The Generic Spacecraft Analyst Assistant (gensaa): a Tool for Developing Graphical Expert Systems

NASA Technical Reports Server (NTRS)

Hughes, Peter M.

1993-01-01

During numerous contacts with a satellite each day, spacecraft analysts must closely monitor real-time data. The analysts must watch for combinations of telemetry parameter values, trends, and other indications that may signify a problem or failure. As the satellites become more complex and the number of data items increases, this task is becoming increasingly difficult for humans to perform at acceptable performance levels. At NASA GSFC, fault-isolation expert systems are in operation supporting this data monitoring task. Based on the lessons learned during these initial efforts in expert system automation, a new domain-specific expert system development tool named the Generic Spacecraft Analyst Assistant (GenSAA) is being developed to facilitate the rapid development and reuse of real-time expert systems to serve as fault-isolation assistants for spacecraft analysts. Although initially domain-specific in nature, this powerful tool will readily support the development of highly graphical expert systems for data monitoring purposes throughout the space and commercial industry.

Decongestion: Diuretics and other therapies for hospitalized heart failure.

PubMed

Vazir, Ali; Cowie, Martin R

2016-04-01

Acute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Often the syndrome is characterized by congestion, and is associated with long hospital admissions and high risk of readmission and further healthcare expenditure. Despite a limited evidence-base, diuretics remain the first-line treatment for congestion. Loop diuretics are typically the first-line diuretic strategy with some evidence that initial treatment with continuous infusion or boluses of high-dose loop diuretic is superior to an initial lower dose strategy. In patients who have impaired responsiveness to diuretics, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. The use of intravenous low-dose dopamine is no longer supported in heart failure patients with preserved systolic blood pressure and its use to assist diuresis in patients with low systolic blood pressures requires further study. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence-base is not robust, and its place in clinical practice is yet to be established. Several novel pharmacological agents remain under investigation. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Mechanisms for fatigue and wear of polysilicon structural thinfilms

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

Alsem, Daniel Henricus

2006-01-01

Fatigue and wear in micron-scale polysilicon structural films can severely impact the reliability of microelectromechanical systems (MEMS). Despite studies on fatigue and wear behavior of these films, there is still an on-going debate regarding the precise physical mechanisms for these two important failure modes. Although macro-scale silicon does not fatigue, this phenomenon is observed in micron-scale silicon. It is shown that for polysilicon devices fabricated in the MUMPs foundry and SUMMiT process stress-lifetime data exhibits similar trends in ambient air, shorter lifetimes in higher relative humidity environments and no fatigue failure at all in high vacuum. Transmission electron microscopy ofmore » the surface oxides of the samples show an approximate four-fold thickening of the oxide at stress concentrations after fatigue failure, but no thickening after fracture in air or after fatigue cycling in vacuo. It is found that such oxide thickening and fatigue failure (in air) occurs in devices with initial oxide thicknesses of ~4-20 nm. Such results are interpreted and explained by a reaction layer fatigue mechanism; specifically, moisture-assisted subcritical cracking within a cyclic stress-assisted thickened oxide layer occurs until the crack reaches a critical size to cause catastrophic failure. Polysilicon specimens from the SUMMiT process are used to study wear mechanisms in micron-scale silicon in ambient air. Worn parts are examined by analytical scanning and transmission electron microscopy, while temperature changes are monitored using infrared microscopy. These results are compared with the development of values of static coefficients of friction (COF) with number of wear cycles. Observations show amorphous debris particles (~50-100 nm) created by fracture through the silicon grains (~500 nm), which subsequently oxidize, agglomerate into clusters and create plowing tracks. A nano-crystalline layer (~20-200 nm) forms at worn regions. No dislocations or extreme temperature increases are found, ruling out plasticity and temperature-assisted mechanisms. The COF reaches a steady-state value of ~0.20±0.05 after a short time at an initial value of ~0.11±0.01. Plowing tracks are found before the steady-state value of the COF is reached, suggesting only a short adhesive wear regime. This suggests a predominantly abrasive wear mechanism, controlled by fracture, which commences by the first particles created by adhesive wear.« less

Mechanisms for fatigue and wear of polysilicon structural thin films

NASA Astrophysics Data System (ADS)

Alsem, Daniel Henricus

Fatigue and wear in micron-scale polysilicon structural films can severely impact the reliability of microelectromechanical systems (MEMS). Despite studies on fatigue and wear behavior of these films, there is still an on-going debate regarding the precise physical mechanisms for these two important failure modes. Although macro-scale silicon does not fatigue, this phenomenon is observed in micron-scale silicon. It is shown that for polysilicon devices fabricated in the MUMPs foundry and SUMMiT(TM) process stress-lifetime data exhibits similar trends in ambient air, shorter lifetimes in higher relative humidity environments and no fatigue failure at all in high vacuum. Transmission electron microscopy of the surface oxides of the samples show an approximate four-fold thickening of the oxide at stress concentrations after fatigue failure, but no thickening after fracture in air or after fatigue cycling in vacuo . It is found that such oxide thickening and fatigue failure (in air) occurs in devices with initial oxide thicknesses of ˜4-20 nm. Such results are interpreted and explained by a reaction-layer fatigue mechanism; specifically, moisture-assisted subcritical cracking within a cyclic stress-assisted thickened oxide layer occurs until the crack reaches a critical size to cause catastrophic failure. Polysilicon specimens from the SUMMiT(TM) process are used to study wear mechanisms in micron-scale silicon in ambient air. Worn parts are examined by analytical scanning and transmission electron microscopy, while temperature changes are monitored using infrared microscopy. These results are compared with the development of values of static coefficients of friction (COF) with number of wear cycles. Observations show amorphous debris particles (˜50-100 nm) created by fracture through the silicon grains (˜500 nm), which subsequently oxidize, agglomerate into clusters and create plowing tracks. A nano-crystalline layer (˜20-200 nm) forms at worn regions. No dislocations or extreme temperature increases are found, ruling out plasticity and temperature-assisted mechanisms. The COF reaches a steady-state value of ˜0.20+/-0.05 after a short time at an initial value of ˜0.11+/-0.01. Plowing tracks are found before the steady-state value of the COF is reached, suggesting only a short adhesive wear regime. This suggests a predominantly abrasive wear mechanism, controlled by fracture, which commences by the first particles created by adhesive wear.

DIY guide-needle-assisted conjunctivodacryocystorhinostomy (CDCR).

PubMed

Paik, Ji-Sun; Kim, Su-Ah; Doh, Sang-Hee

2013-01-01

In this study, we introduce DIY guide-needle-assisted conjunctivodacryocystorhinostomy (CDCR), in which a guide needle helps in measuring the initial Jones tube length for insertion and reduces unnecessary handling for tube changes. Three CDCR procedures were conducted in which the length of the Jones tube was calculated using a 22-gauge DIY guide needle, and a prospective study of tube position change and migration, (a major cause of CDCR failure) was done. Wound healing was almost complete within 4 weeks postoperatively in the osteotomy site, but in cases of partial middle turbinectomy, a little more time was necessary. There was a slight change in Jones tube position in the nasal cavity compared with the expected position of original tube tip, but no tube migration from the caruncle fixation position had occurred by the final follow-up time. This guide-needle-assisted CDCR has multiple advantages, such as easy measurement of the proper initial tube size, utilization of the initial needle path, and easy replacement of tubes. Finally, this approach to CDCR can be readily applied because it uses materials ordinarily found in hospitals to create the devices needed for the procedure, so there is no additional cost.

Usefulness of Tricuspid Annular Diameter to Predict Late Right Sided Heart Failure in Patients With Left Ventricular Assist Device.

PubMed

Nakanishi, Koki; Homma, Shunichi; Han, Jiho; Takayama, Hiroo; Colombo, Paolo C; Yuzefpolskaya, Melana; Garan, Arthur R; Farr, Maryjane A; Kurlansky, Paul; Di Tullio, Marco R; Naka, Yoshifumi; Takeda, Koji

2018-07-01

Although late-onset right-sided heart failure is recognized as a clinical problem in the treatment of patients with left ventricular assist devices (LVADs), the mechanism and predictors are unknown. Tricuspid valve (TV) deformation leads to the restriction of the leaflet motion and decreased coaptation, resulting in a functional tricuspid regurgitation that may act as a surrogate marker of late right-sided heart failure. This study aimed to investigate the association of preoperative TV deformation (annulus dilatation and leaflet tethering) with late right-sided heart failure development after continuous-flow LVAD implantation. The study cohort consisted of 274 patients who underwent 2-dimensional echocardiography before LVAD implantation. TV annulus diameter and tethering distance were measured in an apical 4-chamber view. Late right-sided heart failure was defined as right-sided heart failure requiring readmission and medical and/or surgical treatment after initial LVAD implantation. During a mean follow-up of 25.1 ± 19.0 months after LVAD implantation, late right-sided heart failure occurred in 33 patients (12.0%). Multivariate Cox proportional hazard analysis demonstrated that TV annulus diameter (hazard ratio 1.221 per 1 mm, p <0.001) was significantly associated with late right-sided heart failure development, whereas leaflet tethering distance was not. The best cut-off value of the TV annular diameter was 41 mm (area under the curve 0.787). Kaplan-Meier analysis showed that patients with dilated TV annulus (TV annular diameter ≥41 mm) exhibited a significantly higher late right-sided heart failure occurrence than those without TV annular enlargement (log-rank p <0.001). In conclusion, preoperative TV annulus diameter, but not leaflet tethering distance, predicted the occurrence of late right-sided heart failure after LVAD implantation. Copyright © 2018 Elsevier Inc. All rights reserved.

Extracorporeal liver assist device to exchange albumin and remove endotoxin in acute liver failure: Results of a pivotal pre-clinical study.

PubMed

Lee, Karla C L; Baker, Luisa A; Stanzani, Giacomo; Alibhai, Hatim; Chang, Yu Mei; Jimenez Palacios, Carolina; Leckie, Pamela J; Giordano, Paola; Priestnall, Simon L; Antoine, Daniel J; Jenkins, Rosalind E; Goldring, Christopher E; Park, B Kevin; Andreola, Fausto; Agarwal, Banwari; Mookerjee, Rajeshwar P; Davies, Nathan A; Jalan, Rajiv

2015-09-01

In acute liver failure, severity of liver injury and clinical progression of disease are in part consequent upon activation of the innate immune system. Endotoxaemia contributes to innate immune system activation and the detoxifying function of albumin, critical to recovery from liver injury, is irreversibly destroyed in acute liver failure. University College London-Liver Dialysis Device is a novel artificial extracorporeal liver assist device, which is used with albumin infusion, to achieve removal and replacement of dysfunctional albumin and reduction in endotoxaemia. We aimed to test the effect of this device on survival in a pig model of acetaminophen-induced acute liver failure. Pigs were randomised to three groups: Acetaminophen plus University College London-Liver Dialysis Device (n=9); Acetaminophen plus Control Device (n=7); and Control plus Control Device (n=4). Device treatment was initiated two h after onset of irreversible acute liver failure. The Liver Dialysis Device resulted in 67% reduced risk of death in acetaminophen-induced acute liver failure compared to Control Device (hazard ratio=0.33, p=0.0439). This was associated with 27% decrease in circulating irreversibly oxidised human non-mercaptalbumin-2 throughout treatment (p=0.046); 54% reduction in overall severity of endotoxaemia (p=0.024); delay in development of vasoplegia and acute lung injury; and delay in systemic activation of the TLR4 signalling pathway. Liver Dialysis Device-associated adverse clinical effects were not seen. The survival benefit and lack of adverse effects would support clinical trials of University College London-Liver Dialysis Device in acute liver failure patients. Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Ventricular assist devices and sleep-disordered breathing.

PubMed

Akkanti, Bindu; Castriotta, Richard J; Sayana, Pavani; Nunez, Emmanuel; Rajapreyar, Indranee; Kumar, Sachin; Nathan, Sriram; Majid, Ruckshanda

2017-10-01

Congestive heart failure is one of the leading causes of morbidity and mortality in the United States, and left ventricular assist devices have revolutionized treatment of end-stage heart failure. Given that sleep apnea results in significant morbidity in these patients with advanced heart failure, practicing sleep physicians need to have an understanding of left ventricular assist devices. In this review, we summarize what is known about ventricular assist devices as they relate to sleep medicine. Copyright © 2016 Elsevier Ltd. All rights reserved.

New diagnostic modalities in the diagnosis of heart failure.

PubMed Central

Mitchell, Judith E.; Palta, Sanjeev

2004-01-01

Heart failure (HF) is the one cardiovascular disease that is increasing in prevalence in the United States. As the population continues to age, the incidence will certainly be amplified. However, some studies have shown that HF is correctly diagnosed initially in only 50% of affected patients. Despite the use of history, physical examination, echocardiogram, and chest x-ray, the percentage of correct initial diagnosis of HF is low. Recognizing the symptoms of HF decompensations is often problematic because other diagnoses can mimic them. There are two new diagnostic modalities that offer promise in improving HF diagnostic accuracy and identifying early HF decompensations. These diagnostic modalities include tests utilizing impedance cardiography and the B-type natriuretic peptide assay. They have the potential of increasing the accuracy of HF diagnosis and guide pharmacological treatment in the inpatient and outpatient settings. They may also assist in the recognition (or prediction) of acute HF decompensations. Images Figure 2 PMID:15586645

MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C.

PubMed Central

Mallick, A; Bodenham, A R

1997-01-01

A young male survived hyperpyrexia (42.9 degrees C) following MDMA ("Ecstasy") ingestion. He developed convulsions, rhabdomyolysis, metabolic acidosis, and respiratory failure. This was successfully managed by assisted ventilation, aggressive fluid therapy, and the early administration of dantrolene, in addition to cooling measures. This is the first report of a survivor with such a severe hyperpyrexia. Images Figure 1 PMID:9315942

Rates and determinants of early initiation of breastfeeding and exclusive breast feeding at 42 days postnatal in six low and middle-income countries: A prospective cohort study

PubMed Central

2015-01-01

Background Early initiation of breastfeeding after birth and exclusive breastfeeding through six months of age confers many health benefits for infants; both are crucial high impact, low-cost interventions. However, determining accurate global rates of these crucial activities has been challenging. We use population-based data to describe: (1) rates of early initiation of breastfeeding (defined as within 1 hour of birth) and of exclusive breastfeeding at 42 days post-partum; and (2) factors associated with failure to initiate early breastfeeding and exclusive breastfeeding at 42 days post-partum. Methods Prospectively collected data from women and their live-born infants enrolled in the Global Network’s Maternal and Newborn Health Registry between January 1, 2010-December 31, 2013 included women-infant dyads in 106 geographic areas (clusters) at 7 research sites in 6 countries (Kenya, Zambia, India [2 sites], Pakistan, Argentina and Guatemala). Rates and risk factors for failure to initiate early breastfeeding were investigated for the entire cohort and rates and risk factors for failure to maintain exclusive breastfeeding was assessed in a sub-sample studied at 42 days post-partum. Result A total of 255,495 live-born women-infant dyads were included in the study. Rates and determinants for the exclusive breastfeeding sub-study at 42 days post-partum were assessed from among a sub-sample of 105,563 subjects. Although there was heterogeneity by site, and early initiation of breastfeeding after delivery was high, the Pakistan site had the lowest rates of early initiation of breastfeeding. The Pakistan site also had the highest rate of lack of exclusive breastfeeding at 42 days post-partum. Across all regions, factors associated with failure to initiate early breastfeeding included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and failure to place baby on the mother’s chest after delivery. Factors associated with failure to achieve exclusive breastfeeding at 42 days varied across the sites. The only factor significant in all sites was multiple gestation. Conclusions In this large, prospective, population-based, observational study, rates of both early initiation of breastfeeding and exclusive breastfeeding at 42 days post-partum were high, except in Pakistan. Factors associated with these key breastfeeding indicators should assist with more effective strategies to scale-up these crucial public health interventions. Trial registration Registration at the Clinicaltrials.gov website (ID# NCT01073475). PMID:26063291

Rates and determinants of early initiation of breastfeeding and exclusive breast feeding at 42 days postnatal in six low and middle-income countries: A prospective cohort study.

PubMed

Patel, Archana; Bucher, Sherri; Pusdekar, Yamini; Esamai, Fabian; Krebs, Nancy F; Goudar, Shivaprasad S; Chomba, Elwyn; Garces, Ana; Pasha, Omrana; Saleem, Sarah; Kodkany, Bhalachandra S; Liechty, Edward A; Kodkany, Bhala; Derman, Richard J; Carlo, Waldemar A; Hambidge, K; Goldenberg, Robert L; Althabe, Fernando; Berrueta, Mabel; Moore, Janet L; McClure, Elizabeth M; Koso-Thomas, Marion; Hibberd, Patricia L

2015-01-01

Early initiation of breastfeeding after birth and exclusive breastfeeding through six months of age confers many health benefits for infants; both are crucial high impact, low-cost interventions. However, determining accurate global rates of these crucial activities has been challenging. We use population-based data to describe: (1) rates of early initiation of breastfeeding (defined as within 1 hour of birth) and of exclusive breastfeeding at 42 days post-partum; and (2) factors associated with failure to initiate early breastfeeding and exclusive breastfeeding at 42 days post-partum. Prospectively collected data from women and their live-born infants enrolled in the Global Network's Maternal and Newborn Health Registry between January 1, 2010-December 31, 2013 included women-infant dyads in 106 geographic areas (clusters) at 7 research sites in 6 countries (Kenya, Zambia, India [2 sites], Pakistan, Argentina and Guatemala). Rates and risk factors for failure to initiate early breastfeeding were investigated for the entire cohort and rates and risk factors for failure to maintain exclusive breastfeeding was assessed in a sub-sample studied at 42 days post-partum. A total of 255,495 live-born women-infant dyads were included in the study. Rates and determinants for the exclusive breastfeeding sub-study at 42 days post-partum were assessed from among a sub-sample of 105,563 subjects. Although there was heterogeneity by site, and early initiation of breastfeeding after delivery was high, the Pakistan site had the lowest rates of early initiation of breastfeeding. The Pakistan site also had the highest rate of lack of exclusive breastfeeding at 42 days post-partum. Across all regions, factors associated with failure to initiate early breastfeeding included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and failure to place baby on the mother's chest after delivery. Factors associated with failure to achieve exclusive breastfeeding at 42 days varied across the sites. The only factor significant in all sites was multiple gestation. In this large, prospective, population-based, observational study, rates of both early initiation of breastfeeding and exclusive breastfeeding at 42 days post-partum were high, except in Pakistan. Factors associated with these key breastfeeding indicators should assist with more effective strategies to scale-up these crucial public health interventions. Registration at the Clinicaltrials.gov website (ID# NCT01073475).

An Industrial Perspective on Environmentally Assisted Cracking of Some Commercially Used Carbon Steels and Corrosion-Resistant Alloys

NASA Astrophysics Data System (ADS)

Ashida, Yugo; Daigo, Yuzo; Sugahara, Katsuo

2017-08-01

Commercial metals and alloys like carbon steels, stainless steels, and nickel-based super alloys frequently encounter the problem of environmentally assisted cracking (EAC) and resulting failure in engineering components. This article aims to provide a perspective on three critical industrial applications having EAC issues: (1) corrosion and cracking of carbon steels in automotive applications, (2) EAC of iron- and nickel-based alloys in salt production and processing, and (3) EAC of iron- and nickel-based alloys in supercritical water. The review focuses on current industrial-level understanding with respect to corrosion fatigue, hydrogen-assisted cracking, or stress corrosion cracking, as well as the dominant factors affecting crack initiation and propagation. Furthermore, some ongoing industrial studies and directions of future research are also discussed.

ROENTGEN: case-based reasoning and radiation therapy planning.

PubMed Central

Berger, J.

1992-01-01

ROENTGEN is a design assistant for radiation therapy planning which uses case-based reasoning, an artificial intelligence technique. It learns both from specific problem-solving experiences and from direct instruction from the user. The first sort of learning is the normal case-based method of storing problem solutions so that they can be reused. The second sort is necessary because ROENTGEN does not, initially, have an internal model of the physics of its problem domain. This dependence on explicit user instruction brings to the forefront representational questions regarding indexing, failure definition, failure explanation and repair. This paper presents the techniques used by ROENTGEN in its knowledge acquisition and design activities. PMID:1482869

Minimally invasive surgical implantation of left ventricular epicardial leads for ventricular resynchronization using video-assisted thoracoscopy.

PubMed

Fernández, Angel L; García-Bengochea, José B; Ledo, Ramiro; Vega, Marino; Amaro, Antonio; Alvarez, Julián; Rubio, José; Sierra, Juan; Sánchez, Daniel

2004-04-01

Cardiac resynchronization via left ventricular or biventricular pacing is an option for selected patients with ventricular systolic dysfunction and widened QRS complex. Stimulation through a coronary vein is the technique of choice for left ventricular pacing, but this approach results in a failure rate of approximately 8%. We describe our initial experience with minimally invasive surgical implantation of left ventricular epicardial leads using video-assisted thoracoscopy. A total of 14 patients with congestive heart failure, NYHA functional class 3.2 (0.6) and mean ejection fraction 22.9 (6.8)% were included in this study. Left bundle branch block, QRS complex >140 ms and abnormal septal motion were observed in all cases. Epicardial leads were implanted on the left ventricular free wall under general anesthesia using video-assisted thoracoscopic surgery. Lead implantation was successful in 13 patients. Conversion to a small thoracotomy was necessary in one patient. All patients were extubated in the operating room. None of the patients died during their hospital stay. Follow-up showed reversal of ventricular asynchrony and significant improvement in ejection fraction and functional class. Minimally invasive surgery for ventricular resynchronization using video-assisted thoracoscopy in selected patients is a safe procedure that makes it possible to choose the best site for lead implantation and provides adequate short- and medium-term stimulation.

Temporary metabolic support by extracorporeal blood therapy for liver failure after surgery.

PubMed

Matsubara, S; Okabe, K; Ouchi, K; Sato, T; Matsuno, S

1988-01-01

With the aim of temporarily assisting deterioration of liver function developing after surgery, extracorporeal blood purification therapy (EBPT) (plasma exchange and/or hemofiltration) was carried out in 26 postoperative patients. Initiation of EBPT was instituted according to the criteria of either a serum bilirubin greater than 15 mg/dl or Grade 2 or more coma. Plasma exchange was carried out 235 times in 23 patients and hemofiltration was performed 28 times for seven patients. In addition, hemodialysis and CAPD were linked in eight cases. Plasma exchange was found to control the progression of DIC and endotoxemia. Nine patients (35%) were weaned from EBPT. In the survivors the levels of blood ammonia and number of major complications were significantly lower compared to the nonsurvivors. Three patients treated only with hemofiltration were all lost. Among co-morbid factors present, incidences of renal failure, respiratory failure, and associated liver cirrhosis significantly increased poor clinical outcome on EBPT for postoperative liver failure.

44 CFR 353.7 - Failure to pay.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Failure to pay. 353.7 Section 353.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... LICENSEE RADIOLOGICAL EMERGENCY PLANS AND PREPAREDNESS § 353.7 Failure to pay. In any case where there is a...

44 CFR 354.7 - Failure to pay.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Failure to pay. 354.7 Section 354.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROGRAM § 354.7 Failure to pay. Where a licensee fails to pay a prescribed fee required under this part...

44 CFR 353.7 - Failure to pay.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Failure to pay. 353.7 Section 353.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... LICENSEE RADIOLOGICAL EMERGENCY PLANS AND PREPAREDNESS § 353.7 Failure to pay. In any case where there is a...

44 CFR 354.7 - Failure to pay.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Failure to pay. 354.7 Section 354.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROGRAM § 354.7 Failure to pay. Where a licensee fails to pay a prescribed fee required under this part...

44 CFR 353.7 - Failure to pay.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Failure to pay. 353.7 Section 353.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... LICENSEE RADIOLOGICAL EMERGENCY PLANS AND PREPAREDNESS § 353.7 Failure to pay. In any case where there is a...

44 CFR 354.7 - Failure to pay.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Failure to pay. 354.7 Section 354.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROGRAM § 354.7 Failure to pay. Where a licensee fails to pay a prescribed fee required under this part...

44 CFR 354.7 - Failure to pay.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Failure to pay. 354.7 Section 354.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROGRAM § 354.7 Failure to pay. Where a licensee fails to pay a prescribed fee required under this part...

44 CFR 353.7 - Failure to pay.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Failure to pay. 353.7 Section 353.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... LICENSEE RADIOLOGICAL EMERGENCY PLANS AND PREPAREDNESS § 353.7 Failure to pay. In any case where there is a...

44 CFR 354.7 - Failure to pay.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Failure to pay. 354.7 Section 354.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROGRAM § 354.7 Failure to pay. Where a licensee fails to pay a prescribed fee required under this part...

To ventricular assist devices or not: When is implantation of a ventricular assist device appropriate in advanced ambulatory heart failure?

PubMed Central

Cerier, Emily; Lampert, Brent C; Kilic, Arman; McDavid, Asia; Deo, Salil V; Kilic, Ahmet

2016-01-01

Advanced heart failure has been traditionally treated via either heart transplantation, continuous inotropes, consideration for hospice and more recently via left ventricular assist devices (LVAD). Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure. Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure. The question of when to implant these devices in those patients with advanced, yet still ambulatory heart failure remains a controversial topic. We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure. PMID:28070237

Understanding the C-pulse device and its potential to treat heart failure.

PubMed

Sales, Virna L; McCarthy, Patrick M

2010-03-01

The Sunshine Heart C-Pulse (C-Pulse; Sunshine Heart Inc., Tustin, CA) device is an extra-aortic implantable counterpulsation pump designed as a non-blood contacting ambulatory heart assist device, which may provide relief from symptoms for class II-III congestive heart failure patients. It has a comparable hemodynamic augmentation to intra-aortic balloon counterpulsation devices. The C-Pulse cuff is implanted through a median sternotomy, secured around the ascending aorta, and pneumatically driven by an external system controller. Pre-clinical studies in the acute pig model, and initial temporary clinical studies in patients undergoing off-pump coronary bypass surgery have shown substantial increase in diastolic perfusion of the coronary vessels, which translated to a favorable improvement in ventricular function. A U.S. prospective multi-center trial to evaluate the safety and efficacy of the C-Pulse in class III patients with moderate heart failure is now in progress.

Vacuum-assisted closure therapy in the management of lung abscess.

PubMed

Sziklavari, Zsolt; Ried, Michael; Hofmann, Hans-Stefan

2014-09-06

Despite significant advances in the treatment of thoracic infections, complex lung abscess remains a problem in modern thoracic surgery. We describe the novel application of vacuum-assisted closure for the treatment of a lung abscess. The technical details and preliminary results are reported. After the initial failed conservative treatment of an abscess, minimally invasive surgical intervention was performed with vacuum-assisted closure. The vacuum sponges were inserted in the abscess cavity at the most proximal point to the pleural surface. The intercostal space of the chest wall above the entering place was secured by a soft tissue retractor. The level of suction was initially set to 100 mm Hg, with a maximum suction of 125 mm Hg. The sponge was changed once on the 3rd postoperative day. The abscess cavity was rapidly cleaned and decreased in size. The mini-thoracotomy could be closed on the 9th postoperative day. Closure of the cavity was simple, without any short- or long-term treatment failure. This technique reduced the trauma associated with the procedure. The patient was discharged on the 11th postoperative day. Vacuum-assisted closure systems should be considered for widespread use as an alternative option for the treatment of complicated pulmonary abscess in elderly, debilitated, immunocompromised patients after failed conservative treatment.

Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: design and rationale of the ROADMAP clinical trial.

PubMed

Rogers, Joseph G; Boyle, Andrew J; O'Connell, John B; Horstmanshof, Douglas A; Haas, Donald C; Slaughter, Mark S; Park, Soon J; Farrar, David J; Starling, Randall C

2015-02-01

Mechanical circulatory support is now a proven therapy for the treatment of patients with advanced heart failure and cardiogenic shock. The role for this therapy in patients with less severe heart failure is unknown. The objective of this study is to examine the impact of mechanically assisted circulation using the HeartMate II left ventricular assist device in patients who meet current US Food and Drug Administration-defined criteria for treatment but are not yet receiving intravenous inotropic therapy. This is a prospective, nonrandomized clinical trial of 200 patients treated with either optimal medical management or a mechanical circulatory support device. This trial will be the first prospective clinical evaluation comparing outcomes of patients with advanced ambulatory heart failure treated with either ongoing medical therapy or a left ventricular assist device. It is anticipated to provide novel insights regarding relative outcomes with each treatment and an understanding of patient and provider acceptance of the ventricular assist device therapy. This trial will also provide information regarding the risk of events in "stable" patients with advanced heart failure and guidance for the optimal timing of left ventricular assist device therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

Recent advances in heart failure.

PubMed

Kassi, Mahwash; Hannawi, Bashar; Trachtenberg, Barry

2018-03-01

Acute heart failure continues to be a challenge as there is limited benefit of numerous agents that have been tested. Cardiac resynchronization therapy remains standard of care, yet timing and need for implantable cardiac defibrillator has been brought into question with the recent randomized trials. Several recent advances have been made towards management of heart failure both in drug and device therapy. The purpose of this review is to provide an update on the most important recent studies on heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Two new drugs have been added to the armamentarium for HFrEF; ivabradine and angiotensin receptor-neprilysin inhibitors (ARNIs). Initial data from a new left ventricular assist device (LVAD) pump, the HeartMate 3 (HM III), have demonstrated no reports of pump thrombosis at 6 months, but stroke and right ventricle failure continue to be a challenge with comparable rates compared with the HeartMate II. Several large studies in HFpEF failed to show improvement in outcomes and management continues to be geared towards lifestyle modification and symptom relief. Newer therapies and devices have met with great success, yet there are several therapies that provide no benefit and even harm. A careful review of the recent literature remains instrumental to the effective management of patients with heart failure.

First pediatric transatlantic air ambulance transportation on a Berlin Heart EXCOR left ventricular assist device as a bridge to transplantation.

PubMed

Tissot, Cecile; Buchholz, Holger; Mitchell, Max B; da Cruz, Eduardo; Miyamoto, Shelley D; Pietra, Bill A; Charpentier, Arnaud; Ghez, Olivier

2010-03-01

Mechanical circulatory devices are indicated in patients with refractory cardiac failure as a bridge to recovery or to transplantation. Whenever required, transportation while on mechanical support is a challenge and still limited by technical restrictions or distance. We report the first pediatric case of transatlantic air transportation on a Berlin Heart EXCOR ventricular assist device (Berlin Heart, Berlin, Germany) of a 13-yr-old American female who presented in cardiogenic shock with severe systolic dysfunction while vacationing in France. Rapid hemodynamic deterioration occurred despite maximal medical treatment, and she was supported initially with extracorporeal membrane oxygenation converted to a Berlin Heart EXCOR left ventricular assist device. Long-distance air transportation of the patient was accomplished 3 wks after implantation from Marseille, France, to Denver, Colorado. No adverse hemodynamic effects were encountered during the 13.5-hr flight (8770 km). The patient did not recover sufficient cardiac function and underwent successful orthotopic heart transplantation 3 months after the initial event. Our experience suggests that long-distance air transportation of pediatric patients using the Berlin Heart EXCOR mobile unit as a bridge to recovery or transplantation is feasible and appears safe.

GenSAA: A tool for advancing satellite monitoring with graphical expert systems

NASA Technical Reports Server (NTRS)

Hughes, Peter M.; Luczak, Edward C.

1993-01-01

During numerous contacts with a satellite each day, spacecraft analysts must closely monitor real time data for combinations of telemetry parameter values, trends, and other indications that may signify a problem or failure. As satellites become more complex and the number of data items increases, this task is becoming increasingly difficult for humans to perform at acceptable performance levels. At the NASA Goddard Space Flight Center, fault-isolation expert systems have been developed to support data monitoring and fault detection tasks in satellite control centers. Based on the lessons learned during these initial efforts in expert system automation, a new domain-specific expert system development tool named the Generic Spacecraft Analyst Assistant (GenSAA) is being developed to facilitate the rapid development and reuse of real-time expert systems to serve as fault-isolation assistants for spacecraft analysts. Although initially domain-specific in nature, this powerful tool will support the development of highly graphical expert systems for data monitoring purposes throughout the space and commercial industry.

Patient Characteristics, Health Care Resource Utilization, and Costs Associated with Treatment-Regimen Failure with Biologics in the Treatment of Psoriasis.

PubMed

Foster, Shonda A; Zhu, Baojin; Guo, Jiaying; Nikai, Enkeleida; Ojeh, Clement; Malatestinic, William; Goldblum, Orin; Kornberg, Lori J; Wu, Jashin J

2016-04-01

Psoriasis is a chronic, incurable, and immune-mediated skin disorder that is characterized by erythematous scaly papules and plaques. Understanding of psoriasis at the molecular level has led to the development of biologic agents that target disease-specific inflammatory mediators in psoriatic lesions. Biologic agents have become important components of the psoriasis armamentarium, but some patients become refractory to these agents over time or fail to respond to subsequent biologics. To (a) evaluate demographic and clinical characteristics of psoriasis patients who have treatment patterns suggestive of failure to a newly initiated biologic agent (treatment-regimen failures) compared with those who do not (non-treatment-regimen failures) and (b) to assess health care-related resource utilization and costs in non-treatment-regimen failures and treatment-regimen failures. In this retrospective observational cohort study, patients were selected from the MarketScan claims database of commercially insured individuals and individuals with Medicare supplemental insurance. The index event was a newly initiated biologic agent for the treatment of psoriasis (etanercept, adalimumab, ustekinumab, or infliximab) between January 2010 and December 2011. The analysis included psoriasis patients aged ≥ 18 years with ≥ 1 prescription claim for a biologic and continuous enrollment 12 months pre- and post-index date. Patients with claims for a biologic in the pre-index period were excluded. Patients were divided into treatment-regimen-failure and non-treatment-regimen-failure groups based on their treatment patterns post-index date. The treatment-regimen-failure group included patients who switched to another biologic, discontinued the biologic without restarting, increased the dose of the biologic, or augmented treatment with a nontopical psoriasis medication during the post-index period. Between-group patient characteristics and medication use were compared using analysis of variance for continuous variables and chi-square tests for categorical variables without adjustment. Cost differences were compared using the propensity score-adjusted bin bootstrapping method. Overall, 2,146 patients met the enrollment criteria. The mean age was 45.1 years. Of these patients, 41.5% were considered treatment-regimen failures. Among treatment-regimen failures, 53% were females, and among non-treatment-regimen failures, 61% were male. Patients who experienced treatment-regimen failure had higher incidences of comorbid cerebrovascular disease, hypertension, chronic pulmonary disease, depression, and anxiety in the pre-index period and were more likely to use concomitant topicals (67.0% vs. 58.4%; P < 0.001), methotrexate (20.2% vs. 7.3%; P < 0.001), and cyclosporine (3.1% vs. 1.0%; P < 0.001) in the post-index period. Mean total all-cause health care costs were higher in patients with treatment-regimen failure versus non-treatment-regimen failure during the pre-index period ($8,024 vs. $6,637; P = 0.002), but patients with non-treatment-regimen failure had higher all-cause costs ($30,759 vs. $28,012; P = 0.002) and psoriasis-related costs ($25,286 vs. $19,625; P < 0.001) during the post-index period. The results of the current study demonstrated that psoriasis patients with treatment patterns suggestive of treatment-regimen failure on an index biologic had different characteristics and incurred higher all-cause health care costs than did patients without treatment-regimen failure during the pre-index period. This study was supported by Eli Lilly and Company. Foster, Zhu, Guo, Nikai, Malatestinic, Ojeh, and Goldblum are full-time employees and stockholders of Eli Lilly and Company. Kornberg is a full-time employee of INC Research, which was contracted by Eli Lilly to assist with medical writing. Wu has received research funding from AbbVie, Amgen, Coherus Biosciences, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, and Sandoz; he is a consultant for AbbVie, Amgen, Celgene, Dermira, DUSA Pharmaceuticals, Eli Lilly, and Pfizer. Study concept was developed by Foster, Ojeh, Malatestinic, and Goldblum. Zhu and Guo, along with Foster, took the lead in data collection, and data interpretation was performed by Nikai, Wu, and Foster, with assistance from the other authors. The manuscript was primarily written by Kornberg, along with Foster, with assistance from the other authors. All of the authors were involved with manuscript revision.

Ethical challenges of deactivation of cardiac devices in advanced heart failure.

PubMed

Chamsi-Pasha, Hassan; Chamsi-Pasha, Mohammed A; Albar, Mohammed Ali

2014-06-01

More than 23 million adults worldwide have heart failure (HF). Although survival after heart failure diagnosis has improved over time, mortality from heart failure remains high. At the end of life, the chronic HF patient often becomes increasingly symptomatic, and may have other life-limiting comorbidities as well. Multiple trials have shown a clear mortality benefit with the use of implantable cardioverter defibrillators (ICDs) in patients with cardiomyopathy and ventricular arrhythmia. However, patients who have an ICD may be denied the chance of a sudden cardiac death, and instead are committed to a slower terminal decline, with frequent DC shocks that can be painful and decrease the quality of life, greatly contributing to their distress and that of their families during this period. While patients with ICDs are routinely counseled with regard to the benefits of ICDs, they have a poor understanding of the options for device deactivation and related ethical and legal implications. Deactivating an ICD or not performing a generator change is both legal and ethical, and is supported by guidelines from both sides of the Atlantic. Patient autonomy is paramount, and no patient is committed to any therapy that they no longer wish to receive. Left ventricular assist devices (LVADs) were initially used as bridge in patients awaiting heart transplantation, but they are currently implanted as destination therapy (DT) in patients with end-stage heart failure who have failed to respond to optimal medical therapy and who are ineligible for cardiac transplantation. The decision-making process for initiation and deactivation of LVAD is becoming more and more ethically and clinically challenging, particularly for elderly patients.

Elastic Response and Failure Studies of Multi-Wall Carbon Nanotube Twisted Yarns

NASA Technical Reports Server (NTRS)

Gates, Thomas S.; Jefferson, Gail D.; Frankland, Sarah-Jane V.

2007-01-01

Experimental data on the stress-strain behavior of a polymer multiwall carbon nanotube (MWCNT) yarn composite are used to motivate an initial study in multi-scale modeling of strength and stiffness. Atomistic and continuum length scale modeling methods are outlined to illustrate the range of parameters required to accurately model behavior. The carbon nanotubes yarns are four-ply, twisted, and combined with an elastomer to form a single-layer, unidirectional composite. Due to this textile structure, the yarn is a complicated system of unique geometric relationships subjected to combined loads. Experimental data illustrate the local failure modes induced by static, tensile tests. Key structure-property relationships are highlighted at each length scale indicating opportunities for parametric studies to assist the selection of advantageous material development and manufacturing methods.

Dehumidifier assisted drying of a model fruit pulp-based gel and sensory attributes.

PubMed

Tiwari, Shipra; Ravi, Ramasamy; Bhattacharya, Suvendu

2012-07-01

Model fruit pulp-based gels were prepared by varying mango pulp (0% to 50%), sucrose (0% to 20%), and agar (1% to 3%) and according to a response surface experimental design followed by drying at a low temperature of 40 °C upto 15 h in a tray dryer assisted by a dehumidifier. The moisture content, shrinkage (SHR), and rheological parameters (failure strain, failure stress (FS), firmness, and energy for compression) were determined as a function of drying time. The composition of gel, particularly the agar content had a prominent effect on the characteristics of the dried gel. Detailed descriptive sensory analysis employing principle component analysis (PCA) biplot indicated two distinct groups of attributes; the first group comprised initial and final moisture contents, extent of moisture removal (EMR), and shrinkage. The fracture stress and energy formed the second group. The analysis of variance for failure stress showed that it depended only on the positive linear and quadratic effects of agar (significant at P ≤ 0.01 and 0.05, respectively). The theoretically predicted extent of moisture removal at 95.6% could be achieved when the level of agar was 1.2%; pulp and sucrose levels were also close to their lowest levels of 3.6% and 0.04%, respectively. Scope exists to develop gel-based fruit analogues wherein an appropriate hydrocolloid can be employed along with fruit juice/pulp. To provide a reasonable shelf-life of the developed intermediate moisture containing product, dehumidifier assisted drying is a pragmatic approach that affects sensory and rheological attributes of the dried fruit analogue. © 2012 Institute of Food Technologists®

Outcomes of patients with right ventricular failure on milrinone after left ventricular assist device implantation.

PubMed

Tsiouris, Athanasios; Paone, Gaetano; Brewer, Robert J; Nemeh, Hassan W; Borgi, Jamil; Morgan, Jeffrey A

2015-01-01

Previous studies have grouped together both patients requiring right ventricular assist devices (RVADs) with patients requiring prolonged milrinone therapy after left ventricular assist device (LVAD) implantation. We retrospectively identified 149 patients receiving LVADs and 18 (12.1%) of which developed right ventricular (RV) failure. We then separated these patients into those requiring RVADs versus prolonged milrinone therapy. This included 10 patients who were treated with prolonged milrinone and eight patients who underwent RVAD placement. Overall, the RV failure group had worse survival compared with the non-RV failure cohort (p = 0.038). However, this was only for the subgroup of patients who required RVADs, who had a 1, 6, 12, and 24 month survival of 62.5%, 37.5%, 37.5%, and 37.5%, respectively, versus 96.8%, 92.1%, 86.7%, and 84.4% for patients without RV failure (p < 0.001). Patients treated with prolonged milrinone therapy for RV failure had similar survivals compared with patients without RV failure. In the RV failure group, age, preoperative renal failure, and previous cardiac surgery were predictors of the need for prolonged postoperative milrinone. As LVADs become a more widely used therapy for patients with refractory, end-stage heart failure, it will be important to reduce the incidence of RV failure, as it yields significant morbidity and increases cost.

Computational analysis of an axial flow pediatric ventricular assist device.

PubMed

Throckmorton, Amy L; Untaroiu, Alexandrina; Allaire, Paul E; Wood, Houston G; Matherne, Gaynell Paul; Lim, David Scott; Peeler, Ben B; Olsen, Don B

2004-10-01

Longer-term (>2 weeks) mechanical circulatory support will provide an improved quality of life for thousands of pediatric cardiac failure patients per year in the United States. These pediatric patients suffer from severe congenital or acquired heart disease complicated by congestive heart failure. There are currently very few mechanical circulatory support systems available in the United States as viable options for this population. For that reason, we have designed an axial flow pediatric ventricular assist device (PVAD) with an impeller that is fully suspended by magnetic bearings. As a geometrically similar, smaller scaled version of our axial flow pump for the adult population, the PVAD has a design point of 1.5 L/min at 65 mm Hg to meet the full physiologic needs of pediatric patients. Conventional axial pump design equations and a nondimensional scaling technique were used to estimate the PVAD's initial dimensions, which allowed for the creation of computational models for performance analysis. A computational fluid dynamic analysis of the axial flow PVAD, which measures approximately 65 mm in length by 35 mm in diameter, shows that the pump will produce 1.5 L/min at 65 mm Hg for 8000 rpm. Fluid forces (approximately 1 N) were also determined for the suspension and motor design, and scalar stress values remained below 350 Pa with maximum particle residence times of approximately 0.08 milliseconds in the pump. This initial design demonstrated acceptable performance, thereby encouraging prototype manufacturing for experimental validation.

Microstructural characterization of hydrogen induced cracking in TRIP-assisted steel by EBSD

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

Laureys, A., E-mail: Aurelie.Laureys@UGent.be; Depover, T.; Petrov, R.

2016-02-15

The present work evaluates hydrogen induced cracking by performing an elaborate EBSD (Electron BackScatter Diffraction) study in a steel with transformation induced plasticity (TRIP-assisted steel). This type of steel exhibits a multiphase microstructure which undergoes a deformation induced phase transformation. Additionally, each microstructural constituent displays a different behavior in the presence of hydrogen. The aim of this study is to obtain a better understanding on the mechanisms governing hydrogen induced crack initiation and propagation in the hydrogen saturated multiphase structure. Tensile tests on notched samples combined with in-situ electrochemical hydrogen charging were conducted. The tests were interrupted at stresses justmore » after reaching the tensile strength, i.e. before macroscopic failure of the material. This allowed to study hydrogen induced crack initiation and propagation by SEM (Scanning Electron Microscopy) and EBSD. A correlation was found between the presence of martensite, which is known to be very susceptible to hydrogen embrittlement, and the initiation of hydrogen induced cracks. Initiation seems to occur mostly by martensite decohesion. High strain regions surrounding the hydrogen induced crack tips indicate that further crack propagation may have occurred by the HELP (hydrogen-enhanced localized plasticity) mechanism. Small hydrogen induced cracks located nearby the notch are typically S-shaped and crack propagation was dominantly transgranularly. The second stage of crack propagation consists of stepwise cracking by coalescence of small hydrogen induced cracks. - Highlights: • Hydrogen induced cracking in TRIP-assisted steel is evaluated by EBSD. • Tensile tests were conducted on notched hydrogen saturated samples. • Crack initiation occurs by a H-Enhanced Interface DEcohesion (HEIDE) mechanism. • Crack propagation involves growth and coalescence of small cracks. • Propagation is governed by the characteristics of phases on the crack path.« less

Towards a Personal Health Management Assistant.

PubMed

Ferguson, G; Quinn, J; Horwitz, C; Swift, M; Allen, J; Galescu, L

2010-10-01

We describe design and prototyping efforts for a Personal Health Management Assistant for heart failure patients as part of Project HealthDesign. An assistant is more than simply an application. An assistant understands what its users need to do, interacts naturally with them, reacts to what they say and do, and is proactive in helping them manage their health. In this project, we focused on heart failure, which is not only a prevalent and economically significant disease, but also one that is very amenable to self-care. Working with patients, and building on our prior experience with conversational assistants, we designed and developed a prototype system that helps heart failure patients record objective and subjective observations using spoken natural language conversation. Our experience suggests that it is feasible to build such systems and that patients would use them. The system is designed to support rapid application to other self-care settings. Copyright © 2010 Elsevier Inc. All rights reserved.

A retrospective survey of the causes of bracket- and tube-bonding failures.

PubMed

Roelofs, Tom; Merkens, Nico; Roelofs, Jeroen; Bronkhorst, Ewald; Breuning, Hero

2017-01-01

To investigate the causes of bonding failures of orthodontic brackets and tubes and the effect of premedicating for saliva reduction. Premedication with atropine sulfate was administered randomly. Failure rate of brackets and tubes placed in a group of 158 consecutive patients was evaluated after a mean period of 67 weeks after bonding. The failure rate in the group without atropine sulfate premedication was 2.4%. In the group with premedication, the failure rate was 2.7%. The Cox regression analysis of these groups showed that atropine application did not lead to a reduction in bond failures. Statistically significant differences in the hazard ratio were found for the bracket regions and for the dental assistants who prepared for the bonding procedure. Premedication did not lead to fewer bracket failures. The roles of the dental assistant and patient in preventing failures was relevant. A significantly higher failure rate for orthodontic appliances was found in the posterior regions.

44 CFR 5.29 - Effect of failure to make information materials available.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Effect of failure to make information materials available. 5.29 Section 5.29 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL PRODUCTION OR DISCLOSURE OF INFORMATION...

Intraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation.

PubMed

Silverton, Natalie A; Patel, Ravi; Zimmerman, Josh; Ma, Jianing; Stoddard, Greg; Selzman, Craig; Morrissey, Candice K

2018-02-15

To determine whether intraoperative measures of right ventricular (RV) function using transesophageal echocardiography are associated with subsequent RV failure after left ventricular assist device (LVAD) implantation. Retrospective, nonrandomized, observational study. Single tertiary-level, university-affiliated hospital. The study comprised 100 patients with systolic heart failure undergoing elective LVAD implantation. Transesophageal echocardiographic images before and after cardiopulmonary bypass were analyzed to quantify RV function using tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), fractional area change (FAC), RV global longitudinal strain, and RV free wall strain. A chart review was performed to determine which patients subsequently developed RV failure (right ventricular assist device placement or prolonged inotrope requirement ≥14 days). Nineteen patients (19%) subsequently developed RV failure. Postbypass FAC was the only measure of RV function that distinguished between the RV failure and non-RV failure groups (21.2% v 26.5%; p = 0.04). The sensitivity, specificity, and area under the curve of an abnormal RV FAC (<35%) for RV failure after LVAD implantation were 84%, 20%, and 0.52, respectively. No other intraoperative measure of RV function was associated with subsequent RV failure. RV failure increased ventilator time, intensive care unit and hospital length of stay, and mortality. Intraoperative measures of RV function such as tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and RV strain were not associated with RV failure after LVAD implantation. Decreased postbypass FAC was significantly associated with RV failure but showed poor discrimination. Copyright © 2018 Elsevier Inc. All rights reserved.

Big Data Analysis of Manufacturing Processes

NASA Astrophysics Data System (ADS)

Windmann, Stefan; Maier, Alexander; Niggemann, Oliver; Frey, Christian; Bernardi, Ansgar; Gu, Ying; Pfrommer, Holger; Steckel, Thilo; Krüger, Michael; Kraus, Robert

2015-11-01

The high complexity of manufacturing processes and the continuously growing amount of data lead to excessive demands on the users with respect to process monitoring, data analysis and fault detection. For these reasons, problems and faults are often detected too late, maintenance intervals are chosen too short and optimization potential for higher output and increased energy efficiency is not sufficiently used. A possibility to cope with these challenges is the development of self-learning assistance systems, which identify relevant relationships by observation of complex manufacturing processes so that failures, anomalies and need for optimization are automatically detected. The assistance system developed in the present work accomplishes data acquisition, process monitoring and anomaly detection in industrial and agricultural processes. The assistance system is evaluated in three application cases: Large distillation columns, agricultural harvesting processes and large-scale sorting plants. In this paper, the developed infrastructures for data acquisition in these application cases are described as well as the developed algorithms and initial evaluation results.

Recovery of Serum Cholesterol Predicts Survival After Left Ventricular Assist Device Implantation

PubMed Central

Vest, Amanda R.; Kennel, Peter J.; Maldonado, Dawn; Young, James B.; Mountis, Maria M.; Naka, Yoshifumi; Colombo, Paolo C.; Mancini, Donna M.; Starling, Randall C.; Schulze, P. Christian

2017-01-01

Background Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. Methods and Results A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125–150 mg/dL, 67–85 mg/dL, 32–42 mg/dL, and 97–126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212–0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092–0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. Conclusions Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support. PMID:27623768

Successful weaning of a left ventricular assist device implanted for ischemic heart failure.

PubMed

Beurtheret, Sylvain; Mordant, Pierre; Pavie, Alain; Leprince, Pascal

2010-10-01

We report the case of a patient stabilized under extra-corporeal membrane oxygenation after a refractory cardiogenic shock following myocardial infarction. Persistent left ventricular failure required secondary implantation of the left ventricular assist device (LVAD) HeartMate II. LVAD succeeded in the gradual recovery of myocardial contractility, allowing weaning of the device five months after implantation. Simultaneously, the patient beneficiated from coronary revascularization and resumed normal activity. This case emphasizes potential late recoveries after myocardial infarction complicated by left ventricular failure.

State-of-the-art implantable cardiac assist device therapy for heart failure: bridge to transplant and destination therapy.

PubMed

Park, S J; Kushwaha, S S; McGregor, C G A

2012-01-01

Congestive heart failure is associated with poor quality of life (QoL) and low survival rates. The development of state-of-the-art cardiac devices holds promise for improved therapy in patients with heart failure. The field of implantable cardiac assist devices is changing rapidly with the emergence of continuous-flow pumps (CFPs). The important developments in this field, including pertinent clinical trials, registry reports, innovative research, and potential future directions are discussed in this paper.

Ventricular assist devices in pediatrics

PubMed Central

Fuchs, A; Netz, H

2001-01-01

The implantation of a mechanical circulatory device for end-stage ventricular failure is a possible therapeutic approach in adult and pediatric cardiac surgery and cardiology. The aim of this article is to present mechanical circulatory assist devices used in infants and children with special emphasis on extracorporeal membrane oxygenation, Berlin Heart assist device, centrifugal pump and Medos assist device. The success of long-term support with implantable ventricular assist devices in adults and children has led to their increasing use as a bridge to transplantation in patients with otherwise non-treatable left ventricular failure, by transforming a terminal phase heart condition into a treatable cardiopathy. Such therapy allows rehabilitation of patients before elective cardiac transplantation (by removing contraindications to transplantation mainly represented by organ impairment) or acting as a bridge to recovery of the native left ventricular function (depending on underlying cardiac disease). Treatment may also involve permanent device implantation when cardiac transplantation is contraindicated. Indications for the implantation of assisted circulation include all states of cardiac failure that are reversible within a variable period of time or that require heart transplantation. This article will address the current status of ventricular assist devices by examining historical aspects of its development, current technical issues and clinical features of pediatric ventricular assist devices, including indications and contraindications for support. PMID:22368605

Insomnia Self-Management in Heart Failure

ClinicalTrials.gov

2018-01-05

Cardiac Failure; Heart Failure; Congestive Heart Failure; Heart Failure, Congestive; Sleep Initiation and Maintenance Disorders; Chronic Insomnia; Disorders of Initiating and Maintaining Sleep; Fatigue; Pain; Depressive Symptoms; Sleep Disorders; Anxiety

Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies.

PubMed

Zorn, Kevin C; Gofrit, Ofer N; Orvieto, Marcelo A; Mikhail, Albert A; Galocy, R Matthew; Shalhav, Arieh L; Zagaja, Gregory P

2007-11-01

Previous reports have suggested that a 2% to 5% device failure rate (FR) be quoted when counseling patients about robot-assisted laparoscopic radical prostatectomy (RLRP). We sought to evaluate our FR on the da Vinci system. Since February 2003, more than 800 RLRPs have been performed at our institution using a single three-armed robotic unit. A prospective database was analyzed to determine the device FR and whether it resulted in case abortion or open conversion. Intuitive Surgical Systems provided data concerning the system's performance, including its fault rate. Error messages were classified as recoverable and non-recoverable faults. Between February 2003 and November 2006, 725 RLRP cases were available for evaluation. There were no intraoperative device failures that resulted in a case conversion. Technical errors resulting in surgeon handicap occurred in 3 cases (0.4%). Four patients (0.5%) had their procedures aborted secondary to system failure at initial set-up prior to patient entrance to the operating room. Data analysis retrieved from the da Vinci console reported on a total of 807 procedures since 2003. Only 4 cases (0.4%) were reported from the Intuitive Surgical database to result in either an aborted or a converted case, which compares favorably with our results. Since the last computer system upgrade (September 2005), the mean recoverable and non-recoverable fault rates per procedure were 0.21 and 0.05, respectively. For all the advanced features the da Vinci system offers, it is surprisingly reliable. Throughout our RLRP experience, device failure resulted in case conversion, procedure abortion, and surgeon handicap in 0, 0.5%, and 0.4% of procedures, respectively. As such, a lowered device FR of 0.5% should be used when counseling patients undergoing RLRP. To avoid futile general anesthesia, a policy should be enforced to ensure that the da Vinci system is completely set up before the patient enters the operating room.

Surrogate losses: Understandings of pregnancy loss and assisted reproduction among surrogate mothers.

PubMed

Berend, Zsuzsa

2010-06-01

I explore surrogate mothers' narrative construction of pregnancy loss on surrogacy support websites. Communicating via the Internet, women construct the public online world of surrogacy. Drawing on anthropological and sociological literature I investigate the connections between conceptualizations of loss and understandings of technological practices and the consequences of these understandings for assisted reproduction. Surrogate mothers define loss broadly, ranging from failure to conceive to miscarriage and stillbirth; loss means the failure to give a baby to the intended parents. Assisted reproductive technologies contribute to loss by raising expectations of success, by attempting to maximize results through the transfer of multiple fertilized ova, and by early monitoring and testing. However, surrogates collectively understand technology as a positive force and advocate for reproductive technology. Surrogates' resolve to "give the gift of life" makes them vulnerable to failure and loss, yet also informs repeated efforts to bear children for others with technological assistance.

Application of failure mode and effect analysis in an assisted reproduction technology laboratory.

PubMed

Intra, Giulia; Alteri, Alessandra; Corti, Laura; Rabellotti, Elisa; Papaleo, Enrico; Restelli, Liliana; Biondo, Stefania; Garancini, Maria Paola; Candiani, Massimo; Viganò, Paola

2016-08-01

Assisted reproduction technology laboratories have a very high degree of complexity. Mismatches of gametes or embryos can occur, with catastrophic consequences for patients. To minimize the risk of error, a multi-institutional working group applied failure mode and effects analysis (FMEA) to each critical activity/step as a method of risk assessment. This analysis led to the identification of the potential failure modes, together with their causes and effects, using the risk priority number (RPN) scoring system. In total, 11 individual steps and 68 different potential failure modes were identified. The highest ranked failure modes, with an RPN score of 25, encompassed 17 failures and pertained to "patient mismatch" and "biological sample mismatch". The maximum reduction in risk, with RPN reduced from 25 to 5, was mostly related to the introduction of witnessing. The critical failure modes in sample processing were improved by 50% in the RPN by focusing on staff training. Three indicators of FMEA success, based on technical skill, competence and traceability, have been evaluated after FMEA implementation. Witnessing by a second human operator should be introduced in the laboratory to avoid sample mix-ups. These findings confirm that FMEA can effectively reduce errors in assisted reproduction technology laboratories. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Molecular diagnostic testing for primary biliary cholangitis.

PubMed

Gatselis, Nikolaos K; Dalekos, George N

2016-09-01

A reliable liver autoimmune serology for the diagnosis of primary biliary cholangitis (PBC) is of particular importance. Recognition of patients at early stages and prompt treatment initiation may alter the outcome, slow progression, delays liver failure, and improves survival. In this review, we summarize and discuss the published data obtained from literature searches from PubMed and The National Library of Medicine (USA) and our own experience on the current and potential molecular based approaches to the diagnosis of PBC. Expert commentary: Standardization of liver diagnostic serology and clinical governance are two major points as antimitochondrial antibodies are the diagnostic hallmark of the disease and PBC-specific antinuclear antibodies could assist in the diagnosis and estimation of prognosis. New biomarkers such as novel autoantibodies, genetic polymorphisms, metabolomic profiling, micro-RNA and epigenetics may assist to the understanding, diagnosis and management of the disease.

Failure Modes and Effects Analysis (FMEA) Assistant Tool Feasibility Study

NASA Technical Reports Server (NTRS)

Flores, Melissa; Malin, Jane T.

2013-01-01

An effort to determine the feasibility of a software tool to assist in Failure Modes and Effects Analysis (FMEA) has been completed. This new and unique approach to FMEA uses model based systems engineering concepts to recommend failure modes, causes, and effects to the user after they have made several selections from pick lists about a component s functions and inputs/outputs. Recommendations are made based on a library using common failure modes identified over the course of several major human spaceflight programs. However, the tool could be adapted for use in a wide range of applications from NASA to the energy industry.

New therapy, new challenges: The effects of long-term continuous flow left ventricular assist device on inflammation.

PubMed

Grosman-Rimon, Liza; Billia, Filio; Fuks, Avi; Jacobs, Ira; A McDonald, Michael; Cherney, David Z; Rao, Vivek

2016-07-15

Surgically implanted continuous flow left ventricular assist devices (CF-LVADs) are currently used in patients with end-stage heart failure (HF). However, CF-LVAD therapy introduces a new set of complications and adverse events in these patients. Major adverse events with the CF-LVAD include right heart failure, vascular dysfunction, stroke, hepatic failure, and multi-organ failure, complications that may have inflammation as a common etiology. Our aim was to review the current evidence showing a relationship between these adverse events and elevated levels of inflammatory biomarkers in CF-LVAD recipients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Failure Modes and Effects Analysis (FMEA) Assistant Tool Feasibility Study

NASA Astrophysics Data System (ADS)

Flores, Melissa D.; Malin, Jane T.; Fleming, Land D.

2013-09-01

An effort to determine the feasibility of a software tool to assist in Failure Modes and Effects Analysis (FMEA) has been completed. This new and unique approach to FMEA uses model based systems engineering concepts to recommend failure modes, causes, and effects to the user after they have made several selections from pick lists about a component's functions and inputs/outputs. Recommendations are made based on a library using common failure modes identified over the course of several major human spaceflight programs. However, the tool could be adapted for use in a wide range of applications from NASA to the energy industry.

24 CFR 235.361 - Recovery of assistance payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... or failure to meet contractual obligations, on the part of the mortgagee. (b) The mortgagee shall... where the overpayment resulted from fraud, misrepresentation or failure to meet contractual obligations... contractual obligations means failure to request a required recertification or failure to act on a...

Percutaneous Ventricular Assist Devices: New Deus Ex Machina?

PubMed Central

Arroyo, Diego; Cook, Stéphane

2011-01-01

The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support. PMID:22091361

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

Sattison, M.B.; Blackman, H.S.; Novack, S.D.

The Office for Analysis and Evaluation of Operational Data (AEOD) has sought the assistance of the Idaho National Engineering Laboratory (INEL) to make some significant enhancements to the SAPHIRE-based Accident Sequence Precursor (ASP) models recently developed by the INEL. The challenge of this project is to provide the features of a full-scale PRA within the framework of the simplified ASP models. Some of these features include: (1) uncertainty analysis addressing the standard PRA uncertainties and the uncertainties unique to the ASP models and methods, (2) incorporation and proper quantification of individual human actions and the interaction among human actions, (3)more » enhanced treatment of common cause failures, and (4) extension of the ASP models to more closely mimic full-scale PRAs (inclusion of more initiators, explicitly modeling support system failures, etc.). This paper provides an overview of the methods being used to make the above improvements.« less

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

Sattison, M.B.; Blackman, H.S.; Novack, S.D.

The Office for Analysis and Evaluation of Operational Data (AEOD) has sought the assistance of the Idaho National Engineering Laboratory (INEL) to make some significant enhancements to the SAPHIRE-based Accident Sequence Precursor (ASP) models recently developed by the INEL. The challenge of this project is to provide the features of a full-scale PRA within the framework of the simplified ASP models. Some of these features include: (1) uncertainty analysis addressing the standard PRA uncertainties and the uncertainties unique to the ASP models and methodology, (2) incorporation and proper quantification of individual human actions and the interaction among human actions, (3)more » enhanced treatment of common cause failures, and (4) extension of the ASP models to more closely mimic full-scale PRAs (inclusion of more initiators, explicitly modeling support system failures, etc.). This paper provides an overview of the methods being used to make the above improvements.« less

Dyspnoea, cyanosis and digital clubbing in a 28-year-old patient as a result of hepatopulmonary syndrome.

PubMed

Zieliński, Michał; Hartleb, Marek; Sitek, Piotr; Ziora, Dariusz

2017-01-01

This paper presents a case of a young patient with cyanosis and digital clubbing, until then an active, sporty person. He sought medical assistance due to the growing dyspnoea and the drop of effort tolerance. Initially the diagnostic process focused on the confirmation of the suspicion of pulmonary fibrosis or another interstitial lung disease as causes of the respiratory failure. Due to the atypical presentation of the symptoms, reaching the final diagnosis of digestive system disease with lung involvement required a more thorough multifaceted diagnostics of a number of systems and organs.

[Assisted hatching following embryo implantation failure].

PubMed

Carballo Mondragón, Esperanza; Durán Monterrosas, Leonor; Campos Cañas, Jorge A; González de Jesús, Patricia; Kably Ambe, Alberto

2012-08-01

Assisted hatching in reproduction techniques has improved the successful implantation rates in certain groups of patients with poor prognosis. This study focuses on its effect in groups of patients with previous implantation failure and according to age groups. Compare the pregnancy rates of patients who turned to this technique following an implantation failure using in vitro fertilization with those of patients who did not use assisted hatching before another attempt of in vitro fertilization and according to specific age groups. Cases of patients using assisted hatching in our Center between January 2008 and December 2009 were studied. The results were compared in terms of age in three groups: group I, >35 years; group II, 35-39 years, and group III, > 40 years. Patients in group II had better pregnancy rate (30%) than those in groups I and III (16.98 and 20.83%, respectively). When comparing the results of the group of patients using assisted hatching with those of the group that did not, the first reported a 20% pregnancy rate versus no pregnancy in the other group.

Graphical Displays Assist In Analysis Of Failures

NASA Technical Reports Server (NTRS)

Pack, Ginger; Wadsworth, David; Razavipour, Reza

1995-01-01

Failure Environment Analysis Tool (FEAT) computer program enables people to see and better understand effects of failures in system. Uses digraph models to determine what will happen to system if set of failure events occurs and to identify possible causes of selected set of failures. Digraphs or engineering schematics used. Also used in operations to help identify causes of failures after they occur. Written in C language.

Long-term Outcome of Patients With Undiagnosed Pleural Effusion.

PubMed

Gunluoglu, Gulsah; Olcmen, Aysun; Gunluoglu, Mehmet Zeki; Dincer, Ibrahim; Sayar, Adnan; Camsari, Gungor; Yilmaz, Veysel; Altin, Sedat

2015-12-01

The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively). Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Uncommon but devastating event: total fertilisation failure following intracytoplasmic sperm injection.

PubMed

Goksan Pabuccu, E; Sinem Caglar, G; Dogus Demirkiran, O; Pabuccu, R

2016-03-01

Fertilisation with intracytoplasmic sperm injection (ICSI) is a consequence of complex molecular interactions between spermatozoon and oocyte. Disruption of the process obviously prompts a frustrating event called total fertilisation failure (TFF). Up to 3% of ICSI cycles may result in TFF, and brief counselling for subsequent cycle management is indispensable. Within this perspective, ICSI cycles of a centre over a 10-year period were analysed to document TFF cases. Initial TFF after ICSI and subsequent ICSI cycle of the same cases were documented to clarify predictive factors of successful outcomes after initial TFF. In subsequent cycles, assisted oocyte activation (AOA) with calcium ionophore and Hypo-osmotic swelling test (HOST)/pentoxifilline for sperm selection was used. In the current analysis, successful fertilisation was achieved in 85% of the cases with previous TFF. The significant contributing factors for successful fertilisation in the latter cycle were: improved oocyte quantity and better sperm morphology. In conclusion, sporadic TFF event in the first and only cycle is usually a technically modifiable condition, but repeated TFF could indicate possible gamete defects, which might not be overcomed in the next modified ICSI cycle. © 2015 Blackwell Verlag GmbH.

[Ventilatory dysfunction in motor neuron disease: when and how to act?].

PubMed

Rocha, J Afonso; Miranda, M J

2007-01-01

Amyotrophic lateral sclerosis is a devastating progressive neurodegenerative disorder, involving motor neurons in the cerebral cortex, brainstem and spinal cord. Mean duration of survival from the time of diagnosis is around 15 months, being pulmonary complications and respiratory failure responsible for more than 85% of deaths. Albeit the inevitability of respiratory failure and short-term death, standardized intervention protocols have been shown to significantly delay the need for invasive ventilatory support, thus prolonging survival and enhancing quality of life. The authors present an intervention protocol based on clinical progression and respiratory parameters. Decisions regarding initiation of non-invasive positive pressure ventilation (NIPPV) and mechanically assisted coughing, depend on development of symptoms of hypoventilation and on objective deterioration of respiratory parameters especially in what concerns bulbar muscle function. These include maximum inspiratory capacity (MIC), difference between MIC and vital capacity (MIC-VC), and assisted peak cough flow (PCF). These standardized protocols along with patient and caregivers education, allow for improved quality of life, prolonged survival and delay or eventually prevent the need for tracheotomy and invasive ventilatory support. Supplemental oxygen should be avoided in these patients, since it precludes use of oxymetry as feedback for titrating NIPPV and MAC, and is associated with decreased ventilatory drive and aggravated hypercapnia.

Cochrane Qualitative and Implementation Methods Group guidance series-paper 4: methods for assessing evidence on intervention implementation.

PubMed

Cargo, Margaret; Harris, Janet; Pantoja, Tomas; Booth, Andrew; Harden, Angela; Hannes, Karin; Thomas, James; Flemming, Kate; Garside, Ruth; Noyes, Jane

2018-05-01

This article provides reviewers with guidance on methods for identifying and processing evidence to understand intervention implementation. Strategies, tools, and methods are applied to the systematic review process to illustrate how process and implementation can be addressed using quantitative, qualitative, and other sources of evidence (i.e., descriptive textual and nonempirical). Reviewers can take steps to navigate the heterogeneity and level of uncertainty present in the concepts, measures, and methods used to assess implementation. Activities can be undertaken in advance of a Cochrane quantitative review to develop program theory and logic models that situate implementation in the causal chain. Four search strategies are offered to retrieve process and implementation evidence. Recommendations are made for addressing rigor or risk of bias in process evaluation or implementation evidence. Strategies are recommended for locating and extracting data from primary studies. The basic logic is presented to assist reviewers to make initial review-level judgments about implementation failure and theory failure. Although strategies, tools, and methods can assist reviewers to address process and implementation using quantitative, qualitative, and other forms of evidence, few exemplar reviews exist. There is a need for further methodological development and trialing of proposed approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy.

PubMed

Smith, Brett L; Ellyson, Austin C; Kim, Won I

2018-03-01

To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results. A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modifies established techniques by replacing the initial goniotomy incision of gonioscopy-assisted transluminal trabeculotomy (GATT) with an ab interno trabeculectomy ablation utilizing the trabectome. All surgeries were performed by a single surgeon (W.I.K.) between November 2014 and October 2015 in adults with primary open-angle glaucoma. Recorded outcome measures were intraocular pressure (IOP), number of medications, and complications. Eight patients with an age range of 63-93 yr underwent TIGATT with at least 3 mo of follow-up. Five of the eight initial patients had follow-up to 2 yr. The mean pre-operative IOP was 25 mmHg (standard deviation [SD] 7.0) on four medications (SD 1.1). The mean post-operative IOP at 3 mo was 14 mmHg (SD 1.8) on two medications (SD 1.3). The average decrease in IOP was 9.9 mmHg (SD 7.5) with an average decrease in medications of two (SD 1.4) at 3 mo. At 2 yr, the mean post-operative IOP was 14 mmHg (SD 3.2) on one medication (SD 1.1). The average decrease in IOP was 7.8 mmHg (SD 3.1) with an average decrease in medications of two (SD 1.8). There were two treatment failures that required further glaucoma surgery and one patient was lost to follow-up. The preliminary results and safety profile for TIGATT are promising and appear at least comparable with previously published results for both GATT and trabectome. Initiating the transluminal trabeculotomy with trabectome clearly exposes Schlemm's canal and facilitates threading the microcatheter into the canal. Additionally, if the 360-degree trabeculotomy cannot be completed because of an incompletely patent Schlemm's canal, the patient will at least have a trabectome ablation that can serve as their glaucoma surgery.

The total artificial heart for biventricular heart failure and beyond.

PubMed

Kasirajan, Vigneshwar; Tang, Daniel G; Katlaps, Gundars J; Shah, Keyur B

2012-05-01

Treatment options for late-stage biventricular heart failure are limited but include medical therapy with intravenous inotropes, biventricular assist devices (Bi-VADs) and the total artificial heart (TAH). In this manuscript, we review the indications, surgical techniques and outcomes for the TAH. The TAH offers biventricular replacement, rather than 'assistance', as the device is placed orthotopically after excision of the entire ventricular myocardium and all four native valves. In contrast to patients with Bi-VADs, patients with the TAH have no postoperative inotrope requirements, arrhythmias or inflow/outflow cannulae-related complications. Additionally, patients participate in rehabilitation early after device placement and the development of a portable drive may facilitate hospital discharge in the USA. Furthermore, total heart replacement may be ideal for heart failure associated with unique anatomical and mechanical complications. The TAH is an effective therapeutic option for the treatment of patients dying of heart failure who may not be suitable candidates for left ventricular assist devices.

45 CFR 265.8 - Under what circumstances will we take action to impose a reporting penalty for failure to submit...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true Under what circumstances will we take action to impose a reporting penalty for failure to submit quarterly and annual reports? 265.8 Section 265.8 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES,...

Intervention Mapping Approach in the Design of an Interactive Mobile Health Application to Improve Self-care in Heart Failure.

PubMed

Athilingam, Ponrathi; Clochesy, John M; Labrador, Miguel A

2018-02-01

Heart failure is a complex syndrome among older adults who may experience and interpret symptoms differently. These differences in symptom interpretation may influence decision-making in symptom management. A well-informed and motivated person may develop the knowledge and skills needed to successfully manage symptoms. Therefore, the patient-centered mobile health application HeartMapp was designed to engage patients with heart failure in self-care management by offering tailored alerts and feedback using mobile phones. The main objective of this article is to describe the six-step intervention mapping approach including (1) the initial needs assessment, (2) proximal program objective, (3) selection of theory-based methods, (4) the translation of objectives into an actual program plan for mobile health intervention, (5) adaptation and implementation plan, and (6) evaluation plan that assisted the team in the development of a conceptual framework and intervention program matrix during the development of HeartMapp. The HeartMapp intervention takes the information, motivation, and behavioral skills model as the theoretical underpinning, with "patient engagement" as the key mediator in achieving targeted and persistent self-care behavioral changes in patients with heart failure. The HeartMapp intervention is proposed to improve self-care management and long-term outcomes.

Role of HIV Infection Duration and CD4 Cell Level at Initiation of Combination Anti-Retroviral Therapy on Risk of Failure

PubMed Central

Lodi, Sara; Phillips, Andrew; Fidler, Sarah; Hawkins, David; Gilson, Richard; McLean, Ken; Fisher, Martin; Post, Frank; Johnson, Anne M.; Walker-Nthenda, Louise; Dunn, David; Porter, Kholoud

2013-01-01

Background The development of HIV drug resistance and subsequent virological failure are often cited as potential disadvantages of early cART initiation. However, their long-term probability is not known, and neither is the role of duration of infection at the time of initiation. Methods Patients enrolled in the UK Register of HIV seroconverters were followed-up from cART initiation to last HIV-RNA measurement. Through survival analysis we examined predictors of virologic failure (2HIV-RNA ≥400 c/l while on cART) including CD4 count and HIV duration at initiation. We also estimated the cumulative probabilities of failure and drug resistance (from the available HIV nucleotide sequences) for early initiators (cART within 12 months of seroconversion). Results Of 1075 starting cART at a median (IQR) CD4 count 272 (190,370) cells/mm3 and HIV duration 3 (1,6) years, virological failure occurred in 163 (15%). Higher CD4 count at initiation, but not HIV infection duration at cART initiation, was independently associated with lower risk of failure (p=0.033 and 0.592 respectively). Among 230 patients initiating cART early, 97 (42%) discontinued it after a median of 7 months; cumulative probabilities of resistance and failure by 8 years were 7% (95% CI 4,11) and 19% (13,25), respectively. Conclusion Although the rate of discontinuation of early cART in our cohort was high, the long-term rate of virological failure was low. Our data do not support early cART initiation being associated with increased risk of failure and drug resistance. PMID:24086588

Use of histamine H2 receptor antagonists and outcomes in patients with heart failure: a nationwide population-based cohort study.

PubMed

Adelborg, Kasper; Sundbøll, Jens; Schmidt, Morten; Bøtker, Hans Erik; Weiss, Noel S; Pedersen, Lars; Sørensen, Henrik Toft

2018-01-01

Histamine H 2 receptor activation promotes cardiac fibrosis and apoptosis in mice. However, the potential effectiveness of histamine H 2 receptor antagonists (H2RAs) in humans with heart failure is largely unknown. We examined the association between H2RA initiation and all-cause mortality among patients with heart failure. Using Danish medical registries, we conducted a nationwide population-based active-comparator cohort study of new users of H2RAs and proton pump inhibitors (PPIs) after first-time hospitalization for heart failure during the period 1995-2014. Hazard ratios (HRs) for all-cause mortality and hospitalization due to worsening of heart failure, adjusting for age, sex, and time between heart failure diagnosis and initiation of PPI or H2RA therapy, index year, comorbidity, cardiac surgery, comedications, and socioeconomic status were computed based on Cox regression analysis. Our analysis included 42,902 PPI initiators (median age 78 years, 46% female) and 3,296 H2RA initiators (median age 76 years, 48% female). Mortality risk was lower among H2RA initiators than PPI initiators after 1 year (26% vs 31%) and 5 years (60% vs 66%). In multivariable analyses, the 1-year HR was 0.80 (95% CI, 0.74-0.86) and the 5-year HR was 0.85 (95% CI, 0.80-0.89). These findings were consistent after propensity score matching and for ischemic and nonischemic heart failure, as for sex and age groups. The rate of hospitalization due to worsening of heart failure was lower among H2RA initiators than PPI initiators. In patients with heart failure, H2RA initiation was associated with 15%-20% lower mortality than PPI initiation.

Caed Interactions During A Product Life Cycle Oriented Towards the Decision-Making in the Design of Polymeric Elements

NASA Astrophysics Data System (ADS)

Suffo, M.

2017-08-01

In this work, we present the real case of an industrial product was placed prematurely on the market without having checked the different stages of its life cycle. This type of products must be validated by numerical methods and by mechanical tests to verify their rheological behavior. In particular, the product consists of two small pieces in contact, one made of HDPE and the other one corresponding to a stainless steel. The polymeric piece supports the metal pressure under a constant static load over time. As a result of normal operation, the polymer experienced a “crazing” breakdown, which caused the failure to occur. In the study, design methods and computer assisted analysis software (CAED) have been used. These methods were complemented by scanning electron microscopy that confirmed the initial failure hypothesis. Using the finite element method (FEM), a series of load scenarios were carried out, where the different load hypothesis the product must go through prior to its placing on the market were simulated. It is shown that the failure was initiated by stress concentration on one of the edges of the polymeric piece. The proposed solution of the problem based on the analysis focuses on a simple redesign of the piece, which should have been round, or to the reduction of the thickness of the metal piece. As a result of the alteration of its natural life cycle, the company assumed both monetary costs and the definitive loss of customer confidence.

Ultrasound-assisted oxidative desulfurization and denitrogenation of liquid hydrocarbon fuels: A critical review.

PubMed

Ja'fari, Mahsa; Ebrahimi, Seyedeh Leila; Khosravi-Nikou, Mohammad Reza

2018-01-01

Nowadays, a continuously worldwide concern for development of process to produce ultra-low sulfur and nitrogen fuels have been emerged. Typical hydrodesulfurization and hydrodenitrogenation technology deals with important difficulties such as high pressure and temperature operating condition, failure to treat some recalcitrant compounds and limitations to meet the stringent environmental regulations. In contrary an advanced oxidation process that is ultrasound assisted oxidative desulfurization and denitrogenation satisfies latest environmental regulations in much milder conditions with more efficiency. The present work deals with a comprehensive review on findings and development in the ultrasound assisted oxidative desulfurization and denitrogenation (UAOD) during the last decades. The role of individual parameters namely temperature, residence time, ultrasound power and frequency, pH, initial concentration and types of sulfur and nitrogen compounds on the efficiency are described. What's more another treatment properties that is role of phase transfer agent (PTA) and solvents of extraction step, reaction kinetics, mechanism of the ultrasound, fuel properties and recovery in UAOD are reviewed. Finally, the required future works to mature this technology are suggested. Copyright © 2017 Elsevier B.V. All rights reserved.

Using Performance Tools to Support Experiments in HPC Resilience

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

Naughton, III, Thomas J; Boehm, Swen; Engelmann, Christian

2014-01-01

The high performance computing (HPC) community is working to address fault tolerance and resilience concerns for current and future large scale computing platforms. This is driving enhancements in the programming environ- ments, specifically research on enhancing message passing libraries to support fault tolerant computing capabilities. The community has also recognized that tools for resilience experimentation are greatly lacking. However, we argue that there are several parallels between performance tools and resilience tools . As such, we believe the rich set of HPC performance-focused tools can be extended (repurposed) to benefit the resilience community. In this paper, we describe the initialmore » motivation to leverage standard HPC per- formance analysis techniques to aid in developing diagnostic tools to assist fault tolerance experiments for HPC applications. These diagnosis procedures help to provide context for the system when the errors (failures) occurred. We describe our initial work in leveraging an MPI performance trace tool to assist in provid- ing global context during fault injection experiments. Such tools will assist the HPC resilience community as they extend existing and new application codes to support fault tolerances.« less

Effects of physical guidance on short-term learning of walking on a narrow beam.

PubMed

Domingo, Antoinette; Ferris, Daniel P

2009-11-01

Physical guidance is often used in rehabilitation when teaching patients to re-learn movements. However, the effects of guidance on motor learning of complex skills, such as walking balance, are not clear. We tested four groups of healthy subjects that practiced walking on a narrow (1.27 cm) or wide (2.5 cm) treadmill-mounted balance beam, with or without physical guidance. Assistance was given by springs attached to a hip belt that applied restoring forces towards beam center. Subjects were evaluated while walking unassisted before and after training by calculating the number of times subjects stepped off of the beam per minute of successful walking on the beam (Failures per Minute). Subjects in Unassisted groups had greater performance improvements in walking balance from pre to post compared to subjects in Assisted groups. During training, Unassisted groups had more Failures per Minute than Assisted groups. Performance improvements were smaller in Narrow Beam groups than in Wide Beam groups. The Unassisted-Wide and Assisted-Narrow groups had similar Failures per Minute during training, but the Unassisted-Wide group had much greater performance gains after training. These results suggest that physical assistance can hinder motor learning of walking balance, assistance appears less detrimental for more difficult tasks, and task-specific dynamics are important to learning independent of error experience.

On bioartificial liver assist system: theoretical exploration and strategies for further development.

PubMed

Shi, Q

2000-11-01

The major difficulty in establishing a clinical effective bioartificial liver assist device for treatment of fulminate hepatic failure is limitation of our knowledge and technologies about fresh cell behaviors in culture and a lack of knowledge about the etiology and pathogenesis of hepatic coma. Increasing data from clinical and laboratory investigation have accrued indicating that toxins from necrotic liver tissue, mainly as oxygen reactive substances, have a role in the pathogenesis of hepatic encephalopathy and even multiple system organs failure. This paper presents the data available and suggests a new pathway for artificial and bioartificial liver assist system.

Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement

PubMed Central

Panholzer, Bernd; Cremer, Jochen; Haneya, Assad

2018-01-01

Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed. PMID:29552039

Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement.

PubMed

Huenges, Katharina; Panholzer, Bernd; Cremer, Jochen; Haneya, Assad

2018-01-01

Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed.

Implications of the Failure of the Higher Education Assistance Foundation. Hearing before the Committee on Banking, Housing, and Urban Affairs. United States Senate, One Hundred First Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Banking, Housing and Urban Affairs.

This hearing before the Committee on Banking, Housing, and Urban Affairs, addresses the implications of the anticipated failure of the Higher Education Assistance Foundation (HEAF), the largest guarantor of student loans. HEAF's difficulties have affected Sallie Mae (Student Loan Marketing Association), and have raised general questions about the…

45 CFR 260.58 - What penalty relief is available to a State whose failure to meet the work participation rates is...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false What penalty relief is available to a State whose failure to meet the work participation rates is attributable to providing federally recognized good cause domestic violence waivers? 260.58 Section 260.58 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE...

Pediatric experience with the VentrAssist LVAD.

PubMed

Ruygrok, Peter N; Esmore, Don S; Alison, Peter M; Finucane, Kirsten A; McGuinness, Shay P; McGeorge, Alastair D; Negri, Justin; Jones, Kylie; Gibbs, Helen C

2008-08-01

The purpose of this study is to describe the first experience of implanting a new left ventricular assist device in pediatric patients with end-stage heart failure. In two recent prospective, international, multicenter clinical trials, three children (aged

Efficient 3-D finite element failure analysis of compression loaded angle-ply plates with holes

NASA Technical Reports Server (NTRS)

Burns, S. W.; Herakovich, C. T.; Williams, J. G.

1987-01-01

Finite element stress analysis and the tensor polynomial failure criterion predict that failure always initiates at the interface between layers on the hole edge for notched angle-ply laminates loaded in compression. The angular location of initial failure is a function of the fiber orientation in the laminate. The dominant stress components initiating failure are shear. It is shown that approximate symmetry can be used to reduce the computer resources required for the case of unaxial loading.

Factors Influencing Progressive Failure Analysis Predictions for Laminated Composite Structure

NASA Technical Reports Server (NTRS)

Knight, Norman F., Jr.

2008-01-01

Progressive failure material modeling methods used for structural analysis including failure initiation and material degradation are presented. Different failure initiation criteria and material degradation models are described that define progressive failure formulations. These progressive failure formulations are implemented in a user-defined material model for use with a nonlinear finite element analysis tool. The failure initiation criteria include the maximum stress criteria, maximum strain criteria, the Tsai-Wu failure polynomial, and the Hashin criteria. The material degradation model is based on the ply-discounting approach where the local material constitutive coefficients are degraded. Applications and extensions of the progressive failure analysis material model address two-dimensional plate and shell finite elements and three-dimensional solid finite elements. Implementation details are described in the present paper. Parametric studies for laminated composite structures are discussed to illustrate the features of the progressive failure modeling methods that have been implemented and to demonstrate their influence on progressive failure analysis predictions.

The National Heart Failure Project: a health care financing administration initiative to improve the care of Medicare beneficiaries with heart failure.

PubMed

Masoudi, F A; Ordin, D L; Delaney, R J; Krumholz, H M; Havranek, E P

2000-01-01

This is the second in a series describing Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first article outlined the history of HCFA quality-improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. This article details the objectives and design of the Medicare National Heart Failure Quality Improvement Project (NHF), which has as its goal the improvement of inpatient heart failure care. (c)2000 by CHF, Inc.

Effect of enzyme replacement therapy with alglucosidase alfa (Myozyme®) in 12 patients with advanced late-onset Pompe disease.

PubMed

Papadopoulos, Constantinos; Orlikowski, David; Prigent, Hélène; Lacour, Arnaud; Tard, Céline; Furby, Alain; Praline, Julien; Solé, Guilhem; Hogrel, Jean-Yves; De Antonio, Marie; Semplicini, Claudio; Deibener-Kaminsky, Joelle; Kaminsky, Pierre; Eymard, Bruno; Taouagh, Nadjib; Perniconi, Barbara; Hamroun, Dalil; Laforêt, Pascal

2017-09-01

The efficacy of enzyme replacement therapy (ERT) in patients at an advanced stage of Pompe disease has only been addressed in a few studies. Our objective was to assess the long term effects of ERT in a cohort of patients with severe Pompe disease. We identified patients from the French Pompe Registry with severe respiratory failure and permanent wheelchair use (assisted walk for a few meters was allowed) when starting ERT. Patients' medical records were collected and reviewed and respiratory and motor functions, before ERT initiation and upon last evaluation were compared. Twelve patients (7 males) were identified. Median age at symptom onset was 24years [IQR=15.5; 36.0]. At baseline ventilation was invasive in 11 patients and noninvasive in one, with a median ventilation time of 24h [IQR=21.88; 24.00] (min 20; max 24). ERT was initiated at a median age of 52.5years [IQR=35.75; 66.50]. Median treatment duration was 55months [IQR=39.5; 81.0]. During observational period no adverse reaction to ERT was recorded, five patients (41.67%) died, three decreased their ventilation time by 30, 60 and 90min and two increased their assisted walking distance, by 80 and 20m. Some patients at a very advanced stage of Pompe disease may show a mild benefit from ERT, in terms of increased time of autonomous ventilation and of enlarged distance in assisted walk. ERT can be initiated in these patients in order to retain their current level of independence and ability to perform daily life activities. Copyright © 2017 Elsevier Inc. All rights reserved.

Rat Bite Fever and Streptobacillus moniliformis

PubMed Central

Elliott, Sean P.

2007-01-01

Rat bite fever, caused by Streptobacillus moniliformis, is a systemic illness classically characterized by fever, rigors, and polyarthralgias. If left untreated, it carries a mortality rate of 10%. Unfortunately, its nonspecific initial presentation combined with difficulties in culturing its causative organism produces a significant risk of delay or failure in diagnosis. The increasing popularity of rats and other rodents as pets, together with the risk of invasive or fatal disease, demands increased attention to rat bite fever as a potential diagnosis. The clinical and biological features of rat bite fever and Streptobacillus moniliformis are reviewed, providing some distinguishing features to assist the clinician and microbiologist in diagnosis. PMID:17223620

Machines versus medication for biventricular heart failure: focus on the total artificial heart.

PubMed

Arabia, Francisco A; Moriguchi, Jaime D

2014-09-01

The medical/surgical management of advanced heart failure has evolved rapidly over the last few decades. With better understanding of heart failure pathophysiology, new pharmacological agents have been introduced that have resulted in improvements in survival. For those patients that fail to improve, mechanical circulatory support with left ventricular assist devices and total artificial hearts (TAHs) have served as a beneficial bridge to transplantation. The TAH has continued to play a significant role as a bridge to transplantation in patients with biventricular failure and more selected indications that could not be completely helped with left ventricular assist devices. Improved survival with the TAH has resulted in more patients benefiting from this technology. Improvements will eventually lead to a totally implantable device that will permanently replace the failing human heart.

Left ventricular assist device management in patients chronically supported for advanced heart failure.

PubMed

Cowger, Jennifer; Romano, Matthew A; Stulak, John; Pagani, Francis D; Aaronson, Keith D

2011-03-01

This review summarizes management strategies to reduce morbidity and mortality in heart failure patients supported chronically with implantable left ventricular assist devices (LVADs). As the population of patients supported with long-term LVADs has grown, patient selection, operative technique, and patient management strategies have been refined, leading to improved outcomes. This review summarizes recent findings on LVAD candidate selection, and discusses outpatient strategies to optimize device performance and heart failure management. It also reviews important device complications that warrant close outpatient monitoring. Managing patients on chronic LVAD support requires regular patient follow-up, multidisciplinary care teams, and frequent laboratory and echocardiographic surveillance to ensure optimal outcomes.

The pathophysiology of heart failure.

PubMed

Kemp, Clinton D; Conte, John V

2012-01-01

Heart failure is a clinical syndrome that results when the heart is unable to provide sufficient blood flow to meet metabolic requirements or accommodate systemic venous return. This common condition affects over 5 million people in the United States at a cost of $10-38 billion per year. Heart failure results from injury to the myocardium from a variety of causes including ischemic heart disease, hypertension, and diabetes. Less common etiologies include cardiomyopathies, valvular disease, myocarditis, infections, systemic toxins, and cardiotoxic drugs. As the heart fails, patients develop symptoms which include dyspnea from pulmonary congestion, and peripheral edema and ascites from impaired venous return. Constitutional symptoms such as nausea, lack of appetite, and fatigue are also common. There are several compensatory mechanisms that occur as the failing heart attempts to maintain adequate function. These include increasing cardiac output via the Frank-Starling mechanism, increasing ventricular volume and wall thickness through ventricular remodeling, and maintaining tissue perfusion with augmented mean arterial pressure through activation of neurohormonal systems. Although initially beneficial in the early stages of heart failure, all of these compensatory mechanisms eventually lead to a vicious cycle of worsening heart failure. Treatment strategies have been developed based upon the understanding of these compensatory mechanisms. Medical therapy includes diuresis, suppression of the overactive neurohormonal systems, and augmentation of contractility. Surgical options include ventricular resynchronization therapy, surgical ventricular remodeling, ventricular assist device implantation, and heart transplantation. Despite significant understanding of the underlying pathophysiological mechanisms in heart failure, this disease causes significant morbidity and carries a 50% 5-year mortality. Copyright © 2012 Elsevier Inc. All rights reserved.

Simulation Assisted Risk Assessment: Blast Overpressure Modeling

NASA Technical Reports Server (NTRS)

Lawrence, Scott L.; Gee, Ken; Mathias, Donovan; Olsen, Michael

2006-01-01

A probabilistic risk assessment (PRA) approach has been developed and applied to the risk analysis of capsule abort during ascent. The PRA is used to assist in the identification of modeling and simulation applications that can significantly impact the understanding of crew risk during this potentially dangerous maneuver. The PRA approach is also being used to identify the appropriate level of fidelity for the modeling of those critical failure modes. The Apollo launch escape system (LES) was chosen as a test problem for application of this approach. Failure modes that have been modeled and/or simulated to date include explosive overpressure-based failure, explosive fragment-based failure, land landing failures (range limits exceeded either near launch or Mode III trajectories ending on the African continent), capsule-booster re-contact during separation, and failure due to plume-induced instability. These failure modes have been investigated using analysis tools in a variety of technical disciplines at various levels of fidelity. The current paper focuses on the development and application of a blast overpressure model for the prediction of structural failure due to overpressure, including the application of high-fidelity analysis to predict near-field and headwinds effects.

Developing and implementing a heart failure data mart for research and quality improvement.

PubMed

Abu-Rish Blakeney, Erin; Wolpin, Seth; Lavallee, Danielle C; Dardas, Todd; Cheng, Richard; Zierler, Brenda

2018-04-19

The purpose of this project was to build and formatively evaluate a near-real time heart failure (HF) data mart. Heart Failure (HF) is a leading cause of hospital readmissions. Increased efforts to use data meaningfully may enable healthcare organizations to better evaluate effectiveness of care pathways and quality improvements, and to prospectively identify risk among HF patients. We followed a modified version of the Systems Development Life Cycle: 1) Conceptualization, 2) Requirements Analysis, 3) Iterative Development, and 4) Application Release. This foundational work reflects the first of a two-phase project. Phase two (in process) involves the implementation and evaluation of predictive analytics for clinical decision support. We engaged stakeholders to build working definitions and established automated processes for creating an HF data mart containing actionable information for diverse audiences. As of December 2017, the data mart contains information from over 175,000 distinct patients and >100 variables from each of their nearly 300,000 visits. The HF data mart will be used to enhance care, assist in clinical decision-making, and improve overall quality of care. This model holds the potential to be scaled and generalized beyond the initial focus and setting.

25 CFR 30.123 - What is the Bureau's role in assisting Bureau-funded schools to make AYP?

Code of Federal Regulations, 2010 CFR

2010-04-01

... EDUCATION ADEQUATE YEARLY PROGRESS Failure To Make Adequate Yearly Progress § 30.123 What is the Bureau's...-funded schools to assist them in achieving AYP. This includes technical assistance and other forms of...

25 CFR 30.123 - What is the Bureau's role in assisting Bureau-funded schools to make AYP?

Code of Federal Regulations, 2011 CFR

2011-04-01

... EDUCATION ADEQUATE YEARLY PROGRESS Failure To Make Adequate Yearly Progress § 30.123 What is the Bureau's...-funded schools to assist them in achieving AYP. This includes technical assistance and other forms of...

Effects of physical guidance on short-term learning of walking on a narrow beam

PubMed Central

Domingo, Antoinette; Ferris, Daniel P.

2009-01-01

Physical guidance is often used in rehabilitation when teaching patients to re-learn movements. However, the effects of guidance on motor learning of complex skills, such as walking balance, are not clear. We tested four groups of healthy subjects that practiced walking on a narrow (1.27 cm) or wide (2.5 cm) treadmill-mounted balance beam, with or without physical guidance. Assistance was given by springs attached to a hip belt that applied restoring forces towards beam center. Subjects were evaluated while walking unassisted before and after training by calculating the number of times subjects stepped off of the beam per minute of successful walking on the beam (Failures per Minute). Subjects in Unassisted groups had greater performance improvements in walking balance from pre to post compared to subjects in Assisted groups. During training, Unassisted groups had more Failures per Minute than Assisted groups. Performance improvements were smaller in Narrow Beam groups than in Wide Beam groups. The Unassisted-Wide and Assisted-Narrow groups had similar Failures per Minute during training, but the Unassisted-Wide group had much greater performance gains after training. These results suggest that physical assistance can hinder motor learning of walking balance, assistance appears less detrimental for more difficult tasks, and task-specific dynamics are important to learning independent of error experience. PMID:19674900

P513 A RAPID APPROACH FOR DIAGNOSING CERIODAPHNIA DUBIA REPRODUCTIVE FAILURE

EPA Science Inventory

Sources of failure in C. dubia culture and testing can be difficult to determine without outside assistance. Investigation of these failures can be time consuming. In the current study, USEPA Region 7 laboratory suffered a drop in reproduction in the C. dubia cultures, with wee...

Advances in bioartificial liver assist devices.

PubMed

Patzer, J F

2001-11-01

Rapid advances in development of bioartificial liver assist devices (BLADs) are exciting clinical interest in the application of BLAD technology for support of patients with acute liver failure. Four devices (Circe Biomedical HepatAssist, Vitagen ELAD, Gerlach BELS, and Excorp Medical BLSS) that rely on hepatocytes cultured in hollow-fiber membrane technology are currently in various stages of clinical evaluation. Several alternative approaches for culture and perfusion of hepatocytes have been evaluated in preclinical, large animal models of liver failure, or at a laboratory scale. Engineering design issues with respect to xenotransplantation, BLAD perfusion, hepatocyte functionality and culture maintenance, and ultimate distribution of a BLAD to a clinical site are delineated.

US FDA perspective on regulatory issues affecting circulatory assist devices.

PubMed

Sapirstein, Wolf; Chen, Eric; Swain, Julie; Zuckerman, Bram

2006-11-01

There has been a rapid development in mechanical circulatory support systems in the decade since the US FDA first approved a mechanical device to provide the circulatory support lacking from a failing heart. Devices are presently approved for marketing by the FDA to replace a failing ventricle, the Ventricular Assist Device or the entire heart, Total Artificial Heart. Contemporaneous with, and permitted by, improvement in technology and design, devices have evolved from units located extracorporeally to paracorporeal systems and totally implanted devices. Clinical studies have demonstrated a parallel improvement in the homeostatic adequacy of the circulatory support provided. Thus, while the circulatory support was initially tolerated for short periods to permit recovery of cardiac function, this technology eventually provided effective circulatory support for increasing periods that permitted the FDA to approve devices for bridging patients in end-stage cardiac failure awaiting transplant and eventually a device for destination therapy where patients in end-stage heart failure are not cardiac transplant candidates. The approved devices have relied on displacement pumps that mimic the pulsatility of the physiological system. Accelerated development of more compact devices that rely on alternative pump mechanisms have challenged both the FDA and device manufacturers to assure that the regulatory requirements for safety and effectiveness are met for use of mechanical circulatory support systems in expanded target populations. An FDA regulatory perspective is reviewed of what can be a potentially critical healthcare issue.

Can the Seattle heart failure model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy?

PubMed

Levy, Wayne C; Mozaffarian, Dariush; Linker, David T; Farrar, David J; Miller, Leslie W

2009-03-01

According to results of the REMATCH trial, left ventricular assist device therapy in patients with severe heart failure has resulted in a 48% reduction in mortality. A decision tool will be necessary to aid in the selection of patients for destination left ventricular assist devices (LVADs) as the technology progresses for implantation in ambulatory Stage D heart failure patients. The purpose of this analysis was to determine whether the Seattle Heart Failure Model (SHFM) can be used to risk-stratify heart failure patients for potential LVAD therapy. The SHFM was applied to REMATCH patients with the prospective addition of inotropic agents and intra-aortic balloon pump (IABP) +/- ventilator. The SHFM was highly predictive of survival (p = 0.0004). One-year SHFM-predicted survival was similar to actual survival for both the REMATCH medical (30% vs 28%) and LVAD (49% vs 52%) groups. The estimated 1-year survival with medical therapy for patients in REMATCH was 30 +/- 21%, but with a range of 0% to 74%. The 1- and 2-year estimated survival was

Risk Score to Predict Need for Intensive Care in Initially Hemodynamically Stable Adults With Non-ST-Segment-Elevation Myocardial Infarction.

PubMed

Fanaroff, Alexander C; Chen, Anita Y; Thomas, Laine E; Pieper, Karen S; Garratt, Kirk N; Peterson, Eric D; Newby, L Kristin; de Lemos, James A; Kosiborod, Mikhail N; Amsterdam, Ezra A; Wang, Tracy Y

2018-05-25

Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14%) developed a complication requiring ICU-level care, yet 12 879 (43%) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11% of patients as having very high risk (>30%) of developing complications requiring ICU care and 49% as having low likelihood (<10%) of requiring an ICU. The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Aspergillosis

MedlinePlus

... airway blockage Respiratory failure When to Contact a Medical Professional Call your provider if you develop symptoms ... Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, ...

An Experimental Study of Incremental Surface Loading of an Elastic Plate: Application to Volcano Tectonics

NASA Technical Reports Server (NTRS)

Williams, K. K.; Zuber, M. T.

1995-01-01

Models of surface fractures due to volcanic loading an elastic plate are commonly used to constrain thickness of planetary lithospheres, but discrepancies exist in predictions of the style of initial failure and in the nature of subsequent fracture evolution. In this study, we perform an experiment to determine the mode of initial failure due to the incremental addition of a conical load to the surface of an elastic plate and compare the location of initial failure with that predicted by elastic theory. In all experiments, the mode of initial failure was tension cracking at the surface of the plate, with cracks oriented circumferential to the load. The cracks nucleated at a distance from load center that corresponds the maximum radial stress predicted by analytical solutions, so a tensile failure criterion is appropriate for predictions of initial failure. With continued loading of the plate, migration of tensional cracks was observed. In the same azimuthal direction as the initial crack, subsequent cracks formed at a smaller radial distance than the initial crack. When forming in a different azimuthal direction, the subsequent cracks formed at a distance greater than the radial distance of the initial crack. The observed fracture pattern may explain the distribution of extensional structures in annular bands around many large scale, circular volcanic features.

Left ventricular assist device and drug therapy for the reversal of heart failure.

PubMed

Birks, Emma J; Tansley, Patrick D; Hardy, James; George, Robert S; Bowles, Christopher T; Burke, Margaret; Banner, Nicholas R; Khaghani, Asghar; Yacoub, Magdi H

2006-11-02

In patients with severe heart failure, prolonged unloading of the myocardium with the use of a left ventricular assist device has been reported to lead to myocardial recovery in small numbers of patients for varying periods of time. Increasing the frequency and durability of myocardial recovery could reduce or postpone the need for subsequent heart transplantation. We enrolled 15 patients with severe heart failure due to nonischemic cardiomyopathy and with no histologic evidence of active myocarditis. All had markedly reduced cardiac output and were receiving inotropes. The patients underwent implantation of left ventricular assist devices and were treated with lisinopril, carvedilol, spironolactone, and losartan to enhance reverse remodeling. Once regression of left ventricular enlargement had been achieved, the beta2-adrenergic-receptor agonist clenbuterol was administered to prevent myocardial atrophy. Eleven of the 15 patients had sufficient myocardial recovery to undergo explantation of the left ventricular assist device a mean (+/-SD) of 320+/-186 days after implantation of the device. One patient died of intractable arrhythmias 24 hours after explantation; another died of carcinoma of the lung 27 months after explantation. The cumulative rate of freedom from recurrent heart failure among the surviving patients was 100% and 88.9% 1 and 4 years after explantation, respectively. The quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire score at 3 years was nearly normal. Fifty-nine months after explantation, the mean left ventricular ejection fraction was 64+/-12%, the mean left ventricular end-diastolic diameter was 59.4+/-12.1 mm, the mean left ventricular end-systolic diameter was 42.5+/-13.2 mm, and the mean maximal oxygen uptake with exercise was 26.3+/-6.0 ml per kilogram of body weight per minute. In this single-center study, we found that sustained reversal of severe heart failure secondary to nonischemic cardiomyopathy could be achieved in selected patients with the use of a left ventricular assist device and a specific pharmacologic regimen. Copyright 2006 Massachusetts Medical Society.

Hemodynamic deterioration precedes onset of ventricular tachyarrhythmia after Heartmate II implantation.

PubMed

Yaksh, Ameeta; Kik, Charles; Knops, Paul; Zwiers, Korinne; van Ettinger, Maarten J B; Manintveld, Olivier C; de Wijs, Marcel C J; van der Kemp, Peter; Bogers, Ad J J C; de Groot, Natasja M S

2016-07-08

Early postoperative ventricular tachyarrhythmia (PoVT) after left ventricular assist device (LVAD) implantation are common and associated with higher mortality-rates. At present, there is no data on initiation of these PoVT and the role of alterations in cardiac hemodynamics. A LVAD was implanted in a patient with end-stage heart failure due to a ischemic cardiomyopathy. Alterations in cardiac rhythm and hemodynamics preceding PoVT-episodes during the first five postoperative days were examined by using continuous recordings of cardiac rhythm and various hemodynamic parameters. All PoVT (N=120) were monomorphic, most often preceded by short-long-short-sequences or regular SR and initiated by ventricular runs. Prior to PoVT, mean arterial pressure decreased; heart rate and ST-segments deviations increased. PoVT are caused by different underlying electrophysiological mechanisms. Yet, they are all monomorphic and preceded by hemodynamic deterioration due to myocardial ischemia.

Lack of emergency medical services documentation is associated with poor patient outcomes: a validation of audit filters for prehospital trauma care.

PubMed

Laudermilch, Dann J; Schiff, Melissa A; Nathens, Avery B; Rosengart, Matthew R

2010-02-01

Our previous Delphi study identified several audit filters considered sensitive to deviations in prehospital trauma care and potentially useful in conducting performance improvement, a process currently recommended by the American College of Surgeons Committee on Trauma. This study validates 2 of those proposed audit filters. We studied 4,744 trauma patients using the electronic records of the Central Region Trauma registry and Emergency Medical Services (EMS) patient logs for the period January 1, 2002, to December 31, 2004. We studied whether requests by on-scene Basic Life Support (BLS) for Advanced Life Support (ALS) assistance or failure by EMS personnel to record basic patient physiology at the scene was associated with increased in-hospital mortality. We performed multivariate analyses, including a propensity score quintile approach, adjusting for differences in case mix and clustering by hospital. Overall mortality was 6.1%. A total of 28.2% (n = 1,337) of EMS records were missing patient scene physiologic data. Multivariate analysis revealed that patients missing 1 or more measures of patient physiology at the scene had increased risk of death (adjusted odds ratio = 2.15; 95% CI, 1.13 to 4.10). In 17.4% (n = 402) of cases BLS requested ALS assistance. Patients for whom BLS requested ALS had a similar risk of death as patients for whom ALS was initially dispatched (odds ratio = 1.04; 95% CI, 0.51 to 2.15). Failure of EMS to document basic measures of scene physiology is associated with increased mortality. This deviation in care can serve as a sensitive audit filter for performance improvement. The need by BLS for ALS assistance was not associated with increased mortality.

[Spinal muscular atrophy and respiratory failure. How do primary care pediatricians act in a simulated scenario?].

PubMed

Agra Tuñas, M C; Sánchez Santos, L; Busto Cuiñas, M; Rodríguez Núñez, A

2015-11-01

Spinal muscular atrophy type 1 (SMA-1) tends to be fatal in the first year of life if there is no ventilatory support. The decision whether to start such support is an ethical conflict for healthcare professionals. A scenario of acute respiratory failure in an infant with SMA-1 has been included in a training program using advanced simulation for Primary Care pediatricians (PCP). The performances of 34 groups of 4 pediatricians, who participated in 17 courses, were systematically analyzed. Clinical, ethical and communication aspects with parents were evaluated. The initial technical assistance (Administration of oxygen and immediate ventilatory support) was correctly performed by 94% of the teams. However, the PCP had problems in dealing with the ethical aspects of the case. Of the 85% of the teams that raised the ethical conflict with parents, 29% did so on their own initiative, 23% actively excluded them, and only 6% involved them and took their opinion into account in making decisions. Only 11.7% asked about the quality of life of children and 12% for their knowledge of the prognosis of the disease. None explained treatment alternatives, nor tried to contact the pediatrician responsible for the child. When faced with a simulated SMA-1 infant with respiratory failure, PCP have difficulties in interacting with the family, and to involve it in the decision making process. Practical training of all pediatricians should include case scenarios with an ethical clinical problem. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Mechanical Circulatory Support of the Right Ventricle for Adult and Pediatric Patients With Heart Failure.

PubMed

Chopski, Steven G; Murad, Nohra M; Fox, Carson S; Stevens, Randy M; Throckmorton, Amy L

2018-05-10

The clinical implementation of mechanical circulatory assistance for a significantly dysfunctional or failing left ventricle as a bridge-to-transplant or bridge-to-recovery is on the rise. Thousands of patients with left-sided heart failure are readily benefitting from these life-saving technologies, and left ventricular failure often leads to severe right ventricular dysfunction or failure. Right ventricular failure (RVF) has a high rate of mortality caused by the risk of multisystem organ failure and prolonged hospitalization for patients after treatment. The use of a blood pump to support the left ventricle also typically results in an increase in right ventricular preload and may impair right ventricular contractility during left ventricular unloading. Patients with RVF might also suffer from severe pulmonary dysfunction, cardiac defects, congenital heart disease states, or a heterogeneity of cardiophysiologic challenges because of symptomatic congestive heart failure. Thus, the uniqueness and complexity of RVF is emerging as a new domain of significant clinical interest that motivates the development of right ventricular assist devices. In this review, we present the current state-of-the-art for clinically used blood pumps to support adults and pediatric patients with right ventricular dysfunction or failure concomitant with left ventricular failure. New innovative devices specifically for RVF are also highlighted. There continues to be a compelling need for novel treatment options to support patients with significant right heart dysfunction or failure.

45 CFR 1355.36 - Withholding Federal funds due to failure to achieve substantial conformity or failure to...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Withholding Federal funds due to failure to... Section 1355.36 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL...

45 CFR 1355.36 - Withholding Federal funds due to failure to achieve substantial conformity or failure to...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Withholding Federal funds due to failure to... Section 1355.36 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL...

45 CFR 1355.36 - Withholding Federal funds due to failure to achieve substantial conformity or failure to...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Withholding Federal funds due to failure to... Section 1355.36 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL...

User-Defined Material Model for Progressive Failure Analysis

NASA Technical Reports Server (NTRS)

Knight, Norman F. Jr.; Reeder, James R. (Technical Monitor)

2006-01-01

An overview of different types of composite material system architectures and a brief review of progressive failure material modeling methods used for structural analysis including failure initiation and material degradation are presented. Different failure initiation criteria and material degradation models are described that define progressive failure formulations. These progressive failure formulations are implemented in a user-defined material model (or UMAT) for use with the ABAQUS/Standard1 nonlinear finite element analysis tool. The failure initiation criteria include the maximum stress criteria, maximum strain criteria, the Tsai-Wu failure polynomial, and the Hashin criteria. The material degradation model is based on the ply-discounting approach where the local material constitutive coefficients are degraded. Applications and extensions of the progressive failure analysis material model address two-dimensional plate and shell finite elements and three-dimensional solid finite elements. Implementation details and use of the UMAT subroutine are described in the present paper. Parametric studies for composite structures are discussed to illustrate the features of the progressive failure modeling methods that have been implemented.

The pharmacotherapy implications of ventricular assist device in the patient with end-stage heart failure.

PubMed

Von Ruden, Serena A S; Murray, Margaret A; Grice, Jennifer L; Proebstle, Amy K; Kopacek, Karen J

2012-04-01

Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used asa bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.

[Auto-dialysis: an 11-year experience of a hemodialysis center in France].

PubMed

Montagnac, R; Schillinger, F

1996-03-30

Report 11 years of experience with self-managed hemodialysis in patients medically apt for extra-hospital dialysis and living close enough to small outpatient hemodialysis units to become totally self-sufficient. Among the 276 patients with chronic renal failure managed at the hemodialysis center at the Troyes hospital during the 11-year study period from 1984 through 1994, self-managed hemodialysis at small outpatient units was initiated in 127 (46%). None of these 127 patients required medical assistance or specific care during dialysis sessions. At initial hospital admission, only 60/127 (47%) were totally self-sufficient: 52 (41%) were later graft recipients; and 21 (16.5%) had to return to the hospital for a medical or surgical condition incompatible with extra-hospital care but all of these 21 patients remained self-sufficient. Extra-hospital hemodialysis in units close to the patients residence offers patients a better quality of life, even when medical assistance is required. All patients who require hemodialysis can thus be treated at lower cost without compromising quality of treatment. Perfect self-sufficiency may not be a goal in itself, but self-managed hemodialysis can be a very useful technique for patients without major medical problems. Continuing contact with the organizing hemodialysis center guarantees the safety of the system.

Use of Slow Strain Rate Tensile Testing to Assess the Ability of Several Superalloys to Resist Environmentally-Assisted Intergranular Cracking

NASA Technical Reports Server (NTRS)

Gabb, Timothy P.; Telesman, Jack; Banik, Anthony; McDevitt, Erin

2014-01-01

Intergranular fatigue crack initiation and growth due to environmental degradation, especially at notched features, can often limit the fatigue life of disk superalloys at high temperatures. For clear comparisons, the effects of alloy composition on cracking in air needs to be understood and compared separately from variables associated with notches and cracks such as effective stress concentration, plastic flow, stress relaxation, and stress redistribution. The objective of this study was to attempt using simple tensile tests of specimens with uniform gage sections to compare the effects of varied alloy composition on environment-assisted cracking of several powder metal and cast and wrought superalloys including ME3, LSHR, Udimet 720(TradeMark) ATI 718Plus(Registered TradeMark) alloy, Haynes 282(Trademark), and Inconel 740(TradeMark) Slow and fast strain-rate tensile tests were found to be a useful tool to compare propensities for intergranular surface crack initiation and growth. The effects of composition and heat treatment on tensile fracture strain and associated failure modes were compared. Environment interactions were determined to often limit ductility, by promoting intergranular surface cracking. The response of various superalloys and heat treatments to slow strain rate tensile testing varied substantially, showing that composition and microstructure can significantly influence environmental resistance to cracking.

Effect of porcelain and enamel thickness on porcelain veneer failure loads in vitro.

PubMed

Ge, Chunling; Green, Chad C; Sederstrom, Dalene; McLaren, Edward A; White, Shane N

2014-05-01

Bonded porcelain veneers are widely used esthetic restorations. Although high success and survival rates have been reported, failures occur. Fracture is the most common failure mode. Fractures range from incomplete cracks to the catastrophic. Minimally invasive or thin partial veneers have gained popularity. The aim of this study was to measure the influences of porcelain veneer thickness and enamel substrate thickness on the loads needed to cause the initial fracture and catastrophic failure of porcelain veneers. Model discoid porcelain veneer specimens of varying thickness were bonded to the flattened facial surfaces of incisors, artificially aged, and loaded to failure with a small sphere. Individual fracture events were identified and analyzed statistically and fractographically. Fracture events included initial Hertzian cracks, intermediate radial cracks, and catastrophic gross failure. Increased porcelain, enamel, and their combined thickness had like effects in substantially raising resistance to catastrophic failure but also slightly decreased resistance to initial Hertzian cracking. Fractographic and numerical data demonstrated that porcelain and tooth enamel behaved in a remarkably similar manner. As porcelain thickness, enamel thickness, and their combined thickness increased, the loads needed to produce initial fracture and catastrophic failure rose substantially. Porcelain veneers withstood considerable damage before catastrophic failure. Increased enamel thickness, increased porcelain thickness, and increased combined enamel and porcelain thickness all profoundly raised the failure loads necessary to cause catastrophic failure. Enamel and feldspathic porcelain behaved in a like manner. Surface contact damage occurred initially. Final catastrophic failure followed flexural radial cracking. Bonded porcelain veneers were highly damage tolerant. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Explosive Model Tarantula V1/JWL++ Calibration of LX-17: #2

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

Souers, P C; Vitello, P

2009-05-01

Tarantula V1 is a kinetic package for reactive flow codes that seeks to describe initiation, failure, dead zones and detonation simultaneously. The most important parameter is P1, the pressure between the initiation and failure regions. Both dead zone formation and failure can be largely controlled with this knob. However, V1 does failure with low settings and dead zones with higher settings, so that it cannot fulfill its purpose in the current format. To this end, V2 is under test. The derivation of the initiation threshold P0 is discussed. The derivation of the initiation pressure-tau curve as an output of Tarantulamore » shows that the initiation package is sound. A desensitization package is also considered.« less

Outcomes of Minimally Invasive Temporary Right Ventricular Assist Device Support for Acute Right Ventricular Failure During Minimally Invasive Left Ventricular Assist Device Implantation.

PubMed

Schaefer, Andreas; Reichart, Daniel; Bernhardt, Alexander M; Kubik, Mathias; Barten, Markus J; Wagner, Florian M; Reichenspurner, Hermann; Philipp, Sebastian A; Deuse, Tobias

Right ventricular failure (RVF) may still occur despite the benefits of minimally invasive left ventricular assist device (MI-LVAD) implantation. Our center strategy aims to avoid aggressive postoperative inotrope use by using mechanical support to facilitate right ventricle recovery and adaptation. We herein report first outcomes of patients with minimally invasive temporary right ventricular assist device (MI-t-RVAD) support for RVF during MI-LVAD implantation. Right ventricular failure was defined as requiring more than moderate inotopic support after weaning from cardiopulmonary bypass according to Interagency Registry for Mechanically Assisted Circulatory Support adverse event definitions. All patients requiring MI-t-RVAD support for RVF during MI-LVAD implantation between January, 2012 and April, 2016 were retrospectively reviewed. Clinical endpoints were death or unsuccessful RVAD weaning. Overall 10 patients (90% male, mean age 49.6 ± 14.8 years) underwent MI-t-RVAD implantation. Duration of MI-t-RVAD support was 16.2 ± 11.6 days. Right ventricular assist device weaning and subsequent uneventful awake device explantation was successful in all cases. The 30 day survival was 80%. Our results confirm safety and feasibility of MI-t-RVAD support for acute RVF in the setting of MI-LVAD implantation. The potential benefits of this strategy are more stable hemodynamics in the first postoperative days that usually are crucial for LVAD patients and reduced inotrope requirement.

SU-E-T-421: Failure Mode and Effects Analysis (FMEA) of Xoft Electronic Brachytherapy for the Treatment of Superficial Skin Cancers

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

Hoisak, J; Manger, R; Dragojevic, I

Purpose: To perform a failure mode and effects analysis (FMEA) of the process for treating superficial skin cancers with the Xoft Axxent electronic brachytherapy (eBx) system, given the recent introduction of expanded quality control (QC) initiatives at our institution. Methods: A process map was developed listing all steps in superficial treatments with Xoft eBx, from the initial patient consult to the completion of the treatment course. The process map guided the FMEA to identify the failure modes for each step in the treatment workflow and assign Risk Priority Numbers (RPN), calculated as the product of the failure mode’s probability ofmore » occurrence (O), severity (S) and lack of detectability (D). FMEA was done with and without the inclusion of recent QC initiatives such as increased staffing, physics oversight, standardized source calibration, treatment planning and documentation. The failure modes with the highest RPNs were identified and contrasted before and after introduction of the QC initiatives. Results: Based on the FMEA, the failure modes with the highest RPN were related to source calibration, treatment planning, and patient setup/treatment delivery (Fig. 1). The introduction of additional physics oversight, standardized planning and safety initiatives such as checklists and time-outs reduced the RPNs of these failure modes. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. Conclusion: The FMEA analysis identified the steps in the treatment process presenting the highest risk. The introduction of enhanced QC initiatives mitigated the risk of some of these failure modes by decreasing their probability of occurrence and increasing their detectability. This analysis demonstrates the importance of well-designed QC policies, procedures and oversight in a Xoft eBx programme for treatment of superficial skin cancers. Unresolved high risk failure modes highlight the need for non-procedural quality initiatives such as improved planning software and more robust hardware interlock systems.« less

Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004.

PubMed

Sullivan, Elizabeth; Wang, Yueping; Chapman, Michael; Chambers, Georgina

2008-07-01

The aim of this study was to calculate assisted reproductive technology (ART) success rates for fresh autologous and donor cycles in women aged > or = 45 and the resultant cost per live birth. We performed a retrospective population-based study of 2339 ART cycles conducted in Australia, 2002-2004 to women aged > or = 45 years. The cost-outcome study was performed on fresh autologous treatment cycles. There were 1101 fresh autologous cycles initiated in women aged > or = 45, with a pregnancy rate of 1.9 per 100 initiated cycles. There were 21 women who achieved a clinical pregnancy with 15 (71%) ending in early pregnancy loss and 6 in live singleton births. The live birth rate following fresh autologous initiated cycles was 0.5% [95% confidence interval (CI): 0.1-1.0%]. Fresh donor recipients had an higher live birth rate of 19.1% (95% CI: 15.1-23.2) (odds ratio 43.2; 95% CI: 18.6-100.3) compared with women having fresh autologous cycles. The average cost of a live birth following fresh autologous cycles was 753,107 euros. The success rate of fresh autologous treatment for women aged > or = 45 years was < 1%. The very high cost of a live birth reflects a treatment failure rate of > 99%. The ART profession should counsel patients of the reality of the technology before the patients consent to treatment.

[Impact of end-stage renal disease and kidney transplantation on the reproductive system].

PubMed

Delesalle, A-S; Robin, G; Provôt, F; Dewailly, D; Leroy-Billiard, M; Peigné, M

2015-01-01

Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Virologic outcomes in early antiretroviral treatment: HPTN 052.

PubMed

Eshleman, Susan H; Wilson, Ethan A; Zhang, Xinyi C; Ou, San-San; Piwowar-Manning, Estelle; Eron, Joseph J; McCauley, Marybeth; Gamble, Theresa; Gallant, Joel E; Hosseinipour, Mina C; Kumarasamy, Nagalingeswaran; Hakim, James G; Kalonga, Ben; Pilotto, Jose H; Grinsztejn, Beatriz; Godbole, Sheela V; Chotirosniramit, Nuntisa; Santos, Breno Riegel; Shava, Emily; Mills, Lisa A; Panchia, Ravindre; Mwelase, Noluthando; Mayer, Kenneth H; Chen, Ying Q; Cohen, Myron S; Fogel, Jessica M

2017-05-01

The HIV Prevention Trials Network (HPTN) 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure. To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052. 1566 participants who had a viral load (VL) > 400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350-550 cells/mm 3 at ART initiation) and 734 in the delayed ART arm (204 with a CD4 < 250 cells/mm 3 at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs ≤ 400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs > 1000 copies/mL > 24 weeks after ART initiation. Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by three months; lower VL and higher CD4 at ART initiation were also associated with virologic failure. Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention.

Virologic outcomes in early antiretroviral treatment: HPTN 052

PubMed Central

Eshleman, Susan H.; Wilson, Ethan A.; Zhang, Xinyi C.; Ou, San-San; Piwowar-Manning, Estelle; Eron, Joseph J.; McCauley, Marybeth; Gamble, Theresa; Gallant, Joel E.; Hosseinipour, Mina C.; Kumarasamy, Nagalingeswaran; Hakim, James G.; Kalonga, Ben; Pilotto, Jose H.; Grinsztejn, Beatriz; Godbole, Sheela V.; Chotirosniramit, Nuntisa; Santos, Breno Riegel; Shava, Emily; Mills, Lisa A.; Panchia, Ravindre; Mwelase, Noluthando; Mayer, Kenneth H.; Chen, Ying Q.; Cohen, Myron S.; Fogel, Jessica M.

2017-01-01

INTRODUCTION The HPTN 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure. OBJECTIVE To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052. METHODS 1,566 participants who had a viral load (VL) >400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350–550 cells/mm3 at ART initiation) and 734 in the delayed ART arm (204 with a CD4 <250 cells/mm3 at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs ≤400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs >1,000 copies/mL >24 weeks after ART initiation. RESULTS Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by 3 months; lower VL and higher CD4 at ART initiation were also associated with virologic failure. CONCLUSIONS Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention. PMID:28385131

Pulsed laser ablation of IC packages for device failure analyses

NASA Astrophysics Data System (ADS)

Hong, Ming Hui; Mai, ZhiHong; Chen, G. X.; Thiam, Thomas; Song, Wen D.; Lu, Yongfeng; Soh, Chye E.; Chong, Tow Chong

2002-06-01

Pulsed laser ablation of mold compounds for IC packaging in air and with steam assistance is investigated. It is applied to decap IC packages and expose computer CPU dies for the device failure analyses. Compared with chemical decapping, the laser ablation has advantages of being fast speed, non- contact and dry processing. Laser ablation with the steam assistance results in higher ablation rate and wider ablated crater with much smoother surface morphology. It implies that the steam assisted laser ablation can achieve a faster and better quality laser processing. Audible acoustic wave and plasma optical signal diagnostics are also carried out to have a better understanding of the mechanisms behind. Light wavelength and laser fluence applied in the decapping are two important parameters. The 532 nm Nd:YAG laser decapping at a low laser fluence can achieve a large decapping area with a fine ablation profile. IC packages decapped by the laser ablation show good quality for the device failure analyses.

Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service.

PubMed

Lee, James S; O'Dochartaigh, Domhnall; MacKenzie, Mark; Hudson, Darren; Couperthwaite, Stephanie; Villa-Roel, Cristina; Rowe, Brian H

2015-06-01

Non-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation. The authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support. A retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model. From a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS)<15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001). Patients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.

Physical examination: how to examine the arm with arteriovenous fistula.

PubMed

Sousa, Clemente Neves; Apóstolo, João Luís; Figueiredo, Maria Henriqueta; Martins, Maria Manuela; Dias, Vanessa Filipa

2013-04-01

Physical examination has demonstrated its effectiveness in identifying complications of arteriovenous fistula (AVF). It should be initiated at the stage prior to the construction of the AVF and continue in its accomplishment, maturation, and subsequent use in the treatment of hemodialysis. Nurses should incorporate the physical examination in their practices, in order to preserve the vascular net of patients and assist in the recognition of complications of AVF. It is intended to describe aspects of the physical examination that enable the identification of the AVF complications including: infection, accessory veins, venous stenosis, steal syndrome, high-output cardiac failure, and venous hypertension. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

[Types of ventilatory support and their indications in amyotrophic lateral sclerosis].

PubMed

Perrin, C

2006-06-01

Respiratory muscle weakness represents the major cause of mortality in patients with amyotrophic lateral sclerosis (ALS). As a result, ventilatory assistance is an important part of disease management. Nowadays, noninvasive ventilation (NIV) has become the first choice modality for most patients and represents an alternative to tracheostomy intermittent positive-pressure ventilation. Although, some consensus guidelines have been proposed to initiate NIV in patients with restrictive chronic respiratory failure, these criteria are discussed regarding ALS. While the current consensus recommends that NIV may be used in symptomatic patients with hypercapnia or forced vital capacity<50p.cent of predicted value, early use of NIV is proposed in the literature and reported in this paper.

33 CFR 154.2020 - Certification and recertification-owner/operator responsibilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Procedures,” and in Military Standard MIL-STD-882B for a quantitative failure analysis. For assistance in... quantitative failure analysis is also conducted, the level of safety attained is at least one order of...

A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA.

PubMed

Guise, Andy; Melo, Jason; Mittal, Maria Luisa; Rafful, Claudia; Cuevas-Mota, Jazmine; Davidson, Peter; Garfein, Richard S; Werb, Dan

2018-05-01

Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon. We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n = 17) and a sub-sample of people who inject drugs (n = 4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively. Respondents' accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the 'initiate', responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a 'moral code'. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization. In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms. Copyright © 2018 Elsevier B.V. All rights reserved.

44 CFR 5.21 - Effect of failure to publish.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Effect of failure to publish... failure to publish. 5 U.S.C. 552(a)(1) provides that, except to the extent that a person has actual and... adversely affected by, a matter required to be published in the Federal Register and not so published. ...

44 CFR 353.7 - Failure to pay.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Failure to pay. 353.7 Section... LICENSEE RADIOLOGICAL EMERGENCY PLANS AND PREPAREDNESS § 353.7 Failure to pay. In any case where there is a dispute over the FEMA bill or where FEMA finds that a licensee has failed to pay a prescribed fee required...

Reaction Times to Consecutive Automation Failures: A Function of Working Memory and Sustained Attention.

PubMed

Jipp, Meike

2016-12-01

This study explored whether working memory and sustained attention influence cognitive lock-up, which is a delay in the response to consecutive automation failures. Previous research has demonstrated that the information that automation provides about failures and the time pressure that is associated with a task influence cognitive lock-up. Previous research has also demonstrated considerable variability in cognitive lock-up between participants. This is why individual differences might influence cognitive lock-up. The present study tested whether working memory-including flexibility in executive functioning-and sustained attention might be crucial in this regard. Eighty-five participants were asked to monitor automated aircraft functions. The experimental manipulation consisted of whether or not an initial automation failure was followed by a consecutive failure. Reaction times to the failures were recorded. Participants' working-memory and sustained-attention abilities were assessed with standardized tests. As expected, participants' reactions to consecutive failures were slower than their reactions to initial failures. In addition, working-memory and sustained-attention abilities enhanced the speed with which participants reacted to failures, more so with regard to consecutive than to initial failures. The findings highlight that operators with better working memory and sustained attention have small advantages when initial failures occur, but their advantages increase across consecutive failures. The results stress the need to consider personnel selection strategies to mitigate cognitive lock-up in general and training procedures to enhance the performance of low ability operators. © 2016, Human Factors and Ergonomics Society.

A study comparing three different laser-assisted hatching techniques.

PubMed

Ma, B; Wang, Y; Zhang, H; Zhang, X

2014-01-01

Laser-assisted hatching (LAH) is recognized as a useful technology to improve clinical pregnancy rates and implantation rates. This study reports the differences between a new LAH method and two conventional LAH techniques. The authors studied 151 patients with repeated implantation failure, who were divided into three groups. In group 1, the zona pellucida (ZP) was opened using LAH (n = 52). In group 2, laser-assisted thinning was performed to dissolve the outer layer of the ZP (n = 49). In group 3, laser-assisted thinning was performed to dissolve the inner layer of the ZP (n = 50). The clinical pregnancy rates and implantation rates among the groups were compared. The results demonstrate that there are significant differences in the clinical pregnancy rates and implantation rates between group 3 and the other two groups. Performing laser-assisted thinning to dissolve the inner layer of the ZP markedly increases the pregnancy rates and implantation rates of patients with repeated implantation failure.

Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices

PubMed Central

Luo, Nancy; Rogers, Joseph G.; Dodson, Gwen C.; Patel, Chetan B.; Galanos, Anthony N.; Milano, Carmelo A.; O’Connor, Christopher M.; Mentz, Robert J.

2016-01-01

Within the last decade, advancements in left ventricular assist device (LVAD) therapy have allowed end-stage heart failure patients to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for LVAD therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists. Despite these advantages, palliative care remains underused in many advanced heart failure programs. Here, we describe the benefits of palliative care, barriers to use within heart failure, and specific applications to the integrated care of patients on mechanical circulatory support. PMID:27474339

Evaluating the risk of water distribution system failure: A shared frailty model

NASA Astrophysics Data System (ADS)

Clark, Robert M.; Thurnau, Robert C.

2011-12-01

Condition assessment (CA) Modeling is drawing increasing interest as a technique that can assist in managing drinking water infrastructure. This paper develops a model based on the application of a Cox proportional hazard (PH)/shared frailty model and applies it to evaluating the risk of failure in drinking water networks using data from the Laramie Water Utility (located in Laramie, Wyoming, USA). Using the risk model a cost/ benefit analysis incorporating the inspection value method (IVM), is used to assist in making improved repair, replacement and rehabilitation decisions for selected drinking water distribution system pipes. A separate model is developed to predict failures in prestressed concrete cylinder pipe (PCCP). Various currently available inspection technologies are presented and discussed.

Intralaminar and Interlaminar Progressive Failure Analysis of Composite Panels with Circular Cutouts

NASA Technical Reports Server (NTRS)

Goyal, Vinay K.; Jaunky, Navin; Johnson, Eric R.; Ambur, Damodar

2002-01-01

A progressive failure methodology is developed and demonstrated to simulate the initiation and material degradation of a laminated panel due to intralaminar and interlaminar failures. Initiation of intralaminar failure can be by a matrix-cracking mode, a fiber-matrix shear mode, and a fiber failure mode. Subsequent material degradation is modeled using damage parameters for each mode to selectively reduce lamina material properties. The interlaminar failure mechanism such as delamination is simulated by positioning interface elements between adjacent sublaminates. A nonlinear constitutive law is postulated for the interface element that accounts for a multi-axial stress criteria to detect the initiation of delamination, a mixed-mode fracture criteria for delamination progression, and a damage parameter to prevent restoration of a previous cohesive state. The methodology is validated using experimental data available in the literature on the response and failure of quasi-isotropic panels with centrally located circular cutouts loaded into the postbuckling regime. Very good agreement between the progressive failure analyses and the experimental results is achieved if the failure analyses includes the interaction of intralaminar and interlaminar failures.

Tips on establishing a robotics program in an academic setting.

PubMed

Steers, William D

2006-02-17

Over the past 5 years, robotic-assisted laparoscopic surgery has gone from being a novelty to an accepted approach for intra-abdominal and pelvic surgery. Driving this trend has been the large number of robotic-assisted laparoscopic prostatectomies performed throughout the U.S. Nearly a quarter of the prostatectomies done for prostate cancer in the U.S. in 2006 will use robotic assistance, yet reports fail to confirm cost effectiveness. The most important predictor of a successful program is a champion at the institution. Studies have demonstrated safety and immediate benefits with regard to reduced surgical morbidity such as pain, loss of work, quality of life, and blood loss for a variety of surgeries patients. Specific to prostatectomy for cancer, long-term data on biochemical (PSA) failures and cancer cures, as well as validated secondary outcomes for continence and potency, are still unavailable. Benefits accrue for the surgeon as well with improved ergonomics and potential extension of a surgical career. Yet, enthusiasm for robotics must be tempered by this lack of data and economic limitations. However, if a thoughtful and thorough process in initiating a robotic program is undertaken, the risks to the institution can be minimized. With proper training, the risk to the patient is reduced and with due diligence with regard to market and operative resources, the risk to the surgeon can be eliminated. This report reviews the steps to assess, plan, initiate, and maintain a robotics program at an academic institution with the hope that other programs can benefit from lessons acquired by early adopters of this expensive technology.

Tips on Establishing a Robotics Program in an Academic Setting

PubMed Central

Steers, William D.

2006-01-01

Over the past 5 years, robotic-assisted laparoscopic surgery has gone from being a novelty to an accepted approach for intra-abdominal and pelvic surgery. Driving this trend has been the large number of robotic-assisted laparoscopic prostatectomies performed throughout the U.S. Nearly a quarter of the prostatectomies done for prostate cancer in the U.S. in 2006 will use robotic assistance, yet reports fail to confirm cost effectiveness. The most important predictor of a successful program is a champion at the institution. Studies have demonstrated safety and immediate benefits with regard to reduced surgical morbidity such as pain, loss of work, quality of life, and blood loss for a variety of surgeries patients. Specific to prostatectomy for cancer, long-term data on biochemical (PSA) failures and cancer cures, as well as validated secondary outcomes for continence and potency, are still unavailable. Benefits accrue for the surgeon as well with improved ergonomics and potential extension of a surgical career. Yet, enthusiasm for robotics must be tempered by this lack of data and economic limitations. However, if a thoughtful and thorough process in initiating a robotic program is undertaken, the risks to the institution can be minimized. With proper training, the risk to the patient is reduced and with due diligence with regard to market and operative resources, the risk to the surgeon can be eliminated. This report reviews the steps to assess, plan, initiate, and maintain a robotics program at an academic institution with the hope that other programs can benefit from lessons acquired by early adopters of this expensive technology. PMID:17619728

Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with Enterprise and Neuroform stents: a comparative analysis of the literature.

PubMed

King, Brent; Vaziri, Sasha; Singla, Amit; Fargen, Kyle M; Mocco, J

2015-12-01

The most widely used intracranial stents for stent-assisted coiling are Neuroform (NEU) and Enterprise stents (ENT). This study compares published outcomes between the ENT and NEU coil-assist systems and comments on the published safety and efficacy of stent-assisted coiling in general. A literature search was performed through PubMed for all published series of ENT or NEU stent-assisted coiling of cerebral aneurysms from 2004 to 2014. All studies including 10 or more published cases of stent-assisted coiling with ENT or NEU were included. 47 studies met the inclusion criteria, containing 4238 aneurysms in 4039 patients. 2111 aneurysms were treated with NEU and 2127 were treated with ENT. Mean follow-up was 14.1 months. Overall, thromboembolic events occurred in 6.4% of aneurysms, intracranial hemorrhage (ICH) in 2.6%, permanent morbidity in 3.9%, and mortality in 2.3%. Initial and final 100% angiographic occlusion was seen in 53% and 69% of patients, respectively. Deployment failures (p<0.001), ICH (p=0.001), mortality among all patients (p=0.03), and recanalization (p=0.02) were more commonly reported in NEU treated aneurysms. The ENT system was also associated with higher reported complete occlusion at follow-up (p<0.001). This literature review represents the largest and most robust comparison of stent-assisted coiling devices to date, containing over 4200 aneurysms in more than 4000 patients. Comparative analyses demonstrate that both devices are reported to be safe and effective with comparable permanent morbidity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Are You a Seeker or an Avoider?

ERIC Educational Resources Information Center

Berman, Mark L.

2002-01-01

Some workers may consistently try to avoid failure, responsibility, and negative feedback. Trainers can help by assessing organizational circumstances; assist avoiders in developing knowledge, skills, and positive attitudes; and locate employee assistance programs or counseling if needed. (JOW)

Myocardial recovery during mechanical circulatory support: long-term outcome and elective ventricular assist device implantation to promote recovery as a treatment goal.

PubMed

Dandel, Michael; Hetzer, Roland

2015-01-01

Even after incomplete myocardial recovery during mechanical circulatory support, long-term survival rates after ventricular assist device (VAD) explantation can be better than those expected after heart transplantation even for patients with chronic non-ischemic cardiomyopathy as the underlying cause for VAD implantation. The elective therapeutic use of ventricular assist devices for heart failure reversal in its early stage is a future goal. It may be possible to achieve it by developing tools to predict heart failure reversibility even before ventricular assist device implantation and increasing the number of weaning candidates by improvement of adjunctive therapies to optimize unloading-promoted recovery.  Special attention is focused on the long-term stability of cardiac remission after VAD removal, the clinical relevance unloading-promoted myocardial recovery and on the current knowledge about a potential prediction of myocardial recovery during long-term VAD support already before VAD implantation.

Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure.

PubMed

Schmack, Bastian; Weymann, Alexander; Popov, Aron-Frederik; Patil, Nikhil Prakash; Sabashnikov, Anton; Kremer, Jamila; Farag, Mina; Brcic, Andreas; Lichtenstern, Christoph; Karck, Matthias; Ruhparwar, Arjang

2016-05-05

Right ventricular failure (RVF) is an unfortunate complication that continues to limit outcomes following durable left ventricular assist device (LVAD) implantation. Despite several 'RVF risk scores' having been proposed, preoperative prediction of post-LVAD RVF remains a guesstimate at best. Current strategies for institution of temporary RVAD support are invasive, necessitate additional re-thoracotomy, restrict postoperative mobilization, and/or entail prolonged retention of prosthetic material in-situ. The authors propose a novel surgical strategy comprising simultaneous implantation of a permanent LVAD and percutaneous TandemHeart® plus ProtekDuo® to provide temporary RVAD support and preempt RVF in patients with impaired RV function.

A Mixed Methods Explanatory Study of the Failure/Drop Rate for Freshman STEM Calculus Students

ERIC Educational Resources Information Center

Worthley, Mary

2013-01-01

In a national context of high failure rates in freshman calculus courses, the purpose of this study was to understand who is struggling, and why. High failure rates are especially alarming given a local environment where students have access to a variety of academic, and personal, assistance. The sample consists of students at Colorado State…

pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure.

PubMed

McNamee, J J; Gillies, M A; Barrett, N A; Agus, A M; Beale, R; Bentley, A; Bodenham, A; Brett, S J; Brodie, D; Finney, S J; Gordon, A J; Griffiths, M; Harrison, D; Jackson, C; McDowell, C; McNally, C; Perkins, G D; Tunnicliffe, W; Vuylsteke, A; Walsh, T S; Wise, M P; Young, D; McAuley, D F

2017-05-01

One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO 2 R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO 2 R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO 2 R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO 2 R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.

Initial versus final fracture of metal-free crowns, analyzed via acoustic emission.

PubMed

Ereifej, Nadia; Silikas, Nick; Watts, David C

2008-09-01

To discriminate between initial and final fracture failure loads of four metal-free crown systems by the conjoint detection of acoustic emission signals during compressive loading. Teeth were prepared and used for crown construction with four crown systems; Vita Mark II (VM II) (Vita Zahnfabrik), IPS e.max Ceram/CAD (CAD) (Ivoclar-Vivadent), IPS e.max Ceram/ZirCAD (ZirCAD) (Ivoclar-Vivadent) and BelleGlass/EverStick (BGES) (Kerr/Stick Tech Ltd.). All samples were loaded in compression via a Co/Cr maxillary first molar tooth at 0.2mm/min and released acoustic signals were collected and analyzed. A minimum number of 15 crowns per group were loaded to final failure and values of loading at initial and final fracture were compared. Additional four samples per group were loaded till fracture initiation and were fractographically examined under the optical microscope. A lower threshold of 50dB was selected to exclude spurious background signals. Initial fracture forces were significantly lower than those of final fracture (p<0.05) in all groups and initial failure AE amplitudes were lower than those of final fracture. Mean initial fracture force of ZirCAD samples (1029.1N) was higher than those of VMII (744.4N), CAD (808.8 N) and BGES (979.7 N). Final fracture of ZirCAD also occurred at significantly higher force values (2091.7 N) than the rest of the groups; VMII (1120.9 N), CAD (1468.9 N) and BGES (1576.6 N). Significantly higher values of initial failure AE amplitude were found in VMII than CAD and BGES while those of final fracture were similar. All crowns observed under the microscope at initial fracture had signs of failure. Whereas the metal-free crowns examined showed significant variations in final failure loads, acoustic emission data showed that they all manifested initial failures at significantly lower load values.

Predicting Early Death Among Elderly Dialysis Patients: Development and Validation of a Risk Score to Assist Shared Decision Making for Dialysis Initiation.

PubMed

Thamer, Mae; Kaufman, James S; Zhang, Yi; Zhang, Qian; Cotter, Dennis J; Bang, Heejung

2015-12-01

A shared decision-making tool could help elderly patients with advanced chronic kidney disease decide about initiating dialysis therapy. Because mortality may be high in the first few months after initiating dialysis therapy, incorporating early mortality predictors in such a tool would be important for an informed decision. Our objective is to derive and validate a predictive risk score for early mortality after initiating dialysis therapy. Retrospective observational cohort, with development and validation cohorts. US Renal Data System and claims data from the Centers for Medicare & Medicaid Services for 69,441 (aged ≥67 years) patients with end-stage renal disease with a previous 2-year Medicare history who initiated dialysis therapy from January 1, 2009, to December 31, 2010. Demographics, predialysis care, laboratory data, functional limitations, and medical history. All-cause mortality in the first 3 and 6 months. Predicted mortality by logistic regression. The simple risk score (total score, 0-9) included age (0-3 points), low albumin level, assistance with daily living, nursing home residence, cancer, heart failure, and hospitalization (1 point each), and showed area under the receiver operating characteristic curve (AUROC)=0.69 in the validation sample. A comprehensive risk score with additional predictors was also developed (with AUROC=0.72, high concordance between predicted vs observed risk). Mortality probabilities were estimated from these models, with the median score of 3 indicating 12% risk in 3 months and 20% in 6 months, and the highest scores (≥8) indicating 39% risk in 3 months and 55% in 6 months. Patients who did not choose dialysis therapy and did not have a 2-year Medicare history were excluded. Routinely available information can be used by patients with chronic kidney disease, families, and their nephrologists to estimate the risk of early mortality after dialysis therapy initiation, which may facilitate informed decision making regarding treatment options. Copyright © 2015 National Kidney Foundation, Inc. All rights reserved.

The σ70 region 1.2 regulates promoter escape by unwinding DNA downstream of the transcription start site

PubMed Central

Bochkareva, Aleksandra; Zenkin, Nikolay

2013-01-01

The mechanisms of abortive synthesis and promoter escape during initiation of transcription are poorly understood. Here, we show that, after initiation of RNA synthesis, non-specific interaction of σ70 region 1.2, present in all σ70 family factors, with the non-template strand around position −4 relative to the transcription start site facilitates unwinding of the DNA duplex downstream of the transcription start site. This leads to stabilization of short RNA products and allows their extension, i.e. promoter escape. We show that this activity of σ70 region 1.2 is assisted by the β-lobe domain, but does not involve the β′-rudder or the β′-switch-2, earlier proposed to participate in promoter escape. DNA sequence independence of this function of σ70 region 1.2 suggests that it may be conserved in all σ70 family factors. Our results indicate that the abortive nature of initial synthesis is caused, at least in part, by failure to open the downstream DNA by the β-lobe and σ region 1.2. PMID:23430153

Assessing the potential of e-mail for communicating drug therapy recommendations to physicians in patients with heart failure and ventricular-assist devices.

PubMed

Lekura, Jona; Tita, Cristina; Lanfear, David E; Williams, Celeste T; Jennings, Douglas L

2014-10-01

This project explores electronic mail (e-mail) as a potential medium for pharmacists to communicate pharmacotherapy interventions to prescribers. This retrospective descriptive analysis was conducted at an urban, academic teaching hospital. The pharmacist attempted a drug therapy intervention via e-mail when unable to make face-to-face contact with the attending physician. Eligible patients for this project were admitted to the advanced heart failure (HF) team between December 1, 2010, and July 31, 2011, and had at least 1 attempted e-mail intervention. The primary outcome was the number of accepted interventions, while the secondary end point was the time until a physician e-mail response. A total of 51 e-mail interventions were attempted on 29 patients (mean age = 53, 24% caucasian, 59% male, 69% left ventricular-assist device [VAD]). Overall, of the total 51 interventions,44 (86.3%) were accepted. The average time to a physician e-mail response was 41 minutes. Initiation of drug therapy and changing dose and route or frequency accounted for the most frequent intervention (33%). The most common drug classes involved in the e-mail interventions were angiotensin-converting enzyme inhibitors (15.7%), loop diuretics (9.8%), and antiplatelet agents (7.8%). Clinical pharmacists with well-established physician relationships can effectively implement timely drug therapy recommendations using e-mail communications in patients with advanced HF or VADs. © The Author(s) 2013.

The pharmacotherapy of the HeartMate II, a continuous flow left ventricular assist device, in patients with advanced heart failure: integration of disease, device, and drug.

PubMed

Jennings, Douglas L; Chambers, Rachel M; Schillig, Jessica M

2010-10-01

Advanced heart failure continues to be a significant cause of morbidity and mortality in the US. Patients with advanced heart failure have a poor prognosis without cardiac transplantation. The use of left ventricular assist devices (LVADs) as destination therapy for these patients is therefore expected to increase in the coming years as technology advances. The HeartMate II, a continuous flow implantable device, is currently the only LVAD that has been approved by the Food and Drug Administration for destination therapy in patients with advanced heart failure. The pharmacotherapy associated with this device is very complex and, therefore, the need for expertly trained clinical pharmacists to care for this expanding patient population will also likely increase. Unfortunately, most pharmacists are unfamiliar with the effect of LVADs on the physiology and pharmacotherapy of a patient's heart failure. The purpose of this article is to give clinical pharmacists an introduction to the most common pharmacotherapeutic issues for patients with LVADs and present practical solutions for managing common drug therapy problems.

Failure mechanisms of uni-ply composite plates with a circular hole under static compressive loading

NASA Technical Reports Server (NTRS)

Khamseh, A. R.; Waas, A. M.

1992-01-01

The objective of the study was to identify and study the failure mechanisms associated with compressive-loaded uniply graphite/epoxy square plates with a central circular hole. It is found that the type of compressive failure depends on the hole size. For large holes with the diameter/width ratio exceeding 0.062, fiber buckling/kinking initiated at the hole is found to be the dominant failure mechanism. In plates with smaller hole sizes, failure initiates away from the hole edge or complete global failure occurs. Critical buckle wavelengths at failure are presented as a function of the normalized hole diameter.

Risk Assessment Overview

NASA Technical Reports Server (NTRS)

Prassinos, Peter G.; Lyver, John W., IV; Bui, Chinh T.

2011-01-01

Risk assessment is used in many industries to identify and manage risks. Initially developed for use on aeronautical and nuclear systems, risk assessment has been applied to transportation, chemical, computer, financial, and security systems among others. It is used to gain an understanding of the weaknesses or vulnerabilities in a system so modification can be made to increase operability, efficiency, and safety and to reduce failure and down-time. Risk assessment results are primary inputs to risk-informed decision making; where risk information including uncertainty is used along with other pertinent information to assist management in the decision-making process. Therefore, to be useful, a risk assessment must be directed at specific objectives. As the world embraces the globalization of trade and manufacturing, understanding the associated risk become important to decision making. Applying risk assessment techniques to a global system of development, manufacturing, and transportation can provide insight into how the system can fail, the likelihood of system failure and the consequences of system failure. The risk assessment can identify those elements that contribute most to risk and identify measures to prevent and mitigate failures, disruptions, and damaging outcomes. In addition, risk associated with public and environment impact can be identified. The risk insights gained can be applied to making decisions concerning suitable development and manufacturing locations, supply chains, and transportation strategies. While risk assessment has been mostly applied to mechanical and electrical systems, the concepts and techniques can be applied across other systems and activities. This paper provides a basic overview of the development of a risk assessment.

Estimating time available for sensor fusion exception handling

NASA Astrophysics Data System (ADS)

Murphy, Robin R.; Rogers, Erika

1995-09-01

In previous work, we have developed a generate, test, and debug methodology for detecting, classifying, and responding to sensing failures in autonomous and semi-autonomous mobile robots. An important issue has arisen from these efforts: how much time is there available to classify the cause of the failure and determine an alternative sensing strategy before the robot mission must be terminated? In this paper, we consider the impact of time for teleoperation applications where a remote robot attempts to autonomously maintain sensing in the presence of failures yet has the option to contact the local for further assistance. Time limits are determined by using evidential reasoning with a novel generalization of Dempster-Shafer theory. Generalized Dempster-Shafer theory is used to estimate the time remaining until the robot behavior must be suspended because of uncertainty; this becomes the time limit on autonomous exception handling at the remote. If the remote cannot complete exception handling in this time or needs assistance, responsibility is passed to the local, while the remote assumes a `safe' state. An intelligent assistant then facilitates human intervention, either directing the remote without human assistance or coordinating data collection and presentation to the operator within time limits imposed by the mission. The impact of time on exception handling activities is demonstrated using video camera sensor data.

Effect of Premolar Axial Wall Height on Computer-Aided Design/Computer-Assisted Manufacture Crown Retention.

PubMed

Martin, Curt; Harris, Ashley; DuVall, Nicholas; Wajdowicz, Michael; Roberts, Howard Wayne

2018-03-28

To evaluate the effect of premolar axial wall height on the retention of adhesive, full-coverage, computer-aided design/computer-assisted manufacture (CAD/CAM) restorations. A total of 48 premolar teeth randomized into four groups (n = 12 per group) received all-ceramic CAD/CAM restorations with axial wall heights (AWH) of 3, 2, 1, and 0 mm and 16-degree total occlusal convergence (TOC). Specimens were restored with lithium disilicate material and cemented with self-adhesive resin cement. Specimens were loaded to failure after 24 hours. The 3- and 2-mm AWH specimens demonstrated significantly greater failure load. Failure analysis suggests a 2-mm minimum AWH for premolars with a TOC of 16 degrees. Adhesive technology may compensate for compromised AWH.

Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison.

PubMed

Avery, Ryan; Day, Kevin; Jokerst, Clinton; Kazui, Toshinobu; Krupinski, Elizabeth; Khalpey, Zain

2017-10-10

Advanced heart failure treated with a left ventricular assist device is associated with a higher risk of right heart failure. Many advanced heart failures patients are treated with an ICD, a relative contraindication to MRI, prior to assist device placement. Given this limitation, left and right ventricular function for patients with an ICD is calculated using radionuclide angiography utilizing planar multigated acquisition (MUGA) and first pass radionuclide angiography (FPRNA), respectively. Given the availability of MRI protocols that can accommodate patients with ICDs, we have correlated the findings of ventricular functional analysis using radionuclide angiography to cardiac MRI, the reference standard for ventricle function calculation, to directly correlate calculated ejection fractions between these modalities, and to also assess agreement between available echocardiographic and hemodynamic parameters of right ventricular function. A retrospective review from January 2012 through May 2014 was performed to identify advanced heart failure patients who underwent both cardiac MRI and radionuclide angiography for ventricular functional analysis. Nine heart failure patients (8 men, 1 woman; mean age of 57.0 years) were identified. The average time between the cardiac MRI and radionuclide angiography exams was 38.9 days (range: 1 - 119 days). All patients undergoing cardiac MRI were scanned using an institutionally approved protocol for ICD with no device-related complications identified. A retrospective chart review of each patient for cardiomyopathy diagnosis, clinical follow-up, and echocardiogram and right heart catheterization performed during evaluation was also performed. The 9 patients demonstrated a mean left ventricular ejection fraction (LVEF) using cardiac MRI of 20.7% (12 - 40%). Mean LVEF using MUGA was 22.6% (12 - 49%). The mean right ventricular ejection fraction (RVEF) utilizing cardiac MRI was 28.3% (16 - 43%), and the mean RVEF calculated by FPRNA was 32.6% (9 - 56%). The mean discrepancy for LVEF between cardiac MRI and MUGA was 4.1% (0 - 9%), and correlation of calculated LVEF using cardiac MRI and MUGA demonstrated an R of 0.9. The mean discrepancy for RVEF between cardiac MRI and FPRNA was 12.0% (range: 2 - 24%) with a moderate correlation (R = 0.5). The increased discrepancies for RV analysis were statistically significant using an unpaired t-test (t = 3.19, p = 0.0061). Echocardiogram parameters of RV function, including TAPSE and FAC, were for available for all 9 patients and agreement with cardiac MRI demonstrated a kappa statistic for TAPSE of 0.39 (95% CI of 0.06 - 0.72) and for FAC of 0.64 (95% of 0.21 - 1.00). Heart failure patients are increasingly requiring left ventricular assist device placement; however, definitive evaluation of biventricular function is required due to the increased mortality rate associated with right heart failure after assist device placement. Our results suggest that FPRNA only has a moderate correlation with reference standard RVEFs calculated using cardiac MRI, which was similar to calculated agreements between cardiac MRI and echocardiographic parameters of right ventricular function. Given the need for identification of patients at risk for right heart failure, further studies are warranted to determine a more accurate estimate of RVEF for heart failure patients during pre-operative ventricular assist device planning.

German disease management guidelines: surgical therapies for chronic heart failure.

PubMed

Sindermann, J R; Klotz, S; Rahbar, K; Hoffmeier, A; Drees, G

2010-02-01

The German Disease Management Guideline "Chronic Heart Failure" intends to guide physicians working in the field of diagnosis and treatment of heart failure. The guideline provides a tool on the background of evidence based medicine. The following short review wants to give insights into the role of some surgical treatment options to improve heart failure, such as revascularization, ventricular reconstruction and aneurysmectomy, mitral valve reconstruction, ventricular assist devices and heart transplantation. (c) Georg Thieme Verlag KG Stuttgart-New York.

Comparison of Cardiopulmonary Resuscitation Quality Between Standard Versus Telephone-Basic Life Support Training Program in Middle-Aged and Elderly Housewives: A Randomized Simulation Study.

PubMed

Kim, Tae Han; Lee, Yu Jin; Lee, Eui Jung; Ro, Young Sun; Lee, KyungWon; Lee, Hyeona; Jang, Dayea Beatrice; Song, Kyoung Jun; Shin, Sang Do; Myklebust, Helge; Birkenes, Tonje Søraas

2018-02-01

For cardiac arrests witnessed at home, the witness is usually a middle-aged or older housewife. We compared the quality of cardiopulmonary resuscitation (CPR) performance of bystanders trained with the newly developed telephone-basic life support (T-BLS) program and those trained with standard BLS (S-BLS) training programs. Twenty-four middle-aged and older housewives without previous CPR education were enrolled and randomized into two groups of BLS training programs. The T-BLS training program included concepts and current instruction protocols for telephone-assisted CPR, whereas the S-BLS training program provided training for BLS. After each training course, the participants simulated CPR and were assisted by a dispatcher via telephone. Cardiopulmonary resuscitation quality was measured and recorded using a mannequin simulator. The primary outcome was total no-flow time (>1.5 seconds without chest compression) during simulation. Among 24 participants, two (8.3%) who experienced mechanical failure of simulation mannequin and one (4.2%) who violated simulation protocols were excluded at initial simulation, and two (8.3%) refused follow-up after 6 months. The median (interquartile range) total no-flow time during initial simulation was 79.6 (66.4-96.9) seconds for the T-BLS training group and 147.6 (122.5-184.0) seconds for the S-BLS training group (P < 0.01). Median cumulative interruption time and median number of interruption events during BLS at initial simulation and 6-month follow-up simulation were significantly shorter in the T-BLS than in the S-BLS group (1.0 vs. 9.5, P < 0.01, and 1.0 vs. 10.5, P = 0.02, respectively). Participants trained with the T-BLS training program showed shorter no-flow time and fewer interruptions during bystander CPR simulation assisted by a dispatcher.

13 CFR 302.18 - Post-approval requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 302.18 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE... Federal cost principles (collectively, “Post-Approval Requirements”). A Recipient's failure to comply with... Assistance award, or other adverse consequences to the Recipient. (b) Part 307 (Economic Adjustment...

Evaluation of strength and failure of brittle rock containing initial cracks under lithospheric conditions

NASA Astrophysics Data System (ADS)

Li, Xiaozhao; Qi, Chengzhi; Shao, Zhushan; Ma, Chao

2018-02-01

Natural brittle rock contains numerous randomly distributed microcracks. Crack initiation, growth, and coalescence play a predominant role in evaluation for the strength and failure of brittle rocks. A new analytical method is proposed to predict the strength and failure of brittle rocks containing initial microcracks. The formulation of this method is based on an improved wing crack model and a suggested micro-macro relation. In this improved wing crack model, the parameter of crack angle is especially introduced as a variable, and the analytical stress-crack relation considering crack angle effect is obtained. Coupling the proposed stress-crack relation and the suggested micro-macro relation describing the relation between crack growth and axial strain, the stress-strain constitutive relation is obtained to predict the rock strength and failure. Considering different initial microcrack sizes, friction coefficients and confining pressures, effects of crack angle on tensile wedge force acting on initial crack interface are studied, and effects of crack angle on stress-strain constitutive relation of rocks are also analyzed. The strength and crack initiation stress under different crack angles are discussed, and the value of most disadvantaged angle triggering crack initiation and rock failure is founded. The analytical results are similar to the published study results. Rationality of this proposed analytical method is verified.

Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure.

PubMed

Cooper, Lauren B; Hammill, Bradley G; Peterson, Eric D; Pitt, Bertram; Maciejewski, Matthew L; Curtis, Lesley H; Hernandez, Adrian F

2017-01-01

Heart failure guidelines recommend routine monitoring of serum potassium, and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high-risk patients or according to setting of drug initiation is poorly characterized. We conducted a retrospective cohort study of Medicare beneficiaries linked to laboratory data in 10 states with prevalent heart failure as of July 1, 2011, and incident MRA use between May 1 and September 30, 2011. Outcomes included laboratory testing before MRA initiation and in the early (days 1-10) and extended (days 11-90) post-initiation periods, based on setting of drug initiation and the presence of renal insufficiency. Additional outcomes included abnormal laboratory results and adverse events proximate to MRA initiation. Of 10 443 Medicare beneficiaries with heart failure started on an MRA, 19.7% were initiated during a hospitalization. Appropriate follow-up laboratory testing across all time periods occurred in 25.2% of patients with inpatient initiation compared with 2.8% of patients begun as an outpatient. Patients with chronic kidney disease had higher rates of both hyperkalemia and acute kidney failure in the early (1.3% and 2.7%, respectively) and extended (5.6% and 9.8%, respectively) post-initiation periods compared with those without chronic kidney disease. Patients initiated on MRA therapy as an outpatient had extremely poor rates of guideline indicated follow-up laboratory monitoring after drug initiation. In particular, patients with chronic kidney disease are at high risk for adverse events after MRA initiation. Quality improvement initiatives focused on systems to improve appropriate laboratory monitoring are needed. © 2017 American Heart Association, Inc.

Endocarditis in left ventricular assist device

PubMed Central

Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

2016-01-01

Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry.

PubMed

Benabed, Anais; Bechade, Clemence; Ficheux, Maxence; Verger, Christian; Lobbedez, Thierry

2016-04-01

Diabetic patients treated by peritoneal dialysis (PD) have been reported to be at an increased risk of peritonitis. This has been attributed to impairment in host defense, visual impairment, disability and muscle wasting, which could compromise ability to safely perform catheter connections. This study aimed to evaluate whether assisted PD is associated with a lower risk of peritonitis in diabetic patients. This was a retrospective study based on data from the French Language Peritoneal Dialysis Registry. We included diabetic patients starting PD between 1 January 2002 and 31 December 2012. The end of the observation period was 31 December 2013. Using complementary regression analysis (Fine and Gray, Hurdle models), we assessed the relationship between peritonitis occurrence, peritonitis number over time and the type of assisted PD. Of the 3598 diabetic patients, there were 2040 patients on nurse-assisted PD. These patients were older, more comorbid and more frequently on continuous ambulatory peritoneal dialysis (CAPD). In the multivariate analysis, nurse assistance was associated with a reduced risk of peritonitis in the Fine and Gray [subdistribution hazard ratio: 0.78 (95% confidence interval, CI, 0.68-0.89)] and in the first component of the Hurdle models [rate ratio: 0.82 (95% CI 0.71-0.93)], but not a lower incidence of peritonitis after an initial episode [rate ratio: 0.82 (95% CI 0.95-1.38)]. Transplant failure, glomerulonephritis and CAPD were associated with an increased risk. In France, nurse-assisted PD is associated with a lower risk of peritonitis in diabetic patients treated by PD but not a lower incidence of peritonitis. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

High fidelity computational simulation of thrombus formation in Thoratec HeartMate II continuous flow ventricular assist device

PubMed Central

Wu, Wei-Tao; Yang, Fang; Wu, Jingchun; Aubry, Nadine; Massoudi, Mehrdad; Antaki, James F.

2016-01-01

Continuous flow ventricular assist devices (cfVADs) provide a life-saving therapy for severe heart failure. However, in recent years, the incidence of device-related thrombosis (resulting in stroke, device-exchange surgery or premature death) has been increasing dramatically, which has alarmed both the medical community and the FDA. The objective of this study was to gain improved understanding of the initiation and progression of thrombosis in one of the most commonly used cfVADs, the Thoratec HeartMate II. A computational fluid dynamics simulation (CFD) was performed using our recently updated mathematical model of thrombosis. The patterns of deposition predicted by simulation agreed well with clinical observations. Furthermore, thrombus accumulation was found to increase with decreased flow rate, and can be completely suppressed by the application of anticoagulants and/or improvement of surface chemistry. To our knowledge, this is the first simulation to explicitly model the processes of platelet deposition and thrombus growth in a continuous flow blood pump and thereby replicate patterns of deposition observed clinically. The use of this simulation tool over a range of hemodynamic, hematological, and anticoagulation conditions could assist physicians to personalize clinical management to mitigate the risk of thrombosis. It may also contribute to the design of future VADs that are less thrombogenic. PMID:27905492

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco

PubMed Central

2011-01-01

Background Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Methods Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. Results 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1.10-4.77), positive sputum smear after 3 months of treatment (OR 7.14, 95% CI 4.04-13.2), and hospitalization (OR 2.09, 95% CI 1.01-4.34). Higher weight at treatment initiation was protective. Male sex, substance use, missed doses, and hospitalization appeared to be risk factors for default, but subgroup analyses were limited by small numbers. Conclusions Outcomes of retreatment with a Category II regimen are suboptimal and vary by subgroup. Default among patients receiving tuberculosis retreatment is unacceptably high in urban areas in Morocco, and patients who fail initial tuberculosis treatment are at especially high risk of retreatment failure. Strategies to address risk factors for initial treatment default and to identify patients at risk for failure (including expanded use of drug susceptibility testing) are important given suboptimal retreatment outcomes in these groups. PMID:21356062

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco.

PubMed

Dooley, Kelly E; Lahlou, Ouafae; Ghali, Iraqi; Knudsen, Janine; Elmessaoudi, My Driss; Cherkaoui, Imad; El Aouad, Rajae

2011-02-28

Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1.10-4.77), positive sputum smear after 3 months of treatment (OR 7.14, 95% CI 4.04-13.2), and hospitalization (OR 2.09, 95% CI 1.01-4.34). Higher weight at treatment initiation was protective. Male sex, substance use, missed doses, and hospitalization appeared to be risk factors for default, but subgroup analyses were limited by small numbers. Outcomes of retreatment with a Category II regimen are suboptimal and vary by subgroup. Default among patients receiving tuberculosis retreatment is unacceptably high in urban areas in Morocco, and patients who fail initial tuberculosis treatment are at especially high risk of retreatment failure. Strategies to address risk factors for initial treatment default and to identify patients at risk for failure (including expanded use of drug susceptibility testing) are important given suboptimal retreatment outcomes in these groups.

Biofeedback in the treatment of heart failure.

PubMed

McKee, Michael G; Moravec, Christine S

2010-07-01

Biofeedback training can be used to reduce activation of the sympathetic nervous system (SNS) and increase activation of the parasympathetic nervous system (PNS). It is well established that hyperactivation of the SNS contributes to disease progression in chronic heart failure. It has been postulated that underactivation of the PNS may also play a role in heart failure pathophysiology. In addition to autonomic imbalance, a chronic inflammatory process is now recognized as being involved in heart failure progression, and recent work has established that activation of the inflammatory process may be attenuated by vagal nerve stimulation. By interfering with both autonomic imbalance and the inflammatory process, biofeedback-assisted stress management may be an effective treatment for patients with heart failure by improving clinical status and quality of life. Recent studies have suggested that biofeedback and stress management have a positive impact in patients with chronic heart failure, and patients with higher perceived control over their disease have been shown to have better quality of life. Our ongoing study of biofeedback-assisted stress management in the treatment of end-stage heart failure will also examine biologic end points in treated patients at the time of heart transplant, in order to assess the effects of biofeedback training on the cellular and molecular components of the failing heart. We hypothesize that the effects of biofeedback training will extend to remodeling the failing human heart, in addition to improving quality of life.

Predicting short-term mortality in advanced decompensated heart failure - role of the updated acute decompensated heart failure/N-terminal pro-B-type natriuretic Peptide risk score.

PubMed

Scrutinio, Domenico; Ammirati, Enrico; Passantino, Andrea; Guida, Pietro; D'Angelo, Luciana; Oliva, Fabrizio; Ciccone, Marco Matteo; Iacoviello, Massimo; Dentamaro, Ilaria; Santoro, Daniela; Lagioia, Rocco; Sarzi Braga, Simona; Guzzetti, Daniela; Frigerio, Maria

2015-01-01

The first few months after admission are the most vulnerable period in patients with acute decompensated heart failure (ADHF). We assessed the association of the updated ADHF/N-terminal pro-B-type natriuretic peptide (NT-proBNP) risk score with 90-day and in-hospital mortality in 701 patients admitted with advanced ADHF, defined as severe symptoms of worsening HF, severely depressed left ventricular ejection fraction, and the need for i.v. diuretic and/or inotropic drugs. A total of 15.7% of the patients died within 90 days of admission and 5.2% underwent ventricular assist device (VAD) implantation or urgent heart transplantation (UHT). The C-statistic of the ADHF/NT-proBNP risk score for 90-day mortality was 0.810 (95% CI: 0.769-0.852). Predicted and observed mortality rates were in close agreement. When the composite outcome of death/VAD/UHT at 90 days was considered, the C-statistic decreased to 0.741. During hospitalization, 7.6% of the patients died. The C-statistic for in-hospital mortality was 0.815 (95% CI: 0.761-0.868) and Hosmer-Lemeshow χ(2)=3.71 (P=0.716). The updated ADHF/NT-proBNP risk score outperformed the Acute Decompensated Heart Failure National Registry, the Organized Program to Initiate Lifesaving Treatment in Patients Hospitalized for Heart Failure, and the American Heart Association Get with the Guidelines Program predictive models. Updated ADHF/NT-proBNP risk score is a valuable tool for predicting short-term mortality in severe ADHF, outperforming existing inpatient predictive models.

Heart Failure Epidemiology: European Perspective

PubMed Central

Guha, K; McDonagh, T

2013-01-01

Heart failure poses an increasing problem for global healthcare systems. The epidemiological data which has been accrued over the last thirty years has predominantly been accumulated from experience within North America and Europe. Initial large cohort, prospective longitudinal studies produced the first publications; however latterly the focus has shifted onto epidemiological data governing hospitalisation and mortality. The emphasis behind this shift has been the resource implications with regards to repetitive, costly and prolonged hospitalisation. The European experience in heart failure, though similar to North America has recently demonstrated differences in hospitalisation which may underlie the differences between healthcare system configuration. Heart failure however remains an increasing global problem and the endpoint of a variety of cardiovascular diseases. Allied with the fact of increasingly elderly populations and prior data demonstrating a steep rise in prevalent cases within more elderly populations, it is likely that the increasing burden of disease will continue to pose challenges for modern healthcare. Despite the predicted increase in the number of patients affected by heart failure, over the last thirty years, a clear management algorithm has evolved for the use of pharmacotherapies (neuro-hormonal antagonists), device based therapies (Implantable Cardioverting Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT)) and mechanical therapies including left ventricular assist devices and cardiac transplantation. Though the management of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. When comparing various epidemiological studies from different settings and timepoints, it should be remembered that rates of prevalence and incidence may vary depending upon the definition used, methods of accumulating information (with the possibility of bias) and the chosen cut point of defining left ventricular systolic dysfunction (LVSD). PMID:23597298

Predictors of Engagement in Family Mediation and Outcomes for Families that Fail to Engage.

PubMed

Morris, Megan; Halford, W Kim; Petch, Jemima; Hardwick, David

2018-03-01

An important limitation to the effectiveness of family mediation in assisting separated parents is parents failing to engage in the mediation process. In 524 parents who presented to a telephone-based mediation service, 113 (22%) initiating parents withdrew from mediation before the other parent was invited to participate, 241 (46%) initiating parents had respondent parents who declined to participate in mediation, and 170 cases (33%) completed mediation. We tested whether socio-demographic variables, psychological distress, coparental acrimony, parenting problems, or children's behavioral difficulties predicted mediation engagement. High interparental acrimony predicted failure to engage in mediation, but none of the other variables predicted mediation engagement. We followed a sample of 131 families that did not mediate and found they showed elevated psychological distress, acrimony, parenting problems and child adjustment difficulties, which remained unchanged 6 months later. Further research is needed to explore strategies to enhance respondent parent engagement with mediation, and to address the negative outcomes for those separated families not proceeding with mediation. © 2016 Family Process Institute.

Respiratory complications after diode-laser-assisted tonsillotomy.

PubMed

Fischer, Miloš; Horn, Iris-Susanne; Quante, Mirja; Merkenschlager, Andreas; Schnoor, Jörg; Kaisers, Udo X; Dietz, Andreas; Kluba, Karsten

2014-08-01

Children with certain risk factors, such as comorbidities or severe obstructive sleep apnea syndrome (OSAS) are known to require extended postoperative monitoring after adenotonsillectomy. However, there are no recommendations available for diode-laser-assisted tonsillotomy. A retrospective chart review of 96 children who underwent diode-laser-assisted tonsillotomy (07/2011-06/2013) was performed. Data for general and sleep apnea history, power of the applied diode-laser (λ = 940 nm), anesthesia parameters, the presence of postoperative respiratory complications and postoperative healing were evaluated. After initially uncomplicated diode-laser-assisted tonsillotomy, an adjustment of post-anesthesia care was necessary in 16 of 96 patients due to respiratory failure. Respiratory complications were more frequent in younger children (3.1 vs. 4.0 years, p = 0.049, 95 % CI -1.7952 to -0.0048) and in children who suffered from nocturnal apneas (OR = 5.00, p < 0.01, 95 % CI 1.4780-16.9152) or who suffered from relevant comorbidities (OR = 4.84, p < 0.01, 95 % CI 1.5202-15.4091). Moreover, a diode-laser power higher than 13 W could be identified as a risk factor for the occurrence of a postoperative oropharyngeal edema (OR = 3.45, p < 0.01, 95 % CI 1.3924-8.5602). Postoperative respiratory complications should not be underestimated in children with sleep-disordered breathing (SDB). Therefore, children with SDB, children with comorbidities or children younger than 3 years should be considered "at risk" and children with confirmed moderate to severe OSAS should be referred to a PICU following diode-laser-assisted tonsillotomy. We recommend a reduced diode-laser power (<13 W) to reduce oropharyngeal edema.

45 CFR 400.82 - Failure or refusal to accept employability services or employment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Requirements for Employability Services and Employment Failure Or... recipient of refugee cash assistance under the public/private RCA program or under a publicly-administered...

Bone Graft Substitute Provides Metaphyseal Fixation for a Stemless Humeral Implant.

PubMed

Kim, Myung-Sun; Kovacevic, David; Milks, Ryan A; Jun, Bong-Jae; Rodriguez, Eric; DeLozier, Katherine R; Derwin, Kathleen A; Iannotti, Joseph P

2015-07-01

Stemless humeral fixation has become an alternative to traditional total shoulder arthroplasty, but metaphyseal fixation may be compromised by the quality of the trabecular bone that diminishes with age and disease, and augmentation of the fixation may be desirable. The authors hypothesized that a bone graft substitute (BGS) could achieve initial fixation comparable to polymethylmethacrylate (PMMA) bone cement. Fifteen fresh-frozen human male humerii were randomly implanted using a stemless humeral prosthesis, and metaphyseal fixation was augmented with either high-viscosity PMMA bone cement (PMMA group) or a magnesium-based injectable BGS (OsteoCrete; Bone Solutions Inc, Dallas, Texas) (OC group). Both groups were compared with a control group with no augmentation. Initial stiffness, failure load, failure displacement, failure cycle, and total work were compared among groups. The PMMA and OC groups showed markedly higher failure loads, failure displacements, and failure cycles than the control group (P<.01). There were no statistically significant differences in initial stiffness, failure load, failure displacement, failure cycle, or total work between the PMMA and OC groups. The biomechanical properties of magnesium-based BGS fixation compared favorably with PMMA bone cement in the fixation of stemless humeral prostheses and may provide sufficient initial fixation for this clinical application. Future work will investigate the long-term remodeling characteristics and bone quality at the prosthetic-bone interface in an in vivo model to evaluate the clinical efficacy of this approach. Copyright 2015, SLACK Incorporated.

45 CFR 233.34 - Computing the assistance payment in the initial one or two months (AFDC).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Computing the assistance payment in the initial... § 233.34 Computing the assistance payment in the initial one or two months (AFDC). A State shall compute...) If the initial month is computed prospectively as in paragraph (a) of this section, the second month...

Enhanced stability of steep channel beds to mass failure and debris flow initiation

NASA Astrophysics Data System (ADS)

Prancevic, J.; Lamb, M. P.; Ayoub, F.; Venditti, J. G.

2015-12-01

Debris flows dominate bedrock erosion and sediment transport in very steep mountain channels, and are often initiated from failure of channel-bed alluvium during storms. While several theoretical models exist to predict mass failures, few have been tested because observations of in-channel bed failures are extremely limited. To fill this gap in our understanding, we performed laboratory flume experiments to identify the conditions necessary to initiate bed failures in non-cohesive sediment of different sizes (D = 0.7 mm to 15 mm) on steep channel-bed slopes (S = 0.45 to 0.93) and in the presence of water flow. In beds composed of sand, failures occurred under sub-saturated conditions on steep bed slopes (S > 0.5) and under super-saturated conditions at lower slopes. In beds of gravel, however, failures occurred only under super-saturated conditions at all tested slopes, even those approaching the dry angle of repose. Consistent with theoretical models, mass failures under super-saturated conditions initiated along a failure plane approximately one grain-diameter below the bed surface, whereas the failure plane was located near the base of the bed under sub-saturated conditions. However, all experimental beds were more stable than predicted by 1-D infinite-slope stability models. In partially saturated sand, enhanced stability appears to result from suction stress. Enhanced stability in gravel may result from turbulent energy losses in pores or increased granular friction for failures that are shallow with respect to grain size. These grain-size dependent effects are not currently included in stability models for non-cohesive sediment, and they may help to explain better the timing and location of debris flow occurrence.

13 CFR 315.10 - Loss of certification benefits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Loss of certification benefits. 315.10 Section 315.10 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT... expiration; (b) Failure to submit documentation necessary to start implementation or modify its request for...

13 CFR 117.5 - Illustrative applications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... companies and small business investment companies, which apply for or receive any financial assistance may.... Such discrimination prohibited by § 117.4 includes but is not limited to the failure or refusal... assistance administered by the Small Business Administration, such as but not limited to physicians, dentists...

Managing Employee Assistance Programmes.

ERIC Educational Resources Information Center

Schmidenberg, Olive C.; Cordery, John L.

1990-01-01

Interviews with 20 branch managers and 20 accountants in an Australian bank determined factors influencing the success of an employee assistance program (EAP). It was found that policies requiring supervisors to act against normal managerial practice doom EAPs to failure. Organizational analysis to integrate the EAP within existing organizational…

Feasibility and efficacy of the 2.5 L and 3.8 L impella percutaneous left ventricular support device during high-risk, percutaneous coronary intervention in patients with severe aortic stenosis.

PubMed

Spiro, Jon; Venugopal, Vinod; Raja, Yogesh; Ludman, Peter F; Townend, Jonathan N; Doshi, Sagar N

2015-05-01

Assessment of the feasibility and outcomes of the 2.5 L and 3.8 L Impella cardiac pump in patients with severe aortic stenosis (AS) and left ventricular impairment undergoing percutaneous revascularization (PCI) with or without balloon aortic valvuloplasty (BAV). We reviewed the clinical and procedural findings from a consecutive series of unselected patients with severe AS who underwent PCI during Impella support. In addition, we describe novel "balloon-assist" techniques that allowed implantation of Impella into the left ventricle (LV) when initial unassisted attempts failed. Five patients with severe AS were identified (four males, age 78.2 years, aortic valve area (AVA) 0.6 cm(2) , left ventricular ejection fraction (LVEF) 24 ± 5%, mean Society of Thoracic Surgeons (STS) mortality 11% (range 3-17%)). The Impella catheter traversed the aortic valve (AV) unassisted in only one patient, with four cases requiring balloon-assist techniques. All patients underwent planned revascularisation; mean procedure time 177 min (range 135-252 min), mean number of stents 3.4 (range 1-8), with three patients requiring rotational atherectomy. All procedures were well tolerated, with absence of arrhythmia, hypotension, pulmonary edema, stroke, or myocardial infarction. One patient died 48 hr post-PCI of multi-organ failure. The four remaining patients were well at 30 days. Implantation of the 2.5 and 3.8 L Impella appears feasible in patients with severe AS and left ventricle (LV) impairment. A balloon-assist technique may be used to facilitate device implantation when initial unassisted attempts fail. Improved hemodynamic stability may enhance the tolerability of lengthy and complex procedures. © 2014 Wiley Periodicals, Inc.

Investigating the Role of Interventricular Interdependence in Development of Right Heart Dysfunction During LVAD Support: A Patient-Specific Methods-Based Approach.

PubMed

Sack, Kevin L; Dabiri, Yaghoub; Franz, Thomas; Solomon, Scott D; Burkhoff, Daniel; Guccione, Julius M

2018-01-01

Predictive computation models offer the potential to uncover the mechanisms of treatments whose actions cannot be easily determined by experimental or imaging techniques. This is particularly relevant for investigating left ventricular mechanical assistance, a therapy for end-stage heart failure, which is increasingly used as more than just a bridge-to-transplant therapy. The high incidence of right ventricular failure following left ventricular assistance reflects an undesired consequence of treatment, which has been hypothesized to be related to the mechanical interdependence between the two ventricles. To investigate the implication of this interdependence specifically in the setting of left ventricular assistance device (LVAD) support, we introduce a patient-specific finite-element model of dilated chronic heart failure. The model geometry and material parameters were calibrated using patient-specific clinical data, producing a mechanical surrogate of the failing in vivo heart that models its dynamic strain and stress throughout the cardiac cycle. The model of the heart was coupled to lumped-parameter circulatory systems to simulate realistic ventricular loading conditions. Finally, the impact of ventricular assistance was investigated by incorporating a pump with pressure-flow characteristics of an LVAD (HeartMate II™ operating between 8 and 12 k RPM) in parallel to the left ventricle. This allowed us to investigate the mechanical impact of acute left ventricular assistance at multiple operating-speeds on right ventricular mechanics and septal wall motion. Our findings show that left ventricular assistance reduces myofiber stress in the left ventricle and, to a lesser extent, right ventricle free wall, while increasing leftward septal-shift with increased operating-speeds. These effects were achieved with secondary, potentially negative effects on the interventricular septum which showed that support from LVADs, introduces unnatural bending of the septum and with it, increased localized stress regions. Left ventricular assistance unloads the left ventricle significantly and shifts the right ventricular pressure-volume-loop toward larger volumes and higher pressures; a consequence of left-to-right ventricular interactions and a leftward septal shift. The methods and results described in the present study are a meaningful advancement of computational efforts to investigate heart-failure therapies in silico and illustrate the potential of computational models to aid understanding of complex mechanical and hemodynamic effects of new therapies.

45 CFR 286.195 - What penalties will apply to Tribes?

Code of Federal Regulations, 2010 CFR

2010-10-01

... penalty amount, we will take into consideration the severity of the failure and whether the reasons for the failure were increases in the unemployment rate in the TFAG service area and changes in TFAG... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

45 CFR 1355.36 - Withholding Federal funds due to failure to achieve substantial conformity or failure to...

Code of Federal Regulations, 2013 CFR

2013-10-01

... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL... the immediately preceding child and family services review; (ii) The increased withholding of funds...

36 CFR 800.7 - Failure to resolve adverse effects.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Failure to resolve adverse effects. 800.7 Section 800.7 Parks, Forests, and Public Property ADVISORY COUNCIL ON HISTORIC PRESERVATION... concerning the undertaking and assist the Council in arranging an onsite inspection and an opportunity for...

Accuracy of Seattle Heart Failure Model and HeartMate II Risk Score in Non-Inotrope-Dependent Advanced Heart Failure Patients: Insights From the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients).

PubMed

Lanfear, David E; Levy, Wayne C; Stehlik, Josef; Estep, Jerry D; Rogers, Joseph G; Shah, Keyur B; Boyle, Andrew J; Chuang, Joyce; Farrar, David J; Starling, Randall C

2017-05-01

Timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients not on inotropes is unclear. Relevant prediction models exist (SHFM [Seattle Heart Failure Model] and HMRS [HeartMate II Risk Score]), but use in this group is not established. ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) is a prospective, multicenter, nonrandomized study of 200 advanced heart failure patients not on inotropes who met indications for LVAD implantation, comparing the effectiveness of HeartMate II support versus optimal medical management. We compared SHFM-predicted versus observed survival (overall survival and LVAD-free survival) in the optimal medical management arm (n=103) and HMRS-predicted versus observed survival in all LVAD patients (n=111) using Cox modeling, receiver-operator characteristic (ROC) curves, and calibration plots. In the optimal medical management cohort, the SHFM was a significant predictor of survival (hazard ratio=2.98; P <0.001; ROC area under the curve=0.71; P <0.001) but not LVAD-free survival (hazard ratio=1.41; P =0.097; ROC area under the curve=0.56; P =0.314). SHFM showed adequate calibration for survival but overestimated LVAD-free survival. In the LVAD cohort, the HMRS had marginal discrimination at 3 (Cox P =0.23; ROC area under the curve=0.71; P =0.026) and 12 months (Cox P =0.036; ROC area under the curve=0.62; P =0.122), but calibration was poor, underestimating survival across time and risk subgroups. In non-inotrope-dependent advanced heart failure patients receiving optimal medical management, the SHFM was predictive of overall survival but underestimated the risk of clinical worsening and LVAD implantation. Among LVAD patients, the HMRS had marginal discrimination and underestimated survival post-LVAD implantation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01452802. © 2017 American Heart Association, Inc.

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction.

PubMed

Mor, Joel M; Guo, Yongwei; Koch, Konrad R; Heindl, Ludwig M

2017-10-13

Today's gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

Assessment of hydraulic performance and biocompatibility of a MagLev centrifugal pump system designed for pediatric cardiac or cardiopulmonary support.

PubMed

Dasse, Kurt A; Gellman, Barry; Kameneva, Marina V; Woolley, Joshua R; Johnson, Carl A; Gempp, Thomas; Marks, John D; Kent, Stella; Koert, Andrew; Richardson, J Scott; Franklin, Steve; Snyder, Trevor A; Wearden, Peter; Wagner, William R; Gilbert, Richard J; Borovetz, Harvey S

2007-01-01

The treatment of children with life-threatening cardiac and cardiopulmonary failure is a large and underappreciated public health concern. We have previously shown that the CentriMag is a magnetically levitated centrifugal pump system, having the utility for treating adults and large children (1,500 utilized worldwide). We present here the PediVAS, a pump system whose design was modified from the CentriMag to meet the physiological requirements of young pediatric and neonatal patients. The PediVAS is comprised of a single-use centrifugal blood pump, reusable motor, and console, and is suitable for right ventricular assist device (RVAD), left ventricular assist device (LVAD), biventricular assist device (BVAD), or extracorporeal membrane oxygenator (ECMO) applications. It is designed to operate without bearings, seals and valves, and without regions of blood stasis, friction, or wear. The PediVAS pump is compatible with the CentriMag hardware, although the priming volume was reduced from 31 to 14 ml, and the port size reduced from 3/8 to (1/4) in. For the expected range of pediatric flow (0.3-3.0 L/min), the PediVAS exhibited superior hydraulic efficiency compared with the CentriMag. The PediVAS was evaluated in 14 pediatric animals for up to 30 days, demonstrating acceptable hydraulic function and hemocompatibility. The current results substantiate the performance and biocompatibility of the PediVAS cardiac assist system and are likely to support initiation of a US clinical trial in the future.

Early initiation of beta blockade in heart failure: issues and evidence.

PubMed

Williams, Randall E

2005-09-01

Despite clinical trials demonstrating that inhibitors of the renin-angiotensin and sympathetic nervous systems can reduce the mortality and morbidity risk associated with heart failure, these drugs have remained underutilized in general clinical practice. In particular, many patients with heart failure due to left ventricular systolic dysfunction fail to receive beta blockers, although this class of drugs, as well as other antihypertensive agents such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, are recommended as part of routine heart failure therapy by national expert consensus guidelines. In-hospital initiation of beta-blocker therapy may improve long-term utilization by physicians and compliance by patients through obviating many of the misperceived dangers associated with beta blockade. The following review of the clinical trial data from the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) trial, the Metoprolol Controlled-Release Randomized Intervention Trial in Heart Failure (MERIT-HF), the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial, and the Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) trial on the efficacy, safety, and tolerability of beta blockers indicates that early initiation can be safely achieved and can improve patient outcomes.

Micromechanics Based Failure Analysis of Heterogeneous Materials

NASA Astrophysics Data System (ADS)

Sertse, Hamsasew M.

In recent decades, heterogeneous materials are extensively used in various industries such as aerospace, defense, automotive and others due to their desirable specific properties and excellent capability of accumulating damage. Despite their wide use, there are numerous challenges associated with the application of these materials. One of the main challenges is lack of accurate tools to predict the initiation, progression and final failure of these materials under various thermomechanical loading conditions. Although failure is usually treated at the macro and meso-scale level, the initiation and growth of failure is a complex phenomena across multiple scales. The objective of this work is to enable the mechanics of structure genome (MSG) and its companion code SwiftComp to analyze the initial failure (also called static failure), progressive failure, and fatigue failure of heterogeneous materials using micromechanics approach. The initial failure is evaluated at each numerical integration point using pointwise and nonlocal approach for each constituent of the heterogeneous materials. The effects of imperfect interfaces among constituents of heterogeneous materials are also investigated using a linear traction-displacement model. Moreover, the progressive and fatigue damage analyses are conducted using continuum damage mechanics (CDM) approach. The various failure criteria are also applied at a material point to analyze progressive damage in each constituent. The constitutive equation of a damaged material is formulated based on a consistent irreversible thermodynamics approach. The overall tangent modulus of uncoupled elastoplastic damage for negligible back stress effect is derived. The initiation of plasticity and damage in each constituent is evaluated at each numerical integration point using a nonlocal approach. The accumulated plastic strain and anisotropic damage evolution variables are iteratively solved using an incremental algorithm. The damage analyses are performed for both brittle failure/high cycle fatigue (HCF) for negligible plastic strain and ductile failure/low cycle fatigue (LCF) for large plastic strain. The proposed approach is incorporated in SwiftComp and used to predict the initial failure envelope, stress-strain curve for various loading conditions, and fatigue life of heterogeneous materials. The combined effects of strain hardening and progressive fatigue damage on the effective properties of heterogeneous materials are also studied. The capability of the current approach is validated using several representative examples of heterogeneous materials including binary composites, continuous fiber-reinforced composites, particle-reinforced composites, discontinuous fiber-reinforced composites, and woven composites. The predictions of MSG are also compared with the predictions obtained using various micromechanics approaches such as Generalized Methods of Cells (GMC), Mori-Tanaka (MT), and Double Inclusions (DI) and Representative Volume Element (RVE) Analysis (called as 3-dimensional finite element analysis (3D FEA) in this document). This study demonstrates that a micromechanics based failure analysis has a great potential to rigorously and more accurately analyze initiation and progression of damage in heterogeneous materials. However, this approach requires material properties specific to damage analysis, which are needed to be independently calibrated for each constituent.

25 CFR 30.122 - Must the Bureau assist a school it identified for school improvement, corrective action, or...

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF THE INTERIOR EDUCATION ADEQUATE YEARLY PROGRESS Failure To Make Adequate Yearly Progress § 30... restructuring, the Bureau must provide technical or other assistance described in 20 U.S.C. 6316(b)(4) and 20 U...

25 CFR 30.122 - Must the Bureau assist a school it identified for school improvement, corrective action, or...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., DEPARTMENT OF THE INTERIOR EDUCATION ADEQUATE YEARLY PROGRESS Failure To Make Adequate Yearly Progress § 30... restructuring, the Bureau must provide technical or other assistance described in 20 U.S.C. 6316(b)(4) and 20 U...

40 CFR 35.2035 - Rotating biological contractor (RBC) replacement grants.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works... a grant for 100 percent of the cost, including planning and design costs, of modification or...) The RBC failure has significantly increased the project's capital or operation and maintenance costs...

40 CFR 35.2035 - Rotating biological contractor (RBC) replacement grants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works... a grant for 100 percent of the cost, including planning and design costs, of modification or...) The RBC failure has significantly increased the project's capital or operation and maintenance costs...

33 CFR 154.804 - Review, certification, and initial inspection.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., property, and the environment if an accident were to occur; and (4) If a quantitative failure analysis is... quantitative failure analysis. (e) The certifying entity must conduct all initial inspections and witness all...

33 CFR 154.804 - Review, certification, and initial inspection.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., property, and the environment if an accident were to occur; and (4) If a quantitative failure analysis is... quantitative failure analysis. (e) The certifying entity must conduct all initial inspections and witness all...

33 CFR 154.804 - Review, certification, and initial inspection.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., property, and the environment if an accident were to occur; and (4) If a quantitative failure analysis is... quantitative failure analysis. (e) The certifying entity must conduct all initial inspections and witness all...

33 CFR 154.804 - Review, certification, and initial inspection.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., property, and the environment if an accident were to occur; and (4) If a quantitative failure analysis is... quantitative failure analysis. (e) The certifying entity must conduct all initial inspections and witness all...

Fatigue Failure in Extra-Articular Proximal Tibia Fractures: Locking Intramedullary Nail Versus Double Locking Plates-A Biomechanical Study.

PubMed

Kandemir, Utku; Herfat, Safa; Herzog, Mary; Viscogliosi, Paul; Pekmezci, Murat

2017-02-01

The goal of this study is to compare the fatigue strength of a locking intramedullary nail (LN) construct with a double locking plate (DLP) construct in comminuted proximal extra-articular tibia fractures. Eight pairs of fresh frozen cadaveric tibias with low bone mineral density [age: 80 ± 7 (SD) years, T-score: -2.3 ± 1.2] were used. One tibia from each pair was fixed with LN, whereas the contralateral side was fixed with DLP for complex extra-articular multifragmentary metaphyseal fractures (simulating OTA 41-A3.3). Specimens were cyclically loaded under compression simulating single-leg stance by staircase method out to 260,000 cycles. Every 2500 cycles, localized gap displacements were measured with a 3D motion tracking system, and x-ray images of the proximal tibia were acquired. To allow for mechanical settling, initial metrics were calculated at 2500 cycles. The 2 groups were compared regarding initial construct stiffness, initial medial and lateral gap displacements, stiffness at 30,000 cycles, medial and lateral gap displacements at 30,000 cycles, failure load, number of cycles to failure, and failure mode. Failure metrics were reported for initial and catastrophic failures. DLP constructs exhibited higher initial stiffness and stiffness at 30,000 cycles compared with LN constructs (P < 0.03). There were no significant differences between groups for loads at failure or cycles to failure. For the fixation of extra-articular proximal tibia fractures, a LN provides a similar fatigue performance to double locked plates. The locked nail could be safely used for fixation of proximal tibia fractures with the advantage of limited extramedullary soft tissue damage.

A System for Fault Management for NASA's Deep Space Habitat

NASA Technical Reports Server (NTRS)

Colombano, Silvano P.; Spirkovska, Liljana; Aaseng, Gordon B.; Mccann, Robert S.; Baskaran, Vijayakumar; Ossenfort, John P.; Smith, Irene Skupniewicz; Iverson, David L.; Schwabacher, Mark A.

2013-01-01

NASA's exploration program envisions the utilization of a Deep Space Habitat (DSH) for human exploration of the space environment in the vicinity of Mars and/or asteroids. Communication latencies with ground control of as long as 20+ minutes make it imperative that DSH operations be highly autonomous, as any telemetry-based detection of a systems problem on Earth could well occur too late to assist the crew with the problem. A DSH-based development program has been initiated to develop and test the automation technologies necessary to support highly autonomous DSH operations. One such technology is a fault management tool to support performance monitoring of vehicle systems operations and to assist with real-time decision making in connection with operational anomalies and failures. Toward that end, we are developing Advanced Caution and Warning System (ACAWS), a tool that combines dynamic and interactive graphical representations of spacecraft systems, systems modeling, automated diagnostic analysis and root cause identification, system and mission impact assessment, and mitigation procedure identification to help spacecraft operators (both flight controllers and crew) understand and respond to anomalies more effectively. In this paper, we describe four major architecture elements of ACAWS: Anomaly Detection, Fault Isolation, System Effects Analysis, and Graphic User Interface (GUI), and how these elements work in concert with each other and with other tools to provide fault management support to both the controllers and crew. We then describe recent evaluations and tests of ACAWS on the DSH testbed. The results of these tests support the feasibility and strength of our approach to failure management automation and enhanced operational autonomy.

A System for Fault Management and Fault Consequences Analysis for NASA's Deep Space Habitat

NASA Technical Reports Server (NTRS)

Colombano, Silvano; Spirkovska, Liljana; Baskaran, Vijaykumar; Aaseng, Gordon; McCann, Robert S.; Ossenfort, John; Smith, Irene; Iverson, David L.; Schwabacher, Mark

2013-01-01

NASA's exploration program envisions the utilization of a Deep Space Habitat (DSH) for human exploration of the space environment in the vicinity of Mars and/or asteroids. Communication latencies with ground control of as long as 20+ minutes make it imperative that DSH operations be highly autonomous, as any telemetry-based detection of a systems problem on Earth could well occur too late to assist the crew with the problem. A DSH-based development program has been initiated to develop and test the automation technologies necessary to support highly autonomous DSH operations. One such technology is a fault management tool to support performance monitoring of vehicle systems operations and to assist with real-time decision making in connection with operational anomalies and failures. Toward that end, we are developing Advanced Caution and Warning System (ACAWS), a tool that combines dynamic and interactive graphical representations of spacecraft systems, systems modeling, automated diagnostic analysis and root cause identification, system and mission impact assessment, and mitigation procedure identification to help spacecraft operators (both flight controllers and crew) understand and respond to anomalies more effectively. In this paper, we describe four major architecture elements of ACAWS: Anomaly Detection, Fault Isolation, System Effects Analysis, and Graphic User Interface (GUI), and how these elements work in concert with each other and with other tools to provide fault management support to both the controllers and crew. We then describe recent evaluations and tests of ACAWS on the DSH testbed. The results of these tests support the feasibility and strength of our approach to failure management automation and enhanced operational autonomy

A practical review for cardiac rehabilitation professionals of continuous-flow left ventricular assist devices: historical and current perspectives.

PubMed

Compostella, Leonida; Russo, Nicola; Setzu, Tiziana; Bottio, Tomaso; Compostella, Caterina; Tarzia, Vincenzo; Livi, Ugolino; Gerosa, Gino; Iliceto, Sabino; Bellotto, Fabio

2015-01-01

An increasing number of patients with end-stage heart failure are being treated with continuous-flow left ventricular assist devices (cf-LVADs). These patients provide new challenges to the staff in exercise-based cardiac rehabilitation (CR) programs. Even though experience remains limited, it seems that patients supported by cf-LVADs may safely engage in typical rehabilitative activities, provided that some attention is paid to specific aspects, such as the presence of a short external drive line. In spite of initial physical deconditioning, CR allows progressive improvement of symptoms such as fatigue and dyspnea. Intensity of rehabilitative activities should ideally be based on measured aerobic capacity and increased appropriately over time. Regular, long-term exercise training results in improved physical fitness and survival rates. Appropriate adjustment of cf-LVAD settings, together with maintenance of adequate blood volume, provides maximal output, while avoiding suction effects. Ventricular arrhythmias, although not necessarily constituting an immediate life-threatening situation, deserve treatment as they could lead to an increased rate of hospitalization and poorer quality of life. Atrial fibrillation may worsen symptoms of right ventricular failure and reduce exercise tolerance. Blood pressure measurements are possible in cf-LVAD patients only using a Doppler technique, and a mean blood pressure ≤80 mmHg is considered "ideal." Some patients may present with orthostatic intolerance, related to autonomic dysfunction. While exercise training constitutes the basic rehabilitative tool, a comprehensive intervention that includes psychological and social support could better meet the complex needs of patients in which cf-LVAD may offer prolonged survival.

Acute renal failure as a form of presentation of sarcoidosis in a young adult: a case report

PubMed Central

2014-01-01

Introduction Sarcoidosis is a systemic granulomatous disease. Renal involvement is a rare initial presentation of this disease. Few articles on renal involvement as an initial presentation of sarcoidosis have been published in the literature. Case presentation A 26-year-old Caucasian woman presented with acute renal failure as an initial manifestation of sarcoidosis. Conclusions Renal involvement is an uncommon feature of sarcoidosis and it is essential to establish a fast and correct diagnosis because early therapy avoids progression to terminal renal failure. PMID:25124289

45 CFR 212.4 - Reception; initial determination, provisions of temporary assistance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Reception; initial determination, provisions of temporary assistance. 212.4 Section 212.4 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH...

45 CFR 212.4 - Reception; initial determination, provisions of temporary assistance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true Reception; initial determination, provisions of temporary assistance. 212.4 Section 212.4 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH...

Microcircuit failure analysis using the SEM. [Scanning Electron Microscopes

NASA Technical Reports Server (NTRS)

Nicolas, D. P.

1974-01-01

The scanning electron microscope adds a new dimension to the knowledge that can be obtained from a failed microcircuit. When used with conventional techniques, SEM assists and clarifies the analysis, but it does not replace light microscopy. The most advantageous features for microcircuit analysis are long working distances and great depth of field. Manufacturer related failure modes of microcircuits are metallization defects, poor bonding, surface and particle contamination, and design and fabrication faults. User related failure modes are caused by abuse, such as overstress. The Physics of Failure Procedure followed by the Astrionics Laboratory in failure analysis is described, which is designed to obtain maximum information available from each step.

CRYOGENIC UPPER STAGE SYSTEM SAFETY

NASA Technical Reports Server (NTRS)

Smith, R. Kenneth; French, James V.; LaRue, Peter F.; Taylor, James L.; Pollard, Kathy (Technical Monitor)

2005-01-01

NASA s Exploration Initiative will require development of many new systems or systems of systems. One specific example is that safe, affordable, and reliable upper stage systems to place cargo and crew in stable low earth orbit are urgently required. In this paper, we examine the failure history of previous upper stages with liquid oxygen (LOX)/liquid hydrogen (LH2) propulsion systems. Launch data from 1964 until midyear 2005 are analyzed and presented. This data analysis covers upper stage systems from the Ariane, Centaur, H-IIA, Saturn, and Atlas in addition to other vehicles. Upper stage propulsion system elements have the highest impact on reliability. This paper discusses failure occurrence in all aspects of the operational phases (Le., initial burn, coast, restarts, and trends in failure rates over time). In an effort to understand the likelihood of future failures in flight, we present timelines of engine system failures relevant to initial flight histories. Some evidence suggests that propulsion system failures as a result of design problems occur shortly after initial development of the propulsion system; whereas failures because of manufacturing or assembly processing errors may occur during any phase of the system builds process, This paper also explores the detectability of historical failures. Observations from this review are used to ascertain the potential for increased upper stage reliability given investments in integrated system health management. Based on a clear understanding of the failure and success history of previous efforts by multiple space hardware development groups, the paper will investigate potential improvements that can be realized through application of system safety principles.

Primary care physician perspectives on basal insulin initiation and maintenance in patients with type 2 diabetes mellitus.

PubMed

Kalirai, Samaneh; Stephenson, Judith; Perez-Nieves, Magaly; Grabner, Michael; Hadjiyianni, Irene; Geremakis, Caroline; Pollom, Roy Daniel; Reed, Beverly; Fisher, Lawrence

2018-04-01

To describe primary care physicians' (PCPs) perceptions of patient reactions and concerns about insulin initiation and identify opportunities for increased support. Cross-sectional, online survey of PCPs prescribing basal insulin to adults with type 2 diabetes mellitus (T2DM). PCPs were identified from administrative claims of a large commercial health plan and descriptive results of PCP responses were reported. PCPs (N=100) treated an average of 17 patients receiving insulin during a typical week. More than 85% of insulin initiation recommendations originated with PCPs. Most offered glucose monitoring instructions (96%) and advice on diet, exercise, and diabetes management (96%); 35% provided insulin titration algorithms; 93% reported that patients often or always took their insulin daily within 3 months of initiation; 31% of PCPs reported monthly office contacts with patients for the first 3 months; 16% reported no outreach efforts; fewer than 20% connected patients with support groups. When starting basal insulin, PCPs reported patients feeling personal failure regarding their diabetes treatment (33% often/always) and lacking confidence in their ability to manage insulin therapy (38% often/always). Study results identify additional opportunities for assisting patients in making the transition to insulin, including more frequent direct outreach to monitor insulin usage. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Biventricular support with the Jarvik 2000 axial flow pump: a feasibility study.

PubMed

Radovancevic, Branislav; Gregoric, Igor D; Tamez, Daniel; Vrtovec, Bojan; Tuzun, Egemen; Chee, Hyun Keun; Moore, Sheila; Jarvik, Robert K; Frazier, O H

2003-01-01

Patients with congestive heart failure who are supported with a left ventricular assist device (LVAD) may experience right ventricular dysfunction or failure that requires support with a right ventricular assist device (RVAD). To determine the feasibility of using a clinically available axial flow ventricular assist device as an RVAD, we implanted Jarvik 2000 pumps in the left ventricle and right atrium of two Corriente crossbred calves (approximately 100 kg each) by way of a left thoracotomy and then analyzed the hemodynamic effects in the mechanically fibrillated heart at various LVAD and RVAD speeds. Right atrial implantation of the device required no modification of either the device or the surgical technique used for left ventricular implantation. Satisfactory biventricular support was achieved during fibrillation as evidenced by an increase in mean aortic pressure from 34 mm Hg with the pumps off to 78 mm Hg with the pumps generating a flow rate of 4.8 L/min. These results indicate that the Jarvik 2000 pump, which can provide chronic circulatory support and can be powered by external batteries, is a feasible option for right ventricular support after LVAD implantation and is capable of completely supporting the circulation in patients with global heart failure.

Development of NASA-DeBakey Ventricular Assist Device Using Numerical Aerospace Simulation Technology

NASA Technical Reports Server (NTRS)

Kwak, Dochan

2000-01-01

Over three million Americans and 20 million people worldwide suffer from some form of heart failure. Mechanical heart assist devices are being used as a temporary support to sick ventricle and valves as a bridge-to-transplant or bridge-to-recovery. This viewgraph presentation gives an overview of the development of NASA-DeBakey Ventricular Assist Device (VAD) using numerical aerospace simulation technology.

42 CFR 433.113 - Reduction of FFP for failure to operate a system and obtain initial approval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Reduction of FFP for failure to operate a system... ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.113 Reduction of FFP for failure to operate a system and obtain initial approval. (a) Except as waived under § 433.130 or 433.131...

Comparison of a computer assisted learning program to standard education tools in hospitalized heart failure patients.

PubMed

Dilles, Ann; Heymans, Valerie; Martin, Sandra; Droogné, Walter; Denhaerynck, Kris; De Geest, Sabina

2011-09-01

Education, coaching and guidance of patients are important components of heart failure management. The aim of this study was to compare a computer assisted learning (CAL) program with standard education (brochures and oral information from nurses) on knowledge and self-care in hospitalized heart failure patients. Satisfaction with the CAL program was also assessed in the intervention group. A quasi-experimental design was used, with a convenience sample of in-hospital heart failure patients. Knowledge and self-care were measured using the Dutch Heart Failure Knowledge Scale and the European Heart Failure Self-care Behaviour Scale at hospital admission, at discharge and after a 3-month follow-up. Satisfaction with the CAL program was assessed at hospital discharge using a satisfaction questionnaire. Within and between groups, changes in knowledge and self-care over time were tested using a mixed regression model. Of 65 heart failure patients screened, 37 were included in the study: 21 in the CAL group and 16 in the usual care group. No significant differences in knowledge (p=0.65) or self-care (p=0.40) could be found between groups. However, both variables improved significantly over time in each study group (p<0.0001). Both educational strategies increased knowledge and improved self-care. The design did not allow isolation of the effects of standard education usual care from CAL. Economic and clinical outcomes of both methods should be evaluated in further research. Copyright © 2010. Published by Elsevier B.V.

Age and treatment of kidney failure.

PubMed

Elliott, Meghan J; Tam-Tham, Helen; Hemmelgarn, Brenda R

2013-05-01

This review discusses issues related to treatment of chronic kidney disease, and kidney failure in particular, among older adults. A substantial proportion of older adults have chronic kidney disease and progress to kidney failure. There is considerable variability in treatment practices for advanced kidney disease among older adults, and evidence that treatment decisions such as dialysis initiation may be made without adequate preparation. When initiated, survival among older adults on chronic dialysis remains poor, and is associated with a significant decline in functional status. There is also evidence to suggest that dialysis initiation may not reflect overall treatment goals of elderly patients, but rather a lack of clear communication between patients and health practitioners, and underdeveloped conservative care programs in many centers. Kidney failure is common among older adults. When considering treatment options for kidney failure, patient priorities, preferences, and symptoms should be taken into account, using a shared decision-making approach.

Investigation of heat transfer in zirconium potassium perchlorate at low temperature: A study of the failure mechanism of the NASA standard initiator

NASA Technical Reports Server (NTRS)

Varghese, Philip L.

1989-01-01

The objective of this work was to study the reasons for the failure of pyrotechnic initiators at very low temperatures (10 to 100 K). A two-dimensional model of the NASA standard initiator was constructed to model heat transfer from the electrically heated stainless steel bridgewire to the zirconium potassium perchlorate explosive charge and the alumina charge cup. Temperature dependent properties were used in the model to simulate initiator performance over a wide range of initial temperatures (10 to 500 K). A search of the thermophysical property data base showed that pure alumina has a very high thermal conductivity at low temperatures. It had been assumed to act as a thermal insulator in all previous analyses. Rapid heat transfer from the bridgewire to the alumina at low initial temperatures was shown to cause failure of the initiators if the wire did not also make good contact with the zirconium potassium perchlorate charge. The mode is able to reproduce the results of the tests that had been conducted to investigate the cause for failure. It also provides an explanation for previously puzzling results and suggests simple design changes that will increase reliability at very low initial temperatures.

45 CFR 1355.36 - Withholding Federal funds due to failure to achieve substantial conformity or failure to...

Code of Federal Regulations, 2010 CFR

2010-10-01

... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL... foster care program under title IV-E. (b) Determination of the amount of Federal funds to be withheld...

45 CFR 1355.56 - Failure to meet the conditions of the approved APD.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Failure to meet the conditions of the approved APD. 1355.56 Section 1355.56 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF..., YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

45 CFR 1355.56 - Failure to meet the conditions of the approved APD.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Failure to meet the conditions of the approved APD. 1355.56 Section 1355.56 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF..., YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

45 CFR 1355.56 - Failure to meet the conditions of the approved APD.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Failure to meet the conditions of the approved APD. 1355.56 Section 1355.56 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF..., YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

11 CFR 111.35 - If the respondent decides to challenge the alleged violation or proposed civil money penalty...

Code of Federal Regulations, 2010 CFR

2010-01-01

... staff; (4) Committee computer, software or Internet service provider failures; (5) A committee's failure... software despite the respondent seeking technical assistance from Commission personnel and resources; (2) A... Commission's or respondent's computer systems or Internet service provider; and (3) Severe weather or other...

History of medication-assisted treatment and its association with initiating others into injection drug use in San Diego, CA.

PubMed

Mittal, Maria Luisa; Vashishtha, Devesh; Sun, Shelly; Jain, Sonia; Cuevas-Mota, Jazmine; Garfein, Richard; Strathdee, Steffanie A; Werb, Dan

2017-10-03

Medication-assisted treatment (MAT) remains the gold standard for the treatment of opioid use disorder. MAT also reduces the frequency of injecting among people who inject drugs (PWID). Relatedly, data suggest that PWID play a key role in the initiation of others into drug injecting by exposing injecting practices to injection-naïve drug users. Our primary objective was to test whether a history of MAT enrollment is associated with a reduced odds of PWID providing injection initiation assistance. Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01), is a multi-site cohort study assessing the impact of socio-structural factors on the risk that PWID provide injection initiation assistance. Data were drawn from a participating cohort of PWID in San Diego, CA. The primary outcome was reporting ever providing injection initiation assistance; the primary predictor was reporting ever being enrolled in MAT. Logistic regression was used to model associations between MAT enrollment and ever initiating others into injecting while adjusting for potential confounders. Participants (n = 354) were predominantly male (n = 249, 70%). Thirty-eight percent (n = 135) of participants reported ever initiating others into injection drug use. In multivariate analysis, participants who reported a history of MAT enrollment had significantly decreased odds of ever providing injection initiation assistance (Adjusted Odds Ratio [AOR]: 0.62, 95% Confidence Interval [CI]: 0.39-0.99). These preliminary findings suggest an association between MAT enrollment and a lower odds that male PWID report providing injection initiation assistance to injection-naïve drug users. Further research is needed to identify the pathways by which MAT enrollment may impact the risk that PWID initiate others into drug injecting.

Predictors of Treatment Failure among Adult Antiretroviral Treatment (ART) Clients in Bale Zone Hospitals, South Eastern Ethiopia.

PubMed

Haile, Demewoz; Takele, Abulie; Gashaw, Ketema; Demelash, Habtamu; Nigatu, Dabere

2016-01-01

Treatment failure defined as progression of disease after initiation of ART or when the anti-HIV medications can't control the infection. One of the major concerns over the rapid scaling up of ART is the emergence and transmission of HIV drug resistant strains at the population level due to treatment failure. This could lead to the failure of basic ART programs. Thus this study aimed to investigate the predictors of treatment failure among adult ART clients in Bale Zone Hospitals, South east Ethiopia. Retrospective cohort study was employed in four hospitals of Bale zone named Goba, Robe, Ginir and Delomena. A total of 4,809 adult ART clients were included in the analysis from these four hospitals. Adherence was measured by pill count method. The Kaplan Meier (KM) curve was used to describe the survival time of ART patients without treatment failure. Bivariate and multivariable Cox proportional hazards regression models were used for identifying associated factors of treatment failure. The incidence rate of treatment failure was found 9.38 (95% CI 7.79-11.30) per 1000 person years. Male ART clients were more likely to experience treatment failure as compared to females [AHR = 4.49; 95% CI: (2.61-7.73)].Similarly, lower CD4 count (<100 m3/dl) at initiation of ART was found significantly associated with higher odds of treatment failure [AHR = 3.79; 95% CI: (2.46-5.84).Bedridden [AHR = 5.02; 95% CI: (1.98-12.73)] and ambulatory [AHR = 2.12; 95% CI: (1.08-4.07)] patients were more likely to experience treatment failure as compared to patients with working functional status. TB co-infected clients had also higher odds to experience treatment failure [AHR = 3.06; 95% CI: (1.72-5.44)]. Those patients who had developed TB after ART initiation had higher odds to experience treatment failure as compared to their counter parts [AHR = 4.35; 95% CI: (1.99-9.54]. Having other opportunistic infection during ART initiation was also associated with higher odds of experiencing treatment failure [AHR = 7.0, 95% CI: (3.19-15.37)]. Similarly having fair [AHR = 4.99 95% CI: (1.90-13.13)] and poor drug adherence [AHR = 2.56; 95% CI: (1.12-5.86)]were significantly associated with higher odds of treatment failure as compared to clients with good adherence. The rate of treatment failure in Bale zone hospitals needs attention. Prevention and control of TB and other opportunistic infections, promotion of ART initiation at higher CD4 level, and better functional status, improving drug adherence are important interventions to reduce treatment failure among ART clients in Southeastern Ethiopia.

Lessons learned from 150 continuous-flow left ventricular assist devices: a single institutional 7 year experience.

PubMed

Tsiouris, Athanasios; Paone, Gaetano; Nemeh, Hassan W; Brewer, Robert J; Borgi, Jamil; Hodari, Arielle; Morgan, Jeffrey A

2015-01-01

Continuous-flow (CF) left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure refractory to optimal medical therapy. The goal of this study was to review our 7 year single institutional experience with CF LVADs. Mean age was 50.4 + 12.5 (17-69) years for bridge-to-transplantation (BTT) patients and 57.6 + 10.4 (31-81) years for destination therapy (DT) patients (p < 0.001). Overall, 38 patients (26%) were female and 58 (41%) were African American. Etiology of heart failure was ischemic in 54 patients (37%) and nonischemic in 93 patients (63%). Overall survival at 30 days, 6 months, 12 months, and 2 years was 93%, 89%, 84%, and 81%, respectively. Gastrointestinal bleeding (GIB) was the most common complication (24%), followed by stroke (18%), right ventricular (RV) failure (18%), ventilator-dependent respiratory failure (10%), reoperation for bleeding (10%), and driveline infection (9%). These data demonstrate excellent survival with low mortality for both BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become the gold standard for long-term treatment of end-stage heart failure and a plausible alternative to heart transplantation, we need to continue to improve the incidence of frequent postoperative complications, such as RV failure, driveline infections, strokes, and GIB.

FAA/NASA International Symposium on Advanced Structural Integrity Methods for Airframe Durability and Damage Tolerance

NASA Technical Reports Server (NTRS)

Harris, Charles E. (Editor)

1994-01-01

International technical experts in durability and damage tolerance of metallic airframe structures were assembled to present and discuss recent research findings and the development of advanced design and analysis methods, structural concepts, and advanced materials. The symposium focused on the dissemination of new knowledge and the peer-review of progress on the development of advanced methodologies. Papers were presented on: structural concepts for enhanced durability, damage tolerance, and maintainability; new metallic alloys and processing technology; fatigue crack initiation and small crack effects; fatigue crack growth models; fracture mechanics failure, criteria for ductile materials; structural mechanics methodology for residual strength and life prediction; development of flight load spectra for design and testing; and advanced approaches to resist corrosion and environmentally assisted fatigue.

[Amyotrophic lateral sclerosis--diagnosis and treatment].

PubMed

Jung, H H; Neumann, M; Bloch, K E

2012-07-04

Amyotrophic lateral sclerosis (ALS) represents the most common motoneuron disorder in adulthood. It is characterized by selective degeneration of the motoneurons. About 10% of patients have a genetically determined ALS. Clinically, ALS is characterized by coexistence of signs of the first motoneuron, such as spasticity and hyperreflexia, as well as the second motoneuron, such as muscular atrophy and fasciculations. If such signs are present in at least three regions and if other possible causes have been excluded, a definite diagnosis of ALS can be made based on the revised El-Escorial criteria. Initial manifestations are often focalized and generalization develops during the course. The glutamate antagonist riluzole is worldwide the only approved ALS treatment. However, symptomatic treatments to ameliorate spasticity, drooling, speech and swallowing problems, and assisted ventilation to treat respiratory failure are essential.

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

McAdams, Brian J.; Pearson, Raymond A.

With the continuing trend of decreasing feature sizes in flip-chip assemblies, the reliability tolerance to interfacial flaws is also decreasing. Small-scale disbonds will become more of a concern, pointing to the need for a better understanding of the initiation stage of interfacial delamination. With most accepted adhesion metric methodologies tailored to predict failure under the prior existence of a disbond, the study of the initiation phenomenon is open to development and standardization of new testing procedures. Traditional fracture mechanics approaches are not suitable, as the mathematics assume failure to originate at a disbond or crack tip. Disbond initiation is believedmore » to first occur at free edges and corners, which act as high stress concentration sites and exhibit singular stresses similar to a crack tip, though less severe in intensity. As such, a 'fracture mechanics-like' approach may be employed which defines a material parameter--a critical stress intensity factor (K{sub c})--that can be used to predict when initiation of a disbond at an interface will occur. The factors affecting the adhesion of underfill/polyimide interfaces relevant to flip-chip assemblies were investigated in this study. The study consisted of two distinct parts: a comparison of the initiation and propagation phenomena and a comparison of the relationship between sub-critical and critical initiation of interfacial failure. The initiation of underfill interfacial failure was studied by characterizing failure at a free-edge with a critical stress intensity factor. In comparison with the interfacial fracture toughness testing, it was shown that a good correlation exists between the initiation and propagation of interfacial failures. Such a correlation justifies the continuing use of fracture mechanics to predict the reliability of flip-chip packages. The second aspect of the research involved fatigue testing of tensile butt joint specimens to determine lifetimes at sub-critical load levels. The results display an interfacial strength ranking similar to that observed during monotonic testing. The fatigue results indicate that monotonic fracture mechanics testing may be an adequate screening tool to help predict cyclic underfill failure; however lifetime data is required to predict reliability.« less

Left Ventricular Assist Devices: The Adolescence of a Disruptive Technology.

PubMed

Pinney, Sean P

2015-10-01

Clinical outcomes for patients with advanced heart failure receiving left ventricular assist devices are driven by appropriate patient selection, refined surgical technique, and coordinated medical care. Perhaps even more important is innovative pump design. The introduction and widespread adoption of continuous-flow ventricular assist devices has led to a paradigm shift within the field of mechanical circulatory support, making the promise of lifetime device therapy closer to reality. The disruption caused by this new technology, on the one hand, produced meaningful improvements in patient survival and quality of life, but also introduced new clinical challenges, such as bleeding, pump thrombosis, and acquired valvular heart disease. Further evolution within this field will require financial investment to sustain innovation leading to a fully implantable, durable, and cost-effective pump for a larger segment of patients with advanced heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

Monitoring patients with continuous-flow ventricular assist devices outside of the intensive care unit: novel challenges to bedside nursing.

PubMed

O'Shea, Genevieve; Teuteberg, Jeffrey J; Severyn, Donald A

2013-03-01

Ventricular assist devices provide therapeutic options for patients with severe heart failure who have exhausted available medical therapies. With restoration of organ perfusion with ventricular assist devices, the heart failure resolves and quality of life and functional status improve. The current generation of continuous-flow devices present novel challenges to the clinical assessment of patients by substantially reducing or nearly eliminating any palpable pulse. Patients therefore generally have inadequate arterial pulsatility for most noninvasive monitoring devices such as pulse oximeters or automated blood pressure cuffs to work accurately. This article describes the function of continuous-flow devices and how this function affects common monitoring options, as well as how to clinically assess recipients of continuous-flow devices to promptly identify those whose condition may be deteriorating or who may be receiving inadequate perfusion.

45 CFR 233.25 - Retrospective budgeting; computing the assistance payment after the initial one or two months.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Retrospective budgeting; computing the assistance payment after the initial one or two months. 233.25 Section 233.25 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND...

45 CFR 233.25 - Retrospective budgeting; computing the assistance payment after the initial one or two months.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true Retrospective budgeting; computing the assistance payment after the initial one or two months. 233.25 Section 233.25 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND...

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited.

PubMed

Atlani-Duault, Laëtitia; Dozon, Jean-Pierre; Wilson, Andrew; Delfraissy, Jean-François; Moatti, Jean-Paul

2016-05-28

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states was affected by sans frontièrisme, Health for All, and the AIDS pandemic. Since 2000, France has had an active role in development of global health initiatives and favoured multilateral action for health assistance. Today, with adoption of the 2030 Sustainable Development Goals and the challenges of non-communicable diseases, economic inequality, and climate change, French international health assistance needs new direction. In the context of current debate over global health as a universal goal, understanding and acknowledging France's history could help strengthen advocacy in favour of universal health coverage and contribute to advancing global equity through income redistribution, from healthy populations to people who are sick and from wealthy individuals to those who are poor. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel temporary left ventricular assist system with hydrodynamically levitated bearing pump for bridge to decision: initial preclinical assessment in a goat model.

PubMed

Kishimoto, Satoru; Takewa, Yoshiaki; Tsukiya, Tomonori; Mizuno, Toshihide; Date, Kazuma; Sumikura, Hirohito; Fujii, Yutaka; Ohnuma, Kentaro; Togo, Konomi; Katagiri, Nobumasa; Naito, Noritsugu; Kishimoto, Yuichiro; Nakamura, Yoshinobu; Nishimura, Motonobu; Tatsumi, Eisuke

2018-03-01

The management of heart failure patients presenting in a moribund state remains challenging, despite significant advances in the field of ventricular assist systems. Bridge to decision involves using temporary devices to stabilize the hemodynamic state of such patients while further assessment is performed and a decision can be made regarding patient management. We developed a new temporary left ventricular assist system employing a disposable centrifugal pump with a hydrodynamically levitated bearing. We used three adult goats (body weight, 58-68 kg) to investigate the 30-day performance and hemocompatibility of the newly developed left ventricular assist system, which included the pump, inflow and outflow cannulas, the extracorporeal circuit, and connectors. Hemodynamic, hematologic, and blood chemistry measurements were investigated as well as end-organ effect on necropsy. All goats survived for 30 days in good general condition. The blood pump was operated at a rotational speed of 3000-4500 rpm and a mean pump flow of 3.2 ± 0.6 L min. Excess hemolysis, observed in one goat, was due to the inadequate increase in pump rotational speed in response to drainage insufficiency caused by continuous contact of the inflow cannula tip with the left ventricular septal wall in the early days after surgery. At necropsy, no thrombus was noted in the pump, and no damage caused by mechanical contact was found on the bearing. The newly developed temporary left ventricular assist system using a disposable centrifugal pump with hydrodynamic bearing demonstrated consistent and satisfactory hemodynamic performance and hemocompatibility in the goat model.

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico.

PubMed

Ben Hamida, Amen; Rafful, Claudia; Jain, Sonia; Sun, Shelly; Gonzalez-Zuniga, Patricia; Rangel, Gudelia; Strathdee, Steffanie A; Werb, Dan

2018-02-01

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.

Practical evolution and application of direct intracytoplasmic sperm injection for male factor and idiopathic fertilization failure infertilities.

PubMed

Tucker, M J; Wright, G; Morton, P C; Mayer, M P; Ingargiola, P E; Jones, A E

1995-04-01

To analyze the introduction of a new assisted fertilization technique for the treatment of severe male factor and idiopathic fertilization failure infertilities. Retrospective analysis of 16-month clinical application of IVF-ET where insemination was performed solely by direct intracytoplasmic sperm injection. Clinical IVF-ET program. Ninety-two couples undergoing 105 cycles of sperm injection. One hundred embryo transfers yielded 28 viable pregnancies (28%) from which eight normal deliveries have occurred to date. Complete cleavage arrest or fertilization failure occurred in four cycles, and one couple had all embryos cryopreserved. One thousand one hundred forty-three eggs were injected of which 173 (15%) degenerated. Four hundred seventy-nine of the surviving 970 eggs became normally fertilized (49%), and 381 of these zygotes (79.5%) developed suitably for cryopreservation or for transfer. Thirty-four of 310 embryos transferred implanted, yielding an implantation rate of 11%. Both testicular and epididymal sperm were used successfully to achieve fertilization and pregnancies, as was sperm retrieved by electroejaculation. Older women and couples suffering from prior idiopathic fertilization failure had a markedly poorer outcome. These results confirm that the intracytoplasmic sperm injection technique is a successful form of assisted fertilization that can be applied to a wide range of couples at significant risk from fertilization failure.

Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation

PubMed Central

Kumm, Kayla; Kueht, Michael; Ha, Cindy P.; Yoeli, Dor; Cotton, Ronald T.; Rana, Abbas; O'Mahony, Christine A.; Halff, Glenn; Goss, John A.

2018-01-01

Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo's Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure. PMID:29670765

Application of a PExSim for modeling a POLVAD artificial heart and the human circulatory system with left ventricle assistance

NASA Astrophysics Data System (ADS)

Siewnicka, Alicja; Fajdek, Bartlomiej; Janiszowski, Krzysztof

2010-01-01

This paper presents a model of the human circulatory system with the possible addition of a parallel assist device, which was developed for the purpose of artificial heart monitoring. Information about an identification experiment of an extracorporeal ventricle assist device POLVAD is included. The modelling methods applied and the corresponding functional blocks in a PExSim package are presented. The results of the simulation for physiological conditions, left ventricle failure and pathological conditions with parallel assistance are included.

Improving hemodynamics of cardiovascular system under a novel intraventricular assist device support via modeling and simulations.

PubMed

Zhu, Shidong; Luo, Lin; Yang, Bibo; Li, Xinghui; Wang, Xiaohao

2017-12-01

Ventricular assist devices (LVADs) are increasingly recognized for supporting blood circulation in heart failure patients who are non-transplant eligible. Because of its volume, the traditional pulsatile device is not easy to implant intracorporeally. Continuous flow LVADs (CF-LVADs) reduce arterial pulsatility and only offer continuous flow, which is different from physiological flow, and may cause long-term complications in the cardiovascular system. The aim of this study was to design a new pulsatile assist device that overcomes this disadvantage, and to test this device in the cardiovascular system. Firstly, the input and output characteristics of the new device were tested in a simple cardiovascular mock system. A detailed mathematical model was established by fitting the experimental data. Secondly, the model was tested in four pathological cases, and was simulated and coupled with a fifth-order cardiovascular system and a new device model using Matlab software. Using assistance of the new device, we demonstrated that the left ventricle pressure, aortic pressure, and aortic flow of heart failure patients improved to the levels of a healthy individual. Especially, in state IV level heart failure patients, the systolic blood pressure increased from 81.34 mmHg to 132.1 mmHg, whereas the diastolic blood pressure increased from 54.28 mmHg to 78.7 mmHg. Cardiac output increased from 3.21 L/min to 5.16 L/min. The newly-developed assist device not only provided a physiological flow that was similar to healthy individuals, but also effectively improved the ability of the pathological ventricular volume. Finally, the effects of the new device on other hemodynamic parameters are discussed.

Colonial Legacy, Communist Nostalgia and Failure of Democracy in Sub-Saharan Africa

DTIC Science & Technology

2011-03-29

desperation to acquire this wealth drove African slave owners to appeal to supernatural powers such as witchcraft and gods to assist them in accumulating...supernatural powers such as witchcraft , and gods to assist them in accumulating more slaves or wealth and sometimes this involved human sacrifices.42 The

Are We Boxing In Minority Students for a Lifetime of Failure?

ERIC Educational Resources Information Center

Teicher, Bruce

1980-01-01

States that fail to increase assistance to students unable to pass competency exams may be doing so at their legal peril as both the Equal Protection Clause and Title VII seem to require such assistance. Available from Human Rights, 1155 E. 60th St., Chicago, IL 60637. (Author/IRT)

Two case reports of severe myocarditis associated with the initiation of dolutegravir treatment in HIV patients

PubMed Central

Mahlab-Guri, Keren; Asher, Ilan; Rosenberg-Bezalel, Shira; Elbirt, Daniel; Burke, Michael; Sthoeger, Zev M.

2016-01-01

Abstract Rationale: The integrase inhibitor dolutegravir is now recommended as first-line treatment for HIV. A single case of myocarditis after treatment with dolutegravir was reported in the FLAMINGO trial. We present here 2 cases of severe myocarditis that occurred shortly after the initiation of dolutegravir treatment. Patients concerns: The first case is a 45-year-old female who developed severe congestive heart failure and died, weeks after the initiation of dolutegravir treatment (for simplification of her antiretroviral regimen). The second case was a 51-year-old male who presented with effort dyspnea 3 weeks after the initiation of dolutegravir treatment and was later diagnosed as severe congestive heart failure. The treatment was changed and the patient survived, but he still suffers from severe heart failure with functional impairment. Diagnosis and Outcome: Patient 1 died, patient 2 suffers from severe heart failure. Lessons: We discuss here the possible relationship between the initiation of dolutegravir treatment and the development of lymphocytic myocarditis in our patients, and we suggest a possible mechanism. PMID:27893693

Computer Science and Statistics. Proceedings of the Symposium on the Interface (18th) Held on March 19-21, 1986 in Fort Collins, Colorado.

DTIC Science & Technology

1987-08-26

example, expert systems research would benefit examples are the Acute Renal Failure [15] system, the if it could attract statisticians to assist in...research projects including the Acute Renal Failure [15] system, the 6. EXPLAINING COMPLEX REASONING INTERNIST-] [22] system for diagnosis within the...the MEDAS and Acute Renal Failure systems. task at any point in reasoning about a case is constrained to Entropy-discriminate makes use of a measure

Reliability training

NASA Technical Reports Server (NTRS)

Lalli, Vincent R. (Editor); Malec, Henry A. (Editor); Dillard, Richard B.; Wong, Kam L.; Barber, Frank J.; Barina, Frank J.

1992-01-01

Discussed here is failure physics, the study of how products, hardware, software, and systems fail and what can be done about it. The intent is to impart useful information, to extend the limits of production capability, and to assist in achieving low cost reliable products. A review of reliability for the years 1940 to 2000 is given. Next, a review of mathematics is given as well as a description of what elements contribute to product failures. Basic reliability theory and the disciplines that allow us to control and eliminate failures are elucidated.

Single-center experience of the bridge-to-bridge strategy using the Nipro paracorporeal ventricular assist device.

PubMed

Yoshitake, Shuichi; Kinoshita, Osamu; Nawata, Kan; Hoshino, Yasuhiro; Itoda, Yoshifumi; Kimura, Mitsutoshi; Yamauchi, Haruo; Ono, Minoru

2018-06-25

Currently, we use the Nipro paracorporeal VAD (p-VAD) for initial short-term ventricular support, as a bridge to decision (BTD) or a bridge to candidacy (BTC) treatment, in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels 1 and 2 patients. However, it is possible that compared to patients with primary implantable-VADs (P-iVAD), the bridge-to-bridge (BTB) patients are more likely to develop complications. This retrospective study used data from 24 consecutive BTB patients who were initially implanted with Nipro p-VAD as BTD or BTC treatments between April 2011 and March 2016, and subsequently underwent conversion to an i-VAD. The data from 72 patients who underwent a primary i-VAD (P-iVAD) procedure were used for comparison. Between the two groups, there was no significant difference in the incidence of infectious events (p = 0.72) or stroke (p = 0.44). Orthotropic heart transplantation was performed in 6 of the 24 patients in the BTB group and in 21 of the 72 patients in the P-iVAD group. The 1- and 2-year survival rates were 95.8% and 95.8% in the BTB group and 91% and 85.8% in the P-iVAD group; these values were not significantly different between groups (p = 0.91). Based on these results we conclude that BTB using Nipro p-VAD is a reasonable strategy for treating patients with severe decompensated end-stage heart failure.

Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women

PubMed Central

Reimers, Laura L.; Sotardi, Susan; Daniel, David; Chiu, Lydia G.; Arsdale, Anne Van; Wieland, Daryl L.; Leider, Jason M.; Xue, Xiaonan; Strickler, Howard D.; Garry, David J.; Goldberg, Gary L.; Einstein, Mark H.

2011-01-01

Objective To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. Methods A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. Results Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (>70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR=1.76; 95% CI: 1.15–2.64), and low CD4+ count (p = 0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR] = 3.38; 95% CI: 1.55–7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR = 6.12; 95% CI: 1.90–19.73). Conclusions Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population. PMID:20605046

Correlation between failure and local material property in chopped carbon fiber chip-reinforced sheet molding compound composites under tensile load

DOE PAGES

Tang, Haibin; Chen, Zhangxing; Zhou, Guowei; ...

2018-02-06

To develop further understanding towards the role of a heterogeneous microstructure on tensile crack initiation and failure behavior in chopped carbon fiber chip-reinforced composites, uni-axial tensile tests are performed on coupons cut from compression molded plaque with varying directions. Our experimental results indicate that failure initiation is relevant to the strain localization, and a new criterion with the nominal modulus to predict the failure location is proposed based on the strain analysis. Furthermore, optical microscopic images show that the nominal modulus is determined by the chip orientation distribution. At the area with low nominal modulus, it is found that chipsmore » are mostly aligning along directions transverse to loading direction and/or less concentrated, while at the area with high nominal modulus, more chips are aligning to tensile direction. On the basis of failure mechanism analysis, it is concluded that transversely-oriented chips or resin-rich regions are easier for damage initiation, while longitudinally-oriented chips postpone the fracture. Good agreement is found among failure mechanism, strain localization and chip orientation distribution.« less

Correlation between failure and local material property in chopped carbon fiber chip-reinforced sheet molding compound composites under tensile load

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

Tang, Haibin; Chen, Zhangxing; Zhou, Guowei

To develop further understanding towards the role of a heterogeneous microstructure on tensile crack initiation and failure behavior in chopped carbon fiber chip-reinforced composites, uni-axial tensile tests are performed on coupons cut from compression molded plaque with varying directions. Our experimental results indicate that failure initiation is relevant to the strain localization, and a new criterion with the nominal modulus to predict the failure location is proposed based on the strain analysis. Furthermore, optical microscopic images show that the nominal modulus is determined by the chip orientation distribution. At the area with low nominal modulus, it is found that chipsmore » are mostly aligning along directions transverse to loading direction and/or less concentrated, while at the area with high nominal modulus, more chips are aligning to tensile direction. On the basis of failure mechanism analysis, it is concluded that transversely-oriented chips or resin-rich regions are easier for damage initiation, while longitudinally-oriented chips postpone the fracture. Good agreement is found among failure mechanism, strain localization and chip orientation distribution.« less

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

Fang, Aiman; Laguna, Ignacio; Sato, Kento

Future high-performance computing systems may face frequent failures with their rapid increase in scale and complexity. Resilience to faults has become a major challenge for large-scale applications running on supercomputers, which demands fault tolerance support for prevalent MPI applications. Among failure scenarios, process failures are one of the most severe issues as they usually lead to termination of applications. However, the widely used MPI implementations do not provide mechanisms for fault tolerance. We propose FTA-MPI (Fault Tolerance Assistant MPI), a programming model that provides support for failure detection, failure notification and recovery. Specifically, FTA-MPI exploits a try/catch model that enablesmore » failure localization and transparent recovery of process failures in MPI applications. We demonstrate FTA-MPI with synthetic applications and a molecular dynamics code CoMD, and show that FTA-MPI provides high programmability for users and enables convenient and flexible recovery of process failures.« less

Timing of pregnancy, postpartum risk of virologic failure and loss to follow-up among HIV-positive women

PubMed Central

Onoya, Dorina; Sineke, Tembeka; Brennan, Alana T.; Long, Lawrence; Fox, Matthew P.

2017-01-01

Objectives: We assessed the association between the timing of pregnancy with the risk of postpartum virologic failure and loss from HIV care in South Africa. Design: This is a retrospective cohort study of 6306 HIV-positive women aged 15–49 at antiretroviral therapy (ART) initiation, initiated on ART between January 2004 and December 2013 in Johannesburg, South Africa. Methods: The incidence of virologic failure (two consecutive viral load measurements of >1000 copies/ml) and loss to follow-up (>3 months late for a visit) during 24 months postpartum were assessed using Cox proportional hazards modelling. Results: The rate of postpartum virologic failure was higher following an incident pregnancy on ART [adjusted hazard ratio 1.8, 95% confidence interval (CI): 1.1–2.7] than among women who initiated ART during pregnancy. This difference was sustained among women with CD4+ cell count less than 350 cells/μl at delivery (adjusted hazard ratio 1.8, 95% CI: 1.1–3.0). Predictors of postpartum virologic failure were being viremic, longer time on ART, being 25 or less years old and low CD4+ cell count and anaemia at delivery, as well as initiating ART on stavudine-containing or abacavir-containing regimen. There was no difference postpartum loss to follow-up rates between the incident pregnancies group (hazard ratio 0.9, 95% CI: 0.7–1.1) and those who initiated ART in pregnancy. Conclusion: The risk of virologic failure remains high among postpartum women, particularly those who conceive on ART. The results highlight the need to provide adequate support for HIV-positive women with fertility intention after ART initiation and to strengthen monitoring and retention efforts for postpartum women to sustain the benefits of ART. PMID:28463877

Timing of pregnancy, postpartum risk of virologic failure and loss to follow-up among HIV-positive women.

PubMed

Onoya, Dorina; Sineke, Tembeka; Brennan, Alana T; Long, Lawrence; Fox, Matthew P

2017-07-17

We assessed the association between the timing of pregnancy with the risk of postpartum virologic failure and loss from HIV care in South Africa. This is a retrospective cohort study of 6306 HIV-positive women aged 15-49 at antiretroviral therapy (ART) initiation, initiated on ART between January 2004 and December 2013 in Johannesburg, South Africa. The incidence of virologic failure (two consecutive viral load measurements of >1000 copies/ml) and loss to follow-up (>3 months late for a visit) during 24 months postpartum were assessed using Cox proportional hazards modelling. The rate of postpartum virologic failure was higher following an incident pregnancy on ART [adjusted hazard ratio 1.8, 95% confidence interval (CI): 1.1-2.7] than among women who initiated ART during pregnancy. This difference was sustained among women with CD4 cell count less than 350 cells/μl at delivery (adjusted hazard ratio 1.8, 95% CI: 1.1-3.0). Predictors of postpartum virologic failure were being viremic, longer time on ART, being 25 or less years old and low CD4 cell count and anaemia at delivery, as well as initiating ART on stavudine-containing or abacavir-containing regimen. There was no difference postpartum loss to follow-up rates between the incident pregnancies group (hazard ratio 0.9, 95% CI: 0.7-1.1) and those who initiated ART in pregnancy. The risk of virologic failure remains high among postpartum women, particularly those who conceive on ART. The results highlight the need to provide adequate support for HIV-positive women with fertility intention after ART initiation and to strengthen monitoring and retention efforts for postpartum women to sustain the benefits of ART.

Does short-term virologic failure translate to clinical events in antiretroviral-naïve patients initiating antiretroviral therapy in clinical practice?

PubMed

Mugavero, Michael J; May, Margaret; Harris, Ross; Saag, Michael S; Costagliola, Dominique; Egger, Matthias; Phillips, Andrew; Günthard, Huldrych F; Dabis, Francois; Hogg, Robert; de Wolf, Frank; Fatkenheuer, Gerd; Gill, M John; Justice, Amy; D'Arminio Monforte, Antonella; Lampe, Fiona; Miró, Jose M; Staszewski, Schlomo; Sterne, Jonathan A C

2008-11-30

To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-naïve patients initiating ART. Observational cohort study of patients initiating ART between January 2000 and December 2005. The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States. A total of 13 546 antiretroviral-naïve HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone. Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes). Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48). Among antiretroviral-naïve patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.

Predictors of Treatment Failure among Adult Antiretroviral Treatment (ART) Clients in Bale Zone Hospitals, South Eastern Ethiopia

PubMed Central

Takele, Abulie; Gashaw, Ketema; Demelash, Habtamu; Nigatu, Dabere

2016-01-01

Background Treatment failure defined as progression of disease after initiation of ART or when the anti-HIV medications can’t control the infection. One of the major concerns over the rapid scaling up of ART is the emergence and transmission of HIV drug resistant strains at the population level due to treatment failure. This could lead to the failure of basic ART programs. Thus this study aimed to investigate the predictors of treatment failure among adult ART clients in Bale Zone Hospitals, South east Ethiopia. Methods Retrospective cohort study was employed in four hospitals of Bale zone named Goba, Robe, Ginir and Delomena. A total of 4,809 adult ART clients were included in the analysis from these four hospitals. Adherence was measured by pill count method. The Kaplan Meier (KM) curve was used to describe the survival time of ART patients without treatment failure. Bivariate and multivariable Cox proportional hazards regression models were used for identifying associated factors of treatment failure. Result The incidence rate of treatment failure was found 9.38 (95% CI 7.79–11.30) per 1000 person years. Male ART clients were more likely to experience treatment failure as compared to females [AHR = 4.49; 95% CI: (2.61–7.73)].Similarly, lower CD4 count (<100 m3/dl) at initiation of ART was found significantly associated with higher odds of treatment failure [AHR = 3.79; 95% CI: (2.46–5.84).Bedridden [AHR = 5.02; 95% CI: (1.98–12.73)] and ambulatory [AHR = 2.12; 95% CI: (1.08–4.07)] patients were more likely to experience treatment failure as compared to patients with working functional status. TB co-infected clients had also higher odds to experience treatment failure [AHR = 3.06; 95% CI: (1.72–5.44)]. Those patients who had developed TB after ART initiation had higher odds to experience treatment failure as compared to their counter parts [AHR = 4.35; 95% CI: (1.99–9.54]. Having other opportunistic infection during ART initiation was also associated with higher odds of experiencing treatment failure [AHR = 7.0, 95% CI: (3.19–15.37)]. Similarly having fair [AHR = 4.99 95% CI: (1.90–13.13)] and poor drug adherence [AHR = 2.56; 95% CI: (1.12–5.86)]were significantly associated with higher odds of treatment failure as compared to clients with good adherence. Conclusion The rate of treatment failure in Bale zone hospitals needs attention. Prevention and control of TB and other opportunistic infections, promotion of ART initiation at higher CD4 level, and better functional status, improving drug adherence are important interventions to reduce treatment failure among ART clients in Southeastern Ethiopia. PMID:27716827

Electrophysiological diagnosis and patterns of response to treatment of botulism with neuromuscular respiratory failure.

PubMed

Kongsaengdao, Subsai; Samintarapanya, Kanoksri; Rusmeechan, Siwarit; Sithinamsuwan, Pasiri; Tanprawate, Surat

2009-08-01

In this study we describe the electrophysiological findings in botulism patients with neuromuscular respiratory failure from major botulism outbreaks in Thailand. High-rate repetitive nerve stimulation testing (RNST) of the abductor digiti minimi (ADM) muscle of 17 botulism patients with neuromuscular respiratory failure showed mostly incremental responses, especially in response to >20-HZ stimulation. In the most severe stage of neuromuscular respiratory failure, RNST failed to elicit a compound muscle action potential (CMAP) of the ADM muscle. In the moderately severe stage, the initial CMAPs were of very low amplitude, and a 3-HZ RNST elicited incremental or decremental responses. A 10-HZ RNST elicited mainly decremental responses. In the early recovery stage, the initial CMAP amplitudes of the ADM muscle improved, with initially low amplitudes and an incremental response to 3- and 10-HZ RNSTs. Improved electrophysiological patterns of the ADM muscle correlated with improved respiratory muscle function. Incremental responses to 20-HZ RNST were most useful for diagnosis. The initial electrodiagnostic sign of recovery following treatment of neuromuscular respiratory failure was an increased CMAP amplitude and an incremental response to 10-20-HZ RNST. Muscle Nerve 40: 271-278, 2009.

The National Nursing Assistant Survey: Improving the Evidence Base for Policy Initiatives to Strengthen the Certified Nursing Assistant Workforce

ERIC Educational Resources Information Center

Squillace, Marie R.; Remsburg, Robin E.; Harris-Kojetin, Lauren D.; Bercovitz, Anita; Rosenoff, Emily; Han, Beth

2009-01-01

Purpose: This study introduces the first National Nursing Assistant Survey (NNAS), a major advance in the data available about certified nursing assistants (CNAs) and a rich resource for evidence-based policy, practice, and applied research initiatives. We highlight potential uses of this new survey using select population estimates as examples of…

Assessment of Hydraulic Performance and Biocompatibility of a MagLev Centrifugal Pump System Designed for Pediatric Cardiac or Cardiopulmonary Support

PubMed Central

Dasse, Kurt A.; Gellman, Barry; Kameneva, Marina V.; Woolley, Joshua R.; Johnson, Carl A.; Gempp, Thomas; Marks, John D.; Kent, Stella; Koert, Andrew; Richardson, J. Scott; Franklin, Steve; Snyder, Trevor A.; Wearden, Peter; Wagner, William R.; Gilbert, Richard J.; Borovetz, Harvey S.

2011-01-01

The treatment of children with life-threatening cardiac and cardiopulmonary failure is a large and underappreciated public health concern. We have previously shown that the CentriMag is a magnetically levitated centrifugal pump system, having the utility for treating adults and large children (1,500 utilized worldwide). We present here the Pedi-VAS, a pump system whose design was modified from the CentriMag to meet the physiological requirements of young pediatric and neonatal patients. The PediVAS is comprised of a single-use centrifugal blood pump, reusable motor, and console, and is suitable for right ventricular assist device (RVAD), left ventricular assist device (LVAD), biventricular assist device (BVAD), or extracorporeal membrane oxygenator (ECMO) applications. It is designed to operate without bearings, seals and valves, and without regions of blood stasis, friction, or wear. The PediVAS pump is compatible with the CentriMag hardware, although the priming volume was reduced from 31 to 14 ml, and the port size reduced from 3/8 to ¼ in. For the expected range of pediatric flow (0.3–3.0 L/min), the PediVAS exhibited superior hydraulic efficiency compared with the CentriMag. The PediVAS was evaluated in 14 pediatric animals for up to 30 days, demonstrating acceptable hydraulic function and hemocompatibility. The current results substantiate the performance and biocompatibility of the PediVAS cardiac assist system and are likely to support initiation of a US clinical trial in the future. PMID:18043164

Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us.

PubMed

Fung, Erik; Hui, Elsie; Yang, Xiaobo; Lui, Leong T; Cheng, King F; Li, Qi; Fan, Yiting; Sahota, Daljit S; Ma, Bosco H M; Lee, Jenny S W; Lee, Alex P W; Woo, Jean

2018-01-01

Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.

Comparison of Transplant Waitlist Outcomes for Pediatric Candidates Supported by Ventricular Assist Devices Versus Medical Therapy.

PubMed

Law, Sabrina P; Oron, Assaf P; Kemna, Mariska S; Albers, Erin L; McMullan, D Michael; Chen, Jonathan M; Law, Yuk M

2018-05-01

Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort. This was a retrospective cohort analysis. Data were obtained from the Scientific Registry of Transplant Recipients. The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist device (605 cases) or an equivalent-severity, intensively medically treated group (referred to as MED, 775 cases). None. The impact of ventricular assist devices was estimated via Cox proportional hazards regression (hazard ratio), dichotomizing 1-year outcomes to "poor" (22%: 193 deaths, 114 too sick) versus all others (940 successful transplants, 41 too healthy, 90 censored), while adjusting for conventional risk factors. Among children 0-12 months old, ventricular assist device was associated with a higher risk of poor outcomes (hazard ratio, 2.1; 95% CI, 1.5-3.0; p < 0.001). By contrast, ventricular assist device was associated with improved outcomes for ages 12-18 (hazard ratio, 0.3; 95% CI, 0.1-0.7; p = 0.003). For candidates 1-5 and 6-11 years old, there were no differences in outcomes between the ventricular assist device and MED groups (hazard ratio, 0.8 and 1.0, p = 0.43 and 0.9). The interaction between ventricular assist devices and age group was strongly significant (p < 0.001). This is a comparative study of ventricular assist devices versus medical therapy in children. Age is a significant modulator of waitlist outcomes for children with end-stage heart failure supported by ventricular assist device, with the impact of ventricular assist devices being more beneficial in adolescents.

Intra-Aortic Balloon Counterpulsation in Patients with Chronic Heart Failure and Cardiogenic Shock: Clinical Response and Predictors of Stabilization

PubMed Central

Sintek, Marc A.; Gdowski, Mark; Lindman, Brian R.; Nassif, Michael; Lavine, Kory J.; Novak, Eric; Bach, Richard G.; Silvestry, Scott C.; Mann, Douglas L.; Joseph, Susan M.

2015-01-01

Objective To characterize the clinical response and identify predictors of clinical stabilization after intra-aortic balloon counterpulsation (IABP) support in patients with chronic systolic heart failure in cardiogenic shock prior to implantation of a left ventricular assist device (LVAD). Background Limited data exist regarding the clinical response to IABP in patients with chronic heart failure in cardiogenic shock. Methods We identified 54 patients supported with IABP prior to LVAD implantation. Criteria for clinical decompensation after IABP insertion and before LVAD included the need for more advanced temporary support, initiation of mechanical ventilation or dialysis, increase in vasopressors/inotropes, refractory ventricular arrhythmias, or worsening acidosis. The absence of these indicated stabilization. Results Clinical decompensation after IABP occurred in 23 (43%) patients. Both patients who decompensated and those who stabilized had similar hemodynamic improvements after IABP support but patients who decompensated required more vasopressors/inotropes. Clinical decompensation after IABP was associated with worse outcomes after LVAD implantation, including a 3-fold longer intensive care unit stay and 5-fold longer time on mechanical ventilation (p<0.01 for both). While baseline characteristics were similar between groups, right and left ventricular cardiac power indices (Cardiac power Index= Cardiac Index × Mean arterial pressure / 451)identified patients who were likely to stabilize (AUC=0.82). Conclusions Among patients with chronic systolic heart failure who develop cardiogenic shock, more than half of patients stabilized with IABP support as a bridge to LVAD. Baseline measures of right and left ventricular cardiac power, both measures of work performed for a given flow and pressure, may allow clinicians to identify patients with sufficient contractile reserve who will be likely to stabilize with an IABP versus those who may need more aggressive ventricular support. PMID:26164215

Equine-Assisted Learning in Youths At-Risk for School or Social Failure

ERIC Educational Resources Information Center

Ho, New Fei; Zhou, Jonathan; Fung, Daniel Shuen Sheng; Kua, Phek Hui Jade

2017-01-01

This study examined whether a three-month equine-assisted learning program improved measures of character skills in two independent cohorts of Year 1 youths, in a specialized secondary school for youths with difficulties coping with mainstream curriculum. In 2013, 75 students underwent intervention while 82 students did not. In 2014, 58 students…

Left ventricular assist device implantation in a patient who had previously undergone apical myectomy for hypertrophic cardiomyopathy.

PubMed

Cho, Yang Hyun; Deo, Salil V; Topilsky, Yan; Grogan, Martha A; Park, Soon J

2012-03-01

Apical hypertrophy is a rare variant of hypertropic cardiomyopathy. These patients may present with end-stage congestive heart failure subsequent to long standing diastolic dysfunction. We report the technique for left ventricular assist device insertion in a patient with previous apical myectomy for hypertrophic cardiomyopathy. © 2012 Wiley Periodicals, Inc.

Observation of the initiation and progression of damage in compressively loaded composite plates containing a cutout

NASA Technical Reports Server (NTRS)

Waas, A.; Babcock, C., Jr.

1986-01-01

A series of experiments was carried out to determine the mechanism of failure in compressively loaded laminated plates with a circular cutout. Real time holographic interferometry and photomicrography are used to observe the progression of failure. These observations together with post experiment plate sectioning and deplying for interior damage observation provide useful information for modelling the failure process. It is revealed that the failure is initiated as a localised instability in the zero layers, at the hole surface. With increasing load extensive delamination cracking is observed. The progression of failure is by growth of these delaminations induced by delamination buckling. Upon reaching a critical state, catastrophic failure of the plate is observed. The levels of applied load and the rate at which these events occur depend on the plate stacking sequence.

Mars Exploration Rover Potentiometer Problems, Failures and Lessons Learned

NASA Technical Reports Server (NTRS)

Balzer, Mark

2006-01-01

During qualification testing of three types of non-wire-wound precision potentiometers for the Mars Exploration Rover, a variety of problems and failures were encountered. This paper will describe some of the more interesting problems, detail their investigations and present their final solutions. The failures were found to be caused by design errors, manufacturing errors, improper handling, test errors, and carelessness. A trend of decreasing total resistance was noted, and a resistance histogram was used to identify an outlier. A gang fixture is described for simultaneously testing multiple pots, and real time X-ray imaging was used extensively to assist in the failure analyses. Lessons learned are provided.

Mars Exploration Rover potentiometer problems, failures and lessons learned

NASA Technical Reports Server (NTRS)

Balzer, Mark A.

2006-01-01

During qualification testing of three types of nonwire-wound precision potentiometers for the Mars Exploration Rover, a variety of problems and failures were encountered. This paper will describe some of the more interesting problems, detail their investigations and present their final solutions. The failures were found to be caused by design errors, manufacturing errors, improper handling, test errors, and carelessness. A trend of decreasing total resistance was noted, and a resistance histogram was used to identify an outlier. A gang fixture is described for simultaneously testing multiple pots, and real time X-ray imaging was used extensively to assist in the failure analyses. Lessons learned are provided.

Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association.

PubMed

Page, Robert L; O'Bryant, Cindy L; Cheng, Davy; Dow, Tristan J; Ky, Bonnie; Stein, C Michael; Spencer, Anne P; Trupp, Robin J; Lindenfeld, JoAnn

2016-08-09

Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients. © 2016 American Heart Association, Inc.

Failure modes and effects analysis automation

NASA Technical Reports Server (NTRS)

Kamhieh, Cynthia H.; Cutts, Dannie E.; Purves, R. Byron

1988-01-01

A failure modes and effects analysis (FMEA) assistant was implemented as a knowledge based system and will be used during design of the Space Station to aid engineers in performing the complex task of tracking failures throughout the entire design effort. The three major directions in which automation was pursued were the clerical components of the FMEA process, the knowledge acquisition aspects of FMEA, and the failure propagation/analysis portions of the FMEA task. The system is accessible to design, safety, and reliability engineers at single user workstations and, although not designed to replace conventional FMEA, it is expected to decrease by many man years the time required to perform the analysis.

Analysis and experiments for composite laminates with holes and subjected to 4-point bending

NASA Technical Reports Server (NTRS)

Shuart, M. J.; Prasad, C. B.

1990-01-01

Analytical and experimental results are presented for composite laminates with a hole and subjected to four-point bending. A finite-plate analysis is used to predict moment and strain distributions for six-layer quasi-isotropic laminates and transverse-ply laminates. Experimental data are compared with the analytical results. Experimental and analytical strain results show good agreement for the quasi-isotropic laminates. Failure of the two types of composite laminates is described, and failure strain results are presented as a function of normalized hole diameter. The failure results suggest that the initial failure mechanism for laminates subjected to four-point bending are similar to the initial failure mechanisms for corresponding laminates subjected to uniaxial inplane loadings.

A Comparison of Success and Failure Rates between Computer-Assisted and Traditional College Algebra Sections

ERIC Educational Resources Information Center

Herron, Sherry; Gandy, Rex; Ye, Ningjun; Syed, Nasser

2012-01-01

A unique aspect of the implementation of a computer algebra system (CAS) at a comprehensive university in the U.S. allowed us to compare the student success and failure rates to the traditional method of teaching college algebra. Due to space limitations, the university offered sections of both CAS and traditional simultaneously and, upon…

Is depressed myocyte contractility centrally involved in heart failure?

PubMed

Houser, Steven R; Margulies, Kenneth B

2003-03-07

This review examines the evidence for and against the hypothesis that abnormalities in cardiac contractility initiate the heart failure syndrome and drive its progression. There is substantial evidence that the contractility of failing human hearts is depressed and that abnormalities of basal Ca2+ regulation and adrenergic regulation of Ca2+ signaling are responsible. The cellular and molecular defects that cause depressed myocyte contractility are not well established but seem to culminate in abnormal sarcoplasmic reticulum uptake, storage, and release. There are also strong links between Ca2+ regulation, Ca2+ signaling pathways, hypertrophy, and heart failure that need to be more clearly delineated. There is not substantial direct evidence for a causative role for depressed contractility in the initiation and progression of human heart failure, and some studies show that heart failure can occur without depressed myocyte contractility. Stronger support for a causal role for depressed contractility in the initiation of heart failure comes from animal studies where maintaining or improving contractility can prevent heart failure. Recent clinical studies in humans also support the idea that beneficial heart failure treatments, such as beta-adrenergic antagonists, involve improved contractility. Current or previously used heart failure treatments that increase contractility, primarily by increasing cAMP, have generally increased mortality. Novel heart failure therapies that increase or maintain contractility or adrenergic signaling by selectively modulating specific molecules have produced promising results in animal experiments. How to reliably implement these potentially beneficial inotropic therapies in humans without introducing negative side effects is the major unanswered question in this field.

Descemet Membrane Endothelial Keratoplasty for Failed Deep Anterior Lamellar Keratoplasty: A Case Series.

PubMed

Einan-Lifshitz, Adi; Sorkin, Nir; Boutin, Tanguy; Mednick, Zale; Kreimei, Mohammad; Chan, Clara C; Rootman, David S

2018-06-01

To suggest a new surgical approach for posterior opacities or persistent Descemet membrane (DM) detachment in failed deep anterior lamellar keratoplasty (DALK) and to report the outcome of Descemet membrane endothelial keratoplasty (DMEK) in a series of patients with DALK failure. In this retrospective case series of patients who underwent DMEK for failed DALK at Toronto Western Hospital, 4 patients with failed DALK who underwent DMEK surgery were included. In all 4 cases, big bubble formation during initial DALK surgery had failed and the surgical technique was converted to manual dissection using the Melles technique. In 2 cases, the descemetorhexis in DMEK surgery was performed manually, and in 2 cases, the descemetorhexis was performed with the assistance of the femtosecond laser. Four eyes of 4 patients aged 70 ± 4 years were included. Average follow-up time was 9 ± 5 months. Indications for DALK surgery were corneal dystrophy in 2 patients and corneal scars in the other 2. DALK failure was due to persistent DM detachment that created a double chamber in 2 patients and due to posterior lamellar haze in the other 2. After DMEK surgery, 2 patients had graft detachment and required rebubbling. In 1 patient, the DMEK scroll was attached after 1 rebubble attempt, and in the other patient, a second rebubble attempt was needed. The final visual acuities were 20/40, 20/50, 20/70, and 20/200 (because of dense cataract). All procedures were uneventful. DMEK surgery may be effective in managing DALK failure.

An Exploration of Teachers' Perceptions of the Change Process for School Improvement in Four High Schools in the State of Illinois

ERIC Educational Resources Information Center

Hurlburt, Thomas A.

2012-01-01

Many procedures are used by school districts to initiate change that are integral to the success or failure of that initiative. Many initiatives have failed because they were not implemented successfully. Too often, the failure is attributed to the inability of the administration to get the necessary buy-in from the teaching and support staff. The…

Multi-vehicle detection with identity awareness using cascade Adaboost and Adaptive Kalman filter for driver assistant system.

PubMed

Wang, Baofeng; Qi, Zhiquan; Chen, Sizhong; Liu, Zhaodu; Ma, Guocheng

2017-01-01

Vision-based vehicle detection is an important issue for advanced driver assistance systems. In this paper, we presented an improved multi-vehicle detection and tracking method using cascade Adaboost and Adaptive Kalman filter(AKF) with target identity awareness. A cascade Adaboost classifier using Haar-like features was built for vehicle detection, followed by a more comprehensive verification process which could refine the vehicle hypothesis in terms of both location and dimension. In vehicle tracking, each vehicle was tracked with independent identity by an Adaptive Kalman filter in collaboration with a data association approach. The AKF adaptively adjusted the measurement and process noise covariance through on-line stochastic modelling to compensate the dynamics changes. The data association correctly assigned different detections with tracks using global nearest neighbour(GNN) algorithm while considering the local validation. During tracking, a temporal context based track management was proposed to decide whether to initiate, maintain or terminate the tracks of different objects, thus suppressing the sparse false alarms and compensating the temporary detection failures. Finally, the proposed method was tested on various challenging real roads, and the experimental results showed that the vehicle detection performance was greatly improved with higher accuracy and robustness.

Comparative analysis of ventricular assist devices (POLVAD and POLVAD_EXT) based on multiscale FEM model.

PubMed

Milenin, Andrzej; Kopernik, Magdalena

2011-01-01

The prosthesis - pulsatory ventricular assist device (VAD) - is made of polyurethane (PU) and biocompatible TiN deposited by pulsed laser deposition (PLD) method. The paper discusses the numerical modelling and computer-aided design of such an artificial organ. Two types of VADs: POLVAD and POLVAD_EXT are investigated. The main tasks and assumptions of the computer program developed are presented. The multiscale model of VAD based on finite element method (FEM) is introduced and the analysis of the stress-strain state in macroscale for the blood chamber in both versions of VAD is shown, as well as the verification of the results calculated by applying ABAQUS, a commercial FEM code. The FEM code developed is based on a new approach to the simulation of multilayer materials obtained by using PLD method. The model in microscale includes two components, i.e., model of initial stresses (residual stress) caused by the deposition process and simulation of active loadings observed in the blood chamber of POLVAD and POLVAD_EXT. The computed distributions of stresses and strains in macro- and microscales are helpful in defining precisely the regions of blood chamber, which can be defined as the failure-source areas.

24 CFR 982.508 - Maximum family share at initial occupancy.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Maximum family share at initial... Assistance Payment § 982.508 Maximum family share at initial occupancy. At the time the PHA approves a tenancy for initial occupancy of a dwelling unit by a family with tenant-based assistance under the...

Controversies and Challenges of Ventricular Assist Device Therapy.

PubMed

Lima, Brian; Bansal, Aditya; Abraham, Jacob; Rich, Jonathan D; Lee, Sangjin S; Soleimani, Behzad; Katz, Jason N; Kilic, Ahmet; Young, John S; Patel, Chetan B; Joseph, Susan M

2018-05-15

Left ventricular assist device (LVAD) therapy has emerged as an increasingly vital facet of the treatment algorithm for advanced heart failure. Growing experience with LVAD support has led to substantial improvements in outcomes, with 1-year survival rates approaching that of cardiac transplantation. These therapeutic refinements have engendered growing interests in the potential for expanding the clinical indications for LVAD therapy to patients with less advanced heart failure. The primary obstacles to this evolution of care center largely on the prevention and/or management of the adverse events associated with LVAD therapy along with patient preference. Many programs also face the mounting difficulty of balancing quality outcomes with the increased volume of implants. During the recently assembled Users Meeting organized by St. Jude Medical, heart failure clinicians from nearly 50 LVAD implanting centers discussed these and other challenges and controversies impacting the field. The present review summarizes the key insights gleaned from this meeting. Copyright © 2018 Elsevier Inc. All rights reserved.

Toward a methodology for moral decision making in medicine.

PubMed

Kushner, T; Belliotti, R A; Buckner, D

1991-12-01

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but criticisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a method of moral decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case.

Quantitative image analysis of WE43-T6 cracking behavior

NASA Astrophysics Data System (ADS)

Ahmad, A.; Yahya, Z.

2013-06-01

Environment-assisted cracking of WE43 cast magnesium (4.2 wt.% Yt, 2.3 wt.% Nd, 0.7% Zr, 0.8% HRE) in the T6 peak-aged condition was induced in ambient air in notched specimens. The mechanism of fracture was studied using electron backscatter diffraction, serial sectioning and in situ observations of crack propagation. The intermetallic (rare earthed-enriched divorced intermetallic retained at grain boundaries and predominantly at triple points) material was found to play a significant role in initiating cracks which leads to failure of this material. Quantitative measurements were required for this project. The populations of the intermetallic and clusters of intermetallic particles were analyzed using image analysis of metallographic images. This is part of the work to generate a theoretical model of the effect of notch geometry on the static fatigue strength of this material.

Failure modes for compression loaded angle-ply plates with holes

NASA Technical Reports Server (NTRS)

Burns, S. W.; Herakovich, C. T.; Williams, J. G.

1987-01-01

A combined theoretical-experimental investigation of failure in notched, graphite-epoxy, angle-ply laminates subjected to far-field compression loading indicates that failure generally initiates on the hole boundary and propagates along a line parallel to the fiber orientation of the laminate. The strength of notched laminates with specimen width-to-hole diameter ratios of 5 and 10 are compared to the strength of unnotched laminates. The experimental results are complemented by a three-dimensional finite element stress analysis that includes interlaminar stresses around holes in (+/- theta)s laminates. The finite element predictions indicate that failure is initiated by shear stresses at the hole boundary.

76 FR 33332 - Announcement of Funding Awards for the Technical Assistance and Capacity Building under the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-08

... of key Departmental objectives, including but not limited to, energy efficiency and green building... Awards for the Technical Assistance and Capacity Building under the Transformation Initiative Program...) for the Technical Assistance and Capacity Building under the Transformation Initiative program for...

Separation, failure and temporary relinquishment: women's experiences of early mothering in the context of emergency hysterectomy.

PubMed

Elmir, Rakime; Schmied, Virginia; Wilkes, Lesley; Jackson, Debra

2012-04-01

To describe the experiences of women who have had an emergency hysterectomy following a severe postpartum haemorrhage and the impact on their early mothering experiences. Postpartum haemorrhage and subsequent hysterectomy is a traumatic birth event. Traumatic birth experiences have the potential to impact on a woman's experience of motherhood and her initial relationship with her baby. The relative rarity of this event makes it easy to dismiss the experiences of women having a hysterectomy following childbirth. Little is known about a woman's early mothering experience in the context of having an emergency hysterectomy. Qualitative naturalistic inquiry approach. Data were collected through semi-structured qualitative interviews from 21 Australian women who had an emergency hysterectomy following a severe postpartum haemorrhage. Findings revealed three themes in relation to early mothering experiences in the context of having a hysterectomy following a severe postpartum haemorrhage. They were 'initial separation: lost bonding time', 'feelings of failure' and 'relinquishing care of the infant'. This paper highlights the ways undergoing emergency hysterectomy following childbirth can impact on the experience of early mothering in the postnatal period. Greater recognition and attention to the specific needs of women who have an emergency hysterectomy following childbirth is required. Providing women with an opportunity to talk, debrief and ask questions related to their birthing experiences, will help women to reconcile their feelings. Giving women the opportunity to have their infants with them in intensive care unit, together with ongoing emotional support and anticipatory guidance, may also be useful approaches in assisting women during this difficult and traumatic time. © 2011 Blackwell Publishing Ltd.

Early hemi-diaphragmatic plication through a video assisted mini-thoracotomy in postcardiotomy phrenic nerve paresis

PubMed Central

Tsakiridis, Kosmas; Visouli, Aikaterini N.; Machairiotis, Nikolaos; Christofis, Christos; Stylianaki, Aikaterini; Katsikogiannis, Nikolaos; Mpakas, Andreas; Courcoutsakis, Nicolaos; Zarogoulidis, Konstantinos

2012-01-01

New symptom onset of respiratory distress without other cause, and new hemi-diaphragmatic elevation on chest radiography postcardiotomy, are usually adequate for the diagnosis of phrenic nerve paresis. The symptom severity varies (asymptomatic state to severe respiratory failure) depending on the degree of the lesion (paresis vs. paralysis), the laterality (unilateral or bilateral), the age, and the co-morbidity (respiratory, cardiac disease, morbid obesity, etc). Surgical treatment (hemi-diaphragmatic plication) is indicated only in the presence of symptoms. The established surgical treatment is plication of the affected hemidiaphragm which is generally considered safe and effective. Several techniques and approaches are employed for diaphragmatic plication (thoracotomy, video-assisted thoracoscopic surgery, video-assisted mini-thoracotomy, laparoscopic surgery). The timing of surgery depends on the severity and the progression of symptoms. In infants and young children with postcardiotomy phrenic nerve paresis the clinical status is usually severe (failure to wean from mechanical ventilation), and early plication is indicated. Adults with postcardiotomy phrenic nerve paresis usually suffer from chronic dyspnoea, and, in the absence of respiratory distress, conservative treatment is recommended for 6 months -2 years, since improvement is often observed. Nevertheless, earlier surgical treatment may be indicated in non-resolving respiratory failure. We present early (25th day postcardiotomy) right hemi-diaphragm plication, through a video assisted mini-thoracotomy in a high risk patient with postcardiotomy phrenic nerve paresis and respiratory distress. Early surgery with minimal surgical trauma, short operative time, minimal blood loss and postoperative pain, led to fast rehabilitation and avoidance of prolonged hospitalization complications. The relevant literature is discussed. PMID:23304442

Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings.

PubMed

Melo, J S; Garfein, R S; Hayashi, K; Milloy, M J; DeBeck, K; Sun, S; Jain, S; Strathdee, S A; Werb, D

2018-01-01

The prevention of drug injecting is often cited as a justification for the deployment of law enforcement and for the continuation of drug criminalization policies. We sought to characterize the impact of law enforcement interactions on the risk that people who inject drugs (PWID) report assisting others with injection initiation in three North American countries. Cross-sectional data from PWID participating in cohort studies in three cities (San Diego, USA; Tijuana, Mexico; Vancouver, Canada) were pooled (August 2014-December 2016). The dependent variable was defined as recently (i.e., past six months) providing injection initiation assistance; the primary independent variable was the frequency of recent law enforcement interactions, defined categorically (0 vs. 1 vs. 2-5 vs. ≥6). We employed multivariable logistic regression analyses to assess this relationship while controlling for potential confounders. Among 2122 participants, 87 (4.1%) reported recently providing injection initiation assistance, and 802 (37.8%) reported recent law enforcement interactions. Reporting either one or more than five recent interactions with law enforcement was not significantly associated with injection initiation assistance. Reporting 2-5 law enforcement interactions was associated with initiation assistance (Adjusted Odds Ratio=1.74, 95% Confidence Interval: 1.01-3.02). Reporting interactions with law enforcement was not associated with a reduced likelihood that PWID reported initiating others into injection drug use. Instead, we identified a positive association between reporting law enforcement interactions and injection initiation assistance among PWID in multiple settings. These findings raise concerns regarding the effectiveness of drug law enforcement to deter injection drug use initiation. Copyright © 2017 Elsevier B.V. All rights reserved.

Ventricular fibrillation in an ambulatory patient supported by a left ventricular assist device: highlighting the ICD controversy.

PubMed

Boilson, Barry A; Durham, Lucian A; Park, Soon J

2012-01-01

Left ventricular assist devices (LVADs) provide an effective means of managing advanced pump failure as a means of bridging to cardiac transplantation or as permanent therapy. Although ventricular arrhythmias remain common post-LVAD implantation, such therapy may allow malignant arrhythmias to be tolerated hemodynamically. This report describes the clinical findings in a patient who had likely been in a ventricular tachyarrhythmia for several days and presented in ventricular fibrillation, ambulatory, and mentating normally. This report, with previous similar reports, is additive to the body of evidence that LVADs alter the physiologic impact of ventricular arrhythmias in advanced heart failure and highlights the need for thoughtful programming of implantable cardioverter defibrillator therapies in these patients.

Exercise therapy for an older patient with left ventricular assist device.

PubMed

Park, Won Hah; Seo, Yong Gon; Sung, Ji Dong

2014-06-01

A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.

Flight Validation of a Metrics Driven L(sub 1) Adaptive Control

NASA Technical Reports Server (NTRS)

Dobrokhodov, Vladimir; Kitsios, Ioannis; Kaminer, Isaac; Jones, Kevin D.; Xargay, Enric; Hovakimyan, Naira; Cao, Chengyu; Lizarraga, Mariano I.; Gregory, Irene M.

2008-01-01

The paper addresses initial steps involved in the development and flight implementation of new metrics driven L1 adaptive flight control system. The work concentrates on (i) definition of appropriate control driven metrics that account for the control surface failures; (ii) tailoring recently developed L1 adaptive controller to the design of adaptive flight control systems that explicitly address these metrics in the presence of control surface failures and dynamic changes under adverse flight conditions; (iii) development of a flight control system for implementation of the resulting algorithms onboard of small UAV; and (iv) conducting a comprehensive flight test program that demonstrates performance of the developed adaptive control algorithms in the presence of failures. As the initial milestone the paper concentrates on the adaptive flight system setup and initial efforts addressing the ability of a commercial off-the-shelf AP with and without adaptive augmentation to recover from control surface failures.

Explosive Model Tarantula 4d/JWL++ Calibration of LX-17

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

Souers, P C; Vitello, P A

2008-09-30

Tarantula is an explosive kinetic package intended to do detonation, shock initiation, failure, corner-turning with dead zones, gap tests and air gaps in reactive flow hydrocode models. The first, 2007-2008 version with monotonic Q is here run inside JWL++ with square zoning from 40 to 200 zones/cm on ambient LX-17. The model splits the rate behavior in every zone into sections set by the hydrocode pressure, P + Q. As the pressure rises, we pass through the no-reaction, initiation, ramp-up/failure and detonation sections sequentially. We find that the initiation and pure detonation rate constants are largely insensitive to zoning butmore » that the ramp-up/failure rate constant is extremely sensitive. At no time does the model pass every test, but the pressure-based approach generally works. The best values for the ramp/failure region are listed here in Mb units.« less

Echocardiographic variables after left ventricular assist device implantation associated with adverse outcome.

PubMed

Topilsky, Yan; Hasin, Tal; Oh, Jae K; Borgeson, Daniel D; Boilson, Barry A; Schirger, John A; Clavell, Alfredo L; Frantz, Robert P; Tsutsui, Rayji; Liu, Mingya; Maltais, Simon; Kushwaha, Sudhir S; Pereira, Naveen L; Park, Soon J

2011-11-01

Operative mortality after left ventricular assist device (LVAD) implantation is heavily influenced by patient selection and the technical difficulty of surgery. However, how we treat our patients and LVAD setting may affect the patient outcome beyond this period. We postulated that the presence of echocardiographic variables 1 month after surgery suggesting appropriate degree of LV unloading and an adequate forward flow would be important in determining clinical outcomes after the initial successful LVAD implantation. We retrospectively analyzed various variables in echocardiographic examinations performed 30 days after LVAD implant in 76 consecutive patients receiving continuous flow device for their association with a compound end point (90-day mortality, readmission for heart failure, or New York Heart Association class III or higher at the end of the 90-day period). The echocardiographic associations examined included estimated LVAD flow, with and without native LV contribution, interventricular septal position, the status of aortic valve opening, an estimated left atrial pressure (ELAP), the mitral flow E-wave deceleration time, and the ratio of deceleration time to E-wave velocity (mitral deceleration index [MDI]). Four patients died during the 30- to 90-day period, 6 patients were readmitted for heart failure, and 25 patients were considered to have New York Heart Association class III or higher at the end of the 90-day period. Variables associated with adverse outcome included increased ELAP (odds ratio, 1.30 [1.16-1.48]; P<0.0001), MDI <2 ms/[cm/s] (odds ratio, 4.4 implantation [1.22-18]; P=0.02) and decreased tricuspid lateral annulus velocity (odds ratio, 0.70 implantation [0.48-0.95]; P=0.02). A leftward deviation of interventricular septum was associated with a worse outcome (odds ratio, 3.03 implantation [1.21-13.3]; P=0.01). Mortality and heart failure after LVAD surgery appear to be predominantly determined by echocardiographic evidence of inefficient unloading of the left ventricle and persistence of right ventricular dysfunction. Increased estimated LA pressure and short MDI are associated with worse mid term outcome. Leftward deviation of the septum is associated with worse outcome as well.

Failure analysis of aluminum alloy components

NASA Technical Reports Server (NTRS)

Johari, O.; Corvin, I.; Staschke, J.

1973-01-01

Analysis of six service failures in aluminum alloy components which failed in aerospace applications is reported. Identification of fracture surface features from fatigue and overload modes was straightforward, though the specimens were not always in a clean, smear-free condition most suitable for failure analysis. The presence of corrosion products and of chemically attacked or mechanically rubbed areas here hindered precise determination of the cause of crack initiation, which was then indirectly inferred from the scanning electron fractography results. In five failures the crack propagation was by fatigue, though in each case the fatigue crack initiated from a different cause. Some of these causes could be eliminated in future components by better process control. In one failure, the cause was determined to be impact during a crash; the features of impact fracture were distinguished from overload fractures by direct comparisons of the received specimens with laboratory-generated failures.

Consumer Satisfaction in Long-Term Care: State Initiatives in Nursing Homes and Assisted Living Facilities

ERIC Educational Resources Information Center

Lowe, Timothy J.; Lucas, Judith A.; Castle, Nicholas G.; Robinson, Joanne P.; Crystal, Stephen

2003-01-01

Purpose: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. Design and Methods: Data on state initiatives and programs…

[Systematization of nursing assistance to patients with diabetes mellitus and chronic renal failure].

PubMed

Mascarenhas, Nildo Batista; Pereira, Álvaro; da Silva, Rudval Souza; da Silva, Mary Gomes

2011-01-01

This is a clinical case study developed during the practical activities of the discipline Surgical Clinical Nursing I, of course of Graduation in Nursing of a public university of Bahia State, that aimed to report the application of the Systematization of Nursing Assistance in the assistance to a client whit Diabetes Mellitus and Chronic Renal Insufficiency. With the development of the study, especially after the positive improvement of the client, face to assistance planned and implemented and considering the reflections that emerged, it was possible to evidence the need for interface between Systematization of Nursing Assistance, the nursing staff and client in the care process, at the excellence and uniqueness of nursing care.

Very High Cycle Fatigue Failure Analysis and Life Prediction of Cr-Ni-W Gear Steel Based on Crack Initiation and Growth Behaviors.

PubMed

Deng, Hailong; Li, Wei; Sakai, Tatsuo; Sun, Zhenduo

2015-12-02

The unexpected failures of structural materials in very high cycle fatigue (VHCF) regime have been a critical issue in modern engineering design. In this study, the VHCF property of a Cr-Ni-W gear steel was experimentally investigated under axial loading with the stress ratio of R = -1, and a life prediction model associated with crack initiation and growth behaviors was proposed. Results show that the Cr-Ni-W gear steel exhibits the constantly decreasing S-N property without traditional fatigue limit, and the fatigue strength corresponding to 10⁸ cycles is around 485 MPa. The inclusion-fine granular area (FGA)-fisheye induced failure becomes the main failure mechanism in the VHCF regime, and the local stress around the inclusion play a key role. By using the finite element analysis of representative volume element, the local stress tends to increase with the increase of elastic modulus difference between inclusion and matrix. The predicted crack initiation life occupies the majority of total fatigue life, while the predicted crack growth life is only accounts for a tiny fraction. In view of the good agreement between the predicted and experimental results, the proposed VHCF life prediction model involving crack initiation and growth can be acceptable for inclusion-FGA-fisheye induced failure.

Problems experienced by informal caregivers of individuals with heart failure: An integrative review.

PubMed

Grant, Joan S; Graven, Lucinda J

2018-04-01

The purpose of this review was to examine and synthesize recent literature regarding problems experienced by informal caregivers when providing care for individuals with heart failure in the home. Integrative literature review. A review of current empirical literature was conducted utilizing PubMed, CINAHL, Embase, Sociological Abstracts, Social Sciences Full Text, PsycARTICLES, PsycINFO, Health Source: Nursing/Academic Edition, and Cochrane computerized databases. 19 qualitative, 16 quantitative, and 2 mixed methods studies met the inclusion criteria for review. Computerized databases were searched for a combination of subject terms (i.e., MeSH) and keywords related to informal caregivers, problems, and heart failure. The title and abstract of identified articles and reference lists were reviewed. Studies were included if they were published in English between January 2000 and December 2016 and examined problems experienced by informal caregivers in providing care for individuals with heart failure in the home. Studies were excluded if not written in English or if elements of caregiving in heart failure were not present in the title, abstract, or text. Unpublished and duplicate empirical literature as well as articles related to specific end-stage heart failure populations also were excluded. Methodology described by Cooper and others for integrative reviews of quantitative and qualitative research was used. Quality appraisal of the included studies was evaluated using the Joanna Briggs Institute critical appraisal tools for cross-sectional quantitative and qualitative studies. Informal caregivers experienced four key problems when providing care for individuals with heart failure in the home, including performing multifaceted activities and roles that evolve around daily heart failure demands; maintaining caregiver physical, emotional, social, spiritual, and financial well-being; having insufficient caregiver support; and performing caregiving with uncertainty and inadequate knowledge. Informal caregivers of individuals with heart failure experience complex problems in the home when providing care which impact all aspects of their lives. Incorporating advice from informal caregivers of individuals with heart failure will assist in the development of interventions to reduce negative caregiver outcomes. Given the complex roles in caring for individuals with heart failure, multicomponent interventions are potentially promising in assisting informal caregivers in performing these roles. Published by Elsevier Ltd.

Application of Interface Technology in Progressive Failure Analysis of Composite Panels

NASA Technical Reports Server (NTRS)

Sleight, D. W.; Lotts, C. G.

2002-01-01

A progressive failure analysis capability using interface technology is presented. The capability has been implemented in the COMET-AR finite element analysis code developed at the NASA Langley Research Center and is demonstrated on composite panels. The composite panels are analyzed for damage initiation and propagation from initial loading to final failure using a progressive failure analysis capability that includes both geometric and material nonlinearities. Progressive failure analyses are performed on conventional models and interface technology models of the composite panels. Analytical results and the computational effort of the analyses are compared for the conventional models and interface technology models. The analytical results predicted with the interface technology models are in good correlation with the analytical results using the conventional models, while significantly reducing the computational effort.

24 CFR 982.309 - Term of assisted tenancy.

Code of Federal Regulations, 2010 CFR

2010-04-01

... term of the HAP contract begins on the first day of the lease term and ends on the last day of the... assistance for the family. (c) Family responsibility. (1) If the family terminates the lease on notice to the owner, the family must give the PHA a copy of the notice of termination at the same time. Failure to do...

A Comparative Study of the Efficacy of Group Equine Assisted Counseling with At-Risk Children and Adolescents

ERIC Educational Resources Information Center

Trotter, Kay Sudekum; Chandler, Cynthia K.; Goodwin-Bond, Deborah; Casey, Janie

2008-01-01

This study demonstrates the efficacy of Equine Assisted Counseling (EAC) by comparing EAC to classroom-based counseling. Students (n = 164) identified as being at high risk for academic and/or social failure participated in 12 weekly counseling sessions. Within-group paired sample t-test results comparing pre- and post-treatment scores for…

Medical costs associated with non-Hodgkin's lymphoma in the United States during the first two years of treatment.

PubMed

Kutikova, Lucie; Bowman, Lee; Chang, Stella; Long, Stacey R; Arning, Michael; Crown, William H

2006-08-01

To determine the direct costs of medical care associated with aggressive and indolent non-Hodgkin's lymphoma (NHL) in the United States; to show how costs for aggressive NHL change over time by examining costs related to initial, secondary and palliative treatment phases; and to evaluate the economic consequences of treatment failure in aggressive NHL. A retrospective cohort analysis of 1999 - 2000 direct costs in newly diagnosed NHL patients and controls (subjects without any cancer) was conducted using the MarketScan medical and drug claims database of large employers across the United States. Treatment failure analysis was conducted for aggressive NHL patients, and was defined by the need for secondary treatment or palliative care after initial therapy. Cost of treatment failure was calculated as difference in regression-adjusted costs between patients with initial therapy only and patients experiencing initial treatment failure. Patients with aggressive (n = 356) and indolent (n = 698) NHL had significantly greater health service utilization and associated costs (all P < 05) than controls (n = 1068 for aggressive, n = 2094 for indolent). Mean monthly costs were 5871 dollars for aggressive NHL vs. 355 dollars for controls (P < 0001) and 3833 dollars for indolent NHL vs. 289 dollars for controls (P < 0001). The primary cost drivers were hospitalization (aggressive NHL = 44% of total costs, indolent NHL = 50%) and outpatient office visits (aggressive NHL = 39%, indolent NHL = 34%). For aggressive NHL, mean monthly initial treatment phase costs (10,970 dollars) and palliative care costs (9836 dollars) were higher than costs incurred during secondary phase (3302 dollars). The mean cost of treatment failure in aggressive NHL was 14,174 dollars per month, and 85,934 dollars over the study period. The treatment of NHL was associated with substantial health care costs. Patients with aggressive lymphomas tended to accrue higher costs, compared with those with indolent lymphomas. These costs varied over time, with the highest costs occurring during the initial treatment and palliative care phases. Treatment failure was the most expensive treatment pattern. New strategies to prevent or delay treatment failure in aggressive NHL could help reduce the economic burden of NHL.

Teaching Assistant Competencies in Canada: Building a Framework for Practice Together

ERIC Educational Resources Information Center

Korpan, Cynthia; Sheffield, Suzanne Le-May; Verwoord, Roselynn

2015-01-01

This paper examines the stages of development for a framework of teaching assistant (TA) competencies initiated by the Teaching Assistant and Graduate Student Advancement (TAGSA) special interest group (SIG) of the Society of Teaching and Learning in Higher Education (STLHE). TAGSA initiated an iterative consultative process to inform the creation…

Association Between Efavirenz-Based Compared With Nevirapine-Based Antiretroviral Regimens and Virological Failure in HIV-Infected Children

PubMed Central

Lowenthal, Elizabeth D.; Ellenberg, Jonas H.; Machine, Edwin; Sagdeo, Aditi; Boiditswe, Sefelani; Steenhoff, Andrew P.; Rutstein, Richard; Anabwani, Gabriel; Gross, Robert

2013-01-01

Importance Worldwide, the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz and nevirapine are commonly used in first-line antiretroviral regimens in both adults and children with human immunodeficiency virus (HIV) infection. Data on the comparative effectiveness of these medications in children are limited. Objective To investigate whether virological failure is more likely among children who initiated 1 or the other NNRTI-based HIV treatment. Design, Setting, and Participants Retrospective cohort study of children (aged 3–16 years) who initiated efavirenz-based (n=421) or nevirapine-based (n=383) treatment between April 2002 and January 2011 at a large pediatric HIV care setting in Botswana. Main Outcomes and Measures The primary outcome was time from initiation of therapy to virological failure. Virological failure was defined as lack of plasma HIV RNA suppression to less than 400 copies/mL by 6 months or confirmed HIV RNA of 400 copies/mL or greater after suppression. Cox proportional hazards regression analysis compared time to virological failure by regimen. Multivariable Cox regression controlled for age, sex, baseline immunologic category, baseline clinical category, baseline viral load, nutritional status, NRTIs used, receipt of single-dose nevirapine, and treatment for tuberculosis. Results With a median follow-up time of 69 months (range, 6–112 months; interquartile range, 23–87 months), 57 children (13.5%; 95% CI, 10.4%–17.2%) initiating treatment with efavirenz and 101 children (26.4%; 95% CI, 22.0%–31.1%) initiating treatment with nevirapine had virological failure. There were 11 children (2.6%; 95% CI, 1.3%–4.6%) receiving efavirenz and 20 children (5.2%; 95% CI, 3.2%–7.9%) receiving nevirapine who never achieved virological suppression. The Cox proportional hazard ratio for the combined virological failure end point was 2.0 (95% CI, 1.4–2.7; log rank P<.001, favoring efavirenz). None of the measured covariates affected the estimated hazard ratio in the multivariable analyses. Conclusions and Relevance Among children aged 3 to 16 years infected with HIV and treated at a clinic in Botswana, the use of efavirenz compared with nevirapine as initial antiretroviral treatment was associated with less virological failure. These findings may warrant additional research evaluating the use of efavirenz and nevirapine for pediatric patients. PMID:23632724

Effect of tooth substrate and porcelain thickness on porcelain veneer failure loads in vitro.

PubMed

Ge, Chunling; Green, Chad C; Sederstrom, Dalene A; McLaren, Edward A; Chalfant, James A; White, Shane N

2017-12-19

Bonded porcelain veneers are widely used esthetic restorations. High success and survival rates have been reported, but failures do occur. Fractures are the commonest failure mode. Minimally invasive or thin veneers have gained popularity. Increased enamel and porcelain thickness improve the strength of veneers bonded to enamel, but less is known about dentin or mixed substrates. The purpose of this in vitro study was to measure the influences of tooth substrate type (all-enamel, all-dentin, or half-dentin-half-enamel) and veneer thickness on the loads needed to cause initial and catastrophic porcelain veneer failure. Model discoid porcelain veneer specimens of varying thicknesses were bonded to the flattened facial surfaces of incisors with different enamel and dentin tooth substrates, artificially aged, and loaded to failure with a small sphere. Initial and catastrophic fracture events were identified and analyzed statistically and fractographically. Fracture events included initial Hertzian cracks, intermediate radial cracks, and catastrophic gross failure. All specimens retained some porcelain after catastrophic failure. Cement failure occurred at the cement-porcelain interface not at the cement-tooth interface. Porcelain veneers bonded to enamel were substantially stronger and more damage-tolerant than those bonded to dentin or mixed substrates. Increased porcelain thickness substantially raised the loads to catastrophic failure on enamel substrates but only moderately raised the loads to catastrophic failure on dentin or mixed substrates. The veneers bonded to half-dentin-half-enamel behaved remarkably like those bonded wholly to dentin. Porcelain veneers bonded to enamel were substantially stronger and more damage-tolerant than those bonded to dentin or half-enamel-half dentin. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us

PubMed Central

Fung, Erik; Hui, Elsie; Yang, Xiaobo; Lui, Leong T.; Cheng, King F.; Li, Qi; Fan, Yiting; Sahota, Daljit S.; Ma, Bosco H. M.; Lee, Jenny S. W.; Lee, Alex P. W.; Woo, Jean

2018-01-01

Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management. PMID:29740330

A risk assessment method for multi-site damage

NASA Astrophysics Data System (ADS)

Millwater, Harry Russell, Jr.

This research focused on developing probabilistic methods suitable for computing small probabilities of failure, e.g., 10sp{-6}, of structures subject to multi-site damage (MSD). MSD is defined as the simultaneous development of fatigue cracks at multiple sites in the same structural element such that the fatigue cracks may coalesce to form one large crack. MSD is modeled as an array of collinear cracks with random initial crack lengths with the centers of the initial cracks spaced uniformly apart. The data used was chosen to be representative of aluminum structures. The structure is considered failed whenever any two adjacent cracks link up. A fatigue computer model is developed that can accurately and efficiently grow a collinear array of arbitrary length cracks from initial size until failure. An algorithm is developed to compute the stress intensity factors of all cracks considering all interaction effects. The probability of failure of two to 100 cracks is studied. Lower bounds on the probability of failure are developed based upon the probability of the largest crack exceeding a critical crack size. The critical crack size is based on the initial crack size that will grow across the ligament when the neighboring crack has zero length. The probability is evaluated using extreme value theory. An upper bound is based on the probability of the maximum sum of initial cracks being greater than a critical crack size. A weakest link sampling approach is developed that can accurately and efficiently compute small probabilities of failure. This methodology is based on predicting the weakest link, i.e., the two cracks to link up first, for a realization of initial crack sizes, and computing the cycles-to-failure using these two cracks. Criteria to determine the weakest link are discussed. Probability results using the weakest link sampling method are compared to Monte Carlo-based benchmark results. The results indicate that very small probabilities can be computed accurately in a few minutes using a Hewlett-Packard workstation.

SdrF, a Staphylococcus epidermidis Surface Protein, Contributes to the Initiation of Ventricular Assist Device Driveline–Related Infections

PubMed Central

Arrecubieta, Carlos; Toba, Faustino A.; von Bayern, Manuel; Akashi, Hirokazu; Deng, Mario C.; Naka, Yoshifumi; Lowy, Franklin D.

2009-01-01

Staphylococcus epidermidis remains the predominant pathogen in prosthetic-device infections. Ventricular assist devices, a recently developed form of therapy for end-stage congestive heart failure, have had considerable success. However, infections, most often caused by Staphylococcus epidermidis, have limited their long-term use. The transcutaneous driveline entry site acts as a potential portal of entry for bacteria, allowing development of either localized or systemic infections. A novel in vitro binding assay using explanted drivelines obtained from patients undergoing transplantation and a heterologous lactococcal system of surface protein expression were used to identify S. epidermidis surface components involved in the pathogenesis of driveline infections. Of the four components tested, SdrF, SdrG, PIA, and GehD, SdrF was identified as the primary ligand. SdrF adherence was mediated via its B domain attaching to host collagen deposited on the surface of the driveline. Antibodies directed against SdrF reduced adherence of S. epidermidis to the drivelines. SdrF was also found to adhere with high affinity to Dacron, the hydrophobic polymeric outer surface of drivelines. Solid phase binding assays showed that SdrF was also able to adhere to other hydrophobic artificial materials such as polystyrene. A murine model of infection was developed and used to test the role of SdrF during in vivo driveline infection. SdrF alone was able to mediate bacterial adherence to implanted drivelines. Anti-SdrF antibodies reduced S. epidermidis colonization of implanted drivelines. SdrF appears to play a key role in the initiation of ventricular assist device driveline infections caused by S. epidermidis. This pluripotential adherence capacity provides a potential pathway to infection with SdrF-positive commensal staphylococci first adhering to the external Dacron-coated driveline at the transcutaneous entry site, then spreading along the collagen-coated internal portion of the driveline to establish a localized infection. This capacity may also have relevance for other prosthetic device–related infections. PMID:19412528

Management of end-stage heart failure: a perspective on the Arab Gulf states

PubMed Central

Al Habeeb, Waleed; Stewart, Garrick C.; Mudge, Gilbert H.

2009-01-01

The ever expanding epidemic of end-stage heart failure represents one of the greatest challenges of modern cardiovascular medicine. With medical treatments hampered by significant limitations, physicians caring for patients with advanced heart disease have turned to cardiac transplantation and durable mechanical circulatory assist devices as definitive therapies. These advanced therapeutic modalities are not widely available outside the United States and Europe, but nevertheless offer enormous potential for patients in the Arab Gulf suffering from end-stage heart failure. This review will discuss the management of end-stage heart failure in the Gulf States, with an emphasis on therapies best utilized within a framework of regional cooperation and coordination. PMID:19847084

Compression Fracture of CFRP Laminates Containing Stress Intensifications.

PubMed

Leopold, Christian; Schütt, Martin; Liebig, Wilfried V; Philipkowski, Timo; Kürten, Jonas; Schulte, Karl; Fiedler, Bodo

2017-09-05

For brittle fracture behaviour of carbon fibre reinforced plastics (CFRP) under compression, several approaches exist, which describe different mechanisms during failure, especially at stress intensifications. The failure process is not only initiated by the buckling fibres, but a shear driven fibre compressive failure beneficiaries or initiates the formation of fibres into a kink-band. Starting from this kink-band further damage can be detected, which leads to the final failure. The subject of this work is an experimental investigation on the influence of ply thickness and stacking sequence in quasi-isotropic CFRP laminates containing stress intensifications under compression loading. Different effects that influence the compression failure and the role the stacking sequence has on damage development and the resulting compressive strength are identified and discussed. The influence of stress intensifications is investigated in detail at a hole in open hole compression (OHC) tests. A proposed interrupted test approach allows identifying the mechanisms of damage initiation and propagation from the free edge of the hole by causing a distinct damage state and examine it at a precise instant of time during fracture process. Compression after impact (CAI) tests are executed in order to compare the OHC results to a different type of stress intensifications. Unnotched compression tests are carried out for comparison as a reference. With this approach, a more detailed description of the failure mechanisms during the sudden compression failure of CFRP is achieved. By microscopic examination of single plies from various specimens, the different effects that influence the compression failure are identified. First damage of fibres occurs always in 0°-ply. Fibre shear failure leads to local microbuckling and the formation and growth of a kink-band as final failure mechanisms. The formation of a kink-band and finally steady state kinking is shifted to higher compressive strains with decreasing ply thickness. Final failure mode in laminates with stress intensification depends on ply thickness. In thick or inner plies, damage initiates as shear failure and fibre buckling into the drilled hole. The kink-band orientation angle is changing with increasing strain. In outer or thin plies shear failure of single fibres is observed as first damage and the kink-band orientation angle is constant until final failure. Decreasing ply thickness increases the unnotched compressive strength. When stress intensifications are present, the position of the 0°-layer is critical for stability under compression and is thus more important than the ply thickness. Central 0°-layers show best results for OHC and CAI strength due to higher bending stiffness and better supporting effect of the adjacent layers.

Compression Fracture of CFRP Laminates Containing Stress Intensifications

PubMed Central

Schütt, Martin; Philipkowski, Timo; Kürten, Jonas; Schulte, Karl

2017-01-01

For brittle fracture behaviour of carbon fibre reinforced plastics (CFRP) under compression, several approaches exist, which describe different mechanisms during failure, especially at stress intensifications. The failure process is not only initiated by the buckling fibres, but a shear driven fibre compressive failure beneficiaries or initiates the formation of fibres into a kink-band. Starting from this kink-band further damage can be detected, which leads to the final failure. The subject of this work is an experimental investigation on the influence of ply thickness and stacking sequence in quasi-isotropic CFRP laminates containing stress intensifications under compression loading. Different effects that influence the compression failure and the role the stacking sequence has on damage development and the resulting compressive strength are identified and discussed. The influence of stress intensifications is investigated in detail at a hole in open hole compression (OHC) tests. A proposed interrupted test approach allows identifying the mechanisms of damage initiation and propagation from the free edge of the hole by causing a distinct damage state and examine it at a precise instant of time during fracture process. Compression after impact (CAI) tests are executed in order to compare the OHC results to a different type of stress intensifications. Unnotched compression tests are carried out for comparison as a reference. With this approach, a more detailed description of the failure mechanisms during the sudden compression failure of CFRP is achieved. By microscopic examination of single plies from various specimens, the different effects that influence the compression failure are identified. First damage of fibres occurs always in 0°-ply. Fibre shear failure leads to local microbuckling and the formation and growth of a kink-band as final failure mechanisms. The formation of a kink-band and finally steady state kinking is shifted to higher compressive strains with decreasing ply thickness. Final failure mode in laminates with stress intensification depends on ply thickness. In thick or inner plies, damage initiates as shear failure and fibre buckling into the drilled hole. The kink-band orientation angle is changing with increasing strain. In outer or thin plies shear failure of single fibres is observed as first damage and the kink-band orientation angle is constant until final failure. Decreasing ply thickness increases the unnotched compressive strength. When stress intensifications are present, the position of the 0°-layer is critical for stability under compression and is thus more important than the ply thickness. Central 0°-layers show best results for OHC and CAI strength due to higher bending stiffness and better supporting effect of the adjacent layers. PMID:28872623

38 CFR 21.7158 - False, late, or missing reports.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION All Volunteer Force Educational Assistance Program... institution's or training establishment's willful or negligent failure to report excessive absences from a...

38 CFR 21.7158 - False, late, or missing reports.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION All Volunteer Force Educational Assistance Program... institution's or training establishment's willful or negligent failure to report excessive absences from a...

38 CFR 21.7158 - False, late, or missing reports.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION All Volunteer Force Educational Assistance Program... institution's or training establishment's willful or negligent failure to report excessive absences from a...

38 CFR 21.7158 - False, late, or missing reports.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION All Volunteer Force Educational Assistance Program... institution's or training establishment's willful or negligent failure to report excessive absences from a...

38 CFR 21.7158 - False, late, or missing reports.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION All Volunteer Force Educational Assistance Program... institution's or training establishment's willful or negligent failure to report excessive absences from a...

Evaluation of a Progressive Failure Analysis Methodology for Laminated Composite Structures

NASA Technical Reports Server (NTRS)

Sleight, David W.; Knight, Norman F., Jr.; Wang, John T.

1997-01-01

A progressive failure analysis methodology has been developed for predicting the nonlinear response and failure of laminated composite structures. The progressive failure analysis uses C plate and shell elements based on classical lamination theory to calculate the in-plane stresses. Several failure criteria, including the maximum strain criterion, Hashin's criterion, and Christensen's criterion, are used to predict the failure mechanisms. The progressive failure analysis model is implemented into a general purpose finite element code and can predict the damage and response of laminated composite structures from initial loading to final failure.

48 CFR 42.1503 - Procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... initiatives to assist, promote, and utilize small business (SB), small disadvantaged business (SDB), women... initiatives to assist, promote and utilize SB, SDB, WOSB, HUBZone, VOSB, and SDVOSB. Complied with FAR 52.219...

Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting

PubMed Central

Puttkammer, Nancy; Zeliadt, Steven; Balan, Jean Gabriel; Baseman, Janet; Destiné, Rodney; Domerçant, Jean Wysler; France, Garilus; Hyppolite, Nathaelf; Pelletier, Valérie; Raphael, Nernst Atwood; Sherr, Kenneth; Yuhas, Krista; Barnhart, Scott

2014-01-01

Background The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk. Methods Among adult patients enrolled on ART from 2005–2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6–12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves. Results Among 923 patients with CD4 results available during the period 6–12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation. Conclusions Pharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs. PMID:25390044

Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting.

PubMed

Puttkammer, Nancy; Zeliadt, Steven; Balan, Jean Gabriel; Baseman, Janet; Destiné, Rodney; Domerçant, Jean Wysler; France, Garilus; Hyppolite, Nathaelf; Pelletier, Valérie; Raphael, Nernst Atwood; Sherr, Kenneth; Yuhas, Krista; Barnhart, Scott

2014-01-01

The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk. Among adult patients enrolled on ART from 2005-2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6-12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves. Among 923 patients with CD4 results available during the period 6-12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation. Pharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs.

Worsening heart failure in the setting of dronedarone initiation.

PubMed

Coons, James C; Plauger, Kara M; Seybert, Amy L; Sokos, George G

2010-09-01

To describe a challenging patient case in which dronedarone was selected for a patient with atrial fibrillation and heart failure; the drug may have been associated with worsening heart failure, leading to acute renal and hepatic failure. A 47-year-old male with a history of heart failure with New York Heart Association class III-IV symptoms presented to our institution with ventricular fibrillation and ventricular tachycardia storm. Torsade de pointes secondary to a combination of dofetilide and hypokalemia was determined to be the etiology. Upon stabilization, the patient was initiated on dronedarone 400 mg orally twice daily by the electrophysiology service for atrial fibrillation. The patient had a questionable history of amiodarone intolerance. By hospital day 9 (day 4 of dronedarone therapy), the patient demonstrated a clinical picture consistent with acute renal and hepatic failure possibly due to worsening heart failure. Dronedarone was discontinued on hospital day 10. He was subsequently transferred to an outside hospital where he required milrinone therapy for cardiogenic shock. Laboratory markers of renal and hepatic function improved over the remainder of his hospitalization and he was discharged on hospital day 20. Dronedarone is a newly approved antiarrhythmic agent with multichannel blocking properties similar to amiodarone. Use of the Naranjo probability scale determined that this patient's worsening heart failure leading to acute renal and hepatic failure was possibly caused by dronedarone. The implication from the ANDROMEDA trial as well as our experience in this case is that dronedarone should be used cautiously in patients with heart failure and avoided in patients specifically outlined in the product labeling. This case report, to our knowledge, represents the first published postmarketing report of worsening heart failure complicated by multiorgan dysfunction in the setting of dronedarone initiation. Dronedarone use must be approached with caution in patients with a history of heart failure.

Immunology and human reproduction.

PubMed

Alecsandru, Diana; García-Velasco, Juan Antonio

2015-06-01

The immune system's role in recurrent reproductive failure is a controversial issue in assisted reproduction. New insight about maternal tolerance in assisted reproduction has been reported and could explain some of the recurrent miscarriage and/or recurrent implantation failure related causes named until now as unknown. Most of the previous studies about immune system implication in reproduction were focused on finding markers on peripheral blood. Maternal tolerance begins at the uterine level, so successful adaptation to the fetus happens after a complicated process. Insufficient invasion of the uterine lining by invading extravillous trophoblast is the primary defect in pregnancy disorders such as recurrent miscarriage, and this process is regulated by interaction between maternal killer immunoglobulin-like receptors (KIRs) expressed by the uterine natural killer cells and their ligand human leukocyte antigen (HLA)-C expressed by extravillous trophoblast. Pregnancies are an increased risk of disorders in mothers with KIR AA when the fetus has paternal HLA-C2. Recently, it has been reported that the expression of more than one paternal HLA-C by extravillous trophoblast in assisted reproduction may affect placentation in mothers with KIR AA. The review provides insight about the immune tolerance process. These insights could have an impact on the selection of single embryo transfer and/or oocyte/sperm donor according to HLA-C in patients with recurrent miscarriage or recurrent implantation failure and a KIR AA haplotype.

Tailoring therapy for ischemic cardiomyopathy: is Laplace's law enough?

PubMed

Adhyapak, Srilakshmi M; Parachuri, V Rao

2017-09-01

The burden of heart failure has long plagued the productive years of the population, with therapeutic advances in the timely treatment of ischemic heart disease decreasing its associated mortality. Angiotensin-converting enzyme inhibitors and β-blockers have impacted heart failure therapeutics in a revolutionary way. The importance of blockade of the renin-angiotensin system and adrenergic stimulation are fully accepted concepts that apply in young and old, symptomatic and asymptomatic, borderline low and very low Ejection Fraction (EF), left ventricular failure and biventricular failure. Despite several interventions, both pharmaceutical and device based for the treatment of ensuing heart failure, the incidence is increasing in large proportions. Newer molecules like sacubitril show more promise. Despite these novel therapies, several patients relentlessly progress to a stage of advanced heart failure. The use of left-ventricular-assist devices has variable clinical benefit, with some patients progressing to heart transplantation.

Numerical investigation of contact stresses for fretting fatigue damage initiation

NASA Astrophysics Data System (ADS)

Bhatti, N. A.; Abdel Wahab, M.

2017-05-01

Fretting fatigue phenomena occurs due to interaction between contacting bodies under application of cyclic and normal loads. In addition to environmental conditions and material properties, the response at the contact interface highly depends on the combination of applied loads. High stress concentration is present at the contact interface, which can start the damage nucleation process. At the culmination of nucleation process several micro cracks are initiated, ultimately leading to the structural failure. In this study, effect of ratio of tangential to normal load on contact stresses, slip amplitude and damage initiation is studied using finite element analysis. The results are evaluated for Ruiz parameter as it involves the slip amplitude which in an important factor in fretting fatigue conditions. It is observed that tangential to normal load ratio influences the stick zone size and damage initiation life. Furthermore, it is observed that tensile stress is the most important factor that drives the damage initiation to failure for the cases where failure occurs predominantly in mode I manner.

Text Message Intervention to Improve Cardiac Rehab Participation

ClinicalTrials.gov

2017-11-14

Myocardial Infarction; Percutaneous Coronary Intervention; Coronary Artery Bypass Surgery; Heart Valve Repair or Replacement; Heart Transplant; Left Ventricular Assist Device; Chronic Stable Angina; Chronic Stable Heart Failure

Why natural killer cells are not enough: a further understanding of killer immunoglobulin-like receptor and human leukocyte antigen.

PubMed

Alecsandru, Diana; García-Velasco, Juan A

2017-06-01

The immune system's role in recurrent reproductive failure is a controversial issue in assisted reproduction. Most studies into immune system implication in reproduction have focused on finding markers of peripheral blood and less on the uterine environment. Peripheral blood natural killer cells have become an "immune study core" for women with recurrent miscarriage or recurrent implantation failure, based on the mistaken notion that they cause reproductive failure by killing or "rejecting" the embryo. Maternal-fetal tolerance begins at the uterine level, so successful adaptation to the fetus occurs after a complicated process. Insufficient uterine lining invasion by an invading extravillous trophoblast is the primary defect in pregnancy disorders such as recurrent miscarriage. This process is regulated by the interaction between maternal killer immunoglobulin-like receptors (KIRs), expressed by uterine natural killer cells (uNK), and their ligand human leukocyte antigen (HLA) C, expressed by the extravillous trophoblast. Pregnancies are an increased risk of disorders in mothers with KIR AA when the fetus has paternal HLA-C2. A recent report has indicated that the expression of more than one paternal HLA-C by the extravillous trophoblast in assisted reproduction may affect placentation in mothers with KIR AA. This review provides insight into the immune system's role in assisted reproductive treatments. These insights can have an impact on the selection of single-embryo transfer and/or oocyte/sperm donor according to HLA-C in patients with recurrent implantation failure and recurrent miscarriage depending on their KIR haplotype. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Robot-assisted training for heart failure patients - a small pilot study.

PubMed

Schoenrath, Felix; Markendorf, Susanne; Brauchlin, Andreas Emil; Frank, Michelle; Wilhelm, Markus Johannes; Saleh, Lanja; Riener, Robert; Schmied, Christian Marc; Falk, Volkmar

2015-12-01

The objective of this study was assess robot-assisted gait therapy with the Lokomat® system in heart failure patients. Patients (n = 5) with stable heart failure and a left ventricular ejection fraction of less than 45% completed a four-week aerobic training period with three trainings per week and an integrated dynamic resistance training of the lower limbs. Patients underwent testing of cardiac and inflammatory biomarkers. A cardiopulmonary exercise test, a quality of life score and an evaluation of the muscular strength by measuring the peak quadriceps force was performed. No adverse events occurred. The combined training resulted in an improvement in peak work rate (range: 6% to 36%) and peak quadriceps force (range: 3% to 80%) in all participants. Peak oxygen consumption (range: –3% to + 61%) increased in three, and oxygen pulse (range: –7% to + 44%) in four of five patients. The quality of life assessment indicated better well-being in all participants. NT-ProBNP (+233 to –733 ng/ml) and the inflammatory biomarkers (hsCRP and IL6) decreased in four of five patients (IL 6: +0.5 to –2 mg/l, hsCRP: +0.2 to –6.5 mg/l). Robot-assisted gait therapy with the Lokomat® System is feasible in heart failure patients and was safe in this trial. The combined aerobic and resistance training intervention with augmented feedback resulted in benefits in exercise capacity, muscle strength and quality of life, as well as an improvement of cardiac (NT-ProBNP) and inflammatory (IL6, hsCRP) biomarkers. Results can only be considered as preliminary and need further validation in larger studies. (ClinicalTrials.gov number, NCT 02146196)

Initial Experiences with Machine-Assisted Reconsiderative Test Scoring: A New Method for Partial Credit and Multiple Correct Responses.

ERIC Educational Resources Information Center

Anderson, Paul S.

Initial experiences with computer-assisted reconsiderative scoring are described. Reconsiderative scoring occurs when student responses are received and reviewed by the teacher before points for correctness are assigned. Manually scored completion-style questions are reconsiderative. A new method of machine assistance produces an item analysis on…

Chemotactic activity of cotyledons for mononuclear leukocytes related to occurrence of retained placenta in dexamethasone induced parturition in cattle.

PubMed

Benedictus, L; Jorritsma, R; Knijn, H M; Vos, P L A M; Koets, A P

2011-09-15

Induction of parturition with glucocorticosteroids in cattle is used for research purposes, in diseased or injured pregnant cows, and as a management tool to time parturition. A negative side effect of induction of parturition with glucocorticosteroids is the high incidence of retained placenta that occurs after these calvings. Reaction of the maternal immune system against the 'foreign' foetal membranes contributes to the breakdown of the foetal-maternal attachment. Several studies indicate that failure of this immune assisted detachment increases the occurrence of retained placenta. We hypothesized that retained placenta occurring after induction of parturition with glucocorticosteroids is caused by failure of immune assisted detachment of the foetal membranes. The chemotactic activity of cotyledons for mononuclear leukocytes was used as a parameter to see whether immune assisted detachment of the foetal membranes had occurred. Cotyledons were collected from spontaneously calving non-retained placenta cows and from dexamethasone induced non-retained placenta and retained placenta cows. The study showed that the chemotactic activity of cotyledons for mononuclear leukocytes was lower (P < 0.001) in cotyledons obtained from retained placenta cows in which parturition was induced with dexamethasone compared to the chemotactic activity of cotyledons obtained from spontaneously calving non-retained placenta cows, whereas the chemotactic activity of cotyledons obtained from induced non-retained placenta cows was not lower (P = 0.10) than the chemotactic activity of cotyledons obtained from spontaneously calving non-retained placenta cows. We concluded that induction of parturition with dexamethasone causes a failure of immune assisted detachment of the foetal membranes and the accompanying release of chemotactic factors. As a result, the chemotactic activity of cotyledons for mononuclear leukocytes is lower in induced retained placenta cows than in cotyledons from non-retained placenta cows in which successful immune assisted detachment of the foetal membranes occurs. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Kashiwa, Bryan Andrew; Hull, Lawrence Mark

Highlights of recent phenomenological studies of metal failure are given. Failure leading to spallation and fragmentation are typically of interest. The current ‘best model’ includes the following; a full history stress in tension; nucleation initiating dynamic relaxation; toward a tensile yield function; failure dependent on strain, strain rate, and temperature; a mean-preserving ‘macrodefect’ is introduced when failure occurs in tension; and multifield theoretical refinements

28 CFR Appendix A to Subpart I of... - Federal Financial Assistance Administered by the Department of Justice to Which This Subpart Applies

Code of Federal Regulations, 2014 CFR

2014-07-01

... Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... of the Age Discrimination Act of 1975 Pt. 42, Subpt. I, App. A Appendix A to Subpart I of Part 42...: Failure to list a type of federal assistance in appendix A shall not mean, if the Age Discrimination Act...

Laboratory and 3-D distinct element analysis of the failure mechanism of a slope under external surcharge

NASA Astrophysics Data System (ADS)

Li, N.; Cheng, Y. M.

2015-01-01

Landslide is a major disaster resulting in considerable loss of human lives and property damages in hilly terrain in Hong Kong, China and many other countries. The factor of safety and the critical slip surface for slope stabilization are the main considerations for slope stability analysis in the past, while the detailed post-failure conditions of the slopes have not been considered in sufficient detail. There is however increasing interest in the consequences after the initiation of failure that includes the development and propagation of the failure surfaces, the amount of failed mass and runoff and the affected region. To assess the development of slope failure in more detail and to consider the potential danger of slopes after failure has initiated, the slope stability problem under external surcharge is analyzed by the distinct element method (DEM) and a laboratory model test in the present research. A more refined study about the development of failure, microcosmic failure mechanisms and the post-failure mechanisms of slopes will be carried out. The numerical modeling method and the various findings from the present work can provide an alternate method of analysis of slope failure, which can give additional information not available from the classical methods of analysis.

Laboratory and 3-D-distinct element analysis of failure mechanism of slope under external surcharge

NASA Astrophysics Data System (ADS)

Li, N.; Cheng, Y. M.

2014-09-01

Landslide is a major disaster resulting in considerable loss of human lives and property damages in hilly terrain in Hong Kong, China and many other countries. The factor of safety and the critical slip surface for slope stabilization are the main considerations for slope stability analysis in the past, while the detailed post-failure conditions of the slopes have not been considered in sufficient details. There are however increasing interest on the consequences after the initiation of failure which includes the development and propagation of the failure surfaces, the amount of failed mass and runoff and the affected region. To assess the development of slope failure in more details and to consider the potential danger of slopes after failure has initiated, the slope stability problem under external surcharge is analyzed by the distinct element method (DEM) and laboratory model test in the present research. A more refined study about the development of failure, microcosmic failure mechanism and the post-failure mechanism of slope will be carried out. The numerical modeling method and the various findings from the present work can provide an alternate method of analysis of slope failure which can give additional information not available from the classical methods of analysis.

[Update on the respiratory management of patients with chronic neuromuscular disease].

PubMed

Priou, P; Trzepizur, W; Meslier, N; Gagnadoux, F

2017-12-01

Neuromuscular diseases include a wide range of conditions that may involve potentially life-threatening respiratory complications (infection, respiratory failure). For patients with neuromuscular diseases, clinical assessment of respiratory function and regular pulmonary function tests are needed to screen for nocturnal respiratory disorders, weakness of the diaphragm and potential restrictive disorders and/or chronic hypercapnic respiratory insufficiency, possibly with couch deficiency. MANAGEMENT OF NOCTURNAL RESPIRATORY DISORDERS AND CHRONIC RESPIRATORY FAILURE: Nocturnal respiratory assistance is an important phase of care for nocturnal respiratory disorders and chronic respiratory failure. This may involve continuous positive airway pressure, adaptative servo-ventilation or non-invasive ventilation with a facial or nasal mask. As needed, diurnal assistance may be proposed by mouthpiece ventilation. Should non-invasive ventilation prove insufficient, or if significant swallowing disorders or recurrent bronchial obstruction develop, or in case of prolonged intubation, tracheotomy may be required. In case of lower airway infection with ineffective cough, physical therapy, associated with air stacking, intermittent positive pressure breathing or mechanical in-exsufflation may be proposed. Care for swallowing disorders, nutritional counseling (cachexia, obesity), vaccinations and therapeutic education are integral elements of patient-centered management aiming to prevent the negative impact of infection and to manage respiratory failure of chronic neuromuscular disease. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Radiographic methods of wear analysis in total hip arthroplasty.

PubMed

Rahman, Luthfur; Cobb, Justin; Muirhead-Allwood, Sarah

2012-12-01

Polyethylene wear is an important factor in failure of total hip arthroplasty (THA). With increasing numbers of THAs being performed worldwide, particularly in younger patients, the burden of failure and revision arthroplasty is increasing, as well, along with associated costs and workload. Various radiographic methods of measuring polyethylene wear have been developed to assist in deciding when to monitor patients more closely and when to consider revision surgery. Radiographic methods that have been developed to measure polyethylene wear include manual and computer-assisted plain radiography, two- and three-dimensional techniques, and radiostereometric analysis. Some of these methods are important in both clinical and research settings. CT has the potential to provide additional information on component orientation and enables assessment of periprosthetic osteolysis, which is an important consequence of polyethylene wear.

A cloud-based home management system for patients with a left ventricular assist device: a case report.

PubMed

Nomoto, Shinichi; Utsumi, Momoe; Minakata, Kenji

2016-07-04

Since implantable left ventricular assist devices (LVAD) with smaller configurations became available for bridge-to-transplant or even destination therapy in patients with end-stage heart failure, an increasing number of patients with these devices are receiving home medical management. However, these patients may be anxious about potential complications such as pump failure, thromboembolism, and infections that may occur during home management. To provide a sense of security during home management of patients with LVAD and to establish an ideal shared-care system, we developed a patient-centered cloud-based home management system for patients with LVAD. In this case report, we describe this system and report a trial of it in a 64-year-old patient with an LVAD.

Successful continuous-flow left ventricular assist device implantation with adjuvant tricuspid valve repair for advanced heart failure.

PubMed

Lee, Chih-Hsien; Wei, Jeng

The prevalence of end-stage heart failure (HF) is on the increase, however, the availability of donor hearts remains limited. Left ventricular assist devices (LVADs) are increasingly being used for treating patients with end-stage HF. LVADs are not only used as a bridge to transplantation but also as a destination therapy. HeartMate II, a new-generation, continuous-flow LVAD (cf-LVAD), is currently an established treatment option for patients with HF. Technological progress and increasing implantation of cf-LVADs have significantly improved survival in patients with end-stage HF. Here we report a case of a patient with end-stage HF who was successfully supported using cf-LVAD implantation with adjuvant tricuspid valve repair in a general district hospital.

Learning from Failures: Archiving and Designing with Failure and Risk

NASA Technical Reports Server (NTRS)

VanWie, Michael; Bohm, Matt; Barrientos, Francesca; Turner, Irem; Stone, Robert

2005-01-01

Identifying and mitigating risks during conceptual design remains an ongoing challenge. This work presents the results of collaborative efforts between The University of Missouri-Rolla and NASA Ames Research Center to examine how an early stage mission design team at NASA addresses risk, and, how a computational support tool can assist these designers in their tasks. Results of our observations are given in addition to a brief example of our implementation of a repository based computational tool that allows users to browse and search through archived failure and risk data as related to either physical artifacts or functionality.

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

Exploring gay couples' experience with sexual dysfunction after radical prostatectomy: a qualitative study.

PubMed

Hartman, Mary-Ellen; Irvine, Jane; Currie, Kristen L; Ritvo, Paul; Trachtenberg, Lianne; Louis, Alyssa; Trachtenberg, John; Jamnicky, Leah; Matthew, Andrew G

2014-01-01

This exploratory study examines the experience of three gay couples managing sexual dysfunction as a result of undergoing a radical prostatectomy. Semi-structured interviews were conducted as part of a larger study at an urban hospital in Toronto, Ontario, Canada. Interview transcripts were transcribed verbatim, and analyzed using interpretative phenomenological analysis. The authors clustered 18 subordinate themes under 3 superordinate themes: (a) acknowledging change in sexual experience (libido, erectile function, sexual activity, orgasmic function); (b) accommodating change in sexual experience (strategies: emphasizing intimacy, embracing plan B, focus on the other; barriers: side-effect concerns, loss of naturalness, communication breakdown, failure to initiate, trial and failure, partner confounds); and (c) accepting change in sexual experience (indicators: emphasizing health, age attributions, finding a new normal; barriers: uncertain outcomes, treatment regrets). Although gay couples and heterosexual couples share many similar challenges, we discovered that gay men have particular sexual roles and can engage in novel accommodation practices, such as open relationships, that have not been noted in heterosexual couples. All couples, regardless of their level of sexual functioning, highlighted the need for more extensive programming related to sexual rehabilitation. Equitable rehabilitative support is critical to assist homosexual couples manage distress associated with prostatectomy-related sexual dysfunction.

A prospective observational cohort study in primary care practices to identify factors associated with treatment failure in Staphylococcus aureus skin and soft tissue infections.

PubMed

Lee, Grace C; Hall, Ronald G; Boyd, Natalie K; Dallas, Steven D; Du, Liem C; Treviño, Lucina B; Treviño, Sylvia B; Retzloff, Chad; Lawson, Kenneth A; Wilson, James; Olsen, Randall J; Wang, Yufeng; Frei, Christopher R

2016-11-22

The incidence of outpatient visits for skin and soft tissue infections (SSTIs) has substantially increased over the last decade. The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has made the management of S. aureus SSTIs complex and challenging. The objective of this study was to identify risk factors contributing to treatment failures associated with community-associated S. aureus skin and soft tissue infections SSTIs. This was a prospective, observational study among 14 primary care clinics within the South Texas Ambulatory Research Network. The primary outcome was treatment failure within 90 days of the initial visit. Univariate associations between the explanatory variables and treatment failure were examined. A generalized linear mixed-effect model was developed to identify independent risk factors associated with treatment failure. Overall, 21% (22/106) patients with S. aureus SSTIs experienced treatment failure. The occurrence of treatment failure was similar among patients with methicillin-resistant S. aureus and those with methicillin-susceptible S. aureus SSTIs (19 vs. 24%; p = 0.70). Independent predictors of treatment failure among cases with S. aureus SSTIs was a duration of infection of ≥7 days prior to initial visit [aOR, 6.02 (95% CI 1.74-19.61)] and a lesion diameter size ≥5 cm [5.25 (1.58-17.20)]. Predictors for treatment failure included a duration of infection for ≥7 days prior to the initial visit and a wound diameter of ≥5 cm. A heightened awareness of these risk factors could help direct targeted interventions in high-risk populations.

Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.

PubMed

Ashong, Chester N; Raheem, Shazia A; Hunter, Andrew S; Mindru, Cezarina; Barshes, Neal R

Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen. Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not. Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99). The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.

High-Pressure Hot-Gas Self-Acting Floating Ring Shaft Seal for Liquid Rocket Turbopumps. [tapered bore seals

NASA Technical Reports Server (NTRS)

Burcham, R. E.; Diamond, W. A.

1980-01-01

Design analysis, detail design, fabrication, and experimental evaluation was performed on two self acting floating ring shaft seals for a rocket engine turbopump high pressure 24132500 n/sq m (3500 psig) hot gas 533 K 9500 F) high speed 3142 rad/sec (30000 rmp) turbine. The initial design used Rayleigh step hydrodynamic lift pads to assist in centering the seal ring with minimum rubbing contact. The final design used a convergent tapered bore to provide hydrostatic centering force. The Rayleigh step design was tested for 107 starts and 4.52 hours total. The leakage was satisfactory; however, the design was not acceptable due to excessive wear caused by inadequate centering force and failure of the sealing dam caused by erosion damage. The tapered bore design was tested for 370 starts and 15.93 hours total. Satisfactory performance for the required life of 7.5 hours per seal was successfully demonstrated.

Commercialization of NESSUS: Status

NASA Technical Reports Server (NTRS)

Thacker, Ben H.; Millwater, Harry R.

1991-01-01

A plan was initiated in 1988 to commercialize the Numerical Evaluation of Stochastic Structures Under Stress (NESSUS) probabilistic structural analysis software. The goal of the on-going commercialization effort is to begin the transfer of Probabilistic Structural Analysis Method (PSAM) developed technology into industry and to develop additional funding resources in the general area of structural reliability. The commercialization effort is summarized. The SwRI NESSUS Software System is a general purpose probabilistic finite element computer program using state of the art methods for predicting stochastic structural response due to random loads, material properties, part geometry, and boundary conditions. NESSUS can be used to assess structural reliability, to compute probability of failure, to rank the input random variables by importance, and to provide a more cost effective design than traditional methods. The goal is to develop a general probabilistic structural analysis methodology to assist in the certification of critical components in the next generation Space Shuttle Main Engine.

Covert video monitoring in the assessment of medically unexplained symptoms in children.

PubMed

Wallace, Dustin P; Sim, Leslie A; Harrison, Tracy E; Bruce, Barbara K; Harbeck-Weber, Cynthia

2012-04-01

Diagnosis of medically unexplained symptoms (MUS) occurs after thorough evaluations have failed to identify a physiological cause for symptoms. However, families and providers may wonder if something has been missed, leading to reduced confidence in behavioral treatment. Confidence may be improved through the use of technology such as covert video monitoring to better assess functioning across settings. A 12-year-old male presented with progressive neurological decline, precipitated by chronic pain. After thorough evaluation and the failure of standard treatments (medical, rehabilitative, and psychological) covert video monitoring revealed that the patient demonstrated greater abilities when alone in his room. Negative reinforcement was used to initiate recovery, accompanied by positive reinforcement and a rehabilitative approach. Covert video monitoring assisted in three subsequent cases over the following 3 years. In certain complex cases, video monitoring can inform the assessment and treatment of MUS. Discussion includes ethical and practical considerations.

[Guillain-Barré syndrome as differential diagnosis of intervertebral disk-induced nerve root compression].

PubMed

Perlick, L; Möller, G; Wallny, T; Schmitt, O

1999-01-01

Diagnosis of Guillian-Barré Syndrome usually is not difficult, but diagnostic failure occurs for the variable initial presentation. Diagnosis is based on physical examination showing loss of motor strength in more than one limb and loss of deep tendon reflexes. Ventilatory assistance, pharmacologic maintenance of cardiovascular homeostasis, corticosteroids, IgG and plasma exchange are the dominant therapeutic measures. This article reports on a case of a 59-year old surgeon suffering from degenerative disc disease in the lumbar spine. The patient developed a severe course of the Guillian-Barré Syndrome with persisting motor weakness of the legs. If the primary problem at presentation is limb and back pain the pathology appears to be in the musculoskeletal rather than in neurological system. The awareness of this presentation of Guillian-Barré-Syndrome will eliminate delay in diagnosis.

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies. (e) The failure to meet one or more of the applicable conditions of participation is cause for...

42 CFR 456.656 - Reductions in FFP.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Penalty for Failure To Make a Satisfactory Showing of an... finds a showing satisfactory on its face, but after validation determines the showing to be...

Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative

DTIC Science & Technology

2007-06-01

AD_________________ Award Number: W81XWH-06-2-0045 TITLE: Mass Medication Clinic (MMC) Patient ...SUBTITLE 5a. CONTRACT NUMBER Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative 5b. GRANT NUMBER W81XWH-06-2...sections will describe the events, results, and accomplishments of this study. With validation through this project the Patient Medical Assistant

A new "twist" on right heart failure with left ventricular assist systems.

PubMed

Houston, Brian A; Shah, Keyur B; Mehra, Mandeep R; Tedford, Ryan J

2017-07-01

Despite significant efforts to predict and prevent right heart failure, it remains a leading cause of morbidity and mortality after implantation of left ventricular assist systems (LVAS). In this Perspective, we review the underappreciated anatomic and physiologic principles that govern the relationship between left and right heart function and contribute to this phenomenon. This includes the importance of considering the right ventricle (RV) and pulmonary arterial circuit as a coupled system; the contribution of the left ventricle (LV) to RV contractile function and the potential negative impact of acutely unloading the LV; the influence of the pericardium and ventricular twist on septal function; the role of RV deformation in reduced mechanical efficiency after device placement; and the potential of ongoing stressors of an elevated right-sided preload. We believe an appreciation of these complex issues is required to fully understand the expression of the unique phenotypes of right heart failure after LVAS implantation and for developing better prognostic and therapeutic strategies. Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

The Penn State Heart Assistant: A pilot study of a web-based intervention to improve self-care of heart failure patients.

PubMed

Lloyd, Tom; Buck, Harleah; Foy, Andrew; Black, Sara; Pinter, Antony; Pogash, Rosanne; Eismann, Bobby; Balaban, Eric; Chan, John; Kunselman, Allen; Smyth, Joshua; Boehmer, John

2017-05-01

The Penn State Heart Assistant, a web-based, tablet computer-accessed, secure application was developed to conduct a proof of concept test, targeting patient self-care activities of heart failure patients including daily medication adherence, weight monitoring, and aerobic activity. Patients (n = 12) used the tablet computer-accessed program for 30 days-recording their information and viewing a short educational video. Linear random coefficient models assessed the relationship between weight and time and exercise and time. Good medication adherence (66% reporting taking 75% of prescribed medications) was reported. Group compliance over 30 days for weight and exercise was 84 percent. No persistent weight gain over 30 days, and some indication of weight loss (slope of weight vs time was negative (-0.17; p value = 0.002)), as well as increased exercise (slope of exercise vs time was positive (0.08; p value = 0.04)) was observed. This study suggests that mobile technology is feasible, acceptable, and has potential for cost-effective opportunities to manage heart failure patients safely at home.

Root Cause Investigation of Lead-Free Solder Joint Interfacial Failures After Multiple Reflows

NASA Astrophysics Data System (ADS)

Li, Yan; Hatch, Olen; Liu, Pilin; Goyal, Deepak

2017-03-01

Solder joint interconnects in three-dimensional (3D) packages with package stacking configurations typically must undergo multiple reflow cycles during the assembly process. In this work, interfacial open joint failures between the bulk solder and the intermetallic compound (IMC) layer were found in Sn-Ag-Cu (SAC) solder joints connecting a small package to a large package after multiple reflow reliability tests. Systematic progressive 3D x-ray computed tomography experiments were performed on both incoming and assembled parts to reveal the initiation and evolution of the open failures in the same solder joints before and after the reliability tests. Characterization studies, including focused ion beam cross-sections, scanning electron microscopy, and energy-dispersive x-ray spectroscopy, were conducted to determine the correlation between IMC phase transformation and failure initiation in the solder joints. A comprehensive failure mechanism, along with solution paths for the solder joint interfacial failures after multiple reflow cycles, is discussed in detail.

Amyotrophic lateral sclerosis and assisted ventilation: how patients decide.

PubMed

Lemoignan, Josée; Ells, Carolyn

2010-06-01

Throughout the course of their illness, people with amyotrophic lateral sclerosis (ALS) must make many treatment decisions; however, none has such a significant impact on quality of life and survival as decisions about assisted ventilation. The purpose of this study was to better understand the experience of decision-making about assisted ventilation for ALS patients. Using qualitative phenomenology methodology, 10 semi-structured interviews were conducted with persons with ALS and their caregivers to elicit factors that are pertinent to their decision-making process about assisted ventilation. Six main themes emerged from the interviews. (1) the meaning of the intervention - participants made a sharp distinction between non-invasive ventilation, which they viewed as a means to relieve symptoms of respiratory failure, and invasive ventilation, which they viewed as taking over their breathing and thereby saving their life when they otherwise would die, (2) the importance of context - including functional status, available supports, and financial implications, (3) the importance of values - with respect to communication, relationships, autonomy, life, and quality of life, (4) the effect of fears - particularly respiratory distress, chocking, running out of air, and the process of death itself, (5) the need for information - how use of assisted ventilation would impact daily life, how death from respiratory failure would occur, how caregivers and persons with ALS differ in their information needs and common misconceptions, and (6) adaptation to or acceptance of the intervention - a lengthy process that involved gradual familiarization with the equipment and its benefits. People with ALS and caregivers value autonomy in decision-making about assisted ventilation. Their decision-making process is neither wholly rational nor self-interested, and includes factors that health professionals should anticipate and address. Discussions about assisted ventilation and timing should be tailored to each individual and undertaken periodically.

When does a strategy intervention overcome a failure of inhibition? Evidence from two left frontal brain tumour cases.

PubMed

Robinson, Gail A; Walker, David G; Biggs, Vivien; Shallice, Tim

2016-06-01

Initiation and inhibition of responses are crucial for appropriate behaviour across different settings. Initiation and inhibition difficulties are well documented following frontal damage, although task differences have limited our understanding. The Hayling Sentence Completion Test was designed to assess verbal initiation and inhibition within the same task. This study investigates the ability of two patients with left frontal tumours (KI: high grade glioma; PM: meningioma) to use a strategy to overcome profound suppression failures on the Hayling Test. KI and PM completed the Hayling Test and two experimental tasks. The Selection Investigation assessed verbal initiation on a sentence completion task that varied selection demands (high/low). The Suppression and Strategy Investigation assessed ability to implement four strategies aimed to override a suppression failure and facilitate production of an unconnected word. On the Hayling Test, KI and PM initiated responses to complete high constraint sentences, in contrast to impaired suppression. KI benefitted minimally from strategies to overcome suppression failure although one strategy (object naming) was partially successful. KI's errors revealed fast suppression errors, in contrast to slow no responses, and selection ability was also impaired for verbal initiation. PM, however, implemented each strategy 100% to overcome a suppression failure and had no difficulty completing sentences meaningfully, regardless of selection demands. This first investigation of strategy implementation to overcome profound suppression impairments provides insights into verbal initiation, inhibition, selection and strategy mechanisms, which has implications for neurorehabilitation. Specifically, both patients had profound inhibition deficits but KI also presented with a selection deficit and was unable to implement a strategy. By contrast, PM's selection ability was intact but she was unable to generate, rather than implement, a strategy. We suggest that KI has both fast, uncontrolled semantic output and response inhibition difficulty, whereas PM's difficulty is underpinned by motivational factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

An experimental study of compression failure of fibrous laminated composites in the presence of stress gradients

NASA Technical Reports Server (NTRS)

Waas, A. M.; Knauss, W. G.; Babcock, C. D., Jr.

1990-01-01

Mechanisms of failure in laminates in the presence of a stress raiser were experimentally studied. The damage initiation and propagation throughout the entire load history were examined via real-time holographic interferometry and photomicrography of the hole surface. Multilayered composite flat plates made of T300/BP907 and IM7/8551-7 were tested. It is shown that the failure is initiated as a localized instability in the 0-deg plies at the hole surface approximately at right angles to the loading direction. A series of events is described which culminates in the complete loss of flexural stiffness of each of the delaminated portions, leading to catastrophic failure of the plate.

The integration of an online module on student learning.

PubMed

Yehle, Karen S; Chang, Karen

2012-11-01

Heart failure is a prevalent and costly condition. Patients with better self-management are less likely to be rehospitalized. An online interactive heart failure module was developed and integrated into a medical-surgical nursing course to assist students in learning how to care for patients with heart failure. The purpose of this study was to examine whether the integration of an online heart failure module improved baccalaureate nursing students' heart failure self-management knowledge. A pretest/posttest design was used to examine the effects of student knowledge of heart failure self-management following implementation of an online module. Among 235 students, significant improvement of heart failure self-management knowledge was observed (P < .05). The mean posttest scores ranged from 13.82 to 15.93. Students had problems mastering knowledge of weight monitoring, use of nonsteroidal anti-inflammatory drugs, symptoms to report to physicians, and potassium-based salt substitutes. These findings were similar to four studies examining nurses' knowledge of heart failure. Students and nurses have difficulty mastering similar heart failure education concepts. An additional strategy, such as simulated or case scenarios, needs to be developed to help nurses and nursing students master all key concepts of heart failure self-management.

The impact of initial antibiotic treatment failure: Real-world insights in healthcare-associated or nosocomial pneumonia.

PubMed

Ryan, Kellie; Karve, Sudeep; Peeters, Pascale; Baelen, Elisa; Potter, Danielle; Rojas-Farreras, Sonia; Pascual, Esther; Rodríguez-Baño, Jesús

2018-05-06

To assess real-world treatment patterns and clinical outcomes associated with initial antibiotic therapy (IAT, antibiotics received ≤ 48 h post-initiation of antibiotic therapy), including level of IAT failure, and potential risk factors for IAT failure in healthcare-associated infections. Data were obtained from medical records of adult patients hospitalized with healthcare-associated pneumonia (HCAP) and nosocomial pneumonia (NP), including ventilator-associated pneumonia, from 1 July 2013 to 30 June 2014 in Brazil, France, Italy, Russia and Spain during the retrospective, observational study, RECOMMEND (NCT02364284; D4280R00005). Potential risk factors for IAT failure were explored using logistic regression analyses. Mean (standard deviation) age and Deyo-Charlson Comorbidity Score were 66.0 (16.2) years and 2.4 (2.4), respectively (N = 451). Most patients (62.5%) received monotherapy. Mean (standard deviation) duration of IAT was 8.8 (7.2) days. Multidrug-resistant (MDR) pathogens were identified in 52.4% of patients with ≥ 1 pathogen isolated (154/294). IAT failure was recorded in 72.5% of patients and was significantly associated with isolation of a MDR pathogen and country using multivariate analyses. Real-world data demonstrate the burden of HCAP/NP, with high rates of IAT failure. The association of IAT failure with MDR pathogens highlights the urgent need to understand and account for local prevalence of MDR pathogens when selecting IAT for the management of HCAP/NP. Copyright © 2018. Published by Elsevier Ltd.

Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications.

PubMed

Arancibia, F; Ewig, S; Martinez, J A; Ruiz, M; Bauer, T; Marcos, M A; Mensa, J; Torres, A

2000-07-01

The aim of the study was to determine the causes and prognostic implications of antimicrobial treatment failures in patients with nonresponding and progressive life-threatening, community-acquired pneumonia. Forty-nine patients hospitalized with a presumptive diagnosis of community-acquired pneumonia during a 16-mo period, failure to respond to antimicrobial treatment, and documented repeated microbial investigation >/= 72 h after initiation of in-hospital antimicrobial treatment were recorded. A definite etiology of treatment failure could be established in 32 of 49 (65%) patients, and nine additional patients (18%) had a probable etiology. Treatment failures were mainly infectious in origin and included primary, persistent, and nosocomial infections (n = 10 [19%], 13 [24%], and 11 [20%] of causes, respectively). Definite but not probable persistent infections were mostly due to microbial resistance to the administered initial empiric antimicrobial treatment. Nosocomial infections were particularly frequent in patients with progressive pneumonia. Definite persistent infections and nosocomial infections had the highest associated mortality rates (75 and 88%, respectively). Nosocomial pneumonia was the only cause of treatment failure independently associated with death in multivariate analysis (RR, 16.7; 95% CI, 1.4 to 194.9; p = 0.03). We conclude that the detection of microbial resistance and the diagnosis of nosocomial pneumonia are the two major challenges in hospitalized patients with community-acquired pneumonia who do not respond to initial antimicrobial treatment. In order to establish these potentially life-threatening etiologies, a regular microbial reinvestigation seems mandatory for all patients presenting with antimicrobial treatment failures.

Perioperative management of left ventricular assist devices.

PubMed

Sanjay, O P

2016-10-01

The use of mechanical circulatory support for patients with severe heart failure is on the rist. The poeoperative, intraoperative and postoperative challenges the anaesthesiologists skills. These are discussed in this review.

Patient-Reported Health-Related Quality of Life Is a Predictor of Outcomes in Ambulatory Heart Failure Patients Treated With Left Ventricular Assist Device Compared With Medical Management: Results From the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management).

PubMed

Stehlik, Josef; Estep, Jerry D; Selzman, Craig H; Rogers, Joseph G; Spertus, John A; Shah, Keyur B; Chuang, Joyce; Farrar, David J; Starling, Randall C

2017-06-01

The prospective observational ROADMAP study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management) demonstrated that ambulatory advanced heart failure patients selected for left ventricular assist device (LVAD) were more likely to be alive at 1 year on original therapy with ≥75-m improvement in 6-minute walk distance compared with patients assigned to optimal medical management. Whether baseline health-related quality of life (hrQoL) resulted in a heterogeneity of this treatment benefit is unknown. Patient-reported hrQoL was assessed with EuroQol questionnaire and visual analogue scale (VAS). We aimed to identify predictors of event-free survival and survival with acceptable hrQoL (VAS≥60). LVAD patients had significant improvement in 3 of 5 EuroQol dimensions ( P <0.05), but no significant changes were observed with optimal medical management. Among patients with baseline VAS<55, survival on original treatment was lower for optimal medical management patients compared with those assigned to LVAD (58±7% versus 82±5%; P =0.004). No such difference was seen if baseline VAS was ≥55 (70±7% versus 75±9%; P =0.79). Survival on original therapy with acceptable quality of life was also more likely with LVAD versus optimal medical management if baseline VAS was <55, whereas outcomes in patients with higher baseline VAS scores were similar regardless of treatment assignment ( P =0.046 for treatment arm and baseline VAS interaction). LVAD therapy resulted in improvement of patient health status in heart failure patients with low self-reported hrQoL, but not in patients with acceptable quality of life at the time of LVAD implantation. Patient-reported hrQoL should be integrated into decision making concerning the use and timing of LVAD therapy in heart failure patients who are symptom limited but remain ambulatory. URL: http://www.ClinicalTrials.gov. Unique identifier: NCT01452802. © 2017 American Heart Association, Inc.

NASA Helps Keep the Light Burning for the Saturn Car Company

NASA Technical Reports Server (NTRS)

2003-01-01

The Saturn Electronics & Engineering, Inc. (Saturn) facility in Marks, Miss., that produces lamp assemblies was experiencing itermittent problems with its automotive under the hood lamps. After numerous testing and engineering efforts, technicians could not pin down the root of the problem. So Saturn contacted the NASA Technology Assistance Program (TAP) at Stennis Space Center. The Marks production facility had been experiencing intermittent problems with under the hood lamp assemblies for some time. The failure rate, at 2 percent, was unacceptable. Every effort was made to identify the problem so that corrective action could be put in place. The problem was investigated and researched by Saturn's engineering department. In addition, Saturn brought in several independent testing laboratories. Other measures included examining the switch component suppliers and auditing them for compliance to the design specifications and for surface contaminants. All attempts to identify the factors responsible for the failures were inconclusive. In an effort to get to the root of the problem, and at the recommendation of the Mississippi Department of Economic Development, Saturn contacted the NASA TAP at Stennis. The NASA Materials and Contamination Laboratory, with assistance from the Stennis Prototype Laboratory, conducted a materials evaluation study on the switch components. The laboratory findings showed the failures were caused by a build-up of carbon-based contaminants on the switch components. Saturn Electronics & Engineering, Inc., is a minority-owned provider of contract manufacturing services to a diverse global marketplace. Saturn operates manufacturing facilities globally serving the North American, European, and Asian markets. Saturn's production facility in Marks, Mississippi, produces more than 1,000,000 lamps and switches monthly. "Since the NASA recommendations were implemented, our internal failure rate for intermittency has dropped to less than .02 percent. Most importantly, we restored our high-level of customer satisfaction. Stennis provided an invaluable service to our business," Patrick said. Both NASA and Saturn were pleased with the results form this technical assistance project. The Technology Assistance Program at Stennis makes available to the public NASA technical expertise and access to lab facilities. This project provided both services with a positive outcome.

Examining Productive Failure, Productive Success, Unproductive Failure, and Unproductive Success in Learning

ERIC Educational Resources Information Center

Kapur, Manu

2016-01-01

Learning and performance are not always commensurable. Conditions that maximize performance in the initial learning may not maximize learning in the longer term. I exploit this incommensurability to theoretically and empirically interrogate four possibilities for design: productive success, productive failure, unproductive success, and…

Fatigue Behavior of Computer-Aided Design/Computer-Assisted Manufacture Ceramic Abutments as a Function of Design and Ceramics Processing.

PubMed

Kelly, J Robert; Rungruanganunt, Patchnee

2016-01-01

Zirconia is being widely used, at times apparently by simply copying a metal design into ceramic. Structurally, ceramics are sensitive to both design and processing (fabrication) details. The aim of this work was to examine four computer-aided design/computer-assisted manufacture (CAD/CAM) abutments using a modified International Standards Organization (ISO) implant fatigue protocol to determine performance as a function of design and processing. Two full zirconia and two hybrid (Ti-based) abutments (n = 12 each) were tested wet at 15 Hz at a variety of loads to failure. Failure probability distributions were examined at each load, and when found to be the same, data from all loads were combined for lifetime analysis from accelerated to clinical conditions. Two distinctly different failure modes were found for both full zirconia and Ti-based abutments. One of these for zirconia has been reported clinically in the literature, and one for the Ti-based abutments has been reported anecdotally. The ISO protocol modification in this study forced failures in the abutments; no implant bodies failed. Extrapolated cycles for 10% failure at 70 N were: full zirconia, Atlantis 2 × 10(7) and Straumann 3 × 10(7); and Ti-based, Glidewell 1 × 10(6) and Nobel 1 × 10(21). Under accelerated conditions (200 N), performance differed significantly: Straumann clearly outperformed Astra (t test, P = .013), and the Glidewell Ti-base abutment also outperformed Atlantis zirconia at 200 N (Nobel ran-out; t test, P = .035). The modified ISO protocol in this study produced failures that were seen clinically. The manufacture matters; differences in design and fabrication that influence performance cannot be discerned clinically.

Measuring Readiness in the Operational Reserve

DTIC Science & Technology

2014-06-13

annual medical and dental requirements, failure to conduct individual and collective training requirements, pregnancy , or any other disqualifier for...members Barry M. Stentiford, Ph.D.; MG William D. R. Waff, D.Min.; and Russell G. Conrad, M.S. for their guidance, assistance , and advice. Thanks to the...personnel and staff of Fort Leavenworth’s Combined Arms Research Library for assistance in researching sources. I would also like to thank Venita A

Failure Mechanisms for III-Nitride HEMT Devices

DTIC Science & Technology

2013-11-19

rf plasma-assisted molecular beam epitaxy on freestanding GaN substrates, J. Cryst. Growth 380, 14-17 (2013). ii) Conference presentations (Invited...1 eFinal Report – AOARD Grant FA-2386-11-1-4107 Failure Mechanisms for III-nitride HEMT devices 19 November 2013 Principal Investigators: Martha...aspects of III-nitride HEMT materials and devices. Energy-filtered imaging of unstressed and stressed Ni/Au-gated AlGaN/GaN HEMTs indicated that

77 FR 34973 - Announcement of Funding Awards for HUD's Fiscal Year 2011-2012 Technical Assistance and Capacity...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

... Transformation Initiative (OneCPD TA and Core Curricula) AGENCY: Office of the Assistant Secretary for Community... Transformation Initiative (OneCPD TA and Core Curricula) program. This announcement contains the names of the... Capacity Building under the Transformation Initiative (OneCPD TA and Core Curricula) was designed to...

Respiratory High-Dependency Care Units for the burden of acute respiratory failure.

PubMed

Scala, Raffaele

2012-06-01

The burden of acute respiratory failure (ARF) has become one of the greatest epidemiological challenges for the modern health systems. Consistently, the imbalance between the increasing prevalence of acutely de-compensated respiratory diseases and the shortage of high-daily cost ICU beds has stimulated new health cost-effective solutions. Respiratory High-Dependency Care Units (RHDCU) provide a specialised environment for patients who require an "intermediate" level of care between the ICU and the ward, where non-invasive monitoring and assisted ventilation techniques are preferentially applied. Since they are dedicated to the management of "mono-organ" decompensations, treatment of ARF patients in RHDCU avoids the dangerous "under-assistance" in the ward and unnecessary "over-assistance" in ICU. RHDCUs provide a specialised quality of care for ARF with health resources optimisation and their spread throughout health systems has been driven by their high-level of expertise in non-invasive ventilation (NIV), weaning from invasive ventilation, tracheostomy care, and discharging planning for ventilator-dependent patients. Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Genetics Home Reference: myasthenia gravis

MedlinePlus

... ventilation assistance. This respiratory failure, called a myasthenic crisis, may be triggered by stresses such as infections ... be inherited? More about Inheriting Genetic Conditions Diagnosis & Management Resources Genetic Testing (2 links) Genetic Testing Registry: ...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... specified in § 442.105. (e) The failure to meet one or more of the applicable conditions of participation is...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... specified in § 442.105. (e) The failure to meet one or more of the applicable conditions of participation is...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies, subject to other limitations specified in § 442.105. (e) The failure to meet one or more of the...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies, subject to other limitations specified in § 442.105. (e) The failure to meet one or more of the...

Instrument Failures for the da Vinci Surgical System: a Food and Drug Administration MAUDE Database Study.

PubMed

Friedman, Diana C W; Lendvay, Thomas S; Hannaford, Blake

2013-05-01

Our goal was to analyze reported instances of the da Vinci robotic surgical system instrument failures using the FDA's MAUDE (Manufacturer and User Facility Device Experience) database. From these data we identified some root causes of failures as well as trends that may assist surgeons and users of the robotic technology. We conducted a survey of the MAUDE database and tallied robotic instrument failures that occurred between January 2009 and December 2010. We categorized failures into five main groups (cautery, shaft, wrist or tool tip, cable, and control housing) based on technical differences in instrument design and function. A total of 565 instrument failures were documented through 528 reports. The majority of failures (285) were of the instrument's wrist or tool tip. Cautery problems comprised 174 failures, 76 were shaft failures, 29 were cable failures, and 7 were control housing failures. Of the reports, 10 had no discernible failure mode and 49 exhibited multiple failures. The data show that a number of robotic instrument failures occurred in a short period of time. In reality, many instrument failures may go unreported, thus a true failure rate cannot be determined from these data. However, education of hospital administrators, operating room staff, surgeons, and patients should be incorporated into discussions regarding the introduction and utilization of robotic technology. We recommend institutions incorporate standard failure reporting policies so that the community of robotic surgery companies and surgeons can improve on existing technologies for optimal patient safety and outcomes.

The Use of Pediatric Ventricular Assist Devices in Children's Hospitals From 2000 to 2010: Morbidity, Mortality, and Hospital Charges.

PubMed

Mansfield, Robert T; Lin, Kimberly Y; Zaoutis, Theoklis; Mott, Antonio R; Mohamad, Zeinab; Luan, Xianqun; Kaufman, Beth D; Ravishankar, Chitra; Gaynor, J William; Shaddy, Robert E; Rossano, Joseph W

2015-07-01

The use of ventricular assist devices has increased dramatically in adult heart failure patients. However, the overall use, outcome, comorbidities, and resource utilization of ventricular assist devices in pediatric patients have not been well described. We sought to demonstrate that the use of ventricular assist devices in pediatric patients has increased over time and that mortality has decreased. A retrospective study of the Pediatric Health Information System database was performed for patients 20 years old or younger undergoing ventricular assist device placement from 2000 to 2010. None. Four hundred seventy-five pediatric patients were implanted with ventricular assist devices during the study period: 69 in 2000-2003 (era 1), 135 in 2004-2006 (era 2), and 271 in 2007-2010 (era 3). Median age at ventricular assist device implantation was 6.0 years (interquartile range, 0.5-13.8), and the proportion of children who were 1-12 years old increased from 29% in era 1 to 47% in era 3 (p = 0.002). The majority of patients had a diagnosis of cardiomyopathy; this increased from 52% in era 1 to 72% in era 3 (p = 0.003). Comorbidities included arrhythmias (48%), pulmonary hypertension (16%), acute renal failure (34%), cerebrovascular disease (28%), and sepsis/systemic inflammatory response syndrome (34%). Two hundred forty-seven patients (52%) underwent heart transplantation and 327 (69%) survived to hospital discharge. Hospital mortality decreased from 42% in era 1 to 25% in era 3 (p = 0.004). Median hospital length of stay increased (37 d [interquartile range, 12-64 d] in era 1 vs 69 d [interquartile range, 35-130] in era 3; p < 0.001) and median adjusted hospital charges increased ($630,630 [interquartile range, $227,052-$853,318] in era 1 vs $1,577,983 [interquartile range, $874,463-$2,280,435] in era 3; p < 0.001). Factors associated with increased mortality include age less than 1 year (odds ratio, 2.04; 95% CI, 1.01-3.83), acute renal failure (odds ratio, 2.1; 95% CI, 1.26-3.65), cerebrovascular disease (odds ratio, 2.1; 95% CI, 1.25-3.62), and extracorporeal membrane oxygenation (odds ratio, 3.16; 95% CI, 1.79-5.60). Ventricular assist device placement in era 3 (odds ratio, 0.3; 95% CI, 0.15-0.57) and a diagnosis of cardiomyopathy (odds ratio, 0.5; 95% CI, 0.32-0.84), were associated with decreased mortality. Large-volume centers had lower mortality (odds ratio, 0.55; 95% CI, 0.34-0.88), lower use of extracorporeal membrane oxygenation, and higher charges. The use of ventricular assist devices and survival after ventricular assist device placement in pediatric patients have increased over time, with a concomitant increase in resource utilization. Age under 1 year, certain noncardiac morbidities, and the use of extracorporeal membrane oxygenation are associated with worse outcomes. Lower mortality was seen at larger volume ventricular assist device centers.

Turbine engine rotor health monitoring evaluation by means of finite element analyses and spin tests data

NASA Astrophysics Data System (ADS)

Abdul-Aziz, Ali; Woike, Mark R.; Clem, Michelle; Baaklini, George Y.

2014-04-01

Generally, rotating engine components undergo high centrifugal loading environment which subject them to various types of failure initiation mechanisms. Health monitoring of these components is a necessity and is often challenging to implement. This is primarily due to numerous factors including the presence of scattered loading conditions, flaw sizes, component geometry and materials properties, all which hinder the simplicity of applying health monitoring applications. This paper represents a summary work of combined experimental and analytical modeling that included data collection from a spin test experiment of a rotor disk addressing the aforementioned durability issues. It further covers presentation of results obtained from a finite element modeling study to characterize the structural durability of a cracked rotor as it relates to the experimental findings. The experimental data include blade tip clearance, blade tip timing and shaft displacement measurements. The tests were conducted at the NASA Glenn Research Center's Rotordynamics Laboratory, a high precision spin rig. The results are evaluated and examined to determine their significance on the development of a health monitoring system to pre-predict cracks and other anomalies and to assist in initiating a supplemental physics based fault prediction analytical model.

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

Barr, G.E.; Borns, D.J.; Fridrich, C.

A comprehensive collection of scenarios is presented that connect initiating tectonic events with radionuclide releases by logical and physically possible combinations or sequences of features, events and processes. The initiating tectonic events include both discrete faulting and distributed rock deformation developed through the repository and adjacent to it, as well as earthquake-induced ground motion and changes in tectonic stress at the site. The effects of these tectonic events include impacts on the engineered-barrier system, such as container rupture and failure of repository tunnels. These effects also include a wide range of hydrologic effects such as changes in pathways and flowmore » rates in the unsaturated and saturated zones, changes in the water-table configuration, and in the development of perched-water systems. These scenarios are intended go guide performance-assessment analyses and to assist principal investigators in how essential field, laboratory, and calculational studies are used. This suite of scenarios will help ensure that all important aspects of the system disturbance related to a tectonic scenario are captured in numerical analyses. It also provides a record of all options considered by project analysts to provide documentation required for licensing agreement. The final portion of this report discusses issues remaining to be addressed with respect to tectonic activity. 105 refs.« less

Multiple Fatigue Failure Behaviors and Long-Life Prediction Approach of Carburized Cr-Ni Steel with Variable Stress Ratio

PubMed Central

Deng, Hailong; Li, Wei; Zhao, Hongqiao; Sakai, Tatsuo

2017-01-01

Axial loading tests with stress ratios R of −1, 0 and 0.3 were performed to examine the fatigue failure behavior of a carburized Cr-Ni steel in the long-life regime from 104 to 108 cycles. Results show that this steel represents continuously descending S-N characteristics with interior inclusion-induced failure under R = −1, whereas it shows duplex S-N characteristics with surface defect-induced failure and interior inclusion-induced failure under R = 0 and 0.3. The increasing tension eliminates the effect of compressive residual stress and promotes crack initiation from the surface or interior defects in the carburized layer. The FGA (fine granular area) formation greatly depends on the number of loading cycles, but can be inhibited by decreasing the compressive stress. Based on the evaluation of the stress intensity factor at the crack tip, the surface and interior failures in the short life regime can be characterized by the crack growth process, while the interior failure with the FGA in the long life regime can be characterized by the crack initiation process. In view of the good agreement between predicted and experimental results, the proposed approach can be well utilized to predict fatigue lives associated with interior inclusion-FGA-fisheye induced failure, interior inclusion-fisheye induced failure, and surface defect induced failure. PMID:28906454

Test and Analysis Correlation for a Y-Joint Specimen for a Composite Cryotank

NASA Technical Reports Server (NTRS)

Mason, Brian H.; Sleight, David W.; Grenoble, Ray

2015-01-01

The Composite Cryotank Technology Demonstration (CCTD) project under NASA's Game Changing Development Program (GCDP) developed space technologies using advanced composite materials. Under CCTD, NASA funded the Boeing Company to design and test a number of element-level joint specimens as a precursor to a 2.4-m diameter composite cryotank. Preliminary analyses indicated that the y-joint in the cryotank had low margins of safety; hence the y-joint was considered to be a critical design region. The y-joint design includes a softening strip wedge to reduce localized shear stresses at the skirt/dome interface. In this paper, NASA-developed analytical models will be correlated with the experimental results of a series of positive-peel y-joint specimens from Boeing tests. Initial analytical models over-predicted the experimental strain gage readings in the far-field region by approximately 10%. The over-prediction was attributed to uncertainty in the elastic properties of the laminate and a mismatch between the thermal expansion of the strain gages and the laminate. The elastic properties of the analytical model were adjusted to account for the strain gage differences. The experimental strain gages also indicated a large non-linear effect in the softening strip region that was not predicted by the analytical model. This non-linear effect was attributed to delamination initiating in the softening strip region at below 20% of the failure load for the specimen. Because the specimen was contained in a thermally insulated box during cryogenic testing to failure, delamination initiation and progression was not visualized during the test. Several possible failure initiation locations were investigated, and a most likely failure scenario was determined that correlated well with the experimental data. The most likely failure scenario corresponded to damage initiating in the softening strip and delamination extending to the grips at final failure.

Levitronix bilateral ventricular assist device, a bridge to recovery in a patient with acute fulminant myocarditis and concomitant cerebellar infarction.

PubMed

Huang, Yi-Fan; Hsu, Po-Shun; Tsai, Chien-Sung; Tsai, Yi-Ting; Lin, Chih-Yuan; Ke, Hong-Yan; Lin, Yi-Chang; Yang, Hsiang-Yu

2018-02-07

We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix ® bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix ® haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.

Effects of continuous and pulsatile flows generated by ventricular assist devices on renal function and pathology.

PubMed

Miyamoto, Takuma; Karimov, Jamshid H; Fukamachi, Kiyotaka

2018-03-01

Continuous-flow (CF) left ventricular assist devices (LVADs) are widely used to treat end-stage heart failure. Despite substantial improvement in clinical results, numerous complications remain associated with this technology. Worsening renal function is one, associated with morbidity and mortality in patients supported by CF LVADs. The effects of CF LVAD support on renal function have been investigated since the mid-1990s by many research groups. Area covered: We review the current status of LVAD therapy, experimental results regarding the effects of types of flow generated by LVADs on renal function and pathology, changes in renal function after LVAD implant, the influence of renal function on outcomes, and risk factors for renal dysfunction post implant. This information was obtained through online databases and direct extraction of single studies. Expert commentary: Immediately after CF LVAD implantation, renal function improves temporarily as patients recover from the kidneys' previously low perfusion and congestive state. However, many studies have shown that this initially recovered renal function gradually declines during long-term CF LVAD support. Although it is known that CF LVAD support adversely affects renal function over the long term, just how it does has not yet been clearly defined in terms of clinical symptoms or signs.

Multi-vehicle detection with identity awareness using cascade Adaboost and Adaptive Kalman filter for driver assistant system

PubMed Central

Wang, Baofeng; Qi, Zhiquan; Chen, Sizhong; Liu, Zhaodu; Ma, Guocheng

2017-01-01

Vision-based vehicle detection is an important issue for advanced driver assistance systems. In this paper, we presented an improved multi-vehicle detection and tracking method using cascade Adaboost and Adaptive Kalman filter(AKF) with target identity awareness. A cascade Adaboost classifier using Haar-like features was built for vehicle detection, followed by a more comprehensive verification process which could refine the vehicle hypothesis in terms of both location and dimension. In vehicle tracking, each vehicle was tracked with independent identity by an Adaptive Kalman filter in collaboration with a data association approach. The AKF adaptively adjusted the measurement and process noise covariance through on-line stochastic modelling to compensate the dynamics changes. The data association correctly assigned different detections with tracks using global nearest neighbour(GNN) algorithm while considering the local validation. During tracking, a temporal context based track management was proposed to decide whether to initiate, maintain or terminate the tracks of different objects, thus suppressing the sparse false alarms and compensating the temporary detection failures. Finally, the proposed method was tested on various challenging real roads, and the experimental results showed that the vehicle detection performance was greatly improved with higher accuracy and robustness. PMID:28296902

B-type natriuretic peptide levels and continuous-flow left ventricular assist devices.

PubMed

Sareyyupoglu, Basar; Boilson, Barry A; Durham, Lucian A; McGregor, Christopher G A; Daly, Richard C; Redfield, Margaret M; Edwards, Brooks S; Frantz, Robert P; Pereira, Naveen L; Park, Soon J

2010-01-01

We postulated that postoperative B-type natriuretic peptide (BNP) levels would be reflective of the degree of hemodynamic support rendered by various pump speeds settings (RPM) of continuous-flow left ventricular assist devices (LVADs). Twenty LVAD patients were evaluated prospectively (Jarvik 2000: n = 9, HeartMate II: n = 11). The mean age was 57.7 ± 14.9 years, and 14 were male. B-type natriuretic peptide levels were drawn while the patients were supported on LVADs at variable RPM settings. The RPM settings were correlated with the changes in BNP levels. Eleven patients underwent LVAD implantation for a lifelong support while the rest were as a bridge therapy to transplantation. Four patients required LVAD change out for various causes of pump failure. Postoperative BNP levels decreased dramatically with the initiation of LVAD support. The levels correlated inversely with the degree of hemodynamic support rendered at various RPM settings of the HeartMate II (p < 0.001). Overall, BNP levels decreased significantly in 2 days after RPM increase. We observed a significant inverse correlation between the postoperative BNP levels and the degree of LVAD support. The effective LVAD support seems to result in a marked reduction in BNP levels, and monitoring serial BNP levels may be helpful in managing patients supported on continuous LVAD.

30 CFR 722.13 - Failure to abate.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Failure to abate. 722.13 Section 722.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR INITIAL PROGRAM REGULATIONS ENFORCEMENT PROCEDURES § 722.13 Failure to abate. An authorized representative of the Secretary...

30 CFR 722.13 - Failure to abate.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Failure to abate. 722.13 Section 722.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR INITIAL PROGRAM REGULATIONS ENFORCEMENT PROCEDURES § 722.13 Failure to abate. An authorized representative of the Secretary...

30 CFR 722.13 - Failure to abate.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Failure to abate. 722.13 Section 722.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR INITIAL PROGRAM REGULATIONS ENFORCEMENT PROCEDURES § 722.13 Failure to abate. An authorized representative of the Secretary...

30 CFR 722.13 - Failure to abate.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Failure to abate. 722.13 Section 722.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR INITIAL PROGRAM REGULATIONS ENFORCEMENT PROCEDURES § 722.13 Failure to abate. An authorized representative of the Secretary...

30 CFR 722.13 - Failure to abate.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Failure to abate. 722.13 Section 722.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR INITIAL PROGRAM REGULATIONS ENFORCEMENT PROCEDURES § 722.13 Failure to abate. An authorized representative of the Secretary...

Short pulse duration shock initiation experiments plus ignition and growth modeling on Composition B

NASA Astrophysics Data System (ADS)

May, Chadd M.; Tarver, Craig M.

2014-05-01

Composition B (63% RDX, 36% TNT, 1% wax) is still a widely used energetic material whose shock initiation characteristics are necessary to understand. It is now possible to shock initiate Composition B and other secondary explosives at diameters well below their characteristic failure diameters for unconfined self-sustaining detonation. This is done using very high velocity, very thin, small diameter flyer plates accelerated by electric or laser power sources. Recently experimental detonation versus failure to detonate threshold flyer velocity curves for Composition B using several KaptonTM flyer thicknesses and diameters were measured. Flyer plates with diameters of 2 mm successfully detonated Composition B, which has a nominal failure diameter of 4.3 mm. The shock pressures required for these initiations are greater than the Chapman-Jouguet (C-J) pressure in self-sustaining Composition B detonation waves. The initiation process is two-dimensional, because both rear and side rarefactions can affect the shocked Composition B reaction rates. The Ignition and Growth reactive flow model for Composition B is extended to yield accurate simulations of this new threshold velocity data for various flyer thicknesses.

Perioperative management of left ventricular assist devices

PubMed Central

Sanjay, O. P.

2016-01-01

The use of mechanical circulatory support for patients with severe heart failure is on the rist. The poeoperative, intraoperative and postoperative challenges the anaesthesiologists skills. These are discussed in this review. PMID:27762244

Heart failure - surgeries and devices

MedlinePlus

... right ventricular assist devices (RVAD) or a total artificial hearts. They are considered for use if you have ... be on a heart-lung bypass machine. Total artificial hearts are being developed, but are not yet in ...

Bridge to transplantation with a left ventricular assist device.

PubMed

Jung, Jae Jun; Sung, Kiick; Jeong, Dong Seop; Kim, Wook Sung; Lee, Young Tak; Park, Pyo Won

2012-04-01

A 61-year-old female patient was diagnosed with dilated cardiomyopathy with severe left ventricle dysfunction. Two days after admission, continuous renal replacement therapy was performed due to oliguria and lactic acidosis. On the fifth day, an intra-aortic balloon pump was inserted due to low cardiac output syndrome. Beginning 4 days after admission, she was supported for 15 days thereafter with an extracorporeal left ventricular assist device (LVAD) because of heart failure with multi-organ failure. A heart transplant was performed while the patient was stabilized with the LVAD. She developed several complications after the surgery, such as cytomegalovirus pneumonia, pulmonary tuberculosis, wound dehiscence, and H1N1 infection. On postoperative day 19, she was discharged from the hospital with close follow-up and treatment for infection. She received follow-up care for 10 months without any immune rejection reaction.

Exercise physiology, testing, and training in patients supported by a left ventricular assist device.

PubMed

Loyaga-Rendon, Renzo Y; Plaisance, Eric P; Arena, Ross; Shah, Keyur

2015-08-01

The left ventricular assist device (LVAD) is an accepted treatment alternative for the management of end-stage heart failure. As we move toward implantation of LVADs in less severe cases of HF, scrutiny of functional capacity and quality of life becomes more important. Patients demonstrate improvements in exercise capacity after LVAD implantation, but the effect is less than predicted. Exercise training produces multiple beneficial effects in heart failure patients, which would be expected to improve quality of life. In this review, we describe factors that are thought to participate in the persistent exercise impairment in LVAD-supported patients, summarize current knowledge about the effect of exercise training in LVAD-supported patients, and suggest areas for future research. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Leishmania Antigenuria to Predict Initial Treatment Failure and Relapse in Visceral Leishmaniasis/HIV Coinfected Patients: An Exploratory Study Nested Within a Clinical Trial in Ethiopia.

PubMed

van Griensven, Johan; Mengesha, Bewketu; Mekonnen, Tigist; Fikre, Helina; Takele, Yegnasew; Adem, Emebet; Mohammed, Rezika; Ritmeijer, Koert; Vogt, Florian; Adriaensen, Wim; Diro, Ermias

2018-01-01

Background: Biomarkers predicting the risk of VL treatment failure and relapse in VL/HIV coinfected patients are needed. Nested within a two-site clinical trial in Ethiopia (2011-2015), we conducted an exploratory study to assess whether (1) levels of Leishmania antigenuria measured at VL diagnosis were associated with initial treatment failure and (2) levels of Leishmania antigenuria at the end of treatment (parasitologically-confirmed cure) were associated with subsequent relapse. Methods: Leishmania antigenuria at VL diagnosis and cure was determined using KAtex urine antigen test and graded as negative (0), weak/moderate (grade 1+/2+) or strongly-positive (3+). Logistic regression and Kaplan-Meier methods were used to assess the association between antigenuria and (1) initial treatment failure, and (2) relapse over the 12 months after cure, respectively. Results: The analysis to predict initial treatment failure included sixty-three coinfected adults [median age: 30 years interquartile range (IQR) 27-35], median CD4 count: 56 cells/μL (IQR 38-113). KAtex results at VL diagnosis were negative in 11 (17%), weak/moderate in 17 (27%) and strongly-positive in 35 (36%). Twenty (32%) patients had parasitologically-confirmed treatment failure, with a risk of failure of 9% (1/11) with KAtex-negative results, 0% (0/17) for KAtex 1+/2+ and 54% (19/35) for KAtex 3+ results. Compared to KAtex-negative patients, KAtex 3+ patients were at increased risk of treatment failure [odds ratio 11.9 (95% CI 1.4-103.0); P : 0.025]. Forty-four patients were included in the analysis to predict relapse [median age: 31 years (IQR 28-35), median CD4 count: 116 cells/μL (IQR 95-181)]. When achieving VL cure, KAtex results were negative in 19 (43%), weak/moderate (1+/2+) in 10 (23%), and strongly positive (3+) in 15 patients (34%). Over the subsequent 12 months, eight out of 44 patients (18%) relapsed. The predicted 1-year relapse risk was 6% for KAtex-negative results, 14% for KAtex 1+/2+ and 42% for KAtex 3+ results [hazard ratio of 2.2 (95% CI 0.1-34.9) for KAtex 1+/2+ and 9.8 (95% CI 1.8-82.1) for KAtex 3+, compared to KAtex negative patients; P : 0.03]. Conclusion: A simple field-deployable Leishmania urine antigen test can be used for risk stratification of initial treatment failure and VL relapse in HIV-patients. A dipstick-format would facilitate field implementation.

Biomarkers in acute heart failure.

PubMed

Mallick, Aditi; Januzzi, James L

2015-06-01

The care of patients with acutely decompensated heart failure is being reshaped by the availability and understanding of several novel and emerging heart failure biomarkers. The gold standard biomarkers in heart failure are B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, which play an important role in the diagnosis, prognosis, and management of acute decompensated heart failure. Novel biomarkers that are increasingly involved in the processes of myocardial injury, neurohormonal activation, and ventricular remodeling are showing promise in improving diagnosis and prognosis among patients with acute decompensated heart failure. These include midregional proatrial natriuretic peptide, soluble ST2, galectin-3, highly-sensitive troponin, and midregional proadrenomedullin. There has also been an emergence of biomarkers for evaluation of acute decompensated heart failure that assist in the differential diagnosis of dyspnea, such as procalcitonin (for identification of acute pneumonia), as well as markers that predict complications of acute decompensated heart failure, such as renal injury markers. In this article, we will review the pathophysiology and usefulness of established and emerging biomarkers for the clinical diagnosis, prognosis, and management of acute decompensated heart failure. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Normotensive cardiomyopathy and malignant hypertension in phaeochromocytoma

PubMed Central

Shapiro, L. M.; Trethowan, N.; Singh, S. P.

1982-01-01

A patient with two different presentations of phaeochromocytoma is described. She initially presented with normal blood pressure and heart failure following a prolonged feverish prodrome. A provisional diagnosis of myocarditis or early congestive cardiomyopathy was made and she improved with digoxin and diuretics. Eighteen months later, after a period of normotension free from heart failure, she developed malignant hypertension with recurrence of heart failure. A phaeochromocytoma was surgically removed, with return to normal of blood pressure and cardiac status. It would seem that the initial presentation of the phaeochromocytoma was a catecholamine-induced myocarditis without hypertension and this resolved with the subsequent development of malignant hypertension. The possible mechanisms responsible for this are discussed and it is concluded that phaeochromocytoma should be considered in patients who have heart failure and persistent features of myocarditis. PMID:7100023

76 FR 38548 - Competitive and Noncompetitive Nonformula Federal Assistance Programs-Administrative Provisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

...] Competitive and Noncompetitive Nonformula Federal Assistance Programs--Administrative Provisions for Biomass... Biomass Research and Development Initiative (BRDI). This document contains minor changes to those... a joint Biomass Research and Development Initiative (BRDI) under which competitively awarded grants...

75 FR 33497 - Competitive and Noncompetitive Nonformula Federal Assistance Programs-Administrative Provisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-14

...] Competitive and Noncompetitive Nonformula Federal Assistance Programs--Administrative Provisions for Biomass... specific administrative requirements for the Biomass Research and Development Initiative (BRDI) to... and carry out a joint Biomass Research and Development Initiative (BRDI) under which competitively...

SURFplus Model Calibration for PBX 9502

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

Menikoff, Ralph

2017-12-06

The SURFplus reactive burn model is calibrated for the TATB based explosive PBX 9502 at three initial temperatures; hot (75 C), ambient (23 C) and cold (-55 C). The CJ state depends on the initial temperature due to the variation in the initial density and initial specific energy of the PBX reactants. For the reactants, a porosity model for full density TATB is used. This allows the initial PBX density to be set to its measured value even though the coeffcient of thermal expansion for the TATB and the PBX differ. The PBX products EOS is taken as independent ofmore » the initial PBX state. The initial temperature also affects the sensitivity to shock initiation. The model rate parameters are calibrated to Pop plot data, the failure diameter, the limiting detonation speed just above the failure diameters, and curvature effect data for small curvature.« less

Ventricular assist device implantation in a young patient with non-compaction cardiomyopathy and hereditary spherocytosis.

PubMed

Huenges, Katharina; Panholzer, Bernd; Cremer, Jochen; Haneya, Assad

2018-04-01

A case of a 15-year-old female patient with acute heart failure due to non-compaction cardiomyopathy and hereditary anaemia (hereditary spherocytic elliptocytosis) requiring ventricular assist device implantation as a bridge to transplantation is presented. The possible effects of mechanical stress on erythrocytes potentially induced by mechanical circulatory support remains unclear, but it may lead to haemolytic crisis in patients suffering from hereditary anaemia. In our case, ventricular assist device therapy was feasible, and haematological complications did not occur within 6 weeks of bridging our patient to heart transplantation.

Chronic outpatient management of patients with a left ventricular assist device

PubMed Central

Franzwa, Jennifer

2015-01-01

The use of mechanical circulatory support (MCS) as treatment for advanced heart failure (HF) has grown exponentially over the past 15 years. The continuous flow left ventricular assist device (CF-LVAD) has become the most used form of MCS in advanced HF, especially since approval of use as destination therapy (DT) and with the lack of organ availability. Long-term survival has improved and diligent outpatient management is thus particularly critical to achieve optimal outcomes. This review will discuss outpatient management strategies for patients with HF and a left ventricular assist device (LVAD). PMID:26793331

Failure propagation in multi-cell lithium ion batteries

DOE PAGES

Lamb, Joshua; Orendorff, Christopher J.; Steele, Leigh Anna M.; ...

2014-10-22

Traditionally, safety and impact of failure concerns of lithium ion batteries have dealt with the field failure of single cells. However, large and complex battery systems require the consideration of how a single cell failure will impact the system as a whole. Initial failure that leads to the thermal runaway of other cells within the system creates a much more serious condition than the failure of a single cell. This work examines the behavior of small modules of cylindrical and stacked pouch cells after thermal runaway is induced in a single cell through nail penetration trigger [1] within the module.more » Cylindrical cells are observed to be less prone to propagate, if failure propagates at all, owing to the limited contact between neighboring cells. However, the electrical connectivity is found to be impactful as the 10S1P cylindrical cell module did not show failure propagation through the module, while the 1S10P module had an energetic thermal runaway consuming the module minutes after the initiation failure trigger. Modules built using pouch cells conversely showed the impact of strong heat transfer between cells. In this case, a large surface area of the cells was in direct contact with its neighbors, allowing failure to propagate through the entire battery within 60-80 seconds for all configurations (parallel or series) tested. This work demonstrates the increased severity possible when a point failure impacts the surrounding battery system.« less

Advanced Heart Failure Therapies for Cancer Therapeutics-Related Cardiac Dysfunction.

PubMed

Bianco, Christopher M; Al-Kindi, Sadeer G; Oliveira, Guilherme H

2017-04-01

End-stage heart failure in cancer survivors may result from cardiotoxic chemotherapy and/or chest radiation and require advanced therapies, including left ventricular assist devices (LVADs) and transplantation. Traditionally, such therapies have been underutilized in cancer survivors owing to lack of experience and perceived risk of cancer recurrence. Recent data from large registries, however, have shown excellent outcomes of LVADs and transplantation in cancer survivors, albeit subject to careful selection and special considerations. This article summarizes all aspects of advanced heart failure therapies in patients with cancer therapy-related cardiac dysfunction and underscores the need for careful selection of these candidates. Copyright © 2016 Elsevier Inc. All rights reserved.

Resilience of antagonistic networks with regard to the effects of initial failures and degree-degree correlations

NASA Astrophysics Data System (ADS)

Watanabe, Shunsuke; Kabashima, Yoshiyuki

2016-09-01

In this study we investigate the resilience of duplex networked layers α and β coupled with antagonistic interlinks, each layer of which inhibits its counterpart at the microscopic level, changing the following factors: whether the influence of the initial failures in α remains [quenched (case Q )] or not [free (case F )]; the effect of intralayer degree-degree correlations in each layer and interlayer degree-degree correlations; and the type of the initial failures, such as random failures or targeted attacks (TAs). We illustrate that the percolation processes repeat in both cases Q and F , although only in case F are nodes that initially failed reactivated. To analytically evaluate the resilience of each layer, we develop a methodology based on the cavity method for deriving the size of a giant component (GC). Strong hysteresis, which is ignored in the standard cavity analysis, is observed in the repetition of the percolation processes particularly in case F . To handle this, we heuristically modify interlayer messages for macroscopic analysis, the utility of which is verified by numerical experiments. The percolation transition in each layer is continuous in both cases Q and F . We also analyze the influences of degree-degree correlations on the robustness of layer α , in particular for the case of TAs. The analysis indicates that the critical fraction of initial failures that makes the GC size in layer α vanish depends only on its intralayer degree-degree correlations. Although our model is defined in a somewhat abstract manner, it may have relevance to ecological systems that are composed of endangered species (layer α ) and invaders (layer β ), the former of which are damaged by the latter whereas the latter are exterminated in the areas where the former are active.

The initial effectiveness of liposomal amphotericin B (AmBisome) and miltefosine combination for treatment of visceral leishmaniasis in HIV co-infected patients in Ethiopia: A retrospective cohort study.

PubMed

Abongomera, Charles; Diro, Ermias; de Lima Pereira, Alan; Buyze, Jozefien; Stille, Kolja; Ahmed, Fareed; van Griensven, Johan; Ritmeijer, Koert

2018-05-01

North-west Ethiopia faces the highest burden world-wide of visceral leishmaniasis (VL) and HIV co-infection. VL-HIV co-infected patients have higher (initial) parasitological failure and relapse rates than HIV-negative VL patients. Whereas secondary prophylaxis reduces the relapse rate, parasitological failure rates remain high with the available antileishmanial drugs, especially when administered as monotherapy. We aimed to determine the initial effectiveness (parasitologically-confirmed cure) of a combination of liposomal amphotericin B (AmBisome) and miltefosine for treatment of VL in HIV co-infected patients. We conducted a retrospective cohort study at a Médecins Sans Frontières-supported health center in north-west Ethiopia. We included VL-HIV co-infected adults, treated for VL between January 2011 and August 2014, with AmBisome infusion (30 mg/kg total dose) and miltefosine orally for 28 days (100 mg/day). Proportions of initial treatment outcome categories were calculated. Predictors of initial parasitological failure and of death were determined using multivariable logistic regression. Of the 173 patients included, 170 (98.3%) were male and the median age was 32 years. The proportion of patients with primary VL (48.0%) and relapse VL (52.0%) were similar. The majority had advanced HIV disease (n = 111; 73.5%) and were on antiretroviral therapy prior to VL diagnosis (n = 106; 64.2%). Initial cure rate was 83.8% (95% confidence interval [CI], 77.6-88.6); death rate 12.7% (95% CI, 8.5-18.5) and parasitological failure rate 3.5% (95% CI, 1.6-7.4). Tuberculosis co-infection at VL diagnosis was predictive of parasitological failure (adjusted odds ratio (aOR), 8.14; p = 0.02). Predictors of death were age >40 years (aOR, 5.10; p = 0.009), hemoglobin ≤6.5 g/dL (aOR, 5.20; p = 0.002) and primary VL (aOR, 8.33; p = 0.001). Initial parasitological failure rates were very low with AmBisome and miltefosine combination therapy. This regimen seems a suitable treatment option. Knowledge of predictors of poor outcome may facilitate better management. These findings remain to be confirmed in clinical trials.

Porting Inition and Failure to Linked Cheetah

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

Vitello, P; Souers, P C

2007-07-18

Linked CHEETAH is a thermo-chemical code coupled to a 2-D hydrocode. Initially, a quadratic-pressure dependent kinetic rate was used, which worked well in modeling prompt detonation of explosives of large size, but does not work on other aspects of explosive behavior. The variable-pressure Tarantula reactive flow rate model was developed with JWL++ in order to also describe failure and initiation, and we have moved this model into Linked CHEETAH. The model works by turning on only above a pressure threshold, where a slow turn-on creates initiation. At a higher pressure, the rate suddenly leaps to a large value over amore » small pressure range. A slowly failing cylinder will see a rapidly declining rate, which pushes it quickly into failure. At a high pressure, the detonation rate is constant. A sequential validation procedure is used, which includes metal-confined cylinders, rate-sticks, corner-turning, initiation and threshold, gap tests and air gaps. The size (diameter) effect is central to the calibration.« less

Fracture Surface Analysis of Clinically Failed Fixed Partial Dentures

PubMed Central

Taskonak, B.; Mecholsky, J.J.; Anusavice, K.J.

2008-01-01

Ceramic systems have limited long-term fracture resistance, especially when they are used in posterior areas or for fixed partial dentures. The objective of this study was to determine the site of crack initiation and the causes of fracture of clinically failed ceramic fixed partial dentures. Six Empress 2® lithia-disilicate (Li2O·2SiO2)-based veneered bridges and 7 experimental lithia-disilicate-based non-veneered ceramic bridges were retrieved and analyzed. Fractography and fracture mechanics methods were used to estimate the stresses at failure in 6 bridges (50%) whose fracture initiated from the occlusal surface of the connectors. Fracture of 1 non-veneered bridge (8%) initiated within the gingival surface of the connector. Three veneered bridges fractured within the veneer layers. Failure stresses of the all-core fixed partial dentures ranged from 107 to 161 MPa. Failure stresses of the veneered fixed partial dentures ranged from 19 to 68 MPa. We conclude that fracture initiation sites are controlled primarily by contact damage. PMID:16498078

MicroRNAs in Heart Failure, Cardiac Transplantation, and Myocardial Recovery: Biomarkers with Therapeutic Potential.

PubMed

Shah, Palak; Bristow, Michael R; Port, J David

2017-12-01

Heart failure is increasing in prevalence with a lack of recently developed therapies that produce major beneficial effects on its associated mortality. MicroRNAs are small non-coding RNA molecules that regulate gene expression, are differentially regulated in heart failure, and are found in the circulation serving as a biomarker of heart failure. Data suggests that microRNAs may be used to detect allograft rejection in cardiac transplantation and may predict the degree of myocardial recovery in patients with a left ventricular assist device or treated with beta-blocker therapy. Given their role in regulating cellular function, microRNAs are an intriguing target for oligonucleotide therapeutics, designed to mimic or antagonize (antagomir) their biological effects. We review the current state of microRNAs as biomarkers of heart failure and associated conditions, the mechanisms by which microRNAs control cellular function, and how specific microRNAs may be targeted with novel therapeutics designed to treat heart failure.

[Retrieval and failure analysis of surgical implants in Brazil: the need for proper regulation].

PubMed

Azevedo, Cesar R de Farias; Hippert, Eduardo

2002-01-01

This paper summarizes several cases of metallurgical failure analysis of surgical implants conducted at the Laboratory of Failure Analysis, Instituto de Pesquisas Tecnológicas (IPT), in Brazil. Failures with two stainless steel femoral compression plates, one stainless steel femoral nail plate, one Ti-6Al-4V alloy maxillary reconstruction plate, and five Nitinol wires were investigated. The results showed that the implants were not in accordance with ISO standards and presented evidence of corrosion-assisted fracture. Furthermore, some of the implants presented manufacturing/processing defects which also contributed to their premature failure. Implantation of materials that are not biocompatible may cause several types of adverse effects in the human body and lead to premature implant failure. A review of prevailing health legislation is needed in Brazil, along with the adoption of regulatory mechanisms to assure the quality of surgical implants on the market, providing for compulsory procedures in the reporting and investigation of surgical implants which have failed in service.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: cross-sectional secondary data analysis.

PubMed

Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

2014-08-01

In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. Cross-sectional secondary data analysis. This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. 2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09-2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41-2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99-1.84). Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover. Copyright © 2014 Elsevier Ltd. All rights reserved.

Long-Term Durability Test for the Left Ventricular Assist System EVAHEART under the Physiologic Pulsatile Load.

PubMed

Kitano, Tomoya; Iwasaki, Kiyotaka

The EVAHEART Left Ventricular Assist System (LVAS) was designed for the long-term support of a patient with severe heart failure. It has an original water lubrication system for seal and bearing and wear on these parts was considered one of its critical failure modes. A durability test focusing on wear was designed herein. We developed a mock loop, which generates a physiologic pulsatile flow and is sufficiently durable for a long-term test. The pulsatile load and the low fluid viscosity enable the creation of a severe condition for the mechanical seal. A total of 18 EVAHEART blood pumps completed 2 years of operation under the pulsatile condition without any failure. It indicated the EVAHEART blood pump had a greater than 90% reliability with a 88% confidence level. The test was continued with six blood pumps and achieved an average of 8.6 years, which was longer than the longest clinical use in Japan. The test result showed that no catastrophic, critical, marginal, or minor failures of the blood pump or their symptoms were observed. The seal performance was maintained after the test. Moreover, the surface roughness did not change, which showed any burn or abnormal wear occurred. The original water lubrication system equipped in EVAHEART LVAS prevent severe wear on the seal and the bearing, and it can be used in the bridge to transplant and destination therapy.

Factors affecting stress assisted corrosion cracking of carbon steel under industrial boiler conditions

NASA Astrophysics Data System (ADS)

Yang, Dong

Failure of carbon steel boiler tubes from waterside has been reported in the utility boilers and industrial boilers for a long time. In industrial boilers, most waterside tube cracks are found near heavy attachment welds on the outer surface and are typically blunt, with multiple bulbous features indicating a discontinuous growth. These types of tube failures are typically referred to as stress assisted corrosion (SAC). For recovery boilers in the pulp and paper industry, these failures are particularly important as any water leak inside the furnace can potentially lead to smelt-water explosion. Metal properties, environmental variables, and stress conditions are the major factors influencing SAC crack initation and propagation in carbon steel boiler tubes. Slow strain rate tests (SSRT) were conducted under boiler water conditions to study the effect of temperature, oxygen level, and stress conditions on crack initation and propagation on SA-210 carbon steel samples machined out of boiler tubes. Heat treatments were also performed to develop various grain size and carbon content on carbon steel samples, and SSRTs were conducted on these samples to examine the effect of microstructure features on SAC cracking. Mechanisms of SAC crack initation and propagation were proposed and validated based on interrupted slow strain tests (ISSRT). Water chemistry guidelines are provided to prevent SAC and fracture mechanics model is developed to predict SAC failure on industrial boiler tubes.

Perioperative management of two patients with left ventricular assist devices presenting for noncardiac surgery in the prone position.

PubMed

Chacon, M Megan; Hattrup, Emily A; Shillcutt, Sasha K

2014-03-15

Ventricular assist devices (VADs) provide mechanical circulatory support for patients with advanced heart failure. Patients with VADs are presenting for noncardiac surgery with increasing frequency. Understanding anesthetic management of patients with VADs is timely and necessary for perioperative physicians. We present 2 patients supported by left VADs who required intraoperative prone positioning, and how transesophageal echocardiography and VAD variables can be used to guide management.

Numerical research on the lateral global buckling characteristics of a high temperature and pressure pipeline with two initial imperfections

PubMed Central

Liu, Wenbin; Liu, Aimin

2018-01-01

With the exploitation of offshore oil and gas gradually moving to deep water, higher temperature differences and pressure differences are applied to the pipeline system, making the global buckling of the pipeline more serious. For unburied deep-water pipelines, the lateral buckling is the major buckling form. The initial imperfections widely exist in the pipeline system due to manufacture defects or the influence of uneven seabed, and the distribution and geometry features of initial imperfections are random. They can be divided into two kinds based on shape: single-arch imperfections and double-arch imperfections. This paper analyzed the global buckling process of a pipeline with 2 initial imperfections by using a numerical simulation method and revealed how the ratio of the initial imperfection’s space length to the imperfection’s wavelength and the combination of imperfections affects the buckling process. The results show that a pipeline with 2 initial imperfections may suffer the superposition of global buckling. The growth ratios of buckling displacement, axial force and bending moment in the superposition zone are several times larger than no buckling superposition pipeline. The ratio of the initial imperfection’s space length to the imperfection’s wavelength decides whether a pipeline suffers buckling superposition. The potential failure point of pipeline exhibiting buckling superposition is as same as the no buckling superposition pipeline, but the failure risk of pipeline exhibiting buckling superposition is much higher. The shape and direction of two nearby imperfections also affects the failure risk of pipeline exhibiting global buckling superposition. The failure risk of pipeline with two double-arch imperfections is higher than pipeline with two single-arch imperfections. PMID:29554123

Putting Integrated Systems Health Management Capabilities to Work: Development of an Advanced Caution and Warning System for Next-Generation Crewed Spacecraft Missions

NASA Technical Reports Server (NTRS)

Mccann, Robert S.; Spirkovska, Lilly; Smith, Irene

2013-01-01

Integrated System Health Management (ISHM) technologies have advanced to the point where they can provide significant automated assistance with real-time fault detection, diagnosis, guided troubleshooting, and failure consequence assessment. To exploit these capabilities in actual operational environments, however, ISHM information must be integrated into operational concepts and associated information displays in ways that enable human operators to process and understand the ISHM system information rapidly and effectively. In this paper, we explore these design issues in the context of an advanced caution and warning system (ACAWS) for next-generation crewed spacecraft missions. User interface concepts for depicting failure diagnoses, failure effects, redundancy loss, "what-if" failure analysis scenarios, and resolution of ambiguity groups are discussed and illustrated.

Predicting, examining, and evaluating FAC in US power plants

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

Cohn, M.J.; Garud, Y.S.; Raad, J. de

1999-11-01

There have been many pipe failures in fossil and nuclear power plant piping systems caused by flow-accelerated corrosion (FAC). In some piping systems, this failure mechanism maybe the most important type of damage to mitigate because FAC damage has led to catastrophic failures and fatalities. Detecting the damage and mitigating the problem can significantly reduce future forced outages and increase personnel safety. This article discusses the implementation of recent developments to select FAC inspection locations, perform cost-effective examinations, evaluate results, and mitigate FAC failures. These advances include implementing the combination of software to assist in selecting examination locations and anmore » improved pulsed eddy current technique to scan for wall thinning without removing insulation. The use of statistical evaluation methodology and possible mitigation strategies also are discussed.« less

How and why of orthodontic bond failures: An in vivo study

PubMed Central

Vijayakumar, R. K.; Jagadeep, Raju; Ahamed, Fayyaz; Kanna, Aprose; Suresh, K.

2014-01-01

Introduction: The bonding of orthodontic brackets and their failure rates by both direct and in-direct procedures are well-documented in orthodontic literature. Over the years different adhesive materials and various indirect bonding transfer procedures have been compared and evaluated for bond failure rates. The aim of our study is to highlight the use of a simple, inexpensive and ease of manipulation of a single thermo-plastic transfer tray and the use the of a single light cure adhesive to evaluate the bond failure rates in clinical situations. Materials and Methods: A total of 30 patients were randomly divided into two groups (Group A and Group B). A split-mouth study design was used, for, both the groups so that they were distributed equally with-out bias. After initial prophylaxis, both the procedures were done as per manufactures instructions. All patients were initially motivated and reviewed for bond failures rates for 6 months. Results: Bond failure rates were assessed for over-all direct and indirect procedures, anterior and posterior arches, and for individual tooth. Z-test was used for statistically analyzing, the normal distribution of the sample in a spilt mouth study. The results of the two groups were compared and P value was calculated using Z-proportion test to assess the significance of the bond failure. Conclusion: Over-all bond failure was more for direct bonding. Anterior bracket failure was more in-direct bonding than indirect procedure, which showed more posterior bracket failures. In individual tooth bond failure, mandibular incisor, and premolar brackets showed more failure, followed by maxillary premolars and canines. PMID:25210392

Reliability Programs for Nonelectronic Designs. Volume 2

DTIC Science & Technology

1983-04-01

afforded. Differ- ences between critical and minor failures must be defined in the RFP so that the test need not be stopped for minor failures. However...not be afforded. Specialized test plans must be developed for nonelectronic equipment. First, differences between critical and minor failures must be...determined prior to initiating the test program so that the test need not be stopped for minor failures. Second, although the test must be interrupted

Failure of technetium bone scanning to detect pseudarthroses in spinal fusion for scoliosis

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

Hannon, K.M.; Wetta, W.J.

1977-01-01

A prospective study of 11 patients suggests that present techniques of technetium bone scanning do not assist in recognizing the presence of well-established pseudarthrosis in spinal fusions for scoliosis.

76 FR 81015 - Notice of Public Webinar on Implementation of Distribution Integrity Management Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... discussion of analyses of the initial submissions of data concerning mechanical fitting failures in... information. The DIMP rule also required distribution pipeline operators to report failures of mechanical... mechanical fitting failure reporting will be preliminary at this time. They will be based on a limited set of...

Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy.

PubMed

Park, Soon J; Milano, Carmelo A; Tatooles, Antone J; Rogers, Joseph G; Adamson, Robert M; Steidley, D Eric; Ewald, Gregory A; Sundareswaran, Kartik S; Farrar, David J; Slaughter, Mark S

2012-03-01

The HeartMate II (HMII) destination therapy (DT) trial demonstrated significant improvements in outcomes in continuous-flow left ventricular assist devices compared with patients implanted with the pulsatile-flow HeartMate XVE. The primary hypothesis of the current study is that trial patients enrolled after the initial data cohort would have better clinical outcomes. Two hundred eighty-one patients who underwent HMII for DT from May 2007 to March 2009 (Mid Trial [MT] group) were compared with the initial 133 HMII patients from March 2005 to May 2007 (Early Trial [ET] group). Patient entry criteria were the same during the 2 time periods. Survival, adverse events, and quality of life were compared between the 2 groups. Baseline characteristics were similar between the groups. Compared with the ET group, patients in the MT group had reduced adverse event rates for bleeding requiring transfusions (1.66 versus 1.13 events per patient-year, P<0.001), sepsis (0.38 versus 0.27, P=0.025), device-related infections (0.47 versus 0.27, P<0.001), and hemorrhagic stroke (0.07 versus 0.03, P=0.01). Other event rates were similar between groups including ischemic stroke (0.06 versus 0.05 events per patient-year, P=0.57). Survival at 1 year in the MT group was 73% versus 68% in the ET group (P=0.21). Additionally, there was a significant reduction in deaths caused by hemorrhagic stroke (P=0.01). Quality of life improvements were significant in both the groups (P<0.001). The benefit of DT therapy with the HMII is confirmed in subsequent trial patients, with improved adverse event rates and a strong trend for improvements in survival. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00121485.

Effects of soil-engineering properties on the failure mode of shallow landslides

USGS Publications Warehouse

McKenna, Jonathan Peter; Santi, Paul Michael; Amblard, Xavier; Negri, Jacquelyn

2012-01-01

Some landslides mobilize into flows, while others slide and deposit material immediately down slope. An index based on initial dry density and fine-grained content of soil predicted failure mode of 96 landslide initiation sites in Oregon and Colorado with 79% accuracy. These material properties can be used to identify potential sources for debris flows and for slides. Field data suggest that loose soils can evolve from dense soils that dilate upon shearing. The method presented herein to predict failure mode is most applicable for shallow (depth 8), with few to moderate fines (fine-grained content <18%), and with liquid limits <40.

Failure Mechanisms of Brittle Rocks under Uniaxial Compression

NASA Astrophysics Data System (ADS)

Liu, Taoying; Cao, Ping

2017-09-01

The behaviour of a rock mass is determined not only by the properties of the rock matrix, but mostly by the presence and properties of discontinuities or fractures within the mass. The compression test on rock-like specimens with two prefabricated transfixion fissures, made by pulling out the embedded metal inserts in the pre-cured period was carried out on the servo control uniaxial loading tester. The influence of the geometry of pre-existing cracks on the cracking processes was analysed with reference to the experimental observation of crack initiation and propagation from pre-existing flaws. Based on the rock fracture mechanics and the stress-strain curves, the evolution failure mechanism of the fissure body was also analyzed on the basis of exploring the law of the compression-shear crack initiation, wing crack growth and rock bridge connection. Meanwhile, damage fracture mechanical models of a compression-shear rock mass are established when the rock bridge axial transfixion failure, tension-shear combined failure, or wing crack shear connection failure occurs on the specimen under axial compression. This research was of significance in studying the failure mechanism of fractured rock mass.

Management of failure after surgery for gastro-esophageal reflux disease.

PubMed

Gronnier, C; Degrandi, O; Collet, D

2018-04-01

Surgical treatment of gastro-esophageal reflux disease (ST-GERD) is well-codified and offers an alternative to long-term medical treatment with a better efficacy for short and long-term outcomes. However, failure of ST-GERD is observed in 2-20% of patients; management is challenging and not standardized. The aim of this study is to analyze the causes of failure and to provide a treatment algorithm. The clinical aspects of ST-GERD failure are variable including persistent reflux, dysphagia or permanent discomfort leading to an important degradation of the quality of life. A morphological and functional pre-therapeutic evaluation is necessary to: (i) determine whether the symptoms are due to recurrence of reflux or to an error in initial indication and (ii) to understand the cause of the failure. The most frequent causes of failure of ST-GERD include errors in the initial indication, which often only need medical treatment, and surgical technical errors, for which surgical redo surgery can be difficult. Multidisciplinary management is necessary in order to offer the best-adapted treatment. Copyright © 2018. Published by Elsevier Masson SAS.

The deformation and failure response of closed-cell PMDI foams subjected to dynamic impact loading

DOE PAGES

Koohbor, Behrad; Mallon, Silas; Kidane, Addis; ...

2015-04-07

The present work aims to investigate the bulk deformation and failure response of closed-cell Polymeric Methylene Diphenyl Diisocyanate (PMDI) foams subjected to dynamic impact loading. First, foam specimens of different initial densities are examined and characterized in quasi-static loading conditions, where the deformation behavior of the samples is quantified in terms of the compressive elastic modulus and effective plastic Poisson's ratio. Then, the deformation response of the foam specimens subjected to direct impact loading is examined by taking into account the effects of material compressibility and inertia stresses developed during deformation, using high speed imaging in conjunction with 3D digitalmore » image correlation. The stress-strain response and the energy absorption as a function of strain rate and initial density are presented and the bulk failure mechanisms are discussed. As a result, it is observed that the initial density of the foam and the applied strain rates have a substantial influence on the strength, bulk failure mechanism and the energy dissipation characteristics of the foam specimens.« less

Cervical lung herniation complicating a case of acute asphyxial asthma in a child.

PubMed

Martchek, Melissa A; Padilla, Benjamin E; Zonfrillo, Mark R; Friedlaender, Eron Y

2015-04-01

The abrupt onset of respiratory failure secondary to asthma, known as acute asphyxial asthma (AAA) in adults, is uncommonly reported in children. Here, we report a case of a child with the acute onset of respiratory failure consistent with AAA complicated by the finding of a neck mass during resuscitation. This 11-year-old boy with a history of asthma initially presented in respiratory failure with altered mental status after the complaint of difficulty in breathing minutes before collapsing at home. Initially, his respiratory failure was thought to be secondary to status asthmaticus, and treatment was initiated accordingly. However, a neck mass noted during the resuscitation was cause for concern, and other etiologies for his respiratory failure were considered, including an airway obstructing neck mass. After pediatric surgery and anesthesia consultation for intubation and possible tracheostomy placement, general anesthesia was induced in the operating room with an inhaled anesthetic, with prompt resolution of the bronchspasm and decompression of the neck mass. Review of the imaging and clinical course ultimately yielded a diagnosis of cervical lung herniation as the etiology of his neck mass. We report this case of AAA and cervical lung herniation and a review of the literature of these 2 uncommon phenomena in children.

The Role of Supervisory Assistant Principals in District Change Initiatives within New York City Department of Education High Schools

ERIC Educational Resources Information Center

Quinlan, Robert James

2015-01-01

The onset of the first decade of the 21st century has seen many district change initiatives within the New York City Department of Education. Several of these district initiatives have been instructionally-based and thus have made the role of high school supervisory assistant principals integral in their successful implementation. The purpose of…

Addressing Hate Crimes: Six Initiatives That Are Enhancing the Efforts of Criminal Justice Practitioners. Hate Crimes Series. Bureau of Justice Assistance Monograph.

ERIC Educational Resources Information Center

Wessler, Stephen

This publication focuses on initiatives that are designed to address hate crimes by enhancing efforts of the criminal justice system. After discussing the pivotal role of law enforcement in this effort, the paper describes six Bureau of Justice Assistance-funded initiatives, which include: the International Association of Chiefs of Police Summit:…

Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

PubMed Central

Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea

2016-01-01

Purpose To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. Materials and Methods From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. Results All technical and clinical success–i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control–was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12–32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Conclusion Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding. PMID:27189294

Preventing home health nursing assistant back and shoulder injuries.

PubMed

Leff, E W; Hagenbach, G L; Marn, K K

2000-10-01

Franklin County Home Health Agency (St Albans, Vermont) undertook a performance improvement project in 1996 to reduce employee injuries. A review of recent injuries led to the prevention of licensed nursing assistants' (LNAs') back and shoulder injuries as the first priority. Root causes of injuries were agency communication, employee training, patient home environment, nursing assistant body mechanics, and failure to use safety measures. Given that injury causality is complex and multifactorial, a variety of improvement strategies were implemented over the following two to three years. IMPLEMENTATION OF POTENTIAL SOLUTIONS: Short-term (a few months), mid-term (six months), and long-term (one year) potential solutions to the LNA back and shoulder injury problem were charted. Safety and health training was the major focus of the team's short-term plan. Risk management forms were to be used to identify and follow up on hazardous situations. Project plans that were successfully implemented included revision of LNA plans of care, standardization of the return-to-work process after injury, development of guidelines for identifying unsafe patient lifts and transfers, improved follow-up of employee reports of injury-risk situations in patient homes, improved body mechanics screening of new employees, and a stronger injury-prevention training program for current employees. A less successful initiative was aimed at collecting more data about injuries and causal factors. Employee injuries were gradually reduced from 4-10 per quarter to 0-3 per quarter. Injury prevention requires commitment, persistence, and patience--but not expensive improvements. Multiple interventions increase the chances of success when there are many root causes and lack of evidence regarding the effectiveness of various approaches.

Elevated Body Mass Index Is Not a Risk Factor for Adverse Outcomes Following Ventricular Assist Device Implantation.

PubMed

Hullmann, Jonathan E; Mather, Paul J

2018-06-01

Despite ventricular assist devices (VADs) becoming more common in heart failure (HF) treatment, it is still uncertain which patients are more prone to complications. One potential risk factor is increased body mass index (BMI), which is known to increase both all-cause mortality and mortality from ischemic heart disease; however, the role of the BMI in predicting morbidity and mortality following device implantation is unclear. The study population for this single-institution retrospective chart review consisted of 136 patients with HF, who underwent VAD implantation between 2004 and 2015. Patients were divided into 2 groups based on their BMI: a nonobese group (18.5 < BMI < 30.0; n = 82) or an obese group (BMI >30.0; n = 54). These groups were compared at baseline and after implantation for survival, hospital readmission, and adverse events. No significant difference was found in initial hospital length of stay, number or length of readmissions, or readmission diagnosis. At 1 year, rates of ongoing device support, orthotopic heart transplant (OHT), and death were not significantly different between groups ( P = .89, P = .90, and P = .70, respectively). Multivariate analysis did not identify obesity as an independent predictor of mortality ( P = .90); only biventricular assist device implantation was associated with decreased survival (hazard ratio [HR] = 5.90, P = .002). Obesity in itself should not preclude the use of VAD support in patients with HF, as carefully selected obese patients were shown to have similar rates of hospital readmission, 1-year outcomes, and survival following device implantation compared to nonobese patients.

47 CFR 51.217 - Nondiscriminatory access: Telephone numbers, operator services, directory assistance services...

Code of Federal Regulations, 2011 CFR

2011-10-01

... to have access to its directory assistance services, including directory assistance databases, so... provider, including transfer of the LECs' directory assistance databases in readily accessible magnetic.... Updates to the directory assistance database shall be made in the same format as the initial transfer...

Transformative Change Initiative

ERIC Educational Resources Information Center

Bragg, D. D.; Kirby, C.; Witt, M. A.; Richie, D.; Mix, S.; Feldbaum, M.; Liu, S.; Mason, M.

2014-01-01

The Transformative Change Initiative (TCI) is dedicated to assisting community colleges to scale up innovation in the form of guided pathways, programs of study, and evidence-based strategies to improve student outcomes and program, organization, and system performance. The impetus for TCI is the Trade Adjustment Assistance Community College and…

Implementation of a Tabulated Failure Model Into a Generalized Composite Material Model Suitable for Use in Impact Problems

NASA Technical Reports Server (NTRS)

Goldberg, Robert K.; Carney, Kelly S.; Dubois, Paul; Hoffarth, Canio; Khaled, Bilal; Shyamsunder, Loukham; Rajan, Subramaniam; Blankenhorn, Gunther

2017-01-01

The need for accurate material models to simulate the deformation, damage and failure of polymer matrix composites under impact conditions is becoming critical as these materials are gaining increased use in the aerospace and automotive communities. The aerospace community has identified several key capabilities which are currently lacking in the available material models in commercial transient dynamic finite element codes. To attempt to improve the predictive capability of composite impact simulations, a next generation material model is being developed for incorporation within the commercial transient dynamic finite element code LS-DYNA. The material model, which incorporates plasticity, damage and failure, utilizes experimentally based tabulated input to define the evolution of plasticity and damage and the initiation of failure as opposed to specifying discrete input parameters such as modulus and strength. The plasticity portion of the orthotropic, three-dimensional, macroscopic composite constitutive model is based on an extension of the Tsai-Wu composite failure model into a generalized yield function with a non-associative flow rule. For the damage model, a strain equivalent formulation is used to allow for the uncoupling of the deformation and damage analyses. For the failure model, a tabulated approach is utilized in which a stress or strain based invariant is defined as a function of the location of the current stress state in stress space to define the initiation of failure. Failure surfaces can be defined with any arbitrary shape, unlike traditional failure models where the mathematical functions used to define the failure surface impose a specific shape on the failure surface. In the current paper, the complete development of the failure model is described and the generation of a tabulated failure surface for a representative composite material is discussed.

Energy transmission and power sources for mechanical circulatory support devices to achieve total implantability.

PubMed

Wang, Jake X; Smith, Joshua R; Bonde, Pramod

2014-04-01

Left ventricular assist device therapy has radically improved congestive heart failure survival with smaller rotary pumps. The driveline used to power today's left ventricular assist devices, however, continues to be a source of infection, traumatic damage, and rehospitalization. Previous attempts to wirelessly power left ventricular assist devices using transcutaneous energy transfer systems have been limited by restrictions on separation distance and alignment between the transmit and receive coils. Resonant electrical energy transfer allows power delivery at larger distances without compromising safety and efficiency. This review covers the efforts to wirelessly power mechanical circulatory assist devices and the progress made in enhancing their energy sources. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Toward total implantability using free-range resonant electrical energy delivery system: achieving untethered ventricular assist device operation over large distances.

PubMed

Waters, Benjamin; Sample, Alanson; Smith, Joshua; Bonde, Pramod

2011-11-01

Heart failure is a terminal disease with a very poor prognosis. Although the gold standard of treatment remains heart transplant, only a minority of patients can benefit from transplants. Another promising alternative is mechanical circulatory assistance using ventricular assist devices. The authors envision a completely implantable cardiac assist system affording tether-free mobility in an unrestricted space powered wirelessly by the innovative Free-Range Resonant Electrical Energy Device (FREE-D) system. Patients will have no power drivelines traversing the skin, and this system will allow power to be delivered over room distances and will eliminate trouble-prone wirings, bulky consoles, and replaceable batteries. Copyright © 2011 Elsevier Inc. All rights reserved.

The effect of box preparation on the strength of glass fiber-reinforced composite inlay-retained fixed partial dentures.

PubMed

Ozcan, Mutlu; Breuklander, Marijn H; Vallittu, Pekka K

2005-04-01

Nonstandardized box dimensions for inlay-retained fixed partial dentures (FPDs) may result in uneven distribution of the forces on the connector region of such restorations. The objective of this in vitro study was to evaluate the effect of box dimensions on the initial and final failure strength of inlay-retained fiber-reinforced composite (FRC) FPDs. Twenty-one inlay-retained FPDs were prepared using FRC (everStick) frameworks with unidirectional fiber reinforcement between mandibular first premolars and first molars. Boxes were prepared using conventional inlay burs (Cerinlay), and small and large ultrasonic tips (SONICSYS approx). Box dimensions were measured after preparation with a digital micrometer. All restorations were subjected to thermal cycling (6000 cycles, 5 degrees C-55 degrees C). Fracture testing was performed in a universal testing machine (1 mm/min). Acoustic emission signals were monitored during loading of the specimens. Initial and final fracture strength values (2-way ANOVA, Bonferroni post hoc tests, alpha =.05) and failure types (Fisher exact test) were statistically compared for each group. Significant differences (P =.0146 and P =.0086) were observed between the groups in the dimensions of the boxes prepared using conventional burs buccolingually (2.8-3.0 mm in molars, 3.1-4.3 mm in premolars) and the small size (2.5-2.9, 2.9-3.8 mm) or large size (2.6-3.8, 3.2-4.9 mm) ultrasonic tips for the premolars and the molars, respectively. No significant differences were found at the initial and final failures between the conventionally prepared group (842 +/- 267 N, 1161 +/- 428 N) and those prepared with either small (1088 +/- 381 N, 1320 +/- 380 N) or large ultrasonic tips (1070 +/- 280 N, 1557 +/- 321 N), respectively. The failure analysis demonstrated no significant difference in failure types but predominant delamination of the veneering resin (85%) in all experimental groups. According to acoustic emission tests, a higher energy level was required for final failure of the FRC FPDs with boxes finished using small ultrasonic tips. Standardized box dimensions showed no significant effect on fracture strength at either initial or final failure of the fiber-reinforced FPDs. The FRC FPDs with boxes refined with small ultrasonic burs required a greater energy level before failure. The type of failure observed after the fracture tests was primarily delamination of the veneering resin.

[Biochemical failure after curative treatment for localized prostate cancer].

PubMed

Zouhair, Abderrahim; Jichlinski, Patrice; Mirimanoff, René-Olivier

2005-12-07

Biochemical failure after curative treatment for localized prostate cancer is frequent. The diagnosis of biochemical failure is clear when PSA levels rise after radical prostatectomy, but may be more difficult after external beam radiation therapy. The main difficulty once biochemical failure is diagnosed is to distinguish between local and distant failure, given the low sensitivity of standard work-up exams. Metabolic imaging techniques currently under evaluation may in the future help us to localize the site of failures. There are several therapeutic options depending on the initial curative treatment, each with morbidity risks that should be considered in multidisciplinary decision-making.

Simulating Initial and Progressive Failure of Open-Hole Composite Laminates under Tension

NASA Astrophysics Data System (ADS)

Guo, Zhangxin; Zhu, Hao; Li, Yongcun; Han, Xiaoping; Wang, Zhihua

2016-12-01

A finite element (FE) model is developed for the progressive failure analysis of fiber reinforced polymer laminates. The failure criterion for fiber and matrix failure is implemented in the FE code Abaqus using user-defined material subroutine UMAT. The gradual degradation of the material properties is controlled by the individual fracture energies of fiber and matrix. The failure and damage in composite laminates containing a central hole subjected to uniaxial tension are simulated. The numerical results show that the damage model can be used to accurately predicte the progressive failure behaviour both qualitatively and quantitatively.

Levee reliability analyses for various flood return periods - a case study in Southern Taiwan

NASA Astrophysics Data System (ADS)

Huang, W.-C.; Yu, H.-W.; Weng, M.-C.

2015-01-01

In recent years, heavy rainfall conditions have caused damages around the world. To prevent damages by floods, levees have often been constructed in prone-to-inundation areas. This study performed reliability analyses for the Chiuliao 1st Levee located in southern Taiwan. The failure-related parameters were the water level, the scouring depth, and the in-situ friction angle. Three major failure mechanisms were considered, including the slope sliding failure of the levee, and the sliding and overturning failures of the retaining wall. When the variabilities of the in-situ friction angle and the scouring depth are considered for various flood return periods, the variations of the factor of safety (FS) for the different failure mechanisms show that the retaining wall sliding and overturning failures are more sensitive to the variability of the friction angle. When the flood return period is greater than 2 years, the levee can undergo slope sliding failure for all values of the water level difference. The results for levee stability analysis considering the variability of different parameters could assist engineers in designing the levee cross sections, especially with potential failure mechanisms in mind.

B-type natriuretic peptide testing for detection of heart failure.

PubMed

Saul, Lauren; Shatzer, Melanie

2003-01-01

The incidence of heart failure (HF) is on the increase with the aging population. Heart failure can manifest as either systolic or diastolic dysfunction. Systolic dysfunction causes impaired ventricular contractility with an ejection fraction of less than 45%. In contrast, diastolic dysfunction is evidenced by impaired ventricular relaxation and an ejection fraction greater than 45%. The diagnosis of HF is challenging with patients who present with acute dyspnea and a history of chronic obstructive pulmonary disease or pneumonia. The pathophysiology of HF and the resulting compensatory mechanisms involve a complex neuroendocrine response that includes a release of natriuretic peptides including B-type natriuretic peptides (BNPs). Elevation of BNP is in response to ventricular wall stress and volume overload from HF. BNP promotes natriuresis, diuresis, and vasodilitation and therefore counteracts some of the deleterious effects of the neuroendocrine response in HF Recently, a new laboratory test for BNP has been developed to assist in rapid identification of patients with HF. Research studies have shown that BNP testing assists in differentiating between cardiac and pulmonary causes of acute dyspnea and could be used to evaluate effectiveness of therapy and as a predictor for length of stay and readmission.

Investigating compression failure mechanisms in composite laminates with a transparent fiberglass-epoxy birefringent materials

NASA Technical Reports Server (NTRS)

Shuart, M. J.; Williams, J. G.

1984-01-01

The response and failure of a + or - 45s class laminate was studied by transparent fiberglass epoxy composite birefringent material. The birefringency property allows the laminate stress distribution to be observed during the test and also after the test if permanent residual stresses occur. The location of initial laminate failure and of the subsequent failure propagation are observed through its transparency characteristics. Experimental results are presented.

Devices as destination therapy.

PubMed

Kukuy, Eugene L; Oz, Mehmet C; Rose, Eric A; Naka, Yoshifumi

2003-02-01

The use of circulatory support as destination therapy has been a goal for the treatment of endstage heart failure for several decades. Current investigations are evaluating several circulatory pumps with that particular objective. With continued modification of design, the current and future pumps will become more reliable and provide improved quality of life to patients in need of mechanical circulatory assistance. The new pumps on the horizon specifically address reliability, size, and cost, and are based on the centrifugal system. These devices use the Maglev (Magnetic Levitation) concept that allows for frictionless pumping, low thrombogenicity, minimal noise, and increased durability. Further research with this goal in mind and support from the federal government will be the key to the future use of circulatory assistance as destination therapy for heart failure patients. In addition, the cost-effectiveness of these devices will need to be maintained as the technology improves, as in any new technology that confronts a more intuitive option like the native heart.

Understanding fertilization through intracytoplasmic sperm injection (ICSI)

PubMed Central

Neri, Queenie V.; Lee, Bora; Rosenwaks, Zev; Machaca, Khaled; Palermo, Gianpiero D.

2014-01-01

Summary Since the establishment of in vitro fertilization, it became evident that almost half of the couples failed to achieve fertilization and this phenomenon was attributed to a male gamete dysfunction. The adoption of assisted fertilization techniques particularly ICSI has been able to alleviate male factor infertility by granting the consistent ability of a viable spermatozoon to activate an oocyte. Single sperm injection, by pinpointing the beginning of fertilization, has been an invaluable tool in clarifying the different aspects of early fertilization and syngamy. However, even with ICSI some couples fail to fertilize due to ooplasmic dysmaturity in relation to the achieved nuclear maturation marked by the extrusion of the first polar body. More uncommon are cases where the spermatozoa partially or completely lack the specific oocyte activating factor. In this work, we review the most relevant aspects of fertilization and its failure through assisted reproductive technologies. Attempts at diagnosing and treating clinical fertilization failure are described. PMID:24290744

75 FR 54759 - Competitive and Noncompetitive Non-Formula Federal Assistance Programs-General Award...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-09

... assistance programs: Agriculture and Food Research Initiative (AFRI) as subpart G; the Organic Agriculture Research and Extension Initiative (OREI); and the Integrated Research, Education, and Extension Competitive... 4, 1965, Competitive, Special, and Facilities Research Grant Act, to authorize the Agriculture and...

Student Assistance Program Implementation and Evaluation.

ERIC Educational Resources Information Center

Dykeman, Cass

Recently, educators have initiated programs to help students address the social and emotional problems which can impair academic performance. This paper reviews current knowledge on one such program called a Student Assistance Program (SAP). SAPs were initially designed to intervene with chemically-dependent high school students, but more…

Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

PubMed

Holländer, Sebastian W; Klingen, Hans Joachim; Fritz, Marliese; Djalali, Peter; Birk, Dieter

2014-11-01

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

International comparative study of systems for the government advancement of research and development

NASA Technical Reports Server (NTRS)

Ripke, M.; Foerst, R.

1984-01-01

The reorganization, structure and instruments of government advancement of research in three countries was compared: France, Sweden and the USA. In France the powers are centralized; in Sweden and the USA, decentralized. Assistance to projects is provided with grants and contracts in all three countries. France and Sweden also give loans with conditional waiving of reimbursement in case of failure. In all three countries indirect assistance is provided only with small tax breaks.

Focused review on transthoracic echocardiographic assessment of patients with continuous axial left ventricular assist devices.

PubMed

Topilsky, Yan; Maltais, Simon; Oh, Jae K; Atchison, Fawn W; Perrault, Louis P; Carrier, Michel; Park, Soon J

2011-02-08

Left ventricular assist devices (LVADs) are systems for mechanical support for patients with end-stage heart failure. Preoperative, postoperative and comprehensive followup with transthoracic echocardiography has a major role in LVAD patient management. In this paper, we will present briefly the hemodynamics of axial-flow LVAD, the rationale, and available data for a complete and organized echocardiographic assessment in these patients including preoperative assessment, postoperative and long-term evaluation.

Biventricular hypertrophy and heart failure as initial presentation of Cushing's disease

PubMed Central

Hey, Thomas Morris; Dahl, Jordi Sanchez; Brix, Thomas Heiberg; Søndergaard, Eva Vad

2013-01-01

We present a unique case of a 32-year-old woman with severe biventricular hypertrophy and acute heart failure with reduced left ventricular ejection fraction of 25–30% due to Cushing's disease. The patient was admitted to a specialised cardiac unit and treated with conventional therapy against heart failure. The department of endocrinology was consulted because of clinical suspicion of Cushing's syndrome. Initial biochemistry indicated the presence of adrenocorticotropic hormone (ACTH) dependent Cushing's syndrome and a dexamethasone suppression test confirmed the diagnosis. A cerebral MRI scan revealed a pituitary adenoma and a sinus petrosus inferior catheterisation confirmed increased production of ACTH from the pituitary. The patient was referred to the neurosurgical department and the adenoma was successfully removed by transsphenoidalic catheterisation and ablation. Five months following the initial hospitalisation the patient was nearly in full recovery with respect to her cardiac function and biochemically there were no signs of Cushing's syndrome. PMID:24186856

The Effects of Hot Corrosion Pits on the Fatigue Resistance of a Disk Superalloy

NASA Technical Reports Server (NTRS)

Gabb, Timothy P.; Telesman, Jack; Hazel, Brian; Mourer, David P.

2009-01-01

The effects of hot corrosion pits on low cycle fatigue life and failure modes of the disk superalloy ME3 were investigated. Low cycle fatigue specimens were subjected to hot corrosion exposures producing pits, then tested at low and high temperatures. Fatigue lives and failure initiation points were compared to those of specimens without corrosion pits. Several tests were interrupted to estimate the fraction of fatigue life that fatigue cracks initiated at pits. Corrosion pits significantly reduced fatigue life by 60 to 98 percent. Fatigue cracks initiated at a very small fraction of life for high temperature tests, but initiated at higher fractions in tests at low temperature. Critical pit sizes required to promote fatigue cracking were estimated, based on measurements of pits initiating cracks on fracture surfaces.

Illinois Prekindergarten Program for Children At Risk of Academic Failure. FY 93 Summary Report.

ERIC Educational Resources Information Center

Illinois State Board of Education, Springfield, Dept. of Planning, Research and Evaluation.

The Illinois Prekindergarten Program for Children at Risk of Academic Failure was a grant program for public school districts to enhance growth and development of children ages 3 to 5 who are at risk of academic failure. The program has experienced significant growth since its initial implementation, and the number of participating projects…

Porting Initiation and Failure into Linked CHEETAH

NASA Astrophysics Data System (ADS)

Souers, Clark; Vitello, Peter

2007-06-01

Linked CHEETAH is a thermo-chemical code coupled to a 2-D hydrocode. Initially, a quadratic-pressure dependent kinetic rate was used, which worked well in modeling prompt detonation of explosives of large size, but does not work on other aspects of explosive behavior. The variable-pressure Tarantula reactive flow rate model was developed with JWL++ in order to also describe failure and initiation, and we have moved this model into Linked CHEETAH. The model works by turning on only above a pressure threshold, where a slow turn-on creates initiation. At a higher pressure, the rate suddenly leaps to a large value over a small pressure range. A slowly failing cylinder will see a rapidly declining rate, which pushes it quickly into failure. At a high pressure, the detonation rate is constant. A sequential validation procedure is used, which includes metal-confined cylinders, rate-sticks, corner-turning, initiation and threshold, gap tests and air gaps. The size (diameter) effect is central to the calibration. This work was performed under the auspices of the U.S. Department of Energy by the University of California Lawrence Livermore National Laboratory under contract No. W-7405-Eng-48.

Optimizing the robustness of electrical power systems against cascading failures.

PubMed

Zhang, Yingrui; Yağan, Osman

2016-06-21

Electrical power systems are one of the most important infrastructures that support our society. However, their vulnerabilities have raised great concern recently due to several large-scale blackouts around the world. In this paper, we investigate the robustness of power systems against cascading failures initiated by a random attack. This is done under a simple yet useful model based on global and equal redistribution of load upon failures. We provide a comprehensive understanding of system robustness under this model by (i) deriving an expression for the final system size as a function of the size of initial attacks; (ii) deriving the critical attack size after which system breaks down completely; (iii) showing that complete system breakdown takes place through a first-order (i.e., discontinuous) transition in terms of the attack size; and (iv) establishing the optimal load-capacity distribution that maximizes robustness. In particular, we show that robustness is maximized when the difference between the capacity and initial load is the same for all lines; i.e., when all lines have the same redundant space regardless of their initial load. This is in contrast with the intuitive and commonly used setting where capacity of a line is a fixed factor of its initial load.

Prognostic relevance of CD163 and CD8 combined with EZH2 and gain of chromosome 18 in follicular lymphoma: a study by the Lunenburg Lymphoma Biomarker Consortium.

PubMed

Stevens, Wendy B C; Mendeville, Matias; Redd, Robert; Clear, Andrew J; Bladergroen, Reno; Calaminici, Maria; Rosenwald, Andreas; Hoster, Eva; Hiddemann, Wolfgang; Gaulard, Philippe; Xerri, Luc; Salles, Gilles; Klapper, Wolfram; Pfreundschuh, Michael; Jack, Andrew; Gascoyne, Randy D; Natkunam, Yasodha; Advani, Ranjana; Kimby, Eva; Sander, Birgitta; Sehn, Laurie H; Hagenbeek, Anton; Raemaekers, John; Gribben, John; Kersten, Marie José; Ylstra, Bauke; Weller, Edie; de Jong, Daphne

2017-08-01

In follicular lymphoma, studies addressing the prognostic value of microenvironment-related immunohistochemical markers and tumor cell-related genetic markers have yielded conflicting results, precluding implementation in practice. Therefore, the Lunenburg Lymphoma Biomarker Consortium performed a validation study evaluating published markers. To maximize sensitivity, an end of spectrum design was applied for 122 uniformly immunochemotherapy-treated follicular lymphoma patients retrieved from international trials and registries. The criteria were: early failure, progression or lymphoma-related death <2 years versus long remission, response duration of >5 years. Immunohistochemical staining for T cells and macrophages was performed on tissue microarrays from initial biopsies and scored with a validated computer-assisted protocol. Shallow whole-genome and deep targeted sequencing was performed on the same samples. The 96/122 cases with complete molecular and immunohistochemical data were included in the analysis. EZH2 wild-type ( P =0.006), gain of chromosome 18 ( P =0.002), low percentages of CD8+ cells ( P =0.011) and CD163+ areas ( P =0.038) were associated with early failure. No significant differences in other markers were observed, thereby refuting previous claims of their prognostic significance. Using an optimized study design, this Lunenburg Lymphoma Biomarker Consortium study substantiates wild-type EZH2 status, gain of chromosome 18, low percentages of CD8+ cells and CD163+ area as predictors of early failure to immunochemotherapy in follicular lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP [-like]), while refuting the prognostic impact of various other markers. Copyright© 2017 Ferrata Storti Foundation.

Selection of patients for heart transplantation in the current era of heart failure therapy.

PubMed

Butler, Javed; Khadim, Ghazanfar; Paul, Kimberly M; Davis, Stacy F; Kronenberg, Marvin W; Chomsky, Don B; Pierson, Richard N; Wilson, John R

2004-03-03

We sought to assess the relationship between survival, peak exercise oxygen consumption (VO(2)), and heart failure survival score (HFSS) in the current era of heart failure (HF) therapy. Based on predicted survival, HF patients with peak VO(2) <14 ml/min/kg or medium- to high-risk HFSS are currently considered eligible for heart transplantation. However, these criteria were developed before the widespread use of beta-blockers, spironolactone, and defibrillators-interventions known to improve the survival of HF patients. Peak VO(2) and HFSS were assessed in 320 patients followed from 1994 to 1997 (past era) and in 187 patients followed from 1999 to 2001 (current era). Outcomes were compared between these two groups of patients and those who underwent heart transplantation from 1993 to 2000. Survival in the past era was 78% at one year and 67% at two years, as compared with 88% and 79%, respectively, in the current era (both p < 0.01). One-year event-free survival (without urgent transplantation or left ventricular assist device) was improved in the current era, regardless of initial peak VO(2): 64% vs. 48% for peak VO(2) <10 ml/min/kg (p = 0.09), 81% vs. 70% for 10 to 14 ml/min/kg (p = 0.05), and 93% vs. 82% for >14 ml/min/kg (p = 0.04). Of the patients with peak VO(2) of 10 to 14 ml/min/kg, 55% had low-risk HFSS and exhibited 88% one-year event-free survival. One-year survival after transplantation was 88%, which is similar to the 85% rate reported by the United Network for Organ Sharing for 1999 to 2000. Survival for HF patients in the current era has improved significantly, necessitating re-evaluation of the listing criteria for heart transplantation.

A Summary of Taxonomies of Digital System Failure Modes Provided by the DigRel Task Group

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

Chu T. L.; Yue M.; Postma, W.

2012-06-25

Recently, the CSNI directed WGRisk to set up a task group called DIGREL to initiate a new task on developing a taxonomy of failure modes of digital components for the purposes of PSA. It is an important step towards standardized digital I&C reliability assessment techniques for PSA. The objective of this paper is to provide a comparison of the failure mode taxonomies provided by the participants. The failure modes are classified in terms of their levels of detail. Software and hardware failure modes are discussed separately.

Progressive Failure Analysis Methodology for Laminated Composite Structures

NASA Technical Reports Server (NTRS)

Sleight, David W.

1999-01-01

A progressive failure analysis method has been developed for predicting the failure of laminated composite structures under geometrically nonlinear deformations. The progressive failure analysis uses C(exp 1) shell elements based on classical lamination theory to calculate the in-plane stresses. Several failure criteria, including the maximum strain criterion, Hashin's criterion, and Christensen's criterion, are used to predict the failure mechanisms and several options are available to degrade the material properties after failures. The progressive failure analysis method is implemented in the COMET finite element analysis code and can predict the damage and response of laminated composite structures from initial loading to final failure. The different failure criteria and material degradation methods are compared and assessed by performing analyses of several laminated composite structures. Results from the progressive failure method indicate good correlation with the existing test data except in structural applications where interlaminar stresses are important which may cause failure mechanisms such as debonding or delaminations.

Understanding the gendered patterns of substance use initiation among adolescents living in rural, central Mexico

PubMed Central

Ayers, Stephanie; Marsiglia, Flavio; Hoffman, Steven; Urbaeva, Zhyldyz

2012-01-01

Background Little is known about the age of initiation and gender differences in substance use among adolescents in rural, central Mexico. Methods The cross-sectional data were collected from students enrolled in the Videobachillerato (VIBA) (video high school) program in Guanajuato, Mexico. Questionnaires asked students about the age at which they had used alcohol, cigarettes, or marijuana for the first time. Kaplan-Meier Survival Functions were used to estimate if males and females were significantly different in their cumulative probabilities of initiating substances over time. Results On average, alcohol is initiated at 14.7 years of age, cigarettes at 15.1 years of age, and marijuana at 16.5 years of age. Over time, males had a significantly higher probability of initiating alcohol (Kaplan-Meier Failure Curve: Χ2=26.35, p<0.001), cigarettes (Kaplan-Meier Failure Curve: Χ2=41.90, p<0.001), and marijuana (Kaplan-Meier Failure Curve: Χ2=38.01, p<0.001) compared to females. Conclusions These results highlight the gendered patterns of substance use initiation among adolescents in rural, central Mexico and underscore the need for gendered substance use prevention interventions with these adolescents. By putting forth efforts to understand substance use initiation patterns of adolescents living in rural, central Mexico, culturally specific and efficacious prevention efforts can be tailor-made to create lasting differences. PMID:22421555

An overview of elevated temperature damage mechanisms and fatigue behavior of a unidirectional SCS-6/Ti-15-3 composite

NASA Technical Reports Server (NTRS)

Castelli, Michael G.; Gayda, John

1993-01-01

The fatigue behavior of a unidirectionally reinforced titanium matrix composite (TMC), SiC/Ti-15-3, was thoroughly characterized to support life prediction modeling of advanced TMC disks designed for gas turbine engine applications. The results of this coupon-level experimental investigation are reviewed. On a stress basis, the isothermal fatigue behavior of the (0 deg) TMC revealed significant improvements over the unreinforced matrix. In contrast, the (90 deg) TMC exhibited degraded properties and lives for similar comparisons. This was attributed to the weak fiber/matrix interfacial bond. Encasing the (0 deg) TMC with a Ti-15-3 case did not affect isothermal fatigue lives at higher strain levels. However, at lower strain levels, rapid initiation and propagation of large fatigue cracks in the case degraded the fatigue lives. Thermomechanical fatigue (TMF) lives were significantly reduced for the (0 deg) TMC when compared to isothermal lives. At high strains, in-phase TMF produced extremely short lives. This degradation was attributed to fiber overload failures brought about by stress relaxation in the matrix. At low strains, out-of-phase TMF conditions became life limiting. Environment-assisted surface cracking was found to accelerate fatigue failure. This produced extensive matrix damage with minimal fiber damage. For the (90 deg) TMC, TMF conditions did not promote an additional degradation in cyclic life beyond that observed under isothermal conditions.

The role of the Intra‐aortic balloon pump in supporting children with acute cardiac failure

PubMed Central

Collison, Sathiakar Paul; Dagar, Kulbhusan Singh

2007-01-01

Acute heart failure occurs in children following the operative correction of a congenital anomaly, as an acute change in a child with a congenital anomaly, or in a structurally normal heart with acute myocarditis. Acute heart failure in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices and the use of the intra‐aortic balloon pump (IABP). The principles of intra‐aortic balloon pump usage are described, and the literature regarding the indications and outcome of its use in children is reviewed. PMID:17488858

Self-healing failures in the aerial plant

NASA Astrophysics Data System (ADS)

Kiss, Gabor D.

1994-03-01

This account begins in the wee hours of a bitterly cold night in the winter of '92 - '93. A fiber optic transmission system starts to incur unacceptable errors and switches to a protect channel. The system is being run at 1550 nm because it is a route which is long enough to otherwise require a repeater at 1310 nm. OTDR measurement shows high splice losses. By dawn the high-loss splices have partially recovered so the system is switched back to the original fibers. Failure of the mechanical splices is suspected, the RBOC requests post-mortem assistance from Bellcore, and a team is dispatched immediately to work with RBOC personnel in determining the cause of the failure.

Complications in hair restoration.

PubMed

Lam, Samuel M

2013-11-01

Hair restoration requires a high level of specialized skill on the part of both the surgeon and the assistant team. Recipient-site problems can manifest from either surgeon or assistant error. The surgeon can create an unnatural hairline due to lack of knowledge of natural hair-loss patterns or badly executed recipient sites. He must also be cognizant of how hairs naturally are angled on the scalp to re-create a pattern that appears natural when making recipient sites. Assistants can also greatly contribute to the success or failure of surgery in their task of graft dissection and graft placement. Copyright © 2013 Elsevier Inc. All rights reserved.

Bridge to Removal: A Paradigm Shift for Left Ventricular Assist Device Therapy

PubMed Central

Selzman, Craig H.; Madden, Jesse L.; Healy, Aaron H.; McKellar, Stephen H.; Koliopoulou, Antigone; Stehlik, Josef; Drakos, Stavros G.

2014-01-01

Ventricular assist devices have become standard therapy for patients with advanced heart failure either as a bridge to transplantation or destination therapy. Despite the functional and biologic evidence of reverse cardiac remodeling, few patients actually proceed to myocardial recovery, and even fewer to the point of having their device explanted. An enhanced understanding of the biology and care of the mechanically supported patient has redirected focus on the possibility of using ventricular assist devices as a bridge to myocardial recovery and removal. Herein, we review the current issues and approaches to transforming myocardial recovery to a practical reality. PMID:25442985

Italy enacts new law on medically assisted reproduction.

PubMed

Boggio, Andrea

2005-05-01

In 2004, the Italian Parliament enacted a law regulating medically assisted reproduction. Although the law recognizes as legal certain assisted reproduction techniques, several other procedures are implicitly or expressly banned: oocyte and sperm donation, using embryos for the scientific research purposes and reproductive cloning. In this article, I outline the new legal framework, pointing out some of the shortcomings of its provisions, such as the failure to define what an 'embryo' is, the contradictions between this law and the law on abortion, the opportunity for Italian couples to circumvent some of the prohibitions by resorting to 'reproductive tourism', and the central role that physicians play in the new legal framework.

ESSAA: Embedded system safety analysis assistant

NASA Technical Reports Server (NTRS)

Wallace, Peter; Holzer, Joseph; Guarro, Sergio; Hyatt, Larry

1987-01-01

The Embedded System Safety Analysis Assistant (ESSAA) is a knowledge-based tool that can assist in identifying disaster scenarios. Imbedded software issues hazardous control commands to the surrounding hardware. ESSAA is intended to work from outputs to inputs, as a complement to simulation and verification methods. Rather than treating the software in isolation, it examines the context in which the software is to be deployed. Given a specified disasterous outcome, ESSAA works from a qualitative, abstract model of the complete system to infer sets of environmental conditions and/or failures that could cause a disasterous outcome. The scenarios can then be examined in depth for plausibility using existing techniques.

13 CFR 107.140 - SBA approval of initial Management Expenses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval of...

EXPERIMENTAL AND MODELING SUPPORT TO OPPT AND ORIA UNDER THE "BUY CLEAN" INITIATIVE

EPA Science Inventory

Under the Buy Clean program, EPA is responsible for developing and disseminating guidance that will assist users procure lower-emitting products and devices that aim to reduce the exposure of indoor occupants' exposure. The initial focus has been to assist school personnel minimi...

Seminoma at Roswell Park, 1970 to 1979. An analysis of treatment failures.

PubMed

Huben, R P; Williams, P D; Pontes, J E; Panahon, A M; Murphy, G P

1984-04-01

A retrospective study of all cases of seminoma treated at Roswell Park Memorial Institute from 1970 through 1979 was conducted. Fifty-six evaluable patients treated initially with radiation therapy were seen during this period, and the overall survival rate at an average follow-up period of 52 months was 82%. The survival rate in patients with bulky abdominal or supradiaphragmatic metastases was only 33% (4 of 12 patients). Treatment failures were analyzed to determine their apparent causes and the implication of such failures to the future management of seminoma. The use of combination chemotherapy as the initial treatment modality in advanced seminoma is discussed in light of these results.

Failure prediction in ceramic composites using acoustic emission and digital image correlation

NASA Astrophysics Data System (ADS)

Whitlow, Travis; Jones, Eric; Przybyla, Craig

2016-02-01

The objective of the work performed here was to develop a methodology for linking in-situ detection of localized matrix cracking to the final failure location in continuous fiber reinforced CMCs. First, the initiation and growth of matrix cracking are measured and triangulated via acoustic emission (AE) detection. High amplitude events at relatively low static loads can be associated with initiation of large matrix cracks. When there is a localization of high amplitude events, a measurable effect on the strain field can be observed. Full field surface strain measurements were obtained using digital image correlation (DIC). An analysis using the combination of the AE and DIC data was able to predict the final failure location.

Flexure fatigue testing of 90 deg graphite/epoxy composites

NASA Technical Reports Server (NTRS)

Peck, Ann Nancy W.

1995-01-01

A great deal of research has been performed characterizing the in-plane fiber-dominated properties, under both static and fatigue loading, of advanced composite materials. To the author's knowledge, no study has been performed to date investigating fatigue characteristics in the transverse direction. This information is important in the design of bonded composite airframe structure where repeated, cyclic out-of-plane bending may occur. Recent tests characterizing skin/stringer debond failures in reinforced composite panels where the dominant loading in the skin is flexure along the edge of the frame indicate failure initiated either in the skin or else the flange, near the flange tip. When failure initiated in the skin, transverse matrix cracks formed in the surface skin ply closest to the flange and either initiated delaminations or created matrix cracks in the next lower ply, which in turn initiated delaminations. When failure initiated in the flanges, transverse cracks formed in the flange angle ply closest to the skin and initiated delamination. In no configuration did failure propagate through the adhesive bond layer. For the examined skin/flange configurations, the maximum transverse tension stress at failure correlates very well with the transverse tension strength of the composites. Transverse tension strength (static) data of graphite epoxy composites have been shown to vary with the volume of material stressed. As the volume of material stressed increased, the strength decreased. A volumetric scaling law based on Weibull statistics can be used to predict the transverse strength measurements. The volume dependence reflects the presence of inherent flaws in the microstructure of the lamina. A similar approach may be taken to determine a volume scale effect on the transverse tension fatigue behavior of graphite/epoxy composites. The objective of this work is to generate transverse tension strength and fatigue S-N characteristics for composite materials using 3-point flexure tests of 90 deg graphite/epoxy specimens. Investigations will include the volume scale effect as well as frequency and span-to-thickness ratio effects. Prior to the start of the experimental study, an analytical study using finite element modeling will be performed to investigate the span-to-thickness effect. The ratio of transverse flexure stress to shear stress will be monitored and its values predicted by the FEM analysis compared with the value obtained using a 'strength of materials' based approach.

Two-IMU FDI performance of the sequential probability ratio test during shuttle entry

NASA Technical Reports Server (NTRS)

Rich, T. M.

1976-01-01

Performance data for the sequential probability ratio test (SPRT) during shuttle entry are presented. Current modeling constants and failure thresholds are included for the full mission 3B from entry through landing trajectory. Minimum 100 percent detection/isolation failure levels and a discussion of the effects of failure direction are presented. Finally, a limited comparison of failures introduced at trajectory initiation shows that the SPRT algorithm performs slightly worse than the data tracking test.

Rates of Initial Virological Suppression and Subsequent Virological Failure After Initiating Highly Active Antiretroviral Therapy: The Impact of Aboriginal Ethnicity and Injection Drug Use

PubMed Central

Martin, L.J.; Houston, S.; Yasui, Y.; Wild, T.C.; Saunders, L.D.

2010-01-01

Objectives: To compare rates of initial virological suppression and subsequent virological failure by Aboriginal ethnicity after starting highly active antiretroviral therapy (HAART). Methods: We conducted a retrospective cohort study of antiretroviral-naïve HIV-patients starting HAART in January 1999-June 2005 (baseline), followed until December 31, 2005 in Alberta, Canada. We compared the odds of achieving initial virological suppression (viral load <500 copies/mL) by Aboriginal ethnicity using logistic regression and, among those achieving suppression, rates of virological failure (the first of two consecutive viral loads > 1000 copies/mL) by Aboriginal ethnicity using cumulative incidence curves and Cox proportional hazards models. Sex, injection drug use as an HIV exposure category (IDU), baseline age, CD4 cell count, viral load, calendar year, and HAART regimen were considered as potential confounders. Results: Of 461 study patients, 37% were Aboriginal and 48% were IDUs; 71% achieved initial virological suppression and were followed for 730.4 person-years. After adjusting for confounding variables, compared to non-Aboriginals with other exposures, the odds of achieving initial virological suppression were lower for Aboriginal IDUs (odds ratio (OR)=0.33, 95% CI=0.19-0.60, p=0.0002), non-Aboriginal IDUs (OR=0.30, 95% CI=0.15-0.60, p=0.0006), and Aboriginals with other exposures (OR=0.38, 95% CI=0.21-0.67, p=0.0009). Among those achieving suppression, Aboriginals experienced higher virological failure rates ≥1 year after suppression (hazard ratio=3.35, 95% CI=1.68-6.65, p=0.0006). Conclusions: Future research should investigate adherence among Aboriginals and IDUs treated with HAART and explore their treatment experiences to assess ways to improve outcomes. PMID:21187007

The dynamic failure behavior of tungsten heavy alloys subjected to transverse loads

NASA Astrophysics Data System (ADS)

Tarcza, Kenneth Robert

Tungsten heavy alloys (WHA), a category of particulate composites used in defense applications as kinetic energy penetrators, have been studied for many years. Even so, their dynamic failure behavior is not fully understood and cannot be predicted by numerical models presently in use. In this experimental investigation, a comprehensive understanding of the high-rate transverse-loading fracture behavior of WHA has been developed. Dynamic fracture events spanning a range of strain rates and loading conditions were created via mechanical testing and used to determine the influence of surface condition and microstructure on damage initiation, accumulation, and sample failure under different loading conditions. Using standard scanning electron microscopy metallographic and fractographic techniques, sample surface condition is shown to be extremely influential to the manner in which WHA fails, causing a fundamental change from externally to internally nucleated failures as surface condition is improved. Surface condition is characterized using electron microscopy and surface profilometry. Fracture surface analysis is conducted using electron microscopy, and linear elastic fracture mechanics is used to understand the influence of surface condition, specifically initial flaw size, on sample failure behavior. Loading conditions leading to failure are deduced from numerical modeling and experimental observation. The results highlight parameters and considerations critical to the understanding of dynamic WHA fracture and the development of dynamic WHA failure models.

Failure analysis of thick composite cylinders under external pressure

NASA Technical Reports Server (NTRS)

Caiazzo, A.; Rosen, B. W.

1992-01-01

Failure of thick section composites due to local compression strength and overall structural instability is treated. Effects of material nonlinearity, imperfect fiber architecture, and structural imperfections upon anticipated failure stresses are determined. Comparisons with experimental data for a series of test cylinders are described. Predicting the failure strength of composite structures requires consideration of stability and material strength modes of failure using linear and nonlinear analysis techniques. Material strength prediction requires the accurate definition of the local multiaxial stress state in the material. An elasticity solution for the linear static analysis of thick anisotropic cylinders and rings is used herein to predict the axisymmetric stress state in the cylinders. Asymmetric nonlinear behavior due to initial cylinder out of roundness and the effects of end closure structure are treated using finite element methods. It is assumed that local fiber or ply waviness is an important factor in the initiation of material failure. An analytical model for the prediction of compression failure of fiber composites, which includes the effects of fiber misalignments, matrix inelasticity, and multiaxial applied stresses is used for material strength calculations. Analytical results are compared to experimental data for a series of glass and carbon fiber reinforced epoxy cylinders subjected to external pressure. Recommendations for pretest characterization and other experimental issues are presented. Implications for material and structural design are discussed.

Graft failure after allogeneic hematopoietic stem cell transplantation.

PubMed

Ozdemir, Zehra Narli; Civriz Bozdağ, Sinem

2018-04-18

Graft failure is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) defined as either lack of initial engraftment of donor cells (primary graft failure) or loss of donor cells after initial engraftment (secondary graft failure). Successful transplantation depends on the formation of engrafment, in which donor cells are integrated into the recipient's cell population. In this paper, we distinguish two different entities, graft failure (GF) and poor graft function (PGF), and review the current comprehensions of the interactions between the immune and hematopoietic compartments in these conditions. Factors associated with graft failure include histocompatibility locus antigen (HLA)-mismatched grafts, underlying disease, type of conditioning regimen and stem cell source employed, low stem cell dose, ex vivo T-cell depletion, major ABO incompatibility, female donor grafts for male recipients, disease status at transplantation. Although several approaches have been developed which aimed to prevent graft rejection, establish successful engraftment and treat graft failure, GF remains a major obstacle to the success of allo-HSCT. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) still remains to be the curative treatment option for various non-malignant and malignant hematopoietic diseases. The outcome of allo-HSCT primarily depends on the engraftment of the graft. Graft failure (GF), is a life-threatening complication which needs the preferential therapeutic manipulation. In this paper, we focused on the definitions of graft failure / poor graft function and also we reviewed the current understanding of the pathophysiology, risk factors and treatment approaches for these entities. Copyright © 2018. Published by Elsevier Ltd.

Effect of three cueing devices for people with Parkinson's disease with gait initiation difficulties.

PubMed

McCandless, Paula J; Evans, Brenda J; Janssen, Jessie; Selfe, James; Churchill, Andrew; Richards, Jim

2016-02-01

Freezing of gait (FOG) remains one of the most common debilitating aspects of Parkinson's disease and has been linked to injuries, falls and reduced quality of life. Although commercially available portable cueing devices exist claiming to assist with overcoming freezing; their immediate effectiveness in overcoming gait initiation failure is currently unknown. This study investigated the effects of three different types of cueing device in people with Parkinson's disease who experience freezing. Twenty participants with idiopathic Parkinson's disease who experienced freezing during gait but who were able to walk short distances indoors independently were recruited. At least three attempts at gait initiation were recorded using a 10 camera Qualisys motion analysis system and four force platforms. Test conditions were; Laser Cane, sound metronome, vibrating metronome, walking stick and no intervention. During testing 12 of the 20 participants had freezing episodes, from these participants 100 freezing and 91 non-freezing trials were recorded. Clear differences in the movement patterns were seen between freezing and non-freezing episodes. The Laser Cane was most effective cueing device at improving the forwards/backwards and side to side movement and had the least number of freezing episodes. The walking stick also showed significant improvements compared to the other conditions. The vibration metronome appeared to disrupt movement compared to the sound metronome at the same beat frequency. This study identified differences in the movement patterns between freezing episodes and non-freezing episodes, and identified immediate improvements during gait initiation when using the Laser Cane over the other interventions. Copyright © 2015. Published by Elsevier B.V.

Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys - an experimental porcine model of ischaemic heart failure.

PubMed

Møller-Helgestad, Ole K; Poulsen, Christian B; Christiansen, Evald H; Lassen, Jens F; Ravn, Hanne B

2015-01-15

Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure. 13 pigs were anesthetised and left ventricular failure was induced by occluding the proximal LAD for 45min followed by 30min of reperfusion. Blood flow was measured in the carotid artery, the LAD, and the renal artery. The Impella® and IABP were inserted via the femoral arteries, and the two devices were tested individually and combined after induction of heart failure. Carotid- (p=0.01) and renal blood flow (p=0.045) were higher on Impella®-support, compared to no support. None of the devices altered the blood flow in the LAD. Cardiac power output (p<0.005) and left ventricular work (p<0.00) were also higher on Impella®-support compared to no support. Haemodynamics and blood flow to the brain and kidneys were significantly better on Impella®-support, suggesting that the Impella® is superior to the IABP in a state of ischaemia induced left ventricular failure. These data, however, needs to be confirmed in a proper clinical trial with patients in cardiogenic shock. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Arteriovenous fistula maturation in patients with permanent access created prior to or after hemodialysis initiation.

PubMed

Duque, Juan C; Martinez, Laisel; Tabbara, Marwan; Dvorquez, Denise; Mehandru, Sushil K; Asif, Arif; Vazquez-Padron, Roberto I; Salman, Loay H

2017-05-15

Multiple factors and comorbidities have been implicated in the ability of arteriovenous fistulas (AVF) to mature, including vessel anatomy, advanced age, and the presence of coronary artery disease or peripheral vascular disease. However, little is known about the role of uremia on AVF primary failure. In this study, we attempt to evaluate the effect of uremia on AVF maturation by comparing AVF outcomes between pre-dialysis chronic kidney disease (CKD) stage five patients and those who had their AVF created after hemodialysis (HD) initiation. We included 612 patients who underwent AVF creation between 2003 and 2015 at the University of Miami Hospital and Jackson Memorial Hospital. Effects of uremia on primary failure were evaluated using univariate statistical comparisons and multivariate logistic regression analyses. Primary failure occurred in 28.1% and 26.3% of patients with an AVF created prior to or after HD initiation, respectively (p = 0.73). The time of HD initiation was not associated with AVF maturation in multivariate logistic regression analysis (p = 0.57). In addition, pre-operative blood urea nitrogen (p = 0.78), estimated glomerular filtration rate (p = 0.66), and serum creatinine levels (p = 0.14) were not associated with AVF primary failure in pre-dialysis patients. Our results show that clearance of uremia with regular HD treatments prior to AVF creation does not improve the frequency of vascular access maturation.

Characterization of failure processes in tungsten copper composites under fatigue loading conditions

NASA Technical Reports Server (NTRS)

Kim, Yong-Suk; Verrilli, Michael J.; Gabb, Timothy P.

1989-01-01

A fractographic and metallographic investigation was performed on specimens of a tungsten fiber reinforced copper matrix composite (9 vol percent), which had experienced fatigue failures at elevated temperatures. Major failure modes and possible failure mechanisms, with an emphasis placed on characterizing fatigue damage accumulation, were determined. Metallography of specimens fatigued under isothermal cyclic loading suggested that fatigue damage initiates in the matrix. Cracks nucleated within the copper matrix at grain boundaries, and they propagated through cavity coalescence. The growing cracks subsequently interacted with the reinforcing tungsten fibers, producing a localized ductile fiber failure. Examinations of interrupted tests before final failure confirmed the suggested fatigue damage processes.

Hodgkin's lymphoma coexisting with liver failure secondary to acute on chronic hepatitis B.

PubMed

Palta, Renee; McClune, Amy; Esrason, Karl

2013-04-16

Acute on chronic liver failure (ACLF) is rarely the initial manifestation of a malignant process or precipitated by the initiation of anti-viral treatment with a nucleoside or nucleotide agent. We report an unusual case of ACLF temporally associated with initiation of Entecavir for treatment of chronic hepatitis B. Early Hodgkin's lymphoma (HL) was unmasked with initiation of the anti-viral treatment which may have exacerbated ACLF. To the best of our knowledge, this has not been described in the literature. In reviewing our patients clinical course and liver autopsy, he developed a severe acute exacerbation of his chronic hepatitis B virus coinciding with the institution of antiviral therapy and the underlying HL perhaps modulating the overall degree of hepatic injury.

49 CFR Appendix A to Part 232 - Schedule of Civil Penalties 1

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Failure to meet general design requirements 2,500 5,000 (d) Failure to have proper percentage of operative brakes from Class I brake test 5,000 7,500 (e) Operating with less than 85 percent operative brakes 5,000...) Failure to adopt and comply with periodic assessment plan 7,500 11,000 232.205Class I brake test—initial...

49 CFR Appendix A to Part 232 - Schedule of Civil Penalties 1

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Failure to meet general design requirements 2,500 5,000 (d) Failure to have proper percentage of operative brakes from Class I brake test 5,000 7,500 (e) Operating with less than 85 percent operative brakes 5,000...) Failure to adopt and comply with periodic assessment plan 7,500 11,000 232.205Class I brake test—initial...

49 CFR Appendix A to Part 232 - Schedule of Civil Penalties 1

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Failure to meet general design requirements 2,500 5,000 (d) Failure to have proper percentage of operative brakes from Class I brake test 5,000 7,500 (e) Operating with less than 85 percent operative brakes 5,000...) Failure to adopt and comply with periodic assessment plan 7,500 11,000 232.205Class I brake test—initial...

49 CFR Appendix A to Part 232 - Schedule of Civil Penalties 1

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Failure to meet general design requirements 2,500 5,000 (d) Failure to have proper percentage of operative brakes from Class I brake test 5,000 7,500 (e) Operating with less than 85 percent operative brakes 5,000...) Failure to adopt and comply with periodic assessment plan 7,500 11,000 232.205Class I brake test—initial...

Numerical Analysis of Solids at Failure

DTIC Science & Technology

2011-08-20

failure analyses include the formulation of invariant finite elements for thin Kirchhoff rods, and preliminary initial studies of growth in...analysis of the failure of other structural/mechanical systems, including the finite element modeling of thin Kirchhoff rods and the constitutive...algorithm based on the connectivity graph of the underlying finite element mesh. In this setting, the discontinuities are defined by fronts propagating

Machine-Learning Algorithms Predict Graft Failure After Liver Transplantation.

PubMed

Lau, Lawrence; Kankanige, Yamuna; Rubinstein, Benjamin; Jones, Robert; Christophi, Christopher; Muralidharan, Vijayaragavan; Bailey, James

2017-04-01

The ability to predict graft failure or primary nonfunction at liver transplant decision time assists utilization of scarce resource of donor livers, while ensuring that patients who are urgently requiring a liver transplant are prioritized. An index that is derived to predict graft failure using donor and recipient factors, based on local data sets, will be more beneficial in the Australian context. Liver transplant data from the Austin Hospital, Melbourne, Australia, from 2010 to 2013 has been included in the study. The top 15 donor, recipient, and transplant factors influencing the outcome of graft failure within 30 days were selected using a machine learning methodology. An algorithm predicting the outcome of interest was developed using those factors. Donor Risk Index predicts the outcome with an area under the receiver operating characteristic curve (AUC-ROC) value of 0.680 (95% confidence interval [CI], 0.669-0.690). The combination of the factors used in Donor Risk Index with the model for end-stage liver disease score yields an AUC-ROC of 0.764 (95% CI, 0.756-0.771), whereas survival outcomes after liver transplantation score obtains an AUC-ROC of 0.638 (95% CI, 0.632-0.645). The top 15 donor and recipient characteristics within random forests results in an AUC-ROC of 0.818 (95% CI, 0.812-0.824). Using donor, transplant, and recipient characteristics known at the decision time of a transplant, high accuracy in matching donors and recipients can be achieved, potentially providing assistance with clinical decision making.

Astronaut Joseph Tanner is assisted into his EMU during training

NASA Technical Reports Server (NTRS)

1994-01-01

Astronaut Joseph R. Tanner, STS-66 mission specialist, is assisted by Boeing suit expert Steve Voyles in donning the gloves for his extravehicular mobility unit (EMU) as he prepares to be submerged in a 25-feet deep pool at JSC's Weightless Environment Training Facility (WETF). Though no extravehicular activity (EVA) is planned for the mission, at least two astronauts are trained to perform tasks that would require a space walk in the event of failure of remote systems.

[Neurally adjusted ventilatory assist (NAVA). A new mode of assisted mechanical ventilation].

PubMed

Moerer, O; Barwing, J; Quintel, M

2008-10-01

The aim of mechanical ventilation is to assure gas exchange while efficiently unloading the respiratory muscles and mechanical ventilation is an integral part of the care of patients with acute respiratory failure. Modern lung protective strategies of mechanical ventilation include low-tidal-volume ventilation and the continuation of spontaneous breathing which has been shown to be beneficial in reducing atelectasis and improving oxygenation. Poor patient-ventilator interaction is a major issue during conventional assisted ventilation. Neurally adjusted ventilator assist (NAVA) is a new mode of mechanical ventilation that uses the electrical activity of the diaphragm (EAdi) to control the ventilator. First experimental studies showed an improved patient-ventilator synchrony and an efficient unloading of the respiratory muscles. Future clinical studies will have to show that NAVA is of clinical advantage when compared to conventional modes of assisted mechanical ventilation. This review characterizes NAVA according to current publications on this topic.

A Matched Cohort Study of Patients With End-Stage Heart Failure from Anthracycline-Induced Cardiomyopathy Requiring Advanced Cardiac Support.

PubMed

Thomas, Garry R; McDonald, Michael A; Day, Jennifer; Ross, Heather J; Delgado, Diego H; Billia, Filio; Butany, Jagdish W; Rao, Vivek; Amir, Eitan; Bedard, Philippe L; Thavendiranathan, Paaladinesh

2016-11-15

Anthracycline-induced cardiomyopathy (AIC) may progress to end-stage heart failure requiring mechanical circulatory support or orthotopic heart transplantation (OHT). Previous studies have described important clinical differences between AIC and nonischemic cardiomyopathy (NIC) cohorts requiring these advanced interventions. Therefore, we sought to extend this literature by comparing echocardiographic parameters, treatment strategies, and the prognosis between matched patients from these cohorts. This is a retrospective matched cohort study. All patients who received a ventricular assist device or OHT at a large Canadian center were reviewed (n = 421; 1988 to 2015) and subjects with clinical and pathologic evidence of AIC were included (n = 17, 4.0%). A comparison cohort with idiopathic NIC from the same database, matched 3:1 for age, gender, ethnicity, and year of heart failure onset was selected. The Mann-Whitney rank-sum and Fisher's exact tests were used for comparisons. Patients with AIC were predominantly women (70.6%) with heart failure diagnosed at age 40.2 ± 15.8 and 8.3 ± 8.9 years after anthracycline treatment. Compared with NIC, no differences were seen in co-morbidities, echocardiographic measures, the proportion of patients receiving a defibrillator, ventricular assist device, or OHT, the incidence of graft failure, and all-cause mortality. In contrast to other studies, AIC was not associated with a higher incidence of right ventricular dysfunction. A greater proportion of patients with AIC developed cancer (recurrence or new primary) post-OHT (21.4% vs 2.3%, p = 0.042). In conclusion, we demonstrate that when matched cohorts of patients with end-stage heart failure secondary to AIC and idiopathic NIC are compared, they are similar with respect to co-morbidities, degree of ventricular dysfunction, and advanced therapeutics used. The prognosis with OHT is also similar. Copyright © 2016 Elsevier Inc. All rights reserved.

45 CFR 233.26 - Retrospective budgeting; determining eligibility after the initial one or two months.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true Retrospective budgeting; determining eligibility after the initial one or two months. 233.26 Section 233.26 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES...

45 CFR 233.26 - Retrospective budgeting; determining eligibility after the initial one or two months.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Retrospective budgeting; determining eligibility after the initial one or two months. 233.26 Section 233.26 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES...

13 CFR 108.140 - SBA approval of initial Management Expenses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Organizing A Nmvc Company § 108.140...

Outcome of tacrolimus and vedolizumab after corticosteroid and anti-TNF failure in paediatric severe colitis.

PubMed

Hamel, Blaise; Wu, May; Hamel, Elizabeth O; Bass, Dorsey M; Park, K T

2018-01-01

Severe colitis flare from ulcerative colitis (UC) or Crohn's disease (CD) may be refractory to corticosteroids and antitumour necrosis factor (TNF) agents resulting in high colectomy rates. We aimed to describe the utility of tacrolimus to prevent colectomy during second-line vedolizumab initiation after corticosteroid and anti-TNF treatment failure in paediatric severe colitis. A retrospective cohort analysis was performed between 1 October 2014 and 31 October 2016 at a single tertiary care centre. Inclusion criteria were patients with severe colitis who received tacrolimus before or during vedolizumab induction and previous exposure to anti-TNF therapy with or without corticosteroids. The initiation of tacrolimus was clinician dependent based on an institutional protocol. Twelve patients (10 UC, two CD; median age 16 years; three female) received at least one dose of vedolizumab 10 mg/kg (max of 300 mg) due to anti-TNF therapy failure and persistent flare not responsive to corticosteroids. Of the 12 patients, eight (67%) and four (33%) had failed one or two anti-TNF agents, respectively. Tacrolimus was initiated for acute disease severity during hospitalisation (58%) or ongoing flare during outpatient care (42%). 9 (75%) of 12 patients avoided colectomy or inflammatory bowel disease-related surgery at 24 weeks and eight (68%) continued on vedolizumab maintenance with no adverse events out to 80 weeks. We report real-world data on the outcome of tacrolimus around vedolizumab initiation in paediatric UC or CD after corticosteroid and anti-TNF therapy treatment failure. Our pilot experience indicates a potential benefit of concomitant tacrolimus when initiating vedolizumab therapy.