuel cell (PEFC) with a maximum rated electrical output of 4 kW el and a maximum thermal output of 6.5 kW th. The fuel cell stack can be operated with reformed biogas, or directly using hydrogen produced by the electrolyser. The cell stack in the electrolyser consists of proton exchange membrane (PEM) cells. To evaluate different automatic control strategies for the system, a simplified dynamic model has been developed in MATLAB Simulink. The model based on measurement data taken from the actual system. The evaluation is based on demand curves, investment costs, electricity prices and irradiation. Evaluation criteria included in the model are electrical and total efficiencies as well as economic parameters.

[Skill retention using extraglottic airways in out-of-hospital emergencies: efficacy and long-term results of simulator-based medical education : A prospective follow-up study].

PubMed

Mann, V; Limberg, F; Mann, S T W; Little, S; Müller, M; Sander, M; Röhrig, R

2018-04-11

For emergency medicine personnel (EMP), there is little evidence concerning the adequate timing for refresher courses to maintain routine in the application of extraglottic airways. The aim of this study was to evaluate the efficacy and long-term results of a simulator-based education concept teaching the basic airway management skills with extraglottic airways for EMP and also to draw conclusions concerning the adequate time interval for refresher courses. By use of an explorative, prospective simulator-study with nonphysician EMP, airway management skills using the Larynxmaske Supreme® (LMA‑S) after an introduction lecture were examined. The application of an endotracheal tube (ETT) served as control. Time for preparation of the airway devices, insertion success, and resulting apnea time were assessed immediately after the first introduction lecture (t1) and unannounced 9-12 months thereafter (t2). Comparison of the times for preparation of the LMA‑S at t1 and t2 demonstrated similar results. After the introduction lecture, all paramedics were able to insert the LMA‑S successfully after maximal 2 attempts; 9-12 months later success rates with the LMA‑S were unchanged. Apnea time during airway management was shorter with the LMA‑S compared to the ETT (p < 0.01). Times needed for preparation of the airway devices were similar. The results of this simulator study indicate that a standardized introduction lecture is appropriate to ensure long-lasting procedural skills up to 12 months, so that subsequent refresher courses in basic airway management with the LMA‑S once a year may be adequate. A simulator-based education in basic airway management skills with extraglottic airways is recommended for facilitation of further clinical education according to the current guidelines.

Performance-based versus patient-reported physical function: what are the underlying predictors?

PubMed

Bean, Jonathan F; Olveczky, Daniele D; Kiely, Dan K; LaRose, Sharon I; Jette, Alan M

2011-12-01

Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically. The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care. This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise. A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy. Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R(2)), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores. This study included older adults with mobility limitations and may not generalize to other populations. Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was

Non-Acute Coronary Syndrome Anginal Chest Pain

PubMed Central

Agarwal, Megha; Mehta, Puja K.; Merz, C. Noel Bairey

2010-01-01

Anginal chest pain is one of the most common complaints in the outpatient setting. While much of the focus has been on identifying obstructive atherosclerotic coronary artery disease (CAD) as the cause of anginal chest pain, it is clear that microvascular coronary dysfunction (MCD) can also cause anginal chest pain as a manifestation of ischemic heart disease (IHD), and carries an increased cardiovascular risk. Epicardial coronary vasospasm, aortic stenosis, left ventricular hypertrophy, congenital coronary anomalies, mitral valve prolapse and abnormal cardiac nociception can also present as angina of cardiac origin. For non-acute coronary syndrome (ACS) stable chest pain, exercise treadmill testing (ETT) remains the primary tool for diagnosis of ischemia and cardiac risk stratification; however, in certain subsets of patients, such as women, ETT has a lower sensitivity and specificity for identifying obstructive CAD. When combined with an imaging modality, such as nuclear perfusion or echocardiography testing, the sensitivity and specificity of stress testing for detection of obstructive CAD improves significantly. Advancements in stress cardiac magnetic resonance imaging (MRI) enables detection of perfusion abnormalities in a specific coronary artery territory, as well as subendocardial ischemia associated with MCD. Coronary computed tomography angiography (CCTA) enables visual assessment of obstructive CAD, albeit with a higher radiation dose. Invasive coronary angiography (CA) remains the gold standard for diagnosis and treatment of obstructive lesions that cause medically refractory stable angina. Furthermore, in patients with normal coronary angiograms, the addition of coronary reactivity testing (CRT) can help diagnose endothelial dependent and independent microvascular dysfunction. Life-style modification and pharmacologic intervention remains the cornerstone of therapy to reduce morbidity and mortality in patients with stable angina. This review focuses on

The prognostic value of CT coronary angiography in patients attending hospital with troponin-negative acute chest pain and inconclusive exercise treadmill tests.

PubMed

Mordi, Ify; Tzemos, Nikolaos

2016-05-01

Once acute coronary syndrome (ACS) is excluded in patients presenting to hospital with acute chest pain, usual practice is to stratify future risk of adverse cardiovascular events. Commonly this is performed by pre-discharge exercise treadmill testing (ETT). Often however, patients are unable to perform the test for various reasons, or the final result is inconclusive. This potentially could lead to uncertainty and to unnecessary invasive coronary angiography. We wished to evaluate the potential prognostic significance of CT coronary angiography (CTCA) in patients with prior inconclusive ETTs. Two hundred and thirty-two consecutive patients underwent CTCA and calcium scoring following hospital attendance with acute chest pain and following exclusion of ACS. All patients were followed up for a combined primary outcome of death, non-fatal myocardial infarction, and late revascularization. The mean follow-up period was 2.5 ± 0.9 years. The combined primary outcome occurred in 26 patients (11.2%). Calcium score (HR 1.16; 95% CI 1.02-1.31, P = 0.023 per 100 Agatston unit increase), the presence of coronary artery disease (CAD) on CTCA (non-obstructive CAD, HR 4.52; 95% CI 1.30-15.73, P = 0.018; obstructive CAD, HR 17.00; 95% CI 4.60-62.85, P < 0.001), and ≥3 segments with non-calcified plaque (HR 3.30; 95% CI 1.24-8.76, P = 0.017) were significant univariable predictors of the primary outcome. CTCA was the only significant multivariable predictor of adverse outcome. The presence of CAD assessed by CTCA is a strong predictor of adverse events in patients with troponin-negative acute chest pain and could potentially be used as an alternative, non-invasive risk stratifier in patients with inconclusive exercise tests. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Short-Term Repeatability of Noninvasive Aortic Pulse Wave Velocity Assessment: Comparison Between Methods and Devices.

PubMed

Grillo, Andrea; Parati, Gianfranco; Rovina, Matteo; Moretti, Francesco; Salvi, Lucia; Gao, Lan; Baldi, Corrado; Sorropago, Giovanni; Faini, Andrea; Millasseau, Sandrine C; Scalise, Filippo; Carretta, Renzo; Salvi, Paolo

2017-12-08

Aortic pulse wave velocity (PWV) is an indirect index of arterial stiffness and an independent cardiovascular risk factor. Consistency of PWV assessment over time is thus an essential feature for its clinical application. However, studies providing a comparative estimate of the reproducibility of PWV across different noninvasive devices are lacking, especially in the elderly and in individuals at high cardiovascular risk. Aimed at filling this gap, short-term repeatability of PWV, estimated with 6 different devices (Complior Analyse, PulsePen-ETT, PulsePen-ET, SphygmoCor Px/Vx, BPLab, and Mobil-O-Graph), was evaluated in 102 high cardiovascular risk patients hospitalized for suspected coronary artery disease (72 males, 65 ± 13 years). PWV was measured in a single session twice, at 15-minute interval, and its reproducibility was assessed though coefficient of variation (CV), coefficient of repeatability, and intraclass correlation coefficient. The CV of PWV, measured with any of these devices, was <10%. Repeatability was higher with cuff-based methods (BPLab: CV = 5.5% and Mobil-O-Graph: CV = 3.4%) than with devices measuring carotid-femoral PWV (Complior: CV = 8.2%; PulsePen-TT: CV = 8.0%; PulsePen-ETT: CV = 5.8%; and SphygmoCor: CV = 9.5%). In the latter group, PWV repeatability was lower in subjects with higher carotid-femoral PWV. The differences in PWV between repeated measurements, except for the Mobil-O-Graph, did not depend on short-term variations of mean blood pressure or heart rate. Our study shows that the short-term repeatability of PWV measures is good but not homogenous across different devices and at different PWV values. These findings, obtained in patients at high cardiovascular risk, may be relevant when evaluating the prognostic importance of PWV. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Efficacy and Safety of Using Air Versus Alkalinized 2% Lignocaine for Inflating Endotracheal Tube Cuff and Its Pressure Effects on Incidence of Postoperative Coughing and Sore Throat.

PubMed

Gaur, Pallavi; Ubale, Pravin; Khadanga, Prashant

2017-01-01

We wished to compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. This was a prospective randomized controlled study conducted in a tertiary care set up over a period of 1 year. We included 100 patients in age group of 18-65 years posted for elective surgeries of duration more than 90 min under general anesthesia with N 2 O-O 2 mixture. Patients were randomized using computer-generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1 h and 24 h postoperatively. Demographic data, baseline characteristics (American Society of Anesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anesthesia were comparable among study groups ( P > 0.05). Cuff pressure and volume achieved in the end of surgery were much higher in air group as compared to lignocaine group ( P < 0.05). Incidence of coughing and POST at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Impact of duration of anesthesia on rise in cuff pressure was significantly higher in air group and its effect on cuff-induced laryngotracheal morbidity was significant in both air and lignocaine group. This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST. Duration of anesthesia has also a significant effect on incidence of postoperative trachea-laryngeal morbidity.

Assessing neuromuscular block at the larynx: the effect of change in resting cuff pressure and a comparison with video imaging in anesthetized humans.

PubMed

Girling, K J; Bedforth, N M; Spendlove, J L; Mahajan, R P

1999-02-01

Neuromuscular block (NMB) at the larynx has been assessed by measuring the cuff pressure (CP) in an endotracheal tube (ETT) placed between the vocal cords. In this study, we evaluated the decrease in resting cuff pressure (RCP) after the administration of rocuronium and the effect of this decrease on the assessment of NMB, and we compared CP measurement with an alternative technique, video imaging (VI). In 20 patients, NMB was determined at the hand by mechanomyography and at the larynx initially by CP and subsequently by VI, recording images using a fiberoptic bronchoscope via a laryngeal mask. Train-of-four stimuli were applied at both sites. After baseline measurements, the ETT was replaced, and rocuronium was infused to achieve a steady-state 50% (n = 10) or 75% (n = 10) block at the hand. CP measurements were recorded before and after restoration of RCP to prerocuronium pressure, followed by further VI measurements. The mean RCP decreased from 21 +/- 4 to 12 +/- 5 mm Hg after rocuronium. At 50% block at the hand, the CP estimate of block at the larynx with reduced RCP was 62% +/- 18%, and that after restoring RCP was 29% +/- 13%; VI estimated 27% +/- 14% block. At 75% block at the hand, CP and VI estimated 52% +/- 11% and 46% +/- 9% block, respectively (RCP maintained). We conclude that RCP decreases after the administration of rocuronium, that restoring RCP significantly alters CP estimates of NMB, and that VI is in agreement with CP measurement if RCP is maintained at prerelaxant values. In this study, we show that a muscle relaxant-induced decrease in resting tension at the larynx may confound the assessment of neuromuscular block by cuff pressure measurement. The preliminary data suggest that video imaging may provide a suitable alternative to cuff pressure measurement to assess neuromuscular block at the larynx.

Terminal Ballistics Test and Analysis Guidelines for the Penetration Mechanics Branch

DTIC Science & Technology

1992-01-01

BALLISTIC RESEARCH LABORATORY ABERDEEN PROVING GROUND, MARYLAND 902-05410• • ;11•. 1 H ,.~~~T: ’tI I.I iI•i NOTICES Destroy this report when It is no...ad to aiffag@ "u boo r f et~et. 1AVUdim the ti (Or foe #viewM Of$ttudjOrq, (WlfChir¶ @ 1 * itirc data 16u,’Cei. 9111, ipr’nq am~ fflsiht8,A,r’ thre...dahta A~~fd &M- 1 ComO!#tiAg hAA f# l#*~ h# COINhcVOA Of Rtffl’atior Wfvd Commilifit f"Atidiir thil Wider, WI3ttu Off0 SAY? Otlwr auWt1 Of thitco. ett. Of

A Perspective on Multiaccess Channels

DTIC Science & Technology

1984-09-01

packets that arrived between T and T+ are transmitted. The parameter v is determined by all each transmitter based on the history of the feedback up to time...t. The transmitters also calculate T based on the feedback history . It is helpful to view the packet arrivals in ETt) as being in a distributed queue...Cambridge, MA. 4T TO. JC-N~g 4f aAviE. I -w l 2.1 WPr IfCI’YIL 2. ICA 6-- e NO.Yt4 Z/ ’) eqp~ ~ 46 5AZw’ I.q e L 1!x;Y :r/; YFv (1.~i 21 V4 Gf~~ .. 2 15 5.5

Electronic Topological Transitions in CuNiMnAl and CuNiMnSn under pressure from first principles study

NASA Astrophysics Data System (ADS)

Rambabu, P.; Kanchana, V.

2018-06-01

A detailed study on quaternary ordered full Heusler alloys CuNiMnAl and CuNiMnSn at ambient and under different compressions is presented using first principles electronic structure calculations. Both the compounds are found to possess ferromagnetic nature at ambient with magnetic moment of Mn being 3.14 μB and 3.35 μB respectively in CuNiMnAl and CuNiMnSn. The total magnetic moment for both the compounds is found to decrease under compression. Fermi surface (FS) topology change is observed in both compounds under pressure at V/V0 = 0.90, further leading to Electronic Topological Transitions (ETTs) and is evidenced by the anomalies visualized in density of states and elastic constants under compression.

Mars Global Surveyor Ka-Band Frequency Data Analysis

NASA Astrophysics Data System (ADS)

Morabito, D.; Butman, S.; Shambayati, S.

2000-01-01

for the feed and electronics equipment. A dichroic plate is used to reflect the X-band energy and pass the Ka-band energy to another mirror. The RF energy for each band is then focused onto a feed horn and low-noise amplifier package. After amplification and RF/IF downconversion, the IF signals are sent to the Experimental Tone Tracker (ETT), a digital phase-lock-loop receiver, which simultaneously tracks both X-band and Ka-band carrier signals. Once a signal is detected, the ETT outputs estimates of the SNR in a I -Hz bandwidth (Pc/No), baseband phase and frequency of the signals every I -sec. Between December 1996 and December 1998, the Ka-band and X-band signals from MGS were tracked on a regular basis using the ETT. The Ka-band downlink frequencies described here were referenced to the spacecraft's on-board USO which was also the X-band frequency reference (fka= 3.8 fx). The ETT estimates of baseband phase at I -second sampled time tags were converted to sky frequency estimates. Frequency residuals were then generated for each band by removing a model frequency from each observable frequency at each time tag. The model included Doppler and other effects derived from spacecraft trajectory files obtained from the MGS Navigation Team. A simple troposphere correction was applied to the data. In addition to residuals, the USO frequencies emitted by the spacecraft were estimated. For several passes, the USO frequencies were determined from X-band data and from Ka-band data (referred to X-band by dividing by 3.8) and were found to be in good agreement. In addition, X-band USO frequency estimates from MGS Radio Science data acquired from operational DSN stations were available for comparison and were found to agree within the I Hz level. The remaining sub-Hertz differences were attributed to the different models and software algorithms used by MGS Radio Science and KaBLE-11. A summary of the results of a linear fit of the USO frequency versus time (day of year) is

Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review.

PubMed

Tan, Tze P; Govindarajulu, Arun P; Massicotte, Eric M; Venkatraghavan, Lashmi

2014-07-01

Vocal cord palsy (VCP) is a known complication of anterior cervical spine surgery. However, the true incidence and interventions to minimize this complication are not well studied. To conduct a systematic review to identify the incidence, risk, and interventions for VCP after anterior cervical spine surgery. This is a qualitative systematic literature review. Prospective and retrospective trials of patients undergoing anterior cervical spine surgery that reported on postoperative VCP or recurrent laryngeal nerve palsy. Primary: incidence of VCP after anterior cervical spine surgery; secondary: risk factors and interventions for prevention of VCP after anterior cervical spine surgery. Electronic searches were conducted on Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews for clinical studies reporting VCP in anterior cervical spine surgery, limited to studies published between 1995 and June 2013 in English and French languages. After selection of studies independently by two review authors, data on incidence, risk, and interventions were extracted. Qualitative analysis was performed on three domains: quality of studies, strength of evidence, and impact of interventions. Our search has identified 187 abstracts, and 34 studies met our inclusion criteria. The incidence of VCP ranges from 2.3% to 24.2%. Significant heterogeneity in study design and definition of VCP were used in the published studies. There is good evidence that reoperation increases the risk of VCP. One study of moderate strength suggests that operating from the right side may increase the risk of VCP. Among the interventions studied, endotracheal tube (ETT) cuff pressure monitoring with deflation during retraction has shown to reduce the incidence from 6% to 2%, but this result was not confirmed by randomized control trials. Limited evidence exists for other interventions of intraoperative electromyographic monitoring and methylprednisolone

Optimal Delivery of Aerosols to Infants During Mechanical Ventilation

PubMed Central

Azimi, Mandana; Hindle, Michael

2014-01-01

Abstract Purpose: The objective of this study was to determine optimal aerosol delivery conditions for a full-term (3.6 kg) infant receiving invasive mechanical ventilation by evaluating the effects of aerosol particle size, a new wye connector, and timing of aerosol delivery. Methods: In vitro experiments used a vibrating mesh nebulizer and evaluated drug deposition fraction and emitted dose through ventilation circuits containing either a commercial (CM) or new streamlined (SL) wye connector and 3-mm endotracheal tube (ETT) for aerosols with mass median aerodynamic diameters of 880 nm, 1.78 μm, and 4.9 μm. The aerosol was released into the circuit either over the full inhalation cycle (T1 delivery) or over the first half of inhalation (T2 delivery). Validated computational fluid dynamics (CFD) simulations and whole-lung model predictions were used to assess lung deposition and exhaled dose during cyclic ventilation. Results: In vitro experiments at a steady-state tracheal flow rate of 5 L/min resulted in 80–90% transmission of the 880-nm and 1.78-μm aerosols from the ETT. Based on CFD simulations with cyclic ventilation, the SL wye design reduced depositional losses in the wye by a factor of approximately 2–4 and improved lung delivery efficiencies by a factor of approximately 2 compared with the CM device. Delivery of the aerosol over the first half of the inspiratory cycle (T2) reduced exhaled dose from the ventilation circuit by a factor of 4 compared with T1 delivery. Optimal lung deposition was achieved with the SL wye connector and T2 delivery, resulting in 45% and 60% lung deposition for optimal polydisperse (∼1.78 μm) and monodisperse (∼2.5 μm) particle sizes, respectively. Conclusions: Optimization of selected factors and use of a new SL wye connector can substantially increase the lung delivery efficiency of medical aerosols to infants from current values of <1–10% to a range of 45–60%. PMID:24299500

Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors?

PubMed Central

Ölveczky, Daniele D.; Kiely, Dan K.; LaRose, Sharon I.; Jette, Alan M.

2011-01-01

Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically. Objective The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care. Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise. Methods A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy. Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R2), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores. Limitations This study included older adults with mobility limitations and may not generalize to other populations. Conclusions Performance-based and patient-reported measures of physical function appear to assess

Evidence of Long-Lived Founder Virus in Mother-to-Child HIV Transmission

PubMed Central

Danaviah, Sivapragashini; de Oliveira, Tulio; Bland, Ruth; Viljoen, Johannes; Pillay, Sureshnee; Tuaillon, Edouard; Van de Perre, Philippe; Newell, Marie-Louise

2015-01-01

Exposure of the infant’s gut to cell-associated and cell-free HIV-1 trafficking in breast milk (BM) remains a primary cause of mother-to-child transmission (MTCT). The mammary gland represents a unique environment for HIV-1 replication and host-virus interplay. We aimed to explore the origin of the virus transmitted during breastfeeding, and the link with quasi-species found in acellular and cellular fractions of breast-milk (BM) and in maternal plasma. The C2–V5 region of the env gene was amplified, cloned and sequenced from the RNA and DNA of BM, the RNA from the mother’s plasma (PLA) and the DNA from infant’s dried blood spot (DBS) in 11 post-natal mother-infant pairs. Sequences were assembled in Geneious, aligned in ClustalX, manually edited in SeAL and phylogenetic reconstruction was undertaken in PhyML and MrBayes. We estimated the timing of transmission (ETT) and reconstructed the time for the most recent common ancestor (TMRCA) of the infant in BEAST. Transmission of single quasi-species was observed in 9 of 11 cases. Phylogenetic analysis illustrated a BM transmission event by cell-free virus in 4 cases, and by cell-associated virus in 2 cases but could not be identified in the remaining 5 cases. Molecular clock estimates, of the infant ETT and TMRCA, corresponded well with the timing of transmission estimated by sequential infant DNA PCR in 10 of 11 children. The TMRCA of BM variants were estimated to emerge during gestation in 8 cases. We hypothesize that in the remaining cases, the breast was seeded with a long-lived lineage latently infecting resting T-cells. Our analysis illustrated the role of DNA and RNA virus in MTCT. We postulate that DNA archived viruses stem from latently infected quiescent T-cells within breast tissue and MTCT can be expected to continue, albeit at low levels, should interventions not effectively target these cells. PMID:25793402

Practicality of performing medical procedures in chemical protective ensembles.

PubMed

Garner, Alan; Laurence, Helen; Lee, Anna

2004-04-01

To determine whether certain life saving medical procedures can be successfully performed while wearing different levels of personal protective equipment (PPE), and whether these procedures can be performed in a clinically useful time frame. We assessed the capability of eight medical personnel to perform airway maintenance and antidote administration procedures on manikins, in all four described levels of PPE. The levels are: Level A--a fully encapsulated chemically resistant suit; Level B--a chemically resistant suit, gloves and boots with a full-faced positive pressure supplied air respirator; Level C--a chemically resistant splash suit, boots and gloves with an air-purifying positive or negative pressure respirator; Level D--a work uniform. Time in seconds to inflate the lungs of the manikin with bag-valve-mask, laryngeal mask airway (LMA) and endotracheal tube (ETT) were determined, as was the time to secure LMAs and ETTs with either tape or linen ties. Time to insert a cannula in a manikin was also determined. There was a significant difference in time taken to perform procedures in differing levels of personal protective equipment (F21,72 = 1.75, P = 0.04). Significant differences were found in: time to lung inflation using an endotracheal tube (A vs. C mean difference and standard error 75.6 +/- 23.9 s, P = 0.03; A vs. D mean difference and standard error 78.6 +/- 23.9 s, P = 0.03); time to insert a cannula (A vs. D mean difference and standard error 63.6 +/- 11.1 s, P < 0.001; C vs. D mean difference and standard error 40.0 +/- 11.1 s, P = 0.01). A significantly greater time to complete procedures was documented in Level A PPE (fully encapsulated suits) compared with Levels C and D. There was however, no significant difference in times between Level B and Level C. The common practice of equipping hospital and medical staff with only Level C protection should be re-evaluated.

Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

PubMed

Cerpa, F; Cáceres, D; Romero-Dapueto, C; Giugliano-Jaramillo, C; Pérez, R; Budini, H; Hidalgo, V; Gutiérrez, T; Molina, J; Keymer, J

2015-01-01

The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use.

[Working overseas and cardiovascular diseases: application of a screening method on Oil&Gas employees].

PubMed

Cappelli, M I; Macchione, M; Pulini, S; Aquilina, T; Cancanelli, G

2012-01-01

Working overseas is a reality for decades in the Oil&Gas Industry and many noxae impact on the cardiovascular system. In fitness to work evaluation the physician should consider besides the conventional risk factors, the presence of cardiovascular diseases, and prevent their evolution. A cardiovascular screening and follow up after 2 years was carried out on 42 Oil&Gas employees, over 45 of age, during medical fitness to work. The main tests were ECG, exercise tolerance test (ETT) and echocardiocolordoppler, completed with other instrumental tests. Cardiovascular diseases causing unfitness to working overseas occurred in 7%, blood hypertension in 23%. The screening permitted to diagnose and correct acute cardiovascular diseases, that caused unfitness to work, and disease that can get worse related to occupational risk. Moreover it was fundamental for evaluation of fitness and timing of health surveillance.

Removal of obstructing T-tube and stabilization of the airway.

PubMed

Athavale, Sanjay M; Dang, Jennifer; Rangarajan, Sanjeet; Garrett, Gaelyn

2011-05-01

Although they are extremely effective in maintaining tracheal and subglottic patency, T-tubes themselves can result in airway obstruction from plugging. Many practitioners educate patients on placing a small (5.0) endotracheal tube (ETT) through the tracheal limb of the T-tube if they develop airway obstruction. Unfortunately, this can be a difficult task to complete during acute airway obstruction. In this article, we describe a simple set of steps for rapid relief of airway obstruction and stabilization of the airway in the event of T-tube obstruction. This method requires removal of the T-tube with a Kelly clamp and stabilization of the airway with a tracheostomy tube. Although it is simple, we hope that this technique will prevent morbidity and mortality from acute airway obstructions related to T-tubes. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

PubMed Central

Cerpa, F; Cáceres, D; Romero-Dapueto, C; Giugliano-Jaramillo, C; Pérez, R; Budini, H; Hidalgo, V; Gutiérrez, T; Molina, J; Keymer, J

2015-01-01

The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use. PMID:26312102

CO2 driven endotracheal tube cuff control in critically ill patients: A randomized controlled study.

PubMed

De Pascale, Gennaro; Pennisi, Mariano Alberto; Vallecoccia, Maria Sole; Bello, Giuseppe; Maviglia, Riccardo; Montini, Luca; Di Gravio, Valentina; Cutuli, Salvatore Lucio; Conti, Giorgio; Antonelli, Massimo

2017-01-01

To determine the safety and clinical efficacy of an innovative integrated airway system (AnapnoGuard™ 100 system) that continuously monitors and controls the cuff pressure (Pcuff), while facilitating the aspiration of subglottic secretions (SS). This was a prospective, single centre, open-label, randomized, controlled feasibility and safety trial. The primary endpoint of the study was the rate of device related adverse events (AE) and serious AE (SAE) as a result of using AnapnoGuard (AG) 100 during mechanical ventilation. Secondary endpoints were: (1) mechanical complications rate (2) ICU staff satisfaction; (3) VAP occurrence; (4) length of mechanical ventilation; (5) length of Intensive Care Unit stay and mortality; (6) volume of evacuated subglottic secretions. Sixty patients were randomized to be intubated with the AG endotracheal-tube (ETT) and connected to the AG 100 system allowing Pcuff adjustment and SS aspiration; or with an ETT combined with SS drainage and Pcuff controlled manually. No difference in adverse events rate was identified between the groups. The use of AG system was associated with a significantly higher incidence of Pcuff determinations in the safety range (97.3% vs. 71%; p<0.01) and a trend to a greater volume of aspirated SS secretions: (192.0[64-413] ml vs. 150[50-200], p = 0.19 (total)); (57.8[20-88.7] ml vs. 50[18.7-62] ml, p = 0.11 (daily)). No inter-group difference was detected using AG system vs. controls in terms of post-extubation throat pain level (0 [0-2] vs. 0 [0-3]; p = 0.7), hoarseness (42.9% vs. 75%; p = 0.55) and tracheal mucosa oedema (16.7% vs. 10%; p = 0.65). Patients enrolled in the AG group had a trend to reduced VAP risk of ventilator-associated pneumonia(VAP) (14.8% vs. 40%; p = 0.06), which were more frequently monomicrobial (25% vs. 70%; p = 0.03). No statistically significant difference was observed in duration of mechanical ventilation, ICU stay, and mortality. The use AG 100 system and AG tube in critically

Methods For Collecting , Culturing And Performing Toxicity Tests With Daphnia ambigua

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

Specht, Winona L.

2005-07-01

Toxicity tests conducted on water collected from impacted locations in SRS streams often failed chronic toxicity tests and sometimes failed acute toxicity tests (Specht 1995). These findings prompted SRS to determine the cause of the failures. Some SRS NPDES outfalls were also failing chronic toxicity tests, even though no toxicant could be identified and when TIEs were performed, none of the TIE treatments removed the toxicity. Ultimately, it was determined that the failures were due to the low hardness of SRS surface waters, rather than to the presence of a toxicant. The species of cladoceran that the EPA recommends formore » toxicity testing, Ceriodaphnia dubia, is stressed by the very low hardness of SRS waters. SRS developed an alternate species toxicity test that is similar to the EPA test, but uses an indigenous cladoceran, Daphnia ambigua (Specht and Harmon, 1997; Harmon et al., 2003). In 2001, SCDHEC approved the use of D. ambigua for toxicity testing at SRS, contingent upon approval by EPA Region 4. In 2002, EPA Region 4 approved the use of this species for compliance toxicity testing at SRS. Ultimately, the use of this species demonstrated that SRS effluents were not toxic, and most toxicity testing requirements were removed from the NPDES permit that was issued in December 2003, with the exception of one round of chronic definitive testing on outfalls A-01, A-11, and G-10 just before the next NPDES permit application is submitted to SCDHEC. Although the alternate species test was developed at SRS (1996-1998), the culture was transferred to a contract toxicity testing lab (ETT Environmental) located in Greer, SC in 1998. ETT Environmental became certified by SCDHEC to perform toxicity tests using D. ambigua in 2002, and at this time is the only laboratory certified by SCDHEC to perform tests with this species. Because of the expense associated with maintaining the D. ambigua culture for several years when no toxicity testing is required, SRS decided to

A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

PubMed Central

2013-01-01

Background In emergency settings, verification of endotracheal tube (ETT) location is important for critically ill patients. Ignorance of oesophageal intubation can be disastrous. Many methods are used for verification of the endotracheal tube location; none are ideal. Quantitative waveform capnography is considered the standard of care for this purpose but is not always available and is expensive. Therefore, this feasibility study is conducted to compare a cheaper alternative, bedside upper airway ultrasonography to waveform capnography, for verification of endotracheal tube location after intubation. Methods This was a prospective, single-centre, observational study, conducted at the HRPB, Ipoh. It included patients who were intubated in the emergency department from 28 March 2012 to 17 August 2012. A waiver of consent had been obtained from the Medical Research Ethics Committee. Bedside upper airway ultrasonography was performed after intubation and compared to waveform capnography. Specificity, sensitivity, positive and negative predictive value and likelihood ratio are calculated. Results A sample of 107 patients were analysed, and 6 (5.6%) had oesophageal intubations. The overall accuracy of bedside upper airway ultrasonography was 98.1% (95% confidence interval (CI) 93.0% to 100.0%). The kappa value (Κ) was 0.85, indicating a very good agreement between the bedside upper airway ultrasonography and waveform capnography. Thus, bedside upper airway ultrasonography is in concordance with waveform capnography. The sensitivity, specificity, positive predictive value and negative predictive value of bedside upper airway ultrasonography were 98.0% (95% CI 93.0% to 99.8%), 100% (95% CI 54.1% to 100.0%), 100% (95% CI 96.3% to 100.0%) and 75.0% (95% CI 34.9% to 96.8%). The likelihood ratio of a positive test is infinite and the likelihood ratio of a negative test is 0.0198 (95% CI 0.005 to 0.0781). The mean confirmation time by ultrasound is 16.4 s. No adverse effects

Avoid falling for a jerk(ette): Effectiveness of the Premarital Interpersonal Choices and Knowledge Program among Emerging Adults.

PubMed

Bradford, Kay; Stewart, J Wade; Pfister, Roxane; Higginbotham, Brian J

2016-10-01

Premarital education may help emerging adults form healthy relationships, but evaluation research is needed, particularly with community samples. We studied emerging adults in the Premarital Interpersonal Choices and Knowledge (PICK) program, using a pre- to post- and a posttest-then-retrospective-pretest design to examine change in perceived relationship skills, partner selection, relational patterns, and relationship behaviors and attitudes. Mixed models analyses showed that scores for the treatment group (n = 682) increased from pre to post on all four outcomes. Changes in scores for the nonequivalent comparison group (n = 462) were nonsignificant. In addition, significant differences between pre- and retrospective prescores demonstrated evidence for response shift bias. The results suggest that the PICK program helps participants increase their knowledge regarding the components of healthy relationship formation. © 2016 American Association for Marriage and Family Therapy.

OCTN1 is a high-affinity carrier of nucleoside analogs

PubMed Central

Drenberg, Christina D.; Gibson, Alice A.; Pounds, Stanley B.; Shi, Lei; Rhinehart, Dena P.; Li, Lie; Hu, Shuiying; Du, Guoqing; Nies, Anne T.; Schwab, Matthias; Pabla, Navjotsingh; Blum, William; Gruber, Tanja A.; Baker, Sharyn D.; Sparreboom, Alex

2017-01-01

Resistance to xenobiotic nucleosides used to treat acute myeloid leukemia (AML) and other cancers remains a major obstacle to clinical management. One process suggested to participate in resistance is reduced uptake into tumor cells via nucleoside transporters, although precise mechanisms are not understood. Through transcriptomic profiling, we determined that low expression of the ergothioneine transporter OCTN1 (SLC22A4; ETT) strongly predicts poor event-free survival and overall survival in multiple cohorts of AML patients receiving treatment with the cytidine nucleoside analog cytarabine. Cell biological studies confirmed OCTN1-mediated transport of cytarabine and various structurally-related cytidine analogs, such as 2′deoxycytidine and gemcitabine, occurs through a saturable process that is highly sensitive to inhibition by the classic nucleoside transporter inhibitors dipyridamole and nitrobenzylmercaptopurine ribonucleoside (NBMPR). Our findings have immediate clinical implications given the potential of the identified transport system to help refine strategies that could improve patient survival across multiple cancer types where nucleoside analogs are used in cancer treatment. PMID:28209616

iPTF16fnl: A Faint and Fast Tidal Disruption Event in an E+A Galaxy

DOE PAGES

Blagorodnova, N.; Gezari, S.; Hung, T.; ...

2017-07-20

Here, we present ground-based and Swift observations of iPTF16fnl, a likely tidal disruption event (TDE) discovered by the intermediate Palomar Transient Factory (iPTF) survey at 66.6 Mpc. The light curve of the object peaked at an absolute magmore » $${M}_{g}=-17.2$$. The maximum bolometric luminosity (from optical and UV) was $${L}_{p}\\simeq (1.0\\pm 0.15)\\times {10}^{43}$$ erg s -1, an order of magnitude fainter than any other optical TDE discovered so far. The luminosity in the first 60 days is consistent with an exponential decay, with $$L\\propto {e}^{-(t-{t}_{0})/\\tau }$$, where t 0 = 57631.0 (MJD) and $$\\tau \\simeq 15$$ days. The X-ray shows a marginal detection at $${L}_{X}={2.4}_{-1.1}^{1.9}\\times {10}^{39}$$ erg s -1 (Swift X-ray Telescope). No radio counterpart was detected down to 3σ, providing upper limits for monochromatic radio luminosities of $${\

iPTF16fnl: A Faint and Fast Tidal Disruption Event in an E+A Galaxy

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

Blagorodnova, N.; Gezari, S.; Hung, T.

Here, we present ground-based and Swift observations of iPTF16fnl, a likely tidal disruption event (TDE) discovered by the intermediate Palomar Transient Factory (iPTF) survey at 66.6 Mpc. The light curve of the object peaked at an absolute magmore » $${M}_{g}=-17.2$$. The maximum bolometric luminosity (from optical and UV) was $${L}_{p}\\simeq (1.0\\pm 0.15)\\times {10}^{43}$$ erg s -1, an order of magnitude fainter than any other optical TDE discovered so far. The luminosity in the first 60 days is consistent with an exponential decay, with $$L\\propto {e}^{-(t-{t}_{0})/\\tau }$$, where t 0 = 57631.0 (MJD) and $$\\tau \\simeq 15$$ days. The X-ray shows a marginal detection at $${L}_{X}={2.4}_{-1.1}^{1.9}\\times {10}^{39}$$ erg s -1 (Swift X-ray Telescope). No radio counterpart was detected down to 3σ, providing upper limits for monochromatic radio luminosities of $${\

Effects of Cooling Conditions on Tensile and Charpy Impact Properties of API X80 Linepipe Steels

NASA Astrophysics Data System (ADS)

Han, Seung Youb; Shin, Sang Yong; Lee, Sunghak; Kim, Nack J.; Bae, Jin-Ho; Kim, Kisoo

2010-02-01

In this study, four API X80 linepipe steel specimens were fabricated by varying the cooling rate and finish cooling temperature, and their microstructures and crystallographic orientations were analyzed to investigate the effects of the cooling conditions on the tensile and Charpy impact properties. All the specimens consisted of acicular ferrite (AF), granular bainite (GB), and martensite-austenite (MA) constituents. The volume fraction of MA increased with an increasing cooling rate, and the volume fraction and size of MA tended to decrease with an increasing finish cooling temperature. According to the crystallographic orientation analysis data, the effective grain size and unit crack path decreased as fine ACs having a large amount of high-angle grain boundaries were homogeneously formed, thereby leading to the improvement in the Charpy impact properties. The specimen fabricated with the higher cooling rate and lower finish cooling temperature had the highest upper-shelf energy (USE) and the lowest energy transition temperature (ETT), because it contained a large amount of MA homogeneously distributed inside fine AFs, while its tensile properties remained excellent.

Diagnosing and treating rare lesions in a low resource setting: lessons from ahybrid epithelioid trophoblastic tumor and choriocarcinoma.

PubMed

Akakpo, Patrick K; Ulzen-Appiah, Kofi; Agbeno, Evans; Derkyi-Kwarteng, Leonard

2017-12-01

To raise awareness of the existence of a rare type of malignant trophoblastic tumor and discuss the diagnostic challenges and management of this lesion in a low resource setting. A 35 -year -old G 6 P 3 woman was referred to our facility on account of persistent vaginal bleeding due to a suspected incomplete miscarriage with a cervical mass. Her serum β-HCG was elevated (36,900 mIU/ml) and examination showed a bleeding cervical mass. An initial histopathological diagnosis of moderately differentiated squamous cell carcinoma was reviewed to epithelioid trophoblastic tumor resulting in an extra-fascial hysterectomy. A final histopathological diagnosis of hybrid Epithelioid Trophoblastic Tumor and Choriocarcinoma (ETT/CC) was made after external review and immunohistochemistry. She received subsequent chemotherapy. Epithelioid trophoblastic tumor and its hybrids are difficult to diagnose. They may be diagnosed as moderately differentiated squamous cell carcinoma especially in low resource settings where cervical squamous cell carcinoma is relatively more common. A high index of suspicion, a serum β HCG test and close collaboration between clinicians and pathologists can help make the diagnosis. None.

Theory of noise equivalent power of a high-temperature superconductor far-infrared bolometer in a photo-thermoelectrical mode of operation

NASA Astrophysics Data System (ADS)

Kaila, M. M.; Russell, G. J.

2000-12-01

We present a theory of noise equivalent power (NEP) and related parameters for a high-temperature superconductor (HTSC) bolometer in which temperature and resistance are the noise sources for open circuit operation and phonon and resistance are the noise sources for voltage-biased operation of the bolometer. The bolometer is designed to use a photo-thermoelectrical mode of operation. A mathematical formulation for the open circuit operation is first presented followed by an analysis of the heterodyne case with a bias applied in constant voltage mode. For the first time electrothermal (ET) and thermoelectrical (TE) feedback are treated in the heat balance equation simultaneously. A parallel resistance geometry consisting of thermoelectric and HTSC material legs has been chosen for the device. Computations for the ET-TE feedback show that the response time improves by three orders of magnitude and the responsivity becomes double for the same TE feedback. In the heat balance equation we have included among the heat transfer processes the temperature dependence of the thermal conductance at the bolometer-substrate interface for the dynamic state.

Persistance de la veine cave supérieure gauche: à propos d'un cas

PubMed Central

Abidi, Kamel; Jellouli, Manel; Hammi, Yousra; Gargah, Tahar

2015-01-01

La persistance de la veine cave supérieure gauche (PVCSG) est une malformation congénitale rare et bénigne. Elle est souvent asymptomatique et sa découverte est dans la majorité des cas fortuite. Nous rapportons le cas d'un enfant chez lequel on découvre cette anomalie suite à une perte de connaissance. S.M, âgé de 9 ans, sans antécédents pathologiques notables, admis pour perte de connaissance de durée brève, sans mouvements anormaux toniques ou cloniques. L'examen physique à son admission est normal. L’électrocardiogramme est sans anomalies. La radiographie du thorax a montré un arc moyen gauche en double contour. Le Holter rythmique a montré des signes d'hyperréactivité vagale. L’échocardiographie trans-thoracique (ETT) a mis en évidence une dilatation nette du sinus coronaire et a éliminé la présence d'une cardiopathie. Une angio- IRM cardiaque a confirmé le diagnostic de PVCSG. Par ailleurs l'aorte thoracique a été normale dans ces différents segments. PMID:26664537

Do PICU patients meet technical criteria for performing indirect calorimetry?

PubMed

Beggs, Megan R; Garcia Guerra, Gonzalo; Larsen, Bodil M K

2016-10-01

Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown. In the current study, we aimed to quantify the daily proportion of consecutive PICU patients who met technical criteria to perform indirect calorimetry and describe the technical contraindications when criteria were not met. Prospective, observational, single-centre study conducted in a cardiac and general PICU. All consecutive patients admitted for at least 96 h were included in the study. Variables collected for each patient included age at admission, admission diagnosis, and if technical criteria for indirect calorimetry were met. Technical criteria variables were collected within the same 2 h each morning and include: provision of supplemental oxygen, ventilator settings, endotracheal tube (ETT) leak, diagnosis of chest tube air leak, provision of external gas support (i.e. nitric oxide), and provision of extracorporeal membrane oxygenation (ECMO). 288 patients were included for a total of 3590 patient days between June 2014 and February 2015. The main reasons for admission were: surgery (cardiac and non-cardiac), respiratory distress, trauma, oncology and medicine/other. The median (interquartile range) patient age was 0.7 (0.3-4.6) years. The median length of PICU stay was 7 (5-14) days. Only 34% (95% CI, 32.4-35.5%) of patient days met technical criteria for IC. For patients less than 6 months of age, technical criteria were met on significantly fewer patient days (29%, p < 0.01). Moreover, 27% of patients did not meet technical criteria for IC on any day

Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

PubMed Central

Zou, Jianyong; Su, Chunhua; Lun, Xueping; Liu, Weibing; Yang, Weiling; Zhong, Beilong; Zhu, Haoshuai; Lei, Yiyan; Luo, Honghe; Chen, Zhenguang

2016-01-01

Abstract A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined. From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed. A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia. Our results suggest that clinicians should consider the risk factors for POMC—especially preoperative anxiety—before performing a thymectomy in patients with MG. PMID:26962777

Pressure-induced electronic topological transitions in the charge-density-wave material In 4 Se 3

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

Zhang, Yuhang; Song, Liyan; Shao, Xuecheng

2017-08-01

High-pressure in situ angle dispersive X-ray diffraction (ADXRD) measurements were performed on the charge-density-wave (CDW) material In4Se3 up to 48.8 GPa. Pressure-induced structural changes were observed at 7.0 and 34.2 GPa, respectively. Using the CALYPSO methodology, the first high-pressure phase was solved as an exotic Pca21 structure. The compressional behaviors of the initial Pnnm and the Pca21 phases were all determined. Combined with first-principle calculations, we find that, unexpectedly, the Pnnm phase probably experiences twice electronic topological transitions (ETTs), from the initial possible CDW state to a semimetallic state at about 2.3 GPa and then back to a possible CDWmore » state at around 3.5 GPa, which was uncovered for the first time in CDW systems. In the both possible CDW states, pressure provokes a decrease of band-gap. The observation of a bulk metallic state was ascribed to structural transition to the Pca21 phase. Besides, based on electronic band structure calculations, the thermoelectric property of the Pnnm phase under compression was discussed. Our results show that pressure play a dramatic role in tuning In4Se3's structure and transport properties.« less

The Different Effects of BMI and WC on Organ Damage in Patients from a Cardiac Rehabilitation Program after Acute Coronary Syndrome

PubMed Central

Xu, Lin; Zhao, Hui; Qiu, Jian; Zhu, Wei; Lei, Hongqiang; Cai, Zekun; Huang, Wenhua; Zhang, Heye; Zhang, Yuan-Ting

2015-01-01

One of the purposes of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) is to monitor and control weight of the patient. Our study is to compare the different obesity indexes, body mass index (BMI), and waist circumference (WC), through one well-designed CR program (CRP) with ACS in Guangzhou city of Guangdong Province, China, in order to identify different effects of BMI and WC on organ damage. In our work, sixty-one patients between October 2013 and January 2014 fulfilled our study. We collected the vital signs by medical records, the clinical variables of body-metabolic status by fasting blood test, and the organ damage variables by submaximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) both on our inpatient and four-to-five weeks of outpatient part of CRP after ACS. We mainly used two-tailed Pearson's test and liner regression to evaluate the relationship of BMI/WC and organ damage. Our results confirmed that WC could be more accurate than BMI to evaluate the cardiac function through the changes of left ventricular structure on the CRP after ACS cases. It makes sense of early diagnosis, valid evaluation, and proper adjustment to ACS in CRP of the obesity individuals in the future. PMID:26247035

A database analysis method identifies an endogenous trans-acting short-interfering RNA that targets the Arabidopsis ARF2, ARF3, and ARF4 genes

PubMed Central

Williams, Leor; Carles, Cristel C.; Osmont, Karen S.; Fletcher, Jennifer C.

2005-01-01

Two classes of small RNAs, microRNAs and short-interfering RNA (siRNAs), have been extensively studied in plants and animals. In Arabidopsis, the capacity to uncover previously uncharacterized small RNAs by means of conventional strategies seems to be reaching its limits. To discover new plant small RNAs, we developed a protocol to mine an Arabidopsis nonannotated, noncoding EST database. Using this approach, we identified an endogenous small RNA, trans-acting short-interfering RNA–auxin response factor (tasiR-ARF), that shares a 21- and 22-nt region of sequence similarity with members of the ARF gene family. tasiR-ARF has characteristics of both short-interfering RNA and microRNA, recently defined as tasiRNA. Accumulation of trans-acting siRNA depends on DICER-LIKE1 and RNA-DEPENDENT RNA POLYMERASE6 but not RNA-DEPENDENT RNA POLYMERASE2. We demonstrate that tasiR-ARF targets three ARF genes, ARF2, ARF3/ETT, and ARF4, and that both the tasiR-ARF precursor and its target genes are evolutionarily conserved. The identification of tasiRNA-ARF as a low-abundance, previously uncharacterized small RNA species proves our method to be a useful tool to uncover additional small regulatory RNAs. PMID:15980147

Synthesis, characterization and computational study of the newly synthetized sulfonamide molecule

NASA Astrophysics Data System (ADS)

Murthy, P. Krishna; Suneetha, V.; Armaković, Stevan; Armaković, Sanja J.; Suchetan, P. A.; Giri, L.; Rao, R. Sreenivasa

2018-02-01

A new compound N-(2,5-dimethyl-4-nitrophenyl)-4-methylbenzenesulfonamide (NDMPMBS) has been derived from 2,5-dimethyl-4-nitroaniline and 4-methylbenzene-1-sulfonyl chloride. Structure was characterized by SCXRD studies and spectroscopic tools. Compound crystallized in the monoclinic crystal system with P21/c space group a = 10.0549, b = 18.967, c = 8.3087, β = 103.18 and Z = 4. Type and nature of intermolecular interaction in crystal state investigated by 3D-Hirshfeld surface and 2D-finger print plots revealed that title compound stabilized by several interactions. The structural and electronic properties of title compound have been calculated at DFT/B3LYP/6-311G++(d,p) level of theory. Computationally obtained spectral data was compared with experimental results, showing excellent mutual agreement. Assignment of each vibrational wave number was done on the basis of potential energy distribution (PED). Investigation of local reactivity descriptors encompassed visualization of molecular electrostatic potential (MEP) and average local ionization energy (ALIE) surfaces, visualization of Fukui functions, natural bond order (NBO) analysis, bond dissociation energies for hydrogen abstraction (H-BDE) and radial distribution functions (RDF) after molecular dynamics (MD) simulations. MD simulations were also used in order to investigate interaction of NDMPMBS molecule with 1WKR and 3ETT proteins protein.

Transition state analogs of 5'-methylthioadenosine nucleosidase disrupt quorum sensing.

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

Gutierrez, J.; Crowder, T; Rinaldo-Matthis, A

2009-01-01

5'-Methylthioadenosine/S-adenosylhomocysteine nucleosidase (MTAN) is a bacterial enzyme involved in S-adenosylmethionine-related quorum sensing pathways that induce bacterial pathogenesis factors. Transition state analogs MT-DADMe-Immucillin-A, EtT-DADMe-Immucillin-A and BuT-DADMe-Immucillin-A are slow-onset, tight-binding inhibitors of Vibrio cholerae MTAN (VcMTAN), with equilibrium dissociation constants of 73, 70 and 208 pM, respectively. Structural analysis of VcMTAN with BuT-DADMe-Immucillin-A revealed interactions contributing to the high affinity. We found that in V. cholerae cells, these compounds are potent MTAN inhibitors with IC50 values of 27, 31 and 6 nM for MT-, EtT- and BuT-DADMe-Immucillin-A, respectively; the compounds disrupt autoinducer production in a dose-dependent manner without affecting growth. MT- andmore » BuT-DADMe-Immucillin-A also inhibited autoinducer-2 production in enterohemorrhagic Escherichia coli O157:H7 with IC{sub 50} values of 600 and 125 nM, respectively. BuT-DADMe-Immucillin-A inhibition of autoinducer-2 production in both strains persisted for several generations and caused reduction in biofilm formation. These results support MTAN's role in quorum sensing and its potential as a target for bacterial anti-infective drug design.« less

Experimental evidence of the 6He level at E*=18.3 MeV via the 4He + 3H three-body reaction

NASA Astrophysics Data System (ADS)

Povoroznyk, O. M.; Gorpinich, O. K.; Jachmenjov, O. O.; Mokhnach, H. V.; Ponkratenko, O.; Mandaglio, G.; Curciarello, F.; De Leo, V.; Fazio, G.; Giardina, G.

2012-06-01

Measurements of the t-t and p-t coincidence events in the 3H (α,tt)1H reaction have been obtained at incident energy Eα=67.2 MeV. Various appropriate angular configurations of detectors were chosen in order to observe the population of the 6He* state at around 18 MeV. Its contribution appears at the relative energy of Ett=6.0 MeV as found from an analysis of the bidimensional spectra. We found the formation of the 6He excited state at E*=18.3±0.2 MeV (with a Γ width of 1.1 ± 0.3 MeV) by using the decay into the t+t binary channel, since the threshold energy of the t+t channel is 12.31 MeV. In each analyzed bidimensional energy spectrum of (Et, Et) and (Ep, Et) coincidence events, resonance structures are present due to the formation of both 6He* and 4He* excited states. Our results on the E* and Γ values regarding the 6He* level of about 18 MeV are compared with the results obtained using other reactions. Moreover, we also found new Γ width values of 0.7 ± 0.3 and 0.8 ± 0.4 MeV for the 14.0 ± 0.4 and 16.1 ± 0.4 MeV 6He levels, respectively.

Evidence-Based Psychosocial Treatments for Pediatric Elimination Disorders.

PubMed

Shepard, Jaclyn A; Poler, Joseph E; Grabman, Jesse H

2017-01-01

Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies-18 for nocturnal enuresis and 7 for encopresis-over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified as well-established treatments, Full Spectrum Home Therapy was probably efficacious, lifting was possibly efficacious, and hypnotherapy and retention control training were classified as treatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders.

Evidence for the antiferromagnetic ground state of Zr2TiAl: a first-principles study

NASA Astrophysics Data System (ADS)

Sreenivasa Reddy, P. V.; Kanchana, V.; Vaitheeswaran, G.; Ruban, Andrei V.; Christensen, N. E.

2017-07-01

A detailed study on the ternary Zr-based intermetallic compound Zr2TiAl has been carried out using first-principles electronic structure calculations. From the total energy calculations, we find an antiferromagnetic L11-like (AFM) phase with alternating (1 1 1) spin-up and spin-down layers to be a stable phase among some others with magnetic moment on Ti being 1.22 {μ\\text{B}} . The calculated magnetic exchange interaction parameters of the Heisenberg Hamiltonian and subsequent Heisenberg Monte Carlo simulations confirm that this phase is the magnetic ground structure with Néel temperature between 30 and 100 K. The phonon dispersion relations further confirm the stability of the magnetic phase while the non-magnetic phase is found to have imaginary phonon modes and the same is also found from the calculated elastic constants. The magnetic moment of Ti is found to decrease under pressure eventually driving the system to the non-magnetic phase at around 46 GPa, where the phonon modes are found to be positive indicating stability of the non-magnetic phase. A continuous change in the band structure under compression leads to the corresponding change of the Fermi surface topology and electronic topological transitions (ETT) in both majority and minority spin cases, which are also evident from the calculated elastic constants and density of state calculations for the material under compression.

Partitioning Evapotranspiration in Semiarid Grassland and Shrubland Ecosystems Using Diurnal Surface Temperature Variation

NASA Technical Reports Server (NTRS)

Moran, M. Susan; Scott, Russell L.; Keefer, Timothy O.; Paige, Ginger B.; Emmerich, William E.; Cosh, Michael H.; O'Neill, Peggy E.

2007-01-01

The encroachment of woody plants in grasslands across the Western U.S. will affect soil water availability by altering the contributions of evaporation (E) and transpiration (T) to total evapotranspiration (ET). To study this phenomenon, a network of flux stations is in place to measure ET in grass- and shrub-dominated ecosystems throughout the Western U.S. A method is described and tested here to partition the daily measurements of ET into E and T based on diurnal surface temperature variations of the soil and standard energy balance theory. The difference between the mid-afternoon and pre-dawn soil surface temperature, termed Apparent Thermal Inertia (I(sub A)), was used to identify days when E was negligible, and thus, ET=T. For other days, a three-step procedure based on energy balance equations was used to estimate Qe contributions of daily E and T to total daily ET. The method was tested at Walnut Gulch Experimental Watershed in southeast Arizona based on Bowen ratio estimates of ET and continuous measurements of surface temperature with an infrared thermometer (IRT) from 2004- 2005, and a second dataset of Bowen ratio, IRT and stem-flow gage measurements in 2003. Results showed that reasonable estimates of daily T were obtained for a multi-year period with ease of operation and minimal cost. With known season-long daily T, E and ET, it is possible to determine the soil water availability associated with grass- and shrub-dominated sites and better understand the hydrologic impact of regional woody plant encroachment.

Effects of Rolling and Cooling Conditions on Microstructure and Tensile and Charpy Impact Properties of Ultra-Low-Carbon High-Strength Bainitic Steels

NASA Astrophysics Data System (ADS)

Sung, Hyo Kyung; Shin, Sang Yong; Hwang, Byoungchul; Lee, Chang Gil; Kim, Nack J.; Lee, Sunghak

2011-07-01

Six ultra-low-carbon high-strength bainitic steel plates were fabricated by controlling rolling and cooling conditions, and effects of bainitic microstructure on tensile and Charpy impact properties were investigated. The microstructural evolution was more critically affected by start cooling temperature and cooling rate than by finish rolling temperature. Bainitic microstructures such as granular bainites (GBs) and bainitic ferrites (BFs) were well developed as the start cooling temperature decreased or the cooling rate increased. When the steels cooled from 973 K or 873 K (700 °C or 600 °C) were compared under the same cooling rate of 10 K/s (10 °C/s), the steels cooled from 973 K (700 °C) consisted mainly of coarse GBs, while the steels cooled from 873 K (600 °C) contained a considerable amount of BFs having high strength, thereby resulting in the higher strength but the lower ductility and upper shelf energy (USE). When the steels cooled from 673 K (400 °C) at a cooling rate of 10 K/s (10 °C/s) or 0.1 K/s (0.1 °C/s) were compared under the same start cooling temperature of 873 K (600 °C), the fast cooled specimens were composed mainly of coarse GBs or BFs, while the slowly cooled specimens were composed mainly of acicular ferrites (AFs). Since AFs had small effective grain size and contained secondary phases finely distributed at grain boundaries, the slowly cooled specimens had a good combination of strength, ductility, and USE, together with very low energy transition temperature (ETT).

Availability and use of capnography for in-hospital cardiac arrests in the United Kingdom.

PubMed

Turle, Sarah; Sherren, Peter B; Nicholson, Stuart; Callaghan, Thomas; Shepherd, Stephen J

2015-09-01

Airway complications occur more frequently outside the operating theatre and in emergency situations. Capnography remains the gold standard for confirming correct endotracheal tube placement, retaining high sensitivity and specificity in cardiac arrest. The 2010 European Resuscitation Council guidelines for adult advanced life support recommended waveform capnography in this setting. We investigated current UK practice relating to the availability and use of this technology during cardiac arrest. Between June and November 2014, a study was conducted of all UK acute hospitals with both a level three adult intensive care unit (ICU) and an emergency department (ED). A telephone questionnaire was administered examining intubation practice and utilisation of capnography within the ED, ICU and general wards. Two hundred and eleven hospitals met the inclusion criteria. The response rate was 100%. Arrests were mainly attended by anaesthesia (48%) and ICU physicians (38%) of registrar grade (56%). The ability to measure end tidal carbon dioxide (ETCO2) was available in all but 4 EDs; most used in waveform devices. Most ICUs were similar. However, in 67% of hospitals surveyed, it was not possible to measure ETCO2 in general wards. Where available, 87% used capnography to confirm ETT placement with less than 50% using ETCO2 to determine CPR effectiveness and 8% to prognosticate. We believe this is the first study of its kind to fully investigate the availability and use of capnography during cardiac arrest throughout the hospital. Whilst equipment provision appears adequate in critical care areas, it is insufficient in general wards. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Isolation and Characterization of Glycosylated Phosphoproteins from Herring Fish Bones*

PubMed Central

Zhou, Hai-Yan; Salih, Erdjan; Glimcher, Melvin J.

2010-01-01

Past studies of bone extracellular matrix phosphoproteins such as osteopontin and bone sialoprotein have yielded important biological information regarding their role in calcification and the regulation of cellular activity. Most of these studies have been limited to proteins extracted from mammalian and avian vertebrates and nonvertebrates. The present work describes the isolation and purification of two major highly glycosylated and phosphorylated extracellular matrix proteins of 70 and 22 kDa from herring fish bones. The 70-kDa phosphoprotein has some characteristics of osteopontin with respect to amino acid composition and susceptibility to thrombin cleavage. Unlike osteopontin, however, it was found to contain high levels of sialic acid similar to bone sialoprotein. The 22-kDa protein has very different properties such as very high content of phosphoserine (∼270 Ser(P) residues/1000 amino acid residues), Ala, and Asx residues. The N-terminal amino acid sequence analysis of both the 70-kDa (NPIMA(M)ETTS(M)DSKVNPLL) and the 22-kDa (NQDMAMEASSDPEAA) fish phosphoproteins indicate that these unique amino acid sequences are unlike any published in protein databases. An enzyme-linked immunosorbent assay revealed that the 70-kDa phosphoprotein was present principally in bone and in calcified scales, whereas the 22-kDa phosphoprotein was detected only in bone. Immunohistological analysis revealed diffusely positive immunostaining for both the 70- and 22-kDa phosphoproteins throughout the matrix of the bone. Overall, this work adds additional support to the concept that the mechanism of biological calcification has common evolutionary and fundamental bases throughout vertebrate species. PMID:20833721

Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study

PubMed Central

Jena, Sritam; Kamath, Sriganesh; Masapu, Dheeraj; Veenakumari, H. B.; Ramesh, Venkatapura J.; Bhadrinarayan, Varadarajan; Ravikumar, R.

2016-01-01

Background: Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome. Methods: Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube. Results: The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay. Conclusions: In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation. PMID:27275073

Direct restoration of endodontically treated maxillary central incisors: post or no post at all?

PubMed

von Stein-Lausnitz, Manja; Bruhnke, M; Rosentritt, M; Sterzenbach, G; Bitter, K; Frankenberger, R; Naumann, M

2018-04-30

The aim of this ex-vivo study was to evaluate the impact of cavity size and glass-fiber post (GFP) placement on the load capability of endodontically treated maxillary incisors directly restored with resin composite. Ninety-six extracted human maxillary central incisors were endodontically treated and distributed to four groups (n = 24): access cavity (A), access cavity and uni-proximal class III cavity (U), access cavity and bi-proximal class III cavity (B), and decoronated tooth (D). Specimens were restored with resin composite, and 12 specimen of each group received an adhesively placed glass-fiber post (P). Prior to linear loading, specimens were exposed to thermo-mechanical loading (TCML). Statistical analysis was performed using log-rank test after TCML, Kruskall-Wallis and Mann-Whitney U test to compare load capabilities (F max) . Significantly more failures occurred in group D for specimens without GFP during TCML (p = 0.001). F max (mean (SD) in N was (A) 513 (124), (AP) 554 (201), (U) 438 (171), (UP) 537 (232) (B) 483 (219), (BP) 536 (281), D 143 (181), and DP 500 (331), and differed significantly among groups (p = 0.003). Pair-wise comparison revealed lower F max values for group D compared to all other groups (p < 0.034) except group DP. Endodontically treated maxillary central incisors with cavity sizes up to bi-proximal class III may be successfully directly restored with resin composite. Post placement shows no additional effect except for decoronated endodontically treated incisors. Endodontically treated incisors with access cavities to class III cavities can be successfully restored with resin composite. Post placement for decoronated ETT is recommended.

Surgical fires in laser laryngeal surgery: are we safe enough?

PubMed

Roy, Soham; Smith, Lee P

2015-01-01

Laser surgery of the larynx and airway remains high risk for the formation of operating room fire. Traditional methods of fire prevention have included use of "laser safe" tubes, inflation of a protective cuff with saline, and wet pledgets to protect the endotracheal tube from laser strikes. We tested a mechanical model of laser laryngeal surgery to evaluate the fire risk. Mechanical model. Laboratory. An intubation mannequin was positioned for suspension microlaryngoscopy. A Laser-Shield II cuffed endotracheal tube was placed through the larynx and the cuff inflated using saline. Wet pledgets covered the inflated cuff. A CO2 laser created an inadvertent cuff strike at varying oxygen concentrations. Risk reduction measures were implemented to discern any notable change in the outcome after fire. At 100% FiO2 an immediate fire with sustained flame was created and at 40% FiO2 a near immediate sustained flame was created. At 29% FiO2, a small nonsustained flame was noted. At room air, no fire was created. There was no discernible difference in the severity of laryngeal damage after the fire occurred whether the tube was immediately pulled from the mannequin or if saline was poured down the airway as a first response. While "laser safe" tubes provide a layer of protection against fires, they are not fire proof. Inadvertent cuff perforation may result in fire formation in low-level oxygen enriched environments. Placement of wet pledgets do not provide absolute protection. Endotracheal tube (ETT) cuffs should be placed distally well away from an inadvertent laser strike while maintaining the minimum supplemental oxygen necessary. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Six months of multiwavelength follow-up of the tidal disruption candidate ASASSN-14li and implied TDE rates from ASAS-SN

NASA Astrophysics Data System (ADS)

Holoien, T. W.-S.; Kochanek, C. S.; Prieto, J. L.; Stanek, K. Z.; Dong, Subo; Shappee, B. J.; Grupe, D.; Brown, J. S.; Basu, U.; Beacom, J. F.; Bersier, D.; Brimacombe, J.; Danilet, A. B.; Falco, E.; Guo, Z.; Jose, J.; Herczeg, G. J.; Long, F.; Pojmanski, G.; Simonian, G. V.; Szczygieł, D. M.; Thompson, T. A.; Thorstensen, J. R.; Wagner, R. M.; Woźniak, P. R.

2016-01-01

We present ground-based and Swift photometric and spectroscopic observations of the candidate tidal disruption event (TDE) ASASSN-14li, found at the centre of PGC 043234 (d ≃ 90 Mpc) by the All-Sky Automated Survey for SuperNovae (ASAS-SN). The source had a peak bolometric luminosity of L ≃ 1044 erg s-1 and a total integrated energy of E ≃ 7 × 1050 erg radiated over the ˜6 months of observations presented. The UV/optical emission of the source is well fitted by a blackbody with roughly constant temperature of T ˜ 35 000 K, while the luminosity declines by roughly a factor of 16 over this time. The optical/UV luminosity decline is broadly consistent with an exponential decline, L∝ e^{-t/t_0}, with t0 ≃ 60 d. ASASSN-14li also exhibits soft X-ray emission comparable in luminosity to the optical and UV emission but declining at a slower rate, and the X-ray emission now dominates. Spectra of the source show broad Balmer and helium lines in emission as well as strong blue continuum emission at all epochs. We use the discoveries of ASASSN-14li and ASASSN-14ae to estimate the TDE rate implied by ASAS-SN, finding an average rate of r ≃ 4.1 × 10-5 yr-1 per galaxy with a 90 per cent confidence interval of (2.2-17.0) × 10-5 yr-1 per galaxy. ASAS-SN found roughly 1 TDE for every 70 Type Ia supernovae in 2014, a rate that is much higher than that of other surveys.

Comparison of techniques for visualisation of the airway anatomy for ultrasound-assisted intubation: A prospective study of emergency department patients.

PubMed

Romano, Michael J; Lee, Jacques S; Chenkin, Jordan

2018-02-04

Ultrasound has been shown to be a highly accurate adjunct for confirming endotracheal tube (ETT) placement, however there is no universally accepted scanning technique. The objective of this study was to determine which ultrasound technique provides the highest rate of adequate airway visualisation in a sample of stable emergency department (ED) patients. We conducted a prospective observational study using a convenience sample of ED patients. Airway imaging was performed using the following five techniques: 1) transcricothryoid membrane (TCM), 2) suprasternal notch (SSN) without transducer pressure, 3) SSN with pressure, 4) SSN with pressure to the left of the trachea and 5) SSN with pressure to the right of the trachea. A blinded reviewer scored the adequacy of airway visualisation for each technique. A total of 100 patients were enrolled in the study. SSN to the left of the trachea with pressure had the highest rate of adequate airway visualisation (93.0%, 95% CI 86.1-97.1%), followed by 82.0% (95% CI 73.1-89.0%) for SSN with pressure, 74.0% (95% CI 64.3-82.3%) for TCM, 44.0% (95% CI 34.1-54.3%) for SSN without pressure, and 1.0% (95% CI 0.0-5.4%) for SSN to the right of the trachea. In 76.0% (95% CI 66.4-84.0%) of patients, the SSN view was improved by moving the probe off the midline towards the patient's left. In a sample of ED patients, the airway anatomy relevant for use in endotracheal intubation is best visualised at the SSN to the left of the trachea with transducer pressure applied. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

[Postoperative visual loss due to conversion disorder after spine surgery: a case report].

PubMed

Bezerra, Dailson Mamede; Bezerra, Eglantine Mamede; Silva Junior, Antonio Jorge; Amorim, Marco Aurélio Soares; Miranda, Denismar Borges de

Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. A male patient, 39 years old, 71kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30minutes, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Hydrologic Evaluation of a Humid Climate Poplar Phytoremediation Barrier

NASA Astrophysics Data System (ADS)

Swensen, K.; Rabideau, A. J.

2016-12-01

The emplacement of hybrid poplar trees to function as phytoremediation barriers is an appealing and sustainable groundwater management strategy because of low maintenance costs and the potential to extract large amounts of groundwater without pumping. While the effectiveness of poplar barriers has been assessed by groundwater quality monitoring, less attention has been given to physical hydrologic evaluations needed to improve barrier designs. In this research, a five year hydrologic evaluation was conducted at a poplar phytoremediation site in western NY, with the goal of quantifying ETg (evapotranspiration from groundwater) as a measure of the barrier's effectiveness in a humid climate. To consider transpiration from both vadose zone and groundwater, the hydrologic evaluation included four components: physical ET measurements, theoretical ET calculations, analysis of diurnal groundwater table fluctuations, and vadose zone modeling. The direct measurements of ETT (total) were obtained using sap flow meters installed on multiple trees within the barrier. These data were interpreted using a regression model that included theoretical ET calculations and site-specific measurements of weather parameters and poplar trunk area. Application of this model was challenged by the spatial variation in rooting depth as determined by tree excavations. To further quantify the removal of groundwater by the phytobarrier (ETg), the White Method was applied to interpret diurnal groundwater fluctuations from monitoring wells located within the barrier, in conjunction with a variably saturated-saturated flow model configured to confirm water extraction from ETg. Taken together, the results of this five year hydrologic evaluation highlight the complexity in quantifying humid climate groundwater extraction, as a large number of variables were found to influence these rates. Improved understanding of these controls will contribute to improved barrier designs that maximize ETg.

ASASSN-15oi: a rapidly evolving, luminous tidal disruption event at 216 Mpc

NASA Astrophysics Data System (ADS)

Holoien, T. W.-S.; Kochanek, C. S.; Prieto, J. L.; Grupe, D.; Chen, Ping; Godoy-Rivera, D.; Stanek, K. Z.; Shappee, B. J.; Dong, Subo; Brown, J. S.; Basu, U.; Beacom, J. F.; Bersier, D.; Brimacombe, J.; Carlson, E. K.; Falco, E.; Johnston, E.; Madore, B. F.; Pojmanski, G.; Seibert, M.

2016-12-01

We present ground-based and Swift photometric and spectroscopic observations of the tidal disruption event (TDE) ASASSN-15oi, discovered at the centre of 2MASX J20390918-3045201 (d ≃ 216 Mpc) by the All-Sky Automated Survey for SuperNovae. The source peaked at a bolometric luminosity of L ≃ 1.3 × 1044 erg s-1 and radiated a total energy of E ≃ 6.6 × 1050 erg over the first ˜3.5 months of observations. The early optical/UV emission of the source can be fit by a blackbody with temperature increasing from T ˜ 2 × 104 K to T ˜ 4 × 104 K while the luminosity declines from L ≃ 1.3 × 1044 erg s-1 to L ≃ 2.3 × 1043 erg s-1, requiring the photosphere to be shrinking rapidly. The optical/UV luminosity decline during this period is most consistent with an exponential decline, L∝ e^{-(t-t_0)/τ}, with τ ≃ 46.5 d for t0 ≃ 57241.6 (MJD), while a power-law decline of L ∝ (t - t0)-α with t0 ≃ 57 212.3 and α = 1.62 provides a moderately worse fit. ASASSN-15oi also exhibits roughly constant soft X-ray emission that is significantly weaker than the optical/UV emission. Spectra of the source show broad helium emission lines and strong blue continuum emission in early epochs, although these features fade rapidly and are not present ˜3 months after discovery. The early spectroscopic features and colour evolution of ASASSN-15oi are consistent with a TDE, but the rapid spectral evolution is unique among optically selected TDEs.

Material properties of novel polymeric films

NASA Astrophysics Data System (ADS)

Kim, Gene

the two polymer systems. Also, unique in-house characterization methods such as the vibrational holographic interferometry to measure residual stress in these polymer coatings upon processing, and the environmental tensile tester (ETT) to measure ink diffusion and swelling stresses were used to further characterize these two polymers.

Casting for infantile scoliosis: the pitfall of increased peak inspiratory pressure.

PubMed

Dhawale, Arjun A; Shah, Suken A; Reichard, Samantha; Holmes, Laurens; Brislin, Robert; Rogers, Kenneth; Mackenzie, William G

2013-01-01

Serial cast correction is a popular treatment option for progressive infantile scoliosis. Body casting can lead to chest and abdominal expansion restriction and result in decreased chest wall compliance. There are no studies evaluating the effects of casting on ventilation in infantile scoliosis. This study examines changes in peak inspiratory pressure (PIP) during serial casting for infantile scoliosis. We retrospectively reviewed data obtained from 37 serial Cotrel elongation, derotation, and flexion cast corrections in patients with infantile scoliosis. Patient demographics, radiographic measurements, and anesthesia data were recorded. Anesthesia technique was standardized: children were intubated with rigid endotracheal tubes (ETTs); tidal volume was held constant at 8 to 10 cm(3)/kg using volume control ventilation; and PIP was recorded at baseline, after cast application before window cutout, and after window cutout before extubation. Any complications were documented. We assessed the PIP changes with a repeated measures analysis of variance (ANOVA). The mean age at first casting was 21.8 months (range, 12 to 42 mo) and mean follow-up since first casting was 22.4 months (range, 13 to 40 mo) with mean major Cobb angle of 53±15 degrees. The mean PIP was 15.5±4.9 cm H(2)O before casting, 31.9±7.9 cm H(2)O after cast application, and 20.4±5.6 cm H2O after making windows. There was a 106% increase after casting and 32% increase after window cutout from the baseline PIP levels. There was a significant difference in PIP on repeated measures ANOVA (P<0.0001). Intraoperatively, there was difficulty in maintaining ventilation during 2 procedures and 1 hypotensive episode. One patient developed hypoxemia after casting and another had delayed difficulty in breathing. Casting resulted in an increased PIP due to transient restrictive pulmonary process; after windows were cut out, the PIP reduced but not to baseline. In patients with underlying pulmonary disease, the

Atteinte cardiaque au cours de la dystrophie myotonique de Steinert: expérience marocaine, à propos de 18 cas

PubMed Central

Saghi, Ghita; Bouhouch, Rachida; Salaheddine, Loubna; Birouk, Nezha; Nadifi, Salama; Fellat, Ibtissam; Cherti, Mohamed

2015-01-01

La maladie de Steinert ou dystrophie myotonique de type 1 (DM1) est une maladie génétique à transmission autosomique dominante caractérisée par une myotonie et une atteinte de plusieurs organes dont le cœur. L'atteinte cardiaque est la plus grave des atteintes systémiques puisqu'elle conditionne le pronostic vital. Ce travail a pour but de déterminer les anomalies cardiaques rencontrées au cours de la DM1 et de mettre en exergue l'intérêt d'un examen cardiaque rigoureux et régulier, indépendamment de la sévérité de l'atteinte neuromusculaire, ainsi que l'apport des examens cardiaques complémentaires et notamment l'exploration électrophysiologique. 18 patients atteints de DM1 ont bénéficiés d'une exploration cardiaque systématique. Il s'agit de 9 hommes et de 9 femmes, d’âge moyen de 41,8 +/- 16,2 ans. 66 p.100 des patients sont symptomatiques sur le plan cardiovasculaire. Les anomalies électrocardiographiques sont dominées par un trouble de la conduction intra-ventriculaire dans 16 p.100 des cas et un BAV de 1er degré dans 16 p.100 des cas. L'Holter ECG objective une hyperexcitabilité à l’étage atrial et/ou ventriculaire dans 50p.100 des cas. L'ETT est normale chez 95 p.100 des patients. L'exploration électrophysiologique, réalisée chez 4 patients symptomatiques, a objectivé un bloc tronculaire dans un cas ayant conduit à l'implantation d'un PM double chambre. Un seul patient est décédé suite à une détresse respiratoire. Enfin, on n'a pas noté de corrélation entre l'atteinte cardiaque et neuromusculaire. Une exploration cardiaque est indispensable chez tout patient atteint de DM1, en dépit de l'absence de symptômes, et un bilan annuel minimal s'impose pour guetter un éventuel trouble rythmique et/ou conductif, fatal en l'absence de traitement adéquat. PMID:26097635

The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.

PubMed

Yeung, Joyce; Chilwan, Mehboob; Field, Richard; Davies, Robin; Gao, Fang; Perkins, Gavin D

2014-07-01

Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient

Calcifications valvulaires chez l'hémodialysé au Maroc

PubMed Central

Noto-Kadou-Kaza, Béfa; Abouamrane, Lalla Meryam; Mtiou, Naoufal; El Khaya, Selma; Zamd, Mohamed; Medkouri, Ghislaine; Bengahanem, Mohamed Gharbi; Ramdani, Benyounes

2016-01-01

Introduction Les calcifications valvulaires constituent une des complications cardiovasculaires majeures de l'hémodialysé de par sa prévalence et son caractère prédictif de morbidité et de mortalité. De nombreux facteurs de risque sont à l'origine de ces calcifications. Le but de notre étude est d’évaluer à la fois la prévalence des calcifications valvulaires chez nos patients hémodialysés ainsi que leurs facteurs de risque. Méthodes Il s'agissait d'une étude transversale monocentrique, descriptive et analytique, ayant inclus 111 patients adultes hémodialysés depuis plus de 6 mois au centre d'hémodialyse du CHU Ibn Rochd de Casablanca et qui ont eu à bénéficier d'une ETT durant l'année 2013. Résultats L’âge moyen de nos patients était de 44 ± 14 ans. L'ancienneté moyenne en hémodialyse était de 146 ± 80 mois. La pression artérielle moyenne était de 123 ± 23 mmHg pour la systolique et de 72 ± 13 mmHg pour la diastolique, la PTHi moyenne de 529±460 pg/ml, la calcémie moyenne de 86±10 mg/l et la phosphatémie moyenne de 40±15 mg/l. La CRP moyenne était de 11±19,8 mg/L. Sur le plan thérapeutique, 96% des patients étaient sous carbonate de calcium, 11% sous 25 OH vitamine D, 55,5% sous 1 hydroxy-vitamine D3. La prévalence des calcifications valvulaires était de 15% avec une localisation valvulaire aortique dans 41,2% et valvulaire mitrale dans 41,2%. En analyse univariée, seule la durée d'hémodialyse semble être associée à la survenue des calcifications avec p = 0,09 proche du seuil de significativité. Conclusion La prévalence des calcifications valvulaires chez nos patients hémodialysés reste élevée même si elle parait relativement moindre comparée aux données de la littérature. Aucun facteur de risque connu n'est apparu significativement associé à ces calcifications. PMID:27642453