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Sample records for agitation time initial

  1. Combined effects of sulfites, temperature, and agitation time on production of glycerol in grape juice by Saccharomyces cerevisiae.

    PubMed Central

    Gardner, N; Rodrigue, N; Champagne, C P

    1993-01-01

    Analysis of variance was used to evaluate the simultaneous effects of strain, incubation temperature (15 to 25 degrees C), agitation time (0 to 24 h), and initial sulfite concentration (100 to 300 ppm) on glycerol production in grape juice by Saccharomyces cerevisiae. Fourteen strains were studied to determine their growth patterns in the presence of sulfites and ethanol. Baker's yeast strains were more sensitive to sulfite than wine strains, and little growth occurred at initial sulfite levels greater than 150 ppm. Sensitivity to sulfite increased with increasing levels of ethanol. Three strains exhibiting the best growth in the presence of sulfites and ethanol were selected for interaction studies. Fermentations were carried out until the solids content had decreased to less than 6 degrees Brix, which was the point that glycerol content became stable. For the three strains used, the greatest level of glycerol production was observed in the presence of 300 ppm of sulfite for most incubation temperatures and agitation times. There was significant interaction between the strain, incubation temperature, and agitation time parameters for glycerol synthesis, and a response surface method was used to predict the optimal conditions for glycerol production. Under static conditions, the highest level of glycerol production was observed at 20 degrees C, while incubation at 25 degrees C gave the best results when the cultures were agitated for 24 h. Response surface equations were used to predict that the optimum conditions for glycerol production by S. cerevisiae Y11 were a temperature of 22 degrees C, an initial sulfite concentration of 300 ppm, and no agitation, which yielded 0.68 g of glycerol per 100 ml. PMID:8357243

  2. 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.

  3. 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.

  4. 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.

  5. Time to response to citalopram treatment for agitation in Alzheimer's disease

    PubMed Central

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

    2015-01-01

    Background Agitation is a common and significant problem in Alzheimer’s 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. Methods Response in CitAD was defined as a modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-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. Results In the primary analyses, citalopram was superior to placebo on both the CGIC and the NBRS-A response measures. There were little between-group differences in response rates in the first three weeks of the study (21% vs 19% on the CGIC). Citalopram patients were more likely than placebo patients to be a late responder (18% vs. 8% on CGIC, Fisher’s exact p=0.09; 31% vs. 15% on NBRS-A, Fisher’s exact p=0.02). Approximately half (45–56%) of citalopram responders at end-of-study achieved response later in the study, compared with 30–44% of placebo responders. Discussion Treatment with citalopram for agitation in AD needs to be at least nine weeks in duration to allow sufficient time for full response, and study duration is an important factor to consider in the design of clinical trials for agitation in Alzheimer’s disease. PMID:26238225

  6. Agitation Rate and Time for Complete Dissolution in BCS Biowaivers Based on Investigation of a BCS Biowaiver for Dexketoprofen Tablets.

    PubMed

    Garcia-Arieta, Alfredo; Gordon, John; Gwaza, Luther; Mangas-Sanjuan, V; Álvarez, Covadonga; Torrado, Juan J

    2015-09-08

    The objective of the present work is to investigate the validity of the existing requirements for BCS biowaivers of immediate release products containing a class I drug in relation to the agitation rate (50 or 75 rpm in the paddle apparatus) and the time limit for complete dissolution (30 min) in the current biowaivers in vitro dissolution tests. Further, the possibility of extensions will be examined since it has been proposed that the time limit for complete dissolution should be revised to 60 min, and also, if cone formation occurs with apparatus 2 at 50 rpm, then a higher agitation rate is acceptable to eliminate it. The development of four generic dexketoprofen immediate release tablets is described. Dexketoprofen is the eutomer of ketoprofen. According to the BCS, dexketoprofen is a class I drug. Three out of the four products failed to show bioequivalence for Cmax in the initial bioequivalence study conducted with the product despite similar but nonrapid dissolution profiles at 50 rpm in the paddle apparatus, or similar and very rapid dissolution profiles at 75 rpm. In conclusion, these data indicate that BCS biowaivers for class I drugs should be granted only when dissolution with the paddle apparatus is complete in 30 min at 50 rpm. The time limit for complete dissolution should not be extended to 60 min. Furthermore, the agitation rate should not be increased to 75 rpm, even in the case of a coning effect.

  7. Effects of application time and agitation for bonding orthodontic brackets with two self-etching primer systems.

    PubMed

    Iijima, Masahiro; Ito, Shuichi; Yuasa, Toshihiro; Muguruma, Takeshi; Saito, Takashi; Mizoguchi, Itaru

    2009-01-01

    The purpose of this study was to evaluate the shear bond strength, adhesive remnant index (ARI) and etching effect of two self-etching systems (Transbond Plus, Beauty Ortho Bond) at different application times (3, 10, 30 seconds) with and without agitation. Share bond strengths were examined and the ARI score was estimated (n=15). Enamel surfaces after priming were examined by SEM. Increasing application time and applying agitation of self-etching primers produced slightly increased etching efficacy. Increasing application time did not significantly increase the shear bond strength. Also, agitation did not significantly increase the shear bond strength except for specimen bonded with the Beauty Ortho Bond with 10 seconds application time. No significant difference was found in bond-failure sites among 10 groups. Although increasing application time and applying agitation of both self-etching primers did not affect the shear bond strength, increasing application time in indirect bonding technique should not cause remarkable adverse effect.

  8. Platelet preservation: agitation and containers.

    PubMed

    van der Meer, Pieter F; de Korte, Dirk

    2011-06-01

    For platelets to maintain their in vitro quality and in vivo effectiveness, they need to be stored at room temperature with gentle agitation in gas-permeable containers. The mode of agitation affects the quality of the platelets, and a gentle method of agitation, either a circular or a flat bed movement, provides the best results. Tumblers or elliptical agitators induce platelet activation and subsequent damage. As long as the platelets remain in suspension, the agitation speed is not important. Agitation of the platelet concentrates ensures that the platelets are continuously oxygenated, that sufficient oxygen can enter the storage container and that excess carbon dioxide can be expelled. During transportation of platelet concentrates, nowadays over long distances where they are held without controlled agitation, platelets may tolerate a certain period without agitation. However, evidence is accumulating that during the time without agitation, local hypoxia surrounding the platelets may induce irreversible harm to the platelets. Over the decades, more gas-permeable plastics have been used to manufacture platelet containers. The use of different plastics and their influence on the platelet quality both in vitro and in vivo is discussed. The improved gas-permeability has allowed the extension of platelet storage from 3 days in the early 1980s, to currently at least 7 days. In the light of new developments, particularly the introduction of pathogen reduction techniques, the use of platelet additive solutions and the availability of improved automated separators, further (renewed) research in this area is warranted.

  9. [Difficult situations in radiotherapy: agitated adult patients].

    PubMed

    Noël, S; Noël, G

    2013-10-01

    The causes of agitation in adult patients are numerous. Agitation may cause difficulty or impossibility to initiate the radiotherapy technique but also can lead to accidents harmful to patients. However, the decision to not irradiate agitated patients may lead to a loss of curability chance or chance to palliate symptoms. Before taking such a decision, thinking about the possibilities available to calm the patient should be undertaken with the patient and the referring practitioners to attempt to make this therapy if it is considered major in the management of cancer. In all cases, current adaptations of radiotherapy should be used to deliver an effective radiation of a suitable time and safely. It is notable that the medical literature is extremely rare on this subject. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  10. Temporal patterns of agitated nursing home residents.

    PubMed

    Cohen-Mansfield, J; Marx, M S; Werner, P; Freedman, L

    1992-01-01

    Twenty-four highly agitated, cognitively impaired nursing home residents were studied in depth to determine whether they manifested temporal patterns of agitation. Results demonstrated that agitated behaviors were significantly associated with temporal factors. For instance, residents made more requests for attention during lunch than other time periods, and residents screamed most often during the night. Some agitated behaviors (e.g., aggression) were manifested more frequently in the evening than in the day, consistent with the notion of sundowning in the nursing home. Implications of temporal patterns of agitation for caregivers of severely cognitively impaired and agitated nursing home residents are discussed.

  11. Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial.

    PubMed

    Reade, Michael C; Eastwood, Glenn M; Bellomo, Rinaldo; Bailey, Michael; Bersten, Andrew; Cheung, Benjamin; Davies, Andrew; Delaney, Anthony; Ghosh, Angaj; van Haren, Frank; Harley, Nerina; Knight, David; McGuiness, Shay; Mulder, John; O'Donoghue, Steve; Simpson, Nicholas; Young, Paul

    2016-04-12

    Effective therapy has not been established for patients with agitated delirium receiving mechanical ventilation. To determine the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation. The Dexmedetomidine to Lessen ICU Agitation (DahLIA) study was a double-blind, placebo-controlled, parallel-group randomized clinical trial involving 74 adult patients in whom extubation was considered inappropriate because of the severity of agitation and delirium. The study was conducted at 15 intensive care units in Australia and New Zealand from May 2011 until December 2013. Patients with advanced dementia or traumatic brain injury were excluded. Bedside nursing staff administered dexmedetomidine (or placebo) initially at a rate of 0.5 µg/kg/h and then titrated to rates between 0 and 1.5 µg/kg/h to achieve physician-prescribed sedation goals. The study drug or placebo was continued until no longer required or up to 7 days. All other care was at the discretion of the treating physician. Ventilator-free hours in the 7 days following randomization. There were 21 reported secondary outcomes that were defined a priori. Of the 74 randomized patients (median age, 57 years; 18 [24%] women), 2 withdrew consent later and 1 was found to have been randomized incorrectly, leaving 39 patients in the dexmedetomidine group and 32 patients in the placebo group for analysis. Dexmedetomidine increased ventilator-free hours at 7 days compared with placebo (median, 144.8 hours vs 127.5 hours, respectively; median difference between groups, 17.0 hours [95% CI, 4.0 to 33.2 hours]; P = .01). Among the 21 a priori secondary outcomes, none were significantly worse with dexmedetomidine, and several showed statistically significant benefit, including reduced time to extubation (median, 21.9 hours vs 44.3 hours with placebo; median difference between groups, 19.5 hours [95% CI, 5.3 to 31.1 hours]; P < .001) and accelerated

  12. 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.

  13. Impact of aeration and agitation on metabolic heat and protease secretion of Aspergillus tamarii in a real-time biological reaction calorimeter.

    PubMed

    Dhandapani, Balaji; Mahadevan, Surianarayanan; Dhilipkumar, Sathish Sundar; Rajkumar, Suseela; Mandal, Asit Baran

    2012-06-01

    The effects of aeration and agitation on metabolic heat, alkaline protease production and morphology for Aspergillus tamarii MTCC5152 are reported in this manuscript. Measurement of metabolic heat has been attempted by the continuous and dynamic heat balance method in a biological real-time reaction calorimeter. At lower agitation intensities, growth-related processes were dominating. As a result the protease activity and the product heat yields were lower than those for 350 and 450 rpm. Although biomass growth was necessary to obtain maximum protease yield, agitation seemed to play a vital role in the protease production process. Energy dissipation per circulation function of the process is also deduced from power input. At optimal conditions, 350 rpm and 1 vvm, the gassed power required was 0.133 W. Pellet morphology and protease production were studied under different aeration and agitation intensities of A. tamarii. Pellet structure was considerably influenced by DO, a higher DO level resulted in denser pellets (1,018.4 kg/m(3)) leading to higher protease activity. Coupling of hydrodynamics and bio-reaction highlighted the complex relationship between energy dissipation, substrate uptake rate and fungal physiology. This study emphasised the potential of biocalorimetry as a reliable monitoring and robust control tool for aerobic fermentation of A. tamarii, using agricultural by-products.

  14. Temporal patterns of agitation in dementia.

    PubMed

    Cohen-Mansfield, Jiska

    2007-05-01

    This study investigated the temporal pattern of agitated behaviors in nursing home residents with dementia and compared it with temporal patterns of pleasure, interest in the environment, and sleep. Trained research assistants recorded direct observations of agitation and affect by the Agitation Behavior Mapping Instrument and the Lawton's Modified Behavior Stream for 174 participants from 12 nursing homes. The temporal pattern found for total agitation showed a gradual increase from the morning until approximately 4 pm with a decrease thereafter. Only 26% of the sample showed a clear increase of their agitation in the later hours in comparison to the morning hours based on our criterion. Pleasure did not show a consistent pattern, whereas levels of interest peaked during lunch and dinner times. The results fit with a hypothesis of fatigue of daytime nursing staff members and disruption during shift change and may also be partially accounted for by resident fatigue. Although the literature supports the notion that there is a peak in overall agitation around 4 pm, the term "sundowning" is not supported and should be replaced. The phenomenon of increased levels of agitation during later hours characterizes only a minority of agitated nursing home residents, albeit the most highly agitated.

  15. Reducing agitator energy consumption without sacrificing agitation

    SciTech Connect

    Golobic, R.A.; Derrickson, G.S.

    1982-01-01

    Rising energy costs and their increasing net effect on the cost of a mineral product requires that every aspect of processing-plant operations reduce consumed horsepower without sacrificing the grade of the product. This paper addresses two principles in the design and selection of axial-flow agitator propellers that contribute to significant reductions in required horsepower. The first of these involves the use of good design principles. The swirling wake generated by an agitator propeller induces losses in the pumping action. By designing an agitator of proper twist and shape one can minimize these losses. Depending upon the design chosen for comparison, these losses can be reduced by 30 to 50% without any sacrifice in pumping or without increasing the complexity of the design. The second aspect involves an appropriate selection of the agitator propeller diameter. The required horsepower can be significantly reduced by using a propeller of larger diameter while operating it at a lower revolutions per minute (RPM) with no sacrifice in the pumping. 3 references, 2 figures, 2 tables.

  16. Microbial Ecology in Anaerobic Digestion at Agitated and Non-Agitated Conditions

    PubMed Central

    Tian, Zhuoli; Cabrol, Léa; Ruiz-Filippi, Gonzalo; Pullammanappallil, Pratap

    2014-01-01

    To investigate the distribution and dynamics of microbial community in anaerobic digestion at agitated and non-agitated condition, 454 pyrosequencing of 16s rRNA was conducted. It revealed the distinct community compositions between the two digesters and their progressive shifting over time. Methanogens and syntrophic bacteria were found much less abundant in the agitated digester, which was mainly attributed to the presence of bacterial genera Acetanaerobacterium and Ruminococcus with relatively high abundance. The characterization of the microbial community corroborated the digestion performance affected at the agitated condition, where lower methane yield and delayed methane production rate were observed. This was further verified by the accumulation of propionic acid in the agitated digester. PMID:25313520

  17. Pramipexole Overdose Associated with Visual Hallucinations, Agitation and Myoclonus.

    PubMed

    Cardon-Dunbar, Adeline; Robertson, Tom; Roberts, Michael S; Isbister, Geoffrey K

    2017-05-25

    Pramipexole is a dopamine D2 receptor agonist used to treat idiopathic Parkinson's disease and primary restless legs syndrome. There is limited information on pramipexole overdose. A 59-year-old male ingested 3 mg pramipexole, 2250 mg venlafaxine, 360 mg mirtazapine, with suicidal intent. He presented alert, had normal vital observations and normal pupillary reflexes. He was mildly agitated, reported visual hallucinations and was given 5 mg diazepam. He had a mildly elevated lactate of 1.7 mmol/L, but otherwise normal laboratory investigations. Overnight, he remained agitated with visual hallucinations and developed myoclonus while awake. He had increasing difficulty passing urine on a background of mild chronic urinary retention. On review, 14 h post-ingestion, he was hypervigilant, jittery and mildly agitated. He had pressured speech and difficulty focusing on questioning. He had a heart rate of 110 bpm, but had an otherwise normal examination, with no clonus or extrapyramidal effects. He was unable to mobilize due to dizziness and ataxia. Over the next few hours, he improved, the visual hallucinations and agitation resolved and he mobilized independently. Pramipexole was measured with liquid chromatography mass spectrometry. The initial plasma pramipexole concentration was 34.2 ng/mL (therapeutic range 0.2 to 7 ng/mL), 9 h post-overdose. Concentration time data fitted a one-compartment model with an estimated elimination half-life of 18 h. Pramipexole overdose with hallucination, agitation, and myoclonus is consistent with adverse effects reported with therapeutic toxicity, but mirtazapine and venlafaxine may have contributed. Pramipexole concentrations exceeded the therapeutic range for over 24 h. With the increasing use of pramipexole in restless legs syndrome, adult overdoses may become more common.

  18. Caring for relatives with agitation at home: a qualitative study of positive coping strategies

    PubMed Central

    Jesnick, Leah; Turner, Rebecca; Leavey, Gerard; Livingston, Gill

    2017-01-01

    Background Trials of psychological interventions for reducing agitation in people with dementia living at home have been unsuccessful. Aims To inform future interventions by identifying successful strategies of family carers with relatives with dementia and agitation living at home. Method Qualitative in-depth individual interviews were performed with 18 family carers. We used thematic analysis to identify emerging themes. Results Carers described initial surprise and then acceptance that agitation is a dementia symptom and learned to respond flexibly. Their strategies encompassed: prevention of agitation by familiar routine; reduction of agitation by addressing underlying causes and using distraction; prevention of escalation by risk enablement, not arguing; and control of their emotional responses by ensuring their relative’s safety then walking away, carving out some time for themselves and using family and services for emotional and practical help. Conclusions These strategies can be manualised and tested in future randomised controlled trials for clinical effectiveness in reducing agitation in people with dementia living at home. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28243464

  19. Stabilization and Management of the Acutely Agitated or Psychotic Patient.

    PubMed

    Deal, Nathan; Hong, Michelle; Matorin, Anu; Shah, Asim A

    2015-11-01

    Acutely agitated or psychotic patients are particularly challenging to manage in the emergency department. Often these patients present with little or no history, and an adequate assessment may initially be difficult because of the condition of the patient. This article discusses basic concepts regarding agitation, and the related management goals and strategies. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Effect of hydraulic retention time and seed material on phosphorus recovery and crystal size from urine in an air-agitated reactor.

    PubMed

    Liu, Xiaoning; Hu, Zhengyi; Wang, Jinzhi; Wen, Guoqi

    2014-01-01

    Phosphorus (P) recovery from urine is affected by various parameters. This study evaluates the effects of hydraulic retention time (HRT) and seed material on P recovery and crystal size in an air-agitated reactor. Results show that ortho-phosphate removal and struvite recovery efficiencies were 96.3% and 89.5%, and 97.1% and 93.0%, after five runs of HRTs of 1 and 2 h, respectively. Low loss of crystals from effluent urine solutions indicates high struvite recovery efficiency and is correlated with the structure and design of the reactor. The average particle size decreased from 40.0 to 31.7 μm as the HRT increased from 1 to 2 h. The two types of seed materials (zeolite and molecular sieve) did not affect the ortho-phosphate removal efficiency but affected the struvite crystal size. In particular, multi-stage addition of zeolites increased the average crystal size from 33.7 to 57.0 μm.

  1. 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.

  2. Timing of Initiation of Maintenance Dialysis

    PubMed Central

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

    2016-01-01

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

  3. Principal components analysis of agitation outcomes in Alzheimer's disease.

    PubMed

    Yesavage, Jerome A; Taylor, Joy L; Friedman, Leah; Rosenberg, Paul B; Lazzeroni, Laura C; Leoutsakos, Jeannie-Marie S; Kinoshita, Lisa M; Perlow, Mark J; Munro, Cynthia A; Devanand, D P; Drye, Lea T; Mintzer, Jacobo E; Pollock, Bruce G; Porsteinsson, Anton P; Schneider, Lon S; Shade, David M; Weintraub, Daniel; Lyketsos, Constantine G; Noda, Art

    2016-08-01

    We developed a composite measure of agitation as a secondary outcome of change over time in the Citalopram for Agitation in Alzheimer's disease study (CitAD). CitAD demonstrated a positive effect of citalopram on agitation on the Neurobehavioral Rating Scale agitation subscale (NBRS-A). CitAD included additional agitation measures such as the Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory. We performed principal components analyses on change in individual item of these scales for the same, original CitAD subjects. The first principal component accounted for 12.6% of the observed variance and was composed of items that appear to reflect agitation. The effect size for citalopram calculated using this component was 0.53 (95% CI 0.22-0.83) versus 0.32 for the NBRS-A (95% CI 0.01-0.62). Results suggest that a composite measure of change in agitation might be more sensitive than change in a single primary agitation measure. Published by Elsevier Ltd.

  4. SBASI: Actuated pyrotechnic time delay initiator

    NASA Technical Reports Server (NTRS)

    Salter, S. J.; Lundberg, R. E.; Mcdougal, G. L.

    1975-01-01

    A precision pyrotechnic time delay initiator for missile staging was developed and tested. Incorporated in the assembly is a single bridgewire Apollo standard initiator (SBASI) for initiation, a through-bulkhead-initiator to provide isolation of the SBASI output from the delay, the pyrotechnic delay, and an output charge. An attempt was made to control both primary and secondary variables affecting functional performance of the delay initiator. Design and functional limit exploration was performed to establish tolerance levels on manufacturing and assembling operations. The test results demonstrate a 2% coefficient of variation at any one temperature and an overall 2.7% coefficient of variation throughout the temperature range of 30 to 120 F. Tests were conducted at simulated operational altitude from sea level to 200,000 feet.

  5. Risperidone for control of agitation in dementia patients.

    PubMed

    Falsetti, A E

    2000-05-01

    Currently available research on the use of risperidone to manage agitation in patients with dementia is discussed. Dementia affects up to 70% of nursing-home patients, and more than 90% of them exhibit aggressive or agitated behavior or severe depression. Agitation includes combativeness, hyperactivity, disinhibition, wandering, and restlessness. Environmental interventions are preferred for mild symptoms; medications are the treatment of choice for severe manifestations. Traditional neuroleptics have been the mainstay of treatment for agitated behavior in persons with dementia, but these agents have limited efficacy and are associated with high rates of adverse effects, including worsening of already poor cognitive functioning. Although the literature on the use of risperidone in elderly patients with dementia consists largely of uncontrolled trials, case reports, and chart reviews, it appears that this agent is effective for managing agitation in this population and does so with a low frequency of extrapyramidal symptoms (EPS). Risperidone may also be useful for treating acute agitation in patients with a high risk of EPS and for long-term treatment of "sundowning" (agitation and confusion starting in the late afternoon and worsening at night). A low initial dosage that is gradually adjusted upward is recommended. Risperidone appears effective in controlling agitation in patients with dementia and has a relatively benign adverse-effect profile, but more clinical trials are needed to elucidate its role for this indication.

  6. Polyhomogeneous expansions from time symmetric initial data

    NASA Astrophysics Data System (ADS)

    Gasperín, E.; Valiente Kroon, J. A.

    2017-10-01

    We make use of Friedrich’s construction of the cylinder at spatial infinity to relate the logarithmic terms appearing in asymptotic expansions of components of the Weyl tensor to the freely specifiable parts of time symmetric initial data sets for the Einstein field equations. Our analysis is based on the assumption that a particular type of formal expansions near the cylinder at spatial infinity corresponds to the leading terms of actual solutions to the Einstein field equations. In particular, we show that if the Bach tensor of the initial conformal metric does not vanish at the point at infinity then the most singular component of the Weyl tensor decays near null infinity as O(\\tilde{r}-3\\ln \\tilde{r}) so that spacetime will not peel. We also provide necessary conditions on the initial data which should lead to a peeling spacetime. Finally, we show how to construct global spacetimes which are candidates for non-peeling (polyhomogeneous) asymptotics.

  7. Stabilization of insulin against agitation-induced aggregation by the GMO cubic phase gel.

    PubMed

    Sadhale, Y; Shah, J C

    1999-11-25

    The main objective of the study was to evaluate if the liquid crystalline cubic phase gel of glyceryl monooleate (GMO) protects insulin from agitation induced aggregation. The aggregation of Humulin(R), Regular Iletin I(R) and Regular Iletin II(R), in cubic phase GMO gels at 30 U/g of gel was compared with that in PBS at 100 oscillations/min at 37 degrees C using optical density at 600 nm. The effect of agitation on the secondary structure of insulin in solution and in the gels was determined with circular dichroism (CD) spectroscopy, and the time course of aggregation was also followed by HPLC. A sigmoidal increase in optical density of solution with time indicated formation of increasing amounts of insoluble insulin aggregates. However, in the gels, optical density values stayed at, or around, the initial optical density value, comparable with that of a blank gel suggesting that insulin had not aggregated in the gel. CD spectroscopy of the soluble insulin showed a total loss of native conformation upon aggregation of insulin in solution. In contrast, CD spectra of insulin in the gel were unaltered suggesting protection from aggregation during agitation. Furthermore, agitation of insulin in gels for a duration as long as 2 months at 37 degrees C, had very little adverse effect on the native conformation of insulin, as indicated by the lack of a significant change in its CD spectrum. Therefore, the cubic phase gel was indeed able to protect insulin from agitation-induced aggregation and subsequent precipitation. Although the majority of insulin in solution appeared to have aggregated and precipitated after 8 days by UV and CD spectroscopy, RP-HPLC results indicated the presence of some soluble aggregates of insulin. In summary, the liquid crystalline cubic phase gel of GMO protects peptides, like insulin, from agitation-induced aggregation.

  8. Shape optimisation to maximise crack initiation time.

    PubMed

    Hedia, H S

    2001-01-01

    Most of machine parts, artificial joints and their components used for human body contain fillets, which connects two different diameters or widths. These fillets may cause a failure for these components. So, in this paper an optimisation method is presented which calculates and predicts optimal shape of the longitudinal profile for transition length of a tension bar, which connects two different diameters, using the ANSYS program. This method is applied to maximise the crack initiation time by minimising the fatigue notch factor Kf. A specified program has been developed to calculate the fatigue notch factor using Ansys Parametric Design Language (APDL) which is associated to the ANSYS Package. It was observed that the maximisation of crack initiation time with higher value of the statistical parameter, k, is also a minimisation of stress concentration factor, kt, at the same time.A tension bar with four different transition length, t (t/d=0.333, 0.4167, 0.5 and 0.583) is considered. The crack initiation time of the optimal shape for all cases was increased by 17%, 12%, 9% and 7%, respectively. The stress concentration factor was reduced by 20%, 17%, 15% and 12.5%, respectively.

  9. Cavitation-controlled ultrasonic agitator

    SciTech Connect

    Sheen, S.H.; Lawrence, W.P.; Raptis, A.C.

    1989-10-01

    High-intensity ultrasound generally produces nonlinear acoustic cavitation and streaming in liquids. The ultrasonic energy required to cause cavitation and streaming in a liquid depends on the physical properties of the liquid, e.g., surface tension, viscosity, and entrained gases. Both cavitation and streaming generate acoustic noise whose signatures may be used to distinguish the stage of agitation and thus allow the process to be controlled. An ultrasonic agitator has been designed for application in a confined area with a high-temperature, high-pressure, and corrosive environment. Control of this agitator is based on the detection of noise levels and subharmonics produced during cavitation and streaming. Noise signatures of agitation in different liquids and in liquids with particles have been determined, and discussed. 6 refs., 6 figs.

  10. Downhole gaseous liquid flow agitator

    SciTech Connect

    Kamilos, N.; Kennedy, D.D.; Lederhos, L.J. Jr.

    1989-03-14

    An apparatus is described for agitating and mixing of a gaseous phase and a liquid phase comprising: a first tube having non-blocking internal threads within the first tube to agitate a liquid phase adhering thereto with a gaseous phase passing therethrough, whereby a uniform gaseous phase and liquid phase mixture is formed; and a second tube connected to an end of the first tube having non-blocking internal threads of opposite handedness.

  11. Supervised exercise to reduce agitation in severely cognitively impaired persons.

    PubMed

    Aman, Edris; Thomas, David R

    2009-05-01

    Several studies have shown an improvement in depression, activities of daily living, and agitation in cognitively impaired subjects who undergo a long-term exercise program. These studies have not considered the short-term effects of exercise. The purpose of this study was to investigate the short-term effects of a limited, supervised exercise program on agitation, depression, and activities of daily living in cognitively impaired patients residing in the special needs unit of a nursing home. This study was a prospective comparative study. A 3-week exercise program was implemented at the special needs units of 2 nursing homes. The exercise program involved 30 minutes of exercise (15 minutes of aerobic and 15 minutes of resistance), 3 days per week. There were 50 residents in this study (76% female, 24% male) and they had a mean age of 79.2 +/- 9.7 years. The subjects had a mean SLUMS (Saint Louis Mental Status Examination) score of 1.5 +/- 2.1 (SLUM score range 0-30, 30 meaning full cognitive faculty). Each subject had his or her depression, agitation, activities of daily living, and 6-meter walk time measured before and after the 3-week exercise program. The Cornell Scale for Depression, Pittsburgh Agitation Scale (PAS)/Cohen-Mansfield Agitation Inventory, and ADCS-ADL (Alzheimer's disease cooperative study-activities of daily living) were used to measure depression, agitation, and activities of daily living, respectively. Multiple paired t tests were calculated for each outcome measurement. The post-study scales showed an improvement in the 6-meter walk test and, using the PAS (0-16, 0 meaning no agitation), an improvement in agitation. The improvement in agitation in the entire population was P less than .05; mean PAS pre-study scores were 5.8 +/- 4.8 and mean PAS poststudy scores were 4.5 +/- 3.7 . Among the patients with PAS Pre-Exercise Program Scores greater than 3, thus categorized as agitated, there was a greater decrease in agitation; PAS Pre-Study Scores

  12. Aeroelasticity-based fluid agitation for lab-on-chips.

    PubMed

    Xia, H M; Wang, Z P; Wang, W; Fan, W; Wijaya, A; Wang, Z F

    2013-04-21

    In this study, we report a robust agitation method for small-volume liquids. It utilizes an elastic diaphragm as the bottom of a liquid chamber, upon which an initial tension is also applied to enhance the aeroelasticity effects at small/micro scales. As a result, spontaneous vibration of the diaphragm can be induced by an external air flow, which further provides fluid agitations. The device structure is simple and can be easily fabricated at low cost. More importantly, the vibration amplitude is controllable and varies widely from several tens to several hundred micrometers depending on the applied air pressure. The resulting agitation is effective and applicable at high viscosities of up to 900 cSt. The influences of air pressure and liquid viscosity on the vibration frequency are discussed. Potential applications of this technique for solid particle agitation, focusing and fluid mixing are also demonstrated.

  13. Advanced impeller geometry boosts liquid agitation

    SciTech Connect

    Fasano, J.B.; Bakker, A.; Penney, W.R. )

    1994-08-01

    A traditional agitator impeller often functions as a rather inefficient pump because of the way it produces fluid motion and pressure head. However, one can improve the amount of flow or shear generated by an impeller at constant power consumption and torque by changing its design. For example, a high-efficiency, axial-flow impeller produces more fluid motion per unit of power at constant torque than an otherwise similar pitched-blade turbine. The more-vigorous fluid motion cuts blend time and enhances heat-transfer in various flow-controlled mixing operations, such as blending of miscible fluids. For most applications, a higher degree of agitation intensity can be achieved on the same machine by substituting a high-efficiency impeller for a conventional pitched-blade unit. The high-efficiency impeller features a larger geometric pitch angle (30--60 deg) at the hub than at the tip (10--30 deg). Results from recently conducted controlled experiments indicate the beneficial effects of the high-efficiency impeller on blend time and heat-transfer coefficients in liquid-liquid mixing as well as solids suspension. This articles focuses on liquid agitation, with discussions of solids suspension set aside for a forthcoming piece in this series of articles on mixing.

  14. Behavioral Characteristics of Agitated Nursing Home Residents With Dementia at the End of Life

    PubMed Central

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

    2009-01-01

    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 status who did not die during the trial. Design and Methods We conducted a two-group secondary data analysis of prospective observational data from 10 nursing homes in Birmingham, Alabama. By means of chart review, resident assessments, surveys of certified nursing assistants, and direct observation of residents' daily behaviors and environment, 32 residents (87.34 ± 7.29 years) with a Mini-Mental State Examination (MMSE) score = 4.31 (±5.54) who died were compared with 32 residents (84 ± 6.96 years) with a mean MMSE score = 4.28 (±5.49) who did not die during the clinical trial. Results Residents who died displayed more verbal agitation, less time in verbal interaction with staff, and almost twice as much time restrained in bed during observation time in comparison with residents who did not die during the clinical trial. However, groups did not differ significantly in severity of comorbid illness, functional status, number of painful diagnoses, certified nursing assistants' reports of residents' pain, or opioid or nonopioid analgesic prescription or dosage. Surviving residents were more likely to receive neuroleptic medication than residents who died. Implications Results suggest that agitated nursing home residents may exhibit a heightened level of verbal agitation, decreased verbal interaction with staff, and increased bed restraint up to 3 months prior to death. Prospective observational studies are needed to identify markers for imminent mortality among nursing home residents. PMID:16199401

  15. Effect of agitation of EDTA with 808-nm diode laser on dentin microhardness.

    PubMed

    Arslan, Hakan; Yeter, Kübra Y; Karatas, Ertugrul; Yilmaz, Cenk B; Ayranci, Leyla B; Ozsu, Damla

    2015-02-01

    The aim of this study is to analyze the effect of agitation of ethylenediaminetetraacetic acid (EDTA) with diode laser at different agitation times on root dentin microhardness. Eighty-four specimens were divided randomly into seven groups, as follows: (1) distilled water, (2) 17% EDTA, (3) EDTA with 60 s ultrasonic agitation, (4) EDTA with 10 s laser agitation, (5) EDTA with 20 s laser agitation, (6) EDTA with 30 s laser agitation, and (7) EDTA with 40 s laser agitation. All of the specimens were irrigated with 5% NaOCl and distilled water except the distilled water group. Microhardness values were calculated before and after the procedures. Statistical analyses were performed using one-way ANOVA and Tukey post hoc tests. Statistically significant differences were determined between the distilled water and other groups. Also, statistically significant differences were observed between EDTA with 40 s laser agitation and EDTA, and EDTA with 10 and 20 s laser agitations. Ultrasonic agitation of EDTA affected microhardness of root dentin similar to EDTA (p > .05). All applications decreased the microhardness of root dentin when compared with distilled water. Agitation of EDTA with diode laser for 40 s caused more reduction in microhardness of root dentin when compared with EDTA.

  16. 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.

  17. Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage.

    PubMed

    Rosenthal, Lisa J; Francis, Brandon A; Beaumont, Jennifer L; Cella, David; Berman, Michael D; Maas, Matthew B; Liotta, Eric M; Askew, Robert; Naidech, Andrew M

    Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium and found worse outcomes in health-related quality of life (HRQoL) in the domain of cognitive function. We tested the hypothesis that agitation would have additional prognostic significance on later cognitive function HRQoL. Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium, with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, 3 months, and 1 year. Functional outcomes were measured with the modified Rankin Scale. Among the 81 patients with HRQoL follow-up data available, patients who had agitation and delirium had worse cognitive function HRQoL scores at 28 days (T scores for delirium with agitation 20.9 ± 7.3, delirium without agitation 30.4 ± 16.5, agitation without delirium 36.6 ± 17.5, and neither agitated nor delirious 40.3 ± 15.9; p = 0.03) and at 1 year (p = 0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (p = 0.0006) and was not associated with medication use, seizures, or infection. The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to 1 year later. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  18. Agitation in DWPF Precipitate Pump Pit Tanks

    SciTech Connect

    Marek, J.C.

    1986-01-20

    An experimental program to test the reference agitator design for DWPF Precipitate Pump Pit Tanks has been completed. It was not known whether the reference agitator design would produce uniform mixing of precipitate slurry. There was also a concern that the reference agitator would produce excessive foaming of precipitate. An alternative agitator design that produces good mixing with little or no foam buildup was identified in the tests and is recommended for use in DWPF Precipitate Pump Pit Tanks. 7 refs.

  19. 7 CFR 58.513 - Agitators.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Agitators. 58.513 Section 58.513 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....513 Agitators. Mechanical agitators shall meet the requirements of § 58.417....

  20. 7 CFR 58.513 - Agitators.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Agitators. 58.513 Section 58.513 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....513 Agitators. Mechanical agitators shall meet the requirements of § 58.417....

  1. 7 CFR 58.513 - Agitators.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 false Agitators. 58.513 Section 58.513 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....513 Agitators. Mechanical agitators shall meet the requirements of § 58.417....

  2. 7 CFR 58.513 - Agitators.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Agitators. 58.513 Section 58.513 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....513 Agitators. Mechanical agitators shall meet the requirements of § 58.417....

  3. 7 CFR 58.513 - Agitators.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Agitators. 58.513 Section 58.513 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....513 Agitators. Mechanical agitators shall meet the requirements of § 58.417....

  4. Benzodiazepines: Sedation and Agitation.

    PubMed

    Gallagher, Catherine

    2016-01-01

    Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. At present, benzodiazepines are the most commonly used drugs in sedation practice and provide a pleasant experience for most, but not all, patients. An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail. CPD/CLINICAL RELEVANCE: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely.

  5. 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…

  6. 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…

  7. Assessment and management of agitation in psychiatry: Expert consensus.

    PubMed

    Garriga, Marina; Pacchiarotti, Isabella; Kasper, Siegfried; Zeller, Scott L; Allen, Michael H; Vázquez, Gustavo; Baldaçara, Leonardo; San, Luis; McAllister-Williams, R Hamish; Fountoulakis, Konstantinos N; Courtet, Philippe; Naber, Dieter; Chan, Esther W; Fagiolini, Andrea; Möller, Hans Jürgen; Grunze, Heinz; Llorca, Pierre Michel; Jaffe, Richard L; Yatham, Lakshmi N; Hidalgo-Mazzei, Diego; Passamar, Marc; Messer, Thomas; Bernardo, Miquel; Vieta, Eduard

    2016-01-01

    Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions. An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items. Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic. Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the "ideal" medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.

  8. Agitation

    MedlinePlus

    ... alertness (altered consciousness) can be a sign of delirium . Delirium has a medical cause and should be checked ... PCP, or opiates) Hospitalization (older adults often have delirium while in the hospital) Overactive thyroid gland ( hyperthyroidism ) ...

  9. 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.

  10. Spontaneous knotting of an agitated string.

    PubMed

    Raymer, Dorian M; Smith, Douglas E

    2007-10-16

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

  11. Spontaneous knotting of an agitated string

    PubMed Central

    Raymer, Dorian M.; Smith, Douglas E.

    2007-01-01

    It is well known that a jostled string tends to become knotted; yet the factors governing the “spontaneous” formation of various knots are unclear. We performed experiments in which a string was tumbled inside a box and found that complex knots often form within seconds. We used mathematical knot theory to analyze the knots. Above a critical string length, the probability P of knotting at first increased sharply with length but then saturated below 100%. This behavior differs from that of mathematical self-avoiding random walks, where P has been proven to approach 100%. Finite agitation time and jamming of the string due to its stiffness result in lower probability, but P approaches 100% with long, flexible strings. We analyzed the knots by calculating their Jones polynomials via computer analysis of digital photos of the string. Remarkably, almost all were identified as prime knots: 120 different types, having minimum crossing numbers up to 11, were observed in 3,415 trials. All prime knots with up to seven crossings were observed. The relative probability of forming a knot decreased exponentially with minimum crossing number and Möbius energy, mathematical measures of knot complexity. Based on the observation that long, stiff strings tend to form a coiled structure when confined, we propose a simple model to describe the knot formation based on random “braid moves” of the string end. Our model can qualitatively account for the observed distribution of knots and dependence on agitation time and string length. PMID:17911269

  12. Agitated Depression in Substance Dependence

    PubMed Central

    Leventhal, Adam M.; Gelernter, Joel; Oslin, David; Anton, Raymond F.; Farrer, Lindsay A.

    2011-01-01

    Background Depression with psychomotor agitation (PMA; “agitated depression”) is a putative psychiatric phenotype that appears to associate with some forms of substance dependence. However, it is unclear whether such relationships extend across different substances and independent (I-MDE) versus substance-induced (SI-MDE) subtypes of major depressive episodes. Method We examined whether lifetime depression with (vs. without) PMA was associated with lifetime substance dependence across individuals with lifetime: (1) I-MDE only (n = 575); and (2) SI-MDE only (n = 1683). Data were pooled from several family and genetic studies of substance dependence in which participants received identical structured interviews to diagnose DSM-IV mental disorders. Results In I-MDE, PMA was significantly associated with alcohol, cocaine, opioid, other drug (hallucinogen, inhalant, speed-ball), and sedative dependence. After controlling for demographic and clinical co-factors, PMA's relationship to dependence on opioids, other drugs, and sedatives remained significant, but not its relationship to alcohol or cocaine. In SI-MDE, PMA was significantly associated with alcohol, cocaine, opioid, and other drug dependence. After adjusting for co-factors, associations remained significant for dependence on cocaine and opioids, but not alcohol or other drugs. Relationships between PMA and opioid dependence were stronger in I-MDE than SI-MDE. Depression subtype (I-MDE vs. SI-MDE) did not moderate relations between PMA and non-opioid forms of substance dependence. Conclusions Agitated depression associates with certain forms of substance dependence, particularly opioid dependence. MDE subtype did not alter most PMA-dependence associations, which suggests that the mechanisms underlying this comorbidity are complex and potentially bidirectional. PMID:21277711

  13. The relationships of environment and personal characteristics to agitated behaviors in nursing home residents with dementia.

    PubMed

    Cohen-Mansfield, Jiska; Thein, Khin; Marx, Marcia S; Dakheel-Ali, Maha; Murad, Havi; Freedman, Laurence S

    2012-03-01

    To explore the impact of personal attributes, environmental attributes, and the presentation of 9 categories of stimuli on agitation in nursing home residents with dementia. Participants in this randomized, controlled, observational cross-sectional study were 193 residents of 7 nursing homes, all with a diagnosis of dementia, for whom we obtained data pertaining to cognitive functioning (via the Mini-Mental State Examination), performance of activities of daily living (Minimum Data Set), and role-identity/activities of past interest (Self-Identity Questionnaire). Environmental attributes (eg, noise, lighting) and direct observations of agitation (primary outcome) were recorded via the Agitation Behavior Mapping Inventory. Engagement was measured using the Observational Measurement of Engagement. Both agitation and engagement were assessed for each stimulus (including a control condition). Univariate findings (ie, for 1 explanatory variable at a time) showed agitation to be related to several personal attributes--ie, female gender was related to verbal agitation (P < .0001); low cognitive function was related to total, verbal, and physical agitation (P < .001 for each); low performance of activities of daily living was significantly related to all types of agitation (P < .01 for total agitation and P < .05 for each type of agitation); and unclear speech was significantly related to total agitation (P < .01). Eight of the 9 stimulus categories were significantly related to decreased levels of agitation, with ORs ranging from 0.37 (live human stimuli, P < .001) to 0.79 (inanimate social stimuli, P < .05). Higher levels of engagement were related to lower levels of agitation (P < .001 for total agitation). In the multivariate analyses, higher cognitive function (P < .001), male gender (P < .05), level of engagement with stimuli (eg, duration of engagement for 3 minutes or longer, P < .05), and all 9 stimulus categories, with the exception of music, were independently

  14. 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.

  15. Bayesian estimation of crack initiation times from service data

    NASA Technical Reports Server (NTRS)

    Heller, R. A.; Stevens, G. H.

    1977-01-01

    Lockheed C-130 Hercules aircraft have during their service life been periodically inspected and growing cracks around rivet holes were recorded. This record has recently been used to determine the statistical distributions of crack initiation times and the distribution of initial crack sizes. When crack initiation times are calculated from such cracks, by backward extrapolation of the growth relation, the resulting distribution of crack initiation times will indicate a preponderance of short times to crack initiation. If however, such distributions are combined with the reliability of the inspection procedure, the statistical distribution of missed initiation times can be estimated. The method used is based on Bayes theorem which permits the calculation of the 'prior' distribution (initiation times before inspection) from a knowledge of the 'posterior' distribution (initiation times obtained from the inspection) and a 'likelihood function' (reliability of the inspection) procedure. The results indicate that during an early inspection a large percentage of initiation times will be missed and that the fraction of located initiation times increases during later inspections.

  16. Risk Factors of Emergence Agitation in Adults Undergoing General Anesthesia for Nasal Surgery

    PubMed Central

    Kim, Hyo-Jin; Kim, Hyo-Yeol; Kim, Jin-Kyoung; Choi, Seung-Won

    2015-01-01

    Objectives To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Methods We retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale≥+1 at any time were considered to have emergence agitation. Results The overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)≥5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS≥5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation. Conclusion Emergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients. PMID:25729495

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

    NASA Technical Reports Server (NTRS)

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

    1977-01-01

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

  18. Particle Breakage in Agitated Dryers

    NASA Astrophysics Data System (ADS)

    Hare, Colin L.; Ghadiri, Mojtaba; Dennehy, Robert; Collier, Alan

    2009-06-01

    A method for predicting particle breakage in agitated dryers is described. The method utilizes an estimation of stresses and strains occurring in a dryer bed sheared by an impeller using the Distinct Element Method (DEM). An assemblage of particles is then subjected to these stresses in a shear cell to assess the extent of attrition under a range of stresses and strains. Paracetamol particles in the size range 500-600 μm are used for the experimental work. The relationship of attrition with stress and strain is then incorporated into the distribution of stress and strain in the dryer estimated by DEM. The extent of attrition for a range of conditions including the impeller speed has been analysed. The prediction shows impeller speed to have limited effect on attrition within the range of speeds tested.

  19. Real-time monitoring of changes of adsorbed and crystalline water contents in tablet formulation powder containing theophylline anhydrate at various temperatures during agitated granulation by near-infrared spectroscopy.

    PubMed

    Otsuka, Makoto; Kanai, Yoshinori; Hattori, Yusuke

    2014-09-01

    Real-time monitoring of adsorbed water content (FW) and hydrate formation of theophylline anhydrate (THA) in tablet formulation during agitated granulation was investigated by near-infrared (NIR) spectroscopy. As the wet-granulation process of THA tablet formulation involves change in pseudo-polymorphs between THA and theophylline monohydrate (THM), the pharmaceutical properties of THA tablet depend on the degree of hydration during granulation. After mixing of the powder materials (4 g) containing THA, and excipients and the addition of 600 μL of binding water, the powder was kneaded at 27°C, 40°C, and 50°C and then dried. The mixing, granulating, and drying processes were monitored using NIR. The calibration models to predict THM and total water contents during granulation in THA tablet formulation were obtained by partial least-squares regression. The FW in the formulation was determined by subtracting THM from the water content. The results of the THA formulation powder bed during granulation by NIR monitoring indicated that the transformation pathway of the THA powder was THA ⇒ THM ⇒ THA at 27°C and 40°C, but that at 50°C was THA ⇒ THA ⇒ THA. The pharmaceutical properties, such as tablet porosity, hardness, tablet disintegration time, and dissolution rate of the final THA tablet products, were affected by the degree of crystalline transformation during granulation. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

  20. Emma Goldman: A Study in Female Agitation.

    ERIC Educational Resources Information Center

    Berry, Elizabeth

    The role of the agitator in society and the special characteristics of women agitators--in particular, Emma Goldman, an American anarchist from the early twentieth century--are discussed in this paper. Specific examples of the rhetoric used by Emma Goldman in her speeches (supporting anarchism, against women's suffrage, against abortion control,…

  1. Multivacuum initial conditions and the arrow of time

    NASA Astrophysics Data System (ADS)

    Bousso, Raphael; Zukowski, Claire

    2013-05-01

    Depending on the type and arrangement of metastable vacua in the theory, initial conditions in a de Sitter vacuum with arbitrarily large entropy can be compatible with the observed arrow of time, if the causal patch or related measures are used to regulate divergences. An important condition, however, is that the initial vacuum cannot produce observers from rare fluctuations (Boltzmann brains). Here we consider more general initial conditions where multiple vacua have nonzero initial probability. We examine whether the prediction of an arrow of time is destroyed by a small initial admixture of vacua that can produce Boltzmann brains. We identify general criteria and apply them to two nontrivial examples of such initial probability distributions. The Hartle-Hawking state is superexponentially dominated by the vacuum with smallest positive cosmological constant, so one might expect that other initial vacua can be neglected; but in fact, their inclusion drastically narrows the range of theory parameters for which an arrow of time is predicted. The dominant eigenvector of the global rate equation of eternal inflation is dominated by the longest-lived metastable vacuum. If an arrow of time emerges in the single-initial-vacuum approximation, then we find that this conclusion survives the admixture of other initial vacua. By global-local measure duality, this result amounts to a successful consistency test of certain global cutoffs, including light-cone time and scale-factor time.

  2. 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.

  3. Anxiety and Agitation in Mechanically Ventilated Patients

    PubMed Central

    Tate, Judith Ann; Dabbs, Annette Devito; Hoffman, Leslie; Milbrandt, Eric; Happ, Mary Beth

    2013-01-01

    During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently, and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients; (b) explore how clinicians recognize and interpret anxiety and agitation and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety-Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients’ ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians’ attributions about anxiety or agitation and “knowing the patient” contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or patient’s appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice. PMID:21908706

  4. Agitation in nursing home residents: the role of gender and social context.

    PubMed

    Burgio, L D; Butler, F R; Roth, D L; Hardin, J M; Hsu, C C; Ung, K

    2000-12-01

    We investigated the relationship among gender of resident, staff social interaction, and agitation in 46 (31 male and 15 female) nursing home residents with clinically significant agitation. Direct observations were conducted of resident behaviors and environmental contextual events using a computer-assisted, real-time observational system. The system recorded frequency, duration, and temporal sequencing of events. Results show that female residents displayed almost three times the amount of agitation as male residents (35% vs. 13% of total observation time, respectively), although men in the study were more likely to receive psychoactive drugs for their agitation. Staff spent similar amounts of time verbally interacting and touching male and female residents. Sequential analyses were conducted to examine the likelihood of staff verbal and touch interactions both preceding and following resident agitation using Bakeman and Quera's (1995) SDIS-GSEQ program. Results suggest that staff touch and verbal interaction elicit agitation in a significant proportion of residents. Once agitation occurs, staff were likely to respond by interacting verbally, but not physically, with the resident.

  5. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer's Disease.

    PubMed

    Ledger, Alison J; Baker, Felicity A

    2007-05-01

    This study aimed to investigate the long-term effects of group music therapy on agitation manifested by nursing home residents with Alzheimer's disease. A non-randomised experimental design was employed with one group receiving weekly music therapy (n = 26) and another group receiving standard nursing home care (n = 19). Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, J. (1989). Agitation in the elderly. In N. Billig & P. V. Rabins (Eds.), Issues in geriatric psychiatry (pp. 101-113). Basel, Switzerland: Karger). Although music therapy participants showed short-term reductions in agitation, there were no significant differences between the groups in the range, frequency, and severity of agitated behaviours manifested over time. Multiple measures of treatment efficacy are necessary to better understand the long-term effects music therapy programs have on this population.

  6. Properly choose mechanical agitators for viscous liquids

    SciTech Connect

    Bakker, A.; Gates, L.E.

    1995-12-01

    High-viscosity mixing applications occur in most chemical process industries (CPI) plants. High-viscosity applications occur in the production of food, paint, drilling mud, and greases, to name a few. Mixing can occur in pipeline systems with motionless mixers, or in vessels using mechanical agitators, depending on the application and the process requirements. A wide variety of both motionless mixers and mechanical agitators is available to handle specific mixing problems and fluid types. This article gives an overview of designing the most commonly used agitator for blending applications: a top-entering agitator with a single shaft. The agitator can be equipped with multiple turbine-style impellers of different design, or with helical-ribbon or anchor-style impellers to optimize the agitator for the specific application and blending problem on hand. Although turbulent blending will be briefly discussed here also, this article will focus on blending in the laminar and transitional regimes. Also, the authors will discuss the special requirements for blending non-newtonian fluids, with and without yield stress. They first discuss the flow patterns and applicability of different impeller types and then present some design guidelines.

  7. Effect of individualized music on agitation in individuals with dementia who live at home.

    PubMed

    Park, Heeok; Pringle Specht, Janet K

    2009-08-01

    This pilot study investigated the effect of individualized music on agitation in individuals with dementia who live at home. Fifteen individuals listened to their preferred music for 30 minutes prior to peak agitation time, two times per week for 2 weeks, followed by no music intervention for 2 weeks. The process was repeated once. The findings showed that mean agitation levels were significantly lower while listening to music than before listening to the music. The findings of this pilot study suggest the importance of music intervention for individuals with dementia who live at home.

  8. Congenital Hypothyroidism: Optimal Initial Dosage and Time of Initiation of Treatment: A Systematic Review

    PubMed Central

    Rahmani, Khaled; Yarahmadi, Shahin; Etemad, Koorosh; Koosha, Ahmad; Mehrabi, Yadollah; Aghang, Nasrin; Soori, Hamid

    2016-01-01

    Context Appropriate management of neonates, tested positive for congenital hypothyroidism (CH), in particular, the initial dosage of levothyroxine and the time of initiation of treatment is a critical issue. The aim of this study was to assess all current evidence available on the subject to ascertain the optimal initial dose and optimal initiation time of treatment for children with CH. Evidence Acquisition In this study, all published research related to the initiation treatment dose and the onset time of treatment in congenital hypothyroidism were reviewed. The searched electronic databases included Medline, Science direct, Scopus EMBASE, PsycINFO, Cochrane, BIOSIS and ISI Web of Knowledge. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major thyroid and pediatrics journals published within the past 35 years. Studies were included if they were written in English and investigated levothyroxine dose or timing of treatment or both, used for the treatment of children with congenital hypothyroidism. Results Two thousand three hundred and seventy-four articles (excluding duplicates) were retrieved from the primary search. After reviewing the titles, abstracts and full-texts of studies, eventually, 22 studies were found that met our inclusion criteria. Amongst these, 17 and 12 evaluated outcomes of different treatment doses and treatment timing, respectively. Overall, the majority of these studies emphasized the initial high dose of levothyroxine and early treatment of newborns with hypothyroidism. There were, however, some studies that disagreed with increasing levothyroxine dose at initiation of treatment. Conclusions Considering the results of this review, apparently there is no difference in opinion regarding the early initiation of treatment, whereas determining the optimal dose of levothyroxine for start of treatment in CH patients still remains a controversial issue, demonstrating the need for

  9. Probe initial parton density and formation time via jet quenching

    SciTech Connect

    Wang, Xin-Nian

    2002-09-20

    Medium modification of jet fragmentation function due to multiple scattering and induced gluon radiation leads directly to jet quenching or suppression of leading particle distribution from jet fragmentation. One can extract an effective total parton energy loss which can be related to the total transverse momentum broadening. For an expanding medium, both are shown to be sensitive to the initial parton density and formation time. Therefore, one can extract the initial parton density and formation time from simultaneous measurements of parton energy loss and transverse momentum broadening. Implication of the recent experimental data on effects of detailed balance in parton energy loss is also discussed.

  10. 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

    ... all times (except during periods of startup, shutdown, or malfunction) greater than the agitator... requirements of either § 63.1034 or § 63.1021(b); or (C) Equipped with a closed-loop system that purges the... agitator seal at the time of the weekly inspection, the owner or operator shall follow the procedure...

  11. Agitated Honeybees Exhibit Pessimistic Cognitive Biases

    PubMed Central

    Bateson, Melissa; Desire, Suzanne; Gartside, Sarah E.; Wright, Geraldine A.

    2011-01-01

    Summary Whether animals experience human-like emotions is controversial and of immense societal concern [1–3]. Because animals cannot provide subjective reports of how they feel, emotional state can only be inferred using physiological, cognitive, and behavioral measures [4–8]. In humans, negative feelings are reliably correlated with pessimistic cognitive biases, defined as the increased expectation of bad outcomes [9–11]. Recently, mammals [12–16] and birds [17–20] with poor welfare have also been found to display pessimistic-like decision making, but cognitive biases have not thus far been explored in invertebrates. Here, we ask whether honeybees display a pessimistic cognitive bias when they are subjected to an anxiety-like state induced by vigorous shaking designed to simulate a predatory attack. We show for the first time that agitated bees are more likely to classify ambiguous stimuli as predicting punishment. Shaken bees also have lower levels of hemolymph dopamine, octopamine, and serotonin. In demonstrating state-dependent modulation of categorization in bees, and thereby a cognitive component of emotion, we show that the bees' response to a negatively valenced event has more in common with that of vertebrates than previously thought. This finding reinforces the use of cognitive bias as a measure of negative emotional states across species and suggests that honeybees could be regarded as exhibiting emotions. Video Abstract PMID:21636277

  12. Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine.

    PubMed

    Olives, Travis D; Nystrom, Paul C; Cole, Jon B; Dodd, Kenneth W; Ho, Jeffrey D

    2016-12-01

    Profound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear. The goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol. This was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation. Overall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a

  13. Computing arrival times of firefighting resources for initial attack

    Treesearch

    Romain M. Mees

    1978-01-01

    Dispatching of firefighting resources requires instantaneous or precalculated decisions. A FORTRAN computer program has been developed that can provide a list of resources in order of computed arrival time for initial attack on a fire. The program requires an accurate description of the existing road system and a list of all resources available on a planning unit....

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

    PubMed Central

    Zeller, Scott L.; Citrome, Leslie

    2016-01-01

    Introduction 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. Discussion 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. Conclusion Management of agitation in the ED should encompass a patient-centered approach, incorporating non-pharmacologic approaches

  15. Highlights from PHENIX-I: initial state and early times

    SciTech Connect

    Leitch, Michael J

    2009-01-01

    We will review the latest physics developments from PHENIX concentrating on cold nuclear matter effects, the initial state for heavy-ion collisions, and probes of the earliest stages of the hot-dense medium created in those collisions. Recent physics results from p + p and d + Au collisions; and from direct photons, quarkonia and low-mass vector mesons in A+A collisions will be highlighted. Insights from these measurements into the characteristics of the initial state and about the earliest times in heavy-ion collisions will be discussed.

  16. Initial Time Dependence of Abundances in Solar Energetic Particle Events

    NASA Technical Reports Server (NTRS)

    Reames, Donald V.; Ny, C. K.; Tylka, A. J.

    1999-01-01

    We compare the initial behavior of Fe/O and He/H abundance ratios and their relationship to the evolution of the proton energy spectra in "small" and "large" gradual solar energetic particle (SEP) events. The results are qualitatively consistent with the behavior predicted by the theory of Ng et al. (1999a, b). He/H ratios that initially rise with time are a signature of scattering by non-Kolmogorov Alfven wave spectra generated by intense beams of shock-accelerated protons streaming outward in large gradual SEP events.

  17. Coal storage hopper with vibrating screen agitator

    SciTech Connect

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

    1984-09-11

    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.

  18. 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.

  19. 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.

  20. Flocculation of colloidal sols: Diffusion-controlled vs agitation-induced flocculation

    NASA Technical Reports Server (NTRS)

    1979-01-01

    A proposal for carrying out flocculation experiments in microgravity is presented. These experiments might allow a correlation between theory and experiment. First, all particles, whether single primary particles or aggregates of primary particles would not settle or cream at any agitation rate, or even in the absence of agitation. This failure to separate would keep all aggregates active, still serving as centers for diffusion-controlled flocculation. Keeping all particles suspended would allow the possibility of determining the total number of particles as a function of time from beginning to end of flocculation. Finally, the experiments would allow a definite separation diffusion-controlled and agitation-induced flocculation by studying diffusion-controlled flocculation with and without agitation.

  1. Pain, Agitation, and Delirium Guidelines: Interprofessional Perspectives to Translate the Evidence.

    PubMed

    Jablonski, Juliane; Gray, Jaime; Miano, Todd; Redline, Gretchen; Teufel, Heather; Collins, Tara; Pascual-Lopez, Jose; Sylvia, Martha; Martin, Niels D

    ). Overall mean ventilator-free days and ICU length of stay were 5.4 to 4.5 days (P = .29) and 11.75 to 9.5 days (P = .20), respectively. Measureable patient outcomes are achievable in the early stages of PAD guideline initiatives and can inform future systems-level organizational change. Pain, agitation, and delirium assessment tools form the foundation for clinical implementation and evaluation. High-acuity surgical critical care patients can achieve more time at goal RASS, decreased ventilator days, and less exposure to continuous opioid infusions, all while maintaining stable analgesia.

  2. 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…

  3. 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…

  4. The Effects of Excipients on Protein Aggregation During Agitation: An Interfacial Shear Rheology Study

    PubMed Central

    Liu, Lu; Qi, Wei; Schwartz, Daniel K.; Randolph, Theodore W.; Carpenter, John F.

    2014-01-01

    We investigated the effects of excipients in solutions of keratinocyte growth factor 2 (KGF-2) on protein aggregation during agitation as well as on interfacial shear rheology at the air-water interface. Samples were incubated with or without agitation, and in the presence or absence of the excipients heparin, sucrose or polysorbate 80 (PS80). The effect of excipients on the extent of protein aggregation was determined by UV spectroscopy and microflow imaging (MFI). Interfacial shear rheology was used to detect the gelation time and strength of protein gels at the air-water interface. During incubation, protein particles of size ≥ 1 μm and insoluble aggregates formed faster for KGF-2 solutions subjected to agitation. Addition of either heparin or sucrose promoted protein aggregation during agitation. In contrast, PS 80 substantially inhibited agitation-induced KGF-2 aggregation but facilitated protein particulate formation in quiescent solutions. The combination of PS 80 and heparin or sucrose completely prevented protein aggregation during both non-agitated and agitated incubations. Interfacial rheological measurements showed that KGF-2 in buffer alone formed an interfacial gel within a few minutes. In the presence of heparin, KGF-2 interfacial gels formed too quickly for gelation time to be determined. KGF-2 formed gels in about 10 minutes in the presence of sucrose. The presence of PS80 in the formulation inhibited gelation of KGF-2. Furthermore, the interfacial gels formed by the protein in the absence of PS80 were reversible when PS80 was added to the samples after gelation. Therefore, there is a correspondence between formulations that exhibited interfacial gelation and formulations that exhibited agitation-induced aggregation. PMID:23712900

  5. Biological activity of insulin in GMO gels and the effect of agitation.

    PubMed

    Sadhale, Y; Shah, J C

    1999-11-25

    Glyceryl monooleate (GMO)-water cubic phase gel was previously shown to protect insulin from agitation induced aggregation. However, it is not known if insulin is biologically active in the gel and what effect agitation has on insulin in the gel. Therefore, the objective was to determine the stability of insulin in cubic phase gel in terms of its biological activity in a suitable animal model such as Sprague-Dawley rats. Effect of agitation on biological activity of insulin in cubic phase GMO gel was determined by subcutaneous injections of the agitated and non-agitated gels to two groups of previously fasted rats and measuring the effect on their blood glucose levels. Two groups of rats administered with agitated insulin solution and normal saline were used as controls. The biological activity of insulin was evaluated by comparing AAC (area above the blood glucose level-time curve, in %-h), C(max) (maximum % decrease in blood glucose levels) and t(max) (time required to attain C(max), in h) values for the four groups of rats. Since cubic phase gel is highly viscous, therapeutic equivalency of insulin in the lamellar phase gel, which converts in situ into cubic phase gel, was compared to insulin solution with normal saline as the control, using AAC, C(max) and t(max) of the blood glucose profile. Insulin was biologically active in both agitated and non-agitated gels; however, upon agitation, insulin in solution totally lost its hypoglycemic activity. Agitation of insulin in the cubic phase gel was seen to have very little deleterious effect on its biological activity. Insulin in the lamellar phase gel was not only biologically active but also therapeutically equivalent to insulin solution based on AAC (327.9+/-100.8 and 431.7+/-113.3), C(max) (57. 1+/-7.0 and 70.2+/-6.5) and t(max) (2.8+/-0.7 and 4.0+/-1.7) for the lamellar phase gel and insulin solution, respectively (no significant difference, P0.05). In summary, GMO cubic phase gel protected insulin from

  6. [Incidence of acute agitation and variation in acute agitation management by emergency services].

    PubMed

    Casado Flórez, Isabel; Sánchez Santos, Luis; Rodríguez Calzada, Rafael; Rico-Villademoros, Fernando; Roset Arissó, Pere; Corral Torres, Ervigio

    2017-07-01

    To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

  7. Evaluating time dynamics of topographic threshold relations for gully initiation

    NASA Astrophysics Data System (ADS)

    Hayas, Antonio; Vanwalleghem, Tom; Poesen, Jean

    2016-04-01

    Gully erosion is one of the most important soil degradation processes at global scale. However, modelling of gully erosion is still difficult. Despite advances in the modelling of gully headcut rates and incision rates, it remains difficult to predict the location of gully initiation points and trajectories. In different studies it has been demonstrated that a good method of predicting gully initiation is by using a slope (S) - area (A) threshold. Such an S-A relation is a simple way of estimating the critical discharges needed to generate a critical shear stress that can incise a particular soil and initiate a gully. As such, the simple S-A threshold will vary if the rainfall-runoff behaviour of the soil changes or if the soil's erodibility changes. Over the past decades, important agronomic changes have produced significant changes in the soil use and soil management in SW Spain. It is the objective of this research to evaluate how S-A relations for gully initiation have changed over time and for two different land uses, cereal and olive. Data was collected for a gully network in the Cordoba Province, SW Spain. From photo-interpretation of historical air photos between 1956 and 2013, the gully network and initiation points were derived. In total 10 different time steps are available (1956; 1977; 1984; 1998; 2001; 2004; 2006; 2008; 2010; 2013). Topographical thresholds were extracted by combining the digitized gully network with the DEM. Due to small differences in the alignment of ortophotos and DEM, an optimization technique was developed in GIS to extract the correct S-A value for each point. With the S-A values for each year, their dynamics was evaluated as a function of land use (olive or cereal) and in function of the following variables in each of the periods considered: • soil management • soil cover by weeds, where weed growth was modeled from the daily soil water balance • rainfall intensity • root cohesion, , where root growth was modeled from

  8. Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation

    PubMed Central

    Chau, Elaine M. T.; Manns, Braden J.; Garg, Amit X.; Sood, Manish M.; Kim, S. Joseph; Naimark, David; Nesrallah, Gihad E.; Soroka, Steven D.; Beaulieu, Monica; Dixon, Stephanie; Alam, Ahsan; Tangri, Navdeep

    2016-01-01

    Background: Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published. Objective: The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice. Design: This study is a multicenter, 2-arm parallel, cluster randomized trial. Setting: The study involves 55 advanced chronic kidney disease clinics across Canada. Patients: Patients older than 18 years who are managed by nephrologists for more than 3 months, and initiate dialysis in the follow-up period are included in the study. Measurements: Outcomes will be measured at the patient-level and enumerated within a cluster. Data on characteristics of each dialysis start will be determined by linkages with the Canadian Organ Replacement Register. Primary outcomes include the proportion of patients who start dialysis early with an estimated glomerular filtration rate greater than 10.5 mL/min/1.73 m2 and start dialysis in hospital as inpatients or in an emergency room setting. Secondary outcomes include the rate of change in early dialysis starts; rates of hospitalizations, deaths, and cost of predialysis care (wherever available); quarterly proportion of new starts; and acceptability of the knowledge translation materials. Methods: We randomized 55 multidisciplinary chronic disease clinics (clusters) in Canada to receive either an active knowledge translation intervention or no intervention for the uptake of the guideline on the timing of dialysis initiation. The active knowledge translation intervention consists of audit and feedback as well as patient- and provider-directed educational tools delivered at a comprehensive in

  9. 82. VIEW OF AGITATORS FROM EAST. DRIVE AND STRUCTURAL SUPPORT ...

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

    82. VIEW OF AGITATORS FROM EAST. DRIVE AND STRUCTURAL SUPPORT OF AGITATOR No. 1 IN FOREGROUND. HORIZONTAL AIR LINE PARALLELS AGITATORS IN RIGHT HALF OF VIEW. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  10. 83. AGITATORS No. 2, No. 3, AND No. 4 FROM ...

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

    83. AGITATORS No. 2, No. 3, AND No. 4 FROM EAST. AIR SUPPLY RUNS THROUGH BENT BRACES ON RIGHT. NOTE AGITATOR RAKE LEANING AGAINST RETAINING WALL BETWEEN AGITATOR No. 2 AND No. 3. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  11. Do Past Experiences Predict Agitation in Nursing Home Residents?

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska; Marx, Marcia S.

    1989-01-01

    Examined relationships between agitated behavior and past personality in 408 nursing home residents. Agitated and nonaggressive behaviors were correlated with past stressful events, and physically aggressive behavior was correlated with the lack thereof; no relationships were found between agitated behavior and history of a mental disorder or past…

  12. An analysis of the relationships among engagement, agitated behavior, and affect in nursing home residents with dementia.

    PubMed

    Cohen-Mansfield, Jiska; Dakheel-Ali, Maha; Jensen, Barbara; Marx, Marcia S; Thein, Khin

    2012-05-01

    Affect, behavior, and cognition can be considered as basic constructs that dictate human functioning, with intricate and bi-directional relationships among them. Prior to the present study, relationships among these constructs have not been systematically examined within the context of dementia. Sample 1 contained 185 nursing home residents with a diagnosis of dementia. Sample 2 contained 117 residents with dementia, all of whom manifested agitated behaviors. Outcome measures included stimulus engagement (assessed via the Observational Measure of Engagement), affect (measured using Lawton's Modified Behavior Stream), and agitation/problem behavior (recorded via the Agitated Behaviors Mapping Instrument). Real time direct observations were collected during both stimulus presentation and control conditions. The relationship of engagement with positive affect, represented by the variables of interest and pleasure, were high and positive. No relationship emerged for engagement with negative affect or agitated behavior. A consistent positive relationship was found between agitated behavior and negative affect, and in Sample 2, a negative relationship between agitated behavior and both pleasure and interest. This is the first study to examine relationships among variables that are typically examined individually and, in doing so, has clarified the nomenclature used to describe the constructs of affect, engagement, and agitated behaviors in persons with dementia. The finding that the constructs of engagement, agitated behavior, and affect are multidimensional and that relationships among these constructs occur for some of the dimensions is important for the development of interventions and for clear communication in practice and research.

  13. Wavepacket propagation using time-sliced semiclassical initial value methods.

    PubMed

    Wallace, Brett B; Reimers, Jeffrey R

    2004-12-22

    A new semiclassical initial value representation (SC-IVR) propagator and a SC-IVR propagator originally introduced by Kay [J. Chem. Phys. 100, 4432 (1994)], are investigated for use in the split-operator method for solving the time-dependent Schrodinger equation. It is shown that the SC-IVR propagators can be derived from a procedure involving modified Filinov filtering of the Van Vleck expression for the semiclassical propagator. The two SC-IVR propagators have been selected for investigation because they avoid the need to perform a coherent state basis set expansion that is necessary in other time-slicing propagation schemes. An efficient scheme for solving the propagators is introduced and can be considered to be a semiclassical form of the effective propagators of Makri [Chem. Phys. Lett. 159, 489 (1989)]. Results from applications to a one-dimensional, two-dimensional, and three-dimensional Hamiltonian for a double-well potential are presented.

  14. Initial NIF Shock Timing Experiments: Comparison with Simulation

    NASA Astrophysics Data System (ADS)

    Robey, H. F.; Celliers, P. M.; Boehly, T. R.; Datte, P. S.; Bowers, M. W.; Olson, R. E.; Munro, D. H.; Milovich, J. L.; Jones, O. S.; Nikroo, A.; Kroll, J. J.; Horner, J. B.; Hamza, A. V.; Bhandarkar, S. D.; Giraldez, E.; Castro, C.; Gibson, C. R.; Eggert, J. H.; Smith, R. F.; Park, H.-S.; Young, B. K.; Hsing, W. W.; Landen, O. L.; Meyerhofer, D. D.

    2010-11-01

    Initial experiments are underway to demonstrate the techniques required to tune the shock timing of capsule implosions on the National Ignition Facility (NIF). These experiments use a modified cryogenic hohlraum geometry designed to precisely match the performance of ignition hohlraums. The targets employ a re-entrant Au cone to provide optical access to the shocks as they propagate in the liquid deuterium-filled capsule interior. The strength and timing of the shocks is diagnosed with VISAR (Velocity Interferometer System for Any Reflector) and DANTE. The results of these measurements will be used to set the precision pulse shape for ignition capsule implosions to follow. Experimental results and comparisons with numerical simulation are presented.

  15. Timing accuracy in self-timed movements related to neural indicators of movement initiation.

    PubMed

    Maurer, Lisa K; Sammer, Gebhard; Bischoff, Matthias; Maurer, Heiko; Müller, Hermann

    2014-10-01

    Timely movement initiation is crucial in quick reactions or when a series of movements has to be strung together in a timed fashion to create a coordinated sequence. Stochastic neural variability can lead to misinitiation errors as reaction time studies suggest. Higher reaction times occur when preparatory neural activity reaches an initiation threshold later relative to shorter reaction times. Whether this also applies to self-timed movements is harder to scrutinize because they lack an external event that could serve as a reference for timing accuracy estimations. By example of a self-timed goal-oriented throwing task, we used a method that synchronizes the throwing movements by their kinematic profiles to assess relative timing differences in throwing release. We determined neural preparatory processes of the release using the movement-related electrophysiological Bereitschaftspotential (BP). By analyzing differences in shape and timing of the BP in delayed and non-delayed throws, two variables could be extracted that are related to timing differences on the kinematic level. First, temporal deviations in BP curves partly meet the kinematic deviations. Second, delayed releases were preceded by a short flattening of the BP curves prior to release. Thus, temporal and shape deviations in the neural movement initiation are assumed to delay self-timed movements. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Timing of multikinase inhibitor initiation in differentiated thyroid cancer.

    PubMed

    Brose, Marcia S; Smit, Jan Wa; Lin, Chia-Chi; Pitoia, Fabian; Fellous, Marc; DeSanctis, Yoriko; Schlumberger, Martin; Tori, Masayuki; Sugitani, Iwao

    2017-03-07

    There are limited treatment options for patients with radioactive iodine-refractory, progressive differentiated thyroid cancer. Although there is consensus that multikinase inhibitor therapy should be considered in patients with progressive disease with considerable tumor load or symptomatic disease, uncertainty exists on the optimal timing to treat with a multikinase inhibitor, especially for asymptomatic patients. RIFTOS MKI is an international, prospective, open-label, multicenter, noninterventional study with the primary objective to compare the time to symptomatic progression from study entry in asymptomatic patients with radioactive iodine -refractory, progressive differentiated thyroid cancer for whom there is a decision to initiate multikinase inhibitors at study entry (cohort 1) with those for whom there is a decision to not initiate multikinase inhibitors at study entry (cohort 2). Secondary endpoints are overall survival and progression-free survival, which will be compared between cohorts 1 and 2. Additional secondary endpoints are postprogression survival from time of symptomatic progression, duration of and response to each systemic treatment regimen, and dosing of sorafenib throughout the treatment period. Asymptomatic, multikinase inhibitor-naive patients aged ≥18 years with histologically/cytologically documented differentiated thyroid cancer that is radioactive iodine-refractory are eligible. Patients may receive any therapy for differentiated thyroid cancer, including sorafenib or other multikinase inhibitors if indicated and decided on by the treating physician. In total, 700 patients are estimated to be enrolled from >20 countries. Final analysis will be performed once the last enrolled patient has been followed up with for 24 months. (ClinicalTrials.gov identifier: NCT02303444).

  17. Time correlation between mononucleosis and initial symptoms of MS

    PubMed Central

    Endriz, John; Ho, Peggy P.

    2017-01-01

    Objective: To determine the average age of MS onset vs the age at which Epstein-Barr infection has previously occurred and stratify this analysis by sex and the blood level of Epstein-Barr nuclear antigen 1 (EBNA1) antibody. Methods: Using infectious mononucleosis (IM) as a temporal marker in data from the Swedish epidemiologic investigation of MS, 259 adult IM/MS cases were identified and then augmented to account for “missing” childhood data so that the average age of MS onset could be determined for cases binned by age of IM (as stratified by sex and EBNA1 titer level). Results: Mean age of IM vs mean age of MS reveals a positive time correlation for all IM ages (from ∼5 to ∼30 years), with IM-to-MS delay decreasing with increased age. When bifurcated by sex or EBNA1 blood titer levels, males and high-titer subpopulations show even stronger positive time correlation, while females and low-titer populations show negative time correlation in early childhood (long IM/MS delay). The correlation becomes positive in females beyond puberty. Conclusions: IM/MS time correlation implies causality if IM is time random. Alternative confounding models seem implausible, in light of constraints imposed by time-invariant delay observed here. Childhood infection with Epstein-Barr virus (EBV) in females and/or those genetically prone to low EBNA1 blood titers will develop MS slowly. Males and/or high EBNA1-prone develop MS more rapidly following IM infection at all ages. For all, postpubescent EBV infection is critical for the initiation and rapid development of MS. PMID:28271078

  18. Body Mass Index and Timing of Pubertal Initiation in Boys

    PubMed Central

    Lee, Joyce M.; Kaciroti, Niko; Appugliese, Danielle; Corwyn, Robert F.; Bradley, Robert H.; Lumeng, Julie C.

    2014-01-01

    Objective To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and timing of pubertal onset in a population-based sample of US boys. Design Longitudinal prospective study. Setting Ten US sites that participated in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Participants Of 705 boys initially enrolled in the study, information about height and weight measures and pubertal stage by age 11.5 years was available for 401 boys. Main Exposure The BMI trajectory created from measured heights and weights at ages 2, 3, 4.5, 7, 9, 9.5, 10.5, and 11.5 years. Main Outcome Measure Onset of puberty at age 11.5 years as measured by Tanner genitalia staging. Results Boys in the highest BMI trajectory (mean BMI z score at age 11.5 years, 1.84) had a greater relative risk of being prepubertal compared with boys in the lowest BMI trajectory (mean BMI z score at age 11.5 years, −0.76) (adjusted relative risk=2.63; 95% confidence interval, 1.05–6.61; P=.04). Conclusions The relationship between body fat and timing of pubertal onset is not the same in boys as it is in girls. Further studies are needed to better understand the physiological link between body fat and timing of pubertal onset in both sexes. PMID:20124142

  19. [Just-in-time initiation of optimal dialysis].

    PubMed

    Cornelis, Tom; Kooman, Jeroen P; van der Sande, Frank M

    2010-01-01

    The IDEAL trial shows that the decision to start renal replacement treatment should not depend on GFR alone, but should be taken on the basis of clinical parameters. Quality of Life (QoL) questionnaires and bio-impedance analysis are potential tools for detecting subtle changes in the predialysis clinic. Too early an initiation of dialysis may be deleterious for the patient and the healthcare system. We are convinced that ESRD patients should be informed about intensive haemodialysis (HD), especially nocturnal (home) HD, as the best available dialysis modality. There is substantial evidence which shows that intensive HD improves clinical, biochemical and biological parameters, and may even prolong survival. We believe that 'just-in-time delivery of intensive haemodialysis' may result in optimised QoL and reduced economic burden.

  20. The effects of excipients on protein aggregation during agitation: an interfacial shear rheology study.

    PubMed

    Liu, Lu; Qi, Wei; Schwartz, Daniel K; Randolph, Theodore W; Carpenter, John F

    2013-08-01

    We investigated the effects of excipients in solutions of keratinocyte growth factor 2 (KGF-2) on protein aggregation during agitation as well as on interfacial shear rheology at the air-water interface. Samples were incubated with or without agitation, and in the presence or absence of the excipients heparin, sucrose, or polysorbate 80 (PS80). The effect of excipients on the extent of protein aggregation was determined by UV-visible spectroscopy and micro-flow imaging. Interfacial shear rheology was used to detect the gelation time and strength of protein gels at the air-water interface. During incubation, protein particles of size ≥1 μm and insoluble aggregates formed faster for KGF-2 solutions subjected to agitation. Addition of either heparin or sucrose promoted protein aggregation during agitation. In contrast, PS80 substantially inhibited agitation-induced KGF-2 aggregation but facilitated protein particulate formation in quiescent solutions. The combination of PS80 and heparin or sucrose completely prevented protein aggregation during both nonagitated and agitated incubations. Interfacial rheological measurements showed that KGF-2 in buffer alone formed an interfacial gel within a few minutes. In the presence of heparin, KGF-2 interfacial gels formed too quickly for gelation time to be determined. KGF-2 formed gels in about 10 min in the presence of sucrose. The presence of PS80 in the formulation inhibited gelation of KGF-2. Furthermore, the interfacial gels formed by the protein in the absence of PS80 were reversible when PS80 was added to the samples after gelation. Therefore, there is a correspondence between formulations that exhibited interfacial gelation and formulations that exhibited agitation-induced aggregation.

  1. Chronic divalproex sodium to attenuate agitation and clinical progression of Alzheimer disease.

    PubMed

    Tariot, Pierre N; Schneider, Lon S; Cummings, Jeffrey; Thomas, Ronald G; Raman, Rema; Jakimovich, Laura J; Loy, Rebekah; Bartocci, Barbara; Fleisher, Adam; Ismail, M Saleem; Porsteinsson, Anton; Weiner, Michael; Jack, Clifford R; Thal, Leon; Aisen, Paul S

    2011-08-01

    Agitation and psychosis are common in Alzheimer disease and cause considerable morbidity. We attempted to delay or to prevent agitation and psychosis with the use of divalproex sodium (valproate). To determine whether treatment with valproate could delay or prevent emergence of agitation or psychosis. A multicenter, randomized, double-blind, placebo-controlled trial of flexible-dose valproate in 313 (of 513 screened) individuals with moderate Alzheimer disease who had not yet experienced agitation or psychosis. The study was conducted from November 1, 2005, through March 31, 2009, at 46 sites in the United States. Participants were randomly assigned to valproate treatment at a target dose of 10 to 12 mg per kilogram of body weight per day or identical-appearing placebo for 24 months followed by a 2-month period of single-blind placebo treatment. Time to emergence of clinically significant agitation or psychosis. A total of 122 participants (59 receiving valproate and 63 receiving placebo) completed 24 months of treatment while taking study medication; 42 (27 receiving valproate and 15 receiving placebo) reached 24 months having discontinued study medication; 150 reached month 26. There was no difference between groups in time to emergence of agitation or psychosis (Cox proportional hazard ratio, 0.96; P = .88). There was no difference between groups in change on any secondary outcome. The valproate group had higher rates of somnolence, gait disturbance, tremor, diarrhea, and weakness. Eighty-eight participants underwent magnetic resonance imaging scans at baseline and 12 months; the valproate group showed greater loss in hippocampal and whole-brain volume, accompanied by greater ventricular expansion (P < .001). Valproate treatment did not delay emergence of agitation or psychosis or slow cognitive or functional decline in patients with moderate Alzheimer disease and was associated with significant toxic effects.

  2. 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.

  3. Initial Studies Toward Real-Time Transmission Path Rating

    SciTech Connect

    Singh, Ruchi; Diao, Ruisheng; Cai, Niannian; Huang, Zhenyu; Tuck, Brian; Guo, Xinxin

    2012-07-26

    Demand continues to increase while transmission line construction is being constrained by multiple factors— economic, environmental, and political. Effective and efficient utilization of transmission lines is thus of great importance in an open access environment. Large blocks of power are transferred from areas with inexpensive generation to heavy load demand areas or areas with high generation costs. This results in some transmission paths being loaded closer to their path ratings, which limits further power transfer between areas. Traditionally, rating of important paths was determined off line by assuming the worst-case study scenario; once determined, it could be used for years. With increasing uncertainty arising from rapid growth of renewable energy and smart technologies, path rating studies are needed in near-real time to account for the latest system status and support a reliable and economic power grid. This paper adopts a simplified procedure based on standards of the North American Electric Reliability Corporation (NERC) to determine total transfer capability (TTC) or transfer limit for the purpose of demonstrating the benefits and necessity of real-time path rating. Initial studies are conducted to compute TTC of a two-area test system and a 39-bus test system. Results indicate that path rating can be significantly affected by loading conditions, generator schedules, system topology and other factors.

  4. 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

  5. Sleep disturbances and nocturnal agitation behaviors in older adults with dementia.

    PubMed

    Rose, Karen M; Beck, Cornelia; Tsai, Pao-Feng; Liem, Pham H; Davila, David G; Kleban, Morton; Gooneratne, Nalaka S; Kalra, Gurpreet; Richards, Kathy Culpepper

    2011-06-01

    To examine nighttime sleep patterns of persons with dementia showing nocturnal agitation behaviors and to determine whether restless legs syndrome (RLS), periodic limb movements in sleep (PLMS), and obstructive sleep apnea (OSA) are associated with nocturnal agitation behaviors. Cross-sectional. General community. 59 participants with geriatrician-diagnosed dementia. Participants ages ranged from 66 to 88 years (mean age 79.1; SD 6.0). Mean Mini Mental State Examination (MMSE) score was 20.1 (SD 6.6). MMSE was used to measure baseline cognitive function and not for the diagnosis of dementia. None. Sleep was measured by 2 nights of in-home, attended, portable polysomnography (PSG). Nocturnal agitation was measured over 3 additional nights using the Cohen-Mansfield Agitation Inventory modified for direct observations. Two experts independently and via consensus identified probable RLS. Total sleep time in participants was 5.6 h (SD 1.8 h). Mean periodic limb movements in sleep index (PLMI) was 15.29, and a high percentage (49%) had moderate to severe obstructive sleep apnea. Probable RLS was present in 24% of participants. Those with more severe cognitive impairment had longer sleep latency. Severe cognitive impairment, low apnea hypopnea index (AHI), and probable RLS were associated with nocturnal agitation behaviors (R(2) = 0.35, F(3,55) = 9.40, P < 0.001). It appears that probable RLS is associated with nocturnal agitation behaviors in persons with dementia, while OSA and PLMS are not. Further investigation is warranted to determine if treatment of RLS impacts nocturnal agitation behaviors in persons with dementia.

  6. Constraining Initiation and Onset Time of Plate Tectonics on Earth

    NASA Astrophysics Data System (ADS)

    Roller, G.

    2014-12-01

    The onset time for modern-style plate tectonics is still heavily debated among geoscientists. Proposed timings range from the Phanerozoic to the Hadean. Here I present a new theoretical approach to tackle this question. I combine ideas of nuclear astrophysics and geochronology and apply the concept of sudden nucleosynthesis to calculate so-called nucleogeochronometric Rhenium-Osmium model ages. Sudden nucleosynthesis has been suggested by nuclear theory [1-2] as a possible mechanism for the creation of the heavy isotopes. Hence, this concept may generally be used to identify rapid (r-) neutron-capture process events. For Earth, nucleogeochronometric model age calculations based upon published pyroxenite and komatiite data [3-5] point to an r-process event around 3 Ga. Since the r-process requires high neutron densities and temperatures within seconds, a gravitational core collapse forming at least a part of the inner core is discussed as a possible cause, thus initiating modern-style plate tectonics at that time. This age is in line with an earlier proposed value of 2.7 Ga for an inner core forming event [6], pronounced changes in the magnitude of the geomagnetic field and geological evidence like the onset of extensive plutonism and crust formation starting around the Archean-Proterozoic transition. Besides, results from nucleogeochronometric age calculations for published peridotitic pentlandites [7] lead to corrections as to their previously inconsistent model ages: These are now in good agreement with their Proterozoic 1.43 Ga isochronous regression line, supporting the model. [1] Burbidge et al. (1957) Revs. Mod. Phys. 29, 547 - 650. [2] Hoyle et al. (1960) ApJ 132, 565 - 590. [3] Reisberg et al. (1991) Earth Planet. Sci. Lett. 105, 196 - 213. [4] Roy-Barman et al. (1996) Chem. Geol. 130, 55 - 64. [5] Luck et al. (1984) Earth Planet Sci. Lett. 68, 205 - 208. [6] Hale (1987) Nature 329, 233 -237. [7] Smit et al. (2010) Geochim. Cosmochim. Acta 74, 3292 - 3306.

  7. Chlorpromazine for psychosis induced aggression or agitation.

    PubMed

    Ahmed, Uzair; Jones, Hannah; Adams, Clive E

    2010-04-14

    Agitated or violent behaviour constitutes 10% of all emergency psychiatric treatment. Some guidelines do not recommend the use of chlorpromazine for rapid tranquillisation but it is still often used for this purpose. To examine the effects of oral or intramuscular chlorpromazine for psychosis induced agitation or aggression. We searched the Cochrane Schizophrenia Group Trials Register (up to July 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. Randomised control trials or double blind trials (implying randomisation) comparing chlorpromazine with another drug or placebo for people who are thought to be acutely aggressive or agitated due to psychotic illness. We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed-effects model. One study (total n=30) met the inclusion criteria. When compared with haloperidol (Man 1973) (1 RCT, n=30) people allocated chlorpromazine were no more likely to have one additional injection than those allocated haloperidol (RR 3.00 CI 0.13 to 68.26). This remained true for 2-4 injections (RR 0.90 CI 0.52 to 1.55) and for 5 or more injections (RR 0.75 CI 0.20 to 2.79). Two people allocated chlorpromazine had sudden, serious hypotension while no one allocated haloperidol had such an effect (RR 5.00 CI 0.26 to 96.13). No extrapyramidal symptoms were observed. One person allocated chlorpromazine developed status epilepticus (RR 3.00 CI 0.13 to 68.26). Overall the quality of evidence is limited, poor and dated. Where drugs that have been better evaluated are available, it may be best to avoid use of chlorpromazine. Where chlorpromazine is used for acute aggression or where choices are limited, relevant trials are possible and urgently needed.

  8. Fuel agitating device for internal combustion engine

    SciTech Connect

    Scouten, D.G.

    1992-09-22

    This patent describes an agitator for fuel being conducted to an internal combustion engine. It comprises: a casing, a chamber within the casing between the fuel inlet conduit and the fuel outlet conduit, flow divider means in the chamber for dividing the chamber into a plurality of fuel flow paths on opposite sides thereof, an inner wall in the casing defining the exit portion, flange means in the casing within the chamber and spaced radially inwardly from the inner wall, and conduit means within the flange means for conducting fuel to the outlet conduit.

  9. Initial treatment patterns over time for anaplastic oligodendroglial tumors

    PubMed Central

    Panageas, Katherine S.; Iwamoto, Fabio M.; Cloughesy, Timothy F.; Aldape, Kenneth D.; Rivera, Andreana L.; Eichler, April F.; Louis, David N.; Paleologos, Nina A.; Fisher, Barbara J.; Ashby, Lynn S.; Cairncross, J. Gregory; Roldán Urgoiti, Gloria B.; Wen, Patrick Y.; Ligon, Keith L.; Schiff, David; Robins, H. Ian; Rocque, Brandon G.; Chamberlain, Marc C.; Mason, Warren P.; Weaver, Susan A.; Green, Richard M.; Kamar, Francois G.; Abrey, Lauren E.; DeAngelis, Lisa M.; Jhanwar, Suresh C.; Rosenblum, Marc K.; Lassman, Andrew B.

    2012-01-01

    Anaplastic oligodendroglial tumors are rare neoplasms with no standard approach to treatment. We sought to determine patterns of treatment delivered over time and identify clinical correlates of specific strategies using an international retrospective cohort of 1013 patients diagnosed from 1981–2007. Prior to 1990, most patients received radiotherapy (RT) alone as initial postoperative treatment. After 1990, approximately 50% of patients received both RT and chemotherapy (CT) sequentially and/or concurrently. Treatment with RT alone became significantly less common (67% in 1980–1984 vs 5% in 2005–2007, P < .0001). CT alone was more frequently administered in later years (0% in 1980–1984 vs 38% in 2005–2007; P < .0001), especially in patients with 1p19q codeleted tumors (57% of codeleted vs 4% with no deletion in 2005–2007; P < .0001). Temozolomide replaced the combination of procarbazine, lomustine, and vincristine (PCV) among patients who received CT alone or with RT (87% vs 2% in 2005–2007). In the most recent time period, patients with 1p19q codeleted tumors were significantly more likely to receive CT alone (with temozolomide), whereas RT with temozolomide was a significantly more common treatment strategy than either CT or RT alone in cases with no deletion (P < .0001). In a multivariate polytomous logistic regression model, the following were significantly associated with type of treatment delivered: date (5-year interval) of diagnosis (P < .0001), 1p19q codeletion (P < .0001), pure anaplastic oligodendroglioma histology (P < .01), and frontal lobe predominance (P < .05). Limited level 1 evidence is currently available to guide treatment decisions, and ongoing phase III trials will be critical to understanding the optimal therapy. PMID:22661585

  10. Detonation initiation on the microsecond time scale: DDTs

    SciTech Connect

    Kuehn, Jeffery A; Kassoy, Dr. David R; Nabity, Mr. Matthew W.; Clarke, Dr. John F.

    2006-01-01

    Spatially resolved, thermal power deposition of limited duration into a finite volume of reactive gas is the initiator for a deflagration-to-detonation transition (DDT) on the microsecond time scale. The reactive Euler equations with one-step Arrhenius kinetics are used to derive novel formulas for velocity and temperature variation that describe the physical phenomena characteristic of DDTs. A nonlinear transformation of the variables is shown to yield a canonical equation system, independent of the activation energy. Numerical solutions of the reactive Euler equations are used to describe the detailed sequence of reactive gas dynamic processes leading to an overdriven planar detonation far from the power deposition location. Results are presented for deposition into a region isolated from the planar boundary of the reactive gas as well as for that adjacent to the boundary. The role of compressions and shocks reflected from the boundary into the partially reacted hot gas is described. The quantitative dependences of DDT evolution on the magnitude of thermal power deposition and activation energy are identified.

  11. Detonation initiation on the microsecond time scale: DDTs

    SciTech Connect

    Kassoy, Dr. David R; Kuehn, Jeffery A; Nabity, Mr. Matthew W.; Clarke, Dr. John F.

    2008-01-01

    Spatially resolved, thermal power deposition of limited duration into a finite volume of reactive gas is the initiator for a deflagration-to-detonation transition (DDT) on the microsecond time scale. The reactive Euler equations with one-step Arrhenius kinetics are used to derive novel formulas for velocity and temperature variation that describe the physical phenomena characteristic of DDTs. A transformation of the variables is shown to yield a canonical equation system, independent of the activation energy. Numerical solutions of the reactive Euler equations are used to describe the detailed sequence of reactive gasdynamic processes leading to an overdriven planar detonation far from the power deposition location. Results are presented for deposition into a region isolated from the planar boundary of the reactive gas as well as for that adjacent to the boundary. The role of compressions and shocks reflected from the boundary into the partially reacted hot gas is described. The quantitative dependences of DDT evolution on the magnitude of thermal power deposition and activation energy are identified.

  12. Initial Kernel Timing Using a Simple PIM Performance Model

    NASA Technical Reports Server (NTRS)

    Katz, Daniel S.; Block, Gary L.; Springer, Paul L.; Sterling, Thomas; Brockman, Jay B.; Callahan, David

    2005-01-01

    This presentation will describe some initial results of paper-and-pencil studies of 4 or 5 application kernels applied to a processor-in-memory (PIM) system roughly similar to the Cascade Lightweight Processor (LWP). The application kernels are: * Linked list traversal * Sun of leaf nodes on a tree * Bitonic sort * Vector sum * Gaussian elimination The intent of this work is to guide and validate work on the Cascade project in the areas of compilers, simulators, and languages. We will first discuss the generic PIM structure. Then, we will explain the concepts needed to program a parallel PIM system (locality, threads, parcels). Next, we will present a simple PIM performance model that will be used in the remainder of the presentation. For each kernel, we will then present a set of codes, including codes for a single PIM node, and codes for multiple PIM nodes that move data to threads and move threads to data. These codes are written at a fairly low level, between assembly and C, but much closer to C than to assembly. For each code, we will present some hand-drafted timing forecasts, based on the simple PIM performance model. Finally, we will conclude by discussing what we have learned from this work, including what programming styles seem to work best, from the point-of-view of both expressiveness and performance.

  13. 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.

  14. Finite element analysis of vessel nozzle for agitator supports

    SciTech Connect

    Wong, D.M.

    1996-12-01

    There are many industrial applications involving agitators/mixers supported by a vessel head and nozzle. The flow-induced agitator loads are often neglected or only partially considered in the vessel design stage. Inadequate supports reduce agitator drive operating life and in most cases promote vibration problems leading to fatigue failures. The vessel head and nozzle should be stiff enough to withstand the induced agitator loads. Some of the more significant design criteria are: (1) nozzle and head stiffness should be at least 1 million lb/in; (2) agitator shaft deflection should not be more than 1/32 inch per foot of shaft extension; (3) agitator support plane should not rotate more than 0.15 degree. This paper deals with a parametric finite element study of three tank sizes (4 ft., 8 ft. and 12 ft. diameter) to verify the validity and ease of compliance of these criteria in vessel design.

  15. Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease.

    PubMed

    Martin, J; Marler, M; Shochat, T; Ancoli-Israel, S

    2000-05-01

    Agitation is a common problem in institutionalized patients with Alzheimer's disease (AD). "Sundowning," or agitation that occurs primarily in the evening, is estimated to occur in 10-25% of nursing home patients. The current study examined circadian patterns of agitation in 85 patients with AD living in nursing homes in the San Diego, California, area. Agitation was assessed using behavioral ratings collected every 15 minutes over 3 days, and activity and light exposure data were collected continuously using Actillume recorders. A five-parameter extension of the traditional cosine function was used to describe the circadian rhythms. The mean acrophase for agitation was 14:38, although there was considerable variability in the agitation rhythms displayed by the patients. Agitation rhythms were more robust than activity rhythms. Surprisingly, only 2 patients (2.4%) were "sundowners." In general, patients were exposed to very low levels of illumination, with higher illumination during the night being associated with less robust agitation rhythms with higher rhythm minima (i.e., some agitation present throughout the day and night). Seasonality was examined; however, there were no consistent seasonal patterns found. This is the largest study to date to examine agitation rhythms using behavioral observations over multiple 24 h periods. The results suggest that, although sundowning is uncommon, agitation appears to have a strong circadian component in most patients that is related to light exposure, sleep, and medication use. Further research into the understanding of agitation rhythms is needed to examine the potential effects of interventions targeting sleep and circadian rhythms.

  16. Full moon: does it influence agitated nursing home residents?

    PubMed

    Cohen-Mansfield, J; Marx, M S; Werner, P

    1989-07-01

    This study examined the effect of the full moon on agitation manifested by nursing home residents (N = 24). Observations of agitation were recorded on a behavioral mapping instrument, and occurrence of the full moon was operationalized in the three ways most commonly cited in the literature. The hypothesis that elderly nursing home residents become increasingly agitated during a full moon was not supported by this study. In all analyses, agitation was observed less often when the full moon was full than during the other three lunar phases, although differences were not statistically significant.

  17. Open Source Initiative Powers Real-Time Data Streams

    NASA Technical Reports Server (NTRS)

    2014-01-01

    Under an SBIR contract with Dryden Flight Research Center, Creare Inc. developed a data collection tool called the Ring Buffered Network Bus. The technology has now been released under an open source license and is hosted by the Open Source DataTurbine Initiative. DataTurbine allows anyone to stream live data from sensors, labs, cameras, ocean buoys, cell phones, and more.

  18. On the decreasing number of potash alum small crystals suspended in an agitated supersaturated solution

    NASA Astrophysics Data System (ADS)

    Kubota, N.; Mullin, J. W.

    1984-05-01

    Secondary nuclei, contact-generated in an agitated supersaturated solution of potash alum, decrease in number over a relatively short period of time as a result of agglomeration. This behaviour, which has not been fully appreciated in earlier studies, points to the need for caution when attempting to assess the growth characteristics of very small crystals.

  19. 42 CFR 405.922 - Time frame for processing initial determinations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Time frame for processing initial determinations..., Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B) Initial Determinations § 405.922 Time frame for processing initial determinations. The contractor issues initial determinations...

  20. Sleep disturbance, nocturnal agitation behaviors, and medical comorbidity in older adults with dementia: relationship to reported caregiver burden.

    PubMed

    Kim, Suk-Sun; Oh, Kyeung Mi; Richards, Kathy

    2014-01-01

    The purpose of this secondary analysis study was to determine whether care recipients' nighttime sleep patterns, medical comorbidity, observed nocturnal agitation behaviors, and caregivers' perceptions of nocturnal agitation behaviors in care recipients with dementia are associated with caregiver burden. Sixty care recipient-caregiver dyads, comprising older adults with geriatrician-diagnosed dementia living at home with caregivers, participated. Caregivers' perceptions of the frequency of care recipients' nocturnal agitation behaviors were associated with caregiver burden; however, objective, real-time data on the frequency of nocturnal agitation behaviors were not associated with burden. Care recipients' increased minutes of wakefulness before falling asleep and severe cognitive impairment with musculoskeletal/integument and neurological comorbidities were associated with higher caregiver burden. These results suggest that targeted interventions to reduce sleep onset latency, medical comorbidity, and caregivers' perception of frequency of nocturnal behaviors may reduce caregiver burden. Copyright 2014, SLACK Incorporated.

  1. Lateral root initiation: one step at a time.

    PubMed

    De Smet, Ive

    2012-03-01

    Plant growth relies heavily on a root system that is hidden belowground, which develops post-embryonically through the formation of lateral roots. The de novo formation of lateral root organs requires tightly coordinated asymmetric cell division of a limited number of pericycle cells located at the xylem pole. This typically involves the formation of founder cells, followed by a number of cellular changes until the cells divide and give rise to two unequally sized daughter cells. Over the past few years, our knowledge of the regulatory mechanisms behind lateral root initiation has increased dramatically. Here, I will summarize these recent advances, focusing on the prominent role of auxin and cell cycle activity, and elaborating on the three key steps of pericycle cell priming, founder cell establishment and asymmetric cell division. Taken together, recent findings suggest a tentative model in which successive auxin response modules are crucial for lateral root initiation, and additional factors provide more layers of control.

  2. Modelling gas exchange during platelet storage without agitation.

    PubMed

    Torres, R; Tormey, C A

    2016-11-01

    The aim of this study was to create a model of oxygen distribution within platelet storage bags to evaluate implications of reduced agitation approaches. Based on our model, platelet concentration and surface area most affect internal partial pressure of oxygen, while temperature modifications have least effect, indicating primary potential approaches for optimization of platelet storage with reduced or absent agitation.

  3. AVP-786 for the treatment of agitation in dementia of the Alzheimer's type.

    PubMed

    Garay, Ricardo P; Grossberg, George T

    2017-01-01

    Agitation is common and distressing in patients with Alzheimer-type dementia, but safe, effective treatments remain elusive. Psychological treatments are first-line options, but they have limited efficacy. Off-label psychotropic medications are frequently used, but they also have limited effectiveness, and their use may have harmful side effects, including death. Areas covered: This review discusses the history leading to the conception of AVP-786 (deuterated (d6)-dextromethorphan/quinidine), its pharmacokinetic and pharmacodynamic profiles and safety issues, together with an overview of recent clinical trials. Data were found in the medical literature, in US and EU clinical trial registries and in information provided by the manufacturer. Expert opinion: AVP-786 is one of six investigational compounds in recent phase III clinical development for agitation in Alzheimer disease (AD). Quinidine and deuteration appear to prolong dextromethorphan's plasma half-life and facilitate brain penetration. The FDA granted fast-track designation to AVP-786 and allowed use of data generated on dextromethorphan-quinidine (AVP-923, Nuedexta®) for regulatory filings. AVP-923 reduced agitation in AD and was well tolerated in a phase II RCT that included more than 200 patients. A phase III clinical development program of AVP-786 for AD agitation was recently initiated. This program is expected to start generating results in July 2018.

  4. Symptoms of agitated depression and/or akathisia.

    PubMed

    Peitl, Marija Vučić; Prološčić, Joško; Blažević-Zelić, Sandra; Skarpa-Usmiani, Ivona; Peitl, Vjekoslav

    2011-03-01

    Akathisia is a syndrome characterized by the unpleasant sensation of "inner" restlessness that manifests itself in the inability of sitting still or not moving. Many types of medicaments can cause akathisia as an adverse event of their use and they include: antipsychotics, antidepressants, antiemetics, antihistamines, and psychoactive substances. We will present the case of a 50 year old patient, treated on two occasions for psychotic depression. During the second hospitalization it is possible that antipsychotic treatment combined with an antidepressant caused akathisia or there were symptoms of agitated depression and akathisia present at the same time, which is very difficult to determine in everyday clinical practice. We can conclude that in this case, as in many others, akathisia as a possible adverse effect of psychopharmacs was very hard to identify. Therefore, it is necessary to have akathisia in mind when using certain medicaments, especially when combining several that use the same enzymatic system and consequently raise levels of at least one of them.

  5. Effect of Preferred Music on Agitation After Traumatic Brain Injury.

    PubMed

    Park, Soohyun; Williams, Reg Arthur; Lee, Donghyun

    2016-04-01

    Agitation is a common behavioral problem after traumatic brain injury (TBI), which threatens the safety of patients and caregivers and disrupts the rehabilitation process. This study aimed to evaluate the effects of a preferred music intervention on the reduction of agitation in TBI patients and to compare the effects of preferred music with those of classical "relaxation" music. A single group, within-subjects, randomized crossover trial design was formed, consisting of 14 agitated patients with cognitive impairment after severe TBI. Patients listened to preferred music and classical "relaxation" music, with a wash-out period in between. Patients listening to the preferred music reported a significantly greater reduction in agitation compared with the effect seen during the classical "relaxation" music intervention (p = .046). These findings provide preliminary evidence that the preferred music intervention may be effective as an environmental therapeutic approach for reducing agitation after TBI.

  6. Effects of Tween 80 on cellulase stability under agitated conditions.

    PubMed

    Okino, Shohei; Ikeo, Makoto; Ueno, Yoshiki; Taneda, Daisuke

    2013-08-01

    The mechanism of the increase in the hydrolysis rate and yield by the addition of Tween 80 to the hydrolysis reaction of filter paper was investigated under static and agitated conditions. The increase in the hydrolysis rate by addition of Tween 80 was observed under the agitated condition only. The effects of Tween 80 on the changes in the protein concentration of individual cellulase components were investigated in the absence of substrates. Agitation of the enzyme solution resulted in the drastic decrease of SDS-PAGE bands intensity of CBH2 (cellobiohydrolase 2). The addition of Tween 80 prevented this. Thus, the Tween 80 functions to stabilize instable cellulase components under the agitated condition. Moreover, addition of Tween 80 completely suppressed the decrease of CBH2 intensity by agitation at 30°C. Results suggest that Tween 80 stabilizes instable cellulase components not only during hydrolysis, but during enzyme production also.

  7. Protocol for the management of psychiatric patients with psychomotor agitation.

    PubMed

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

    2017-09-08

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

  8. Time-Distance Helioseismology with the MDI Instrument: Initial Results

    NASA Technical Reports Server (NTRS)

    Duvall, T. L., Jr.; Kosovichev, A. G.; Scherrer, P. H.; Bogart, R. S.; Bush, R. I.; DeForest, C.; Hoeksema, J. T.; Schou, J.; Saba, J. L. R.; Tarbell, T. D.; Title, A. M.; Wolfson, C. J.; Milford, P. N.

    1997-01-01

    In time-distance helioseismology, the travel time of acoustic waves is measured between various points on the solar surface. To some approximation, the waves can be considered to follow ray paths that depend only on a mean solar model, with the curvature of the ray paths being caused by the increasing sound speed with depth below the surface. The travel time is effected by various inhomogeneities along the ray path, including flows, temperature inhomogeneities, and magnetic fields. By measuring a large number of times between different locations and using an inversion method, it is possible to construct 3-dimensional maps of the subsurface inhomogeneities. The SOI/MDI experiment on SOHO has several unique capabilities for time-distance helioseismology. The great stability of the images observed without benefit of an intervening atmosphere is quite striking. It his made it possible for us to detect the travel time fo separations of points as small as 2.4 Mm in the high-resolution mode of MDI (0.6 arc sec 1/pixel). This has enabled the detection of the supergranulation flow. Coupled with the inversion technique, we can now study the 3-dimensional evolution of the flows near the solar surface.

  9. Mechanical agitation induces counterintuitive aggregation of pre-dispersed carbon nanotubes.

    PubMed

    Fernandes, Ricardo M F; Buzaglo, Matat; Regev, Oren; Furó, István; Marques, Eduardo F

    2017-05-01

    Mechanical agitation is commonly used to fragment and disperse insoluble materials in liquids. However, here we show that when pristine single-walled carbon nanotubes pre-dispersed in water are subject to vortex-shaking for very short periods (typically 10-60s, power density ∼0.002WmL(-1)), re-aggregation counterintuitively occurs. The initial dispersions are produced using surfactants as dispersants and powerful tip sonication (∼1WmL(-1)) followed by centrifugation. Detailed imaging by light and electron microscopies shows that the vortex-induced aggregates consist of loose networks (1-10(2)μm in size) of intertwined tubes and thin bundles. The average aggregate size increases with vortexing time in an apparently logarithmic manner and depends on the dispersant used, initial concentration of nanotubes and size distribution of bundles. The aggregation is, nonetheless, reversible: if the vortex-shaken dispersions are mildly bath-sonicated (∼0.03WmL(-1)), the flocs break down and re-dispersal occurs. Molecular insight for the mechanism behind this surprising phenomenon is put forth.

  10. Prazosin for the treatment of behavioral symptoms in patients with Alzheimer disease with agitation and aggression.

    PubMed

    Wang, Lucy Y; Shofer, Jane B; Rohde, Kirsten; Hart, Kim L; Hoff, David J; McFall, Yun H; Raskind, Murray A; Peskind, Elaine R

    2009-09-01

    Agitation/aggression in Alzheimer disease (AD) is a major cause of patient distress, caregiver burden, and institutionalization. Enhanced behavioral responsiveness to central nervous system norepinephrine (NE) release may contribute to the pathophysiology of agitation/aggression in AD. Prazosin, a nonsedating generic medication used for hypertension and benign prostatic hypertrophy, antagonizes NE effects at brain postsynaptic alpha-1 adrenoreceptors. This pilot study examined the efficacy and tolerability of prazosin for behavioral symptoms in patients with agitation/aggression in AD. Double-blind, placebo controlled, parallel group study. A university AD center and a nursing home in Seattle, WA. Twenty-two nursing home and community-dwelling participants with agitation/aggression and probable or possible AD (mean age: 80.6 +/- 11.2). Randomization to placebo (N = 11) or prazosin (N = 11). Medication was initiated at 1 mg/day and increased up to 6 mg/day using a flexible dosing algorithm. The Brief Psychiatric Rating Scale (BPRS) and Neuropsychiatric Inventory (NPI) at Weeks 1, 2, 4, 6, and 8. The Clinical Global Impression of Change (CGIC) at Week 8. Participants taking prazosin (mean dose: 5.7 +/- 0.9 mg/day) had greater improvements than those taking placebo (mean dose: 5.6 +/- 1.2 mg/day) on the NPI (mean change: -19 +/- 21 versus -2 +/- 15, chi = 6.32, df = 1, p = 0.012) and BPRS (mean change: -9 +/- 9 versus -3 +/- 5, chi = 4.42, df = 1, p = 0.036) based on linear mixed effects models and the CGIC (mean: 2.6 +/- 1.0 versus 4.5 +/- 1.6, z = 2.57, p = 0.011 [Mann-Whitney test]). Adverse effects and blood pressure changes were similar between prazosin and placebo groups. Prazosin was well tolerated and improved behavioral symptoms in patients with agitation/aggression in AD.

  11. Nanocellulose Composite Materials Synthesizes with Ultrasonic Agitation

    NASA Astrophysics Data System (ADS)

    Kidd, Timothy; Folken, Andrew; Fritch, Byron; Bradley, Derek

    We have extended current techniques in forming nanocellulose composite solids, suspensions and aerogels to enhance the breakdown of cellulose into its molecular components. Using only mechanical processing which includes ball milling, using a simple mortar and pestle, and ultrasonic agitation, we are able to create very low concentration uniform nanocellulose suspensions in water, as well as incorporate other materials such as graphite, carbon nanotubes, and magnetic materials. Of interest is that no chemical processing is necessary, nor is the use of nanoparticles, necessary for composite formation. Using both graphite and carbon nanotubes, we are able to achieve conducting nanocellulose solids and aerogels. Standard magnetic powder can also be incorporated to create magnetic solids. The technique also allows for the creation of an extremely fine nanocellulose suspension in water. Using extremely low concentrations, less than 1% cellulose by mass, along with careful control over processing parameters, we are able to achieve highly dilute, yet homogenous nanocellulose suspensions. When air dried, these suspensions have similar hardness and strength properties to those created with more typical starting cellulose concentrations (2-10%). However, when freeze-dried, these dilute suspensions form aerogels with a new morphology with much higher surface area than those with higher starting concentrations. We are currently examining the effect of this higher surface area on the properties of nanocellulose aerogel composites and how it influences the impact of incorporating nanocellulose into other polymer materials.

  12. Initial Validation of NDVI time seriesfrom AVHRR, VEGETATION, and MODIS

    NASA Technical Reports Server (NTRS)

    Morisette, Jeffrey T.; Pinzon, Jorge E.; Brown, Molly E.; Tucker, Jim; Justice, Christopher O.

    2004-01-01

    The paper will address Theme 7: Multi-sensor opportunities for VEGETATION. We present analysis of a long-term vegetation record derived from three moderate resolution sensors: AVHRR, VEGETATION, and MODIS. While empirically based manipulation can ensure agreement between the three data sets, there is a need to validate the series. This paper uses atmospherically corrected ETM+ data available over the EOS Land Validation Core Sites as an independent data set with which to compare the time series. We use ETM+ data from 15 globally distributed sites, 7 of which contain repeat coverage in time. These high-resolution data are compared to the values of each sensor by spatially aggregating the ETM+ to each specific sensors' spatial coverage. The aggregated ETM+ value provides a point estimate for a specific site on a specific date. The standard deviation of that point estimate is used to construct a confidence interval for that point estimate. The values from each moderate resolution sensor are then evaluated with respect to that confident interval. Result show that AVHRR, VEGETATION, and MODIS data can be combined to assess temporal uncertainties and address data continuity issues and that the atmospherically corrected ETM+ data provide an independent source with which to compare that record. The final product is a consistent time series climate record that links historical observations to current and future measurements.

  13. 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

  14. [The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation].

    PubMed

    Namigar, Turgut; Serap, Karacalar; Esra, Akdaş Tekin; Özgül, Odacılar; Can, Öztürk Ali; Aysel, Ak; Achmet, Ali

    Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that previously stated goals are well achieved as the risk of complications of oversedation is minimized. We revised and prospectively tested the Ramsay Sedation Scale (RSS) for interrater reliability and compared it with the Riker Sedation-Agitation Scale (RSAS) and the Richmond Agitation Sedation Scale (RASS) to test construct validity during midazolam-remifentanil sedation. A convenience sample of ICU patients was simultaneously and independently examined by pairs of trained evaluators by using the revised RSAS, RSS, and RASS. Ninety-two ICU patients were examined a total of 276 times by evaluator pairs. The mean patient age was 61.32±18.68years, 45,7% were female (n=42), 54.3% male (n=50). Their APACHE values varied between 3 and 39 with an average of 13.27±7.86 and 75% of the cases were under mechanical ventilation. When classified by using RSS (2.70±1.28), 10.9% were anxious or agitated (RSS1), 68.5% were calm (RSS 2-3), and 20.6% were sedated (RSS 4-6). When classified by using RASS (-0.64±1.58), 20.7% were anxious or agitated (RASS+1 to +4), 63.0% were calm (RASS 0 to -2), and 16.3% were sedated (RASS -3 to -5). When classified by using RSAS (2.63±1.00), 12% were anxious or agitated (RSAS 5-7), 57.6% were calm (RSAS 4), and 30.4% were sedated (RSAS 1-3). RSS was correlated with the RSAS (r=-0.656, p<0.001) and RASS was correlated with the RSAS (r=0.565, p<0.001). RSS was highly correlated with the RASS (r=-0.664, p<0.001). Ramsay is both reliable and valid (high correlation with the RASS and RSAS scales) in assessing agitation and sedation in adult ICU patients. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  15. 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 (Fo) 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.

  16. Effect of dexmedetomidine on sevoflurane requirements and emergence agitation in children undergoing ambulatory surgery.

    PubMed

    Kim, Na Young; Kim, So Yeon; Yoon, Hye Jin; Kil, Hae Keum

    2014-01-01

    Dexmedetomidine, a potent selective α2-adrenergic agonist, produces sedation and analgesia. This study was conducted to assess the effect of dexmedetomidine infusion on sevoflurane requirements, recovery profiles, and emergence agitation in children undergoing ambulatory surgery. Forty children undergoing ambulatory hernioplasty or orchiopexy were randomized into two groups. The dexmedetomidine group (Group D, n=20) received dexmedetomidine 1 μg/kg, followed by 0.1 μg/kg/h until the end of surgery, whereas the saline group (Group S, n=20) received volume-matched normal saline. Sevoflurane was used for induction and maintenance of anesthesia and caudal block was performed in all children. End-tidal sevoflurane concentration (ET-sevo), the incidence of emergence agitation, pain scores, and sedation scores were recorded. Hemodynamic changes and other adverse effects were assessed in the perioperative period. ET-sevo of Group D was significantly reduced in 23.8-67% compared to Group S during surgery. The incidence of emergence agitation was lower in Group D than in Group S (5% vs. 55%, p=0.001). Postoperative pain was comparable, and discharge time was not different between the groups. Mean arterial pressure and heart rate were significantly lower in Group D during surgery. Intraoperative infusion of dexmedetomidine reduced sevoflurane requirements and decreased emergence agitation without delaying discharge in children undergoing ambulatory surgery. However, caution should be taken in regard to bradycardia and hypotension.

  17. Effect of Dexmedetomidine on Sevoflurane Requirements and Emergence Agitation in Children Undergoing Ambulatory Surgery

    PubMed Central

    Kim, Na Young; Kim, So Yeon; Yoon, Hye Jin

    2014-01-01

    Purpose Dexmedetomidine, a potent selective α2-adrenergic agonist, produces sedation and analgesia. This study was conducted to assess the effect of dexmedetomidine infusion on sevoflurane requirements, recovery profiles, and emergence agitation in children undergoing ambulatory surgery. Materials and Methods Forty children undergoing ambulatory hernioplasty or orchiopexy were randomized into two groups. The dexmedetomidine group (Group D, n=20) received dexmedetomidine 1 µg/kg, followed by 0.1 µg/kg/h until the end of surgery, whereas the saline group (Group S, n=20) received volume-matched normal saline. Sevoflurane was used for induction and maintenance of anesthesia and caudal block was performed in all children. End-tidal sevoflurane concentration (ET-sevo), the incidence of emergence agitation, pain scores, and sedation scores were recorded. Hemodynamic changes and other adverse effects were assessed in the perioperative period. Results ET-sevo of Group D was significantly reduced in 23.8-67% compared to Group S during surgery. The incidence of emergence agitation was lower in Group D than in Group S (5% vs. 55%, p=0.001). Postoperative pain was comparable, and discharge time was not different between the groups. Mean arterial pressure and heart rate were significantly lower in Group D during surgery. Conclusion Intraoperative infusion of dexmedetomidine reduced sevoflurane requirements and decreased emergence agitation without delaying discharge in children undergoing ambulatory surgery. However, caution should be taken in regard to bradycardia and hypotension. PMID:24339309

  18. Morphology and structure characterization of bacterial celluloses produced by different strains in agitated culture.

    PubMed

    Bi, J-C; Liu, S-X; Li, C-F; Li, J; Liu, L-X; Deng, J; Yang, Y-C

    2014-11-01

    The influence of bacterial species/strains in agitated culture was investigated on the morphology and structure characteristics of bacterial cellulose. Komagataeibacter nataicola Y19 and Gluconacetobacter entanii ACCC10215 were inoculated in Hestrin-Schramm (HS) medium and subjected to agitated cultivation. Different kinds of BCs were obtained including flocky asterisk-like BC by G. entanii ACCC10215 and solid sphere-like BC by K. nataicola Y19. The SEM results showed that the asterisk-like BC had larger pores than the solid sphere-like BC. The FT-IR and X-ray diffraction results showed the asterisk-like BC had lower crystallinity (81·43%), higher cellulose Iα mass fraction (79·74%) and smaller crystallite size. The different species/strains can influence the morphology and structure characteristics of BC in agitated culture. We examined the influence of different species/strains on the morphology, macro- and microstructure of BCs produced in agitated culture for the first time, which suggest that different BCs with potential applications could be obtained by choosing different species or strains and fermentation method. © 2014 The Society for Applied Microbiology.

  19. Timing of Initiation of RRT and Modality Selection

    PubMed Central

    2015-01-01

    There is no shortage of studies and registry data examining outcomes of patients on dialysis and those with a renal transplant. However, recently, there has been a greater focus on the events leading up to the institution of kidney replacement therapy. Associative data suggest that early and consistent predialysis care leads to better outcomes, including greater take-on to home-based therapy, diminished use of tunneled venous hemodialysis catheters, and improved early and even late survival. What transpires during predialysis visits is also important. Simple dissemination of facts to the unprepared patient is unlikely to be effective in moving the patient and family along in the process of the series of choices that have to be made around therapy. A more flexible and circumspect approach is needed, including recognizing when the patient is or is not ready for change. There seems to be no optimal timing of dialysis start that can be applied to the ESRD population as a whole, although the pendulum seems to be swinging back toward symptom-based rather than eGFR-based starts. PMID:25762523

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

    SciTech Connect

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

    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 was 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

  1. 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

  2. Agitation in Dementia: Relation to Core Cerebrospinal Fluid Biomarker Levels

    PubMed Central

    Bloniecki, Victor; Aarsland, Dag; Cummings, Jeffrey; Blennow, Kaj; Freund-Levi, Yvonne

    2014-01-01

    Background The objective of this study was to examine the associations of agitation with the cerebrospinal fluid dementia biomarkers total-tau (T-tau), phosphorylated-tau (P-tau) and Aβ1-42. Methods One hundred patients (mean age ± SD, 78.6 ± 7.5 years) with dementia and neuropsychiatric symptoms, of whom 67% were female, were included. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI; 46.5 ± 11.8 points). Results Total CMAI correlated with T-tau [rs (31) = 0.36, p = 0.04] and P-tau [rs (31) = 0.35, p = 0.05] in patients with Alzheimer's disease (AD; n = 33) but not in the total dementia population (n = 95). Conclusions Our results suggest that tau-mediated pathology including neurofibrillary tangles and the intensity of the disease process might be associated with agitation in AD. PMID:25298777

  3. 91. VIEW OF PORTLAND FILTER VACUUM RECEIVER FROM NORTHWEST. AGITATORS ...

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

    91. VIEW OF PORTLAND FILTER VACUUM RECEIVER FROM NORTHWEST. AGITATORS No. 4 AND No. 5 VISIBLE IN BACKGROUND. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  4. 84. AGITATORS No. 3, No. 4 AND No. 5 FROM ...

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

    84. AGITATORS No. 3, No. 4 AND No. 5 FROM SOUTHEAST. OLD PORTLAND FILTER FLOOR IS SEEN THROUGH FRAMING, LOWER RIGHT. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  5. 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.

  6. 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.

  7. Effect of initial product temperature and initial pH on foaming time during vacuum evaporation of liquid whole eggs.

    PubMed

    Girton, A R; Macneil, J H; Anantheswaran, R C

    1999-10-01

    During earlier studies on vacuum concentration of liquid egg white, the phenomena of foaming during the initial stages of the process were reported. In these studies, it was also shown that no concentration took place during the foaming period that varied from test to test. To minimize the total process time, this present study was undertaken to investigate what variables contributed to foaming, how they could be controlled, and what effect they had on product quality and functional properties. This study investigated the relationships among initial product temperature, initial pH, and foaming of liquid whole eggs. Two temperatures (9 and 20 C) and three pH levels (6.5, 7.3, and 8.5) were studied using a vacuum evaporation system with a maximum vacuum of 5 kPa. Tests showed that higher initial pH levels had decreased foaming times. At the end of foaming experiments, the liquid whole egg was evaluated to determine the extent of functional property change during foaming. A decrease in foaming time resulted in a decrease in whip time. The cakes made from the processed liquid whole egg had larger volumes than those from the unprocessed control. Furthermore, the liquid whole egg, which foamed the longest, had higher (P < 0.05) cake volumes. Our current experiments also verified our earlier findings that no product concentration takes place during the foaming process.

  8. 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%.

  9. Impact of Ambient Bright Light on Agitation in Dementia

    PubMed Central

    Barrick, Ann Louise; Sloane, Philip D.; Williams, Christianna S.; Mitchell, C. Madeline; Connell, Bettye Rose; Wood, Wendy; Hickman, Susan E.; Preisser, John S.; Zimmerman, Sheryl

    2013-01-01

    Objective To evaluate the effect of ambient bright light therapy on agitation among institutionalized persons with dementia. Methods High intensity, low glare ambient lighting was installed in activity and dining areas of a state psychiatric hospital unit in North Carolina and a dementia-specific residential care facility in Oregon. The study employed a cluster-unit crossover design involving four ambient lighting conditions: AM bright light, PM bright light, All Day bright light, and Standard light. Sixty-six older persons with dementia participated. Outcome measures included direct observation by research personnel and completion by staff caregivers of the 14-item, short form of the Cohen-Mansfield Agitation Inventory (CMAI). Results Analyses of observational data revealed that for participants with mild/moderate dementia, agitation was higher under AM light (p=0.003), PM light (p<0.001), and All Day light (p=0.001) than Standard light. There also was a trend toward severely demented participants being more agitated during AM light than Standard light (p=0.053). Analysis of CMAI data identified differing responses by site: the North Carolina site significantly increased agitation under AM light (p=0.002) and PM light (p=0.013) compared with All Day light while in Oregon, agitation was higher for All Day light compared to AM light (p=0.030). In no comparison was agitation significantly lower under any therapeutic condition, in comparison to Standard lighting. Conclusions Ambient bright light is not effective in reducing agitation in dementia and may exacerbate this behavioral symptom. PMID:20104513

  10. Design of agitation systems in Bingham slurries by pilot simulation

    SciTech Connect

    Nielsen, M.G.

    1987-01-01

    A method was required to determine the optimum agitator speed needed to produce overall motion of the Defense Waste Processing Facility (DWPF) high-level waste slurries in remote process cell vessels. Project schedule and limited process space required an accurate determination of agitator horsepower and size without the benefit of full-scale testing. The small scale testing of unique clear rheologically similar fluid is described along with tests and scale-up procedures. 2 refs., 3 figs.

  11. Agitator Mixing Analysis in a HB-Line Flat Tank

    SciTech Connect

    Lee, S.Y.

    2002-07-31

    In support of the HB-Line Engineering agitator mixing project, flow pattern calculations have been made for a 45 degrees pitched three-blade agitator submerged in a flat rectangular tank. The work is intended to determine agitator speeds that provide acceptable mixing performance for various tank liquid levels based on flow rates past solids deposited on the bottom surface of the flat tank. The modeling results will help ensure the acceptable suspension of solid particles as a function of agitator speed and tank liquid level during precipitation operations. The numerical modeling and calculations have been performed using a computational fluid dynamics approach. Three-dimensional steady-state momentum and continuity equations were used as the basic equations to estimate fluid motion driven by an agitator with three 45 degrees pitched blades. Hydraulic conditions were fully turbulent (Reynolds number about 2x104). A standard two-equation turbulence model (k-e), was used to capture turbulent eddy motion. The commercial finite volume code, Fluent [7], was used to create a prototypic geometry file with a non-orthogonal mesh. Hybrid meshing was used to fill the computational region between the round-edged tank bottom and agitator regions. At high rotational speeds and low tank levels, a surface vortex can reach the agitator blades and allow air to be drawn into the solid-fluid mixing zone. This is not desirable in terms of mixing performance. The analysis results show that the lowest liquid level among the four considered, 4.5 inches, is higher than the critical liquid height for air entrainment for agitator speeds up to 600 rpm. All the analysis results demonstrate that about 600 rpm provides adequate solids mixing capability for various tank levels (12, 8.5, 7, and 4.5 inches) containing 20-micron solids with a specific gravity of 2.5.

  12. Citalopram for agitation in Alzheimer's disease: design and methods.

    PubMed

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

    2012-01-01

    Agitation is one of the most common neuropsychiatric symptoms of Alzheimer's disease (AD), and is associated with serious adverse consequences for patients and caregivers. Evidence-supported treatment options for agitation are limited. The citalopram for agitation in Alzheimer's disease (CitAD) study was designed to evaluate the potential of citalopram to ameliorate these symptoms. CitAD is a randomized, double-masked, placebo-controlled multicenter clinical trial, with two parallel treatment groups assigned in a 1:1 ratio and randomization stratified by clinical center. The study included eight recruiting clinical centers, a chair's office, and a coordinating center located in university settings in the United States and Canada. A total of 200 individuals having probable AD with clinically significant agitation and without major depression were recruited for this study. Patients were randomized to receive citalopram (target dose of 30 mg/d) or matching placebo. Caregivers of patients in both treatment groups received a structured psychosocial therapy. Agitation was compared between treatment groups using the NeuroBehavioral Rating Scale and the AD Cooperative Study- Clinical Global Impression of Change, which are the primary outcomes. Functional performance, cognition, caregiver distress, and rates of adverse and serious adverse events were also measured. The authors believe the design elements in CitAD are important features to be included in trials assessing the safety and efficacy of psychotropic medications for clinically significant agitation in AD. Copyright © 2012 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  13. Emergence agitation after cataract surgery in children: a comparison of midazolam, propofol and ketamine.

    PubMed

    Chen, Jiayao; Li, Wenxian; Hu, Xiao; Wang, Dingding

    2010-09-01

    The aim of this study was to determine whether the concurrent use of either of a subhypnotic dose of midazolam, propofol or ketamine with fentanyl just before discontinuing the sevoflurane anesthesia would effectively sedate the children as they recovered and significantly decrease the incidence and severity of emergence agitation and would not delay patient awakening and discharge. Postoperative emergence agitation may occur in children after general anesthesia with volatile anesthetics. Children who undergo cataract surgery after sevoflurane induction and sevoflurane-remifentanil maintenance may experience this type of agitation. In 120 un-premedicated children aged 1-7 years, mask induction with sevoflurane was performed and they were then randomly assigned to one of the three antiagitation postoperative groups (n = 40). We studied the postoperative antiagitation effects of subhypnotic doses of midazolam combined with fentanyl, propofol with fentanyl or ketamine with fentanyl administered just before discontinuing the sevoflurane anesthesia. A score for the level of agitation can be assigned based on the recovery mental state (RMS) scale and the recently published pediatric anesthesia emergence delirium scale (PAED). Postoperative factors assessed included emergence behaviors, the time to eye opening, the time to discharge from the postanesthesia care unit (PACU) to the ward. There were significantly more agitated children in the ketamine-group when compared to the midazolam-group or to the propofol-group at all time P < 0.05), especially at 10 and 15 min. The PAED scale showed a significant advantage for midazolam-fentanyl [5 (2-15)] and propofol-fentanyl [6 (3-15)] versus ketamine-fentanyl [10 (3-20)] (P < 0.05). The time to discharge from the PACU to the ward was not significantly different among the groups. Intravenous administration of a subhypnotic dose of midazolam or propofol in addition to a low dose of fentanyl just before discontinuing the sevoflurane

  14. Stability, boundedness, and lagrange stability of fractional differential equations with initial time difference.

    PubMed

    Çiçek, Muhammed; Yakar, Coşkun; Oğur, Bülent

    2014-01-01

    Differential inequalities, comparison results, and sufficient conditions on initial time difference stability, boundedness, and Lagrange stability for fractional differential systems have been evaluated.

  15. 18 CFR 701.204 - Time limits for WRC initial determinations regarding requests for information.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... initial determinations regarding requests for information. 701.204 Section 701.204 Conservation of Power... Time limits for WRC initial determinations regarding requests for information. (a) An initial determination to grant or deny each request for information will be made within ten (10) working days of receipt...

  16. 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

    2017-07-13

    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.

  17. Macro-level Age Norms for the Timing of Sexual Initiation and Adolescents’ Early Sexual Initiation in 17 European Countries

    PubMed Central

    Madkour, Aubrey Spriggs; de Looze, Margaretha; Ma, Ping; Halpern, Carolyn Tucker; Farhat, Tilda; ter Bogt, Tom F. M.; Ehlinger, Virginie; Nic Gabhainn, Saoirse; Currie, Candace; Godeau, Emmanuelle

    2014-01-01

    Purpose To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. Methods Nationally-representative data from 17 countries that participated in the 2006/07 European Social Survey (ESS-3, n=33,092) and the 2005/06 Health Behaviour in School-Aged Children Study (HBSC, n=27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16) self-reported age at sexual initiation which we defined as early (<15 years) or not (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. Results In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR 0.60, 95% CI 0.45-0.79); associations with ESI were stronger for parent cohort (ages 31-65) norms (AOR 0.37, 95% CI 0.23-0.58) than for peer cohort (ages 15-20) norms (AOR 0.60, 95% CI 0.49-0.74). For boys, overall norms were also significantly negatively associated with ESI (AOR 0.68, 95% CI 0.46-0.99), as were parent cohort norms (AOR 0.66, 95% CI 0.45-0.96). Peer cohort norms were not significantly related to boys’ ESI. Conclusion Macro-level cultural norms may impact adolescents’ sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted. PMID:24508092

  18. Macro-level age norms for the timing of sexual initiation and adolescents' early sexual initiation in 17 European countries.

    PubMed

    Madkour, Aubrey Spriggs; de Looze, Margaretha; Ma, Ping; Halpern, Carolyn Tucker; Farhat, Tilda; Ter Bogt, Tom F M; Ehlinger, Virginie; Nic Gabhainn, Saoirse; Currie, Candace; Godeau, Emmanuelle

    2014-07-01

    To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. Nationally representative data from 17 countries that participated in the 2006/2007 European Social Survey (ESS-3, n = 33,092) and the 2005/2006 Health Behaviour in School-Aged Children Study (HBSC, n = 27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16 years) self-reported age at sexual initiation, which we defined as early (<15 years) or not early (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR .60, 95% CI .45-.79); associations with ESI were stronger for parent cohort (ages 31-65 years) norms (AOR .37, 95% CI .23-.58) than for peer cohort (ages 15-20 years) norms (AOR .60, 95% CI .49-.74). For boys, overall norms were also significantly negatively associated with ESI (AOR .68, 95% CI .46-.99), as were parent cohort norms (AOR .66, 95% CI .45-.96). Peer cohort norms were not significantly related to boys' ESI. Macrolevel cultural norms may impact adolescents' sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

  19. The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 Pain, Agitation, and Delirium Guidelines in an integrated and interdisciplinary fashion.

    PubMed

    Barr, Juliana; Pandharipande, Pratik P

    2013-09-01

    In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines. Review article. Multispecialty critical care units. Adult ICU patients. This article describes: 1) the ICU pain, agitation, and delirium care bundle in more detail, linking pain, sedation/agitation, and delirium management in an integrated and interdisciplinary fashion; 2) pain, agitation, and delirium implementation strategies; and 3) the potential synergistic benefits of linking pain, agitation, and delirium management strategies to other evidence-based ICU practices, including spontaneous breathing trials, ICU early mobility programs, and ICU sleep hygiene programs, in order to improve ICU patient outcomes and to reduce costs of care. Linking the ICU pain, agitation, and delirium management strategies with spontaneous awakening trials, spontaneous breathing trials, and early mobility and sleep hygiene programs is associated with significant improvements in ICU patient outcomes and reductions in their costs of care. The 2013 ICU pain, agitation, and delirium guidelines provide critical care providers with an evidence-based, integrated, and interdisciplinary approach to managing pain, agitation/sedation, and delirium. The ICU pain, agitation, and delirium care bundle provides a framework for facilitating implementation of the pain, agitation, and delirium guidelines. Widespread implementation of the ICU pain, agitation, and delirium care bundle is likely to result in large-scale improvements in ICU patient outcomes and significant reductions in costs.

  20. 34 CFR 5.81 - Time for initiation of request for review.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Time for initiation of request for review. 5.81 Section 5.81 Education Office of the Secretary, Department of Education AVAILABILITY OF INFORMATION TO THE PUBLIC PURSUANT TO PUB. L. 90-23 (Eff. until 7-14-10) Administrative Review § 5.81 Time for initiation...

  1. Effects of agitation in emulsion polymerization of n-butyl methacrylate and its copolymerization with N-methylol acrylamide

    NASA Astrophysics Data System (ADS)

    Krishnan, Sitaraman

    Effects of agitation in emulsion polymerization were investigated using a 2 dm3 stirred reactor and Rushton turbine agitators and a semi-batch mode of reaction. High-solids recipes giving monodisperse polymer particles with core-shell morphology were developed for monomer-starved, semi-batch emulsion copolymerization of n-butyl methacrylate (BMA) and N-methylol acrylamide (NMA). A larger agitator, or a higher agitation speed, resulted in higher particle concentration, more viscous latex, less water-soluble polymer, and higher mass of coagulum. Better incorporation of NMA in the polymer particles was because of greater particle-water interfacial area and more efficient macromixing in the reactor. A mechanism where the surface of the polymer particles is the most favorable site for copolymerization, is proposed for the incorporation of NMA. Nucleation of a greater number of particles at higher agitation intensity was a general observation for recipes with surfactant concentrations below the critical micelle concentration (cmc). Effects of agitation on the kinetics of emulsion polymerization of BMA were studied using reaction calorimetry. At a reaction temperature of 70°C, the molecular weight was higher at higher agitation speed, while at 50°C, the converse was true. The order of dependence of the mass of coagulum on the agitation speed depended on the surfactant coverage of the polymer particles: the variation was almost two-fold (1.2 to 2.3). The coagulum mass was related to surfactant coverage using results from the DLVO theory. The volume-surface average diameter of the monomer droplets in the emulsion scaled to the 1.6 power of agitation speed, and the droplet size distribution was log-normal. Thermal crosslinking of the copolymer particles and films was investigated, and the effect of carbon tetrabromide on the gel content of the copolymer films was studied experimentally and theoretically. The increase in the gel content as a function of time during thermal

  2. Initiation time of near-infrared laser-induced slip on the surface of silicon wafers

    SciTech Connect

    Choi, Sungho; Jhang, Kyung-Young

    2014-06-23

    We have determined the initiation time of laser-induced slip on a silicon wafer surface subjected to a near-infrared continuous-wave laser by numerical simulations and experiments. First, numerical analysis was performed based on the heat transfer and thermoelasticity model to calculate the resolved shear stress and the temperature-dependent yield stress. Slip initiation time was predicted by finding the time at which the resolved shear stress reached the yield stress. Experimentally, the slip initiation time was measured by using a laser scattering technique that collects scattered light from the silicon wafer surface and detects strong scattering when the surface slip is initiated. The surface morphology of the silicon wafer surface after laser irradiation was also observed using an optical microscope to confirm the occurrence of slip. The measured slip initiation times agreed well with the numerical predictions.

  3. Effect of passive ultrasonic agitation during final irrigation on cleaning capacity of hybrid instrumentation.

    PubMed

    Vinhorte, Marcilene Coelho; Suzuki, Eduardo Hideki; de Carvalho, Maíra Sousa; Marques, André Augusto Franco; Sponchiado Júnior, Emílio Carlos; Garcia, Lucas da Fonseca Roberti

    2014-05-01

    To evaluate the effect of passive ultrasonic agitation on the cleaning capacity of a hybrid instrumentation technique. Twenty mandibular incisors with mesiodistal-flattened root shape had their crowns sectioned at 1 mm from the cementoenamel junction. Instrumentation was initiated by catheterization with K-type files (Denstply Maillefer) #10, #15, and #20 at 3 mm from the working length. Cervical preparation was performed with Largo bur #1 (Dentsply Maillefer) followed by apical instrumentation with K-type files #15, #20 and #25, and finishing with ProTaper F2 file (Denstply Maillefer). All files were used up to the working length under irrigation with 1 mL of 2.5% sodium hypochlorite (Biodynâmica) at each instrument change. At the end of instrumentation, the roots were randomly separated into 2 groups (n = 10). All specimens received final irrigation with 1 mL of 2.5% sodium hypochlorite. The solution remained in the root canals in Group 1 for one minute; and ultrasonic agitation was performed in Group 2 for one minute using a straight tip inserted at 1 mm from working length. The specimens were processed histologically and the sections were analyzed under optic microscope (×64) to quantify debris present in the root canal. The samples submitted to ultrasonic agitation (Group 2) presented significant decrease in the amount of debris in comparison with those of Group 1 (p < 0.05). The hybrid instrumentation technique associated with passive ultrasonic agitation promoted greater debris removal in the apical third of the root canals.

  4. The effect of ketamine on the incidence of emergence agitation in children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia.

    PubMed

    Lee, Yoon Sook; Kim, Woon Young; Choi, Jae Ho; Son, Joo Hyung; Kim, Jae Hwan; Park, Young Cheol

    2010-05-01

    The rapid emergence and recovery from general anesthesia afforded by sevoflurane is associated with a high incidence of emergence agitation in children. Small doses of ketamine reduce the incidence of emergence agitation. This study compared the effects of ketamine 0.25 mg/kg and 0.5 mg/kg on emergence agitation and postoperative pain. The effects of added intravenous ketamine were evaluated in 93 children, ASA I-II, 2-14 years old, undergoing an adenotonsillectomy. The patients were allocated randomly to one of three groups receiving saline (group C), ketamine 0.25 mg/kg (group K0.25) or ketamine 0.5 mg/kg (group K0.5). The children in each group were administered the study drugs 10 minutes before the end of surgery. The recovery characteristics, including the time to extubation, delivery time from the PACU, postoperative nausea and vomiting, agitation and pain were assessed. There were no significant differences in the extubation time, delivery time and postoperative nausea and vomiting between the three groups. There were significant differences in modified CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) between the three groups. The incidence of emergence agitation was low in the K0.25 and K0.5 groups compared to the control group. However, there was no significant difference between the K0.25 and K0.5 groups. There was no significant difference in the incidence of emergence agitation between K0.25 and K0.5 groups. However, K0.5 group showed a lower pain score than K0.25 group.

  5. Making and suspension capabilities of vibratory agitators in a slab tank

    SciTech Connect

    Ramsey, C.J.; Kyser, E.A. III; Tatterson, G.B.

    1988-12-31

    Seven different vibratory agitators, consisting of single and dual flat blade configurations or dual angle blade configurations, were studied for their ability to produce mixing and solid suspension in a slab tank. The mixing behavior of the various configurations was recorded on video tape, and mixing times were measured as the time needed to disperse injected dye. The solid suspension tests, using ash tray sand, were conducted to determine the minimum stroke frequency of the agitators needed for complete off-bottom suspension. The mixing studies demonstrated that vibratory agitation produced strong vertical fluid motion, good bulk circulation and dispersion in the liquid. The effects of stroke frequency, n; amplitude, a; blade width, w; blade clearance, c; and liquid depth, h, on mixing time, {theta}, were studied. Single blade geometries produced complete mixing in the least number of strokes. The most effective geometry, in terms of both mixing and solid suspension, was a single flat blade with minimum off-bottom clearance and a blade width/tank thickness ratio, w/T, of 0.74 at the maximum stroke amplitude of 51 mm.

  6. 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

    ... barrier fluid at a pressure that is at all times (except during periods of startup, shutdown, or... device that meets the requirements of § 63.1015; or (C) Equipped with a closed-loop system that purges... dripping from the agitator seal at the time of the weekly inspection, the owner or operator shall follow...

  7. 40 CFR 65.109 - Standards: Agitators in gas/vapor service and in light liquid service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Operated with the barrier fluid at a pressure that is at all times (except during periods of startup... system to a control device that meets the requirements of § 65.115; or (C) Equipped with a closed-loop... liquids dripping from the agitator seal at the time of the weekly inspection, the owner or operator shall...

  8. [Switching from antipsychotics to aripiprazole and risk of agitation].

    PubMed

    Chaumette, B; Masson, M; Barde, M; Gay, O; Gaillard, R

    2017-05-25

    The exact modalities of switching between two antipsychotics are rarely studied despite the high frequency of this issue in clinical practice. In this context, description of clinical cases may be enlightening. We report on three new cases of agitation after replacing a dopaminergic antagonist with aripiprazole. A literature review indicated no other predictive clinical feature associated with a higher risk of agitation than therapeutic history. In fact, patients who previously received a greater dose of antipsychotic are more at risk to present paradoxical agitation when switching to aripiprazole. This has led to the hypothesis of dopaminergic hypersensitivity: dopaminergic antagonists could increase the number of receptors to be activated by a partial agonist-like aripiprazole. In one of the cases described here, the patient had received aripiprazole two years previously without any particular side effects. The reintroduction of aripiprazole after a treatment by risperidone was followed by agitation. Other pharmacological hypotheses to explain this agitation involve cholinergic and histaminergic rebounds as well. The frequency of these paradoxical reactions is probably underreported, and psychiatrists should be more attentive to them. During the replacement, aripiprazole should be prescribed at the maximal posology from the start, and the previous antipsychotic should be maintained and slowly decreased in no fewer than four weeks. Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  9. Managing verbal agitation in people with dementia and delirium.

    PubMed

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients.

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

    PubMed

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

    2017-07-01

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

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

    Agha, Sohail

    2009-12-01

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

  13. Application of hydraulically assembled shaft coupling hubs to large agitators

    SciTech Connect

    Murray, W.E.; Anderson, T.D.; Bethmann, H.K.

    1991-12-31

    This paper describes the basis for and implementation of hydraulically assembled shaft coupling hubs for large tank-mounted agitators. This modification to the original design was intended to minimize maintenance personnel exposure to ionizing radiation and also provide for disassembly capability without damage to shafts or hubs. In addition to realizing these objectives, test confirmed that the modified couplings reduced agitator shaft end runouts approximately 65%, thereby reducing bearing loads and increasing service life, a significant enhancement for a nuclear facility. 5 refs.

  14. Application of hydraulically assembled shaft coupling hubs to large agitators

    SciTech Connect

    Murray, W.E.; Anderson, T.D. ); Bethmann, H.K. )

    1991-01-01

    This paper describes the basis for and implementation of hydraulically assembled shaft coupling hubs for large tank-mounted agitators. This modification to the original design was intended to minimize maintenance personnel exposure to ionizing radiation and also provide for disassembly capability without damage to shafts or hubs. In addition to realizing these objectives, test confirmed that the modified couplings reduced agitator shaft end runouts approximately 65%, thereby reducing bearing loads and increasing service life, a significant enhancement for a nuclear facility. 5 refs.

  15. 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.

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

    PubMed

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

    2014-04-01

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

  17. Cost Worksheet for Out-of-School Time and Community School Initiatives.

    ERIC Educational Resources Information Center

    Langford, Barbara Hanson

    This worksheet is part of a series of technical assistance resources on financing and sustaining out-of-school time and community school initiatives. The worksheet is intended to help developers of such programs to create one type of financial projection--an operating budget--that identifies the range of costs that their initiative will incur. To…

  18. Influence of apheresis container size on the maintenance of platelet in vitro storage properties after a 30-h interruption of agitation.

    PubMed

    Wagner, Stephen J; Skripchenko, Andrey; Seetharaman, Shalini; Myrup, Andrew; Kurtz, James; Thomas-Montgomery, Dedeene; Awatefe, Helen; Moroff, Gary

    2010-08-01

    We have previously conducted studies investigating maintenance of apheresis platelet in vitro quality measures during storage under simulated shipping conditions in which agitation was interrupted. This study examines the effect of increasing bag surface area on the preservation of in vitro platelet properties during storage with continuous agitation and with a 30 h interruption of agitation. Apheresis platelets were collected in 100% plasma with the Amicus separator to provide two identical platelet products, each with approximately 4-5 x 10(11) platelets. After collection, the volume was divided equally between 1.0 and 1.3 L PL2410 containers. In an initial study, both products were continuously agitated. In a second study, both products were subjected to a single 30-h period of interrupted agitation between Days 2 and 3 of storage by placement in a standard shipping box at room temperature. In each study, units were assayed during storage for standard in vitro platelet quality measures. Platelets stored in the 1.3 L container maintained slightly greater mean pH during 7 day storage with either continuous agitation (n=6) or with a 30-h interruption of agitation (n=12) than those of similarly treated identical platelets stored in the 1.0 L container. Most noteworthy, in experiments with products stored in the 1.0 L container in which there was a large decrease in pH to levels <6.7 or <6.3 on days 5 or 7, respectively, the pH in the matched product stored in the 1.3 L container was substantially greater (0.17+/-06 and 0.37+/-0.09 pH units greater, n=4, respectively). Other measures showed either small differences or comparability of platelet in vitro parameters with storage in the two containers after an interruption of agitation.

  19. Time Estimation in Young Children: An Initial Force Rule Governing Time Production.

    ERIC Educational Resources Information Center

    Droit-Volet, Sylvie

    1998-01-01

    Studied time estimation for a button-pressing response in 3- and 5.5-year-olds under "minimal,""temporal," and "force" instructions. Found that force--but not temporal--instructions improved 3-year-olds' timing accuracy. When instructed to press harder, they pressed longer. Older children were more accurate with…

  20. Local velocity scaling in T400 vessel agitated by Rushton turbine in a fully turbulent region

    NASA Astrophysics Data System (ADS)

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

    The 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 Rushton turbine 133 mm in diameter. The velocity fields were measured in the zone in upward flow to the impeller for impeller rotation speeds from 300 rpm to 850 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 50 000 < Re < 189 000. 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 axial turbulence intensity was found to be in the majority in the range from 0.388 to 0.540, which corresponds to the high level of turbulence intensity.

  1. Influence of agitation and aeration in xanthan production by Xanthomonas campestris pv pruni strain 101.

    PubMed

    Borges, C D; da Moreira, A S; Vendruscolo, C T; Ayub, M A Z

    2008-01-01

    Production, viscosity, and chemical composition of xanthan synthesized by bacterium Xanthomonas campestris pv pruni strain 101 were evaluated in bioreactor systems. During the process, the volumetric oxygen mass transfer coefficient (k(L)a) and the biomass were determined and the pH was monitored. The cultures were grown in a 3 I bioreactor, with aeration and agitation varying as follows: conditions (A) 300 rpm, 3 vvm and (B) 200 rpm, 2 vvm, at 28 degrees C. Our results showed that gum production was dependent on k(L)a, with a maximum yield of 8.15 g/l at 300 rpm, 3 vvm, 54 h of fermentation, k(L)a 21.4/h, while biomass was not affected. All aqueous solutions of 3% (w/v) xanthans synthesized showed a pseudoplastic behavior. The highest viscosity was reached under the strongest aeration/agitation conditions. All xanthan samples contained glucose, mannose, rhamnose, and glucuronic acid as their main components. The highest agitation and aeration rates used under condition A (300 rpm and 3 vvm) favorably influenced the yield and viscosity of the xanthan produced by bacterium X. campestris pv pruni 101 at different fermentation times.

  2. Sevoflurane-emergence agitation: effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery.

    PubMed

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

    2010-04-01

    The use of sevoflurane in paediatric anaesthesia which could enable rapid recovery is complicated by the frequent occurrence of emergence agitation. The aim of this study was to test the efficacy of supplementing midazolam-based oral premedication with low-dose oral ketamine in reducing sevoflurane-related emergence agitation. Ninety-two healthy preschool children who have been scheduled for elective dental procedures under general anaesthesia were allocated into two groups (46 patients for each): group M received oral midazolam 0.5 mg kg(-1), whereas group KM received similar premedication in addition to ketamine 2 mg kg(-1). Acceptance of drug mixture and onset of action were monitored over the next 30 min. Induction of anaesthesia was carried out using sevoflurane 8 vol% in 100% oxygen via face mask. Anaesthesia was maintained with sevoflurane 1.5-2 vol% in oxygen-nitrous oxide mixture. Following extubation, standard scoring scale was used for assessing quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 microg kg(-1). The time of hospital discharge allowance was recorded. Vast majority of children accepted the premedication. There were no significant differences between both groups regarding recovery from sevoflurane and allowance of hospital discharge. Onset of action of premedication was shorter in group KM. Similarly, postoperative agitation score and rescue fentanyl consumption were markedly lower in group KM upon admission to the postanaesthesia care unit (P<0.01). Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced emergence agitation without delaying hospital discharge.

  3. 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.

  4. Practical stability with respect to initial time difference for Caputo fractional differential equations

    NASA Astrophysics Data System (ADS)

    Agarwal, Ravi; O'Regan, D.; Hristova, S.; Cicek, M.

    2017-01-01

    Practical stability with initial data difference for nonlinear Caputo fractional differential equations is studied. This type of stability generalizes known concepts of stability in the literature. It enables us to compare the behavior of two solutions when both initial values and initial intervals are different. In this paper the concept of practical stability with initial time difference is generalized to Caputo fractional differential equations. A definition of the derivative of Lyapunov like function along the given nonlinear Caputo fractional differential equation is given. Comparison results using this definition and scalar fractional differential equations are proved. Sufficient conditions for several types of practical stability with initial time difference for nonlinear Caputo fractional differential equations are obtained via Lyapunov functions. Some examples are given to illustrate the results.

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

    NASA Technical Reports Server (NTRS)

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

    2012-01-01

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

  6. Prediction of the crack initiation time of the alloys used in high temperature water

    SciTech Connect

    Tsubota, M.; Kanazawa, Y.

    1994-12-31

    Correlations between applied stress ({sigma}) and SCC initiation time (t) of sensitized 304 stainless steel, alloy 600 and alloy X-750 were studied. A general expression t = m {times} {sigma}{sup {minus}n} was obtained from both the analysis of the uni-axial constant load test data and the theoretical considerations of the crack initiation process. The n-value was determined from the process of crack initiation, and the m-value was a constant determined from material and environmental conditions.

  7. Errors in Postural Preparation Lead to Increased Choice Reaction Times for Step Initiation in Older Adults

    PubMed Central

    Nutt, John G.; Horak, Fay B.

    2011-01-01

    Background. This study asked whether older adults were more likely than younger adults to err in the initial direction of their anticipatory postural adjustment (APA) prior to a step (indicating a motor program error), whether initial motor program errors accounted for reaction time differences for step initiation, and whether initial motor program errors were linked to inhibitory failure. Methods. In a stepping task with choice reaction time and simple reaction time conditions, we measured forces under the feet to quantify APA onset and step latency and we used body kinematics to quantify forward movement of center of mass and length of first step. Results. Trials with APA errors were almost three times as common for older adults as for younger adults, and they were nine times more likely in choice reaction time trials than in simple reaction time trials. In trials with APA errors, step latency was delayed, correlation between APA onset and step latency was diminished, and forward motion of the center of mass prior to the step was increased. Participants with more APA errors tended to have worse Stroop interference scores, regardless of age. Conclusions. The results support the hypothesis that findings of slow choice reaction time step initiation in older adults are attributable to inclusion of trials with incorrect initial motor preparation and that these errors are caused by deficits in response inhibition. By extension, the results also suggest that mixing of trials with correct and incorrect initial motor preparation might explain apparent choice reaction time slowing with age in upper limb tasks. PMID:21498431

  8. Heat-transfer coefficients in agitated vessels. Sensible heat models

    SciTech Connect

    Kumpinsky, E.

    1995-12-01

    Transient models for sensible heat were developed to assess the thermal performance of agitated vessels with coils and jackets. Performance is quantified with the computation of heat-transfer coefficients by introducing vessel heating and cooling data into model equations. Of the two model categories studied, differential and macroscopic, the latter is preferred due to mathematical simplicity and lower sensitivity to experimental data variability.

  9. 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.

  10. Time to Initiation of Clozapine Treatment in Children and Adolescents with Early-Onset Schizophrenia.

    PubMed

    Trinczek, E; Heinzel-Gutenbrunner, M; Haberhausen, M; Bachmann, C J

    2016-11-01

    Introduction: Early-onset schizophrenia (EOS) has a poor prognosis and is difficult to treat, which often leads to the initiation of clozapine treatment. Studies in adults have shown that the initiation of clozapine treatment is often delayed. There is a lack of studies concerning the initiation of clozapine in children and adolescents with EOS. The aim of this study was to investigate the time span from first EOS-related psychiatric hospitalization to clozapine initiation. Methods: We retrospectively studied a consecutive cohort of children and adolescents with EOS and first-time clozapine prescriptions from a tertiary care child and adolescent psychiatric center in Germany. Results: Clinical records with data on clozapine initiation were available for 112 patients (35.7% females, mean age: 15.2±1.6 years). The mean time from first EOS-related hospitalization to clozapine initiation was 1.1 (±1.0) years, with an average of 2.3 (±1.1) prior antipsychotic treatment episodes. Higher age and higher IQ predicted earlier clozapine initiation. At the time of clozapine initiation, 40.2% of patients received antipsychotic polypharmacy. Prior to clozapine, 33.9% of patients had received 3 or more antipsychotic treatment episodes. Discussion: In our study, clozapine treatment was initiated markedly earlier than in the few existing studies, which may partly be due to the expected poor prognosis of EOS. The significant portion of patients undergoing 3 or more antipsychotic trials or antipsychotic polypharmacy prior to clozapine may indicate a need for improved dissemination of knowledge on the effectiveness of clozapine in treatment-resistant schizophrenia in order to promote timely clozapine prescriptions in these cases. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Comparative effectiveness of early versus conventional timing of dialysis initiation in advanced CKD.

    PubMed

    Crews, Deidra C; Scialla, Julia J; Boulware, L Ebony; Navaneethan, Sankar D; Nally, Joseph V; Liu, Xiaobo; Arrigain, Susana; Schold, Jesse D; Ephraim, Patti L; Jolly, Stacey E; Sozio, Stephen M; Michels, Wieneke M; Miskulin, Dana C; Tangri, Navdeep; Shafi, Tariq; Wu, Albert W; Bandeen-Roche, Karen

    2014-05-01

    Previous observational studies examining outcomes associated with the timing of dialysis therapy initiation in the United States have often been limited by lead time and survivor bias. Retrospective cohort study comparing the effectiveness of early versus later (conventional) dialysis therapy initiation in advanced chronic kidney disease (CKD). The analysis used inverse probability weighting to account for an individual's contribution to different exposure groups over time in a pooled logistic regression model. Patients contributed risk to both exposure categories (early and later initiation) until there was a clear treatment strategy (ie, dialysis therapy was initiated early or estimated glomerular filtration rate [eGFR] decreased to <10mL/min/1.73m(2)). Patients with CKD who had at least one face-to-face outpatient encounter with a Cleveland Clinic health care provider as of January 1, 2005, and at least 3 eGFRs in the range of 20-30mL/min/1.73m(2) measured at least 180 days apart. Timing of dialysis therapy initiation as determined using model-based interpolation of eGFR trajectories over time. Timing was defined as early (interpolated eGFR at dialysis therapy initiation≥10mL/min/1.73m(2)) or later (eGFR < 10mL/min/1.73m(2)) and was time-varying. Death from any cause occurring from the time that eGFR was equal to 20mL/min/1.73m(2) through September 15, 2009. The study population consisted of 652 patients meeting inclusion criteria. Most (71.3%) of the study population did not initiate dialysis therapy during follow-up. Patients who did not initiate dialysis therapy (n=465) were older, more likely to be white, and had more favorable laboratory profiles than those who started dialysis therapy. Overall, 146 initiated dialysis early and 80 had eGFRs decrease to <10mL/min/1.73m(2). Many participants (n=426) were censored prior to attaining a clear treatment strategy and were considered undeclared. There was no statistically significant survival difference for the

  12. 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

  13. Predictors of time to initiation of symptomatic therapy in early Parkinson's disease.

    PubMed

    Simuni, Tanya; Long, Jeffrey D; Caspell-Garcia, Chelsea; Coffey, Christopher S; Lasch, Shirley; Tanner, Caroline M; Jennings, Danna; Kieburtz, Karl D; Marek, Kenneth

    2016-07-01

    To determine clinical and biological variables that predict time to initiation of symptomatic therapy in de novo Parkinson's disease patients. Parkinson's Progression Markers Initiative is a longitudinal case-control study of de novo, untreated Parkinson's disease participants at enrolment. Participants contribute a wide range of motor and non-motor measures, including biofluids and imaging biomarkers. The machine learning method of random survival forests was used to examine the ability of baseline variables to predict time to initiation of symptomatic therapy since study enrollment (baseline). There were 423 PD participants enrolled in PPMI and 33 initial baseline variables. Cross-validation results showed that the three-predictor subset of disease duration (time from diagnosis to enrollment), the modified Schwab and England activities of daily living scale, and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score modestly predicted time to initiation of symptomatic therapy (C = 0.70, pseudo-R (2) = 0.13). Prediction using the three variables was similar to using the entire set of 33. None of the biological variables increased accuracy of the prediction. A prognostic index for time to initiation of symptomatic therapy was created using the linear and nonlinear effects of the three top variables based on a post hoc Cox model. Our findings using a novel machine learning method support previously reported clinical variables that predict time to initiation of symptomatic therapy. However, the inclusion of biological variables did not increase prediction accuracy. Our prognostic index constructed, based on the group-level survival curve can provide an indication of the risk of initiation of ST for PD patients based on functions of the three top predictors.

  14. Final rinse optimization: influence of different agitation protocols.

    PubMed

    Paragliola, Raffaele; Franco, Vittorio; Fabiani, Cristiano; Mazzoni, Annalisa; Nato, Fernando; Tay, Franklin R; Breschi, Lorenzo; Grandini, Simone

    2010-02-01

    This study examined the effect of different root canal irrigant agitation protocols in the penetration of an endodontic irrigant into dentinal tubules. Fifty-six human single-rooted teeth were shaped with nickel-titanium instruments, and a final rinse of 5% sodium hypochlorite labeled with 0.2% alizarin red was performed. Specimens were assigned to 7 groups (N = 8) and submitted to the following rinse activation protocols: no agitation (control group), K-File or gutta-percha agitation, or different sonic (EndoActivator [Advanced Endodontics, Santa Barbara, CA] and Plastic Endo, Lincolnshire, IL) and ultrasonic (Satelec [Acteongroup, Merignac, France] and EMS, Nyon, Switzerland) agitations. Specimens were sectioned at 1, 3, and 5 mm from the apex in 1-mm-thick slabs, ground, and prepared for fluorescence microscopy at 100x with a wavelength of 450 milliseconds. Irrigant penetration into dentinal tubules was analyzed by using Kruskal-Wallis analysis of variance followed by post-hoc comparisons. Groups were ranked in the following order: control = K-file = gutta-percha < EndoActivator = Plastic Endo < Satelec = EMS. At 1 mm from the apex, the highest score was found for the EMS group compared with the control, K-file, gutta-percha, EndoActivator, and Plastic Endo groups, whereas no difference was found with the Satelec group. The results support the use of an ultrasonic agitation to increase the effectiveness of the final rinse procedure in the apical third of the canal walls. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. Magnetic shaft seals prevent hazardous leakage from wastewater agitators

    SciTech Connect

    Traino, F.A.

    1985-11-01

    The US Department of Energy's laboratory in Miamisburg, OH, operated by Monsanto Research Corporation, processes approximately 45,000 gallons per week of low-level radioactive wastewater to meet Federal Environmental Protection Agency quality standards. Preventing the spread of radioactive contamination throughout the operating area demands effective sealing of all process piping, valves, pumps, and agitators. Rotating shafts of pumps and agitators installed a the start of operations in 1947 were sealed by stuffing glands with graphite impregnated asbestos packing. These pumps proved to be unsatisfactory. In the mid-1970's, new process pumps with mechanical seals and some with magnetic drives were installed. Later, in January 1979, new agitator shaft drives with double tandem, spring-loaded mechanical seals were installed, maintenance of these pumps was costly. The agitator drive shafts were redesigned to accommodate magnetic seals of the type successfully used in blowers and vacuum/pressure pumps in other plant locations. One inherent advantage of the magnetic seal is that it operates with a face loading as much as 50% less than a conventional spring-loaded mechanical seal. The lower loading by a predetermined uniform magnetic force contributes to long face life. Other advantages include compactness, ease of assembly with only a few parts, and insensitivity to vibration. The magnetic shaft seals installed on the agitator shafts in February 1983 are still in service without any leakage or need for maintenance. Based on current operating data and a projected five-year meantime between failures, the estimated cost benefit of the magnetic seals over spring-loaded mechanical seals over spring-loaded mechanical seals will be $640 vs $2400 respectively per seal, with 60% less downtime for maintenance.

  16. An interdisciplinary perspective on the agitated brain injured patient.

    PubMed

    Sandel, M E; Zwil, A S; Fugate, L P

    1995-01-01

    The Special Interest Group on Brain Injury of the American Academy of Physical Medicine and Rehabilitation is developing a practice parameter for the agitated patient following traumatic brain injury (TBI). The eventual goal of the project is to create an interdisciplinary practice guideline for classifying and treating these patients using a common nosology, based on contributions from the literatures of neurosurgery, psychology, psychiatry and rehabilitation medicine. It is envisioned that a uniform classification system would ultimately promote interdisciplinary research and serve to advance our understanding and treatment of this patient population. In the acute post-injury period, many TBI patients can be characterized by confusion, agitation, post-traumatic amnesia and delirium. In various acute care settings, psychiatrists, psychologists or rehabilitation medicine physicians (physiatrists) are asked to evaluate and treat this population of patients. Each of these disciplines employ specialty-based diagnostic criteria and rating instruments, with little or no consensus across disciplines concerning the appropriateness of these tools. This article reviews the classification and rating systems utilized within the fields of neurosurgery, rehabilitation medicine, psychology and psychiatry, to describe patients displaying agitated behaviors. The authors review the literature establishing the definitions, measurement and possible neuroanatomic and neurophysiologic substrate for delirium and brain-injury agitation, with its characteristic cognitive and behavioral manifestations. Pharmacologic treatment is briefly reviewed to emphasize the significantly different viewpoints from the fields of rehabilitation medicine and psychiatry. The authors explore support from the literature for an interdisciplinary definition for agitation following TBI which includes criteria for delirium, post-traumatic amnesia, and associated behavioral excesses such as disinhibition

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  18. 5 CFR 890.1012 - Time limits for OPM to initiate permissive debarments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Time limits for OPM to initiate permissive debarments. 890.1012 Section 890.1012 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1012 Time limits for OPM...

  19. 5 CFR 890.1012 - Time limits for OPM to initiate permissive debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Time limits for OPM to initiate permissive debarments. 890.1012 Section 890.1012 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1012 Time limits for OPM...

  20. 5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Time limits for OPM to initiate mandatory debarments. 890.1005 Section 890.1005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED... Imposed Against Health Care Providers Mandatory Debarments § 890.1005 Time limits for OPM to...

  1. Irrigation initiation timing in soybean grown on sandy soils in Northeast Arkansas

    USDA-ARS?s Scientific Manuscript database

    Irrigation initiation timing was evaluated in furrow-irrigated soybean field with sandy soils in Mississippi County, AR. A major objective of this 2015 study was to validate and expand irrigation timing recommendations that pair plant growth measures with weather cues including use of local weather ...

  2. Contextual and Developmental Predictors of Sexual Initiation Timing among Mexican-Origin Girls

    ERIC Educational Resources Information Center

    Bámaca-Colbert, Mayra Y.; Greene, Kaylin M.; Killoren, Sarah E.; Noah, Aggie J.

    2014-01-01

    Using data from a longitudinal study of Mexican-origin girls (ages 11-17 at Time 1), we examined sociocultural (i.e., family structure, nativity, and acculturation), interpersonal (i.e., supportive parenting and conflict), and developmental (i.e., menarche timing and autonomy expectations) predictors of sexual initiation. Using Cox proportional…

  3. Using Title I To Support Out-of-School Time and Community School Initiatives. Strategy Brief.

    ERIC Educational Resources Information Center

    Deich, Sharon; Wegener, Victoria; Wright, Elisabeth

    Despite the demonstrated social value of out-of-school time and community school initiatives, such programs lack dedicated funding sources available to support their efforts. This strategy brief argues that Title I of the Elementary and Secondary Education Act can serve as an important funding source for out-of-school time programs and community…

  4. Evaluation of the Massachusetts Expanded Learning Time (ELT) Initiative: Final Study Findings

    ERIC Educational Resources Information Center

    Checkoway, Amy; Gamse, Beth; Velez, Melissa; Linkow, Tamara

    2013-01-01

    The Massachusetts Expanded Learning Time (ELT) initiative provides grants to selected schools to redesign their schedules by adding 300-plus instructional hours to the school year to improve outcomes, broaden enrichment opportunities, and provide teachers with more planning and professional development time. The Massachusetts Department of…

  5. The Critical care Pain Observation Tool is reliable in non-agitated but not in agitated intubated patients.

    PubMed

    Chookalayia, Hoda; Heidarzadeh, Mehdi; Hassanpour-Darghah, Mohammad; Aghamohammadi-Kalkhoran, Masoomeh; Karimollahi, Mansoreh

    2017-09-15

    The Critical-Care Pain. Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures). Patients were divided into four groups according to their RASS score: 1. All patients (RASS -3 to +2), 2. Sedated patients (RASS -3 to -1), 3. Restless patients (RASS +1), 4. Agitated patients (RASS +2). Discriminant and criterion validity, confirmatory factor analysis and internal reliability showed good validity and reliability in the critical care pain observation tool in all groups except agitated patients. The results showed that, in general, the CPOT has good version of the critical care pain observation tool has good psychometric properties to evaluate pain in non-verbal patients admitted to intensive care units who have a RASS score ranging from -3 to +1, but it is not a good tool to evaluate pain in patients who are agitated according to RASS. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Fine Drop Recovery in Batch Gas-Agitated Liquid-Liquid Dispersions

    NASA Astrophysics Data System (ADS)

    Shahrokhi, H.; Shaw, J. M.

    1996-11-01

    The hydrodynamics of batch gas-agitated liquid-liquid dispersions has received comparatively little attention in the open literature1-5. Such systems arise in diverse contexts but operate on the same basic principle. Two immiscible liquids form stratified layers initially and return to this stratified state at the end of a batch. Liquid from the lower liquid phase is entrained and then dispersed by gas bubbles passing from the lower to the upper liquid phase. At the end of a batch, the liquids separate under the influence of gravity. Fine drops separate slowly. For industrial processes such as nickel conversion, long settling periods reduce equipment productivity. Metal drops entrained in the lower density slag phase also pose leaching problems in slag heaps. We assessed fine drop production in such batch systems previously5. In this work, we address fine drop recovery. The net rate of fine drop recovery can be up to five times greater than Standard Settling experiments if low speed recirculation loops are imposed within the upper liquid phase that are perpendicular to the liquid-liquid interface. The principal mechanism for enhanced fine drop recovery, in this case, arises from improving drop liquid-liquid interface coalescence. 1. Hatzikiriakos et al., A.I.Ch.E. J., 36, 677-684 (1990). 2. Hatzikiriakos et al., Chem. Eng. Sci., 45, 2349-2356 (1990). 3. Konduru & Shaw, Proc. Int. Symp. Materials Handling in Pyromet., Hamilton, Cda, 14-24 (1991). 4. ibid, Can. J. Chem. Eng., 70, 381-384 (1992). 5. Shahrokhi & Shaw, Chem. Eng. Sci., 49, 5203-5213 (1994).

  7. More Time for Learning: Promising Practices and Lessons Learned. Massachusetts Expanded Learning Time Initiative 2010 Progress Report

    ERIC Educational Resources Information Center

    Massachusetts 2020, 2010

    2010-01-01

    Massachusetts is heralded nationally for being the first in the nation to enact a state policy to redesign and expand the learning day for all students to advance academic achievement, broaden enrichment opportunities, and improve instruction. The Expanded Learning Time (ELT) Initiative has gained momentum over the past several years due to the…

  8. Time for a New Day: Broadening Opportunities for Massachusetts Schoolchildren. Expanded Learning Time Initiative 2006-2007 Annual Report

    ERIC Educational Resources Information Center

    Massachusetts 2020, 2007

    2007-01-01

    Our children deserve an education that fully prepares them for the future--success in college, the workforce and a healthy, fulfilled life. The Expanded Learning Time (ELT) Initiative in Massachusetts is redesigning schools to offer children new learning and enrichment opportunities made possible because of an expanded school schedule. With state…

  9. Improving quality in measuring time to initiation of CPR during in-hospital resuscitation.

    PubMed

    Siems, Ashley; Tomaino, Elyse; Watson, Anne; Spaeder, Michael C; Su, Lillian

    2017-09-01

    Time from the onset of "low or no flow" indicators of cardiac failure to initiation of cardiopulmonary resuscitation is an important quality metric thought to improve the likelihood of survival and preservation of end organ function. We hypothesized that delays in initiation of chest compressions were under recognized during in-hospital resuscitation and aimed to develop a system which identifies the actual time of deterioration during cardiac events. Retrospective review on prospectively identified resuscitation records and monitor data were compared. Return of spontaneous circulation, survival, and changes in functional status of patients pre- and post-events with chest compressions were collected as outcome measures. Between October 2012 and April 2015, 59 events which met eligibility criteria occurred in either our pediatric cardiac or general pediatric intensive care units. The median time from event onset to initiation of chest compressions was 47s(s) (interquartile range (IQR) 28-80s) as assessed using monitor data, while the resuscitation record reported a median time of 0s (IQR 0-60s), reflecting the time from recognition to initiation of chest compressions. According to the resuscitation record, 81% vs. 63% of events achieved the quality standard of less than one minute depending on which review method was used (p=0.04). There is a significant difference between time of deterioration to initiation of chest compressions and the time of recognition to initiation of chest compressions. Resuscitation records should be modified to include more information about the actual timing of patient deterioration. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    PubMed Central

    Holway, Giuseppina Valle

    2015-01-01

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

  11. Well-posedness of the time-varying linear electromagnetic initial-boundary value problem

    NASA Astrophysics Data System (ADS)

    Xie, Li; Lei, Yin-Zhao

    2007-09-01

    The well-posedness of the initial-boundary value problem of the time-varying linear electromagnetic field in a multi-medium region is investigated. Function spaces are defined, with Faraday's law of electromagnetic induction and the initial-boundary conditions considered as constraints. Gauss's formula applied to a multi-medium region is used to derive the energy-estimating inequality. After converting the initial-boundary conditions into homogeneous ones and analysing the characteristics of an operator introduced according to the total current law, the existence, uniqueness and stability of the weak solution to the initial-boundary value problem of the time-varying linear electromagnetic field are proved.

  12. Incidence and Timing of Cancer in HIV-Infected Individuals Following Initiation of Combination Antiretroviral Therapy

    PubMed Central

    Yanik, Elizabeth L.; Napravnik, Sonia; Cole, Stephen R.; Achenbach, Chad J.; Gopal, Satish; Olshan, Andrew; Dittmer, Dirk P.; Kitahata, Mari M.; Mugavero, Michael J.; Saag, Michael; Moore, Richard D.; Mayer, Kenneth; Mathews, W. Christopher; Hunt, Peter W.; Rodriguez, Benigno; Eron, Joseph J.

    2013-01-01

    Background Cancer is an important cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), but patterns of cancer incidence after combination antiretroviral therapy (ART) initiation remain poorly characterized. Methods We evaluated the incidence and timing of cancer diagnoses among patients initiating ART between 1996 and 2011 in a collaboration of 8 US clinical HIV cohorts. Poisson regression was used to estimate incidence rates. Cox regression was used to identify demographic and clinical characteristics associated with cancer incidence after ART initiation. Results At initiation of first combination ART among 11 485 patients, median year was 2004 (interquartile range [IQR], 2000–2007) and median CD4 count was 202 cells/mm3 (IQR, 61–338). Incidence rates for Kaposi sarcoma (KS) and lymphomas were highest in the first 6 months after ART initiation (P < .001) and plateaued thereafter, while incidence rates for all other cancers combined increased from 416 to 615 cases per 100 000 person-years from 1 to 10 years after ART initiation (average 7% increase per year; 95% confidence interval, 2%–13%). Lower CD4 count at ART initiation was associated with greater risk of KS, lymphoma, and human papillomavirus–related cancer. Calendar year of ART initiation was not associated with cancer incidence. Conclusions KS and lymphoma rates were highest immediately following ART initiation, particularly among patients with low CD4 cell counts, whereas other cancers increased with time on ART, likely reflecting increased cancer risk with aging. Our results underscore recommendations for earlier HIV diagnosis followed by prompt ART initiation along with ongoing aggressive cancer screening and prevention efforts throughout the course of HIV care. PMID:23735330

  13. Incidence and timing of cancer in HIV-infected individuals following initiation of combination antiretroviral therapy.

    PubMed

    Yanik, Elizabeth L; Napravnik, Sonia; Cole, Stephen R; Achenbach, Chad J; Gopal, Satish; Olshan, Andrew; Dittmer, Dirk P; Kitahata, Mari M; Mugavero, Michael J; Saag, Michael; Moore, Richard D; Mayer, Kenneth; Mathews, W Christopher; Hunt, Peter W; Rodriguez, Benigno; Eron, Joseph J

    2013-09-01

    Cancer is an important cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), but patterns of cancer incidence after combination antiretroviral therapy (ART) initiation remain poorly characterized. We evaluated the incidence and timing of cancer diagnoses among patients initiating ART between 1996 and 2011 in a collaboration of 8 US clinical HIV cohorts. Poisson regression was used to estimate incidence rates. Cox regression was used to identify demographic and clinical characteristics associated with cancer incidence after ART initiation. At initiation of first combination ART among 11 485 patients, median year was 2004 (interquartile range [IQR], 2000-2007) and median CD4 count was 202 cells/mm(3) (IQR, 61-338). Incidence rates for Kaposi sarcoma (KS) and lymphomas were highest in the first 6 months after ART initiation (P < .001) and plateaued thereafter, while incidence rates for all other cancers combined increased from 416 to 615 cases per 100 000 person-years from 1 to 10 years after ART initiation (average 7% increase per year; 95% confidence interval, 2%-13%). Lower CD4 count at ART initiation was associated with greater risk of KS, lymphoma, and human papillomavirus-related cancer. Calendar year of ART initiation was not associated with cancer incidence. KS and lymphoma rates were highest immediately following ART initiation, particularly among patients with low CD4 cell counts, whereas other cancers increased with time on ART, likely reflecting increased cancer risk with aging. Our results underscore recommendations for earlier HIV diagnosis followed by prompt ART initiation along with ongoing aggressive cancer screening and prevention efforts throughout the course of HIV care.

  14. Effects of individualized versus classical "relaxation" music on the frequency of agitation in elderly persons with Alzheimer's disease and related disorders.

    PubMed

    Gerdner, L A

    2000-03-01

    Confusion and agitation in elderly patients are crucial problems. This study tested Gerdner's mid-range theory of individualized music intervention for agitation. An experimental repeated measures pretest-posttest crossover design compared the immediate and residual effects of individualized music to classical "relaxation" music relative to baseline on the frequency of agitated behaviors in elderly persons with Alzheimer's disease and related disorders (ADRD). Thirty-nine subjects were recruited from six long-term-care facilities in Iowa. The sample consisted of 30 women and 9 men (mean age 82 years) with severe cognitive impairment. Baseline data were collected for 3 weeks. Findings from the Modified Hartsock Music Preference Questionnaire guided the selection of individualized music. Group A (n = 16) received individualized music for 6 weeks followed by a 2-week "washout" period and 6 weeks of classical "relaxation" music. Group B (n = 23) received the same protocol but in reverse order. Music interventions were presented for 30 minutes, two times per week. The Modified Cohen-Mansfield Agitation Inventory measured the dependent variable. A repeated measures analysis of variance with Bonferroni post hoc test showed a significant reduction in agitation during and following individualized music compared to classical music. This study expands science by testing and supporting a theoretically based intervention for agitation in persons with ADRD.

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

    PubMed

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

    2015-12-01

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

  16. Controversies in Timing of Dialysis Initiation and the Role of Race and Demographics

    PubMed Central

    Streja, Elani; Nicholas, Susanne B.; Norris, Keith C

    2013-01-01

    Dialysis remains the predominant form of renal replacement therapy in the U.S., but the optimal timing for the initiation of dialysis remains poorly defined. Not only clinical factors such as signs/symptoms of uremia, co-existing cardiovascular disease, and presence of diabetes, but also key demographic characteristics including age, gender, race/ethnicity and socioeconomics have all been considered as potential modifying factors in the decision for the timing of dialysis initiation. The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) suggests that dialysis be initiated when signs/symptoms attributable to kidney failure such as serositis, acid-base or electrolyte abnormalities, pruritus, poorly controlled volume status or blood pressure, deteriorating nutritional status despite dietary intervention, or cognitive impairment are visible or noted. These signs/symptoms typically occur when the glomerular filtration rate (GFR) is in the range of 5 to 10 ml/min/1.73 m2, although they may occur at higher levels of GFR. We review recent data on the timing of dialysis initiation, their implications for managing patients with late stage CKD, and the important role of considering key demographics in making patient-centered decisions for the timing of dialysis initiation. PMID:24102770

  17. Structural Barriers to Timely Initiation of Antiretroviral Treatment in Vietnam: Findings from Six Outpatient Clinics

    PubMed Central

    Tran, Dam Anh; Shakeshaft, Anthony; Ngo, Anh Duc; Rule, John; Wilson, David P.; Zhang, Lei; Doran, Christopher

    2012-01-01

    In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm3 CD4), late initiators (100–200 cells/mm3) and timely initiators (200–350 cells/mm3). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam’s treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients. PMID:23240013

  18. Agitated saline bubble-enhanced transthoracic echocardiography: a novel method to visualize the position of central venous catheter.

    PubMed

    Wen, Ming; Stock, Konrad; Heemann, Uwe; Aussieker, Mario; Küchle, Claudius

    2014-03-01

    The purpose of this study is to describe a novel method to visualize the position of central venous catheters, which is safe, expeditious, and less expensive than the routine postprocedural chest radiograph. Retrospective comparative study. Dialysis Center of the Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Two hundred and two adult patients undergoing central venous catheter placement for dialysis, plasmapheresis, or administration of medication and solutions. None. Data of 202 adult patients with 219 central venous catheterizations were retrospectively analyzed. Each catheter insertion was followed by an agitated saline bubble-enhanced transthoracic echocardiography, which was used to localize the tip of the catheter. The position of catheter was then controlled by chest radiograph in all cases. During the 13-month study period, two catheter malpositions occurred. Both were identified by agitated saline bubble-enhanced transthoracic echocardiography and confirmed by chest radiograph. The mean time between catheter insertion and chest radiograph control (28.3 min) was clearly longer than agitated saline bubble-enhanced transthoracic echocardiography (3.2 min) (p < 0.001). The total costs of the procedure were reduced by 86.7-95.0%. Specific complications related to the procedure were not observed. The results revealed that the accuracy of agitated saline bubble-enhanced transthoracic echocardiography is equivalent to the chest radiograph. It offers a safe, cost-effective, expeditious alternative to routine chest radiograph for position controls of central venous catheters.

  19. Time to and factors associated with insulin initiation in patients with type 2 diabetes mellitus.

    PubMed

    Machado-Alba, Jorge Enrique; Machado-Duque, Manuel Enrique; Moreno-Gutierrez, Paula Andrea

    2015-03-01

    Determine the time between the start of oral antidiabetic therapy (OAD) and the initiation of insulin therapy and to establish factors associated with insulin prescription among patients with type 2 diabetes mellitus (T2DM) in Colombia. Cohort, retrospective, population-based study. We identify patients with T2DM who started OAD therapy between 1 January 2007 and 31 December 2008, and a 5-year follow-up was performed. Kaplan-Meier survival analysis for time to start insulin therapy was generated and factors associated with insulin initiation were determined using logistic regression. A total of 1042 patients (52.4% women), mean age 63.4 years at the start of pharmacological treatment. After 5 years, 272 patients (26.1%) initiated insulin therapy. Using combination therapy of metformin and glibenclamide was associated with greater risk of insulin initiation (OR: 1.64, 95% CI: 1.12-2.40, p=0.010), while being a male over 45 years of age (OR: 0.59, 95% CI: 0.37-0.96, p=0.034) and initiating OAD therapy with metformin (OR: 0.30, 95% CI: 0.20-0.46, p<0.001) reduced the risk of insulin use. After 5 years of OAD treatment, 26.1% of people with T2DM started insulin therapy. Age, sex and type of initial OAD affected the probability of switching to insulin in these patients in Colombia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Breast-feeding initiation time and neonatal mortality risk among newborns in South India.

    PubMed

    Garcia, C R; Mullany, L C; Rahmathullah, L; Katz, J; Thulasiraj, R D; Sheeladevi, S; Coles, C; Tielsch, J M

    2011-06-01

    To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region. Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h. Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 1  h after birth. Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.

  1. Time to initiation of antiretroviral therapy among patients who Are ART eligible in Rwanda: improvement over time.

    PubMed

    Teasdale, Chloe A; Wang, Chunhui; Francois, Uwinkindi; Ndahimana, Jean dʼAmour; Vincent, Mutabazi; Sahabo, Ruben; El-Sadr, Wafaa M; Abrams, Elaine J

    2015-03-01

    Delayed initiation of antiretroviral therapy (ART) in eligible patients is a concern in resource-limited countries. We analyzed data on HIV-positive patients ≥15 years enrolled at 41 ICAP-supported health care facilities in Rwanda, 2005-2010, to determine time to ART initiation among patients eligible at enrollment compared with those ineligible or of indeterminate eligibility who become eligible during follow-up. ART eligibility was based on CD4 cell count (CD4) and WHO staging; patients lacking CD4 and WHO stage were considered indeterminate. Cumulative incidence of reaching ART eligibility and to ART initiation after eligibility was generated using competing risk estimators. A total of 31,033 ART-naive adults were enrolled; 64.2% were female. At enrollment, 10,158 (32.7%) patients were ART eligible, 13,372 (43.1%) were ineligible for ART, and 7503 (24.2%) patients were indeterminate. Among patients retained in care pre-ART eligibility, 17.9% [95% confidence interval (CI): 17.2 to 18.6] of ineligible and 22.8% (95% CI: 21.7 to 23.8) of indeterminate patients at enrollment reached ART eligibility within 12 months. Cumulative incidence of ART initiation within 3 months for patients eligible at enrollment was 77.2% (95% CI: 76.4 to 78.0) compared with 67.9% (95% CI: 66.4 to 69.3) for ineligible and 63.8% (95% CI: 61.9 to 65.8) for patients with indeterminate eligibility at enrollment (P < 0.05). Over the study period, there was more rapid ART initiation for patients who became ART eligible. We found higher rates of ART initiation within 3 months among patients who were ART eligible at enrollment compared with those who reached eligibility during follow-up. From 2006 to 2011, earlier initiation of ART after eligibility was observed likely reflecting improved program quality.

  2. Droperidol for psychosis-induced aggression or agitation.

    PubMed

    Khokhar, Mariam A; Rathbone, John

    2016-12-15

    initial adequate sedation, we found an effect (1 RCT, N = 153, RR 0.54, 95% CI 0.24 to 1.20, moderate-quality evidence). In terms of adverse effects, we found no statistically significant differences between the two drugs for either airway obstruction (1 RCT, N = 153, RR 0.13, 95% CI 0.01 to 2.55, low-quality evidence) or respiratory hypoxia (1 RCT, N = 153, RR 0.70, 95% CI 0.16 to 3.03, moderate-quality evidence) - but use of midazolam did result in three people (out of around 70) needing some sort of 'airway management' with no such events in the droperidol group. There were no data for mental state, service use and costs.Furthermore, when droperidol was compared to olanzapine, for the outcome of tranquillisation or asleep by any time point, we found no clear differences between the older drug (droperidol) and olanzapine (e.g. at 30 minutes: 1 RCT, N = 221, RR 1.02, 95% CI 0.94 to 1.11, high-quality evidence). There was a suggestion that participants allocated droperidol needed less additional medication after 60 minutes than people given the olanzapine (1 RCT, N = 221, RR 0.56, 95% CI 0.36 to 0.87, high-quality evidence). There was no evidence that droperidol caused more cardiovascular arrhythmia (1 RCT, N = 221, RR 0.32, 95% CI 0.01 to 7.88, moderate-quality evidence) and respiratory airway obstruction (1 RCT, N = 221, RR 0.97, 95% CI 0.20 to 4.72, low-quality evidence) than olanzapine. For 'being ready for discharge', there was no difference between groups (1 RCT, N = 221, RR 1.06, 95% CI 0.83 to 1.34, high-quality evidence). There were no data for mental state and costs. Previously, the use of droperidol was justified based on experience rather than evidence from well-conducted and reported randomised trials. However, this update found high-quality evidence with minimal risk of bias to support the use of droperidol for acute psychosis. Also, we found no evidence to suggest that droperidol should not be a treatment option for people acutely ill and disturbed because

  3. A Patient‐Centric Goal in Time to Blood Pressure Control from Drug Therapy Initiation

    PubMed Central

    Wang, Junling; Tak, Sunghee

    2013-01-01

    Abstract A time frame in which newly diagnosed hypertensive patients attain blood pressure (BP) goal would guide patients through uncertainty associated with initiating drug therapy for hypertension control. This study estimates time to BP goal resulting from drug therapy initiation among real‐world hypertensive patients and identifies factors associated with variations in time to BP goal. The study uses a historical cohort design. Hypertensive patients who had initiated antihypertensive drug therapy between July 1, 2002, and December 31, 2003, were followed up to 12 months until the end of 2004. Electronic medical records from a medical group were linked with pharmacy claims, as well as with medical claims. Survival analyses were used to compare lengths of time needed to reach BP goals. A total of 223 patients from a real world practice setting had initiated antihypertensive drug therapy. The patients took 3.25 months (95% CI: 2.49–4.82) to reach BP goal. The patient‐centric time to BP goal was 7.1 weeks longer than those reported in controlled experimental settings. This finding highlights the gap between results of controlled clinical trials and their application to clinical practice, and informs healthcare practitioners of the importance of setting a patient‐centric goal in pharmacological treatment of hypertension. Clin Trans Sci 2012; Volume #: 1–6 PMID:23399083

  4. A patient-centric goal in time to blood pressure control from drug therapy initiation.

    PubMed

    Hong, Song Hee; Wang, Junling; Tak, Sunghee

    2013-02-01

    A time frame in which newly diagnosed hypertensive patients attain blood pressure (BP) goal would guide patients through uncertainty associated with initiating drug therapy for hypertension control. This study estimates time to BP goal resulting from drug therapy initiation among real-world hypertensive patients and identifies factors associated with variations in time to BP goal. The study uses a historical cohort design. Hypertensive patients who had initiated antihypertensive drug therapy between July 1, 2002, and December 31, 2003, were followed up to 12 months until the end of 2004. Electronic medical records from a medical group were linked with pharmacy claims, as well as with medical claims. Survival analyses were used to compare lengths of time needed to reach BP goals. A total of 223 patients from a real world practice setting had initiated antihypertensive drug therapy. The patients took 3.25 months (95% CI: 2.49-4.82) to reach BP goal. The patient-centric time to BP goal was 7.1 weeks longer than those reported in controlled experimental settings. This finding highlights the gap between results of controlled clinical trials and their application to clinical practice, and informs healthcare practitioners of the importance of setting a patient-centric goal in pharmacological treatment of hypertension. © 2013 Wiley Periodicals, Inc.

  5. Transcriptional activation domains stimulate initiation and elongation at different times and via different residues.

    PubMed Central

    Brown, S A; Weirich, C S; Newton, E M; Kingston, R E

    1998-01-01

    Transcriptional activators can stimulate multiple steps in the transcription process. We have used GAL4 fusion proteins to characterize the ability of different transcriptional activation domains to stimulate transcriptional elongation on the hsp70 gene in vitro. Stimulation of elongation apparently occurs via a mechanistic pathway different from that of stimulation of initiation: the herpes simplex virus VP16, heat shock factor 1 (HSF1) and amphipathic helix (AH) activation domains all stimulate initiation, but only VP16 and HSF1 stimulate elongation; and mutations in hydrophobic residues of the HSF1 activation domains impair stimulation of elongation but not of initiation, while mutations in adjacent acidic residues impair stimulation of initiation more than of elongation. Experiments in which activators were exchanged between initiation and elongation demonstrate that the elongation function of HSF1 will stimulate RNA polymerase that has initiated and is transcriptionally engaged. Transcriptional activators thus appear to have at least two distinct functions that reside in the same domain, and that act at different times to stimulate initiation and elongation. PMID:9606196

  6. [Pain, agitation and delirium in acute respiratory failure].

    PubMed

    Funk, G-C

    2016-02-01

    Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically.

  7. Real-time assembly landscape of bacterial 30S translation initiation complex.

    PubMed

    Milón, Pohl; Maracci, Cristina; Filonava, Liudmila; Gualerzi, Claudio O; Rodnina, Marina V

    2012-05-06

    Initiation factors guide the ribosome in the selection of mRNA and translational reading frame. We determined the kinetically favored assembly pathway of the 30S preinitiation complex (30S PIC), an early intermediate in 30S initiation complex formation in Escherichia coli. IF3 and IF2 are the first factors to arrive, forming an unstable 30S-IF2-IF3 complex. Subsequently, IF1 joins and locks the factors in a kinetically stable 30S PIC to which fMet-tRNA(fMet) is recruited. Binding of mRNA is independent of initiation factors and can take place at any time during 30S PIC assembly, depending on the cellular concentration of the mRNA and the structural determinants at the ribosome-binding site. The kinetic analysis shows both specific and cumulative effects of initiation factors as well as kinetic checkpoints of mRNA selection at the entry into translation.

  8. My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India

    PubMed Central

    Kermode, Michelle; Longleng, Verity; Singh, Bangkim Chingsubam; Hocking, Jane; Langkham, Biangtung; Crofts, Nick

    2007-01-01

    Background The north-east Indian states of Manipur and Nagaland are two of the six high HIV prevalence states in the country, and the main route of HIV transmission is injecting drug use. Understanding the pathways to injecting drug use can facilitate early intervention with HIV prevention programs. While several studies of initiation into injecting drug use have been conducted in developed countries, little is known about the situation in developing country settings. The aim of this study was to increase understanding of the contextual factors associated with initiation into injecting drug use in north-east India, and the influence of these factors on subsequent initiation of others. Method In mid 2006 a cross-sectional survey among 200 injecting drug users (IDUs) was undertaken in partnership with local NGOs that provide HIV prevention and care services and advocacy for IDUs in Imphal, Manipur and Dimapur, Nagaland. The questionnaire elicited detailed information about the circumstances of the first injection and the contexts of participants' lives. Demographic information, self-reported HIV status, and details about initiation of others were also recorded. Results Initiation into injecting drug use occurred at 20 years of age. The drugs most commonly injected were Spasmo-proxyvon (65.5%) and heroin (30.5%). In 53.5% cases, a needle belonging to someone else was used. Two-thirds (66.7%) had used the drug previously, and 91.0% had known other IDUs prior to initiation (mean = 7.5 others). The first injection was usually administered by another person (94.5%), mostly a friend (84.1%). Initiation is a social event; 98% had others present (mean = 2.7 others). Almost 70% of participants had initiated at least one other (mean = 5 others). Initiation of others was independently associated with being male and unemployed; having IDU friends and using alcohol around the time of initiation; and having been taught to inject and not paid for the drug at the time of initiation

  9. Location of Acute Infarcts and Agitation and Aggression in Stroke.

    PubMed

    Tang, Wai Kwong; Liu, Xiang Xin; Liang, Huajun; Chen, Yang Kun; Chu, Winnie Chiu Wing; Ahuja, Anil T; Abrigo, Jill; Mok, Vincent Chung Tong; Ungvari, Gabor S; Wong, Ka Sing; Spalletta, Gianfranco

    2017-01-01

    The role of the infarct location in the development of poststroke agitation (PSA) is largely unknown. This study examined the association between the locations of infarcts and PSA at 9 months following the index stroke in 213 patients with the Chinese version of the Neuropsychiatric Inventory. Compared with the non-PSA group, PSA patients had a higher number and volume of acute pontine infarcts. Ventral pontine and lateral cerebellar infarcts were independent predictors of PSA in the multivariate analysis.

  10. Prevention of Sevoflurane Delirium and Agitation With Propofol

    PubMed Central

    Messieha, Zakaria

    2013-01-01

    Emergence delirium and agitation (EAD) associated with sevoflurane general anesthesia are very commonly observed in young children. Such events pose a risk for injury as well as decreased parental satisfaction, especially in the ambulatory and office-based setting. This article reviews the different approaches described in the literature to reduce EAD. A novel approach using a Bispectral Index System (BIS)-guided anesthesia with propofol washout technique is proposed as a viable and effective approach to prevent EAD. PMID:23763562

  11. Agitation Dredging: Lessons and Guidelines from Past Projects

    DTIC Science & Technology

    1984-07-01

    Sandwick. The Sandick also moved 415 cu yd/hr in the Umpqua River in deeper water with the aid of 0 currents (see paragraphs A36-A42 for descriptions of...cited in several projects as being especially helpful. In the Umpqua River (para- graphs A36-A42), propwash agitation was successful in 20 ft of water...A16 Missouri River .......... ................. A21 Pacific Northwest. ......... ................ A26 Tillamook Bay. ..... ...................... A33

  12. Ultrasonic agitation method for accelerating batch leaching tests

    SciTech Connect

    Caldwell, R.J.; Stegemann, J.A.; Chao, C.C.

    1996-12-31

    A method has been developed which uses ultrasonic cavitation to accelerate batch leaching tests. Batch leaching tests, in which attainment of an equilibrium between the solid sample and liquid leachant is desired, usually involve particle size reduction and mixing to hasten mass transfer of soluble compounds. In the study discussed here, mixing in the form of ultrasonic cavitation was used to supply an intense level of agitation. Breaking the liquid boundary layer surrounding individual waste particles ensured a maximum concentration gradient between the solid and liquid phases and accelerated attainment of steady state concentrations. Evaluation of the acceleration technique was made through comparison of leachate quality of stabilized/solidified (S/S) residue samples tested using the Wastewater Technology Centre`s (WTC) equilibrium extraction (EE) and an ultrasonically agitated version of the same test method (UEE). The sample preparation, liquid-to-solid ratio, extraction fluid, etc., specified in the EE method were held constant for the EE and UEE samples, while the duration and method of agitation was altered for the UEE samples. To date, this evaluation has been made using five metal finishing residues, which were selected based on their elevated concentrations of regulated contaminants. The results of the evaluations are presented and suggestions are made as to the applicability of this accelerated test method.

  13. Long time existence results for bore-type initial data for BBM-Boussinesq systems

    NASA Astrophysics Data System (ADS)

    Burtea, Cosmin

    2016-11-01

    In this paper we deal with the long time existence for the Cauchy problem associated to BBM-type Boussinesq systems of equations which are asymptotic models for long wave, small amplitude gravity surface water waves. As opposed to previous papers devoted to the long time existence issue, we consider initial data with nontrivial behavior at infinity which may be used to model bore propagation.

  14. 5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Time limits for OPM to initiate mandatory debarments. 890.1005 Section 890.1005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED... years of the event that forms the basis for the debarment. If the basis for the proposed debarment is a...

  15. 18 CFR 701.207 - Extension of time limits for WRC initial and final determinations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Extension of time limits for WRC initial and final determinations. 701.207 Section 701.207 Conservation of Power and Water... among two or more components of the agency having substantial subject-matter interest therein. ...

  16. 18 CFR 701.207 - Extension of time limits for WRC initial and final determinations.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Extension of time limits for WRC initial and final determinations. 701.207 Section 701.207 Conservation of Power and Water... among two or more components of the agency having substantial subject-matter interest therein. ...

  17. 18 CFR 701.207 - Extension of time limits for WRC initial and final determinations.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Extension of time limits for WRC initial and final determinations. 701.207 Section 701.207 Conservation of Power and Water... among two or more components of the agency having substantial subject-matter interest therein. ...

  18. Timely initiation of breastfeeding is associated with the practice of exclusive breastfeeding in Indonesia.

    PubMed

    Paramashanti, Bunga Astria; Hadi, Hamam; Gunawan, I Made Alit

    2016-12-01

    Exclusive breastfeeding has been proven to be essential for optimal health, and for reducing infections and mortality in children. However, exclusive breastfeeding coverage both in Indonesia and in globalremains low. This study evaluated the relationship between the timely initiation of breastfeeding and the practice of exclusive breastfeeding in Indonesia. This cross-sectional study used Riskesdas 2013 data. Participants were 7,667 mothers whose children were aged 6-23 months in Indonesia, and were selected based on the completeness of the variables. The data were analysed using descriptive statistics, chisquare tests, and a multiple logistic regression that considered the sampling weight. STATA 13.0 was used for the analyses, and the significance level was set at p<0.05. Timely initiation of breastfeeding within 1 hour of parturition (OR=3.66, 95% CI: 2.14-3.64), timely initiation of breastfeeding at or after 1 hour following parturition (OR=2.79, 95% CI: 3.00-4.46), and neonatal illness (OR=0.69, 95% CI: 0.53-0.91) were significantly associated with an exclusive breastfeeding history among children aged 6-23 months. Other factors, such as the mother's age, mother's educational level, child's birth weight, household economic status, and residential area were not associated with an exclusive breastfeeding history. Timely initiation of breastfeeding and the prevention of neonatal illness should be the main interventions to improve exclusive breastfeeding coverage in Indonesia.

  19. Married Thai Working Mothers: Coping with Initial Part-Time Doctoral Study

    ERIC Educational Resources Information Center

    Thinnam, Thanit

    2011-01-01

    Advanced educational attainment can "grow" a career. But acquiring a doctoral qualification adds study to existing work and family responsibilities, especially for women. This phenomenological research explores the experiences of eight Thai working mothers enrolled in the initial stage of part-time doctoral programs in Thailand. A…

  20. 49 CFR 7.31 - What time limits apply to DOT with respect to initial determinations?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Multi-track processing of initial requests. (1) A DOT component may use two or more processing tracks by distinguishing between simple and more complex requests based on the amount of work and/or time needed to process... processing may provide requesters in its slower track(s) with an opportunity to limit the scope of their...

  1. Parental Monitoring during Early Adolescence Deters Adolescent Sexual Initiation: Discrete-Time Survival Mixture Analysis

    ERIC Educational Resources Information Center

    Huang, David Y. C.; Murphy, Debra A.; Hser, Yih-Ing

    2011-01-01

    We used discrete-time survival mixture modeling to examine 5,305 adolescents from the 1997 National Longitudinal Survey of Youth regarding the impact of parental monitoring during early adolescence (ages 14-16) on initiation of sexual intercourse and problem behavior engagement (ages 14-23). Four distinctive parental-monitoring groups were…

  2. Palm Beach County's Prime Time Initiative: Improving the Quality of After-School Programs

    ERIC Educational Resources Information Center

    Spielberger, Julie; Lockaby, Tracey

    2008-01-01

    This report covers the third year of Chapin Hall's process evaluation of the Prime Time Initiative of Palm Beach County, Florida, a system-building effort to strengthen the quality of after-school programs in the county. During the past two decades, the after-school field has expanded enormously, partly in response to increasing concern about…

  3. Evaluation of Massachusetts Expanded Learning Time (ELT) Initiative: Implementation and Outcomes after Four Years

    ERIC Educational Resources Information Center

    Boulay, Beth; Gamse, Beth; Checkoway, Amy; Maree, Kenyon; Fox, Lindsay

    2011-01-01

    The Massachusetts Department of Elementary and Secondary Education (ESE) has supported a multi-year study of the Expanded Learning Time (ELT) initiative to learn about the process and impact of ELT. Abt Associates Inc. is conducting this research. The study has two components: 1) a planning and implementation component that explores the…

  4. Married Thai Working Mothers: Coping with Initial Part-Time Doctoral Study

    ERIC Educational Resources Information Center

    Thinnam, Thanit

    2011-01-01

    Advanced educational attainment can "grow" a career. But acquiring a doctoral qualification adds study to existing work and family responsibilities, especially for women. This phenomenological research explores the experiences of eight Thai working mothers enrolled in the initial stage of part-time doctoral programs in Thailand. A…

  5. How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania

    PubMed Central

    2013-01-01

    Background Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Methods Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation. Results Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10–2.58) and 2.00 (95% CI 1.05–3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41–5.59) and 4.10 (95% CI 1.68–10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Conclusion Late ANC initiation is a significant maternal and

  6. Rapid initialization of real-time PPP by resolving undifferenced GPS and GLONASS ambiguities simultaneously

    NASA Astrophysics Data System (ADS)

    Geng, Jianghui; Shi, Chuang

    2017-04-01

    Rapid initialization of real-time precise point positioning (PPP) has constantly been a difficult problem. Recent efforts through multi-GNSS and multi-frequency data, though beneficial indeed, have not proved sufficiently effective in reducing the initialization periods to far less than 10 min. Though this goal can be easily reached by introducing ionosphere corrections as accurate as a few centimeters, a dense reference network is required which is impractical for wi de-area applications. Leveraging the latest development of GLONASS PPP ambiguity resolution (PPP-AR) technique, we propose a composite strategy, where simultaneous GPS and GLONASS dual-frequency PPP-AR is carried out, and herein, the reliability of partial AR improves dramatically. We used 14 days of data from a German network and divided them into hourly data to test this strategy. We found that the initialization periods were shortened drastically from over 25 min when only GPS data were processed to about 6 min when GPS and GLONASS PPP-AR were accomplished simultaneously. More encouragingly, over 50% of real-time PPP solutions could be initialized successfully within 5 min through our strategy, in contrast to only 4% when only GPS data were used. We expect that our strategy can provide a promising route to overcoming the difficulty of achieving PPP initializations within a few minutes.

  7. Rapid initialization of real-time PPP by resolving undifferenced GPS and GLONASS ambiguities simultaneously

    NASA Astrophysics Data System (ADS)

    Geng, Jianghui; Shi, Chuang

    2016-11-01

    Rapid initialization of real-time precise point positioning (PPP) has constantly been a difficult problem. Recent efforts through multi-GNSS and multi-frequency data, though beneficial indeed, have not proved sufficiently effective in reducing the initialization periods to far less than 10 min. Though this goal can be easily reached by introducing ionosphere corrections as accurate as a few centimeters, a dense reference network is required which is impractical for wi de-area applications. Leveraging the latest development of GLONASS PPP ambiguity resolution (PPP-AR) technique, we propose a composite strategy, where simultaneous GPS and GLONASS dual-frequency PPP-AR is carried out, and herein, the reliability of partial AR improves dramatically. We used 14 days of data from a German network and divided them into hourly data to test this strategy. We found that the initialization periods were shortened drastically from over 25 min when only GPS data were processed to about 6 min when GPS and GLONASS PPP-AR were accomplished simultaneously. More encouragingly, over 50% of real-time PPP solutions could be initialized successfully within 5 min through our strategy, in contrast to only 4% when only GPS data were used. We expect that our strategy can provide a promising route to overcoming the difficulty of achieving PPP initializations within a few minutes.

  8. Breast-feeding patterns, time to initiation, and mortality risk among newborns in southern Nepal.

    PubMed

    Mullany, Luke C; Katz, Joanne; Li, Yue M; Khatry, Subarna K; LeClerq, Steven C; Darmstadt, Gary L; Tielsch, James M

    2008-03-01

    Initiation of breast-feeding within 1 h after birth has been associated with reduced neonatal mortality in a rural Ghanaian population. In South Asia, however, breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified. Data were collected during a community-based randomized trial of the impact of topical chlorhexidine antisepsis interventions on neonatal mortality and morbidity in southern Nepal. In-home visits were conducted on d 1-4, 6, 8, 10, 12, 14, 21, and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding. Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time. Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth, 3.4% of infants were breast-fed and 56.6% were breast-fed within 24 h of birth. Partially breast-fed infants (72.6%) were at higher mortality risk [relative risk (RR) = 1.77; 95% CI = 1.32-2.39] than those exclusively breast-fed. There was a trend (P = 0.03) toward higher mortality with increasing delay in breast-feeding initiation. Mortality was higher among late (> or = 24 h) compared with early (< 24 h) initiators (RR = 1.41; 95% CI = 1.08-1.86) after adjustment for low birth weight, preterm birth, and other covariates. Improvements in breast-feeding practices in this setting may reduce neonatal mortality substantially. Approximately 7.7 and 19.1% of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life, respectively. Community-based breast-feeding promotion programs should remain a priority, with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding.

  9. Dexmedetomidine use during strabismus surgery in agitated children.

    PubMed

    Mizrak, Ayse; Erbagci, Ibrahim; Arici, Tulin; Avci, Neslihan; Ganidagli, Suleyman; Oner, Unsal

    2011-01-01

    We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 μg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 μg/kg and rocuronium bromide 0.5 mg/kg. 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0-4.0) in group D and 0.0 (IQR 1.0-2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5-3.0) in group D and 2.0 (IQR 1.5-3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0-2.0) in group D and 4.5 (4.0-5.0) in group P] (p = 0.0001). Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery. Copyright © 2011 S. Karger AG, Basel.

  10. [Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial].

    PubMed

    Ozcan, Ayse; Kaya, Ayse Gunay; Ozcan, Namik; Karaaslan, Gul Meltem; Er, Esen; Baltaci, Bulent; Basar, Hulya

    2014-01-01

    Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. 62 American Society of Anesthesiologists patient classification status I children, aged 2-7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75mLkg(-1), 0.25% bupivacaine. At the end of the surgery, ketamine 0.25mgkg(-1), midazolam 0.03mgkg(-1) and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por

  11. Synthesis of Zeolites Na-P1 from South African Coal Fly Ash: Effect of Impeller Design and Agitation

    PubMed Central

    Mainganye, Dakalo; Ojumu, Tunde Victor; Petrik, Leslie

    2013-01-01

    South African fly ash has been shown to be a useful feedstock for the synthesis of some zeolites. The present study focuses on the effect of impeller design and agitation rates on the synthesis of zeolite Na-P1 which are critical to the commercialization of this product. The effects of three impeller designs (4-flat blade, Anchor and Archimedes screw impellers) and three agitation speeds (150, 200 and 300 rpm) were investigated using a modified previously reported synthesis conditions; 48 hours of ageing at 47 °C and static hydrothermal treatment at 140 °C for 48 hours. The experimental results demonstrated that the phase purity of zeolite Na-P1 was strongly affected by the agitation rate and the type of impeller used during the ageing step of the synthesis process. Although zeolite Na-P1 was synthesized with a space time yield (STY) of 15 ± 0.4 kg d−1m−3 and a product yield of 0.98±0.05 g zeolites/g fly ash for each impeller at different agitation speeds, zeolite formation was assessed to be fairly unsuccessful in some cases due the occurrence of undissolved mullite and/or the formation of impurities such as hydroxysodalite with the zeolitic product. This study also showed that a high crystalline zeolite Na-P1 can be synthesized from South African coal fly ash using a 4-flat blade impeller at an agitation rate of 200 rpm during the ageing step at 47 °C for 48 hours followed by static hydrothermal treatment at 140 °C for 48 hours. PMID:28809261

  12. Meteorological factors and timing of the initiating event of human parturition

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

  13. Meteorological factors and timing of the initiating event of human parturition.

    PubMed

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

    2011-03-01

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

  14. Optimal initial condition of passive tracers for their maximal mixing in finite time

    NASA Astrophysics Data System (ADS)

    Farazmand, Mohammad

    2017-05-01

    The efficiency of fluid flow for mixing passive tracers is often limited by fundamental laws and/or design constraints, such that a perfectly homogeneous mixture cannot be obtained in finite time. Here we address the natural corollary question: Given a fluid flow, what is the optimal initial tracer pattern that leads to the most homogeneous mixture after a prescribed finite time? For ideal passive tracers, we show that this optimal initial condition coincides with the right singular vector (corresponding to the smallest singular value) of a suitably truncated Perron-Frobenius (PF) operator. The truncation of the PF operator is made under the assumption that there is a small length-scale threshold ℓν under which the tracer blobs are considered, for all practical purposes, completely mixed. We demonstrate our results on two examples: a prototypical model known as the sine flow and a direct numerical simulation of two-dimensional turbulence. Evaluating the optimal initial condition through this framework requires only the position of a dense grid of fluid particles at the final instance and their preimages at the initial instance of the prescribed time interval. As such, our framework can be readily applied to flows where such data are available through numerical simulations or experimental measurements.

  15. Clinical monitoring scales in acute brain injury: assessment of coma, pain, agitation, and delirium.

    PubMed

    Riker, Richard R; Fugate, Jennifer E

    2014-12-01

    Serial clinical examination represents the most fundamental and basic form of neurological monitoring, and is often the first and only form of such monitoring in patients. Even in patients subjected to physiological monitoring using a range of technologies, the clinical examination remains an essential tool to follow neurological progress. Key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). The Glasgow Coma Scale has been the traditional tool to measure consciousness, but the full outline of unresponsiveness (FOUR) score has recently been validated in a variety of settings, and at present, both represent clinically useful tools. Assessment of PAD in neurologically compromised patients present special challenges. For pain, the Numeric Rating Scale is the preferred initial approach, with either the Behavioral Pain Scale or the Critical Care Pain Observation Tool in subjects who are not able to respond. The Nociception Coma Scale-Revised may be useful in patients with severe disorders of consciousness. Conventional sedation scoring tools for critical care, such as the Richmond Area Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) may provide reasonable tools in some neurocritical care patients. The use of sedative drugs and neuromuscular blockers may invalidate the use of some clinical examination tools in others. The use of sedation interruption to assess neurological status can result in physiological derangement in unstable patients (such as those with uncontrolled intracranial hypertension), and is not recommended.

  16. Effect of agitation speed on the morphology of Aspergillus niger HFD5A-1 hyphae and its pectinase production in submerged fermentation.

    PubMed

    Ibrahim, Darah; Weloosamy, Haritharan; Lim, Sheh-Hong

    2015-08-26

    To investigate the impact of agitation speed on pectinase production and morphological changing of Aspergillus niger (A. niger) HFD5A-1 in submerged fermentation. A. niger HFM5A-1 was isolated from a rotted pomelo. The inoculum preparation was performed by adding 5.0 mL of sterile distilled water containing 0.1% Tween 80 to a sporulated culture. Cultivation was carried out with inoculated 1 × 10(7) spores/mL suspension and incubated at 30 °C with different agitation speed for 6 d. The samples were withdrawn after 6 d cultivation time and were assayed for pectinase activity and fungal growth determination. The culture broth was filtered through filter paper (Whatman No. 1, London) to separate the fungal mycelium. The cell-free culture filtrate containing the crude enzyme was then assayed for pectinase activity. The biomass was dried at 80 °C until constant weight. The fungal cell dry weight was then expressed as g/L. The 6 d old fungal mycelia were harvested from various agitation speed, 0, 50, 100, 150, 200 and 250 rpm. The morphological changing of samples was then viewed under the light microscope and scanning electron microscope. In the present study, agitation speed was found to influence pectinase production in a batch cultivation system. However, higher agitation speeds than the optimal speed (150 rpm) reduced pectinase production which due to shear forces and also collision among the suspended fungal cells in the cultivation medium. Enzyme activity increased with the increasing of agitation speed up to 150 rpm, where it achieved its maximal pectinase activity of 1.559 U/mL. There were significant different (Duncan, P < 0.05) of the pectinase production with the agitation speed at static, 50, 100, 200 and 250 rpm. At the static condition, a well growth mycelial mat was observed on the surface of the cultivation medium and sporulation occurred all over the fungal mycelial mat. However with the increased in agitation speed, the mycelial mat turned slowly

  17. Effect of agitation speed on the morphology of Aspergillus niger HFD5A-1 hyphae and its pectinase production in submerged fermentation

    PubMed Central

    Ibrahim, Darah; Weloosamy, Haritharan; Lim, Sheh-Hong

    2015-01-01

    AIM: To investigate the impact of agitation speed on pectinase production and morphological changing of Aspergillus niger (A. niger) HFD5A-1 in submerged fermentation. METHODS: A. niger HFM5A-1 was isolated from a rotted pomelo. The inoculum preparation was performed by adding 5.0 mL of sterile distilled water containing 0.1% Tween 80 to a sporulated culture. Cultivation was carried out with inoculated 1 × 107 spores/mL suspension and incubated at 30 °C with different agitation speed for 6 d. The samples were withdrawn after 6 d cultivation time and were assayed for pectinase activity and fungal growth determination. The culture broth was filtered through filter paper (Whatman No. 1, London) to separate the fungal mycelium. The cell-free culture filtrate containing the crude enzyme was then assayed for pectinase activity. The biomass was dried at 80 °C until constant weight. The fungal cell dry weight was then expressed as g/L. The 6 d old fungal mycelia were harvested from various agitation speed, 0, 50, 100, 150, 200 and 250 rpm. The morphological changing of samples was then viewed under the light microscope and scanning electron microscope. RESULTS: In the present study, agitation speed was found to influence pectinase production in a batch cultivation system. However, higher agitation speeds than the optimal speed (150 rpm) reduced pectinase production which due to shear forces and also collision among the suspended fungal cells in the cultivation medium. Enzyme activity increased with the increasing of agitation speed up to 150 rpm, where it achieved its maximal pectinase activity of 1.559 U/mL. There were significant different (Duncan, P < 0.05) of the pectinase production with the agitation speed at static, 50, 100, 200 and 250 rpm. At the static condition, a well growth mycelial mat was observed on the surface of the cultivation medium and sporulation occurred all over the fungal mycelial mat. However with the increased in agitation speed, the

  18. Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs.

    PubMed

    Yu, Margaret K; O'Hare, Ann M; Batten, Adam; Sulc, Christine A; Neely, Emily L; Liu, Chuan-Fen; Hebert, Paul L

    2015-08-07

    The secular trend toward dialysis initiation at progressively higher levels of eGFR is not well understood. This study compared temporal trends in eGFR at dialysis initiation within versus outside the Department of Veterans Affairs (VA)-the largest non-fee-for-service health system in the United States. The study used linked data from the US Renal Data System, VA, and Medicare to compare temporal trends in eGFR at dialysis initiation between 2000 and 2009 (n=971,543). Veterans who initiated dialysis within the VA were compared with three groups who initiated dialysis outside the VA: (1) veterans whose dialysis was paid for by the VA, (2) veterans whose dialysis was not paid for by the VA, and (3) nonveterans. Logistic regression was used to estimate average predicted probabilities of dialysis initiation at an eGFR≥10 ml/min per 1.73 m(2). The adjusted probability of starting dialysis at an eGFR≥10 ml/min per 1.73 m(2) increased over time for all groups but was lower for veterans who started dialysis within the VA (0.31; 95% confidence interval [95% CI], 0.30 to 0.32) than for those starting outside the VA, including veterans whose dialysis was (0.36; 95% CI, 0.35 to 0.38) and was not (0.40; 95% CI, 0.40 to 0.40) paid for by the VA and nonveterans (0.39; 95% CI, 0.39 to 0.39). Differences in eGFR at initiation within versus outside the VA were most pronounced among older patients (P for interaction <0.001) and those with a higher risk of 1-year mortality (P for interaction <0.001). Temporal trends in eGFR at dialysis initiation within the VA mirrored those in the wider United States dialysis population, but eGFR at initiation was consistently lowest among those who initiated within the VA. Differences in eGFR at initiation within versus outside the VA were especially pronounced in older patients and those with higher 1-year mortality risk. Copyright © 2015 by the American Society of Nephrology.

  19. Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs

    PubMed Central

    O’Hare, Ann M.; Batten, Adam; Sulc, Christine A.; Neely, Emily L.; Liu, Chuan-Fen; Hebert, Paul L.

    2015-01-01

    Background and objectives The secular trend toward dialysis initiation at progressively higher levels of eGFR is not well understood. This study compared temporal trends in eGFR at dialysis initiation within versus outside the Department of Veterans Affairs (VA)—the largest non–fee-for-service health system in the United States. Design, setting, participants, & measurements The study used linked data from the US Renal Data System, VA, and Medicare to compare temporal trends in eGFR at dialysis initiation between 2000 and 2009 (n=971,543). Veterans who initiated dialysis within the VA were compared with three groups who initiated dialysis outside the VA: (1) veterans whose dialysis was paid for by the VA, (2) veterans whose dialysis was not paid for by the VA, and (3) nonveterans. Logistic regression was used to estimate average predicted probabilities of dialysis initiation at an eGFR≥10 ml/min per 1.73 m2. Results The adjusted probability of starting dialysis at an eGFR≥10 ml/min per 1.73 m2 increased over time for all groups but was lower for veterans who started dialysis within the VA (0.31; 95% confidence interval [95% CI], 0.30 to 0.32) than for those starting outside the VA, including veterans whose dialysis was (0.36; 95% CI, 0.35 to 0.38) and was not (0.40; 95% CI, 0.40 to 0.40) paid for by the VA and nonveterans (0.39; 95% CI, 0.39 to 0.39). Differences in eGFR at initiation within versus outside the VA were most pronounced among older patients (P for interaction <0.001) and those with a higher risk of 1-year mortality (P for interaction <0.001). Conclusions Temporal trends in eGFR at dialysis initiation within the VA mirrored those in the wider United States dialysis population, but eGFR at initiation was consistently lowest among those who initiated within the VA. Differences in eGFR at initiation within versus outside the VA were especially pronounced in older patients and those with higher 1-year mortality risk. PMID:26206891

  20. Interdependence of initial cell density, drug concentration and exposure time revealed by real-time impedance spectroscopic cytotoxicity assay.

    PubMed

    Caviglia, C; Zór, K; Canepa, S; Carminati, M; Larsen, L B; Raiteri, R; Andresen, T L; Heiskanen, A; Emnéus, J

    2015-05-21

    We investigated the combined effect of the initial cell density (12,500, 35,000, 75,000, and 100,000 cells cm(-2)) and concentration of the anti-cancer drug doxorubicin on HeLa cells by performing time-dependent cytotoxicity assays using real-time electrochemical impedance spectroscopy. A correlation between the rate of cell death and the initial cell seeding density was found at 2.5 μM doxorubicin concentration, whereas this was not observed at 5 or 100 μM. By sensing the changes in the cell-substrate interaction using impedance spectroscopy under static conditions, the onset of cytotoxicity was observed 5 h earlier than when using a standard colorimetric end-point assay (MTS) which measures changes in the mitochondrial metabolism. Furthermore, with the MTS assay no cytotoxicity was observed after 15 h of incubation with 2.5 μM doxorubicin, whereas the impedance showed at this time point cell viability that was below 25%. These results indicate that impedance detection reveals cytotoxic events undetectable when using the MTS assay, highlighting the importance of combining impedance detection with traditional drug toxicity assays towards a more in depth understanding of the effect of anti-cancer drugs on in vitro assays. Moreover, the detection of doxorubicin induced toxicity determined with impedance under static conditions proved to be 6 times faster than in perfusion culture.

  1. Inferring Where and When Replication Initiates from Genome-Wide Replication Timing Data

    NASA Astrophysics Data System (ADS)

    Baker, A.; Audit, B.; Yang, S. C.-H.; Bechhoefer, J.; Arneodo, A.

    2012-06-01

    Based on an analogy between DNA replication and one dimensional nucleation-and-growth processes, various attempts to infer the local initiation rate I(x,t) of DNA replication origins from replication timing data have been developed in the framework of phase transition kinetics theories. These works have all used curve-fit strategies to estimate I(x,t) from genome-wide replication timing data. Here, we show how to invert analytically the Kolmogorov-Johnson-Mehl-Avrami model and extract I(x,t) directly. Tests on both simulated and experimental budding-yeast data confirm the location and firing-time distribution of replication origins.

  2. Time to initiation of treatment with polymyxin B cartridge hemoperfusion in septic shock patients.

    PubMed

    Takeyama, Naoshi; Noguchi, Hiroshi; Hirakawa, Akihiko; Kano, Hideki; Morino, Kazuma; Obata, Toru; Sakamoto, Tetsuya; Tamai, Fumihiro; Ishikura, Hiroyasu; Kase, Youichi; Kobayashi, Makoto; Naka, Toshio; Takahashi, Yoshiki

    2012-01-01

    We investigated whether early initiation of hemoperfusion with a polymyxin B cartridge (PMX) after the diagnosis of septic shock could improve the clinical outcome. A prospective, open-labeled, multicenter cohort study was performed at intensive care units in Japan. 41 patients received PMX within 6 h after the diagnosis of septic shock (early group) and 51 patients were treated after 6 h (late group). The early group had a significantly shorter duration of ventilator support and also had a lower catecholamine requirement. PMX was effective for improvement of hypotension, hypoperfusion, the sequential organ failure assessment score, and pulmonary oxygenation regardless of the timing of its initiation. The 28-day mortality rate did not differ between the two groups. Early initiation of PMX shortened the duration of ventilator support and also reduced the catecholamine requirement, so early treatment of septic shock should achieve a better outcome. Copyright © 2012 S. Karger AG, Basel.

  3. Midazolam-Droperidol, Droperidol, or Olanzapine for Acute Agitation: A Randomized Clinical Trial.

    PubMed

    Taylor, David McD; Yap, Celene Y L; Knott, Jonathan C; Taylor, Simone E; Phillips, Georgina A; Karro, Jonathan; Chan, Esther W; Kong, David C M; Castle, David J

    2017-03-01

    We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and requiring intravenous medication sedation for acute agitation were enrolled and randomized to an intravenous bolus of midazolam 5 mg-droperidol 5 mg, droperidol 10 mg, or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg, or olanzapine 5 mg. The primary outcome was the proportion of patients adequately sedated at 10 minutes. Three hundred forty-nine patients were randomized to the 3 groups. Baseline characteristics were similar across the groups. Ten minutes after the first dose, significantly more patients in the midazolam-droperidol group were adequately sedated compared with the droperidol and olanzapine groups: differences in proportions 25.0% (95% confidence interval [CI] 12.0% to 38.1%) and 25.4% (95% CI 12.7% to 38.3%), respectively. For times to sedation, the differences in medians between the midazolam-droperidol group and the droperidol and olanzapine groups were 6 (95% CI 3 to 8) and 6 (95% CI 3 to 7) minutes, respectively. Patients in the midazolam-droperidol group required fewer additional doses or alternative drugs to achieve adequate sedation. The 3 groups' adverse event rates and lengths of stay did not differ. Midazolam-droperidol combination therapy is superior, in the doses studied, to either droperidol or olanzapine monotherapy for intravenous sedation of the acutely agitated ED patient. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. Self-similar space-time evolution of an initial density discontinuity

    SciTech Connect

    Rekaa, V. L.; Pécseli, H. L.; Trulsen, J. K.

    2013-07-15

    The space-time evolution of an initial step-like plasma density variation is studied. We give particular attention to formulate the problem in a way that opens for the possibility of realizing the conditions experimentally. After a short transient time interval of the order of the electron plasma period, the solution is self-similar as illustrated by a video where the space-time evolution is reduced to be a function of the ratio x/t. Solutions of this form are usually found for problems without characteristic length and time scales, in our case the quasi-neutral limit. By introducing ion collisions with neutrals into the numerical analysis, we introduce a length scale, the collisional mean free path. We study the breakdown of the self-similarity of the solution as the mean free path is made shorter than the system length. Analytical results are presented for charge exchange collisions, demonstrating a short time collisionless evolution with an ensuing long time diffusive relaxation of the initial perturbation. For large times, we find a diffusion equation as the limiting analytical form for a charge-exchange collisional plasma, with a diffusion coefficient defined as the square of the ion sound speed divided by the (constant) ion collision frequency. The ion-neutral collision frequency acts as a parameter that allows a collisionless result to be obtained in one limit, while the solution of a diffusion equation is recovered in the opposite limit of large collision frequencies.

  5. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    PubMed

    Attin, Mina; Winslow, Katheryn; Smith, Tyler

    2014-04-01

    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  6. Time Required to Initiate a Defensive Reaction to Direct and Feint Attacks in Fencing.

    PubMed

    Gutiérrez-Davila, Marcos; Rojas, F Javier; Gutiérrez-Cruz, Carmen; García, Carlos; Navarro, Enrique

    2016-12-01

    The two-fold purpose of this study was to analyze the time required by a fencer to initiate a defensive action in response to a direct attack, which involves identifying when the defending fencer detects the just-noticeable difference, and, secondly, to assess the effect that an attacker's rapid armed hand movement (feint attack) has on the time required to initiate a defensive move. Twenty-four elite fencers and a fencing master were included in the study. Four adapted force plates were installed on a scaffold used as a fencing piste. A 3D video analysis system recorded the location of 2 markers installed on the fencing master's shoulder and sword. The results confirm that the defending fencer has a mean movement time of 0.353 ± 0.028 s to perform the defensive action, which provides an advantage over the attacking fencer. The velocity of movement in the peripheral visual field has no influence on the time required by elite fencers to initiate a defensive action. This confirms the crucial role that response inhibition processes play when nonrelevant actions are perceived. Kinematic analysis of markers suggests that the eye movements of elite fencers are not the only source of information used while observing an attack.

  7. Time to Initiation of Antiretroviral Therapy Among Patients Who Are ART Eligible in Rwanda: Improvement Over Time

    PubMed Central

    Teasdale, Chloe A.; Wang, Chunhui; Francois, Uwinkindi; d’Amour Ndahimana, Jean; Vincent, Mutabazi; Sahabo, Ruben; El-Sadr, Wafaa M.; Abrams, Elaine J.

    2016-01-01

    Background Delayed initiation of antiretroviral therapy (ART) in eligible patients is a concern in resource-limited countries. Methods We analyzed data on HIV-positive patients ≥15 years enrolled at 41 ICAP-supported health care facilities in Rwanda, 2005–2010, to determine time to ART initiation among patients eligible at enrollment compared with those ineligible or of indeterminate eligibility who become eligible during follow-up. ART eligibility was based on CD4+ cell count (CD4+) and WHO staging; patients lacking CD4+ and WHO stage were considered indeterminate. Cumulative incidence of reaching ART eligibility and to ART initiation after eligibility was generated using competing risk estimators. Results A total of 31,033 ART-naive adults were enrolled; 64.2% were female. At enrollment, 10,158 (32.7%) patients were ART eligible, 13,372 (43.1%) were ineligible for ART, and 7503 (24.2%) patients were indeterminate. Among patients retained in care pre-ART eligibility, 17.9% [95% confidence interval (CI): 17.2 to 18.6] of ineligible and 22.8% (95% CI: 21.7 to 23.8) of indeterminate patients at enrollment reached ART eligibility within 12 months. Cumulative incidence of ART initiation within 3 months for patients eligible at enrollment was 77.2% (95% CI: 76.4 to 78.0) compared with 67.9% (95% CI: 66.4 to 69.3) for ineligible and 63.8% (95% CI: 61.9 to 65.8) for patients with indeterminate eligibility at enrollment (P < 0.05). Over the study period, there was more rapid ART initiation for patients who became ART eligible. Conclusions We found higher rates of ART initiation within 3 months among patients who were ART eligible at enrollment compared with those who reached eligibility during follow-up. From 2006 to 2011, earlier initiation of ART after eligibility was observed likely reflecting improved program quality. PMID:25415291

  8. Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes.

    PubMed

    Palatnik, Anna; Mele, Lisa; Landon, Mark B; Reddy, Uma M; Ramin, Susan M; Carpenter, Marshall W; Wapner, Ronald J; Varner, Michael W; Rouse, Dwight J; Thorp, John M; Sciscione, Anthony; Catalano, Patrick; Saade, George R; Caritis, Steve N; Sorokin, Yoram

    2015-10-01

    The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and ≥30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome, .44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P = .76; neonatal intensive care unit admission, P = .8; cesarean delivery, P = .82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P = .04), although there was not a clear cut GA trend where this outcome improved with treatment. Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Timing of dialysis initiation in transplant-naive and failed transplant patients

    PubMed Central

    Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

    2017-01-01

    Over the past two decades, most guidelines have advocated early dialysis initiation on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m2, from 20% in 1996 to 52% in 2008. During this period, patients starting dialysis with an eGFR ≥15 ml/min/1.73 m2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes in patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Dialysis reinitiation in patients with a failing renal allograft encounters similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients. In this Review, we will discuss studies of dialysis initiation and compare risks and benefits of early versus late dialysis therapy. PMID:22371250

  10. Time-resolved, laser initiated detonation of TATP supports the previously predicted non-redox mechanism.

    PubMed

    Bulatov, Valery; Reany, Ofer; Grinko, Ruslan; Schechter, Israel; Keinan, Ehud

    2013-04-28

    Our previously reported computational study of the decomposition pathways of triacetone triperoxide (TATP), 1, predicted that unlike most energetic materials, which involve self-combustion of fuel and oxidants, 1 decomposes via a thermoneutral, non-redox pathway that involves entropy burst. These predictions are now corroborated by time-resolved monitoring of deflagration or detonation of 1 using a fast video camera following initiation by a short pulse focused laser beam. While a fireball always accompanies the explosion of 1 under air, the formation of a fireball is totally prevented under a nitrogen atmosphere. These observations indicate that combustion of the gaseous primary products occurs as a secondary event only in the presence of exogenous oxygen. The composition of the product mixture was found to depend on the experimental conditions. With long pulse focused laser beam (150 μs at 1064 nm) at either 210 or 110 mJ, the small amounts of charcoal needed for initiation suggest that the energy required to initiate 1 by pulse laser is 4-10 mJ, much smaller than the energy required for initiation by either mechanical stress or electric discharge. This time-resolved study highlights the very unusual properties of the peroxide based explosives.

  11. 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

  12. Factors associated with timely initiation of antiretroviral therapy in two HIV clinics in Lilongwe, Malawi.

    PubMed

    Johnson, D C; Feldacker, C; Tweya, H; Phiri, S; Hosseinipour, M C

    2013-01-01

    The World Health Organization (WHO) estimates that only 30% of eligible, HIV-infected individuals start antiretroviral therapy (ART). This study seeks to explore the geographic and individual factors associated with starting ART on time. This retrospective study includes 15,734 HIV-positive adults initiating ART at two HIV clinics in Lilongwe, Malawi. The outcome was starting ART within two weeks of meeting ART eligibility as defined by the Malawi ART guidelines. Euclidean distance from patient neighbourhood to their clinic was calculated using Google Earth. Logistic regression models assessed factors influencing starting ART on time. Of 15,734 adults initiating ART, 8178 were from Lighthouse (LH) and 7556 were from Martin Preuss Center (MPC). Combined, 68.7% started treatment on time. Patients who were eligible for ART based on a CD4 cell count <250 cells/mm(3) versus WHO stage were less likely to begin ART on time at both LH (odds ratio [OR] 0.16; 95% CI 0.13-0.19) and MPC (OR 0.24; 95% CI 0.21-0.28). Likelihood of starting on time decreased with each kilometer further from clinic location among LH patients (OR 0.97; 95% CI 0.94-0.99); distance was not significant at MPC. In conclusion, predictors differed by clinic. Distance to clinic and type of eligibility for ART significantly influence starting ART on time.

  13. The surgical waiting time initiative: A review of the Nigerian situation.

    PubMed

    Abdulkareem, Imran Haruna

    2014-11-01

    The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24

  14. Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery.

    PubMed

    Khattab, Ahmed Metwally; El-Seify, Zeinab Ahmed

    2009-07-01

    The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation. Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 mug/ kg. The time of hospital discharge allowance was recorded. Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU (P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM (P < 0.05). Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool

  15. Patterns and Timing of Initial Relapse in Patients Subsequently Undergoing Transplantation for Hodgkin's Lymphoma

    SciTech Connect

    Dhakal, Sughosh; Biswas, Tithi; Liesveld, Jane L.; Friedberg, Jonathan W.; Phillips, Gordon L.; Constine, Louis S.

    2009-09-01

    Purpose: To evaluate the patterns and timing of initial recurrence in patients with Hodgkin's lymphoma (HL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplantation to enhance our understanding of the natural history of this disease and its modern treatment strategies and to direct approaches to disease surveillance. Methods and Materials: The records of 69 patients with HL who had undergone high-dose chemotherapy with autologous stem cell transplantation in our center between May 1992 and June 2006 were analyzed. The initial diagnosis had been made between April 1982 and January 2005 at a median patient age of 33 years (range, 19-65). The patients were segregated according to the initial stage (Stage I-II vs. III-IV). Results: Early-stage HL patients developed a relapse at a median of 2.1 years (range, 0.5-10.3), with 91% of relapses at the initial disease site, 71% of which (65% overall) were only in previously involved sites. Advanced-stage HL patients developed a relapse at a median of 1.5 years (range, 0.6-10.5), with 97% at the initial site, 71% of which (69% overall) were only in previously involved sites. Single-site relapses occurred in 47% of early- vs. 26% of advanced-stage patients, and extranodal relapses occurred in 12% of early- vs. 31% of advanced-stage patients. Conclusions: Almost all patients with HL who develop relapse and subsequently undergo high-dose chemotherapy with autologous stem cell transplantation initially developed recurrence in previously involved disease sites. Early-stage HL relapses often occurred in single sites, and advanced-stage disease relapses were more likely in multiple and extranodal sites. The interval to recurrence was brief, suggesting that the frequency of screening should be the greatest in the early post-therapy years.

  16. Flow-induced agitations create a granular fluid.

    PubMed

    Nichol, Kiri; Zanin, Alexey; Bastien, Renaud; Wandersman, Elie; van Hecke, Martin

    2010-02-19

    We fluidize a granular medium through localized stirring and probe the mechanical response of quiescent regions far away from the main flow. In these regions the material behaves like a liquid: high-density probes sink, low-density probes float at the depth given by Archimedes' law, and drag forces on moving probes scale linearly with the velocity. The fluidlike character of the material is set by agitations generated in the stirred region, suggesting a nonlocal rheology: the relation between applied stress and observed strain rate in one location depends on the strain rate in another location.

  17. Dynamic response of the Initial Systolic Time Interval to a breathing stimulus measured with impedance cardiography

    NASA Astrophysics Data System (ADS)

    Meijer, Jan H.; Hoekstra, Femke; Habers, Esther; Verdaasdonk, Ruud M.; Janssen, Thomas W. J.

    2010-04-01

    The Initial Systolic Time Interval (ISTI) is a measure for the time delay between the electrical and mechanical activity of the heart. The present study reports about the dynamic response of ISTI to a Valsalva manoeuvre. This response was investigated in 22 young healthy volunteers, having different levels of training in sports. The time course of the ISTI during the Valsalva manoeuvre was found to follow a distinct pattern and to be analogous to the course of the Pre-Ejection Period (PEP), also obtained from ECG and ICG signals, reported earlier. The recordings show a definite influence of the Frank-Starling mechanism and are to some extent consistent with reports on the time course of sympathetic activation. The highly trained subjects showed an ISTI that was systematically longer at all moments of the manoeuvre.

  18. Timing of vasopressor initiation and mortality in septic shock: a cohort study

    PubMed Central

    2014-01-01

    Introduction Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation of key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce the mortality in this condition. This study examined whether early initiation of vasopressor therapy is associated with improved survival in fluid therapy-refractory septic shock. Methods Utilizing a well-established database, relevant information including duration of time to vasopressor administration following the initial documentation of recurrent/persistent hypotension associated with septic shock was assessed in 8,670 adult patients from 28 ICUs in Canada, the United States of America, and Saudi Arabia. The primary endpoint was survival to hospital discharge. Secondary endpoints were length of ICU and hospital stay as well as duration of ventilator support and vasopressor dependence. Analysis involved multivariate linear and logistic regression analysis. Results In total, 8,640 patients met the definition of septic shock with time of vasopressor/inotropic initiation documented. Of these, 6,514 were suitable for analysis. The overall unadjusted hospital mortality rate was 53%. Independent mortality correlates included liver failure (odds ratio (OR) 3.46, 95% confidence interval (CI), 2.67 to 4.48), metastatic cancer (OR 1.63, CI, 1.32 to 2.01), AIDS (OR 1.91, CI, 1.29 to 2.49), hematologic malignancy (OR 1.88, CI, 1.46 to 2.41), neutropenia (OR 1.78, CI, 1.27 to 2.49) and chronic hypertension (OR 0.62 CI, 0.52 to 0.73). Delay of initiation of appropriate antimicrobial therapy (OR 1.07/hr, CI, 1.06 to 1.08), age (OR 1.03/yr, CI, 1.02 to 1.03), and Acute Physiology and Chronic Health Evaluation (APACHE) II Score (OR 1.11/point, CI, 1.10 to 1.12) were also found to be significant independent correlates of mortality. After adjustment, only a weak correlation between vasopressor delay and hospital mortality was found (adjusted OR 1.02/hr, 95% CI

  19. Time-symmetric initial data sets in four-dimensional dilaton gravity

    NASA Astrophysics Data System (ADS)

    Ortín, Tomás

    1995-09-01

    I study the time-symmetric initial-data problem in theories with a massless scalar field (dilaton), free or coupled to a Maxwell field in the stringy way, finding different initial-data sets describing an arbitrary number of black holes with arbitrary masses, charges, and asymptotic value of the dilaton. The presence of the scalar field gives rise to a number of interesting effects. The mass and charges of a single black hole are different in its two asymptotically flat regions across the Einstein-Rosen bridge. The same happens to the value of the dilaton at infinity. This forbids the identification of these asymptotic regions in order to build (Misner) wormholes in the most naive way. Using different techniques, I find regular initial data for stringy wormholes. The price paid is the existence singularities in the dilaton field. The presence of a single-valued scalar seems to constrain strongly the allowed topologies of the initial spacelike surface. Other kinds of scalar fields (taking values on a circle or being defined up to an additive constant) are also briefly considered.

  20. Effect of timely initiation of breastfeeding on child health in Ghana.

    PubMed

    Fosu-Brefo, Rita; Arthur, Eric

    2015-01-01

    Early initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana. Cross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey. The results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child's health. Additionally, factors such as the wealth of the household, mother's education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana. The findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.

  1. Xpert MTB/RIF detection of rifampin resistance and time to treatment initiation in Harare, Zimbabwe

    PubMed Central

    Metcalfe, John Z.; Makumbirofa, Salome; Makamure, Beauty; Sandy, Charles; Bara, Wilbert; Mason, Peter; Hopewell, Philip C.

    2016-01-01

    Background Patients at elevated risk of drug-resistant tuberculosis are prioritized for testing with Xpert MTB/RIF® (“Xpert”), though clinical utility in this population is understudied. Design From November 2011 to June 2014, consecutive outpatients with history of prior tuberculosis in high-density suburbs of Harare, Zimbabwe were tested with Xpert, solid and liquid culture, and the microscopically-observed drug susceptibility assay. Diagnostic accuracy for rifampin-resistance and time to second-line regimens were ascertained. The rpoB gene was sequenced in cases of culture-confirmed rifampin resistance and genotypic sensitivity. Results Among 352 retreatment patients, 71 (20%) had rifampin-resistant, 98 (28%) rifampin-susceptible, 64 (18%) culture-negative/Xpert-positive, and 119 (34%) culture-negative/Xpert-negative TB. Xpert was 86% (95% CI 75-93%) sensitive and 98% (95% CI 92-100%) specific for rifampin-resistant TB. The positive predictive value of Xpert-determined rifampin resistance for MDR-TB was 82% (95% CI 70-91%). Fifty-nine of 71 (83%) participants initiated SLDs, with a median time to regimen initiation of 18 days (IQR, 10-44 days). Conclusion The diagnostic accuracy of Xpert for rifampin-resistance is high, though predictive value for MDR-TB is lower than anticipated. Xpert allows for faster SLD initiation under programmatic conditions, relative to culture-based drug susceptibility testing. PMID:27287639

  2. Contextual and developmental predictors of sexual initiation timing among Mexican-origin girls.

    PubMed

    Bámaca-Colbert, Mayra Y; Greene, Kaylin M; Killoren, Sarah E; Noah, Aggie J

    2014-10-01

    Using data from a longitudinal study of Mexican-origin girls (ages 11-17 at Time 1), we examined sociocultural (i.e., family structure, nativity, and acculturation), interpersonal (i.e., supportive parenting and conflict), and developmental (i.e., menarche timing and autonomy expectations) predictors of sexual initiation. Using Cox proportional hazards models, we explored whether Time 1 variables predicted the occurrence and timing of first sexual intercourse reported 2.5 and 3.5 years later. Results indicated that the likelihood of early sexual intercourse was higher among first-generation than second-generation immigrants. In addition, living with a stepparent (compared with two biological parents) was associated with a higher likelihood of early intercourse. Furthermore, early autonomy expectations emerged as a salient predictor of intercourse, such that girls with earlier autonomy expectations were more likely to have earlier intercourse than girls with later autonomy expectations. Taken together, results highlight the importance of considering developmental and contextual factors when studying Mexican-origin girls' sexual initiation.

  3. Initial tsunami source estimation by inversion with an intelligent selection of model parameters and time delays

    NASA Astrophysics Data System (ADS)

    Mulia, Iyan E.; Asano, Toshiyuki

    2016-01-01

    We propose a method for accurately estimating the initial tsunami source. Our technique is independent of the earthquake parameters, because we only use recorded tsunami waveforms and an auxiliary basis function, instead of a fault model. We first use the measured waveforms to roughly identify the source area using backward propagated travel times, and then infer the initial sea surface deformation through inversion analysis. A computational intelligence approach based on a genetic algorithm combined with a pattern search was used to select appropriate least squares model parameters and time delays. The proposed method significantly reduced the number of parameters and suppressed the negative effect of regularization schemes that decreased the plausibility of the model. Furthermore, the stochastic approach for deriving the time delays is a more flexible strategy for simulating actual phenomena that occur in nature. The selected parameters and time delays increased the accuracy, and the model's ability to reveal the underlying physics associated with the tsunami-generating processes. In this paper, we applied the method to the 2011 Tohoku-Oki tsunami event and examined its effectiveness by comparing the results to those using the conventional method.

  4. Contextual and Developmental Predictors of Sexual Initiation Timing among Mexican-origin Girls

    PubMed Central

    Bámaca-Colbert, Mayra Y.; Greene, Kaylin M.; Killoren, Sarah E.; Noah, Aggie J.

    2014-01-01

    Using data from a longitudinal study of Mexican-origin girls (ages 11–17 at Time 1), we examined sociocultural (i.e., family structure, nativity, and acculturation), interpersonal (i.e., supportive parenting and conflict), and developmental (i.e., menarche timing and autonomy expectations) predictors of sexual initiation. Using Cox proportional hazards models, we explored whether Time 1 variables predicted the occurrence and timing of first sexual intercourse reported 2.5 to 3.5 years later. Results indicated that the likelihood of early sexual intercourse was higher among first-generation than second-generation immigrants. In addition, living with a step-parent (compared to two biological parents) was associated with a higher likelihood of early intercourse. Furthermore, early autonomy expectations emerged as a salient predictor of intercourse, such that girls with earlier autonomy expectations were more likely to have earlier intercourse than girls with later autonomy expectations. Taken together, results highlight the importance of considering developmental and contextual factors when studying Mexican-origin girls’ sexual initiation. PMID:25243331

  5. Timing of First Antenatal Care (ANC) and Inequalities in Early Initiation of ANC in Nepal.

    PubMed

    Paudel, Yuba Raj; Jha, Trishna; Mehata, Suresh

    2017-01-01

    The provision and uptake of quality and timely antenatal care (ANC) is an essential element of efforts to improve health outcomes for women and newborn babies. Antenatal consultations assist in early identification and treatment of complications during pregnancy. This study aimed to provide an information on distribution and inequalities in early initiation of ANC in Nepal. The distribution and inequalities in the early initiation of ANC were examined using Nepal Demographic and Health Surveys 2011. Bivariate and multivariate logistic regression was used to assess inequalities. Overall, 70% of the women had started their first ANC at 4 month or earlier. Among participants who had never attended school, just more than half (52%) received first ANC at 4 months or earlier, while majority of participants (97%) who had received higher education received first ANC at recommended time. Similarly, 89% of those from richest quintile and 48% of those from poorest quintile received first ANC at recommended time. In adjusted analysis, women from richest wealth quintile were significantly more likely to initiate ANC early (AOR: 3.74, 95% CI: 2.31-6.05) compared to the poorest. Similarly, women with higher level education were significantly more likely (AOR: 11.40, 95% CI: 5.05-25.73) to initiate ANC early compared to women who had never attended school. A significantly lower odds of early ANC take up was observed among madhesi other caste (AOR: 0.56, 95% CI: 0.35-0.90) compared to brahmin/chhetri women. Women whose pregnancy was unwanted were significantly less likely to attend first ANC at 4 months or early (AOR: 0.73, 95% CI: 0.58-0.93) in comparison to women whose pregnancy was wanted. The differences in the recommended timing of initiation of ANC were evident among women with different educational, economic levels, and caste/ethnic groups. Rural women were less likely to have checkups as per guidelines. The findings suggest to a need of interventions to raise female

  6. Differential contribution of velocity and distance to time estimation during self-initiated time-to-collision judgment.

    PubMed

    Li, You; Mo, Lei; Chen, Qi

    2015-07-01

    To successfully intercept/avoid a moving object, human brain needs to precisely estimate the time-to-collision (TTC) of the object. In real life, time estimation is determined conjointly by the velocity and the distance of a moving object. However, surprisingly little is known concerning whether and how the velocity and the distance dimensions contribute differentially to time estimation. In this fMRI study, we demonstrated that variations of velocity evoked substantially different behavioral and neural responses than distance during self-initiated TTC judgments. Behaviorally, the velocity dimension induced a stronger time dilation effect than the distance dimension that participants' responses were significantly more delayed by increasing velocity than by decreasing distance, even with the theoretical TTC being equated between the two conditions. Neurally, activity in the dorsal fronto-parietal TTC network was parametrically modulated by variations in TTC irrespective of whether the variations in TTC were caused by velocity or distance. Importantly, even with spatial distance being equated, increasing velocity induced illusory perception of longer spatial trajectory in early visual cortex. Moreover, as velocity increased, the early visual cortex showed enhanced connectivity with the TTC network. Our results thus implied that with increasing velocity, TTC judgments depended increasingly on the velocity-induced illusory distance information from early visual cortex and was eventually tampered.

  7. Abnormal dissolutions of chlorpromazine hydrochloride tablets in water by paddle method under a high agitation condition.

    PubMed

    Aoyagi, Nobuo; Rimando, Annie Policarpio; Izutsu, Kenichi; Katori, Noriko; Kojima, Shigeo

    2003-09-01

    All sugar-coated tablets of chlorpromazine hydrochloride except for those produced by one manufacture showed concave dissolution profiles in water by paddle method at 100 rpm but not at 50 rpm. The study was undertaken to clarify the agitation-dependent abnormal dissolutions. The strange dissolutions were also observed in water at different ionic strengths but not in buffer solutions of pH 1.2, 4.0 and 6.8. When monitored, the pH's of water in dissolution vessels for the abnormal tablets increased with time at 100 rpm and some of them exceeded pH 8 but did not at 50 rpm. The solubility of chlorpromazine hydrochloride decreased with the increase of pH which was too low to dissolve the whole amount of drug contained in a tablet at pH 8. The elevation of pH seemed to be mainly brought about by dissolution of calcium carbonate popularly used for sugar-coated tablets, because larger amount of calcium ion was dissolved out from the abnormal tablets at 100 rpm than from a normal tablet and from them at 50 rpm. These findings indicate that the concave dissolution profiles should be caused by the decrease of drug solubility with increase in pH of water, probably because of dissolution of calcium carbonate. We should pay attention to the change in pH of water which may differ depending on the agitation speed of dissolution tests.

  8. Data Mining Techniques to Estimate Plutonium, Initial Enrichment, Burnup, and Cooling Time in Spent Fuel Assemblies

    SciTech Connect

    Trellue, Holly Renee; Fugate, Michael Lynn; Tobin, Stephen Joesph

    2015-03-19

    The Next Generation Safeguards Initiative (NGSI), Office of Nonproliferation and Arms Control (NPAC), National Nuclear Security Administration (NNSA) of the U.S. Department of Energy (DOE) has sponsored a multi-laboratory, university, international partner collaboration to (1) detect replaced or missing pins from spent fuel assemblies (SFA) to confirm item integrity and deter diversion, (2) determine plutonium mass and related plutonium and uranium fissile mass parameters in SFAs, and (3) verify initial enrichment (IE), burnup (BU), and cooling time (CT) of facility declaration for SFAs. A wide variety of nondestructive assay (NDA) techniques were researched to achieve these goals [Veal, 2010 and Humphrey, 2012]. In addition, the project includes two related activities with facility-specific benefits: (1) determination of heat content and (2) determination of reactivity (multiplication). In this research, a subset of 11 integrated NDA techniques was researched using data mining solutions at Los Alamos National Laboratory (LANL) for their ability to achieve the above goals.

  9. Effect of viscosity on the mixing efficiency in a self-agitation anaerobic baffled reactor.

    PubMed

    Qi, Wei-Kang; Guo, Yi-Ling; Xue, Mei; Du, Jing-Ru; Li, Weicheng; Li, Yu-You

    2015-05-01

    One special self-agitation reactor, which does not require a mechanical mixer or other equipment for mixing, has been introduced. Self-agitation is affected by variation in viscosity property. To obtain and research the effect of viscosity on mixing behavior in the self-agitation reactor, Fluent® was used to create numerical simulations and to visualize the fluid flow status. The results show that when the viscosity of the liquid is 1 mPa s, the entire self-agitation results in an almost completely mixed reactor. The substrate becomes difficult to agitate, and the diffusion of the substrate and the tracer become quite after every self-agitation, as the viscosity increases. Once the viscosity is higher than 25 mPa s, the substrate and tracer could not be mixed in the entire reactor, and the reactor is recognized as the combination of several completely mixed reactors between which little exchange of liquid occurs.

  10. Significance of the initiation time of urate-lowering therapy in gout patients: A retrospective research.

    PubMed

    Feng, Xin; Li, Yao; Gao, Wei

    2015-12-01

    To evaluate the efficacy and safety of the initiation time of urate-lowering treatments (ULT) in gout patients. We retrospectively reviewed patients who were diagnosed with gout and were treated with ULT for at least 3 years. They were divided into two groups: group 1: 123 patients initiating ULT during an acute attack of gout; group 2: 457 patients prescribed ULT after an acute attack. Both demographic and clinical characteristics associated with gout were analyzed. Comparing patients in group 1 versus group 2: the former exhibited a shorter duration of gout (6.3±2.1 vs. 8.9±3.3 years). At the baseline, there was no significant difference in mean serum urate (SU; 7.8±1.4mg/dL vs. 7.9±1.9mg/dL, respectively). SU target levels (<6.0mg/dL) were achieved by 66.7 and 65.6% of the patients, respectively. The duration from initiation of ULT until the SU target was attained was lower in group 1 than in group 2. During the first 12 weeks, patients on ULT in group 1 had higher attack rates than those in group 2. The incidence of chronic kidney disease increased in percentage in group 1 was lower than in group 2. Our survey revealed that in patients experiencing acute gout, initiation of ULT decreased the time required to reach the target SU and the incidence of CKD, but the attack rate was greater in the first 12 weeks. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  11. 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.

  12. 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.

  13. Fear of blindness in the Collaborative Initial Glaucoma Treatment Study: patterns and correlates over time.

    PubMed

    Janz, Nancy K; Wren, Patricia A; Guire, Kenneth E; Musch, David C; Gillespie, Brenda W; Lichter, Paul R

    2007-12-01

    The objective of this study was to describe the prevalence of fear of blindness (FOB) and the factors associated with FOB during 5 years of follow-up in the Collaborative Initial Glaucoma Treatment Study. Randomized controlled clinical trial. A total of 607 newly diagnosed patients with open-angle glaucoma were recruited from 14 clinical centers in the United States. Patients were assigned randomly either to initial medical therapy or initial trabeculectomy. Study participants received clinical examinations and quality-of-life (QOL) evaluations at baseline and 6-month intervals. The QOL questionnaire was administered by trained telephone interviewers at a centralized interviewing center. The QOL questionnaire included an assessment of FOB, measures of vision-related functioning, and measures of general physical and psychosocial well being. Ordinal logistic regression analyses were used to assess clinical and QOL measures associated with FOB over time. After being told about the glaucoma diagnosis but before randomization, 34% of patients reported at least a moderate amount of FOB. This percent dropped to 11% at 5 years. In multivariable ordinal logistic regression models, younger age, being white, and having less education and a lower income were associated with increased FOB (all P<0.05). At the 36-month follow-up, visual field progression was associated significantly with increased FOB (P = 0.006); visual acuity loss, although related to increased FOB, did not achieve statistical significance (P = 0.327). Self-reported visual function measures explained more of the variation in FOB over time than did demographic, clinical, or physical or psychosocial measures. Initial treatment assignment (medicine or surgery) was not associated with FOB. The most significant correlate over time with FOB was the perceived impact on an individual's ability to perform visual tasks. More attention to reducing glaucoma patients' FOB at diagnosis and over time is warranted. Fear of

  14. 77 FR 71200 - Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-29

    ... MANAGEMENT Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41 AGENCY: U.S... Full-Time School Attendance. As required by the Paperwork Reduction Act of 1995, (Pub. L. 104-13, 44 U... to (202) 395-6974. SUPPLEMENTARY INFORMATION: RI 25-41, Initial Certification of Full-Time School...

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

    PubMed Central

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

    2016-01-01

    Background: 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. Objective: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. Method: 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. Results: 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%). Conclusion: 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. PMID:27857778

  16. A simple method for bakers' yeast cell disruption using a three-phase fluidized bed equipped with an agitator.

    PubMed

    Charinpanitkul, Tawatchai; Soottitantawat, Apinan; Tanthapanichakoon, Wiwut

    2008-12-01

    A three-phase fluidized bed equipped with a turbine agitator was utilized as a simple device for disrupting bakers' yeast cells (Saccharomyces cerevisiae). The degree of yeast cell disruption was evaluated based on the number of broken cells and its validity was confirmed by the total amount of crude soluble proteins released and by microscopic observation. It was found that the equipment could yield 90% of yeast cell disruption. With the presence of glass beads, the degree of cell disruption became higher as agitating speed is increased. The disruption enhancement would be attributed to the grinding effect resulting from the interaction between yeast cells and glass beads. One-thousand micrometers of glass beads yielded a higher degree of disruption than larger ones. An increase in liquid flow rate hindered the degree of disruption because of shorter contact time although the shear rates in the yeast suspension would become more rigorous.

  17. Ontogenic timing mechanism initiates the expression of rat intestinal sucrase activity

    SciTech Connect

    Yeh, K.Y.; Holt, P.R.

    1986-03-01

    Morphologic and enzymic differentiation occurs in rat small intestinal epithelium during 16-20 days of postnatal life. This change is considered to be initiated by an ontogenic timing mechanism and is modulated by extrinsic systemic and luminal factors. The importance of the ontogenic timing was tested directly using a transplantation technique in which jejunal isografts from newborn (day 0) and 5-day-old (day 5) rats were implanted under the skin of newborn (day 0) hosts. Isografts showing cryptvillus architecture were obtained in 44% and 21% of transplants, respectively. Day 0 isografts and host intestine expressed sucrase activity at about 16-18 days of age and showed similar crypt cell labeling and epithelial migration after (3H)thymidine injection. Day 5 isografts expressed sucrase activity when the hosts were 13 days of age, whereas host intestine showed no detectable sucrase activity. Isograft lactase activities in both experimental transplant models were significantly higher than host intestinal lactase up to 28 days of age, suggesting that luminal factors are important in modulating lactase activity during the first 4 wk of postnatal life. It is concluded that (a) no systemic factors at day 13 inhibit the expression of sucrase activity and (b) an ontogenic timing mechanism in the jejunum initiates the expression of sucrase activity.

  18. The initiation of adolescent sexual and contraceptive behavior during changing times.

    PubMed

    Cooksey, E C; Rindfuss, R R; Guilkey, D K

    1996-03-01

    This paper examines changes in the initiation of adolescent sexual and contraceptive behavior in the United States between 1978 and 1988. Since a number of contextual changes occurred during this time period including a focusing of public attention on adolescent pregnancy along with the widespread publicity surrounding AIDS, we expected that the response to these events not only would change over time, but would also vary across social groups. Using data from Cycles III and IV of the National Survey of Family Growth, we find that the overall population patterns of earlier initiation of sexual intercourse and increased use of condoms at first intercourse are not found in all segments of the population. In general, the effects of race, religion, mother's education, and age changed during this time period. The long-term trend of younger age at first intercourse was halted for Blacks, and reversed for White, fundamentalist Protestants, but continued for all other Whites. Overall, patterns throughout the decade suggest that pressures from parents, religious groups, and others either lead to a later age at first intercourse, or use of contraception, but not both. A notable exception is that increased maternal education leads to both a later age at first intercourse and a higher likelihood of using contraception at first intercourse.

  19. Time-resolved study of laser initiated shock wave propagation in superfluid 4He

    NASA Astrophysics Data System (ADS)

    Garcia, Allan; Buelna, Xavier; Popov, Evgeny; Eloranta, Jussi

    2016-09-01

    Intense shock waves in superfluid 4He between 1.7 and 2.1 K are generated by rapidly expanding confined plasma from laser ablation of a metal target immersed in the liquid. The resulting shock fronts in the liquid with initial velocities up to ca. Mach 10 are visualized by time-resolved shadowgraph photography. These high intensity shocks decay within 500 ns into less energetic shock waves traveling at Mach 2, which have their lifetime in the microsecond time scale. Based on the analysis using the classical Rankine-Hugoniot theory, the shock fronts created remain in the solid phase up to 1 μs and the associated thermodynamic state appears outside the previously studied region. The extrapolated initial shock pressure of 0.5 GPa is comparable to typical plasma pressures produced during liquid phase laser ablation. A secondary shock originating from fast heat propagation on the metal surface is also observed and a lower limit estimate for the heat propagation velocity is measured as 7 × 104 m/s. In the long-time limit, the high intensity shocks turn into liquid state waves that propagate near the speed of sound.

  20. Propagated fixed-bed mixed-acid fermentation: Part I: Effect of volatile solid loading rate and agitation at high pH.

    PubMed

    Golub, Kristina W; Forrest, Andrea K; Mercy, Kevin L; Holtzapple, Mark T

    2011-11-01

    Countercurrent fermentation is a high performing process design for mixed-acid fermentation. However, there are high operating costs associated with moving solids, which is an integral component of this configuration. This study investigated the effect of volatile solid loading rate (VSLR) and agitation in propagated fixed-bed fermentation, a configuration which may be more commercially viable. To evaluate the role of agitation on fixed-bed configuration performance, continuous mixing was compared with periodic mixing. VSLR was also varied and not found to affect acid yields. However, increased VSLR and liquid retention time did result in higher conversions, productivity, acid concentrations, but lower selectivities. Agitation was demonstrated to be important for this fermentor configuration, the periodically-mixed fermentation had the lowest conversion and yields. Operating at a high pH (∼9) contributed to the high selectivity to acetic acid, which might be industrially desirable but at the cost of lower yield compared to a neutral pH.

  1. 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.

  2. Effects of sentence-structure complexity on speech initiation time and disfluency.

    PubMed

    Tsiamtsiouris, Jim; Cairns, Helen Smith

    2013-03-01

    There is general agreement that stuttering is caused by a variety of factors, and language formulation and speech motor control are two important factors that have been implicated in previous research, yet the exact nature of their effects is still not well understood. Our goal was to test the hypothesis that sentences of high structural complexity would incur greater processing costs than sentences of low structural complexity and these costs would be higher for adults who stutter than for adults who do not stutter. Fluent adults and adults who stutter participated in an experiment that required memorization of a sentence classified as low or high structural complexity followed by production of that sentence upon a visual cue. Both groups of speakers initiated most sentences significantly faster in the low structural complexity condition than in the high structural complexity condition. Adults who stutter were over-all slower in speech initiation than were fluent speakers, but there were no significant interactions between complexity and group. However, adults who stutter produced significantly more disfluencies in sentences of high structural complexity than in those of low complexity. After reading this article, the learner will be able to: (a) identify integral parts of all well-known models of adult sentence production; (b) summarize the way that sentence structure might negatively influence the speech production processes; (c) discuss whether sentence structure influences speech initiation time and disfluencies. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Initial combination therapy for type 2 diabetes mellitus: is it ready for prime time?

    PubMed

    Zinman, Bernard

    2011-01-01

    The increased prevalence of type 2 diabetes mellitus is primarily being driven by the increasing global rates of overweight/obesity. Given the magnitude of this epidemic, we can expect these metabolic abnormalities to play an increasing role in the development of cardiovascular disease. In a pathophysiologic sense, type 2 diabetes is a multiorgan, multifactorial condition, characterized by β-cell dysfunction, insulin resistance in peripheral tissues and the liver, defective incretin activity, and elevated levels of free fatty acids and proinflammatory mediators. Despite the considerable burden of disease associated with type 2 diabetes, most patients are not at, or are unable to achieve, recommended glycemic control guideline targets. In part, this is because of the relentlessly progressive nature of the disease, but it may also be attributable to the current diabetes treatment paradigm, which is characterized by ineffective lifestyle interventions, followed by monotherapy and frequent early treatment failure with prolonged periods of elevated glucose as a consequence of clinical inertia. Thus, it is most appropriate to rethink the current treatment paradigm for type 2 diabetes in the context of a more aggressive initial therapy; specifically with early initiation of combination therapy. Our current understanding of the complex pathophysiology of the disease and the progressive deterioration in glycemic control over time supports the philosophy of earlier intervention with a more comprehensive initial therapy. Thus, while control of hyperglycemia remains the paramount goal, focusing on the underlying pathophysiology of type 2 diabetes is increasingly becoming the therapeutic strategy, with the aim of potentially providing disease modification. Although this is a logical approach, it remains to be demonstrated that early combination therapy will result in disease modification in a clinical setting. Not surprisingly, the incretin-based therapies have gained a great

  4. Variational data assimilation for the optimized ozone initial state and the short-time forecasting

    NASA Astrophysics Data System (ADS)

    Park, Soon-Young; Kim, Dong-Hyeok; Lee, Soon-Hwan; Lee, Hwa Woon

    2016-03-01

    In this study, we apply the four-dimensional variational (4D-Var) data assimilation to optimize initial ozone state and to improve the predictability of air quality. The numerical modeling systems used for simulations of atmospheric condition and chemical formation are the Weather Research and Forecasting (WRF) model and the Community Multiscale Air Quality (CMAQ) model. The study area covers the capital region of South Korea, where the surface measurement sites are relatively evenly distributed. The 4D-Var code previously developed for the CMAQ model is modified to consider background error in matrix form, and various numerical tests are conducted. The results are evaluated with an idealized covariance function for the appropriateness of the modified codes. The background error is then constructed using the NMC method with long-term modeling results, and the characteristics of the spatial correlation scale related to local circulation are analyzed. The background error is applied in the 4D-Var research, and a surface observational assimilation is conducted to optimize the initial concentration of ozone. The statistical results for the 12 h assimilation periods and the 120 observatory sites show a 49.4 % decrease in the root mean squared error (RMSE), and a 59.9 % increase in the index of agreement (IOA). The temporal variation of spatial distribution of the analysis increments indicates that the optimized initial state of ozone concentration is transported to inland areas by the clockwise-rotating local circulation during the assimilation windows. To investigate the predictability of ozone concentration after the assimilation window, a short-time forecasting is carried out. The ratios of the RMSE (root mean squared error) with assimilation versus that without assimilation are 8 and 13 % for the +24 and +12 h, respectively. Such a significant improvement in the forecast accuracy is obtained solely by using the optimized initial state. The potential improvement in

  5. Variational data assimilation for the optimized ozone initial state and the short-time forecasting

    NASA Astrophysics Data System (ADS)

    Park, Soon-Young; Kim, Dong-Hyeok; Lee, Soon-Hwan; Lee, Hwa Woon

    2016-04-01

    In this study, we apply the four-dimensional variational (4D-Var) data assimilation to optimize initial ozone state and to improve the predictability of air quality. The numerical modeling systems used for simulations of atmospheric condition and chemical formation are the Weather Research and Forecasting (WRF) model and the Community Multiscale Air Quality (CMAQ) model . The study area covers the capital region of South Korea, where the surface measurement sites are relatively evenly distributed. The 4D-Var code previously developed for the CMAQ model is modified to consider background error in matrix form, and various numerical tests are conducted. The results are evaluated with an idealized covariance function for the appropriateness of the modified codes. The background error is then constructed using the NMC method with long-term modeling results, and the characteristics of the spatial correlation scale related to local circulation is analyzed. The background error is applied in the 4D-Var research, and a surface observational assimilation is conducted to optimize the initial concentration of ozone. The statistical results for the 12-hour assimilation periods and the 120 observatory sites show a 49.4% decrease in the root mean squred error (RMSE), and a 59.9% increase in the index of agreement (IOA). The temporal variation of spatial distribution of the analysis increments indicates that the optimized initial state of ozone concentration is transported to inland areas by the clockwise-rotating local circulation during the assimilation windows. To investigate the predictability of ozone concentration after the assimilation window, a short-time forecasting is carried out. The ratios of the RMSE with assimilation versus that without assimilation are 8% and 13% for the +24 and +12 hours, respectively. Such a significant improvement in the forecast accuracy is obtained solely by using the optimized initial state. The potential improvement in ozone prediction for

  6. Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury

    PubMed Central

    2011-01-01

    Introduction Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients. Methods Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT. Results Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05). Conclusions Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified. PMID:21645350

  7. Initial operation of the NSTX-Upgrade real-time velocity diagnostic

    DOE PAGES

    Podestà, M.; Bell, R. E.

    2016-11-03

    A real-time velocity (RTV) diagnostic based on active charge-exchange recombination spectroscopy is now operational on the National Spherical Torus Experiment-Upgrade (NSTX-U) spherical torus (Menard et al 2012 Nucl. Fusion 52 083015). We designed the system in order to supply plasma velocity data in real time to the NSTX-U plasma control system, as required for the implementation of toroidal rotation control. Our measurements are available from four radii at a maximum sampling frequency of 5 kHz. Post-discharge analysis of RTV data provides additional information on ion temperature, toroidal velocity and density of carbon impurities. Furthermore, examples of physics studies enabled bymore » RTV measurements from initial operations of NSTX-U are discussed.« less

  8. Assimilating Cloud Initiation based on Time Series Analysis into flash flood prediction model

    NASA Astrophysics Data System (ADS)

    Shiff, Shilo; Lensky, Itamar

    2015-04-01

    We used Temporal Fourier Analysis on time series (2010-2013) of Meteosat Second Generation (MSG) European geostationary weather satellite to generate cloud free climatological values of channel 1 (0.6um) reflectance and channel 9 (10.8um) brightness temperatures (BT) on pixel basis. Discrepancy between measured reflectance and/or BT and their climatological values are used to detect "cloud contaminated" pixels. This algorithm is very sensitive to sub-pixel clouds that are visible only in the High Resolution Visible channel, but not in the spectral channels. This method is valuable for early detection of convection. We used this cloud initiation method within high-resolution numerical weather forecasts to improve its accuracy in terms of early warning on the location and timing of potential flash floods.

  9. Initial operation of the NSTX-Upgrade real-time velocity diagnostic

    NASA Astrophysics Data System (ADS)

    Podestà, M.; Bell, R. E.

    2016-12-01

    A real-time velocity (RTV) diagnostic based on active charge-exchange recombination spectroscopy is now operational on the National Spherical Torus Experiment-Upgrade (NSTX-U) spherical torus (Menard et al 2012 Nucl. Fusion 52 083015). The system has been designed to supply plasma velocity data in real time to the NSTX-U plasma control system, as required for the implementation of toroidal rotation control. Measurements are available from four radii at a maximum sampling frequency of 5 kHz. Post-discharge analysis of RTV data provides additional information on ion temperature, toroidal velocity and density of carbon impurities. Examples of physics studies enabled by RTV measurements from initial operations of NSTX-U are discussed.

  10. Finite difference time domain method for simulation of damage initiation in thin film coatings

    NASA Astrophysics Data System (ADS)

    Smalakys, Linas; Momgaudis, Balys; Grigutis, Robertas; Melninkaitis, Andrius

    2016-12-01

    Time resolved digital holography (TRDH) is a versatile tool that provides valuable insights into the dynamics of femtosecond damage initiation by providing spatiotemporal information of excited material. However, interpreting of TRDH data in thin film dielectric coatings is rather complicated without appropriate theoretical models that are able to correctly describe underlying nature of damage formation. Therefore, a model based on finite difference time domain (FDTD) method with complete Keldysh theory for nonlinear ionization of atoms and multiple rate equation (MRE) method for conduction band electrons was developed. The model was used to reproduce both temporal and spatial characteristics of TRDH experiment performed on Ta2O5 dielectric coating. Fitted material parameters were then applied to indirectly estimate LIDT of the coating.

  11. Initial operation of the NSTX-Upgrade real-time velocity diagnostic

    SciTech Connect

    Podestà, M.; Bell, R. E.

    2016-11-03

    A real-time velocity (RTV) diagnostic based on active charge-exchange recombination spectroscopy is now operational on the National Spherical Torus Experiment-Upgrade (NSTX-U) spherical torus (Menard et al 2012 Nucl. Fusion 52 083015). We designed the system in order to supply plasma velocity data in real time to the NSTX-U plasma control system, as required for the implementation of toroidal rotation control. Our measurements are available from four radii at a maximum sampling frequency of 5 kHz. Post-discharge analysis of RTV data provides additional information on ion temperature, toroidal velocity and density of carbon impurities. Furthermore, examples of physics studies enabled by RTV measurements from initial operations of NSTX-U are discussed.

  12. Onset time of hyperkalaemia after angiotensin receptor blocker initiation: when should we start serum potassium monitoring?

    PubMed

    Park, I-W; Sheen, S S; Yoon, D; Lee, S-H; Shin, G-T; Kim, H; Park, R W

    2014-02-01

    Angiotensin receptor blockers (ARBs) frequently induce hyperkalaemia in high-risk patients. Early detection of hyperkalaemia can reduce the subsequent harmful effects. This study was performed to examine the onset time of hyperkalaemia after ARB therapy. We carried out a retrospective analysis to determine the onset time of hyperkalaemia (serum potassium >5·5 mm) among hospitalized patients newly starting ARB therapy between 2004 and 2012, in a tertiary teaching hospital. Predefined possible risk factors and concomitant medications were evaluated. During the 97-month study period, a total of 4267 hospitalized patients started ARBs as new drugs and 225 patients showed hyperkalaemia. A significantly increased risk of hyperkalaemia was detected among patients with a high baseline potassium [odds ratio (OR) 6·0] and those who took non-potassium-sparing diuretics (OR 2·2) or potassium supplements (OR 1·6). A high glomerular filtration rate (GFR) was associated with a lower risk of hyperkalaemia (OR 0·992). Fifty-two percentage of hyperkalaemic events occurred within the first week after initiation of ARB therapy. The highest frequency of hyperkalaemia occurred on the first day after initiation of ARBs. Hyperkalaemia occurred earlier in patients with a high baseline serum potassium level, reduced GFR, diabetes and in those without heart failure. Hyperkalaemia occurs most frequently at the beginning of ARB therapy in hospitalized patients. Monitoring of serum potassium and estimated GFR after initiation of ARBs should be started within a few days or not later than 1 week, especially in patients with risk factors. © 2013 John Wiley & Sons Ltd.

  13. Time-resolved studies of impact-initiated combustion in aluminum powder compacts

    NASA Astrophysics Data System (ADS)

    Breidenich, Jennifer; Dixon, Sean; Aydelotte, Brady; Thadhani, Naresh

    2011-06-01

    The mechanisms of combustion reaction occurring under impact loading of aluminum powder compacts are studied using UV/Vis spectroscopy to gain time-resolved chemical information. Impact experiments performed on aluminum powder compacts reveal light emission due to reaction at velocities greater than 400m/s in air, while no reaction is observed in a vacuum (50mTorr). Light emission and reaction occurrence is also sensitive to the density of the Al powder compacts. Upon combustion, wavelengths indicative of the well-known reaction Al +O2 --> AlO + O , a sharp doublet at 398 nm and multiple broad peaks between 420 and 500 nm, are observed. Microsecond time-resolved chemical information is gained through analysis of these wavelengths using a spectrometer coupled with an electron multiplier CCD camera. The impact initiated reaction is also monitored by high speed imaging of transient deformation profiles which are compared to those predicted using numerical simulations employing ANSYS-AUTODYN-3D computer code. The insight obtained from the combination of these analyses of impact-initiated combustion reaction in aluminum powder compacts will be presented. Funded by DTRA, Grant No. HDTRA1-10-1-0038

  14. Initial operation of the NSTX-U Real-Time Velocity diagnostic

    NASA Astrophysics Data System (ADS)

    Podesta, M.; Bell, R. E.

    2016-10-01

    A Real-Time Velocity (RTV) diagnostic based on active charge-exchange recombination spectroscopy is now operational on the National Spherical Torus Experiment-Upgrade (NSTX-U) spherical torus. The system has been designed to supply plasma velocity data in real time to the NSTX-U Plasma Control System, as required for the implementation of toroidal rotation control. Measurements are available from four radii, spanning from the core to the plasma edge, at a maximum sampling frequency of 5 kHz. Post-discharge analysis of RTV data provides additional information on ion temperature, toroidal velocity and density of carbon impurities. Initial results from RTV measurements are presented and compared with those from the main NSTX-U charge-exchange recombination system. Examples of physics studies enabled by RTV measurements from initial operations of NSTX-U are then discussed, with emphasis on the effects of plasma disturbances such as sawteeth and MHD instabilities on toroidal velocity and its temporal evolution. Work supported by the US DoE Office of Science - Fusion Energy Sciences, under Contract Number DE-AC02-09CH11466).

  15. Assessment of the Amount of Calcium Ions Released after the use of Different Chelating Agents and Agitation Protocols

    PubMed Central

    Pedro, Fábio Luis Miranda; Costa, Laura Maria Amorim Santana; Filho, Gilberto Siebert; Guedes, Orlando Aguirre; Pereira, Thiago Machado; Borges, Alvaro Henrique

    2017-01-01

    Background: The main goal of endodontic treatment is to achieve cleaning and shaping prior to the filling process. Objective: This study aimed to evaluate, using atomic absorption spectrometry, the release of Calcium ions after the use of different chelating agents and protocols of agitation. Method: Ninety human canine teeth were randomly assigned to one of nine groups (n=10), as follows: 1) 0.2% Chitosan and manual agitation; 2) 0.2% Chitosan and sonic agitation; 3) 0.2% Chitosan and ultrasonic agitation; 4) 17% EDTA and manual agitation; 5) 17% EDTA and sonic agitation; 6) 17% EDTA and ultrasonic agitation; 7) distilled water and manual agitation; 8) distilled water and sonic agitation; 9) distilled water and ultrasonic agitation. Following instrumentation, all chelating substances remained inside the root canal for 3 min. Then the fluid was collected for the identification and quantification of Calcium ions. The amount of Calcium ions released in each group was compared using analysis of variance (ANOVA) and the Kolmogorov-Smirnov and Levene tests followed by Tukey’s post-hoc test. Significance was set at 5%. Results: The groups in which 0.2% Chitosan was used showed the highest concentration of Calcium ions (p<0.05). Concerning the agitation method, ultrasonic agitation showed the greatest values, followed by sonic and manual agitation (all comparisons, p<0.05). Conclusion: The present findings suggest that, among the combinations here tested, Chitosan associated with ultrasonic agitation yielded the greatest release of Calcium ions. PMID:28458729

  16. Timing of HAART initiation and clinical outcomes in human immunodeficiency virus type 1 seroconverters.

    PubMed

    2011-09-26

    To estimate the clinical benefit of highly active antiretroviral therapy (HAART) initiation vs deferral in a given month in patients with CD4 cell counts less than 800/μL. In this observational cohort study of human immunodeficiency virus type 1 seroconverters from CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe), we constructed monthly sequential nested subcohorts between January 1996 and May 2009, including all eligible HAART-naive, AIDS-free individuals with a CD4 cell count less than 800/μL. The primary outcome was time to AIDS or death in those who initiated HAART in the baseline month compared with those who did not, pooled across subcohorts and stratified by CD4 cell count. Using inverse probability-of-treatment weighted survival curves and Cox proportional hazards regression models, we estimated the absolute and relative effects of treatment with robust 95% confidence intervals (CIs). Of 9455 patients with 52,268 person-years of follow-up, 812 (8.6%) developed AIDS and 544 (5.8%) died. In CD4 cell count strata of 200 to 349, 350 to 499, and 500 to 799/μL, HAART initiation was associated with adjusted hazard ratios (95% CIs) for AIDS/death of 0.59 (0.43-0.81), 0.75 (0.49-1.14), and 1.10 (0.67-1.79), respectively. In the analysis of all-cause mortality, HAART initiation was associated with adjusted hazard ratios (95% CIs) of 0.71 (0.44-1.15), 0.51 (0.33-0.80), and 1.02 (0.49-2.12), respectively. Numbers needed to treat (95% CIs) to prevent 1 AIDS event or death within 3 years were 21 (14-38) and 34 (20-115) in CD4 cell count strata of 200 to 349 and 350 to 499/μL, respectively. Compared with deferring in a given month, HAART initiation at CD4 cell counts less than 500/μL (but not 500-799/μL) was associated with slower disease progression.

  17. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia.

    PubMed

    Abu-Shahwan, Ibrahim; Chowdary, Khalid

    2007-09-01

    Emergence agitation or delirium is a known phenomenon that may occur in children undergoing general anesthesia with inhaled agents. Our aim was to test the hypothesis that the addition of a small dose of ketamine at the end of sevoflurane anesthesia will result in a decrease in the incidence and severity of such phenomenon. We performed a randomized double blind study involving 85 premedicated children 4-7 years old undergoing dental repair. Children were premedicated with acetaminophen and midazolam. Anesthesia was induced and maintained with sevoflurane in N2O/O2. Group K received ketamine 0.25 mg.kg (-1) and Group S received saline. We evaluated recovery characteristics upon awakening and during the first 30 min using the Pediatric Anesthesia Emergence Delirium scale. Eighty of the 85 enrolled children completed the study. There were 42 children in Group I. Emergence agitation was diagnosed in seven children in the ketamine group (16.6%) and in 13 children in the placebo group (34.2%). There was no difference in time to meet recovery room discharge criteria between the two groups. We conclude that the addition of ketamine 0.25 mg.kg(-1) can decrease the incidence of emergence agitation in children after sevoflurane general anesthesia.

  18. 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

  19. Improved performance in viscous mycelial fermentations by agitator retrofitting.

    PubMed

    Buckland, B C; Gbewonyo, K; Dimasi, D; Hunt, G; Westerfield, G; Nienow, A W

    1988-05-01

    For viscous mycelial fermentations it was demonstrated at the pilot-plant scale that the replacement of standard radial flow Rushton turbines with larger diameter axial-flow Prochem hydrofoil impellers significantly improved oxygen transfer efficiency. It was also determined that the Streptomyces broth under evaluation is highly shear thinning. Separate experiments using a Norcardia broth with similar Theological properties demonstrated that the oxygen transfer coefficient, K(L)a, can be greatly increased by use of water additions to reduce broth viscosity. These observations are consistent with the hypothesis that the improvement in oxygen transfer by changing agitator types is primarily due to an improvement in bulk mixing. A model is presented, based on the concepts of Bajpai and Reuss, which explains this improvement in performance in terms of enlargement of the well mixed micromixer region for viscous mycelial broths.

  20. 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.

  1. Real-time detection of lipid bilayer assembly and detergent-initiated solubilization using optical cavities

    NASA Astrophysics Data System (ADS)

    Sun, V.; Armani, A. M.

    2015-02-01

    The cellular membrane governs numerous fundamental biological processes. Therefore, developing a comprehensive understanding of its structure and function is critical. However, its inherent biological complexity gives rise to numerous inter-dependent physical phenomena. In an attempt to develop a model, two different experimental approaches are being pursued in parallel: performing single cell experiments (top down) and using biomimetic structures (bottom up), such as lipid bilayers. One challenge in many of these experiments is the reliance on fluorescent probes for detection which can create confounds in this already complex system. In the present work, a label-free detection method based on an optical resonant cavity is used to detect one of the fundamental physical phenomena in the system: assembly and solubilization of the lipid bilayer. The evanescent field of the cavity strongly interacts with the lipid bilayer, enabling the detection of the bilayer behavior in real-time. Two independent detection mechanisms confirm the formation and detergent-assisted solubilization of the lipid bilayers: (1) a refractive index change and (2) a material loss change. Both mechanisms can be monitored in parallel, on the same device, thus allowing for cross-confirmation of the results. To verify the proposed method, we have detected the formation of self-assembled phosphatidylcholine lipid bilayers from small unilamellar vesicles on the device surface in real-time. Subsequently, we exposed the bilayers to two different detergents (non-ionic Triton X-100 and anionic sodium dodecyl sulfate) to initiate solubilization, and this process was also detected in real-time. After the bilayer solubilization, the device returned to its initial state, exhibiting minimal hysteresis. The experimental wash-off was also collected and analyzed using dynamic light scattering.

  2. STEREO WAVES Capabilities for Studying Initiation and Early-time Dynamics of Solar Eruptions

    NASA Technical Reports Server (NTRS)

    Kaiser, M. L.

    2005-01-01

    In 2006, NASA will launch the twin STEREO spacecraft from Kennedy Space Center into a pair of heliocentric orbits near 1 AU such that the spacecraft will move away from Earth (ahead and behind) at about 22 degrees per year. The purposes of the STEREO Mission are to understand the causes and mechanisms of coronal mass ejection (CME) initiation and to follow the propagation of CMEs through the heliosphere. Additionally, STEREO will study the mechanisms and sites of solar energetic particle (SEP) acceleration and determine 3-D time-dependent traces of the magnetic topology, temperature, density and velocity of the solar wind between the sun and Earth. To accomplish these goals, each STEREO spacecraft will be equipped with set of optical and particles and fields instruments including the STEREO WAVES (SWAVES) instrument which will use radio waves to track the location of CME-driven shocks (via type I1 bursts) and the 3-D topology of open field lines along which energetic particles flow (via the ubiquitous type I11 bursts). Type 11 bursts very often commence with a series of special type 111 bursts (called SA or type 111-L bursts) that likely coincide with CME liftoff time, thus SWAVES should be able to determine this time to within 15 sec. It is also known that the occurrence of SEP events is usually accompanied by type I1 radio bursts at decametric wavelengths as well as strong type III bursts at all wavelengths. SWAVES will be able to determine the initiation of these bursts to within 15 sec, and from the simultaneous measurements from the two spacecraft, should be able to triangulate their source locations. The utility of radio observations and the capabilities of SWAVES will be illustrated by showing a number of examples using the similar Wind WAVES instrument in combination with SOH0 coronagraph and RHESSI high energy X-ray/gamma ray observations.

  3. 17 CFR 201.530 - Initial decision on permanent order: Timing for submitting proposed findings and preparation of...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Initial decision on permanent order: Timing for submitting proposed findings and preparation of decision. 201.530 Section 201.530... Rules Relating to Temporary Orders and Suspensions § 201.530 Initial decision on permanent order: Timing...

  4. 17 CFR 201.530 - Initial decision on permanent order: Timing for submitting proposed findings and preparation of...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Initial decision on permanent order: Timing for submitting proposed findings and preparation of decision. 201.530 Section 201.530... Rules Relating to Temporary Orders and Suspensions § 201.530 Initial decision on permanent order: Timing...

  5. 17 CFR 201.530 - Initial decision on permanent order: Timing for submitting proposed findings and preparation of...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Initial decision on permanent order: Timing for submitting proposed findings and preparation of decision. 201.530 Section 201.530... Rules Relating to Temporary Orders and Suspensions § 201.530 Initial decision on permanent order: Timing...

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

    PubMed

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

    2014-01-01

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

  7. Initial Systolic Time Interval (ISTI) as a Predictor of Intradialytic Hypotension (IDH)

    NASA Astrophysics Data System (ADS)

    Biesheuvel, J. D.; Vervloet, M. G.; Verdaasdonk, R. M.; Meijer, J. H.

    2013-04-01

    In haemodialysis treatment the clearance and volume control by the kidneys of a patient are partially replaced by intermittent haemodialysis. Because this artificial process is performed on a limited time scale, unphysiological imbalances in the fluid compartments of the body occur, that can lead to intradialytic hypotensions (IDH). An IDH endangers the efficacy of the haemodialysis session and is associated with dismal clinical endpoints, including mortality. A diagnostic method that predicts the occurrence of these drops in blood pressure could facilitate timely measures for the prevention of IDH. The present study investigates whether the Initial Systolic Time Interval (ISTI) can provide such a diagnostic method. The ISTI is defined as the time difference between the R-peak in the electrocardiogram (ECG) and the C-wave in the impedance cardiogram (ICG) and is considered to be a non-invasive assessment of the time delay between the electrical and mechanical activity of the heart. This time delay has previously been found to depend on autonomic nervous function as well as preload of the heart. Therefore, it can be expected that ISTI may predict an imminent IDH caused by a low circulating blood volume. This ongoing observational clinical study investigates the relationship between changes in ISTI and subsequent drops in blood pressure during haemodialysis. A registration of a complicated dialysis showed a significant correlation between a drop in blood pressure, a decrease in relative blood volume and a substantial increase in ISTI. An uncomplicated dialysis, in which also a considerable amount of fluid was removed, showed no correlations. Both, blood pressure and ISTI remained stable. In conclusion, the preliminary results of the present study show a substantial response of ISTI to haemodynamic instability, indicating an application in optimization and individualisation of the dialysis process.

  8. Real-time observation of the initiation of RNA polymerase II transcription.

    PubMed

    Fazal, Furqan M; Meng, Cong A; Murakami, Kenji; Kornberg, Roger D; Block, Steven M

    2015-09-10

    Biochemical and structural studies have shown that the initiation of RNA polymerase II transcription proceeds in the following stages: assembly of the polymerase with general transcription factors and promoter DNA in a 'closed' preinitiation complex (PIC); unwinding of about 15 base pairs of the promoter DNA to form an 'open' complex; scanning downstream to a transcription start site; synthesis of a short transcript, thought to be about 10 nucleotides long; and promoter escape. Here we have assembled a 32-protein, 1.5-megadalton PIC derived from Saccharomyces cerevisiae, and observe subsequent initiation processes in real time with optical tweezers. Contrary to expectation, scanning driven by the transcription factor IIH involved the rapid opening of an extended transcription bubble, averaging 85 base pairs, accompanied by the synthesis of a transcript up to the entire length of the extended bubble, followed by promoter escape. PICs that failed to achieve promoter escape nevertheless formed open complexes and extended bubbles, which collapsed back to closed or open complexes, resulting in repeated futile scanning.

  9. Real-Time Imaging of a Single Gene Reveals Transcription-Initiated Local Confinement.

    PubMed

    Germier, Thomas; Kocanova, Silvia; Walther, Nike; Bancaud, Aurélien; Shaban, Haitham Ahmed; Sellou, Hafida; Politi, Antonio Zaccaria; Ellenberg, Jan; Gallardo, Franck; Bystricky, Kerstin

    2017-10-03

    Genome dynamics are intimately linked to the regulation of gene expression, the most fundamental mechanism in biology, yet we still do not know whether the very process of transcription drives spatial organization at specific gene loci. Here, we have optimized the ANCHOR/ParB DNA-labeling system for real-time imaging of a single-copy, estrogen-inducible transgene in human cells. Motion of an ANCHOR3-tagged DNA locus was recorded in the same cell before and during the appearance of nascent MS2-labeled mRNA. We found that transcription initiation by RNA polymerase 2 resulted in confinement of the mRNA-producing gene domain within minutes. Transcription-induced confinement occurred in each single cell independently of initial, highly heterogeneous mobility. Constrained mobility was maintained even when inhibiting polymerase elongation. Chromatin motion at constant step size within a largely confined area hence leads to increased collisions that are compatible with the formation of gene-specific chromatin domains, and reflect the assembly of functional protein hubs and DNA processing during the rate-limiting steps of transcription. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  10. “Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

    PubMed Central

    Saleem, Haneefa T.; Mushi, Dorothy; Hassan, Saria; Bruce, R. Douglas; Cooke, Alexis; Mbwambo, Jessie; Lambdin, Barrot H.

    2016-01-01

    Background Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania. Methods We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach. Results Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART. Conclusion Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients. PMID:26831364

  11. Linearized semiclassical initial value time correlation functions with maximum entropy analytic continuation

    SciTech Connect

    Liu, Jian; Miller, William H.

    2008-08-01

    The maximum entropy analytic continuation (MEAC) method is used to extend the range of accuracy of the linearized semiclassical initial value representation (LSC-IVR)/classical Wigner approximation for real time correlation functions. The LSC-IVR provides a very effective 'prior' for the MEAC procedure since it is very good for short times, exact for all time and temperature for harmonic potentials (even for correlation functions of nonlinear operators), and becomes exact in the classical high temperature limit. This combined MEAC+LSC/IVR approach is applied here to two highly nonlinear dynamical systems, a pure quartic potential in one dimensional and liquid para-hydrogen at two thermal state points (25K and 14K under nearly zero external pressure). The former example shows the MEAC procedure to be a very significant enhancement of the LSC-IVR, for correlation functions of both linear and nonlinear operators, and especially at low temperature where semiclassical approximations are least accurate. For liquid para-hydrogen, the LSC-IVR is seen already to be excellent at T = 25K, but the MEAC procedure produces a significant correction at the lower temperature (T = 14K). Comparisons are also made to how the MEAC procedure is able to provide corrections for other trajectory-based dynamical approximations when used as priors.

  12. The Initial Systolic Time Interval in patients with spinal cord injury measured with impedance cardiography

    NASA Astrophysics Data System (ADS)

    Hoekstra, Femke; Martinsen, Ørjan G.; Verdaasdonk, Rudolf M.; Janssen, Thomas W. J.; Meijer, Jan H.

    2012-12-01

    The Initial Systolic Time Interval (ISTI), obtained from the electrocardiogram and impedance cardiogram, is considered to be a measure for the time delay between the electrical and mechanical activity of the heart. This time delay is influenced by the sympathetic nerve system. Therefore, an observational study was performed in a group of patients (SCI) with spinal cord injuries. The relationship between the ISTI and the total heart cycle (RR-interval) was established by varying the RR-interval using an exercise stimulus to increase the heart rate. The slope of this relationship was observed to be significantly higher in the SCI-group as compared with a control group, although there was no difference in ISTI in the range of common heart rates during the test between the groups. This slope and the ISTI was observed to be significantly different in an acute patient having a recent spinal cord injury at a high level. Because of the variety in injury levels and incompleteness of the injuries further, more specific research is necessary to draw decisive conclusions with respect to the contribution of autonomic nervous control on the ISTI in SCI, although the present observations are notable.

  13. Redox-initiated hydrogel system for detection and real-time imaging of cellulolytic enzyme activity.

    PubMed

    Malinowska, Klara H; Verdorfer, Tobias; Meinhold, Aylin; Milles, Lukas F; Funk, Victor; Gaub, Hermann E; Nash, Michael A

    2014-10-01

    Understanding the process of biomass degradation by cellulolytic enzymes is of urgent importance for biofuel and chemical production. Optimizing pretreatment conditions and improving enzyme formulations both require assays to quantify saccharification products on solid substrates. Typically, such assays are performed using freely diffusing fluorophores or dyes that measure reducing polysaccharide chain ends. These methods have thus far not allowed spatial localization of hydrolysis activity to specific substrate locations with identifiable morphological features. Here we describe a hydrogel reagent signaling (HyReS) system that amplifies saccharification products and initiates crosslinking of a hydrogel that localizes to locations of cellulose hydrolysis, allowing for imaging of the degradation process in real time. Optical detection of the gel in a rapid parallel format on synthetic and natural pretreated solid substrates was used to quantify activity of T. emersonii and T. reesei enzyme cocktails. When combined with total internal reflection fluorescence microscopy and AFM imaging, the reagent system provided a means to visualize enzyme activity in real-time with high spatial resolution (<2 μm). These results demonstrate the versatility of the HyReS system in detecting cellulolytic enzyme activity and suggest new opportunities in real-time chemical imaging of biomass depolymerization.

  14. 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.

  15. 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…

  16. Behavior management approach for agitated behavior in Japanese patients with dementia: a pilot study

    PubMed Central

    Sato, Junko; Nakaaki, Shutaro; Torii, Katsuyoshi; Oka, Mizuki; Negi, Atsushi; Tatsumi, Hiroshi; Narumoto, Jin; Furukawa, Toshi A; Mimura, Masaru

    2013-01-01

    Background Agitated behaviors are frequently observed in patients with dementia and can cause severe distress to caregivers. However, little evidence of the efficacy of nonpharmacological interventions for agitated behaviors exists for patients with dementia. The present pilot study aimed to evaluate a behavioral management program developed by the Seattle Protocols for patients with agitated behaviors in Japan. Methods Eighteen patients with dementia (Alzheimer’s disease, n = 14; dementia with Lewy bodies, n = 4) participated in an open study testing the effectiveness of a behavioral management program. The intervention consisted of 20 sessions over the course of 3 months. The primary outcomes were severity of agitation in dementia, as measured using the Agitated Behavior in Dementia scale (ABID) and the Cohen-Mansfield Agitation Inventory (CMAI). Results The behavioral management program resulted in significant reductions in total scores on both the ABID and CMAI. Although both physically agitated and verbally agitated behavior scores on the ABID improved significantly, symptoms of psychosis did not improve after the intervention. Conclusion The behavioral management technique may be beneficial to distressed caregivers of patients with dementia. In the future, a well designed study to develop the behavioral management program more fully is needed. PMID:23293522

  17. 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 =…

  18. 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…

  19. 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.

  20. Time-honored treatments for the initial management of acute coronary syndromes: Challenging the status quo.

    PubMed

    McCarthy, Cian P; Donnellan, Eoin; Wasfy, Jason H; Bhatt, Deepak L; McEvoy, John W

    2017-10-01

    Morphine, oxygen, and nitrates are time-honored therapies for the initial management of acute coronary syndrome (ACS). The traditional goal of these agents in ACS has been to (1) relieve symptoms, (2) prevent infarction or limit its size, and (3) improve outcomes, both acutely and during follow-up. Despite their ongoing use in routine ACS care, nitrates, morphine, and oxygen have no evidence of clinical outcomes benefit from randomized trials. Furthermore, emerging data have recently suggested that, in certain situations, morphine and oxygen may actually be associated with harm in the setting of ACS. In this review article, we thoroughly examine updated evidence for each of these acute-phase ACS agents with respect to their individual risks and benefits. We review guideline recommendations for these therapies and outline future directions for their use in clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Transport numbers in the surface layers of asymmetric membranes from initial time measurements

    SciTech Connect

    Compan, V.; Lopez, M.L. ); Sorensen, T.S. ); Garrido, J. )

    1994-09-08

    The initial time asymmetry potentials of two ultra filtration membranes (cellulose acetate and polysulfone membranes) were measured in electrochemical cells using Ag/AgCl electrodes and NaCl solutions. The concentration in the two electrode chambers differed slightly by a fixed concentration difference. Either the membranes were brought to equilibrium with the left-hand solution and subsequently exposed to the right-hand solution at the right-hand face, or the procedure was reversed. From such measurements it is possible to evaluate the transport numbers corresponding to each of the two surface layers of the membrane under conditions such that the effects of autoprotolysis of water and of foreign ions may be neglected. These measurements permit a description of each of the surface layers of the membranes and make possible an electrochemical characterization of the asymmetry of ultrafiltration membranes. The asymmetry is given by the difference between surface layer transport numbers. 31 refs., 13 figs., 4 tabs.

  2. ANALYTICAL THEORY FOR THE INITIAL MASS FUNCTION. III. TIME DEPENDENCE AND STAR FORMATION RATE

    SciTech Connect

    Hennebelle, Patrick

    2013-06-20

    The present paper extends our previous theory of the stellar initial mass function (IMF) by including time dependence and by including the impact of the magnetic field. The predicted mass spectra are similar to the time-independent ones with slightly shallower slopes at large masses and peak locations shifted toward smaller masses by a factor of a few. Assuming that star-forming clumps follow Larson-type relations, we obtain core mass functions in good agreement with the observationally derived IMF, in particular, when taking into account the thermodynamics of the gas. The time-dependent theory directly yields an analytical expression for the star formation rate (SFR) at cloud scales. The SFR values agree well with the observational determinations of various Galactic molecular clouds. Furthermore, we show that the SFR does not simply depend linearly on density, as is sometimes claimed in the literature, but also depends strongly on the clump mass/size, which yields the observed scatter. We stress, however, that any SFR theory depends, explicitly or implicitly, on very uncertain assumptions like clump boundaries or the mass of the most massive stars that can form in a given clump, making the final determinations uncertain by a factor of a few. Finally, we derive a fully time dependent model for the IMF by considering a clump, or a distribution of clumps accreting at a constant rate and thus whose physical properties evolve with time. In spite of its simplicity, this model reproduces reasonably well various features observed in numerical simulations of converging flows. Based on this general theory, we present a paradigm for star formation and the IMF.

  3. Timing of dialysis initiation in the geriatric population: toward a patient-centered approach.

    PubMed

    Treit, Kathryn; Lam, Daniel; O'Hare, Ann M

    2013-01-01

    Over the last 10-15 years, the incidence of treated end-stage renal disease (ESRD) among older adults has increased and dialysis is being initiated at progressively higher levels of estimated glomerular filtration rate (eGFR). Average life expectancy after dialysis initiation among older adults is quite limited, and many experience an escalation of care and loss of independence after starting dialysis. Available data suggest that treatment decisions about dialysis initiation in older adults in the United States are guided more by system- than by patient-level factors. Stronger efforts are thus needed to ensure that treatment decisions for older adults with advanced kidney disease are optimally aligned with their goals and preferences. There is growing interest in more conservative approaches to the management of advanced kidney disease in older patients who prefer not to initiate dialysis and those for whom the harms of dialysis are expected to outweigh the benefits. A number of small single center studies, mostly from the United Kingdom report similar survival among the subset of older adults with a high burden of comorbidity treated with dialysis vs. those managed conservatively. However, the incidence of treated ESRD in older US adults is several-fold higher than in the United Kingdom, despite a similar prevalence of chronic kidney disease, suggesting large differences in the social, cultural, and economic context in which dialysis treatment decisions unfold. Thus, efforts may be needed to adapt conservative care models developed outside the United States to optimally meet the needs of US patients. More flexible approaches toward dialysis prescription and better integration of treatment decisions about conservative care with those related to modality selection will likely be helpful in meeting the needs of individual patients. Regardless of the chosen treatment strategy, time can often be a critical ally in centering care on what matters most to the patient, and

  4. Effect of intervention initiation timing of pulsed electromagnetic field on ovariectomy-induced osteoporosis in rats.

    PubMed

    Zhou, Jun; Liao, Yuan; Zeng, Yahua; Xie, Haitao; Fu, Chengxiao; Li, Neng

    2017-09-01

    The aim of this study is to explore the effect of timing of initiation of pulsed electromagnetic field (PEMF) therapy on bone mass, microarchitecture, and biomechanical properties, and to investigate receptor activator of NF-kB (RANK) expression in ovariectomized (OVX) rats. Sixty female Sprague-Dawley rats were randomly divided into two equal batches of three groups each (10 rats in each group). The first batch comprised of sham-operated (Sham-0 group), ovariectomized (OVX-0 group), and ovariectomized plus treated with PEMF starting from the day of OVX (Early PEMF group). The second batch comprised of sham-operated (Sham-12 group), ovariectomized (OVX-12 group), and ovariectomized plus treated with PEMF starting 12 weeks after OVX (Late PEMF group). Rats (whole body) in the early and late PEMF groups were exposed to PEMF (3.8 mT peak, 8 Hz pulse burst repetition rate). After 12 weeks of PEMF therapy, Early PEMF prevented OVX-induced deterioration in bone mineral density (BMD) and mechanical properties in lumbar vertebral body and femur, and deterioration in bone microarchitecture in lumbar vertebral body and proximal tibia. Late PEMF intervention only inhibited deterioration of BMD, bone microarchitecture, and mechanical properties in lumbar vertebral body. Both early and late PEMF therapy suppressed RANK protein expression in OVX rats without a concomitant effect on RANK mRNA expression. These results demonstrate that timing of initiation of PEMF therapy plays an important role in achieving optimal beneficial effects. The specific PEMF parameters may exert these favorable biological responses, at least partially, via inhibition of protein expression of RANK. Bioelectromagnetics. 38:456-465, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  5. Importance of Baseline Prognostic Factors With Increasing Time Since Initiation of Highly Active Antiretroviral Therapy

    PubMed Central

    2012-01-01

    Background The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear. Methods We analyzed data on 20,379 treatment-naive HIV-1–infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of follow-up, 1844 AIDS events, and 1005 deaths). Results Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART). Conclusions Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART. PMID:18043315

  6. WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies.

    PubMed

    Börnhorst, Claudia; Wijnhoven, Trudy M A; Kunešová, Marie; Yngve, Agneta; Rito, Ana I; Lissner, Lauren; Duleva, Vesselka; Petrauskiene, Ausra; Breda, João

    2015-04-30

    Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children. The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation. One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14;1.29]), 'flavoured milk' (1.18 [1.08;1.28]), 'candy bars or chocolate' (1.31 [1.22;1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14;1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20;1.45]), 'pizza, French fries (chips), hamburgers'(1.30 [1.18;1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83;0.95]) and 'fresh fruits' (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04;1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07;1.23]). The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen

  7. Evidence of Program Quality and Youth Outcomes in the DYCD Out-of-School Time Initiative: Report on the Initiative's First Three Years

    ERIC Educational Resources Information Center

    Russell, Christina A.; Mielke, Monica B.; Reisner, Elizabeth R.

    2009-01-01

    In September 2005, the New York City Department of Youth and Community Development (DYCD) launched the Out-of-School Time Programs for Youth (OST) initiative to provide young people throughout New York City with access to high-quality programming after school, on holidays, and during the summer at no cost to their families. Working closely with…

  8. Evidence of Program Quality and Youth Outcomes in the DYCD Out-of-School Time Initiative: Report on the Initiative's First Three Years. Executive Summary

    ERIC Educational Resources Information Center

    Russell, Christina A.; Mielke, Monia B.; Reisner, Elizabeth R.

    2009-01-01

    In September 2005, the New York City Department of Youth and Community Development (DYCD) launched the Out-of-School Time Programs for Youth (OST) initiative to provide young people throughout New York City with access to high-quality programming after school, on holidays, and during the summer at no cost to their families. Working closely with…

  9. Do sound levels and space contribute to agitation in nursing home residents with dementia?

    PubMed

    Joosse, Laura L

    2012-07-01

    Individuals with dementia living in nursing homes may be exposed to non-therapeutic levels of sound. There is insufficient research examining the relationship between sound levels, personal space, and agitation in people with dementia. Using an observational designed study, 53 participants from four southeastern Wisconsin nursing homes were observed; data on sound levels, space, and agitation levels were obtained. Sound was a significant predictor of agitation. The accumulation of sound predicted agitated behavior and explained 16% of the variance, F(5, 47) = 4.520, p < 0.002, and adjusted R(2) = 0.253. The findings suggest agitation may be a clue that sound in the environment is causing stress for residents with dementia.

  10. Relaxing music at mealtime in nursing homes: effects on agitated patients with dementia.

    PubMed

    Hicks-Moore, Sandee Lynn

    2005-12-01

    Agitation in individuals with severe cognitive impairment is a significant problem that affects care and overall quality of life. Building on research conducted by Goddaer and Abraham (1994), this quasi-experimental study proposed that relaxing music played during meals would exert a calming effect and decrease agitated behaviors among nursing home residents with dementia. Thirty residents residing in a Special Care Unit participated in the 4-week study. The Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989) was used to gather data. Baseline data was obtained in Week 1 (no music). Music was introduced in Week 2, removed in Week 3, and reintroduced in Week 4. At the end of the 4-week study, overall reductions in the cumulative incidence of total agitated behaviors were observed. Reductions in absolute numbers of agitated behaviors were achieved during the weeks with music and a distinct pattern was observed.

  11. The effects of agitation and aeration on the production of gluconic acid by Aspergillus niger

    SciTech Connect

    Dronawat, S.N.; Svihla, C.K.; Hanley, T.R.

    1995-12-31

    The effects of agitation and aeration in the production of gluconic acid by Aspergillus niger from a glucose medium were investigated. Experiments were conducted at aeration rates of 5.0 and 10.0 L/min. Four different agitation speeds were investigated for each aeration rate. Gluconic acid concentration and biomass concentration were analyzed, and the rate of consumption of substrate by A. niger was noted. The main purpose of this work was to find the optimal conditions of agitation and aeration for the growth of A. niger and production of gluconic acid in submerged culture in a batch fermentor at a bench-top scale. The oxygen-transfer rates at different agitation and aeration rates were calculated. The gluconic acid concentration and rate of growth of A. niger increased with increase in the agitation and aeration rates.

  12. [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.

  13. Quetiapine reduces irritability and risk of suicide in patients with agitated depression.

    PubMed

    Nishiyama, Akiyoshi; Matsumoto, Hideo

    2013-07-20

    Patients who suffer from agitated depression accompanied by psychomotor agitation and irritability are prone to suicidal ideation and attempts and must therefore be diagnosed and treated with utmost care. Clinically, there have been more than a few cases of suicidal attempts that seemed to have been provoked by careless prescription of antidepressant medication. In the present study, administration of quetiapine to 3 patients in the acute phase of agitated depression resulted in rapid improvement in irritability and alleviation of depression. Depression in these 3 patients was caused by chronic (persistent) anxiety and tension. During the acute phase, the patients evidenced psychomotor agitation and irritability, often experiencing a sudden, overwhelming urge to commit suicide. Findings from the present study suggest that treatment with quetiapine in patients with this type of agitated depression can quickly alleviate symptoms of anxiety and irritability and reduce the risk of suicide.

  14. 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

    2017-02-10

    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, kL 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;9999: 1-9. © 2017 Wiley Periodicals, Inc.

  15. Toward a Semi-Self-Paced EEG Brain Computer Interface: Decoding Initiation State from Non-Initiation State in Dedicated Time Slots

    PubMed Central

    Yang, Lingling; Leung, Howard; Peterson, David A.; Sejnowski, Terrence J.; Poizner, Howard

    2014-01-01

    Brain computer interfaces (BCIs) offer a broad class of neurologically impaired individuals an alternative means to interact with the environment. Many BCIs are “synchronous” systems, in which the system sets the timing of the interaction and tries to infer what control command the subject is issuing at each prompting. In contrast, in “asynchronous” BCIs subjects pace the interaction and the system must determine when the subject’s control command occurs. In this paper we propose a new idea for BCI which draws upon the strengths of both approaches. The subjects are externally paced and the BCI is able to determine when control commands are issued by decoding the subject’s intention for initiating control in dedicated time slots. A single task with randomly interleaved trials was designed to test whether it can be used as stimulus for inducing initiation and non-initiation states when the sensory and motor requirements for the two types of trials are very nearly identical. Further, the essential problem on the discrimination between initiation state and non-initiation state was studied. We tested the ability of EEG spectral power to distinguish between these two states. Among the four standard EEG frequency bands, beta band power recorded over parietal-occipital cortices provided the best performance, achieving an average accuracy of 86% for the correct classification of initiation and non-initiation states. Moreover, delta band power recorded over parietal and motor areas yielded a good performance and thus could also be used as an alternative feature to discriminate these two mental states. The results demonstrate the viability of our proposed idea for a BCI design based on conventional EEG features. Our proposal offers the potential to mitigate the signal detection challenges of fully asynchronous BCIs, while providing greater flexibility to the subject than traditional synchronous BCIs. PMID:24586440

  16. Time-Dependent Changes in QT Dynamics after Initiation and Termination of Paroxysmal Atrial Fibrillation.

    PubMed

    Yamaguchi, Yoshiaki; Mizumaki, Koichi; Nishida, Kunihiro; Sakamoto, Tamotsu; Kataoka, Naoya; Nakatani, Yosuke; Inoue, Hiroshi

    2015-12-01

    Little is known about time-dependent changes in QT dynamics after initiation of atrial fibrillation (AF) and after restoration of sinus rhythm (SR) in patients with paroxysmal AF. Beat-to-beat QT and RR intervals in CM5 lead were measured automatically in 13 patients with both AF and SR on the single 24-hour Holter electrocardiology recording. QT-RR relation was analyzed at six periods of time: 1 hour before AF onset (Pre(0-1h)), 0-1 hour and 4-5 hours after AF onset (AF(0-1h) and AF(4-5h)), and 0-1 hour, 2-3 hours, and 4-5 hours after the restoration of SR (SR(0-1h), SR(2-3h), and SR(4-5h)). QT-RR slope was gradually decreased after AF onset and gradually returned to the baseline level after restoration of SR. The slope became greater at SR(4-5h) than at AF(4-5h) and AF(0-1h). In patients receiving antiarrhythmic drugs (AADs; n = 5), QT-RR slope was greater at SR(4-5h) than in those not receiving AADs (n = 8). In patients with paroxysmal AF, bradycardia-dependent QT prolongation was attenuated during AF, and was corrected and gradually augmented along with continuation of SR, especially in patients receiving AADs. This could increase the risk of developing torsade de pointes. ©2015 Wiley Periodicals, Inc.

  17. Initial Study of an Effective Fast-Time Simulation Platform for Unmanned Aircraft System Traffic Management

    NASA Technical Reports Server (NTRS)

    Xue, Min; Rios, Joseph

    2017-01-01

    Small Unmanned Aerial Vehicles (sUAVs), typically 55 lbs and below, are envisioned to play a major role in surveilling critical assets, collecting important information, and delivering goods. Large scale small UAV operations are expected to happen in low altitude airspace in the near future. Many static and dynamic constraints exist in low altitude airspace because of manned aircraft or helicopter activities, various wind conditions, restricted airspace, terrain and man-made buildings, and conflict-avoidance among sUAVs. High sensitivity and high maneuverability are unique characteristics of sUAVs that bring challenges to effective system evaluations and mandate such a simulation platform different from existing simulations that were built for manned air traffic system and large unmanned fixed aircraft. NASA's Unmanned aircraft system Traffic Management (UTM) research initiative focuses on enabling safe and efficient sUAV operations in the future. In order to help define requirements and policies for a safe and efficient UTM system to accommodate a large amount of sUAV operations, it is necessary to develop a fast-time simulation platform that can effectively evaluate requirements, policies, and concepts in a close-to-reality environment. This work analyzed the impacts of some key factors including aforementioned sUAV's characteristics and demonstrated the importance of these factors in a successful UTM fast-time simulation platform.

  18. The neural time course of evaluating self-initiated joint attention bids.

    PubMed

    Caruana, Nathan; de Lissa, Peter; McArthur, Genevieve

    2015-08-01

    During interactions with other people, we constantly evaluate the significance of our social partner's gaze shifts in order to coordinate our behaviour with their perspective. In this study, we used event-related potentials (ERPs) to investigate the neural time course of evaluating gaze shifts that signal the success of self-initiated joint attention bids. Nineteen participants were allocated to a "social" condition, in which they played a cooperative game with an anthropomorphic virtual character whom they believed was controlled by a human partner in a nearby laboratory. Participants were required to initiate joint attention towards a target. In response, the virtual partner shifted his gaze congruently towards the target-thus achieving joint attention--or incongruently towards a different location. Another 19 participants completed the same task in a non-social "control" condition, in which arrows, believed to be controlled by a computer program, pointed at a location that was either congruent or incongruent with the participant's target fixation. In the social condition, ERPs to the virtual partner's incongruent gaze shifts evoked significantly larger P350 and P500 peaks compared to congruent gaze shifts. This P350 and P500 morphology was absent in both the congruent and incongruent control conditions. These findings are consistent with previous claims that gaze shifts differing in their social significance modulate central-parietal ERPs 350 ms following the onset of the gaze shift. Our control data highlights the social specificity of the observed P350 effect, ruling out explanations pertaining to attention modulation or error detection. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Real time correlation function in a single phase spaceintegral--beyond the linearized semiclassical initial valuerepresentation

    SciTech Connect

    Liu, Jian; Miller, William H.

    2007-07-10

    It is shown how quantum mechanical time correlation functions [defined, e.g., in Eq. (1.1)] can be expressed, without approximation, in the same form as the linearized approximation of the semiclassical initial value representation (LSC-IVR), or classical Wigner model, for the correlation function [cf. Eq. (2.1)], i.e., as a phase space average (over initial conditions for trajectories) of the Wigner functions corresponding to the two operators. The difference is that the trajectories involved in the LSC-IVR evolve classically, i.e., according to the classical equations of motion, while in the exact theory they evolve according to generalized equations of motion that are derived here. Approximations to the exact equations of motion are then introduced to achieve practical methods that are applicable to complex (i.e., large) molecular systems. Four such methods are proposed in the paper--the full Wigner dynamics (full WD) and the 2nd order WD based on 'Winger trajectories', and the full Donoso-Martens dynamics (full DMD) and the 2nd order DMD based on 'Donoso-Martens trajectories'--all of which can be viewed as generalizations of the original LSC-IVR method. Numerical tests of these four versions of this new approach are made for two anharmonic model problems, and for each the momentum autocorrelation function (i.e., operators linear in coordinate or momentum operators) and the force autocorrelation function (non-linear operators) have been calculated. These four new approximate treatments are indeed seen to be significant improvements to the original LSC-IVR approximation.

  20. A real-time emergency response workstation using a 3-D numerical model initialized with sodar

    SciTech Connect

    Lawver, B.S.; Sullivan, T.J.; Baskett, R.L.

    1993-01-28

    Many emergency response dispersion modeling systems provide simple Gaussian models driven by single meteorological tower inputs to estimate the downwind consequences from accidental spills or stack releases. Complex meteorological or terrain settings demand more sophisticated resolution of the three-dimensional structure of the atmosphere to reliably calculate plume dispersion. Mountain valleys and sea breeze flows are two common examples of such settings. To address these complexities, the authors have implemented the three-dimensional diagnostic MATHEW mass-adjusted wind field and ADPIC particle-in-cell dispersion models on a workstation for use in real-time emergency response modeling. MATHEW/ADPIC have shown their utility in a variety of complex settings over the last 15 years within the Department of Energy`s Atmospheric Release Advisory Capability (ARAC) project. The models are initialized using an array of surface wind measurements from meteorological towers coupled with vertical profiles from an acoustic sounder (sodar). The workstation automatically acquires the meteorological data every 15 minutes. A source term is generated using either defaults or a real-time stack monitor. Model outputs include contoured isopleths displayed on site geography or plume densities shown over 3-D color shaded terrain. The models are automatically updated every 15 minutes to provide the emergency response manager with a continuous display of potentially hazardous ground-level conditions if an actual release were to occur. Model run time is typically less than 2 minutes on 6 megaflop ({approximately}30 MIPS) workstations. Data acquisition, limited by dial-up modem communications, requires 3 to 5 minutes.

  1. The primary eye care examination: opening the case history and the patient's uninterrupted initial talking time.

    PubMed

    Pointer, Jonathan S

    2014-01-01

    The uninterrupted initial talking time (UITT) of optometric patients was measured in response to the clinician's opening question: "Do you have any problems with your eyes or your sight?" UITT was measured surreptitiously by the optometrist. Also noted was whether an eye/sight problem was claimed by the patient and whether or not this was subsequently confirmed by the examination. Data were collected from 822 adults, mean age 59.1yrs (SD 17.6), range 16.0-92.0yrs. UITT data were positively skewed; median value 28.87s (IQR 19.81-43.03s) and no statistically significant difference between genders (p=0.9). 53% of patients had completed their opening statement by 30s, and 90% after 1min. 75% of these individuals (age range 26-75yrs) had a median UITT 27.82s; younger patients (16-25yrs) spoke for a significantly shorter time (18.39s: p=0.002) and elderly patients (≥76yrs) a significantly longer time (37.27s: p=0.003) than the majority value. Previously unexamined patients, habitual spectacle wearers, and individuals presenting with an eye/sight problem all recorded a significantly longer UITT (p≤0.006) than their peers. The practitioner's opening question had a sensitivity of 0.54/specificity of 0.95, and a positive predictive value (PV) of 0.78/negative PV of 0.87: with a calculated value of κ=0.53, the strength of agreement between subjective claim and objective outcome could be regarded as 'moderate'. These data suggest that an optometric patient's UITT of <30s is unlikely to prove disruptive to the clinical routine. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  2. Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia.

    PubMed

    Dalens, Bernard J; Pinard, Anne Marie; Létourneau, Dany-Roch; Albert, Natalie T; Truchon, René J Y

    2006-04-01

    Magnetic resonance imaging (MRI) requires long-lasting immobilization that frequently can only be provided by general anesthesia in pediatric patients. Sevoflurane provides adequate anesthesia but many patients experience emergence agitation. Small doses of ketamine and nalbuphine provide moderate sedation but their benefits have subsided at the time of emergence. We hypothesized that delaying their administration until the end of the procedure would prevent emergence agitation without prolonging patient wake-up and discharge times from the postanesthesia care unit. We performed a double-blind study involving 90 patients (aged 6 mo to 8 yr) randomly allocated to 1 of 3 groups receiving either saline (S-group), ketamine (0.25 mg/kg) (K-group), or nalbuphine (0.1 mg/kg) (N-group) at the end of an MRI procedure under sevoflurane anesthesia. We evaluated emergence conditions, sedation/agitation status and completion of discharge criteria at 30 min. The three groups were comparable in age, sex ratio, physical status, and associated medical disorders. Emergence conditions did not differ significantly. There were significantly more agitated children, at all times, in the S-group and more obtunded patients at early times (5 and 10 min) in both K- and N-groups. All patients met discharge criteria at 30 min but significantly more children were awake and quiet in the K-group and still more in the N-group. In conclusion, small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge. Nalbuphine provided better results than ketamine.

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

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

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

  4. Mechanically controlled radical polymerization initiated by ultrasound

    NASA Astrophysics Data System (ADS)

    Mohapatra, Hemakesh; Kleiman, Maya; Esser-Kahn, Aaron Palmer

    2017-02-01

    In polymer chemistry, mechanical energy degrades polymeric chains. In contrast, in nature, mechanical energy is often used to create new polymers. This mechanically stimulated growth is a key component of the robustness of biological materials. A synthetic system in which mechanical force initiates polymerization will provide similar robustness in polymeric materials. Here we show a polymerization of acrylate monomers initiated and controlled by mechanical energy provided by ultrasonic agitation. The activator for an atom-transfer radical polymerization is generated using piezochemical reduction of a Cu(II) precursor complex, which thus converts a mechanical activation of piezoelectric particles to the synthesis of a new material. This polymerization reaction has some characteristics of controlled radical polymerization, such as narrow molecular-weight distribution and linear dependence of the polymeric chain length on the time of mechanical activation. This new method of controlled radical polymerization complements the existing methods to synthesize commercially useful well-defined polymers.

  5. Mechanically controlled radical polymerization initiated by ultrasound

    NASA Astrophysics Data System (ADS)

    Mohapatra, Hemakesh; Kleiman, Maya; Esser-Kahn, Aaron Palmer

    2016-10-01

    In polymer chemistry, mechanical energy degrades polymeric chains. In contrast, in nature, mechanical energy is often used to create new polymers. This mechanically stimulated growth is a key component of the robustness of biological materials. A synthetic system in which mechanical force initiates polymerization will provide similar robustness in polymeric materials. Here we show a polymerization of acrylate monomers initiated and controlled by mechanical energy provided by ultrasonic agitation. The activator for an atom-transfer radical polymerization is generated using piezochemical reduction of a Cu(II) precursor complex, which thus converts a mechanical activation of piezoelectric particles to the synthesis of a new material. This polymerization reaction has some characteristics of controlled radical polymerization, such as narrow molecular-weight distribution and linear dependence of the polymeric chain length on the time of mechanical activation. This new method of controlled radical polymerization complements the existing methods to synthesize commercially useful well-defined polymers.

  6. Anticipatory Postural Control of Stability during Gait Initiation Over Obstacles of Different Height and Distance Made Under Reaction-Time and Self-Initiated Instructions.

    PubMed

    Yiou, Eric; Artico, Romain; Teyssedre, Claudine A; Labaune, Ombeline; Fourcade, Paul

    2016-01-01

    Despite the abundant literature on obstacle crossing in humans, the question of how the central nervous system (CNS) controls postural stability during gait initiation with the goal to clear an obstacle remains unclear. Stabilizing features of gait initiation include anticipatory postural adjustments (APAs) and lateral swing foot placement. To answer the above question, 14 participants initiated gait as fast as possible in three conditions of obstacle height, three conditions of obstacle distance and one obstacle-free (control) condition. Each of these conditions was performed with two levels of temporal pressure: reaction-time (high-pressure) and self-initiated (low-pressure) movements. A mechanical model of the body falling laterally under the influence of gravity and submitted to an elastic restoring force is proposed to assess the effect of initial (foot-off) center-of-mass position and velocity (or "initial center-of-mass set") on the stability at foot-contact. Results showed that the anticipatory peak of mediolateral (ML) center-of-pressure shift, the initial ML center-of-mass velocity and the duration of the swing phase, of gait initiation increased with obstacle height, but not with obstacle distance. These results suggest that ML APAs are scaled with swing duration in order to maintain an equivalent stability across experimental conditions. This statement is strengthened by the results obtained with the mechanical model, which showed how stability would be degraded if there was no adaptation of the initial center-of-mass set to swing duration. The anteroposterior (AP) component of APAs varied also according to obstacle height and distance, but in an opposite way to the ML component. Indeed, results showed that the anticipatory peak of backward center-of-pressure shift and the initial forward center-of-mass set decreased with obstacle height, probably in order to limit the risk to trip over the obstacle, while the forward center-of-mass velocity at foot

  7. Anticipatory Postural Control of Stability during Gait Initiation Over Obstacles of Different Height and Distance Made Under Reaction-Time and Self-Initiated Instructions

    PubMed Central

    Yiou, Eric; Artico, Romain; Teyssedre, Claudine A.; Labaune, Ombeline; Fourcade, Paul

    2016-01-01

    Despite the abundant literature on obstacle crossing in humans, the question of how the central nervous system (CNS) controls postural stability during gait initiation with the goal to clear an obstacle remains unclear. Stabilizing features of gait initiation include anticipatory postural adjustments (APAs) and lateral swing foot placement. To answer the above question, 14 participants initiated gait as fast as possible in three conditions of obstacle height, three conditions of obstacle distance and one obstacle-free (control) condition. Each of these conditions was performed with two levels of temporal pressure: reaction-time (high-pressure) and self-initiated (low-pressure) movements. A mechanical model of the body falling laterally under the influence of gravity and submitted to an elastic restoring force is proposed to assess the effect of initial (foot-off) center-of-mass position and velocity (or “initial center-of-mass set”) on the stability at foot-contact. Results showed that the anticipatory peak of mediolateral (ML) center-of-pressure shift, the initial ML center-of-mass velocity and the duration of the swing phase, of gait initiation increased with obstacle height, but not with obstacle distance. These results suggest that ML APAs are scaled with swing duration in order to maintain an equivalent stability across experimental conditions. This statement is strengthened by the results obtained with the mechanical model, which showed how stability would be degraded if there was no adaptation of the initial center-of-mass set to swing duration. The anteroposterior (AP) component of APAs varied also according to obstacle height and distance, but in an opposite way to the ML component. Indeed, results showed that the anticipatory peak of backward center-of-pressure shift and the initial forward center-of-mass set decreased with obstacle height, probably in order to limit the risk to trip over the obstacle, while the forward center-of-mass velocity at foot

  8. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit.

    PubMed

    Lu, Xing; Li, Jun; Li, Tong; Zhang, Jie; Li, Zhi-Bo; Gao, Xin-Jing; Xu, Lei

    2016-04-01

    To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU. This randomized, prospective study was conducted in Tianjin Third Central Hospital, China. Using a sealed-envelope method, the patients were randomly divided into 2 groups (40 patients per group). Each patient of group A received an initial loading dose of midazolam at 0.3-3mg/kg·h 24 h before extubation, followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation. Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation. The dose of sedation was regulated according to RASS sedative scores maintaining in the range of -2-1. All patients were continuously monitored for 60 min after extubation. During the course, heart rate (HR), mean artery pressure (MAP), extubation time, adverse reactions, ICU stay, and hospital stay were observed and recorded continuously at the following time points: 24 h before extubation (T1), 12 h before extubation (T2), extubation (T3), 30 min after extubation (T4), 60 min after extubation (T5). Both groups reached the goal of sedation needed for ICU patients. Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam, reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)), respectively (p= 0.017). There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam. In the group A, HR was not significantly increased after extubation; however, in the group B, HR was significantly increased compared with the preextubation values (p < 0.05). HR was significantly higher in the group B compared with the group A at 30 and 60 min after extubation (both, p <0.05). Compared with preextubation values, MAP was significantly increased at extubation in the group B (p < 0.05) and MAP was significantly higher at T3, T4, T5 in the group B than group A (p < 0

  9. Spore Release of Bremia lactucae on Lettuce Is Affected by Timing of Light Initiation and Decrease in Relative Humidity.

    PubMed

    Su, H; van Bruggen, A H; Subbarao, K V

    2000-01-01

    ABSTRACT A suction-impaction mini-spore trap was developed to study the effect of light initiation and decreasing relative humidity (RH) on spore release of Bremia lactucae in a controlled environment. Three light periods (from 0400 to 1600, 0600 to 1800, and 0800 to 2000 h, circadian time) at a constant RH of 99 to 100% were used for studying the effect of light initiation on spore release. Few spores were released during the dark periods. Spore release increased sharply after the initiation of the three light periods, reached a maximum 1 to 2 h after light initiation, and then declined until only a few spores could be detected. The effect of reduction in RH on spore release was studied by comparing decreases in RH 2 h before and 2 h after light initiation at 0800 h. When RH decreased from 100 to 94% 2 h before light initiation, spore release increased within 1 h, followed by a second increase after light initiation. When RH decreased 2 h after light initiation, spore release continued to increase after the initial increase after light initiation, reached a maximum 1 h after the reduction in RH, and then declined. The results suggest that both light initiation and reduction in RH can trigger spore release and that these factors have separate effects on spore release of Bremia lactucae.

  10. Evaluation of the Massachusetts Expanded Learning Time (ELT) Initiative. Year Five Final Report: 2010-2011. Executive Summary

    ERIC Educational Resources Information Center

    Checkoway, Amy; Gamse, Beth; Velez, Melissa; Caven, Meghan; de la Cruz, Rodolfo; Donoghue, Nathaniel; Kliorys, Kristina; Linkow, Tamara; Luck, Rachel; Sahni, Sarah; Woodford, Michelle

    2012-01-01

    The Massachusetts Expanded Learning Time (ELT) initiative was established in 2005 with planning grants that allowed a limited number of schools to explore a redesign of their respective schedules and add time to their day or year. Participating schools are required to expand learning time by at least 300 hours per academic year to improve student…

  11. Evaluation of the Massachusetts Expanded Learning Time (ELT) Initiative. Year Five Final Report: 2010-2011. Volume I

    ERIC Educational Resources Information Center

    Checkoway, Amy; Gamse, Beth; Velez, Melissa; Caven, Meghan; de la Cruz, Rodolfo; Donoghue, Nathaniel; Kliorys, Kristina; Linkow, Tamara; Luck, Rachel; Sahni, Sarah; Woodford, Michelle

    2012-01-01

    The Massachusetts Expanded Learning Time (ELT) initiative was established in 2005 with planning grants that allowed a limited number of schools to explore a redesign of their respective schedules and add time to their day or year. Participating schools are required to expand learning time by at least 300 hours per academic year to improve student…

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

    PubMed

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

    2014-01-01

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

  13. Recovery of Copper from Effluents by Cementation on Aluminum in a Multirotating Cylinder-Agitated Vessel

    NASA Astrophysics Data System (ADS)

    Abdel-Aziz, M. H.; El-Ashtoukhy, E.-S. Z.; Bassyouni, M.

    2016-02-01

    Recovery of copper from synthetic waste solution using cementation technique in a new agitated vessel employing multirotating aluminum cylinders impeller was investigated. Parameters studied are cylinder diameter, rotation speed, initial copper ion concentrations, and effect of surfactants. Solution analysis and scanning electron microscopy were employed to investigate the kinetic and mechanism of the process. The rate of recovery was found to be at its maximum value at the operating conditions of 350 rpm rotation speed, 5000 ppm initial CuSO4 concentration, and 1.2 cm cylinder diameter. All data were correlated by the dimensionless equation: {Sh} = 1.16 {Sc}^{0.33} {Re}^{0.63} ( {{d_{{c}} }/L} )^{0.54}, with an average deviation of ±8.5 pct and a standard deviation of 5.88 pct. Presence of nonylphenol ethoxylate surfactant in the solution decreased the rate of recovery by an amount ranging from 2.94 to 38.57 pct depending on the operating conditions. The present geometry gave higher rates of recovery compared to both the single rotating cylinder and rotating disc reactor.

  14. Age at Time of Initial Sexual Intercourse and Health of Adolescent Girls.

    PubMed

    Lara, Lúcia A S; Abdo, Carmita H N

    2016-10-01

    Adolescence is characterized by marked changes in the body, psychology, and sexual behavior due to increasing production of hormones. In this review we aimed to assess the effect of age at the time of first sexual intercourse (sexarche) on the health of adolescent girls, and identify factors that might protect against early initiation of sexual relations in girls. The PubMed, Lilacs, and Google Scholar databases were searched for clinical trials, comparative studies, case-control studies, cross-sectional studies, cohort studies, multicenter studies, observational studies, meta-analyses, and systematic reviews published up to December 2014 on this theme. The search terms were: "sexual debut," "coitarche," "sexarche," and "young people," "adolescent," "unplanned pregnancy," "adolescent contraception," and "STDs." Data were extracted from 28 studies and 41 references were used to introduce the theme and to support the discussion. Sexarche has been occurring in increasingly younger girls. A young age at sexarche can lead to subsequent risky sexual behavior. Girls who have sexarche when they are 14 years old or younger are less likely to use contraception on this occasion, take more time before they start using contraception in subsequent sexual relations, are more likely to have several sex partners, have a higher risk for depression, have lower self-esteem and more episodes of repentance, and have a higher risk for a sexually transmitted disease and cervical cancer. Girls with low educational, socioeconomic, and cultural status, little parental monitoring, parental separation, and absence of religiosity tend to experience sexarche at a younger age. Adolescent girls who postpone sexarche until they are 16 years old are physically and psychologically healthier than those who have sexarche at a younger age. This suggests that providing adolescent girls with appropriate education about sexual relations might reduce the negative effect of sexual relations at a young age.

  15. Changes in physical activity, sedentary time, and risk of falling: The Women's Health Initiative Observational Study.

    PubMed

    Bea, Jennifer W; Thomson, Cynthia A; Wallace, Robert B; Wu, Chunyuan; Seguin, Rebecca A; Going, Scott B; LaCroix, Andrea; Eaton, Charles; Ockene, Judith K; LaMonte, Michael J; Jackson, Rebecca; Jerry Mysiw, W; Wactawski-Wende, Jean

    2017-02-01

    Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n=93,676; Y3 n=76,598; Y6 n=75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N=6475). Falls per year (0, 1, 2, ≥3) were assessed annually by self-report questionnaire and then dichotomized as ≤1 and ≥2falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend <0.0001). Increasing sedentary time minimally decreased falling (1% Y3; 2% Y6; p<0.05). Increasing activity up to ≥9MET-h/wk. (OR: 1.12, 95% CI: 1.03-1.22) or maintaining ≥9MET-h/wk. (OR: 1.20, 95% CI: 1.13-1.29) increased falling at Y3 and Y6 (p for trend <0.001). Adding lean body mass to the models attenuated these relationships. Physically active lifestyles increased falling among post-menopausal women. Additional fall prevention strategies, such as balance and resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. The initial time-course of headache in patients with spontaneous subarachnoid hemorrhage.

    PubMed

    Čomić, Hata; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-08-15

    If acute severe headache disappears early after its onset, the question arises whether subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course and minimal duration of headache in a consecutive series of neurologically intact patients with spontaneous SAH. We included patients admitted between 2012 and 2015 within 48h after spontaneous SAH with a normal level of consciousness and no focal deficits. We retrieved data on headache severity, measured with a Numeric Rating Scale (NRS), <48h after ictus. We analyzed the proportion of patients with a first NRS 0 and NRS <3 within 48h after ictus and minimal headache duration. Patients were censored in case of a decrease in level of consciousness, aneurysm treatment, or early discharge. We included 106 patients (62 aneurysmal SAH, 33 perimesencephalic hemorrhage, 11 other spontaneous SAH). All patients were treated with analgesics. Within 48h after ictus, a first NRS 0 was reported by 9 patients (8%;95%CI:3%-14%) and a first NRS <3 by 22 patients (21%;95%CI:13%-28%). Shortest time lapse until NRS 0 was 10h in a patient with aneurysmal SAH who had been on acetaminophen and tramadol since 2:35h after ictus. In a cohort of SAH patients with a normal level of consciousness and no focal deficits who all used analgetics, headache disappeared in around 10% within 48h after ictus. Our data indicate that a diagnostic work-up for SAH is also needed in patients using analgesics in whom headache has disappeared after 10h. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Enhanced evaluation data initiates a collaborative out-of-school time food sponsors work group.

    PubMed

    Rifkin, Robin; Williams, Lauren A; Grode, Gabrielle M; Roberts-Johnson, Wendy-Anne

    2015-01-01

    Philadelphia's Healthy Kids, Healthy Communities Out-of-School Time (OST) Initiative led by the Health Promotion Council developed 10 Healthy Living Guidelines for Out-of-School Time Programs to support a healthy environment for Philadelphia youth in 200 OST programs. Health Promotion Council participated in an enhanced cross-site evaluation with the national Robert Wood Johnson Foundation evaluator during the final year of funding to learn more about food and nutrition in the OST setting, and to share data and engage the OST food providers. A plate waste study measured the quantity and nutrition composition of meals served to youth compared to food not eaten. Staff interviews measured program adherence to the Healthy Living Guidelines, along with other facets of the food environment in 7 Philadelphia OST programs. Online surveys were sent to OST programs. Food providers (sponsors) were interviewed using Appreciative Inquiry methodology to gain insight into systems, goals, and common interests. Aggregated plate waste data from 7 observations showed an average of 42% of the food uneaten after meal/snack consumption, and high sodium content of the meals. Twenty-nine staff at OST programs completed the online survey, and 3 food sponsors were interviewed. Recommendations to improve the food included increasing variety, offering more salads, fruits and vegetables, and culturally appropriate foods. Food sponsor interviews showed a variety of meal production, distribution, service and training systems, and an interest in working together. The food sponsors met to review the data and prioritized common goals. They continue to work together to improve systems and meals for food service. A food sponsors work group formed and continues as a result of sharing enhanced cross-site data about food in OST settings. Food sponsors continue to work together to improve systems and nutritional offerings for Philadelphia OST programs.

  18. Controllers and Pilots Play a Key Role in Runway Safety Initiatives Through Real-Time Simulation

    NASA Technical Reports Server (NTRS)

    Madson, Mike; Bender, Kim

    2004-01-01

    A new and innovative way to evaluate runway safety initiatives for airports is through the use of interactive real-time simulation. The National Aeronautics and Space Administration (NASA) operates an integrated suite of simulators that can give both pilots and tower controllers the ability to simultaneously "try out" ideas in the safety of virtual reality. In February of 2003, the FAA conducted a demonstration in the NASA facilities for Dallas/Fort Worth International Airport (DFW) of a concept to reduce runway crossings and enhance the efficiency of the airport. Currently DFW experiences about 1,700 runway crossings per day, which contribute to arrival and departure delays and the potential for runway incursions. The proposed concept included the addition of new perimeter taxiways on the East and West sides of the airport. Through use of NASA's unique simulation capabilities, DFW controllers and commercial pilots provided expert feedback on the safety and operational implications by directly experiencing the proposed changes. Overall, the data collected from the participants and the simulators demonstrated that the concept would improve operations at DFW, if implemented. Improvements were observed in many areas including departure rates, taxi duration, runway crossings, and controller and pilot communications.

  19. System-wide flow initiative slashes patient wait times in the ED, boosts volume by 25%.

    PubMed

    2012-06-01

    Emergency department administrators at Cambridge Health Alliance, a three-hospital health care organization in Cambridge, MA, implemented a system-wide flow initiative that has reduced the average length-of-stay for rapid assessment patients from three hours to just over an hour. Under the approach, patients are immediately placed in a room, and providers and registration staff come to the patients rather than the traditional approach of having patients constantly move from place to place with wait times in between each interval of care. The approach relies on "patient partners," non-clinical personnel who are trained in customer service, to greet and quick-register patients who present to the ED for care. Administrators say 97% of patients who present to the ED are in a room within five minutes, and over 90% of them are seen by a provider within 14 minutes. The leave-without-being-seen (LWBS) rate has been slashed from 4.5% to 0.6%. System-wide ED volume, which was dropping before the new approach was implemented, has gone from 77,000 patients per year to nearly 100,000 patients per year.

  20. Controllers and Pilots Play a Key Role in Runway Safety Initiatives Through Real-Time Simulation

    NASA Technical Reports Server (NTRS)

    Madson, Mike; Bender, Kim

    2004-01-01

    A new and innovative way to evaluate runway safety initiatives for airports is through the use of interactive real-time simulation. The National Aeronautics and Space Administration (NASA) operates an integrated suite of simulators that can give both pilots and tower controllers the ability to simultaneously "try out" ideas in the safety of virtual reality. In February of 2003, the FAA conducted a demonstration in the NASA facilities for Dallas/Fort Worth International Airport (DFW) of a concept to reduce runway crossings and enhance the efficiency of the airport. Currently DFW experiences about 1,700 runway crossings per day, which contribute to arrival and departure delays and the potential for runway incursions. The proposed concept included the addition of new perimeter taxiways on the East and West sides of the airport. Through use of NASA's unique simulation capabilities, DFW controllers and commercial pilots provided expert feedback on the safety and operational implications by directly experiencing the proposed changes. Overall, the data collected from the participants and the simulators demonstrated that the concept would improve operations at DFW, if implemented. Improvements were observed in many areas including departure rates, taxi duration, runway crossings, and controller and pilot communications.

  1. 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.

  2. 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

  3. 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.

  4. Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children.

    PubMed

    Chen, Jia-Yao; Jia, Ji-E; Liu, Ting-Jie; Qin, Ming-Ju; Li, Wen-Xian

    2013-04-01

    Children undergoing strabismus surgery under sevoflurane anesthesia often experience emergence agitation (EA) and postoperative vomiting (POV). This study compared the effects of intraoperative dexmedetomidine, ketamine, and placebo on postoperative EA and POV. Eighty-four children (aged two to seven years) undergoing elective strabismus surgery under sevoflurane anesthesia were randomly assigned to one of three groups (n = 28 each). Intraoperatively, the placebo, dexmedetomidine, and ketamine groups received normal saline, dexmedetomidine 1 μg·kg(-1) iv plus a 1 μg·kg(-1)·hr(-1) infusion, and ketamine 1 mg·kg(-1) iv plus a 1 mg·kg(-1)·hr(-1) infusion, respectively. Agitation scores (Pediatric Anesthesia Emergence Delirium [PAED] scale) and POV were assessed in the postanesthetic care unit (PACU) and for 24 hr on the ward. Pain scores and times to laryngeal mask airway (LMA™) removal, resumption of mental orientation, and discharge from the PACU were also assessed. Seventy-eight children completed the study. Peak PAED scores for EA were lower in the dexmedetomidine (P < 0.001) and ketamine (P = 0.002) groups than in the placebo group. Incidence of POV was lower in the dexmedetomidine group (15%) than in the ketamine (44%; P = 0.02) or placebo (45.8%; P = 0.02) groups. Pain scores on the ward were lower in the dexmedetomidine (P < 0.001) and ketamine (P < 0.001) groups than in the placebo group. Time to LMA removal was similar in all groups. Time for resumption of mental orientation and time to discharge from PACU were longer in the dexmedetomidine and ketamine groups than in the placebo group. Dexmedetomidine and ketamine appear to prevent postoperative agitation and pain after sevoflurane anesthesia for pediatric strabismus surgery. Dexmedetomidine also prevents POV.

  5. Dain’s invariant on non-time symmetric initial data sets

    NASA Astrophysics Data System (ADS)

    Valiente Kroon, J. A.; Williams, J. L.

    2017-06-01

    We extend Dain’s construction of a geometric invariant characterising static initial data sets for the vacuum Einstein field equations to situations with a non-vanishing extrinsic curvature. This invariant gives a measure of how much an initial data set with non-vanishing ADM 4-momentum deviates from stationarity. In particular, it vanishes if and only if the initial data set is stationary. Thus, the invariant provides a quantification of the amount of gravitational radiation contained in the initial data set.

  6. Effect of period, water temperature and agitation on loss of water-soluble carbohydrates and protein from grass hay: implications for equine feeding management.

    PubMed

    Longland, A C; Barfoot, C; Harris, P A

    2014-01-18

    The effects of different water-soaking treatments on removal of water-soluble carbohydrates (WSC), WSC constituents and protein from four UK hays were determined. Hays were soaked in water for up to 16 hours at mean temperatures of 8°C, 16°C, in hot tap water (initially 49°C) or agitated and rinsed in clean water at 16°C. Initial hay WSC contents ranged from 154 to 216 g/kg dry matter. Losses of WSC from hays after 16 hours soaking at 8°C, 16°C, 16°C plus agitation and 49°C averaged 28, 46, 49 and 44 per cent, respectively. Corresponding percentage losses of fructan were 16, 37, 39 and 33. Percentage losses of sucrose averaged 55 (8°C), 86 (16°C), 91 (16°C+agitation) and 82 (initial temperature 49°C), those of glucose were 60, 85, 75 and 75, and of fructose were 41, 52, 54 and 46. Hay crude protein contents were not significantly changed by any of the soaking treatments. Soaking at 8°C generally resulted in reduced losses of WSC compared to when soaked at the higher temperatures. Thus, in cold weather using warmer water to soak hays may effect greater WSC loss, although very prolonged soaking at warm temperatures might encourage the proliferation of unwanted micro-organisms in the soak liquor.

  7. 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

  8. Change in agitation in Alzheimer's disease in the placebo arm of a 9-week controlled trial

    PubMed Central

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

    2015-01-01

    Background Placebo responses raise significant challenges for design of clinical trials. We report changes in agitation outcomes in the placebo arm of a recent trial of citalopram for agitation in Alzheimer's disease (AD). Methods In the Citalopram for Agitation in Alzheimer's Disease (Cit AD) study, all participants and caregivers received a psychosocial intervention and 92 were assigned to placebo for 9 weeks. Outcomes included Neurobehavioral Rating Scale agitation subscale (NBRS-A), modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (CGIC), Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (NPI A/A) and Total (NPI-Total) and ADLs. Continuous outcomes were analyzed with mixed-effects modeling and dichotomous outcomes with logistic regression. Results Agitation outcomes improved over 9 weeks: NBRS-A mean (SD) decreased from 7.8 (3.0) at baseline to 5.4 (3.2), CMAI from 28.7 (6.7) to 26.7 (7.4), NPI A/A from 8.0 (2.4) to 4.9 (3.8), and NPI-Total from 37.3 (17.7) to 28.4 (22.1). The proportion of CGI-C agitation responders ranged from 21 to 29% and was significantly different from zero. MMSE improved from 14.4 (6.9) to 15.7 (7.2) and ADLs similarly improved. Most of the improvement was observed by 3 weeks and was sustained through 9 weeks. The major predictor of improvement in each agitation measure was a higher baseline score in that measure. Conclusions We observed significant placebo response which may be due to regression to the mean, response to a psychosocial intervention, natural course of symptoms, or nonspecific benefits of participation in a trial. PMID:26305876

  9. 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.

  10. Effects of ultrasonic agitation on adhesion strength of micro electroforming Ni layer on Cu substrate.

    PubMed

    Zhao, Zhong; Du, Liqun; Xu, Zheng; Shao, Ligeng

    2016-03-01

    Micro electroforming is an important technology, which is widely used for fabricating micro metal devices in MEMS. The micro metal devices have the problem of poor adhesion strength, which has dramatically influenced the dimensional accuracy of the devices and seriously limited the development of the micro electroforming technology. In order to improve the adhesion strength, ultrasonic agitation method is applied during the micro electroforming process in this paper. To explore the effect of the ultrasonic agitation, micro electroforming experiments were carried out under ultrasonic and ultrasonic-free conditions. The effects of the ultrasonic agitation on the micro electroforming process were investigated by polarization and alternating current (a.c.) impedance methods. The real surface area of the electroforming layer was measured by cyclic voltammetry method. The compressive stress and the crystallite size of the electroforming layer were measured by X-ray Diffraction (XRD) method. The adhesion strength of the electroforming layer was measured by scratch test. The experimental results show that the imposition of the ultrasonic agitation decreases the polarization overpotential and increases the charge transfer process at the electrode-electrolyte interface during the electroforming process. The ultrasonic agitation increases the crystallite size and the real surface area, and reduces the compressive stress. Then the adhesion strength is improved about 47% by the ultrasonic agitation in average. In addition, mechanisms of the ultrasonic agitation improving the adhesion strength are originally explored in this paper. The mechanisms are that the ultrasonic agitation increases the crystallite size, which reduces the compressive stress. The lower the compressive stress is, the larger the adhesion strength is. Furthermore, the ultrasonic agitation increases the real surface area, enhances the mechanical interlocking strength and consequently increases the adhesion

  11. 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.

  12. [Patients in a state of agitation at the admission service of a Rouen hospital emergency department].

    PubMed

    Moritz, F; Bauer, F; Boyer, A; Lemarchand, P; Kerleau, J M; Moirot, E; Navarre, C; Muller, J M

    1999-10-09

    To determine the incidence and causes of agitation states in patients presenting at the Rouen University Hospital emergency room and to analyze the management scheme. A prospective study was conducted over a 9 month period in 100 consecutive patients presenting a state of agitation assessed using the Overt Aggression Scale. A pre-planned management protocol was applied. The incidence of states of agitation was 0.56%. There were 43 women and 57 men, mean age 33 years. Most of the agitated patients were admitted between 6 p.m. and 4 a.m. (69%). Over the 9 month period, 2 patients were admitted twice for agitation and 2 absconded. Low glucose level was the cause of agitation in 4 cases. Alcohol and/or drug use concerned 73% of the agitated patients and was the most frequently observed triggering factor (17%). Only 6% of the patients had a regular employment. Physical restraining measures and sedation were required in 86% and 84% of the cases respectively. Among 67 patients given loxapine for sedation, 2 developed acute dyskinesia and 9 low blood pressure. One out of 4 patients were referred to a psychiatric unit. Patients in a state of agitation are young, often female, and in a difficult socio-economic situation. Hypoglycemia is the main differential diagnosis. A triggering factor can often be identified. A state of agitation is not a repetitive condition but occurs as a short-lived episode in the patientís history. Such patients need rapid care to avoid further aggravation and disruption of the emergency room activity, and to prevent the patient from fleeing. Loxapine provides effective sedation but requires regular monitoring of blood pressure and can provoke acute dyskinesia in young subjects.

  13. 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.

  14. Dronabinol for the treatment of agitation and aggressive behavior in acutely hospitalized severely demented patients with noncognitive behavioral symptoms.

    PubMed

    Woodward, Matthew R; Harper, David G; Stolyar, Arkadiy; Forester, Brent P; Ellison, James M

    2014-04-01

    Behavioral disturbances occur frequently in demented individuals and greatly increase the burden of their care. The efficacy of pharmacotherapeutic treatment options is modest. This study was conducted to explore the efficacy and safety of dronabinol as an adjunctive treatment for agitation and aggressive behavior in severely demented patients. Using a retrospective systematic chart review, we studied 40 inpatients from the McLean Hospital Geriatric Neuropsychiatry Inpatient Unit diagnosed with dementia and treated with dronabinol for behavioral or appetite disturbances. A group of geriatric psychiatrists consulted medical records to rate the patients' behaviors prior to initiation of dronabinol treatment and following up to seven days of treatment, using the Pittsburgh Agitation Scale, Clinical Global Impression, and Global Assessment of Functioning. Data on percentage of food consumed at each meal, sleep duration, and adverse events were also collected from medical records. The addition of dronabinol to patients' treatment regimens was associated with significant decreases in all domains of the Pittsburgh Agitation Scale. There were also significant improvements in Clinical Global Impression scores, sleep duration and percentage of meals consumed during the treatment periods. Twenty-six adverse events were recorded during dronabinol treatment, none of which led to medication discontinuation. This report represents the largest studied cohort of dementia patients treated with dronabinol to date and confirms earlier reports that dronabinol can serve as an adjunctive treatment for neuropsychiatric symptoms in dementia. Further research, including prospective controlled trials, is needed to clarify dronabinol's role in treating noncognitive behavioral symptoms of demented individuals. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  15. Investigating Progression in Substance Use Initiation Using a Discrete-Time Multiple Event Process Survival Mixture (MEPSUM) Approach

    PubMed Central

    Richmond-Rakerd, Leah S.; Fleming, Kimberly A.; Slutske, Wendy S.

    2015-01-01

    The order and timing of substance initiation has significant implications for later problematic patterns of use. Despite the need to study initiation from a multivariate framework, survival analytic methods typically cannot accommodate more than two substances in one model. The Discrete-Time Multiple Event Process Survival Mixture (MEPSUM; Dean, Bauer, & Shanahan, 2014) model represents an advance by incorporating more than two outcomes and enabling establishment of latent classes within a multivariate hazard distribution. Employing a MEPSUM approach, we evaluated patterns of tobacco, alcohol, and cannabis initiation in the National Longitudinal Study of Adolescent to Adult Health (N=18,923). We found four classes that differed in their ages and ordering of peak initiation risk. Demographics, externalizing psychopathology, and personality significantly predicted class membership. Sex differences in the association between delinquency and initiation patterns also emerged. Findings support the utility of the MEPSUM approach in elucidating developmental pathways underlying clinically relevant phenomena. PMID:27127730

  16. Effect of ketamine versus alfentanil following midazolam in preventing emergence agitation in children after sevoflurane anaesthesia: a prospective randomized clinical trial.

    PubMed

    Bilgen, Sevgi; Köner, Özge; Karacay, Safak; Sancar, Nurcan Kizilcik; Kaspar, Elif Cigdem; Sözübir, Selami

    2014-12-01

    To investigate the effect of intranasal ketamine versus alfentanil in addition to oral midazolam for the prevention of emergence agitation in children. Children undergoing urological surgery with sevoflurane anaesthesia received oral midazolam 40 min before induction and were then randomly assigned to receive 2 mg/kg ketamine, 10 µg/kg alfentanil or 1 ml isotonic saline intranasally. Parental separation status and mask acceptance were assessed preoperatively. Emergence agitation was evaluated using a paediatric anaesthesia emergence delirium (PAED) score. Data from 78 children were evaluated in the study. There were no significant differences between the groups in demographic characteristics, recovery times or parental separation scores. Mask acceptance was significantly better in the ketamine group than in the saline group. The mean PAED score in the ketamine group was significantly better than in the other two groups, but was similar in the saline and alfentanil groups. The incidence of emergence agitation was 3.8%, 36.0% and 40.7% in the ketamine, alfentanil and saline groups, respectively. The addition of intranasal ketamine to oral midazolam significantly improved the quality of induction and reduced sevoflurane-induced emergence agitation, in children undergoing urological surgery. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Finite-time fuzzy stabilisation and control for nonlinear descriptor systems with non-zero initial state

    NASA Astrophysics Data System (ADS)

    Su, Zhan; Zhang, Qingling; Ai, Jun; Sun, Xin

    2015-01-01

    For nonlinear descriptor systems, this paper presents an approach to obtain a fuzzy controller with guaranteed finite-time stability and finite-time boundedness with non-zero initial state, which outperforms some recent work and additionally provides a precision estimation of model approximation. We prove necessary and sufficient conditions of finite-time stability and finite-time boundedness with non-zero initial state for nonlinear descriptor systems. Using Takagi-Sugeno fuzzy dynamic models and proposed sufficient conditions, we define fuzzy sets and use linear matrix inequalities to satisfy differential linear matrix inequalities. A simulation confirms efficiency and precision of the given method.

  18. The effects of initial conditions and control time on optimal actuator placement via a max-min Genetic Algorithm

    SciTech Connect

    Redmond, J.; Parker, G.

    1993-07-01

    This paper examines the role of the control objective and the control time in determining fuel-optimal actuator placement for structural vibration suppression. A general theory is developed that can be easily extended to include alternative performance metrics such as energy and time-optimal control. The performance metric defines a convex admissible control set which leads to a max-min optimization problem expressing optimal location as a function of initial conditions and control time. A solution procedure based on a nested Genetic Algorithm is presented and applied to an example problem. Results indicate that the optimal locations vary widely as a function of control time and initial conditions.

  19. Cumulative Risk for Early Sexual Initiation among American Indian Youth: A Discrete-Time Survival Analysis

    ERIC Educational Resources Information Center

    Mitchell, Christina M.; Whitesell, Nancy Rumbaugh; Spicer, Paul; Beals, Janette; Kaufman, Carol E.

    2007-01-01

    Approximately 3 million teens are diagnosed with a sexually transmitted disease (STD) annually; STDs rates for American Indian young adults are among the highest of any racial/ethnic group. An important risk factor for STDs is early initiation of sex. In this study, we examined risk for early initiation with 474 American Indian youth ages 14-18,…

  20. Academic Skills Rovers: A Just in Time Peer Support Initiative for Academic Skills and Literacy Development

    ERIC Educational Resources Information Center

    Copeman, Peter; Keightley, Polly

    2014-01-01

    In 2013 the University of Canberra (UC) initiated a program of peer-assisted academic skills help, the Academic Skills Rovers program, with the goal of providing drop-in peer learning support to students at campus locations where they congregate to study. The Academic Skills Rovers were initially recruited from the teacher education discipline,…

  1. Cumulative Risk for Early Sexual Initiation among American Indian Youth: A Discrete-Time Survival Analysis

    ERIC Educational Resources Information Center

    Mitchell, Christina M.; Whitesell, Nancy Rumbaugh; Spicer, Paul; Beals, Janette; Kaufman, Carol E.

    2007-01-01

    Approximately 3 million teens are diagnosed with a sexually transmitted disease (STD) annually; STDs rates for American Indian young adults are among the highest of any racial/ethnic group. An important risk factor for STDs is early initiation of sex. In this study, we examined risk for early initiation with 474 American Indian youth ages 14-18,…

  2. Effect of incremental exercise on initiation and movement times in a choice response, whole body psychomotor task

    PubMed Central

    McMorris, T; Delves, S; Sproule, J; Lauder, M; Hale, B

    2005-01-01

    Objectives: To examine how exercise at moderate and maximal intensities affects performance on a choice response time, whole body psychomotor task. Methods: Subjects (n = 12) were tested on a three-choice response time task, after rest and after exercise at 70% and 100% maximum power output (W·max). The dependent variables were time to begin forward momentum (initiation time) and time to complete the movement (movement time). Stride time for the first and second strides and number of strides to cover first 1.1 m were also measured. Blood lactate concentrations and heart rate were recorded before and after completion of each psychomotor test. The subjects subjectively assessed the amount of effort that they used to complete the task. Results: Repeated measures analysis of variance showed a significant effect for initiation (F2,22 = 11.47, p<0.001) and movement times (F2,22 = 14.61, p<0.001). Post hoc least significant difference (LSD) tests showed that initiation time after exercise at 70% W·max was significantly faster than that in the other two conditions. Speed of initiation after rest was significantly quicker than that after exercise at W·max. For movement time, LSD tests showed that time after maximal exercise was significantly slower than that in the other two conditions. Stride time for the second stride showed a significant effect (F2,22 = 6.20, p<0.01). LSD tests found that time after exercise at W·max was significantly slower in the other two conditions. Stepwise multiple regression analyses found that the increment of change, from rest, of lactate concentrations could significantly predict the increment of change in initiation (R2 = 0.40) and movement (R2 = 0.50) times. Conclusions: Exercise affects a whole body task differently from purely cognitive tasks. Central factors are probably more important than peripheral factors. PMID:16046339

  3. Using HIV Viral Load From Surveillance to Estimate the Timing of Antiretroviral Therapy Initiation.

    PubMed

    Braunstein, Sarah L; Robertson, McKaylee M; Myers, Julie; Nash, Denis

    2016-10-01

    HIV surveillance programs do not typically collect comprehensive data on antiretroviral therapy (ART). We validated a population-based measure of ART initiation that uses HIV viral load (VL) results in the absence of data on ART. We used CD4/VL data reported to NYC HIV Surveillance for persons aged ≥13 years and diagnosed with HIV from 2006 to 2012 to validate estimates of ART initiation date based on 3 ART initiation definitions: (1) ≥1-log decline in copies per milliliter between 2 VLs over 3 months; (2) ≥2-log decline in copies per milliliter between 2 VLs over 3 months; and (3) the earliest of either a ≥1-log decline in VL over 3 months, or a change from detectable VL to undetectable VL (<400 copies/mL) over any interval. We plotted median CD4 counts by quarter before and after ART initiation to compare estimated initiation date with nadir of the CD4 trajectory. A total of 24,348 persons were diagnosed with HIV in NYC from 2006 to 2012. In all, 12,123 persons had probable ART initiation based on ≥2-log decline, 12,719 based on ≥1-log decline, and 14,311 based on ≥1-log decline or detectable-undetectable change. Lowest median CD4 count occurred at the estimated ART initiation date for all 3 definitions. The definition based on a ≥1-log VL decline or a change from detectable to undetectable VL captured more ART initiations and identified earlier initiation dates. Serial VL measures are a valid source for estimating ART initiation. A definition that includes a ≥1-log VL decline or a change from detectable to undetectable VL performed best.

  4. Using HIV Viral Load From Surveillance to Estimate the Timing of Antiretroviral Therapy Initiation

    PubMed Central

    Braunstein, Sarah L.; Robertson, McKaylee M.; Myers, Julie; Nash, Denis

    2017-01-01

    Introduction HIV surveillance programs do not typically collect comprehensive data on antiretroviral therapy (ART). We validated a population-based measure of ART initiation that uses HIV viral load (VL) results in the absence of data on ART. Methods We used CD4/VL data reported to NYC HIV Surveillance for persons aged ≥13 years and diagnosed with HIV from 2006 to 2012 to validate estimates of ART initiation date based on 3 ART initiation definitions: (1) ≥1-log decline in copies per milliliter between 2 VLs over 3 months; (2) ≥2-log decline in copies per milliliter between 2 VLs over 3 months; and (3) the earliest of either a ≥1-log decline in VL over 3 months, or a change from detectable VL to undetectable VL (<400 copies/mL) over any interval. We plotted median CD4 counts by quarter before and after ART initiation to compare estimated initiation date with nadir of the CD4 trajectory. Results A total of 24,348 persons were diagnosed with HIV in NYC from 2006 to 2012. In all, 12,123 persons had probable ART initiation based on ≥2-log decline, 12,719 based on ≥1-log decline, and 14,311 based on ≥1-log decline or detectable–undetectable change. Lowest median CD4 count occurred at the estimated ART initiation date for all 3 definitions. The definition based on a ≥1-log VL decline or a change from detectable to undetectable VL captured more ART initiations and identified earlier initiation dates. Conclusions Serial VL measures are a valid source for estimating ART initiation. A definition that includes a ≥1-log VL decline or a change from detectable to undetectable VL performed best. PMID:27152466

  5. Time-Of-Flight Mass Spectrometry of Laser Exploding Foil Initiated PETN Samples

    NASA Astrophysics Data System (ADS)

    Fajardo, Mario

    2015-06-01

    We report the results of time-of-flight mass spectrometry (TOFMS) measurements of the gaseous products of thin film PETN samples reacting in-vacuo. The PETN sample spots are produced by masked physical vapor deposition of PETN onto a first-surface aluminum mirror. A pulsed laser beam imaged through the soda lime glass mirror substrate converts the aluminum layer into a high-temperature high-pressure plasma which initiates chemical reactions in the overlying PETN sample. We had previously proposed to exploit differences in gaseous product chemical identities and molecular velocities to provide a chemically-based diagnostic for distinguishing between ``detonation-like'' and deflagration responses. Briefly: we expect in-vacuum detonations to produce hyperthermal (v ~ 10 km/s) thermodynamically-stable products such as N2, CO2, and H2O, and for deflagrations to produce mostly reaction intermediates, such as NO and NO2, with much slower molecular velocities - consistent with the expansion-quenched thermal decomposition of PETN. We observe primarily slow reaction intermediates (NO2, CH2NO3) at low laser pulse energies, the appearance of NO at intermediate laser pulse energies, and the appearance of hyperthemal CO/N2 at mass 28 amu at the highest laser pulse energies. However, these results are somewhat ambiguous, as the NO, NO2, and CH2NO3 intermediates persist and all species become hyperthermal at the higher laser pulse energies. Also, the purported CO/N2 signal at 28 amu may be contaminated by silicon ablated from the glass mirror substrate. We plan to mitigate these problems in future experiments by adopting the ``Buelow'' sample configuration which employs an intermediate foil barrier to shield the energetic material from the laser and the laser driven plasma. [RW PA#4930

  6. Mud depocenters on continental shelves—appearance, initiation times, and growth dynamics

    NASA Astrophysics Data System (ADS)

    Hanebuth, Till J. J.; Lantzsch, Hendrik; Nizou, Jean

    2015-12-01

    Mud accumulates on continental shelves under a variety of environmental conditions and results in a diverse formation of mud depocenters (MDCs). Their three-dimensional architectures have been in the focus of several recent studies. Due to some terminological confusion concerning MDCs, the present study sets out to define eight individual MDC types in terms of surface sediment distribution and internal geometry. Under conditions of substantial sediment supply, prodeltas (distal zones off river deltas; triangular sheets), subaqueous deltas (disconnected from deltas by strong normal-to-shore currents; wedge-like clinoforms), and mud patches (scattered distribution) and mud blankets (widespread covers) are formed. Forced by hydrodynamic conditions, mud belts in the strict sense (detached from source; elongated bodies), and shallow-water contourite drifts (detached from source; growing normal to prevailing current direction; triangular clinoforms) develop. Controlled by local morphology, mud entrapments (in depressions, behind morphological steps) and mud wedges (triangular clinoforms growing in flow direction) are deposited. Shelf mud deposition took place (1) during early outer-shelf drowning (~14 ka), (2) after inner-shelf inundation to maximum flooding (9.5-6.5 ka), and (3) in sub-recent times (<2 ka). Subsequent expansion may be (1) concentric, in cases where the depocenter formed near the fluvial source, (2) uni-directional, extending along advective current transport paths, and (3) progradational, forming clinoforms that grow either parallel or normal to the bottom current direction. Classical mud belts may be initiated around defined nuclei, the remote sites of which are determined by seafloor morphology rather than the location of the source. From a stratigraphic perspective, mud depocenters coincide with sea-level highstand-related, shelf-wide condensed sections. They often show a conformable succession from transgressive to highstand systems tract stages.

  7. New radiometric dating constrains the time for initiation of the Karakorum fault zone (KFZ), SW Tibet

    NASA Astrophysics Data System (ADS)

    Wang, Shifeng; Fang, Xiaomin; Lai, Qingzhou; Zheng, Dewen; Wang, Yanbin

    2009-10-01

    The Karakorum fault zone (KFZ), composed of strike-slip faults, has played an important role in intra-continental deformation during the Cenozoic convergence between the Indian and Eurasian plates. However, the spatial and temporal evolution of the KFZ remains under debate. This paper reports new zircon U-Pb Sensitive High Resolution Ion MicroProbe (SHRIMP) and biotite 40Ar/ 39Ar ages for samples from the fault zone to clarify the timing of events. The ages of Zircon U-Pb fall mainly around 47-50 Ma, which corresponds to a period of important magmatic activity of the Gangdese granitic belt (also known as the Trans-Himalayan magmatic belt). A metamorphic event followed in the period around 32 Ma, and that was then followed by a medium temperature cooling event between about 12 and 7.7 Ma. Biotite 40Ar/ 39Ar ages provide evidence that the 12-7.7 Ma cooling event coincides with the initiation of the KFZ cutting through the Ayilari granite. The Ayilari granite pluton does not seem to have experienced the separate 25-23 Ma cooling event, as shown in previous studies 60-80 km west of the current study area [Lacassin, R., Valli, F., Arnaud, N., Leloup, P.H., Paquette, J.L., Li, H., Tapponnier, P., Chevalier, M.L., Guillot, S., Maheo, G., Xu, Z., 2004. Large-scale geometry, offset and kinematic evolution of the Karakorum fault, Tibet. Earth and Planetary Science Letters 219 (3-4), 255-269.; Valli, F., Arnaud, N., Leloup, H.P., Sobel, E.R., Maheo, G., Lacassin, R., Guillot, S., Li, H., Tapponnier, P., Xu, Z., 2007. Twenty million years of continuous deformation along the Karakorum fault, western Tibet: a thermochronological analysis. Tectonics 26, doi: 10.1029/2005TC001913.; Valli, F., Leloup, P., Paquette, J., Arnaud, N., Li, H., Tapponnier, P., Lacassin, R., Guillot, S., Liu, D., Deloule, E., Xu, Z., Mahéo, G., 2008. New U-Th/Pb constraints on timing of shearing and long-term slip-rate on the Karakorum fault. Tectonics 27, doi:10.1029/2007TC002184.]. We conclude that the

  8. 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.

  9. 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

  10. 20 CFR 663.530 - Is there a time limit on the period of initial eligibility for training providers?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Is there a time limit on the period of initial eligibility for training providers? 663.530 Section 663.530 Employees' Benefits EMPLOYMENT AND... I OF THE WORKFORCE INVESTMENT ACT Eligible Training Providers § 663.530 Is there a time limit on the...

  11. 20 CFR 663.530 - Is there a time limit on the period of initial eligibility for training providers?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Is there a time limit on the period of initial eligibility for training providers? 663.530 Section 663.530 Employees' Benefits EMPLOYMENT AND... WORKFORCE INVESTMENT ACT Eligible Training Providers § 663.530 Is there a time limit on the period of...

  12. 41 CFR 302-11.23 - When must I request to have my initial time period extended?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time...

  13. 41 CFR 302-11.23 - When must I request to have my initial time period extended?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time...

  14. 41 CFR 302-11.23 - When must I request to have my initial time period extended?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time...

  15. 41 CFR 302-11.23 - When must I request to have my initial time period extended?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time...

  16. 41 CFR 302-11.23 - When must I request to have my initial time period extended?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... have my initial time period extended? 302-11.23 Section 302-11.23 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS General Rules Time...

  17. 77 FR 33007 - Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... MANAGEMENT Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41 AGENCY: U.S... Full-Time School Attendance. As required by the Paperwork Reduction Act of 1995, (Pub. L. 104-13, 44 U... other technological collection techniques or other forms of information technology, e.g.,...

  18. Evaluation of the turbulent kinetic dissipation rate in an agitated vessel

    NASA Astrophysics Data System (ADS)

    Kysela, Bohus; Konfrst, Jiri; Chara, Zdenek; Sulc, Radek; Jasikova, Darina

    The design of agitated tanks depends on operating conditions and processes for that are used for. An important parameter for the scale-up modelling is the dissipation rate of the turbulent kinetic energy. The dissipation rate is commonly assumed to be a function of the impeller power input. But this approach gives no information about distribution of the dissipation rate inside the agitated volume. In this paper the distributions of the dissipation rate inside the agitated vessels are estimated by evaluations of the CFD (Computational Fluid Dynamics). The results obtained from RANS (Reynolds Averaged Navier-Stokes equations) k-ɛ turbulent model and LES (Large Eddy Simulations) with Smagorinsky SGS (Sub Grid Scale) model are compared. The agitated vessels with standard geometry equipped with four baffles and stirred by either a standard Rushton turbine or a high shear impeller were investigated. The results are compared with mean dissipation rate estimated from the total impeller power input.

  19. Update on pharmaceutical intervention for disorders of consciousness and agitation after traumatic brain injury in children.

    PubMed

    Suskauer, Stacy J; Trovato, Melissa K

    2013-02-01

    Responsiveness and agitation are common targets for pharmaceutical intervention after traumatic brain injury (TBI) in children. This focused review presents a critical discussion of the limited literature available on the use of medications for disorders of consciousness and agitation in children with TBI. For disorders of consciousness, evidence from several small studies supports a potential benefit of dopaminergic agents for improving responsiveness in some children with lower levels of function after TBI. Larger studies, likely requiring multicenter collaborations, are needed to more definitively address questions regarding the use of medications for responsiveness in children with TBI. The literature regarding use of pharmaceutical agents for agitation in children with TBI is even more limited. The dearth of literature regarding the effects of medications used for agitation in children with TBI highlights the need for additional basic and clinical science contributions in this area. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  20. A meta-analytic review of the association between agitation and suicide attempts.

    PubMed

    Rogers, Megan L; Ringer, Fallon B; Joiner, Thomas E

    2016-08-01

    Agitation has been implicated as an acute risk factor for suicidal behavior, yet the literature to date has not been consolidated to better understand this relationship. We conducted a meta-analysis of the association between agitation and suicidal behavior to synthesize the existing literature (k=13 studies) and point out future directions for research. Results indicated that the association between agitation and suicidal behavior is moderate (Hedge's g=0.40, p=0.007, 95% CI [0.08, 0.72]). Follow-up meta-regressions revealed that age, gender, and year of publication were not significant moderators of the magnitude of this relationship. However, there was evidence of publication bias, as shown by a funnel plot and Egger's test. These findings suggest the importance of future research that examines the nature of the association between agitation and suicidal behavior longitudinally and with novel research designs, as implications for clinical practice and suicide risk assessment may be substantial.

  1. Hydraulic characteristics simulation of an innovative self-agitation anaerobic baffled reactor (SA-ABR).

    PubMed

    Qi, Wei-Kang; Hojo, Toshimasa; Li, Yu-You

    2013-05-01

    An investigation was conducted on a self-agitation anaerobic baffled reactor (SA-ABR) with agitation caused solely by the release of stored gas. The compound in the reactor is mixed without the use of any mechanical equipment and electricity. The computational fluid dynamics (CFD) simulation used to provide details of the flow pattern and information about the agitation process and a solid basis for design and optimization purposes. Every self-agitation cycle could be separated into the pressure energy storage process, the exergonic process and the buffer stage. The reactor is regarded as the combination of continuous stirred tank reactor and a small plug flow reactor. The liquid level and diffusion varies widely depending on the length of the U-tube. The compound transition phenomenon in the 1st chamber mainly occurs during the energy exergonic process and buffer stage. The fluid-diffusion in the 3rd and 4th chambers mainly happens after the buffer period.

  2. Calculation of correlated initial state in the hierarchical equations of motion method using an imaginary time path integral approach.

    PubMed

    Song, Linze; Shi, Qiang

    2015-11-21

    Based on recent findings in the hierarchical equations of motion (HEOM) for correlated initial state [Y. Tanimura, J. Chem. Phys. 141, 044114 (2014)], we propose a new stochastic method to obtain the initial conditions for the real time HEOM propagation, which can be used further to calculate the equilibrium correlation functions and symmetrized correlation functions. The new method is derived through stochastic unraveling of the imaginary time influence functional, where a set of stochastic imaginary time HEOM are obtained. The validity of the new method is demonstrated using numerical examples including the spin-Boson model, and the Holstein model with undamped harmonic oscillator modes.

  3. Calculation of correlated initial state in the hierarchical equations of motion method using an imaginary time path integral approach

    SciTech Connect

    Song, Linze; Shi, Qiang

    2015-11-21

    Based on recent findings in the hierarchical equations of motion (HEOM) for correlated initial state [Y. Tanimura, J. Chem. Phys. 141, 044114 (2014)], we propose a new stochastic method to obtain the initial conditions for the real time HEOM propagation, which can be used further to calculate the equilibrium correlation functions and symmetrized correlation functions. The new method is derived through stochastic unraveling of the imaginary time influence functional, where a set of stochastic imaginary time HEOM are obtained. The validity of the new method is demonstrated using numerical examples including the spin-Boson model, and the Holstein model with undamped harmonic oscillator modes.

  4. Effect of impeller type and agitation on the performance of pilot scale ASBR and AnSBBR applied to sanitary wastewater treatment.

    PubMed

    de Novaes, Luciano Farias; Saratt, Bruna Luckmann; Rodrigues, José Alberto Domingues; Ratusznei, Suzana Maria; de Moraes, Deovaldo; Ribeiro, Rogers; Zaiat, Marcelo; Foresti, Eugenio

    2010-08-01

    The objective of this work was to assess the effect of agitation rate and impeller type in two mechanically stirred sequencing batch reactors: one containing granulated biomass (denominated ASBR) and the other immobilized biomass on polyurethane foam (denominated AnSBBR). Each configuration, with total volume of 1 m(3), treated 0.65 m(3) sanitary wastewater at ambient temperature in 8-h cycles. Three impeller types were assessed for each reactor configuration: flat-blade turbine impeller, 45 degrees -inclined-blade turbine impeller and helix impeller, as well as two agitation rates: 40 and 80 rpm, resulting in a combination of six experimental conditions. In addition, the ASBR was also operated at 20 rpm with a flat-blade turbine impeller and the AnSBBR was operated with a draft tube and helix impeller at 80 and 120 rpm. To quantify how impeller type and agitation rate relate to substrate consumption rate, results obtained during monitoring at the end of the cycle, as well as the time profiles during a cycle were analyzed. Increasing agitation rate from 40 rpm to 80 rpm in the AnSBBR improved substrate consumption rate whereas in the ASBR this increase destabilized the system, likely due to granule rupture caused by the higher agitation. The AnSBBR showed highest solids and substrate removal, highest kinetic constant and highest alkalinity production when using a helix impeller, 80 rpm, and no draft tube. The best condition for the ASBR was achieved with a flat-blade turbine impeller at 20 rpm. The presence of the draft tube in the AnSBBR did not show significant improvement in reactor efficiency. Furthermore, power consumption studies in these pilot scale reactors showed that power transfer required to improve mass transfer might be technically and economically feasible.

  5. TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda.

    PubMed

    Kayumba, Kizito; Nsanzimana, Sabin; Binagwaho, Agnes; Mugwaneza, Placidie; Rusine, John; Remera, Eric; Koama, Jean Baptiste; Ndahindwa, Vedaste; Johnson, Pamela; Riedel, David J; Condo, Jeanine

    2016-07-01

    Delays in testing HIV-exposed infants and obtaining results in resource-limited settings contribute to delays for initiating antiretroviral therapy (ART) in infants. To overcome this challenge, Rwanda expanded its national mobile and Internet-based HIV/AIDS informatics system, called TRACnet, to include HIV polymerase chain reaction (PCR) results in 2010. This study was performed to evaluate the impact of TRACnet technology on the time to delivery of test results and the subsequent initiation of ART in HIV-infected infants. A retrospective cohort study was conducted on 380 infants who initiated ART in 190 health facilities in Rwanda from March 2010 to June 2013. Program data collected by the TRACnet system were extracted and analyzed. Since the introduction of TRACnet for processing PCR results, the time to receive results has significantly decreased from a median of 144 days [interquartile range (IQR): 121-197 days] to 23 days (IQR: 17-43 days). The number of days between PCR sampling and health facility receipt of results decreased substantially from a median of 90 days (IQR: 83-158 days) to 5 days (IQR: 2-8 days). After receiving PCR results at a health facility, it takes a median of 44 days (IQR: 32-77 days) before ART initiation. Result turnaround time was significantly associated with time to initiating ART (P < 0.001). An increased number of staff trained for HIV care and treatment was also significantly associated with decreased time to ART initiation (P = 0.004). The use of mobile technology for communication of HIV PCR results, coupled with well-trained and skilled personnel, can reduce delays in communicating results to providers. Such reductions may improve timely ART initiation in resource-limited settings.

  6. Antiretroviral treatment initiation does not differentially alter neurocognitive functioning over time in youth with behaviorally acquired HIV.

    PubMed

    Nichols, Sharon L; Bethel, James; Kapogiannis, Bill G; Li, Tiandong; Woods, Steven P; Patton, E Doyle; Ren, Weijia; Thornton, Sarah E; Major-Wilson, Hanna O; Puga, Ana M; Sleasman, John W; Rudy, Bret J; Wilson, Craig M; Garvie, Patricia A

    2016-04-01

    Although youth living with behaviorally acquired HIV (YLWH) are at risk for cognitive impairments, the relationship of impairments to HIV and potential to improve with antiretroviral therapy (ART) are unclear. This prospective observational study was designed to examine the impact of initiation and timing of ART on neurocognitive functioning in YLWH in the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Treatment naïve YLWH age 18-24 completed baseline and four additional assessments of attention/working memory, complex executive, and motor functioning over 3 years. Group 1 co-enrolled in an early ART initiation study and initiated ART at enrollment CD4 >350 (n = 56); group 2 had CD4 >350 and were not initiating ART (n = 66); group 3 initiated ART with CD4 <350 (n = 59) per standard of care treatment guidelines at the time. Treatment was de-intensified to boosted protease inhibitor monotherapy at 48 weeks for those in group 1 with suppressed viral load. Covariates included demographic, behavioral, and medical history variables. Analyses used hierarchical linear modeling. All groups showed improved performance with peak at 96 weeks in all three functional domains. Trajectories of change were not significantly associated with treatment, timing of treatment initiation, or ART de-intensification. Demographic variables and comorbidities were associated with baseline functioning but did not directly interact with change over time. In conclusion, YLWH showed improvement in neurocognitive functioning over time that may be related to practice effects and nonspecific impact of study participation. Neither improvement nor decline in functioning was associated with timing of ART initiation or therapy de-intensification.

  7. Time-of-flight mass spectrometry of laser exploding foil initiated PETN samples

    NASA Astrophysics Data System (ADS)

    Fajardo, Mario E.; Molek, Christopher D.; Fossum, Emily C.

    2017-01-01

    We report the results of time-of-flight mass spectrometry (TOFMS) measurements of the gaseous products of thin-film pentaerythritol tetranitrate [PETN, C(CH2NO3)4] samples reacting in vacuo. The PETN sample spots are produced by masked physical vapor deposition [A.S. Tappan, et al., AIP Conf. Proc. 1426, 677 (2012)] onto a first-surface aluminum mirror. A pulsed laser beam imaged through the soda lime glass mirror substrate converts the aluminum layer into a high-temperature high-pressure plasma which initiates chemical reactions in the overlying PETN sample. We had previously proposed [E.C. Fossum, et al., AIP Conf. Proc. 1426, 235 (2012)] to exploit differences in gaseous product chemical identities and molecular velocities to provide a chemically-based diagnostic for distinguishing between "detonation-like" and deflagration responses. Briefly: we expect in-vacuum detonations to produce hyperthermal (v˜10 km/s) thermodynamically-stable products such as N2, CO2, and H2O, and for deflagrations to produce mostly reaction intermediates, such as NO and NO2, with much slower molecular velocities - consistent with the expansion-quenched thermal decomposition of PETN. We observe primarily slow reaction intermediates (NO2, CH2NO3) at low laser pulse energies, the appearance of NO at intermediate laser pulse energies, and the appearance of hyperthemal CO/N2 at mass 28 amu at the highest laser pulse energies. However, these results are somewhat ambiguous, as the NO, NO2, and CH2NO3 intermediates persist and all species become hyperthermal at the higher laser pulse energies. Also, the purported CO/N2 signal at 28 amu may be contaminated by silicon ablated from the glass mirror substrate. We plan to mitigate these problems in future experiments by adopting the "Buelow" sample configuration which employs an intermediate foil barrier to shield the energetic material from the laser and the laser driven plasma [S.J. Buelow, et al., AIP Conf. Proc. 706, 1377 (2003)].

  8. Stabilization of bovine insulin against agitation-induced aggregation using RNA aptamers.

    PubMed

    Malik, Ravinder; Roy, Ipsita

    2013-08-16

    Stabilization of monomeric insulin is a primary requirement for preserving the efficacy of the final formulation. Degraded and/or aggregated protein as well as the presence of any of the conventional excipients can result in immunogenic or anaphylactic reactions, and reduced bioavailability of the protein drug. The aim of this work was to select novel RNA-based stabilizers of bovine insulin which would recognize and bind to the monomeric protein and help retain its bioactivity. RNA aptamers were selected by an in vitro selection method. They were screened for their ability to inhibit insulin fibrillation using agitation as a stress condition. The in vitro activity of insulin was determined by phosphorylation of downstream proteins in the cell. In vivo bioactivity was determined in a diabetic rat model. RNA aptamers, which bound to insulin with very low dissociation constants and high specificity, were selected. These sequences were aligned and consensus regions were found. The RNA sequences had no effect on the signalling cascade initiated by insulin. The bioactivity of insulin, as measured by its ability to lower plasma glucose level in a diabetic rat model, also remained unchanged. RNA aptamers are a novel class of protein stabilizers which have the ability to disrupt protein-protein interactions and hence inhibit protein aggregation. Their non-toxic and non-immunogenic nature makes such formulations safe for use.

  9. Family Initiated Discussions About Organ Donation at the Time of Death

    PubMed Central

    Rodrigue, James R.; Cornell, Danielle L.; Krouse, Jennifer; Howard, Richard J.

    2009-01-01

    Some family members initiate organ donation discussions before being approached by donor coordinators or healthcare providers. We examined differences between families that did versus did not initiate organ donation discussions and factors predicting donation consent among those families that self-initiated the discussion. Next-of-kin of donor-eligible individuals (147 donors, 138 non-donors) from one organ procurement organization completed a telephone interview. Seventy-three families (25.6%) first mentioned organ donation, and 54 (74%) of them consented to donation. Several characteristics of the deceased and next-of-kin were associated with whether family members initiated the donation discussion with donation coordinators or healthcare providers. Also, family mention of donation was more likely to yield consent when the deceased was younger (OR = 0.95, CI = 0.92, 0.99), next-of-kin was a registered donor (OR = 3.86, CI = 2.84, 6.76), and when family was more satisfied with the healthcare team (OR = 1.20, CI = 1.04, 1.39). Knowing the deceased’s donation intentions and being exposed to positive organ donation messages are more likely to trigger families to raise donation with providers. OPOs and healthcare providers should work collaboratively to develop strategies for how best to respond to families who initiate this conversation. PMID:19788451

  10. Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe.

    PubMed

    Vogt, Florian; Rehman, Andrea M; Kranzer, Katharina; Nyathi, Mary; Van Griensven, Johan; Dixon, Mark; Ndebele, Wedu; Gunguwo, Hilary; Colebunders, Robert; Ndlovu, Mbongeni; Apollo, Tsitsi; Ferrand, Rashida A

    2017-04-01

    Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown. To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents. We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models. Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively. Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.

  11. Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe

    PubMed Central

    Rehman, Andrea M.; Kranzer, Katharina; Nyathi, Mary; Van Griensven, Johan; Dixon, Mark; Ndebele, Wedu; Gunguwo, Hilary; Colebunders, Robert; Ndlovu, Mbongeni; Apollo, Tsitsi; Ferrand, Rashida A.

    2017-01-01

    Background: Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown. Objective: To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents. Methods: We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models. Results: Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively. Conclusions: Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up. PMID:28002183

  12. Is the hypothesis about a low entropy initial state of the Universe necessary for explaining the arrow of time?

    NASA Astrophysics Data System (ADS)

    Goldstein, Sheldon; Tumulka, Roderich; Zanghı, Nino

    2016-07-01

    According to statistical mechanics, microstates of an isolated physical system (say, a gas in a box) at time t0 in a given macrostate of less-than-maximal entropy typically evolve in such a way that the entropy at time t increases with |t -t0| in both time directions. In order to account for the observed entropy increase in only one time direction, the thermodynamic arrow of time, one usually appeals to the hypothesis that the initial state of the Universe was one of very low entropy. In certain recent models of cosmology, however, no hypothesis about the initial state of the Universe is invoked. We discuss how the emergence of a thermodynamic arrow of time in such models can nevertheless be compatible with the above-mentioned consequence of statistical mechanics, appearances to the contrary notwithstanding.

  13. 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.

  14. Effect of agitation on ligninase activity and ligninase production by Phanerochaete chrysosporium

    SciTech Connect

    Venkatadri, R.; Irvine, R.L. )

    1990-09-01

    The white rot fungus Phanerochaete chrysosporium produces extracellular ligninases as part of its idiophasic ligninolytic system. Agitation has been widely reported to suppress both ligninase production and lignin degradation. Results show that mechanical inactivation of ligninase is possibly the reason why ligninase accumulation is low or absent in agitated shake-flask cultures. Agitation seems to affect the catalytic activity of ligninase and has no apparent effect on either the rate of ligninase production or the physiology of P. chrysosporium. The detergents Tween 20, Tween 40, Tween 60, Tween 80, and 3-((3-cholamidopropyl)dimethylammonio)-1-propanesuflonate (CHAPS) are able to protect both purified ligninase and extant ligninase in culture fluids (free of biomass) against mechanical inactivation due to agitation. Addition of Tween 80 at the end of primary growth to agitated shake flasks containing either pelleted or immobilized mycelial cultures results in production and maintenance of high levels of ligninase activity over several days under conditions of high agitation. Possible mechanisms by which the detergents could protect ligninase are discussed.

  15. [The effect of ketamine on reducing postoperative agitation after sevoflurane anesthesia in pediatric strabismus surgery].

    PubMed

    Kawaraguchi, Yoshitaka; Miyamoto, Yoshikazu; Fukumitsu, Kazuo; Taniguchi, Akihiro; Hirao, Osamu; Kitamura, Seiji; Kinouchi, Keiko

    2002-12-01

    We investigated the effect of ketamine on reducing postoperative agitation after sevoflurane anesthesia in children undergoing elective strabismus surgery. Fifty-five children, 3-9 years of age, were randomly assigned to the following three groups; ketamine (group K, n = 18), pentazocine (group P, n = 19), and flurbiprofen axetil(group F, n = 18). Group K received ketamine 1 mg.kg-1 intravenously, followed by infusion of ketamine 1 mg.kg-1.hr-1 during surgery, group P received pentazocine 0.2 mg.kg-1 intravenously after induction of anesthesia, and Group F received intravenous flurbiprofen axetil, 1 mg.kg-1 5 minutes before the end of surgery. Agitation (evaluated by Aono's four-point scale; AFPS) and awareness (evaluated by Steward score) were assessed just before tracheal extubation(T 1), 5 minutes after tracheal extubation(T 2), arrival at the ward(T 3), and 60 minutes after arrival at the ward(T 4). We considered AFPS > or = 3 patients as "agitated" and APFS < or = 2 patients as "not agitated". At T 1 and T 2, the incidence of agitation(AFPS > or = 3) in group K was less than that of group F and group P. However, in group K, more patients needed oxygen supplement after extubation. We concluded that coadministration of ketamine could be beneficial for reducing postoperative agitation after sevoflurane anesthesia in pediatric strabismus surgery.

  16. Effect of ketorolac on the prevention of emergence agitation in children after sevoflurane anesthesia

    PubMed Central

    Kim, Deokkyu; Doo, A Ram; Lim, Hyungsun; Son, Ji-Seon; Lee, Jun-Rae; Han, Young-Jin

    2013-01-01

    Background The purpose of this study was to evaluate the effects of ketorolac on the incidence and severity of emergence agitation in children recovering from sevoflurane anesthesia. Methods Eighty-five children aged 3 to 7 years were randomly assigned to the control group or the ketorolac group (1 mg/kg ketorolac). The children were evaluated by the Pediatric Anesthesia Emergence Delirium Scale and a four-point agitation scale. Results The median agitation scores did not differ significantly between the two groups. The overall incidence of emergence agitation was similar in the two groups (41% in the control group vs. 32% in the ketorolac group, P = 0.526). The number of children who received rescue drugs for treatment of emergence agitation was not significantly different between the two groups. Conclusions The administration of 1 mg/kg of ketorolac is not effective in decreasing the incidence and severity of emergence agitation in children aged 3 to 7 years after sevoflurane anesthesia. PMID:23560190

  17. 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

  18. Times of Quiet, Times of Agitation: Sverdrup's Conjecture and the Bermuda Coral Record

    NASA Astrophysics Data System (ADS)

    Berger, W. H.; Pätzold, J.; Wefer, G.

    The distinguished Norwegian oceanographer Harald U. Sverdrup (1888-1957) proposed, in 1918, that an increased amount of energy in the system, during periods of high sunspot activity, results in increased strength of winds in the North Atlantic. Changes in wind strength and mixing in the North Atlantic should affect coral growth on Bermuda. We test this proposition with an 800-year record of Montastrea cavernosa from this island, comparing the cycles found within the series of growth bands (that is, rates of growth) with the cycles found in the sunspot record. The main lines in the solar record, for the last 300 years, are as follows: 11.2, 9.9, 10.6, 12.0, and 9.3 (in the order of strength). In the coral record, strong periods appear near 37.5, 30.8, 27.0, 21.7, 7.5 and 6.0 years. There is no peak near 11 years. However, when testing for predictability (that is, deviation from expectation by forward extrapolation of thickness of growth bands), periods appear (in the order of amplitude) at 30, 10.5, 21, 9.1, 33.6, 55, 7.2, 80 and 6.2 years. All can conceivably be interpreted as whole-number sunspot multiples (3 x 9.9; 1 x 10.6; 2 x 10.6; 1 x 9.3; 3 x 11.2; 5 x 11.2; 2/3 x 11.2; 7 x 11.2 or 8 x 9.9; 2/3 x 9.3) thus giving support to Sverdrup's conjecture. However, other factors also must be considered, including internal oscillations and tidal cycles.

  19. The clock is ticking: the rate and timeliness of antiretroviral therapy initiation from the time of treatment eligibility in Kenya

    PubMed Central

    Odeny, Thomas A; DeCenso, Brendan; Dansereau, Emily; Gasasira, Anne; Kisia, Caroline; Njuguna, Pamela; Haakenstad, Annie; Gakidou, Emmanuela; Duber, Herbert C

    2015-01-01

    Introduction Understanding the determinants of timely antiretroviral therapy (ART) initiation is useful for HIV programmes intent on developing models of care that reduce delays in treatment initiation while maintaining a high quality of care. We analysed patient- and facility-level determinants of time to ART initiation among patients who initiated ART in Kenya. Methods We collected facility-level information and conducted a retrospective chart review of adults initiating ART between 2007 and 2012 at 51 health facilities in Kenya. We evaluated the association between patient- and facility-level covariates at the time of ART eligibility and time to ART initiation. We also explored the determinants associated with timeliness of ART initiation. Results The analysis included 11,942 patients. The median age at the time eligibility was first determined was 37 years (interquartile range [IQR] 31–45). Overall, 75% of patients initiated ART within two months of eligibility. The median CD4 cell count at the time eligibility was first determined rose from 132 (IQR 51–217) in 2007 to 195 (IQR 91–286) in 2011 to 2012 (p<0.001). The cumulative probability of ART initiation among treatment-eligible patients increased over time: 87.1% (95% confidence interval [CI] 85.1–89.0%) in 2007; 96.8% (96.0–97.5%) in 2008; 97.1% (96.3–97.7%) in 2009; 98.5% (98.0 −98.9%) in 2010; and 99.7% (95% CI 99.4 −99.8%) in 2011 to 2012 (p<0.0001). In multivariate analyses, attending a health facility with high ART patient volumes within two months of eligibility was considered the key facility-level determinant of ART initiation (adjusted odds ratio 0.57, 95% CI 0.45–0.72, p<0.001). Patient-level determinants included being eligible for ART in the years subsequent to 2007, advanced World Health Organization clinical stage and low CD4 cell count at the time eligibility was first determined. Conclusions Overall, the time between treatment eligibility and ART initiation decreased

  20. Solution-dispersed CuO nanoparticles anode buffer layer: Effect of ultrasonic agitation duration on photovoltaic performance

    NASA Astrophysics Data System (ADS)

    Sabri, Nasehah Syamin; Yap, Chi Chin; Yahaya, Muhammad; Salleh, Muhamad Mat; Jumali, Mohammad Hafizuddin Haji

    2016-11-01

    The performance of inverted type hybrid organic solar cell based on poly(3-hexyltheopene):[6,6]-phenyl C61-butyric acid methyl ester (P3HT:PCBM) can be improved by adding an anode buffer layer of copper oxide (CuO). CuO that serves as an electron blocking layer which could effectively reduce the charge recombination at the photoactive layer (P3HT:PCBM)/silver (Ag) interfaces. At the same time, Cuo anode buffer layer could accelerate the holes collection from the photoactive layer to the top electrode. In this study we investigated the effects of ultrasonic agitation duration in preparation of solution-dispersed CuO anode buffer layer on the performance of the devices with a configuration of fluorine tin oxide (FTO)/zinc oxide (ZnO) nanorod arrays/P3HT:PCBM/ CuO/Ag. Different durations of ultrasonic agitation (0, 5, 15 and 25 min) were used for CuO nanoparticles solution dispersion to obtain the optimum particle size distribution of CuO. It was found that the smallest average particle size of CuO was obtained by applying the ultrasonic agitation for longest duration of 25 min. The highest power conversion efficiency of 1.22% was recorded from the device incorporating with CuO anode buffer layer with the smallest average particle size. It is believed that CuO anode buffer layer with the smallest average particle size had the least agglomerates, thus leading to better film formation and contact surface area.

  1. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa.

    PubMed

    Ballard, Clive G; O'Brien, John T; Reichelt, Katharina; Perry, Elaine K

    2002-07-01

    Behavioral and psychological symptoms in dementia are frequent and are a major management problem, especially for patients with severe cognitive impairment. Preliminary reports have indicated positive effects of aromatherapy using select essential oils, but there are no adequately powered placebo-controlled trials. We conducted a placebo-controlled trial to determine the value of aromatherapy with essential oil of Melissa officinalis (lemon balm) for agitation in people with severe dementia. Seventy-two people residing in National Health Service (U.K.) care facilities who had clinically significant agitation in the context of severe dementia were randomly assigned to aromatherapy with Melissa essential oil (N = 36) or placebo (sunflower oil) (N = 36). The active treatment or placebo oil was combined with a base lotion and applied to patients' faces and arms twice a day by caregiving staff. Changes in clinically significant agitation (Cohen-Mansfield Agitation Inventory [CMAI]) and quality of life indices (percentage of time spent socially withdrawn and percentage of time engaged in constructive activities, measured with Dementia Care Mapping) were compared between the 2 groups over a 4-week period of treatment. Seventy-one patients completed the trial. No significant side effects were observed. Sixty percent (21/35) of the active treatment group and 14% (5/36) of the placebo-treated group experienced a 30% reduction of CMAI score, with an overall improvement in agitation (mean reduction in CMAI score) of 35% in patients receiving Melissa balm essential oil and 11% in those treated with placebo (Mann-Whitney U test; Z = 4.1, p < .0001). Quality of life indices also improved significantly more in people receiving essential balm oil (Mann-Whitney U test; percentage of time spent socially withdrawn: Z = 2.6, p = .005; percentage of time engaged in constructive activities: Z = 3.5, p = .001). The finding that aromatherapy with essential balm oil is a safe and effective

  2. SLA: A Time for New Initiatives-- CI Division Formed, Fundraising Goal Set, Certification Coming

    ERIC Educational Resources Information Center

    DiMattia, Susan; Blumenstein, Lynn

    2004-01-01

    Several initiatives were announced at the Special Libraries Association (d.b.a. SLA) conference, June 4-9, at the Gaylord Opryland Hotel in Nashville. A petition drive resulted in formation of a Competitive Intelligence (CI) Division from the former CI Section of the Leadership and Management Division. The board encouraged the member-driven…

  3. SLA: A Time for New Initiatives-- CI Division Formed, Fundraising Goal Set, Certification Coming

    ERIC Educational Resources Information Center

    DiMattia, Susan; Blumenstein, Lynn

    2004-01-01

    Several initiatives were announced at the Special Libraries Association (d.b.a. SLA) conference, June 4-9, at the Gaylord Opryland Hotel in Nashville. A petition drive resulted in formation of a Competitive Intelligence (CI) Division from the former CI Section of the Leadership and Management Division. The board encouraged the member-driven…

  4. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

    PubMed Central

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2007-01-01

    Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy

  5. Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis

    PubMed Central

    Cortes, Claudia P.; Wehbe, Firas H.; McGowan, Catherine C.; Shepherd, Bryan E.; Duda, Stephany N.; Jenkins, Cathy A.; Gonzalez, Elsa; Carriquiry, Gabriela; Schechter, Mauro; Padgett, Denis; Cesar, Carina; Madero, Juan Sierra; Pape, Jean W.; Masys, Daniel R.; Sterling, Timothy R.

    2013-01-01

    Background Antiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART initiation on mortality, is unclear. Methods We conducted a retrospective observational multi-center cohort study among HIV-infected persons concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study population included persons for whom 6 months of anti-tuberculosis therapy is recommended. Results Of 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64 cells/mm3, 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+ lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1 RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007). Conclusions The increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration guidelines should be re-evaluated. PMID:24066096

  6. Impact of time to start treatment following infection with application to initiating HAART in HIV-positive patients.

    PubMed

    Lok, Judith J; DeGruttola, Victor

    2012-09-01

    We estimate how the effect of antiretroviral treatment depends on the time from HIV-infection to initiation of treatment, using observational data. A major challenge in making inferences from such observational data arises from biases associated with the nonrandom assignment of treatment, for example bias induced by dependence of time of initiation on disease status. To address this concern, we develop a new class of Structural Nested Mean Models (SNMMs) to estimate the impact of time of initiation of treatment after infection on an outcome measured a fixed duration after initiation, compared to the effect of not initiating treatment. This leads to a SNMM that models the effect of multiple dosages of treatment on a time-dependent outcome, in contrast to most existing SNNMs, which focus on the effect of one dosage of treatment on an outcome measured at the end of the study. Our identifying assumption is that there are no unmeasured confounders. We illustrate our methods using the observational Acute Infection and Early Disease Research Program (AIEDRP) Core01 database on HIV. The current standard of care in HIV-infected patients is Highly Active Anti-Retroviral Treatment (HAART); however, the optimal time to start HAART has not yet been identified. The new class of SNNMs allows estimation of the dependence of the effect of 1 year of HAART on the time between estimated date of infection and treatment initiation, and on patient characteristics. Results of fitting this model imply that early use of HAART substantially improves immune reconstitution in the early and acute phase of HIV-infection. © 2012, The International Biometric Society.

  7. Trajectory-Based Takeoff Time Predictions Applied to Tactical Departure Scheduling: Concept Description, System Design, and Initial Observations

    NASA Technical Reports Server (NTRS)

    Engelland, Shawn A.; Capps, Alan

    2011-01-01

    Current aircraft departure release times are based on manual estimates of aircraft takeoff times. Uncertainty in takeoff time estimates may result in missed opportunities to merge into constrained en route streams and lead to lost throughput. However, technology exists to improve takeoff time estimates by using the aircraft surface trajectory predictions that enable air traffic control tower (ATCT) decision support tools. NASA s Precision Departure Release Capability (PDRC) is designed to use automated surface trajectory-based takeoff time estimates to improve en route tactical departure scheduling. This is accomplished by integrating an ATCT decision support tool with an en route tactical departure scheduling decision support tool. The PDRC concept and prototype software have been developed, and an initial test was completed at air traffic control facilities in Dallas/Fort Worth. This paper describes the PDRC operational concept, system design, and initial observations.

  8. Will changes in phenology track climate change? A study of growth initiation timing in coast Douglas-fir

    USGS Publications Warehouse

    Ford, Kevin R.; Harrington, Constance A.; Bansal, Sheel; Gould, Petter J.; St. Clair, Bradley

    2016-01-01

    Under climate change, the reduction of frost risk, onset of warm temperatures and depletion of soil moisture are all likely to occur earlier in the year in many temperate regions. The resilience of tree species will depend on their ability to track these changes in climate with shifts in phenology that lead to earlier growth initiation in the spring. Exposure to warm temperatures (“forcing”) typically triggers growth initiation, but many trees also require exposure to cool temperatures (“chilling”) while dormant to readily initiate growth in the spring. If warming increases forcing and decreases chilling, climate change could maintain, advance or delay growth initiation phenology relative to the onset of favorable conditions. We modeled the timing of height- and diameter-growth initiation in coast Douglas-fir (an ecologically and economically vital tree in western North America) to determine whether changes in phenology are likely to track changes in climate using data from field-based and controlled-environment studies, which included conditions warmer than those currently experienced in the tree's range. For high latitude and elevation portions of the tree's range, our models predicted that warming will lead to earlier growth initiation and allow trees to track changes in the onset of the warm but still moist conditions that favor growth, generally without substantially greater exposure to frost. In contrast, towards lower latitude and elevation range limits, the models predicted that warming will lead to delayed growth initiation relative to changes in climate due to reduced chilling, with trees failing to capture favorable conditions in the earlier parts of the spring. This maladaptive response to climate change was more prevalent for diameter-growth initiation than height-growth initiation. The decoupling of growth initiation with the onset of favorable climatic conditions could reduce the resilience of coast Douglas-fir to climate change at the warm

  9. Will changes in phenology track climate change? A study of growth initiation timing in coast Douglas-fir.

    PubMed

    Ford, Kevin R; Harrington, Constance A; Bansal, Sheel; Gould, Peter J; St Clair, J Bradley

    2016-11-01

    Under climate change, the reduction of frost risk, onset of warm temperatures and depletion of soil moisture are all likely to occur earlier in the year in many temperate regions. The resilience of tree species will depend on their ability to track these changes in climate with shifts in phenology that lead to earlier growth initiation in the spring. Exposure to warm temperatures ('forcing') typically triggers growth initiation, but many trees also require exposure to cool temperatures ('chilling') while dormant to readily initiate growth in the spring. If warming increases forcing and decreases chilling, climate change could maintain, advance or delay growth initiation phenology relative to the onset of favorable conditions. We modeled the timing of height- and diameter-growth initiation in coast Douglas-fir (an ecologically and economically vital tree in western North America) to determine whether changes in phenology are likely to track changes in climate using data from field-based and controlled-environment studies, which included conditions warmer than those currently experienced in the tree's range. For high latitude and elevation portions of the tree's range, our models predicted that warming will lead to earlier growth initiation and allow trees to track changes in the onset of the warm but still moist conditions that favor growth, generally without substantially greater exposure to frost. In contrast, toward lower latitude and elevation range limits, the models predicted that warming will lead to delayed growth initiation relative to changes in climate due to reduced chilling, with trees failing to capture favorable conditions in the earlier parts of the spring. This maladaptive response to climate change was more prevalent for diameter-growth initiation than height-growth initiation. The decoupling of growth initiation with the onset of favorable climatic conditions could reduce the resilience of coast Douglas-fir to climate change at the warm edges of

  10. 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

  11. Time to initiation of multidrug resistant tuberculosis treatment in a high incidence district in Lima, Peru

    PubMed Central

    Otero, L; De Orbegoso, A; Navarro, AF; Ríos, J; Párraga, T; Gotuzzo, E; Seas, C; Van der Stuyft, P

    2016-01-01

    We determined the time to start MDR-TB treatment. Time from the first positive smear to MDR-TB treatment was >30 days in 35% (13/37) of patients. Also in 27% (24/88) of patients switched to MDR-TB treatment, time from the last dose of a drug susceptible regimen was > 30 days. PMID:25429916

  12. The JDRF CCTN CGM TIME Trial: Timing of Initiation of continuous glucose Monitoring in Established pediatric type 1 diabetes: study protocol, recruitment and baseline characteristics.

    PubMed

    Lawson, Margaret L; Bradley, Brenda; McAssey, Karen; Clarson, Cheril; Kirsch, Susan E; Mahmud, Farid H; Curtis, Jacqueline R; Richardson, Christine; Courtney, Jennilea; Cooper, Tammy; Downie, Cynthia J; Rajamannar, Gopalan; Barrowman, Nicholas

    2014-07-18

    Continuous glucose monitoring (CGM) has been shown to improve glucose control in adults with type 1 diabetes. Effectiveness of CGM is directly linked with CGM adherence, which can be challenging to maintain in children and adolescents. We hypothesize that initiating CGM at the same time as starting insulin pump therapy in pump naïve children and adolescents with type 1 diabetes will result in greater CGM adherence and effectiveness compared to delaying CGM introduction by 6 months, and that this is related to greater readiness for making behaviour change at the time of pump initiation. The CGM TIME Trial is a multicenter randomized controlled trial. Eligible children and adolescents (5-18 years) with established type 1 diabetes were randomized to simultaneous initiation of pump (Medtronic Veo©) and CGM (Enlite©) or to standard pump therapy with delayed CGM introduction. Primary outcomes are CGM adherence and hemoglobin A1C at 6 and 12 months post pump initiation. Secondary outcomes include glycemic variability, stage of readiness, and other patient-reported outcomes with follow-up to 24 months. 144 (95%) of the 152 eligible patients were enrolled and randomized. Allowing for 10% withdrawals, this will provide 93% power to detect a between group difference in CGM adherence and 86% power to detect a between group difference in hemoglobin A1C. Baseline characteristics were similar between the treatment groups. Analysis of 12 month primary outcomes will begin in September 2014. The CGM TIME Trial is the first study to examine the relationship between timing of CGM initiation, readiness for behaviour change, and subsequent CGM adherence in pump naïve children and adolescents. Its findings will advance our understanding of when and how to initiate CGM in children and adolescents with type 1 diabetes. ClinicalTrial.gov NCT01295788. Registered 14 February 2011.

  13. The JDRF CCTN CGM TIME Trial: Timing of Initiation of continuous glucose Monitoring in Established pediatric type 1 diabetes: study protocol, recruitment and baseline characteristics

    PubMed Central

    2014-01-01

    Background Continuous glucose monitoring (CGM) has been shown to improve glucose control in adults with type 1 diabetes. Effectiveness of CGM is directly linked with CGM adherence, which can be challenging to maintain in children and adolescents. We hypothesize that initiating CGM at the same time as starting insulin pump therapy in pump naïve children and adolescents with type 1 diabetes will result in greater CGM adherence and effectiveness compared to delaying CGM introduction by 6 months, and that this is related to greater readiness for making behaviour change at the time of pump initiation. Methods/Design The CGM TIME Trial is a multicenter randomized controlled trial. Eligible children and adolescents (5-18 years) with established type 1 diabetes were randomized to simultaneous initiation of pump (Medtronic Veo©) and CGM (Enlite©) or to standard pump therapy with delayed CGM introduction. Primary outcomes are CGM adherence and hemoglobin A1C at 6 and 12 months post pump initiation. Secondary outcomes include glycemic variability, stage of readiness, and other patient-reported outcomes with follow-up to 24 months. 144 (95%) of the 152 eligible patients were enrolled and randomized. Allowing for 10% withdrawals, this will provide 93% power to detect a between group difference in CGM adherence and 86% power to detect a between group difference in hemoglobin A1C. Baseline characteristics were similar between the treatment groups. Analysis of 12 month primary outcomes will begin in September 2014. Discussion The CGM TIME Trial is the first study to examine the relationship between timing of CGM initiation, readiness for behaviour change, and subsequent CGM adherence in pump naïve children and adolescents. Its findings will advance our understanding of when and how to initiate CGM in children and adolescents with type 1 diabetes. Trial registration ClinicalTrial.gov NCT01295788. Registered 14 February 2011. PMID:25034216

  14. Effects of visual interference on initial motor program errors and execution times in the choice step reaction.

    PubMed

    Uemura, Kazuki; Oya, Toshihisa; Uchiyama, Yasushi

    2013-05-01

    The purpose of this study was to examine whether visual interference has any effect on error in the initial direction of anticipatory postural adjustment (APA) prior to a step (indicating a motor program error) and response time during the choice step execution. Twenty healthy young participants were instructed to execute forward stepping as quickly and accurately as possible on the side indicated by a central arrow (←, left vs. →, right) of a visual cue in the neutral condition. In the flanker condition, they were additionally required to ignore the 2 flanking arrows on each side (→→→→→, congruent or →→←→→, incongruent). Errors in the direction of the initial weight transfer (APA errors) and the step execution times were measured from the vertical force data. In the incongruent condition, the percentage of APA errors and the step execution times were significantly greater than those in the neutral and congruent conditions. A linear mixed model revealed that the step execution time in trials with APA errors was longer than those in trials without APA errors. The visual interference effect of a flanker task may load selective attention and judgment processing during movement initiation, leading to increased initial motor program errors and prolonged step execution times even in healthy young adults. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

    PubMed

    French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

    2013-12-01

    The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

  16. Drying process optimization for an API solvate using heat transfer model of an agitated filter dryer.

    PubMed

    Nere, Nandkishor K; Allen, Kimberley C; Marek, James C; Bordawekar, Shailendra V

    2012-10-01

    Drying an early stage active pharmaceutical ingredient candidate required excessively long cycle times in a pilot plant agitated filter dryer. The key to faster drying is to ensure sufficient heat transfer and minimize mass transfer limitations. Designing the right mixing protocol is of utmost importance to achieve efficient heat transfer. To this order, a composite model was developed for the removal of bound solvent that incorporates models for heat transfer and desolvation kinetics. The proposed heat transfer model differs from previously reported models in two respects: it accounts for the effects of a gas gap between the vessel wall and solids on the overall heat transfer coefficient, and headspace pressure on the mean free path length of the inert gas and thereby on the heat transfer between the vessel wall and the first layer of solids. A computational methodology was developed incorporating the effects of mixing and headspace pressure to simulate the drying profile using a modified model framework within the Dynochem software. A dryer operational protocol was designed based on the desolvation kinetics, thermal stability studies of wet and dry cake, and the understanding gained through model simulations, resulting in a multifold reduction in drying time.

  17. Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America

    PubMed Central

    Crabtree-Ramírez, Brenda; Caro-Vega, Yanink; Shepherd, Bryan E.; Grinsztejn, Beatriz; Wolff, Marcelo; Cortes, Claudia P.; Padgett, Denis; Carriquiry, Gabriela; Fink, Valeria; Jayathilake, Karu; Person, Anna K.; McGowan, Catherine; Sierra-Madero, Juan

    2016-01-01

    Background Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in “real life” settings in Latin America has not been evaluated. Methods Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) ≥18 years of age at enrolment, from 2001–2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. Results A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%), followed by Pneumocystis pneumonia (24%), Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8–12.1) weeks before 2009 to 4.3 (IQR 2.0–7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001), having a non-tuberculosis OI (p<0.001), study site (p<0.001), and more recent years of OI diagnosis (p<0.001). Discussion The time from diagnosis of an OI to HAART initiation has

  18. Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America.

    PubMed

    Crabtree-Ramírez, Brenda; Caro-Vega, Yanink; Shepherd, Bryan E; Grinsztejn, Beatriz; Wolff, Marcelo; Cortes, Claudia P; Padgett, Denis; Carriquiry, Gabriela; Fink, Valeria; Jayathilake, Karu; Person, Anna K; McGowan, Catherine; Sierra-Madero, Juan

    2016-01-01

    Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in "real life" settings in Latin America has not been evaluated. Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) ≥18 years of age at enrolment, from 2001-2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%), followed by Pneumocystis pneumonia (24%), Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8-12.1) weeks before 2009 to 4.3 (IQR 2.0-7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001), having a non-tuberculosis OI (p<0.001), study site (p<0.001), and more recent years of OI diagnosis (p<0.001). The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the

  19. Initial results on the composition of fingerprints and its evolution as a function of time by GC/MS analysis.

    PubMed

    Weyermann, Céline; Roux, Claude; Champod, Christophe

    2011-01-01

    Determining the time since deposition of fingermarks may prove necessary to assess their relevance to criminal investigations. The crucial factor is the initial composition of fingermarks, because it represents the starting point of any aging model. This study mainly aimed to characterize the initial composition of fingerprints, which show a high variability between donors (inter-variability), but also to investigate the variations among fingerprints from the same donor (intra-variability). Solutions to reduce this initial variability using squalene and cholesterol as target compounds are proposed and should be further investigated. The influence of substrates was also evaluated, and the initial composition was observed to be larger on porous surface than nonporous surfaces. Preliminary aging of fingerprints over 30 days was finally studied on a porous and a nonporous substrate to evaluate the potential for dating of fingermarks. Squalene was observed to decrease in a faster rate on a nonporous substrate.

  20. Agitation during prolonged mechanical ventilation at a long-term acute care hospital: risk factors, treatments, and outcomes.

    PubMed

    O'Connor, Heidi; Al-Qadheeb, Nada S; White, Alexander C; Thaker, Vishal; Devlin, John W

    2014-01-01

    The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV. Patients admitted to an LTACH for PMV over a 1-year period were categorized into agitated and nonagitated groups. The presence of agitation risk factors, management strategies, and relevant outcomes were extracted and compared between the 2 groups. A total of 80 patients were included, 41% (33) with agitation and 59% (47) without. Compared to the nonagitated group, the agitated group had a lower Sequential Organ Failure Assessment score (P < .0006), a greater transfer rate from an academic center (P = .05), a greater delirium frequency at both baseline (P = .04) and during admission (P < .001), and a greater rate of benzodiazepine discontinuation (P = .02). Although the use of scheduled antipsychotic (P = .0005) or restraint (P = .002) therapy was more common in the agitated group, use of benzodiazepines (P = .16), opioids (P = .11), or psychiatric evaluation (P = .90) was not. Weaning success, duration of LTACH stay, and daily costs were similar. Agitation among the LTACH patients undergoing PMV is associated with greater delirium and use of antipsychotics and restraints but does not influence weaning success or LTACH stay. Strategies focused on agitation prevention and treatment in this population need to be developed and formally evaluated. © The Author(s) 2013.

  1. Probabilistic evaluation of initiation time in RC bridge beams with load-induced cracks exposed to de-icing salts

    SciTech Connect

    Lu Zhaohui; Zhao Yangang; Yu Zhiwu; Ding Faxing

    2011-03-15

    In this study, a reliability-based method for predicting the initiation time of reinforced concrete bridge beams with load-induced cracks exposed to de-icing salts is presented. A practical model for predicting the diffusion coefficient of chloride ingress into load-induced cracked concrete is proposed. Probabilistic information about uncertainties related to the surface chloride content and the threshold chloride concentration has been estimated from a wide review of previous experimental or statistical studies. Probabilistic analysis to estimate the time to corrosion initiation with/without considering the effect of the load-induced cracks on the chloride ingress into concrete has been carried out. Results of the analysis demonstrate the importance of considering the effect of the load-induced cracks for correct prediction of corrosion initiation in RC bridge beams exposed to chlorides.

  2. 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.

  3. Delayed egg hatching of Anopheles gambiae (Diptera: Culicidae) pending water agitation.

    PubMed

    Ebrahimi, Babak; Shakibi, Sanam; Foster, Woodbridge A

    2014-05-01

    Mosquito eggs laid on water surfaces typically hatch spontaneously soon after the embryos within them become fully formed first-instar larvae. However, we have found that Anopheles gambiae Giles, an important vector of malaria in Africa, exhibits delayed hatching until the water surface is agitated, a feature overlooked in most laboratory colonies. Agitation within 24 h postoviposition, before embryonation was complete, failed to stimulate delayed postembryonic hatching of isolated eggs on the following day (day 2), when < 1% had hatched spontaneously. However, 5 min of water agitation of these dormant pharate first-instar larvae on day 2 resulted in an almost immediate hatch of 63.3 versus 0% of nonagitated controls, plus another 3.9 versus 0.3%, respectively, during the following 24 h. With daily agitation, installment hatching occurred mainly during 2-6 d postoviposition. The mean cumulative hatch after 7 d of daily agitation was 83.1 versus 1.1% of nonagitated eggs. Experiments with eggs in groups demonstrated that egg density and activity of already-hatched larvae had no stimulatory effect. Eggs stored 1-4 wk at 25.5 or at 15.5 degrees C, and then agitated daily for 6 d at 25.5 degrees C, showed a gradual decline in viability. Viability was sustained longer at the lower temperature. Implications of agitation-induced egg hatching for rainy-season and dry-season ecology of An. gambiae are discussed. Suspended hatching and cool storage already are proving convenient for efficient mass rearing and accurate modeling of weather-based population dynamics.

  4. Delayed Egg Hatching of Anopheles gambiae (Diptera: Culicidae) Pending Water Agitation

    PubMed Central

    Ebrahimi, Babak; Shakibi, Sanam; Foster, Woodbridge A.

    2014-01-01

    Mosquito eggs laid on water surfaces typically hatch spontaneously soon after the embryos within them become fully formed first-instar larvae. However, we have found that Anopheles gambiae Giles, an important vector of malaria in Africa, exhibits delayed hatching until the water surface is agitated, a feature overlooked in most laboratory colonies. Agitation within 24 h postoviposition, before embryonation was complete, failed to stimulate delayed postembryonic hatching of isolated eggs on the following day (day 2), when <1% had hatched spontaneously. However, 5 min of water agitation of these dormant pharate first-instar larvae on day 2 resulted in an almost immediate hatch of 63.3 versus 0% of nonagitated controls, plus another 3.9 versus 0.3%, respectively, during the following 24 h. With daily agitation, installment hatching occurred mainly during 2– 6 d postoviposition. The mean cumulative hatch after 7 d of daily agitation was 83.1 versus 1.1% of nonagitated eggs. Experiments with eggs in groups demonstrated that egg density and activity of already-hatched larvae had no stimulatory effect. Eggs stored 1–4 wk at 25.5 or at 15.5°C, and then agitated daily for 6 d at 25.5°C, showed a gradual decline in viability. Viability was sustained longer at the lower temperature. Implications of agitation-induced egg hatching for rainy-season and dry-season ecology of An. gambiae are discussed. Suspended hatching and cool storage already are proving convenient for efficient mass rearing and accurate modeling of weather-based population dynamics. PMID:24897850

  5. 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.

  6. The use of chemical restraints reduces agitation in patients transported by emergency medical services.

    PubMed

    Weiss, Steve; Peterson, Kari; Cheney, Paul; Froman, Phil; Ernst, Amy; Campbell, Micha

    2012-11-01

    Agitated patients are the primary source of injury to patients and providers during ambulance transport. Our primary hypothesis was that the addition of a chemical restraint agent (midazolam) to a restraint protocol would reduce agitation to a greater extent than a restraint protocol with physical restraint alone. The local emergency medical services restraint protocol (RP) was implemented on October 1, 2006. It included a form for data collection about each restrained patient. On April 1, 2007, chemical restraint (CR) using midazolam in addition to physical restraints was made available through the RP, and paramedics were educated in its use. Transported patients were divided into pre-CR and post-CR. The post-CR group was split into those who received and those who did not receive midazolam. Agitation was measured on a validated agitation behavior scale with a parametric (Rasch) adjustment. There were 96 patients in the pre-CR group and 522 patients in the post-CR group. Forty-three percent of the pre-CR group and 49% of the post-CR group had a decrease in agitation during transport (NS). Of the 522 in the post-CR group, 110 were physically restrained and given midazolam (21%) and 412 were physically restrained without midazolam (79%). There was a significantly greater decrease in agitation scores (-17 ± 21 vs. -7 ± 17) in the subjects receiving midazolam compared to those who did not. If available, CR is used in about 20% of restrained patients. When CR is used, there is a decrease in the subject's agitation. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. The effect of massage on agitated behaviours in older people with dementia: a literature review.

    PubMed

    Moyle, Wendy; Murfield, Jenny E; O'Dwyer, Siobhan; Van Wyk, Sierra

    2013-03-01

    To review the literature on massage used to manage agitated behaviours in older people with dementia, assess its efficacy as a non-pharmacological approach and provide recommendations for future research. Agitation has traditionally been managed with chemical or physical restraint. There has been a growing interest in complementary therapies such as massage. A literature review.  Cooper's five-stage model of synthesising research guided the review process. The search terms 'massage', 'agitation' and 'dementia' were defined, and 10 databases were searched in October 2011. No date limitations were applied, although searches were limited to articles written in English. For relevant records, full-text copies were obtained and assessed in terms of inclusion criteria and methodological quality using the Validity Rating Tool (VRT). Data were extracted using a form constructed with reference to the checklist of items to consider in data extraction, produced by the Cochrane Handbook for Systematic Reviews of Interventions. Thirteen studies met the inclusion criteria and were assessed on the VRT. One study was considered of adequate methodological quality to be included in the review. This prospective study found that massage significantly reduced levels of agitation in 52 cognitively impaired residents in two long-term care facilities. There is a severe paucity of research that considers the effects of massage on managing agitated behaviours in older people with dementia. Whilst conclusions cannot be drawn from the one study included in this review, it did provide evidence to support the use of massage as a non-pharmacological approach to managing agitation in older people with dementia. More research, of better methodological quality, is needed. There is a need for health practitioners to be aware of the limited evidence for massage as an intervention for agitation and to provide opportunities to validate massage practice. © 2012 Blackwell Publishing Ltd.

  8. Dominant formation of the microsized carbon coils by a short time SF6 flow incorporation during the initial deposition stage.

    PubMed

    Jeon, Young-Chul; Yi, Soung Soo; Kim, Sung-Hoon

    2013-08-01

    By SF6 gas incorporation for relatively short time during the initial deposition stage, carbon coils could be formed on nickel catalyst layer-deposited silicon oxide substrate using C2H2 and H2 as source gases under thermal chemical vapor deposition system. The characteristics (formation density and morphology) of as-grown carbon coils were investigated as a function of SF6 flow injection time. 5-min SF6 flow injection time is appropriate to produce the dominant microsized geometry for carbon coils without the appearance of the nanosized carbon coils. The geometry for the microsized carbon coils follows a typical double-helix structure and the shape of the rings constituting the coils is a flat-type. Fluorine's intrinsic etching characteristics for the nanosized carbon coils during the initial deposition stage seems to be the cause for the dominant formation of the microsized carbon coils in the case of 5-min SF6 flow injection time.

  9. Real-time 3-dimensional echocardiography for prosthetic valve endocarditis: initial experience.

    PubMed

    Kort, Smadar

    2006-02-01

    Real-time 3-dimensional echocardiography is a relatively new technology with rapidly growing potential applications. Prosthetic valve endocarditis is still a challenging diagnosis despite improvements in image qualities obtained by both transthoracic and transesophageal echocardiograms. The purpose of this article is to present 4 cases of suggested prosthetic valve endocarditis, in which real-time 3-dimensional echocardiography was performed, and to discuss the potential use of real-time 3-dimensional echocardiography for this application.

  10. Predictors of Nursing Home Admission among Alzheimer's Disease Patients with Psychosis and/or Agitation

    PubMed Central

    Miller, Edward Alan; Schneider, Lon S.; Rosenheck, Robert A.

    2014-01-01

    Background The purpose of this study is to identify factors that predict nursing home placement among community-dwelling Alzheimer's Disease (AD) patients with psychosis or agitation in a randomized clinical trial. Methods 418 participants with AD enrolled in the CATIE-AD trial of anti-psychotic medications and having no evidence of nursing home use at baseline were followed 9 months post-random assignment using data provided by caregiver proxy. χ2 tests, t-tests and Cox proportional hazard modeling were used to examine the baseline correlates of nursing home use. Results Of outpatients with no prior nursing home use, 15.0% were placed in a nursing home in the 9 months following baseline, with the average time to placement being 122 days. Bivariate analyses indicate that those with prior outpatient mental health use at study entry were more likely to be admitted; so too were those with worse physical functioning—lower scores on the AD Cooperative Study Activities of Daily Living Scale (ADCS-ADL), lower utility scores on the Health Utility Index (HUI)-III, and worse cognition on the Mini-Mental State Examination. Controlling for other factors, non-Hispanic white race (hazard ratio [HR]=2.16) and prior mental health use (HR=1.87) increased the likelihood of admission. Those with higher ADCS-ADL scores were less likely to be placed (HR=0.97). Conclusion Factors leading to nursing home entry among psychotic/agitated AD patients are similar to the general population, though high incidence of nursing home entry highlights the importance of accounting for such utilization in health economic studies of AD outcomes. It also highlights the importance of using information on ADLs and other characteristics to develop profiles identifying those at greater or lesser risk of nursing home entry and, in so doing inform population planning associated with AD and identification of those patients and caregivers who might benefit most from interventions to prevent eventual placement

  11. Do bartonella infections cause agitation, panic disorder, and treatment-resistant depression?

    PubMed

    Schaller, James L; Burkland, Glenn A; Langhoff, P J

    2007-09-13

    Bartonella is an emerging infection found in cities, suburbs, and rural locations. Routine national labs offer testing for only 2 species, but at least 9 have been discovered as human infections within the last 15 years. Some authors discuss Bartonella cases having atypical presentations, with serious morbidity considered uncharacteristic of more routine Bartonella infections. Some atypical findings include distortion of vision, abdominal pain, severe liver and spleen tissue abnormalities, thrombocytopenic purpura, bone infection, arthritis, abscesses, heart tissue and heart valve problems. While some articles discuss Bartonella as a cause of neurologic illnesses, psychiatric illnesses have received limited attention. Case reports usually do not focus on psychiatric symptoms and typically only as incidental comorbid findings. In this article, we discuss patients exhibiting new-onset agitation, panic attacks, and treatment-resistant depression, all of which may be attributed to Bartonella. Three patients receiving care in an outpatient clinical setting developed acute onset personality changes and agitation, depression, and panic attacks. They were retrospectively examined for evidence of Bartonella infections. The medical and psychiatric treatment progress of each patient was tracked until both were significantly resolved and the Bartonella was cured. The patients generally seemed to require higher dosing of antidepressants, benzodiazepines, or antipsychotics in order to function normally. Doses were reduced following antibiotic treatment and as the presumed signs of Bartonella infection remitted. All patients improved significantly following treatment and returned to their previously healthy or near-normal baseline mental health status. New Bartonella species are emerging as human infections. Most do not have antibody or polymerase chain reaction (PCR) diagnostic testing at this time. Manual differential examinations are of unknown utility, due to many factors

  12. On the long time behavior of the doubly infinite toda lattice under initial data decaying at infinity

    NASA Astrophysics Data System (ADS)

    Kamvissis, Spyridon

    1993-05-01

    We provide rigorous analysis of the long time behavior of the (doubly infinite) Toda lattice under initial data that decay at infinity, in the absence of solitions. We solve (approximately and for large times) the Riemann-Hilbert matrix factorization problem equivalent to the related inverse scattering problem with the help of the Beals-Coifman formula, by reducing it to a simpler one through a series of contour deformations in the spirit of the Deift-Zhou method.

  13. The Prime Time Initiative of Palm Beach County, Florida: QIS Development Process Evaluation--Year 2 Report

    ERIC Educational Resources Information Center

    Spielberger, Julie; Lockaby, Tracey

    2006-01-01

    This report covers the second year of a 3-year process evaluation of the Prime Time Initiative of Palm Beach County, Florida, a system-building effort to strengthen the availability and quality of after-school programs in the county. During the past two decades, the after-school field has expanded enormously. This growth has occurred partly in…

  14. Redesigning Today's Schools to Build a Stronger Tomorrow: The Massachusetts Expanded Learning Time Initiative 2007-2008 Annual Report

    ERIC Educational Resources Information Center

    Massachusetts 2020, 2008

    2008-01-01

    Our children deserve an education that fully prepares them for the future--success in college, the workforce and a healthy, fulfilled life. The Massachusetts Expanded Learning Time (ELT) Initiative is redesigning and expanding the school schedule to offer children new learning and enrichment opportunities. With state resources, participating…

  15. Spectral and amplitude-time characteristics of radiation of plasma of a repetitively pulsed discharge initiated by runaway electrons

    NASA Astrophysics Data System (ADS)

    Lomaev, M. I.; Beloplotov, D. V.; Sorokin, D. A.; Tarasenko, V. F.

    2016-02-01

    Spectral and amplitude-time characteristics of radiation of plasma of a repetitively pulsed discharge initiated by runaway electrons were studied experimentally in nitrogen. Intense emission lines of copper atoms, nitrogen atoms, and ions, as well as the first and the second positive systems of nitrogen, NO, and CN, were observed in the regime of repetitively pulsed excitation.

  16. Late-time Kerr tails: generic and non-generic initial data sets, 'up' modes, and superposition

    NASA Astrophysics Data System (ADS)

    Burko, Lior M.; Khanna, Gaurav

    2011-01-01

    Three interrelated questions concerning Kerr spacetime late-time scalar-field tails are considered numerically, specifically the evolutions of generic and non-generic initial data sets, the excitation of 'up' modes, and the resolution of an apparent paradox related to the superposition principle. We propose to generalize the Barack-Ori formula for the decay rate of any tail multipole given a generic initial data set, to the contribution of any initial multipole mode. Our proposal leads to a much simpler expression for the late-time power-law index. Specifically, we propose that the late-time decay rate of a kinematically allowed Yellm spherical harmonic multipole moment because of an initial Y_{\\ell ^{\\prime } m} multipole is independent of the azimuthal number m and is given by t-n, where n = ell' + ell + 1 for ell < ell' and n = ell' + ell + 3 for ell >= ell'. We also show explicitly that the angular symmetry group of a multipole does not determine its late-time decay rate.

  17. 20 CFR 663.530 - Is there a time limit on the period of initial eligibility for training providers?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Is there a time limit on the period of initial eligibility for training providers? 663.530 Section 663.530 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER...

  18. Development of the teneral adult Anoplophora glabripennis (Coleoptera: Cerambycidae): time to initiate and completely bore out of maple wood

    Treesearch

    V. Sanchez; M.A. Keena

    2013-01-01

    Anoplophora glabripennis (Motschulsky) is an introduced invasive pest with the potential to devastate hardwood forests in North America. Using artificial pupal chambers, we documented the time required by teneral adults at three temperatures (20, 25, and 30°C), 60-80% RH, and a photoperiod of 16:8 (L:D) h to initiate boring after eclosion...