A double-blind randomized placebo-controlled withdrawal trial comparing memantine and antipsychotics for the long-term treatment of function and neuropsychiatric symptoms in people with Alzheimer's disease (MAIN-AD).

PubMed

Ballard, Clive; Thomas, Alan; Gerry, Stephen; Yu, Ly-Mee; Aarsland, Dag; Merritt, Claire; Corbett, Anne; Davison, Christopher; Sharma, Narenda; Khan, Zunera; Creese, Byron; Loughlin, Paul; Bannister, Carol; Burns, Alistair; Win, Soe Nyunt; Walker, Zuzana

2015-04-01

Neuropsychiatric symptoms in Alzheimer disease (AD) cause significant distress and present a complex clinical challenge for treatment. Pharmacological treatment options are limited to antipsychotics, which carry extensive safety issues. There is emerging evidence to support the potential benefits of memantine, currently licensed for moderate to severe AD, in the prophylaxis of neuropsychiatric symptoms. The MAIN-AD study is a double-blind randomized placebo-controlled withdrawal trial comparing memantine with antipsychotics for the treatment of neuropsychiatric symptoms over 24 weeks. A total of 199 people with probable AD living in care homes already receiving an antipsychotic were randomized to receive either memantine or to continue an antipsychotic. The primary outcomes were function (Bristol Activities of Daily Living Scale [BADLS]) and agitation (Cohen-Mansfield Agitation Inventory [CMAI]). Secondary outcomes were Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), and mortality. There was no significant difference between groups on the BADLS or CMAI. At 24 weeks, there was a nonsignificant adjusted difference in favor of memantine on the BADLS of 0.23 (95% CI -1.80-2.27; P = .82) and in favor of antipsychotic on the CMAI of 0.09 (95% CI -0.35-8.53; P = .07). Although there were no significant differences in total NPI, there were 5.01 (95% CI -1.68-11.70; P = .05) and 3.63 (95% CI -1.40-8.67; P = .16) point advantages favoring antipsychotics at weeks 12 and 24, respectively. In addition, in an exploratory analysis, individuals allocated to antipsychotics were significantly less likely to experience relapse of neuropsychiatric symptoms at all time points. The group receiving memantine had a nonsignificant 1.3-point advantage on the MMSE at 24 weeks. This study indicates no benefits for memantine in the long-term treatment and prophylaxis of clinically significant neuropsychiatric symptoms. The results did indicate some benefits for antipsychotic medications in reducing the relapse of neuropsychiatric symptoms, but this must be balanced against increased mortality risk. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Neuropsychiatric symptoms and quality of life in patients in the final phase of dementia.

PubMed

Koopmans, Raymond T C M; van der Molen, Marloes; Raats, Monique; Ettema, Teake P

2009-01-01

To assess neuropsychiatric symptoms and quality of life in a group of patients in the final phase of dementia. All patients with dementia (n = 216) residing on dementia special care units of two Dutch nursing homes were included in the study provided they met the criteria for the final phase of dementia. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory Nursing Home version (NPI-NH) and the Cohen Mansfield Agitation Inventory (CMAI). Quality of life was assessed with the QUALIDEM. Of the 216 dementia patients 39 met the criteria for the final phase of dementia. The patients showed a specific pattern of behaviours with a high prevalence of apathy, agitation and behaviours that were mainly observed during morning care such as making strange noises, grabbing, performing repetitious mannerism, spitting, hitting, screaming and pushing. Overall quality of life of these patients in the final phase of dementia was moderate. In this small sample, patients in the final phase of dementia show specific behavioural problems, that mainly should be addressed with psychosocial interventions. (c) 2008 John Wiley & Sons, Ltd.

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial.

PubMed

Ballard, Clive; Corbett, Anne; Orrell, Martin; Williams, Gareth; Moniz-Cook, Esme; Romeo, Renee; Woods, Bob; Garrod, Lucy; Testad, Ingelin; Woodward-Carlton, Barbara; Wenborn, Jennifer; Knapp, Martin; Fossey, Jane

2018-02-01

Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. ISRCTN Registry ISRCTN62237498.

Effects of Dementia-Care Mapping on Residents and Staff of Care Homes: A Pragmatic Cluster-Randomised Controlled Trial

PubMed Central

van de Ven, Geertje; Draskovic, Irena; Adang, Eddy M. M.; Donders, Rogier; Zuidema, Sytse U.; Koopmans, Raymond T. C. M.; Vernooij-Dassen, Myrra J. F. J.

2013-01-01

Background The effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention. Methods Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents’ neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects. Results 34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI −2·7 to 7·6; p = 0·34). More NPSs were reported in the intervention group than in usual care (p = 0·02). Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02). There were no other significant effects. Conclusions Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect. Trial Registration Dutch Trials Registry NTR2314. PMID:23844003

Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial.

PubMed

van de Ven, Geertje; Draskovic, Irena; Adang, Eddy M M; Donders, Rogier; Zuidema, Sytse U; Koopmans, Raymond T C M; Vernooij-Dassen, Myrra J F J

2013-01-01

The effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention. Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents' neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects. 34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI -2·7 to 7·6; p = 0·34). More NPSs were reported in the intervention group than in usual care (p = 0·02). Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02). There were no other significant effects. Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect. Dutch Trials Registry NTR2314.

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial

PubMed Central

Orrell, Martin; Williams, Gareth; Garrod, Lucy; Testad, Ingelin; Woodward-Carlton, Barbara; Wenborn, Jennifer; Knapp, Martin

2018-01-01

Background Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. Methods and findings This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory–Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen’s D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI −7.39, −1.15; Cohen’s D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI −7.07,−2.02; Cohen’s D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen’s D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. Conclusions These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. Trial registration ISRCTN Registry ISRCTN62237498 PMID:29408901

A double-blind randomised comparison of risperidone and haloperidol in the treatment of behavioural and psychological symptoms in Chinese dementia patients.

PubMed

Chan, W C; Lam, L C; Choy, C N; Leung, V P; Li, S W; Chiu, H F

2001-12-01

Behavioural and psychological symptoms (BPSD) are common during the course of dementia and present severe problems to patients and their caregivers. To assess the therapeutic efficacy and safety of haloperidol and risperidone in treating BPSD in Chinese dementia patients. A 12-week double-blind randomised comparison of haloperidol and risperidone treatments was conducted in 58 patients with DSM-IV diagnosis of dementia of Alzheimer's type or vascular dementia. They were randomly assigned to receive flexible doses (0.5 to 2 mg/day) of haloperidol or risperidone. Clinical response was evaluated using the Cohen-Mansfield Agitation Inventory (CMAI), the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Simpson-Angus Scale, Functional Assessment Staging and Cantonese version of the Mini-Mental State Examination. The mean doses at the last week were 0.90 mg/day of haloperidol and 0.85 mg/day of risperidone. Both haloperidol and risperidone significantly reduced the severity of BPSD (scores on CMAI and BEHAVE-AD), with no significant between-group differences. Haloperidol-treated patients showed a worsening on Simpson-Angus scale while there was no significant change in this measure in risperidone-treated patients. Low-dose haloperidol and risperidone were well tolerated and associated with reductions in the severity and frequency of behavioural symptoms in subjects with dementia. Risperidone may have a more favourable risk-benefit profile in view of its lower propensity to induce extrapyramidal symptoms. Copyright 2001 John Wiley & Sons, Ltd.

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

PubMed

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

2014-06-01

Agitation is common, persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful, but the evidence regarding non-pharmacological interventions is unclear. We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia, considering dementia severity, the setting, the person with whom the intervention is implemented, whether the effects are immediate or longer term, and cost-effectiveness. We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia, included papers' references, and contacted authors about 'missed' studies. We included quantitative studies, evaluating non-pharmacological interventions for agitation in dementia, in all settings. We rated quality, prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy, we present a qualitative evidence synthesis. In addition, we calculated standardised effect sizes (SESs) with available data, to compare heterogeneous interventions. In the health economic analysis, we reviewed economic studies, calculated the cost of effective interventions from the effectiveness review, calculated the incremental cost per unit improvement in agitation, used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. We included 160 out of 1916 papers screened. Supervised person-centred care, communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents, both immediately and up to 6 months afterwards. In care home residents, during interventions but not at follow-up, activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with 'therapeutic touch' or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement, even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities, £80-696; music therapy, £13-27; sensory interventions, £3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM, £31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI), the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities, £4 for music therapy, £24 to £143 for sensory interventions, and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores. A multicomponent intervention in participants with mild to moderate dementia had a positive monetary net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000. Although there were some high-quality studies, there were only 33 reasonably sized (> 45 participants) randomised controlled trials, and lack of evidence means that we cannot comment on many interventions' effectiveness. There were no hospital studies and few studies in people's homes. More health economic data are needed. Person-centred care, communication skills and DCM (all with supervision), sensory therapy activities, and structured music therapies reduce agitation in care-home dementia residents. Future interventions should change care home culture through staff training and permanently implement evidence-based treatments and evaluate health economics. There is a need for further work on interventions for agitation in people with dementia living in their own homes. The study was registered as PROSPERO no. CRD42011001370. The National Institute for Health Research Health Technology Assessment programme.

Cross-cultural differences in demented geropsychiatric inpatients with behavioral disturbances.

PubMed

Akpaffiong, M; Kunik, M E; Hale, D; Molinari, V; Orengo, C

1999-10-01

Cross-cultural differences in treatment and diagnosis exist in several psychiatric disorders. This study examines phenomenological and treatment differences between Caucasian and African-American patients presenting to a geropsychiatric unit for treatment of behavioral disturbances associated with dementia. One hundred and forty-one Caucasian patients were compared to 56 African-American patients consecutively admitted to a VA geropsychiatric inpatient unit. At admission, differences in behavior disturbances between the two groups were examined using the Mini-Mental State Examination (MMSE), Cohen-Mansfield Agitation Inventory (CMAI), Hamilton Rating Scale for Depression (HAM-D), Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Differences in treatment were assessed by comparing medication types and doses between the two groups. Results showed that Caucasian and African-American patients with dementia and behavioral disturbances presented and responded similarly to like treatment on an inpatient geropsychiatric unit. The similarity between the two groups may be explained by the multi-ethnic make-up of the interdisciplinary treatment team and by the use of standardized scales to measure symptomatology and response. Copyright 1999 John Wiley & Sons, Ltd.

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

PubMed

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

2015-03-01

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

[Biography and dementia. Origin of challenging behavior in patients with multi-infarct dementia or senile dementia of the Alzheimer type in long term care with reference the biographical level].

PubMed

Höwler, Elisabeth

2011-10-01

The aim of this study was to explore the connection between the nature of agitated behaviour and meaningful biographical experiences within two types of dementia in a moderate stadium. The two dementia types included Alzheimer Disease (SDAT) and Multi-infarction aphrenia (MID). Biographical narrative interviews with 26 nursing home residents suffering from dementia have been concluded. Topics were their first thirty years of life (based on a foreign anamnesis). The challenging behaviour has been observed systematically in nursing situations. The data has been evaluated with the comparative casuistics method (Jüttemann, 1990). The behaviour has been measured with the CMAI-scale before and also after having moved to a nursing home. Residents behaviour patterns can be divided into three biographical central characters: Life as finding, life as emotional disorder and life as struggle. Institutional characteristics: Loss of near rhythms of life, losing control over the personal area, experience of social isolation and certain characteristics from nurses: staff detractions and the exercise of nursing actions which appears threats contribute to the phenomena. A disparity is shown between the types of dementia in terms of patterns of demonstrated behaviour. In addition gender differences could be shown. The recognition of the phenomena by means of the CMAI-scale elucidate that the phenomena appears for the first time or is stronger after the resettlement to a nursing home. These findings can improve nurses' understanding of the phenomena within long-term care.

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

PubMed

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

2017-03-01

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

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

PubMed

Richeson, Nancy E

2003-01-01

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

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

PubMed

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

2016-03-01

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

Effects of indoor gardening on sleep, agitation, and cognition in dementia patients--a pilot study.

PubMed

Lee, Y; Kim, S

2008-05-01

A pilot study was performed to examine the efficacy of indoor gardening on sleep, agitation and cognition of dementia patients. Twenty-three institutionalized dementia patients who had sleep disturbance and/or agitation participated in a 5-week study protocol of 1 week of baseline and 4 weeks of treatment. The study design was a one group repeated measures study. For the first and fifth week of the study period, sleep patterns, agitation, and cognition were evaluated using a sleep diary, Modified Cohen-Mansfield Agitation Inventory and revised Hasegawa Dementia Scale respectively. Significant improvement in wake after sleep onset, nap, nocturnal sleep time, and nocturnal sleep efficiency was identified. On the contrary sleep onset time, wake-up time, total sleep time did not change after indoor gardening. Agitation and cognition score was significantly improved. Indoor gardening was found to be effective for sleep, agitation, and cognition of dementia patients. Randomized controlled studies of larger sample size are needed to confirm treatment effect.

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2018-03-01

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

Neuropsychiatric Inventory data in a Belgian sample of elderly persons with and without dementia.

PubMed

Squelard, Gilles P; Missotten, Pierre A; Paquay, Louis; De Lepeleire, Jan; Buntinx, Frank J V M; Fontaine, Ovide; Adam, Stephane R; Ylieff, Michel J D

2012-01-01

This study assesses and compares prevalence of psychological and behavioral symptoms in a Belgian sample of people with and without dementia. A total of 228 persons older than 65 years with dementia and a group of 64 non-demented persons were assessed using the Neuropsychiatric Inventory (NPI) in 2004. Within the group without dementia, the most frequent symptoms were depression, agitation, and irritability. Within the group with dementia, the most common symptoms were depression, irritability, apathy, and agitation. Prevalence of delusions (P < 0.05), hallucinations (P < 0.05), anxiety (P < 0.05), agitation (P < 0.05), apathy (P < 0.01), aberrant motor behavior (P < 0.01), and eating disorders (P < 0.05) were significantly higher in the group with dementia. Depression, elation, irritability, disinhibition, and sleeping disorders are not specific to dementia. Agitation, apathy, anxiety, and delusions are more frequent in dementia but were not specific to the dementia group because their prevalence rates were close to 10% in the group without dementia. Hallucinations, aberrant motor behavior, and eating disorders are specific to dementia. The distinction between specific and nonspecific symptoms may be useful for etiological research on biological, psychological, and environmental factors.

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

PubMed

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

2017-03-01

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

Severity of Neuropsychiatric Symptoms in Nursing Home Residents.

PubMed

Helvik, Anne-Sofie; Engedal, Knut; Wu, Bei; Benth, Jūratė Šaltytė; Corazzini, Kirsten; Røen, Irene; Selbæk, Geir

2016-01-01

We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia.

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

PubMed

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

2012-06-01

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

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

PubMed

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

2009-02-01

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

Tolerability of extended-release quetiapine fumarate compared with immediate-release quetiapine fumarate in older patients with Alzheimer's disease with symptoms of psychosis and/or agitation: a randomised, double-blind, parallel-group study.

PubMed

De Deyn, Peter Paul; Eriksson, Hans; Svensson, Hanna

2012-03-01

The objective of this study was to assess the safety and tolerability of extended-release quetiapine fumarate (quetiapine XR) compared with quetiapine immediate-release (quetiapine IR) in older patients with Alzheimer's disease with symptoms of psychosis and/or agitation. This was a 6-week, double-blind, double-dummy, randomised study. Of the 109 patients screened, 100 were randomised to receive quetiapine XR (n = 68) or quetiapine IR (n = 32), at doses of 50 and 25 mg/day, respectively. Treatment was escalated to 100 mg/day by Day 4. At Day 8, a flexible-dose (50-300 mg/day) period began when dose adjustment was made at the investigator's discretion. The primary variable was incidence and type of adverse events (AEs). Secondary variables included efficacy and other safety assessments. Mean daily doses were 143.6 and 142.0 mg in the quetiapine XR and quetiapine IR groups, respectively. Ninety patients completed the study; only one withdrew (in the quetiapine XR group) because of an AE. Laboratory evaluations identified severe neutropaenia (one patient), mild neutropaenia (three patients) and eosinophilia (five patients); however, these were not reported, as AEs and confounding factors, such as patient age, concomitant illness and medication, made it difficult to determine any relationship to quetiapine treatment. Numerical improvements from baseline were seen across both treatment groups in Neuropsychiatric Inventory frequency × severity total, Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory, Clinical Global Impression-Severity of Illness and Clinical Global Impression-Improvement scores. Quetiapine XR dosed up to 300 mg/day was generally well tolerated, with a similar profile to that of quetiapine IR. Copyright © 2011 John Wiley & Sons, Ltd.

Prevalence and associated behavioral symptoms of depression in mild cognitive impairment and dementia due to Alzheimer's disease.

PubMed

Van der Mussele, Stefan; Bekelaar, Kim; Le Bastard, Nathalie; Vermeiren, Yannick; Saerens, Jos; Somers, Nore; Mariën, Peter; Goeman, Johan; De Deyn, Peter P; Engelborghs, Sebastiaan

2013-09-01

Mild cognitive impairment (MCI) is a clinical concept that categorizes subjects who are in an intermediate cognitive state between normal aging and dementia. The aims of this study are to determine the prevalence of significant depressive symptoms in MCI and Alzheimer's disease (AD) patients and to characterize the behavior associated with significant depressive symptoms in MCI and AD patients. A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms of dementia and MCI was performed. The study population consisted of 270 MCI and 402 AD patients. Behavioral assessment was performed by means of Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cohen-Mansfield Agitation Inventory. The presence of significant depressive symptoms was defined as a Cornell Scale for Depression in Dementia total score >7. The prevalence of significant depressive symptoms in AD patients (25%) was higher compared with MCI patients (16%) (p = 0.005). Patients with significant depressive symptoms showed an increased severity of frontal lobe symptoms, behavioral symptoms and agitation (Middelheim Frontality Score, Behave-AD and Cohen-Mansfield Agitation Inventory total scores; p < 0.001). Also, most of the individual frontal lobe and behavioral symptoms were more prevalent and severe, resulting in higher Behave-AD global scores. Mild cognitive impairment patients with depressive symptoms showed more severe behavioral symptoms and more severe verbally agitated behavior than AD patients without depressive symptoms (p < 0.001). Frontal lobe and behavioral symptoms are more prevalent and severe in MCI and AD patients with significant depressive symptoms as compared with patients without depressive symptoms. Copyright © 2012 John Wiley & Sons, Ltd.

Association of premorbid personality with behavioral and psychological symptoms in dementia with Lewy bodies: Comparison with Alzheimer's disease patients.

PubMed

Tabata, Kazuki; Saijo, Yasuaki; Morikawa, Fumiyoshi; Naoe, Juichiro; Yoshioka, Eiji; Kawanishi, Yasuyuki; Nakagi, Yoshihiko; Yoshida, Takahiko

2017-06-01

The aim of this study was to elucidate the relation between premorbid personality traits and behavioral and psychological symptoms in dementia (BPSD) in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) patients. Forty-one DLB patients and 98 AD patients were assessed for BPSD using the Neuropsychiatric Inventory (NPI). Each patient's midlife personality traits were rated by a family member using the NEO Five-Factor Inventory (NEO-FFI) questionnaire. In multiple regression analyses for DLB patients, NPI total score and anxiety were significantly associated with premorbid openness, delusion with premorbid agreeableness, and agitation with premorbid conscientiousness. In AD patients, depression was significantly associated with premorbid neuroticism, and agitation, apathy, and irritability with premorbid agreeableness. Premorbid personalities affected BPSD differently in DLB and AD. Given the differences in the effects of premorbid personalities on BPSD, additional studies are needed to develop interventions to reduce these symptoms. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

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

PubMed

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

2013-11-01

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

Irritable temperament and lifetime psychotic symptoms as predictors of anxiety symptoms in bipolar disorder.

PubMed

Serafini, Gianluca; Geoffroy, Pierre A; Aguglia, Andrea; Adavastro, Giulia; Canepa, Giovanna; Pompili, Maurizio; Amore, Mario

2018-01-01

Affective temperaments, hopelessness, alexithymia, and anxiety/agitation symptoms may play a significant role in the psychopathological characteristics of bipolar disorder (BD). Here, we aimed to investigate the eventual association between the mentioned explanatory variables and anxiety/agitation symptoms in BD. We recruited at the Section of Psychiatry, Department of Neuroscience, University of Genoa (Italy), 92 BD inpatients having a mean age of 52 (±13.8) years. Participants were assessed using specific psychometric instruments. Anxiety/agitation symptoms have been evaluated using the 11-item of the Beck Depression Inventory II (BDI-II). Overall, 53.8% of participants presented with anxiety/agitation symptoms and 46.2% without. The two groups significantly differed about socio-economic status, lifetime psychotic symptoms, and residual depressive symptoms between episodes. Anxiety/agitation symptoms significantly correlated with irritable affective temperament (r = 0.407; p = .01), hopelessness (r = 0.541; p ≤ .001), difficulty identifying feelings (r = 0.440; p ≤ .001), difficulty describing feelings (r = 0.437; p ≤ .001), and externally oriented-thinking (r = 0.393; p ≤ .001). After multivariate analyses, irritable affective temperament (OR = 2.457, p ≤ .01) and less lifetime psychotic symptoms (OR = 0.007, p ≤ .05) remained the only significant variables associated with anxiety/agitation symptoms. The generalization of the main findings is limited by the small sample size and cross-sectional study design. Nevertheless, our results suggest that the careful assessment of affective temperaments and psychotic symptoms may help to early identify BD patients suffering from anxiety/agitation symptoms and may allow to perform targeted interventions in the clinical practice.

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

PubMed

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

2004-06-01

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

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

PubMed

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

2007-01-01

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

Optimization of DRASTIC method by supervised committee machine artificial intelligence to assess groundwater vulnerability for Maragheh-Bonab plain aquifer, Iran

NASA Astrophysics Data System (ADS)

Fijani, Elham; Nadiri, Ata Allah; Asghari Moghaddam, Asghar; Tsai, Frank T.-C.; Dixon, Barnali

2013-10-01

Contamination of wells with nitrate-N (NO3-N) poses various threats to human health. Contamination of groundwater is a complex process and full of uncertainty in regional scale. Development of an integrative vulnerability assessment methodology can be useful to effectively manage (including prioritization of limited resource allocation to monitor high risk areas) and protect this valuable freshwater source. This study introduces a supervised committee machine with artificial intelligence (SCMAI) model to improve the DRASTIC method for groundwater vulnerability assessment for the Maragheh-Bonab plain aquifer in Iran. Four different AI models are considered in the SCMAI model, whose input is the DRASTIC parameters. The SCMAI model improves the committee machine artificial intelligence (CMAI) model by replacing the linear combination in the CMAI with a nonlinear supervised ANN framework. To calibrate the AI models, NO3-N concentration data are divided in two datasets for the training and validation purposes. The target value of the AI models in the training step is the corrected vulnerability indices that relate to the first NO3-N concentration dataset. After model training, the AI models are verified by the second NO3-N concentration dataset. The results show that the four AI models are able to improve the DRASTIC method. Since the best AI model performance is not dominant, the SCMAI model is considered to combine the advantages of individual AI models to achieve the optimal performance. The SCMAI method re-predicts the groundwater vulnerability based on the different AI model prediction values. The results show that the SCMAI outperforms individual AI models and committee machine with artificial intelligence (CMAI) model. The SCMAI model ensures that no water well with high NO3-N levels would be classified as low risk and vice versa. The study concludes that the SCMAI model is an effective model to improve the DRASTIC model and provides a confident estimate of the pollution risk.

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

PubMed

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

2018-05-31

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

The Lifestyle Engagement Activity Program (LEAP): Implementing Social and Recreational Activity into Case-Managed Home Care.

PubMed

Low, Lee-Fay; Baker, Jessica Rose; Harrison, Fleur; Jeon, Yun-Hee; Haertsch, Maggie; Camp, Cameron; Skropeta, Margaret

2015-12-01

The Lifestyle Engagement Activity Program (LEAP) incorporates social support and recreational activities into case-managed home care. This study's aim was to evaluate the effect of LEAP on engagement, mood, and behavior of home care clients, and on case managers and care workers. Quasi-experimental. Five Australian aged home care providers, including 2 specializing in care for ethnic minorities. Clients (n = 189) from 5 home care providers participated. The 12-month program had 3 components: (1) engaging support of management and staff; (2) a champion to drive practice change; (3) staff training. Case managers were trained to set meaningful social and/or recreational goals during care planning. Care workers were trained in good communication, to promote client independence and choice, and in techniques such as Montessori activities, reminiscence, music, physical activity, and humor. Data were collected 6 months before program commencement, at baseline, and 6 and 12 months. The Homecare Measure of Engagement Staff report and Client-Family interview were primary outcomes. Secondary outcomes were the Cohen-Mansfield Agitation Inventory; apathy, dysphoria, and agitation subscales of the Neuropsychiatric Inventory-Clinician Rating; the geriatric depression scale; UCLA loneliness scale; and home care satisfaction scale. Staff provided information on confidence in engaging clients and the Utrecht Work Engagement Scale. Twelve months after program commencement, clients showed a significant increase in self- or family-reported client engagement (b = 5.39, t[113.09] = 3.93, P < .000); and a significant decrease in apathy (b = -0.23, t(117.00) = -2.03, P = .045), dysphoria (b = -0.25, t(124.36) = -2.25, P = .026), and agitation (b = -0.97, t(98.15) = -3.32, P = .001) on the Neuropsychiatric Inventory-Clinician. Case managers and care workers both reported significant increases in their confidence to socially and recreationally engage clients (b = 0.52, t(21.33) = 2.80, P = .011, b = 0.29, t(198.69) = 2.58, P = .011, respectively). There were no significant changes in care worker-rated client engagement or client or family self-complete measures of depression or loneliness (P > .05). Client and family self-rated apathy increased over 12 months (b = 0.04, t(43.36) = 3.06, P = .004; b = 3.63, t(34.70) = 2.20, P = .035) CONCLUSIONS: LEAP demonstrated that home care providers can incorporate social and recreational care into usual practice for older clients, and that this benefits clients' engagement, dysphoria, and agitation. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Effects of viewing a preferred nature image and hearing preferred music on engagement, agitation, and mental status in persons with dementia

PubMed Central

Eggert, Julia; Vincent, Ellen; Parker, Veronica; Daily, Shaundra B; Pham, Hiep; Watson, Alison Turner; Summey, Hollie; Roy, Tania

2015-01-01

Background: The purpose of the described exploratory study was to test proactive strategies for enhancing engagement and cognitive ability while diminishing dementia-related disordered behaviors of those diagnosed with Alzheimer’s disease and other dementias. Study participants resided in an Memory Care unit of an assisted living community. Method: The researchers measured the effects of exposure to music and nature images on engagement using the Individualized Dementia Engagement and Activities Scale tool, on cognitive ability using the Montreal Cognitive Assessment, and on agitation using the Cohen-Mansfield Agitation Inventory. Result: The within-subject study design revealed that use of both music and nature images hold promise for reducing undesirable behaviors and improving engagement of residents. Conclusion: The authors suggest caregivers for those with Alzheimer’s disease and other dementias can effectively use nature images and music to improve engagement and reduce disordered behaviors, thus potentially enhancing quality of life for the care recipient as well as the caregiver while possibly reducing the costs of medications used to control dementia-related undesirable behaviors. PMID:26770801

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

PubMed

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

2009-06-01

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

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

PubMed

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

2016-08-01

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

Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT.

PubMed

Fleiner, Tim; Dauth, Hannah; Gersie, Marleen; Zijlstra, Wiebren; Haussermann, Peter

2017-08-29

The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care. Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents. Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication. This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia. German Clinical Trial Register DRKS00006740 . Registered 28 October 2014.

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

PubMed

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

Agitation is common among patients with Alzheimer disease; safe, effective treatments are lacking. To assess the efficacy, safety, and tolerability of dextromethorphan hydrobromide-quinidine sulfate for Alzheimer disease-related agitation. Phase 2 randomized, multicenter, double-blind, placebo-controlled trial using a sequential parallel comparison design with 2 consecutive 5-week treatment stages conducted August 2012-August 2014. Patients with probable Alzheimer disease, clinically significant agitation (Clinical Global Impressions-Severity agitation score ≥4), and a Mini-Mental State Examination score of 8 to 28 participated at 42 US study sites. Stable dosages of antidepressants, antipsychotics, hypnotics, and antidementia medications were allowed. In stage 1, 220 patients were randomized in a 3:4 ratio to receive dextromethorphan-quinidine (n = 93) or placebo (n = 127). In stage 2, patients receiving dextromethorphan-quinidine continued; those receiving placebo were stratified by response and rerandomized in a 1:1 ratio to dextromethorphan-quinidine (n = 59) or placebo (n = 60). The primary end point was change from baseline on the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (scale range, 0 [absence of symptoms] to 12 [symptoms occur daily and with marked severity]). A total of 194 patients (88.2%) completed the study. With the sequential parallel comparison design, 152 patients received dextromethorphan-quinidine and 127 received placebo during the study. Analysis combining stages 1 (all patients) and 2 (rerandomized placebo nonresponders) showed significantly reduced NPI Agitation/Aggression scores for dextromethorphan-quinidine vs placebo (ordinary least squares z statistic, -3.95; P < .001). In stage 1, mean NPI Agitation/Aggression scores were reduced from 7.1 to 3.8 with dextromethorphan-quinidine and from 7.0 to 5.3 with placebo. Between-group treatment differences were significant in stage 1 (least squares mean, -1.5; 95% CI, -2.3 to -0.7; P<.001). In stage 2, NPI Agitation/Aggression scores were reduced from 5.8 to 3.8 with dextromethorphan-quinidine and from 6.7 to 5.8 with placebo. Between-group treatment differences were also significant in stage 2 (least squares mean, -1.6; 95% CI, -2.9 to -0.3; P=.02). Adverse events included falls (8.6% for dextromethorphan-quinidine vs 3.9% for placebo), diarrhea (5.9% vs 3.1% respectively), and urinary tract infection (5.3% vs 3.9% respectively). Serious adverse events occurred in 7.9% with dextromethorphan-quinidine vs 4.7% with placebo. Dextromethorphan-quinidine was not associated with cognitive impairment, sedation, or clinically significant QTc prolongation. In this preliminary 10-week phase 2 randomized clinical trial of patients with probable Alzheimer disease, combination dextromethorphan-quinidine demonstrated clinically relevant efficacy for agitation and was generally well tolerated. clinicaltrials.gov Identifier: NCT01584440.

Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period.

PubMed

Wetzels, Roland B; Zuidema, Sytse U; de Jonghe, Jos F M; Verhey, Frans R J; Koopmans, Raymond T C M

2010-12-01

To determine the course of neuropsychiatric symptoms (NPSs) in nursing home residents with dementia and to determine their variability across diagnosis. Prospective cohort study over 2 years. Fourteen dementia special care units in nine nursing homes in The Netherlands. One hundred seventeen residents with dementia. NPSs were measured using the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). The majority of residents had moderately severe to severe dementia. All but a few residents (97%) showed any NPS, and co-occurrence of NPSs was high. Agitation, irritability, and aberrant motor behavior were the most prevalent over the 2 years. Depression and anxiety as well as NPI total score decreased over time, whereas apathy tended to increase. Agitation and aberrant motor behavior were the most persistent symptoms. In asymptomatic residents, highest incidence rates were found for apathy, aggression/ agitation, irritability, and aberrant motor behavior. Anxiety and apathy were more prevalent in Alzheimer disease (AD) compared with vascular disease (VaD); vice versa, aggression and depression were more prevalent in VaD. Differences in change over time between AD and VaD were found for irritability and disinhibition. This is the first study examining the 2-year course of NPSs in a large group of nursing home residents with dementia. Virtually all residents demonstrated and/or developed NPSs. Although affective symptoms decreased, apathy tended to increase. Agitated behaviors were particularly persistent. Our data may contribute to improve mental healthcare for demented nursing home residents.

Caregiver burden associated with behavioral and psychological symptoms of dementia in elderly people in the local community.

PubMed

Matsumoto, Naomi; Ikeda, Manabu; Fukuhara, Ryuji; Shinagawa, Shunichiro; Ishikawa, Tomohisa; Mori, Takaaki; Toyota, Yasutaka; Matsumoto, Teruhisa; Adachi, Hiroyoshi; Hirono, Nobutsugu; Tanabe, Hirotaka

2007-01-01

Despite many studies about the association between caregiver burden and behavioral and psychological symptoms of dementia (BPSD), there have been no population-based studies to evaluate caregiver burden associated with each BPSD. To evaluate caregiver burden associated with the individual BPSD in elderly people living in the community. The subjects were 67 participants with dementia living with their caregivers (diagnosed in the third Nakayama study): 51 Alzheimer's disease, 5 vascular dementia and 11 other. The Neuropsychiatric Inventory (NPI) and NPI Caregiver Distress Scale (NPI-D) were used to assess subjects' BPSD and related caregiver distress, respectively. In the subjects exhibiting BPSD, aberrant motor behavior had the highest mean NPI score, and depression/dysphoria had the lowest. Agitation/aggression had the highest mean NPI-D score, and euphoria/elation had the lowest. Delusion, agitation/aggression, apathy/indifference, irritability/lability and aberrant motor behavior showed a correlation between the NPI and NPI-D scores. The burden associated with BPSD is different for each symptom and does not always depend on frequency and severity of BPSD. These findings suggest that some symptoms, such as agitation/aggression and irritability/lability, may affect the caregivers significantly, although their frequency and severity are low. Copyright (c) 2007 S. Karger AG, Basel.

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

PubMed Central

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

2014-01-01

Background Light therapy has shown great promise as a nonpharmacological method to improve symptoms associated with Alzheimer’s disease and related dementias (ADRD), with preliminary studies demonstrating that appropriately timed light exposure can improve nighttime sleep efficiency, reduce nocturnal wandering, and alleviate evening agitation. Since the human circadian system is maximally sensitive to short-wavelength (blue) light, lower, more targeted lighting interventions for therapeutic purposes, can be used. Methods The present study investigated the effectiveness of a tailored lighting intervention for individuals with ADRD living in nursing homes. Low-level “bluish-white” lighting designed to deliver high circadian stimulation during the daytime was installed in 14 nursing home resident rooms for a period of 4 weeks. Light–dark and rest–activity patterns were collected using a Daysimeter. Sleep time and sleep efficiency measures were obtained using the rest–activity data. Measures of sleep quality, depression, and agitation were collected using standardized questionnaires, at baseline, at the end of the 4-week lighting intervention, and 4 weeks after the lighting intervention was removed. Results The lighting intervention significantly (P<0.05) decreased global sleep scores from the Pittsburgh Sleep Quality Index, and increased total sleep time and sleep efficiency. The lighting intervention also increased phasor magnitude, a measure of the 24-hour resonance between light–dark and rest–activity patterns, suggesting an increase in circadian entrainment. The lighting intervention significantly (P<0.05) reduced depression scores from the Cornell Scale for Depression in Dementia and agitation scores from the Cohen–Mansfield Agitation Inventory. Conclusion A lighting intervention, tailored to increase daytime circadian stimulation, can be used to increase sleep quality and improve behavior in patients with ADRD. The present field study, while promising for application, should be replicated using a larger sample size and perhaps using longer treatment duration. PMID:25246779

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

PubMed

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

2017-09-01

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

The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review.

PubMed

Terum, Toril Marie; Andersen, John Roger; Rongve, Arvid; Aarsland, Dag; Svendsboe, Ellen J; Testad, Ingelin

2017-07-01

Neuropsychiatric symptoms (NPSs) are common in dementia, and they have been identified as important care-recipient variables in terms of their impact on caregiver burden. The aim of this review was to describe how individual NPSs in dementia, assessed using the Neuropsychiatric Inventory, are associated with caregiver burden. We performed a systematic review of English language, peer-reviewed articles retrieved from MEDLINE, PSYCINFO, and EMBASE. A total of 13 studies met the inclusion criteria. Four studies examined the association between individual NPSs and caregiver burden using the Spearman rank correlation test, while three used Pearson's correlation test. Of the remaining studies, five used multiple regression analyses and one the chi-squared test. The majority of included studies did not differentiate between dementia subtypes in the analysis or mainly included only caregivers of people with Alzheimer's disease. The Clinical Dementia Rating score and mean Mini-Mental State Examination score indicate mild to moderate dementia. The majority of caregivers were women, most of whom were children (53.8%) or spouses (36%). The data indicated that irritability, followed by agitation, sleep disturbances, anxiety, apathy, and delusion seem to impact caregiver burden the most. Our principal finding is that irritability, agitation, sleep disturbances, anxiety, apathy, and delusion seem to exert the most impact on caregiver burden. Heterogeneity in the measures and statistical analyses used, however, makes it difficult to make conclusive interpretations. Future research in this field would benefit from standardization of the scientific methodology in use. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

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

PubMed

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

2016-09-01

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

Successful ingredients in the SMILE study: resident, staff, and management factors influence the effects of humor therapy in residential aged care.

PubMed

Brodaty, Henry; Low, Lee-Fay; Liu, Zhixin; Fletcher, Jennifer; Roast, Joel; Goodenough, Belinda; Chenoweth, Lynn

2014-12-01

To test the hypothesis that individual and institutional-level factors influence the effects of a humor therapy intervention on aged care residents. Data were from the humor therapy group of the Sydney Multisite Intervention of LaughterBosses and ElderClowns, or SMILE, study, a single-blind cluster randomized controlled trial of humor therapy conducted over 12 weeks; assessments were performed at baseline, week 13, and week 26. One hundred eighty-nine individuals from 17 Sydney residential aged care facilities were randomly allocated to the humor therapy intervention. Professional performers called "ElderClowns" provided 9-12 weekly humor therapy 2-hour sessions, augmented by trained staff, called "LaughterBosses." Outcome measures were as follows: Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and proxy-rated quality of life in dementia population scale. Facility-level measures were as follows: support of the management for the intervention, commitment levels of LaughterBosses, Environmental Audit Tool scores, and facility level of care provided (high/low). Resident-level measures were engagement, functional ability, disease severity, and time-in-care. Multilevel path analyses simultaneously modeled resident engagement at the individual level (repeated measures) and the effects of management support and staff commitment to humor therapy at the cluster level. Models indicated flow-on effects, whereby management support had positive effects on LaughterBoss commitment, and LaughterBoss commitment increased resident engagement. Higher resident engagement was associated with reduced depression, agitation, and neuropsychiatric scores. Effectiveness of psychosocial programs in residential aged care can be enhanced by management support, staff commitment, and active resident engagement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.

PubMed

Maust, Donovan T; Kales, Helen C; McCammon, Ryan J; Blow, Frederic C; Leggett, Amanda; Langa, Kenneth M

2017-10-01

Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care. Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old. BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity. Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02). A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia. Copyright © 2017 American Association for Geriatric Psychiatry. All rights reserved.

A Controlled Agitation Process for Improving Quality of Canned Green Beans during Agitation Thermal Processing.

PubMed

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

2016-06-01

This work introduces the concept of a controlled agitation thermal process to reduce quality damage in liquid-particulate products during agitation thermal processing. Reciprocating agitation thermal processing (RA-TP) was used as the agitation thermal process. In order to reduce the impact of agitation, a new concept of "stopping agitations after sufficient development of cold-spot temperature" was proposed. Green beans were processed in No. 2 (307×409) cans filled with liquids of various consistency (0% to 2% CMC) at various frequencies (1 to 3 Hz) of RA-TP using a full-factorial design and heat penetration results were collected. Corresponding operator's process time to impart a 10-min process lethality (Fo ) and agitation time (AT) were calculated using heat penetration results. Accordingly, products were processed again by stopping agitations as per 3 agitation regimes, namely; full time agitation, equilibration time agitation, and partial time agitation. Processed products were photographed and tested for visual quality, color, texture, breakage of green beans, turbidity, and percentage of insoluble solids in can liquid. Results showed that stopping agitations after sufficient development of cold-spot temperatures is an effective way of reducing product damages caused by agitation (for example, breakage of beans and its leaching into liquid). Agitations till one-log temperature difference gave best color, texture and visual product quality for low-viscosity liquid-particulate mixture and extended agitations till equilibration time was best for high-viscosity products. Thus, it was shown that a controlled agitation thermal process is more effective in obtaining high product quality as compared to a regular agitation thermal process. © 2016 Institute of Food Technologists®

Multidisciplinary, Nurse-Led Psychiatric Consultation in Nursing Homes: A Pilot Study in Clinical Practice.

PubMed

Koekkoek, Bauke; van Baarsen, Carlijn; Steenbeek, Mirella

2016-07-01

To determine the effects of multidisciplinary, nurse-led psychiatric consultation on behavioral problems of nursing home residents. Residents often suffer from psychiatric symptoms, while staff psychiatric expertise varies. A pre-post study was conducted in seven homes using the Neuropsychiatric Inventory Nursing Home version (NPI-NH). In 71 consultations during 18 months, 56-75% of residents suffered from agitation/aggression, depression, anxiety, and disinhibition. Post-intervention (n = 54), frequency, and severity of psychiatric symptoms were significantly and clinically meaningfully reduced. Also, staff suffered from less work stress. Nurse-led psychiatric consultation is valuable to both nursing home residents and staff. © 2015 Wiley Periodicals, Inc.

Multisensory Stimulation as an Intervention Strategy for Elderly Patients With Severe Dementia: A Pilot Randomized Controlled Trial.

PubMed

Sánchez, Alba; Marante-Moar, M Pilar; Sarabia, Carmen; de Labra, Carmen; Lorenzo, Trinidad; Maseda, Ana; Millán-Calenti, José Carlos

2016-06-01

The objective of this study was to compare the effect of multisensory stimulation environment (MSSE) and one-to-one activity sessions in the symptomatology of elderly individuals with severe dementia. Thirty-two participants were randomly assigned to the following 3 groups: MSSE, activity, and control group. The MSSE and activity groups participated in two 30-minute weekly sessions over 16 weeks. Pre-, mid-, and posttrial; 8-week follow-up behavior; mood; cognitive status; and dementia severity were registered. Patients in the MSSE group demonstrated a significant improvement in the Neuropsychiatric Inventory and Bedford Alzheimer Nursing Severity Scale scores compared with the activity group. Both MSSE and activity groups showed an improvement during the intervention in the Cohen-Mansfield Agitation Inventory aggressive behavior factor and total score, with no significant differences between groups. The MSSE may have better effects on neuropsychiatric symptoms and dementia severity in comparison with one-to-one activity sessions in patients with severe dementia. © The Author(s) 2015.

Memantine may affect pseudobulbar affect in patients with Alzheimer's disease.

PubMed

Prokšelj, Tatjana; Jerin, Aleš; Kogoj, Aleš

2013-12-01

Behavioural symptoms are common in moderate to severe Alzheimer's disease (AD) and are improved by memantine with the most pronounced effect on agitation/aggression. Dextromethorphan in combination with quinidine is the only drug approved by US Food and Drug Administration for the treatment of pseudobulbar affect (PBA) on the basis of efficacy in patients with multiple sclerosis or amyotrophic lateral sclerosis. The aim of our study was to evaluate the efficacy of memantine on PBA in patients with AD. In a prospective, double-blind, case-control study to assess PBA with pathological laughter and crying scale patients were administered memantine (final dose of 20 mg daily) or citalopram (20 mg once daily), each for 10 weeks. The number of episodes of involuntary emotional expression, Neuropsychiatric Inventory (NPI) and Overt Aggression Scale-Modified (OAS-M) total scores were also recorded. Furthermore, the platelet serotonin (5-HT) concentration was measured. Although memantine had beneficial effects on PBA, it also had a crucial impact on behavioural symptoms, especially aggression and agitation (to an average of 3.5 times higher end-point scores on OAS-M and increase of NPI total scores for an average of 114% of initial value). Therefore, the study was prematurely stopped. In addition, we had evidenced a drop of platelet 5-HT concentration (to an average of 73% of initial value). Surprisingly, our research showed the opposite action of memantine on neuropsychiatric symptoms as expected. In a limited number of AD patients with PBA, memantine had a beneficial effect on involuntary emotional expression, but it potentiated agitation/aggression, irritability and caused a crucial drop of the platelet 5-HT concentration.

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

PubMed Central

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

2014-01-01

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

Ketamine as a first-line treatment for severely agitated emergency department patients.

PubMed

Riddell, Jeff; Tran, Alexander; Bengiamin, Rimon; Hendey, Gregory W; Armenian, Patil

2017-07-01

Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue medication dosing, and changes in vital signs. 106 patients were enrolled and 98 met eligibility criteria. There was no significant difference between groups in initial agitation scores. Based on agitation scores, more patients in the ketamine group were no longer agitated than the other medication groups at 5-, 10-, and 15-min after receiving medication. Patients receiving ketamine had similar rates of redosing, changes in vital signs, and adverse events to the other groups. In highly agitated and violent emergency department patients, significantly fewer patients receiving ketamine as a first line sedating agent were agitated at 5-, 10-, and 15-min. Ketamine appears to be faster at controlling agitation than standard emergency department medications. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2016-01-01

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

Automated agitation management accounting for saturation dynamics.

PubMed

Rudge, A D; Chase, J G; Shaw, G M; Lee, D

2004-01-01

Agitation-sedation cycling in critically ill is damaging to patient health and increases length of and cost. A physiologically representative model of the agitation-sedation system is used as a platform to evaluate feedback controllers offering improved agitation management. A heavy-derivative controller with upper and infusion rate bounds maintains minimum plasma concentrations through a low constant infusion, and minimizes outbursts of agitation through strong, timely boluses. controller provides improved agitation management using from 37 critically ill patients, given the saturation of effect at high concentration. Approval was obtained the Canterbury Ethics Board for this research.

Probable reasons for expressed agitation in persons with dementia.

PubMed

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

1998-05-01

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

7 CFR 58.417 - Mechanical agitators.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Mechanical agitators. 58.417 Section 58.417 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....417 Mechanical agitators. The mechanical agitators shall be of sanitary construction. The carriages...

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

PubMed

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

2015-04-21

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

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

PubMed

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

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

PubMed

Ozdemir, Leyla; Karabulut, Erdem

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

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

PubMed

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

2018-06-01

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

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

PubMed

Shahriari, Ali; Khooshideh, Maryam; Sheikh, Mahdi

2016-01-01

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

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

PubMed

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

2016-08-01

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

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

PubMed

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

2018-06-03

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

Risk factors for agitation in critically ill patients

PubMed Central

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

2016-01-01

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

LEACHING OF URANIUM ORES USING ALKALINE CARBONATES AND BICARBONATES AT ATMOSPHERIC PRESSURE

DOEpatents

Thunaes, A.; Brown, E.A.; Rabbits, A.T.; Simard, R.; Herbst, H.J.

1961-07-18

A method of leaching uranium ores containing sulfides is described. The method consists of adding a leach solution containing alkaline carbonate and alkaline bicarbonate to the ore to form a slurry, passing the slurry through a series of agitators, passing an oxygen containing gas through the slurry in the last agitator in the series, passing the same gas enriched with carbon dioxide formed by the decomposition of bicarbonates in the slurry through the penultimate agitator and in the same manner passing the same gas increasingly enriched with carbon dioxide through the other agitators in the series. The conditions of agitation is such that the extraction of the uranium content will be substantially complete before the slurry reaches the last agitator.

The Use of Cannabinoids in Treating Dementia.

PubMed

Weier, Megan; Hall, Wayne

2017-08-01

To review and summarise the current evidence on the safety and efficacy of using cannabinoids to treat behavioural and neuropsychiatric symptoms of dementia. Two randomised controlled trials testing a synthetic form of tetrahydrocannabinol have shown that while well tolerated, there was no significant therapeutic effect, based on changes to scores on the neuropsychiatric inventory (NPI). Case reports and open label trials have indicated that there may be some therapeutic benefit of adding synthetic cannabinoids as an adjunctive therapy to reduce agitation, aberrant motor behaviour and nighttime behaviour. More well-controlled clinical trials in older populations with varying severity of dementia are needed to evaluate the effectiveness of cannabinoids in treating behaviour symptoms of dementia. We provide suggestions for designing such trials and evaluating possible adverse effects of cannabinoids on cognitive and neuropsychiatric functioning.

Type of homogenization and fat loss during continuous infusion of human milk.

PubMed

García-Lara, Nadia Raquel; Escuder-Vieco, Diana; Alonso Díaz, Clara; Vázquez Román, Sara; De la Cruz-Bértolo, Javier; Pallás-Alonso, Carmen Rosa

2014-11-01

Substantial fat loss may occur during continuous feeding of human milk (HM). A decrease of fat loss has been described following homogenization. Well-established methods of homogenization of HM for routine use in the neonatal intensive care unit (NICU) would be desirable. We compared the loss of fat based on the use of 3 different methods for homogenizing thawed HM during continuous feeding. Sixteen frozen donor HM samples were thawed, homogenized with ultrasound and separated into 3 aliquots ("baseline agitation," "hourly agitation," and "ultrasound"), and then frozen for 48 hours. Aliquots were thawed again and a baseline agitation was applied. Subsequently, aliquots baseline agitation and hourly agitation were drawn into a syringe, while ultrasound was applied to aliquot ultrasound before it was drawn into a syringe. The syringes were loaded into a pump (2 mL/h; 4 hours). At hourly intervals the hourly agitation infusion was stopped, the syringe was disconnected and gently shaken. During infusion, samples from the 3 groups were collected hourly for analysis of fat and caloric content. The 3 groups of homogenization showed similar fat content at the beginning of the infusion. For fat, mean (SD) hourly changes of -0.03 (0.01), -0.09 (0.01), and -0.09 (0.01) g/dL were observed for the hourly agitation, baseline agitation, and ultrasound groups, respectively. The decrease was smaller for the hourly agitation group (P < .001). When thawed HM is continuously infused, a smaller fat loss is observed when syringes are agitated hourly versus when ultrasound or a baseline homogenization is used. © The Author(s) 2014.

Efficacy of antipsychotics in dementia depended on the definition of patients and outcomes: a meta-epidemiological study.

PubMed

Smeets, C H W; Zuidema, S U; Hulshof, T A; Smalbrugge, M; Gerritsen, D L; Koopmans, R T C M; Luijendijk, H J

2018-05-18

Postulating that efficacy of antipsychotics for agitation and psychosis in dementia is best estimated in trials among patients with these symptoms and with symptom-specific outcomes, we investigated whether clinically broader definitions affected the pooled efficacy. Trials were searched in multiple databases and categorized according to patient population (agitated, psychotic, mixed) and outcome scale (agitation, psychosis, generic). Standardized mean differences with 95% confidence intervals were calculated for conventional and atypical antipsychotics separately. Thirty trials met our inclusion criteria. Conventional antipsychotics might have a small effect in agitated patients on agitation scales (-0.44; -0.88, 0.01), and in psychotic patients on psychosis scales (-0.31; -0.61, -0.02). There was no effect on generic scales. Efficacy of atypical antipsychotics was not established in agitated patients on agitation scales (-0.15; -0.43, 0.13), and in psychotic patients on psychosis scales (-0.11; -0.20, -0.03), but was small in mixed patients on agitation scales (-0.29; -0.40, -0.18). Pooled efficacy of antipsychotics for agitation and psychosis in dementia is biased when based on trials that included patients without these target symptoms, or on results measured with generic scales. This finding is important for reviewers and guideline developers who select trials for reviews. Copyright © 2018. Published by Elsevier Inc.

Anterior Ethmoidal Nerve Block in Prevention of Postoperative Agitation

ClinicalTrials.gov

2018-02-08

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

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

PubMed

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

2018-04-16

Agitation is a common manifestation of bipolar disorder and schizophrenia which includes symptoms ranging from inner tension and unease to violence and aggression. Much of the existing literature has focused on agitation in the acute setting, with the patient experience poorly defined. Thus, the aim of this study was to characterize agitation and its management from a patient perspective, with the focus on those who reside in the community. Surveys were completed across Germany, Spain and the UK by 583 community dwelling patients with schizophrenia or bipolar disorder who experienced episodes of agitation. Patients were recruited via either their physician or through patient support groups. The survey captured information on demographics, disease characteristics, frequency of agitation episodes and different pre-defined severity levels ranging from mild to severe, symptoms experienced during an episode, awareness of agitation and coping strategies employed by the patient. Statistics were descriptive in nature. The most commonly reported symptoms during an episode of agitation were feeling uneasy (n = 373, 64%), restless (n = 368, 63%) or nervous (n = 368, 63%). Patients experienced an average of 22.4 (SD 57.2) mild, 15.4 (SD 61.2) moderate, 6.8 (SD 63.3) moderate-intense and 2.9 (SD 24.4) severe episodes within the last 12 months; on average 2.7 (SD 6.8) required hospital attendance. Half of patients (n = 313) had attended hospital due to agitation. In total, 71% of patients (n = 412) were aware they were becoming agitated either always or sometimes and 61% of patients (n = 347) were aware of agitation triggers either always or sometimes. The majority of patients reported being able to sometimes control their agitation (56%, n = 329) but 16% (n = 94) stated that there is typically nothing they can do. To cope with episodes 55% (n = 125) of schizophrenia patients and 66% (n = 234) of bipolar disorder patients reported taking prescribed medication. Community based patients with schizophrenia and bipolar disorder reported frequently experiencing agitation episodes which they defined most commonly as feeling uneasy, restless or nervous. A range of coping strategies were reported but they were not always successful, highlighting an area of unmet need in this population.

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

PubMed

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

2017-06-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2015-03-04

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

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

PubMed

Zeller, Scott L; Citrome, Leslie

2016-03-01

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

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

PubMed

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

2011-12-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-01-01

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

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

PubMed

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

1999-01-01

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

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

PubMed

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

2013-01-01

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

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

PubMed

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

2006-10-01

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

Effect of Aromatherapy Massage on Agitation and Depressive Mood in Individuals With Dementia.

PubMed

Yang, Ya-Ping; Wang, Chi-Jane; Wang, Jing-Jy

2016-09-01

The current study examined the effects of aromatherapy massage on alleviating agitation and depressive mood in individuals with dementia. A randomized controlled trial and repeated measures design was conducted. A total of 59 participants were randomly assigned to intervention or control groups. The intervention group received aromatherapy massage once per week for 8 weeks. Results indicated no significant changes over time in overall agitation for either group, but agitation decreased from Week 1 to Week 5 for the intervention group. In addition, the overall depressive symptoms decreased significantly over time for the intervention group compared to the control group (p < 0.001). However, changes in agitation within 24 hours following aromatherapy massage showed some significant changes in Weeks 5 and 9. Aromatherapy massage can be an effective and safe intervention to alleviate specific agitated behaviors and depressive mood in individuals with dementia. [Journal of Gerontological Nursing, 42(9), 38-46.]. Copyright 2016, SLACK Incorporated.

Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

PubMed Central

Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

2012-01-01

It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents to the emergency setting. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this article and Project BETA (Best practices in Evaluation and Treatment of Agitation), but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed. PMID:22461916

Treating agitation with dexmedetomidine in the ICU.

PubMed

Boyer, Jeanne

2009-01-01

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

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

PubMed

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

2017-04-01

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

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

PubMed Central

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

2013-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed

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

2018-01-08

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

Hydrodynamic effects on cell growth in agitated microcarrier bioreactors

NASA Technical Reports Server (NTRS)

Cherry, Robert S.; Papoutsakis, E. Terry

1988-01-01

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

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

PubMed

Kavanagh, Nicole; Corrigan, Owen I

2004-07-26

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

Effect of mixing during fermentation in yogurt manufacturing.

PubMed

Aguirre-Ezkauriatza, E J; Galarza-González, M G; Uribe-Bujanda, A I; Ríos-Licea, M; López-Pacheco, F; Hernández-Brenes, C M; Alvarez, M M

2008-12-01

In traditional yogurt manufacturing, the yogurt is not agitated during fermentation. However, stirring could be beneficial, particularly for improving heat and mass transport across the fermentation tank. In this contribution, we studied the effect of low-speed agitation during fermentation on process time, acidity profile, and microbial dynamics during yogurt fermentation in 2 laboratory-scale fermenters (3 and 5 L) with different heat-transfer characteristics. Lactobacillus bulgaricus and Streptococcus thermophilus were used as fermenting bacteria. Curves of pH, lactic acid concentration, lactose concentration, and bacterial population profiles during fermentation are presented for static and low-agitation conditions during fermentation. At low-inoculum conditions, agitation reduced the processing time by shortening the lag phase. However, mixing did not modify the duration or the shape of the pH profiles during the exponential phase. In fermentors with poor heat-transfer characteristics, important differences in microbial dynamics were observed between the agitated and nonagitated fermentation experiments; that is, agitation significantly increased the observable specific growth rate and the final microbial count of L. bulgaricus.

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

PubMed

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

2015-11-01

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

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

PubMed

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

2015-05-01

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

Association between caregiver depression and individual behavioral and psychological symptoms of dementia in Taiwanese patients.

PubMed

Huang, Si-Sheng; Liao, Yi-Cheng; Wang, Wen-Fu

2015-09-01

The aim of this study was to investigate caregiver depression associated with neuropsychiatric symptoms in Taiwanese people. A cross-sectional design was used in this study. Two hundred seventy-six pairs of patients with dementia and their caregivers who visited the memory clinic of a general hospital from July 2001 to October 2008 were recruited. Caregiver depression was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D); the behavioral and psychological symptoms of dementia were evaluated using the Neuropsychiatric Inventory. Demographic data of the patients and caregivers, including cognitive functions and clinical dementia ratings, were collected. In addition to descriptive statistics, we examined the relationship between each parameter and caregiver depression using Pearson correlation, independent t-test, or analysis of variance. The results showed a statistically significant positive correlation between the total Neuropsychiatric Inventory score and CES-D score (r = 0.345, P < 0.001) in the bivariate analyses. For individual behavioral and psychological symptoms of dementia, agitation/aggression, anxiety, nighttime behavior disturbances, irritability/lability, and hallucinations were the five leading symptoms significantly associated with caregiver depression (CES-D). Carefully managing these symptoms is likely to reduce depression in dementia caregivers. © 2015 Wiley Publishing Asia Pty Ltd.

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

System for agitating the acid in a lead-acid battery

DOEpatents

Weintraub, Alvin; MacCormack, Robert S.

1987-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

PubMed

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

2012-05-01

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

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

PubMed

Mufti, Hani N; Hirsch, Gregory M

2017-12-01

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

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

PubMed

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

2012-02-28

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

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

PubMed Central

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

2009-01-01

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

Prehospital Agitation and Sedation Trial (PhAST): A Randomized Control Trial of Intramuscular Haloperidol versus Intramuscular Midazolam for the Sedation of the Agitated or Violent Patient in the Prehospital Environment.

PubMed

Isenberg, Derek L; Jacobs, Dorian

2015-10-01

Violent patients in the prehospital environment pose a threat to health care workers tasked with managing their medical conditions. While research has focused on methods to control the agitated patient in the emergency department (ED), there is a paucity of data looking at the optimal approach to subdue these patients safely in the prehospital setting. Hypothesis This study evaluated the efficacy of two different intramuscular medications, midazolam and haloperidol, to determine their efficacy in sedating agitated patients in the prehospital setting. This was a prospective, randomized, observational trial wherein agitated patients were administered intramuscular haloperidol or intramuscular midazolam to control agitation. Agitation was quantified by the Richmond Agitation and Sedation Scale (RASS). Paramedics recorded the RASS and vital signs every five minutes during transport and again upon arrival to the ED. The primary outcome was mean time to achieve a RASS less than +1. Secondary outcomes included mean time for patients to return to baseline mental status and adverse events. Five patients were enrolled in each study group. In the haloperidol group, the mean time to achieve a RASS score of less than +1 was 24.8 minutes (95% CI, 8-49 minutes), and the mean time for the return of a normal mental status was 84 minutes (95% CI, 0-202 minutes). Two patients required additional prehospital doses for adequate sedation. There were no adverse events recorded in the patients administered haloperidol. In the midazolam group, the mean time to achieve a RASS score of less than +1 was 13.5 minutes (95% CI, 8-19 minutes) and the mean time for the return of normal mental status was 105 minutes (95% CI, 0-178 minutes). One patient required additional sedation in the ED. There were no adverse events recorded among the patients administered midazolam. Midazolam and haloperidol administered intramuscularly appear equally effective for sedating an agitated patient in the prehospital setting. Midazolam appears to have a faster onset of action, as evidenced by the shorter time required to achieve a RASS score of less than +1 in the patients who received midazolam. Haloperidol offers an alternative option for the sedation of an agitated patient. Further studies should focus on continued investigation into appropriate sedation of agitated patients in the prehospital setting.

GROUT HOPPER MODELING STUDY

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

Lee, S.

2011-08-30

The Saltstone facility has a grout hopper tank to provide agitator stirring of the Saltstone feed materials. The tank has about 300 gallon capacity to provide a larger working volume for the grout slurry to be held in case of a process upset, and it is equipped with a mechanical agitator, which is intended to keep the grout in motion and agitated so that it won't start to set up. The dry feeds and the salt solution are already mixed in the mixer prior to being transferred to the hopper tank. The hopper modeling study through this work will focusmore » on fluid stirring and agitation, instead of traditional mixing in the literature, in order to keep the tank contents in motion during their residence time so that they will not be upset or solidified prior to transferring the grout to the Saltstone disposal facility. The primary objective of the work is to evaluate the flow performance for mechanical agitators to prevent vortex pull-through for an adequate stirring of the feed materials and to estimate an agitator speed which provides acceptable flow performance with a 45{sup o} pitched four-blade agitator. In addition, the power consumption required for the agitator operation was estimated. The modeling calculations were performed by taking two steps of the Computational Fluid Dynamics (CFD) modeling approach. As a first step, a simple single-stage agitator model with 45{sup o} pitched propeller blades was developed for the initial scoping analysis of the flow pattern behaviors for a range of different operating conditions. Based on the initial phase-1 results, the phase-2 model with a two-stage agitator was developed for the final performance evaluations. A series of sensitivity calculations for different designs of agitators and operating conditions have been performed to investigate the impact of key parameters on the grout hydraulic performance in a 300-gallon hopper tank. For the analysis, viscous shear was modeled by using the Bingham plastic approximation. Steady state analyses with a two-equation turbulence model were performed with the FLUENT{trademark} codes. All analyses were based on three-dimensional results. Recommended operational guidance was developed by using the basic concept that local shear rate profiles and flow patterns can be used as a measure of hydraulic performance and spatial stirring. Flow patterns were estimated by a Lagrangian integration technique along the flow paths from the material feed inlet. The modeling results show that when the two-stage agitator consisting of a 45{sup o} pitched propeller and radial flat-plate blades is run at 140 rpm speed with 28 in diameter, the agitator provides an adequate stirring of the feed materials for a wide range of yield stresses (1 to 21 Pa) and the vortex system is shed into the remote region of the tank boundary by the blade passage in an efficient way. The results of this modeling study were used to develop the design guidelines for the agitator stirring and dispersion of the Saltstone feed materials in a hopper tank.« less

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

PubMed

Kadić, Adnan; Palmqvist, Benny; Lidén, Gunnar

2014-01-01

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

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

PubMed

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

2009-02-01

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

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

PubMed

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

2017-03-01

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

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

PubMed

Sung, Huei-Chuan; Chang, Anne M

2005-10-01

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

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

PubMed

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

2015-06-01

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

CFD simulation of local and global mixing time in an agitated tank

NASA Astrophysics Data System (ADS)

Li, Liangchao; Xu, Bin

2017-01-01

The Issue of mixing efficiency in agitated tanks has drawn serious concern in many industrial processes. The turbulence model is very critical to predicting mixing process in agitated tanks. On the basis of computational fluid dynamics(CFD) software package Fluent 6.2, the mixing characteristics in a tank agitated by dual six-blade-Rushton-turbines(6-DT) are predicted using the detached eddy simulation(DES) method. A sliding mesh(SM) approach is adopted to solve the rotation of the impeller. The simulated flow patterns and liquid velocities in the agitated tank are verified by experimental data in the literature. The simulation results indicate that the DES method can obtain more flow details than Reynolds-averaged Navier-Stokes(RANS) model. Local and global mixing time in the agitated tank is predicted by solving a tracer concentration scalar transport equation. The simulated results show that feeding points have great influence on mixing process and mixing time. Mixing efficiency is the highest for the feeding point at location of midway of the two impellers. Two methods are used to determine global mixing time and get close result. Dimensionless global mixing time remains unchanged with increasing of impeller speed. Parallel, merging and diverging flow pattern form in the agitated tank, respectively, by changing the impeller spacing and clearance of lower impeller from the bottom of the tank. The global mixing time is the shortest for the merging flow, followed by diverging flow, and the longest for parallel flow. The research presents helpful references for design, optimization and scale-up of agitated tanks with multi-impeller.

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

PubMed

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

2015-01-01

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

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

ERIC Educational Resources Information Center

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

2007-01-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Hypokalemia and agitation in acute psychotic patients.

PubMed

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

1999-04-19

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

The minimum record time for PIV measurement in a vessel agitated by a Rushton turbine

NASA Astrophysics Data System (ADS)

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

In PIV studies published in the literature focusing on the investigation of the flow field in an agitated vessel the record time is ranging from the tenths and the units of seconds. The aim of this work was to determine minimum record time for PIV measurement in a vessel agitated by a Rushton turbine that is necessary to obtain relevant results of velocity field. The velocity fields were measured in a fully baffled cylindrical flat bottom vessel 400 mm in inner diameter agitated by a Rushton turbine 133 mm in diameter using 2-D Time Resolved Particle Image Velocimetry in the impeller Reynolds number range from 50 000 to 189 000. This Re range secures the fully-developed turbulent flow of agitated liquid. Three liquids of different viscosities were used as the agitated liquid. On the basis of the analysis of the radial and axial components of the mean- and fluctuation velocities measured outside the impeller region it was found that dimensionless minimum record time is independent of impeller Reynolds number and is equalled N.tRmin = 103 ± 19.

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

PubMed

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

2017-06-06

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

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

PubMed

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

2014-04-01

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

Neuropsychiatric disorders in persons with severe traumatic brain injury: prevalence, phenomenology, and relationship with demographic, clinical, and functional features.

PubMed

Ciurli, Paola; Formisano, Rita; Bivona, Umberto; Cantagallo, Anna; Angelelli, Paola

2011-01-01

To characterize neuropsychiatric symptoms in a large group of individuals with severe traumatic brain injury (TBI) and to correlate these symptoms with demographic, clinical, and functional features. The Neuropsychiatric Inventory (NPI), a frequently used scale to assess behavioral, emotional, and motivational disorders in persons with neurological diseases, was administered to a sample of 120 persons with severe TBI. Controls were 77 healthy subjects. A wide range of neuropsychiatric symptoms was found in the population with severe TBI: apathy (42%), irritability (37%), dysphoria/depressed mood (29%), disinhibition (28%), eating disturbances (27%), and agitation (24%). A clear relationship was also found with other demographic and clinical variables. Neuropsychiatric disorders constitute an important part of the comorbidity in populations with severe TBI. Our study emphasizes the importance of integrating an overall assessment of cognitive disturbances with a specific neuropsychiatric evaluation to improve clinical understanding and treatment of persons with TBI.

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

PubMed

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

2018-01-01

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

Valproate for agitation in critically ill patients: A retrospective study.

PubMed

Gagnon, David J; Fontaine, Gabriel V; Smith, Kathryn E; Riker, Richard R; Miller, Russell R; Lerwick, Patricia A; Lucas, F L; Dziodzio, John T; Sihler, Kristen C; Fraser, Gilles L

2017-02-01

The purpose was to describe the use of valproate therapy for agitation in critically ill patients, examine its safety, and describe its relationship with agitation and delirium. This retrospective cohort study evaluated critically ill adults treated with valproate for agitation from December 2012 through February 2015. Information on valproate prescribing practices and safety was collected. Incidence of agitation, delirium, and concomitant psychoactive medication use was compared between valproate day 1 and valproate day 3. Concomitant psychoactive medication use was analyzed using mixed models. Fifty-three patients were evaluated. The median day of valproate therapy initiation was ICU day 7, and it was continued for a median of 7 days. The median maintenance dose was 1500 mg/d (23 mg/kg/d). The incidence of agitation (96% vs 61%, P < .0001) and delirium (68% vs 49%, P = .012) significantly decreased by valproate day 3. Treatment with opioids (77% vs 65%, P = .02) and dexmedetomidine (47% vs 24%, P = .004) also decreased. In mixed models analyses, valproate therapy was associated with reduced fentanyl equivalents (-185 μg/d, P = .0003) and lorazepam equivalents (-2.1 mg/d, P = .0004). Hyperammonemia (19%) and thrombocytopenia (13%) were the most commonly observed adverse effects. Valproate therapy was associated with a reduction in agitation, delirium, and concomitant psychoactive medication use within 48 hours of initiation. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2017-07-01

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

Predictors of hyperphagia in institutionalized patients with dementia.

PubMed

Wu, Hua-Shan

2014-12-01

Hyperphagia, a common eating behavioral change in patients with dementia, is one of the risk factors for institutional placement. No study of hyperphagia has yet been conducted on institutionalized patients with dementia. There is currently no academic consensus over the correlations among hyperphagic behaviors, agitated behaviors, cognitive function, and demographic characteristics in this patient group. This study explores the prevalence and predictors of hyperphagic behaviors in institutionalized patients with dementia. A cross-sectional and correlational design was used. The participants were recruited from seven dementia special care units and assisted living facilities in Taiwan. One hundred seventy-nine patients with dementia agreed to participate. Two research assistants were trained to collect data using the subscale for hyperphagic behaviors, the Cohen-Mansfield Agitation Inventory, the Cognitive Abilities Screening Instrument, and a dementia patient demographic characteristics datasheet. The prevalence of hyperphagic behaviors in institutionalized patients with dementia was 50.8% (91/179). After excluding the variables from the long-term memory, short-term memory, attention, abstraction and judgment, and verbally nonaggressive behavior subscales scores, we found gender, length of institutionalization, category fluency, and physically nonaggressive behavior subscale scores to be significant predictors of hyperphagic behaviors (p < .05). Findings suggest that institutionalized male patients with dementia with longer institutionalization who have either a relatively low-fluency task score or a relatively high frequency of physically nonaggressive behaviors are at greater risk for exhibiting hyperphagic behaviors. Once hyperphagic behaviors are found in a patient, a transdisciplinary case meeting should be held to develop an appropriate dietary management plan, and further identification and treatment should be done by a neurologist or a psychiatrist.

Maximising platelet availability by delaying cold storage.

PubMed

Wood, B; Johnson, L; Hyland, R A; Marks, D C

2018-04-06

Cold-stored platelets may be an alternative to conventional room temperature (RT) storage. However, cold-stored platelets are cleared more rapidly from circulation, reducing their suitability for prophylactic transfusion. To minimise wastage, it may be beneficial to store platelets conventionally until near expiry (4 days) for prophylactic use, transferring them to refrigerated storage to facilitate an extended shelf life, reserving the platelets for the treatment of acute bleeding. Two ABO-matched buffy-coat-derived platelets (30% plasma/70% SSP+) were pooled and split to produce matched pairs (n = 8 pairs). One unit was stored at 2-6°C without agitation (day 1 postcollection; cold); the second unit was stored at 20-24°C with constant agitation until day 4 then stored at 2-6°C thereafter (delayed-cold). All units were tested for in vitro quality periodically over 21 days. During storage, cold and delayed-cold platelets maintained a similar platelet count. While pH and HSR were significantly higher in delayed-cold platelets, other metabolic markers, including lactate production and glucose consumption, did not differ significantly. Furthermore, surface expression of phosphatidylserine and CD62P, release of soluble CD62P and microparticles were not significantly different, suggesting similar activation profiles. Aggregation responses of delayed-cold platelets followed the same trend as cold platelets once transferred to cold storage, gradually declining over the storage period. The metabolic and activation profile of delayed-cold platelets was similar to cold-stored platelets. These data suggest that transferring platelets to refrigerated storage when near expiry may be a viable option for maximising platelet inventories. © 2018 International Society of Blood Transfusion.

Behavioral Characteristics of Agitated Nursing Home Residents with Dementia at the End of Life

ERIC Educational Resources Information Center

Allen, Rebecca S.; Burgio, Louis D.; Fisher, Susan E.; Hardin, J. Michael; Shuster, John L., Jr.

2005-01-01

Purpose: The purpose of this study was to examine group differences in verbal agitation, verbal interaction, bed restraint, pain, analgesic and neuroleptic medication use, and medical comorbidity among agitated nursing home residents who died during a 6-month clinical trial compared with residents of the same gender and similar initial cognitive…

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

ERIC Educational Resources Information Center

Cohen-Mansfield, Jiska

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

PubMed

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

2018-02-01

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

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

PubMed

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

2012-11-01

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

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

PubMed

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

2018-06-01

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

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

PubMed

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

2015-12-01

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

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

PubMed

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

2015-01-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

Hayes, Ariel; Russ, Mark J

2016-03-01

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

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

PubMed Central

Rose, Karen; Specht, Janet; Forch, Windy

2016-01-01

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

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

PubMed

Langhout, Regina Day

2016-12-01

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

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

PubMed

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

2015-01-01

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

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

PubMed Central

Ijaopo, E O

2017-01-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

Spira, Adam P; Edelstein, Barry A

2006-06-01

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

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

PubMed

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

2016-08-01

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

Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

PubMed Central

2012-01-01

Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. Trial registration The trial is registered in the Netherlands National Trial Register: NTR2314. PMID:22214264

Effectiveness of Inhaled Loxapine in Dual-Diagnosis Patients: A Case Series.

PubMed

Roncero, Carlos; Ros-Cucurull, Elena; Grau-López, Lara; Fadeuilhe, Christian; Casas, Miguel

2016-01-01

Episodes of psychotic agitation are frequent in patients with dual diagnosis, that is, in patients with concomitant psychiatric and substance use disorders. Rapid intervention is needed to treat the agitation at a mild stage to prevent the escalation to aggressive behavior. Inhaled loxapine has been demonstrated to rapidly improve symptoms of mild-to-moderate agitation in adults with psychiatric disorders (schizophrenia and bipolar disorder), but data on patients with dual diagnosis are scarce. This study is a retrospective review of data from a case series of patients with dual diagnosis, which were attended for symptoms of agitation while at the emergency room (n = 9), in the outpatient clinic (n = 4), or during hospitalization (n = 1) at 1 center in Spain. All patients received inhaled loxapine for treating the agitation episodes. Data from 14 patients with dual diagnosis were reviewed. All patients had 1 or more psychiatric disorders (schizophrenia, bipolar I disorder, drug-induced psychotic disorder, posttraumatic stress, borderline or antisocial personality disorder, depression, or anxiety) along with a variety of substance use disorders (alcohol, cocaine, cannabis, amphetamines, hypnotics and antianxiety drugs, caffeine, or street drugs). Overall, only 1 dose of inhaled loxapine (9.1 mg) was needed to calm each patient during an acute episode of agitation. Inhaled loxapine was rapid, effective, and well accepted in all dual-pathology patients presenting with acute agitation in the emergency setting. Inhaled loxapine facilitated both patient cooperation and an adequate management of his or her disease.

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

PubMed

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

2018-05-11

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

Association of plasma homovanillic acid with behavioral symptoms in patients diagnosed with dementia: a preliminary report.

PubMed

Sweet, R A; Pollock, B G; Mulsant, B H; Rosen, J; Lo, K H; Yao, J K; Henteleff, R A; Mazumdar, S

1997-12-01

Neuroleptic treatment of psychotic symptoms or agitated behavior in elderly patients diagnosed with dementia is associated with reduced efficacy and increased rates of neuroleptic-induced parkinsonism in comparison to younger patients with schizophrenia. We report the first study to examine the relationship between an in vivo measure of dopaminergic function, plasma homovanillic acid (pHVA), and ratings of psychosis, agitation, and parkinsonism before and after neuroleptic treatment in dementia patients. Pretreatment pHVA was significantly correlated with parkinsonian rigidity, with a trend observed with agitation and hostility. Though mean pHVA did not change during perphenazine treatment, intraindividual change in pHVA at day 15 was correlated with improvement in hostility, with a similar trend for improvement in agitation. These preliminary findings are consistent with reports associating dopaminergic function with agitated, but not psychotic, symptoms in patients diagnosed with dementia, and with a reduced responsivity of dopaminergic systems to neuroleptic treatment in these patients.

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

PubMed

Horn, Mathilde; Vaiva, Guillaume; Dumais, Alexandre

2015-01-01

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

Behavioral and caregiver reaction of dementia as measured by the neuropsychiatric inventory in Nigerian community residents.

PubMed

Baiyewu, Olusegun; Smith-Gamble, Valerie; Akinbiyi, Akinsola; Lane, Kathleen A; Hall, Kathleen S; Ogunniyi, Adesola; Gureje, Oyewusi; Hendrie, Hugh C

2003-12-01

The Neuropsychiatric Inventory (NPI) has been used to assess behavioral symptoms of dementia in the United States, Taiwan, Japan, and Italy. This report evaluates the use of the NPI to assess behavioral symptoms of dementia in a population of Yoruba, Nigerians aged 65 years and older who are subjects in the Indianapolis-Ibadan Dementia Project. In this study, the NPI, Blessed Dementia Scale, and Mini-Mental State Examination (MMSE) were used to assess Nigerian subjects with dementia. For this study the NPI was translated, back translated, and harmonized into Yoruba. The harmonized version of the NPI showed good interrater and test-retest reliability. The Cronbach alpha on 40 subjects was .80 for total severity score, .73 for frequency, and .73 for distress, indicating good internal consistency. The MMSE correlated with the NPI total score and severity scores of delusion, hallucination, and agitation, whereas the Blessed correlated with the NPI total score and severity scores of depression, anxiety, and nighttime behavior. The NPI was found to be a reliable tool to assess behavioral symptoms and caregiver distress of dementia in the Yoruba. Behavioral disturbances were as common in the Yoruba patients with dementia as in studies in other countries that have used the NPI, but the pattern of behavioral disturbances and caregiver response varied among the countries.

Effect of Pore Clogging on Kinetics of Lead Uptake by Clinoptilolite.

PubMed

Inglezakis; Diamandis; Loizidou; Grigoropoulou

1999-07-01

The kinetics of lead-sodium ion exchange using pretreated natural clinoptilolite are investigated, more specifically the influence of agitation (0, 210, and 650 rpm) on the limiting step of the overall process, for particle sizes of 0.63-0.8 and 0.8-1 mm at ambient temperature and initial lead solutions of 500 mg l-1 without pH adjustment. The isotopic exchange model is found to fit the ion exchange process. Particle diffusion is shown to be the controlling step for both particle sizes under agitation, while in the absence of agitation film diffusion is shown to control. The ion exchange process effective diffusion coefficients are calculated and found to depend strongly on particle size in the case of agitation at 210 rpm and only slightly on particle size at 650 rpm. Lead uptake rates are higher for smaller particles only at rigorous agitation, while at mild agitation the results are reversed. These facts are due to partial clogging of the pores of the mineral during the grinding process. This is verified through comparison of lead uptake rates for two samples of the same particle size, one of which is rigorously washed for a certain time before being exposed to the ion exchange. Copyright 1999 Academic Press.

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

PubMed

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

2018-02-01

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

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

PubMed

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

2017-06-01

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

The Effect of Diode Laser With Different Parameters on Root Fracture During Irrigation Procedure.

PubMed

Karataş, Ertuğrul; Arslan, Hakan; Topçuoğlu, Hüseyin Sinan; Yılmaz, Cenk Burak; Yeter, Kübra Yesildal; Ayrancı, Leyla Benan

2016-06-01

The aim of this study is to compare the effect of a single diode laser application and agitation of EDTA with diode laser with different parameters at different time intervals on root fracture. Ninety mandibular incisors were instrumented except the negative control group. The specimens were divided randomly into 10 groups according to final irrigation procedure: (G1) non-instrumented; (G2) distilled water; (G3) 15% EDTA; (G4) ultrasonically agitated EDTA; (G5) single 1.5W/100 Hz Diode laser; (G6) single 3W/100 Hz Diode laser; (G7) 1.5W/100 Hz Diode laser agitation of EDTA for 20 s; (G8) 1.5W/100 Hz Diode laser agitation of EDTA for 40 s; (G9) 3W/100 Hz Diode laser agitation of EDTA for 20 s; and (G10) 3W/100 Hz Diode laser agitation of EDTA for 40 s. The specimens were filled, mounted in acrylic resin, and compression strength test was performed on each specimen. Statistical analysis was carried out using one way ANOVA and Tukey's post hoc tests (P = 0.05). The statistical analysis revealed that there were statistically significant differences among the groups (P < 0.05). Laser-agitated irrigation with a 3W/100 Hz Diode laser for both 20 s and 40 s decreased the fracture resistance of teeth. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

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

PubMed

Nott, Melissa T; Chapparo, Christine

2008-09-01

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

Clinical Symptom Responses to Atypical Antipsychotic Medications in Alzheimer’s Disease: Phase 1 Outcomes from the CATIE-AD Effectiveness Trial

PubMed Central

Sultzer, David L.; Davis, Sonia M.; Tariot, Pierre N.; Dagerman, Karen S.; Lebowitz, Barry D.; Lyketsos, Constantine G.; Rosenheck, Robert A.; Hsiao, John K.; Lieberman, Jeffrey A.; Schneider, Lon S.

2009-01-01

Objective To measure the effects of atypical antipsychotic medication on psychiatric and behavioral symptoms in patients with Alzheimer’s disease (AD) and psychosis or agitated behavior. Method The CATIE-AD effectiveness study included 421 outpatients with AD and psychosis or agitated/aggressive behavior. Patients were assigned randomly to masked flexible-dose treatment with olanzapine, quetiapine, risperidone, or placebo for up to 36 weeks. Patients could be re-randomized to a different medication treatment at the clinician’s discretion, which ended the Phase 1 period. Psychiatric and behavioral symptoms, functional abilities, cognition, care needs, and quality of life were measured at regular intervals. Results At the last observation in Phase 1 compared to placebo, there was greater improvement in patients treated with olanzapine or risperidone on the Neuropsychiatric Inventory total score, with risperidone on the Clinical Global Impression of Change, with olanzapine or risperidone on the Brief Psychiatric Rating Scale (BPRS) Hostile Suspiciousness factor, and with risperidone on the BPRS Psychosis factor. There was worsening with olanzapine on the BPRS Withdrawn Depression factor. Among patients continuing Phase 1 treatment at 12 weeks, there were no significant antipsychotic – placebo group differences on measures of cognition, functional skills, care needs, or quality of life, except for worsening of functional skills in the olanzapine treatment group compared to placebo. Conclusion In this descriptive analysis of clinical outcomes in AD outpatients in usual care settings, some clinical symptoms improved with atypical antipsychotic treatment. Antipsychotic medications may be more effective for particular symptoms, such as anger, aggression, and paranoid ideas. Functional abilities, care needs, or quality of life do not appear to improve with antipsychotic treatment. PMID:18519523

Staff Distress Improves by Treating Pain in Nursing Home Patients With Dementia: Results From a Cluster-Randomized Controlled Trial.

PubMed

Aasmul, Irene; Husebo, Bettina Sandgathe; Flo, Elisabeth

2016-12-01

Most people with dementia develop neuropsychiatric symptoms (NPSs), which are distressing for their carers. Untreated pain may increase the prevalence and severity of NPSs and thereby staff burden. We investigated the association between NPSs and the impact of individual pain treatment on distress in nursing home staff. Nursing home (NH) units were cluster-randomized to an intervention group (33 NH units; n = 175) or control group (27 NH units; n = 177). Patients in the intervention group received individual pain treatment for eight weeks, followed by a four-week washout period; control groups received care as usual. Staff informants (n = 138) used the Neuropsychiatric Inventory-NH version (including caregiver distress) as primary outcome to assess their own distress. Other outcomes were pain (Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale) and cognitive functioning (Mini-Mental State Examination). Using hierarchical regression analysis, all NPS items at baseline were associated with staff distress (P < 0.01) apart from euphoria; agitation had the largest contribution (β = 0.24). Using mixed models, we found significantly lower staff distress in the intervention group compared to the control group. Moreover, we also found significantly reduced distress in the control group, and there were still effects in both groups throughout the washout period. Individual pain treatment reduced staff distress in the intervention group compared to control group especially in regard to agitation-related symptoms and apathy. Furthermore, our results indicated a multifactorial model of staff distress, in which enhanced knowledge and understanding of NPSs and pain in people with advanced dementia may play an important role. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging.

PubMed

Lyketsos, C G; Steinberg, M; Tschanz, J T; Norton, M C; Steffens, D C; Breitner, J C

2000-05-01

The authors report findings from a study of 5,092 community residents who constituted 90% of the elderly resident population of Cache County, Utah. The 5,092 participants, who were 65 years old or older, were screened for dementia. Based on the results of this screen, 1,002 participants (329 with dementia and 673 without dementia) underwent comprehensive neuropsychiatric examinations and were rated on the Neuropsychiatric Inventory, a widely used method for ascertainment and classification of dementia-associated mental and behavioral disturbances. Of the 329 participants with dementia, 214 (65%) had Alzheimer's disease, 62 (19%) had vascular dementia, and 53 (16%) had another DSM-IV dementia diagnosis; 201 (61%) had exhibited one or more mental or behavioral disturbances in the past month. Apathy (27%), depression (24%), and agitation/aggression (24%) were the most common in participants with dementia. These disturbances were almost four times more common in participants with dementia than in those without. Only modest differences were observed in the prevalence of mental or behavioral disturbances in different types of dementia or at different stages of illness: participants with Alzheimer's disease were more likely to have delusions and less likely to have depression. Agitation/aggression and aberrant motor behavior were more common in participants with advanced dementia. On the basis of their findings in this large community population of elderly people, the authors conclude that a wide range of dementia-associated mental and behavioral disturbances afflict the majority of individuals with dementia. Because of their frequency and their adverse effects on patients and their caregivers, these disturbances should be ascertained and treated in all cases of dementia.

Effectiveness of Exercise- and Cognitive-Based Treatments on Salivary Cortisol Levels and Sundowning Syndrome Symptoms in Patients with Alzheimer's Disease.

PubMed

Venturelli, Massimo; Sollima, Alessio; Cè, Emiliano; Limonta, Eloisa; Bisconti, Angela V; Brasioli, Anna; Muti, Ettore; Esposito, Fabio

2016-07-14

Sundowning syndrome (SDS) in patients with Alzheimer's disease (AD) is characterized by the intensification of behavioral disorders at sunset. Despite SDS etiology being unclear, a strong relationship between high cortisol levels and SDS has been reported. Aerobic exercise (AE) and cognitive training (CT) can reduce cortisol levels. However, whether SDS would benefit from AE and CT is still unknown. Therefore, the aim of this study was to investigate whether AE and CT treatments are effective in reducing SDS via downregulation of cortisol levels. The possible additive effects of combined AE+CT were also assessed. Eighty AD patients were randomly assigned to AE (n = 20), CT (n = 20), AE+CT (n = 20), and standard therapy (no treatment, NT; n = 20). Treatments were administered for 3 months, 5 days/week, 1 hour before sunset. Before and after treatments, salivary cortisol levels were sampled at 7, 11, 15, at sunset, and 20 (time of day). Blind assessment of behavioral disorders (neuropsychiatric inventory, NPI) and agitation (agitated behavior scale, ABS) were also performed. After interventions, cortisol levels were reduced in AE and AE+CT by ∼26%. In the same groups, NPI and ABS decreased by ∼50%. By contrast, cortisol and behavioral disorders were similar to baseline in CT and NT. Changes in NPI and ABS were significantly correlated with the reduction in cortisol levels. AE or AE+CT effects on SDS and cortisol levels and the lack of effect of CT alone indicate the effectiveness of an exercise-based treatment on SDS, suggesting a possible hypothalamic-pituitary-adrenal axis dysregulation underpinning SDS.

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

PubMed

Hellweg, Stephanie; Schuster-Amft, Corina

2016-07-19

Agitation is frequently observed during early recovery after traumatic brain injury (TBI). Agitated behaviour often interferes with a goal-orientated rehabilitation and can be a substantial hindrance to therapy. Despite the relatively high occurance of agitation in TBI population there is no objective assessement in German (G) available. An existing scale with excellent psychometric properties is the "Agitated Behavior Scale (ABS)" developed by Corrigan in 1989. The aim of the study was to translate the Agitated Behavior Scale (ABS) into German (ABS-G) and investigate the inter- and intrarater reliability and internal consistency in patients with moderate to severe TBI. A formal nine-step translation and cross-cultural adaptation procedure (TCCA) was applied. Subsequently a prospective observational patient study was conducted. To examine the interrater reliability and internal consistency, two therapists rated 20 patients independently after a therapy session. This procedure was repeated twice on a weekly basis. The intrarater reliability was assessed through video recordings from three patients. Nine raters scored the demonstrated behaviour on the videotape with the ABS-G independently twice within one month. The inter- and intrarater reliability were evaluated with the Spearman rank correlation coefficient and the quadratic weighted kappa. The internal consistency was tested with Cronbach's alpha. Behaviour of 20 patients (18 males; mean age 41 ± 20.7; mean Functional Independence Measure (FIM) cognitive score on admission 7.1 ± 4.04; mean ABS-G score at first observation 17.3 ± 2.83) was assessed threefold. Interrater reliability yielded a correlation coefficient for ABS-G total score of all 60 paired observations of r s 0.845 and a weighted Kappa of 0.738. Intrarater reliability for ABS-G total score ranged between r s 0.719 and 0.953 and showed a weighted Kappa between 0.871 and 0.953. Cronbach's alpha indicated moderate internal consistency with 0.661. This study demonstrates that the ABS-G is a reliable instrument for evaluating agitation in patients with moderate to severe TBI. Hereby it would be possible to monitor agitation objectively and optimise the management of agitated patients according to international recommendations.

Amelioration of lesions associated with 24-hour suboptimal platelet storage at 16 °C by a p38MAPK inhibitor, VX-702.

PubMed

Wagner, S J; Skripchenko, A; Seetharaman, S; Kurtz, J

2015-04-01

Previous studies with p38MAPK inhibitors at room temperature demonstrated that they improve a large number of platelet storage parameters, but cannot substantially inhibit p38MAPK activation nor protect against widespread decrements in platelet quality parameters during 4 °C storage. In this study, platelet quality parameters and inhibition of p38MAPK by VX-702 were studied after incubation of platelets at 16 °C without agitation, suboptimal storage conditions which produce moderate platelet decrements. Trima apheresis units were collected and aliquoted into three 60-ml CLX storage bags: (i) a control aliquot which was held at 20-24 °C with constant agitation; (ii) a test aliquot which was held at 20-24 °C with agitation until Day 2, when it was reincubated at 16 ± 1 °C for 24 ± 0·5 h without agitation and then returned 20-24 °C with agitation; (iii) a test aliquot containing 1 μm VX-702 stored in an identical fashion as aliquot 2. Aliquots were tested for an array of platelet storage parameters and p38MAPK activation on Days 1, 4 and 7. Many platelet storage parameters and p38MAPK activation were adversely affected by 24-h incubation at 16 °C without agitation. With the exception of ESC, addition of VX-702 prevented p38MAPK activation and the decrements in most observed parameters. Unlike 4 °C storage, VX-702 prevents activation of p38MAPK and decrements in many platelet storage parameters after exposure to 16 °C without agitation for 24 h. © 2014 International Society of Blood Transfusion.

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

NASA Astrophysics Data System (ADS)

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

2017-05-01

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

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

PubMed

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

2010-09-01

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

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

PubMed

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

2017-02-08

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

A prospective study of ketamine versus haloperidol for severe prehospital agitation.

PubMed

Cole, Jon B; Moore, Johanna C; Nystrom, Paul C; Orozco, Benjamin S; Stellpflug, Samuel J; Kornas, Rebecca L; Fryza, Brandon J; Steinberg, Lila W; O'Brien-Lambert, Alex; Bache-Wiig, Peter; Engebretsen, Kristin M; Ho, Jeffrey D

2016-08-01

Ketamine is an emerging drug for the treatment of acute undifferentiated agitation in the prehospital environment, however no prospective comparative studies have evaluated its effectiveness or safety in this clinical setting. We hypothesized 5 mg/kg of intramuscular ketamine would be superior to 10 mg of intramuscular haloperidol for severe prehospital agitation, with time to adequate sedation as the primary outcome measure. This was a prospective open label study of all patients in an urban EMS system requiring chemical sedation for severe acute undifferentiated agitation that were subsequently transported to the EMS system's primary Emergency Department. All paramedics were trained in the Altered Mental Status Scale and prospectively recorded agitation scores on all patients. Two 6-month periods where either ketamine or haloperidol was the first-line therapy for severe agitation were prospectively compared primarily for time to adequate sedation. Secondary outcomes included laboratory data and adverse medication events. 146 subjects were enrolled; 64 received ketamine, 82 received haloperidol. Median time to adequate sedation for the ketamine group was 5 minutes (range 0.4-23) vs. 17 minutes (range 2-84) in the haloperidol group (difference 12 minutes, 95% CI 9-15). Complications occurred in 49% (27/55) of patients receiving ketamine vs. 5% (4/82) in the haloperidol group. Complications specific to the ketamine group included hypersalivation (21/56, 38%), emergence reaction (5/52, 10%), vomiting (5/57, 9%), and laryngospasm (3/55, 5%). Intubation was also significantly higher in the ketamine group; 39% of patients receiving ketamine were intubated vs. 4% of patients receiving haloperidol. Ketamine is superior to haloperidol in terms of time to adequate sedation for severe prehospital acute undifferentiated agitation, but is associated with more complications and a higher intubation rate.

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

PubMed

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

2015-05-01

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

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

PubMed

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

2017-05-01

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

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

PubMed

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

2017-05-01

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

Time to Response to Citalopram Treatment for Agitation in Alzheimer Disease.

PubMed

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

2015-11-01

Agitation is a common and significant problem in Alzheimer disease (AD). In the recent Citalopram for Agitation in Alzheimer's Disease (CitAD) study, citalopram was efficacious for the treatment of AD agitation. Here we examined the time course and predictors of response to treatment. Response in CitAD was defined as a modified Alzheimer Disease Cooperative Study Clinical Global Impression of Change (CGIC) score of 1 or 2 or a Neurobehavioral Rating Scale agitation subscale (NBRS-A) score reduction ≥ 50% from baseline. "Stable early response" was defined as meeting the aforementioned criteria at both weeks 3 and 9, "late response" was response at week 9 but not at week 3, and "unstable response" was response at week 3 but not at week 9. In the primary analyses, citalopram was superior to placebo on both the CGIC and the NBRS-A response measures. Little between-group differences were found in response rates in the first 3 weeks of the study (21% versus 19% on the CGIC). Citalopram patients were more likely than placebo patients to be a late responder (18% versus 8% on CGIC, Fisher's exact p = 0.09; 31% versus 15% on NBRS-A, Fisher's exact p = 0.02). Approximately half of citalopram responders (45%-56%) at end of study achieved response later in the study compared with 30%-44% of placebo responders. Treatment with citalopram for agitation in AD needs to be at least 9 weeks in duration to allow sufficient time for full response. Study duration is an important factor to consider in the design of clinical trials for agitation in AD. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2017-01-01

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

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

PubMed

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

2016-06-01

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

Agitation

MedlinePlus

There are many causes of agitation. Some of them are: Alcohol intoxication or withdrawal Allergic reaction Caffeine intoxication Certain forms of heart, lung, liver, or kidney disease Intoxication or withdrawal from drugs of abuse (such as ...

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

PubMed

Soares, Ana; Guieysse, Benoit; Mattiasson, Bo

2006-02-01

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

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

PubMed

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

2016-01-01

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

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

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

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

2014-02-15

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

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

PubMed

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

2017-05-01

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

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

PubMed

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

1996-08-20

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

PubMed

Córcoles, David; Malagón, Angeles; Bellsolà, Magdalena; Gonzalez, Ana; Cortizo, Romina; Leon, Jordi; Bulbena, Antoni; Pérez, Victor; Martín, Luis M

2018-05-01

The aim of the study was to evaluate whether the neuropsychiatric symptoms interfere with cognitive impairment detection in primary care and to describe which of them generate more confusion. Descriptive and observational study. Mobile psychiatric unit in collaboration with primary healthcare centers in Barcelona. A total of 104 patients over 65years referred to mobile psychiatric unit from primary healthcare clinicians suspecting mental disease. All patients received a DSM-IV-TR diagnosis. We included in the study the Mini Mental State Examination (MMSE), Neuropsichiatric Inventory, Severe Psychiatric Illness scale, Global Assessment of Functioning, Clinical Global Impression and Word Health Organisation Dissability Assessment Schedule. 55.8% of patients referred from primary care had altered MMSE score. Neuropsychiatric symptoms more frequently associated with suspected cognitive impairment were delusions, hallucinations, agitation, disinhibition, irritability and purposeless motor behavior. When psychiatric symptoms of Severe Mental Disorder (SMD) are detected in elderly individuals with no history of SMD, cognitive impairment should be suspected and a screening test be done. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Apple juice improved behavioral but not cognitive symptoms in moderate-to-late stage Alzheimer's disease in an open-label pilot study.

PubMed

Remington, Ruth; Chan, Amy; Lepore, Alicia; Kotlya, Elizabeth; Shea, Thomas B

2010-06-01

Preclinical studies demonstrate that apple juice exerts multiple beneficial effects including reduction of central nervous system oxidative damage, suppression of Alzheimer's disease (AD) hallmarks, improved cognitive performance, and organized synaptic signaling. Herein, we initiated an open-label clinical trial in which 21 institutionalized individuals with moderate-to-severe AD consumed 2 4-oz glasses of apple juice daily for 1 month. Participants demonstrated no change in the Dementia Rating Scale, and institutional caregivers reported no change in Alzheimer's Disease Cooperative Study (ADCS)-Activities of Daily Living (ADL) in this brief study. However, caregivers reported an approximate 27% (P < .01) improvement in behavioral and psychotic symptoms associated with dementia as quantified by the Neuropsychiatric Inventory, with the largest changes in anxiety, agitation, and delusion. This pilot study suggests that apple juice may be a useful supplement, perhaps to augment pharmacological approaches, for attenuating the decline in mood that accompanies progression of AD, which may also reduce caregiver burden.

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

NASA Astrophysics Data System (ADS)

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

2017-03-01

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

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

NASA Astrophysics Data System (ADS)

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

2017-08-01

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

Integrated air stream micromixer for performing bioanalytical assays on a plastic chip.

PubMed

Geissler, Matthias; Li, Kebin; Zhang, Xuefeng; Clime, Liviu; Robideau, Gregg P; Bilodeau, Guillaume J; Veres, Teodor

2014-10-07

This paper describes the design, functioning and use of an integrated mixer that relies on air flux to agitate microliter entities of fluid in an embedded microfluidic cavity. The system was fabricated from multiple layers of a thermoplastic elastomer and features circuits for both liquid and air supply along with pneumatic valves for process control. Internally-dyed polymer particles have been used to visualize flow within the fluid phase during agitation. Numerical modelling of the micromixer revealed an overall efficacy of 10(-1) to 10(-2) for momentum transfer at the air-water interface. Simulation of air vortex dynamics showed dependency of the flow pattern on the velocity of the flux entering the cavity. Three bioanalytical assays have been performed as proof-of-concept demonstrations. In a first assay, cells of Listeria monocytogenes were combined with magnetic nanoparticles (NPs), resulting in high-density coverage of the bacteria's surface with NPs after 1 min of agitation. This finding is contrasted by a control experiment without agitation for which interaction between bacteria and NPs remains low. In a second one, capture and release of genomic DNA from fungi through adsorption onto magnetic beads was tested and shown to be improved by agitation compared to non-agitated controls. A third assay finally involved fluorescently-labelled target oligonucleotide strands and polystyrene particles modified with DNA capture probes to perform detection of nucleic acids on beads. Excellent selectivity was obtained in a competitive hybridization process using a multiplexed micromixer chip design.

The effect of the medicine administration route on health-related quality of life: Results from a time trade-off survey in patients with bipolar disorder or schizophrenia in 2 Nordic countries.

PubMed

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

2016-07-16

Agitation episodes are common among patients with schizophrenia or bipolar disorder. Oral and intramuscular administration methods are commonly used in pharmacological treatment of acute agitation. Recently, an innovative inhalation product with loxapine(Adasuve®)has become available for treatment of acute agitation episodes associated with bipolar disorder or schizophrenia. The objective for the present study was to investigate the impact of the pharmacological treatment's administration methods on the health-related quality of life (HRQoL) in patients with bipolar disorder or schizophrenia in Denmark and Sweden using a time trade-off (TTO) approach. The TTO methodology was used to examine the HRQoL impact of administration method of pharmacological treatment of acute agitation. Data were collected via an internet-based survey, using an existing panel of respondents with schizophrenia or bipolar disorder. Respondents considered living with schizophrenia/ bipolar disorder, having one yearly agitation episode treated with inhaler better than living with the same conditions and receiving treatment with tablet or injection. The utility value was 0.762 for inhalable treatment, 0.707 for injection and 0.734 for tablet treatment. Patients' preference for treatment delivery options showed that inhalation was associated with a significant utility gain when compared to injection or tablets. Inhalable loxapine may be a new tool for control of agitation episodes for strengthening the patient provider alliance when taking patient's preference for delivery method into consideration.

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

PubMed

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

2005-01-01

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

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

PubMed

Wong, Yen-Ming; Siow, Lee-Fong

2015-05-01

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

Process Optimization on Micro-Aeration Supply for High Production Yield of 2,3-Butanediol from Maltodextrin by Metabolically-Engineered Klebsiella oxytoca

PubMed Central

Jantama, Sirima Suvarnakuta; Kanchanatawee, Sunthorn

2016-01-01

An optimization process with a cheap and abundant substrate is considered one of the factors affecting the price of the production of economical 2,3-Butanediol (2,3-BD). A combination of the conventional method and response surface methodology (RSM) was applied in this study. The optimized levels of pH, aeration rate, agitation speed, and substrate concentration (maltodextrin) were investigated to determine the cost-effectiveness of fermentative 2,3-BD production by metabolically-engineered Klebsiella oxytoca KMS005. Results revealed that pH, aeration rate, agitation speed, and maltodextrin concentration at levels of 6.0, 0.8 vvm, 400 rpm, and 150 g/L respectively were the optimal conditions. RSM also indicated that the agitation speed was the most influential parameter when either agitation and aeration interaction or agitation and substrate concentration interaction played important roles for 2,3-BD production by the strain from maltodextrin. Under interim fed-batch fermentation, 2,3-BD concentration, yield, and productivity were obtained at 88.1±0.2 g/L, 0.412±0.001 g/g, and 1.13±0.01 g/L/h respectively within 78 h. PMID:27603922

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

PubMed

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

2016-12-01

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

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

PubMed

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

2015-12-01

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

Utility and Clinical Profile of Dexmedetomidine in Pediatric Cardiac Catheterization Procedures: A Matched Controlled Analysis.

PubMed

Riveros, Ricardo; Makarova, Natalya; Riveros-Perez, Efrain; Chodavarapu, Praneeta; Saasouh, Wael; Yılmaz, Hüseyin Oğuz; Cuko, Evis; Babazade, Rovnat; Kimatian, Stephen; Turan, Alparslan

2017-12-01

Dexmedetomidine is increasingly used in children undergoing cardiac catheterization procedures. We compared the percentage of surgical time with hemodynamic instability and the incidence of postoperative agitation between pediatric cardiac catheterization patients who received dexmedetomidine infusion and those who did not and the incidence of postoperative agitation. We matched 653 pediatric patients scheduled for cardiac catheterization. Two separate multivariable linear mixed models were used to assess the association between dexmedetomidine use and intraoperative blood pressure and heart rate instability. A multivariate logistic regression was used for relationship between dexmedetomidine and postoperative agitation. No difference between the study groups was found in the duration of MAP ( P = .867) or heart rate (HR) instabilities ( P = .224). The relationship between dexmedetomidine use and the duration of negative hemodynamic effects does not depend on any of the considered CHD types (all P > .001) or intervention ( P = .453 for MAP and P = .023 for HR). No difference in postoperative agitation was found between the study groups ( P = .590). Our study demonstrated no benefit in using dexmedetomidine infusion compared with other general anesthesia techniques to maintain hemodynamic stability or decrease agitation in pediatric patients undergoing cardiac catheterization procedures.

Heat transfer phenomena during thermal processing of liquid particulate mixtures-A review.

PubMed

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

2017-05-03

During the past few decades, food industry has explored various novel thermal and non-thermal processing technologies to minimize the associated high-quality loss involved in conventional thermal processing. Among these are the novel agitation systems that permit forced convention in canned particulate fluids to improve heat transfer, reduce process time, and minimize heat damage to processed products. These include traditional rotary agitation systems involving end-over-end, axial, or biaxial rotation of cans and the more recent reciprocating (lateral) agitation. The invention of thermal processing systems with induced container agitation has made heat transfer studies more difficult due to problems in tracking the particle temperatures due to their dynamic motion during processing and complexities resulting from the effects of forced convection currents within the container. This has prompted active research on modeling and characterization of heat transfer phenomena in such systems. This review brings to perspective, the current status on thermal processing of particulate foods, within the constraints of lethality requirements from safety view point, and discusses available techniques of data collection, heat transfer coefficient evaluation, and the critical processing parameters that affect these heat transfer coefficients, especially under agitation processing conditions.

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

PubMed

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

2010-03-01

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

Americium behaviour in plastic vessels.

PubMed

Legarda, F; Herranz, M; Idoeta, R; Abelairas, A

2010-01-01

The adsorption of (241)Am dissolved in water in different plastic storage vessels was determined. Three different plastics were investigated with natural and distilled waters and the retention of (241)Am by these plastics was studied. The same was done by varying vessel agitation time, vessel agitation speed, surface/volume ratio of water in the vessels and water pH. Adsorptions were measured to be between 0% and 70%. The adsorption of (241)Am is minimized with no water agitation, with PET or PVC plastics, and by water acidification. Copyright 2009 Elsevier Ltd. All rights reserved.

Principal components analysis of the hypomanic attitudes and positive predictions inventory and associations with measures of personality, cognitive style and analogue symptoms in a student sample.

PubMed

Dodd, Alyson L; Mansell, Warren; Sadhnani, Vaneeta; Morrison, Anthony P; Tai, Sara

2010-01-01

An integrative cognitive model proposed that ascribing extreme personal appraisals to changes in internal state is key to the development of the symptoms of bipolar disorder. The Hypomanic Attitudes and Positive Predictions Inventory (HAPPI) was developed to measure these appraisals. The aim of the current study was to validate an expanded 61-item version of the HAPPI. In a largely female student sample (N = 134), principal components analysis (PCA) was performed on the HAPPI. Associations between the HAPPI and analogue bipolar symptoms after 3 months were examined. PCA of the HAPPI revealed six categories of belief: Self Activation, Self-and-Other Critical, Catastrophic, Extreme Appraisals of Social Approval, Appraisals of Extreme Agitation, and Loss of Control. The HAPPI predicted all analogue measures of hypomanic symptoms after 3 months when controlling for baseline symptoms. In a more stringent test incorporating other psychological measures, the HAPPI was independently associated only with activation (e.g. thoughts racing) at 3 months. Dependent dysfunctional attitudes predicted greater conflict (e.g. irritability), depression and reduced well-being, hypomanic personality predicted self-reported diagnostic bipolar symptoms, and behavioural dysregulation predicted depression. Extreme beliefs about internal states show a modest independent association with prospective analogue bipolar symptoms, alongside other psychological factors. Further work will be required to improve the factor structure of the HAPPI and study its validity in clinical samples.

Agitation, Mixing, and Transfers Induced by Bubbles

NASA Astrophysics Data System (ADS)

Risso, Frédéric

2018-01-01

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

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

PubMed

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

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

Cocaine-induced agitated delirium: a case report and review.

PubMed

Plush, Theodore; Shakespeare, Walter; Jacobs, Dorian; Ladi, Larry; Sethi, Sheeba; Gasperino, James

2015-01-01

Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachycardia to multiorgan system failure. Classic features of acute intoxication include tachycardia, arterial vasoconstriction, enhanced thrombus formation, mydriasis, psychomotor agitation, and altered level of consciousness. At the extreme end of this toxidrome is a rare condition known as cocaine-induced agitated delirium. This syndrome is characterized by severe cardiopulmonary dysfunction, hyperthermia, and acute neurologic changes frequently leading to death. We report a case of cocaine-induced agitated delirium in a man who presented to our institution in a paradoxical form of circulatory shock. Rapid evaluation, recognition, and proper management enabled our patient not only to survive but also to leave the hospital without neurologic sequelae. © The Author(s) 2013.

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

PubMed

Hawranik, Pamela; Johnston, Pat; Deatrich, Judith

2008-06-01

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

Effects of ultrasonic pretreatment on quantity and composition of bacterial DNA recovered from granular activated carbon used for drinking water treatment.

PubMed

Kim, Tae Gwan; Kim, Sun-Hye; Cho, Kyung-Suk

2014-01-01

Effects of ultrasonic pretreatment on bacterial DNA recovery from granular activated carbon (GAC) were investigated. GAC (Calgon F400), biologically activated, was sampled from an actual drinking water plant. Different ultrasonic energy densities (0-400 J·cm(-3)) were applied with agitation (250 rpm for 30 min), and recovered bacterial DNA was quantified using quantitative PCR. Energy density was linearly correlated with the concentration of carbon fines produced from GAC during ultrasonication. Ultrasonication alone had no effect on DNA recovery at ≤60 J·cm(-3), but a strongly adverse effect at >67 J·cm(-3) due to the produced carbon fines. Agitation along with ultrasonication strongly enhanced the bacterial DNA recovery when ≤40 J·cm(-3) was applied, although it did not affect the production of carbon fines. Ribosomal tag pyrosequencing was used to compare recovered bacterial communities (0, 20 and 30 J·cm(-3) with or without agitation). Ultrasonication allowed for obtaining a more diverse and richer bacterial community from GAC, compared with the control. Agitation did not show a positive effect on community organization (richness and diversity). Consistently, canonical correspondence analysis indicated that the energy density was associated with the relative abundances of particular bacterial members (P < 0.05), while agitation did not. Correspondence analysis revealed that the recovered bacterial communities were grouped according to the applied energy densities. In conclusion, ultrasonication and agitation influence the recovered DNA in quality and quantity, respectively, and carbon fines as a by-product by ultrasonication interfere with the DNA recovery.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2016-03-01

To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Eight Scottish ICUs over a 12-month period. Mechanically ventilated patients. None. The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman ρ = 0.75) and were reliable in clinician-clinician (weighted kappa; κ = 0.66) and clinician-researcher (κ = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale (ρ = 0.24) and was reliable in clinician-clinician (κ = 0.58) and clinician-researcher (κ = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale (ρ = 0.54), and reliability in clinician-clinician (κ = 0.29) and clinician-researcher (κ = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time.

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

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

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

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

PubMed

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

2013-11-13

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

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

PubMed

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

2007-01-01

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

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

PubMed

Shupe, Alan M; Liu, Shijie

2012-09-01

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

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

PubMed

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

2017-09-19

The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, -5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival. Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (-4.1 points) than placebo + haloperidol (-2.3 points) (mean difference, -1.9 points [95% CI, -2.8 to -0.9]; P < .001). The lorazepam + haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, -1.0 mg [95% CI, -2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol group; mean difference, 47% [95% CI, 14% to 73%], P = .007; nurses: 77% for the lorazepam + haloperidol group vs 30% for the placebo + haloperidol group; mean difference, 47% [95% CI, 17% to 71%], P = .005). No significant between-group differences were found in delirium-related distress and survival. The most common adverse effect was hypokinesia (3 patients in the lorazepam + haloperidol group [19%] and 4 patients in the placebo + haloperidol group [27%]). In this preliminary trial of hospitalized patients with agitated delirium in the setting of advanced cancer, the addition of lorazepam to haloperidol compared with haloperidol alone resulted in a significantly greater reduction in agitation at 8 hours. Further research is needed to assess generalizability and adverse effects. clinicaltrials.gov Identifier: NCT01949662.

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

PubMed Central

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

2017-01-01

IMPORTANCE The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. OBJECTIVE To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. DESIGN, SETTING, AND PARTICIPANTS Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. INTERVENTIONS Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. MAIN OUTCOMES AND MEASURES The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range, −5 [unarousable] to 4 [very agitated or combative]) from baseline to 8 hours after treatment administration. Secondary end points were rescue neuroleptic use, delirium recall, comfort (perceived by caregivers and nurses), communication capacity, delirium severity, adverse effects, discharge outcomes, and overall survival. RESULTS Among 90 randomized patients (mean age, 62 years; women, 42 [47%]), 58 (64%) received the study medication and 52 (90%) completed the trial. Lorazepam + haloperidol resulted in a significantly greater reduction of RASS score at 8 hours (−4.1 points) than placebo + haloperidol (−2.3 points) (mean difference, −1.9 points [95% CI, −2.8 to −0.9]; P < .001). The lorazepam + haloperidol group required less median rescue neuroleptics (2.0 mg) than the placebo + haloperidol group (4.0 mg) (median difference, −1.0 mg [95% CI, −2.0 to 0]; P = .009) and was perceived to be more comfortable by both blinded caregivers and nurses (caregivers: 84% for the lorazepam + haloperidol group vs 37% for the placebo + haloperidol group; mean difference, 47% [95% CI, 14% to 73%], P = .007; nurses: 77% for the lorazepam + haloperidol group vs 30% for the placebo + haloperidol group; mean difference, 47% [95% CI, 17% to 71%], P = .005). No significant between-group differences were found in delirium-related distress and survival. The most common adverse effect was hypokinesia (3 patients in the lorazepam + haloperidol group [19%] and 4 patients in the placebo + haloperidol group [27%]). CONCLUSIONS AND RELEVANCE In this preliminary trial of hospitalized patients with agitated delirium in the setting of advanced cancer, the addition of lorazepam to haloperidol compared with haloperidol alone resulted in a significantly greater reduction in agitation at 8 hours. Further research is needed to assess generalizability and adverse effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01949662 PMID:28975307

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

PubMed

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

2018-01-01

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

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

PubMed

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

2014-02-01

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

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

PubMed

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

1999-07-01

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

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

PubMed

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

2017-05-01

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

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

PubMed

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

2018-05-01

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

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

PubMed

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

2017-09-01

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

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2005-12-01

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

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

PubMed

Dolder, Christian; McKinsey, Jonathan

2010-01-01

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

Pumping Characteristics of a Helical Screw Agitator with a Draught Tube

NASA Astrophysics Data System (ADS)

Hwang, Jung-Hoon; Kim, Youn-Jea

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

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

PubMed

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

2014-11-18

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

Operator Exposure to Hydrogen Sulfide from Dairy Manure Storages Containing Gypsum Bedding.

PubMed

Fabian-Wheeler, Eileen E; Hile, Michael L; Murphy, Dennis J; Hill, Davis E; Meinen, Robert; Brandt, Robin C; Elliott, Hershel A; Hofstetter, Daniel

2017-01-26

Dairy manure storages containing gypsum-based bedding have been linked anecdotally with injury and death due to presumed dangerous levels of gases released. Recycled gypsum products are used as a cost-effective bedding alternative to improve animal welfare and provide agronomic benefits to manure recycled back to the land. Sulfur contained in gypsum (calcium sulfate) can contribute to hydrogen sulfide (H2S) gas formation under the anaerobic storage conditions typical of dairy manure slurry. Disturbance of stored manure during agitation releases a burst of volatile gases. On-farm monitoring was conducted to document conditions during manure storage agitation relative to gas concentration and operator safety. One objective was to document operator exposure to H2S levels; therefore, each operator wore a personal gas monitor while performing tasks associated with manure storage agitation. Data from three dairy bedding management categories on ten farms were compared: (1) traditional organic bedding, (2) gypsum bedding, and (3) gypsum bedding plus a manure additive thought to reduce H2S formation and/or release. Portable meters placed around the perimeter of dairy manure storages recorded H2S concentrations prior to and during 19 agitation events. Results show that farms using gypsum bedding produced higher H2S concentrations during manure storage agitation than farms using traditional bedding. In most cases, gypsum-containing manure storages produced H2S levels above recognized safe thresholds for both livestock and humans. Farm operators were most at risk during activities in close proximity to the manure storage during agitation, and conditions 10 m away from the storage were above the 20 ppm H2S threshold on some farms using gypsum bedding. Although H2S concentrations rose to dangerous levels, only two of 18 operators were exposed to >50 ppm H2S during the first 60 min of manure storage agitation. Operators who are aware of the risk of high H2S concentrations near gypsum-laden manure storages can reduce their exposure risk by working upwind and away from the H2S plume within a closed tractor cab. Copyright© by the American Society of Agricultural Engineers.

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

PubMed

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

2008-12-01

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

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

PubMed

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

2015-10-01

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

Coal storage hopper with vibrating screen agitator

DOEpatents

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

1984-01-01

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

Coal storage hopper with vibrating-screen agitator

DOEpatents

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

1982-04-27

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

Impact of varying analytical methodologies on grain particle size determination.

PubMed

Kalivoda, J R; Jones, C K; Stark, C R

2017-01-01

The determination of particle size is an important quality control measurement for feed manufacturers, nutritionists, and producers. The current approved method for determining the geometric mean diameter by weight (d) and geometric standard deviation (S) of grains is standard ANSI/ASAE S319.4. This method controls many variables, including the suggested quantity of initial material and the type, number, and size of sieves. However, the method allows for variations in sieving time, sieve agitators, and the use of a dispersion agent. The objective of this experiment was to determine which method of particle size analysis best estimated the particle size of various cereal grain types. Eighteen samples of either corn, sorghum, or wheat were ground and analyzed using different variations of the approved method. Treatments were arranged in a 5 × 3 factorial arrangement with 5 sieving methods: 1) 10-min sieving time with sieve agitators and no dispersion agent, 2) 10-min sieving time with sieve agitators and dispersion agent, 3) 15-min sieving time with no sieve agitators or dispersion agent, 4) 15-min sieving time with sieve agitators and no dispersion agent, and 5) 15-min sieving time with sieve agitators and dispersion agent conducted in 3 grain types (ground corn, sorghum, and wheat) with 4 replicates per treatment. The analytical method that resulted in the lowest d and greatest S was considered desirable because it was presumably representative of increased movement of particles to their appropriate sieve. Analytical method affected d and S ( ≤ 0.05) measured by both standards. Inclusion of sieve agitators and dispersion agent in the sieve stack resulted in the lowest d, regardless of sieving time. Inclusion of dispersion agent reduced d ( ≤ 0.05) by 32 and 36 µm when shaken for 10 and 15 min, respectively, compared to the same sample analyzed without dispersion agent. The addition of the dispersion agent also increased S. The dispersion agent increased the quantity of very fine particles collected in the pan; therefore, S was significantly greater ( ≤ 0.05). Corn and sorghum ground using the same mill parameters had similar d ( > 0.05), but wheat ground using the same mill parameters was 120 to 104 µm larger ( ≤ 0.05) than corn and sorghum, respectively. Both sieve agitators and dispersion agent should be included when conducting particle size analysis. The results indicate that 10 and 15 min of sieving time produced similar results.

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

PubMed Central

2013-01-01

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

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

PubMed

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

2013-10-01

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

An Agitation Experiment with Multiple Aspects

ERIC Educational Resources Information Center

Spencer, Jordan L.

2006-01-01

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

High-Aspect-Ratio Rotating Cell-Culture Vessel

NASA Technical Reports Server (NTRS)

Wolf, David A.; Sams, Clarence; Schwarz, Ray P.

1992-01-01

Cylindrical rotating cell-culture vessel with thin culture-medium layer of large surface area provides exchange of nutrients and products of metabolism with minimal agitation. Rotation causes averaging of buoyant forces otherwise separating components of different densities. Vessel enables growth of cells in homogeneous distribution with little agitation and little shear stress.

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities.

PubMed

Suzuki, Mizue; Hattori, Hideyuki; Fukuda, Koji; Ooshiro, Hajime; Saruhara, Takayuki; Furuta, Yoshie; Abe, Kunihiko; Kanamori, Masao

2017-01-01

The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly). Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores. The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD. When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

Changes in Neuropsychiatric Inventory Associated with Semagacestat Treatment of Alzheimer's Disease.

PubMed

Rosenberg, Paul B; Lanctôt, Krista L; Herrmann, Nathan; Mintzer, Jacobo E; Porsteinsson, Anton P; Sun, Xiaoying; Raman, Rema

2016-08-10

In a recent report, 76 weeks' treatment with a gamma-secretase inhibitor (semagacestat) was associated with poorer cognitive outcomes in Alzheimer's disease (AD). We sought to examine the effect of semagacestat treatment on neuropsychiatric symptoms (NPS). 1,537 participants with mild to moderate AD were randomized to 76 weeks' treatment with placebo versus two doses of semagacestat. NPS were assessed with the Neuropsychiatric Inventory (NPI-Total and subdomains). Cognition was assessed with the Alzheimer's Disease Assessment Scale-Cognitive (first 11 items, ADAS11). Mixed-Model Repeated Measures was used to compare the effects of treatment assignment on change in NPI-total and subdomains over time. Survival analysis was used to assess the treatment effect on time to first worsening of NPS (NPI-Total ≥10 or NPI subdomain ≥4) for subjects with no or minor NPS at baseline. Participants on high dose semagecestat (140 mg) had greater increase in NPI-Total and greater risk of incident first worsening in NPI-Total and in subdomains of aberrant motor behavior, appetite, depression/dysphoria, and sleep. ADAS11 increased more in participants whose NPI-Total increased. In participants with mild to moderate AD, high dose semagacestat treatment was associated with greater severity and faster worsening of NPS in a pattern resembling an agitated depression. Increased NPS was associated with cognitive decline regardless of treatment assignment. These findings suggest that greater NPS may be the result of gamma-secretase treatment and emphasize the importance of monitoring NPS as potential adverse events in trials of novel treatments for AD.

[Temporal perspective and other psychological factors making it difficult to adapt to requirements of treatment in chronic dialysis patients].

PubMed

Zawadzka, Barbara; Byrczek, Magdalena; Zawadzka, Sara

2014-01-01

The study analyzed the relationship between temporal perspective, selected personal resources, and unhealthy behavior, manifesting in problems with adherence to fluid intake restrictions, in chronic.hemodialyzis patients. The authors tried to answer the question whether there is temporal perspective and other psychological factors increasing the risk of non-adaptive behaviors. Sixty-one patients, aged 23-81 years (m = 59; SD = 13,9) on chronic hemodialysis at the Department of Nephrology University Hospital were qualified to the study. The study group consisted of 30 patients with poorer fluid regimen adherence and 31 con- trols, who maintained fluid regimen. The patients were qualified on the bases of the average interdialysis weight gains measured nine times during three weeks. The following research tools were used: P. Zimbardo and J. Boyd ZTPI test; P.T. Costa and R.R. McCrae NEO-FFI Inventory; J. Strelau Temperament Inventory, R. Schwarzer GSES; M. F. Scheier; C. S. Carver and M. W. Bridges LOT-R; M. Watson and S. Greer CECS; BJ. Felton, TA. Revenson, GA. Hinrichsen AIS. Difficulties in adapting to the fluid intake restrictions are significantly associated with temporal orientation towards negative aspects of the present and the past. Non-adaptive health behaviors are typical for patients with temperamental lack of balance between agitation and inhibition processes and are characterized by high agreeableness and low conscientious- ness. The association between excessive anger control and the risk of non-adherence medical recommendations. Time perception and other personality factors form mechanisms regulating health behaviors in chronically treatment patients.

Evaluation of personalised, one-to-one interaction using Montessori-type activities as a treatment of challenging behaviours in people with dementia: the study protocol of a crossover trial.

PubMed

van der Ploeg, Eva S; O'Connor, Daniel W

2010-01-24

The agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Behaviours stemming from pain, major depression or psychosis benefit from treatment with analgesics, antidepressants or antipsychotics. In other cases, psychotropic medications have limited efficacy but are used very widely. Therefore, increasingly more attention has been paid to nonpharmacological interventions which are associated with fewer risks. The aim of the current study is to test if personalised one-to-one interaction activities based on Montessori principles will reduce the frequency of behavioural symptoms of dementia significantly more than a relevant control condition. We will conduct a controlled trial with randomised cross-over between conditions. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to Montessori or control blocks for two weeks then switched to the other condition. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. The control intervention consists of conversation or reading from and looking at pictures in a newspaper to control for non-specific benefits of one-to-one interaction. Presence of target behaviour will be noted as well as level of engagement and type of affect displayed. Secondary measures also include the Cohen-Mansfield Agitation Inventory and information on time and funds spend to prepare the activities. If our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia, it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone. Australian New Zealand Clinical Trials Registry - ACTRN12609000564257.

Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias

PubMed Central

Kazui, Hiroaki; Yoshiyama, Kenji; Kanemoto, Hideki; Suzuki, Yukiko; Sato, Shunsuke; Hashimoto, Mamoru; Ikeda, Manabu; Tanaka, Hibiki; Hatada, Yutaka; Matsushita, Masateru; Nishio, Yoshiyuki; Mori, Etsuro; Tanimukai, Satoshi; Komori, Kenjiro; Yoshida, Taku; Shimizu, Hideaki; Matsumoto, Teruhisa; Mori, Takaaki; Kashibayashi, Tetsuo; Yokoyama, Kazumasa; Shimomura, Tatsuo; Kabeshita, Yasunobu; Adachi, Hiroyoshi; Tanaka, Toshihisa

2016-01-01

Background/Aims Behavioral and psychological symptoms of dementia (BPSDs) negatively impact the prognosis of dementia patients and increase caregiver distress. The aims of this study were to clarify the differences of trajectories of 12 kinds of BPSDs by disease severity in four major dementias and to develop charts showing the frequency, severity, and associated caregiver distress (ACD) of BPSDs using the data of a Japan multicenter study (J-BIRD). Methods We gathered Neuropsychiatric Inventory (NPI) data of patients with Alzheimer’s disease (AD; n = 1091), dementia with Lewy bodies (DLB; n = 249), vascular dementia (VaD; n = 156), and frontotemporal lobar degeneration (FTLD; n = 102) collected during a 5-year period up to July 31, 2013 in seven centers for dementia in Japan. The NPI composite scores (frequency × severity) of 12 kinds of items were analyzed using a principal component analysis (PCA) in each dementia. The factor scores of the PCA were compared in each dementia by disease severity, which was determined with Clinical Dementia Rating (CDR). Results Significant increases with higher CDR scores were observed in 1) two of the three factor scores which were loaded for all items except euphoria in AD, 2) two of the four factor scores for apathy, aberrant motor behavior (AMB), sleep disturbances, agitation, irritability, disinhibition, and euphoria in DLB, and 3) one of the four factor scores for apathy, depression, anxiety, and sleep disturbances in VaD. However, no increases were observed in any of the five factor scores in FTLD. Conclusions As dementia progresses, several BPSDs become more severe, including 1) apathy and sleep disturbances in AD, DLB, and VaD, 2) all of the BPSDs except euphoria in AD, 3) AMB, agitation, irritability, disinhibition, and euphoria in DLB, and 4) depression and anxiety in VaD. Trajectories of BPSDs in FTLD were unclear. PMID:27536962

EXTRACTION APPARATUS

DOEpatents

Ballard, A.E.; Brigham, H.R.

1958-10-28

An apparatus whereby relatlvely volatile solvents may be contacted with volatile or non-volatile material without certaln attendant hazards is described. A suitable apparatus for handling relatively volatlle liqulds may be constructed comprising a tank, and a closure covering the tank and adapted to be securely attached to an external suppont. The closure is provided with a rigidly mounted motor-driven agitator. This agitator is connected from the driving motor lnto the lnterlor of the tank through a gland adapted to be cooled witb inert gas thereby eliminating possible hazard due to frictional heat. The closure is arranged so that the tank may be removed from it without materially dlsturbing the closure which, as described, carrles the motor driven agitator and other parts.

40 CFR 63.1331 - Equipment leak provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in pumps and agitator seals in light liquid service shall not be considered to be a leak. For purposes of this subpart, a “bleed port” is a technologically-required feature of the pump or seal whereby polymer fluid used to provide lubrication and/or cooling of the pump or agitator shaft exits the pump...

Continuous process for forming sheet metal from an alloy containing non-dendritic primary solid

DOEpatents

Flemings, Merton C.; Matsuniya, Tooru

1983-01-01

A homogeneous mixture of liquid-solid metal is shaped by passing the composition from an agitation zone onto a surface moving relative to the exit of the agitation zone. A portion of the composition contacting the moving surface is solidified and the entire composition then is formed.

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

USDA-ARS?s Scientific Manuscript database

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

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

ERIC Educational Resources Information Center

Zigman, Daniel; Young, Meredith; Chalk, Colin

2013-01-01

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

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

PubMed

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

2002-04-15

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

Structural control of ultra-fine CoPt nanodot arrays via electrodeposition process

NASA Astrophysics Data System (ADS)

Wodarz, Siggi; Hasegawa, Takashi; Ishio, Shunji; Homma, Takayuki

2017-05-01

CoPt nanodot arrays were fabricated by combining electrodeposition and electron beam lithography (EBL) for the use of bit-patterned media (BPM). To achieve precise control of deposition uniformity and coercivity of the CoPt nanodot arrays, their crystal structure and magnetic properties were controlled by controlling the diffusion state of metal ions from the initial deposition stage with the application of bath agitation. Following bath agitation, the composition gradient of the CoPt alloy with thickness was mitigated to have a near-ideal alloy composition of Co:Pt =80:20, which induces epitaxial-like growth from Ru substrate, thus resulting in the improvement of the crystal orientation of the hcp (002) structure from its initial deposition stages. Furthermore, the cross-sectional transmission electron microscope (TEM) analysis of the nanodots deposited with bath agitation showed CoPt growth along its c-axis oriented in the perpendicular direction, having uniform lattice fringes on the hcp (002) plane from the Ru underlayer interface, which is a significant factor to induce perpendicular magnetic anisotropy. Magnetic characterization of the CoPt nanodot arrays showed increase in the perpendicular coercivity and squareness of the hysteresis loops from 2.0 kOe and 0.64 (without agitation) to 4.0 kOe and 0.87 with bath agitation. Based on the detailed characterization of nanodot arrays, the precise crystal structure control of the nanodot arrays with ultra-high recording density by electrochemical process was successfully demonstrated.

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

PubMed

Kittipeerachon, Mantana; Chaichan, Warawat

2016-10-01

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

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

PubMed

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

2018-01-01

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

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

ERIC Educational Resources Information Center

Corbett, Julia B.

2001-01-01

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

Mechanisms of cell damage in agitated microcarrier tissue culture reactors

NASA Technical Reports Server (NTRS)

Cherry, Robert S.; Papoutsakis, E. Terry

1986-01-01

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

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

ERIC Educational Resources Information Center

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

2013-01-01

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

102. DETAIL OF LEAD ROUGHER CELL INTERIOR. NOTE SEVERAL CELLS ...

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

102. DETAIL OF LEAD ROUGHER CELL INTERIOR. NOTE SEVERAL CELLS COMBINED INTO ONE LARGER CELL FOR THIS STAGE, DIPPER FOR SAMPLING SLIME, AND TWO DIFFERENT STYLES OF GALIGHER "AGITAIR" FIXED BAFFLES AROUND AGITATOR. GALIGHER AGITATORS HAVE PADDLE BLADES ON BOTTOM OF DISKS. - Shenandoah-Dives Mill, 135 County Road 2, Silverton, San Juan County, CO

Metal Alloy Compositions And Process Background Of The Invention

DOEpatents

Flemings, Merton C.; Martinez-Ayers, Raul A.; de Figueredo, Anacleto M.; Yurko, James A.

2003-11-11

A skinless metal alloy composition free of entrapped gas and comprising primary solid discrete degenerate dendrites homogeneously dispersed within a secondary phase is formed by a process wherein the metal alloy is heated in a vessel to render it a liquid. The liquid is then rapidly cooled while vigorously agitating it under conditions to avoid entrapment of gas while forming solid nuclei homogeneously distributed in the liquid. Agitation then is ceased when the liquid contains a small fraction solid or the liquid-solid alloy is removed from the source of agitation while cooling is continued to form the primary solid discrete degenerate dendrites in liquid secondary phase. The solid-liquid mixture then can be formed such as by casting.

Confirmatory Factor Analysis of the Delirium Rating Scale Revised-98 (DRS-R98).

PubMed

Thurber, Steven; Kishi, Yasuhiro; Trzepacz, Paula T; Franco, Jose G; Meagher, David J; Lee, Yanghyun; Kim, Jeong-Lan; Furlanetto, Leticia M; Negreiros, Daniel; Huang, Ming-Chyi; Chen, Chun-Hsin; Kean, Jacob; Leonard, Maeve

2015-01-01

Principal components analysis applied to the Delirium Rating Scale-Revised-98 contributes to understanding the delirium construct. Using a multisite pooled international delirium database, the authors applied confirmatory factor analysis to Delirium Rating Scale-Revised-98 scores from 859 adult patients evaluated by delirium experts (delirium, N=516; nondelirium, N=343). Confirmatory factor analysis found all diagnostic features and core symptoms (cognitive, language, thought process, sleep-wake cycle, motor retardation), except motor agitation, loaded onto factor 1. Motor agitation loaded onto factor 2 with noncore symptoms (delusions, affective lability, and perceptual disturbances). Factor 1 loading supports delirium as a single construct, but when accompanied by psychosis, motor agitation's role may not be solely as a circadian activity indicator.

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

PubMed

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

2014-07-01

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

Mathematical model for carbon dioxide evolution from the thermophilic composting of synthetic food wastes made of dog food

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

Chang, J.I.; Tsai, J.J.; Wu, K.H.

2005-07-01

The impacts of the aeration and the agitation on the composting process of synthetic food wastes made of dog food were studied in a laboratory-scale reactor. Two major peaks of CO{sub 2} evolution rate were observed. Each peak represented an independent stage of composting associated with the activities of thermophilic bacteria. CO{sub 2} evolutions known to correlate well with microbial activities and reactor temperatures were fitted successfully to a modified Gompertz equation, which incorporated three biokinetic parameters, namely, CO{sub 2} evolution potential, specific CO{sub 2} evolution rate, and lag phase time. No parameters that describe the impact of operating variablesmore » are involved. The model is only valid for the specified experimental conditions and may look different with others. The effects of operating parameters such as aeration and agitation were studied statistically with multivariate regression technique. Contour plots were constructed using regression equations for the examination of the dependence of CO{sub 2} evolution potentials on aeration and agitation. In the first stage, a maximum CO{sub 2} evolution potential was found when the aeration rate and the agitation parameter were set at 1.75 l/kg solids-min and 0.35, respectively. In the second stage, a maximum existed when the aeration rate and the agitation parameter were set at 1.8 l/kg solids-min and 0.5, respectively. The methods presented here can also be applied for the optimization of large-scale composting facilities that are operated differently and take longer time.« less

Children's drawings as a measure of anxiety level: a clinical pilot study.

PubMed

Puura, Arto; Puura, Kaija; Rorarius, Michael; Annila, Päivi; Viitanen, Hanna; Baer, Gerhard

2005-03-01

No simple method exists to distinguish children in need for premedication. The present study was planned to detect preoperative anxiety levels of children by rating their drawings. Sixty ASA I children aged 4-7 years undergoing adenoidectomy were divided into AGIT and CALM groups according to agitation level observed during venous cannulation. All children drew a picture at three different times: (i) just after arrival in the day-case unit, (ii) 10 min before operation and, (iii) prior to leaving for home. The children were also randomized to three premedication groups: group D, rectal diazepam 0.5 mg x kg(-1); group P, 0.9% NaCl 0.1 ml x kg(-1) rectally; group NT, no premedication. Five features (size of the drawing, form of the drawing line, colors used, mark of the pen and clarity of the picture) from the children's drawings were rated with a 3-point scale. The ratings of each feature were made to form a sum score of anxiety ranging from 0 to 10. In the analysis of variance for repeated measures both the premedication group and agitation score were taken into the model as factors. The anxiety score of the drawings of the agitated children (during venous cannulation) was significantly higher already after arrival in the hospital [AGIT 4.76 (95% CI: 3.56-5.96) Vs CALM 3.67 (95% CI: 2.97-4.37) P = 0.029], but there were no statistical differences between the different premedication groups. When routine sedative premedication is not used the drawings of the children might detect the children needing sedative premedication.

Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review.

PubMed

Richards, John R; Albertson, Timothy E; Derlet, Robert W; Lange, Richard A; Olson, Kent R; Horowitz, B Zane

2015-05-01

Overdose of amphetamine, related derivatives, and analogues (ARDA) continues to be a serious worldwide health problem. Patients frequently present to the hospital and require treatment for agitation, psychosis, and hyperadrenegic symptoms leading to pathologic sequelae and mortality. To review the pharmacologic treatment of agitation, psychosis, and the hyperadrenergic state resulting from ARDA toxicity. MEDLINE, PsycINFO, and the Cochrane Library were searched from inception to September 2014. Articles on pharmacologic treatment of ARDA-induced agitation, psychosis, and hyperadrenergic symptoms were selected. Evidence was graded using Oxford CEBM. Treatment recommendations were compared to current ACCF/AHA guidelines. The search resulted in 6082 articles with 81 eligible treatment involving 835 human subjects. There were 6 high-quality studies supporting the use of antipsychotics and benzodiazepines for control of agitation and psychosis. There were several case reports detailing the successful use of dexmedetomidine for this indication. There were 9 high-quality studies reporting the overall safety and efficacy of β-blockers for control of hypertension and tachycardia associated with ARDA. There were 3 high-quality studies of calcium channel blockers. There were 2 level I studies of α-blockers and a small number of case reports for nitric oxide-mediated vasodilators. High-quality evidence for pharmacologic treatment of overdose from ARDA is limited but can help guide management of acute agitation, psychosis, tachycardia, and hypertension. The use of butyrophenone and later-generation antipsychotics, benzodiazepines, and β-blockers is recommended based on existing evidence. Future randomized prospective trials are needed to evaluate new agents and further define treatment of these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2014-03-31

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

Gas hydrate cool storage system

DOEpatents

Ternes, Mark P.; Kedl, Robert J.

1985-01-01

This invention is a process for formation of a gas hydrate to be used as a cool storage medium using a refrigerant in water. Mixing of the immiscible refrigerant and water is effected by addition of a surfactant and agitation. The difficult problem of subcooling during the process is overcome by using the surfactant and agitation and performance of the process significantly improves and approaches ideal.

Impact of dissolved oxygen concentration on some key parameters and production of rhG-CSF in batch fermentation.

PubMed

Krishna Rao, Dasari V; Ramu, Chatadi T; Rao, Joginapally V; Narasu, Mangamoori L; Bhujanga Rao, Adibhatla Kali S

2008-09-01

The impact of different levels of agitation speed, carbondioxide and dissolved oxygen concentration on the key parameters and production of rhG-CSF in Escherichia coli BL21(DE3)PLysS were studied. Lower carbondioxide concentrations as well as higher agitation speeds and dissolved oxygen concentrations led to reduction in the acetate concentrations, and enhanced the cell growth, but inhibited plasmid stability and rhG-CSF expression. Similarly, higher carbondioxide concentrations and lower agitation speeds as well as dissolved oxygen concentrations led to enhanced acetate concentrations, but inhibited the cell growth and protein expression. To address the bottlenecks, a two-stage agitation control strategy (strategy-1) and two-stage dissolved oxygen control strategy (strategy-2) were employed to establish the physiological and metabolic conditions, so as to improve the expression of rhG-CSF. By adopting strategy-1 the yields were improved 1.4-fold over constant speed of 550 rpm, 1.1-fold over constant dissolved oxygen of 45%, respectively. Similarly, using strategy-2 the yields were improved 1.6-fold over constant speed of 550 rpm, 1.3-fold over constant dissolved oxygen of 45%, respectively.

Aggression and Agitation in Dementia.

PubMed

Wolf, M Uri; Goldberg, Yael; Freedman, Morris

2018-06-01

This article reviews the treatment of aggression and agitation in dementia. Both nonpharmacologic and pharmacologic approaches to responsive behaviors are discussed. Practical treatment strategies are applied to common behavioral symptoms. Aggressive and agitated behavior is common in dementia. Behavioral symptoms lead to reduced quality of life and distress for both patients and caregivers. They can also lead to poor outcomes and are associated with significant financial implications for the individual and health care system. A wide range of difficult behaviors exists, with limited evidence for deciding on treatment. Clinicians should integrate the available evidence with practical and commonsense strategies to target these difficult-to-treat behaviors. Treating aggression and agitation in dementia is challenging. Viewing behaviors as a response to either internal or external stimuli can help guide treatment. Treatment should emphasize nonpharmacologic approaches as an initial step, using practical and commonsense strategies. Caregivers and family should be actively involved in the planning and implementation of behavioral plans. It is essential to minimize both medical and nonmedical factors that may be contributing to behaviors. When pharmacologic options are required, it is important to choose medications that will target specific behavioral goals, having both practical consideration and the best evidence in mind.

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

PubMed

Gaspar, A; Strodiot, L; Thonart, P

1998-01-01

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

Development of a new type of high pressure calorimetric cell, mechanically agitated and equipped with a dynamic pressure control system: Application to the characterization of gas hydrates

NASA Astrophysics Data System (ADS)

Plantier, F.; Marlin, L.; Missima, D.; Torré, J.-P.

2013-12-01

A novel prototype of calorimetric cell has been developed allowing experiments under pressure with an in situ agitation system and a dynamic control of the pressure inside the cell. The use of such a system opens a wide range of potential practical applications for determining properties of complex fluids in both pressurized and agitated conditions. The technical details of this prototype and its calibration procedure are described, and an application devoted to the determination of phase equilibrium and phase change enthalpy of gas hydrates is presented. Our results, obtained with a good precision and reproducibility, were found in fairly good agreement with those found in literature, illustrate the various interests to use this novel apparatus.

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

PubMed

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

2010-10-01

Dexmedetomidine, a specific α(2) agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease emergence agitation in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy (T&A). One hundred twenty-two patients with obstructive sleep apnea syndrome undergoing T&A, ages 2 to 10 years, completed this prospective, randomized, U.S. Food and Drug Administration-approved study. After mask induction with sevoflurane, group D received IV dexmedetomidine 2 μg · kg(-1) over 10 minutes, followed by 0.7 μg · kg(-1) · h(-1), and group F received IV fentanyl bolus 1 μg · kg(-1). Anesthesia was maintained with sevoflurane, oxygen, and nitrous oxide. Fentanyl 0.5 to 1 μg · kg(-1) was given to subjects in both groups for an increase in heart rate or systolic blood pressure 30% above preincision values that continued for 5 minutes. Observers in the postanesthesia care unit (PACU) were blinded to treatment groups. Pain was evaluated using the objective pain score in the PACU on arrival, at 5 minutes, at 15 minutes, then every 15 minutes for 120 minutes. Emergence agitation was evaluated at the same intervals by 2 scales: the Pediatric Anesthesia Emergence Delirium scale and a 5-point scale described by Cole. Morphine (0.05 to 0.1 mg · kg(-1)) was given for pain (score >4) or severe agitation (score 4 or 5) lasting more than 5 minutes. In group D, 9.8% patients needed intraoperative rescue fentanyl in comparison with 36% in group F (P = 0.001). Mean systolic blood pressure and heart rate were significantly lower in group D (P < 0.05). Minimum alveolar concentration values were significantly different between the 2 groups (P = 0.015). The median objective pain score was 3 for group D and 5 for group F (P = 0.001). In group D, 10 (16.3%) patients required rescue morphine, in comparison with 29 (47.5%) in group F (P = 0.002). The frequency of severe emergence agitation on arrival in the PACU was 18% in group D and 45.9% in group F (P = 0.004); at 5 minutes and at 15 minutes, it was lower in group D (P = 0.028). The duration of agitation on the Cole scale was statistically lower in group D (P = 0.004). In group D, 18% of patients and 40.9% in group F had an episode of Spo(2) below 95% (P = 0.01). An intraoperative infusion of dexmedetomidine combined with inhalation anesthetics provided satisfactory intraoperative conditions for T&A without adverse hemodynamic effects. Postoperative opioid requirements were significantly reduced, and the incidence and duration of severe emergence agitation was lower with fewer patients having desaturation episodes.

Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia.

PubMed

Jessop, Tiffany; Harrison, Fleur; Cations, Monica; Draper, Brian; Chenoweth, Lynn; Hilmer, Sarah; Westbury, Juanita; Low, Lee-Fay; Heffernan, Megan; Sachdev, Perminder; Close, Jacqueline; Blennerhassett, Jenny; Marinkovich, Millicent; Shell, Allan; Brodaty, Henry

2017-08-01

Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management. LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations. While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.

The MOBID-2 pain scale: Reliability and responsiveness to pain in patients with dementia

PubMed Central

Husebo, BS; Ostelo, R; Strand, LI

2014-01-01

Background Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale is a staff-administered pain tool for patients with dementia. This study explores MOBID-2's test–retest reliability, measurement error and responsiveness to change. Methods Analyses are based upon data from a cluster randomized trial including 352 patients with advanced dementia from 18 Norwegian nursing homes. Test–retest reliability between baseline and week 2 (n = 163), and weeks 2 and 4 (n = 159) was examined in patients not expected to change (controls), using intraclass correlation coefficient (ICC2.1), standard error of measurement (SEM) and smallest detectable change (SDC). Responsiveness was examined by testing six priori-formulated hypotheses about the association between change scores on MOBID-2 and other outcome measures. Results ICCs of the total MOBID-2 scores were 0.81 (0–2 weeks) and 0.85 (2–4 weeks). SEM and SDC were 1.9 and 3.1 (0–2 weeks) and 1.4 and 2.3 (2–4 weeks), respectively. Five out of six hypotheses were confirmed: MOBID-2 discriminated (p < 0.001) between change in patients with and without a stepwise protocol for treatment of pain (SPTP). Moderate association (r = 0.35) was demonstrated with Cohen-Mansfield Agitation Inventory, and no association with Mini-Mental State Examination, Functional Assessment Staging and Activity of Daily Living. Expected associations between change scores of MOBID-2 and Neuropsychiatric Inventory – Nursing Home version were not confirmed. Conclusion The SEM and SDC in connection with the MOBID-2 pain scale indicate that the instrument is responsive to a decrease in pain after a SPTP. Satisfactory test–retest reliability across test periods was demonstrated. Change scores ≥ 3 on total and subscales are clinically relevant and are beyond measurement error. PMID:24799157

How to Radicalize Graduate Students: Take These Simple Steps to Intimidate, Alienate, and Agitate Your Own Flock of Graduate Students

ERIC Educational Resources Information Center

Steffen, Heather

2011-01-01

As the recession, budget cuts, endowment losses, and Republican governors gut university funding, campuses across the country have become host to occupations, union actions, and demonstrations. One can take steps to intimidate, alienate, and agitate a flock of graduate students. The author discusses steps that offer simple ways to rile up and…

Efficacy of 3D conforming nickel titanium rotary instruments in eliminating canal wall bacteria from oval-shaped root canals.

PubMed

Bortoluzzi, Eduardo A; Carlon, Daniel; Meghil, Mohamed M; El-Awady, Ahmed R; Niu, Lina; Bergeron, Brian E; Susin, Lisiane; Cutler, Christopher W; Pashley, David H; Tay, Franklin R

2015-05-01

To evaluate the effectiveness of TRUShape® 3D Conforming Files, compared with Twisted Files, in reducing bacteria load from root canal walls, in the presence or absence of irrigant agitation. Extracted human premolars with single oval-shaped canals were infected with Enterococcus faecalis. Teeth in Group I (N=10; NaOCl and QMix® 2in1 as respective initial and final irrigants) were subdivided into 4 subgroups: (A) TRUShape® instrumentation without irrigant activation; (B) TRUShape® instrumentation with sonic irrigant agitation; (C) Twisted Files without irrigant agitation; (D) Twisted Files with sonic irrigant agitation. To remove confounding factor (antimicrobial irrigants), teeth in Group II (N=10) were irrigated with sterile saline, using the same subgroup designations. Specimens before and after chemomechanical débridement were cultured for quantification of colony-forming units (CFUs). Data from each group were analyzed separately using two-factor ANOVA and Holm-Sidak multiple comparison (α=0.05). Canal wall bacteria were qualitatively examined using scanning electron microscopy (SEM) and light microscopy of Taylor-modified Brown and Brenn-stained demineralised sections. CFUs from subgroups in Group I were not significantly different (P=0.935). For Group II, both file type (P<0.001) and irrigant agitation (P<0.001) significantly affected log-reduction in CFU concentrations. The interaction of these two factors was not significant (P=0.601). Although SEM showed reduced canal wall bacteria, bacteria were present within dentinal tubules after rotary instrumentation, as revealed by light microscopy of longitudinal root sections. TRUShape® files removed significantly more canal wall bacteria than Twisted Files when used without an antibacterial irrigant; the latter is required to decontaminate dentinal tubules. Root canal disinfection should not be focused only on a mechanistic approach. Rather, the rational choice of a rotary instrumentation system should be combined with the use of well-tested antimicrobial irrigants and delivery/agitation techniques to establish a clinically realistic chemomechanical débridement protocol. Published by Elsevier Ltd.

Efficacy and safety of perioperative parecoxib for acute postoperative pain treatment in children: a meta-analysis.

PubMed

Bu, Xueshan; Yang, Lei; Zuo, Yunxia

2015-12-01

Perioperative parecoxib administration reduces postoperative pain, opioid consumption, and adverse events in adult patients. However, the efficacy and safety of parecoxib in children remain unclear. This metaanalysis included related published studies to address this concern. Eight databases in the literature until February 2015 were systematically explored to identify randomized controlled trials (RCTs) comparing perioperative parecoxib administration and placebo/standard treatments for acute postoperative pain in children. Primary outcomes were postoperative pain scores and adverse events. The Face, Legs, Activity, Crying, Consolability scale was used to score pain in children younger than 6 years, whereas the Visual Analog Scale was used in children older than 6 years. Secondary outcomes were sedation scores (measured using the Ramsay scale), agitation scores (measured using the Sedation-Agitation Scale), and opioid consumption. The methodological quality of RCTs was independently assessed in accordance with the "Risk of bias" of Cochrane Collaboration. Data were analyzed using Review Manager 5.2. Twelve RCTs involving 994 patients met the inclusion criteria. Compared with children who received placebo treatment, those who received parecoxib demonstrated lower early (2 h) and later (12 h) postoperative pain scores; lower incidence rates of postoperative nausea, vomiting, and agitation; higher early (1 h) postoperative sedation scores; and lower agitation scores. Similarly, children who received parecoxib had lower early (2 h) and later (12 h) postoperative pain scores, lower incidence rates of postoperative nausea and vomiting, and lower early (1 h) postoperative sedation scores compared with those who received standard treatments; however, these children showed no significant difference in agitation scores. Unfortunately, data on the effect of parecoxib on opioid consumption were insufficient. Overall, these results suggested that perioperative parecoxib administration was associated with less acute postoperative pain and fewer adverse events compared with placebo or standard treatments. Parecoxib administration also resulted in less emergence agitation compared with placebo treatment and less excessive sedation concern compared with standard treatments. However, the long-term effects, effects on opioid consumption, and patient satisfaction of parecoxib administration warrant further investigation.

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

PubMed

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

2013-07-01

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

Tramadol in traumatic brain injury: Should we continue to use it?

PubMed Central

Mahmood, Saeed; Al-Thani, Hassan; El-Menyar, Ayman; Alani, Mushrek; Al-Hassani, Ammar; Mathrdikkal, Saji; Peralta, Ruben; Latifi, Rifat

2015-01-01

Background and Aims: Tramadol is commonly used to treat moderate to moderately-severe pain in adults. We aimed to analyze the clinical relevance of tramadol use during weaning and extubation in patients with traumatic brain injury (TBI). Material and Methods: A retrospective observational study was conducted and included all the intubated TBI patients at the level I trauma center between 2011 and 2012. Data included patient's demographics, mechanism of injury (MOI), Glasgow Coma Scale (GCS), injury severity score, length of Intensive Care Unit (ICU) stay length of stay (LOS), agitation scale, analgesics, failure of extubation and tracheostomy. Patients were divided into two groups based on whether they received tramadol (Group 1) or not (Group 2) during ventilatory weaning. Chi-square and Student's t-tests were used for categorical and continuous variables; respectively. Logistic regression analysis was performed for predictors of agitation in ICU. Results: The study included 393 TBI patients; the majority (96%) was males with a mean age of 33.6 ± 14 years. The most common MOI were motor vehicle crash (39%), fall (29%) and pedestrian (17%). The associated injuries were mainly chest (35%) and abdominal (16%) trauma. Tramadol was administered in 51.4% of TBI patients. Tracheostomy was performed in 12.4% cases. Agitation was observed in 34.2% cases. Group 1 patients had significantly lower age (31.6 ± 12.4 vs. 35.7 ± 15.6; P = 0.005) and head AIS (3.5 ± 0.8 vs. 3.9 ± 0.9; P = 0.001) compared to Group 2. The incidence of agitation, ICU and hospital LOS were higher in Group 1. Failure of extubation and tracheostomy were reported more frequently in Group 1 (P = 0.001). On multivariate analysis, tramadol use was an independent predictor for agitation (adjusted odds ratio 21; P = 0.001), followed by low GCS. Conclusion: Patients with TBI who received tramadol are more likely to develop agitation, undergo tracheostomy and to have longer hospital LOS. Therefore, an extensive risk-benefit assessment would help to attain maximum efficacy of the drug in TBI patients. PMID:26330713

Effect of application mode on interfacial morphology and chemistry between dentin and self-etch adhesives

PubMed Central

Zhang, Ying; Wang, Yong

2012-01-01

Objective To investigate the influence of application mode on the interfacial morphology and chemistry between dentin and self-etch adhesives with different aggressiveness. Methods The occlusal one-third of the crown was removed from un-erupted human third molars, followed by abrading with 600 grit SiC under water. Rectangular dentin slabs were prepared by sectioning the tooth specimens perpendicular to the abraded surfaces. The obtained dentin slabs were treated with one of the two one-step self-etch adhesives: Adper Easy Bond (AEB, PH~2.5) and Adper Prompt L-Pop (APLP, PH~0.8) with (15s, active application) or without (15s, inactive application) agitation. The dentin slabs were fractured and the exposed adhesive/dentin (A/D) interfaces were examined with micro-Raman spectroscopy and scanning electron microscopy (SEM). Results The interfacial morphology, degree of dentin demineralization (DD) and degree of conversion (DC) of the strong self-etch adhesive APLP showed more significant dependence on the application mode than the mild AEB. APLP exhibited inferior bonding at the A/D interface if applied without agitation, evidenced by debonding from the dentin substrate. The DDs and DCs of the APLP with agitation were higher than those of without agitation in the interface, in contrast to the comparable DD and DC values of two AEB specimen groups with different application modes. Raman spectral analysis revealed the important role of chemical interaction between acid monomers of self-etch adhesives and dentin in the above observations. Conclusion The chemical interaction with dentin is especially important for improving the DC of the strong self-etching adhesive at the A/D interface. Agitation could benefit polymerization efficacy of the strong self-etch adhesive through enhancing the chemical interaction with tooth substrate. PMID:23153573

How is agitation and restlessness managed in the last 24 h of life in patients whose care is supported by the Liverpool care pathway for the dying patient?

PubMed

Gambles, M; McGlinchey, T; Latten, R; Dickman, A; Lowe, D; Ellershaw, J E

2011-12-01

Guidance regarding the patient centred management of agitation and restlessness reinforces the importance of considering underlying causes, non-pharmacological approaches to treatment and judicious use of medications titrated to patient need. In contrast, recent reports in the literature suggest that the practice of continuous deep sedation until death is prevalent in the UK. To use data from the National Care of the Dying Audit-Hospitals (NCDAH) to explore the administration of medication for management of agitation and restlessness in the last 24 h of life. Hospitals submitted data from up to 30 consecutive adult patients whose care in the final hours/days of life was supported by the Liverpool Care Pathway for the Dying Patient (LCP). Data on the total dose received in the last 24 h of life PRN and the last dose prescribed for administration via continuous subcutaneous infusion (CSCI) for agitation and restlessness were submitted. 155 hospitals provided data from 3893 patients. Median total doses in the last 24 h for midazolam, haloperidol and levomepromazine, respectively, were: PRN only, 2.5, 1.5 and 6.25 mg; CSCI only, 10, 3 and 6.25 mg; PRN+CSCI, 15, 3 and 12.5 mg. Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no 'blanket' policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

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

PubMed Central

2014-01-01

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

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

PubMed

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

2013-04-01

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

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

PubMed

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

2018-04-10

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

EXACT: rivastigmine improves the high prevalence of attention deficits and mood and behaviour symptoms in Alzheimer's disease*

PubMed Central

Gauthier, S; Juby, A; Rehel, B; Schecter, R

2007-01-01

The objective of this study was to investigate the impact of rivastigmine therapy on attention, apathy, anxiety and agitation in patients with mild-to-moderate Alzheimer's disease (AD) in a real-world clinical setting. Patients with mild-to-moderate AD were enrolled in the study by physicians across Canada. They were treated with open-label rivastigmine (dose at the discretion of the prescribing physicians) for a period of 6 months. Changes from baseline in attention, apathy, anxiety and agitation were assessed using an abbreviated Clinician's Global Impression of Change at 3- and 6-month visits. The Mini Mental State Examination (MMSE) was also used at these visits. Use and changes in use of psychotropic medications were recorded, as were changes in caregiver burden. Analyses of subgroups (outpatients vs. institutionalised patients) were also performed. A total of 2119 patients were enrolled in the study by 375 physicians. At baseline, 91% had deficits in attention, 85.4% had symptoms of anxiety, 78.5% exhibited apathy and 70.1% showed agitation. At 6 months, 67.5% of evaluable patients had improved on the symptom of attention, while 62.3%, 62.6% and 56.0% had improvements in anxiety, apathy and agitation respectively. The percentages with improvements were higher in the institutional subgroup than among outpatients. There was an overall mean improvement of 1.1 points on the MMSE at 6 months. Approximately four times as many caregivers reported a reduced burden than an increased burden at 6 months (40.3% vs. 10.3%). The majority of patients treated with rivastigmine experienced improvements in attention, anxiety, apathy and agitation. These real-life findings further demonstrate the proven efficacy of rivastigmine in patients with mild-to-moderate AD. PMID:17504350

Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial.

PubMed

Olsen, Christine; Pedersen, Ingeborg; Bergland, Astrid; Enders-Slegers, Marie-José; Patil, Grete; Ihlebaek, Camilla

2016-12-01

The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL). A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used. A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found. Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

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

PubMed

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

2010-06-01

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

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

PubMed

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

2008-11-01

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

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

PubMed

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

2016-08-01

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

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

PubMed

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

2017-01-01

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

Experiments in randomly agitated granular assemblies close to the jamming transition

NASA Astrophysics Data System (ADS)

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

2004-11-01

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

Experiments in randomly agitated granular assemblies close to the jamming transition

NASA Astrophysics Data System (ADS)

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

2004-03-01

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

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

PubMed

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

2018-03-06

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

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

NASA Astrophysics Data System (ADS)

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

2018-06-01

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

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

PubMed

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

2008-09-01

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

Optimization and modeling of laccase production by Trametes versicolor in a bioreactor using statistical experimental design.

PubMed

Tavares, A P M; Coelho, M A Z; Agapito, M S M; Coutinho, J A P; Xavier, A M R B

2006-09-01

Experimental design and response surface methodologies were applied to optimize laccase production by Trametes versicolor in a bioreactor. The effects of three factors, initial glucose concentration (0 and 9 g/L), agitation (100 and 180 rpm), and pH (3.0 and 5.0), were evaluated to identify the significant effects and its interactions in the laccase production. The pH of the medium was found to be the most important factor, followed by initial glucose concentration and the interaction of both factors. Agitation did not seem to play an important role in laccase production, nor did the interaction agitation x medium pH and agitation x initial glucose concentration. Response surface analysis showed that an initial glucose concentration of 11 g/L and pH controlled at 5.2 were the optimal conditions for laccase production by T. versicolor. Under these conditions, the predicted value for laccase activity was >10,000 U/L, which is in good agreement with the laccase activity obtained experimentally (11,403 U/L). In addition, a mathematical model for the bioprocess was developed. It is shown that it provides a good description of the experimental profile observed, and that it is capable of predicting biomass growth based on secondary process variables.

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

PubMed

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

2017-10-01

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

A little "dab" will do ya' in: a case report of neuro-and cardiotoxicity following use of cannabis concentrates.

PubMed

Rickner, Shannon S; Cao, Dazhe; Kleinschmidt, Kurt; Fleming, Steven

2017-11-01

The use of marijuana and cannabis concentrates is increasing, especially following decriminalization in several states. Psychosis and cardiotoxicity have been reported following cannabis use; however, myocardial injury from "dabbing" has not yet been reported. We report a case of hyperthermia, tachycardia, hypertension, severe agitation, neuro-, and cardiotoxicity following the use of "dabs" where there is concomitant confirmatory biological and sample testing. A 17-year-old athletic man developed agitation requiring sedation and intubation for safety, with peak systolic blood pressures in the 190s and hyperthermia (to 102 °F). He developed elevated serum troponins with persistent tachycardia despite sedation and no clear non-intoxicant etiology. It was discovered that the patient had recently been "dabbing"; an exhaustive search of his home found a sample of the "dabs" which was analyzed along with a comprehensive urine drug screen by tandem liquid mass spectroscopy (t-LCMS) for confirmation. Tetrahydrocannabinol (THC) has been increasingly associated with agitation and cardiotoxicity, while cannabidiol (CBD) has been associated with neuroprotective, inhibitory states. We propose that increasing concentrations of THC as well as THC:CBD ratios seen in cannabis concentrates such as "dabs" may cause agitation and end-organ damage through sympathomimetic and serotonergic pathways.

Assessment of neuropsychiatric symptoms in dementia: toward improving accuracy

PubMed Central

Stella, Florindo

2013-01-01

The issue of this article concerned the discussion about tools frequently used tools for assessing neuropsychiatric symptoms of patients with dementia, particularly Alzheimer's disease. The aims were to discuss the main tools for evaluating behavioral disturbances, and particularly the accuracy of the Neuropsychiatric Inventory – Clinician Rating Scale (NPI-C). The clinical approach to and diagnosis of neuropsychiatric syndromes in dementia require suitable accuracy. Advances in the recognition and early accurate diagnosis of psychopathological symptoms help guide appropriate pharmacological and non-pharmacological interventions. In addition, recommended standardized and validated measurements contribute to both scientific research and clinical practice. Emotional distress, caregiver burden, and cognitive impairment often experienced by elderly caregivers, may affect the quality of caregiver reports. The clinician rating approach helps attenuate these misinterpretations. In this scenario, the NPI-C is a promising and versatile tool for assessing neuropsychiatric syndromes in dementia, offering good accuracy and high reliability, mainly based on the diagnostic impression of the clinician. This tool can provide both strategies: a comprehensive assessment of neuropsychiatric symptoms in dementia or the investigation of specific psychopathological syndromes such as agitation, depression, anxiety, apathy, sleep disorders, and aberrant motor disorders, among others. PMID:29213846

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

PubMed

Kadaria, Dipen; Sinclair, Scott E

2012-10-01

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

Advanced Mitigation Process (AMP) for Improving Laser Damage Threshold of Fused Silica Optics

NASA Astrophysics Data System (ADS)

Ye, Xin; Huang, Jin; Liu, Hongjie; Geng, Feng; Sun, Laixi; Jiang, Xiaodong; Wu, Weidong; Qiao, Liang; Zu, Xiaotao; Zheng, Wanguo

2016-08-01

The laser damage precursors in subsurface of fused silica (e.g. photosensitive impurities, scratches and redeposited silica compounds) were mitigated by mineral acid leaching and HF etching with multi-frequency ultrasonic agitation, respectively. The comparison of scratches morphology after static etching and high-frequency ultrasonic agitation etching was devoted in our case. And comparison of laser induce damage resistance of scratched and non-scratched fused silica surfaces after HF etching with high-frequency ultrasonic agitation were also investigated in this study. The global laser induce damage resistance was increased significantly after the laser damage precursors were mitigated in this case. The redeposition of reaction produce was avoided by involving multi-frequency ultrasonic and chemical leaching process. These methods made the increase of laser damage threshold more stable. In addition, there is no scratch related damage initiations found on the samples which were treated by Advanced Mitigation Process.

Optimization conditions of samples saponification for tocopherol analysis.

PubMed

Souza, Aloisio Henrique Pereira; Gohara, Aline Kirie; Rodrigues, Ângela Claudia; Ströher, Gisely Luzia; Silva, Danielle Cristina; Visentainer, Jesuí Vergílio; Souza, Nilson Evelázio; Matsushita, Makoto

2014-09-01

A full factorial design 2(2) (two factors at two levels) with duplicates was performed to investigate the influence of the factors agitation time (2 and 4 h) and the percentage of KOH (60% and 80% w/v) in the saponification of samples for the determination of α, β and γ+δ-tocopherols. The study used samples of peanuts (cultivar armadillo), produced and marketed in Maringá, PR. The factors % KOH and agitation time were significant, and an increase in their values contributed negatively to the responses. The interaction effect was not significant for the response δ-tocopherol, and the contribution of this effect to the other responses was positive, but less than 10%. The ANOVA and response surfaces analysis showed that the most efficient saponification procedure was obtained using a 60% (w/v) solution of KOH and with an agitation time of 2 h. Copyright © 2014 Elsevier Ltd. All rights reserved.

Study of blades inclination influence of gate impeller with a non-Newtonian fluid of Bingham

NASA Astrophysics Data System (ADS)

Rahmani, Lakhdar; Seghier, O.; Draoui, B.; Benachour, E.

2016-03-01

A large number of chemical operations, biochemical or petrochemical industry is very depending on the rheological fluids nature. In this work, we study the case of highly viscous of viscoplastic fluids in a classical system of agitation: a cylindrical tank with plate bottom without obstacles agitated by gate impeller agitator. We are interested to the laminar, incompressible and isothermal flows. We devote to a numerical approach carried out using an industrial code CFD Fluent 6.3.26 based on the method of finites volumes discretization of Navier - Stokes equations formulated in variables (U.V.P). The threshold of flow related to the viscoplastic behavior is modeled by a theoretical law of Bingham. The results obtained are used to compare between the five configurations suggested of power consumption. We study the influence of inertia by the variation of Reynolds number.

Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane.

PubMed

Lapin, S L; Auden, S M; Goldsmith, L J; Reynolds, A M

1999-01-01

We prospectively studied one hundred ASA physical status I-II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane. Patients given oral midazolam premedication had significantly longer recovery times, but no delay in discharge home compared with those not premedicated. However, children anaesthetized with sevoflurane and no premedication had an unacceptably high incidence (67%) of postoperative agitation. The use of oral midazolam preoperatively did decrease the amount of postoperative agitation seen with sevoflurane. We conclude that although sevoflurane does shorten recovery times, the degree of associated postoperative agitation makes it unacceptable as a sole anaesthetic for myringotomy surgery.

CFD study of the thermal transfer of a non-Newtonian fluid within a tank mechanically stirred by an anchor-shaped impeller

NASA Astrophysics Data System (ADS)

Rahmani, L.; Seghier, O.; Benmoussa, A.; Draoui, B.

2018-06-01

The most of operations of chemical, biochemical or petrochemical industries are carried out in tanks or in reactors which are mechanically-controlled. The optimum mode of operation of these devices requires a finalized knowledge of the thermo-hydrodynamic behavior induced by the agitator. In the present work, the characterization of the incompressible hydrodynamic and thermal fields of a non-Newtonian fluid (Bingham) in a flat, non-baffled cylindrical vessel fitted with anchor agitator was undertaken by numerical simulation, using the CFD code Fluent (6.3.26) based on the finite volume discretization method of the energy equation and the Navier-Stokes equations which are formulated in (U.V.P) variables. We have summarized this simulated system by comparing of the consumed power and the Nusselt number for this type of mobile (Anchor agitator).

Removal of Methylene Blue and Orange-G from Waste Water Using Magnetic Biochar

NASA Astrophysics Data System (ADS)

Mubarak, N. M.; Fo, Y. T.; Al-Salim, Hikmat Said; Sahu, J. N.; Abdullah, E. C.; Nizamuddin, S.; Jayakumar, N. S.; Ganesan, P.

2015-04-01

The study on the removal of methylene blue (MB) and orange-G dyes using magnetic biochar derived from the empty fruit bunch (EFB) was carried out. Process parameters such as pH, adsorbent dosage, agitation speed and contact time were optimized using Design-Expert Software v.6.0.8. The statistical analysis reveals that the optimum conditions for the maximum adsorption of MB are at pH 2 and pH 10, dosage 1.0 g, and agitation speed and contact time of 125 rpm and 120 min respectively. While for orange-G, at pH 2, dosage 1.0 g, and agitation speed and contact time of 125 rpm and 120 min respectively. The maximum adsorption capacity of 31.25 mg/g and 32.36 mg/g for MB and orange-G respectively. The adsorption kinetic for both dyes obeyed pseudo-second order.

Control of mechanically activated polymersome fusion: Factors affecting fusion

DOE PAGES

Henderson, Ian M.; Paxton, Walter F.

2014-12-15

Previously we have studied the mechanically-activated fusion of extruded (200 nm) polymer vesicles into giant polymersomes using agitation in the presence of salt. In this study we have investigated several factors contributing to this phenomenon, including the effects of (i) polymer vesicle concentration, (ii) agitation speed and duration, and iii) variation of the salt and its concentration. It was found that increasing the concentration of the polymer dramatically increases the production of giant vesicles through the increased collisions of polymersomes. Our investigations also found that increasing the frequency of agitation increased the efficiency of fusion, though ultimately limited the sizemore » of vesicle which could be produced due to the high shear involved. Finally it was determined that salt-mediation of the fusion process was not limited to NaCl, but is instead a general effect facilitated by the presence of solvated ionic compounds, albeit with different salts initiating fusion at different concentration.« less

Advanced Mitigation Process (AMP) for Improving Laser Damage Threshold of Fused Silica Optics

PubMed Central

Ye, Xin; Huang, Jin; Liu, Hongjie; Geng, Feng; Sun, Laixi; Jiang, Xiaodong; Wu, Weidong; Qiao, Liang; Zu, Xiaotao; Zheng, Wanguo

2016-01-01

The laser damage precursors in subsurface of fused silica (e.g. photosensitive impurities, scratches and redeposited silica compounds) were mitigated by mineral acid leaching and HF etching with multi-frequency ultrasonic agitation, respectively. The comparison of scratches morphology after static etching and high-frequency ultrasonic agitation etching was devoted in our case. And comparison of laser induce damage resistance of scratched and non-scratched fused silica surfaces after HF etching with high-frequency ultrasonic agitation were also investigated in this study. The global laser induce damage resistance was increased significantly after the laser damage precursors were mitigated in this case. The redeposition of reaction produce was avoided by involving multi-frequency ultrasonic and chemical leaching process. These methods made the increase of laser damage threshold more stable. In addition, there is no scratch related damage initiations found on the samples which were treated by Advanced Mitigation Process. PMID:27484188

A randomised controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia.

PubMed

Fu, Chieh-Yu; Moyle, Wendy; Cooke, Marie

2013-07-10

Aromatherapy and hand massage therapies have been reported to have some benefit for people with dementia who display behavioural symptoms; however there are a number of limitations of reported studies. The aim is to investigate the effect of aromatherapy (3% lavender oil spray) with and without hand massage on disruptive behaviour in people with dementia living in long-term care. In a single blinded randomised controlled trial 67 people with a diagnosis of dementia and a history of disruptive behaviour, from three long-term care facilities were recruited and randomised using a random number table into three groups: (1) Combination (aromatherapy and hand massage) (n = 22), (2) Aromatherapy (n = 23), (3) Placebo control (water spray) (n = 22). The intervention was given twice daily for six weeks. Data on residents' behaviour (CMAI) and cognition (MMSE) were collected before, during and after the intervention. Despite a downward trend in behaviours displayed not one of the interventions significantly reduced disruptive behaviour. Further large-scale placebo controlled studies are required where antipsychotic medication is controlled and a comparison of the methods of application of aromatherapy are investigated. ACTRN12612000917831.

Evaluation of personalised, one-to-one interaction using Montessori-type activities as a treatment of challenging behaviours in people with dementia: the study protocol of a crossover trial

PubMed Central

2010-01-01

Background The agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Behaviours stemming from pain, major depression or psychosis benefit from treatment with analgesics, antidepressants or antipsychotics. In other cases, psychotropic medications have limited efficacy but are used very widely. Therefore, increasingly more attention has been paid to nonpharmacological interventions which are associated with fewer risks. The aim of the current study is to test if personalised one-to-one interaction activities based on Montessori principles will reduce the frequency of behavioural symptoms of dementia significantly more than a relevant control condition. Methods/Design We will conduct a controlled trial with randomised cross-over between conditions. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to Montessori or control blocks for two weeks then switched to the other condition. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. The control intervention consists of conversation or reading from and looking at pictures in a newspaper to control for non-specific benefits of one-to-one interaction. Presence of target behaviour will be noted as well as level of engagement and type of affect displayed. Secondary measures also include the Cohen-Mansfield Agitation Inventory and information on time and funds spend to prepare the activities. Discussion If our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia, it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone. Trial Registration Australian New Zealand Clinical Trials Registry - ACTRN12609000564257 PMID:20096137

Prevention of Emergence Agitation with Ketamine in Rhinoplasty.

PubMed

Demir, Canser Yilmaz; Yuzkat, Nureddin

2018-06-01

Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20 min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty. Totally 140 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were equally and randomly divided into two groups: saline group (control group) (n = 70) and ketamine group (n = 70). Twenty minutes before surgery completion, 1 ml saline was administered via the intravenous (i.v.) route to the saline group, while 0.5 mg/kg ketamine was administered via i.v. patients in the ketamine group. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). For postoperative pain evaluation, the Numerical Rating Scale (NRS) was scored (from 0 to 10) every 10 min until the patients were discharged from PACU. EA incidence in the control group was as high as 54.3%, while in the ketamine group it was 8.6% just after extubation (p < 0.001). In the PACU, EA incidence was 28.6% in the control group, while none of the patients had EA in the PACU in the ketamine group (p < 0.001). Male gender, severe pain (NRS ≥ 5), and smoking were defined as significant risk factors for EA both after extubation and during follow-ups in the PACU (p < 0.001). Emergence agitation after rhinoplasty is a common complication, likely disturbing operative outcomes in adults. Ketamine at sub-anesthetic doses is highly effective in preventing EA. Further, larger-scale prospective studies are warranted to determine preventive measures for EA development in rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sample Preparation of Nano-sized Inorganic Materials for Scanning Electron Microscopy or Transmission Electron Microscopy: Scientific Operating Procedure SOP-P-2

DTIC Science & Technology

2015-07-01

samples must be thoroughly degreased and dried to eliminate any outgassing from organic contamination and water. Samples can be cleaned ultrasonically ...in an ultrasonic bath for at least 10 minutes to ensure separation of particles (University of California, Riverside, n.d.). These solutions can...be further agitated in the ultrasonic bath to separate particles. It should be noted that excessive ultrasonic agitation can damage samples

Radio emission of sea surface at centimeter wavelengths and is fluctuations

NASA Technical Reports Server (NTRS)

Tseytlin, N. M.; Shutko, A. M.; Zhislin, G. M.

1981-01-01

The eigen thermal radio emission of the sea was examined as well as the agitated surface of the sea when the reflection (scattering) is similar in nature to diffused scattering. The contribution of this emission to the total emission of the sea is practically constant in time, and the time fluctuations of the radio emissions of the sea are basically determined only by a change in the eigen emission of the sea, connected with the agitation.

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

PubMed Central

Gen, Keishi; Takahashi, Yuki

2013-01-01

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

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

PubMed

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

2013-09-01

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

Modulation of a methane Bunsen flame by upstream perturbations

NASA Astrophysics Data System (ADS)

de Souza, T. Cardoso; Bastiaans, R. J. M.; De Goey, L. P. H.; Geurts, B. J.

2017-04-01

In this paper the effects of an upstream spatially periodic modulation acting on a turbulent Bunsen flame are investigated using direct numerical simulations of the Navier-Stokes equations coupled with the flamelet generated manifold (FGM) method to parameterise the chemistry. The premixed Bunsen flame is spatially agitated with a set of coherent large-scale structures of specific wave-number, K. The response of the premixed flame to the external modulation is characterised in terms of time-averaged properties, e.g. the average flame height ⟨H⟩ and the flame surface wrinkling ⟨W⟩. Results show that the flame response is notably selective to the size of the length scales used for agitation. For example, both flame quantities ⟨H⟩ and ⟨W⟩ present an optimal response, in comparison with an unmodulated flame, when the modulation scale is set to relatively low wave-numbers, 4π/L ≲ K ≲ 6π/L, where L is a characteristic scale. At the agitation scales where the optimal response is observed, the average flame height, ⟨H⟩, takes a clearly defined minimal value while the surface wrinkling, ⟨W⟩, presents an increase by more than a factor of 2 in comparison with the unmodulated reference case. Combined, these two response quantities indicate that there is an optimal scale for flame agitation and intensification of combustion rates in turbulent Bunsen flames.

Aggregation and Particle Formation of Therapeutic Proteins in Contact With a Novel Fluoropolymer Surface Versus Siliconized Surfaces: Effects of Agitation in Vials and in Prefilled Syringes.

PubMed

Teska, Brandon M; Brake, Jeffrey M; Tronto, Gregory S; Carpenter, John F

2016-07-01

We examined the effects of an accelerated agitation protocol on 2 protein therapeutics, intravenous immunoglobulin (IVIG) and Avastin (bevacizumab), in contact with a novel fluoropolymer surface and more typical siliconized surfaces. The fluoropolymer surface provides "solid-phase" lubrication for the syringe plunger-obviating the need for silicone oil lubrication in prefilled syringes. We tested the 2 surfaces in a vial system and in prefilled glass syringes. We also examined the effects of 2 buffers, phosphate-buffered saline (PBS) and 0.2-M glycine, with and without the addition of polysorbate 20, on agitation-induced aggregation of IVIG. Aggregation was monitored by measuring subvisible particle formation and soluble protein loss. In both vials and syringes, protein particle formation was much lower during agitation with the fluoropolymer surface than with the siliconized surface. Also, particle formation was greater in PBS than in glycine buffer, an effect attributed to lower colloidal stability of IVIG in PBS. Polysorbate 20 in the formulation greatly inhibited protein particle formation. Overall, the fluoropolymer plunger surface in an unsiliconized glass barrel was demonstrated to be a viable solution for eliminating silicone oil droplets from prefilled syringe formulations and providing a consistent system for rationale formulation development and simplified particle analysis. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2018-05-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

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

2012-05-08

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

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

PubMed

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

2011-06-01

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

Protein aggregation and particle formation in prefilled glass syringes.

PubMed

Gerhardt, Alana; Mcgraw, Nicole R; Schwartz, Daniel K; Bee, Jared S; Carpenter, John F; Randolph, Theodore W

2014-06-01

The stability of therapeutic proteins formulated in prefilled syringes (PFS) may be negatively impacted by the exposure of protein molecules to silicone oil-water interfaces and air-water interfaces. In addition, agitation, such as that experienced during transportation, may increase the detrimental effects (i.e., protein aggregation and particle formation) of protein interactions with interfaces. In this study, surfactant-free formulations containing either a monoclonal antibody or lysozyme were incubated in PFS, where they were exposed to silicone oil-water interfaces (siliconized syringe walls), air-water interfaces (air bubbles), and agitation stress (occurring during end-over-end rotation). Using flow microscopy, particles (≥2 μm diameter) were detected under all conditions. The highest particle concentrations were found in agitated, siliconized syringes containing an air bubble. The particles formed in this condition consisted of silicone oil droplets and aggregated protein, as well as agglomerates of protein aggregates and silicone oil. We propose an interfacial mechanism of particle generation in PFS in which capillary forces at the three-phase (silicone oil-water-air) contact line remove silicone oil and gelled protein aggregates from the interface and transport them into the bulk. This mechanism explains the synergistic effects of silicone oil-water interfaces, air-water interfaces, and agitation in the generation of particles in protein formulations. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Approach to Emergencies in Schizophrenia in University Hospital "Vrapče".

PubMed

Silić, Ante; Savić, Aleksandar; Čulo, Ilaria; Kos, Suzana; Vukojević, Jakša; Brumen, Daška; Ostojić, DraŽenka

2018-06-01

An emergency in psychiatric setting is any disorder in thought process, feelings and/or behavior of the patient that requires urgent therapeutic intervention. In general, we can observe an increase in numbers of psychiatric emergencies throughout the world and in Croatia as well. Agitation and aggression are one of the most common causes of emergency in psychiatry. Agitation is common and frequent in patients suffering from schizophrenia. Patient can be agitated in various levels such as: mild, moderate or severe and can alternate between these levels in the same presentation. Agitated patients often require hospitalization that includes pharmacotherapy and sometimes physical restraining, in order to treat the cause of agitation and prevent auto and/or heterodestructive behavior. In this paper we focus on patients suffering from schizophrenia that were admitted in University Hospital "Vrapče" in 2017, and assess the numbers through the criteria of voluntary vs. involuntary admissions and physical restraint usage. Out of total observations, 130 (35.6%) were patients admitted for the first time and 179 (49%) were patients later diagnosed with schizophrenia spectrum and other psychotic disorders. Court ordered involuntary hospitalization was ordered for 35 (2.8%) patients out of total admitted patients, and 68.6% (N24) of them were diagnosed with schizophrenia spectrum and other psychotic disorders. Physical restraint was used for 122 patients out of total admissions and 28.7% (N35) of restrained patients were diagnosed with schizophrenia spectrum and other psychotic disorders. Emergencies in patient suffering from schizophrenia are extremely delicate and demanding situations in every-day clinical practice of psychiatrist. There is an increased risk involved for the patient but for the staff as well. All interventions should be individualized and patient should carefully monitored throughout the entire process. All professionals involved in care for a patient should be up to date with medical and legal issues.

Precursor preparation for Ca-Al layered double hydroxide to remove hexavalent chromium coexisting with calcium and magnesium chlorides

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

Zhong, Lihua; He, Xiaoman; Qu, Jun

Al(OH){sub 3} and Ca(OH){sub 2} powders are co-ground to prepare a precursor which hydrates into a layered double hydroxide (LDH) phase by agitation in aqueous solution with target hexavalent chromium (Cr(VI)) at room temperature, to achieve an obvious improvement in removal efficiency of Cr(VI) through an easy incorporation into the structure. Although the prepared precursor transforms into LDH phases also when agitated in the solutions of calcium and magnesium chlorides, it incorporates Cr(VI) preferentially to the chloride salts when they coexist. The adsorption isotherm and kinetic studies show that the phenomena occurring on the Al-Ca precursor fit a pseudo-second-order kineticsmore » with a Langmuir adsorption capacity of 59.45 mg/g. Besides, characterizations of the prepared precursor and the samples after adsorption are also performed by X-ray diffraction (XRD), Fourier transform infrared (FT-IR), Transmission electron microscope (TEM) to understand the reason of the preferential incorporation of Cr(VI) to the coexisting chloride salts during the LDH phase formation. - Graphical abstract: Activated Ca-Al hydroxides (C{sub 3}A) transformed into Ca-Al-OH compound when agitated in water. Ca-Al precursor (C{sub 3}A) was agitated in a hexavalent chromium (Cr(VI)) solution to form Al-Ca-CrO{sub 4} LDH product. Ca-Al-CrO{sub 4} LDH phase occurred preferentially to Ca-Al-MCl{sub 2} LDH phases in the solutions of calcium and magnesium chlorides, it incorporates Cr(VI) preferentially to the chloride salts when they coexist. - Highlights: • Activated Ca-Al hydroxides transformed into LDH when agitated in water with some inorganic substances. • Hexavalent Cr was incorporated in the LDH structure at high adsorption capacity. • Ca-Al-Cr LDH phase occurred preferentially to Ca-Al-MCl{sub 2} LDH phases with coexistence. • The prepared Ca-Al hydroxides had high performance as adsorbent even with high salinity of the solution.« less

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

PubMed

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

2015-12-01

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

Modeling and optimization of poly(3hydroxybutyrate-co-3hydroxyvalerate) production from cane molasses by Azohydromonas lata MTCC 2311 in a stirred-tank reactor: effect of agitation and aeration regimes.

PubMed

Zafar, Mohd; Kumar, Shashi; Kumar, Surendra; Dhiman, Amit K

2012-07-01

The effects of agitation and aeration rates on copolymer poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [P(3HB-co-3HV)] production by Azohydromonas lata MTCC 2311 using cane molasses supplemented with propionic acid in a bioreactor were investigated. The experiments were conducted in a three-level factorial design by varying the impeller (150-500 rev min(-1)) and aeration (0.5-1.5 vvm) rates. Further, the data were fitted to mathematical models [quadratic polynomial equation and artificial neural network (ANN)] and process variables were optimized by genetic algorithm-coupled models. ANN and hybrid ANN-GA were found superior for modeling and optimization of process variables, respectively. The maximum copolymer concentration of 7.45 g l(-1) with 21.50 mol% of 3HV was predicted at process variables: agitation speed, 287 rev min(-1); and aeration rate, 0.85 vvm, which upon validation gave 7.20 g l(-1) of P(3HB-co-3HV) with 21 mol% of 3HV with the prediction error (%) of 3.38 and 2.32, respectively. Agitation speed established a relative high importance of 72.19% than of aeration rate (27.80%) for copolymer accumulation. The volumetric gas-liquid mass transfer coefficient (k (L) a) was strongly affected by agitation and aeration rates. The highest P(3HB-co-3HV) productivity of 0.163 g l(-1) h(-1) was achieved at 0.17 s(-1) of k (L) a value. During the early phase of copolymer production process, 3HB monomers were accumulated, which were shifted to 3HV units (9-21%) during the cultivation period of 24-42 h. The enhancement of 7.5 and 34% were reported for P(3HB-co-3HV) production and 3HV content, respectively, by hybrid ANN-GA paradigm, which revealed the significant utilization of cane molasses for improved copolymer production.

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

PubMed

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

2016-02-01

The agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis. The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and non-pharmaceutical therapies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia.

PubMed

Galinkin, J L; Fazi, L M; Cuy, R M; Chiavacci, R M; Kurth, C D; Shah, U K; Jacobs, I N; Watcha, M F

2000-12-01

Many children are restless, disoriented, and inconsolable immediately after bilateral myringotomy and tympanosotomy tube placement (BMT). Rapid emergence from sevoflurane anesthesia and postoperative pain may increase emergence agitation. The authors first determined serum fentanyl concentrations in a two-phase study of intranasal fentanyl. The second phase was a prospective, placebo-controlled, double-blind study to determine the efficacy of intranasal fentanyl in reducing emergence agitation after sevoflurane or halothane anesthesia. In phase 1, 26 children with American Society of Anesthesiologists (ASA) physical status I or II who were scheduled for BMT received intranasal fentanyl, 2 microg/kg, during a standardized anesthetic. Serum fentanyl concentrations in blood samples drawn at emergence and at postanesthesia care unit (PACU) discharge were determined by radioimmunoassay. In phase 2, 265 children with ASA physical status I or II were randomized to receive sevoflurane or halothane anesthesia along with either intranasal fentanyl (2 microg/kg) or saline. Postoperative agitation, Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores, and satisfaction of PACU nurses and parents with the anesthetic technique were evaluated. In phase 1, the mean fentanyl concentrations at 10 +/- 4 min (mean +/- SD) and 34 +/- 9 min after administering intranasal fentanyl were 0.80 +/- 0.28 and 0.64 +/- 0.25 ng/ml, respectively. In phase 2, the incidence of severe agitation, highest CHEOPS scores, and heart rate in the PACU were decreased with intranasal fentanyl. There were no differences between sevoflurane and halothane in these measures and in times to hospital discharge. The incidence of postoperative vomiting, hypoxemia, and slow respiratory rates were not increased with fentanyl. Serum fentanyl concentrations after intranasal administration exceed the minimum effective steady state concentration for analgesia in adults. The use of intranasal fentanyl during halothane or sevoflurane anesthesia for BMT is associated with diminished postoperative agitation without an increase in vomiting, hypoxemia, or discharge times.

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

PubMed

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

2017-07-01

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

Trial design innovations: Clinical trials for treatment of neuropsychiatric symptoms in Alzheimer's Disease

PubMed Central

Zhong, K

2015-01-01

Neuropsychiatric symptoms are common in Alzheimer's disease (AD) and other neurodegenerative disorders. Recent progress has been made with clinical trials, advancing new therapies for psychosis in Parkinson's disease (PD), agitation in AD, and apathy in AD. Definitions have emerged for agitation and apathy in patients with cognitive impairment, facilitating recruitment of clinical trial populations. Progress in clinical trial design and the agents being assessed promise to advance therapies for disabling symptoms and improve quality of life for patients and caregivers. PMID:26206713

Submerged culture conditions for the production of mycelial biomass and antimicrobial metabolites by Polyporus tricholoma Mont.

PubMed Central

Vieira, Gladys Rosane Thomé; Liebl, Mariane; Tavares, Lorena Benathar Ballod; Paulert, Roberta; Smânia Júnior, Artur

2008-01-01

Basidiomycete fungi of the Polyporus genus are a source of secondary metabolites which are of medicinal interest as antibacterial compounds. As these substances are produced in a small amount by the fungi, the study of the cultivation conditions in vitro that could possibly optimize their production seems of major importance. The effects of glucose and lactose, pH and agitation on biomass concentration and on the specific growth rate caused by the basidiomycete Polyporus tricholoma were investigated. The initial pH (4.5, 6.5 and 8.5) was autoregulated at pH 5.5, and the agitation increased the mycelial growth and the specific growth rate. The high concentration of carbon sources (4%) increased biomass production. The lactose concentration and the absence of agitation were determinant in the production of antibacterial metabolites. The characterization of the antibacterial substance by GC-MS indicated a major compound, isodrimenediol, produced by the fungus Polyporus tricholoma with activity against Staphylococcus aureus. PMID:24031266

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

PubMed

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

2015-10-01

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

Agitation apparatus. [Patent application

DOEpatents

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

1982-03-12

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

EXTRACTION METHOD FOR SEPARATING URANIUM, PLUTONIUM, AND FISSION PRODUCTS FROM COMPOSITIONS CONTAINING SAME

DOEpatents

Seaborg, G.T.

1957-10-29

Methods for separating plutonium from the fission products present in masses of neutron irradiated uranium are reported. The neutron irradiated uranium is first dissolved in an aqueous solution of nitric acid. The plutonium in this solution is present as plutonous nitrate. The aqueous solution is then agitated with an organic solvent, which is not miscible with water, such as diethyl ether. The ether extracts 90% of the uraryl nitrate leaving, substantially all of the plutonium in the aqueous phase. The aqueous solution of plutonous nitrate is then oxidized to the hexavalent state, and agitated with diethyl ether again. In the ether phase there is then obtained 90% of plutonium as a solution of plutonyl nitrate. The ether solution of plutonyl nitrate is then agitated with water containing a reducing agent such as sulfur dioxide, and the plutonium dissolves in the water and is reduced to the plutonous state. The uranyl nitrate remains in the ether. The plutonous nitrate in the water may be recovered by precipitation.

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

PubMed

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

2016-01-01

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

In-line mixing states monitoring of suspensions using ultrasonic reflection technique.

PubMed

Zhan, Xiaobin; Yang, Yili; Liang, Jian; Zou, Dajun; Zhang, Jiaqi; Feng, Luyi; Shi, Tielin; Li, Xiwen

2016-02-01

Based on the measurement of echo signal changes caused by different concentration distributions in the mixing process, a simple ultrasonic reflection technique is proposed for in-line monitoring of the mixing states of suspensions in an agitated tank in this study. The relation between the echo signals and the concentration of suspensions is studied, and the mixing process of suspensions is tracked by in-line measurement of ultrasonic echo signals using two ultrasonic sensors. Through the analysis of echo signals over time, the mixing states of suspensions are obtained, and the homogeneity of suspensions is quantified. With the proposed technique, the effects of impeller diameter and agitation speed on the mixing process are studied, and the optimal agitation speed and the minimum mixing time to achieve the maximum homogeneity are acquired under different operating conditions and design parameters. The proposed technique is stable and feasible and shows great potential for in-line monitoring of mixing states of suspensions. Copyright © 2015 Elsevier B.V. All rights reserved.

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

PubMed

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

2001-06-01

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

Extraction of coffee silverskin to convert waste into a source of antioxidant

NASA Astrophysics Data System (ADS)

Tangguh, Patrick; Kusumocahyo, Samuel P.

2017-01-01

Coffee silverskin (CS) is a thin layer of coffee bean, and is regarded as a waste during coffee roasting process. In this work, coffee silverskin was extracted by three types of method: conventional extraction (CE) with agitation, conventional extraction (CE) without agitation and ultrasound-assisted extraction (UAE). The total phenolic content, the total flavonoid content and the antioxidant activity of the extract were analyzed. It was found that the type of extraction method, the extraction time and the extraction temperature strongly influenced the total phenolic content, the total flavonoid content and the antioxidant activity of the extract. Comparison between conventional extraction (CE) and ultrasound-assisted extraction (UAE) were statistically analyzed using 3-way ANOVA test. The optimum extraction time and temperature for each method were analyzed using 2-way ANOVA test. It was found that the optimum condition to obtain a high antioxidant activity of 68.9% was by using CE with agitation with the extraction time and temperature of 60 minutes and 60˚C, respectively.

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

PubMed

Alibeu, J P; Jobert, J

1990-01-01

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

Implementation of a baby doll therapy protocol for people with dementia: Innovative practice.

PubMed

Braden, Barbara A; Gaspar, Phyllis M

2015-09-01

Dementia is exhibited by both emotional and physical states such as agitation. Chemical restraints, often used for agitated behaviors, are not always effective and produce untoward effects. Baby doll therapy is a nonpharmacologic therapy that can affect agitated behavior in dementia patients, yet a protocol for the therapy did not exist. An implementation protocol for doll therapy for those with dementia was developed and implemented with 16 residents in a dementia care center. Outcomes were measurements of the impact of the dolls on six areas of the resident's behavior and their reactions to the doll. Participants had an increase in level of happiness, activity/liveliness, interaction with staff and others, and ease of giving care. There was also a reduction in the level of anxiety. The increase in happiness was a statistically significant outcome. Baby doll therapy is an effective nonpharmacological approach for improving the well-being of patients with moderate to severe dementia. © The Author(s) 2014.

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

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

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

2013-12-15

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

Nanosilver microalgae biosynthesis: cell appearance based on SEM and EDX methods

NASA Astrophysics Data System (ADS)

Pancasakti Kusumaningrum, Hermin; Zainuri, Muhammad; Marhaendrajaya, Indras; Subagio, Agus

2018-05-01

Microbial contamination has caused public health problems in the world population. This problem has spurred the development of methods to overcome and prevent microbial invasion. The extensive use of antibiotics has facilitated the continued emergence and spread of resistant organisms. Synthesized of silver nanoparticle (AgNPs) on microalgae Chlorella pyrenoidosa offer environmentally safe antimicrobial agent. The present study is focused on the biosynthesis of AgNPs using microalgae C. pyrenoidosa. The research methods was conducted by insertion of nanosilver particle into microalgae cells with and without agitation to speed up the process of formation nanosilver microalgae. The formation of microalgae SNP was analyzes by UV-Vis spectrophotometer, Scanning Electron Micrograph (SEM) and Energy-dispersive X-ray spectroscopy (EDX) methods. The research result showed that nanosilver microalgae biosynthesis using the agitation treatment was exhibited better performance in particle insertion and cell stability, comparing with no agitation treatment. However, synthesis of nanosilver microalgae tend to reduce the cell size.

Some factors affecting efficiency of the ultrasound-aided enzymatic hydrolysis of cotton cellulose.

PubMed

Szabo, Orsolya Erzsebet; Csiszar, Emilia

2017-01-20

The efficiency of the enzymatic hydrolysis of cellulose with low frequency ultrasound (horn-type reactor) was investigated and characterized by the concentration of reducing sugars liberated. Small squares of bleached cotton fabric were used for comparing the efficiency of different agitation methods (i.e. magnetic stirring, horizontal and vertical mechanical agitation) and ultrasound. At the same enzyme dosage and substrate level, sonication at 40, 60 and 80% amplitudes (I diss : 16.2, 32.2 and 43.4W/cm 2 , respectively) intensified the hydrolysis over the most efficient mechanical agitation (i.e. magnetic stirring) alone by 15%, 24% and 54%, respectively. For mapping the ultrasonicated field, fabric layers positioned perpendicularly to the ultrasonic probe at different distances were hydrolysed. The optimal operating conditions were reached at 60% amplitude and 9mm The yield depended mainly on important factors such as amplitude, the presence of a reflector, distance from horn and form of substrate. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

Qambrani, Naveed Ahmed; Oh, Sang-Eun

2013-01-01

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

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

PubMed Central

2014-01-01

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

[Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study].

PubMed

Lee, Byoung Sook; Kwak, Su Young

2017-02-01

This aim of this phenomenological study was to describe and understand the experience of spiritual conflict in hospice nurses by identifying the meanings and structures of the experience. Participants were 12 nurses working for one year or more at hospice units of general hospitals in a metropolitan city and experiencing of spiritual conflict as hospice nurses. Over six months data were collected using individual in-depth interviews and analyzed with the method suggested by Colaizzi. The experience of spiritual conflict in participants was organized into three categories, six theme-clusters, and 13 themes. The participants felt existential anxiety on death and a fear of death which is out of human control and skepticism for real facts of human beings facing death. They also experienced agitation of fundamental beliefs about life with agitation of the philosophy of life guiding themselves and mental distress due to fundamental questions that are difficult to answer. Also they had distress about poor spiritual care with guilty feelings from neglecting patients' spiritual needs and difficulties in spiritual care due to lack of practical competencies. Findings indicate the experience of spiritual conflict in hospice nurses is mainly associated with frequent experience of death in hospice patients. The experience of spiritual conflict consisted of existential anxiety, agitation of fundamental beliefs and distress over poor spiritual care. So, programs to help relieve anxiety, agitation and distress are necessary to prevent spiritual conflict and then spiritual burnout in hospice nurses. © 2017 Korean Society of Nursing Science

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

PubMed

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

2016-05-01

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

Effects of space flight and mixing on bacterial growth in low volume cultures

NASA Technical Reports Server (NTRS)

Kacena, M. A.; Manfredi, B.; Todd, P.

1999-01-01

Previous investigations have shown that liquid suspension bacterial cultures grow to higher cell concentrations in spaceflight than on Earth. None of these studies included ground-control experiments designed to evaluate the fluid effects potentially responsible for the reported increases. Therefore, the emphasis of this research was to both confirm differences in final cell concentration between 1g and microgravity cultures, and to examine the effects of mixing as a partial explanation for this difference. Flight experiments were performed in the Fluid Processing Apparatus (FPA), aboard Space Shuttle Missions STS-63 and STS-69, with simultaneous 1g static and agitated controls. Additional static 1g, agitated, and clino-rotated controls were performed in 9-ml culture tubes. This research revealed that both E. coli and B. subtilis samples cultured in space flight grew to higher final cell densities (120-345% increase) than simultaneous static 1g controls. The final cell concentration of E. coli cells cultured under agitation was 43% higher than in static 1g cultures and was 102% higher with clino-rotation. However, for B. subtilis cultures grown while being agitated on a shaker or clino-rotated, the final cell concentrations were nearly identical to those of the simultaneous static 1g controls. Therefore, these data suggest that the unique fluid quiescence in the microgravity environment (lack of sedimentation, creating unique transfer of nutrients and waste products), was responsible for the enhanced bacterial proliferation reported in this and other studies.

Process optimization for reverse micellar extraction of stem bromelain with a focus on back extraction.

PubMed

Dhaneshwar, Amrut D; Chaurasiya, Ram Saran; Hebbar, H Umesh

2014-01-01

In the current study, reverse micellar extraction (RME) for the purification of stem bromelain was successfully achieved using the sodium bis(2-ethylhexyl) sulfosuccinate (AOT)/isooctane system. A maximum forward extraction efficiency of 58.0% was obtained at 100 mM AOT concentration, aqueous phase pH of 8.0 and 0.2 M NaCl. Back extraction studies on altering stripping phase pH and KCl concentration, addition of counter-ion and iso-propyl alcohol (IPA) and mechanical agitation with glass beads indicated that IPA addition and agitation with glass beads have significant effects on extraction efficiency. The protein extraction was higher (51.9%) in case of the IPA (10% v/v) added system during back extraction as compared to a cetyltrimethylammonium bromide (100 mM) added system (9.42%). The central composite design technique was used to optimize the back extraction conditions further. Concentration of IPA, amount of glass beads, mixing time, and agitation speed (in rpm) were the variables selected. IPA concentration of 8.5% (v/v), glass bead concentration of 0.6 (w/v), and mixing time of 45 min at 400 rpm resulted in higher back extraction efficiency of 45.6% and activity recovery of 88.8% with purification of 3.04-fold. The study indicated that mechanical agitation using glass beads could be used for destabilizing the reverse micelles and release of bromelain back into the fresh aqueous phase. © 2014 American Institute of Chemical Engineers.

Decolorization of distillery spent wash effluent by electro oxidation (EC and EF) and Fenton processes: A comparative study.

PubMed

David, Charles; Arivazhagan, M; Tuvakara, Fazaludeen

2015-11-01

In this study, laboratory scale experiments were performed to degrade highly concentrated organic matter in the form of color in the distillery spent wash through batch oxidative methods such as electrocoagulation (EC), electrofenton (EF) and Fenton process. The effect of corresponding operating parameters, namely initial pH: 2-10; current intensity: 1-5A; electrolysis time: 0.5-4h; agitation speed: 100-500rpm; inter-electrode distance: 0.5-4cm and Fenton's reagent dosage: 5-40mg/L was employed for optimizing the process of spent wash color removal. The performance of all the three processes was compared and assessed in terms of percentage color removal. For EC, 79% color removal was achieved using iron electrodes arranged with 0.5cm of inter-electrode space and at optimum conditions of pH 7, 5A current intensity, 300rpm agitation speed and in 2h of electrolysis time. In EF, 44% spent wash decolorization was observed using carbon (graphite) electrodes with an optimum conditions of 0.5cm inter-electrode distance, pH 3, 4A current intensity, 20mg/L FeSO4 and agitation speed of 400rpm for 3h of electrolysis time. By Fenton process, 66% decolorization was attained by Fenton process at optimized conditions of pH 3, 40mg/L of Fenton's reagent and at 500rpm of agitation speed for 4h of treatment time. Copyright © 2015 Elsevier Inc. All rights reserved.

Micro-computed tomography evaluation of the removal of calcium hydroxide medicament from C-shaped root canals of mandibular second molars.

PubMed

Ma, J Z; Shen, Y; Al-Ashaw, A J; Khaleel, H Y; Yang, Y; Wang, Z J; Peng, B; Haapasalo, M

2015-04-01

To use micro-computed tomography (μ-CT) to evaluate the amount of calcium hydroxide [Ca(OH)2 ] remaining in the C-shaped root canals of mandibular second molars after attempting to remove it with passive ultrasonic and sonic irrigation. Thirty mandibular second molars, 15 in C1 and 15 in C2 configurations as first identified by μ-CT, were divided into three groups (five C1 and five C2 in each group) for the three irrigation methods. All teeth were prepared to ProTaper Universal F2 and filled with Ca(OH)2 paste. The Ca(OH)2 was removed with F2 files and irrigation without agitation or with agitation using either EndoActivator or ultrasonics. μ-CT was used to measure the initial amount of Ca(OH)2 present. After removal of Ca(OH)2, μ-CT imaging was used to assess the percentage of volume of residual Ca(OH)2 in the canal. Data were analysed using one-way anova test. There was no significant difference in the mean volume of the root canal systems after instrumentation amongst the three groups. The three irrigation techniques left 2-17% of Ca(OH)2 in the root canals after removal. The mean volume of the remaining Ca(OH)2 was higher in the group without agitation than in the groups with sonic or ultrasonic agitation (P < 0.05). In the apical third, 68% of the canal space remained occupied by Ca(OH)2 when no agitation was used, whereas 28% and 31% remained filled by Ca(OH)2 in the EndoActivator and ultrasonic groups, respectively. There was no significant difference in the amount of residual Ca(OH)2 between the EndoActivator and ultrasonic groups. The proportion of remaining Ca(OH)2 in the apical canals was higher than in the middle and coronal canals in all groups (P < 0.05). A considerable proportion of the apical canal space remained filled with Ca(OH)2 in the C-shaped root canals after instrumentation and conventional needle irrigation. Although combining rotary instrumentation and irrigation with sonic or ultrasonic agitation reduced the amount of residual Ca(OH)2 in the C-shaped root canals, the large amount of calcium hydroxide in the critical apical area remains a concern. Alternative strategies should be considered in medication of the apical canal in C-shaped teeth. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Adsorption of basic dyes on granular activated carbon and natural zeolite.

PubMed

Meshko, V; Markovska, L; Mincheva, M; Rodrigues, A E

2001-10-01

The adsorption of basic dyes from aqueous solution onto granular activated carbon and natural zeolite has been studied using an agitated batch adsorber. The influence of agitation, initial dye concentration and adsorbent mass has been studied. The parameters of Langmuir and Freundlich adsorption isotherms have been determined using the adsorption data. Homogeneous diffusion model (solid diffusion) combined with external mass transfer resistance is proposed for the kinetic investigation. The dependence of solid diffusion coefficient on initial concentration and mass adsorbent is represented by the simple empirical equations.

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

PubMed

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

2016-11-01

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

A Modern-Day Fight Club? The Stabilization and Management of Acutely Agitated Patients in the Emergency Department.

PubMed

New, Andrew; Tucci, Veronica Theresa; Rios, Juan

2017-09-01

This article is an overview of the treatment and management of acutely agitated patients as they present in the emergency department or emergency psychiatric facility. This article focuses on how a patient encounter may unfold and what issues need to be considered along the way. Verbal de-escalation is emphasized as a standard of care, including the offering of environmental changes and medications when indicated. Approved medications are reviewed as well as the proper use of restraints. Copyright © 2017 Elsevier Inc. All rights reserved.

Grain refinement control in TIG arc welding

NASA Technical Reports Server (NTRS)

Iceland, W. F.; Whiffen, E. L. (Inventor)

1975-01-01

A method for controlling grain size and weld puddle agitation in a tungsten electrode inert gas welding system to produce fine, even grain size and distribution is disclosed. In the method the frequency of dc welding voltage pulses supplied to the welding electrode is varied over a preselected frequency range and the arc gas voltage is monitored. At some frequency in the preselected range the arc gas voltage will pass through a maximum. By maintaining the operating frequency of the system at this value, maximum weld puddle agitation and fine grain structure are produced.

Does item overlap render measured relationships between pain and challenging behaviour trivial? Results from a multicentre cross-sectional study in 13 German nursing homes.

PubMed

Kutschar, Patrick; Bauer, Zsuzsa; Gnass, Irmela; Osterbrink, Jürgen

2017-07-01

Several studies suggest that pain is a trigger for challenging behaviour in older adults with cognitive impairment. However, such measured relationships might be confounded due to item overlap as instruments share similar or identical items. The purpose of this study was to examine whether the frequently observed association between pain and challenging behaviour might be traced back to item overlap. This multicentre cross-sectional study was conducted in 13 nursing homes and examined pain (measure: Pain Assessment in Advanced Dementia Scale) and challenging behaviour (measure: Cohen-Mansfield Agitation Inventory) in 150 residents with severe cognitive impairment. The extent of item overlap was determined by juxtaposition of both measures' original items. As expected, comparison between these instruments revealed an extensive item overlap. The statistical relationship between the two phenomena can be traced back mainly to the contribution of the overlapping items, which renders the frequently stated relationship between pain and challenging behaviour trivial. The status quo of measuring such associations must be contested: constructs' discrimination and instruments' discrimination have to be discussed critically as item overlap may lead to biased conclusions and assumptions in research as well as to inadequate care measures in nursing practice. © 2017 John Wiley & Sons Ltd.

At-risk symptoms of bipolar disorder in a university student cohort.

PubMed

Haussleiter, Ida S; Lorek, Sandra; Zeschel, Eike; Mattausch, Svenja; Meyers, Milena; Juckel, Georg

2018-05-06

To assess the occurrence and frequency of bipolar at-risk symptoms in a large sample of previously undiagnosed students using the new screening tool Bochumer Screeningbogen Bipolar (BSB). 2329 students of the Ruhr-University Bochum, Germany completed online demographic data as well as various self-rating questionnaires (BSB; Hypomania Checklist 32; Altman Self-Rating Mania Scale; Beck Depression Inventory). Within the student cohort (64.4% female, mean age 24.3 years) every fifth student currently suffered from moderate to severe depressive symptoms; every sixth student had already thought about suicide and every other student reported a history of mood swings. The most frequently reported depressive symptoms included physical exhaustion, depressed mood, and tiredness. The most frequently reported (hypo)manic symptoms included physical agitation, feeling extremely energetic, and lack of concentration. The BSB showed good convergent validity with other established questionnaires capturing depressive or (hypo)manic symptoms, as well as a stable administration of underlying constructs. The BSB correlated significantly with the already established applied questionnaires. The predictive power of the BSB regarding the development of bipolar disorder cannot be correctly quantified at present. The further purpose of this exploratory web-based study should be to examine the validity of the presented measures in a longitudinal design. Copyright © 2018 Elsevier B.V. All rights reserved.

Pettiness: Conceptualization, measurement and cross-cultural differences.

PubMed

Ng, Reuben; Levy, Becca

2018-01-01

Although pettiness, defined as the tendency to get agitated over trivial matters, is a facet of neuroticism which has negative health implications, no measure exists. The goal of the current study was to develop, and validate a short pettiness scale. In Study 1 (N = 2136), Exploratory Factor Analysis distilled a one-factor model with five items. Convergent validity was established using the Big Five Inventory, DASS, Satisfaction with Life Scale, and Conner-Davidson Resilience Scale. As predicted, pettiness was positively associated with neuroticism, depression, anxiety and stress but negatively related to extraversion, agreeableness, conscientiousness, openness, life satisfaction and resilience. Also, as predicted, pettiness was not significantly related to physical functioning, or blind and constructive patriotism, indicating discriminant validity. Confirmatory Factor Analysis in Study 2 (N = 734) revealed a stable one-factor model of pettiness. In Study 3 (N = 532), the scale, which showed a similar factor structure in the USA and Singapore, also reflected predicted cross-cultural patterns: Pettiness was found to be significantly lower in the United States, a culture categorized as "looser" than in Singapore, a culture classified as "tighter" in terms of Gelfand and colleagues' framework of national tendencies to oppose social deviance. Results suggest that this brief 5-item tool is a reliable and valid measure of pettiness, and its use in health research is encouraged.

A novel experimental approach to investigate the effect of different agitation methods using sodium hypochlorite as an irrigant on the rate of bacterial biofilm removal from the wall of a simulated root canal model.

PubMed

Mohmmed, Saif Alarab; Vianna, Morgana E; Penny, Matthew R; Hilton, Stephen T; Mordan, Nicola; Knowles, Jonathan C

2016-10-01

Root canal irrigation is an important adjunct to control microbial infection. This study aimed primarily to develop a transparent root canal model to study in situ Enterococcus faecalis biofilm removal rate and remaining attached biofilm using passive or active irrigation solution for 90s. The change in available chlorine and pH of the outflow irrigant were assessed. A total of forty root canal models (n=10 per group) were manufactured using 3D printing. Each model consisted of two longitudinal halves of an 18mm length simulated root canal with size 30 and taper 0.06. E. faecalis biofilms were grown on the apical 3mm of the models for 10days in Brain Heart Infusion broth. Biofilms were stained using crystal violet for visualization. The model halves were reassembled, attached to an apparatus and observed under a fluorescence microscope. Following 60s of 9mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic and ultrasonic methods for 30s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analyzed using Kruskal-Wallis test and generalized linear mixed model. The highest level of biofilm removal was with ultrasonic agitation (90.13%) followed by sonic (88.72%), gutta-percha (80.59%), and passive irrigation group (control) (43.67%) respectively. All agitation groups reduced the available chlorine and pH of NaOCl more than that in the passive irrigation group. The 3D printing method provided a novel model to create a root canal simulation for studying and understanding a real-time biofilm removal under microscopy. Ultrasonic agitation of NaOCl left the least amount of residual biofilm in comparison to sonic and gutta-percha agitation methods. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Latz, Michael I.; Rohr, Jim

2013-07-01

Bathyphotometer measurements of bioluminescence are used as a proxy for the abundance of luminescent organisms for studying population dynamics; the interaction of luminescent organisms with physical, chemical, and biological oceanographic processes; and spatial complexity especially in coastal areas. However, the usefulness of bioluminescence measurements has been limited by the inability to compare results from different bathyphotometer designs, or even the same bathyphotometer operating at different volume flow rates. The primary objective of this study was to compare measurements of stimulated bioluminescence of four species of cultured dinoflagellates, the most common source of bioluminescence in coastal waters, using two different bathyphotometer flow agitators as a function of bathyphotometer volume flow rate and dinoflagellate concentration. For both the NOSC and BIOLITE flow agitators and each species of dinoflagellate tested, there was a critical volume flow rate, above which average bioluminescence intensity, designated as bathyphotometer bioluminescence potential (BBP), remained relatively constant and scaled directly with dinoflagellate cell concentration. At supra-critical volume flow rates, the ratio of BIOLITE to NOSC BBP was nearly constant for the same species studied, but varied between species. The spatial pattern and residence time of flash trajectories within the NOSC flow agitator indicated the presence of dominant secondary recirculating flows, where most of the bioluminescence was detected. A secondary objective (appearing in the Appendix) was to study the feasibility of using NOSC BBP to scale flow-stimulated bioluminescence intensity across similar flow fields, where the contributing composition of luminescent species remained the same. Fully developed turbulent pipe flow was chosen because it is hydrodynamically well characterized. Average bioluminescence intensity in a 2.54-cm i.d. pipe was highly correlated with wall shear stress and BBP. This correlation, when further scaled by pipe diameter, effectively predicted bioluminescence intensity in fully developed turbulent flow in a 0.83-cm i.d. pipe. Determining similar correlations between other bathyphotometer flow agitators and flow fields will allow bioluminescence potential measurements to become a more powerful tool for the oceanographic community.

Becoming tobacco-free: Changes in staff and patient attitudes and incident reports in a large academic mental health and addictions hospital.

PubMed

Riad-Allen, Lilian; Dermody, Sarah Siodmok; Herman, Yarissa; Bellissimo, Kim; Selby, Peter; George, Tony Peter

2017-03-01

Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban. A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4-6 months and 10-12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period. We observed positive changes in staff and patient attitudes toward the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2, 99) = 3.25, p = .04, but no change F (2, 21) = 1.09, p = .35 in fire-related incidents. We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative. During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. (Am J Addict 2017;26:183-191). © 2017 American Academy of Addiction Psychiatry.

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

PubMed

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

2018-04-01

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

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

PubMed

Saringcarinkul, Ananchanok; Manchupong, Sithapan; Punjasawadwong, Yodying

2008-08-01

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

Becoming tobacco-free: Changes in staff and patient attitudes and incident reports in a large academic mental health and addictions hospital

PubMed Central

Riad-Allen, Lilian; Dermody, Sarah S.; Herman, Yarissa; Bellissimo, Kim; Selby, Peter; George, Tony P.

2017-01-01

Background and Objective Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban. Methods A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4-6 months and 10-12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period. Results We observed positive changes in staff and patient attitudes towards the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2,99) = 3.25, p=0.04, but no change F (2, 21) = 1.09, p=0.35 in fire-related incidents. Discussion and Conclusions We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative. Scientific Significance During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. PMID:28211960

A randomised controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia

PubMed Central

2013-01-01

Background Aromatherapy and hand massage therapies have been reported to have some benefit for people with dementia who display behavioural symptoms; however there are a number of limitations of reported studies. The aim is to investigate the effect of aromatherapy (3% lavender oil spray) with and without hand massage on disruptive behaviour in people with dementia living in long-term care. Methods In a single blinded randomised controlled trial 67 people with a diagnosis of dementia and a history of disruptive behaviour, from three long-term care facilities were recruited and randomised using a random number table into three groups: (1) Combination (aromatherapy and hand massage) (n = 22), (2) Aromatherapy (n = 23), (3) Placebo control (water spray) (n = 22). The intervention was given twice daily for six weeks. Data on residents’ behaviour (CMAI) and cognition (MMSE) were collected before, during and after the intervention. Results Despite a downward trend in behaviours displayed not one of the interventions significantly reduced disruptive behaviour. Conclusions Further large-scale placebo controlled studies are required where antipsychotic medication is controlled and a comparison of the methods of application of aromatherapy are investigated. Trial registration ACTRN12612000917831 PMID:23837414

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

PubMed

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

2001-06-01

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

Reduction of ammonia and volatile organic compounds from food waste-composting facilities using a novel anti-clogging biofilter system.

PubMed

Ryu, Hee Wook; Cho, Kyung-Suk; Lee, Tae-Ho

2011-04-01

The performance of a pilot-scale anti-clogging biofilter system (ABS) was evaluated over a period of 125days for treating ammonia and volatile organic compounds emitted from a full-scale food waste-composting facility. The pilot-scale ABS was designed to intermittently and automatically remove excess biomass using an agitator. When the pressure drop in the polyurethane filter bed was increased to a set point (50 mm H(2)O m(-1)), due to excess biomass acclimation, the agitator automatically worked by the differential pressure switch, without biofilter shutdown. A high removal efficiency (97-99%) was stably maintained for the 125 days after an acclimation period of 1 week, even thought the inlet gas concentrations fluctuated from 0.16 to 0.55 g m(-3). Due the intermittent automatic agitation of the filter bed, the biomass concentration and pressure drop in the biofilter were maintained within the ranges of 1.1-2.0 g-DCW g PU(-1) and below 50 mm H(2)O m(-1), respectively. Copyright © 2011 Elsevier Ltd. All rights reserved.

Performance evaluation of extractor cutting blade configuration in Inulin extraction process from Dahlia sp. L tuber

NASA Astrophysics Data System (ADS)

Sundari, E.; Praputri, E.; Marthiana, W.; Jaya, M.

2018-03-01

Inulin, a polysaccharide plant-based nutrient, can be isolated from dahlia flower tubers by liquid-solid extraction processes and is generally carried out in an extractor tank equipped with an agitator. To accelerate the diffusion rate of solute from the solid phase (bulk phase) to the external surface (boundary layer) in order to increase yield of inulin, the size reduction of material is required. The purpose of this research was to design the cutting blade needed for dahlia tuber size reduction and investigate the effect of blade types, agitator speed (350, 700, 1050, and 1400 rpm), and configuration of cutting blade to material fineness at 90 minutes of contacting time. The results showed that higher cutting blade speed results in higher cut material fineness rate. The best conditions was achieved by the configuration of two four-blade turbine combined with one three-blade turbine with fineness rate more than 90% in 30 minutes of contacting time at every variation of agitator speed. The cutting blade designed in this study can be used for size reduction purpose of tubers other than dahlia tubers.

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

PubMed

Major-Godlewska, Marta; Karcz, Joanna

2018-01-01

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

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

PubMed

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

2013-10-01

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

Enhancement of docosahexaenoic acid production by Schizochytrium SW1 using response surface methodology

NASA Astrophysics Data System (ADS)

Nazir, Mohd Yusuf Mohd; Al-Shorgani, Najeeb Kaid Nasser; Kalil, Mohd Sahaid; Hamid, Aidil Abdul

2015-09-01

In this study, three factors (fructose concentration, agitation speed and monosodium glutamate (MSG) concentration) were optimized to enhance DHA production by Schizochytrium SW1 using response surface methodology (RSM). Central composite design was applied as the experimental design and analysis of variance (ANOVA) was used to analyze the data. The experiments were conducted using 500 mL flask with 100 mL working volume at 30°C for 96 hours. ANOVA analysis revealed that the process was adequately represented significantly by the quadratic model (p<0.0001) and two of the factors namely agitation speed and MSG concentration significantly affect DHA production (p<0.005). Level of influence for each variable and quadratic polynomial equation were obtained for DHA production by multiple regression analyses. The estimated optimum conditions for maximizing DHA production by SW1 were 70 g/L fructose, 250 rpm agitation speed and 12 g/L MSG. Consequently, the quadratic model was validated by applying of the estimated optimum conditions, which confirmed the model validity and 52.86% of DHA was produced.

[Scoping review on the concepts of touch and massage and their effects on agitation and stress in aged hospitalized patients suffering from dementia

PubMed

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

2016-09-01

This scoping review examines the effects of touch/massage on agitation and stress in aged hospitalized patients suffering from dementia. This intervention is multidimensional, at the edges of medical neurosciences, nursing sciences, and social sciences. This review is primarily supported by a biological model of social relations, describing the interconnection between cognition, affect, and endocrine aspects of attachment modes. It is also guided by nursing sciences conceptualizations which anchors touch/massage in the heart of nursing practice. The importance of touch/massage and its emotional regulation capacity is discussed in the light of these conceptualizations. The needs for that kind of contact in aged demented inpatients appears to be related to sensory loss and to a lack of emotional and social contacts. Evidence of the benefits of touch/massage is synthesized and indicate that this intervention is sometimes difficult to provide for agitated patients. Finally, proposals are made to develop a scientific agenda in clinical settings in order to continue the development of evidence and thus contribute to better inform nursing practice.

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

PubMed

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

2018-04-10

Aggressive, agitated or violent behaviour due to psychosis constitutes an emergency psychiatric treatment where fast-acting interventions are required. Risperidone is a widely accessible antipsychotic that can be used to manage psychosis-induced aggression or agitation. To examine whether oral risperidone alone is an effective treatment for psychosis-induced aggression or agitation. We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (up to April 2017); this register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records into the register. Randomised controlled trials (RCTs) comparing rapid use of risperidone and other drugs, combinations of drugs or placebo for people exhibiting aggression or agitation (or both) thought to be due to psychosis. We independently inspected all citations from searches, identified relevant abstracts, and independently extracted data from all included studies. For binary data we calculated risk ratio (RR) and for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CI) and used a fixed-effect model. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' tables. The review now contains data from nine trials (total n = 582) reporting on five comparisons. Due to risk of bias, small size of trials, indirectness of outcome measures and a paucity of investigated and reported 'pragmatic' outcomes, evidence was graded as very-low quality. None of the included studies provided useable data on our primary outcome 'tranquillisation or asleep' by 30 minutes, repeated need for tranquillisation or any economic outcomes. Data were available for our other main outcomes of agitation or aggression, needing restraint, and incidence of adverse effects.Risperidone versus haloperidol (up to 24 hours follow-up)For the outcome, specific behaviour - agitation, no clear difference was found between risperidone and haloperidol in terms of efficacy, measured as at least 50% reduction in the Positive and Negative Syndrome Scale - Psychotic Agitation Sub-score (PANSS-PAS) (RR 1.04, 95% CI 0.86 to 1.26; participants = 124; studies = 1; very low-quality evidence) and no effect was observed for need to use restraints (RR 2.00, 95% CI 0.43 to 9.21; participants = 28; studies = 1; very low-quality evidence). Incidence of adverse effects was similar between treatment groups (RR 0.94, 95% CI 0.54 to 1.66; participants = 124; studies = 1; very low-quality evidence).Risperidone versus olanzapineOne small trial (n = 29) reported useable data for the comparison risperidone versus olanzapine. No effect was observed for agitation measured as PANSS-PAS endpoint score at two hours (MD 2.50, 95% CI -2.46 to 7.46; very low-quality evidence); need to use restraints at four days (RR 1.43, 95% CI 0.39 to 5.28; very-low quality evidence); specific movement disorders measured as Behavioural Activity Rating Scale (BARS) endpoint score at four days (MD 0.20, 95% CI -0.43 to 0.83; very low-quality evidence).Risperidone versus quetiapineOne trial reported (n = 40) useable data for the comparison risperidone versus quetiapine. Aggression was measured using the Modified Overt Aggression Scale (MOAS) endpoint score at two weeks. A clear difference, favouring quetiapine was observed (MD 1.80, 95% CI 0.20 to 3.40; very-low quality evidence). No evidence of a difference between treatment groups could be observed for incidence of akathisia after 24 hours (RR 1.67, 95% CI 0.46 to 6.06; very low-quality evidence). Two participants allocated to risperidone and one allocated to quetiapine experienced myocardial ischaemia during the trial.Risperidone versus risperidone + oxcarbazepineOne trial (n = 68) measured agitation using the Positive and Negative Syndrome Scale - Excited Component.(PANSS-EC) endpoint score and found a clear difference, favouring the combination treatment at one week (MD 2.70, 95% CI 0.42 to 4.98; very low-quality evidence), but no effect was observed for global state using Clinical Global Impression - Improvement (CGI-I) endpoint score at one week (MD -0.20, 95% CI -0.61 to 0.21; very-low quality evidence). Incidence of extrapyramidal symptoms after 24 hours was similar between treatment groups (RR 1.59, 95% CI 0.49 to 5.14; very-low quality evidence).Risperidone versus risperidone + valproic acidTwo trials compared risperidone with a combination of risperidone plus valproic acid. No clear differences between the treatment groups were observed for aggression (MOAS endpoint score at three days: MD 1.07, 95% CI -0.20 to 2.34; participants = 54; studies = 1; very low-quality evidence) or incidence of akathisia after 24 hours: RR 0.75, 95% CI 0.28 to 2.03; participants = 122; studies = 2; very low-quality evidence). Overall, results for the main outcomes show no real effect for risperidone. The only data available for use in this review are from nine under-sampled trials and the evidence available is of very low quality. This casts uncertainty on the role of risperidone in rapid tranquillisation for people with psychosis-induced aggression. High-quality pragmatic RCTs are feasible and are needed before clear recommendations can be drawn on the use of risperidone for psychosis-induced aggression or agitation.

Enhancing Results of Microarray Hybridizations Through Microagitation

PubMed Central

Toegl, Andreas; Kirchner, Roland; Gauer, Christoph; Wixforth, Achim

2003-01-01

Protein and DNA microarrays have become a standard tool in proteomics/genomics research. In order to guarantee fast and reproducible hybridization results, the diffusion limit must be overcome. Surface acoustic wave (SAW) micro-agitation chips efficiently agitate the smallest sample volumes (down to 10 μL and below) without introducing any dead volume. The advantages are reduced reaction time, increased signal-to-noise ratio, improved homogeneity across the microarray, and better slide-to-slide reproducibility. The SAW micromixer chips are the heart of the Advalytix ArrayBooster, which is compatible with all microarrays based on the microscope slide format. PMID:13678150

Enhanced attrition bioreactor for enzyme hydrolysis of cellulosic materials

DOEpatents

Scott, Timothy C.; Scott, Charles D.; Faison, Brendlyn D.; Davison, Brian H.; Woodward, Jonathan

1997-01-01

A process for converting cellulosic materials, such as waste paper, into fuels and chemicals, such as sugars and ethanol, utilizing enzymatic hydrolysis of the major carbohydrate of paper: cellulose. A waste paper slurry is contacted by cellulase in an agitated hydrolyzer. An attritor and a cellobiase reactor are coupled to the agitated hydrolyzer to improve reaction efficiency. Additionally, microfiltration, ultrafiltration and reverse osmosis steps are included to further increase reaction efficiency. The resulting sugars are converted to a dilute product in a fluidized-bed bioreactor utilizing a biocatalyst, such as microorganisms. The dilute product is then concentrated and purified.

Enhanced attrition bioreactor for enzyme hydrolysis or cellulosic materials

DOEpatents

Scott, Timothy C.; Scott, Charles D.; Faison, Brendlyn D.; Davison, Brian H.; Woodward, Jonathan

1996-01-01

A process for converting cellulosic materials, such as waste paper, into fuels and chemicals, such as sugars and ethanol, utilizing enzymatic hydrolysis of the major carbohydrate of paper: cellulose. A waste paper slurry is contacted by cellulase in an agitated hydrolyzer. An attritor and a cellobiase reactor are coupled to the agitated hydrolyzer to improve reaction efficiency. Additionally, microfiltration, ultrafiltration and reverse osmosis steps are included to further increase reaction efficiency. The resulting sugars are converted to a dilute product in a fluidized-bed bioreactor utilizing a biocatalyst, such as microorganisms. The dilute product is then concentrated and purified.

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

PubMed

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

2017-02-25

Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I 2 =0%, p =0.004) and its excitement sub-score (WMD=-1.97, p <0.0001) as well as the PANSS total score at 14 days (WMD=-7.13, I 2 =0%, p =0.004) and its excitement sub-score at 7 and 14 days (WMD=-1.97 to -1.92, p =0.002 to 0.0001) after ECT. The ECT-APs combination was superior to APs monotherapy with respect to the PANSS total score at treatment endpoint (WMD=-10.40, p=0.03) and 7 days (WMD=-5.01, p =0.02). Headache (number-needed-to-harm (NNH)=3, 95%CI=2-4) was more frequent in the ECT alone group compared to AP monotherapy. According to the GRADE approach, the evidence levels of main outcomes were rated as ''very low'' (37.5%) and "low" (50%). Pooling of the data based on 7 RCTs from China found no advantage of ECT alone or ECT-APs combination in the treatment of agitation related outcomes in schizophrenia patients. However, ECT alone or ECT-APs combination were associated with significant reduction in the PANSS total score. High-quality RCTs are needed to confirm the current interpretations.

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

PubMed

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

2015-02-01

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

Wall shear stress effects of different endodontic irrigation techniques and systems.

PubMed

Goode, Narisa; Khan, Sara; Eid, Ashraf A; Niu, Li-na; Gosier, Johnny; Susin, Lisiane F; Pashley, David H; Tay, Franklin R

2013-07-01

This study examined débridement efficacy as a result of wall shear stresses created by different irrigant delivery/agitation techniques in an inaccessible recess of a curved root canal model. A reusable, curved canal cavity containing a simulated canal fin was milled into mirrored titanium blocks. Calcium hydroxide (Ca(OH)2) paste was used as debris and loaded into the canal fin. The titanium blocks were bolted together to provide a fluid-tight seal. Sodium hypochlorite was delivered at a previously-determined flow rate of 1 mL/min that produced either negligible or no irrigant extrusion pressure into the periapex for all the techniques examined. Nine irrigation delivery/agitation techniques were examined: NaviTip passive irrigation control, Max-i-Probe(®) side-vented needle passive irrigation, manual dynamic agitation (MDA) using non-fitting and well-fitting gutta-percha points, EndoActivator™ sonic agitation with medium and large points, VPro™ EndoSafe™ irrigation system, VPro™ StreamClean™ continuous ultrasonic irrigation and EndoVac apical negative pressure irrigation. Débridement efficacies were analysed with Kruskal-Wallis ANOVA and Dunn's multiple comparisons tests (α=0.05). EndoVac was the only technique that removed more than 99% calcium hydroxide debris from the canal fin at the predefined flow rate. This group was significantly different (p<0.05) from the other groups that exhibited incomplete Ca(OH)2 removal. The ability of the EndoVac system to significantly clean more debris from a mechanically inaccessible recess of the model curved root canal may be caused by robust bubble formation during irrigant delivery, creating higher wall shear stresses by a two-phase air-liquid flow phenomenon that is well known in other industrial débridement systems. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Platelet monoamine oxidase type B, MAOB intron 13 and MAOA-uVNTR polymorphism and symptoms of post-traumatic stress disorder.

PubMed

Svob Strac, Dubravka; Kovacic Petrovic, Zrnka; Nikolac Perkovic, Matea; Umolac, Danica; Nedic Erjavec, Gordana; Pivac, Nela

2016-07-01

Post-traumatic stress disorder (PTSD), a disorder that develops following exposure to traumatic experience(s), is frequently associated with agitation, aggressive behavior and psychotic symptoms. Monoamine oxidase (MAO) degrades different biogenic amines and regulates mood, emotions and behavior, and has a role in the pathophysiology of various neuropsychiatric disorders. The aim of the study was to investigate the association between different symptoms occurring in PTSD [PTSD symptom severity assessed by the Clinician Administered PTSD Scale (CAPS), agitation and selected psychotic symptoms assessed by the Positive and Negative Syndrome Scale (PANSS)] and platelet MAO-B activity and/or genetic variants of MAOB rs1799836 and MAOA-uVNTR polymorphisms in 249 Croatian male veterans with PTSD. Our study revealed slightly higher platelet MAO-B activity in veterans with PTSD with more severe PTSD symptoms and in veterans with agitation, and significantly higher platelet MAO-B activity in veterans with more pronounced psychotic symptoms compared to veterans with less pronounced psychotic symptoms. Platelet MAO-B activity was associated with smoking but not with age. Genetic variants of MAOB rs1799836 and MAOA-uVNTR were not associated with agitation and selected psychotic symptoms in veterans with PTSD. A marginally significant association was found between MAOB rs1799836 polymorphism and severity of PTSD symptoms, but it was not confirmed since carriers of G or A allele of MAOB rs1799836 did not differ in their total CAPS scores. These findings suggest an association of platelet MAO-B activity, but a lack of association of MAOB rs1799836 and MAOA-uVNTR, with selected psychotic symptoms in ethnically homogenous veterans with PTSD.

Cationic Surface Charge Combined with Either Vitronectin or Laminin Dictates the Evolution of Human Embryonic Stem Cells/Microcarrier Aggregates and Cell Growth in Agitated Cultures

PubMed Central

Lam, Alan Tin-Lun; Li, Jian; Chen, Allen Kuan-Liang; Reuveny, Shaul

2014-01-01

The expansion of human pluripotent stem cells (hPSC) for biomedical applications generally compels a defined, reliable, and scalable platform. Bioreactors offer a three-dimensional culture environment that relies on the implementation of microcarriers (MC), as supports for cell anchorage and their subsequent growth. Polystyrene microspheres/MC coated with adhesion-promoting extracellular matrix (ECM) protein, vitronectin (VN), or laminin (LN) have been shown to support hPSC expansion in a static environment. However, they are insufficient to promote human embryonic stem cells (hESC) seeding and their expansion in an agitated environment. The present study describes an innovative technology, consisting of a cationic charge that underlies the ECM coatings. By combining poly-L-lysine (PLL) with a coating of ECM protein, cell attachment efficiency and cell spreading are improved, thus enabling seeding under agitation in a serum-free medium. This coating combination also critically enables the subsequent formation and evolution of hPSC/MC aggregates, which ensure cell viability and generate high yields. Aggregate dimensions of at least 300 μm during early cell growth give rise to ≈15-fold expansion at 7 days' culture. Increasing aggregate numbers at a quasi-constant size of ≈300 μm indicates hESC growth within a self-regulating microenvironment. PLL+LN enables cell seeding and aggregate evolution under constant agitation, whereas PLL+VN requires an intermediate 2-day static pause to attain comparable aggregate sizes and correspondingly high expansion yields. The cells' highly reproducible bioresponse to these defined and characterized MC surface properties is universal across multiple cell lines, thus confirming the robustness of this scalable expansion process in a defined environment. PMID:24641164

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

DOEpatents

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

2016-03-15

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

[Poisoning with Jimson weed. Five cases treated with physostigmine].

PubMed

Amlo, H; Haugeng, K L; Wickstrøm, E; Koss, A; Husebye, T; Jacobsen, D

1997-08-10

During the autumn of 1995, the National Poisons Information Centre was contacted about several cases of poisoning with Jimson weed (Datura stramonium). Five cases are described here. Upon admission to hospital the patients had moderate to severe anticholinergic symptoms, such as mydriasis, sinus tachycardia, agitation, dry mouth, urine retention, fever, hypertension, hallucinations and seizures. Owing to their agitated behaviour, gastrointestinal decontamination was impossible. Repeated doses of physostigmine (2-3 mg) administered intravenously reversed the anticholinergic features without side-effects. In the most severe case, physostigmine was needed for 18 hours (total dose; 25.5 mg). The patients recovered in a day or two, but mydriasis persisted in many cases.

Process for converting cellulosic materials into fuels and chemicals

DOEpatents

Scott, Charles D.; Faison, Brendlyn D.; Davison, Brian H.; Woodward, Jonathan

1994-01-01

A process for converting cellulosic materials, such as waste paper, into fuels and chemicals utilizing enzymatic hydrolysis of the major constituent of paper, cellulose. A waste paper slurry is contacted by cellulase in an agitated hydrolyzer. The cellulase is produced from a continuous, columnar, fluidized-bed bioreactor utilizing immobilized microorganisms. An attritor and a cellobiase reactor are coupled to the agitated hydrolyzer to improve reaction efficiency. The cellulase is recycled by an adsorption process. The resulting crude sugars are converted to dilute product in a fluidized-bed bioreactor utilizing microorganisms. The dilute product is concentrated and purified by utilizing distillation and/or a biparticle fluidized-bed bioreactor system.

Enhanced attrition bioreactor for enzyme hydrolysis or cellulosic materials

DOEpatents

Scott, T.C.; Scott, C.D.; Faison, B.D.; Davison, B.H.; Woodward, J.

1996-04-16

A process is described for converting cellulosic materials, such as waste paper, into fuels and chemicals, such as sugars and ethanol, utilizing enzymatic hydrolysis of the major carbohydrate of paper: cellulose. A waste paper slurry is contacted by cellulase in an agitated hydrolyzer. An attritor and a cellobiase reactor are coupled to the agitated hydrolyzer to improve reaction efficiency. Additionally, microfiltration, ultrafiltration and reverse osmosis steps are included to further increase reaction efficiency. The resulting sugars are converted to a dilute product in a fluidized-bed bioreactor utilizing a biocatalyst, such as microorganisms. The dilute product is then concentrated and purified. 1 fig.

Enhanced attrition bioreactor for enzyme hydrolysis of cellulosic materials

DOEpatents

Scott, T.C.; Scott, C.D.; Faison, B.D.; Davison, B.H.; Woodward, J.

1997-06-10

A process is described for converting cellulosic materials, such as waste paper, into fuels and chemicals, such as sugars and ethanol, utilizing enzymatic hydrolysis of the major carbohydrate of paper: cellulose. A waste paper slurry is contacted by cellulase in an agitated hydrolyzer. An attritor and a cellobiase reactor are coupled to the agitated hydrolyzer to improve reaction efficiency. Additionally, microfiltration, ultrafiltration and reverse osmosis steps are included to further increase reaction efficiency. The resulting sugars are converted to a dilute product in a fluidized-bed bioreactor utilizing a biocatalyst, such as microorganisms. The dilute product is then concentrated and purified. 1 fig.

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

PubMed

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

2013-03-01

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

Evaluation of methods for the microbiological control of natural corks for sparkling wine bottles.

PubMed

Centeno, S; Calvo, M A

2000-01-01

The various parameters proposed in Norm 0.20/95 of Catalunya (Spain) for the microbiological analysis of natural corks for sparkling wines were evaluated. The best results were obtained through the use of 1/4 Ringer's solution or saline for rinsing with an agitation time of 30 min, and an agitation speed of 150-200 rpm. Tryptone soya agar (TSA) and Sabouraud dextrose agar (SDA) were used as a culture medium for the bacteria and fungi, respectively, and a cultivation time of 48 h and incubation temperatures of 37 +/- 2 degrees C for bacteria and 28 degrees C for yeast and filamentous fungi.

Endocrinology and the skin.

PubMed

Phillips, Patrick J; Weightman, Warren

2006-10-01

'I've got these ugly red blotches on my legs and they are getting worse?' Lisa, 32 years of age, is an accountant who always presents herself meticulously. You can understand why she doesn't like the raised red brown blotches on her shins. The lesions are raised, indurated with follicular accentuation. They are an uneven red-brown colour that doesn't fade with pressure, nor does the tissue pit. Lisa seems more upset and agitated than you expected. When you ask if she's under stress at work she breaks down in tears and says she feels 'agitated and on edge all the time and can't sit still for a minute'.

Effect of cell size and shear stress on bacterium growth rate

NASA Astrophysics Data System (ADS)

Fadlallah, Hadi; Jarrahi, Mojtaba; Herbert, Éric; Peerhossaini, Hassan; PEF Team

2015-11-01

Effect of shear stress on the growth rate of Synechocystis and Chlamydomonas cells is studied. An experimental setup was prepared to monitor the growth rate of the microorganisms versus the shear rate inside a clean room, under atmospheric pressure and 20 °C temperature. Digital magnetic agitators are placed inside a closed chamber provided with airflow, under a continuous uniform light intensity over 4 weeks. In order to study the effect of shear stress on the growth rate, different frequencies of agitation are tested, 2 vessels filled with 150 ml of each specie were placed on different agitating system at the desired frequency. The growth rate is monitored daily by measuring the optical density and then correlate it to the cellular concentration. The PH was adjusted to 7 in order to maintain the photosynthetic activity. Furthermore, to measure the shear stress distribution, the flow velocity field was measured using PIV. Zones of high and low shear stress were identified. Results show that the growth rate is independent of the shear stress magnitude, mostly for Synechocystis, and with lower independency for Chlamydomonas depending on the cell size for each species.

Effect of Be Modification on the Oxide Bifilms and Tensile Strength Reliability of Al-Si-Mg Alloys Containing Excess Fe

NASA Astrophysics Data System (ADS)

Asadian Nozari, M.; Taghiabadi, R.; Karimzadeh, M.; Ghoncheh, M. H.

2018-03-01

The effect of oxide bifilms and Be modification (0.2 wt pct) on the tensile strength reliability of the as-cast and T6 heat-treated Al-9Si-0.35Mg-1.5Fe alloy was investigated using Weibull analysis. For this purpose, the density of oxide bifilms in the molten alloy was intentionally increased by surface agitation. According to the results, Be modifies the β-Al5FeSi particles to the less harmful α-Fe compounds and substantially decreases the bifilm density in the castings leading to improved tensile properties and higher reliability. Moreover, the beneficial effect of Be was found to be more in the samples containing higher amounts of bifilms. For instance, in the heat-treated condition, Be increased the Weibull modulus of the non-agitated and surface-agitated samples by 4 and 94 pct, respectively. This improvement can be attributed to the strengthening effect of Be on the young surface oxides so that they resist more against rupture when melt is subjected to the surface turbulence. The reduced pressure test and fractography investigations also confirmed the reduction of bifilm density and bifilm-related defects in Be-modified samples.

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

PubMed

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

2011-08-01

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

Effect of Be Modification on the Oxide Bifilms and Tensile Strength Reliability of Al-Si-Mg Alloys Containing Excess Fe

NASA Astrophysics Data System (ADS)

Asadian Nozari, M.; Taghiabadi, R.; Karimzadeh, M.; Ghoncheh, M. H.

2018-06-01

The effect of oxide bifilms and Be modification (0.2 wt pct) on the tensile strength reliability of the as-cast and T6 heat-treated Al-9Si-0.35Mg-1.5Fe alloy was investigated using Weibull analysis. For this purpose, the density of oxide bifilms in the molten alloy was intentionally increased by surface agitation. According to the results, Be modifies the β-Al5FeSi particles to the less harmful α-Fe compounds and substantially decreases the bifilm density in the castings leading to improved tensile properties and higher reliability. Moreover, the beneficial effect of Be was found to be more in the samples containing higher amounts of bifilms. For instance, in the heat-treated condition, Be increased the Weibull modulus of the non-agitated and surface-agitated samples by 4 and 94 pct, respectively. This improvement can be attributed to the strengthening effect of Be on the young surface oxides so that they resist more against rupture when melt is subjected to the surface turbulence. The reduced pressure test and fractography investigations also confirmed the reduction of bifilm density and bifilm-related defects in Be-modified samples.

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

NASA Astrophysics Data System (ADS)

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

2018-03-01

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

Music therapy for early cognitive rehabilitation post-childhood TBI: an intrinsic mixed methods case study.

PubMed

Bower, Janeen; Catroppa, Cathy; Grocke, Denise; Shoemark, Helen

2014-10-01

The primary aim of this case study was to explore the behavioural changes of a paediatric patient in post-traumatic amnesia (PTA) during a music therapy session. A secondary objective was to measure the effect of the music therapy intervention on agitation. Video data from pre, during and post-music therapy sessions were collected and analysed using video micro-analysis and the Agitated Behaviour Scale. The participant displayed four discrete categories of behaviours: Neutral, Acceptance, Recruitment and Rejection. Further analysis revealed brief but consistent and repeated periods of awareness and responsiveness to the live singing of familiar songs, which were classified as Islands of Awareness. Song offered an Environment of Potential to maximise these periods of emerging consciousness. The quantitative data analysis yielded inconclusive results in determining if music therapy was effective in reducing agitation during and immediately post the music therapy sessions. The process of micro-analysis illuminated four discrete participant behaviours not apparent in the immediate clinical setting. The results of this case suggest that the use of familiar song as a music therapy intervention may harness early patient responsiveness to foster cognitive rehabilitation in the early acute phase post-TBI.

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

NASA Astrophysics Data System (ADS)

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

2017-06-01

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

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

Pickenheim, B.; Hansen, E.; Leishear, R.

A 10-inch READCO mixer is used for mixing the premix (45 (wt%) fly ash, 45 wt% slag, and 10 wt% portland cement) with salt solution in the Saltstone Production Facility (SPF). The Saltstone grout free falls into the grout hopper which feeds the suction line leading to the Watson SPX 100 duplex hose pump. The Watson SPX 100 pumps the grout through approximately 1500 feet of piping prior to being discharged into the Saltstone Disposal Facility (SDF) vaults. The existing grout hopper has been identified by the Saltstone Enhanced Low Activity Waste Disposal (ELAWD) project for re-design. The current nominalmore » working volume of this hopper is 12 gallons and does not permit handling an inadvertent addition of excess dry feeds. Saltstone Engineering has proposed a new hopper tank that will have a nominal working volume of 300 gallons and is agitated with a mechanical agitator. The larger volume hopper is designed to handle variability in the output of the READCO mixer and process upsets without entering set back during processing. The objectives of this task involve scaling the proposed hopper design and testing the scaled hopper for the following processing issues: (1) The effect of agitation on radar measurement. Formation of a vortex may affect the ability to accurately measure the tank level. The agitator was run at varying speeds and with varying grout viscosities to determine what parameters cause vortex formation and whether measurement accuracy is affected. (2) A dry feeds over addition. Engineering Calculating X-ESR-Z-00017 1 showed that an additional 300 pounds of dry premix added to a 300 gallon working volume would lower the water to premix ratio (W/P) from the nominal 0.60 to 0.53 based on a Salt Waste Processing Facility (SWPF) salt simulant. A grout with a W/P of 0.53 represents the upper bound of grout rheology that could be processed at the facility. A scaled amount of dry feeds will be added into the hopper to verify that this is a recoverable situation. (3) The necessity of baffles in the hopper. The preference of the facility is not to have baffles in the hopper; however, if the initial testing indicates inadequate agitation or difficulties with the radar measurement, baffles will be tested.« less

Symptoms of depression as possible markers of bipolar II disorder.

PubMed

Benazzi, Franco

2006-05-01

Underdiagnosis and misdiagnosis of bipolar-II disorder (BP-II) as a major depressive disorder (MDD) are frequently reported. The study aim was to find which symptoms of depression could be possible cross-sectional markers of BP-II, in order to reduce underdiagnosing BP-II. Consecutive 379 BP-II and 271 MDD major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen, by a senior psychiatrist in a private practice. Inside-MDE hypomanic symptoms (elevated mood and increased self-esteem always absent by definition) were systematically assessed. Mixed depression was defined as an MDE plus 3 or more inside-MDE hypomanic symptoms, a definition validated by Akiskal and Benazzi. The MDE symptoms significantly more common in BP-II versus MDD were weight gain, increased eating, hypersomnia, psychomotor agitation, worthlessness, and diminished ability to concentrate. The inside-MDE hypomanic symptoms significantly more common in BP-II were distractibility, racing/crowded thoughts, irritability, psychomotor agitation, more talkativeness, increased risky and goal-directed activities. Multiple logistic regression showed that hypersomnia, racing/crowded thoughts, irritability, and psychomotor agitation were independent predictors of BP-II. Irritability had the most balanced combination of sensitivity and specificity predicting BP-II. Psychomotor agitation had the highest specificity but the lowest sensitivity. Racing/crowded thoughts had the highest sensitivity but the lowest specificity. These symptoms had a similar positive predictive value (PPV) for BP-II, which was around 70% (PPV is more clinically useful than sensitivity and specificity), which in turn was similar to the PPV of mixed depression and atypical depression (two diagnostic clinical markers of BP-II). All possible combinations of these symptoms had a PPV similar to that of the individual symptoms. The validity as BP-II markers of these symptoms was supported by a significant association with bipolar family history. Hypersomnia, racing/crowded thoughts, irritability, and psychomotor agitation may be useful, cross-sectional markers of BP-II. Finding these symptoms in depression should lead the clinician to careful probing for history of hypomania, which should reduce the BP-II misdiagnosed as MDD. Results may also have treatment impacts, as antidepressants used alone (i.e., no concurrent mood stabilising agent) in BP-II depression misdiagnosed as MDD may increase cycling.

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

PubMed

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

2017-11-06

Symptoms of anxiety, irritability, and agitation (AIA) are prevalent among patients with bipolar I disorder (BD-I) mania with depressive symptoms, and could potentially be used to aid physicians in the identification of this more severe form of BD-I. Using data from two clinical trials, the aims of this post hoc analysis were to describe the phenomenology of bipolar mania in terms of AIA and depressive symptoms, and to evaluate the influence of these symptoms on the likelihood of remission during treatment. Patients with a BD-I manic or mixed episode (Diagnostic and Statistical Manual of Mental Disorders IV criteria) were randomised to 3 weeks of double-blind treatment with asenapine, placebo, or olanzapine (active comparator). Anxiety was defined as a score of ≥3 on the Positive and Negative Syndrome Scale 'anxiety' item, irritability as a score of ≥4 on the Young Mania Rating Scale (YMRS) 'irritability' item, and agitation as a score of ≥3 on the YMRS 'increased motor activity-energy' item. Depressive symptoms were defined as a score of ≥1 on three or more individual Montgomery-Åsberg Depression Rating Scale (MADRS) items, or a MADRS Total score of ≥20. A total of 960 patients with BD-I were analysed, 665 with a manic episode and 295 with a mixed episode. At baseline, 61.4% had anxiety, 62.4% had irritability, 76.4% had agitation, and 34.0% had all three AIA symptoms ('severe AIA'); 47.3% had three or more depressive symptoms, and 13.5% had a MADRS total score of ≥20. Anxiety, irritability, and severe AIA (but not agitation) were statistically significantly more common in patients with depressive symptoms. Patients with anxiety or severe AIA at baseline were statistically significantly less likely to achieve remission (YMRS total <12). In general, remission rates were higher with asenapine and olanzapine than with placebo, irrespective of baseline AIA or depressive symptoms. Assessment of AIA symptoms in bipolar mania could enable physicians to identify patients with more severe depressive symptoms, allowing for appropriate intervention. Assessment and monitoring of AIA may help physicians to predict which patients may be harder to treat and at risk for self-harm. Trial registration ClinicalTrials.gov NCT00159744, NCT00159796. Registered 8 September 2005 (retrospectively registered).

Efficacy, Safety, and Tolerability of Armodafinil Therapy for Hypersomnia Associated With Dementia With Lewy Bodies: A Pilot Study

PubMed Central

Lapid, Maria I.; Kuntz, Karen M.; Mason, Sara S.; Aakre, Jeremiah A.; Lundt, Emily S.; Kremers, Walter; Allen, Laura A.; Drubach, Daniel A.; Boeve, Bradley F.

2017-01-01

Background/Aims Hypersomnia is common in dementia with Lewy bodies (DLB). We assessed the efficacy, safety, and tolerability of armodafinil for hypersomnia associated with DLB. Methods We performed a 12-week pilot trial of armodafinil therapy (125–250 mg orally daily) in DLB outpatients with hypersomnia. Patients underwent neurologic examinations, neuropsychological battery, laboratory testing, electrocardiography, and polysomnography. Efficacy was assessed at 2, 4, 8, and 12 weeks. Safety assessment included laboratory examinations, QTc interval, and heart rate. Tolerability was assessed by analysis of adverse events. Data were analyzed using the last-observation-carried-forward method. Results Of 20 participants, 17 completed the protocol. Median age was 72 years, most were men (80%), and most had spouses as caregivers. Epworth Sleepiness Scale (P<.001), Maintenance of Wakefulness Test (P=.003), and Clinical Global Impression of Change (P<.001) scores improved at week 12. Neuropsychiatric Inventory total score (P=.003), visual hallucinations (P=.003), and agitation (P=.02) improved at week 4. Caregiver overall quality of life improved at week 12 (P=.004). No adverse events occurred. Conclusion These pilot data suggest improvements in hypersomnia and wakefulness and reasonable safety and tolerability of armodafinil therapy in hypersomnolent patients with DLB. Our findings inform the use of pharmacologic strategies to manage hypersomnolence in these patients. PMID:28448998

Grouping and trajectories of the neuropsychiatric symptoms in patients with Alzheimer's disease, part I: symptom clusters.

PubMed

Garre-Olmo, Josep; López-Pousa, Secundino; Vilalta-Franch, Joan; de Gracia Blanco, Manuel; Vilarrasa, Antoni Bulbena

2010-01-01

Behavioral and psychological symptoms of dementia (BPSD) are frequently observed in Alzheimer's disease (AD) and affect more than 80% of patients over the course of AD. The goal of this study was to establish a model for grouping the symptoms of BPSD into clinical syndromes. Over a 24-month period, an observational study was conducted using a population of ambulatory patients with AD of mild to moderate severity. The Neuropsychiatric Inventory (NPI) was administered to the patients' caregivers every 6 months. BPSD were grouped using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of the NPI scores of each assessment. The sample population consisted of 491 patients (70.9% women) with an average age of 75.2 years (SD=6.6). The five EFA suggested that there was a stable three-factor structure. According to the results of the EFA, three models of symptom grouping were adjusted using CFA methodology. The CFA model that satisfactorily grouped the NPI scores into three factors included a psychotic syndrome (hallucinations, delusions), an affective syndrome (depression, anxiety, irritability, agitation) and a behavior syndrome (euphoria, disinhibition, apathy, aberrant motor behavior). Based on our findings, we propose a model for grouping the BDSD in which there are core nuclear syndromes (psychotic and affective) as well as an unspecified behavior syndrome comprising satellite symptoms that may be related to the presence of the nuclear syndromes.

TREATMENT TANK CORROSION STUDIES FOR THE ENHANCED CHEMICAL CLEANING PROCESS

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

Wiersma, B.

2011-08-24

Radioactive waste is stored in high level waste tanks on the Savannah River Site (SRS). Savannah River Remediation (SRR) is aggressively seeking to close the non-compliant Type I and II waste tanks. The removal of sludge (i.e., metal oxide) heels from the tank is the final stage in the waste removal process. The Enhanced Chemical Cleaning (ECC) process is being developed and investigated by SRR to aid in Savannah River Site (SRS) High-Level Waste (HLW) as an option for sludge heel removal. Corrosion rate data for carbon steel exposed to the ECC treatment tank environment was obtained to evaluate themore » degree of corrosion that occurs. These tests were also designed to determine the effect of various environmental variables such as temperature, agitation and sludge slurry type on the corrosion behavior of carbon steel. Coupon tests were performed to estimate the corrosion rate during the ECC process, as well as determine any susceptibility to localized corrosion. Electrochemical studies were performed to develop a better understanding of the corrosion mechanism. The tests were performed in 1 wt.% and 2.5 wt.% oxalic acid with HM and PUREX sludge simulants. The following results and conclusions were made based on this testing: (1) In 1 wt.% oxalic acid with a sludge simulant, carbon steel corroded at a rate of less than 25 mpy within the temperature and agitation levels of the test. No susceptibility to localized corrosion was observed. (2) In 2.5 wt.% oxalic acid with a sludge simulant, the carbon steel corrosion rates ranged between 15 and 88 mpy. The most severe corrosion was observed at 75 C in the HM/2.5 wt.% oxalic acid simulant. Pitting and general corrosion increased with the agitation level at this condition. No pitting and lower general corrosion rates were observed with the PUREX/2.5 wt.% oxalic acid simulant. The electrochemical and coupon tests both indicated that carbon steel is more susceptible to localized corrosion in the HM/oxalic acid environment than in the PUREX/oxalic acid environment. (3) The corrosion rates for PUREX/8 wt.% oxalic acid were greater than or equal to those observed for the PUREX/2.5 wt.% oxalic acid. No localized corrosion was observed in the tests with the 8 wt.% oxalic acid. Testing with HM/8 wt.% oxalic acid simulant was not performed. Thus, a comparison with the results with 2.5 wt.% oxalic acid, where the corrosion rate was 88 mpy and localized corrosion was observed at 75 C, cannot be made. (4) The corrosion rates in 1 and 2.5 wt.% oxalic acid solutions were temperature dependent: (a) At 50 C, the corrosion rates ranged between 90 to 140 mpy over the 30 day test period. The corrosion rates were higher under stagnant conditions. (b) At 75 C, the initial corrosion rates were as high as 300 mpy during the first day of exposure. The corrosion rates increased with agitation. However, once the passive ferrous oxalate film formed, the corrosion rate decreased dramatically to less than 20 mpy over the 30 day test period. This rate was independent of agitation. (5) Electrochemical testing indicated that for oxalic acid/sludge simulant mixtures the cathodic reaction has transport controlled reaction kinetics. The literature suggests that the dissolution of the sludge produces a di-oxalatoferrate ion that is reduced at the cathodic sites. The cathodic reaction does not appear to involve hydrogen evolution. On the other hand, electrochemical tests demonstrated that the cathodic reaction for corrosion of carbon steel in pure oxalic acid involves hydrogen evolution. (6) Agitation of the oxalic acid/sludge simulant mixtures typically resulted in a higher corrosion rates for both acid concentrations. The transport of the ferrous ion away from the metal surface results in a less protective ferrous oxalate film. (7) A mercury containing species along with aluminum, silicon and iron oxides was observed on the interior of the pits formed in the HM/2.5 wt.% oxalic acid simulant at 75 C. The pitting rates in the agitated and non-agitated solution were 2 mils/day and 1 mil/day, respectively. A mechanism by which the mercury interacts with the aluminum and silicon oxides in this simulant to accelerate corrosion was proposed.« less

Abstinence symptomatology associated with cessation of chronic cocaine abuse among methadone-maintained patients.

PubMed

Margolin, A; Avants, S K; Kosten, T R

1996-08-01

We assessed cocaine abstinence symptomatology in a sample of 100 cocaine-abusing, methadone-maintained patients who completed an anonymous questionnaire retrospectively rating the intensity of 18 symptoms at six time points, from 30 minutes to 2 weeks, post-cocaine use. We found that a majority of patients endorsed symptoms related to dysphoria 24 hours post-binge. However, these symptoms tended to be mild to moderate in intensity and relatively short-lived. Principal components analyses extracted four factors accounting for 64% of the variance: psychoticism, exhaustion, agitation, recovery. Early post-binge period was dominated by psychoticism and agitation, followed by recovery for the duration of the period assessed.

Data on the agitation of a viscous Newtonian fluid by radial impellers in a cylindrical tank.

PubMed

Ameur, Houari; Kamla, Youcef; Sahel, Djamel

2017-12-01

In this paper, the data assembled concerning the agitation of a Newtonian fluid in a cylindrical vessel is disclosed. The stirred vessel is not provided with baffles and has a flat-bottom. The data presents some information on the characteristics of two impellers: a six-blade Rushton turbine and a six-blade paddle impeller. The flow patterns generated by both impellers are depicted and compared. Also, the power required when changing the impeller rotational speed is given. The data summarized here via three-dimensional calculations of velocities and viscous dissipation in the whole volume of the tank provides additional knowledge for the best choice of impellers for each industrial process.

Radiochemical separation of gallium by amalgam exchange

USGS Publications Warehouse

Ruch, R.R.

1969-01-01

An amalgam-exchange separation of radioactive gallium from a number of interfering radioisotopes has been developed. A dilute (ca. 0.3%) gallium amalgam is agitated with a slightly acidic solution of 72Ga3+ containing concentrations of sodium thiocyanate and either perchlorate or chloride. The amalgam is then removed and the radioactive gallium stripped by agitation with dilute nitric acid. The combined exchange yield of the perchlorate-thiocyanate system is 90??4% and that of the chloride-thiocyanate system is 75??4%. Decontamination yields of most of the 11 interfering isotopes studied were less than 0.02%. The technique is applicable for use with activation analysis for the determination of trace amounts of gallium. ?? 1969.

Process for converting cellulosic materials into fuels and chemicals

DOEpatents

Scott, C.D.; Faison, B.D.; Davison, B.H.; Woodward, J.

1994-09-20

A process is described for converting cellulosic materials, such as waste paper, into fuels and chemicals utilizing enzymatic hydrolysis of the major constituent of paper, cellulose. A waste paper slurry is contacted by cellulase in an agitated hydrolyzer. The cellulase is produced from a continuous, columnar, fluidized-bed bioreactor utilizing immobilized microorganisms. An attrition mill and a cellobiase reactor are coupled to the agitated hydrolyzer to improve reaction efficiency. The cellulase is recycled by an adsorption process. The resulting crude sugars are converted to dilute product in a fluidized-bed bioreactor utilizing microorganisms. The dilute product is concentrated and purified by utilizing distillation and/or a biparticle fluidized-bed bioreactor system. 1 fig.

[Clinical course of acute poisoning with olanzapine].

PubMed

Balicka-Slusarczyk, Barbara; Szczeklik, Jerzy; Szpak, Dorota; Groszek, Barbara

2005-01-01

Olanzapine is a new atypical antipsychotic drug acting on different receptors. A variety of pharmacologic effects are responsible for toxicity and the variety of clinical symptoms seen in overdose: tachycardia, agitation or aggression, dysarthria, extrapyramidal dystonic effects, sedation or coma, small pupils, blurred vision, respiratory depression, hypotension. A retrospective analysis of clinical course of eight acute olanzapine intoxication treated at the Department of Clinical Toxicology Jagiellonian University Medical College is presented. CNS symptoms manifested in fluctuations between somnolence/coma and agitation/aggression and miosis were observed in most of the patients. Increased CPK activity was stated in the most of patients. All of the patients recovered, poisoning severity according PSS was moderate and severe.

Method to prepare Semtex

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

Alcaraz, A; Dougan, A

This procedure requires the binder and uncoated RDX be prepared in separate steps, see Figure 1: (1) The binder and dye are mixed by agitation with a water-insoluble organic solvent (e.g., toluene), I; (2) The RDX/PETN is agitated thoroughly with water, II; (3) The binder solution I is added to the RDX/water mixture at II with thorough mixing to form a slurry III; (4) In the next step the solvent is distilled off at IV leaving resulting granules; (5) The next step is followed by filtration at V, which may be done by vacuum; (6) The composition is then driedmore » at VI to a dough-like consistency.« less

[Coupling AFM fluid imaging with micro-flocculation filtration process for the technological optimization].

PubMed

Zheng, Bei; Ge, Xiao-peng; Yu, Zhi-yong; Yuan, Sheng-guang; Zhang, Wen-jing; Sun, Jing-fang

2012-08-01

Atomic force microscope (AFM) fluid imaging was applied to the study of micro-flocculation filtration process and the optimization of micro-flocculation time and the agitation intensity of G values. It can be concluded that AFM fluid imaging proves to be a promising tool in the observation and characterization of floc morphology and the dynamic coagulation processes under aqueous environmental conditions. Through the use of AFM fluid imaging technique, optimized conditions for micro-flocculation time of 2 min and the agitation intensity (G value) of 100 s(-1) were obtained in the treatment of dye-printing industrial tailing wastewater by the micro-flocculation filtration process with a good performance.

Kinetics of insulin aggregation in aqueous solutions upon agitation in the presence of hydrophobic surfaces.

PubMed Central

Sluzky, V; Tamada, J A; Klibanov, A M; Langer, R

1991-01-01

The stability of protein-based pharmaceuticals (e.g., insulin) is important for their production, storage, and delivery. To gain an understanding of insulin's aggregation mechanism in aqueous solutions, the effects of agitation rate, interfacial interactions, and insulin concentration on the overall aggregation rate were examined. Ultraviolet absorption spectroscopy, high-performance liquid chromatography, and quasielastic light scattering analyses were used to monitor the aggregation reaction and identify intermediate species. The reaction proceeded in two stages; insulin stability was enhanced at higher concentration. Mathematical modeling of proposed kinetic schemes was employed to identify possible reaction pathways and to explain greater stability at higher insulin concentration. Images PMID:1946348

Aminophylline overdose

MedlinePlus

... MUSCLES AND JOINTS Muscle twitching and cramping NERVOUS SYSTEM Confusion , hallucination Convulsions Dizziness Fever Headache Irritability, restlessness Confused thinking, poor judgment and agitation (psychosis) Sweating Trouble sleeping ...

Charging of multiple interacting particles by contact electrification.

PubMed

Soh, Siowling; Liu, Helena; Cademartiri, Rebecca; Yoon, Hyo Jae; Whitesides, George M

2014-09-24

Many processes involve the movement of a disordered collection of small particles (e.g., powders, grain, dust, and granular foods). These particles move chaotically, interact randomly among themselves, and gain electrical charge by contact electrification. Understanding the mechanisms of contact electrification of multiple interacting particles has been challenging, in part due to the complex movement and interactions of the particles. To examine the processes contributing to contact electrification at the level of single particles, a system was constructed in which an array of millimeter-sized polymeric beads of different materials were agitated on a dish. The dish was filled almost completely with beads, such that beads did not exchange positions. At the same time, during agitation, there was sufficient space for collisions with neighboring beads. The charge of the beads was measured individually after agitation. Results of systematic variations in the organization and composition of the interacting beads showed that three mechanisms determined the steady-state charge of the beads: (i) contact electrification (charging of beads of different materials), (ii) contact de-electrification (discharging of beads of the same charge polarity to the atmosphere), and (iii) a long-range influence across beads not in contact with one another (occurring, plausibly, by diffusion of charge from a bead with a higher charge to a bead with a lower charge of the same polarity).

Effects of fiber manipulation methods on optical fiber properties

NASA Astrophysics Data System (ADS)

Reynolds, Robert O.; Bechter, Andrew; Crass, Jonathan

2016-07-01

Optical fibers are routinely used to couple high-resolution spectrographs to modern telescopes, enabling important advantages in areas such as the search for extrasolar planets using spectroscopic radial velocity measurements of candidate stars. Optical fibers partially scramble the input illumination, and this feature enables a fiber feed to provide more uniform illumination to the spectrograph optics, thereby reducing systematic errors in radial velocity measurements. However fibers suffer from focal ratio degradation (FRD), a spreading of the beam at the output of the fiber with respect to that at the fiber input, which results in losses in throughput and resolution. Modal noise, a measurement uncertainty caused by inherent fiber properties and evident as a varying spatial intensity at the fiber exit plane, reduces the signal to noise ratio in the data. Devices such as double scramblers are often used to improve scrambling, and better fiber end preparation can mitigate FRD. Many instruments agitate the fiber during an observation to reduce modal noise, and stretching the fiber during use has been shown to offer a greater reduction in that noise. But effects of agitation and stretching on fiber parameters such as total transmission and focal ratio degradation have not been adequately studied. In this paper we present measurements of transmission loss and focal ratio degradation for both agitated and stretched fibers.

Optimization of Culture Conditions for Enhanced Growth, Lipid and Docosahexaenoic Acid (DHA) Production of Aurantiochytrium SW1 by Response Surface Methodology.

PubMed

Nazir, Yusuf; Shuib, Shuwahida; Kalil, Mohd Sahaid; Song, Yuanda; Hamid, Aidil Abdul

2018-06-11

In this study, optimization of growth, lipid and DHA production of Aurantiochytrium SW1 was carried out using response surface methodology (RSM) in optimizing initial fructose concentration, agitation speed and monosodium glutamate (MSG) concentration. Central composite design was applied as the experimental design and analysis of variance (ANOVA) was used to analyze the data. ANOVA analysis revealed that the process which adequately represented by quadratic model was significant (p < 0.0001) for all the response. All the three factors were significant (p < 0.005) in influencing the biomass and lipid data while only two factors (agitation speed and MSG) gave significant effect on DHA production (p < 0.005). The estimated optimal conditions for enhanced growth, lipid and DHA production were 70 g/L fructose, 250 rpm agitation speed and 10 g/L MSG. Consequently, the quadratic model was validated by applying the estimated optimum conditions, which confirmed the model validity where 19.0 g/L biomass, 9.13 g/L lipid and 4.75 g/L of DHA were produced. The growth, lipid and DHA were 28, 36 and 35% respectively higher than that produced in the original medium prior to optimization.

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

PubMed Central

Lee, Victoria E.; Thornton, Alex

2018-01-01

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

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

PubMed

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

2018-01-01

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

Transesterification process to manufacture ethyl ester of rape oil

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

Korus, R.A.; Hoffman, D.S.; Bam, N.

1993-12-31

A process for the production of the ethyl ester of winter rape [EEWR] for use as a biodiesel fuel has been studied. The essential part of the process is the transesterification of rape oil with ethanol, in the presence of a catalyst, to yield the ethyl ester of rape oil as a product and glycerin as a by-product. Experiments have been performed to determine the optimum conditions for the preparation of EEWR. The process variables were: (1) temperature, (2) catalyst, (3) rate of agitation, (4) water content of the alcohol used, and (5) the amount of excess alcohol used. Themore » optimum conditions were: (1) room temperature, (2) 0.5% sodium methoxide or 1% potassium hydroxide catalyst by weight of rapeseed oil, (3) extremely vigorous agitation with some splashing during the initial phase of the reaction and agitation was not necessary after the reaction mixture became homogeneous, (4) absolute ethanol was necessary for high conversion, and (5) 50% excess ethanol with NaOCH{sub 3} or 100% excess with KOH gave a maximum conversion. Viscosity, cloud point and pour point of the EEWR were measured. A preliminary break-even cost for the commercial production of EEWR was found to be $0.55/liter [$2.08/US gallon].« less

Musical dual-task training in patients with mild-to-moderate dementia: a randomized controlled trial.

PubMed

Chen, Yu-Ling; Pei, Yu-Cheng

2018-01-01

Dual-task training may improve dual-task gait performance, balance, and cognition in older adults with and without cognitive impairment. Although music has been widely utilized in dementia management, there are no existing protocols for music-based dual-task training. This randomized controlled study developed a Musical Dual-Task Training (MDTT) protocol that patients with dementia can use to practice walking and making music simultaneously, to enhance attention control in patients during dual-tasking. Twenty-eight adults diagnosed with mild-to-moderate dementia were assigned to the MDTT (n=15) or control groups (n=13). The MDTT group received MDTT, while the control group participated in non-musical cognitive and walking activities. The effects of MDTT were evaluated through the primary outcome of attention control, and secondary outcomes of dual-task performance, balance, falls efficacy, and agitation. The MDTT group showed a significant improvement in attention control, while the control group did not ( P <0.001). A significant effect favored MDTT over control treatment for the secondary outcome of falls efficacy ( P =0.02) and agitation ( P <0.01). MDTT, a music therapy intervention that demands a high level of cognitive processing, enhances attention control, falls efficacy, and helps alleviate agitation in patients with mild-to-moderate dementia.

Particulate contamination removal from wafers using plasmas and mechanical agitation

DOEpatents

Selwyn, G.S.

1998-12-15

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

Particulate contamination removal from wafers using plasmas and mechanical agitation

DOEpatents

Selwyn, Gary S.

1998-01-01

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

The glass is not yet half empty: agitation but not Varroa treatment causes cognitive bias in honey bees.

PubMed

Schlüns, Helge; Welling, Helena; Federici, Julian René; Lewejohann, Lars

2017-03-01

Honey bees (Apis mellifera) are prone to judge an ambiguous stimulus negatively if they had been agitated through shaking which simulates a predator attack. Such a cognitive bias has been suggested to reflect an internal emotional state analogous to humans who judge more pessimistically when they do not feel well. In order to test cognitive bias experimentally, an animal is conditioned to respond to two different stimuli, where one is punished while the other is rewarded. Subsequently a third, ambiguous stimulus is presented and it is measured whether the subject responds as if it expects a reward or a punishment. Generally, it is assumed that negative experiences lower future expectations, rendering the animals more pessimistic. Here we tested whether a most likely negatively experienced formic acid treatment against the parasitic mite Varroa destructor also affects future expectations of honey bees. We applied an olfactory learning paradigm (i.e., conditioned proboscis extension response) using two odorants and blends of these odorants as the ambiguous stimuli. Unlike agitating honey bees, exposure to formic acid did not significantly change the response to the ambiguous stimuli in comparison with untreated bees. Overall evidence suggests that the commonest treatment against one of the most harmful bee pests has no detrimental effects on cognitive bias in honey bees.

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

PubMed

Deng, Wenyi; Su, Yaxin

2014-07-01

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

The emergence of superstructural order in insulin amyloid fibrils upon multiple rounds of self-seeding

NASA Astrophysics Data System (ADS)

Surmacz-Chwedoruk, Weronika; Babenko, Viktoria; Dec, Robert; Szymczak, Piotr; Dzwolak, Wojciech

2016-08-01

Typically, elongation of an amyloid fibril entails passing conformational details of the mother seed to daughter generations of fibrils with high fidelity. There are, however, several factors that can potentially prevent such transgenerational structural imprinting from perpetuating, for example heterogeneity of mother seeds or so-called conformational switching. Here, we examine phenotypic persistence of bovine insulin amyloid ([BI]) upon multiple rounds of self-seeding under quiescent conditions. According to infrared spectroscopy, with the following passages of homologous seeding, daughter fibrils gradually depart from the mother seed’s spectral characteristics. We note that this transgenerational structural drift in [BI] amyloid leads toward fibrils with infrared, chiroptical, and morphological traits similar to those of the superstructural variant of fibrils which normally forms upon strong agitation of insulin solutions. However, in contrast to agitation-induced insulin amyloid, the superstructural assemblies of daughter fibrils isolated through self-seeding are sonication-resistant. Our results suggest that formation of single amyloid fibrils is not a dead-end of the amyloidogenic self-assembly. Instead, the process appears to continue toward the self-assembly of higher-order structures although on longer time-scales. From this perspective, the fast agitation-induced aggregation of insulin appears to be a shortcut to amyloid superstructures whose formation under quiescent conditions is slow.

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

NASA Technical Reports Server (NTRS)

Cherry, Robert S.; Papoutsakis, E. Terry

1987-01-01

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

Musical dual-task training in patients with mild-to-moderate dementia: a randomized controlled trial

PubMed Central

Chen, Yu-Ling; Pei, Yu-Cheng

2018-01-01

Background/aims Dual-task training may improve dual-task gait performance, balance, and cognition in older adults with and without cognitive impairment. Although music has been widely utilized in dementia management, there are no existing protocols for music-based dual-task training. This randomized controlled study developed a Musical Dual-Task Training (MDTT) protocol that patients with dementia can use to practice walking and making music simultaneously, to enhance attention control in patients during dual-tasking. Methods Twenty-eight adults diagnosed with mild-to-moderate dementia were assigned to the MDTT (n=15) or control groups (n=13). The MDTT group received MDTT, while the control group participated in non-musical cognitive and walking activities. The effects of MDTT were evaluated through the primary outcome of attention control, and secondary outcomes of dual-task performance, balance, falls efficacy, and agitation. Results The MDTT group showed a significant improvement in attention control, while the control group did not (P<0.001). A significant effect favored MDTT over control treatment for the secondary outcome of falls efficacy (P=0.02) and agitation (P<0.01). Conclusion MDTT, a music therapy intervention that demands a high level of cognitive processing, enhances attention control, falls efficacy, and helps alleviate agitation in patients with mild-to-moderate dementia. PMID:29881275

Interprofessional Team's Perception of Care Delivery After Implementation of a Pediatric Pain and Sedation Protocol.

PubMed

Staveski, Sandra L; Wu, May; Tesoro, Tiffany M; Roth, Stephen J; Cisco, Michael J

2017-06-01

Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function. Before and after implementation of the guidelines, interprofessional team members were surveyed about the members' perception of analgesia, sedation, and delirium management RESULTS: Members of the interprofessional team felt more comfortable with pain and sedation management after implementation of the guidelines. Team members reported improvements in team communication on patients' comfort. Members thought that important information was less likely to be lost during transfer of care. They also noted that the team carried out comfort management plans and used pharmacological and nonpharmacological therapies better after implementation of the guidelines than they did before implementation. Guidelines for pain and sedation management were associated with perceived improvements in team function and patient care by members of the interprofessional team. ©2017 American Association of Critical-Care Nurses.

Continuous lactic acid fermentation using a plastic composite support biofilm reactor.

PubMed

Cotton, J C; Pometto, A L; Gvozdenovic-Jeremic, J

2001-12-01

An immobilized-cell biofilm reactor was used for the continuous production of lactic acid by Lactobacillus casei subsp. rhamnosus (ATCC 11443). At Iowa State University, a unique plastic composite support (PCS) that stimulates biofilm formation has been developed. The optimized PCS blend for Lactobacillus contains 50% (wt/wt) agricultural products [35% (wt/wt) ground soy hulls, 5% (wt/wt) soy flour, 5% (wt/wt) yeast extract, 5% (wt/wt) dried bovine albumin, and mineral salts] and 50% (wt/wt) polypropylene (PP) produced by high-temperature extrusion. The PCS tubes have a wall thickness of 3.5 mm, outer diameter of 10.5 mm, and were cut into 10-cm lengths. Six PCS tubes, three rows of two parallel tubes, were bound in a grid fashion to the agitator shaft of a 1.2-1 vessel for a New Brunswick Bioflo 3000 fermentor. PCS stimulates biofilm formation, supplies nutrients to attached and suspended cells, and increases lactic acid production. Biofilm thickness on the PCS tubes was controlled by the agitation speed. The PCS biofilm reactor and PP control reactor achieved optimal average production rates of 9.0 and 5.8 g l(-1) h(-1), respectively, at 0.4 h(-1) dilution rate and 125-rpm agitation with yields of approximately 70%.

Butorphanol Injection

MedlinePlus

... of these symptoms or those listed in the IMPORTANT WARNINGS section, call your doctor immediately or get emergency medical attention: agitation, hallucinations (seeing things or hearing voices that ...

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

PubMed Central

2012-01-01

Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients’ well-being, quality of life, and satisfaction with care. Trial registration ClinicalTrials.gov Identifier NCT01654029 PMID:23050517

Investigations into in situ Enterococcus faecalis biofilm removal by passive and active sodium hypochlorite irrigation delivered into the lateral canal of a simulated root canal model.

PubMed

Mohmmed, S A; Vianna, M E; Penny, M R; Hilton, S T; Mordan, N J; Knowles, J C

2018-06-01

To investigate in situ Enterococcus faecalis biofilm removal from the lateral canal of a simulated root canal system using passive or active irrigation protocols. Root canal models (n = 43) were manufactured from transparent resin materials using 3D printing. Each canal was created with an 18 mm length, apical size 30, a .06 taper and a lateral canal of 3 mm length, with 0.3 mm diameter. Biofilms were grown in the lateral canal and apical 3 mm of the main canal for 10 days. Three models from each group were examined for residual biofilm using SEM. The other forty models were divided into four groups (n = 10). The models were observed under a fluorescence microscope. Following 60 s of 9 mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic or ultrasonic methods for 30 s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analysed using generalized linear mixed models. A significance level of 0.05 was used throughout. The greatest level of biofilm removal was obtained with ultrasonic agitation (66.76%) followed by sonic (45.49%), manual agitation (43.97%) and passive irrigation groups (38.67%), respectively. The differences were significant between the residual biofilm in the passive irrigation and both sonic and ultrasonic groups (P = 0.001). Agitation resulted in better penetration of 2.5% NaOCl into the lateral canal of an artificial root canal model. Ultrasonic agitation of NaOCl improved the removal of biofilm. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Intravenous midazolam-droperidol combination, droperidol or olanzapine monotherapy for methamphetamine-related acute agitation: subgroup analysis of a randomized controlled trial.

PubMed

Yap, Celene Y L; Taylor, David McD; Knott, Jonathan C; Taylor, Simone E; Phillips, Georgina A; Karro, Jonathan; Chan, Esther W; Kong, David C M; Castle, David J

2017-07-01

To examine the efficacy and safety of (1) midazolam-droperidol versus droperidol and (2) midazolam-droperidol versus olanzapine for methamphetamine-related acute agitation. A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-droperidol 5 mg combined, droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg or olanzapine 5 mg, respectively. The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-droperidol, droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. A midazolam-droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than droperidol or olanzapine alone. © 2017 Society for the Study of Addiction.

Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer.

PubMed

Lu, Jing; Liu, Zhongkai; Xia, Kunpeng; Shao, Changzhong; Guo, Shengdong; Wang, Shenggang; Li, Kezhong

2015-01-01

To discuss the effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer. 115 cases of lung cancer patients with American society of anesthesiologists class (ASA) grade I~II who received selective operation were randomly divided into the research group and the control group. The research group patients were given preoperative parecoxib sodium 40 mg plus postoperative normal saline 2 ml, while the control group patients were treated with preoperative normal saline 2 ml plus postoperative parecoxib sodium 40 mg. The pain condition at postoperative 1, 2, 4, 8, 12, 24 and 48 h were evaluated by visual analogue scale (VAS), and emergence agitation was tested by agitation score. Finally there were 56 cases and 57 cases can be used for evaluation in the research group and control group. The VAS scores after 1, 2, 4, 8, 12, 24 and 48 h in the research group and control group were [2.23±0.45, 2.35±0.48, 2.51±0.51, 2.41±0.45, 2.28±0.42, 2.16±0.39, 2.11±0.40] and [3.80±0.62, 4.01±0.64, 4.31±0.67, 4.10±0.64, 3.65±0.70, 3.12±0.66, 2.46±0.53], respectively. The research group were obviously lower than the control group, the difference were statistically significant (P<0.05). The rate of agitation was 24.44% (11/56) in the research group, significantly lower than the control group of 59.65% (34/57) (P<0.05). Preemptive analgesia with parecoxib sodium can obviously relieve acute pain using in patients undergoing radical resection of lung cancer, and is helpful to reduce the incidence of emergence agitation.

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

PubMed

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

2017-06-01

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

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

PubMed Central

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

2009-01-01

Atypical antipsychotic drugs have been used off-label in clinical practice for treatment of serious dementia-associated agitation and aggression. Following reports of cerebrovascular adverse events associated with the use of atypical antipsychotic in elderly patients with dementia, the FDA issued black box warnings for several atypical antipsychotics, titled “Cerebrovascular Adverse Events, including Stroke, in Elderly Patients with Dementia.” Subsequently, the FDA initiated a meta-analysis of safety data from 17 registration trials across six antipsychotic drugs (five atypical antipsychotics and haloperidol). In 2005, the Agency issued a black box warning regarding increased risk of mortality associated with the use of atypical antipsychotic drugs in this patient population. Geriatric mental health experts participating in a 2006 consensus conference reviewed evidence on the safety and efficacy of antipsychotics, as well as nonpharmacologic approaches, in treating dementia-related symptoms of agitation and aggression. They concluded that, while problems in clinical trials design may have been one of the contributors to the failure to find a signal of drug efficacy, the findings related to drug safety should be taken seriously by clinicians in assessing the potential risks and benefits of treatment in a frail population, and in advising families about treatment. Information provided to patients and family members should be documented in the patient’s chart. Drugs should be used only when non-pharmacologic approaches have failed to adequately control behavioral disruption. Participants also agreed that that there is a need for an FDA-approved medication for the treatment of severe, persistent or recurrent dementia-related symptoms of agitation and aggression (even in the absence of psychosis), that are unresponsive to nonpharmacologic intervention. The authors have outlined methodological enhancements to better evaluate treatment approaches in future registration trials, and they provided an algorithm for improving the treatment of these patients in nursing home and non-nursing home settings. PMID:18494535

An intermittent rocking platform for integrated expansion and differentiation of human pluripotent stem cells to cardiomyocytes in suspended microcarrier cultures.

PubMed

Ting, Sherwin; Chen, Allen; Reuveny, Shaul; Oh, Steve

2014-09-01

The development of novel platforms for large scale production of human embryonic stem cells (hESC) derived cardiomyocytes (CM) becomes more crucial as the demand for CMs in preclinical trials, high throughput cardio toxicity assays and future regenerative therapeutics rises. To this end, we have designed a microcarrier (MC) suspension agitated platform that integrates pluripotent hESC expansion followed by CM differentiation in a continuous, homogenous process. Hydrodynamic shear stresses applied during the hESC expansion and CM differentiation steps drastically reduced the capability of the cells to differentiate into CMs. Applying vigorous stirring during pluripotent hESC expansion on Cytodex 1 MC in spinner cultures resulted in low CM yields in the following differentiation step (cardiac troponin-T (cTnT): 22.83±2.56%; myosin heavy chain (MHC): 19.30±5.31%). Whereas the lower shear experienced in side to side rocker (wave type) platform resulted in higher CM yields (cTNT: 47.50±7.35%; MHC: 42.85±2.64%). The efficiency of CM differentiation is also affected by the hydrodynamic shear stress applied during the first 3days of the differentiation stage. Even low shear applied continuously by side to side rocker agitation resulted in very low CM differentiation efficiency (cTnT<5%; MHC<2%). Simply by applying intermittent agitation during these 3days followed by continuous agitation for the subsequent 9days, CM differentiation efficiency can be substantially increased (cTNT: 65.73±10.73%; MHC: 59.73±9.17%). These yields are 38.3% and 39.3% higher (for cTnT and MHC respectively) than static culture control. During the hESC expansion phase, cells grew on continuously agitated rocker platform as pluripotent cell/MC aggregates (166±88×10(5)μm(2)) achieving a cell concentration of 3.74±0.55×10(6)cells/mL (18.89±2.82 fold expansion) in 7days. These aggregates were further differentiated into CMs using a WNT modulation differentiation protocol for the subsequent 12days on a rocking platform with an intermittent agitation regime during the first 3days. Collectively, the integrated MC rocker platform produced 190.5±58.8×10(6) CMs per run (31.75±9.74 CM/hESC seeded). The robustness of the system was demonstrated by using 2 cells lines, hESC (HES-3) and human induced pluripotent stem cell (hiPSC) IMR-90. The CM/MC aggregates formed extensive sarcomeres that exhibited cross-striations confirming cardiac ontogeny. Functionality of the CMs was demonstrated by monitoring the effect of inotropic drug, Isoproterenol on beating frequency. In conclusion, we have developed a simple robust and scalable platform that integrates both hESC expansion and CM differentiation in one unit process which is capable of meeting the need for large amounts of CMs. Copyright © 2014. Published by Elsevier B.V.

SAFE KLEEN

EPA Pesticide Factsheets

Technical product bulletin: this surface washing agent used in oil spill cleanups can be applied by spray, brush, mop, or standard pressure washing equipment. Agitation during application assists efficiency.

Management of behavioural and psychological symptoms of dementia by an aroma-massage with acupressure treatment protocol: A randomised clinical trial.

PubMed

Fung, Jo Kamen Ka-Man; Tsang, Hector Wing-Hong

2018-05-01

This study evaluates the clinical effectiveness of a multicomponent aroma-massage with an acupressure treatment protocol and compared it to cognitive training for the management of behavioural and psychological symptoms of dementia. Pharmacological interventions have been unsatisfactory in managing behavioural and psychological symptoms of dementia; thus, complementary and alternative medicine has been extensively researched to identify an adjunct safe and cost-effective intervention. This randomised clinical trial utilised a three-arm parallel group design. Cognitive training was used as a conventional intervention to manage behavioural and psychological symptoms of dementia, whereas exercise was considered "treatment as usual" in this study; both were used as comparisons with the experimental protocol. There were three treatment groups: Group 1: aroma-massage with acupressure + exercise, Group 2: cognitive training + exercise and Group 3: aroma-massage with acupressure + cognitive training. Sixty older adults were recruited and randomly assigned to the three groups (20 each). Using the 29-item Chinese Version of the Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, Mini-mental State Examination and Barthel Index-20, the outcome measures were assessed at preintervention, postintervention and the 3-month follow-up to assess behaviour, Activities of Daily Living, cognition, and behavioural and psychological symptoms of dementia severity and distress. Multiple comparisons performed through repeated measures were analysed to detect between-group differences and within-subject differences, as well as the interaction effects between groups and times. The Group 1 and 3 participants showed a significant reduction in the severity and distress caused by behavioural and psychological symptoms of dementia, whereas Group 2 did not demonstrate similar effects. This clinical study suggests that aroma-massage with acupressure is as effective as cognitive training and can enhance cognitive training in reducing the severity and distress of behavioural and psychological symptoms of dementia. Aroma-massage with acupressure may serve as an adjunct therapy to reduce behavioural and psychological symptoms of dementia. This therapy is safe, cost-effective and can be implemented by caregivers and family members who are not professionally trained. © 2017 John Wiley & Sons Ltd.

42 CFR 483.102 - Applicability and definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... changes in circumstances associated with work, school, family, or social interaction, manifests agitation... of interpersonal relationships and social isolation; (B) Concentration, persistence, and pace. The...

The modern role of antipsychotics for the treatment of agitation and psychosis in Alzheimer's disease.

PubMed

Creese, Byron; Da Silva, Miguel Vasconcelos; Johar, Iskandar; Ballard, Clive

2018-05-21

Antipsychotics have long been the mainstay of treatment for agitation and psychosis in Alzheimer's disease. Despite their current use successive studies have shown that they only confer a modest benefit which must be balanced against their well-established serious side effects (extrapyramidal symptoms, stroke, accelerated cognitive decline and mortality). Areas covered: This review outlines the current guidance on antipsychotic usage and the evidence of their continued usage against a backdrop of emerging pharmacological treatments and an increasing emphasis on the importance of non-pharmacological interventions. Expert commentary: The current justification for antipsychotic use in the context of the changing landscape of prescribing and provide a view on the most promising alternative candidates to this class of drug are appraised.

Prehospital chemical restraint of a noncommunicative autistic minor by law enforcement.

PubMed

Ho, Jeffrey D; Nystrom, Paul C; Calvo, Darryl V; Berris, Marc S; Norlin, Jeffrey F; Clinton, Joseph E

2012-01-01

When responders are dealing with an agitated patient in the field, safety for all involved may sometimes only be accomplished with physical or chemical restraints. While experiences using chemical restraint in the prehospital setting are found in the medical literature, the use of this by law enforcement as a first-response restraint has not previously been described. We report a case of successful law enforcement-administered sedation of a noncommunicative, autistic, and violent minor using intramuscular droperidol and diphenhydramine. Although this case has some unique characteristics that allowed chemical restraint to be given by the law enforcement agency, it calls attention to some specific prehospital issues that need to be addressed when dealing with autistic patients with extreme agitation.

Using Complementary and Alternative Medicine to Treat Pain and Agitation in Dementia: A Review of Randomized Controlled Trials from Long-Term Care with Potential Use in Critical Care.

PubMed

Anderson, Alison R; Deng, Jie; Anthony, Robert S; Atalla, Sebastian A; Monroe, Todd B

2017-12-01

The risk of pain in adults with dementia worsens with advancing age. Painful comorbidities may be underassessed and inadequately treated. Receiving treatment in critical care settings may indicate greater occurrences of pain and complications. Pain may exacerbate behavioral and psychological symptoms of dementia (BPSD), such as agitation. Complementary and alternative medicine (CAM) therapies may alleviate pain and BPSD, and continuity of therapy may bolster these therapeutic effects. This review did not reveal an apparent benefit of aromatherapy; however, improvements in BPSD have been shown previously. Massage and human interaction did demonstrate efficacy in reducing BPSD and pain. Copyright © 2017 Elsevier Inc. All rights reserved.

Hydrodynamic effects on cells in agitated tissue culture reactors

NASA Technical Reports Server (NTRS)

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

1986-01-01

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

Spontaneous vesicle formation at lipid bilayer membranes.

PubMed

Edwards, D A; Schneck, F; Zhang, I; Davis, A M; Chen, H; Langer, R

1996-09-01

Unilamellar vesicles are observed to form spontaneously at planar lipid bilayers agitated by exothermic chemical reactions. The membrane-binding reaction between biotin and streptavidin, two strong transmembrane neutralization reactions, and a weak neutralization reaction involving an "antacid" buffer, all lead to spontaneous vesicle formation. This formation is most dramatic when a viscosity differential exists between the two phases bounding the membrane, in which case vesicles appear exclusively in the more viscous phase. A hydrodynamic analysis explains the phenomenon in terms of a membrane flow driven by liberated reaction energy, leading to vesicle formation. These results suggest that energy liberated by intra- and extracellular chemical reactions near or at cell and internal organelle membranes can play an important role in vesicle formation, membrane agitation, or enhanced transmembrane mass transfer.

[The expressions of anxiety in the elderly. Their diagnosis and therapy].

PubMed

Scapicchio, P L

1995-10-01

Among the most common manifestations of anxiety in the elderly are those associated with neurological disorders. The etiology is often unclear, as anxiety and agitation may be a consequence of insight into the cognitive impairment rather than the direct expression of the neurological deficit. Benzodiazepines are the treatment of choice, particularly the 3-OH compounds that are non oxidised and without active metabolites. Concern about the use of benzodiazepines in the elderly may have been overstated. If used judiciously this class of drugs can prove extremely helpful in reducing day-time anxiety and night-time insomnia. Other medications that are commonly used to treat agitation and disruptive behaviour in demented elderly patients include antipsychotics, beta-blockers, trazodone, buspirone, anticonvulsants.

Thyroid storm

MedlinePlus

... return the body temperature to normal Monitoring any excess fluid in older people with heart or kidney disease Medicines to manage agitation Vitamins and glucose The final goal of treatment is ...

Pollutants' Release, Redistribution and Remediation of Black Smelly River Sediment Based on Re-Suspension and Deep Aeration of Sediment.

PubMed

Zhu, Lin; Li, Xun; Zhang, Chen; Duan, Zengqiang

2017-04-01

Heavily polluted sediment is becoming an important part of water pollution, and this situation is particularly acute in developing countries. Sediment has gradually changed from being the pollution adsorbent to the release source and has influenced the water environment and public health. In this study, we evaluated the pollutant distribution in sediment in a heavily polluted river and agitated the sediment in a heavily polluted river to re-suspend it and re-release pollutants. We found that the levels of chemical oxygen demand (COD), NH₄⁺-N, total nitrogen (TN), and total phosphorus (TP) in overlying water were significantly increased 60 min after agitation. The distribution of the pollutants in the sediment present high concentrations of pollutants congregated on top of the sediment after re-settling, and their distribution decreased with depth. Before agitation, the pollutants were randomly distributed throughout the sediment. Secondly, deep sediment aeration equipment (a micro-porous air diffuser) was installed during the process of sedimentation to study the remediation of the sediment by continuous aeration. The results revealed that deep sediment aeration after re-suspension significantly promoted the degradation of the pollutants both in overlying water and sediment, which also reduced the thickness of the sediment from 0.9 m to 0.6 m. Therefore, sediment aeration after suspension was efficient, and is a promising method for sediment remediation applications.

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

PubMed Central

2018-01-01

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

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

PubMed

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

2018-05-01

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

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

PubMed

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

1992-02-01

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

Precursor preparation for Ca-Al layered double hydroxide to remove hexavalent chromium coexisting with calcium and magnesium chlorides

NASA Astrophysics Data System (ADS)

Zhong, Lihua; He, Xiaoman; Qu, Jun; Li, Xuewei; Lei, Zhiwu; Zhang, Qiwu; Liu, Xinzhong

2017-01-01

Al(OH)3 and Ca(OH)2 powders are co-ground to prepare a precursor which hydrates into a layered double hydroxide (LDH) phase by agitation in aqueous solution with target hexavalent chromium (Cr(VI)) at room temperature, to achieve an obvious improvement in removal efficiency of Cr(VI) through an easy incorporation into the structure. Although the prepared precursor transforms into LDH phases also when agitated in the solutions of calcium and magnesium chlorides, it incorporates Cr(VI) preferentially to the chloride salts when they coexist. The adsorption isotherm and kinetic studies show that the phenomena occurring on the Al-Ca precursor fit a pseudo-second-order kinetics with a Langmuir adsorption capacity of 59.45 mg/g. Besides, characterizations of the prepared precursor and the samples after adsorption are also performed by X-ray diffraction (XRD), Fourier transform infrared (FT-IR), Transmission electron microscope (TEM) to understand the reason of the preferential incorporation of Cr(VI) to the coexisting chloride salts during the LDH phase formation. Ca-Al precursor (C3A) was agitated in a hexavalent chromium (Cr(VI)) solution to form Al-Ca-CrO4 LDH product. Ca-Al-CrO4 LDH phase occurred preferentially to Ca-Al-MCl2 LDH phases in the solutions of calcium and magnesium chlorides, it incorporates Cr(VI) preferentially to the chloride salts when they coexist.

An Innovative Approach to Improving the Accuracy of Delirium Assessments Using the Confusion Assessment Method for the Intensive Care Unit.

PubMed

DiLibero, Justin; O'Donoghue, Sharon C; DeSanto-Madeya, Susan; Felix, Janice; Ninobla, Annalyn; Woods, Allison

2016-01-01

Delirium occurs in up to 80% of intensive care unit (ICU) patients. Despite its prevalence in this population, there continues to be inaccuracies in delirium assessments. In the absence of accurate delirium assessments, delirium in critically ill ICU patients will remain unrecognized and will lead to negative clinical and organizational outcomes. The goal of this quality improvement project was to facilitate sustained improvement in the accuracy of delirium assessments among all ICU patients including those who were sedate or agitated. A pretest-posttest design was used to evaluate the effectiveness of a program to improve the accuracy of delirium screenings among patients admitted to a medical ICU or coronary care unit. Two hundred thirty-six delirium assessment audits were completed during the baseline period and 535 during the postintervention period. Compliance with performing at least 1 delirium assessment every shift was 85% at baseline and improved to 99% during the postintervention period. Baseline assessment accuracy was 70.31% among all patients and 53.49% among sedate and agitated patients. Postintervention assessment accuracy improved to 95.51% for all patients and 89.23% among sedate and agitated patients. The results from this project suggest the effectiveness of the program in improving assessment accuracy among difficult-to-assess patients. Further research is needed to demonstrate the effectiveness of this model across other critical care units, patient populations, and organizations.

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

PubMed

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

2017-06-01

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

Ketamine

MedlinePlus

... DEA Museum and Visitors' Center National Prevention Week Ketamine Last Updated: Wednesday, December 27, 2017 What is ... Agitation, depression, unconsciousness Hallucinations Flashbacks Read More About Ketamine Be Informed. Search for information about a drug ...

Citalopram

MedlinePlus

... mood changes, irritability, agitation, dizziness, numbness, tingling or electric shock-like sensations in the hands or feet, ... may make you drowsy. Do not drive a car or operate machinery until you know how this ...

Diazepam

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... is used to relieve anxiety, muscle spasms, and seizures and to control agitation caused by alcohol withdrawal. ... sugar.If you are taking diazepam to control seizures and have an increase in their frequency or ...

Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort.

PubMed

Arbus, Christophe; Gardette, Virginie; Bui, Eric; Cantet, Christelle; Andrieu, Sandrine; Nourhashémi, Fati; Schmitt, Laurent; Vellas, Bruno

2010-02-01

Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription. REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI). A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI >or= 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression. The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.

Anosognosia and Its Relation to Psychiatric Symptoms in Early-Onset Alzheimer Disease.

PubMed

Yoon, Bora; Shim, Yong S; Hong, Yun Jeong; Choi, Seong Hye; Park, Hee Kyung; Park, Sun Ah; Jeong, Jee Hyang; Yoon, Soo Jin; Yang, Dong-Won

2017-05-01

We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.

Music therapy and Alzheimer's disease: Cognitive, psychological, and behavioural effects.

PubMed

Gómez Gallego, M; Gómez García, J

2017-06-01

Music therapy is one of the types of active ageing programmes which are offered to elderly people. The usefulness of this programme in the field of dementia is beginning to be recognised by the scientific community, since studies have reported physical, cognitive, and psychological benefits. Further studies detailing the changes resulting from the use of music therapy with Alzheimer patients are needed. Determine the clinical improvement profile of Alzheimer patients who have undergone music therapy. Forty-two patients with mild to moderate Alzheimer disease underwent music therapy for 6 weeks. The changes in results on the Mini-mental State Examination, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale and Barthel Index scores were studied. We also analysed whether or not these changes were influenced by the degree of dementia severity. Significant improvement was observed in memory, orientation, depression and anxiety (HAD scale) in both mild and moderate cases; in anxiety (NPI scale) in mild cases; and in delirium, hallucinations, agitation, irritability, and language disorders in the group with moderate Alzheimer disease. The effect on cognitive measures was appreciable after only 4 music therapy sessions. In the sample studied, music therapy improved some cognitive, psychological, and behavioural alterations in patients with Alzheimer disease. Combining music therapy with dance therapy to improve motor and functional impairment would be an interesting line of research. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

[Characterisation and prevalence of the psychological and behavioural symptoms in patients with dementia].

PubMed

López-Pousa, S; Vilalta-Franch, J; Garre-Olmo, J; Pons, S; Cucurella, M G

To assess the prevalence of behavioural and psychological symptoms (BPS's) in patients with dementia in Spain and their dementia-specific characteristics. A cross-sectional and retrospective study of 1025 patients from 52 specialized dementia care units using the Neuropsychiatric Inventory (NPI). Patients with a probable diagnosis of Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease and dementia (PDD) were selected for BPS's characterisation. The global prevalence of BPS's was 66.7% (684 patients; 95% CI = 63.8-69.6%). BPS's were under-diagnosed in one third of cases. A total of 668 patients with NPI of 4 or superior and a diagnosis of AD (n = 380; 56.8%), DLB (n = 156; 23.3%) and PDD (n = 132; 19.7%) had a NPI mean of 21.1 (SD = 14.7), 25.6 (SD = 13.9) and 21.8 (SD = 14.2), respectively. Apathy, depression and anxiety were the most common BPS's. Delusions and hallucinations were significantly more prevalent in DLB. Dementia severity was correlated with the global NPI value and with all the sub-items, but anxiety and euphoria. The presence of agitation, euphoria or lability was associated with a deficient therapeutic fulfillment. A high prevalence of non-diagnosed BPS's was observed in the studied population. This has serious negative consequences for the quality of life of patients and their social environment. Therefore we propose an active search and subsequent correct treatment of BPS's in all patients with dementia.

Functional Impairment and Changes in Depression Subtypes for Women in STAR*D: A Latent Transition Analysis

PubMed Central

Rothschild, Anthony J.; Lapane, Kate L.

2016-01-01

Abstract Objective: To characterize the association between functional impairment and major depression subtypes at baseline and to characterize changes in subtypes by functional impairment level in women receiving citalopram in level 1 of the Sequenced Treatment Alternatives to Relieve Depression trial. Method: Women who completed baseline and week 12 study visits were included. Items from the self-reported Quick Inventory of Depressive Symptomatology were used to define the latent depression subtypes. The Work and Social Adjustment Scale was used to classify baseline functional impairment. A latent transition analysis model provided estimates of the prevalence of subtype membership and transition probabilities by functional impairment level. Results: Of the 755 women included, 69% had major functional impairment at baseline. Regardless of functional impairment level, the subtypes were differentiated by depression severity, appetite changes, psychomotor disturbances, and insomnia. Sixty-seven percent of women with normal/significant functional impairment and 60% of women with major impairment were likely to transition to a symptom resolution subtype at week 12. Women with baseline major impairment who were in the severe with psychomotor agitation subtype at the beginning of the study were least likely to transition to the symptom resolution subtype (4% chance). Conclusions: Functional impairment level was related to both the baseline depression subtype and the likelihood of moving to a different subtype. These results underscore the need to incorporate not only depression symptoms but also functioning in the assessment and treatment of depression. PMID:26488110

Grouping and trajectories of neuropsychiatric symptoms in patients with Alzheimer's disease. Part II: two-year patient trajectories.

PubMed

Garre-Olmo, Josep; López-Pousa, Secundino; Vilalta-Franch, Joan; de Gracia Blanco, Manuel; Vilarrasa, Antoni Bulbena

2010-01-01

Behavioral and psychological symptoms of dementia (BPSD) are characterized by fluctuations in their frequency and severity as well as by differences in the concurrent presentation of different symptoms. The goal of the current study was to identify groups of patients with Alzheimer's disease (AD) that had similar trajectories in the expression of BPSD. Over a 24-month period, an observational study was conducted using a population of ambulatory patients with AD of mild or moderate severity. The Neuropsychiatric Inventory (NPI) was administered every 6 months to the patient's caregiver. To classify patients according to changes in the frequency and severity of BPSD, growth mixture models were fitted to the applied to the grouping of NPI subscales in the following three categories: psychotic syndrome (hallucinations and delusions), affective syndrome (depression, anxiety, irritability, and agitation), and behavioral syndrome (disinhibition, euphoria, apathy, and aberrant motor behavior). The sample population consisted of 491 patients (70.9% women) that had an average age of 75.2 years (SD=6.6). Different trajectory patterns were identified based on differences in changes over the time in the frequency (stable, increasing, decreasing, or fluctuating in course) and severity (low, moderate, or elevated severity) for psychotic syndrome, emotional syndrome, and behavior syndrome. Patients with AD display a high degree of variability in the evolutionary course of BPSD. It is possible to identify groups of patients with similar evolutionary trajectories in terms of changes in the frequency and severity of BPSD.

Neuropsychiatric symptom clusters and functional disability in cognitively-impaired-not-demented individuals.

PubMed

Peters, Kevin R; Rockwood, Kenneth; Black, Sandra E; Hogan, David B; Gauthier, Serge G; Loy-English, Inge; Hsiung, Ging-Yuek R; Jacova, Claudia; Kertesz, Andrew; Feldman, Howard H

2008-02-01

Previous research has shown that cognitively-impaired-not-demented (CIND) individuals with at least one neuropsychiatric symptom (NPS) have more functional disability than individuals without any NPSs. The objectives of the present study were to determine whether there are consistent clusters of NPS in CIND individuals and whether certain NPS clusters are more strongly associated with measures of functional disability than other NPS clusters in this population. This was a cross-sectional baseline study of NPS using the Neuropsychiatric Inventory (NPI) in a national clinic-based observational cohort study (the Canadian Cohort Study of Cognitive Impairment and Related Dementias study). The present investigation focuses on a subset of CIND subjects (73%) whose informant endorsed the presence of at least one NPI item. A hierarchical cluster analysis identified two NPS clusters. One consisted of mood factors (i.e., depression, anxiety, apathy, irritability, and problems with sleep) and the other cluster captured frontal symptoms (i.e., aberrant motor behavior, disinhibition, agitation, and problems with appetite). NPSs grouped within the mood cluster were more common than the frontal cluster (95% of subjects had at least one NPS within the mood cluster versus 53% in the frontal cluster). However, the frontal cluster was more strongly associated with functional disability measures even after controlling for cognitive status (i.e., the Mini-Mental State Exam) and the mood cluster score. The frontal cluster of NPSs was more strongly associated with functional disability than the mood cluster.